President Barack Obama’s drug czar, Gil Kerlikowske, doesn’t like the term “drug war.” He argues that none of the smart guys in law enforcement uses it.
Instead, the smart guys talk about middle-of-the-road strategies that emphasize treatment over incarceration — as did both Presidents Richard Nixon and George W. Bush — while they also advocate tough law enforcement.
Folks in the drug czar’s office have “gotten really good at stealing the rhetoric of drug policy reformers,” griped Bill Piper of the anti-drug war Drug Policy Alliance, but they don’t mean it. Obama may talk up having a dialogue on legalization and decriminalization, but his newly announced strategy proclaims, “Legalization of drugs will not be considered in this approach.”
Nonetheless, Rafael Lemaitre, spokesman for the Office for National Drug Control Policy, credited the administration’s approach as representing a “revolution” in drug strategy, one based on science, research and evidence. The drug czar’s office maintains that addiction is “not a moral failing on the part of the individual — but a disease of the brain that can be prevented and treated.” The 2012 drug plan emphasizes treatment for “substance-use disorder” — and there will be more of that because the disorder happens to be covered in the president’s Affordable Care Act.
Is it a disease of the brain? I asked Columbia University psychology professor Carl Hart, who is also a board member of Drug Policy Alliance. Hart laughed. “A behavioral disease, therefore the brain is involved? OK, we can say that about everything.”
I admit, the addiction-is-an-illness line never worked for me. It leaves out personal will. It sanitizes destructive decision-making. It suggests that people cannot get clean without a health care professional.
Art Caplan, director of the Center for Bioethics at the University of Pennsylvania, came up with the best explanation I’ve heard for the disease argument. People don’t want to see addicts jailed, he said, so they’ve come up with a scenario to spare users from incarceration. Ergo: “The whole drug establishment is invoking the disease model as an antidote to the criminal justice model.”
A drug czar fact sheet maintains, “The Obama Administration has remained clear that we cannot arrest our way out of the drug problem through an enforcement-centric ‘war on drugs.’” (I guess the smart guys do say “war on drugs.”)
But the Obama administration doesn’t want to cure the criminal justice system; it wants to medicalize addiction at a time when many Americans are looking for alternatives to federal drug policies that don’t work.
I have no doubt that Kerlikowske believes in treatment. I know people who entered programs that helped free them from the bonds of self-destruction. But I am skeptical about the efficacy of a wholesale expansion of drug treatment programs — especially the addicts-cannot-help-it kind. For one thing, addicts have to want to get clean in order to get clean.
“Who is the world’s biggest believer that addiction is not a disease?” asked Caplan. “Alcoholics Anonymous, which has ‘a volitional orientation.’”
Debra J. Saunders is a San Francisco Chronicle columnist. Her email address is firstname.lastname@example.org.