The Fix.

THE FIX By Michael Massing New Press, $22.50

IT'S OFTEN THE CASE THAT social problems fail to get solved not because we don't know how but because the country lacks enthusiasm for the most effective solution. he social havoc wrought by the epidemic of hard-core drug abuse in the inner city is among the more depressing examples. Since the early 1970s, two lessons from the nation's war on drugs have been clear. The first is that even the most successful law enforcement efforts to block illegal importation, distribution, and consumption of illicit drugs can reduce these activities only temporarily; alternative sources and distribution routes always spring up to meet demand. The second lesson is that drug treatment programs, though they're expensive and suffer a high failure rate, are much more successful than more politically popular cops-and-robbers efforts at achieving long term reductions in drug use.

The history of how this lesson was learned again and again, and the street-level consequences of ignoring it, are the subject of Michael Massing's fine new book. Massing, who for many years has been one of the country's very best magazine writers on domestic and international affairs, follows a blueprint quite similar to that of Nicholas Lemann's The Promised Land. Like Lemann's book, Massing's shifts its narrative back and forth between ground level reality (in The Fix, it's the story of a struggling nonprofit drug treatment center in Spanish Harlem) and the bureaucratic machinations of Washington policy makers. And as Lemann did, Massing blends narrative with analysis, relating every development in his story to the larger question of how to solve the problem. Longtime readers of The Washington Monthly will recognize this journalistic approach as the one most favored by this magazine, and Massing's application of it makes for an absorbing and important book.

Massing is careful not to associate himself with those who favor outright legalization of hard drugs, even though he shares much of that movement's skepticism about criminal prosecution of drug offenders. The just-make-them-legal line has always struck me as a glib analysis based on the false premise that legalizing shady activity will chase shady characters away from it. (Last time I checked, the mob still controlled much of this country's legal gambling in Las Vegas and elsewhere.) As Massing shows, it also overlooks a key lesson of prohibition: Though the outlawing of alcohol was disproportionate and futile, its repeal did lead to an increase in per capita alcohol consumption from 0.97 gallons to 2.07 gallons between 1934 and 1944. That's tolerable for a substance whose use is often harmless--the same might be said of marijuana, whose use Massing sensibly favors decriminalizing, or at least not worrying much about. (I haven't smoked the stuff in adult life, and certainly don't consider it as harmless as social drink, but I agree with Massing that whatever social harm it has brought hasn't been in the same league as that created by harder drugs.) But legalization wouldn't be tolerable for drugs whose power to addict and intoxicate cause as much harm as heroin and crack. Indeed, Massing notes, even the seemingly harmless Valium, widely prescribed in the early 1970s, was by the late 1970s "sending more people to hospital emergency rooms than any other drug, heroin and cocaine included" Doctors stopped writing the prescriptions, and the problem receded. If harder drugs were made legal, such hospital admissions would almost certainly go through the roof.

The ground-level narrative in Massing's book tells the story of Raphael Flores, proprietor of Hot Line Cares, a perpetually broke drug treatment office Flores founded in 1970. Hot Line Cares, which is essentially just a cramped office "on the second floor of an otherwise abandoned tenement," doesn't actually provide drug treatment. Rather, Flores and his ragtag staff run a sort of travel agency for addicts, guiding them through the labyrinthine world of detox centers and long-term care facilities. This might at first sound like a superfluous task, but in fact it's essential, because beds at these facilities are so scarce. (There are only about 500 detox beds for drug addicts in all of New York City, for example.) It requires an unusual amount of cunning to get an addict into the system before his or her urge for another fix overpowers the desire to get clean. As Massing points out, New York City has an appallingly balkanized drug treatment system with no central intake office. "If a Holiday Inn is full, it will at least call the Ramada down the street to see if it has a vacancy," Massing writes. "Not so two treatment programs" For drug treatment to have any hope of working, the one or two weeks of detox must be followed by long-term drug treatment--preferably a year or more. But, according to one study Massing cites, only one in 14 detox clients were referred to these programs. The reason, Massing argues, is financial disincentive. New York hospitals are reimbursed by Medicaid up to $1,000 per day for detox: "If patients relapse, their eventual return is almost guaranteed" Actually curing addicts, in other words, would be bad for business. Battling against these appalling imperatives, Flores rustles addicts off the streets, buys them bus tickets to upstate treatment centers, and keeps them moving through the system.

No doubt Flores will be hailed by some conservative who reads Massing's book as an example of why private charity is superior to government programs. But while Flores is shown to be heroically dedicated, Massing makes clear that his shoestring efforts are a poor substitute for large-scale government action. Indeed, by the end of the book, Hot Line Cares has gone bust, fallen victim to scarce philanthropic funds and Flores' own Dostoevskian personal demons, which include a busted marriage and a tendency toward addiction himself. (At one particularly low point, Massing suggests, Flores succumbs to a crack habit.) The job is simply too big for Flores, or even a thousand Floreses. It requires taxpayer-funded intervention.

That's where Massing's second narrative thread, about 30 years of federal drug policy making, comes in. If Flores is the hero of the ground level story, Dr. Jerome Jaffe is the hero of the Washington story. Through experimentation in the late 1960s with such new, highly effective drug treatment therapies such as methadone, an Illinois program devised by Jaffe increased patients' employment rate by 70 percent over the course of their treatment, while reducing their arrest rate by 40 percent. The results caught the eye of the Nixon White House, which brought Jaffe, a Democrat, to Washington to make drug policy; Nixon wanted drug use down, and he didn't much care that the person doing it was a liberal. Massing, who is clearly pitching his book to the liberal intelligentsia, makes a bit too much of this irony. In fact, as has often been noted, Nixon's pragmatism, along with the prevailing liberalism of the time, made many of his social welfare proposals--for example, his support for a guaranteed income--much more liberal than anything Democrats are putting forward today. Nonetheless, it is surprising to learn that Jaffe's most crucial White House ally was Egil "Bud" Krogh Jr., better remembered by history as the Watergate felon who headed up the plumbers unit. Massing portrays Krogh as something approaching a tragic hero; apparently, when he wasn't arranging the burglary of Daniel Ellsberg's psychiatrist's office, Krogh was a phenomenally idealistic and effective government official.

Massing tells a wonderful story about Jaffe's first big White House challenge: to reduce skyrocketing heroin use by the U.S. military, which according to one estimate encompassed 10 to 15 percent of all GIs in Vietnam. The Pentagon's solution--throwing offenders in the brig--was clogging the military justice system but doing little to end the problem. Jaffe came up with a better solution that relied for its effectiveness on the GIs' overpowering desire to return to the United States: subject all GIs to urinalysis before shipping them home. Anybody who flunked would have to stay in Vietnam for detox. When Jaffe presented his plan to the Pentagon, the generals insisted that this would play havoc with the complex logistics of troop movement. Jaffe, who as a newcomer to Washington was blissfully ignorant of the need to defer to "realism" and bureaucratic authority, replied, "I cannot believe that the mightiest army on earth can't get its troops to piss in a bottle" The plan was implemented, and the percentage of GIs using heroin quickly dropped by more than half.

At home, Jaffe persuaded Nixon to secure $420 million in funding for drug treatment and prevention, "more than eight times the amount when Nixon took office," and twice as much as the Nixon administration was spending on "law and order" interdiction. The program appears to have been an enormous success: By early 1973, narcotics-related deaths had declined 48 percent in New York City, Cook County, Washington, D.C., and San Francisco County, and 94 of the nation's largest cities had experienced a drop in crime. Some of this decrease may have been attributable to the disruption of the fabled "French [heroin] connection" by various foreign governments in the summer of 1972; Massing downplays this cops-and-robbers development, presumably because it is slightly inconvenient to his argument. But the striking fact remains that this was a period when the number of addicts receiving federally funded treatment jumped 300 percent within a single year.

Unfortunately, 1972 proved to be the high-water mark of the liberal, "demand side" approach to reducing hard-core drug use. The end was brought about (of course) by a liberal struggling to toughen his image: Nelson Rockefeller, then governor of New York, but hoping to win the Republican presidential nomination in 1976. Early in 1973, Rockefeller unveiled a new get tough initiative on drugs that gave mandatory life sentences to anybody convicted of selling any quantity of heroin, methadone, LSD, amphetamines, and hashish. Jaffe, naturally, opposed the state plan, telling Rockefeller it would give a harsher sentence to someone who sold drugs than it would to someone who killed a policeman. But the law-and-order Nixon White House could hardly stand in the way of a growing law-and-order movement, especially while Bud Krogh, whose illegal activities were fingered by John Dean in April 1973, was being engulfed in Watergate. Jaffe resigned two months later.

Through the Ford and Carter administrations, funding for the law enforcement anti-drug efforts continued to grow while funding for drug treatment stayed flat; by 1976, the federal government was spending about the same amount on each, and within a few years it was spending much more on law enforcement. Meanwhile, a grassroots anti-marijuana movement, led by anxious middle-class parents of wayward teenagers, took hold. (It didn't help matters for liberals that Jimmy Carter's drug advisor, Dr. Peter Bourne, was spotted at a Washington party where cocaine and marijuana were ingested; he later resigned after a minor scandal involving his writing a Quaalude prescription to a White House aide.) In the 1980s, when Nancy Reagan sought to ditch her Marie Antionette image by plunging into public policy, the issue she chose was drug abuse, and her "Just Say No" campaign quickly became the captive of anti-marijuana forces. Although this campaign eventually did help bring casual teenage marijuana consumption down, it shifted limited financial resources away from the hardcore users, whose consumption continued to increase. When asked about this, Mrs. Reagan said, "I never have thought that money is the answer" In fact, the whole idea that drug addicts could be "cured" was regarded by the Just Say No crowd as vaguely subversive, because it undermined its no-turning-back warnings to teenagers thinking of experimenting with drugs.

The closest thing to a leering villain in Massing's book is William Bennett, drug czar to George Bush. According to Massing, Bennett's interest in the job was entirely careerist. When a drug survey showed casual drug use was declining while hardcore use was soaring, Bennett took it "like a punch in the stomach," according to an aide quoted by Massing. David Tell, another aide (now a writer for the conservative Weekly Standard) told Massing: "He panicked. He wanted to be J. Edgar Hoover and save the country. Now he felt there was no problem anymore" After nineteen months on the job, Bennett quit in 1990 and promptly made a financial killing with The Book of Virtues, his anthology of moral parables, and its many spin-offs.

The election of Bill Clinton might have been expected to revive federal funding for drug treatment, not only because Clinton was a Democrat, but because his brother, Roger, was a drug-treatment success story. Early in 1993, however, a University of Michigan study showed a 22 percent increase in the number of high school seniors who had smoked marijuana during the previous year--the first increase of any kind in fourteen years. As Massing points out, this still put high school marijuana use at less than half what it had been during the hedonistic late 1970s. But Republicans were quick to make hay out of this increase during the administration of a confessed onetime dope-smoker (albeit one who didn't inhale), and any chance of shifting federal anti-drug money to drug treatment evaporated. By 1996, drug treatment accounted for only one-third of the federal drug budget. Around this time, of course, conservative get tough policies on crime seemed to be getting the same sort of historic payoff that liberal drug treatments had had back in 1972. One wishes Massing had given this development a bit more careful examination at the national level. Instead, Massing confines his discussion to what happened in New York City under Mayor Rudolph Giuliani. Massing concedes the efficacy of Giuliani's zero-tolerance strategy, which dictated that prosecuting all manner of minor offenses would help kill off the "climate of disorder" that bred more serious crime. (The inspiration was a widely read article in The Atlantic Monthly by James Q. Wilson and George Kelling.) But Massing argues that the drug trade mostly moved off the streets and indoors (though that in itself was obviously a great help in maintaining social order). In 1995, even as drug dealers were being swept off the streets by the New York Police Department, the city's hospitals were registering the same number of cocaine-related and heroin-related visits as the year before, and drug mortality figures "were actually moving upward" Busting fare-beaters might be successful in keeping pickpockets off the subways, Massing concludes, but "given the power of addiction, the normal rules of deterrence simply did not apply" Still, it's unfortunate for Massing that his book deadline came along just as growing evidence was emerging that the cocaine epidemic really was ending. Although there's a decent case to be made that it receded largely for reasons having nothing to do with police action, Massing devotes frustratingly little attention to this controversy.

Massing's larger point, though, remains unassailable: If the nation were more serious about ending the kind of drug abuse that ruins lives and neighborhoods, it would spend considerably more money on proven methods of drug treatment. Today, Massing writes, the United States has 10 times as many hardcore drug users as it had when Richard Nixon became president in 1969. Yet the nation's drug-treatment system can accommodate only half of all serious addicts. Massing proposes, sensibly, that the current $17 billion federal drug budget be rejiggered so that half the money goes to law enforcement and half (as opposed to the current one-third) goes to treatment. As I write this, the zeitgeist seems headed in precisely the opposite direction. Giuliani recently announced a plan to end methadone treatment for heroin addicts in New York's city-run hospitals, making it the first major city to pull the plug on a form of drug treatment that's compiled a 30-year track record of success. "They think the jails are full now?" the Associated Press quoted one former heroin addict as saying. "Do you know what it would be like without methadone?" Massing's exemplary, cool-headed book will hopefully restore some sense to this debate.

TIMOTHY NOAH is a contributing editor for The Washington Monthly.