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Some Perspective: The First "Drug Czar"

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Jerome Jaffe, M.D.

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Although the term "drug czar" wasn't coined by a newsman until more than a decade later, it was Jerome Jaffe who first fulfilled this role. Appointed by President Nixon in 1971, Dr. Jaffe directed what was then known as the Special Action Office for Drug Abuse Prevention. He was a rarity among "drug czars" in being a scientist who attempted to build policy on the basis of evidence rather than slogans.

The following description of his early days in the Nixon administration is excerpted from a review of Michael Massing's book The Fix by Prof. David F. Duncan:

Jaffe has described his meeting with an essentially clueless Nixon. He sidestepped Nixon’s idea of the death penalty for dealers and suggested that the one value of law enforcement might be in pushing up the street price of drugs and thus encouraging more addicts to seek treatment – this idea was later taken up by Peter Reuter of the Rand Corporation but his research showed that the effect of aggressive law enforcement on supply was essentially nil and on price was tiny.

Jaffe attempted to make four points in his meeting with the President an d each was to bear fruit in shaping the future of drug policy under Nixon. The first was the need for more research and evaluation of treatment. The expansion of a small division within the National Institute of Mental Health into a National Institute on Drug Abuse and a National Institute on Alcoholism and Alcohol Abuse grew in part out of this recommendation. Second, he noted that currently there were a dozen different federal agencies funding treatment that didn't even talk to each other. He felt that coordination of all these efforts was needed in pursuit of a coherent national strategy. This led to the creation of the Special Action Office for Drug Abuse Prevention, which he was startled to find himself appointed director of, as the nation’s first “drug czar”. Third, given the extent of heroin addiction, he urged that methadone maintenance should not be restricted to a few small research projects but should be made widely available. Fourth, he urged that funding for treatment be dramatically increased. These last two points were at the heart of what Massing refers to as “The Fix”.

Jaffe's first big White House assignment was to develop a plan for controlling the skyrocketing prevalence of heroin use among U.S. servicemen in Vietnam, which involved 10 to 15 percent of all GIs in Vietnam if not more. Pentagon policy was that heroin use was a crime and that any serviceman who used heroin should be arrested and prosecuted. The result of this was an over-burdened military justice system but no reduction in heroin use. Jaffe urged that the Pentagon should adopt a treatment approach instead of a punitive one.

Massing suggests that Jaffe's solution relied for its effectiveness on the GIs' overpowering desire to return to the United States. He advised the Pentagon to subject all GIs to urinalysis before shipping them home. GIs who tested positive for heroin would have to stay in Vietnam for detox. The military’s reaction to his plan was to object that it would play havoc with the complex logistics of troop movement, to which Massing reports that Jaffe replied, "I cannot believe that the mightiest army on Earth can't get its troops to piss in a bottle" When his plan was implemented, Massing reports that the percentage of GIs using heroin quickly dropped by more than half.

Jaffe himself tells it quite differently. It appears that as an academic and researcher he was aware of the growing evidence that most heroin users do not become addicted and the early follow-ups showing that most of the troops who were addicted to heroin in Vietnam abstained successfully, and usually without any treatment, after returning home (Jaffe and Harris, 1974). He didn’t fool himself into believing that the urine screening program actually deterred heroin use among the troops while serving in Nam. What he expected was that once word of the urinalysis got around heroin using GIs who weren’t addicted would stop using for the last weeks before rotation home and only the truly addicted would be unable to do so and thus fail the urine test. This is apparently what happened but it gave the politically useful appearance of a far greater success. The classic follow-up study by Robins, et al. (1980) confirmed that most of the GIs who became addicted to heroin while serving in Vietnam recovered fully and permanently after returning to the US and also found that recovery rates were not improved by receiving treatment – a finding the implications of which I discussed in several publications of that period (Duncan, 1974, 1975, 1976 & 1977).

I believe that the rapid recovery of Vietnam addicts demonstrates that for most of the GIs who became addicted, heroin use served as a coping mechanism for dealing with the stress of serving in a war zone. The relief they obtained by using heroin served as a negative reinforcer and negative reinforcement produces powerful habituation. Once they returned home their heroin using behavior extinguished in an environment where for most of them it was no longer being reinforced. Those who persisted in their addiction, according to Robins, et al. (1980), were the ones who returned to conditions of poverty, an alcoholic parent, etc. –- exactly the ones who would continue to need a stress reliever. Treatment was far less relevant than environmental change, which is what Moos et al. have found to be true for alcoholism treatment (Moos, Finney, & Cronkite, 1990; Finney & Moos, 1992).

As Massing reports, Jaffe was able to convince the Nixon administration to increase funding for drug abuse treatment eightfold over what it had been when Nixon took office. For the only time so far since America began its failed experiment with drug prohibition, the treatment budget was larger (twofold) than that for drug law enforcement.

The full review may be read at http://commonplacebook.tripod.com/id82.html.