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'JUST SAY NO': AN EXCHANGE
April 22, 1999

Sue Rusche
The New York Review of Books

Note: The following letter to the NYRB is in reference to a
book review of:
The Fix by Michael Massing
335 pages, $25.00 (hardcover) published by Simon and
Schuster and;
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

To the Editors:

Malcolm Gladwell, reviewing The Fix in "Just Say 'Wait a
Minute"' [NYR, December 17,1998] and author Michael
Massing distort reality by misrepresenting facts and ignoring
science in their analyses of drug policy. Both accuse the parent
movement of ending a policy initiated in the Nixon
administration to treat heroin addiction. ( Treating heroin addicts
didn't end. ) "The focus was on the hard-core user of drugs like
heroin," Mr. Gladwell writes, "not casual users of 'soft' drugs like
marijuana.... 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."' Mr. Massing writes that for
parents; "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."

What nonsense. Parents mobilized in 1976-1977 in response to
the greatest escalation in adolescent drug use in history, from
less than 1 percent of twelve-to seventeen-year-olds in 1962 to
34 percent in 1979. By then 65 percent of high-school seniors
had tried an illicit drug, 39 percent were using drugs monthly,
and 1 in 9 smoked marijuana daily. Young peoples' alcohol use
paralleled their drug use, and the combination was deadly. While
the death rate for all other age groups declined, adolescents'
death rate rose by 8 percent, an increase fueled by the
unprecedented upsurge in drug use. With 11 percent of seniors
smoking pot daily, a level of use that can hardly be called
"casual," parents learned from their children what scientists only
now are confirming in their laboratories: marijuana produces an
addiction that requires treatment. Parents were not against
treatment, they were desperately seeking treatment for their drug-
addicted children. Their goal was not to end treatment for heroin
addicts, but to expand treatment for all addicts, including
adolescents.

National Families in Action, one of the parent organizations both
reviewer and author accuse of eschewing treatment, has referred
thousands of parents seeking help for their children to drug-
treatment facilities across the nation. Two decades ago, this was
no easy thing to do. Most treatment available then was for adult
men addicted to heroin, the one drug few adolescents were
abusing. Few facilities had slots for adolescents, or any expertise
in treating them. That left private, non-drug-specific therapy,
where parents reported repeatedly that the focus was on their
children's "underlying problems" rather than their drug use,
allowing their addiction to continue unabated. In fact, the
parental demand for adolescent drug treatment was so great, it
spawned a new industry: residential facilities that ( 1 ) treated
addiction to all drugs, ( 2 ) treated addiction as the primary
problem, and ( 3 ) treated adolescents.

Mr. Massing ignores, and Mr. Gladwell seems incapable of
grasping, the real contribution the parent movement made:
convincing the nation that preventing drug use is a crucial
component of the comprehensive approach needed to reduce
drug abuse, drug addiction, and drug-related death. Parents
initiated a drug-prevention effort that eventually grew to include
government agencies, private industry, private foundations, and
nonprofit organizations. Between 1979 and 1992, this effort cut
regular drug use in half among all Americans ( from 25 million
to 11 million ), by two thirds among adolescents and young
adults, and cut daily marijuana use among seniors by 500 percent
( from 11 percent to 2 percent ), facts both author and reviewer
choose to ignore.

Given National Families in Action's decade-long work in Atlanta
public-housing communities, to cite just one example, Mr.
Gladwell's assertion that parents are "not concerned about inner-
city addicts" is simply wrong. Also wrong is his view of
addiction. He accuses parents of irrationally fearing that drugs
might be "fun" and sets out to prove that they aren't, betraying a
stunning ignorance of science. Neuroscience has now shown that
addictive drugs act directly on a part of the brain called the brain
reward system, which, among other things, produces feelings of
pleasure. Drugs turn this system on powerfully by mimicking the
way brain chemicals work. Because the brain reward system is
part of a larger brain circuit that underlies a primitive form of
learning called operant conditioning, activating it not only
produces pleasure, but also teaches people to repeat the drug-
taking behaviors that turned it on in the first place. Despite Mr.
Gladwell's personal experience, the vast majority of drug users
confirm that drugs are indeed "fun," at least initially, and one of
the fundamental reasons they are is because they activate the
biological substrate of pleasure.

Moreover, repeated drug use, reinforced by the rewarding effects
all addictive drugs produce, sets in motion a continuum of other
biological changes. Tolerance to drugs' pleasure-producing
effects develops, requiring larger doses and setting the stage for
the development of physical dependence. Continued drug use,
especially to deal with stress or emotional problems, can lead to
psychological dependence. Other factors, such as learning and
memory, also play a role. At some point towards the end of this
progression, the user becomes addicted and can no longer control
his drug-taking behavior. Mr. Gladwell is right when he says that
not everyone who uses drugs will become addicted. He is wrong,
however, when he asserts that "parents think the problem is
about drugs, when it is really about users." Such reductionism
reveals an ignorance of the nature of addiction that borders on
arrogance.

Mr. Gladwell and Mr. Massing make the very mistake they
accuse the parent movement of making. They focus on a single
factor to explain a disorder that is multifaceted. At the very least,
we must not only consider the drug and the user, but biology and
the environment as well, to try to understand drug addiction,
which is a complex problem that requires a complex set of
solutions. Focusing our effort on just one solution, even one as
important as treatment, is a prescription for failure. When all is
said and done, our nation's drug problem is like a dike with
several holes. Plugging up only one, or even a few, still permits
water to flood through the others, eventually undermining
everything. Until we can grasp this, we won't be able to figure
out how to fix the dike permanently. Attacking those who are
trying to reinforce it may sell a lot of books ( and book reviews
), but it won't solve the drug problem.

Sue Rusche Co-founder and Executive Director National
Families in Action Atlanta, Georgia

Malcolm Gladwell replies: I am delighted that Ms. Rusche has
chosen to correct my "stunning ignorance of science" with such
a brisk and authoritative account of the addictive process. It was
very informative. I'm not sure how useful it is, how ever, to point
out that drugs really are fun because surveys of "the vast
majority of drug users" tell us so. Of course, drug users find
drugs fun. That's why they are drug users. As I recall, my interest
was in why people who aren't drug users don't seem to find drugs
fun---which strikes me as a far more pertinent question. What is
it about the "operant conditioning" system that Rusche talks
about that makes drugs irresistible for a select few, and
eminently resistible for the rest of us? Should Ms. Rusche come
across an answer to that question in her readings through
contemporary neuroscience, I'd be very happy if she would let
me know.

The balance of her letter, I'm afraid, I find a little bit confusing.
Rusche seems quite upset that Massing does not give the parents'
movement sufficient credit for fighting the good fight against
middle-class marijuana use. The truth is---and I'm sorry if I didn't
make this clear in my review--- that he makes that very point
over and over again. Massing thinks that the parents' movement
was so single-minded in its pursuit of reducing marijuana use, in
fact, that it neglected the much more serious drug problems of
the inner city. Rusche also objects to the suggestion that the
parents' movement was anti-treatment. Not so, she says. The
parents' movement spawned an entirely new industry of
residential drug treatment facilities. "Parents were not against
treatment," she writes, "they were desperately seeking treatment
for their drug-addicted children."

But that's just it. The treatment programs they created for their
children were in private facilities, which few except middle- and
upper-middle-class families could afford. Meanwhile, by the
time of the Reagan administration, federal funds available for
public treatment programs---for the programs that dealt with the
real core of the drug problem---had shrunk to about a quarter of
what they had been during the Nixon years. Massing's rather
depressing conclusion is that during a critical early period of the
war on drugs, the lobbying groups led by people like Ms.
Rusche did not really understand what war they were supposed
to be fighting. It sounds, from Ms. Rusche's letter, as if that is
still the case.