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. CAPTION: A PATIENT AND HIS METHADONE AT A CLINIC IN 1970 ec CAPTION: Methadone is given out at a clinic at 17th and R streets NW in 1972, a year when the city's heroin deaths declined. ec