The Facts About Drug Abuse
The Drug Abuse Council, 1980
The Federal Government's Response to Illicit Drugs, 1969-1978
Note on Acronyms
ACRONYMS ARE USED throughout this chapter for a number of federal agencies. Among those most often referred to are:
ADAMHA Alcohol, Drug Abuse, and Mental Health Administration
BNDD Bureau of Narcotics and Dangerous Drugs
DEA Drug Enforcement Administration
FBN Federal Bureau of Narcotics
NIDA National Institute on Drug Abuse
NIMH National Institute of Mental Health
ODALE Office of Drug Abuse Law Enforcement
ODAP Office of Drug Abuse Policy
OMB Office of Management and Budget
SAODAP Special Action Office for Drug Abuse Prevention
Throughout the twentieth century the government of the United States has engaged, in one form or another, in efforts to prevent its citizens from using certain designated psychoactive drugs. The use of nonapproved drugs has been defined as illegal, and billions of taxpayer dollars have been spent and millions of man-hours devoted to curtailing the availability of such drugs. Yet in spite of these efforts there are now as many users and abusers of illicit drugs as ever before. Similarly, the misuse of legally available drugs has dramatically increased.
Data on the use of illicit drugs do not conclusively demonstrate that the federal government's antidrug efforts have failed, but they do provide compelling reasons to undertake a thorough reappraisal of federal policies and programs. Evaluations made by both federal government study groups and private organizations' have resulted in changes-particularly in preventive and treatment approaches-but federal drug policies have remained fundamentally the same for decades.
This chapter will concentrate on the response of the federal government to the issues of illicit drug use andmisuse from 1969 to the present. It was during this period that our country experienced an unprecedented growth in the governmental response to the use of illicit drugs. This period also roughly coincides with the years during which the Drug Abuse Council has been studying drug issues and policy.
To understand the U.S. government's response to illicit drugs in the 1970s it is necessary to know something of the history. Our nation's current drug policies and programs are the result of over seventy years of development. Detailed analyses such as those provided by David Musto2and Rufus King3 offer insight into this process. It is clear from these analyses that the government's response to public fear of certain drugs and drug users has primarily consisted of law enforcement or quasi-enforcement strategies intended to prohibit both new and continued use of nonapproved substances. The belief that some drugs are so innately harmful that the citizens of this country should and could be prevented from using them has been the basic tenet of American drug policy for the past seven decades.
Several major pieces of drug legislation and presidential initiatives have shaped public policy in the drug field. The first pertinent legislation in this area passed by Congress was the District of Columbia Pharmacy Act in 1906.4 Although this act applied only to the District of Columbia, it set a precedent for Congress to deal with drug issues. This act permitted a physician to prescribe narcotics to addicts, but only when "necessary for the cure" of addiction; the prescription of narcotic drugs to nonaddicted persons was limited to the treatment of injury or disease. The intent of the act was to prevent the further -spread of addictive drug use. It first raised the difficult philosophical question of government regulation of physician prescribing practices with respect to addictive drugs, an issue still actively debated.
The Harrison Narcotic Act,' passed in late 1914, marked the official entry of the government into the area of narcotics control. This act simplified record keeping on the dispensation of certain narcotic drugs, and required that standard forms be filed and maintained for two years on the sales of narcotic drugs. Revenue agents could inspect these records at will. However, physicians were allowed to dispense drugs without keeping records if in actual attendance on their patients. Numerous patent medicines containing small amounts of morphine, cocaine, opium, and heroin were still permitted to be sold by mail order or in general stores.
Through regulations issued by the Treasury Department pursuant to the Harrison Narcotic Act, the federal government hampered the treatment of heroin and morphine addiction to such a degree that by the early 1920s those clinics in the country which regularly provided opiates to registered addicts (so-called "maintenance clinics") were closed, and few private physicians dared to provide these drugs to addicts . 6 This effectively ended the medical profession's active involvement in the treatment of drug addiction until the 1960s. From the 1920s on, the federal government was for all practical purposes in charge of attempts to control illicit drug use. Although there were, at the time, serious questions raised about the constitutionality of using federal police powers to restrict, and eventually prohibit, the use of certain drugs, the popular belief was that the use of these drugs must be eliminated even when occurring in the context of medical treatment for addiction.
In 1929 Congress passed the Porter Act 7 ostensibly addressing the treatment needs of convicted addicts. The Porter Act called for the building of two narcotics "farms" in which those convicted of the "crime" of drug addiction would be housed in order to receive compulsory treatment. The underlying assumption of the act seemed to be that treatment-enforced abstinence-required isolation and a controlled environment. Although the Porter Act became law in January 1929, the first farm did not open until 1935 in Lexington, Kentucky. A second farm opened in 1938 in Fort Worth, Texas. The treatment rendered at these farms was not successful, with most addicts returning to addiction after discharge." In reality the farms were little more than specialized prisons. In fact, Musto reports that "not until the late 1960s were the bars removed from the Lexington facility and the cells turned into rooms."9
In 1930 the first federal agency specifically devoted to the control of illicit drugs, the Federal Bureau of Narcotics (FBN), was established. Because the federal regulation of narcotic drugs was based on the taxing power of Congress, the FBN was made part of the Treasury Department and was concerned only with enforcement issues. The FBN was responsible, at least initially, for enforcing the Harrison Narcotic Act and controlling only what were then thought of as the most dangerous drugs-cocaine and the opiates. The FBN's policies were predicated on the belief that "the most effective way of gaining public compliance with a law regulating a dangerous drug was a policy of high fines and severe mandatory prison sentences for first convictions." 10
The FBN did not initially support a federal antimarijuana effort. However, newspaper accounts of serious crimes attributed to marijuana users and the drug's "Mexican purveyors" triggered a series of events that culminated in the passage of the Marihuana Tax Act of 1937. 11 The FBN changed its policies after this act was passed, vigorously enforcing the federal laws prohibiting marijuana. 12
Passage of the Marihuana Tax Act in effect imposed a total prohibition on marijuana use. Marijuana was described in congressional hearings as impairing the ability to think rationally, dangerous to the mind and body, and leading to insanity. It was further claimed that marijuana led to the commission of violent crimes, spread drug use to school children, and resulted in impotence in the habitual user. It was not until the early 1970s that many of these views began to be modified. To this day, however, their effects on public attitudes and policies linger.
During the late 1940s and early 1950s there were reports that rates of heroin addiction had risen, particularly in inner-city minority communities. This period coincided with the beginning of the so-called "McCarthy era," a time when public fear of nonconforming behavior was high and tolerance of it low. Drugs were linked to communism. As David Musto has written, "The Federal Bureau of Narcotics linked Red China's attempts to get hard cash, as well as to destroy Western society, to the clandestine sale of large amounts of heroin to drug pushers in the United States."13 In addition, a theory that addicts began with marijuana use and moved inexorably to the use of heroin (or morphine or cocaine)-the progression" or "stepping-stone" theory-was widely believed.
In this atmosphere, the Boggs Act14 was passed in late 1951. The Boggs Act increased penalties for all drug law violators and for the first time made penalties for violation of the marijuana laws the same as those for narcotic drugs. This act also introduced, at the federal level, the concept of minimum mandatory jail sentences for drug law offenders.
The Boggs Act-and later amendments which further increased penalties 15 -reflected an undeviating reliance on law enforcement activities and harsh penalties to deal with the perceived "drug menace." The Boggs Act-and the later Narcotic Control Act of 1956-passed after only cursory hearings, which did not delve into either the causes or the nature of the use of illicit drugs. The widespread fear of communism and intolerance of nonconforming views and behavior at the time made it politically feasible-even desirable-to advocate reliance on the criminal justice system to control and punish narcotics users. The need for treatment was ignored. Most Americans directly affected by these laws were politically impotent, disliked, and distrusted because of prevailing racial and ethnic prejudices.
The first notice of change in official attitudes came in 1963 with President Kennedy's appointment of an Advisory Commission on Narcotic and Drug Abuse (the Prettyman Commission) to review the nation's drug problems and the government's response to them. The Prettyman Commission report 16 challenged many of the assumptions which had long dominated official thinking in the drug area. It recommended a decreased use of minimum mandatory sentences, an increase in appropriations for research, and the transfer of the FBN to the Department of Health, Education, and Welfare. It also recommended that the final judgment on the legitimate medical use of narcotics be given back to the medical profession.
The Prettyman Commission noted the fragmentation of federal activities in the drug field and recommended that "the President appoint a Special Assistant for Narcotic and Drug Abuse from the White House staff to provide continuous advice and assistance in launching a coordinated attack. " 17 Although the commission made many recommendations, few were implemented at that time.
One recommendation of the commission which did receive attention was that a civil commitment system be established "to provide an alternative method of handling the federally convicted offender who is a confirmed narcotic or marijuana abuser." Such a system was instituted by the Narcotic Addict Rehabilitation Act of 1966 (NARA)."' Although NARA ostensibly considered drug addiction a "medical problem," addicts committed under NARA programs were basically perceived as prisoners.
By the mid-1960s, illicit drug use had become a highly visible and emotional issue throughout the United States. It was widely believed that illicit drug use was increasing rapidly and for the first time reaching into the suburbs and affecting white middle-class youth. News reports often tended toward sensationalism in presenting stories on LSD and hallucinogenic drug use on college campuses. Anti-Vietnam War protesters became identified with marijuana use. The use of illicit drugs was, in general, identified as an antisocial gesture and was associated in the public's mind with mental illness and rising rates of street crime.
In February 1968 President Johnson established "a new and powerful Bureau of Narcotics and Dangerous Drugs (BNDD)" within the justice Department."' Johnson had seen that the federal enforcement of narcotics laws was fragmented. The Federal Bureau of Narcotics in the Treasury Department had some responsibilities, while the Bureau of Drug Abuse Control (BDAC)-an agency created only three years earlier in 1965 in the Department of Health, Education, and Welfare-had been assigned certain regulatory functions having to do with nonnarcotic drugs. In an attempt to unify the federal response, the FBN and BDAC were abolished and the new BNDD was given full authority to enforce all U.S. narcotics laws, from worldwide operations to work with state and local law enforcement officials. In addition, BNDD was directed to "conduct an extensive campaign of research and a nationwide public education program on drug abuse and its tragic effects." In fact, in President Johnson's message to Congress proposing Reorganization Plan No. 1, the only mention of any federal effort in research- treatment, or education was in the context of the justice Department's BNDD. The emphasis was again on law enforcement and the relationship between drugs and crime.
Understanding the Growth of the Governmental Response to Illicit Drugs
During Richard Nixon's presidential terms, the issue of "drug abuse" was given a higher priority and greater visibility than at any other time in our country's history. In January 1969 the annual federal. budget for drug treatment, education, research, and law enforcement was $81.4 million; five years later it was $760 million-nearly a tenfold increase. A series of major legislative, organizational, and programmatic changes accompanied these dramatic budget increases. The reasons for this enormous increase in the federal response can be traced to three unforeseen circumstances of need and opportunity.
The Need to Reduce Rates of Urban Street Crime. Rising street crime was a key issue in the 1968 presidential campaign. The urban riots of the mid-1960s and the rising crime-rate figures issued by the FBI provided fuel for much of the campaign rhetoric about the growing "lawlessness" and "violence" of America. "Law and order" emerged as the dominant domestic theme of the 1968 Republican presidential campaign .20
Campaign promises to "get tough" with urban street crime are historically easier to make than to fulfill. The jurisdiction and power of the federal government to prevent burglaries and armed robberies-among the most common types of urban street crime--are limited. Except in the District of Columbia, such violations are usually matters for state, not federal, action. Even if Congress had extended the legal authority of the federal law enforcement agencies, these agencies (FBI, IRS, BNDD) did not have the manpower to address urban street crime effectively.
In spite of the passage of "tough" legislation such as preventive detention, harsh prison sentences, and "no-knock" warrantless searches, crime rates continued to rise, as reported by the FBI, jeopardizing the administration's promised law and order. Even in the District of Columbia, where the federal government could exercise some contrcl, the crime rate increased during the first year of the Nixon presidency.
Clearly, from a political perspective the Nixon administration needed to show progress in some area of crime control before the 1972 election. This was one element underlying the growth since 1969 of the federal government's efforts to control the use of illicit drugs.
The Public's Increasing Concern About Heroin Addiction. The association of illicit drug use with street crime and violence developed over a long period of time. By the late 1960s, the relationship between heroin "addiction' and street crime was generally accepted as fact, despite the absence of any careful research and documentation. 22 Heroin had become inextricably linked in the public's mind with the urban crisis; and as public anxiety about crime grew, so too did the fear of heroin and heroin addicts.
The public's fear of heroin was intensified by reports of increased use of narcotics among American soldiers stationed in Vietnam. The thought of "soldier-junkies," trained in guerrilla warfare, returning to the streets of urban America heightened public concern and led to further demands for government action. "Drug abuse" (particularly heroin addiction) rapidly became a major public concern, as reflected in the opinion polls of that time, adding another argument for an expanded government effort.
But neither the need for an effective crime reduction program nor the growing public concern about heroin explain by themselves the increased federal response: a third element was crucial. In all likelihood the government's efforts to prevent "drug abuse" would have expanded without this third element, but it is doubtful that the expansion would have been anywhere near the same magnitude.
* In the late 1960s no distinction was made between heroin use and heroin addiction-all use of heroin was believed addictive. More recent studies indicate that this is not necessarily accurate.21
The Emergence of New Approaches to the Problem of Heroin Addiction. Three new avenues of response to the problems of heroin addiction and heroin-related crime emerged. Although distinct from one another, these three approaches in time became interrelated in subsequent government programs. The opportunities they presented led-some say misled-federal policyrnakers to believe that they could respond to the problems of heroin addiction more successfully than previously.
First, the legislative basis for federal drug law enforcement efforts changed. Federal regulations and controls on drugs before 1970 were based primarily on the power to levy taxes and prohibit traffic in smuggled goods. Thus virtually all federal drug law enforcement programs were administered by the Treasury Department-until the creation of the Bureau of Narcotics and Dangerous Drugs in the justice Department by executive order in 1968; simultaneously the Treasury Department's Federal Bureau of Narcotics was abolished. This transfer of jurisdiction was given a statutory basis in 1970 with the passage of the Comprehensive Drug Abuse Prevention and Control Act.2"
This act addressed a broad range of drug program efforts, providing increased support for drug treatment, rehabilitation, and education as well as enforcement. The enforcement provisions of this legislation (Title II of the act) were part of a larger attempt to reduce criminal activity through improved federal law enforcement. Congress and the Nixon administration sought through this legislation to recodify the existing drug laws into one comprehensive law. Most narcotics law enforcement powers were given to the justice Department, thus allowing the Attorney General to exercise control over all dangerous drugs (e.g., amphetamines and barbiturates) and narcotics. This was the first federal law making it illegal to traffic in or possess certain drugs which did not refer to the taxing authority. Instead, the justification for federal-as opposed to state-enforcement was shifted to the power of Congress to regulate interstate commerce. The concept of the "interstate commerce" powers of Congress had greatly expanded in the decades prior to this new drug legislation. Supreme Court rulings on the "New Deal" legislation of the 1930s and 1940s and on the civil rights cases of the 1960s had clearly broadened the scope of activities that Congress could regulate under its constitutional authority to regulate "interstate commerce."
This shift in the constitutional basis of drug law enforcement allowed the federal government to become more directly involved in suppressing one presumed major cause of urban street crime about which there was great public fear. It offered some hope that expanded and intensified efforts to combat trafficking in illicit drugs could succeed where past efforts had failed.
A second new avenue of response centered around bilateral agreements to reduce the international flow of illicit drugs-particularly heroin-into the United States. For more than sixty years, beginning with the Hague International Opium Convention of 1912, the United States has negotiated bilateral and multilateral international agreements to keep illicit opiates out of the country. Since opium, of which heroin is a derivative, is not grown anywhere in the United States, all the heroin used by addicts in this country comes from foreign sources; hence the concept that if opium is not cultivated elsewhere, heroin will not be available for use here. Since, however, it is virtually impossible to prevent the growth of the opium poppy everywhere, a second line of defense has been to disrupt international trafficking in opium, its chemical conversion into heroin in foreign laboratories, and its subsequent shipment into the United States.
In January 1969, up to 80 percent of the heroin used in the United States was believed to be of Turkish origin. The major processing country for converting Turkish opium into heroin for shipment to American East Coast port cities was reputed to be France. The operations in these two countries were frequently blamed for the rising rates of heroin addiction reported in the United States in the late 1960s.
The Nixon administration sought greater international cooperation to keep illicit drugs from entering the United States .14 In early 1971, just as public concern about heroin was reaching its peak, separate agreements were reached with France and Turkey enlisting their formal assistance in keeping heroin out of the United States. The French government agreed to take steps to close down the clandestine laboratories operating principally around Marseilles and to prevent the traffic of opium into, and heroin out of, France. The agreement with Turkey-the culmination of five years of negotiations-amounted to a total. ban on -poppy cultivation in Turkey in return for American financial aid for crop substitution programs and income compensation for Turkish farmers.
It was anticipated that these two agreements would significantly reduce the flow of heroin to the United States, and that the resulting shortage would reduce the levels of heroin addiction and heroin-related crime. Thcy were touted as major victories on the international front of the new "war on drug abuse." The federal government sought to capitalize on these agreements by negotiating agreements with other potential "source" and "processing" countries. The hoped-for success of these efforts to control international supplies thus emerged as the second new avenue of the government's heroin control effort.
The third new avenue of response was the use of methadone to treat heroin addiction. Methadone is a synthetic analgesic developed by the Germans during World War 11 as a substitute for morphine. After the war and throughout the 1950s, methadone was used in the United States as a detoxifying agent for heroin addicts. In 1964 Drs. Vincent P. Dole and Marie E. Nyswander of the Rockefeller Institute in New York City found that they were able to maintain six heroin addicts on a stable dosage-level of methadone without their craving heroin. Dole and Nyswander soon began an expanded program of methadone maintenance to both demonstrate methadone's potential and evaluate the program's impact. In 1966 they reported the initial results of their work: Among the most widely publicized of their results was that criminal activity among the enrolled addicts had been "virtually eliminated. '125 Public and government interest in the concept of methadone maintenance grew, and by the late 1960s methadone programs were in operation in many urban centers, providing addicts with an alternative to the more traditional forms of treatment which emphasized abstinence, and which had not proved successful for large numbers of addicts.
While methadone maintenance programs are generally considered "treatment," particularly by their staffs and clients, the idea of using methadone treatment as part of the larger national effort to reduce urban street crime had begun to take hold by late 1969. The proposition put forth was that if an addict's dependence on heroin was broken (by substituting legally prescribed methadone), the crime rate would be reduced, because-so the theory went-addicts committed a large proportion of the street crime in order to feed their illicit habits. A 1970 Domestic Council Summary Option Paper on Drugs stated, "The Federal government has only one economical and effective technique for reducing crime in the streets-methadone maintenance. -26
Methadone thus offered an important new form of treatment to heroin addicts as well as a possibility of reducing urban street crime. Which aspect was considered more important is difficult to determine. In any event, the emergence of methadone treatment was a crucial -part of the developing "solution" to the problems of heroin addiction and heroin-related crime.
Thus in the late 1960s and early 1970s several new and potentially significant approaches developed. Many believed that if effectively applied in concert they could substantially reduce the rate of heroin addiction and associated problems, particularly the crimes committed to raise money to support heroin addiction. These developments, coinciding as they did with the political commitment to reduce urban street crime and respond to the growing public concern about heroin addiction, had much to do with the enormous growth of the federal response to illicit drugs which began in 1969.
The Federal Response, 1969-1971
In January 1969 the federal government's response to illicit drugs as measured in dollars spent was small; $86 million was spent in fiscal year 1969 (FY 69), and only a modest increase to $101.9 million was requested for FY 70 .27
The principal federal agencies involved in the drug field during this period were the National Institute of Mental Health (NIMH) in the Department of Health, Education, and Welfare; the Bureau of Narcotics and Dangerous Drugs in the justice Department; and the Customs Bureau of the Treasury Department. These three agencies accounted for the bulk of the federal drug effort in four operational areas: treatment and rehabilitation; education, prevention, and training; research; and law enforcement. NIMH was the major federal sponsor of all non-law-enforcement programs, while BNDD and Customs each held some responsibility for the federal drug law enforcement effort. The emergence of BNDD created an intense bureaucratic rivalry with Customs regarding jurisdictional responsibilities for drug law enforcement programs. Although this dispute was supposed to have been settled in 1969 when BNDD was authorized to conduct overseas operations and Customs was restricted to border searches, it has surfaced frequently in subsequent years; even now the situation seems merely a temporary truce. (See Staff Paper 2, "Drug Law Enforcement Efforts," below.)
The FY 71 budget was the first to be completely developed by the Nixon administration, and in it the federal drug budget more than doubled to a total of $212.5 million. The major increases in the FY 71 budget were for treatment and rehabilitation and education, prevention, and training. While the drug law enforcement budget rose by more than 50 percent, it was for the first time surpassed in absolute numbers by expenditures for treatment and rehabilitation, which by this time were assuming added dimensions as part of the crime reduction effort (see Figure 1. 1).
Since the use of illicit drugs was of growing public concern and government interest, federal budget makers were clearly more receptive to agency budget requests for new drug programs, and by FY 71 there were fifteen separate federal agencies involved in some kind of drug-related effort. For some, such as the Office of Education, the Veterans Administration, and the Department of Transportation, FY 71 marked the first year they had undertaken specific drug activities. For others, such as the Department of Housing and Urban Development and the Office of Economic Opportunity, drug-related expenditures, which until then had been minimal, rose dramatically. This expansion of the federal drug budget was accompanied by greater problems of interagency coordination. Although federal response to the use of illicit drugs was growing, it generally lacked cohesion and overall purpose (other than a commitment to "solve the drug problem"). This lack of coordination led Hutt and Wald to comment in 1972, "Federal activities in the drug abuse field tend to be ad hoc reactions to current crises rather than well-considered, long-term programs.11211
The proposed FY 72 budget, announced in February 1971, projected a drug budget of $265 million-an increase of just over $50 million. This proposal envisioned federal expenditures of $96 million for law enforcement, $101 million for treatment and rehabilitation, $24 million for research, and $44 million for education, prevention, and training. By this time there were sixteen separate federal agencies involved in the drug effort, with little coordination between them. The resulting bureaucratic nightmare was graphically depicted in a government report covering all federal drug efforts except law enforcement (Figure 1.2).
In early 1971, the National Commission on Marihuana and Drug Abuse began work on the first of two consecutive one-year studies it was to undertake. The appointment of this federal study commission, the scope of its work, and the schedule for the completion of its two reports had been delineated in the Comprehensive Drug Abuse Prevention and Control Act of 1970. (The Senate and the House of Representatives each appointed two members to the thirteen-member commission; President Nixon selected the remaining nine.) Congress had stipulated that the commission first complete a comprehensive study of marijuana-related issues by March 1972 (discussed more fully in Staff Paper 5, "Marijuana and Cocaine," below). in the commission's second year, Congress directed it to complete a more general examination and analysis of the nature, causes, and significance of the "drug abuse" problem in the United States, and further directed it to present recommendations for legislative and administrativ6 actions consistent with the commission's findings and conclusions.
However, on June 17, 1971, long before the scheduled completion of the commission's second report, President Nixon sent to Congress a special message on drug abuse in which he requested a supplemental budget of $155 million and a reorganization of responsibilities regarding drug treatment, education, prevention, research, and, most notably, coordination. Citing the immediacy of the drug problem and the need for a more effective response, Nixon simultaneously issued an executive order establishing the position of Special Consultant to the President for Narcotics and Dangerous Drugs in order to "institute to the extent legally possible" the legislation which he proposed to Congress. It was at this point that the fundamental restructuring of the federal government's response to illicit drugs began.
President Nixon's Message to Congress, June 17, 1971.19 President Nixon's message to Congress on June 17, 1971 raised the issue of illicit drug use to the highest level of government concern and responsibility. This statement was the culminating step in the declaration of a strong and irrevocable public commitment to reduce the crime heroin addicts were thought to commit and bring the problems of illicit drug use under control. "If we cannot destroy the drug menace in America , Nixon informed Congress and the American public, "then it will surely in time destroy us. I am not prepared to accept this alternative." Although the President spoke of the general problems of "drug abuse," there is little doubt that the chief problems and concerns to which he referred were those relating to heroin addiction.
Clearly, public alarm about heroin-related crime and addicted Vietnam veterans demanded a more effective governmental response than previous ones. Equally clear was the fact that increased funding alone had not been successful. According to Nixon: "We must now candidly recognize that the deliberate procedures embodied in present efforts to control drug abuse are not sufficient in themselves. The problem has assumed the dimensions of a national emergency."
Forceful measures were required, so the thinking went, if the twin problems of heroin addiction and urban crime were to be curtailed. Speed was essential to the Nixon administration because of the political aspects of illicit drug use. Predictably, the policies and programs it advocated were consistent with enforcement and quasi-enforcement approaches which had characterized past federal efforts. The government's response to the use of illicit drugs in 1971 sprang from the same assumptions about their innate harmfulness and arrived at fundamentally the same conclusions as had been espoused for more than sixty years. The changes proposed were those of technique, size, and scope only.
The president acknowledged the problems of undirected growth in the government's response.
We must recognize that piecemeal efforts, even where individually successful, cannot have a major impact on the drug abuse problem unless and until they are forged together into a broader and more integrated program involving all levels of government and private effort. We need a coordinated effort if we are to move effectively against drug abuse.
A two-sided approach was developed to coordinate the federal drug effort. On the "supply" side were all federal drug law enforcement efforts to halt the illegal production, distribution, and use of prohibited substances. On the "demand" side were all federally sponsored efforts at treatment and rehabilitation and education, prevention, training, and research. Each approach was envisioned as separate and independent of the other, although they shared the same goals of eliminating illicit drug use and drug-related crime in America.
To control "demand" the Nixon administration proposed a dramatic reorganization which would temporarily centralize responsibility for all federally sponsored efforts in drug treatment, rehabilitation, education, prevention, training, and research in a new White House Agency, the Special Action Office for Drug Abuse Prevention (SAODAP). The director of SAODAP was to be immediately accountable to the President. From an organizational standpoint it made sense to coordinate the many federal agencies involved. To have ignored the management problems displayed in Figure 1.2 above would have led to further chaos and undercut the potential of any federal response. However, this does not explain why such coordinative responsibilities were lodged in the White House under presidential supervision. Other federal programs also involved a number of federal agencies, yet coordination could usually be achieved through more regular bureaucratic measures such as cabinet- or sub-cabinet-level working agreements. What made the drug issue different?
One explanation lies in the deteriorating relationship at that time between the White House staff and various federal agencies. Particularly with respect to the funding of methadone maintenance programs, the White House felt that there was considerable bureaucratic "foot-dragging. "30 Administration officials had become persuaded of the benefits of methadone maintenance as a way to reduce "heroin and criminal recidivism," but they had been unsuccessful in gaining the full support and cooperation of NIMH, the agency which normally would have funded and overseen these programs. NIMH officials were cautious of government "sanctioning one addiction [to methadone] in order to reduce the burden on society of heroin addiction,' and continued to resist White House pressures to fund a greater number of methadone programs .31 The administration contended that NIMH opposed the programs because to endorse the concept of methadone maintenance would have been tantamount to admitting the failure of the psychiatric profession to successfully treat heroin addiction .32
While mention of methadone is made only once in President Nixon's message to Congress, the proposed creation of SAODAP and the accompanying redelegation of authority would help circumvent NIMH and increase federal support for methadone. The administration sought thus to bypass-since it could not cajole-a reluctant bureaucracy. The president's designation of Dr. Jerome Jaffe-a prominent supporter of the use of methadone in treatment-as his Special Consultant for Narcotics and Dangerous Drugs until SAODAP could be legally constituted by Congress left no doubt as to the administration's intention. Indeed, when Dr. Jaffe assumed leadership responsibilities in mid-1971, there were 135 federally funded drug treatment programs; eighteen months later, with a significantly increased drug treatment budget, the number had nearly tripled to 394 .33 Treatment for heroin addiction was emphasized in this program expansion and the rate of growth of methadone treatment programs was accelerated.
A second explanation for centralizing drug-policy-making responsibilities in the White House is that the administration anticipated a successful campaign against illicit drug use and drug-related crime and wanted to take political credit for it. If the needs were great, so were the opportunities. The president's message to Congress exuded confidence in spite of the crisis rhetoric in which it was couched; the message sought to portray illicit drugs as the villain in a domestic war which could only be won by forceful presidential leadership, as the following excerpt suggests.
Narcotics addiction is a problem which afflicts both the body and the soul of America. It is a problem which baffles many Americans. In our history we have faced great difficulties again and again, wars and depressions and divisions among our people have tested our will as a people-and we have prevailed.
The threat of narcotics among our people is one which properly frightens many Americans. It comes quietly into homes and destroys children, it moves into neighborhoods and breaks the fiber of community which makes neighbors.... And we are not without the will to deal with this matter. We have the moral resources to do the job. Now we need the authority and the funds to match our moral resources. I am confident that we will prevail in this struggle as we have in many others. But time is critical. Every day we lose compounds the tragedy which drugs inflict on individual Americans. The final issue is not whether we will conquer drug abuse, but how soon.
The message drew upon traditional perceptions and fears of illicit drugs and illicit drug users in order to rally public support for a renewed crusade against a social evil. The rhetoric was consistent with the tenor of the times. Leading a war against illicit drugs was certain to enhance any politician's popularity. And, although the public pronouncements tended towards the dramatic, the reorganization and expansion called for, particularly regarding federal efforts in drug treatment and prevention, were clearly warranted.
The president's message leaves no doubt that the administration thought a war against illicit drugs could be won. The president proposed only a three-to-five-year life for SAODAP because it was to be "an emergency response to a national problem which we intend to bring under control." This "war" was going to be swift, requiring immediate and decisive action and sufficient financing. SAODAF's role was to give the White House direct involvement, visibility, and credit.
Development of the Expanded Federal Response
Having made a public commitment to respond forcefully to the problems of illicit drug use, the administration commenced a period of whirlwind activity. Each of the three new avenues of response-methadone treatment, international negotiations, and domestic drug law enforcement programs-were vigorously pursued in an attempt to launch a comprehensive attack on the perceived problems. Funding was increased commensurately. In his message to Congress the president had requested a supplemental budget of $155 million to bolster the new drug programs. When passed by Congress, this supplemental appropriation raised the FY 72 drug budget to $418 million-four times what it had been only two years earlier.
Treatment. When he took office in 1971, President Nixon's new drug advisor, Dr. Jerome Jaffe, turned first to the problems of the Vietnam soldier and veteran, among whom rates of addiction were reported to be extraordinarily high. The drug treatment programs of the Veterans Administration (VA) were expanded; many new centers opened, enabling the VA to attract more addicted veterans into treatment. And to stem the reported flow of drug-addicted soldiers returning to the United States, the Defense Department initiated a massive urinalysis detection program to screen all Vietnam servicemen for illicit drug use before they left Southeast Asia; any heroin- or opiate-using soldiers testing positive were to be detained for treatment and rehabilitation. President Nixon informed Congress, "We will be requesting legislation to permit the military services to retain for treatment any individual due for discharge who is a narcotic addict. All of our servicemen must be accorded the right to rehabilitation. 1134 In all, nearly $50 million of the president's supplemental budget was applied to expanding the drug treatment and rehabilitation capabilities of the Defense Department and Veterans Administration.
The SAODAP staff also immediately assumed responsibility for directing the expansion of drug treatment programs throughout the United States. Although NIMH received an additional $51 million for treatment and rehabilitation as a result of the supplemental budget, raising its total treatment and rehabilitation budget to $100 million, control of the expenditure of these funds was largely shifted from NIMH to SAODAP and the White House staff. With respct to program expansion, the emphasis was placed on heroin addiction treatment and "there was a massive expansion of methadone maintenance programs throughout the country. "35
The first new goal of treatment was to enable any addict who wished it to obtain it without delay. This meant eliminating the waiting lists for entry at many programs, and expanding treatment in communities where it was needed but not yet available. When Dr. Jaffe assumed responsibilities in June 1971, federally funded treatment programs were located in 54 cities; only eighteen months later the number of cities involved had quadrupled to 214 .36 The speed and size of this expansion was dramatic by any account. The earliest available federal estimate places the number of clients in federally funded treatment programs at just ovar twenty thousand in October 1971; by December 1972 the figure was over sixty thousand .37
The only recognized approaches for heroin addiction other than the expanding methadone treatment were abstinence oriented and usually took place in a residential community setting. While popular and sonletimes effective treatment approaches for small numbers of addicts, these abstinence programs had not and-according to federal policy makerscould not have a significant impact on urban crime. Methadone thus became a new hope, in spite of the objections of the Food and Drug Administration about insufficient research or the opposition from minority communities about the underlying philosophy of using one addictive drug to treat another .311 In December 1972, the Food and Drug Administration published new regulations which loosened federal controls over methadone, changing its status from that of an investigational new drug to a new drug requiring ongoing, long-term study .39 By October 1973, nearly
eighty thousand persons were enrolled in methadone maintenance programs .40 Some of these programs were federally funded; all operated with federal government approval.
From the government's perspective, methadone treatment programs had certain advantages over therapeutic community programs. Methadone allowed greater numbers of people to be treated in fewer programs, thus making rapid program expansion easier. For a large number of heroin addicts unable to successfully remain drug-free, the expansion of methadone programs offered an invaluable alternative to heroin addiction. Moreover, the cost per client of methadone maintenance was substantially less than the cost in a therapeutic community. And although methadone treatment could not meet the public's demand for drug abstinence, it could satisfy the even more popular demand for a reduction in heroin-related crime. Finally, methadone programs staffed with medical doctors and operated in more traditional medical clinical style could be more easily understood by the public. The encounter sessions and heavy psychological orientation of the therapeutic community were often misunderstood, even though the drug-free orientation was commended. Thus, the expansion of heroin treatment programs-particularly using methadone treatment-became SAODAP's first objective.
International Activities. In his June 1971 message to Congress, President Nixon had proposed an all-out global war on international drug trafficking. To dramatize his intentions, Nixon called together the U.S ambassadors to Turkey, France, Mexico, Luxembourg, Thailand, the Republic of Vietnam, and the United Nations to discuss ways to encourage greater cooperation from other nations in the effort to control the illegal growing and trafficking of opium worldwide. "I sought to make it . . . clear," he told Congress of this meeting, "that I consider the heroin addiction of American citizens an international problem of grave concern to this Nation, and I instructed our Ambassadors to make this clear to their liost governments. We want good relations with [email protected] countries, but we cannot buy good relations at the expense of temporizing on this prob-
lem . -41
Two weeks later President Nixon formally announced that the Government of Turkey had agreed to impose a total ban on opium poppy cultivation following the 1972 harvest. In return the United States pledged $35.7 million in aid over a five-year period to compensate Turkey for the projected financial loss on legitimate sales of opium, and to help Turkish farmers develop substitute crops offering new sources of income. The agreement was hailed as a "most significant breakthrough" even though the ban was not to take effect until a year after its announcement .42 The Turkish agreement was intended to help launch a concentrated American
effort to halt all illicit opium production throughout the world. During the following twelve months, however, that effort far surpassed any tangible results.
In September 1971 President Nixon established a new Cabinet Committee on International Narcotics Control, to oversee the further development of U.S. international drug control efforts. The Cabinet Committee, chaired by the Secretary of State, directed the U.S. embassies in fifty-nine countries to prepare Narcotics Control Action Plans to be used as a basis for negotiating bilateral agreements with foreign countries in furtherance of U.S. international drug control programs. Apparently, however, it was decided that other countries were not to be offered the same type of broad-based economic assistance which had been extended to Turkey. Rather, the Narcotics Control Action Plans were to be more limited in scope, essentially offering law enforcement assistance to improve the "intelligence capability and law enforcement capacity of the host . `43 Furthermore, whereas Turkey had been offered the "carrot," other nations were threatened with the "stick" of, among other things, termination of economic and military assistance .44 This change in strategy suggests that the administration was aware, even before the Turkish ban took effect, of the severe limitations of this approach. There simply were too many countries where opium could be grown and converted to heroin for sale in the lucrative U.S. market .45 It would have been difficult to negotiate similar agreements with all other potential "source" countries, and even if diplomatically possible the cost would have been prohibitive. Moreover, because of the remoteness of many areas from their governments, not every country could successfully impose an opium ban even if it agreed to try. Gradually, therefore, international interdiction efforts replaced prevention of opium cultivation as the major objective of the U.S. international drug control effort.
Thus, despite active presidential involvement, no dramatic bilateral agreements other than that with Turkey and the aforementioned one with France were produced to show success on the international front.
In addition to bilateral efforts, efforts were also made to strengthen the enforcement provisions of the 1961 Single Convention on Narcotic Drugs, the governing international agreement on illicit drug control. In 1971 the United States submitted proposed amendments to the Single Convention which were largely directed toward improving controls on illicit opium cultivation in source countries. These amendments were formally agreed upon at a plenipotentiary conference in 1972 and submitted to the signatory countries for their ratification. The Nixon administration apparently regarded the amendments as a bold new approach in international narcotics control, despite the ineffectiveness of the basic treaty .41,
In return for strengthening the 1961 Single Convention, the opium growing countries pressured the United States to support a second international agreement which would for the first time place multinational controls on synthetic, "psychotropic" drugs such as hallucinogens, amphetamines, barbiturates, and tranquilizers. This treaty, also drafted in 1971, became known as the Psychotropic Convention.47 The opium-producing countries viewed its ratification as a demonstration of the industrialized nations' seriousness about controlling the spread of nonnarcotic drug misuse. American support of the Psychotropic Convention thus became a necessary quid pro quo for support from the opium-producing nations on strengthening the Single Convention.
President Nixon sent the Psychotropic Convention to the Senate for approval on June 29, 1971. The proposed treaty met strong opposition because it threatened to limit domestic flexibility in regulating various psychoactive drugs. It was argued that the treaty would further remove the medical and scientific professions from decision-making responsibilities in U.S. domestic drug policy. To date neither the Psychotropic Convention nor the changes in domestic law that it would have required have been passed.
Domestic Drug Law Enforcement. Until 1970 BNDD and its principal predecessor, the Federal Bureau of Narcotics, were often accused of concentrating too much law enforcement effort on users and street dealers in order to inflate the number of arrests made. In 1970 BNDD claimed this policy had been reversed, with efforts being redirected to the higher levels of the illicit drug distribution structure. BNDD director John Ingersoll explained the anticipated result of this change to a House Appropriations subcommittee in March 1970.
The shift in emphasis of federal narcotic and dangerous drug law enforcement from the addict, abuser, and small-time street peddler to the important illicit traffickers and illegal supply sources will undoubtedly result in fewer total arrests. But those made should have a greater impact on the supply of narcotics and drugs available for distribution to the consumers in this country than a larger number of less significant arrests. 48
However, in 1971 the administration sought to increase the number of arrests by getting BNDD to move once again against street-level dealers.49 The administration apparently believed that this would suggest a more active and successful "offensive" in its "war" on illicit drugs and drug users. BNDD resisted the change, contending that such efforts should be carried out by state and local agencies, and it continued to go after the higher levels of the drug distribution systems. Like NIMH, BNDD was not immediately responsive to the administration's wishes. And so once again the White House created a new agency under direct White House control. In January 1972 the Office of Drug Abuse Law Enforcement (ODALE) was created by executive order within the justice Department.50 ODALE was made "responsible for the development and implementation of a concentrated program throughout the federal government for the enforcement of federal laws relating to the prevention of drug abuse and for cooperation with state and local governments in the enforcement of their drug abuse laws ."51The director of ODALE was also made a special consultant to the president for drug-abuse law enforcement, thus becoming the nation's chief drug law enforcement spokesman.
Within a month after its establishment, ODALE had selected thirty three target cities and had deployed strike forces consisting of federal investigators and agents, assistant U.S. attorneys, and state and local police officers. These strike forces concentrated on the lower and middle levels of the domestic heroin distribution systems, and, according to one observer, -were instructed -to "make arrests by any lawful means possible, even if it meant bypassing the normal channels. `52 By combining the specialized enforcement authorities and powers of various federal agencies e.g., the Internal Revenue Service, Customs, BNDD, the Immigration and Naturalization Service, the Alcohol, Tobacco, and Firearms Agency, etc. -ODALE was in a unique position to "bypass normal channels." The strike forces were sufficiently funded to be able to make extensive use of undercover agents and "buy money" to purchase drugs and pay infofmants; investigative grand juries were empaneled; and ODALE was empowered to use court-authorized wiretaps and "no-knock" warrants in making arrests. As expected, the number of arrests rose quickly and the increased figures were publicized. Rapidly and dramatically, ODALE became a prominent, highly visible part of the administration's "war on drugs."
The Congressional Response: Passage of the Drug Abuse Office and Treatment Act of 1972
Congress responded to President Nixon's challenge for quick and decisive action by passing the Drug Abuse Office and Treatment Act of 1972 (P. L. 92-255), just nine months after his June 1971 message and a year in advance of the scheduled completion of the second report of the National Commission on Marihuana and Drug Abuse .51 This new legislation reorganized a major part of the federal drug effort, effected important changes in the roles of state and local government in the planning and funding of drug treatment services, and expanded the overall size of the federal drug effort by voting higher budget authorizations. Compared with most major legislation, action on this bill was quick and thorough: Two Senate committees and one House committee held hearings on the proposed legislation; after the Senate and House passed differing versions, a Conference Committee ironed out the differences, and then both bodies passed the compromise legislation by unanimous votes.
The final wording of the Drug Abuse Office and Treatment Act showed Congress and the president to be in general agreement on the best organizational arrangements for effectively coordinating the federal drug effort. The basic "supply" and "demand" approach was adopted, and SAODAP was established to coordinate and oversee the development of federal drug-abuse prevention activities,* the "demand" side of the equation. Congress acceded to the president's request that SAODAP be made a part of the executive office of the president. Since at this time the question of the limits of executive authority was uppermost in the minds of many legislators, this was generally interpreted as a strong affirmation of congressional intent to deal decisively with the drug issue. Congress agreed with the president that SAODAP need be only a temporary agency, and established June 30, 1975 as the date by which SAODAP -would be -replaced by a new National Institute on Drug Abuse, operating within the traditional channels of the Department of Health, Education, and Welfare.
SAODAP's primary responsibilities were to reorganize and direct the federal programs in drug treatment, rehabilitation, education, prevention, training, and research. Moreover, SAODAP would be responsible for coordinating these "demand" efforts with the federal drug law enforcement programs, though the agency would have no authority over the latter. SAODAP's position was a difficult one: Congress and the president expected it to coordinate, "from outside and above," the activities of fourteen agencies that until then had existed in relative autonomy; to attain its goal in a short period of time; and to coordinate these activities in a field where there was considerable disagreement as to the most effective means of dealing with the problems.
*The legislation used the term "drug abuse prevention" to refer to all non-law-enforcement drug efforts including treatment and rehabilitation; education, prevention, and training; and research.
To help the new agency accomplish these formidable tasks, Congress included in the legislation several provisions designed to insure a coordinated federal drug effort. 54 First, it established SAODAP as a kind of mini-Office of Management and Budget, though limited to the drug abuse prevention programs of the various federal agencies. -SAODAP was empowered to reprogram an agency's drug-abuse prevention funds if necessary to insure greater conformity with the overall policies and priorities it would set. Second, Congress established a special fund of $40 million for SAODAP for each of three fiscal years "to provide additional incentives to Federal departments and agencies to develop more effective drug abuse prevention functions and to give the Director [of SAODAP] the flexibility to encourage, and respond quickly and efficiently to, the development of promising programs and approaches." Although Congress stipulated that at least 90 percent of these funds had to be spent by federal agencies other than SAODAP, they had to be spent according to SAODAP directives. Third, SAODAP received the power of "management oversight review." This -power, although never actually exercised, gave it the authority to assume the drug-abuse prevention functions of an uncooperative federal agency for up to thirty days. The explicit legislative granting of such power is very rare; the potential authority is usually enough to persuade any recalcitrants of the advantages of cooperation.
Although the purpose of this reorganization was to streamline, coordinate, and make more efficient the federal response, it also effectively muted opposition. In fact, when he signed the legislation enacting SAODAP, President Nixon warned that "heads will roll" if the agency directors did not cooperate with the new office.51 The president named Dr. Jaffe -to direct SAODAP and expand the work he had already begun under executive order. When SAODAP formally began in March 1972, policy and programmatic decisions had essentially been made; it was simply a matter of carrying them out. What reservations there were within and without government were largely ignored or overridden. Recommendations such as those put forth by the National Commission on Marihuana and Drug Abuse in 1972 and 1973 were quickly rejected because they were inconsistent with the policies and programs the administration had already chosen to pursue.
In sum, up to and through the 1972 presidential elections the Nixon administration sought to be (1) responsive to the public concern about heroin addiction and heroin-related crime, (2) effective, in contrast to the lack of success which had characterized past drug efforts, and (3) quick, so that "progress" could be claimed at the earliest possible moment. Most of the bureaucratic restraints which might have impeded the Nixon administration's "war on drugs" had been overcome, so its potential to "solve the drug problem" could be tested.
Deemphasis of the Drug Issue and Emergence of the National Institute on Drug Abuse (NI15A)
Eighteen months after the enactment of the Drug Abuse Office and Treatment Act, and only ten months after his reelection, President Nixon signaled a change in direction by announcing in September 1973, "We have turned the corner on drug addiction in the United States."511 Although caveats followed this declaration, the announcement was an important milestone in the history of the government's response to illicit drugs. In addition to being a statement of "victory," the president's message also implied disengagement from the war.
In the days and weeks following this announcement, administration officials offered evidence in support of the President's statement .57 This "evidence" included claims of an apparent shortage of heroin on the East Coast, an increase in the street price of the drug, an increase in the number of drug seizures and arrests, the expansion of drug treatment availability and utilization, a reported decline in the incidence of new heroin use, and heroin-related crime being down. Not everyone agreed: Some challenged the accuracy of the statistics, others challenged their interpretation. Still others accepted the evidence, but cautioned that the downward trend might only be temporary.
In retrospect, it is clear that the "turn the corner" speech was based on more than statistics. Other factors were also at work, and a brief review of certain events which occurred between June 1971 and September 1973 will help to explain the turnabout.
First, the 1972 presidential election had passed. Though it is difficult to assess what part this may have played in the administration's response to the drug issue, there is little doubt that it had some importance. Illicit drugs were a major political issue, and anyone running for national elective office was expected to address it.
Second, the armies of addicted Vietnam soldiers never materialized. The severity of the problem had been overestimated; among those soldiers who did use opium or heroin in Vietnam, subsequent research showed that relatively few were either dysfunctional or addicted users after their return to the United States .58
Third, public interest in the drug issued waned. There were a host of possible explanations for this: The problems had been overdrarnatized and public fears exaggerated, the rate of urban crime had leveled off, other domestic issues had taken precedence, the media had run out of things to say, or it was simply part of the natural ebb and flow of public interest. Whatever the reasons, there is little question that the public's attention had become diverted elsewhere.
Fourth, the new avenues of response to the use of illicit drugs, which had been pursued with varying degrees of success, had in their combined effect failed to measure up to original expectations, and it seemed unlikely that any further improvement would result from a widened or intensified effort in these areas.
For example, federal law enforcement efforts against street-level drug activities had backfired. ODALE was not always well received by local law enforcement agencies, and its ability to have a significant impact on street-level drug activities was seriously questioned.59 In April 1973, ODALE agents were involved in two criticized "no-knock" entries into homes in Collinsville, Illinois. The events in Collinsville precipitated a thorough review of the agency and a reevaluation of the need for unique enforcement authorities against drug dealers and users. In effect, ODALE had gone too far in "bypassing the normal channels." Instead of becoming a positive symbol of how to win a war on drugs, ODALE became the focal point of criticisms about the excesses of that war. On June 30, 1973, ODALE was abolished in yet another drug-law-enforcement agency reorganizations The position of special consultant to the president for drug-abuse law enforcement matters was also abolished, and Congress subsequently repealed the no-knock and preventive detention sections of the federal statutes. Federal law enforcement strategy reverted to a concentration on the upper levels of drug distribution systems.
The Turkish opium ban did contribute to a shortage of heroin in 1973, principally in the eastern United States. But because the government had been unable to negotiate any other significant bilateral agreements, it became clear that the Turkish ban would have only a temporary effect. The period immediately after the Turkish ban took effect was the high point in terms of any practical significance which it could have had. The demand for heroin and the consequent profits to be realized were bound to generate new supplies and supply routes-it was only a matter of time. Bilateral agreements thus failed to provide any lasting "solution."
Drug treatment programs, methadone programs in particular, had been expanded to a point where everyone voluntarily seeking treatment could get it. Overall, the quality of the treatment offered in methadone as well as drug-free programs improved. Program personnel gained experience and with it increasing expertise. Increased funding assured greater program stability. However, treatment supply exceeded treatment demand; in this crucial respect the administration's goal had been reached: Unless more people were to enter treatment, the maximum short-term impact of this approach had also probably been reached.
The administration, through SAODAP, had also achieved a more coordinated federal effort on the "demand" side. Much overlapping, duplication, and inefficiency had been eliminated. Within the framework of its policies and programs, the federal response was functioning much more smoothly.
And the budget was sufficient; the total FY 74 drug budget was $760 million. Lack of funds no longer limited the potential of the federal drug response; at the same time there was no indication that increasing the budget further would measurably improve the situation.
There seemed little need to any longer maintain a strong White House identification with the drug issue. Within the framework of the policies and programs the administration had chosen to pursue the situation was probably as good as it would get in the foreseeable future. Politically, this may have suggested to the federal government that the issue could be returned to a more "normal" status within the bureaucracy and be dealt with like most other urban and social problems.
Whether or not the president's assessment of the situation in his "turn the corner" speech was correct, it triggered a turn in government activity in the drug field. The more extraordinary measures of the previous years could no longer be justified, On the contrary, it became necessary for government budget- and policymakers to make major changes in the federal drug effort in order to prove that a victory had been won. Even before the president's pronouncement, drug law enforcement programs had been moved away from active White House involvement to a newly formed Drug Enforcement Administration within the Department of justice. Federal efforts against street-level drug dealers and users were quietly abandoned. International efforts to curtail illicit drug cultivation and trafficking continued, but were less publicized. SAODAP remained in existence until June 30, 1975, but it lost its influence after the "turn the corner" speech. The trend in budget requests was also reversed: The overall treatment and rehabilitation budget for FY 75 (proposed in January 1974) was $33 million less than in the previous fiscal year, marking the first drug budget cutback in the Nixon administrations Furthermore, the administration sought increasingly to shift drug programming responsibilities to the states, under the aegis of its "new federalism" policies.
The combined effect of these actions was significantly to reduce the visibility and controversy of the federal drug effort. This was beneficial in the sense that the drug issue was temporarily freed from the political rhetoric that had bound it. But the loss of momentum was unfortunate to the extent that the government's opportunity to shape a more comprehensive approach to drug problems in America was not decisively acted upon.
One of the most important and lasting byproducts of this chain of events was the creation of a new agency, the National Institute on Drug Abuse (NIDA) within HEW. This was created by a departmental reorganization announced by the Secretary of Health, Education, and Welfare on September 23, 1973. The announcement occurred more than a year in advance of the congressional requirement in the Drug Abuse Office and Treatment Act of 1972 for the creation of such an agency no later than December 30, 1974 .113
Organizationally, NIDA was made a fourth-level agency in HEW. As Figure 1.3 illustrates, the director of NIDA is one of three agency directors reporting to the administrator of the Alcohol, Drug Abuse, and Mental. Health Administration (ADAMHA). The administrator of ADAMHA is, in turn, one of six Public Health Service officials reporting to the assistant secretary for health, who in turn is one of many assistant secretaries reporting to the secretary of HEW.
Despite this organizational arrangement, NIDA was charged with providing "leadership, policies and goals for the Federal effort in the prevention, control and treatment of narcotic addiction and drug abuse, and the rehabilitation of affected individuals." Clearly, NIDA was intended to succeed SAODAP as the lead agency on the "demand" side of the federal drug effort.
But NIDA was not and could not be a substitute for SAODAP. SAODAP was designed to be a policy and coordinating office, with minimal direct program responsibilities. NIDA was given the bulk of drug treatment program responsibilities but very limited coordinating powers. Much of SAODAP's authority was contained in P. L. 92-255, and most of those powers were not transferable to NIDA without congressional approval. Even if the powers were to be transferred, the decisions and directions taken by NIDA, buried as it was within HEW, would obviously have attracted less attention and carried less weight than when the very same actions were announced by a White House office.
Although the earlier-than-anticipated emergence of NIDA and diminution of SAODAP made many of those involved with drug treatment and prevention anxious about the future, some found solace in the fact that the drug treatment and prevention effort had been removed from the immediate control of NIMH. Under the HEW reorganization NIDA was established as separate and equal to NIMH. Similarly, responsibility in the alcoholism field had been removed from NIMH and given to another new separate and equal agency, the National Institute on Alcohol Abuse and Alcoholism. The effect of removing NIMH control from these fields was to allow each to more fully develop its own approaches. Inasmuch as drug problems in many respects lie outside traditional mental health concerns, the creation of NIDA independent of NIMH was applauded by many people in the drug treatment and prevention fields.
The Arguments for and against the Continuation of SAODAP
Even though NIDA was in full operation by mid-1974, SAODAP continued to function until its expiration date of June 30, 1975, though with greatly reduced staff levels and diminished bureaucratic status. It was maintained to exercise those coordinating functions which could not legally be transferred to NIDA. Moreover, it provided the drug treatment and prevention fields with a symbolic organizational parity with drug law enforcement concerns, a role which NIDA could not fulfill.
By early 1975, questions were being raised about the implications of SAODAP's impending demise. The future direction and scope of the federal drug effort seemed uncertain. Gerald Ford had succeeded Richard Nixon as president, and Ford's views and commitment regarding the drug field were largely unknown.
In March 1975, Senator William Hathaway, chairman of the Senate Subcommittee on Alcoholism and Narcotics, introduced legislation amending the Drug Abuse Office and Treatment Act of 1972. The proposed legislation called for a modified version of SAODAP, to be called the Office of Drug Abuse Prevention Policy (ODAPP), which would continue certain policymaking and coordinating functions of the predecessor agency. The expiration of SAODAP along with other provisions of P. L. 92255-including funding authorizations for future federal treatment, prevention, and research efforts-gave Congress its first opportunity to review both the 1972 legislation and the status of the federal response.114
This congressional review prompted President Ford to direct the Domestic Council to undertake its own assessment in order to define more clearly the administration's drug policies and prepare the administration's response to any congressional action .6' These congressional and executive office assessments reconsidered the tone and approach of the government's response to illicit drug use in a distinctively less politicized way than had marked the crisis atmosphere during the Nixon administration.
Both Congress and the administration sought to back away from the warlike rhetoric of the Nixon administration. The emphasis on "victories" and "solutions" was replaced by more cautious statements about "goals" and "objectives." Congress amended its Declaration of National Policy by adopting more temperate wording. The Domestic Council Report to the president was even more straightforward with respect to its assessment of goals:
We should stop raising unrealistic expectations of total elimination of drug abuse from our society. At the same time, we should in no way signal tacit acceptance of drug abuse or a lessened commitment to continue aggressive efforts aimed at eliminating it entirely. The sobering fact is that some members of any society will seek escape from the stresses of life through drug use. Prevention, education, treatment, and rehabilitation will curtail their number, but will not eliminate drug use entirely. As long as there is demand, criminal drug traffickers will make some supply available, provided that the potential profits outweigh the risks of detection and punishment. Vigorous supply reduction efforts will reduce, but not eliminate, supply. And reduction in the supply of one drug may only cause abuse prone individuals to turn to another substance.
All of this indicates that, regrettably, we will probably always have a drug problem of some proportion. Therefore we must be prepared to continue our efforts and our commitment indefinitely, in order to contain the problem at a minimal level, and in order to minimize the adverse social costs of drug abuse.""
This acknowledgment of the persistence of drug problems and the impossibility of achieving a quick victory had no direct effect on the operational aspects of the various drug programming efforts; it only sought to adjust public expectations of them.
Congress and the Ford administration relieved some of the anxieties felt in the drug treatment field after the "turn the corner" speech by halting the one-year budget cutback which had been initiated with that speech. Although questions were raised about the adequacy of the administration's budget proposal, many agencies and individuals were pleased -simply by this temporizing action.
More serious difficulties between Congress and the president arose over whether some modified version of SAODAP should be continued. Many in Congress argued for such an agency; President Ford and his administration were opposed to it. The proponents of a successor agency to SAODAP contended that White House coordination of the drug effort was still necessary .7 They held that without some successor to SAODAP the earlier organizational Difficulties could easily reappear, maintaining that the logic which dictated congressional approval of SAODAP in 1972 extended to the proposed Office of Drug Abuse Prevention Policy in 1975. Congressional proponents further argued that NIDA, as a fourth-level HEW agency, would never be able to exercise any real control over the "demand" side of the federal drug effort. They pointed cut that 51 percent of all federal expenditures for drug prevention programs were made by agencies other than NIDA, and thus concluded that "for NIDA to coordinate and lead the Federal drug abuse prevention effort, both from a structural and from a fiscal perspective, would be difficult at best and, more likely, actually impossible."""
President Ford and the Domestic Council Task Force agreed on the need for continued coordination, but they differed with the proponents of ODAPP on the way to achieve it. Rather than have a special White House agency just to coordinate the "demand" side of the federal drug effort, President Ford opted for "strong Cabinet management" of the program.
In April 1976 he created the Cabinet Committee for Drug Abuse Prevention (CCDAP), chaired by the Secretary of HEW, which included the Secretaries of Defense and Labor and the administrator of the Veterans Administration. CCDAF was given responsibility for the oversight and coordination of all federal activities involving drug prevention, treatment, and rehabilitation, integrating the efforts of all the cabinet departments and agencies involved. Moreover, CCDAP was expected to "give HEW, ADAMHA, and NIDA the organizational strength and authority to provide the interdepartmental and interagency coordination needed to maintain the progress which has been made in drug abuse treatment and prevention. "
ODAPP's sponsors sought to extend its projected responsibilities of review, -formulation, and coordination of drug policies and priorities to all drug policies and programs, including drug law enforcement programs and international negotiations. This was to be the major difference between ODAPP and SAODAP, whose authority had been confined to drug treatment, rehabilitation, education, prevention, and research. This proposed extension of authority for ODAPP gained support for several reasons: First, it sought to reconceptualize the federal drug effort by bridging the gap between the enforcement and treatment approaches. ODAPP was envisioned as the forum in government by which the long-standing philosophical conflicts between the medical and law enforcement communities could be faced and, ideally, reconciled.70 At the very least, ODAPP was being designed to insure a more comprehensive review of the drug programs and policies of the various federal agencies.
Second, this extension of ODAPP's authority was proposed at a time when the balance between drug law enforcement and drug treatment and prevention programs was once again shifting in favor of law enforcement.71 The drug law enforcement budget was rising while drug treatment and prevention funds remained level; and, bureaucratically, DEA was a higher level agency within the justice Department than was NIDA in HEW. ODAPP was supported partly in the hope that it could keep a balance between these two principal agencies and their respective approaches to the drug problem.
Third, support for ODAPP stemmed from the congressional desire to have one single administration official with overall responsibility for national drug policy who would be accountable to Congress. At the time Congress was considering ODAPP, officials of the Office of Management and Budget (OMB) were refusing to testify before Congress on drug policy issues, and the directors of the various drug agencies (NIDA and DEA in particular) spoke only for their own programs and policies. The unresolved areas, as well as the overall concerns, of national policy could easily be unintentionally overlooked in this situation. ODAPP was designed to rectify this.72
President Ford and the Domestic Council Task Force also recognized the need to coordinate treatment and enforcement approaches. In its report the Domestic Council stated, "Strong coordinative mechanisms are necessary to ensure that the efforts of these [Federal] departments and agencies are integrated into an effective overall program, and that the approach adopted in each is consistent with the President's priorities."" However, the administration maintained that such coordination could be attained without a White House agency. Instead, it chose to formalize the division of the drug functions developed during the Nixon administration. Thus the government's response split the effort into three separate areas, each with a "lead agency . '174 The Drug Enforcement Administration was designated as the "lead agency" for drug law enforcement, the State Department for international activities, and NIDA for prevention and treatment. To strengthen interagency coordination within each functional area, President Ford convened three separate cabinet committees, each with oversight and coordination responsibilities within one area.
Going a step further in acknowledging some need for "program oversight and limited interagency coordination at the Executive Office level "75President Ford and the Domestic Council accordingly made several more recommendations.76 Foremost among them was the recommendation that the Strategy Council on Drug Abuse* be revitalized to provide overall policy guidance, and that a small staff at OMB be maintained to assist the Strategy Council and executive office in formulating drug policy. However, these recommendations fell considerably short of a White House Office for drug abuse.
*The Strategy Council, mandated in 1972 by P.L. 92-255, consists of government officials and private citizens appointed by the president.
The argument that Congress needed one person or office to be accountable to it for total federal drug policy was rejected by the administration. "The best places to get such information and to seek accountability for progress," said President Ford, "are the departments and agencies which have direct responsibility and program authority."77
In point of fact, the arguments raised both for and against ODAPP were illusory. There were other ways to satisfy the needs cited by the proponents of ODAPP, and the creation of ODAPP would not have guaranteed the advantages envisioned anyway. For example, the Ford administration could have coordinated its response to the drug problems of America without an ODAPP, just as it could have allowed the partitions between the medical and legal approaches to continue despite ODAPP's presence.
The ODAPP concept was strongly supported by the majority of individuals, associations, and private organizations working in the drug treatment, rehabilitation, education, prevention, and research fields. All had felt seriously threatened by the funding cutbacks of the Nixon administration's last budget, and the elimination of SAODAP had added to the uncertainty about future federal commitment. Accordingly, these associations and organizations, many of which had developed during the years of budget expansion, vigorously lobbied Congress to support the small White House agency for drugs as a sign of their support for the drug field. Congressional spokesmen took note of the symbolic importance of ODAPP, explaining that "there is a clear danger that elimination of that office [SAODAP or ODAPP] would have enormous symbolic significance to this field. There is no way in which this move [the elimination of SAODAP], coupled with recent proposals to cut funds, can appear to be anything but a drastic retrenchment in Federal priorities ."711
The Ford administration's opposition to ODAPP was also symbolic, but not in relation to the drug field. President Ford had committed himself to a reduction of executive office power and a restoration of the powers of the various cabinet departments and federal agencies. He wished to reverse the concentration of power in the White House which had characterized the Nixon administrations trend to which SAODAP was both a symbolic and a real contributor. To the Ford administration, the negative symbolism of a new White House drug office-even a small one-overrode any positive symbolism it might have conveyed to the drug field.
In March 1976, eight months after SAODAP had expired, Congress passed legislation creating in the White House the Office of Drug Abuse Policy (ODAP, a slight shortening of the originally proposed name) .71, Compared to SAODAP, ODAP was organizationally small and its legislatively granted powers limited, but its coordinating responsibilities extended to law enforcement and international negotiations, thus giving it broader scope than its predecessor.
President Ford signed the legislation creating ODAP only because sections of the same bill contained the necessary funding authorizations to continue federal efforts in drug treatment and prevention. The president remained steadfastly opposed to ODAP in principle, and in signing the legislation he said:
I have voiced strong opposition to the reestablishment of a special office for drug abuse in the White House. I believe that such an office would be duplicative and unnecessary and that it would detract from strong Cabinet management of the Federal drug abuse program. Therefore, while I am signing this bill because of the need for Federal funds for drug abuse prevention and treatment, I do not intend to seek appropriations for the new Office of Drug Abuse Policy created by the bill. 110
This impasse continued throughout Ford's presidency; ODAP had been legally constituted but remained a "paper" agency with neither staff nor funds. Instead, President Ford continued his plan for supervision of government response to illicit drug use through three cabinet committees, one each for law enforcement, international narcotics control, and treatment and prevention.
Government Response under Presidents Ford and Carter
Drug problems and issues faded from the limelight during the Ford administration, a change generally viewed as salutary when compared to the tumultuous years preceding it. Funding levels in all areas remained reasonably stable, as did program operations. Although whatever gains had resulted from the Turkish opium ban were reversed by the new availability of Mexican heroin, no new "wars" were proclaimed. Utilization of existing treatment capacity did increase throughout the country and funding was increased to treat several thousand more people. The Drug Enforcement Administration continued to confiscate large amounts of illicit drugs, but the overall impact on illicit trafficking was marginal.
Guided by the Domestic Council's "White Paper on Drug Abuse," the Ford administration accepted the verdict that the "drug problem" could not be eliminated. Instead of trying to rally public support to end "drug abuse," the administration started seeking to develop greater public tolerance of this ineradicable phenomenon.
Although the style was different and the goals less ambitious, the Ford administration's response to illicit drugs was largely predicated on the same assumptions about the innate harmfulness of illicit drugs that have guided the government's response to drugs throughout the twentieth century. The administration's response continued to rest upon law enforcement or quasi-enforcement strategies fundamentally intended to prohibit new or continued use of nonapproved psychoactive substances. Though these assumptions were not challenged, the limits of any attempt to "solve" the problems of illicit drug use were at last openly acknowl-edged-a significant change from previous administrations.
In his one major public statement on the use of illicit drugs, President Ford devoted less than three paragraphs to treatment and prevention issues. The remainder of his six-page message to Congress" addressed the drug-crime nexus, law enforcement efforts, proposals for mandatory minimum sentences for traffickers and bail denial, the activities of Customs, use of the Internal Revenue Service to go after traffickers, international control and cooperation, and the like. Support for programs in treatment and prevention was derived, as with enforcement, from the longstanding fears and assumptions about illicit drugs, their users, and their effects on society.
When Jimmy Carter became president some observers of the drug field expected swift and significant policy and programmatic changes to result, in part because of Carter's close association with Dr. Peter Bourne, a highly regarded drug program expert. In March 1977, under some pressure from Congress, President Carter activated ODAP, naming Dr. Bourne as its director. It was believed that ODAP might devise a more unified and coordinated government response to illicit drugs, melding the goals and concerns of the treatment, prevention, and enforcement communities.
No sooner had ODAP been activated, however, than President Carter announced his intention of abolishing the office. This announcement was made as part of the Reorganization Plan No. 1 of 1977, in which President Carter sought to streamline and reduce the White House staff. As a result, ODAP expired in April 1978, after completing a series of drug policy studies spanning the treatment, prevention, and enforcement fields. 82 ODAP's legal functions were transferred to the president. Dr. Bourne remained as special assistant to the president in part to "advise the President on drug policy and assist in the coordination of interagency efforts," until his resignation in July 1978. Several ODAP staff members were transferred to the Domestic Policy Staff, where they continue to provide some overall review of drug policy issues. The results of this reorganization resemble the plan of strong cabinet management with "some" executive coordination advocated by the Ford administration.
Shortly after announcing his reorganization plan, President Carter presented Congress with his first major message on drug issues.113 His primary concern was the fragmentation and lack of coordination among drug programs and agencies. (This organizational problem has persisted in spite of all the attention it has received.) President Carter stressed the continuing need for international cooperation, and directed the individual agencies involved to give the drug issues a high priority. Like Presidents Nixon and Ford before him, Carter stressed international law enforcement efforts to eradicate the illicit cultivation of drugs and interrupt international trafficking networks. And like his predecessors, he urged Congress to ratify the Psychotropic Convention.
With respect to law enforcement, President Carter announced support for programs which would promise "swift and severe punishment" to traffickers in drugs. These programs include the investigation of links between organized crime and drug trafficking, revocation of passports and freezing assets of known major traffickers, support of legislation raising the dollar value of property seized from and forfeited by a drug violator through administrative action, study of possible denial of bail or any release prior to trial for certain major drug-traffic offenders, and the possible emendation of the Tax Reform Act to allow for easier investigation of major traffickers (if this would not infringe on the privacy of citizens). For the most part, these proposals are conceptually indistinguishable from those made by Presidents Nixon and Ford; all sought to enact measures that would deter major drug traffickers in the hope of reducing the availability of illicit drugs at the street level.
As for drug treatment, President Carter called upon NIDA to include more programs for abusers of barbiturates, amphetamines, and combinations of drugs (including alcohol). He supported expansion of rehabilitation and job-training programs for former heroin addicts. President Carter also expressed the need for better coordination of federally sponsored research efforts on a variety of drugs, including opiates, alcohol, and tobacco. He expressed the hope that this would save money and "lead to greater scientific understanding of addiction problems."
In recent years the barbiturates have been recognized as a major drug problem (this problem has resulted in part from their widespread licit medical use). The special attention that President Carter directed to be given to these and other sedative-hypnotic drugs will cover the whole gamut of federal drug response: Prescribing practices of physicians will be reviewed, more intensive efforts will be made to prosecute physicians who deliberately overprescribe, DEA will investigate street marketing activities and audit companies lawfully manufacturing the drugs, and HEW will study the question whether barbiturates should remain on the market. In focusing such specific attention on barbiturate abuse, President Carter took a significant step toward extending the federal government's response to drugs beyond a traditional concern with such illicit drugs as heroin, cocaine, and marijuana.
And in what amounted to his most significant policy break with Presidents Nixon and Ford, Carter endorsed the decriminalization of possession of small amounts of marijuana for personal use, noting that "penalties against possession of a drug should not be more damaging to an individual than the use of the drug itself."
Nevertheless, the overall thrust of President Carter's first major statement on drug issues does not suggest any fundamental changes in the specifics of government response. The tone does suggest a less emotional approach than that of the early 1970s; the inclusion of licit drugs which can be dangerously misused suggests a broader understanding of the concept of "drug abuse"; and the adoption of a marijuana decriminalization position suggests that fundamental changes in government response could occur after current policies and programs are clearly, repeatedly shown not to work. But in a broader context President Carter's drug statement further reflects the tortuously slow process by which public opinion and public policy change.
Some Concluding Thoughts
The overriding observation which emerges from a review of the federal government's history of response to illicit drugs is that its drug policy changes slowly if at all. Federal drug programs have changed considerably in the past decade, but policy remains essentially unchanged. Faith remains strong in the power of criminal sanctions to deter illicit drug use and the effectiveness of law enforcement efforts to eliminate that use which does occur.
Two deeply rooted premises have guided federal response: One is that there are certain drugs which people shouldbe prohibited from using under any circumstances. The second is that the government can then prevent their use. The first premise is philosophical in nature, the second pragmatic.
The philosophical question of the justification of prohibition can always be argued at great length; there is no single "answer" as such. With respect to the pragmatic issue, the belief that government can prevent illicit drug use, there is more concrete evidence to analyze. The experience of the 1970s clearly shows that even with an extensive, generally efficient, and popularly supported federal effort, it is impossible to prohibit the presence of nonapproved drugs in American society. It is difficult to conceive how that effort might have been expanded or intensified to be more successful while still respecting the traditional values of a free society.
Federal policymakers are by now generally cognizant of the limits of current federal drug policy. Why then do they continue to pursue the same fundamental policies? Because the public demands it; to relax the prohibitionary goal is tantamount to being "soft on drugs" (a most pejorative term that has been used in ugly ways to cast aspersions on those who question the wisdom of prohibition). In a democratic society, policymakers cannot stray too far from what the public wants or they will simply be replaced. Federal drug policy will not change substantially until there is public support to do so.
But federal drug officials have not conveyed to the public an understanding of the limits to their potential accomplishments; it is far easier politically to highlight occasionally successful programs and to emphasize long-range goals or aspirations. Policyrnakers also seem reluctant to engage the public in a discussion of the philosophy of drug prohibition. One reason for this difficulty is that for many years the federal government fueled the popular demand for drug prohibition. Yet those who are familiar with drug policy recognize now that the designation of certain drugs as illicit and as targets for prohibition has roots in racism, hysteria, and sensationalism. It is also now apparent, based on current knowledge about drugs and their effects, that prohibition has been based on much misinformation and misunderstanding.
In the context of these general observations, the following concluding thoughts are offered:
1. The most important contribution which federal drug agencies can now make to future drug policy is to provide the American public with opportunities to carefully and sensibly reexamine the wisdom of drug prohibition. Even though they are now more than five years old, the two reports of the National Commission on Marihuana and Drug Abuse would still make an excellent starting point for this reappraisal process.
2. Until the drug issue becomes less vulnerable to sensationalism, there is no way to guarantee that excesses in the federal drug effort, such as those of the early 1970s, can be prevented. Federal drug policies and programs ought to be the product of careful, thoughtful consideration. Impulsive, hastily conceived programs such as ODALE can do great damage to our society.
3. The federal drug effort needs greater coordination; the treatment, enforcement, and international components cannot be left to go -their own -ways. Coordination without "teeth" has beer, more superficial. than substantive.
4. From a policy, bureaucratic, and budgetary perspective, criminal justice and drug law enforcement agencies have been too dominant in our national response to the abuse of psychoactive drugs. This dominance has not served society well; rather than bringing out the best in us, it has led us to rely too heavily on our meaner, more punitive instincts.
APPENDIX A: A Budget Perspective
Overview of Fiscal Years 1970-1978. It is impossible to account exactly for all funds expended on the federal government's response to illicit drugs. The figures presented in this report are, however, sufficiently accurate to be used for an overall fiscal analysis and review of significant trends and priorities. Table 1. 1 presents the federal drug budget by function for fiscal years 1970-1978.
From July 1969 through September 1978, the federal government spent approximately $5.7 billion on its drug-related efforts. Of this total, $2.4 billion was spent on treatment and rehabilitation, $2.3 billion on law enforcement, and the remainder ($.95 billion) was spent on education, prevention, and training ($.4 billion), research ($.4 billion), and planning ($.15 billion).
The effect which the "war on drug abuse" had on the budget is clearly demonstrable beginning with FY 72 (which began July 1, 1971, two weeks after President Nixon's special message to Congress). (See Figure 1.4.) The most rapid expansion of the federal drug budget occurred during FY 72 and FY 73. After FY 74 and Nixon's "turn the corner" speech, the rate of budget expansion slowed considerably. (In fact, if adjusted for inflation, the buying power of the federal drug effort was lower in FY 78 than it had been since FY 72.) Still, although the annual rate of growth of the federal drug budget slowed, the absolute size at which its annual total more-or-less leveled off was much higher than ever before. The average annual federal drug expenditure for the years 1974-78 was over $800 million; for 1973-78-a six-and-one-quarter-year period-it totaled $5 billion.
Perhaps the most useful index of federal priorities in the drug area is a comparison of the treatment and rehabilitation budget with the law enforcement budget. Figure 1.4 displays the rapid growth of the treatment and rehabilitation bud get between FY 71 and FY 73; however, since FY 73 it has alternately declined and increased, ending up at nearly the same level as in FY 73 ($366 million in FY 78 compared to $350 million in FY 73). The drug law enforcement budget, on the other hand, has risen steadily, doubling in size from $200 to $400 million in the same time period.
If we look at these items in a slightly different way-as a percentage of the total federal drug expenditure for each year-we find a rapid expansion of the treatment and rehabilitation strategy between FY 71 and FY 73 and detectable slippage since FY 73 (Figure 1.5). In contrast, the percentage of the total drug effort allocated to law enforcement rose from a low of 29 percent in FY 73 to 45 percent, its highest level, in FY 78.
This apparent reversal in strategy in the period FY 71-73-with treatment more heavily funded than enforcement-is explainable insofar as one accepts the thesis that drug treatment programs-in particular, methadone treatment programs-derived at least part of their government support from concern more with reducing criminal recidivism that with reducing heroin recidivism. If so, then recent government response to illicit drug use has remained rather consistently dominated by an enforcement approach, as indeed it has since the early 1900s. Moreover, insofar as drug treatment has been funded because of its crime reduction potential, it may have been in part ill-defined as "treatment" in a traditional health context. The pursuit of this avenue of response-crime reduction through treatment-may offer a reasonable explanation for the brief reversal during FY 71-73 in the traditional balance between treatment and enforcement approaches. If so, this adds greater credence to the contention that the underlying assumptions
and strategies of the government's response to illicit drugs has changed very little in the 1970s.
The FY 79 Budget Request. President Carter released his proposed FY 79 budget on January 20, 1978. Inasmuch as this budget request is the first one fully prepared by the Carter administration it is logical to turn to it for any signs of impending changes in the government response to drugs. The currently available budget documents suggest that it will remain essentially unchanged. However, a complete analysis is precluded because neither OMB'nor ODAP has compiled drug-related expenditures on an agency-by-agency basis as they previously did every year since 1971. Without that compilation it is not possible to add in agency expenditures for third-party reimbursement, nor is it possible to estimate accurately either the non-line-item expenditures of federal agencies or how block grants will be used.
Thus at this time it is not possible to include the FY 79 figures in our tables and figures. This absence of an overall analysis of the drug budget by either OMB or ODAP could allow a return to a situation where agency drug budgets dictate overall federal drug policy rather than the other way around.
In the absence of an overall analysis of the federal drug budget, the budget proposals for NIDA and DEA-the two principal federal drug agencies-may serve as a useful surrogate. NIDA's budget will increase to $275.2 million in FY 79, a $13.1 million increase over FY 78. The greater part of this increase-$11.8 million-is earmarked for research, in response to the preliminary recommendations of the president's Commission on Mental Health. NIDA will continue to support a treatment capacity of 102,000, with a maximum local matching rate of 40 percent; the treatment budget will remain at $161 million.
The Drug Enforcement Administration will receive a modest budgetary increase if President Carter's request is approved; the DEA budget for FY 79 will be $193 million, compared to $188.5 million in FY 78. Funding for direct enforcement activities will increase by $4.2 million to a total of $137.2 million, while DEA's research and development program will be cut by more than half to $2.3 million.
Overall, the FY 79 federal drug budget proposal seems to maintain the status quo. The total expenditure will increase a little, as it has in each of the past several years; the relationship between treatment and enforcement approaches will remain essentially unchanged.
APPENDIX B: A Comment On The Role of State and Local Governments*
The material for this appendix is largely drawn from a paper by Peter Goldberg, "The Role of the City in Responding to the Problems of Drug Abuse," in Rehabilitation Aspects of Drug Dependence, ed. Arnold Schecter (Cleveland: CRC Press, 1977).
In addition to the federal government, state and local governments have been active in the drug field. However, the activities and directions of state and local governments vary from jurisdiction to jurisdiction, thus making it impossible to generalize about these efforts as if they were uniform. In recent years, organizations such as the National Association of State Drug Abuse Program Coordinators, the National League of Cities, and U.S. Conference of Mayors have attempted to catalog expenditures at the state and local level and offer some general analysis of policy decisions and program directions. The Drug Abuse Council cannot add substantively to that information.
One important issue, however, deserves comment, that of the intergovernmental system for planning and programming established by the Drug Abuse Office and Treatment Act of 1972 (P. L. 92-255). The system, perhaps inadvertently, has resulted in a nearly total absence of any sustained, systematic large-city government participation in the state or federal policy making and program planning processes. It is an inexplicable situation, since the nation's most severe drug problems are concentrated in its large central cities.
The conditions of heroin addiction and crime which initially prompted an expanded federal response to illicit drug use in the early 1970s were concentrated in the larger cities of this country. In fact, the increased federal response was required partly because the scope and extent of the problems associated with addictive drug use had far transcended the ability of city governments to respond effectively. Also, state governments-whose legislatures were frequently dominated by rural and suburban interests-were often reluctant to become extensively involved in what they felt was essentially a central-city problem. Before the passage of the Drug Abuse Office and Treatment Act of 1972, only New York, California, and Illinois had undertaken major efforts in drug treatment and prevention.
Nevertheless, when the federal government began its large-scale expansion of the drug effort, the states lobbied for and succeeded in obtaining the major role in that effort. The role of local government was ignored; large cities-where the social costs of illicit drug use are the most severe-were left out of the formal policyrnaking and funding process. This imbalance between city and state responsibilities can be traced to the congressional authorization of annual formula (block) grants to states, detailed in Section 409 of the Drug Abuse Office and Treatment Act. In return for the block grants, Congress required each state to establish a drug abuse coordinating agency and annually prepare a drug abuse plan to meet treatment and prevention needs. Thus Congress, in effect, required even nonurban states such as North Dakota, Vermont, and Montana-states having comparatively small drug problems-to plan a drug abuse response effort, while cities such as Newark, Detroit, New Orleans, Boston, and Los Angeles were ignored in the legislation.
The resulting problems were first of all political. Large-city concerns and needs tend to be underrepresented at the state level of government, where rural and suburban interests are disproportionately powerful. Moreover, blacks and other minority populations have added yet another political concern, most clearly articulated in a resolution passed by the National Black Caucus of Local Elected Officials in June 1974.
Whereas, unfortunately, the problems of drug abuse have disproportionately affected large numbers of Black and Spanish-speaking Americans, these minority populations tend to be most underrepresented at the state level where drug abuse policies are being increasingly formulated, thus creating a large discrepancy between those most afflicted by the problems and those establishing the policies and procedures to solve the problems.
In addition to these political concerns, the drug problems themselves in rural and suburban areas are often quite different from those in the central city. While heroin may be the major drug of abuse (alcohol excepted) in the large cities, other parts of a state are usually concerned with other drugs. And while treatment may be the most pressing need in dealing with heroin addiction in the central city, the emphasis desired or demanded by the rest of the state may be for education and prevention programs. Although the larger cities may want increased funding for methadone programs, other areas of the state where heroin is not a problem may be unsympathetic to this use of one addictive drug to treat another. In the final analysis, different units of government are bound to have different needs, priorities, and philosophies, all justified from their own perspectives.
The imbalance between state and large-city determinations of problems and priorities has become further aggravated as the principal federal drug treatment and prevention agency, NIDA, has sought to become more reliant on state plans in determining federal funding decisions. In fact, NIDA has recently announced its intention to fund virtually all of its treatment and prevention efforts through statewide services contracts with state governments by 1979. It is argued that this will be administratively efficient; but this increasing substitution of state decision making for federal does not augur well for the large cities, where drug and drug-related problems are most severe.
In some instances a strong state role has worked well; this is most often true in states where there are no large urban centers. But in many other instances, potentially serious problems between state and large-city governments have impeded the effective flow of funds and delivery of services. City organizations such as the National League of Cities and the U.S. Conference of Mayors have repeatedly expressed their dissatisfaction with the lack of state responsiveness to large city needs in the drug area. Representatives of a number of large-city governments have also voiced strong and specific complaints about this. There is clearly a need to make some adjustments in the state planning process so that plans more adequately and appropriately allow for large-city needs and participation. Such adjustments can be made without dismantling the state planning system.
NIDA and the cities need to communicate more directly on drug issues and learn more from one another. To an unfortunate extent federal drug policies are formulated without discussion or collaboration with local elected officials from areas where drug and drug-related problems are particularly severe. This situation must be remedied if our drug policies and programs are to work more efficiently. NIDA needs to develop mechanisms by which it can more aggressively and systematically seek large-city government input in its deliberations, and, conversely, cities need to develop a better understanding of why NIDA does what it does. The concept of an Office of Urban Services within the NIDA bureaucracy to facilitate these crucial interactions would seem to have merit.
Finally, NIDA should seriously consider initiating a program to fund city coordinating agencies with responsibility for developing city-wide drug abuse plans in a number of cities with the highest concentrations of drug-related problems. These plans should provide for interaction with the state government. Cleveland needs such an agency and plan far more than does the state of Idaho, Atlanta more than Vermont.
A federal system that funds only state drug abuse plans and agencies is either focusing solely on administrative ease or operating in ignorance of the actual problems. Plans should not proliferate uncontrollably across the country, but if the federal government is to require planning it should at least make certain that there will be direct participation from those areas most afflicted and concerned. An additional benefit of funding city agencies would be that it would give local elected officials a dependable and developed local source of advice and assistance on drug issues and problems.