GETTING SMARTER ABOUT DRUG ABUSERS

WASHINGTON -- For the moment, Barry McCaffrey, who heads the Office of
National Drug Control Policy, doesn't want to argue drug policy. He
wants to use this modest lunch in his office (turkey on white toast,
tea and water) to get some facts out so that when people do argue drug
policy, they can argue from agreed-upon facts.

He's talking about me, I suspect, but he's talking about lots of
people, "including the president of the United States who said at
least twice that the United States, with 5 percent of the world's
population, uses half the world's supply of illegal drugs."

Wrong, says McCaffrey. The real figure? Nobody knows for sure, but the
retired general and present drug "czar" thinks it may be closer to 11
percent.

Does it matter? Of course it matters, he says. You can't make rational
policy until you have some fairly clear idea of the problem the policy
is to address. Painting pictures of America as a drug-ridden society
leads to bad policy -- as does the tendency in some quarters to
conflate the various drug abuses into a single dreadful statistic.

Quite apart from the different -- and differentially addictive --
drugs of choice, McCaffrey is saying, it is important to distinguish
between two broad types of drug users.

"One group of people take drugs to feel better. The second group of
people are using drugs to feel good."

What is he talking about? "I've got underlying mental health problems,
psychiatric problems," he says, lapsing into his habit of describing
other people in first-person terms. "I'm a 14-year-old girl and I'm
sitting there in this treatment center with 16 other girls telling
this drug policy guy I wouldn't be alive today were it not for drugs.
I was using drugs to self-medicate. I've got a severe mental health
problem, and, by the way, if you diagnose me with that mental problem
at an earlier age, and start treating that, I won't turn into a
chronic addict at 25."

That's the first group of abusers. The second: "You go down to the
Johns Hopkins Research Center where they have laboratory rats and
rhesus monkeys. If you take a male rhesus monkey and give him an
option of pushing a lever to open a trap door to get at water, food, a
lady rhesus monkey or cocaine, for sure he'll go for the cocaine.
He'll wind up chronically addicted to cocaine. He'll malnourish
himself. He'll go into neurotoxic shock and die. He will choose
cocaine over any other reward -- and it won't have anything to do with
mental health problems or growing up with a bad rhesus monkey mother.
It's the drugs."

The point? Some drug abusers can stop on their own; some
can't.

It's what our young people know, and what too many of their
well-meaning advisers can't bring themselves to acknowledge. Not
everyone is equally susceptible to addiction. Or to put it another
way, our children have contemporaries who use drugs recreationally,
often for years, without getting hooked. Drawing a link between casual
use and hard-core addiction makes as much sense to them as drawing a
link between the glass of cabernet you have at dinner and the
stupefied wino devoting his life to collecting "spare change" for the
next bottle of cheap wine.

But then there are the others. "I'm not undisciplined or immoral or
weak," McCaffrey describes them. "My brain is telling me I must
continue this behavior or I'm going to feel intensely bad. . . .if you
get me off drugs, in mandatory treatment and testing, even for say 30
days, I've got the flush back in my cheeks, and a lot of my problems
start disappearing. Keep me in treatment for a year, and the
likelihood of my going back to work and remaking family connections
skyrockets."

But if McCaffrey is right -- not just about our haphazard use of
statistics but also about drug abuse typology -- why isn't he
screaming from the rooftops that throwing people in prison for abusing
drugs (or, more accurately, for selling drugs to support their
addictions) makes no sense at all? Why isn't he saying, as former
Baltimore Mayor Kurt Schmoke was saying years ago, that the drug
problem ought to be treated more like a medical problem than a
criminal justice problem?

And how do the facts he lays out support the administration's proposal
to stick a $1.6 billion military, criminal justice and drug
interdiction nose into Colombia?

Maybe next lunch.