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Old Habits

Medicalization is the hot new thing in drug treatment. Just like in 1970.

Dr. Robert Dupont
Joseph Kohl
Kurt Schmoke

By Edward Ericson Jr. | Posted 7/28/2010

Second of a four-part series.

Read part 1, part 3, and part 4.

Page 2 of 5.   1  2  3  4  5  

The seminal heroin eradication program was conducted in Washington, D.C. from 1970 through 1973, and, even at the conceptual stage, proposed a medical/public health model. The designer of that program, Dr. Robert DuPont, was young and confident. He envisioned a three-year program that would treat every heroin addict in Washington, D.C.--5,000 of them, by his estimate.

"Heroin addiction is like an epidemic of Plague--the infected person passes his infection to those around him," DuPont wrote in his proposal, dated Feb. 4, 1970. "To stop this epidemic, swift massive action must be taken to treat all infected persons. Unless all infected persons are reached, the epidemic may rage without abatement despite modest treatment success with some infected persons."

DuPont's paper came on the heels of a shocking study he led that discovered that 44 percent of D.C. jail inmates tested positive for drugs. Most of them were heroin addicts.

Defining the district's problem as "a continually rising crime wave" caused by heroin addicts stealing to support their habits, DuPont proposed the creation of a non-profit government "Addiction Control Agency" with a budget of $6 million by 1971 (about $32 million in 2009 dollars). Asserting that, with methadone maintenance therapy, "the problem of heroin addiction is solvable," DuPont set "the goal of the elimination of heroin addiction in the Metropolitan Washington area within three years."

DuPont's proposal touted the political advantage to President Richard Nixon of establishing a Task Force on Heroin Addiction, and included estimates of both the addict population and their crimes' financial damage. "Making some relatively conservative assumptions, [the] data reveal that the direct dollar cost of heroin addiction in the District of Columbia in stolen money and goods is approximately $240,000,000 a year," DuPont wrote.

In sum, DuPont's 1970 drug treatment model contained every major element of modern drug treatment systems, plus it had the advantage of urgency and novelty. DuPont became the director of the D.C. Narcotics Treatment Administration in 1970 and endeavored to measure treatment intakes, drug use by those in treatment, crime, and employment rates.

Three years later, while carefully crediting police efforts to stem the drug trade and the various drug treatment approaches he had instituted, DuPont declared victory in the journal Science--with a few caveats. One was the rise of illicit methadone use, including "a marked increase in methadone overdose deaths." He also urged vigilance. "It is imperative that both treatment and law enforcement efforts be maintained if heroin abuse is to be kept at the lowest feasible level," DuPont wrote. "The passage of time alone will tell whether the problem is truly solved."

Still, DuPont took credit for halving the district's crime rate by late 1972. His program became especially influential with federal policy makers, Dr. Jerome Jaffe recalls, chiefly because "they could show a large drop in crime."

Jaffe, now a psychiatry professor at the University of Maryland and a bSAS board member, is something of an elder statesman in Baltimore drug treatment circles. He advised Nixon on drug treatment strategies as chief of the Special Action Office for Drug Abuse Prevention and was credited with helping to devise the federal government's drug treatment bureaucracy in the early 1970s. Though his own office was funded for only a few years, Jaffe helped design and erect a permanent bureaucratic drug treatment structure before the political winds shifted and law enforcement would again dominate drug policy.

Even 40 years ago, drug treatment was not new. When Nixon tapped him in 1970, Jaffe was a pioneer in methadone research and practice, having established a successful program in Chicago in the late 1960s. Also up and running were Synanon (an alternative-treatment community that emphasized harsh self-examination and "lifetime rehabilitation" that meant one could never be cured, only treated), and therapeutic communities such as Phoenix House (a New York group home founded in 1967 that emphasized self discipline and social structure). A federal "civil commitment" law had passed in 1966, enabling the family members of drug addicts to force their loved ones into a government-paid six-month, in-patient program followed by outpatient monitoring.

But the programs were fragmented and federal policymakers did not know which ones brought consistent results. In the early '70s, federal drug policy "was spread across 15 agencies," Jaffe says, and Nixon asked for ideas from people both inside and outside his administration.

"Our group recommended several things to extend because they work," Jaffe says. "One was therapeutic communities, one was methadone."

The civil commitment system phased out because it was shown to be less effective than other methods, Jaffe says. Nixon encouraged this kind of scientific study to improve drug treatment approaches by establishing the National Institute on Drug Abuse (NIDA), tapping DuPont to head it in 1973. "[Nixon] did say let's have an overall way to measure outcomes," Jaffe says. "The concept that we need to do it has endured."

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