The money spent on treating heroin addicts is substantial. With the added costs of capturing, trying, convicting and incarcerating heroin distributors, users and abusers, the aggregate dollar outlay for controlling heroin supply and demand becomes enormous.
One reason the return on our investment in drug law enforcement and addiction treatment is so low is that addiction control strategies ignore the political and economic realities of (1) upper world groups who "fight heroin addiction," and (2) the functions of the underworld heroin market. Both factors help perpetuate heroin addiction. "Fighting heroin" creates pressure groups who develop vital interests in sustaining the addiction "problem" and vitiating attempts at policy reform such as heroin decriminalization, which might be the most rational approach.
An analysis of addiction treatment strategies and their outcomes should therefore elucidate the official "mission" in society of these programs, their manifest and intended purposes and consequences, and their latent functions—the covert goals and unintended consequences of heroin control efforts.
THE LATENT GOALS OF ADDICTION TREATMENT STRATEGIES
An agency or program originally created for one purpose frequently and insidiously acquires additional, often unplanned functions. Operations might then be influenced more by the acquired objectives than by the purposes that first motivated the establishment of the agency or program. Official goals are manifest, since they appear in legislation, directives or formal announcements under which programs are created or policy publicly justified. Actual goals must be inferred from the behavior of functionaries within organizations, in terms of the real objectives they seem to establish. Those interests and objectives often emerge different from the publicly proclaimed objectives and may appropriately be called latent goals. Robert K. Merton's thesis was that organizations and their personnel displace manifest goals and functions with latent goals and functions.'1
The impact of addiction treatment policy and programs on reaching their formal, overt goals seems minimal. What, then, motivates people in these organizations? Is it only the go9.1 of eliminating heroin abuse? Although the formal goal and manifest function of most addiction treatment and rehabilitation programs is ultimately to "self-destruct"—to be unnecessary—their covert goal and latent function is self-perpetuation, continually expending vast sums of public dollars on the interminable treatment of addicts in programs destined to fail. Worse is a current federal retrenchment in addiction treatment funding. Rehabilitation programs nationwide will fight a grim holding action, not getting much new money and desperately trying to keep their current funding. With a perennial economic squeeze organizational survival becomes paramount—a matter of bread and butter.
On January 17, 1961, in his farewell radio and television address to the American people, outgoing President Dwight D. Eisenhower coined the term "military-industrial complex":
In the councils of government, we must guard against the acquisition of unwarranted influence, whether sought or unsought, by the military-industrial complex. The potential for the disastrous rise of misplaced power exists and will persist.2
Eisenhower did not allude to the nascent stages of a similar titanic complex in the social service field, "The education-povertymental health industrial complex,"' a social pork barrel consisting of a broad array of groups whose basic industry is ministering to the psychosocial problems of poverty. These are the service deliverers, the social or human services workers, the mental health professionals and the storefront lawyers—the "helping professions" and "caregivers" who depend on a steady flow of funds from labor-intensive federal programs designed to help the disadvantaged. This "social pork barrel," says Shapiro," . . . just like the military-industrial complex, makes thousands of workers dependent on the federal budget for their jobs and way of life."4 Are our manpower and financial resources enriched or decimated by the compelling necessity of human services professionals feeding their families through government grants?
In 1973 Sonnenreich coined the term "drug abuse—industrial complex":
About four years ago we spent a total of $66.4 million for the entire federal effort in the drug abuse area. . . . This year we have spent $796 million, and the budget estimates that have been submitted indicate that we will exceed the $1 billion mark. When we do so we become, for want of a better term, a drug abuse industrial complex.'5
Sonnenreich referred to the combined economic effect of federal drug law enforcement and addiction treatment efforts. What kind of political and economic clout do these programs have in our communities?
DRUG LAW ENFORCEMENT: THE TURNKEY INDUSTRY
Federal outlays for fiscal year 1969 for all drug abuse-oriented programs, both law enforcement and treatment, was $81 million. Five years later, in 1974, the federal government spent $800 million on these efforts, a dramatic 1,000 percent increase. Obviously, the handling of addicts by police, courts and corrections is big business and has been since heroin and addiction were criminalized in 1914. It is estimated that over $600 million a year is spent to arrest, convict and incarcerate addicts and suppliers.
This "turnkey industry" is a profitable enterprise for customs agents, police, courts, correctional institutions, attorneys, and peripheral hangers-on like bail bondsmen, jail and prison construction contractors, urine-testing laboratories, and even some ex-offender programs. It provides thousands of jobs for middle-class Americans. Though the stated goal of this turnkey industry is to self-destruct ("crush crime"), its unstated mission is self-maintenance. Quite simply, the criminal justice system needs addicts and has developed what Veblen called a "vested interest" in addiction. If crime and addiction were somehow to disappear tomorrow, many police officers and their ancillary personnel would be out of jobs. Chasing addicts and pushers provides federal, state and local drug law enforcement agencies and personnel with a reason for being.
Policy impacts are the effects a policy or program has on the target population and other features of the environment. Impacts are intended or unintended, anticipated or unanticipated. Policies and programs may not have their intended impact on a problem. "Spillover effects" represent the unanticipated consequences of policies and programs. Examples of unanticipated consequences of heroin criminalization illustrate the negative spillovers of narcotic control policy since 1914.
Undeniably, the criminalization of heroin has had a corrupting influence on the entire criminal justice system. Anti-narcotic laws provide a special incentive for the corruption of police, judicial and corrections personnel. People who have worked with intelligent and aggressive heroin addicts know of their cunning, their single-mindedness and their absolute amorality where their drug supply is concerned. Standard practices place the police officer who has a narcotics assignment in a continuing illegal relationship with a series of user/seller informants. The addict's desperate attention to his own needs and the officer's power over the addict make a tremendous risk for the honest police officer. The evidence is mounting that narcotics law enforcement officers, dealing as individuals with small-fry users and dealers, are vulnerable to corruption.
THE KNAPP COMMISSION
The New York City Police Department has been rocked by major narcotics scandals. In 1971 the Knapp Commission's ten-month-long investigation revealed the following corrupt practices among officers: 6
1. Keeping money and/or narcotics confiscated at the time of arrest or raid
2. Selling narcotics to addict-informants in exchange for stolen goods
3. Passing confiscated heroin to police informants for sale to addicts
4. "Flaking," or planting heroin on narcotics suspects
5. "Padding," or adding to the quantity of narcotics found on an arrested person to upgrade an arrest
6. Storing heroin, needles and other drug paraphernalia in police lockers
7. Illegally tapping suspects' telephones
8. Accepting money or narcotics from suspected narcotics law violators as payment for the disclosure of official information
9. Financing heroin transactions
10. Determining the purity and strength of unfamiliar heroin they had seized by giving the narcotics to addict-informants to test on themselves
11. Kidnapping critical witnesses to prevent them from testifying
12. Providing armed protection for heroin dealers
13. Offering to obtain "hit men" to kill potential witnesses
Law enforcement agencies look good if (1) fewer crimes are reported, (2) a greater number of arrests are made—whether or not those arrested are important criminals, and (3) a higher percentage of convictions—whether or not the convictions are for important crimes or of important criminals—are obtained. The emphasis, in other words, is on quantity, not quality. The pressure on the police investigator is not to eradicate or reduce the traffic in heroin. It is to develop such an interrelationship that he can secure the number of arrests and convictions that will mark him and his department as good performers. Small-fry heroin users and dealers serve this need.
Myles Ambrose, former head of the U.S. Treasury Department's Bureau of Customs and President Nixon's first director of the Office of Drug Abuse Law Enforcement (ODALE), said that "Police corruption appears to be a factor in disappointing local and state drives against narcotics pushers."' He implied that local efforts to eliminate narcotics sellers were faltering because of police corruption. Former Attorney General John Mitchell, referring to the lack of effective local drug law enforcement efforts, alluded to corruption when he said that, ". . . the system of law enforcement has not worked out for various reasons I will not go into."
The dramatic forays of police seizures are only a small part of total police activity against narcotics violators. The major, more routine, day-to-day work is so structured that it automatically fragments a narcotics detail and drives it into a position where illegal action is easy; legal action is difficult and sometimes close to impossible.
Corruption at Federal Level
Pervasive organized corruption of this kind runs to the federal level as well, mainly the Drug Enforcement Administration, the U.S. Border Patrol and the Customs Service. Charges against DEA include criticism for abandoning a probe into alleged heroin smuggling by Nixon contributor-billionaire Robert Vesco, a series of scandals involving DEA with filming narcotics suspects in sex traps, surveillance of U.S. mail, a bizarre catalog of assassination devices, an intramural bureaucratic war within the agency itself, and assorted other charges of graft, murder, heroin peddling and overzealous door smashing and gunslinging by DEA agents.
As a result, nearly all of DEA's top staff were shifted or removed from office. Perhaps for this reason the Carter administration considered abolishing DEA and redistributing its functions elsewhere in the Department of Justice and to the Treasury Department.9 Internal corruption in this agency may be one reason it never decreased the heroin trade.
Some critics of DEA argue that protection of heroin profiteers is not caused by internal corruption in the heart of DEA but is, in fact, the function of DEA under present anti-narcotic laws. Narcotics enforcement does little more than preserve the monopoly of professionals in the heroin trade by making life difficult only for amateur and unorganized dealers who cannot afford big payoffs.'° In this view, DEA is little more than a weak regulatory agency whose benign neglect rationalizes and legitimizes the big conglomerates in the huge heroin industry created by anti-narcotics laws.
Corruption goes beyond police and involves prosecutors, attorneys, bondsmen, certain judges and, allegedly, some state legislators." Several large-scale heroin dealers in southern California told me that a prominent member of the California State Senate was once a "kingpin" of the heroin trade.
The punitive approach to the heroin problem, requiring increased police power, has led to gross infringement of constitutional liberties. Law enforcement agencies have committed excesses in the pursuit of evidence. These excesses, in turn, have evoked a judicial conterreaction in the form of restrictions upon the use of evidence, which are designed to discourage unconstitutional police practices.
A leading Supreme Court decision on entrapment was evoked by overzealous undercover agents in a narcotics case—Sherman v. United States (1958). Decisions involving admissibility of evidence arising from illegal arrests have been rendered most often in narcotics prosecutions—Johnson v. United States (1948) and Draper v. United States (1959). Legal restraints on lawful search and seizure have stemmed largely from litigation over the past fifty years concerning a variety of forms of physical intrusion by police in the course of obtaining evidence of violations of narcotics laws." The same is true with respect to the developing law of wiretapping, bugging and other forms of electronic surveillance.'' Indeed, probably no single phenomenon is more responsible for the whole pattern of judicial restraint on methods of law enforcement than the unfortunate experience with enforcing narcotic drug laws.
ADDICTION MONGERERS AND DRUG ABUSEOLOGISTS
Federal support for addiction treatment and rehabilitation rose from $28 million in 1969 to over $350 million in 1974. Like drug law enforcement organizations, addiction treatment programs and personnel that depend on government grants have an important economic stake in maintaining their hegemony. Such programs are big business. How committed are they to the politics and economics of organizational survival?
Psychiatrist Thomas Szasz says the addiction mongerers and drug abuseologists associated with treatment programs need to produce more and more heroin addicts in order to make themselves indispensable. Szasz calls this enterprise a "racket":
Obviously, addiction has been the glamour stock of the late sixties and early seventies, and addiction mongering the only true growth industry in America during these years. . . . The whole business of addiction-mongering is a gigantic hoax, a socially and professionally validated racket. . . . [Addiction treatment is] . . . malicious medical meddling into personal habits, a pseudomedical enterprise that redefines personal preferences [using heroin] as a scientific and medical problem, concealing medical coercion as treatment and [thereby] creating an immense economic interest. . . .14
Treatment programs and their funding sources employ men and women, some in high-status jobs. They have a vested interest in the maintenance of their programs and, by extension, in perpetuating the supposed malady they are mandated to "cure." Even though their overt mission is to contain heroinism, they promote addiction through treatments that fail. Programs consistently cling to the status quo and resist innovations that might make them obsolete.
The executive director of a big treatment program recently asked me to write a "heroin maintenance" protocol for his agency to submit for possible funding. My interest was deflated when, after further clarification, all he really wanted was a standard cost-benefit analysis to legitimize his agency's huge annual expenditures on ineffective inpatient detoxification of heroin addicts. His intention was to demonstrate to funding sources that it was cheaper for them to pay for periodic in-hospital detoxification than to let addicts run freely in the community, where they would use more and more heroin and commit more crimes in support of the habit. Periodic detoxification, said the program director, at least keeps addicts off the streets for seven days every six months and reduces their tolerance to affordable levels so they can "maintain" themselves on smaller doses of illegal heroin for less money. What he meant by "modified heroin maintenance" was continued illicit heroin use (his idea of "heroin maintenance"), "modified" periodically by inpatient detoxification to reduce tolerance. I refused to write the protocol.
ADDICTION TREATMENT ROLES
There seems to be an increase in the "heroin problem" proportionate to the attention directed at its eradication. The larger the structure developed to treat addicts, the larger becomes the population of addicts needed to feed and support it. Treatment programs and the criminal justice system supply that need. And since their heroin control efforts have generally failed to cut supplies or reduce demand for the drug, an endless supply of heroin addicts is virtually guaranteed.
The interests of those in high-echelon occupational roles in these treatment organizations become more entrenched the longer the organizations persist and the more permanent becomes their funding. Scuttling these ineffective treatment programs and their sponsoring bureaucracies poses a real threat to those whose careers have been narrowly defined by treating heroin addicts. Thus, treatment programs and their funding sources have been a force of conservatism and resistance to reforms in laws and policies relating to the criminalization of heroin. With a vested interest like this, it is doubtful whether the heroin "crisis" will ever be "solved."
An examination of the industrial aspects of addiction treatment and rehabilitation must involve descriptions of work and occupations relevant to the enterprise. These job titles (which exclude law enforcement roles) are directly related to addiction treatment, rehabilitation and prevention/education and, though hardly exhaustive, the list represents the kinds of roles addiction treatment has spawned:
A. Treatment Program Management
1. Program directors
2. Deputy directors
3. Assistant directors
4. Clinical directors
5. Training specialists
6. Public information officers
7. Personnel directors
8. Fiscal control officers
9. Management assistants
B. Medical Treatment
2. Nurses (RNs and LVNs)
3. Medical assistants
5. Laboratory technicians
6. Hospital administrators
7. Hospital deputy administrators
8. Hospital ancillary staff (dieticians, cleaning, and the like)
9. Pharmacists and pharmacy technicians
C. Community-based Treatment
1. Directors, counseling services
2. Therapeutic counselors
3. Group facilitators
4. Intake counselors
5. Vocational rehabilitation counselors
6. Social workers
8. Psychologist assistants
9. Psychiatric social workers
D. Community Program Support Personnel
1. Community organization specialists
2. Drug program development specialists
3. Mental health program development specialists
4. Addiction prevention/education specialists
5. Outreach counselors
6. Street caseworkers
7. Youth specialists
8. Day-care specialists
9. Recreation specialists
10. Family counselors
E. Addiction Prevention/Education
1. Education coordinators
3. Drug counselors (in school)
4. Health counselors (in school)
5. Student aides (in school)
F. Training In Addiction Treatment And Rehabilitation
1. Training directors
2. Training program coordinators
G. Federal/State/Local Drug Abuse Treatment Authority
1. Agency directors, deputy directors and assistant directors
2. Chief administrators
3. Deputy administrators
4. Coordinators for education/prevention
5. Coordinators for treatment and rehabilitation
6. Coordinators for state planning
7. Coordinators for county planning
8. Coordinators for municipal planning
9. Community program monitoring/evaluation personnel
H. Research/Evaluation Personnel
1. Directors of evaluation and research
2. Research/evaluation assistants
3. Research Analysts
4. Research Assistants/statistical clerks
5. Epidemiologists (in program or academic setting)
6. Pharmacologists (in lab, program or academic setting)
7. Social scientists (in academic or program setting)
8. Toxicologists (in lab, program or academic setting)
I. Consultants and Lecturers In Addition Treatment/Prevention
5. Consultants-criminal justice
6. Consultants-state planning
7. Consultants-community planning
9. Consultants-drugs in industry
10. Lecturers-drug abuse control policy
11. Lecturers-addiction treatment
12. Lecturers-addiction prevention
13. Lecturers-addicts and the law
14. Lecturers-addict behavior
15. Lecturers-biochemical research
What all these service deliverers want and need is more money, and they are determined to hang onto their positions, whether or not their ministrations cure addicts.
Another latent function performed by addiction treatment policies and programs is cooptation of potentially dissident minorities—black, brown and Asian—into established social service delivery systems of local communities. By this process marginal groups adopt the values and goals of the established elites to win benefits from the institutions controlled by elites.15 Selznick used the relationship between the Tennessee Valley Authority and powerful groups within the valley to exemplify this type of cooptation.16
In some respects, addiction treatment and rehabilitation „programs have replaced the community action agencies of President Johnson's "Great Society" as a means of coopting minority professionals and paraprofessionals into the "establishment." Just as there was a relationship between the War on Poverty and the "blackening" of urban social service bureaucracies,17 there appears to be a direct association between the "heroin problem" and occupational entry of blacks, browns and Asians into the not-so-revolutionary health care delivery system.
Among other spin-off industries created by recent expansion of addiction treatment is the business of urine testing. The extent of urinalysis testing for drugs is largely unknown. Goldberg estimated that 15 million urine samples are analyzed yearly for the presence of drugs. Eight million are from methadone maintenance programs and five million from the military.18 Undoubtedly these figures are low for today. Urinalysis for drugs has become a multimillion dollar industry and one of the chief economic beneficiaries of the burgeoning drug abuse industrial complex. Suffice it to say that all this testing supports a huge laboratory industry. It costs taxpayers about $25 million a year just to conduct required urinalyses on methadone maintenance cleints. Regarding urine testing in methadone maintenance programs, Paul Blachly focused on its industrial aspects by noting, ". . . once having been established as procedure, it is virtually impossible to stop this wasteful practice. By this time, to terminate the practice would put people out of work, and there is now a vested interest in maintaining the status quo."19
In the early 1970s Frederick Douglass Intermediate School in Harlem received a $125,000 federal grant to test the urine of all children in the fifth through eighth grades. Of thousands of samples, only two specimens were positive for illicit drugs. In Alabama, Governor Wallace's Commission on Drug Abuse recommended that the state test the urine of every junior and senior high school student at least once a year. The civil liberties implications of such testing programs will not be explored here. Given the unreliability of urinalyses (many urine samples appear to be "sink-tested"), the costs of testing would seem to outweigh the benefits.
Other profit makers in the addiction treatment industry include pharmaceutical manufacturers themselves, who provide drugs used to treat addiction, including tons of methadone hydrochloride each year. Drug companies not only make money treating addicts. They create addicts.
In their quest for profits, drug manufacturers are described by critics as ". . . pushers who push through promotion and advertising means to create a drug acculturated society ready to take drugs and often immune to their hazards."2° The industry, of course, counters that the degree to which drug promotion through advertising affects either the prescribing practices of physicians or the degree of drug misuse by Americans is unknown. Contrary to the arguments of the pharmaceutical companies, repeated studies of prescribing practices have shown that doctors get their knowledge of drugs and suggestions as to their use from advertisements in medical journals and from the "detail men" who plug drugs in doctors' offices. Such advertising constantly recommends products to "treat" the sadness of death in the family, the nervousness of a child's first day at school, the apprehension of a visit to the dentist and other ordinary problems of everyday living.
Women, the elderly and other roles are constantly stereotyped in ads for psychotropic drugs which generally show greater appeal to emotion than advertisements for non-mood-altering drugs. Here, for example, is part of an ad for Abbot's Placidyl, a hypnotic similar to chloral hydrate ("knock-out drops"):
The night has a thousand whys. The answers used to come easy. But lately everything's becoming a problem. She can't understand why her husband has to work late, why her son has to wear his hair so long, why the price of hamburger changes every time she goes to the supermarket. And now there is a new problem: she can't fall asleep. This patient needs help. She needs Placidyl.21
For the elderly who appear depressed, CIBA, Inc., offers Ritalin, a stimulant related to amphetamine: "Before treatment, the geriatric patient was withdrawn, apathetic. Ritalin will bring your elderly patient out of his apathetic/withdrawn senile behavior."22 And into what frame of mind? CIBA notes the following possible adverse reactions to Ritalin: nervousness; insomnia; hypersensitivity (including skin rash, uticaria, fever, arthralgia, exfoliative dermatitis, erythema multiforme with necrotizing vasculitis, and thrombocytopenic purpura); anorexia; nausea; dizziness; palpitations; headache; dyskinesia; blood pressure elevations or hypotension; tachycardia; angina; cardiac arrhythmia; and weight loss. Ritalin is also recommended as adjunctive therapy for minimal brain dysfunction in children. Thousands of youngsters are given Ritalin or amphetamines to alter classroom behavior. Critics charge that physicians, school authorities and drug manufacturers under the guise of "helping" children, are using chemicals to control them—drugging for deportment, as it were."
Drug companies employ persuasive lobbying techniques creating an almost impenetrable legal framework that protects them. Both consumers and physicians are captives of this industry. It is estimated that Roche Laboratories, Inc., alone spent about a quarter billion dollars in the 1960s for the promotion of just two tranquilizers—Librium and Valium—which subsequently became best sellers and household words.24 Valium (diazepam) is the most frequently prescribed drug in the United States, with more than 70 million prescriptions sold in 1976. According to NIDA reports, Valium is the number one abused drug in emergency room overdose episodes and is listed as the first or second most abused drug by nineteen of the twenty-three cities reporting to the federal Drug Abuse Warning Network (DAWN) reporting system.25 Nevertheless, Valium is still pushed heavily in slick medical journal ads. 26
Big advertising investments by drug manufacturers pay off by creating a need by physicians and their patients for psychoactive substances. The result is that by 1972, next to mining, the pharmaceutical manufacturing industry was the most profitable in America in terms of sales.27 This high profitability results directly from government protection of the industry's oligopolistic practices and heavy promotional spending.
The inescapable conclusion is that drug advertising is associated with prescription drug misuse and is a contributing factor in the translation of social, political and economic problems into medical ones supposedly amenable to chemotherapeutic management.
THE NATIONAL DRUG ABUSE CONFERENCE
The yearly National Drug Abuse Conference has become the gathering place of treatment and rehabilitation interest groups and a sales convention where addiction industrialists hawk their latest wares. It is a huge social event where some in attendance abuse most every drug in the book, especially gallons of liquor at many free cocktail parties (one such drunken party at the Conrad Hilton in Chicago was billed to the National Institute of Mental Health!)
Included in the program notes of the 1974 National Drug Abuse Conference were "thank-yous" to these companies who provided conference "assistance"—mainly cash donations, hospitality suites and sales booths and decorations on the floor of the convention:
1. Eli Lilly and Company (a major manufacturer of bulk methadone)
2. Bristol Laboratories (another major manufacturer of methadone, whose product Methenex is laced with an antagonist)
3. Hoffman LaRoche, Inc. (manufacturers of Valium and Librium, the number one abused tranquilizers in America)
4. Brinkman Instruments, Inc. (manufacturer of urine-testing hardware for methadone maintenance and drug-free programs)
5. Drug Intervene Systems, Inc. (a urine-testing outfit)
6. Syva Company (another manufacturer of on-site urine testing equipment for treatment programs)
7. Ultrachem Corporation (a major lab performing urinalyses for addiction treatment programs)
8. Biochemical Procedures, Inc. (a urine-testing subsidiary of Bristol-Meyers)
It is ironic that major drug companies sponsor the National Drug Abuse Conference.
Computer firms with "client tracking systems" for sale also dominated the 1974 conference. Here is a promotional flyer issued by one firm to conferees:
Welcome! Creative Socio-Medics would like to welcome you to the first National Drug Abuse Conference. . . . We have been successful in designing, installing and operating drug treatment program information systems. The following are examples of information systems we are currently providing to more than 300 addiction treatment programs across the country:
1. Central Intake/Referral
2. Central Pharmacy
5. Toxicology and Laboratory
7. Third-party billing (Medicaid)
8. Budget/Cost Analysis
9. Client I.D. Cards
10. Client Tracking
This firm's major competitor in the field offered this alcoholic inducement to potential drug program customers:
You are cordially invited to visit with us in Suite 1000. Cocktails will be served between 4 p.m. and 8 p.m. We will be on hand to discuss our capabilities in computer technology for various substance abuse programs. We offer you the following benefits:
1. Continuous Client Tracking from Intake to Termination
2. Single Input Document
3. Easy-to-use Client Treatment Aid
4. Improved Communication Among Counselors
5. Enhanced communication between program components
6. Counselor and Client Accountability
7. Tailored Packages to Fit your Specific Needs
Both these computer firms wined and dined me in Chicago, San Francisco, San Jose, Sacramento, Los Angeles and San Bernardino. They wanted to land a large federally funded client tracking contract for a whole network of addiction treatment programs. Neither company was selected, however. Instead we developed an in-house system, and hand-tracked client movement at half the expense. Nevertheless, with the winding down of the space program, these computer soft- and hardware firms have made a significant entry into the drug abuse-industrial complex.
Various interest groups, some supported by government grants, have combined to maintain and expand addiction treatment programs. The following groups "sponsored" the 1975 National Drug Abuse Conference in New York City. They contributed substantial sums of money toward staging this annual gala event of the addiction treatment community:
1. National Institute on Drug Abuse (NIDA)
2. National Institute on Alcohol Abuse and Alcoholism (NIAAA)
3. The Drug Abuse Council, Inc.
4. The International Council on Alcohol and Addiction
5. The National Council on Alcoholism
6. Therapeutic Communities of America, Inc.
7. North American Association of Therapeutic Communities, Inc.
8. The Greater New York Coalition on Drug Abuse
9. P.A.C.T. (Provide Addicts Care Today)
10. The National Free Clinic Council, Inc.
11. The National Federation of Concerned Drug Abuse Workers
12. The National Association for the Prevention of Addiction to Narcotics
13. The National Association of State Drug Abuse Program Coordinators
14. The National Association of County Drug Abuse Coordinators
15. The National Coordinating Council on Drug Education
16. The National Addiction Services Guild
Nineteen similar groups sponsored the later 1977 National Drug Abuse Conference in San Francisco. On the surface, at least, these groups seem to hold widely divergent treatment viewpoints and ideologies. The effort to separate medicine from politics in this area, and the rivalries and jealousies among drug abuseologists have complicated the addiction issue. The treatment field is filled with zealots, each convinced he has the best, perhaps the only, program capable of reaching addicts. Their advocacy of one final "solution" or another to the heroin problem is suffused with emotion that turns differences of opinion into heated conflicts. Many such organizations, with great sincerity, extol detoxification and abstinence. Others, with equal fervor, trumpet the substitution of methadone or Darvon-N for heroin. Some say residential treatment is the only way to keep addicts "clean." Still others recommend narcotic antagonists, Jesus, hypnosis, transcendental meditation, psychotherapy, biofeedback, acupuncture, electrosleep, aversive conditioning, nutritional therapy, or chanting to various mantras. It almost seems appropriate to turn to drugs to escape the clamorings and confusion that permeate the quest for the addiction treatment dollar. And here all these groups coalesce: Addicts are diseased and need the kind of treatment only these organizations presumably have the expertise to provide. To provide this "therapy," all they need is more and more taxpayers' money.
UNIONIZATION OF ADDICTION TREATMENT WORKERS
Increased pressure in addiction treatment programs and government funding agencies to drive out experientially trained paraprofessionals, mainly ex-addicts, to make room for degreed professionals has led to the unionization of drug treatment workers. The National Federation of Concerned Drug Abuse Workers is composed mainly of ex-addict East Coast black and Puerto Rican counselors. Their union, they say, is a response to increasing professionalization of the treatment field. They feel that although they have a "Ph.D in streets," they are being squeezed out, and that services in the future will be provided by drug abuse "experts" with degrees, but without know-how. "Credentialing" of treatment program staff workers by governments is their main concern. The union members want their experience as addicts counted when licenses to treat addicts are given. Whether or not those with raw experience will be successful is still questionable. If they are not, most of them will be out of jobs with little prospect for other work.
NONPROFIT CORPORATIONS IN ADDICTION TREATMENT: THE DRUG ABUSE HUSTLE
An important vehicle for delivery of addiction treatment services has been the private, nonprofit corporation set up to receive government treatment grants and fee-for-service contracts. Over half the treatment programs nationwide are nonprofit, and their road to funding is paved with "RFPs" (Requests for Proposals) from all levels of government. Marketing ability, not service delivery or evaluation skills, may account for a contract award in the requestfor-proposal process.28 Recently, the principal in one of the nation's largest consulting firms in the substance abuse area told me the grant award process was "90 percent politics." This service-delivery and evaluation research community consists of RFP readers, bidders and winners.
The nonprofit groups have flourished in addiction treatment for three major reasons. First, relative to government agencies themselves, these groups provided a vehicle for rapid and relatively inexpensive expansion of addiction treatment services and mobilization of resources during the Nixon war on heroin. Few of them are burdened either financially or operationally with the elaborate bureaucracies associated with government agencies. Their argument to funding sources is that they can do the treatment and rehabilitation job better, cheaper and faster than government itself. Second, extant nonprofit treatment providers had a natural involvement in their surrounding communities. New ones were often implemented with substantial input from local elites as well as "community advocates" on their boards of directors. Although addiction treatment programs are difficult to locate in communities because citizens fear addicts, the nonprofits were not viewed as invading foreigners (as government agencies so often are) imposing their will without community support and input. Third, in a capitalist society nonprofit corporations are surrounded by halos of probity. They are not burdened with the tarnished image of profit-making companies out to rip off governments and consumers nor do they resemble government programs wasting the taxpayers' money on "moon-shot" approaches that do not work.
The image is of a sincere administrator of a nonprofit program in the poor part of the city spending his time in good works on behalf of sick addicts and the victimized community, not in calculating new and devious ways to beat the government out of more money.
In nonprofit corporations the pecuniary interest of the board and staff is uncoupled from the rises and falls in corporate putput,and income. In theory this allows nonprofits to concentrate on client needs and services without concern that this will affect staff incomes .29
Nonprofit treatment programs in the same communities cooperate extensively, bouncing clients back and forth by mutual referrals. Various territorial claims and each other's effectiveness are never openly questioned, unless the financial going gets rough and war breaks out between programs over who is going to get the remaining grant scraps. Some "networks" of nonprofit addiction treatment corporations have tumbled like houses of cards under these battles over who gets how much of what.
What cooperation there is among such programs is frequently incestuous, as when the director of one treatment program is a paid consultant to two others, or when the ranking member of a drug abuse task force or coalition that distributes government treatment dollars is the head of an agency destined to receive part of the money. The same individual may sit on the governing board of directors of several nonprofit addiction treatment agencies and have a financial interest in a profit-making firm doing business with the treatment programs. Potential conflicts of interest are passed off in the field as "pooling of talent."
FRAUD IN ADDICTION TREATMENT PROGRAMS
Mind-boggling fraud and illegal activities in and between addiction treatment programs are not uncommon. A person who finds out too much about these under-the-table dealings can be murdered. A number of homicides in Los Angeles have recently been attributed to shadowy deals in and between drug abuse treatment programs.
Fraudulent practices include:
1. Bribes and kickbacks
2. Rampant self-dealing
3. Double billings and padded billings to funding sources such as Medicaid
4. Charging funding sources for services never performed
5. Phony reports on numbers of clients in treatment
6. Unreasonable and uncustomary fees, salaries and fringe benefits for addiction treatment program staff
7. Using work hours for profit-making (or political) activities
8. Embezzlement and theft
9. Violent assault
Self-dealing is a common racket in the treatment "business." It is a business transaction in which the same person(s) appear(s) simultaneously on both sides of a money-making deal, on one hand as the staff of a nonprofit addiction program and on the other as a profit-making provider of services to that program. The arrangement usually involves siphoning off government grant and fee-forservice money into a subsidiary profit-making corporation.
For example, a typical operation might involve the following parties, all engaged in self-dealing and other criminal acts: (1) the director, deputy director and intake director of a huge addiction treatment program, (2) two small profit-making hospitals to which the treatment program sends its addicts for detoxification, (3) a profit-making consulting firm composed of two partners, one of whom is intake director at the drug program, and (4) the owner of the hospitals where the addicts are detoxified. The scheme works like this. The consulting firm makes a deal with the hospitals, which are going broke, to turn a quick profit by converting them into inpatient detoxification units for heroin addicts. All detoxification cases will be reimbursed through Medicaid at the rate of $120 a day per client. The consulting firm agrees to write the licensure protocols, for which the owner of the hospitals will pay a flat fee to the consultants. The fee is withheld until enough patients have been detoxified to pay it with Medicaid funds.
After the hospitals begin operations, the consulting firm signs a contract with them to provide ongoing "training and consultation" to the detox units at the rate of $3 a day per patient, paid from Medicaid reimbursements. The consulting firm's "take" from this arrangement eventually exceeds $60,000 a year. However, the consulting firm never provides the "training" services, an unfortunate development since the hospital nursing staff lacks even the most rudimentary knowledge of detoxification procedures. They do not know, for example, how to treat a narcotic overdose if it occurs on the ward. Thus, the lives of the patients are endangered. No matter. Money is the goal in this operation, not quality care.
This whole arrangement between the drug program, the hospitals and the consulting firm is characterized by conflicts of interest, fraud, kickbacks, bribes, self-dealing and misrepresentation of financial records. One member of the two-man consulting firm is in a direct conflict of interest. He earns substantial profits from the consulting firm and at the same time manages the drug program intake unit where he uses his position to funnel addicts into the hospitals for which he is a paid consultant. He uses his work hours at the federally funded drug program to feather his consulting firm's nest. The consulting firm of which he is a member, in turn, bribes his boss, the executive director of the drug program, with under-the-table payments of $500 a month (from Medicaid funds) and the deputy director of the same program with $100 a month to make sure that these administrators "keep their mouths shut" regarding their intake director's self-dealing and also to be certain that the program's detoxification cases are all channeled into the designated hospitals.
In addition to this arrangement, another treatment program director in another part of the city gets $100 a month (in Medicaid money) to make sure that all his detoxification cases are funneled through the same two hospitals. A virtual endless flow of clients is thus guarenteed through this series of bribes and kickbacks utilizing taxpayers' money. The drug program directors get paid off because they have the addicts. The administrator of the detoxification hospitals gets a kickback of $600 a month from the consulting firm, again Medicaid money, because he guarantees the availability of hospital beds for detoxification cases. The bribes paid by the consulting firm are covered in its financial ledgers by recording them as payments for "consultant services" rendered to the hospitals. Such "services," however, are never rendered. The real service is guaranteeing an interminable flow of sick junkies in order to line the pockets of all involved.
Finally, out of its take the consulting firm pays street people a "finder's" fee of $25 for every addict they bring to the drug program intake units for detoxification. Phony Medicaid cards are sold at some drug programs for about $25 apiece.
This whole operation could be run on an honest basis with the interests of clients at heart. It is not a fraudulent practice, for example, to use a portion of Medicaid detoxification reimbursement for legitimate training, evaluation and some consultation if such "expert" services are actually provided. But in this case greed gor in the way—greed on the part of the consultants, the hospital administrator and owners and the drug program directors. They preferred to take the money and do nothing. As a result, the detoxification unit staffs were never properly trained, the consulting firm made money without rendering contracted services and the bribes and kickbacks remained in full swing to the drug program administrators and the "body snatchers."
The operation outlined here is only one of many suspect enterprises in the drug treatment industry. For example, the doctor leading the list of American physicians receiving more than $100,000 a year for treating welfare patients operated three methadone maintenance clinics in New York City .3° In a similar vein an addiction treatment program in New York City receiving over $3.2 million a year from federal, state and city grants was recently charged with purchasing profit-making properties with federal funds, forging payroll checks, padding treatment enrollment lists, and maintaining a $200,000 "slush fund" of NIDA monies to cover unauthorized program expenditures.31
The drug abuse treatment hustle goes right to the top—to the National Institute on Drug Abuse, which supports a tight little network of "experts" in the medical approach to the heroin dilemma. Using taxpayers' money, the members of the NIDA fraternity take turns hiring one another to study, quantify, assist and evaluate heroin control policy. Perhaps for this reason, NIDA recently was investigated by the Inspector General of HEW for a whole series of possible abuses of grants and contracts.32
A typical NIDA research project involved showing pornographic movies to subjects stoned on marijuana. Unfortunately for those lining up for the experiment, Congress got wind of it and terminated the project. But similar imaginative studies have slipped through unnoticed: an $80,000 grant to measure how drugs and alcohol affect a person's ability to recognize smiles, scowls and other facial expressions; a $363,000 study to find out whether marijuana smoking makes a person susceptible to hypnosis. Researchers armed with NIDA grants roam the globe. One group examined the sociocultural aspects of marijuana use among the Zulus of South Africa. This expedition cost the taxpayers $174,000. Later a team of scientists was off to North Yemen, spending $275,000 to study a stimulant obtained by chewing leaves found only in that country.
A research rationale is not necessary to see the world on government travel vouchers. During 1977 NIDA's director, Robert DuPont, visited Bangkok, Geneva, Honolulu, London, Miami, Denver, Houston, Montreal, Nigeria, Paris, Puerto Rico and Rome. The official purpose was to deliver speeches at various drug conventions. A review of the talks indicates that they were all variations of the same basic speech.
When critics call NIDA's cozy circle of bureaucrats "the family," they are not being metaphorical. Consider the case of Lee Dogoloff, a NIDA official who later moved over to the White House as a drug advisor to President Carter. While Dogoloff, an ex-social worker, was at NIDA, his wife, Mary Lou, was paid about $17,000 by a Rochester, New York, firm called BRX to work on a NIDAsponsored study of drug abuse treatment programs in rural areas. She also collected at least $7,200 on another NIDA contract from a Maryland consultant firm named Macro Systems, Inc., whose mission was to update drug treatment manuals used by NIDA program officials. Dogoloff himself hired his wife to accompany him to an official conference in Thailand. He paid for her plane ticket, but the government footed the bill for her salary and expenses. Her job was to "prepare seminar logistics" or, more plainly, to take notes.33
Dogoloff met his wife in the early 1970s when she worked as his assistant in Washington, D.C.'s, Narcotics Treatment Administration (NTA). The director of this program was Robert DuPont, later director of NIDA. Another official in the program was Richard Katon, who was close to both the Dogoloffs and DuPont. The four of them have been picking the fruit of the heroin addiction tree ever since. DuPont became the head of the White House Special Action Office of Drug Abuse Prevention (SAODAP), which evolved as NIDA in 1973. Then Lee Dogoloff was named a top official at NIDA. Richard Katon put aside a career as a medical doctor to form a private consulting firm which soon began winning lucrative NIDA contracts. Mary Lou Dogoloff, whose chief qualification as a drug abuse expert is a BA in English, joined Katon's firm.
Friendship can be almost as useful a credential as marriage when the drug abuse bureaucracy is looking for experts. For example, DuPont's friend Katon obtained a $78,000 contract to "develop NIDA statistical publications." He also was given an $800,000 contract for "Drug Abuse Management Information Technical Assistance." In 1977 Katon won the information contract again, but the cost jumped to $1 million.
This "old boy network" extends to the House Narcotics Committee, which is supposed to oversee NIDA. The committee's chief counsel, Joseph Nellis, said he did not have enough staff to check out allegations properly that NIDA was wasting taxpayers' money. Maybe his wife should have helped. In 1977 NIDA awarded a $150,000 contract to Muriel Nellis. For this she was supposed to assemble a "national coalition on women's issue in substance abuse." The fact is that most of these consulting contracts are not worth the requisition forms they are printed on. They are a form of white-collar welfare that has made government drug abuse consulting a boom industry.
Take, for example, the federal CODAP contract with Macro Systems, Inc. This million dollar plum is for compiling statistics on drug users, their problems and their treatment at NIDA-funded clinics. Unfortunately, the numbers frequently do not jibe with reality, and the jumbled picture they present is of no value to individual treatment programs. But the staff at every NIDAsupported clinic has to spend an inordinate amount of time filling out the complicated computerized CODAP forms. In fact, they must be trained to fill out the forms by still other paid consultants.
What do all these NIDA consulting contracts add to resolving the heroin problem? The millions spent do a great deal for the financial health of a small group of "experts" but nothing directly for the mental health of heroin addicts. In fact, one easily gets the impression that many NIDA officials and consultants have never seen a real addict. All they talk about is "data acquisition," "treatment modalities" and "targeting" federal drug abuse treatment dollars. The plain truth is that the average college student knows more about drug abuse on the streets than the NIDA professionals. This was graphically demonstrated when NIDA and the federal drug abuse bureaucracy failed for ten years to detect the rapid spread of a popular but extremely dangerous dissociative anesthetic, phencyclidine hydrochloride, or PCP. NIDA did not spot the upsurge in its use until the drug already was making headlines in forty states.
NIDA spends 60 percent of its treatment budget on heroin addicts, but devotes only 5 percent of its money to the more than 5 million Americans who abuse barbiturates, which are responsible for far more injuries and deaths than heroin. Heroin addiction obviously is the more politically attractive problem, since it is associated in the public mind with street crime. There is not much political mileage in taking on the drugs that much of middle-class America abuses. Moreover, these prescription medications are produced by large, influential corporations that would not welcome a federal assault on their products. But the teenager who swallows a handful of Valiums at a party, guzzles some tequila and takes a few barbiturates is the one who most often ends up with an overdose in a hospital emergency room.
What we have at NIDA, then, if one looks beyond the blatant conflicts of interest, is a growing band of academic experts, armed with the latest jargon, who are as hooked on federal dollars as their clients are on dangerous drugs.
ADDICTION COST ESTIMATE STUDIES
Most analysts of addiction treatment do not stress the kinds of economic benefits to providers that have been outlined here. The analysts focus instead on the social and economic "costs" of addiction to American society. I have tried to demonstrate that these very costs can be interpreted as benefits to agencies and their personnel.
A recent federal report put the "annual costs" of heroin addiction to the American people at $10 billion—a figure fourteen times the federal government expenditure in 1975 to combat air and water pollution, nearly eight times the federal health research budget, and almost four times the 1975 federal investment in elementary and secondary education. This $10 billion estimate does not include welfare, insurance and other public health costs related to illegal heroin abuse, nor the indirect costs heroin addiction supposedly inflicts on families and communities. The federal report cited the following costs:
1. $6.9 billion in property loss resulting from "drug-related crimes"
2. $1.5 billion in lost productivity costs (absenteeism, unemployment, loss of earnings)
3. $1.1 billion in direct program costs (federal, state, local and private treatment, rehabilitation and prevention, including drug traffic prevention)
4. $620 million for criminal justice system costs (police salaries, court and correctional system costs) in cases directly involving drug offenses
5. $200 million in health costs (hospital emergencies, inpatient and mental health hospital care for drug-related cases)'"
Such huge estimates should be subjected to closer empirical scrutiny, since they suffer from major methodological problems.
UNANALYZED BENEFITS OF HEROINISM
The economic benefits of heroin abuse, such as those outlined above regarding profit makers in the drug abuse industrial complex, must be subtracted from cost-estimate studies. Admittedly, the purpose of such investigations usually is to measure costs. Intelligent public discourse and policy formulation must be based on some sort of cost-benefit analysis, however crude. But when one considers the impressive cost statistics, it is interesting to speculate on the adverse economic effects if heroin abuse were eliminated. Not only drug law enforcement and treatment organizations benefit economically from heroin abuse. Underworld beneficiaries also exist, including opium growers, laboratories converting morphine base to heroin, smugglers, distributors and street-level bagmen.
Illicit heroin use provides a kind of "shadow welfare system" in big American cities. Traffic in goods stolen by addicts represents a broad avenue through which merchandise flows down from the more affluent society into the indigent strata. The fence is the middleman, paying 10 to 20 percent on stolen goods. This secret domestic Marshall Plan is perhaps one of the more successful and less well-advertised anti-poverty, pro-business programs in the nation.
The nonaddicted disadvantaged population benefits because valuable and desirable stolen goods are available at vastly reduced prices: stereos, tape decks, kitchen appliances, color television sets, new clothes, auto parts, and so on. Even those who have property stolen by addicts from their homes, apartments and businesses sometimes benefit by lodging inflated claims against insurance companies who, in turn, benefit by raising the cost of premiums to cover their losses. Anti-theft insurance is booming.
The government benefits indirectly by the fact that the poor can acquire merchandise such as clothing and other household items which otherwise would have to be supplied through public assistance at taxpayers' expense. Benefits to manufacturing abound. Small appliance producers and their employees should realize, for example, that for every MixMaster "ripped off" by an addict, a replacement is usually purchased at retail price. Burglar alarm manufacturers and installers have never been so busy, and parallel private police systems have sprung up to guard against residential than public police in America. Large department stores and supermarkets, who budget for "shrinkage" due to shoplifting by addicts, manage to sidestep disaster by passing their losses along to customers who, in turn, demand raises at work to help defray the higher cost of living. One begins to see that heroin abuse plays a part in the inflationary spiral. Secondhand stores, pawnbrokers, swap meets and flea markets would undoubtedly feel the pinch if their supplies of goods stolen by addicts were suddenly reduced. The list and ramifications go on. The point is, these "benefits" are not addressed in heroin addiction "cost-estimate" studies.
For the present, the government should do the public a service by quietly interring the $10 billion heroin "cost" figure and honestly recognize the economic benefits heroinism produces for upper- and underworld people and organizations.
UNDERWORLD BENEFICIARIES OF HEROIN CRIMINALIZATION
The upper-world interests discussed above are just one element of the drug abuse industrial complex. Heroin directly provides a profit-making system with an expansive infrastructure of growers, couriers, distributors, salesmen, customers, cutmen, bagmen, bag followers, fences and informants. Dealing heroin is an important means of social mobility for individuals who, because of ethnic/ racial background and lower-class position, are blocked from advancement in the more respectable "channels." This subeconomy in dope probably plays a role in thwarting potential and real dissent among the poor over the existing allocation of legal jobs and opportunities which the dominant society holds:
Politics and the rackets have furnished an important means of social mobility for individuals who, because of ethnic background and low class position, are blocked from advancement in the "respectable" channels.35
Merton also felt that the culturally induced success goal exerts pressure on the disadvantaged to engage in criminal behavior as the only available means of getting ahead.
Economist Paul Bullock has argued that one critical reason for the existence of heroin subeconomies is that it has been profitable to important sectors of the regular economy:
Society has deemed the preservation of the subeconomy [in heroin] preferable to the establishment of family income guarantees at a level above the poverty line, or the reform of existing employment structures to accommodate the needs of those excluded.36
In other words, the existence of the subeconomy in junk helps thwart dissent among the urban poor over the existing allocation of legal jobs and opportunities which the dominant society controls. Hustling dope:
. . . contributes to the quasi-stable social existence in slum areas capable of exploding from the tremendous economic and social tension generated by poverty, uncertainty, hunger, disease, and insecurity. . . . Instead of sporadic or permanent explosions, crime, narcotics selling and gambling operate as social depressants built into the life of the ghetto."
So much of the so-called "heroin problem" is the consequence of class and culture conflict over the distribution of opportunities in society and over approved forms of recreation and entertainment that to eliminate heroinism would require almost unimaginable social reform. In many ways the heroin subeconomy in America helps perserve the status quo.
1. On the manifest and latent functions of public policy and organizations, see Robert K. Merton, Social Theory and Social Structure, 3rd ed. (New York: Free Press, 1957), p. 199.
2. Dwight D. Eisenhower, Public Papers of the Presidents of the United States, Dwight D. Eisenhower, 1960-1961 (Washington, D.C.: U.S. Government Printing Office, 1961), p. 1037.
3. On the social service "pork barrel," see Walter Shapiro, "The Two Party Pork Barrel," The Washington Monthly, April 1975, pp. 24-30; and David A. Stockman, "The Social Pork Barrel," The Public Interest 15 (Spring 1975): 3-30.
4. Shapiro, "Two Party Pork Barrel," p. 25.
5. Michael R. Sonnenreich, "Discussion of the Final Report of the National Commission on Marijuana and Drug Abuse," Villanova Law Review 18 (May 1973): 818.
6. Commission to Investigate Allegations of Police Corruption and the City's Anti-Corruption Procedures, (Knapp Commission), Report, in Police Corruption: A Sociological Perspective, ed. Lawrence W. Sherman (New York: Anchor Books, 1974), pp. 30-31.
7. Ambrose quoted in "Ambrose Critical of Local Efforts," Los Angeles Times (March 30, 1972), Pt. II, p. 1.
8. Mitchell quoted in "Attorney General Sees Problem in Drug Law Enforcement," Los Angeles Times, (January 29, 1972), Pt. I, p. 7.
9. See "Bell Wants Panel to Pick FBI Chief; Plans Drug Agency End," Long Beach Independent Press-Telegram, (February 11, 1977), p. A-16.
10. This view of DEA is suggested by a respected economist, Thomas C. Schelling, "Economics and Criminal Enterprise," The Public Interest 7 (Spring 1967): 61-78.
11. Commission to Investigate Allegations of Police Corruption and the City's Anti-Corruption Procedures, (Knapp Commission), Report, in Police Corruption, ed. Sherman, p. 135.
12. Among the relevant cases here are Angello v. United States (1925); Johnson v. United States (1948); Rochin v. California (1952); Jones v. United States (1960); Wong Sun v. United States (1963); Kerr v. California (1963); and Delaware v. Prouse (1979).
13. See Olmstead v. United States (1928) (prohibition); and Lee v. United States (1952) (narcotics).
14. Thomas S. Szasz, Ceremonial Chemistry: The Ritual Persecution of Drugs, Addicts, and Pushers (New York: Doubleday, 1974), pp. 56, 108.
15. Harmon L. Zeigler and G. Wayne Peak, Interest Groups in American Society 2nd ed. (Englewood Cliffs, N.J.: Prentice-Hall, 1972), p. 164.
16. Philip Selznick, TVA and the Grass Roots (Berkeley, Calif.: University of California Press, 1949).
17. On the cooptation of minorities and the poor into social service bureaucracies, see Dale Rogers Marshall, The Politics of Participation in Poverty: A Case Study of the Economic and Youth Opportunities Agency of Greater Los Angeles (Berkeley, Calif.: University of California Press, 1971); and Paul B. Fischer, "The 'War on Poverty' and the 'Blackening' of Urban Bureaucracies," Policies Studies Journal 2 (March 1974): 179-86.
18. Peter Goldberg, "The Uses and Abuses of Urinalysis," in Developments in the Field of Drug Abuse: Proceedings of the National Drug Abuse Conference-1974, ed. Edward C. Senay, Vernon Shorty, and Harold Alksne (Cambridge, Mass.: Schenkman Publishing Co., 1974), p. 932.
19. Paul M. Blachly, Letter to the Editor, Journal of the American Medical Association 238 (July 4, 1977): 27.
20. David C. Lewis et al., "The Ethics of 'Ethical' Drug Promotion," in Developments in the Field of Drug Abuse, ed. Senay, Shorty, and Alksne, p. 968.
21. Medical World News (May 31, 1976), p. 9.
22. Ibid., p. 10.
23. On drugging in schools, see Edgard Z. Friedenberg, "Schools Out," New York Review of Books (November 23, 1975), pp. 30-35; and Peter Schrag and Diane Divoky, The Myth of the Hyperactive Child and Other Means of Child Control (New York: Pantheon Books, 1975).
24. John Pekkanen, The American Connection (New York: Follet Books, 1973), chapters 1-5.
25. Reported in: "Federal Agency Lists Most Widely Abused Drugs," Journal of the American Medical Association 236 (August 2, 1976): 432.
26. For example, The Western Journal of Medicine, which generally contains very little advertising, devotes its full back cover to Valium in The Western Journal of Medicine 133 (December 5, 1980).
27. Pekkanen, The American Connection, chapter 1.
28. Albert W. Biderman and Laure M. Sharp, The Competitive Evaluation Research Industry (Washington, D.C.: Bureau of Social Research, 1972).
29. Amitai Etzioni and P. Doty, "Profit in Not-for-Profit Corporations: The Example of Health Care," Political Science Quarterly 91 (Fall 1976): 433-40.
30. "State Names Doctors on Medi-Cal $100,000 List," Los Angeles Times(November 1, 1975), Pt. I, p. 20.
31. "Bronx Drug Program Under Investigation," New York Times (March 29, 1977), p. 1.
32. "HEW Investigation," Science 193 (June 1978): 200.
33. H. Kurtz, "The Drug Abuse Hustle," The New Republic (April 15, 1978), p. 10.
34. "Heroin Use in U.S. on Increase Again," Los Angeles Times (December 13, 1974), Pt. I, p. 1.
35. William F. Whyte, "Social Organization in the Slums," American Sociological Review 8 (February 1943): 8, 34-39.
36. Paul Bullock, "Youth in the Labor Market: Employment Patterns and Career Aspirations in Watts and East Los Angeles" (Los Angeles: Institute of Industrial Relations, University of California, Los Angeles, mimeographed), p. 241.
37. Stanley Friedlander and Robert Shick, Unemployment in the Urban Core: An Analysis of Thirty Cities with Policy Recommendations (New York: Praeger Publishers, 1971), pp. 188-89.