The Fix by Michael Massing
by Michael Massing
Simon & Schuster. 320 pp. $25.00
Since the end of the 1960’s, when drug abuse first surfaced as a widespread social problem in the United States, successive national initiatives have been launched to bring it under control. They have followed a dismayingly cyclical pattern.
Typically, a new finding about the expanding scope of drug use is announced with great alarm. Cover stories in Time and Newsweek follow, and then comes a presidential initiative. A new task force or agency comes into being, with a budget featuring a greater commitment of funds. Then the downswing begins. Political conflict arises over the allocation of the money. Advocates of drug treatment decry the sums spent on law enforcement. Mayors besiege Congress with complaints that federal funds never reach their cities. Newspapers report the bickering, and public interest wanes. The crisis that only yesterday was rightly said to be poisoning an entire generation fades temporarily from view.
In short, it would appear that Washington is much better at responding to short-term public anxiety about drugs than at reducing drug use over the long term. Michael Massing, however, takes an even dimmer view. “It would be hard,” he writes in his new book, The Fix, “to think of an area of U.S. social policy” where the federal government “has failed more completely.”
For over a decade now, Massing has been subjecting our drug policy to skeptical inquiry in the New York Review of Books and elsewhere, picking up a MacArthur Foundation “genius grant” in the process. In The Fix, he provides a detailed account of that policy from the Nixon era to the current moment. Interspersed throughout his narrative are portraits of what drug addiction looks like up close in New York City’s Spanish Harlem. Though a critic of legalization, Massing believes that law enforcement is the wrong vehicle for combating drugs. Instead, he favors vastly expanding treatment for heroin and cocaine addicts.
Surprising as it may sound, Massing regards the Nixon era as a kind of golden age of enlightened drug policy. The hero of the tale, in his account, is Jerome Jaffe, a psycho-pharmacologist at the University of Chicago who, having established one of the earliest state drug-treatment programs, was summoned to Washington in 1971 to help address the rise in heroin addiction among GI’s returning from Vietnam. Jaffe soon found himself installed at the head of the Special Action Office for Drug Abuse, which made him, in effect, the nation’s first “drug czar.”
According to Massing, Jaffe and his colleagues viewed themselves not as law-enforcement officers but as scientists responding to a medical problem. Their primary tenet was that reducing demand for drugs should take precedence over reducing supply. Translated into practical terms, this meant above all providing treatment to chronic abusers, while relegating to a subsidiary level of urgency any measures to curtail the distribution and sale of illegal drugs.
After the Nixon years, little in the history of U.S. drug policy meets with Massing’s approval. He especially dismisses as ineffective the various domestic and international law-enforcement initiatives adopted by Presidents Ford, Carter, Reagan, Bush, and Clinton. (For part of the Bush period, I worked under William J. Bennett in the Office of National Drug Control Policy.) The country’s heroin and cocaine addicts, he asserts, are desperate for a way out. To reach them, we should pick up where Jerome Jaffe left off and fund “treatment on demand.”
The Fix does an admirable job of illustrating the unglamorous and destructive nature of drug abuse; its portraits of abject addicts and unspeakably cruel dealers are vividly drawn and deeply disturbing. Yet as a history of U.S. drug policy the book is seriously flawed, and as a set of policy prescriptions even more so.
To begin with, there is simply not much that is new in The Fix, The story it tells of the Nixon administration, for example, has been told before, most notably by Edward Jay Epstein in Agency of Fear (1977), a book that takes a far less charitable view of the period. There are also some curious gaps in Massing’s narrative. While it is true that under Nixon the federal government embarked on an aggressive attempt to rehabilitate heroin addicts, Massing only briefly describes how Nixon also acted vigorously in the law-enforcement area, striking to break up heroin rings that were centered in Marseilles. This disruption of the “French Connection” was essential to making heroin temporarily harder to find in the United States, which in turn prompted many addicts to seek treatment. Though it may offer the key to whatever success Nixon’s drug policy enjoyed, Massing tells us very little about this nexus between “supply” and “demand.”
Nor is this Massing’s only omission. In 1989, President Bush announced a 53-percent increase in federal spending on drug treatment. The Clinton administration has augmented funding for treatment to an even greater extent. How has the money been put to use? Has it made a difference? Though such questions have obvious bearing on the thesis of The Fix, Massing never explores them.
Another set of difficulties arises with Massing’s policy recommendations. His favored program corresponds in every respect to the conventional wisdom of the “treatment community”—the loose collection of physicians, psychotherapists, and miscellaneous Ph.D.’s who believe that drug addiction should be handled on a voluntary basis by public-health authorities rather than coercively by the criminal-justice system. But the remedies offered by the treatment community are only partial at best.
While it is certainly true that addicts who successfully complete treatment tend not to relapse into continuous drug use and criminality, a very high percentage of those who begin therapy subsequently drop out. Simply making rehabilitation programs available for the asking would therefore do little good. Indeed, Massing’s own vivid portraits of addicts in Spanish Harlem show how difficult it is to convince those under the spell of narcotics to seek help.
A number of studies demonstrate, moreover, that an approach Massing shuns—namely, compulsion—is an essential tool for helping addicts turn their lives around. According to an investigation conducted by the Research Triangle Institute, as many as 50 percent of patients who enter drug treatment do so under some form of legal duress. Another study reveals that approximately 90 percent enroll in therapy only in response to a court order or when faced with the threat of imprisonment, dismissal from work, or the demand of an angry spouse.
In any case, hard-core drug use is by no means the crux of the problem that Massing makes it out to be. What he refuses to recognize is that every drug addict begins as a casual user; even Jaffe’s efforts were designed, as Massing himself writes, “to find a way to prevent the dabblers from becoming addicts.” Throughout The Fix, we are introduced to characters in Spanish Harlem who, while not yet junkies or crack-heads, are headed down a treacherous path. Yet Massing opposes all measures that would keep such dabblers on the straight and narrow. In particular, he sees no role for government in shaping attitudes toward drug use, especially among the young.
If we have learned anything over the past several decades, however, it is that public attitudes are vital in keeping drug use in check. Recent data from cities that test every arrestee for drugs—one of the best indicators of trends in consumption—show that cocaine is increasingly the drug of an older cohort whose appetite is difficult, perhaps impossible, to sate. Among younger arrestees, by contrast, the consumption of cocaine, while still high, has declined. This suggests that our recent mix of domestic law-enforcement measures and a less tolerant public culture may be acting as a deterrent for young people. Unfortunately, Massing has nothing to say about this fascinating trend or about what it may mean.
What he does say, over and over again, is that federal efforts to interdict drugs have consistently failed to produce a long-term impact on their availability. About this he is right. But that hardly means that all law-enforcement efforts are in vain. The New York City police department, for example, has carried out much-publicized operations to break up drug-trafficking in troubled neighborhoods. While such programs may offer only short-term success, they still have made life bearable again for many inner-city dwellers. Yet even they come in for censure in The Fix. The “lopsided reliance on enforcement,” writes Massing in a passage of stunning irrelevance, is “sucking up resources that could have otherwise been used to hire more teachers, build more schools, and buy more textbooks.”
For a journalist who has been writing about drug policy for so long and to such acclaim, Massing too seems to have remained caught in an infinite loop, in his case one of tired political thinking: his chief proposal is the creation of yet another federal drug office, this one modeled on Jerome Jaffe’s during the Nixon years. If we are ever to break out of the analytic cycle, it will not be by ignoring or rejecting approaches that have actually worked, tendentiously rewriting history, or mindlessly resurrecting the discredited slogans of the past. This applies to those who devise and implement our drug policy, and it applies no less strenuously to their critics.