Those of us who oppose American drug policy come up against the problem of explaining our views to other people. Even friends and relatives frequently find our ideas hard to accept. This is not surprising. America has a long history of temperance crusades and drug misinformation. Since 1980, the war on drugs has flooded the United States with news stories and public service spots that portray all currently illegal drugs as dangerous and addicting for anyone who tries them. As a result many Americans believe that drug use should be thoroughly repressed.
As drug reformers, we must critique drug war news, advertisements and counter false accounts with more accurate descriptions. In order to do that, drug reformers need to make distinctions that drug warriors ignore. For example, we have to distinguish the "hard drugs" of h eroin and crack from marijuana.' And we have to distinguish between drug use and drug abuse. Drug war rhetoric is not truthful when it defines all illicit drug use as abuse. The U.S. federal government's own studies show that there is a great deal of experimentation and moderate use that never causes problems. Consider, for instance, cocaine —the most widely abused illicit drug in America today. According to the National Institute of Drug Abuse's (NIDA) own national surveys at least twenty-two million Americans have tried, used or experimented with cocaine (overwhelmingly by snorting or sniffing powdered cocaine and not by smoking crack). The NIDA surveys show that the vast majority of these people have not become abusers or addicts. In fact most people who try cocaine do not experience problems at all.
Although it is still heretical to say so in the United States, NIDA's own surveys have long found that most experimental and occasional cocaine use never turns into abuse.' But some drug use does became abuse (or misuse, as the British say). Some people do get into trouble with drugs, do use drugs too much, and do experience significant problems. American drug war ideology and rhetoric explains and combats drug abuse by combining two seemingly contradictory ideas— chemical determinism and an extreme psychological individualism. On the one hand, drug war propaganda insists that drugs are so pharmacologically powerful and seductive that enormous military and police force must be marshaled to prevent people from getting near them. On the other hand, when confronted with the problem of reducing demand, drug warriors have tended to offer the same individualistic solution for everyone — say no. Essentially, people are advised to just stop it.
Unlike drug warriors, drug reformers have concluded that drug use can not be eliminated, that criminalizing use is unjust and ineffective, and that wise public policy should instead seek to reduce the harm that drugs cause. I find that most reformers endorse honest, truthful drug education (not propaganda) and the idea that people with drug abuse problems should be able to get the kind of voluntary treatment or counseling they want when they desire it.'
American drug policy has much to learn from the Netherlands on this point (as on so many others). But as Dutch policymakers observe, treatment is only a mopping up activity and drug education only can do so much. Neither SWAT teams and propaganda, nor treatment and education, can address the underlying causes of drug abuse — especially of the frequent and heavy heroin and crack use that has been the focus of so much political and public attention. Crack and heroin abuse remain the glaring public failure of the drug war and an issue about which drug reformers must be able to speak knowledgeably and persuasively.
Crack and heroin abuse are different. They constitute the most severe and feared illicit drug abuse problems. Crack is a form of smokeable cocaine and heroin is usually injected with a hypodermic needle. The mode of ingestion of both drugs contributes significantly to the character of their abuse — to their "hardness." Smoking (or occasionally injecting) cocaine and injecting (or smoking) heroin provides a much stronger "rush" than sniffing either drug. The phrases "hard drugs" and, even better, "hard drug abuse" serve as shorthand terms for the drugs themselves as well as the specific "hard" ways they are ingested.
Smoking crack and injecting heroin are physically and psychologically harsh and disruptive things to do. The sociologist, Steven Mugford, reports how one middle-class man described trying crack. "All the stories comparing the crack high to a sexual orgasm are partly true" he said. "But the stories don't tell you that smoking crack is like having an orgasm while being run over by a Mack Truck. I don't want to do that again." A minority of people from all social classes may be willing to undergo such an experience once or twice, or from time to time. But those who persist, who do so heavily and frequently, are almost certainly trying to escape from some substantial distressing personal or, more likely, social problem.
Just as drug war ideology can not easily discuss the differences among drugs, or between use and abuse, it can not easily discuss the unequal susceptibility of different groups to frequent crack smoking and heroin injecting. Drug reformers need to talk about the social sources of so much crack and heroin abuse. We need to develop sophisticated analyses as well as short phrases and sound bites. This too is part of drug policy.
Most Americans probably know intuitively that injecting heroin and smoking crack are relatively uncommon among the upper-middle class. They rightly sense that frequent heroin and crack use occurs disproportionally among the most disadvantaged people in our society. But they could study every TV billboard and magazine spot that the Partnership for a Drug Free America has ever made, and they would not learn about the connections between poverty and hard drug abuse.4 Good drug research, journalism and education needs to bring out the realities that drug war propaganda hides.5 Certainly middle class, upper-middle class, and wealthy men and women get in trouble with illicit drugs (especially from sniffing powdered cocaine). Some of them quit on their own and some of them develop so many problems that they go into treatment. When people from economically well-off backgrounds come out of treatment their prognosis is very good. They return to careers and jobs, homes and families. They have things worth fighting for, things that make it worthwhile to control their drug use or give it up entirely. In those rare cases when upper-middle class adults loose "everything" they own, they still retain college and professional school credentials and marketable skills as well as networks of friends and associates to assist them. Sometimes they have family businesses to go into. Even the worst middle-class drug abusers can, and usually do, put their lives back together.
However, when men and women from poverty backgrounds and neighborhoods come out of treatment (if they can find it) they confront an entirely different situation. They have neither bank accounts nor private homes. They typically return to overcrowded and inadequate housing and frequently to families coping with severe troubles and stress. They have usually received an inferior education at a time when well-paying blue-collar jobs are disappearing. Without new job opportunities and training programs, most correctly perceive that they face a lifetime of low-wage work. In short, the young, poor inner-city men and women returning from treatment (or trying to give up drugs on their own) face the same limited opportunities and demoralizing situations that made escape into hard drugs seem like an appealing alternative in the first place.
Middle-class status, with its benefits and stability, tends to immunize people not against drug use, but against long-term hard drug abuse. It is not a sure fire prevention, but it makes a huge difference. Poverty, on the other hand, makes one especially vulnerable to frequent use of hard drugs — to escaping from a dreadful condition into one that seems, temporarily at least, more pleasant. The ratio of abuse to use of hard drugs is much higher among the poor than it is among the middle class and wealthy.6
There are certainly many personal and biographical factors that might push anyone, rich, poor or middle-class, into a pattern of hard drug abuse. But growing up poor greatly increases the likelihood of it happening. Poverty substantially increases the incidence of personal problems and tragedies that can lead someone into heavy hard drug use. Therefore, the three most important things to understand about the social sources of long-term crack and heroin abuse are: poverty, poverty and poverty.
Recently, several other drug researchers and I gave the annual address for a Community Board in Manhattan where we reside. The Community Board is the neighborhood level of political organization in New York City and Board Seven covers the whole Upper West Side of Manhattan between Central Park and the Hudson River. This is a heterogenous neighborhood that includes the Columbia University community, yuppie gentrification, lots of professional middle class families, and real ghetto and barrio neighborhoods.
I suggested to this audience that we imagine designing an experiment to compare the susceptibility to crack addiction of two groups of teenagers and young adults: one group from the upper-middle class and the other from real poverty backgrounds. How would we do this? First, we would want a community where the two groups lived cheek by jowl, where some streets were primarily upper-middle class, and others were chiefly poor. Second, our experiment should go on in a neighborhood where both groups have access to crack, where sales are common, open and well known. Third, this condition should exist for a number ofyears so that we can see what happens over time. That, of course, is precisely the situation on the Upper West Side. Along many blocks of upper Columbus Avenue, on Manhattan Avenue, and on various stretches of Amsterdam Avenue, crack can usually be purchased day and night, and especially on Friday and Saturday nights. New York Times articles have from time to time listed the heaviest crack-selling locations in the area. The people at the meeting were well familiar with the availability of crack. Some of them had gotten involved in community politics, they explained, because they would walk out of their expensive co-op apartments on their way to work, or when taking their kids to school, and find themselves confronted with dealers hawking crack. And much of this had been going on since 1986.
I asked this roomful of knowledgeable people a series of questions: In the five years that crack has been called an "epidemic" in New York City, and that crack had been available in their own neighborhood, had anybody heard about a serious crack problem among upper-middle class youth. Had anyone in the room heard of a crack problem among teenagers from the families of the professional middle class? Had anybody heard even a rumor of a crack problem at the prestigious private schools servicing the neighborhood — schools like Dalton, Trinity and Horace Mann? There were bright, adventurous, middle-class kids going to the elite public high schools — Hunter, Stuyvesant and Bronx Science — and riding on subways and buses to get around. Had they developed any significant crack problems? Was there a substantial crack problem among the Columbia University students who are scattered all over the area?
The answer of every one in that audience to every one of those questions was "no." No one, absolutely no one, had heard of any such problem, or even a rumor of a crack problem, among the middle class and upper-middle class. With more than five years of exposure to crack, the upper-middle class youth of the Upper West Side have developed no significant problem with the drug. Nor have the middle class developed any significant problem with heroin which has also long been widely available where they live. New York City is probably the urban crack and heroin capital of the world. Any New York City high school student or young adult could take a bus or subway to get the drugs. Many could just walk to find them. Since 1986 I have quizzed people from all over New York City and the surrounding suburbs about crack and heroin use in their neighborhoods, schools and social circles. My informants report having seen little crack or heroin abuse among the upper-middle class. The many hundreds of working class and middle class students I have talked to at the City University of New York say the same thing. There has undoubtedly been some hard drug experimentation, perhaps even considerable experimentation, by a small fraction of middle class men and women. But compared to the poor, many fewer middle class men and women have become longterm crack heads or heroin junkies.
Since 1986 the New York newspapers have printed hundreds of crack stories, and the TV and radio have broadcast even more. Although the news media have usually talked about all crack use as "abuse," they have actually given evidence of middle class experimentation. The media have told about middle-class men (especially white men from New Jersey) driving by in their cars and purchasing crack from street dealers (especially in Washington Heights). U.S. Senator Alphonse D'Amato once had himself filmed making such a purchase to dramatize how easy and common such sales were. There have also been news stories about middle-class individuals who snorted a great deal of cocaine, and a few stories about one or two professionals who have smoked crack heavily. But none of the New York news media has reported finding anything more than isolated cases of heavy crack or heroin use among the middle class.
If crack and heroin use have not become large problems for the middle class in New York City, have they become middle class problems anywhere? Since 1986 there have been uncountable media reports throughout the United States about how crack is highly or instantly addicting and its use extremely contagious. The warnings have gotten a great deal of coverage. But neither journalists nor drug researchers have ever found evidence for a serious hard drug problem among the middle class. Ironically, the intense coverage of crack and other drugs since 1986 helps us to see what, in the long run, has not been happening — what has not been a story.
For example, any reporter in America could get nationwide coverage and the career boost of lifetime with a story about a white, upper-middle class, suburban high school with a large gang of crack users. The story almost writes itself. The inevitable headline would be: "The School They Call Crack High." There has certainly been news coverage of crack use by students in poverty and ghetto schools. But there have been no stories about prosperous middle class neighborhoods and high schools with a major crack epidemic. The reason is, they don't exist. I challenge any drug warrior to find an upper-middle class neighborhood or high school with a crack problem that resembles those in poverty neighborhood schools. If anyone announced finding such a place it would be such a big story that teams of TV and newsmagazine reporters would immediately be on their way prepared to camp out for a week.'
The drug warriors' exaggerations of the contagiousness of crack, which helped make crack a major news story, have shown very dramatically, if only we look, that heavy crack and heroin use is not primarily a result of intrinsic properties in the substances themselves. Even when the middle class has easy access to the drugs (as on Manhattan's west side), heavy crack-smoking and heroin-injecting are still relatively rare. Sweeping anti-drug rhetoric,and chemical determinism obscure the social and economic sources of hard drug abuse. American programs do not addresses hard drug abuse among the people most susceptible to it and who suffer from it the most. Instead, our policy makers have given us a futile and expensive war on drugs, and the ritualistic incantation of a magic phrase: "just say no."
What, then, can be done for the poor to help them deal with drug abuse in their communities and families? Many things. My first suggestion on this point, as on so many other matters relating to drugs, is that we have much to learn from how the Netherlands handles this. The Dutch make it clear that they regard dealing with poverty to be an important part of the process of dealing with drug abuse. Eddy Englesmann, the Head of the Alcohol and Drugs Branch of the Ministry of Public Health and Welfare puts it this way, distinguishing the Dutch approach from the American.
The Dutch prefer a policy of social control, adaption and integration to a policy of social exclusion through criminalization. Instead of a war against drugs, we prefer to wage a war against underdevelopment, deprivation and [low] socioeconomic status.8
The Netherlands and other Northern European nations have dramatically reduced their poverty and urban decay to levels far below what we have become accustomed to in the United States. The governments of the Sweden, Finland, Norway, Switzerland, Denmark, and West Germany (to choose the most obvious examples) have been much more successful than the U.S. in reducing poverty and homelessness. They have done so through careful programs for jobs, training, housing, education, medical care, birth control, and family support. And they have found that when people's social circumstances and life chances are more secure, then their drug use patterns are more moderate, less abusive, and that people are less inclined to get involved in hard drugs. When women and men's social situations and life chances more like those of the middle class, their drug use patterns also more like those of the middle class.
There is certainly some heroin use in all European countries, but European drug experts and researchers find that hard drug abuse is primarily a problem among the lowest strata of their societies too. Because the advanced European industrial democracies have a relatively small proportion of their population in real poverty, they have substantially lower rates of heroin injecting. Only in the de-
industrialized portions of Northern Britain, primarily among the white working class, does hard drug abuse approach the levels of American cities and towns. Yet even in Britain conditions are not as bad as in the United States.9
Unfortunately, current economic and drug policy mainly makes life harder for the poor. The poor, especially the young, are disproportionately the first casualties, the body count, of the drug war. The most heart-wrenching victims are the young people killed as bystanders in gun fights between drug dealers, or between dealers and police. There are the bright, enterprising young people from poverty neighborhoods recruited into the drug business because it offered the best jobs around. There are the young men and women locked in prisons and stigmatized for life for possessing or selling small amounts of the wrong white powder. And, there are the men and women dying of AIDS because repressive laws and policies prevented them from getting clean needles. 10
There is yet another terrible consequence of the war on drugs for the increasing numbers of American youth who live in poverty and despair. The drug war camouflages and lies about the social and economic sources of much of their hard drug abuse, and so prevents people from seriously addressing the underlying problems. Government policies have not sought to reduce poverty. Rather the government has, as Englesmann puts it, pursued a policy of "social exclusion through criminalization"; it has worsened life for the poor.
The effort to fully transform and humanize American drug policies involves social and economic reform; it will, unfortunately, take decades. However, some changes are inexpensive (or at least cheaper than current policies) and could be done quickly. This includes making hypodermic needles freely available and decriminalizing possession of small quantities of all drugs (as the Netherlands has done). The huge sums spent on incarcerating petty drug offenders could instead be spent on education, job training and voluntary treatment on request.
Long-term change can also be speeded up considerably by further educating the American public about the inadequacies and injustices of current drug policy, and about the realities of drug use and abuse. When people ask us what causes so much crack and heroin use, we should just say "poverty." And when they ask us how American society should deal with poverty — we should just say, "look at what the Netherlands has done." We should help people to see what Dutch policy has demonstrated — that drug reform and social reform are not only necessary, they are also inextricably linked, and they are possible.
Harry G. Levine is a professor at the department of sociology at Queens College, City University of New York, Flushing, N.Y. 11367.
The ideas for this paper were developed in over five years of collaboration and continuous conversation with Craig Reinarman. For elaboration of some of the topics discussed here, see Craig Reinarman and Harry G Levine, *Crack in Context" Politics and Media in the Making of a Drug Scare." Comtemporary Drug Problems 16, 4:535-577, 1989. Also see Marsha Rosenbaum's excellent booklet Just Say What?: An Alternative View on Solving America's Drug Problem, San Francisco: The National Council on Crime and Delinquency, 1989. Rosenbaum explores themes touched on in this paper and provided inspiration for the title. The phrase "Just say poverty" was suggested by Lauren Seiler. Kevin Zeese, Arnold Trebach and Marsha Rosenbaum created the plenary session at the Drug Policy Foundation conference in 1991 at which I gave an earlier version of this paper. Craig Reinarman, Lynn Zimmer and Bernard Cohen made very helpful suggestions on earlier drafts.
'The phrases 'hard drugs" and "hard drug abuse" are not technical terms, but are central to European drug reform policies And are familiar to Americans. I am using the terms here to refer to heroin and crack (and not, for example, to powdered cocaine that is sniffed or snorted). As noted in the body of the paper "hard drugs" and "hard drug abuse" are short hand phrases that include both the drugs themselves and the specific (hard) ways they are ingested. For cocaine and opiates (as for psychoactive substances in general) the mode of ingestion has a major effect on the drug experience. The importance of mode ingestion is stressed in any sensible general discussion of drugs. See, for example, Edward Brecher, Licit and Illicit Drugs Boston: Little Brown, 1972; Eric Goode, Drugs in American Society New York: McGraw-Hill, 1988; and Arnold Trebach and Kevin Zeese (eds)Drug Prohibition and the Conscience of Nations, Washington, D.C.: Drug Policy Foundation, 1990.
2National Household Survey Findings, 1990. Washington, D.C.: Alcohol Drug Abuse and Mental Health Administration
31 base this conclusion on five years participation in Drug Policy Foundation events, involvement in New York with a closely related group, and publications such as Trebach and Zeese (eds)Dru,g Prohibition and the Conscience of Nations. 'On the Partnership ads see, Lynn Zimmer, "The Partnership for a Drug Free America and the Politics of Fear" working paper presented at a plenary at the Drug Policy Foundation Conference, Washington, D.C., November 1991. On the idea of drugs as evil see Reinarman and Levine, "Crack in Context"; Trebach and Zeese; Drug Prohibition.and the Conscience of Nations Szasz Ceremonial Chemistry, David Musto, The American Disease: The Origins of Nor.
cotic Control (expanded edition) New York: Oxford University Press, 1987; Harry G. Levine, "The Alcohol Problem in America: From Temperance to Alcoholism" The British Journal of Addiction 79:109-119, 1984. Levine, "Temperance Cultures" in G. Edwards, M. Lader & C. Drummond (eds) The Nature of Alcohol and Drug Related Problems. London: Oxford University Press: 1992.
°In their path-brealci ng book, Cocaine Changes, Dan Waldorf, Craig Reinarman and Sheigla Murphy focus on the social factors that protect people from drug abuse in general and cocaine abuse in particular. The authors interviewed 267 heavy cocaine users. By any standard, these people consumed an enormous quantity of cocaine. In order to qualify for their sample one had to use at least two grams of cocaine a week for six months, or some cocaine everyday for a year. Many respondents used more. Yet despite this heavy and frequent use, many of the people the researchers studied experienced relatively few problems when sniffing powdered cocaine. Further, many of the heavy users, including some with substantial problems, eventually stopped using without much difficulty. In identifying the factors that protect people from drug abuse, the authors develop the notion of having what they call "a stake in a conventional life" —primarily careers, homes, and families. This stake or commitment to a stable life-style helps most people in the middle class who experiment with drugs to avoid getting into trouble in the first place. And this stake, and the resources of middle class families and status, helps bring back those who have moved from moderate or recreational use to abuse. See: Dan Waldorf, Craig Reinarman and Sheigla Murphy. Cocaine Changes: The Experience of Using and Quitting. Philadelphia: Temple University Press, 1991. °I use the term "poverty" to include not only those people formally under the current arbitrary poverty line (at least thirty million Americans), but also another thirty to fifty million (or more) people who are only slightly better off. It is worth remembering that most of the able-bodied adult poor without young children work part time or full time. Many families move back and forth across an arbitrary poverty line over the years depending upon changes in job availability, housing costs, medical expenses and other factors. In short, those most at risk from crack and heroin include many people who might be called working-class or even lower-middle class. I have used the phrases "middle class" and "upper-middle class" to indicate people who are among the more economically secure groups in our society. 'Reporters and newspapers have been more aware of the temptations and risks in totally inventing a drug story since 1981 when the Washington Post had to give back the Pulitzer prize because a reporter had fabricated the story of a eight year-old heroin addict. For the complete account of how and why the Washington Post let such a thing happen, and why the reporter did it, see: Craig Reinarman, "Jimmy's World," paper presented at a plenary session at the Drug Policy Foundation Conference, Washington D.C., November 1991.
Occasionally media reports note the lack of crack or heroin in middle-class areas and suburbs. For example, near the height of the crack "crisis" the New York Times (October 7, 1989, P. 26) reported that except for a few "urban pockets' in suburban counties, suburban "educators, law enforcement officals and young people say crack and most other narcotics are rarely seen in the suburbs, whether modest or wealthy."
°Eddy Englesmann, "The Pragmatic Strategies of the Dutch 'Drug Czar' pp. 49-55 in Trebach and Zeese, Drug Prohibition.
°A number of European drug experts and sociologists have helped me to understand patterns of drug use in various European countries, especially Peter Cohen of Amsterdam, Pat O'Hare and the others in Liverpool connected with the International Journal of Drug Policy, and several German drug and alcohol researchers, especially Henner Hess and Christa Appel.
'°It is important to note that the drug war's greatest casualties are not only from among the poor, but also from among poor minority youth — especially Latinos and African-Americans. Many whites are affected, of course, but minority youth are disproportionately shot as bystanders, locked up for petty use, recruited into the business, and infected with the AIDS virus because of punitive laws and policies which prevent heroin addicts from getting clean hypodermic needles. Racism, too, has rendered American society at best insensitive, at worst blind, to their suffering.