June 10, 1999
CRACK'S LEGACY / A SPECIAL REPORT
In States' Anti-Drug Fight, a Renewal for Treatment
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By TIMOTHY EGAN
HOENIX -- A thief, a burglar,
a gang member, a drug dealer
and a mother stepped into a windowless room in this overbaked
city one Tuesday afternoon, strip-searched of pride and any material possession that made them
somebody outside the brick-walled room.
They are drug addicts in treatment, and every one of them
might well be in prison under
Federal law and the statutes of
most other states. But in defiance
of Arizona's political establishment, voters here took the law
into their own hands and voted
twice, by large majorities, to
make their state the first to mandate treatment instead of prison
for drug offenders.
So they sat in the ground-floor
room, five people on a shaky frontier, talking about how tough it
was to keep away from the pills,
powder and smoke that used to
run their lives. Several had been
heavy users of crack cocaine,
once characterized as so addictive that its users were deemed to
be beyond help. All of them have
tested clean for drugs.
"Believe me, this is harder
than jail," said Albert Delatorre,
the former gang member who
would have faced up to five years
in prison before the new law mandated treatment. "It's been a
struggle. But treatment has
helped me become a man. I've
grown up." He is 22.
A dozen years after the national alarm over crack speeded the
discarding of drug treatment in
favor of punitive laws that helped
create the world's largest prison
system, drug policy is taking another turn. Treatment is making
a comeback, driven largely by a
grass-roots revolt.
In changing its laws, Arizona
has taken the boldest step. But at
least 40 states are giving judges
and prosecutors discretion within
existing laws to steer offenders
toward treatment instead of jail
through drug courts. A number of
states are considering changing
their mandatory prison laws for
drug offenders, most notably New
York, which was the first to require long sentences for possession of small amounts of drugs 26
years ago.
In the crack years of the 1980's,
treatment programs were gutted
while the drug-fighting budget
quadrupled. News reports said
crack was the most addictive substance of all, and prisons started
to fill with people who once might
have received help instead. As a
result, the number of Americans
locked up on drug offenses has
grown to 400,000 today from
50,000 in 1980.
Yet even during the height of
the prison boom, when some people were sentenced to life behind
bars for possessing small
amounts of a drug, a number of
treatment centers continued to
have success.
While not all addicts respond to
treatment -- some studies show
that a majority fail, usually in the
first month -- these programs
showed that crack was less addictive than some other street drugs,
or even nicotine, and that many of
its users responded to conventional group therapy. Habitual users
of crack, according to a five-year
Federal survey of treatment published last year, showed greater
success at staying clean than alcoholics.
"It was simply nonsense, this
notion that crack addicts were
untreatable," said Dr. Mitchell
Rosenthal, the president of Phoenix House of New York, the nation's largest private, nonprofit
drug treatment institution, which
has worked with more than 75,000
addicts over the last 30 years.
Some of the experts who called
crack the worst drug of all have
done an about-face.
"I've changed my view because of the data that has come in
over the last 10 years," said Dr.
Charles P. O'Brien, chief of psychiatry at the Veterans Affairs Medical
Center in Philadelphia, who in the late 80's
described crack as "by far, the most addictive drug we've ever had to deal with."
What changed his mind were national
surveys that showed 84 percent of people
who tried cocaine -- either smoking it as
crack or inhaling it in powder form -- did
not become addicted. Dr. O'Brien said he
had also been swayed by a study of habitual
users of crack who were assigned to treatment. A year after treatment, at least half
tested free of drugs, according to the study,
which he co-wrote.
"It turns out that many people can, and
do, stop using crack -- even those who were
addicted to it," Dr. O'Brien said.
THE IMPETUS
From the Voters,
a New Mandate
ocking up crack users is still the policy in
the Federal system. A person caught with
five grams of crack -- worth about $125 on
the street -- and prosecuted under Federal
drug laws in any state faces a mandatory
five years in prison if convicted. Crack is the
only drug that carries a mandatory prison
term for possession.
But in Arizona, because of a voter initiative, the same crack user prosecuted under
state laws cannot be sent to prison. Instead,
he must undergo drug treatment. The money
for treatment comes from the offenders
themselves and from a tax on liquor.
Many states have adopted similar policies
by establishing drug courts, which sentence
people to treatment as a way to keep them
out of jail. Started in Miami by judges and
prosecutors frustrated by the conveyer-belt
justice of the war on drugs, these courts have
grown from a handful at the start of the
decade to nearly 600 nationwide. More than
90,000 people have been sent to treatment
through drug courts.
In recent months, even some of the most
punitive states have turned away from imprisoning all drug offenders. The Legislature
in Washington, a state that helped start the
policy of life in prison after three convictions,
recently passed, 97 to 0, a bill that would give
judges discretion to send addicts to treatment instead of jail.
Louisiana, which trails only Texas in the
percentage of its population in prison, has
embarked on an ambitious drug court program, led by prosecutors and judges who say
their jails can take no more people whose
only crime is drug use.
Drug courts have sprouted throughout
New York, New Jersey and Connecticut,
though the basic laws on mandatory sentences for a host of drug crimes have not
changed. In many cases, it is prosecutors
who have discretion to send offenders to
treatment, instead of filing charges that
could lead to jail time.
"Drug courts work," said Judge John R.
Schwartz, chief of the city court system in
Rochester, N.Y. "They treat the underlying
disease of addiction. Prison does not break
the cycle of addiction."
While critics say the drug courts coddle
chronic abusers who belong in jail, the cost
savings have won over many others. Treatment instead of prison saves about $20,000
per person a year, according to a study last
year by the National Center on Addiction and
Substance Abuse at Columbia University.
Gen. Barry R. McCaffrey, the director of
national drug policy, has become a promoter
of drug courts, saying they "constitute one of
the most monumental changes in social justice in this country since World War II."
After three years as the drug czar, General McCaffrey says he has concluded that
treatment is the best way to reduce drug use.
The Clinton Administration has increased
financing for treatment by 17 percent over
the last four years. But President Clinton's
drug-fighting budget, at $18 billion, the biggest in history, still directs nearly two-thirds
of the money to enforcement and interdiction
of the drug supply, a proportion unchanged
since the Reagan Administration.
Treatment will get about $3 billion from
the budget.
According to the General Accounting Office, the investigative arm of Congress, 70
percent of the people sent to drug courts
successfully complete treatment. People
who are sent to prison instead of treatment
are four times as likely to commit another
drug crime within five years of release, the
report found.
"Drug treatment programs are like Madonna -- they keep reinventing themselves
after everyone has written them off," said
Barbara Zugor, executive director of one of
Arizona's oldest treatment centers, the
Treatment Assessment Screening Center.
On Ms. Zugor's office wall are pictures of
her with the nation's drug czars through the
years, from William J. Bennett, who advocated locking up casual users, to General
McCaffrey, who says he has dropped the
term "drug war" as inappropriate.
Looking at the pictures, Ms. Zugor said
drug policy had essentially gone full circle,
from the hope of early treatment years to a
harsh period of prison-building and zero tolerance to a trend toward treatment but with
a coercive element.
"For all the money we've spent as a
country, we haven't really had a good debate
on what works," she said. "I do know this,
though: Law enforcement and the courts and
prosecutors seem to be awfully tired of picking people up and sending them off to jail."
THE CHANGE
Retired Millionaire
Began Effort in 1996
rizona might seem an odd state to turn
the table on American drug policy. Its voters
are generally conservative and definitely not
soft on crime. For years, the state's imprisonment rate has ranked among the top. And
under the state's basic drug laws, it is a
felony to possess even the smallest amount
of drugs like marijuana.
In the last five years, the prison population
has ballooned by 50 percent, to 26,000. State
officials say drug and alcohol abuse are at
the root of the crimes of about 75 percent of
the inmates, matching national surveys.
Arizona used to proclaim zero tolerance
toward drugs, a policy publicized with commercials showing graphic images of prison
life. A tent camp for prisoners -- nicknamed
Camp Arpaio, after the tough-talking Maricopa County Sheriff, Joseph Arpaio -- was
perhaps the most visible symbol of crime
and punishment in the Grand Canyon state.
But in 1996, a retired millionaire, Joseph G.
Sperling, started a political rockslide that is
still sending down stones. Sperling, who
is 78 and calls himself a lifetime student of
British empiricism and economic history,
made his fortune by building a university
system for profit and then taking public the
company that ran the system, called Apollo.
But he was not ready to retire.
"As a social scientist, I thought the drug
war was one of the most disastrous public
policies I'd ever encountered," he said in an
interview from Vienna, where he was vacationing. "Three years ago, I was talking with
some Arizona politicians, and I said, 'We
ought to reform the drug laws.' "
Sperling was particularly incensed by
how crack had been depicted in the press and
by policy makers as something that turned
people into robots or animals. A front-page
article in The New York Times in 1988, for
example, reported alarm among drug experts: "Once people become addicted, these
experts say, it is nearly impossible for them
to stop using crack and never go back to it
again."
Sperling said, "It was the same thing
people said about marijuana-crazed blacks
back in 1914."
Joined by George Soros, the philanthropist
who has poured millions of dollars into overturning drug laws in several states,
Sperling became a principal financial backer
of an initiative to change Arizona's drug
laws, Proposition 200.
Virtually the entire Arizona political establishment, the press and major national antidrug leaders campaigned against Proposition 200. Its most controversial part could
have made drugs like heroin, LSD or marijuana legal for medical purposes when prescribed by two doctors.
But a less-discussed provision mandated
treatment instead of prison for drug offenders as well as for certain nonviolent lawbreakers, mainly criminals whose core problem was drug addiction.
Proposition 200 passed by a 2-to-1 ratio in
1996.
Then the Legislature amended the
measure, saying voters had committed a
grave error. But then supporters of the original initiative put it up for another statewide
vote and again it passed, with a 57 percent
majority in 1998.
"It was a dirty little secret that most
people understood -- the drug war had
failed," Sperling said. "The people were
way ahead of the politicians on this."
The part of the law that allowed doctors to
prescribe major drugs has been effectively
halted by Federal restrictions on the medical
use of such drugs.
But the treatment provision was quietly
put to work more than two years ago, and
early results show that three-fourths of the
people who complete treatment test clean for
drugs afterward.
The initiative labeled pro-drug by its opponents "is doing more to reduce drug use and
crime than any other state program," said
Judge Rudy Gerber of the Arizona Appellate
Court.
Proposition 200's requirement that offenders get treatment instead of prison infuriated
Rick Romley, the prosecutor of Maricopa
County, which encompasses Phoenix, because he believes that the threat of punishment is essential.
Under a county treatment program called
Do Drugs, Do Time, drug users are threatened with jail if they do not agree to accept
treatment. Using this coercive approach, the
program has been very successful, officials
at the prosecutor's office said, with a recidivism rate of less than 10 percent.
"We believe strongly in treatment," said
Barnett Lotstein, a special assistant to the
Maricopa County prosecutor. "We're not
'lock 'em up and throw away the key' people.
But you have to have something to hold over
people, a hammer if you will."
Not far from the new office buildings and
sports complexes of downtown Phoenix is a
strip of asphalt that used to be the haunt of
crack addicts. In recent months, many of
them have disappeared. Some have been
rounded up by the police and sent to jail on a
variety of charges. But many others are in
treatment, county officials said.
Asked about the view of experts in the
1980's that crack addiction was untreatable,
Norman Helber, Maricopa County's chief
adult probation officer, said, "We seem to
have an awful lot of ex-crack addicts in
Arizona who could tell you otherwise."
THE EARLY FIGHT
Combining 'War'
and Prevention
ichard M. Nixon was the first President
to declare a "War on Drugs," but he also
directed about two-thirds of all Federal anti-drug money at treatment and prevention,
particularly of heroin addiction, with great
success, as measured by sharp drops in
crimes committed by drug addicts. Nixon's
policy, led by a young psychiatrist, Dr. Jerome H. Jaffe, expanded federally financed
treatment centers from 6 in 1969 to more
than 300 in 1973.
"What worked for Jerome Jaffe a quarter-century ago could be just as effective today,"
Michael Massing wrote in his narrative history of drug policy, "The Fix" (Simon &
Schuster, 1998)
Discouraged by news accounts of addicts
who had skipped out of treatment, Gov. Nelson A. Rockefeller of New York became one
of the first major politicians to turn against
treatment.
"Let's be frank," he said in a 1973 speech.
"We have found no cure."
The Governor created some of the nation's
most punitive drug laws, which locked people
up for 15 years for possessing certain drugs.
For the next 20 years, the dominant sentiment among politicians and prosecutors was
"nothing works," and treatment fell out of
favor -- particularly in the crack years.
THE PROCESS
Trying to Rebuild
Wrecked Lives
ver since his mother handed him a marijuana joint laced with opium at the age of 10,
Leslie Angle said, he has had a companionship with illegal drugs. Angle is 39 now,
gray haired, with a bit of a slouch.
"Crack is the one drug that made me see
that I needed help," he said. "I hit my bottom
with that drug." He was homeless, stealing to
stay high, selling stolen property. He has
been in and out of jail a half-dozen times for a
variety of petty crimes, all of them tied to his
drug addiction.
Angle entered the Proposition 200
treatment program in Arizona early last
year and pays about $40 a week, using money
from Social Security disability payments for
mental illness. Like others in treatment, he
attends about two sessions of group therapy
a week, led by a licensed counselor.
There is no acupuncture. No synthetic
substitutes such as methadone. No shock
therapy or drugs designed to mute the
brain's pleasure impulses. The treatment is
aimed at getting Angle to recognize the
patterns of abuses in his life.
"This teaches me things I didn't know
before," Angle said. "I'm tired of just
stumbling along through life -- sick of everything I became. This program has taught me
that I have a choice: that I can change."
In New York, Phoenix House admits about
1,000 people every year to a residential treatment program. Many of them might otherwise go to prison under the state's Rockefeller drug laws. The laws give judges no choice
but to sentence offenders to jail, but prosecutors often decide not to press charges if an
offenders agrees to stay in a program like
Phoenix House.
Gov. George E. Pataki of New York, a
Republican, has suggested that the drug
laws, arguably the harshest in the country,
could be amended to give judges discretion
to send some first-time offenders to treatment instead of jail. Critics say Pataki
proposal is too modest, but Democrats, concerned they would be labeled soft on drug
crime if they agreed to the changes, have
refused to act on it.
A majority of the people who enter Phoenix House identify crack as their primary
drug. Treatment involves extensive group
therapy for 12 to 18 months, paid for by state
and Federal grants, or donations. The routine is strict, with 10 people to a room,
military-like insistence on neatness, punctuality and politeness.
For people who are used to instant gratification, Phoenix House is a long, slow process
-- a prospect that makes many addicts balk
at entering on their own.
But the program's results defy the assessment that crack addicts are untreatable.
About 70 percent of those who complete at
least a year of the program have tested drug-free up to five years later, said Dr. Mitchell
Rosenthal, president of Phoenix House.
"Crack and me were like best friends,"
said Danny Servera, a 31-year-old New Yorker who has been in treatment for eight
months. Servera is a natty dresser who
used to manage a men's clothing store. This
is his second time in treatment for crack.
"I never woke up in the morning with the
shakes or anything like that," Servera
said. "For me, it was always mental. I'd
start to think about getting high as a way to
numb myself."
Treatment is built around the person, not
the drug. It involves rebuilding a life, in
contrast to prison, where the concept of
rehabilitation has been all but abandoned.
"There's a growing number of us who
never walked away from the belief that the
key to bringing down drug use is trying to
change behavior," said Barbara Broderick,
who administers the drug treatment fund for
the state of Arizona. "Prison should be for
violent people and the recalcitrant."
It is prison where most hard-core drug
users who get in trouble with the law now
reside. More than 90 percent of them have
had no treatment for the addictions that got
them behind bars, where drugs often remain
freely available.
Locking up these people, in the view of
some criminologists, is a main reason crime
is down. But as many of the nation's 400,000
imprisoned drug offenders are released in
the coming years, they are likely to follow a
pattern that has already taken hold: the ones
who have not been treated -- the great
majority -- will commit another crime within five years.
