Advice for the New Drug Czar

Seattle newspapers and our own reporting confirm that Seattle Police Chief Gil Kerlikowske will be President Obama's nominee for director of the Office of National Drug Control.

This is a good thing. Chief Kerlikowske is a respected voice on gun and drug policy. Within the realm of urban policing, Chief Kerlikowske is a progressive voice. As the new "Drug Czar," he will surely bring a welcome change in tone from the Bush Administration's John Walters. Since Chief Kerlikowske is new to Washington, we thought we would offer some unsolicited advice:

Chief Kerlikowske, we're not sure whether to offer congratulations or condolences. You're facing a tough assignment.

Some thoughts:

1. Talk to Americans as if we are thinking adults. (This worked surprisingly well for the president during the campaign.) Explain that substance abuse is a permanent challenge, not a temporary problem to be solved in a burst of enthusiasm. Tell cultural conservatives that drug users and, yes, even drug sellers are actual human beings, not stage extras in the culture wars, and that a "drug-free society" will arrive on the Twelfth of Never. Tell libertarians, and some liberals, that the drug problem isn't just some statist or reactionary myth: Drug abuse, and not just the drug war, causes great harms.

2. You'll be told that we have a national strategy resting on three legs: enforcement, prevention, and treatment. Don't believe it. There is no coherent strategy. Enforcement, prevention, and treatment are the names of three quarrelling constituency groups whose pressures you will sometimes need to resist and whose dearly-held beliefs you must be ready to challenge.

The biggest prevention program, D.A.R.E., has never been shown to reduce actual drug use; the treatment evaluation literature looks better until you notice how heavily it relies on simplistic before-and-after designs; law enforcement isn't even asked to show that its activities have useful results. There are useful things to be done in all three categories, but resist the temptation to just keep feeding the beast more resources.

3. "Drug czar" is a silly title. We're not fighting a war, you don't have czar-like powers, and the last actual czar who fought an actual war got clobbered. You're stuck with the title. But don't get sucked in to the rhetoric of "'enemies"' and "'victory."' The drug problem isn't like that.

4.There are some real "'drug wars"' raging: in Afghanistan, in Colombia, and in northern Mexico. Those wars matter terribly to the countries involved, but no outcome of those wars is likely to make the drug situation in the United States noticeably better or worse. We can't solve our drug problem in other countries; the drug traffic adapts, and will find new sources of supply and smuggling routes as long as there are U.S. customers with money. Reducing the drug trade's contribution to the carnage is more important than reducing the flow of drugs. Tell the Afghan and Mexican governments to pick whatever strategies they think will best protect their citizens and defeat the Taliban in Afghanistan and the violent drug gangs in Mexico, whether or not those strategies include eradicating crops or extraditing dealers.

5. We can help by shrinking our domestic markets. Offenders under criminal justice supervision account for half of all hard-drug consumption. Hawaii's Judge Steven Alm has shown that frequent testing and swift, automatic, but relatively mild sanctions can sharply reduce methamphetamine use among probationers. This is a cheap solution that also actually shrinks the population behind bars by reducing both probation revocations and arrests for new crimes. But it works only if the authorities can organize themselves to deliver the sanctions.

Carefully adapted to local conditions, testing-and-sanctions can be extended nationwide, to every probationer and parolee, and everyone released on bail, who has an illicit-drug problem. The current practice of forcing large numbers of drug users into treatment, with incarceration as the alternative, wastes resources. Voluntary treatment should be more broadly provided. Coerced drug treatment should be reserved for those who don't respond to the threat of short jail stays.

6. Treatment needs to be more accessible and more accountable. Good news: even lousy treatment has benefits greater than its costs. Bad news: much of the treatment actually delivered is, in fact, pretty lousy. Demand to see results, and insist on rigorous evaluations. Focus resources on effective programs. It's an outrage to have addicts dying of overdoses while on waiting lists for methadone treatment.

7. Engage family doctors, internists, emergency room personnel, and mental health counselors to identify and address their patients' drug problems. Many more drug abusers (including problem drinkers) visit primary-care providers than will ever seek formal substance abuse treatment, but most primary care providers never perform highly cost-effective screening and brief intervention, because they're neither trained for it nor paid for it. Many don't think that dealing with drug abuse is in their job description; it needs to be.

8. Flagrant retail drug markets still devastate too many American neighborhoods, especially poor urban areas where African-Americans and Latinos live. Imprisoning half the young men in those neighborhoods is neither useful nor just, but that's the result of routine street-level drug enforcement. Since every dealer arrested makes room for a replacement, we're just running on a treadmill. "'Drug kingpins,"' too, are replaceable. We now keep 500,000 drug dealers behind bars at any one time; there wouldn't be a significant rise in drug abuse if that number were halved. There are smarter and less brutal things to do.

9.One practical alternative to routine drug law enforcement is to break up markets with as few arrests as possible. This was an approach first used in High Point, North Carolina, and is now being tried out in dozens of places nationwide. Identify all the dealers in a market, build cases against them, and warn all of them, simultaneously, that they have a choice of stopping -- right now -- or going to prison. If that threat is made convincing, most dealers quit and there's enough capacity to arrest and imprison the rest. When all the dealers in a neighborhood quit or get sent away at once, the market is gone, and a little bit of enforcement will keep it from coming back. Committed users still get their drugs, discreetly, but crime drops and the residents get their streets back. Can this general approach work elsewhere? Try to find out.

10. Prescription pain-killers and stimulants are now traded hand-to-hand among middle school and high school students. So far, no one has a convincing idea about how to deal with the problem. Get someone thinking about it.

11. All these measures bring one common injunction: Take public management seriously. No matter how good a program is in concept, it won’t work if it isn’t actually delivered. Your job should be more than a bully pulpit. Demand to see results. Build on what is working. Criticize what isn’t. Be rigorous. Separate research from propaganda.

12. Our data collection systems are pathetically ill-matched to the actual drug problem. We spend a ton of money measuring drug abuse where it mostly isn't, but no longer know which drugs the arrestee population is using. We know far too little about many high-risk populations that don't carefully fill out surveys and don't answer the phone. Fixing these problems will require knocking some heads together.

Best of luck. You're a brave soul.

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