IT'S NOT A WAR AGAINST DRUGS - IT'S A WAR AGAINST A DISEASE

TED KOPPEL We are, in many respects, a nation of addicts. We eat too much,
we smoke too much, we drink too much coffee, we consume too much alcohol,
we take too much prescription medicine. Even in relatively benign areas
like diet and exercise, many of us are inclined toward wretched excess. But
in all of those areas, assuming, of course, that we're talking about
adults, we are acting within the law. Drug addiction, on the other hand,
falls into a unique category. Most of the time, the purchase, possession or
consumption of marijuana is illegal. That is true almost all the time of
powdered cocaine, crack or heroin. The laws differ from state to state, but
if you are a drug addict, you're very likely to end up in prison. That is
essentially a political judgment. American society as a whole has decided
that we should focus our manpower and money on trying to keep drugs out of
the country, that we should punish those who sell those drugs but also
those who buy and consume them. Our focus tonight is primarily on that last
group and most particularly on those consumers who are addicted to illegal
drugs. What if you were told that drug addiction is a chronic disease
comparable to heart disease or cancer? That, as Nightline correspondent
Dave Marash now reports, is precisely what some of the nation's leading
doctors and scientists are contending.

DAVE MARASH, ABC NEWS (VO) According to a survey of public opinion polls
going back almost 50 years, scenes like this define what most Americans
know about drug addiction. TV, these polls show, is where most Americans
learn what they know or think they know about drugs. This review of a half
century of polling published today by JAMA, the Journal of the American
Medical Association, reveals some interesting patterns. Most Americans
agree drug use has reached dangerous levels but, they say, not in their own
backyards. Eighty-two percent call drug abuse a serious problem nationally,
but just 27 percent see it locally. And while 43 percent of parents see a
national crisis of kids abusing drugs, just eight percent found the crisis
in their own children's schools. And with government statistics showing
drug abuse dropping significantly over the decade of the '90s, only 15
percent of Americans polled see the situation improving while 58 percent
think America's drug problems have never been worse. (on camera) And what
about drug treatment? Well, few Americans seem to believe that it works.
Just 19 percent of those polled gave drug treatment strong support.
Skepticism about drug treatment programs is epidemic in America.

1ST CITIZEN I can't imagine how addicts would benefit from treatment. I
think the old-fashioned way of going cold turkey would be the best way to
do it.

3RD CITIZEN I think they should be put in jail. I think they should be
treated for the crime that they commit like everybody else.

4TH CITIZEN I think a first-time offender, I would definitely opt for
treatment. Second time, third time, jail. (Clip of doctors-scientists meeting)

DOCTOR Around the turn of the century, narcotics were very widely used.

DAVE MARASH (VO) This week in Washington, some three dozen top doctors and
scientists gathered to tell the country most of what it knows about drugs
is flat wrong. Their message-drug addiction is like many other chronic
diseases, no more mysterious, no less serious than heart disease, asthma,
diabetes or hypertension, and no more likely to select as its victims poor
people or racial minorities.

JEFFREY MERRILL, UNIVERSITY OF PENNSYLVANIA The real demography of the drug
addict of today is a white, middle-class, educated individual or the
children of those white, middle-class, educated individuals. It is the
neighbor next door or maybe it's somebody in your own house but it's not
somebody who is located in another community of another race or of another
ethnic group.

DAVE MARASH (VO) Even more revealing, the doctors' report says many, if not
most addicts are no more responsible for their sickness than sufferers from
heart attacks or strokes.

DR ALAN LESHNER, NATIONAL INSTITUTE ON DRUG ABUSE An analogy here is to
lung cancer. People gave themselves lung cancer if they got lung cancer
from smoking, but once they have it, we treat it as lung cancer. The same
is true with addiction. Prolonged drug use changes the brain in fundamental
and long-lasting ways and we know that those brain changes actually are the
core, the essence of the compulsion that characterizes all addictions, you
know, the compulsion to use drugs. And that makes it, at its essence, a
brain disease.

DAVE MARASH (VO) Treating drug addiction, the doctors say, means not
counting cures, but measuring slow, subtle recoveries that add up to useful
lives.

DR DAVID LEWIS, BROWN UNIVERSITY It's a chronic disease with its ups and
its downs and abstinence may not occur easily or ever, but there's
functional improvement, there's decrease in crime, there's better health.

DAVE MARASH (VO) Modest goals, modest results. But Dr Lewis insists
realistic expectations for drug treatment will be repaid well over time in
functioning lives.

DR DAVID LEWIS So I'd say the percentage is better than 50-50 or 50 percent
when someone comes to treatment that treatment will help, and as repeated
treatments take place it goes up and up and up and starts to get in 70, 80,
90 percent.

CAROL SHAPIRO (PH) A lot of times people go through detoxification many
times and I think one of the things we're learning with the disease is
relapse is very common.

DAVE MARASH (VO) Carol Shapiro runs La Bodega, a New York City drug
treatment center based on healing addicts through their families. The
overwhelming majority of American drug addicts have health insurance, not
that this means their insurance offers much coverage for drug treatment.
Just two percent of today's full-time employees are covered for inpatient
rehabilitation and just one percent have full coverage for outpatient
treatment.

CAROL SHAPIRO I think it's a travesty that insurance would not pay for drug
treatment like we would pay for any other illness.

DAVE MARASH (VO) Senator Paul Wellstone wants insurance companies to start
thinking of alcohol and drug addiction as a chronic illness and remove the
limitations on their coverage that have become a part of the managed care
era of the 1990s.

SEN PAUL WELLSTONE, (D), MINNESOTA And we're saying that if in a health
insurance plan you have substance abuse coverage, treat that, pay for that
the same way you would anything else. Treat it the same way you would any
other kind of illness. Don't discriminate against people.

DAVE MARASH (VO) Wellstone says this would cost an additional $1.35 a year
per subscriber, an increase the insurance industry says could force some
customers to drop their health insurance policies entirely. Still, Dr David
Lewis, director of the physicians' campaign, insists whoever pays for it,
full coverage for drug treatment is a bargain.

DR DAVID LEWIS It decreases health costs and complications of addiction. It
decreases injury markedly. It increases productivity and it's a great
anti-crime measure.

DAVE MARASH (on camera) Getting drug addicts into treatment can, the
doctors claim, preempt their criminal careers and do so for a fraction of
the annual $25,900 per person cost of incarceration. Getting the American
public to recognize this, the doctors say, is their biggest challenge in
helping America deal effectively with its

national drug abuse problem.

I'm Dave Marash for Nightline in Washington.

TED KOPPEL When we come back, a congressman who became a believer in drug
treatment after he was forced to confront his own alcoholism and the chief
judge of New York State, who spearheaded efforts to bring drug treatment
courts to New York.

(Commercial Break)

TED KOPPEL It was 1981 when then Minnesota state senator Jim Ramstad had
his last alcohol blackout. His arrest for disorderly conduct was front page
news. Seventeen years later, Representative Jim Ramstad is cosponsor of a
bill in the US Congress to oblige private insurers to cover treatment for
drug and alcohol addiction. He joins us here in our Washington bureau. And
joining us from our New York bureau, the chief judge of the state of New
York, Judith Kaye, who oversees the state's seven drug treatment courts.

And you'd better start by telling us, Judge Kaye, what a drug treatment
court does.

JUDITH KAYE, CHIEF JUDGE NEW YORK STATE (New York) Well, what a drug
treatment court does is to try to break the recycling, the cycling and
recycling of non-violent substance abusers through the criminal courts of
the state of New York.

TED KOPPEL By doing what?

JUDGE JUDITH KAYE By offering an intensive judicial supervision, drug
treatment, case counseling, a very, very rigorous program for those willing
to go into it with the cooperation of the district attorney, defense
counsel, numerous others and at the end of a year or two years, the person,
we believe and we see, will no longer be recycled through the system but
will go on, hopefully, to be a productive member of society.

TED KOPPEL Now, in some states, is it not true, and obviously it is not in
New York, but in some states is it not true that there is no option here
for a judge? In other words, some state laws are so rigorous that if
someone has used certain drugs, they are obliged to be sent to prison,
aren't they?

JUDGE JUDITH KAYE Well, true, but this is a nationwide movement now.
Indeed, 48 of the 50 states, Puerto Rico and Guam all are involved in this
drug treatment court movement. We're finding very, very promising success
with this experiment.

TED KOPPEL Congressman Ramstad, I can understand and I think most Americans
have become, over the years, sympathetic to the notion that alcoholism is a
disease. I'm not sure they're quite ready to believe that drug addiction is
a disease.

REP JIM RAMSTAD, (R), MINNESOTA (Washington) Well, unfortunately there's a
greater stigma in some quarters attached to drug addiction. The fact is
that whether your drug of choice is alcohol, as mine was, or marijuana or
cocaine or whatever, it's all the same, it's all about chemical abuse and
chemical dependency. If a person is totally chemically dependent then he or
she does suffer from a disease that's long been recognized by the American
Medical Association as such and we as policymakers have to start treating
substance abuse, chemical dependency as a disease.

TED KOPPEL That's going to be a problem, Judge Kaye, isn't it because it's
a very slippery slope and very easy to get to the point where then the
logical extension of all of that is to decriminalize drug use?

JUDGE JUDITH KAYE Oh, I don't think so at all and there are many offenders,
violent offenders in particular who should be punished with incarceration.

TED KOPPEL No, no, no. That's too easy, judge. I'm not talking about
violent offenders. I'm talking about simply someone who is a user of drugs.
If there's another crime involved, obviously that's no problem. But let's
say the only crime is the use of crack or the use of cocaine or the use of
heroin. If you were to say that in each of those instances we are going to
treat those people as though they had heart disease or emphysema or cancer,
then is it not logical at some point that you would say if, indeed, this is
a chronic disease we shouldn't be sending people like that to jail.

JUDGE JUDITH KAYE Fair enough, but we're not going to treat every single
non-violent offender, substance abuser who comes through the criminal
courts as diseased. Many of them are and it's just not right to incarcerate
diseased people who will simply come out the other end as substance abusers
again and be recycled through the system again. The real problem is to
identify those who are suffering from the disease of substance abuse and
help them help themselves to cure the disease.

TED KOPPEL Congressman Ramstad, let's move to an area that I know is very
near and dear to your heart and that is the notion of legalizing or making
mandatory that insurance companies would have to pay for the treatment of,
and are you talking about both drug and alcohol addicts?

REP JIM RAMSTAD That's right. We're talking about substance abusers who are
covered by insurance policies. We do not believe they should be
discriminated against vis-a-vis people with other diseases or surgical
services. And all our legislation, the Substance Abuse Treatment Parity Act
does is provide for parity, saying you cannot erect barriers for treatment
for chemical dependency that you don't have for physical diseases. You have
to treat them the same. Right now there are higher co-payments, higher
deductibles, limited treatment stays. It's alarming, Ted, that over the
last decade because of this phenomenon, these barriers that have been
created by the insurance companies, 50 percent of the treatment centers in
America have closed. Sixty percent of adolescent treatment centers have
closed. People don't have access to treatment. Right now there are 26
million Americans suffering the ravages of chemical addiction, 10 percent
of our population and 16 million of them are covered by insurance policies
which have these barriers. We need to knock down those barriers and we need
to provide access to treatment for those addicts/alcoholics.

TED KOPPEL Judge Kaye, you were giving me the impression before that some
sort of a distinction has to be made, though, in your courts even, that you
will not simply accept the claim of every drug addict who comes through
your court that he or she is sick, addicted.

JUDGE JUDITH KAYE That is true.

TED KOPPEL All right. Now how do you make that distinction and if you care
to address it, having made that distinction, does that mean that those
people who don't qualify in your court also wouldn't qualify for insurance
coverage?

JUDGE JUDITH KAYE Well I don't know the answer about insurance coverage,
but in the court system of course we make judgments all the time. That's
what judges do. We make the very fine judgment as to which of these people
would benefit from the program, which of these people, in effect, suffer
the disease of substance abuse and will merely, well, they'll be marching
to a drumbeat-drugs, crime, jail, drugs, crime, jail. And those are the
people we're looking for, the people who we can help to break this terrible
recycling, terrible for the courts, terrible for the defendants, terrible
for all of society.

TED KOPPEL Congressman Ramstad, I know you want to get in here. We're going
to take a short break and

I've got a question I want to ask you when we come back. More, in a moment.

(Commercial Break)

TED KOPPEL And we're back once again with the chief judge of New York
State, Judith Kaye, and with Minnesota Representative Jim Ramstad.

Congressman Ramstad, you heard the judge say before the break that she and
other judges and district attorneys make sort of ad hoc decisions as to who
should or should not qualify for treatment rather than jail, but you can't
make laws that way. I mean when you're making legislation, you can't sort
of leave it up to the insurance company to decide well this person ought to
go to jail but this person deserves treatment.

REP JIM RAMSTAD Well, first of all, let me say as chairman of the House Law
Enforcement Caucus and as one who has certainly followed a tough law and
order stance, I don't think the two are mutually exclusive, that is,
incarceration and treatment. We have to deal with both, Ted, and I do not
support decriminalization of drugs. I think that sends exactly the wrong
message to our young people, makes the jobs of parenting, it would be a
disaster, I believe. But having said that, I think what we need to do is
to, if you look at the population in the American prisons, 1.2 million
people incarcerated tonight in America, 80 percent of them are there
because of drugs and/or alcohol. Now, we've got to very, at the very outset
concentrated on people already in prison because most of those prisoners at
some point are going to get out and if we don't deal with the underlying
drug and alcohol problem when they're in prison, we're just going to have
more hardened criminals when they're released.

TED KOPPEL But you understand, Congressman, better than most that society
doesn't really want to hear that. Society does not want to spend money on
rehabilitation. Society wants to spend money on warehousing. Get those
people off the street, get them off my block.

REP JIM RAMSTAD Well, that's part of our job as policymakers, we have to
educate and I agree with you, Ted, that America right now is numbed to the
pervasiveness of this drug and alcohol problem. We need to do a better job
of educating them and we need to also, I must say the level of
understanding of this problem and of treatment is much higher in the
Minnesota legislature than it is in the Congress of the United States a few
blocks from here.

TED KOPPEL Let me come after you for a moment because I think you're, the
beginning of your answer was a little bit facile. In other words, I
understand it's politically advisable to say that you are not in favor of
the decriminalization of drugs or the legalization of drugs and I
understand why you say that. But if, indeed, we are taking the position, if
these doctors and scientists take the position that what you are dealing
with is not criminals but people who have a disease, then on what basis are
we sending those people to jail, assuming, of course, that they haven't
held somebody up, that they haven't killed somebody, that they haven't
injured somebody? In other words, if another crime has been committed while
they were under the influence of drugs, different story. But simply the
drug user.

REP JIM RAMSTAD I committed disorderly conduct during my last alcoholic
blackout, as you mentioned at the top of this program. I went into
treatment. I didn't go to jail. Judge Kaye deals with first offenders,
non-violent property offenders for the most part, who are addicts, and
sends them to treatment. We have to deal, I think as Judge Kay pointed out,
on a case by case basis at the judicial level with non-violent first time
offenders who happen to be addicts or alcoholics. We need to deal with
their underlying problem of their addiction or they're going to come back
as more hardened offenders later on.

TED KOPPEL And yet, Judge Kaye, in every other respect, discretion is being
taken out of the hands of judges. It's three strikes and you're out, it's
mandatory sentencing. Why is this going to be the exception across the nation?

JUDGE JUDITH KAYE Well, not everything is mandatory. As you point out, some
things are, but by and large, what judges do is tailor made and depends
very much on the exercise, the individual exercise of discretion by judges
and ...

TED KOPPEL And so if I get a good judge, I'm lucky. If I get a bad judge or
an intemperate judge, I'm unlucky, right?

JUDGE JUDITH KAYE Oh, no.

TED KOPPEL That doesn't sound like a very good system.

JUDGE JUDITH KAYE No, it is a good system. We do depend enormously on the
discretion of judges and at the same time the enforcement of the law and
here we are finding an effective way to enforce the law and at the same
time to help people who are sick and not criminals but ill people.

TED KOPPEL Again, I just want to come back one more time, Congressman, to
the notion of this legislation that you and Senator Wellstone want to pass
here because you can leave certain things up to the discretion of judges,
but the insurance companies are going to want something definite. They're,
you know, you're not going to be able to leave this up to the discretion of
insurance companies as to whether someone is or is not sick. How are you
going to define that?

REP JIM RAMSTAD Just like any other disease. Medical doctors at treatment
centers make a diagnosis just like they do for heart disease or diabetes or
kidney disease. They diagnose people either chemically dependent, that is
sick with the disease of alcoholism and drug addiction or not. So that's up
to the local physicians, the chemical dependency professionals who make
these diagnoses every day.

TED KOPPEL Congressman Ramstad, Judge Kaye, thanks very much indeed.

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