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Just Say 'Wait a Minute'

Malcolm Gladwell
The New York Review of Books
December 17, 19989

A Review of:

The Fix, by Michael Massing 335 pages, $25.00 (hardcover)
published by Simon and Schuster

Drug Crazy: How We Got into This Mess and How We Can Get
Out, by Mike Gray 251 pages, $23.95 (hardcover) published by
Random House

(See Response: Just Say No: An Exchange)

1.

On a hot, muggy night in the summer of 1976, Ron and Marsha "Keith" Schuchard held a thirteenth-birthday party for their daughter in the backyard of their suburban Atlanta home. The Schuchards were English professors, comfortably middle class, and they worried about their daughter. Her personality had suddenly taken a turn for the worse. She was moody and indifferent and only wanted to hang out with her friends. When she asked for a party, the Schuchards were briefly encouraged, because they thought she was coming out of her shell. But as the night wore on, they grew more and more alarmed.

The "guests"--many of whom they had never seen before--kept to the shadows of the backyard. Cars pulled up in the driveway, with teenagers yelling "Where's the party?" One girl tried to use the phone but seemed to have difficulty dialing. Looking out on the gathering from their upstairs window, the Schuchards could see little flickers of lights in the corners of the lawn. Finally, when the last of the kids had gone home, the couple went outside in their pajamas and crawled around in the backyard grass with flashlights, trying to figure out what had happened. They found beer cans and empty wine bottles. But what they also found--and what bothered them the most--was marijuana butts and roach clips.

That teenagers occasionally do things--and ingest things--that do not meet the approval of their parents is not, of course, all that unusual. But this particular case was different. In fact, in his new book, The Fix, Michael Massing locates the beginning of what he calls the drug counterrevolution at that moment, late at night, in the suburbs of Atlanta. The Schuchards decided that the reason for their daughter's disaffection was not normal adolescent angst, nor was it the malt liquor and the wine. It was the marijuana. "We had a sense," Keith Schuchard would say later, "of something invading our families, of being taken over
by a culture that was very dangerous, very menacing." The next morning, Schuchard demanded that her daughter give her the names of everyone at the party, and called each parent in turn. She began researching the dangers of marijuana. She fired off a letter to Robert DuPont, the director of the National Institute on Drug Abuse ( NIDA ), and so impressed him when they met that he asked her to write a handbook on parents and drug abuse. She obliged with Parents, Peers, and Pot, a vitriolic attack on the drug culture that claimed pot did everything from causing "enlarged breasts" among adolescent boys to destroying the immune system. It was the biggest best seller in NIDA history, with more than a million copies printed.

By this point, Schuchard had hooked up with a neighbor, Sue Rusche, and formed Families in Action, the country's first antidrug parents' group, and was intensively lobbying the president's drug adviser. By 1980, she and other concerned parents had joined together to form another, still larger antimarijuana group, the National Federation of Parents for Drug-Free Youth ( NFP ), and by January of the following year, with the election of Ronald Reagan, the NFP became one of the
most powerful grass-roots lobbying groups in the land. "The dream we dared to speak of rather timidly three years ago in this auditorium," Schuchard said at a national drug abuse convention in the spring of 1981, "seems well on its way to realization--that is, the growth of the parents' movement for drug-free youth from a handful of scattered individuals and groups to an increasingly cohesive, articulate, and powerful national movement." To Massing, American drug policy has never really recovered from the rise of the likes of Keith Schuchard. In the 1970s, during the Nixon administration, American drug policy had
followed a strict medical model. The focus was on the hard-core user of drugs like heroin, not casual users of "soft" drugs like marijuana. Millions of federal dollars were spent on providing on-demand treatment for heroin users and liberalizing access to methadone. Drug policy was directed by psychiatrists, and users were patients. The parents' movement turned that policy upside down. Their concern was not with inner-city addicts, but with suburban teenagers, not with heroin but with pot, and not with treatment but with "zero tolerance." The NFP helped to re-create Nancy Reagan as antidrug crusader. They successfully pushed for the appointment of Carlton Turner as the White House drug
adviser, and Turner represented the antithesis of the old drug policy. As Massing writes:

To start, Turner rejected their idea of distinguishing between hard-core and occasional users. In his view, there was no such thing as "casual" or "recreational" drug use. Nor did he accept the distinction between "hard" and "soft" drugs. To his mind, that was "a very smooth public relations ploy to get the American public to accept all kinds of drugs. It was like soft drinks--you can drink them with impunity if you don't mind a few cavities." From now on, Tuner asserted, all types of drugs were to be regarded as equally dangerous, and all types of drug use as equally reprehensible.

In the Reagan years, the budget for treating drug addicts was cut to about a quarter of what it had been just ten years earlier, while billions of dollars were added to the budget for drug reinforcement, overseas interdiction, and prisons. The key outside strategist, pushing the new director, was now another NFP activist, the group's treasurer, a middle-aged Massachusetts businessman named Otto Moulton. Moulton, Massing writes, was a "giant teddy bear" of a man, with a "round belly, fleshy face, and flock of curly locks," who was obsessed with the threat
posed to American civilization by marijuana. In his basement he had a huge collection of drug literature and paraphernalia, and he would regularly fire off "Otto Bombs"--letters packed with extensive documentation--to public officials. Moulton, Massing writes, came to "exercise a sort of veto power over what people said and wrote about drugs." Nancy Reagan's office would send him materials for approval. Moulton, meanwhile, would try to use his contacts to cut off federal money for drug treatment clinics. The parents hated the government's emphasis on heroin–which they considered a marginal menace. They hated the idea that addicts might be treated as patients, and they pressured Nancy Reagan into spending her time with schoolchildren and to stop meeting with recovering addicts.

Then, with the election of George Bush, came the appointment of William Bennett as drug czar. He was an English professor and a moralist who knew nothing whatsoever about drugs, which, according to the perverse logic of the counterrevolution, made perfect sense, because the point of the counterrevolution was to take control of the fight against drugs away from the professionals and give it to the parents, and to transform it from a medical crusade into a moral one. In the late 1980s, even as the crack epidemic was first starting to explode in inner cities, Bennett and his drug office remained stubbornly focused
elsewhere. "Our office was created not because of the hard-core user problem, but because of concern about exploding drug use in the suburbs and among young people," Massing quotes Bruce Carnes, one of Bennett's top aides, as saying. "It was not directed at hard-core addicts. They consumed the vast bulk of the drugs, and contributed a significant part of the crime, but they weren't the main threat to your kids becoming drug users." The drug war was all about "our kids" now.

2.

The Fix is about the consequences of this counterrevolution. It is the story of what was lost when the parents' movement turned our attention away from treatment and hard drugs. In particular, it is the story of an improbable, all-too-brief golden age in American drug policy, a period of no more than two or three years in the middle of the Nixon administration, when America, in Massing's eyes, suddenly got it right. His heroes are two young men on Nixon's staff, Jeff Donfeld and Bud Krogh ( the White House fixer who would later get swept up in the
Watergate scandal ), and Jerome Jaffe, a liberal psychiatrist who in the 1960s pioneered some of the most success-ful drug treatment programs in the country.

Donfeld was one of Nixon's domestic policy staff, and his portfolio was drugs. He was a "brash conservative" who despised the 1960s counter-culture. But before long he became fascinated with the success of an experimental methadone treatment in Chicago, the Illinois Drug Abuse Program ( IDAP ), which had shown great success in reducing crime, unemployment, and heroin use. Donfeld turned to Krogh, who had been given the responsibility for attacking the crime problem in the District of Columbia, and convinced Krogh that it might be worth trying out the Chicago program in the District. "The District of Columbia
became a laboratory in my mind," Massing quotes Krogh as saying,

a place where we could put more funding into treatment and see what happened.... The administration's emphasis had been so overwhelmingly on the law-enforcement side, that I concluded that if we could get a substantial portion of the addict population into some kind of treatment program, where they would have a chance to function and not be driven to commit street crimes, that would be a very important contribution to the law-enforcement side.

The plan worked. Early results from the D.C. pilot project showed stunning drops in criminal activity among those enrolled in treatment. Emboldened, Krogh went to John Ehrlichman, arguing that the program should be instituted nationally, and by the summer of 1971--after a complex round of bureaucratic maneuvering--Nixon called a bipartisan group of congressmen to the White House and announced that he was appointing Jaffe to head "a new, all-out offensive" against drugs, using treatment as its principal weapon. To fund the effort, Nixon more than
doubled the federal money available for treatment programs, to $105 million. By 1973, the total drug budget would reach $420 million, eight times greater than the amount when Nixon had first taken office. Most of that money was put directly into creating drug treatment and methadone replacement programs for heroin users, creating, for the first--and, as it turned out, the last--time in American history, treatment on demand for intravenous drug addicts. "By the spring of 1973," Massing writes, (excerpt) so many [drug treatment] slots had been created that some cities had excess capacity, and Jaffe, seeking to take advantage, was setting up mechanisms to coax more addicts off the street.... [He] was urging cities to create outreach teams to scour copping zones. To make it easier for addicts to gain access to programs,
Jaffe was issuing contracts to cities to set up IDAP-like central intake units. And, to help get more drug offenders into treatment, he was expanding [his agency's] Treatment Alternatives to Street Crime program....

The results, at least as reflected in national crime statistics, were impressive. In 1972 crime fell nationally for the first time in 17 years. Crime was down 4.1 percent in Chicago, 4.5 percent in Philadelphia, 8.8 percent in Boston, 15.8 percent in Detroit, and 19 percent in San Francisco. In the District of Columbia, where treatment on demand had been in place longest, crime fell 26.9 percent in 1972. In New York the crime rate fell 18 percent, even though drug arrests and incarceration rates were down sharply that year. The administration that was known for its conservatism and its insistence on law and order had taken the most liberal approach possible to the drug program--and it had worked.
So what happened? Massing gives a number of explanations, but the gist of each is the same: that the drug treatment community never succeeded in explaining its ideas to the general public. Jaffe wanted resources devoted entirely to reducing the demand for drugs, and giving up on the fruitless game of reducing the supply. But that's a hard sell at the best of times, and as the country drifted steadily rightward in the early 1980s it became all but impossible. Nixon coined the phrase "drug war" in introducing the Jaffe plan.

But later presidents would discover that the true political power in that phrase lay in taking it literally: in fighting drugs at the source with guns and soldiers and helicopters. Jaffe's approach also involved creating a hierarchy of illicit drugs, in which heroin was at the top of the list and commanded most of the attention and marijuana was at the bottom. But by the end of the 1970s the drug treatment fraternity, through sheer arrogance or laziness or both, had allowed the message that heroin was the most dangerous of drugs and marijuana the least dangerous to be distorted into something even less publicly palatable, namely that heroin was bad and that marijuana was good.

Massing, for example, retells the extraordinary story of how the Carter administration's drug adviser--Peter Bourne--was forced to resign. In December 1977, Bourne decided to attend a party headed by NORML--the pro-marijuana lobby group headed by Keith Stroup.

If nothing else, Keith Stroup knew how to throw a good party, and the event, held in a posh Dupont Circle townhouse, drew several hundred lawyers, congressional aides, politicians, bureaucrats, and lobbyists, plus assorted marijuana growers and paraphernalia merchants. Waiters carried silver trays bearing caviar and thick joints rolled from the finest grass. Around ten o'clock, a charge went through the crowd: Peter Bourne had arrived.

Mobbed by well-wishers, he was quickly escorted upstairs to a private room where the inner circle was gathered. Among those present were Hunter Thompson, David Kennedy (Robert's son), and Keith Stroup. A small, bulletlike container of coke was being passed among the people in the room.

Bourne stayed for a short while, then headed back downstairs and left.

When six months later this story emerged--that the White House drug czar had been to a party where cocaine was used--Bourne was forced to resign. Bourne maintained, in his own defense, that he didn't use the drug at the party. But that was hardly the issue. What was he doing at a NORML party to begin with? Should it surprise anyone that parents like Keith Schuchard--confronting marijuana use in their children for the first time--would read about this in the paper and conclude that federal drug policy didn't, exactly, reflect their concerns?

There is a more fundamental problem here, though, that goes beyond politics. It wasn't just that the parents' movement and the counterrevolution felt that their interests were being slighted by a hard-drug, treatment-based approach, or that the public, in the end, finds interdiction much more satisfying than more passive demand-reduction measures (such as methadone treatment . It was that the parents felt that a treatment-based approach was incompatible with a true war on drugs. For the parents, Massing writes, "the notion of recovery meant that addicts could get well--a message that, they felt, undermined their warning to young people not to use drugs." Treatment, to the hard-liners, is part of the problem. Massing quotes Carlton Turner: "Under President Reagan, I didn't believe that our philosophy should be that it's all right for kids to use marijuana, cocaine, PCP, and Quaaludes, that--'Hey, that's all right, go do it, and then when you wake up and become a heroin addict, we'll put you on methadone.' That's not what this country is all about."

It is hard to overestimate the gulf between these two positions. They are so irreconcilable, so intractable, that they have made it almost impossible to discuss drug policy in this country in an understandable and rational manner. This fall, for example, when President Clinton's drug czar, General Barry McCaffrey, announced that he wanted to make methadone more widely available, one of the first to attack the plan was New York mayor Rudy Giuliani, who argued that instead of replacing one kind of addiction with another the goal should be to "try to make
America drug free." This, of course, is a strange position for someone as obsessed with law and order as Giuliani. How does he think the 30,000 addicts in New York currently taking methadone would finance their habits if the government were suddenly to take their free methadone away? By getting jobs at McDonald's?

But then, Giuliani's position is hardly stranger than McCaffrey's previous decision to dramatically escalate the drug war in Mexico. McCaffrey has stated on several occasions that he doesn't think the United States can do much to stop the flow of drugs across the border, but he has channeled millions of dollars toward hardening the border anyway because, as he told Massing, if smugglers are forced out to sea "there'll be less murder and corruption of democratic institutions in Mexico and
the United States." Thus has the drug debate descended into incoherence. We have a drug czar who does not believe in practicing interdiction practicing interdiction and a mayor who prides himself as a crime fighter opposing the one drug strategy that has been proven to fight crime.

3.

One way to appreciate just how far apart these two positions are is to consider a relatively simple question. How much fun are drugs? One of the principal claims of what used to be called the "drug culture" was that drugs are really, really fun, and the parents' movement has always taken that claim at face value. Nancy Reagan's "Just Say No" campaign was about abstinence because the assumption was that, to the overwhelming majority of teenagers, even the smallest initial exposure to pot or cocaine or heroin would prove irresistible. This same assumption is behind the drug counter-revolution's hostility to treatment. William Bennett, Massing writes, simply didn't believe that
anyone addicted to drugs would voluntarily decide to try to end their addiction. The addict, as Bennett put it in one of his early speeches, "is a man or woman whose power to exercise such rational volition has already been seriously eroded by drugs, and whose life is instead organized largely--even exclusively--around the pursuit and satisfaction of his addiction." Bennett would never have used the word "fun," of course, in connection with drug use, but that's essentially what he's implying. Drugs are so appealing that why would anyone want to give them up?

There is something poignant about this attitude. The great unspoken anxiety of those who do not use drugs as adolescents (and I'm assuming Nancy Reagan and William Bennett fall into that category) is that they are missing out on something fabulous, and, of course, it is this very same anxiety that drives those who are using drugs toward even more extravagant claims on their behalf. It is a mutually reinforcing loop, but it has no particular grounding in reality because, of course, drugs really aren't that much fun--at least not in the way that straitlaced adolescents and anxious parents think that they are. This is a
critical point, but so often overlooked that it is worth examining in more detail.

Earlier this year, for example, a group of researchers at the University of Michigan led by the psychiatrist Ovide Pomerleau published a short report in the journal Addiction. Pomerleau and his colleagues polled four separate groups of people about how they felt when they first experimented with cigarettes: heavy smokers, light smokers, ex-smokers, and never-smokers. What they found is that there are huge differences in how much pleasure people derived from their first few cigarettes. In fact, the amount of pleasure neophyte smokers experienced correlates closely with how heavily they ended up smoking later in life. Of the people who experimented with cigarettes a few times and then never smoked again, only about a quarter got any sort of
pleasant "high" from their first cigarette. Of the ex-smokers--people who smoked for a while but later managed to quit--about a third got a pleasurable buzz. Of people who were light smokers, about half remembered their first cigarette well. Of the heavy smokers, though, 78 percent remembered getting a good buzz from their first few puffs. How much people smoke depends, in other words, an awful lot on how much they like smoking.

Put that way, the conclusion of the study sounds really obvious and almost silly. But it's an important point. We often assume that the reason most teens don't take up smoking is that we have successfully armed them against the powerful lure of nicotine: convinced them that it is a dangerous and filthy habit, made cigarettes hard for minors to buy, made it impossible to smoke inside buildings or in restaurants. What Pomerleau is suggesting is that for an awful lot of us--not all of us, of course, but many of us--cigarettes don't present a powerful lure at all. We don't start smoking because smoking makes us feel sick.

This is true, in some sense, for nearly all addictive drugs. In the 1996 Household Survey on Drug Abuse, 1.1 percent of those polled said that they had used heroin at least once. But only 18 percent of those had used it in the past year, and only 9 percent had used it in the past month. That is not the profile of a universally likable drug. The figures for cocaine are even more striking. Of those who have ever tried cocaine, less than 1 percent--0.9 percent--are regular users. Some of that other 99.1 percent are, no doubt, recovered addicts, people who painfully reclaimed their lives from the grip of the drug. But an awful lot
of them are people who snorted once or twice and were left either ambivalent or nauseated. Even a drug as mild as pot evokes as many negative reactions as positive:some people find it delightful. Lots of others complain it makes them paranoid or simply puts them to sleep.

The only drug that gets consistently high marks is Ecstasy. Ecstasy is wonderful. It makes you love everyone without reservation. But that's also why the appeal of Ecstasy is necessarily limited. Who really wants to love everyone without reservation? The first--and only--time Iused cocaine was at a New Year's Eve party in Toronto, in the late 1980s. Someone pulled me into a back room and offered me a line. I snorted half of it, and waited for my world to explode. When it didn't, I snorted the second half, and for my pains all I got was an itchy nose and a bad headache.

This is not to say that no one likes drugs. Of course, some people do. It's just that what is most striking about almost all drugs is how extraordinarily selective their appeal is. 99.1 percent of cocaine experimenters don't go on to become users. We, as a society, take that as evidence of something intrinsically problematic with cocaine. But doesn't it really suggest that there is something intrinsically problematic with those 0.9 percent who become regular users? This is really the issue at the heart of the great, irreconcilable difference between the Jaffe camp and the parents' camp. It isn't just that the parents think that drugs are fun--when they are not--it's that parents think the problem is about drugs, when it is really about users.

This same mistake is made by those who take the libertarian position on drugs, and who believe that most of the problems associated with drugs are the result of the fact that they are illegal. In his new book Drug Crazy, Mike Gray paints a lively and quite convincing portrait of all the corruption and futility of drug prohibition. He makes a devastating argument against interdiction, for example, pointing out that all of the heroin consumed in the United States every year can fit inside a single
steel can go container. (To put that in perspective, in a typical month the port of Los Angeles alone processes about 130,000 cargo containers from incoming ships, of which customs inspectors have the time and resources to inspect only about 400.) These are fine arguments. But when Gray starts to actually talk about the people who use these drugs, he--like so many on the exact opposite end of the spectrum--starts to lose his way.

Gray tells the story, for instance, of Dr. William Stewart Halsted, one of the founders of the Johns Hopkins Hospital. Halsted was a world-famous surgeon, renowned for his skill and ingenuity, a happily married man with an "exemplary" private life. He was also, unbeknownst to almost everyone, a morphine addict for all of his adult life, and despite years of trying, was never able to cut his addiction to less than 180 milligrams of morphine a day. Halsted's story, Gray writes,

is revealing not only because it shows that a morphine addict on the proper maintenance dose can be productive. It also illustrates the incredible power of the drug in question. Here was a man with almost unlimited resources--moral, physical, financial, medical--who tried everything he could think of to quit, and he was hooked until the day he died.

The first of these three sentences is undoubtedly true. Halsted was taking morphine to break his previous addiction to cocaine, the same way that addicts today take methadone to break their addiction to heroin, and these kinds of maintenance regimens can, under ideal circumstances, permit addicts to lead normal lives. That was part of the logic behind the Jaffe model. The second sentence, however, is simply wrong. Halsted's addiction tells you nothing whatever about the incredible power of the drug in question, because there are plenty of people who are able to quit cocaine without the need of additional drugs, and plenty more who would have found it possible to break a morphine habit. All Halsted's addiction tells you is something about
Halsted: that he was one of those people--like the 0.9 percent of cocaine experimenters who take up the drug regularly, or the handful in Pomerleau's study who took their first puffs and liked it--who have some kind of intrinsic affinity for addictive drugs. We don't really know, of course, what precisely this intrinsic affinity is. Some of it is probably genetic. There are also probably certain environmental effects that can powerfully reinforce these addictive tendencies. The point is simply that
addiction is not a universal response to drugs.

Massing brackets his discussion of the politics of the drug war with a detailed and fascinating profile of a drug treatment referral center in Harlem. He follows, in particular, a woman named Yvonne Hamilton, charting, over the course of several years, her ultimately successful battle against cocaine addiction. Two of Yvonne's siblings, Massing tells us, turned out well: one was a pastor in Queens and another a high school teacher. But Yvonne was in trouble from the beginning. She was sampling her mother's tranquilizers and bottles of liquor while barely into her teens. In junior high, she began smoking pot. In high school, she took LSD, and then after school, while working, she developed
a drinking problem. When, in 1985, she first freebased cocaine, her life changed forever. "At once," Massing writes, "she felt a burst of pleasure go off in her brain. It quickly surged down her body, tingling her skin, roiling her stomach, grabbing her groin. 'I'll do this drug until the day I die,' she told herself."

Yvonne Hamilton is different from most of us: different from her family, and different from most people in East Harlem, for whom the abundantly available drugs on the street there hold no particular appeal. What the parents do not understand is that the key to the drug war is not about broadcasting antidrug messages, or teaching kids how to say no, or crawling around your backyard looking for roach clips. It is, as Massing argues persuasively, about understanding precisely what makes people like Yvonne Hamilton different, and giving her the kind of help and attention her difference demands.