Lowering the Costs of Drug Abuse: A Hybrid Approach
Roseville Area High School
The United States, along with the rest of the world, has struggled to reduce the costs of drug abuse in its society—the cost in lost revenue, in lost lives, and in lost dreams—throughout its history. A number of different approaches have been tried with varying levels of effort and varying results. To analyze the problems of illegal drugs in U.S. society objectively and economically, consider three models, or approaches, to address the issue of drug use and abuse in our country: the legal, the public/societal health, and the treatment approach. This essay suggests that efforts going forward should “take a page" from the successes and failures of these models. A hybrid approach can return a greater benefit from our investment of money and resources than any single approach has or could.
To briefly explain these three models, a purely legal approach is a tough “law and order" set of policies that focuses on criminal penalties to deter use and punish marketers and users of illegal drugs. The public/societal health approach establishes policies and structures that protect groups who suffer the effects of drug abuse, whether it be taxpayer-aided costs of treating AIDS caused by sharing dirty needles, or the loss in economic productivity and societal harmony when drugs replace work or spoil our collective interaction. Finally, the treatment approach addresses drug problems using a “disease" model, like a doctor treats a patient with heart disease or cancer. None of these approaches are cheap, but we can take an honest, non-moralistic look at how much bang for the buck each can achieve. To determine how best to use parts of each model, we need to take a closer look at the costs we're presently facing.
Drugs are expensive. In 2005 alone, the United States budgeted $12,162.7 million dollars for drug-related services and control and they predict the number to rise by $300 million next year.1 The costs of drugs involve more than expenditures to curb their use. They also involve opportunity costs, what we could accomplish if drugs didn't interfere, and revenue costs due to black market economies that pay no taxes. The societal costs of drugs include the violence surrounding criminal black markets (such as gang warfare for markets), destroyed families, loss of productivity, and quite simply a loss of societal harmony. But, as Andrew Weil in his book “From Chocolate to Morphine" reminds us, “Drugs are here to stay... it is vain to hope that drugs will ever disappear and that any effort to eliminate them from society is doomed to failure." 2 So how can we as a society improve in our effort towards alleviating the costs of drug abuse? Let's start with a review of the legal approach.
Legal remedies address real dangers that drugs pose to society at large. The most concrete example of the necessity of legal action concerns the oldest of all drugs, alcohol. Minimum drinking age laws and laws against drunk driving are effective and appropriate. The costs of not having them are too high. Raising the drinking age to 21 and toughening blood alcohol standards for DWIs reduced traffic fatalities of drivers between the ages of 18-20 years old by 13% in the last two decades and 22,798 lives have been saved between 1975 and 2003.3 Conversely, the legal strategy of complete prohibition, implemented for alcohol in the 1920s, suggests that best intentions don't
produce best results. During alcohol prohibition in this country, the black market and organized crime stepped in to fill the void of making illegal the oldest drug in human history. Sales of medicinal alcohol, which was 95 percent pure alcohol, increased 400 percent between 1923 and 1931. There was actually a statistical increase in deaths and drunkenness. The costs of law enforcement and incarceration rose dramatically during the period, as did the collective, non-taxed wealth of organized crime.4
Similar patterns can be seen in today's illegal drug trade and our legal approach to stemming it. As we poured money into enforcement and imprisonment, cocaine powder, sold in 30-40% concentrations, evolved into crack cocaine, with much more toxic concentrations as high as 90%. Easily spotted marijuana fields of old turned into less detectable and more easily smuggled designer pot, grown in botany labs, that are much more potent. As drugs become more dangerous, the streets become more dangerous, and law enforcement and incarceration increases. In 1997, four out of five drug arrests (79.5%) were for possession, with 44% of those arrests for marijuana offenses. Between 1980 and 1997, while the number of drug offenders entering prisons skyrocketed, the proportion of state prison space housing violent offenders declined from 55% to 47%.5 In 2000, the government projected costs of incarcerating non-violent drug offenders at approximately $24 billion, and the numbers are growing.6 If we reflect on the lessons learned from alcohol prohibition and its repeal, we should consider if a purely legal strategy to stem the use of recreational drugs is the most cost-effective way to lower demand and chip away at the profitable black market. If it's fair to say that legalizing recreational drugs is too extreme a measure and sends the wrong message to our society, then it's also fair to take a closer look at strategies that provide real benefits for all of the money we are willing to spend to send that message.
Many experts, and governments including our own, have proposed addressing the drug problem as a public health and societal problem. An example of the latter approach is the work of the Partnership for a drug free America, whose ads are designed to change collective attitudes about drugs. While legal measures appear increasingly inefficient, changes to social attitudes and realistic public health policies can offer a different angle on curbing drug abuse. We especially have seen gains using this model to address problems with our legal drugs, alcohol and tobacco. In most demographic groups, smoking is on the decline. Similarly, social attitudes have shaped the way Americans use alcohol. In decades past, the “three martini lunch" was part of doing business. Today, it is generally considered inappropriate, even a cause for termination, to drink during the workday. In the illegal drug arena, consider the cost of health care for addicts who contract AIDS by sharing needles. The United States Centers for Disease Control and Prevention state that “36% of AIDS cases in the United States can be traced back to intravenous drug use."7 No, the drugs themselves do not cause AIDS, but the dirty needles do. Providing clean needles in an environment where cops are not waiting outside to arrest them, and perhaps treatment professionals are there inside to offer help to those who would take it, blend the public health model with the third approach,
treatment, that can lower the cost to all of us to treat AIDS and increase opportunity to convert drug addicts, who might be thieves and prostitutes, into working taxpayers.
The treatment model takes a one-on-one approach to the drug problems. We have great success stories from countless treatment centers and 12 step programs for alcohol and other addictions. Though treatment centers are expensive, staffed by doctors and health care professionals, the treatment model has shown an impressive return on investment. One study concluded that “using an average lifetime cost of HIV infection ($56,000) and the average cost per person entering HIV counseling and testing ($215), if more than 1 person in 260 changes his or her behavior to prevent one additional HIV infection, the ratio of medical care savings to costs of counseling and testing would be greater than 1.0, (that is, it is a cost-saving prevention
strategy)."8 States like Arizona, California, and Maryland have implemented treatment and counseling approaches for non-violent drug users. California's Proposition 36, enacted in 2001, “allows first and second time non-violent, drug possession offenders the opportunity to receive substance abuse treatment instead of incarceration," California has saved several million dollars by reducing prison populations of drug users by 35% under Proposition 36.9 Other than saving money, treatment programs help users reenter the economy without the stigma of a criminal record, thus increasing the economy's profits while creating productive members of society.
It is hard to flesh out details of a hybrid approach in a short essay. But if we appreciate where each approach—the legal, the public/societal health, and the treatment-oriented—succeeds and falls short, then we have a basis for small successes as we've achieved with tobacco and alcohol, this society's legal drugs. Legally, invest in stopping the trade and punishing the dealers. Consider alternatives for users and resist the calls to “get tough on users" when it hasn't shown to improve the situation. Fewer cases, fewer prison cells, perhaps more “bang." From a public/societal health model, invest in sensible programs to stem the spread of expensive diseases and integrate treatment options, just as we care for those entrapped by our legal drugs and the numerous problems they cause. Include honest information about dangers of all drugs, legal and illegal, in our public service messages. This gains credibility with cynical youth who react to a flurry of anti-pot ads with rolling eyes. Finally, look at treatment options that are cost effective, including non-clinical solutions that are shown to work. Complex problems demand thoughtful, carefully targeted solutions, and appreciating the benefits of all three of these models might be our best hope to reduce the costs of drug abuse.
1 National Drug Control Budget Summary, National Drug Control Strategy, FY 2004-FY 2006.
2 Andrew Weil, M.D. and Winnifred Rosen, From Chocolate To Morphine (Boston/New York: Houghton Mifflin Company, 1983,1993,1998) p. 1.
3 Minimum Drinking Age Statistics, Mothers Against Drug Driving.
4 Thorton, Mark. “Policy Analysis: Alcohol Prohibition Was a Failure." Cato Institute, Public Policy Analysis, No. 157. July 17,1991.
5 The Sentencing Project, Drug Policy and the Criminal Justice System, August 1999.
Thorton, Mark. “Policy Analysis: Alcohol Prohibition Was a Failure
." Cato Institute, Public Policy Analysis
, No. 157. July 17,1991.
7 Public Health Crisis, The Drug Policy Alliance, “What's Wrong With the War On Drugs."
8 Preventive Medicine. 1995 Jan; 24 (1).3-8. Gorsky RD; MacGowan RJ; Swanson NM; DelGado BP; Department of Health Management and Policy, University of New Hampshire, Durham 03824, USA.
9 About Proposition 36, California Proposition 36: The Substance Abuse and Crime Prevention Act of 2000.