DRUGS: MISSING THE BIG STORY

When it comes to press coverage of the drug issue, the main action is
in Mexico. American correspondents there pore over financial records,
examine court documents, and interview officials to chronicle the
pernicious effects drug trafficking has had on that country's
political system. Meticulously researched, lushly documented, and
numbingly detailed, these stories resemble the exposes of municipal
malfeasance that were popular during the heyday of investigative
journalism in the 1970s.

A typically knotty lead in The New York Times: "The longtime private
secretary to a patriarch of Mexico's governing party has told American
authorities about a series of dealings between narcotics traffickers and
high-ranking political leaders, including members of the family of former
President Carlos Salinas de Gortari." Last November, The Washington Post
ran a five-part, 17,000-word series on drug trafficking along the
U.S.-Mexico border and the violence and corruption it has spawned.

At a time when so many news organizations are cutting back foreign
coverage, such a commitment of resources seems admirable, and the
Times, for one, was rewarded this year with a Pulitzer Prize. Yet, in
the rush to recount events in Tijuana and Juarez, the press has been
neglecting another, more important front in the drug war -- the battle
at home.

In the U.S., the press favors two types of drug stories: teenage drug
use (teen drug crisis, headlined the New York Post, August 21, 1996)
and well-to-do junkies (heroin's hold on Hollywood, Entertainment
Weekly cover story, August 9, 1996). Or both (heroin alert: rockers,
models, and the new drug crisis: are teens at risk? Newsweek cover
story, August 26, 1996).

In reality, middle-class heroin addiction is neither new nor
particularly widespread. And the rise of teen drug use in recent years
is confined mostly to marijuana. National surveys affirm that
America's drug problem consists mainly of a hard core of users who are
disproportionately poor, unemployed, and black or Hispanic. There are
about 3.6 million hard-core users, according to the federal
government, and they consume an estimated 75 percent of the heroin and
cocaine used in the United States. They also account for most of the
crime, child abuse, overdose deaths, and other terrible consequences
of drug use.

To the extent that these users surface in the media, it is usually in
stories about street sweeps, prison overcrowding, or child welfare.
What's missing is any sustained coverage of the really significant
stories -- the effectiveness of treatment in reducing addicts'
dependence, and the difficulty they have in getting it.

The Office of National Drug Control Policy says that the U.S.
treatment system has enough capacity to help only half of those 3.6
million hard-core users. This is not by accident. For the last twenty
years, drug treatment has been systematically underfunded at all
levels of government. The result: long waiting lists for treatment in
cities around the country. In New York state alone, an estimated
100,000 people who want treatment are unable to get it in any given
year. Where are the news stories?

Part of the problem is the popular wisdom -- in newsrooms as in the
general public -- that treatment does not work. Everybody knows
someone who has done well in treatment, only to relapse soon after
leaving it. Feeding this skepticism are the disparaging remarks about
treatment made by politicians trying to look tough on drugs, such as

New York Mayor Rudolph Giuliani, who recently launched a stinging
attack on methadone.

The pols -- and the popular perceptions -- are wrong. Take the case of
a typical street junkie, an addict who's been injecting heroin or
smoking crack for years and supporting his habit by shoplifting,
robbing, or other hustles. While caught up in his drug-taking, such a
person will not generally give much thought to treatment. But for most
there comes a point when drug use begins to cause serious problems,
from physical ailments to family dysfunction to trouble with the law,
and when this happens many junkies become open to treatment.

They have several varieties to choose from. One is methadone. A
synthetic opiate that blocks the craving for heroin, methadone is
usually dispensed in clinics that require patients to come for a daily
dose plus some counseling. Methadone works solely on heroin users, and
most experts agree that to be fully effective it needs to be
accompanied by an array of services, including vocational assistance.
For addicts who use drugs other than heroin, or who use heroin but do
not want to take methadone (daily trips to a clinic are not always
possible), there are "drug-free" outpatient clinics, which offer
intensive counseling and other services but no pharmaceuticals.

Addicts who feel the need for a more radical change in their lives can
enroll in residential programs. Lasting anywhere from three months to
two years, such programs commonly offer counseling, educational
programs, and vocational training, all served up in a highly
structured environment in which everything from meal hours to leisure
time is strictly regulated.

A year in a residential program costs about $18,000. Methadone costs
$4,000 to $6,000 a year, and non-methadone outpatient programs even
less. (Most programs that treat indigent addicts get money from
Medicaid as well as direct grants from the federal or state
government.) By contrast, a year in prison costs between $25,000 and
$30,000, not including the sums spent on arrest and
prosecution.

It is the relative cheapness that makes treatment so cost-effective.
In a 1994 study, the RAND Corporation sought to compare the
effectiveness of treatment with that of three other types of
drug-control programs: local police action, border interdiction, and
drug-suppression programs abroad. How much, RAND asked, would it cost
to reduce cocaine use by 1 percent by relying on each of these four
approaches? Using sophisticated computer analysis, RAND found that,
relying solely on drug-fighting efforts abroad, the government would
have to spend $783 million more a year to reduce cocaine consumption
by 1 percent; relying on interdiction, it would have to spend $366
million more, and on domestic law enforcement, $246 million.

Relying solely on treatment, however, the government would have to
spend only $34 million more to achieve that 1 percent reduction. In
other words, treatment was seven times more cost-effective than local
law enforcement, ten times more effective than interdiction, and
twenty-three times more effective than attacking drugs at their source.

Many other studies show that treatment works. In 1996, for instance,
the U.S. government released a study of hard-core users in treatment.
The number using cocaine dropped from 39.5 percent before treatment to
17.8 percent a year later; for heroin, the number went from 23.6
percent to 12.6 percent. Overall, drug consumption decreased by
roughly 50 percent.

This is not to deny the reality of relapse. Most addicts require two,
three, or more exposures to treatment before the process takes hold.
Over time, though, treatment produces dramatic reductions in drug use
and related crime. In one analysis, California found that, for every
dollar invested in treatment, the state saved seven dollars, mostly
from reductions in crime and health-care costs.

Despite all this, about two-thirds of the federal drug budget goes for
law enforcement and interdiction, and only one-third for treatment and

prevention. Press coverage of the drug issue is even more imbalanced.
Newspapers and TV news programs rarely report on the mass of research
demonstrating the effectiveness of treatment. Nor do they describe
what happens to addicts who are turned away from treatment programs
for lack of space.

Most striking of all is the lack of stories about how hard it is to
gain entry to treatment. The drug treatment world is a balkanized and
fractious place. Each program serves different populations, features
different approaches, and has different admissions criteria. In most
cities there's no central entry point where addicts can apply for
help, no registry of which programs have openings. And, because
treatment centers are so competitive, they will rarely refer a drug
user to another program, even when they are full.

In some cases, there are even financial disincentives to helping
addicts. Most clinicians, for instance, agree that a patient
completing detox will relapse if he is not referred to a longer-term
program. But hospitals in New York state are reimbursed up to $1,000 a
day for each detox bed that is filled; if a patient relapses, his
eventual return for another round of detox is almost guaranteed. Thus
are hospitals rewarded for failure.

All in all, the nation's treatment system almost seems designed to
make sure addicts don't get help. By any journalistic standard, this
would seem a good story. Yet, in an extensive reading of newspaper
clips, I found just one in-depth account of the trouble addicts have
in getting into detox in New York City, the nation's drug capital. The
four-part series appeared six years ago, in the Los Angeles Times.

Articles detailing the gaps in the treatment world are equally rare.
In February 1997, Christopher Wren of The New York Times wrote about
the shocking scarcity of methadone capacity nationwide (ex-addicts
find methadone more elusive than heroin). With more than 800,000
heroin addicts in the U.S., he noted, the nation's methadone clinics
can accommodate only 115,000 of them. Eight states have no methadone
at all.

Last August, The Washington Post ran a biting expose of chaos and
disarray in the District of Columbia's drug treatment system (in d.c.,
many addicts and few services). Reporter Peter Slevin described how
many drug-using criminal offenders -- mandated by judges to treatment
- -- had to wait as long as six months behind bars because no beds were
available. Slevin interviewed parole officers who were working the
phones on behalf of their clients, desperately seeking treatment for
them before they returned to a life of drugs and crime.

Journalists could tell similar stories in almost every large city. Few
do. In terms of drama, reporting on the lack of treatment slots or the
barriers to entering detox cannot compare with stalking drug lords in
Mexico or watching coca fields being sprayed in Colombia. But tales of
the treatment crisis may be more important stories.

By showing how poorly the treatment system is serving addicts, and yet
how much promise treatment holds, news organizations could help bring
about real reform. Doing so, though, would require sending reporters
not just south of the border but down the street.

Michael Massing, a contributing editor to CJR, is the author of The
Fix, a book about America's drug problem, published in October by
Simon & Schuster

Checked-by: Rich O'Grady