Drug Use: Source and Spread

...Drug use usually starts early, in the first few years of adolescence. But notwithstanding popular mythology about shadowy, raincoated pushers corrupting young innocents on school playgrounds, children almost never purchase their first drug experience. Generally speaking, drug dealers still make most of their money from known, regular customers, and they still — all things being equal — prefer to avoid the risk of selling their wares to strangers, however young. Similarly, new and novice users themselves are typically reluctant to accept an unfamiliar substance from an unfamiliar face. In fact, young people rarely make any independent effort to seek out drugs for the first time. They don't have to; use ordinarily begins through simple personal contact with other users. Where drugs are concerned, as with so much else, young people respond most immediately and directly to the blandishments of peer pressure. And so first use invariably involves the free and enthusiastic offer of a drug by a friend.

This friend — or "carrier," in epidemiological terms — is seldom a hard-core addict. In the terminal stage of an uninterrupted drug use career, the addict is almost completely present-minded — preoccupied with finding and taking his drug; other planning and organizational skills have largely deserted him. He very often cannot maintain anything resembling a normal family or work life. Some addicts may attempt to become dealers to earn money, but most fail at this work, too, since they lack sufficient self-control to avoid consuming their own sales inventory. What's more, an addict's active enthusiasm for his drug's euphoric high or soothing low tends significantly to recede over time; for biochemical reasons, that high or low becomes increasingly difficult to reproduce (except at risk of a lethal overdose), and drug taking becomes a mostly defensive effort to head off the unpleasant psychological effects of a "crash" — or the intensely painful physical effects of actual withdrawal.

In short, the bottomed-out addict is a mess. He makes the worst possible advertisement for new drug use. And he is not likely to have much remaining peer contact with non-users in any case, as he isolates himself in the world of addicts and dealers necessary to maintain his habit. Simply put, a true addict's drug use is not very contagious.

The non-addicted casual or regular user, however, is a very different story. He is likely to have a still-intact family, social and work life. He is likely still to "enjoy" his drug for the pleasure it offers. And he is thus much more willing and able to proselytize his drug use — by action or example — among his remaining non-user peers, friends and acquaintances. A non-addict's drug use, in other words, is highly contagious. And casual or regular use — whether ongoing or brand new — may always lead to addiction; again, we have no accurate way to predict its eventual trajectory.

These facts about drug use phenomenology are both a problem and an advantage for any intelligent national drug control campaign. Unfortunately, they mean that those specifically addict-directed efforts of law enforcement and treatment — though urgently required for neighborhood safety and reasons of simple compassion — will remain difficult, time-consuming, and labor intensive, and will promise to reduce the number of American drug users only, for the most part, on a one-by-one, case-by-case basis. They also mean that non-addicted casual and regular use remains a grave issue of national concern, despite NIDA's report of recent dramatic declines in its prevalence. Non-addicted users still comprise the vast bulk of our drug-involved population. There are many millions of them. And each represents a potential agent of infection for the non-users in his personal ambit.

But there is good news, too. Though compared to addiction, non-addicted drug behavior is the more common and contagious form, it is also more susceptible to change and improvement. The same general techniques employed to slow and mixed effect with addicts may achieve markedly better results with non-addicts. Casual and regular drug users are much more easily induced to enter treatment, for example, and they are much more likely to reduce or cease their use as a result of it.

In fact, all the basic mechanisms we use against illegal drugs — to raise their price; to restrict their availability; to intensify legal and social sanctions for their sale, purchase, and use; and to otherwise depress general demand for them — have a more immediate and positive behavioral effect on non-addicts than on addicts. And in the search for longterm solutions to epidemic drug use, this fact works to our benefit. Any additional short-term reduction in the number of American casual or regular drug users will be a good in itself, of course. But because it is their kind of drug use that is most contagious, any further reduction in the non-addicted drug user population will also promise still greater future reductions in the number of Ameri cans who are recruited to join their dangerous ranks....

Criminal Sanctions

Making streets safer and drug users more accountable for their actions requires the criminal justice system to expand and reform in an unprecedented way. Effective street-level enforcement means dramatically increasing the number of drug offenders arrested. But unless there is a system ready to absorb them, drug control will end at the police station.

Expansion does not merely mean more police or more prisons (though it surely requires both). It means enlarging the system as a whole so that drug offenders can be dealt with swiftly, justly and efficiently through every step of the judicial and correctional process. Further necessary expansion el-forts must not perpetuate imbalances in our present system. Again, a large police force may be able to double the number of drug-related arrests it makes, but unless there is a sufficient number of jails, prosecutors, judges, courtrooms, prisons, and administrative staff, a point of diminishing returns is soon reached: more arrests mean less thorough and effective punishment.

If state and local officials wish to expand their capacity to prosecute and sentence drug offenders they must broaden their notions of what constitutes punishment. In many jurisdictions, the choice of criminal sanctions is between prison or nothing at all. Dealers involved in large-scale drug traffic and violent predatory crime are obvious candidates for prison sentences that will both take them off the streets for significant periods of time and deter other potential offenders. Such sentences put a strain on the system, but the demands of justice and domestic security require them.

Other types of offenders, however, can be dealt with in more efficient and often less expensive ways. Military-style boot camps, with their rigorous regimes and austere conditions, bring a sense of order and discipline to the lives of youthful, non-violent first-time offenders, and perhaps serve as a deterrent against future crimes. Halfway houses and strictly supervised addiction recovery programs can meet the demands of offenders who require treatment. A number of states have successfully experimented with various house arrest programs that keep an offender incapacitated at his own expense. "Casual" users who maintain a job and a steady income should face stiff fines — much stiffer than they do now — and, where appropriate, property forfeiture. The 1988 Anti-Drug Abuse Act further broadens the array of penalties a judge has at his disposal by providing courts with the power to deny or withhold certain federal benefits from convicted drug offenders. The Administration will encourage the regular application of that provision to ensure that it becomes a more widely used tool for penalizing drug use.

These are the sorts of alternative sanctions that the criminal justice system must explore if it is successfully going to deter and contain drug use. But such measures can be — and must be — complemented by a host of less formal sanctions aimed specifically at those first-time and occasional users who, because their activities are too often viewed as relatively inconsequential, now avoid any penalty whatsoever. These are the users who should have their names published in local papers. They should be subject to drivers' license suspension, employer notification, overnight or weekend detention, eviction from public housing, or forfeiture of the cars they drive while purchasing drugs.
Whatever the extent of their offense, if they use drugs they should be held accountable.

Young offenders in particular must be confronted with penalties that both deter them from future drug use and embarrass them among their peers. Today, many young drug offenders boast about their lenient treatment in the hands of the authorities and wear it as a badge of pride; corrections officials must make sure that when juveniles are caught using or selling drugs, their punishment becomes a source of shame. We need a mix of sanctions for juvenile drug use that includes school suspension, parental notification, and postponement of driver's license eligibility, and extends to weekends of "community service" that involve arduous and unenviable public chores.

Other aspects of our state criminal justice systems also need reform. Our probation systems provide a vivid example of the need for more accountability. In many jurisdictions, the probation system is so overcrowded and so loosely managed that it can barely be said to exist in any meaningful sense. Offenders who violate the conditions of probation often go unpunished, remaining at liberty until they are arrested again for yet another drug offense. Probation, like parole, court-supervised treatment, and some release programs, should be tied to a regular and rigorous program of drug testing in order to coerce offenders to abstain from drugs while integrating them back into the community. Such programs make prison space available for those drug offenders we cannot safely return to the streets. But unless they rigidly enforce drug abstinence under the threat of incarceration, these efforts lose their teeth. Drug tests should be a part of every stage of the criminal justice process — at the time of arrest and throughout the period of probation or incarceration, and parole — because they are the most effective way of keeping offenders off drugs both in and out of detention.

The many available alternatives to incarceration should not lead us to conclude that states and localities don't need more prisons and jails. They do. And they need them immediately and urgently. Most state prisons are already operating far above their designed capacity: the most recent surveys show Pennsylvania's correctional facilities operating at 138 percent capacity; Oklahoma at 142 percent; and Massachusetts at 1'73 percent. During 1986, 16 percent of New Jersey's prison population had to be housed in local jails due to overcrowding in state facilities. And, most notoriously, many states have been forced under court order to release prisoners before their terms have been served whenever a court-established prison population limit has been exceeded.

Recognizing the dimensions of this crisis, several states have embarked on ambitious plans to expand the capacity of their correctional facilities. Those plans should be carried out without delay, and the Administration will further this expansion by providing funds and technical assistance for the design and planning of other new and enlarged state prisons. The task of building them, however, remains with state governments, who poorly serve their constituents when prison construction is stalled or resisted.

So, clearly, effective local drug enforcement very much depends on the creation of more prison space.

Office of National Drug Control Policy, National Drug Control Strategy, Government Printing Office, 1989, p.10.