Why drugs keep flowing: too little emphasis on treating heavy users

A MAJOR new study indicates that the United States is emphasizing the wrong tactics in its multibillion-dollar, worldwide effort to slow a heavy cocaine-use ``epidemic'' that is ravaging its inner-city neighborhoods and suburban homes.

Dollar for dollar, spending on treatment of cocaine users is far more effective than the high-profile police and military action the US mounted throughout the 1980s to curb the flow of cocaine, suggests the California-based Rand Drug Policy Research Center in twin reports last month.

The studies are the first ever to compare the effectiveness of various domestic and international anti-cocaine tactics. The results are seen as applicable to other drugs, such as heroin.

Rand researchers were able to show that even if only 13 percent of cocaine users stayed off the drug after counseling, treatment is still twice as effective at reducing overall cocaine consumption as domestic and international law enforcement efforts.

Clinton administration officials say they are following the reports' recommendations and trying to shift more of the $12 billion US antidrug effort toward treating hard-core drug users.

But critics say budget shortfalls and partisan bickering are freezing expensive, ineffective antidrug policies in place. Dr. Herbert Kleber, medical director of the Columbia University Center on Addiction and Substance Abuse, says President Clinton needs to fight harder for a treatment increase: ``I see good intentions, but no follow-through.''

Dr. Kleber is referring to Clinton's campaign pledge to provide drug treatment ``on demand,'' and the administration's request for $355 million in its fiscal 1995 budget for new heavy drug-user treatment programs.

``We're focusing our efforts on the hard-core drug user,'' says Lee Brown, director of the Office of National Drug Control Policy. Mr. Brown adds that the Clinton health-care proposal, if enacted, would cover 30 days of drug treatment.

But a House appropriations subcommittee has cut the increase to $60 million and Clinton's health care proposal is stalled, essentially leaving US antidrug spending where it was in the 1980s - 65 percent to law enforcement and 35 percent to treatment and education.

Kleber, who was a drug policy official in the Bush administration, says a shift in policy is long overdue. ``The funding for treatment has been a bipartisan failure,'' he says. ``The Republican administrations did not ask for enough for treatment, and Congress gave us a third of what we asked for.''

C. Peter Rydell, principal author of the study says, the ``real loser'' in the study was US programs to seize trafficker assets, destroy coca crops, and aid local law enforcement in cocaine-producing countries such as Colombia, Bolivia, and Peru.

Latin American governments have long questioned US drug policies, arguing that the problem is the US demand for drugs that fuels drug production in their countries. An accompanying Rand study found that despite a drop in total cocaine users from a peak of 9 million in the early 1980s to just over 7 million today, a sharp increase in heavy cocaine users has kept total US cocaine consumption constant.

The number of heavy cocaine users jumped sharply, from approximately a million in 1980 to 1.7 million in 1992. The rise was due in part to the advent of a new, highly-addictive, more purified form of cocaine known as ``crack'' in the 1980s. Drug policy experts say the US has gotten mixed results from the over $100 billion it has spent on antidrug efforts since 1980. The total number of drug users has been declining, according to the National Household Survey on Drug Abuse, but last year's survey found that reported drug use among high school students increased for the first time since 1979.

The author of the Rand study and drug policy experts warn that aggressive domestic law-enforcement efforts must be maintained to discourage casual drug use, and treatment for heavy users must be increased.

Peter Reuter, a government professor at the University of Maryland, says that, politically, treatment for heavy users is very unpopular.

``It's a population that is in and out of programs, commits a lot of crimes, and does a lot of harm to society,'' he says, ``but that's the reason to treat them.''