Did Nixon Get the Struggle on Medicine Proper? Michael Massing’s The Repair

The Repair by Michael Massing. Berkeley, CA: College of California Press, 2000, 335 pp., $25.00.

The mud jacket of Michael Massing’s The Repair summarizes his thesis in daring purple letters: “Under the Nixon Administration, America Had an Effective Drug Policy. WE SHOULD RESTORE IT. (Nixon Was Right).” That may be a fairly extraordinary declare to make relating to an administration that gained workplace largely by the “Southern Strategy” that had at its coronary heart Nixon’s declaration of a “War on Drugs” and whose insurance policies created the cocaine epidemic that precipitated so many new issues a decade later. At most, I might agree that the Nixon administration’s pursuit of a essentially unhealthy coverage included some worthwhile efforts which were devalued by each subsequent administration. This was not as a result of Nixon or his closest advisers have been proper about drug coverage however as a result of Nixon was extra curious about international coverage points and his benign neglect of home coverage allowed various constructive developments to blossom within the midst of the mire of incompetence and corruption that characterised his presidency.

Perceptively concluding that “policies being formulated in Washington today bear little relation to what is taking place on the street,” Massing makes an attempt to depict the actual results of drug coverage on the avenue stage. Sadly, he would not depend on the epidemiologic proof or learn the cautious analyses performed by researchers like myself who’ve systematically examined what is really going down on the road. As an alternative he depends on the journalist’s ordinary — and normally deceptive — software of dramatic anecdotes.

Massing’s anecdotal case is introduced by the tales of Raphael Flores and Yvonne Hamilton. Flores runs Scorching Line Cares, a drop-in heart for addicts in Spanish Harlem. Scorching Line Cares, which Flores based in 1970, is actually only a cramped workplace in of an in any other case deserted tenement the place Flores and his workers advise and help addicts who wish to get into remedy. Given the fragmented state of drug abuse remedy in New York Metropolis, and in most different American communities, it’s no simple job to attach addicts with acceptable care and even more durable to attach them with ample aftercare. Massing writes, “If a Holiday Inn is full, it will at least call the Ramada down the street to see if it has a vacancy. Not so two treatment programs”

Yvonne Hamilton is a crack addict making an attempt to get her life collectively. Massing describes her trials and tribulations as she copes together with her sickness and makes her means by New York Metropolis’s remedy non-system. It’s an affecting story and nicely informed. The creator presents it as an argument for remedy and perversely as an argument towards decriminalization or legalization. However she is among the many examples that present that prohibition doesn’t forestall dependancy. And enhancements in her drug downside appear to have much less to do with the remedy she did obtain than with adjustments in her life scenario.

These two lives present a touchstone to which his narrative will later return. The center third of the ebook shifts dramatically in tone as Massing chronicles the evolution of the struggle on medicine in Washington. Throughout Nixon’s tenure, the federal government spent extra money on remedy (the “demand” aspect) than on stopping drug trafficking (the “supply” aspect), which he argues led to declines in each drug overdoses and crime charges. As successive presidents felt strain to emphasise the “war” fairly than remedy, he asserts that the variety of persistent addicts skyrocketed. Within the third and final part Massing returns to Spanish Harlem, the place Hamilton continues a tough wrestle to stay drug-free and Flores struggles to maintain his heart afloat and to maintain from falling into dependancy himself.

It’s the second a part of the ebook that’s the coronary heart of Massing’s thesis. It’s a story that’s acquainted to these of us who’re lively within the discipline of drug coverage and, along with students, different journalists have informed it earlier than — Dan Baum (1996) and Mike Grey (1998) doing so significantly nicely — however I’ll summarize (with some particulars Massing missed or ignored) the historical past of drug coverage underneath Nixon for the reader who isn’t accustomed to the story.

In 1968, as Richard Nixon was making his comeback run for the presidency, he adopted the “Southern Strategy” that has been the important thing to Republican victories in presidential races ever since. Because the finish of Reconstruction each Democratic presidential candidate had been in a position to depend on the votes of the “solid South” however the Northern Democrats’ assist for civil rights had been the reason for growing disaffection within the South, as epitomized by Strom Thurmond’s unbiased run for President towards Truman in 1948. Then, in 1964, Alabama Governor George Wallace’s bid for the Democratic nomination for President confirmed that racism received votes within the North in addition to the South. Nixon needed to win the South, in addition to racists’ votes within the North, with out offending extra conventional Republican voters by an brazenly racist marketing campaign. The reply Nixon and his advisers discovered was to marketing campaign towards crime, which most People fairly falsely equated with minorities. So what if the crime price was really declining, People appear to all the time imagine that crime is growing simply as they appear to all the time blame it on cultural or racial outsiders.

Even higher than campaigning towards crime, the Nixon staff quickly realized, was campaigning towards medicine. Most People, once more falsely, equated drug customers with violent criminals. Higher nonetheless, for that nice “silent majority” whose votes they sought a marketing campaign towards medicine symbolized a marketing campaign towards each Blacks and far hated hippies and anti-war protestors. When Nixon declared “war on drugs” he was interesting to the basest components of the American voters and it labored, simply because it has labored for different candidates since.

The success of his anti-crime/anti-drug marketing campaign introduced Nixon with a severe dilemma when he took workplace – individuals have been anticipating outcomes. At first his administration thought-about admitting that constitutionally crime management was a state duty and proposing to behave by assist of coaching applications and grant-in-aid to state and native police forces, however his strategy had little political pizzazz and was largely deserted after it did not impress the general public. Nixon had some concepts of his personal, reminiscent of a nationwide obligatory demise penalty for promoting medicine – a technique that has been tried in Crimson China and in Singapore and has clearly failed in each nations – however happily he was extra curious about international coverage and left the seek for an answer to the drug downside within the fingers of John Ehrlichman and the White Home Home Coverage Council.

Inside the Home Coverage Council Egil “Bud” Krogh Jr., a younger lawyer who is best remembered as the person who headed the White Home “plumbers” of Watergate fame, was charged with duty for locating a strategy to visibly affect medicine and crime earlier than the 1972 election. Massing portrays Krogh as one thing approaching the tragic hero of the story, however I am unsure that many aside from Massing and Krogh himself maintain such a constructive view of his public service. In any case, it’s true that Krogh performed a key function in shaping each the nice and the unhealthy within the Nixon administration’s drug insurance policies.

In considered one of his different roles as liaison to the federal government of the District of Columbia, Krogh had turn into acquainted with psychiatrist Robert Dupont who was working one of many early methadone upkeep applications in DC. Krogh was reluctant to just accept a upkeep strategy to dependancy however he did see that it was the one strategy that truly had some proof of effectiveness. In June of 1970, Krogh despatched the Council’s youngest lawyer Jeffrey Donfeld to go to methadone applications in New York and Chicago, together with the primary such program, which was directed by Vincent Dole and Marie Nyswander of Rockefeller College, and a “mixed modality” mannequin developed by College of Chicago psychiatrists Jerome Jaffe and Edward Senay.

Donfeld was doubtful concerning the claimed effectiveness of methadone remedy and much more doubtful about its political acceptability – in phrases which have since turn into acquainted, he questioned if it might ship the incorrect message. Donfeld discovered Jaffe specifically to be “politically sensitive” to the emotional points concerned in methadone upkeep. Donfeld believed that the “mixed modality approach,” which he referred to as “different strokes for different folks”, by providing a spread of remedies that included cleansing, drug-free, and upkeep approaches, successfully masked the methadone program from political criticism.

A lot as Raphael Flores is the hero of the primary a part of the ebook, Jerome Jaffe is Massing’s hero for the second half. Jaffe has described his assembly with an basically clueless Nixon. He sidestepped Nixon’s concept of the demise penalty for sellers and prompt that the one worth of regulation enforcement is likely to be in pushing up the road value of medication and thus encouraging extra addicts to hunt remedy – this concept was later taken up by Peter Reuter of the Rand Company however his analysis confirmed that the impact of aggressive regulation enforcement on provide was basically nil and on value was tiny.

Jaffe tried to make 4 factors in his assembly with the President an d every was to bear fruit in shaping the way forward for drug coverage underneath Nixon. The primary was the necessity for extra analysis and analysis of remedy. The enlargement of a small division throughout the Nationwide Institute of Psychological Well being right into a Nationwide Institute on Drug Abuse and a Nationwide Institute on Alcoholism and Alcohol Abuse grew partially out of this advice. Second, he famous that presently there have been a dozen completely different federal businesses funding remedy that did not even discuss to one another. He felt that coordination of all these efforts was wanted in pursuit of a coherent nationwide technique. This led to the creation of the Particular Motion Workplace for Drug Abuse Prevention, which he was startled to seek out himself appointed director of, because the nation’s first “drug czar”. Third, given the extent of heroin dependancy, he urged that methadone upkeep shouldn’t be restricted to some small analysis initiatives however ought to be made broadly obtainable. Fourth, he urged that funding for remedy be dramatically elevated. These final two factors have been on the coronary heart of what Massing refers to as “The Fix”.

Jaffe’s first large White Home project was to develop a plan for controlling the skyrocketing prevalence of heroin use amongst U.S. servicemen in Vietnam, which concerned 10 to 15 p.c of all GIs in Vietnam if no more. Pentagon coverage was that heroin use was a criminal offense and that any serviceman who used heroin ought to be arrested and prosecuted. The results of this was an over-burdened navy justice system however no discount in heroin use. Jaffe urged that the Pentagon ought to undertake a remedy strategy as a substitute of a punitive one.

Massing means that Jaffe’s answer relied for its effectiveness on the GIs’ overpowering need to return to the USA. He suggested the Pentagon to topic all GIs to urinalysis earlier than delivery them residence. GIs who examined constructive for heroin must keep in Vietnam for detox. The navy’s response to his plan was to object that it might play havoc with the advanced logistics of troop motion, to which Massing studies that Jaffe replied, “I cannot believe that the mightiest army on Earth can’t get its troops to piss in a bottle” When his plan was carried out, Massing studies that the proportion of GIs utilizing heroin shortly dropped by greater than half.

Jaffe himself tells it fairly in a different way. It seems that as an instructional and researcher he was conscious of the rising proof that almost all heroin customers don’t turn into addicted and the early follow-ups exhibiting that a lot of the troops who have been hooked on heroin in Vietnam abstained efficiently, and normally with none remedy, after returning residence (Jaffe and Harris, 1974). He did not idiot himself into believing that the urine screening program really deterred heroin use among the many troops whereas serving in Nam. What he anticipated was that after phrase of the urinalysis received round heroin utilizing GIs who weren’t addicted would cease utilizing for the final weeks earlier than rotation residence and solely the actually addicted could be unable to take action and thus fail the urine take a look at. That is apparently what occurred however it gave the politically helpful look of a far higher success. The traditional follow-up examine by Robins, et al. (1980) confirmed that a lot of the GIs who turned hooked on heroin whereas serving in Vietnam recovered totally and completely after returning to the US and likewise discovered that restoration charges weren’t improved by receiving remedy – a discovering the implications of which I mentioned in a number of publications of that interval (Duncan, 1974, 1975, 1976 & 1977).

I imagine that the fast restoration of Vietnam addicts demonstrates that for a lot of the GIs who turned addicted, heroin use served as a coping mechanism for coping with the stress of serving in a struggle zone. The aid they obtained by utilizing heroin served as a damaging reinforcer and damaging reinforcement produces highly effective habituation. As soon as they returned residence their heroin utilizing habits extinguished in an atmosphere the place for many of them it was now not being strengthened. Those that continued of their dependancy, in keeping with Robins, et al. (1980), have been those who returned to situations of poverty, an alcoholic mother or father, and many others. – precisely those who would proceed to wish a stress reliever. Therapy was far much less related than environmental change, which is what Moos and his coleagues have discovered to be true for alcoholism remedy (Moos, Finney, & Cronkite, 1990; Finney & Moos, 1992).

As Massing studies, Jaffe was in a position to persuade the Nixon administration to extend funding for drug abuse remedy eightfold over what it had been when Nixon took workplace. For the one time to date since America started its failed experiment with drug prohibition, the remedy price range was bigger (twofold) than that for drug regulation enforcement. Massing attributes a decline in narcotics-related deaths and in crime charges to this price range improve and a greater than 300 p.c improve within the variety of individuals in remedy. It might be good for remedy advocates like me if that was true however no educated analyst is prone to agree that it’s.

Whereas extra addicts in remedy in all probability performed some function in lowering the numbers of narcotics-related deaths, there have been two different elements that in all probability performed a far higher function. First, was the introduction in 1971 of naloxone (NarcanĀ®), a full narcotic antagonist, which changed nalorphone (NallineĀ®), a partial narcotic antagonist, because the drug of alternative for treating narcotic overdoses. Second, was the rising reputation of amphetamines and different stimulants leading to them changing heroin as the first drug of dependancy in America. This may occasionally even have contributed to the reducing demise price in a tertiary trend by lowering demand for heroin and due to this fact lowering the worth and growing the purity of heroin on the road which would scale back deaths that always outcome from allergic reactions to the impurities in illicit heroin.

There’s robust proof that the provision of methadone upkeep in a neighborhood with giant numbers of heroin addicts will carry a couple of discount in charges of property crimes, particularly the burglaries and petty thefts that addicts most frequently have interaction in to lift cash to assist their behavior. It is vitally doubtless that the enlargement of this modality underneath Nixon and Jaffe did decrease crime charges. Crime charges, nonetheless, have been already trending downward and the continuation of that development was in all probability extra necessary than any authorities coverage.

The gravest defect of The Repair lies in its tacit assumption that the overall path and aim of our nation’s present drug coverage is ok and simply wants some tinkering with its price range priorities in an effort to “fix” it. Nicely, Nixon did not repair it, nor will or can any future president. The aim of eliminating leisure drug use has by no means been achieved wherever neither is there any good cause why society ought to be higher for attaining such a aim.

I directed one of many early remedy facilities to make the most of the “mixed modality” strategy that Jaffe advocated and I proceed to imagine in its worth. The fragmented state of most remedy companies as we speak, so nicely illustrated by Massing’s two examples, actually is a severe barrier to the effectiveness of remedy. So I will surely agree with Massing that America would profit enormously from each a return to higher funding for remedy and using multimodality remedy. However no public well being downside might be adequately managed by remedy, or secondary and tertiary prevention as we in public well being choose to name it. It is just by major prevention that an issue as large as drug dependancy might be meaningfully lowered. It actually can’t be lowered by working a system wherein between a 3rd and two-thirds of the present sufferers do not want any remedy in any respect as a result of their drug use is leisure and never addictive.

Efficient major prevention of drug abuse, nonetheless, needs to be one thing far completely different from telling individuals to “just say no” and telling prophylactic lies to youngsters in D.A.R.E. lessons. To begin with, efficient prevention (major, secondary or tertiary) should concentrate on the precise downside of dependancy fairly than on all use of sure chosen medicine. Most customers of any of the broadly used medicine, except nicotine customers, should not addicted, should not at nice danger of changing into addicted, should not doing any substantial hurt to themselves, and are not harming anybody else by their use of the drug. Even a small proportion of tobacco people who smoke should not addicted and should not harming themselves by smoking. Society has no legitimate curiosity in stopping drug use however a really clear curiosity in stopping dependancy.

Second, major prevention can’t be achieved by scaring individuals — least of all by scaring them with lies. Packages like D.A.R.E. make a powerful impression on many preadolescents and early adolescents who swear they’re by no means going to make use of medicine however by their mid-teens most of them have discovered by commentary that a lot the D.A.R.E. officer informed them was lies and they aren’t solely able to experiment with medicine however cynical in viewing any legitimate warnings they may obtain from adults about actual dangers. Efficient prevention have to be based mostly on information not scare tales. As an alternative of insisting that youngsters ought to keep drug-free ceaselessly, which nearly nobody in our society is or ought to be, we ought to be instructing them easy methods to responsibly assess medicine and conditions of use in order that they will select properly what and when and the way relating to drug use.

Criminalizing medicine and drug use makes all ranges of prevention tougher. No drug consumer or abuser goes to be higher off for being arrested. Therapy within the prison justice system is a good suggestion for many who are arrested for actual crimes reminiscent of theft or assault however remedy within the prison justice system is all the time preventing an uphill battle towards the hurt executed by the system. Quite a few research have proven that any type of punishment for drug use will increase the probability that the drug consumer will turn into or persist in being addicted.

Massing is a really advantageous journalist however he would not have the background essential to conduct a significant evaluation of drug coverage and its results. You’ll be able to’t be taught to be a physicist by watching Nova specials and you are not going to achieve a lot of an understanding of drug coverage by studying books like The Repair. As an introduction to the issues within the discipline it has benefit however I might suggest the equally nicely written journalistic accounts by Baum (1996) or Grey (1998).


Baum, D.(1996). Smoke and Mirrors: The Struggle on Medicine and the Politics of Failure. New York: Little Brown.

Duncan, D. F. (1974). Reinforcement of drug abuse: Implications for prevention. Scientific Toxicology Bulletin, four(2), 69-75.

Duncan, D. F. (1975). The acquisition, upkeep and remedy of polydrug dependence: A public well being mannequin. Journal of Psychedelic Medicine, 7(2), 207-213.

Duncan, D. F. (1976). Stress and adolescent drug dependence. Medical Science, four, 381

Duncan, D. F. (1977). Life stress as a precursor to adolescent drug dependence. Worldwide Journal of the Addictions, 12 (eight), 1047-1056.

Finney, J. W., and Moos, R. H. (1992). The long-term course of handled alcoholism: II. Predictors and correlates of 10-year functioning and mortality. Journal of Research on Alcohol, 53 (2), 142-153.

Grey, M. (1998). Drug Loopy: How We Acquired Into this Mess and How We Can Get Out of It. New York: Random Home.

Jaffe, J. H., and Harris, G. T. (1973). So far as heroin is worried, the worst is over. Psychology At present, 85, 68-79, 85.

Moos, R. H., Finney, J. W., and Cronkite, R. C. (1990). Alcoholism Therapy: Context, Course of, and Consequence. New York: Oxford College Press.

Robins, LN, Helzer, JE, Hesselbrock, M, and Want, E. (1980). Vietnam veterans three years after Vietnam: how our examine modified our view of heroin. In: L. Brill and C. Winick (Eds), The Yearbook of Substance Use and Abuse, vol. II. New York: Human Sciences Press, pp. 213-230.

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