NIXON HAD IT RIGHT

A '70s Project Showed Drug Treatment Works

Few American cities have been more devastated by illegal drug use than
Washington. Abusers of heroin, crack and cocaine have fed robbery and
burglary rates, sent child welfare caseloads soaring and clogged
courts and jails. They also have overwhelmed the city's treatment
centers; of the District's estimated 65,000 substance abusers, barely
10 percent can be accommodated by local treatment programs today.

It wasn't always like this. Hard as it may be to believe, a little
more than 25 years ago the District fought the drug war
successfully--and a crucial element of that success was a
comprehensive drug treatment system, one that was considered a model
for the nation. The system's brief but remarkable history provides
compelling evidence of just how effective treatment can be in reducing
drug abuse and crime in the nation's cities.

Today, of course, drug treatment is not held in high regard. From
Mayor Rudolph Giuliani's bitter attacks on methadone programs in New
York City to President Clinton's utter indifference in the White
House, treatment seems the least favored weapon in the war on drugs.
Of the $16 billion the federal government is spending this year to
fight drugs, fully two-thirds goes for enforcement and interdiction
and just one-third for treatment and prevention. Next year's budget
will be even more lopsided, as a result of the recent budget
negotiations in which Congress voted $942 million in emergency
appropriations for drug enforcement. The Coast Guard is to get new
high-speed Barracuda patrol boats, the Customs Service new P-3B
surveillance planes, and the Colombian police six new Black Hawk
helicopters. The National Guard is to step up its patrols along the
Mexican border, and X-ray machines are to be installed from Tijuana to
Brownsville so agents can peer into the holds of container trucks.
Drug treatment, meanwhile, will receive an increase of a mere $275
million.

Lost in this game of numbers is any recognition of the real benefits a
full-service treatment system could have for Washington and other
cities. But they are clear enough from the one time such an approach
was tried.

In the late 1960s, Washington, like many other cities, was gripped by
a heroin epidemic. Among those seeking to confront it was a
Harvard-educated psychiatrist, Robert DuPont. Tall and sandy-haired,
DuPont (no relation to the Delaware family) had come to Washington in
1966 to work at the National Institutes of Health, then had gone on to
counsel inmates at the D.C. Department of Corrections, many of whom
were hooked on heroin.

At the time, treatment was all but unavailable in Washington. In
Chicago, however, a pioneering psycho-pharmacologist named Jerome
Jaffe had set up a network of clinics offering the synthetic narcotic
methadone and other treatments to help addicts get off heroin.
Impressed, DuPont convinced Mayor Walter Washington to set up a
small-scale version in the District, and in the fall of 1969,
methadone became available in the nation's capital for the first time.

The program soon expanded, thanks to the support of the Nixon White
House. It's not that Richard Nixon had any special compassion for drug
addicts. But during the 1968 campaign, he had promised to reverse the
steep rise in the nation's crime rate, and he had singled out the
District for special attention. Once in office, he turned for help to
one of his top aides, Egil "Bud" Krogh Jr.

Krogh, remembered mainly for his role in the break-in into the offices
of former Pentagon official Daniel Ellsberg's psychiatrist in 1971,
was an earnest pragmatist, he soon began riding around in squad cars
to see what might be done. Throughout 1969, Krogh helped increase the
size of the D.C. police department, procured a helicopter for its use,
and had sodium-vapor lights installed on many of the city's streets.

The more Krogh looked into the District's crime problem, though, the
more he felt the need to stem the city's drug problem. Learning of
DuPont's work in the District, Krogh summoned him to his office at the
Old Executive Office Building, where DuPont described the success his
program was having in reducing the criminal activity of its clients.
Intrigued, Krogh asked DuPont if he would like to expand the program,
and when he agreed, Krogh quickly found the necessary funds. On Feb.
19, 1970, the Narcotics Treatment Administration (NTA) opened its
doors, offering mainly methadone but also residential treatment and
drug-free outpatient care. The system was immediately swamped with
applicants.

Krogh regarded the program as a sort of laboratory. If the District's
crime rate went down, then perhaps more money could be made available
for treatment nationally. And, in fact, in 1970, crime in the District
fell by 5.2 percent--the first such decrease in years. D.C. police
officials credited the expansion of the police force, the use of more
aggressive tactics--and the availability of drug treatment.

Armed with these results, Krogh began lobbying for a national
treatment offensive. The White House was at first reluctant, but,
shaken by reports that as many as 10 to 15 percent of the GIs then
returning from Vietnam were addicted to heroin, Nixon announced on
June 17, 1971, that he was setting up a special-action office under
the direction of Jaffe, the Chicago treatment specialist, to expand
services for addicts. Over the next year, Jaffe spent hundreds of
millions of government dollars to open methadone clinics and
residential programs around the country. By the fall of 1972,
treatment was available nationwide to all addicts who wanted it.

In addition to finding treatment, the Nixon administration
successfully attacked the suppliers of heroin, including the infamous
French Connection. But fully two-thirds of the government's resources
went to stop the demand for drugs. In Washington, the NTA, which
initially had to limit its intake to 25 patients a day, was now able
to admit all those who wanted help. The impact was immediate.
Throughout 1972, the number of District residents dying from
heroin-related overdoses declined month by month; in September of that
year, the city recorded not a single heroin death. The city's crime
rate, meanwhile, declined a remarkable 26.9 percent for the year.
(Nationally, crime fell by 3 percent in 1972--the first such decline
in 17 years.) By 1973, the heroin epidemic in the District--as in the
nation as a whole--was ebbing.

That, however, was the system's high point. In 1973, when Jaffe left
the government, DuPont replaced him, and without his direction, the
NTA quickly lost its focus. It was further hurt by cuts in federal
treatment. Under the Reagan administration in the 1980s, the system
completely collapsed, and enforcement absorbed 80 percent of its budget.

Just as treatment was lagging, crack hit Washington and other cities.
By 1989, the crack scourge was causing such alarm that President
George Bush vowed to stop it. William Bennett, his drug czar, decided
to make the District of Columbia a "test case" for his policy. To that
end, he proposed a $100 million plan for the city, with some of the
money going for more treatment. Unlike Krogh, however, Bennett failed
to involve local officials, and the D.C. government--led by a mayor
convicted of crack possession in 1990--was rudderless.

Today, the District's treatment system is a shambles. Residential
facilities are so overwhelmed that many drug offenders--mandated to
treatment by judges--languish in prison for months for lack of a bed.
At any one time, the District's Addiction Prevention and Recovery
Administration (APRA) has about 600 people on its waiting list for
methadone maintenance. The crush is due in part to bureaucratic
inefficiency, but even more to inadequate funding. Between 1993 and
1998, APRA's budget fell from $31.3 million to $19.7 million--a 37
percent drop.

The crisis is hardly limited to the District. Today, the United States
has an estimated 4 million hard-core users of heroin, crack, cocaine
and methamphetamine. While making up only 20 percent of all the drug
users in the country (the rest being mainly recreational users), these
chronic users account for an estimated 75 percent of all the drugs
consumed, as well as most of the crime, child abuse and other
associated problems.

At the moment, the nation's treatment programs can accommodate only
about 50 percent of these users. In other words, nearly 2 million
people who might benefit from help are unable to get it. According to
the Office of National Drug Control Policy, making up this difference
would cost an additional $3.4 billion a year--more than 10 times the
amount appropriated by Congress.

Could a return to the approach and funding patterns of the Nixon era
work today? Of course, the problems are different today. Like other
cities, the District has many more addicts than it did in the early
1970s. And those addicts have many more problems, from homelessness
and mental illness to AIDS and tuberculosis. What's more, many of
today's users are hooked on crack and cocaine, for which treatments
like methadone are useless. Nonetheless, study after study has
confirmed the cost-effectiveness of treatment in dealing with
addiction. In 1996, for instance, the U.S. government, in a study of
hard-core users entering treatment, found that the number who used
cocaine fell from 39.5 percent before treatment to 17.8 percent a year
later; for heroin, the rate went from 23.6 percent to 12.6 percent. A
1994 Rand Corp. study found that drug treatment was seven times more
cost-effective than domestic law enforcement, 10 times more effective
than interdiction, and 23 times more effective than drug-suppression
efforts in countries that supply drugs.

It's time to reflect that reality. Rather than buying more exotic
hardware, we should expand treatment in drug-afflicted cities, such as
Washington. For the cost of a single Customs' surveillance plane ($47
million), the District could treat all those on its waiting list--and
more. If we gave treatment a chance again, we might learn what works.
We know what doesn't.

Michael Massing is the author of the newly published book, "The Fix"
(Simon & Schuster), a study of U.S. drug policy since the 1960s.

Checked-by: Patrick Henry