Chapter Five Looking ahead

The Commission sought to achieve two major objectives. First, we have called for change in common conceptions and definitions of drug use In the first three Chapters, we outlined a systematic way of looking at drug use and its social consequences. Second, we have tried to design a process by which policy can be rationally formulated. In the previous Chapter we applied that process, focusing on the utility of the present system. Now we must move beyond the present system, anticipating the direction of policy in the future.
An important and recurrent theme of this Report has been our belief that contemporary public attitudes toward drugs and their users tend to be inconsistent and founded on many misconceptions. One participant in the Commission-sponsored Salk Institute Seminar on Societal Features of Repetitive Drug Use observed :
Another common societal reaction to drug use is oversimplification of the inherently complicated issues. This response is illustrative of man's remarkable penchant for excessively reducing ambiguity, for forcing a graded spectrum of differences into a dichotomy of black or white, and for producing stereotypes and artificial categories. These efforts to reduce ambiguity and complexity are especially apparent in emotionally Iaden areas such as the use of drugs where for many people the term, "drug users," conjures up images of longhaired psychedelic hippie drop-outs, the heroin addict mugger, or the Bowery Street alcoholic. Such stereotypes ignore the variation in drug users and perhaps more importantly seduce us into believing that there are simple, isolated causes of drug use. Simplistic explanations include permissive child-rearing patterns, glamorization of drug use by the massmedia with all the skills and power of Madison Avenue techniques, the decline of religion, and so forth in an endless series (Salk Institute, 1973) .
We have emphasized that drug use is a complicated human behavior having diverse roots in our culture. We have emphasized as well that the behavioral consequences of drug use are varied, depending as much on the user and his environment as on the drug. From this perspective, individual responsibility, not drugs, is the issue.
In the history of governmental action, policy has more often than not been ad hoc and oriented toward short-terni obectives. All too often, it has been shaped by emotionalism and transient social anxieties. The law, especially the criminal law, has served as the principal response to a wide range of social problems.
It is time to establish a drug policy which permits control without crisis and which makes provision for review and appropriate change.
To facilitate the development of long-term strategies and evenhanded, well-tailored responses by all of society's institutions, the Commission has sought to establish a method of rational thinking about drug policy. Our proposed policy-making process involves a series of questions whose answers define the issues and identify the alternatives which must be weighed.
The specific recommendations for present policy which were presented in the previous Chapter are based on application of this process in the present social context. The process began with a single question : what is the problem ? The Commission could not accept answers such as, "drug abuse," which reaffirm the question. Careful examination of the term indicated that it is used to indicate disapproval of drug use, particularly that which is contrary to law. Somehow, the logical policy-making process has been turned around. Instead of determining policy according to the definition of the problem, society has been defining the problem on the basis of its policy.
Gathering the best data available on incidence and consequences of drug use, the Commission has looked carefully for the grounds of legitimate social concern. The problem does not lie in drug use itself, for much use, even when illegal, does not have immediately harmful consequences either for the user or for the community. Nor does the difficulty relate to any use of particular drugs though, plainly, certain drugs are associated with more serious individual and social consequences than others. The Commission found that the problem is in the behavior induced by the drug experience or by drug dependence which impacts adversely on the public safety or, by inhibiting social functioning, on the public health and welfare.
Having defined the drug problem in terms of objective standards of public concern, the Commission was then able to set the criteria for selecting and formulating appropriate drug policy. The Commission concluded that the following policy is appropriate : our society should continue to discourage any drug use outside medical channels or established social patterns. The primary concern of drug policy should be with disruptive or dysfunctional drug use. Finally, drug policy should not limit its concern to illegal drug taking, but should also include dysfunctional or disruptive use of "lawful" substances such as alcohol and barbiturates.
The Commission was influenced by some delimiting conditions when it began to translate policy objectives into specific recommendations. Presently, an atmosphere of crisis intrudes upon even the most dispassionate thinking about drug policy. Public opinions about drug use reflect emotion and fear which complicate policymaking. Popular perception of the drug problem is selective in its attention to illegal use and in its inattention to the legal but often irresponsible use of substances such as alcohol and barbiturates. These characteristics of public opinion function to limit the balance and direction of thinking about drug policy.
Another characteristic of public opinion in the drug area is impatience. The common dissatisfaction with current drug policy is accompanied by a resistance to experimental or long-term policy choices. The demand for quick, dramatic solutions often generates quick and dramatic government spending and law enforcement activity as the symbols if not the substance of decisive action.
Another constraint affecting current policy choices is the implicit requirement of accommodating the sizeable structure of policy and programs already in operation. This structure cannot be changed quickly, but the Commission has proposed some changes in this structure : increased internal consistency, flexibility and coordination.
Finally, immediate policy decisions are based on a growing but incomplete body of knowledge about drug-using behavior and the efficacy of existing policy responses. In any field, knowledge is, of course,` always incomplete. In the drug area, however, empirical research was begun only recently, and the number of unanswered questions encourages modesty and prudence in thinking about drug policy.
Each of these conditions affected the Commission's activity and its formulation of the specific recommendations in Chapter Four. Those recommendations do not call for dramatic changes in policy goals or for radically new programs and approaches.
The Commission does not anticipate that any control system, much less the present one, can eliminate disapproved drug use or dependence. To a certain degree, the Commission's recommendations are designed to dam a river where its flow is strongest. Most of the proposals in the preceding Chapter suggest ways of repairing and strengthening that dam. At the same time, they point the way to a transformation of policy that will hopefully lead to a more effective response.

THE IMMEDIATE FUTURE: THE GOAL OF THE COMMISSION'S RECOMMENDATIONS

Changing Attitudes
Popular conceptions and definitions of drugs and drug use, are, in an important sense, the drug problem. The Commission believes that much of the popular imagery and concern about the American "drug problem" is unjustified by the facts. The Commission also believes that much of this concern is essentially symbolic of deeper social and generational conflict. In general, society has failed to understand the symbolic character of much drug use, particularly experimental and recreational use among youth, and has failed to understand the symbolic nature of its own formal response to drug use. These ancillary social forces have diverted attention away from problems of genuine concern : the difficulties associated with the largely marginal positon of American adolescents on the one hand and the disruptive or dysfunctional use of legitimate drugs such as alcohol and barbiturates on the other.
The Commission cannot change public opinion or redirect the corn-mon concern about drug use. Its interest here is to indicate that conceptions of the problem inevitably guide efforts to solve it. In part, the failures of present drug policies reflect failures in perception.
The Commission welcomes some of the emergent changes in public opinion. Increasingly, the drug problem is recognized as part of, rather than the cause of, other social and economic conditions. In recent years, the public has begun to differentiate its concern according to the adverse social consequences of certain patterns of drug use. We must accelerate these trends, defining our concerns more precisely. and linking them to reasonable action.

Filling the Informational Gaps
The Commission's recommendations repeatedly stress the need for well-conceived research to fill gaps in present knowledge about drug use. Some of this research should be directed toward the problems posed by policy questions. Additional data are needed, for example, on the incidence of drug use, and the frequency of drug use patterns. Even more critical, however, is the need for evaluative research of present treatment and prevention programs. Current knowledge in this area is inadequate and has created a major difficulty in the Commission's work. In short, it is now impossible to tell whether current treatment and prevention programs are producing their intended consequences.
Directed research does not mean directed results. The Commission emphasizes that the research program must always be apolitical. Its purpose is not to defend present methods and policies, but to test and refine them. The research recommendations in this Report, are designed to make drug research a precursor of the response to the drug problem, rather than an academic camp follower.
Unifying the Government Response
The Commission's recommendations are not intended to foreclose the government's role with respect to the drug problem ; rather, they are directed towards maximizing the efficiency and flexibility of the governmental response. With the proliferation of agencies and programs has come a welter of government projects. Some of these are duplicative, others work at cross purposes, and still others have failed for a variety of reasons. The absence of an integrated effort both reflects and maintains inconsistent policies. In addition, existing agencies have not effectively disseminated and implemented developing information. The Commission has recommended unifying all federal drug programs within a Single Agency.1 It has further recommended that each state government also create one directing agency so that interaction between the federal and state agencies will result in a coordinated government response.
While urging a single umbrella federal drug agency, the Commis sion recognizes the danger that such an agency might institutionalize the Government response, and with it the problem as well. Bureaucracies tend to perpetuate themselves, not only from the desire to protect positions and resources, but also because of the nature of the bureaucracy. Bureaucrats often exaggerate the problems which occupy their entire attention. They are reluctant to give up on programs in which they have become invested. Having become specialists, they sometimes continue to work on their problems with a reluctance to acknowledge that such attention is no longer required.
In recognition of these hazards, the Commission has also recommended that the legislation establishing the Single Agency also provide for its phasing-out. In five years, unless Congress specifically acts otherwise, the Agency would be disbanded, and its various programs and activities be terminated or redistributed among the permanent federal departments.

Developing the Private Response
The most important change in the present response should be a vigorous reinvolvement of the private sector and the reactivation of informal non-legal controls on drug-using behavior. In his January 20, 1973 Inaugural Address, President Nixon stated:
In trusting too much in government, we have asked of it more than it can deliver. This leads only to inflated expectations, to reduced individual effort, and to a disappointment and frustration that erode confidence both in what government can do and in what people can
do.
Past emphasis on a Government solution to the drug problem, and on the regulation of drug consumption through legal controls, seems to have encouraged other social institutions to abandon responsibility for controlling drug-using behavior. As a result, the extensive network of informal social controls that formerly deterred drug use has become less and less effective.
Legal controls, by themselves, are not enough. Laws work well when they reinforce a moral consensus of the community. In the last decade, however, legal controls have neither rested on nor reflected a broad consensus regarding drug use. Consequently, the principal argument against the use of illegal drugs has come to be the prohibition provided by law. Even this deterrent has been undermined as the other social institutions such as the schools, churches and families have withdrawn from actively supporting and reinforcing the legal norm. With little outside support the agencies charged with enforcing the laws have tended to become erratic and inconsistent. The result is that the legal system itself has lost some of its moral authority.
Private institutions and agencies have begun to play a greater role in providing drug treatment, counseling and education services. They will have to do still more. But their most important responsibility will be to revitalize the informal controls on drug-taking behavior. Schools, churches, families, businesses, community organizations, service organizations, each working from their own particular perspective and sets of values, will have to encourage the development of self-discipline with regard to drug use. This common effort must not rely only on legal distinctions between licit and illicit drugs. The largest single element in the drug problem, intensified• and compulsive use of alcohol, is for the most part entirely legal. Informal social controls must place primary emphasis on preventing disruptive or dysfunctional use, and on emphasizing the moral responsibility to exercise judgment and restraint with respect to drug use.
Recognizing that the primary drug problem does not rest with experimental, recreational or circumstantial use, even though such use may be irresponsible, the private sector must focus its energies on those engaged in intensified and compulsive drug use. Since most of these users apparently turn to drugs to cope with or escape from other problems, it is inappropriate simply to tell these people that drug taking is not a good solution to their problems.
The motivations involved in drug use undoubtedly vary from user to user. Among relatively affluent youth, for example, there are a number of possibilities : boredom, a desire for adventure, alienation from adult values, an orientation toward autonomy. Other youth may be motivated toward drug use by altogether different factors, particularly a sense of despair and hopelessness about their personal futures. For intensified adult users of drugs like barbiturates and alcohol, the motivation may be to relieve anxiety, to offset, feelings of inadequacy, or simply to cope with daily stress.
In summing up the Salk Seminar on the "Societal Features of Repetitive Drug Use," the group's moderator observed :
There are a number of other developments in society that may interact with drug taking, but which are impossible to evaluate in terms of influences on abuse patterns. These factors include social changes that disrupt traditional value systems and goals. Contemporary examples would especially include the increased mobility of many people; world-wide communication systems that flood the individual with crisis after crisis over which he feels no control; urbanization and the subsequent alteration in the relationship of modern man to his community and to his work ; changes in religious and philosophical systems ; the loosening of extended family and kinship ties ; and finally, the general affluence and leisure of many people today in comparison to that of their ancestors.
Different motivations imply different circumstances and these require different responses, but all should share one essential feature: the primary thrust must not be to warn or threaten against drug use, but rather to guide the individual to some other solution to his problems. In fact, there is no reason why these prevention programs should emphasize drugs at all. Their focus should be on alternative methods for meeting individual needs and on other ways for a person to cope with his particular set of problems.
In Chapter Four, the Commission described some of the kinds of prevention programs that private institutions will have to develop. Among teenage youth, particularly in high-risk socio-economic settings, the types of opportunity needed most desperately are improved education and meaningful, long-term employment. In the suburbs and on the campuses, the opportunity provided must be one for purposeful and influential involvement in the adult world. As we continue to prolong the period of formal education, we must develop productive roles for students to fill even as they learn. Programs which allow college students to perform useful social services as part of their education, and involvement of young people in politics, offer attractive alternatives to drug use, as well as being highly beneficial in their own right.
For troubled individuals, whether adult or child, society must afford an array of psychiatric, psychological and social services treating the person in the context of his total environment. Indeed, this country should work to improve the network of institutional supports for all potentially troubled populations, applying the teachings of preventive medicine to protection of the public health and welfare.
Even this brief summary indicates the importance which the Commission places on the development of a comprehensive private response to drug use and drug dependence. Private institutions must increase their involvement in this area so that their effort and influence be ;rne at least equal to those of the public sector. Ultimately, the non-governmental social institutions must become the primary agencies of social control of drug use. Recent history has demonstrated plainly that legal controls are neither subtle enough nor extensive enough to deal with behavior that is essentially private and inordinately complex. Moreover, there are strong constitutional and philosophical reasons why legal controls should not predominate in this matter. If society is to make acceptable progress in dealing with the drug problem, the private sector will have to assume the greater part of the burden.

Improving Controls on Availability

The Commission recognizes that reducing the lawful supply of a drug does not always reduce the demand and, where the demand remains substantial, illegal suppliers will probably attempt to meet it. With respect to certain drugs, increased legal controls on availability can operate to reduce their unnecessary and excessive use within the medical system. Prescription practices for hypnosedative drugs, particularly the barbiturates and the tranquilizers, have become lax ; both physicians and patients too frequently underestimate the risks posed by these drugs. Physicians must exercise greater restraint in prescribing them and patients must recognize the limits of their usefulness.
The Commission would also improve the enforcement of the laws against illegal drug trafficking, by increasing coordination between enforcement agencies, by bolstering the calibre and morale of law enforcement personnel and by encouraging the development of longterm law enforcement strategies to penetrate trafficking networks at the highest levels. From these improvements, the Commission anticipates some reduction in the illegal supply of drugs like heroin and cocaine, but it does not expect the drug problem will be solved by better trafficking controls. Enforcing laws against illegal supply can only assist to a degree. The emphasis must remain at the other end of the problem : the demand. This means dealing with the individual's desire to use drugs, and the meaning attached to drug use.

Rationalizing Consumption Controls
This Report has dealt at some length with the philosophical, constitutional, and practical difficulties with legal controls on drug consumption : the criminal laws against possession and use. The Commission has concluded that most of these laws must remain for the time being. However, the role of the legal system must be oriented toward directing users in need of treatment or prevention services to programs which can assist them. Actual restraint or deprivation of liberty should be reduced to the minimum amount consistent with the objective of maximizing therapy or counselling.
These changes in the function of the consumption laws would not remove all constitutional doubt, or make them the optimal means of social intervention. In time, the informal controls applied by private institutions must largely replace legal ones. In the interim, it is believed that the recommended change in the purpose and the consequence of the possession laws can convert the present response from a detriment into an asset.

Expanding Treatment, Rehabilitation, and Prevention Services
The proposed change in the response of the criminal justice system to drug consumption will also require a considerable expansion' of treatment and rehabilitation programs and facilities. In order to reach those users whom the legal system does not detect, these programs must also encourage and accept voluntary entrants.
Expansion of treatment services does not only mean more money and room for more patients. Facilities must also expand their capacity to provide the kinds of treatment that will be effective in individual cases. Even if legal controls are at hand to place a drug user into a program and require his participation, treatment can succeed only if the user determines that the treatment alternative will prove beneficial. If drug treatment helps the user in a manner that makes sense to the society but not to the user, it will be an exercise in futility and the user will return to his former patterns of consumption.

THE IMMEDIATE FUTURE

Some consequences of these changes to the present system may be anticipated. Government drug programs will be run more efficiently ; the confusion of effort and waste of money , which now . characterizes much of the public sector's response will disappear. For the first time, programs will be evaluated in terms of what they have accomplished; some will be improved, some eliminated. Law enforcement will increase the pressure on the illegal supply system, particularly on the higher levels of that system. Legal and professionally imposed controls will reduce the use of certain drugs within the medical system. Private institutions will become far more active in treatment and prevention. Treatment and prevention programs will accommodate greater numbers of people. Useful information about drug use will be available and systematic research will begin to play a major part in shaping the social response through policies based on analysis, not analogy.
Whether drug-using behavior will change is harder to say. Diminished supply, more effective treatment and revitalization of informal controls should decrease the use of drugs like heroin and cocaine. Tighter controls on lawful supply should reduce the use of drugs like barbiturates within the medical system.
No changes in public policy can be expected to have an immediate impact on the meaning which individuals and social groups attach to draw any conclusion that such use will decline significantly in the foreseeable future will result from social forces already at work rather than from any new policy.
From this perspective, the Commission sees little evidence of any decline in the rate of experimental use, particularly of marihuana and hallucinogenic drugs, by young people. There are no data from which to draw any conclusion that such use will decline significantly in the near future. As the youth culture becomes more familiar with particular drugs, certain structures and rituals of use have emerged which minimize disruption : for example, the number of bad LSD trips does seem to have declined measurably (Douglas, 1973).
Youthful experimentation will remain one of the most difficult aspects of the drug problem. This Report has pointed out that neither legal restraints nor drug education have been effective in diminishing the extent of youthful experimentation with drugs. Further, because most young users do not engage in intensified or compulsive use patterns, treatment and rehabilitation programs are not at issue for this group. If use among young people does decline in the next few years, it will probably manifest the passing of a fad, and perhaps a more successful effort by the private institutions to provide alternatives to drug use.
The Commission does not anticipate a quick end to the heroin problem. A large segment of the current heroin-dependent population resists any form of treatment while new users continue to be recruited. However, there are indications that the spread of heroin use is self-limiting, even among particularly susceptible populations. Among U.S. servicemen in Vietnam, for example, virtually every factor favored heavy drug use : a concentration of a highly vulnerable population, ready availability of drugs, long periods of boredom compounded by stress, a sense of purposelessness and frustration, and widespread peer group use. Yet, an extensive study of the drug problem among American military personnel in Vietnam indicated an overall incidence of regular heroin use of less than 10% (Fisher, 1972a, b). Moreover, the great majority of frequent and regular users there stopped using heroin once they left Vietnam. Those who continued their use apparprobable, as new populations encounter the drug.
This experience suggests that in the worst of cases, regardless of the nature of the social response, heroin use will not increase indefinitely, and that, in time, it will begin to decline. Some observers speculate that the so-called epidemic of use in this country has already peaked. Nonetheless, future episodes of increased use are always possible, even probable, as new populations encounter the drug.
The Commission does not anticipate the imminent discovery of a cure or vaccine for drug dependence. Compulsive drug use does not seem to be the kind of phenomenon for which science will discover a "magic bullet." Research into the development of antagonists, immunization agents, and chemical blockades is important, but anyone who looks to such efforts for an easy or a complete solution is overemphasizing the part that any particular drug plays in the problem and is ascribing causal resolution to something that is only symptomatic.
The drug problem is a behavior problem, and the patterns of activity which relate to disruptive or dysfunctional behavior indicate that the choice of a particular drug is probably the most interchangeable of all the variables. Drug use is a behavior that is transmitted by circumstances, experiences and ideas rather than by viruses or bacteria. Purely medical solutions cannot succeed. Unless we can change the circumstances, there is little that can be done that will radically alter the motivation and the behavior.
Finally, the Commission foresees a possible continuing increase in the already extensive phenomenon of circumstantial use, slowed only by reduced availability of specific substances within legitimate medical channels. Only an effective long-term policy can forestall or diminish this development.
The drug problem, as perplexing and extensive as it is, is not going to bring about the collapse of our society. We will make some progress in dealing with it, but we should not harbor unrealistic hopes for the future. While an atmosphere free from emotionalism is necessary for rational policy planning, the Commission warns against the complacency which can come from overly optimistic expectations. This would only set the stage for a recurrence of the crisis atmosphere whenever a particular program fails to produce the expected results.

POLICYMAKING OVER THE LONG TERM

Over the next five years, the Commission anticipates further de-emphasis of the drug problem, and a more measured governmental response to it. We hope that private institutions will be ready to assume the major share of responsibility, particularly in the critically important field of prevention. State and local governments should continue to be active in operating treatment programs, and the federal government should continue to provide necesary financial assistance, to fund and direct research, to enforce drug trafficking laws, and to plan overall policy. Regulation of consumption behavior, however, should devolve more on informal, non-legal controls and upon a common ethic regarding the role of drugs in the life of the individual and the society.
Consistent with the change in public perception of the drug problem, the Commission anticipates that many of the special drug agencies in the government will disappear. Drug programs and policies should instead be integrated with those agencies which deal with the whole complex of related social problems. Treatment programs should become part of general community mental health services; rehabilitation and counseling functions should be merged with other social services. Hopefully, this change in the government response would parallel developments in the private sector, with overall preventive efforts concentrating on the broad question of dysfunctional interaction between individuals and society, rather than on drug use alone.
These changes may not occur. Indeed, the adverse consequences of drug use may increase measurably over the next few years. If so, society will have to consider more radical alterations of its response. If the program goals are not achieved, the financial resources which the public will need to devote to the drug problem will continue to increase. If illegal use patterns remain at present levels for the next five years, it may signify that these patterns may have become institutionalized among certain segments of the population, in the same way that heavy alcohol use is institutionalized and structured in the general culture. In this event, the country will have to face some very difficult policy choices.

Confronting the Basic Questions
The Commission does not consider the policies it has recommended, whether they work well or not, to be eternally applicable. The policy-making process is an ongoing one, and even while society is implementing a given decision, policy makers must be constantly rethinking the parts and the whole of the problem. Programs should not be jettisoned before they are fairly and fully tested, but at the same time, no program choice should be regarded as permanent.
In guiding the social response to drug use, policy makers should continually confront a number of basic issues. The Commission identifies four which it feels will require particular attention while a coherent drug policy emerges.

I. How much intensified and compulsive drug use can this country tolerate—
Ideally, of course, the answer would be none, but as a practical matter society cannot realistically hope to achieve the ideal. Instead, it must aim to reduce such use to a tolerable level.
What constitutes a tolerable level, of course, is the difficult issue. It does not depend solely upon absolute numbers of users, or absolute calculations of consequences, or even upon the ratio of users to general population. The cost of reducing use is an equally relevant factor. So, too, is the degree to which intensified and compulsive use involves adverse consequences for the public safety, health and welfare.
That this society is apparently willing to tolerate certain problems rather than give high priority to their reduction below some minimum level is reflected in the existence of nine million alcoholics, 50,000 highway fatalities a year, and a 5% rate of unemployment. This does not mean that policy makers think these levels are desirable, or would not prefer to see them lower. For whatever the reason, society feels it can live with such casualties and, therefore, does not choose to expend more resources or sacrifice more freedom to achieve further reduction in the casualties. If any of these problems rose to an "intolerable level," for instance, if unemployment reached 10% or more, the society would give the problem a much higher priority and take increased action to diminish it. As long as society faces a number of problems, it cannot concentrate on finding the optimal solution to any one of them. Designating a tolerable level is always a difficult choice, but a vital one. After a certain reduction in intensified and compulsive drug use is accomplished, society will have to stop devoting special attention to this problem and turn to others that have become more urgent.

2. Does the cost of any part of the response outweigh its benefits?
The importance of reducing intensified and compulsive drug use should not blind policy makers to the fact that any given decrease in use is worth only so much to society. Even if all drug programs and controls had a beneficial effect on the level and consequences of consumption, some would still cost more than their benefits justified.
The cost of a response doe's not simply consist of the money it requires. Detrimental effects on other policies, programs, or social values count as well. In addition, nearly every operation will have negative as well as positive effects on the problem it addresses. Critics of heroin maintenance proposals properly point out that, while a maintenance program might reduce some of the social disruption resulting from heroin dependence, it could also increase the level of use. On the other side of this issue, the present controls on availability of heroin, while they undoubtedly keep the level of use down, aggravate some of its harmful consequences.
Policy makers must continually ask whether the problem that stems from the drug use is greater than the problems created by the response to that use. They must judge every part of the response not simply by its benefits in reducing use, but also on the basis of the various costs of sustaining it.

3. What exactly is society's duty toward the drug user, particularly the dependent user?
The policy maker's first concern must be the preservation of the collective welfare. In approaching the problem of drug dependence, he must first ask what is necessary to prevent or reduce harmful public consequences. Beyond that, however, lie the issues of what obligations the society has toward the user as an individual, and how it should meet those obligations. Does the country have a responsibility to help the drug-dependent person when he requests help, to provide him with the necessary treatment and rehabilitation services? Does the duty extend to helping him whether or not he wants help, compelling him to accept treatment? Can society just ignore the dependent user, recognizing no other duty than to leave him alone? At present, society has chosen to help the user whether or not he wants it. However, policy makers should continue to study this problem, recognizing that whenever coercion is introduced, philosophical, constitutional and practical issues arise.

4. Should a policy of disapproval or discouragement of drug use discriminate among different drugs?
Recognizing that some degree of psychoactive drug use seems to be inevitable in all societies, policy makers must determine whether this society should maintain a posture of undifferentiated disapproval, or whether it should try to channel use toward less harmful substances and behavior. Our laws have already made alcohol the preferred social drug. That historical fact should not prevent further evaluation of the wisdom of this preference. While continuing to disapprove use in general, society might find it efficacious to make an integrated set of availability decisions, reflecting the relative risk potential of various substances.

Reappraisal: The Need for Evaluation

In addition to keeping the basic issues constantly in mind, policy makers must periodically rethink their decisions in detail and overhaul the entire response. In four years, the measures which the Commission has recommended will have had time for a full trial. If they have failed to meet expectations, reappraisal is inevitable. A second evaluation will be no less necessary if the response achieves a measure of success.
Should the drug "problem" appear to have receded at the end of four years, the country will be strongly tempted to forget about it and leave present policies and programs unchanged. This could well leave society unprepared to deal with some future recurrence of the problem, a new crisis in the never-ending cycle. Accordingly, the Commission recommends that Congress establish a commission four years hence, with the specific responsibility to:
•    evaluate the social response to drug use during the preceding four years;
•    consider the results of both directed and undirected research programs;
•    recommend to Congress whether the unified federal agency should be continued, dissolved, or modified;
•    determine which measures have justified their costs and which have not;
•    propose needed new policies, programs and techniques;
•    reexamine fully the basic issues and consider whether departures from the present response are required.
Like this Commission, the successor should be independent from any other operating or policy-making body. It should be empowered and equipped to conduct its own research projects, to do its own evaluations, and to publish its findings after a one-year study.
In carrying out the charge placed on this Commission, we have done our utmost to study all the information presently available, to consider all the possibilities for present action, and to propose every recommendation which we judged useful. Even so, some of the essential questions could not be answered by books, laboratory research, or drug use surveys. Only experience and time will tell us whether new techniques and methods will work and whether the policies we have proposed are realistic. In appraising the events of the next four years, the second commission will have the advantage of judging our hypotheses and predictions by what has actually occurred.
While a second examination of the drug use problem will be necessary to complete the work of the first, we hope that the efforts of this Commission will benefit the next. If the approach which we have outlined proves succesful, the second commission should find itself working in a calm public climate and in a strong position to begin the final deemphasis of the drug problem and its reintegration into the larger framework of human resources policy planning. Realistic objectives will have been established. An effective preventive approach, managed largely by the private sector, will have begun to take effect. The problem of perspective will have been replaced by the problem in perspective. With this hope, the National Commission on Marihuana and Drug Abuse presents its final Report to the President, the Congress, and the people of the United States.

1 See page 293 and footnote on pages 291-292.