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Why America is losing the war on drugs Addicts can't be helped without coercion

Jail is a lousy place to get clean (Spencer Platt/Getty Images)

Jail is a lousy place to get clean (Spencer Platt/Getty Images)


March 4, 2022   7 mins

In the summer and early fall of 2020, as protests and riots swept across the United States, a new consensus began to emerge among progressive activists, writers and politicians. Given that black men, from George Floyd to Daniel Prude, were dying in drug and mental health-related altercations with law enforcement, perhaps police should not be handling these issues at all.

The writer Ta-Nehisi Coates, for instance, wondered whether “people with guns” should even be responding to mental health calls. Pilot projects were launched all over the country to replace police with civilian response teams for 911 calls involving mental health, drugs and homelessness. Congresswoman Katie Porter introduced a bill to pay states and cities to set up more such units, while her colleague Cori Bush introduced a bill that does much the same. In many cities, “decriminalisation”, long a rallying cry for progressive critics of policing, became standard operating procedure.

The activists are right that police cannot be the “solution” to mental illness and drug abuse, which overlap in about 50% of cases. But the programmes developed to replace law enforcement have had mixed results. That’s because in many of America’s progressive enclaves, the problem isn’t that it’s the police who are responding to these emergencies. It’s that there is little the police can legally do once they get there.

Lejon Butler is a tall, lean, black man who lives in Rodeo, a bedroom community in the North Bay Area. As a kid in the East Bay in the Eighties, he recalls going to school and being taught to “Just Say No” to drugs, then coming home and smelling the familiar chemical odour of freebased cocaine wafting through the air.

Lejon’s mother, Martin, who is now deceased, and his stepfather, Craig, were drug addicts. But Craig was such a high-functioning addict that he was able to conceal his use from his family for years. He ran a successful landscaping business while getting high every day, even trading services with one of his clients for Oxycontin. But a few years ago, he overdosed. After that, dementia set in.

By now Craig was living in Richmond, a working-class residential city in the East Bay. A few months before Lejon’s mother passed away, Craig had started to become violent towards her. When she died, in April 2021, he fell into a deep depression. He became aggressive and unpredictable. He threatened to kill his grandson with a samurai sword. He put a dagger to his own stomach and threatened to gut himself. On January 5 this year, he started a fire in his kitchen and then refused to leave the house, acting like nothing had happened. His family called 911.

The responding officer was Brian Lande, who, as part of the county’s Mental Health Evaluation Team, specialises in handling these sorts of calls. Officer Lande had spoken to Craig only a few days earlier. He makes a point of checking in on people with mental illness and addiction issues when they’re not in crisis. That way he’s able to get to know them as they really are, and not just when they’re sick.

When Lande arrived at Craig’s house, Lejon, his wife, and his niece Dnaya were already outside. Lande intended to put a psychiatric hold on Craig, which would allow a hospital to keep him for up to 72 hours. He also recommended that Dnaya fill out an application for a restraining order, which might help persuade the hospital to keep him there instead of just releasing him within a few hours.

The family had been through this drill many times before. Craig fell neatly through a gap in the system. He had dementia, but that didn’t count as a “mental illness” for the purposes of institutionalisation. He threatened his relatives’ lives, but he rarely actually attacked them, so the criminal justice system wasn’t inclined to take him seriously. “Someone’s going to have to get killed for them to do anything,” Lejon told me.

An ambulance pulled up, and the EMTs walked over to get a rundown from the cops. Then they went inside with two of the officers and came out with Craig on a gurney. Craig is in his seventies, and looks, if anything, older. He’s a small, stout Japanese-American man with sheet-white hair and an unkempt beard and moustache. His belligerence with the family stopped as soon as the first responders arrived. Suddenly he was compliant and reasonable.

This, according to Lejon, was a tactic of his stepfather’s. “He’s a very intelligent man,” Lejon said. His antics cease the moment he’s interacting with the authorities. Craig was deemed stable and released back to the family that evening, at which point the chaos flared right back up again.

It’s a pattern Officer Lande has seen time and again. “People have crises, they go to the hospital, they get stabilised,” he said. “They agree to a treatment plan. Then there’s no follow-up.” He continued: “Having a system of coercive mental healthcare that’s limited to emergency psychiatric crises that’s wedded strictly to voluntary participation — you’re condemning people to not getting the level of care they need. You’re condemning them to never get better.”

Craig is drug-addicted and psychologically debilitated, but he at least has a house to sleep in and a family to keep tabs on him. Hundreds of thousands of Americans suffering mental illness and substance addiction lack even that basic structure to their lives. In recent months, we’ve seen what happens when the most violent among them are left to their demons: America’s cities have been struck by a series of grisly, unprovoked murders of women committed by homeless men.

The deceased in these homicides were not the only victims. The acutely mentally ill and drug-addicted are prisoners of their sicknesses, and despite all the money we’ve thrown at homelessness, our policies have amounted to a wholesale abandonment of these broken people to their grim fates.

In San Francisco, that chronic failure has become the city’s official policy. An entire downtown neighbourhood, right in the heart of the city, has been effectively ceded to drug dealers, addicts and the mentally ill, all in the name of compassion. Users in the Tenderloin smoke fentanyl and shoot heroin on the sidewalks in broad daylight. When it rains, the train station there becomes a huge underground shooting gallery.

Following the spectacular failure of the War on Drugs, the prevailing ideology in the addiction treatment world became “harm reduction”. Harm reduction aims to respect the rights and dignity of drug addicts by destigmatising their drug use; to minimise the social harms that accompany drug addiction such as crime, incarceration and discrimination; to save lives by providing safeguards against overdoses; and to offer detoxification but not to require it as a condition for social services and subsidies. The motto of harm reduction is “meeting people where they’re at”, rather than compelling abstinence as a one-size-fits-all-solution.

But the approach has its critics, who view it as well-intentioned but ineffective. “There are aspects of harm reduction that I support, and there are aspects that blur the lines between harm reduction and enabling,” said Tom Wolf, a former addict in San Francisco. “The most important thing is to have a full continuum of care that focuses on recovery, not an indefinite maintenance of one’s addiction.”

“Out of thousands of people I saw maybe two get clean,” said Ginny Burton, a former addict in Seattle, describing her work as a case manager employing the harm reduction model. “What I’ve seen actually work, and experienced myself, is separation. Separate the person from the destructive environment. Maintain that separation long enough for the person to get clarity. Then implement services based on priority of need.”

This is how she got clean. “Thank God I was arrested,” she said. But in cities like Seattle and San Francisco, the enforcement policies that resulted in her arrest don’t exist anymore. “If I was loaded today, I wouldn’t be able to pull myself out,” she said. “I wouldn’t be arrested.”

Tom Ostly, who was a prosecutor under the former San Francisco District Attorney, agrees that the state’s coercive powers are what are needed to jolt drug-addicted people into making the commitment to go clean. He once prosecuted a man who had walked up to a random man on the street, punched him in the face and broke his nose. The whole assault was caught on video. With his priors, the defendant was facing 12-15 years in prison.

It turned out the man’s son had died, and the grief had turned the father into a drug addict. The day of the assault was the anniversary of his son’s death. He had been on a self-destructive spiral. Facing 15 years in prison, he agreed to go to intensive drug rehab instead, where he received counselling for PTSD. He’s now taking classes to be a drug counsellor and will soon graduate from college.

Those kinds of prosecutions just don’t happen anymore in San Francisco, where it’s considered more humane to allow people to continue killing themselves with drugs than to force them to stop. “The current administration lets everyone out and gives them no services,” said Ostly. “It’s bullshit.”

Jail is a lousy place to get clean, and drug use in and of itself should not be treated as a crime. Those lessons have come across loud and clear from the failed War on Drugs. But in rejecting the politics of mass incarceration, we’ve also thrown out the very idea of coercion. And without that, we’re empty-handed in the struggle against addiction and the rampant crime that it engenders.

Drug addiction itself is coercive. Giving an addict the “choice” to continue to use or to voluntarily get clean is as illusory as pushing someone off a roof and giving them the choice to either fall or fly. The current approach in cities such as San Francisco, Officer Lande said, “assumes people exercise full voluntary volition over their behaviour, and they don’t”. The decision to get clean has to be as non-optional as an addict’s “choice” to continue using. It has to be forced.

That doesn’t have to mean jail — in fact, it shouldn’t. Ginny was incarcerated repeatedly, but she finally got clean not through the criminal justice system but through her diversion to drug court and mandated rehabilitation. Nevertheless, coercion was an indispensable element in that successful intervention. The certainty of consequences is what finally broke through the fog of addiction.

“You don’t want to overly criminalise people,” said Officer Lande. “But you have to have some non-carceral way. Some judicial process beyond what the current system has.”

“Right now it’s very black or white,” he continued. “You’re either a psychotic or you’re not. You’re either a grave danger to others or you’re not. We don’t have anything in that grey area. We just have to wait until people are hitting rock bottom before we can do something.”


Leighton Woodhouse is writer and documentary filmmaker.

lwoodhouse

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Stephen Walshe
Stephen Walshe
2 years ago

The problem with decriminalisation / legalisation and destigmatisation of drug abuse is that drug addiction is really bad for people, and, perhaps more importantly, for the people around them. Society cannot be neutral about the use of drugs which can cause users to become unproductive, unemployable, bad parents, violent, or mentally ill.

Warren T
Warren T
2 years ago
Reply to  Stephen Walshe

Add to the list “reproductive”. They spawn children into this toxic mix as well.

Brian Villanueva
Brian Villanueva
2 years ago

50 years ago we essentially got rid of involuntary commitment largely because of the public outcry over psychiatric hospital abuse. Whether that uproar was real or was caused by “One Flew Over the Cuckoo’s Nest” is a question that will never be known. What is known is that we have now gone too far the other way.

A wealthy nation cannot call itself civilized when it allows obviously crazy (“mentally ill” sanitizes it too much) and addicted people to roam its streets and terrorize the functional members of society. We are wealthy enough to fix this, and we ought to do so.

Chris Wheatley
Chris Wheatley
2 years ago

Once upon a time in London, it was not safe for any person to walk the streets without being attacked by bad men, drunks, drug addicts, anyone who was physically powerful. The Peelers were set up to protect ordinary citizens and they morphed into the modern police force.

Today, those ‘bad’ men are no longer bad. They are victims. They are black and poor and, of course, have mental problems. Ex-aspiring politicians like Angela Davis in California believe that prisons should be abolished and the police should be disbanded. Then there will be true equality in the world.

Except that the new ‘equality’ will mean that the strong (drunks, brawlers, drug addicts, people with guns) will attack and kill the weak. So the weak will need more weapons in order to survive. There will be shoot-outs far worse than the one in OK Corral and nobody will go to prison. Psychiatrists will make even more money treating these ‘mentally ill’ people.

Surely, it must be obvious that treating violence, rape, drug abuse, mayhem, etc, as illnesses will result in an ever-increasing number of patients until everybody will be ill, even the psychiatrists.

I feel gloomy today.

Last edited 2 years ago by Chris Wheatley
2A Solution
2A Solution
2 years ago
Reply to  Chris Wheatley

Well at least a bunch of these liberal idiots will end up casualties.

Jeremy Bray
Jeremy Bray
2 years ago

If addiction is regarded as a disease compassion is appropriate.

But we have gone through a period when extreme measures have been imposed on the sick and the well during covid to prevent the risk of infection to the vulnerable. Ought not the leftist solution to drug addiction perhaps mirror this. So banning drugs should be the policy solution lest they infect the vulnerable, and like covid blacks seem in the US to be more susceptible to the infection of addiction so strict enforcement of drug policy might be seen as an anti-racist measure. Strict curfews and isolation for those addicted should be the policy of choice in Democrat areas.

Curiously, the left and Democrat politicians don’t seem to see it this way. Instead they pursue a libertarian “let every man enjoy his addiction and trash his community” approach.

Democrats need to work out if they are proper authoritarian leftists or “let it all hang out and hang the public good” right wingers when it comes to addiction.

Diane Merriam
Diane Merriam
1 year ago
Reply to  Jeremy Bray

Nixon declared the “War on Drugs” in 1971 to go after the blacks and the hippies. 50 years and trillions of dollars later, it’s just as easy, if not easier to get drugs that cost no more, or even less, than they did before. Worse, they’re even stronger and far less reliable as to what you get when you buy them. That’s why many of the overdoses. If you can’t even make a dent in something after all those years and all those dollars, then it’s time to admit it’s not going to be won, or at least not by the tactics used so far.

Warren T
Warren T
2 years ago

Once again, the immutable law of unintended consequences reigns. I remember when the “mental institutions” were shut down nationally. We used to put people with mental issues into these facilities to protect them, and society, from the carnage. However, it was deemed insensitive and inhumane to keep these people “locked up” against their will.
Now we have entire districts filled with open air crime and mentally ill people wandering the streets, “in the name of compassion.” Surely, we can devise a system that meets in the middle, but that doesn’t seem possible today.

Last edited 2 years ago by Warren T
J S
J S
2 years ago

I take a NY subway filled with drug-addled zombies that everyone just ignores until they wreak havoc. Social breakdown as “compassion,” how did we get here?

Peter LR
Peter LR
2 years ago

Presumably ‘the war on drugs’ has two aspects: the war against drug use and the war against drug supply. The author makes his point well regarding treatment. Has the other part of the war failed too? If the supply business model is also being left to choice then no matter how many addicts are helped to become clean there is an endless market for new “business”. Is that too deemed an unwinable war?

Hardee Hodges
Hardee Hodges
2 years ago
Reply to  Peter LR

The war was lost long ago and drugs are cheaper today than ever before. New addicts arrive from older ones profiting from a weakness. Those that dabble in drugs for fun need to be aware of their risks, but few really are. Education is critical.

2A Solution
2A Solution
2 years ago
Reply to  Peter LR

That would first mean Xiden and the commiecrats would be willing to close the borders…

Jeffrey Chongsathien
Jeffrey Chongsathien
2 years ago

Yep. I’ve been banging on about this for decades. A druggie’s rights and freedoms should be diminished for their own sake (and ours) when they’ve diminished themselves chemically (for whatever reason). I blame the idiot libertarians and their nonsense mental models about the perfectly rational human and the perfectly isolated human. “But this dangerous”. But this is right.

Diane Merriam
Diane Merriam
1 year ago

40+ years an often active Libertarian and I’ve never met one that said people were perfectly rational or perfectly isolated. There have been people who just read Atlas Shrugged for the first time, but Rand wasn’t a Libertarian. She disavowed us and we disavowed her a very long time ago. But I’ve read plenty of people who claim they have met Libertarians like that. Is it possible that there’s a myth or set of myths out there that don’t actually have any grounding in reality?

Dick Illyes
Dick Illyes
2 years ago

Let’s let addicts go to any physician and get a prescription for their drug. Take the profit out of it, get rid of the cartels and pushers, and put addicts into contact with medical professionals who can help them if they want to get clean.
The drugs cost next to nothing to produce and addicts could maintain somewhat normal lives. The endless thievery to maintain a habit would end. Pushing your friends into addiction to help fund your own problem would end.
Taking the profit out of it is the only way it will ever end.

2A Solution
2A Solution
2 years ago
Reply to  Dick Illyes

That won’t work. There are drugs most everyone can handle – think weed – and then the rest. People doing the rest will never pull their own weight.

Last edited 2 years ago by 2A Solution
Billy Bob
Billy Bob
2 years ago
Reply to  2A Solution

It’s not a case of them pulling their own weight, but removing the profit incentive for gangs, the addict doesn’t have to resort to thieving to find their habit and they will constantly come into contact with support if they decide to get clean and turn their life around

Diane Merriam
Diane Merriam
1 year ago
Reply to  2A Solution

At least it would take the money and the violence out of it. And back in the days before Prohibition (not just alcohol) there were many addicts that pulled their own weight and had regular jobs and all that. They just spent a part of their earnings on drugs.

Studio Largo
Studio Largo
1 year ago
Reply to  Dick Illyes

We already have this. It’s called the pharmaceutical industry.

Edward De Beukelaer
Edward De Beukelaer
2 years ago

Those interested in this subject should read: Radical Help: How We Can Remake the Relationships Between Us and Revolutionise the Welfare State by Hillary Cottam
As long as we continue to prefer health and social support for people in ways that suit ‘the functioning of the state’ (spreadsheets, accountants, business, one fit for all etc) no progress will ever be made in these issues and lots of money squandered.

Hardee Hodges
Hardee Hodges
2 years ago

After many. many years and watching tons of money disappear into rehab services, I conclude only the addict can stop and only when they decide. Until then they are on a path to certain death often a tragic one. The only way I know to help them is in an institution with no walls. Addicts enter and all of their drugs are available. They get a bed, food, drugs. In return they keep their area and themselves tidy. If they leave they can’t return to this nirvana fir 30 days. Meanwhile counselling is available round the clock. They can stay until they die or decide to leave. Try as we might, these addicts are quite ill and we don’t know how to help them recover. But we can reduce their cost to society and themselves with hopes they will find a way out. One day I hope some place will be brave enough to try such an approach.

N T
N T
2 years ago

If you had stopped with the subtitle, it would have been brilliant. I understand the need for fill, but the rest was fill compared to that insight.

Elaine Giedrys-Leeper
Elaine Giedrys-Leeper
2 years ago

Well the Portugese have had an interesting take on this since 2000.
The Portuguese Drug Policy Model (PDPM) abolished the distinction between hard and soft drugs and “decriminalized the public and private use, acquisition, and possession of all illegal drugs, as long as they do not exceed the amount required for an average individual’s use for 10 days (Law n. 30/2000, November 29, 2000).”
This moved the drug addiction problem from the public order to the public health domain. Money and effort was put into harm reduction, education of schoolchildren, outpatient treatment units etc.
Initially they saw big reductions in HIV, Hepatitis B and C, incarcerations in prison, usage rates and drug deaths however, these optimistic outcomes have not been entirely sustained over 20 years for all sorts of political and financial reasons as outlined in these 2 good articles :
https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-021-00394-7
https://transformdrugs.org/blog/drug-decriminalisation-in-portugal-setting-the-record-straight
From a cost benefit point of view I remember one analysis (lost somewhere in my deep litter filing system) which indicated that this sort of holistic, health approach, in the long term (20 years +) was a darn sight cheaper than tossing a lot of people into prison and having them repeatedly rotate through the criminal justice system.

2A Solution
2A Solution
2 years ago

Lock them up. Make it a nice lockup…