An Ounce of Prevention, Pt. I

Hillary Clinton [1] surprised me when she said, on a recent trip to Mexico, "Our insatiable demand for illegal drugs fuels the drug trade." Strong words, and far more sagacious than George W. Bush's declaration, during a trip to Mexico in 2001, that, "One of the reasons why drugs are shipped, the main reason why drugs are shipped through Mexico to the United States, is because United States citizens use drugs."

The difference is that Clinton couldn't' be more right and, of course, knows it. But if moment of clarity is followed by the same old enforcement-based approach to the drug problem, we will continue to fail at reducing our "insatiable demand."

Not that the drug-related violence isn't a problem that needs addressing right now. The deaths of 8,000 people in just two years calls for action to prevent further loss of life. Stopping the flow of arms from the U.S. into Mexico must be a priority [2].

In the latest flurry of activity to help stem the drug-related violence that has engulfed Mexico and begun to spill over the US border, Department of Homeland Security Secretary Janet Napolitano and Attorney General Eric Holder are meeting with their Mexican counterparts today in the city of Cuernavaca.

A centerpiece issue of the visit will be a new US pledge to help stem the flow of guns and other high-powered weapons into Mexico. The US is promising to beef up "exit controls" – improving detection systems at the border and at ports of entry – to help Mexico fight the drug-trafficking organizations behind more than 7,000 deaths since January 2008.

The meeting comes as Mexico, which has long criticized lax gun laws in the US but has offered little in terms of inspections and intelligence, has started to formulate its own policy on the illegal gun trade, even launching a border inspection pilot program last month.

But the meeting Thursday, to focus primarily on the gun trade, gives Mexico a chance to address a key complaint: that no matter how hard they fight drug traffickers, their efforts will be undermined if the US continues to arm them.

Whether America arms them or not, drug traffickers will stay in business as long as there is a demand for their product. To date, the "war on drugs" has failed abysmally at reducing that "insatiable demand."

In July 2008, a report revealed that Americans were the world's top drug users [3]. A year later, we most likely still are. And, while the study revealed that 16.2% of Americans had at least tried cocaine and 42.2% of Americans used marijuana (the actual numbers could be greater, considering that people might not be entirely honest about their drug use), that wasn't its most interesting finding.

Drug use "does not appear to be simply related to drug policy," the researchers wrote, "since countries with more stringent policies toward illegal drug use did not have lower levels of such drug use than countries with more liberal policies."

In the Netherlands, where drug policy is more liberal than the United States, 1.9 percent of survey participants said they had used cocaine and 19.8 percent marijuana.

And despite the US government's massive anti-drug efforts, the United States remains the world's top drug market, one amply supplied by South American cartels.

And our drug policy is equalled in its degree of failure only by our drug prevention efforts [4].

Despite investing $1 billion in a massive anti-drug campaign, a controversial new study suggests that the push has failed to help the United States win the war on drugs.

A congressionally mandated study released today concluded that the National Youth Anti-Drug Media Campaign launched in the late 1990s to encourage young people to stay away from drugs "is unlikely to have had favorable effects on youths."

In fact, the study's authors assert that anti-drug ads may have unwittingly delivered the message that other kids were doing drugs, inadvertently slowing measured progress that was being made to curb marijuana use among teenagers.

"Youths who saw the campaign ads took from them the message that their peers were using marijuana," the report suggests as a possible reason for its findings. "In turn, those who came to believe that their peers were using marijuana were more likely to initiate use themselves."

Talk about "out of frying pan and...", well, you know the rest. I thought the commercials were at least funnier than the deadly serious "This is your brain. This is your brain on drugs." ads. Come to think of it my friends and I made fun of those, back then, intoning "This is an egg. This is an egg in a frying pan." over the announcer whenever such a commercial came on.

Since it's been on the air, I've been a regular viewer of "Intervention" on A&E [6], and I think if my friends and I had seen anything like it, we'd have laughed a lot less, if at all, about drug warnings.

(Warning, if you're a parent or the child of an addict or acoholic, watching some of these children beg their parents to go into treatment may be too much.)

Perhaps sitting kids down and having them watch "Intervention" or something like it would be a good start. They'd see real addicts at rock bottom, in a way that does not glamorize or sugar coat the reality of addiction and what it does to the bodies, minds, lives, and families of addicts.

The successes and failures would make it clear that it's a ride some can't get off, and one that takes them to their grave, but not before it stops at some very dark places along the way. It's about an honest at look at addiction as you'll find on television. The producers show probably as much as they can get away with, even for cable, and seem to be showing "nothing but the truth," as unvarnished as is possible on television, between car wax and diaper commercials.

Honest discussion — not scare tactics or oversimplified slogans — about the realities of addiction its far-reaching effects is one part of the most effective method of reducing demand for drugs: prevention.

The other half is what comes at the end of "Intervention" — 90 days in a treatment facility, fully covered. Family and friends usually urge the often reluctant addicts to "accept this gift." That's appropriate, because it is a gift; something rare and precious, available to very few who need it. For most it's a gift denied.

According to the National Survey on Drug Use and Health [8], from the Substance Abuse & Mental Health Services Association, in 2007 some 22.3 million Americans aged 12 and up were classified with substance dependence or abuse in the past year. Of those, only 2.4 million, or 10.3% received treatment at "specialty facilities" — defined as  hospitals (inpatient only), drug or alcohol rehabilitation facilities (inpatient or outpatient), or mental health centers — meaning that 20.8 million needed, but did not receive treatment.

Of those 20.8 million, 1.3 million reported that they "perceived a need for treatment for their illicit drug or alcohol abuse problem." Some 380,000, or 28.5%, made an effort to get treatment, but found none available. And among those who needed — and felt they needed — treatment but did not get it, the top reasons (33.4%) they didn't get it because they lacked health insurance and couldn't afford the cost of treatment.

However you add it up, the numbers make it pretty clear that we have a huge opportunity to decrease demand for drugs — and by extension decrease the effects of addiction both here at home and in Mexico. We've had the chance for a long time, and just haven't been willing to grab it.

The statistics are dry and abstract, but multiply them by the millions addicts and families featured on "Intervention" (keeping in mind that 1/3 of Americans have a family member with a drug or alcohol abuse) problem), for whom desperately-needed help is unavailable, and add the communities where these families (and their addicted relatives live), and you get some idea of the cost of addiction.

Maybe you'll even consider whether treatment should be a "gift" to some lucky enough to be featured on "Intervention" or rationed to the rest based on the ability to pay, rather than need.

That's one of the reasons I watch "Intervention." Just over sixteen years ago, I "woke up," caught a break, or had a "moment of clarity" on the heels of my last drink [9], which also happened to be the occasion of my last blackout, and my last episode of drunk driving. (The last before my luck ran out, because I hadn't had an accident, hurt anyone, or gotten pulled over ... yet.)

I came to in my car, parked behind the the house I was living in at the time, after giving a friend a ride home from a keg party. (To this day, I have no memory beyond backing out of the driveway when we left the party.) I got out of the car, and walked around it to check for damage that indicate I'd had an accident. (I learned later, that I'd delivered my friend home safe and sound.) Finding none, I staggered inside, and became violently ill in the bathroom, just before splashing cold water on my face, I looked in the mirror.

At that moment, a gift I've had all my life kicked in: the ability to know when I'm in or about to get into trouble over my head, while I still have enough time to back out. I already knew that if my problem got bad enough to need treatment in a "special facility" no one would be able to afford to put me in one, even if I wanted to go.

A couple of days later, I walked into an AA meeting. Shortly afterwards, three friends of mine walked in. One of them said to me, "I was wondering when you'd show up." I stayed, and listened, and wrestled with whether I had a problem or not. I mused to another drunk that after listening to people talk about losing homes, jobs, families, careers, relationships, reputations, etc., that I wasn't sure I belonged there. He asked me if I thought I could ever drink "in moderation," and when I said no told me that if I didn't feel like I'd lost enough, I could go back to drinking and, "all this and more could be yours."

So, I watch not just to remember the gift I received, of the life I wouldn't have had if I'd continued drinking [10], but also to remind myself of those who need that gift even more than I did, but for whom it isn't available.

That's because for too long we've treated addicts as prisoners in our criminal justice system instead of patients in our health care system.