Pubdate: 17 Dec 1998
Source: The New York Review of Books 
Copyright: 1998 The New York Review of Books 
Page: p4
Author: Malcolm Gladwell 
Note: Our newshawk writes: "The NY Review of Books has usually ignored
books on drugs and drug policy, so this review, the first item in the
issue, is unusual. As for Letters to the Editor, they seldom publish any
except from well-known persons. But anyone with some credentials after his
name, please do write on this one to at least encourge the them to follow
up with more such reviews."


a review of:

The Fix by Michael Massing 335 pages, $25.00 (hardcover) published by Simon
and Schuster

Drug Crazy: How We Got into This Mess and How We Can Get Out by Mike Gray
251 pages, $23.95 (hardcover) published by Random House


On a hot, muggy night in the summer of 1976, Ron and Marsha "Keith"
Schuchard held a thirteenth-birthday party for their daughter in the
backyard of their suburban Atlanta home. The Schuchards were English
professors, comfortably middle class, and they worried about their
daughter. Her personality had suddenly taken a turn for the worse. She was
moody and indifferent and only wanted to hang out with her friends. When
she asked for a party, the Schuchards were briefly encouraged, because they
thought she was coming out of her shell. But as the night wore on, they
grew more and more alarmed.

The "guests"--many of whom they had never seen before--kept to the shadows
of the backyard. Cars pulled up in the driveway, with teenagers yelling
"Where's the party?" One girl tried to use the phone but seemed to have
difficulty dialing. Looking out on the gathering from their upstairs
window, the Schuchards could see little flickers of lights in the corners
of the lawn. Finally, when the last of the kids had gone home, the couple
went outside in their pajamas and crawled around in the backyard grass with
flashlights, trying to figure out what had happened. They found beer cans
and empty wine bottles. But what they also found--and what bothered them
the most--was marijuana butts and roach clips.

That teenagers occasionally do things--and ingest things--that do not meet
the approval of their parents is not, of course, all that unusual. But this
particular case was different. In fact, in his new book, The Fix, Michael
Massing locates the beginning of what he calls the drug counterrevolution
at that moment, late at night, in the suburbs of Atlanta. The Schuchards
decided that the reason for their daughter's disaffection was not normal
adolescent angst, nor was it the malt liquor and the wine. It was the
marijuana. "We had a sense," Keith Schuchard would say later, "of something
invading our families, of being taken over by a culture that was very
dangerous, very menacing." The next morning, Schuchard demanded that her
daughter give her the names of everyone at the party, and called each
parent in turn. She began researching the dangers of marijuana. She fired
off a letter to Robert DuPont, the director of the National Institute on
Drug Abuse (NIDA), and so impressed him when they met that he asked her to
write a handbook on parents and drug abuse. She obliged with Parents,
Peers, and Pot, a vitriolic attack on the drug culture that claimed pot did
everything from causing "enlarged breasts" among adolescent boys to
destroying the immune system. It was the biggest best seller in NIDA
history, with more than a million copies printed.

By this point, Schuchard had hooked up with a neighbor, Sue Rusche, and
formed Families in Action, the country's first antidrug parents' group, and
was intensively lobbying the president's drug adviser. By 1980, she and
other concerned parents had joined together to form another, still larger
antimarijuana group, the National Federation of Parents for Drug-Free Youth
(NFP), and by January of the following year, with the election of Ronald
Reagan, the NFP became one of the most powerful grass-roots lobbying groups
in the land. "The dream we dared to speak of rather timidly three years ago
in this auditorium," Schuchard said at a national drug abuse convention in
the spring of 1981, "seems well on its way to realization--that is, the
growth of the parents' movement for drug-free youth from a handful of
scattered individuals and groups to an increasingly cohesive, articulate,
and powerful national movement."

To Massing, American drug policy has never really recovered from the rise
of the likes of Keith Schuchard. In the 1970s, during the Nixon
administration, American drug policy had followed a strict medical model.
The focus was on the hard-core user of drugs like heroin, not casual users
of "soft" drugs like marijuana. Millions of federal dollars were spent on
providing on-demand treatment for heroin users and liberalizing access to
methadone. Drug policy was directed by psychiatrists, and users were
patients. The parents' movement turned that policy upside down. Their
concern was not with inner-city addicts, but with suburban teenagers, not
with heroin but with pot, and not with treatment but with "zero tolerance."
The NFP helped to re-create Nancy Reagan as antidrug crusader. They
successfully pushed for the appointment of Carlton Turner as the White
House drug adviser, and Turner represented the antithesis of the old drug
policy. As Massing writes:

To start, Turner rejected their idea of
distinguishing between hard-core and occasional
users. In his view, there was no such thing as
"casual" or "recreational" drug use. Nor did he
accept the distinction between "hard" and "soft"
drugs. To his mind, that was "a very smooth
public relations ploy to get the American public
to accept all kinds of drugs. It was like soft
drinks--you can drink them with impunity if you
don't mind a few cavities." From now on, Tuner
asserted, all types of drugs were to be regarded
as equally dangerous, and all types of drug use
as equally reprehensible.

In the Reagan years, the budget for treating drug addicts was cut to about
a quarter of what it had been just ten years earlier, while billions of
dollars were added to the budget for drug reinforcement, overseas
interdiction, and prisons. The key outside strategist, pushing the new
director, was now another NFP activist, the group's treasurer, a
middle-aged Massachusetts businessman named Otto Moulton. Moulton, Massing
writes, was a "giant teddy bear" of a man, with a "round belly, fleshy
face, and flock of curly locks," who was obsessed with the threat posed to
American civilization by marijuana. In his basement he had a huge
collection of drug literature and paraphernalia, and he would regularly
fire off "Otto Bombs"--letters packed with extensive documentation--to
public officials. Moulton, Massing writes, came to "exercise a sort of veto
power over what people said and wrote about drugs." Nancy Reagan's office
would send him materials for approval. Moulton, meanwhile, would try to use
his contacts to cut off federal money for drug treatment clinics. The
parents hated the government's emphasis on heroin--which they considered a
marginal menace. They hated the idea that addicts might be treated as
patients, and they pressured Nancy Reagan into spending her time with
schoolchildren and to stop meeting with recovering addicts.

Then, with the election of George Bush, came the appointment of William
Bennett as drug czar. He was an English professor and a moralist who knew
nothing whatsoever about drugs, which, according to the perverse logic of
the counterrevolution, made perfect sense, because the point of the
counterrevolution was to take control of the fight against drugs away from
the professionals and give it to the parents, and to transform it from a
medical crusade into a moral one. In the late 1980s, even as the crack
epidemic was first starting to explode in inner cities, Bennett and his
drug office remained stubbornly focused elsewhere. "Our office was created
not because of the hard-core user problem, but because of concern about
exploding drug use in the suburbs and among young people," Massing quotes
Bruce Carnes, one of Bennett's top aides, as saying. "It was not directed
at hard-core addicts. They consumed the vast bulk of the drugs, and
contributed a significant part of the crime, but they weren't the main
threat to your kids becoming drug users." The drug war was all about "our
kids" now.


The Fix is about the consequences of this counterrevolution. It is the
story of what was lost when the parents' movement turned our attention away
from treatment and hard drugs. In particular, it is the story of an
improbable, all-too-brief golden age in American drug policy, a period of
no more than two or three years in the middle of the Nixon administration,
when America, in Massing's eyes, suddenly got it right. His heroes are two
young men on Nixon's staff, Jeff Donfeld and Bud Krogh (the White House
fixer who would later get swept up in the Watergate scandal), and Jerome
Jaffe, a liberal psychiatrist who in the 1960s pioneered some of the most
success-ful drug treatment programs in the country.

Donfeld was one of Nixon's domestic policy staff, and his portfolio was
drugs. He was a "brash conservative" who despised the 1960s
counter-culture. But before long he became fascinated with the success of
an experimental methadone treatment in Chicago, the Illinois Drug Abuse
Program (IDAP), which had shown great success in reducing crime,
unemployment, and heroin use. Donfeld turned to Krogh, who had been given
the responsibility for attacking the crime problem in the District of
Columbia, and convinced Krogh that it might be worth trying out the Chicago
program in the District. "The District of Columbia became a laboratory in
my mind," Massing quotes Krogh as saying,

a place where we could put more funding into
treatment and see what happened.... The
administration's emphasis had been so
overwhelmingly on the law-enforcement side, that I
concluded that if we could get a substantial portion
of the addict population into some kind of
treatment program, where they would have a
chance to function and not be driven to commit
street crimes, that would be a very important
contribution to the law-enforcement side.

The plan worked. Early results from the D.C. pilot project showed stunning
drops in criminal activity among those enrolled in treatment. Emboldened,
Krogh went to John Ehrlichman, arguing that the program should be
instituted nationally, and by the summer of 1971--after a complex round of
bureaucratic maneuvering--Nixon called a bipartisan group of congressmen to
the White House and announced that he was appointing Jaffe to head "a new,
all-out offensive" against drugs, using treatment as its principal weapon.
To fund the effort, Nixon more than doubled the federal money available for
treatment programs, to $105 million. By 1973, the total drug budget would
reach $420 million, eight times greater than the amount when Nixon had
first taken office. Most of that money was put directly into creating drug
treatment and methadone replacement programs for heroin users, creating,
for the first--and, as it turned out, the last--time in American history,
treatment on demand for intravenous drug addicts. "By the spring of 1973,"
Massing writes, (excerpt)so many [drug treatment] slots had been created
that some cities had excess capacity, and Jaffe, seeking to take advantage,
was setting up mechanisms to coax more addicts off the street.... [He] was
urging cities to create outreach teams to scour copping zones. To make it
easier for addicts to gain access to programs, Jaffe was issuing contracts
to cities to set up IDAP-like central intake units. And, to help get more
drug offenders into treatment, he was expanding [his agency's] Treatment
Alternatives to Street Crime program....

The results, at least as reflected in national crime statistics, were
impressive. In 1972 crime fell nationally for the first time in 17 years.
Crime was down 4.1 percent in Chicago, 4.5 percent in Philadelphia, 8.8
percent in Boston, 15.8 percent in Detroit, and 19 percent in San
Francisco. In the District of Columbia, where treatment on demand had been
in place longest, crime fell 26.9 percent in 1972. In New York the crime
rate fell 18 percent, even though drug arrests and incarceration rates were
down sharply that year. The administration that was known for its
conservatism and its insistence on law and order had taken the most liberal
approach possible to the drug program--and it had worked.

So what happened? Massing gives a number of explanations, but the gist of
each is the same: that the drug treatment community never succeeded in
explaining its ideas to the general public. Jaffe wanted resources devoted
entirely to reducing the demand for drugs, and giving up on the fruitless
game of reducing the supply. But that's a hard sell at the best of times,
and as the country drifted steadily rightward in the early 1980s it became
all but impossible. Nixon coined the phrase "drug war" in introducing the
Jaffe plan.

But later presidents would discover that the true political power in that
phrase lay in taking it literally: in fighting drugs at the source with
guns and soldiers and helicopters. Jaffe's approach also involved creating
a hierarchy of illicit drugs, in which heroin was at the top of the list
and commanded most of the attention and marijuana was at the bottom. But by
the end of the 1970s the drug treatment fraternity, through sheer arrogance
or laziness or both, had allowed the message that heroin was the most
dangerous of drugs and marijuana the least dangerous to be distorted into
something even less publicly palatable, namely that heroin was bad and that
marijuana was good.

Massing, for example, retells the extraordinary story of how the Carter
administration's drug adviser--Peter Bourne--was forced to resign. In
December 1977, Bourne decided to attend a party headed by NORML--the
pro-marijuana lobby group headed by Keith Stroup.

If nothing else, Keith Stroup knew how to throw a
good party, and the event, held in a posh Dupont
Circle townhouse, drew several hundred lawyers,
congressional aides, politicians, bureaucrats, and
lobbyists, plus assorted marijuana growers and
paraphernalia merchants. Waiters carried silver
trays bearing caviar and thick joints rolled from the
finest grass. Around ten o'clock, a charge went
through the crowd: Peter Bourne had arrived.

Mobbed by well-wishers, he was quickly escorted
upstairs to a private room where the inner circle
was gathered. Among those present were Hunter
Thompson, David Kennedy (Robert's son), and
Keith Stroup. A small, bulletlike container of coke
was being passed among the people in the room.

Bourne stayed for a short while, then headed back
downstairs and left.

When six months later this story emerged--that the White House drug czar
had been to a party where cocaine was used--Bourne was forced to resign.
Bourne maintained, in his own defense, that he didn't use the drug at the
party. But that was hardly the issue. What was he doing at a NORML party to
begin with? Should it surprise anyone that parents like Keith
Schuchard--confronting marijuana use in their children for the first
time--would read about this in the paper and conclude that federal drug
policy didn't, exactly, reflect their concerns?

There is a more fundamental problem here, though, that goes beyond
politics. It wasn't just that the parents' movement and the
counterrevolution felt that their interests were being slighted by a
hard-drug, treatment-based approach, or that the public, in the end, finds
interdiction much more satisfying than more passivedemand-reduction
measures (such as methadone treatment). It was that the parents felt that a
treatment-based approach was incompatible with a true war on drugs. For the
parents, Massing writes, "the notion of recovery meant that addicts could
get well--a message that, they felt, undermined their warning to young
people not to use drugs." Treatment, to the hard-liners, is part of the
problem. Massing quotes Carlton Turner: "Under President Reagan, I didn't
believe that our philosophy should be that it's all right for kids to use
marijuana, cocaine, PCP, and Quaaludes, that--'Hey, that's all right, go do
it, and then when you wake up and become a heroin addict, we'll put you on
methadone.' That's not what this country is all about."

It is hard to overestimate the gulf between these two positions. They are
so irreconcilable, so intractable, that they have made it almost impossible
to discuss drug policy in this country in an understandable and rational
manner. This fall, for example, when President Clinton's drug czar, General
Barry McCaffrey, announced that he wanted to make methadone more widely
available, one of the first to attack the plan was New York mayor Rudy
Giuliani, who argued that instead of replacing one kind of addiction with
another the goal should be to "try to make America drug free." This, of
course, is a strange position for someone as obsessed with law and order as
Giuliani. How does he think the 30,000 addicts in New York currently taking
methadone would finance their habits if the government were suddenly to
take their free methadone away? By getting jobs at McDonald's?

But then, Giuliani's position is hardly stranger than McCaffrey's previous
decision to dramatically escalate the drug war in Mexico. McCaffrey has
stated on several occasions that he doesn't think the United States can do
much to stop the flow of drugs across the border, but he has channeled
millions of dollars toward hardening the border anyway because, as he told
Massing, if smugglers are forced out to sea "there'll be less murder and
corruption of democratic institutions in Mexico and the United States."
Thus has the drug debate descended into incoherence. We have a drug czar
who does not believe in practicing interdiction practicing interdiction and
a mayor who prides himself as a crime fighter opposing the one drug
strategy that has been proven to fight crime.


One way to appreciate just how far apart these two positions are is to
consider a relatively simple question. How much fun are drugs? One of the
principal claims of what used to be called the "drug culture" was that
drugs are really, really fun, and the parents' movement has always taken
that claim at face value. Nancy Reagan's "Just Say No" campaign was about
abstinence because the assumption was that, to the overwhelming majority of
teenagers, even the smallest initial exposure to pot or cocaine or heroin
would prove irresistible. This same assumption is behind the drug
counter-revolution's hostility to treatment. William Bennett, Massing
writes, simply didn't believe that anyone addicted to drugs would
voluntarily decide to try to end their addiction. The addict, as Bennett
put it in one of his early speeches, "is a man or woman whose power to
exercise such rational volition has already been seriously eroded by drugs,
and whose life is instead organized largely--even exclusively--around the
pursuit and satisfaction of his addiction." Bennett would never have used
the word "fun," of course, in connection with drug use, but that's
essentially what he's implying. Drugs are so appealing that why would
anyone want to give them up?

There is something poignant about this attitude. The great unspoken anxiety
of those who do not use drugs as adolescents (and I'm assuming Nancy Reagan
and William Bennett fall into that category) is that they are missing out
on something fabulous, and, of course, it is this very same anxiety that
drives those who are using drugs toward even more extravagant claims on
their behalf. It is a mutually reinforcing loop, but it has no particular
grounding in reality because, of course, drugs really aren't that much
fun--at least not in the way that straitlaced adolescents and anxious
parents think that they are. This is a critical point, but so often
overlooked that it is worth examining in more detail.

Earlier this year, for example, a group of researchers at the University of
Michigan led by the psychiatrist Ovide Pomerleau published a short report
in the journal Addiction. Pomerleau and his colleagues polled four separate
groups of people about how they felt when they first experimented with
cigarettes: heavy smokers, light smokers, ex-smokers, and never-smokers.
What they found is that there are huge differences in how much pleasure
people derived from their first few cigarettes. In fact, the amount of
pleasure neophyte smokers experienced correlates closely with how heavily
they ended up smoking later in life. Of the people who experimented with
cigarettes a few times and then never smoked again, only about a quarter
got any sort of pleasant "high" from their first cigarette. Of the
ex-smokers--people who smoked for a while but later managed to quit--about
a third got a pleasurable buzz. Of people who were light smokers, about
half remembered their first cigarette well. Of the heavy smokers, though,
78 percent remembered getting a good buzz from their first few puffs. How
much people smoke depends, in other words, an awful lot on how much they
like smoking.

Put that way, the conclusion of the study sounds really obvious and almost
silly. But it's an important point. We often assume that the reason most
teens don't take up smoking is that we have successfully armed them against
the powerful lure of nicotine: convinced them that it is a dangerous and
filthy habit, made cigarettes hard for minors to buy, made it impossible to
smoke inside buildings or in restaurants. What Pomerleau is suggesting is
that for an awful lot of us--not all of us, of course, but many of
us--cigarettes don't present a powerful lure at all. We don't start smoking
because smoking makes us feel sick.

This is true, in some sense, for nearly all addictive drugs. In the 1996
Household Survey on Drug Abuse, 1.1 percent of those polled said that they
had used heroin at least once. But only 18 percent of those had used it in
the past year, and only 9 percent had used it in the past month. That is
not the profile of a universally likable drug. The figures for cocaine are
even more striking. Of those who have ever tried cocaine, less than 1
percent--0.9 percent--are regular users. Some of that other 99.1 percent
are, no doubt, recovered addicts, people who painfully reclaimed their
lives from the grip of the drug. But an awful lot of them are people who
snorted once or twice and were left either ambivalent or nauseated. Even a
drug as mild as pot evokes as many negative reactions as positive:some
people find it delightful. Lots of others complain it makes them paranoid
or simply puts them to sleep.

The only drug that gets consistently high marks is Ecstasy. Ecstasy is
wonderful. It makes you love everyone without reservation. But that's also
why the appeal of Ecstasy is necessarily limited. Who really wants to love
everyone without reservation? The first--and only--time Iused cocaine was
at a New Year's Eve party in Toronto, in the late 1980s. Someone pulled me
into a back room and offered me a line. I snorted half of it, and waited
for my world to explode. When it didn't, I snorted the second half, and for
my pains all I got was an itchy nose and a bad headache.

This is not to say that no one likes drugs. Of course, some people do. It's
just that what is most striking about almost all drugs is how
extraordinarily selective their appeal is. 99.1 percent of cocaine
experimenters don't go on to become users. We, as a society, take that as
evidence of something intrinsically problematic with cocaine. But doesn't
it really suggest that there is something intrinsically problematic with
those 0.9 percent who become regular users? This is really the issue at the
heart of the great, irreconcilable difference between the Jaffe camp and
the parents' camp. It isn't just that the parents think that drugs are
fun--when they are not--it's that parents think the problem is about drugs,
when it is really about users.

This same mistake is made by those who take the libertarian position on
drugs, and who believe that most of the problems associated with drugs are
the result of the fact that they are illegal. In his new book Drug Crazy,
Mike Gray paints a lively and quite convincing portrait of all the
corruption and futility of drug prohibition. He makes a devastating
argument against interdiction, for example, pointing out that all of the
heroin consumed in the United States every year can fit inside a single
steel cargo container. (To put that in perspective, in a typical month the
port of Los Angeles alone processes about 130,000 cargo containers from
incoming ships, of which customs inspectors have the time and resources to
inspect only about 400.) These are fine arguments. But when Gray starts to
actually talk about the people who use these drugs, he--like so many on the
exact opposite end of the spectrum--starts to lose his way.

Gray tells the story, for instance, of Dr. William Stewart Halsted, one of
the founders of the Johns Hopkins Hospital. Halsted was a world-famous
surgeon, renowned for his skill and ingenuity, a happily married man with
an "exemplary" private life. He was also, unbeknownst to almost everyone, a
morphine addict for all of his adult life, and despite years of trying, was
never able to cut his addiction to less than 180 milligrams of morphine a
day. Halsted's story, Gray writes,

is revealing not only because it shows that a
morphine addict on the proper maintenance dose
can be productive. It also illustrates the incredible
power of the drug in question. Here was a man
with almost unlimited resources--moral, physical,
financial, medical--who tried everything he could
think of to quit, and he was hooked until the day
he died.

The first of these three sentences is undoubtedly true. Halsted was taking
morphine to break his previous addiction to cocaine, the same way that
addicts today take methadone to break their addiction to heroin, and these
kinds of maintenance regimens can, under ideal circumstances, permit
addicts to lead normal lives. That was part of the logic behind the Jaffe
model. The second sentence, however, is simply wrong. Halsted's addiction
tells you nothing whatever about the incredible power of the drug in
question, because there are plenty of people who are able to quit cocaine
without the need of additional drugs, and plenty more who would have found
it possible to break a morphine habit. All Halsted's addiction tells you is
something about Halsted: that he was one of those people--like the 0.9
percent of cocaine experimenters who take up the drug regularly, or the
handful in Pomerleau's study who took their first puffs and liked it--who
have some kind of intrinsic affinity for addictive drugs. We don't really
know, of course, what precisely this intrinsic affinity is. Some of it is
probably genetic. There are also probably certain environmental effects
that can powerfully reinforce these addictive tendencies. The point is
simply that addiction is not a universal response to drugs.

Massing brackets his discussion of the politics of the drug war with a
detailed and fascinating profile of a drug treatment referral center in
Harlem. He follows, in particular, a woman named Yvonne Hamilton, charting,
over the course of several years, her ultimately successful battle against
cocaine addiction. Two of Yvonne's siblings, Massing tells us, turned out
well: one was a pastor in Queens and another a high school teacher. But
Yvonne was in trouble from the beginning. She was sampling her mother's
tranquilizers and bottles of liquor while barely into her teens. In junior
high, she began smoking pot. In high school, she took LSD, and then after
school, while working, she developed a drinking problem. When, in 1985, she
first freebased cocaine, her life changed forever. "At once," Massing
writes, "she felt a burst of pleasure go off in her brain. It quickly
surged down her body, tingling her skin, roiling her stomach, grabbing her
groin. 'I'll do this drug until the day I die,' she told herself."

Yvonne Hamilton is different from most of us: different from her family,
and different from most people in East Harlem, for whom the abundantly
available drugs on the street there hold no particular appeal. What the
parents do not understand is that the key to the drug war is not about
broadcasting antidrug messages, or teaching kids how to say no, or crawling
around your backyard looking for roach clips. It is, as Massing argues
persuasively, about understanding precisely what makes people like Yvonne
Hamilton different, and giving her the kind of help and attention her
difference demands. 
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Checked-by: Richard Lake