HEADLINE: Just Saying 'No' Is Not Enough

BYLINE: By David F. Musto; David F. Musto is the author of "The
American Disease: Origins of Narcotic Control."

THE FIX By Michael Massing. 335 pp. New York: Simon & Schuster. $25.

Michael Massing has been writing about drug issues in the United States
for a decade. He believes the central problem to be the hard-core users of
heroin and cocaine, who are "disproportionately poor, unemployed and
members of minority groups." Although hard-core users are only a fifth of
total users, they consume three-fourths of the cocaine and heroin used in
this country and are responsible for most of the pathological behavior that
elicits public and governmental responses. If we could provide appropriate
treatment to anyone in this population who wanted it, Massing maintains,
the whole drug problem would diminish, as would the illness and crime
associated with it. The result of Massing's investigation is "The Fix," a
balanced and significant analysis of the American drug problem that carries
specific, practical recommendations for reform.

He separates himself from the "legalization/harm-reduction camp" that
asserts that drug-related diseases and social pathology are the fault of
drug-control laws themselves. Having spent long periods observing drug
treatment centers, roaming the streets of Harlem and hanging out with drug
users, he has experienced a "real-life rebuttal to the rosy accounts of
addiction offered by the revisionists." Regardless of the drug laws,
addiction and drug use create terrible conditions: child abuse reports in
New York rose from 36,000 in 1985 to 59,000 in 1989 when the crack epidemic
hit the city. Massing's approach contrasts with recent books like Mike
Gray's "Drug Crazy," which calls for a radical revision of our drug laws.
Gray describes a golden age of drug use prior to the Harrison Narcotic Act
of 1914, when "the country had looked upon addicts as unfortunate citizens
with a medical problem." To right current wrongs, he recommends that we put
the provision of drugs "back in the hands of doctors and pharmacists."

Massing also distances his position from apostles of draconian penalties
and those who put their faith in interdiction. His middle way has one clear
emphasis, and that is comprehensive treatment. He knows this would work
because we had such a program once; it succeeded wonderfully, but we let it
slip away. We were therefore unable to mount a powerful defense against
cocaine and crack in the mid-1980's, and now we have 10 times as many
hard-core users as we faced during the Nixon Administration.

Nixon's strategy aimed directly at reducing crime in anticipation of the
1972 election. Treatment was part of a broad program that included foreign
policy to shut down the Turkish-French connection; the Office of Drug
Abuse Law Enforcement to attack street crime; the Internal Revenue Service
to go after illicit profits. That crime reduction held first place among
Nixon's priorities -- not the care of addicts -- is illustrated by the
Administration's surprising willingness to adopt methadone, a synthetic
opiate, as its preferred treatment for heroin users. At the time, a
high-ranking official in the Bureau of Narcotics and Dangerous Drugs told
me that the bureau would hand out heroin if it thought that would cut
crime. This attitude was surprising because the substitution of one
addiction by another contradicted the previously adamant stand by Nixon's
adherents against any drug use.

How did Nixon come to approve the financing of methadone treatment for tens
of thousands of addicts? Massing draws on interviews with key actors and
internal Government documents to provide an answer. The most persuasive
element was the methadone program developed in Washington by Robert
DuPont, later the Director of the National Institute on Drug Abuse. Heroin
use was skyrocketing; crime was rampant. In his 1968 campaign Nixon had
declared that "D. C. should not stand for disorder and crime." Washington
became the laboratory for national drug policies. In 1970 DuPont, with
support from the White House, established the Narcotics Treatment
Administration, which was soon flooded with applicants. Although nondrug
treatment was also offered, methadone appeared to cut the crime rate
quickly, and that impressed the President and his aides. By the 1972
election crime had fallen by 50 percent in the District of Columbia, an
achievement that was widely broadcast.

Of course, the methadone program was only one of the actions taken to
reduce crime in Washington. Even Egil Krogh, the Nixon aide most
responsible for creating the political will for this ambitious national
treatment program, did not know if the program was responsible for the drop
in crime, but he knew that from a political perspective, "it was a
slam-dunk great success."

Massing has no doubts about the success of the treatment program. His
conviction comes from his encounter with Nixon's drug expert, Jerome Jaffe,
a psychopharmacologist and psychiatrist plucked in 1970 from the University
of Chicago, where he had established a treatment program that employed a
range of options, including drug-free therapy. He was asked first to head a
committee of experts from outside the Government to come up with a
response to drug addiction. His report was practical rather than
theoretical and named methadone as the best treatment for heroin addiction
(the major addiction at that time) and the best way to reduce crime.
Following the adoption of what was basically his proposal, Jaffe entered
Government service.

His first big administrative assignment was to deal with addicted Army
personnel coming back from Vietnam. This he did with ingenuity and
dispatch, and then began work as the "drug czar," the first head of the
Special Action Office for Drug Abuse Policy. Jaffe was neither a good
administrator nor an adept politician -- he was a scientist. Many of his
psychiatric and scientific colleagues distrusted him for working with
Nixon. Some critics lambasted him in the most vitriolic terms for
advocating methadone; they described the program as an enslavement of
minorities. In Massing he has found a vindicator.

Massing advocates Jaffe's "code," a set of principles that summed up his
approach to drug use: "Chronic drug users are at the heart of the nation's
drug problem; a diverse array of services is required; Government must
assure their availability and efficacy; law enforcement is an adjunct to
rehabilitation and, always, reducing demand for drugs through education
and treatment must take precedence over law enforcement efforts to reduce
the supply of drugs. Massing says the Nixon Administration, following the
Jaffe prescription, managed to bring a "serious heroin epidemic" under
control "in a few short years."

Massing recommends setting up an organization like the Special Action
Office for Drug Abuse Prevention that would engage only in reducing demand
for illicit drugs, to be headed by a "C. Everett Koop-type figure" and
backed in the White House by a facsimile of Egil Krogh -that is, a
high-ranking White House official whose special province would be drug
abuse. A comprehensive national treatment program for drug and alcohol
abuse should be established. In Massing's view, the most unfortunate
mistake in the recent history of drug programs was the Government's shift
of emphasis from heroin to marijuana, in response to increased complaints
by parents, during the latter half of the Carter Administration. Treatment
for the hard core shriveled. During the Reagan Administration the amount
spent for treatment in real dollars fell to less than a quarter of what
had been provided in the Nixon Administration.

Massing's powerful arguments for more treatment programs, especially
methadone, must be put into a larger historical context. The 1970's
witnessed the climax of a long-simmering reaction against law enforcement
as the chief tool against drug abuse. That era of toleration, however,
peaked about 1980, and since then we have been on a slope leading toward
intolerance of drug use. Mayor Rudolph W. Giuliani's attack on methadone
maintenance is a recent example of opposition to any drug use by former
users. As valuable as methadone may be for some (and I believe it can be
helpful), it is an uphill battle to justify it to those who have zero
tolerance for drugs. Can a national policy that was feasible in 1970 be
resurrected three decades later in a less friendly climate?

Finally, remarkable claims for treatment in the early 1970's must be
tempered by the knowledge that most people in trouble with drugs were
taking heroin, for which methadone is a stabilizing replacement. Today,
cocaine users are the vast majority of the hard-core population, a problem
for which methadone is useless. Massing's recommendations are too
valuable to be oversold.