How the Office of the President Has Shaped the Landscape of the Treatment Industry
The War on Drugs has proven to be America’s longest war. It was Nixon who coined the term, although the concept was years in the making. From the inception of this war, there has been a concern with how to reduce the supply of drugs (a largely international issue) and the demand for drugs (a domestic issue). Each president, through President Obama today, has absorbed that two-pronged task into the nation’s drug policy. This article looks at four presidential campaigns against drugs: those of Richard Nixon (1969-1974), Ronald Reagan (1981-1989), Bill Clinton (1993-2001), and Barack Obama (2009-2016). These four presidents reflect an equal balance of the Republican and Democratic parties and represent nearly three decades of leadership over the last 47 years.
How Nixon Fought and Lost the War on Drugs
Only one year into office, President Nixon signed into law a major piece of drug legislation, the Controlled Substances Act (CSA) of 1970. The CSA reflects a complex legal latticework in the area of drug criminalization and includes the rules on scheduling drugs still in use today. But the CSA also provides insight into how President Nixon and his administration thought about drugs. The CSA doled out severe punishments for drug dealers. For example, a drug dealer could be sentenced to 15 years on a first conviction for the sale of certain narcotics, 30 years if a minor was the buyer, and life in prison if involved in a drug-selling crime syndicate. Under the CSA, individuals who bought drugs potentially faced prison time but would get a less severe sentence than drug dealers. Overall, the CSA sent out the message that President Nixon was taking a very hard line against drug sales and a bit of a softer line against drug use but continued to make it a crime nonetheless.
Only two years into office, in 1971, President Nixon faced some alarming statistics about heroin use, both in Vietnam and the US. According to a congressional report released in the spring of 1971, 15 percent of those in service in the Vietnam War (November 1, 1955-April 30, 1975) were experiencing heroin addiction. In the US, government surveys revealed that 550,000 Americans were using heroin. That June, President Nixon took to the podium to address what he considered to be an emergency situation regarding drug abuse in America. In his “Special Message to the Congress on Drug Abuse Prevention and Control,” President Nixon made clear that drugs were America’s topmost enemy. It was in this very speech that he announced that the US was waging a war on drugs.
While President Nixon advised of the need to control the influx of drugs from outside the US, much of the speech focused on the demand side of the drug epidemic equation. President Nixon repeatedly underscored the need to rehabilitate those Americans who were suffering from drug abuse.
To ensure his demand for rehabilitation would be effectively executed, in his speech President Nixon:
- Announced the creation of the Comprehensive Drug Act, a law focused on rehabilitation: To fund the implementation of the terms of this act, President Nixon asked Congress for a total of $105 million to be added to the 1972 budget for the express purpose of rehabilitation (for a total requested budget of $371 million for the War on Drugs).
- Requested that federal authority in the area of drug rehabilitation be mainly consolidated under one new federal agency, the Special Action Office of Drug Abuse Prevention (with an initial three-year term): This agency had extensive tasks, including running rehabilitation programs through the federal agencies equipped to deliver such services.
- Asked that Congress make an amendment to the Narcotic Addict Rehabilitation Act of 1966 to expand access to methadone maintenance programs: This heroin substitution therapy had proven to be effective.
- Instructed the Special Consultant for Narcotics and Dangerous Drugs to review all federal laws to facilitate the federal government’s role in providing treatment: Nixon also advised that he would pass any necessary legislation to achieve this end.
Today, we undoubtedly have the benefit of hindsight. A main criticism leveled against the War on Drugs is that it excessively criminalized the drug issue. Although there were numerous promises made to rehabilitate Americans, there is an enormous gap today between the people who need drug treatment and the people who actually seek it or access it. According to the 2013 National Survey on Drug Use and Health, in 2013, there were an estimated 22.7 million Americans 12 years of age and older who needed treatment for abuse of drugs yet only 2.5 million of this population received treatment at a qualified rehab center. Not only has treatment lagged, but incarceration rates for drug use and drug-involved crimes are alarming. One survey shows that of the approximate 2.3 million inmates in the US, more than 50 percent are in jail for a drug offense.
In addition to there being a near universal consensus that Nixon’s War on Drugs strategy failed, many agree that certain groups and neighborhoods were disproportionately negatively impacted. In the US, people who live in impoverished urban areas were at the frontline of the War on Drugs and absorbed the brunt of its devastating impact, such as arrests, family fragmentation, deepening of addiction, and violence. In supplier countries, such as Colombia, violence and poverty abounded while drug cartels rose in power (in turn funding and expanding their international illegal market activities). Former President Jimmy Carter has remarked that a major failing of Nixon’s drug policy approach was that it was not sufficiently humane. Carter’s remark juxtaposed against Nixon’s rehabilitation-oriented policy promises in 1971 demonstrates the wide gulf that, over time, can open up between presidential policy intentions and outcomes.
Reagan’s Place in the War
Nixon may have been the father of the War on Drugs, but his legacy continued through the subsequent presidential line. When President Reagan came to office, he not only inherited a drug epidemic but also countenanced a new enemy in the War on Drugs: crack cocaine. While Nixon’s speech and drug policy may have been fueled primarily by a concern for heroin abuse, crack cocaine especially galvanized the Reagan administration’s “Just Say No” efforts.
Consider President Reagan’s “Campaign Against Drug Abuse” speech from the White House on September 14, 1986. With First Lady Nancy Reagan by his side, President Reagan’s speech made clear that he was very much in the trenches with Nixon on framing the drug epidemic as a war-like situation. President Regan described drugs in enemy terms, as a “menacing” force and referred to the War on Drugs as a “war for freedom.” President Reagan had not broken from the conception of the need for a war against drugs even though the America he faced was as steeped in drug abuse as Nixon’s America.
In his speech, Reagan referenced the following drug statistics of the day:
- There were 500,000 Americans suffering from heroin abuse (a decrease of only 50,000 compared to a survey taken from Nixon’s era).
- An estimated 4-5 million American were currently using cocaine.
- One in every 12 Americans were smoking marijuana regularly.
- Of those individuals who regularly used drugs, the highest rate of consumption was in the 18-25 age group (the very group that would be expected to be working and/or studying).
President Reagan shared with the public six initiatives to help ensure that the US would win the War on Drugs. The six initiatives were that workplaces be drug-free, that schools be drug-free, that treatment be available to those experiencing substance abuse, that there would be a ramping up of international efforts to stem drug trafficking, that a strengthening of law enforcement would occur, and that an expansion of public education would take place. Framed as a sign of his administration’s progress, President Reagan proudly advised the public that federal spending on law enforcement more than tripled since 1981 (his first year in office). But the government’s financial dedication and policy efforts had led to 10,000 drug-related convictions. Today, we understand that locking up the drug problem doesn’t stop the drug problem. Boastful statistics of yesteryear can register today as failures.
Unlike the presidents before him, President Reagan made room on the drug policy reigns for the first lady. Nancy Reagan addressed the public in this speech to make a sincere plea to “Just Say No.” The first lady explained that this phrase was not a slogan drawn up in the White House. It was spontaneous. On an earlier trip to a school in Oakland, California, the first lady described how a group of students asked her what to do if someone offered them drugs. The first lady advised them to “just say no,” and from there, the students started a “Just Say No” group. Thereafter, at least 10,000 more groups were founded in schools across the US. The first lady was astounded and grateful that her simple response had proven so motivational. While the story is poignant, today, many say that the slogan sounds like it was destined to fail, and many would agree that the Reagan administration’s drug policy did fail.
The Drug Policy Alliance (DPA), a leading US organization dedicated to the advancement of scientific, compassionate, and health and human rights-based drug policies, voices some of the main criticisms against the Reagan administration’s drug policy approach. First, the DPA notes that when Reagan assumed office, he shifted many of the resources away from the health sector toward the Department of Justice. In fact, in 1986, the most severe federal mandatory sentencing terms for drug crimes came into law. For example, under these guidelines, an individual who was found in possession of 5 grams (equal to about two sugar packets) of crack cocaine was subject to an automatic five years in prison. As a result of this sentencing scheme, incarceration rates for lower-level drug offenses rose dramatically over the next 20 years. Relatedly, as resources went toward criminalization efforts, they were diverted from harm-reduction policies, like needle exchanges, which in a tragic turn helped spur the rate of HIV infections. As drug policies do not live in a vacuum, their impact is manifold and far-reaching. Like Nixon, despite Reagan’s presidential interest in stemming drug abuse, the drug policies he devised backfired in many ways.
Clinton Continues the War
During his 1992 campaign for the presidency, Bill Clinton said that he supported treatment rather than imprisonment for individuals who used drugs. However, early into office, President Clinton continued the War on Drugs and its emphasis on criminalization of individuals involved in drug offenses, including those who used drugs. In fact, President Clinton rejected a recommendation that would involve greater leniency in the sentencing of crack cocaine offenses. Also, when presented with the opportunity to lift the ban on federal funding of needle exchange programs, President Clinton declined to do so.
Supporters of former President Clinton would argue that these decisions must be understood in context. However, overall, there is a general agreement that his administration exacerbated the failings of the War on Drugs when it had an opportunity to set policy in the direction of expanding treatment availability. This point is especially forceful in regard to incarceration rates during the Clinton era.
As Salon reports, under President Clinton, the incarcerated population increased by 673,000 people (that’s 235,000 more than under former President Reagan). The Clinton administration may have also contributed to the social conditions that fueled the drug epidemic. For instance, while President Clinton’s federal budget decreased by $17 billion for public housing, funding for the department of corrections increased by $19 billion. Also, $1 billion in federal funding for state education was redirected to the construction of penitentiaries. Conviction of a drug felony, under President Clinton, also meant that a person was permanently ineligible for public housing, food stamps, and cash assistance. As these statistics are not being provided alongside President’s Clinton’s rationale for his acts, they are intended only to shed light on how a War-on-Drugs approach can end up funding incarceration efforts over treatment efforts.
As former President Clinton has remained in the public spotlight, he has been forthcoming about his role in this country’s high incarceration rates. Speaking to signing the Violent Crime Control and Law Enforcement Act into law, Clinton acknowledged that he supported sentences that seem unduly harsh, but the law resulted in a sharp decline in crime in history. Clinton admitted that many inmates, many of whom were young, spent too much of their lives in prison. Clinton did not speak to what hardships may befall these men and women after release from prison. It is well documented that some individuals who are released from prison are financially, socially, and psychologically vulnerable. For convicted felons, government assistance will not be available, which could potentially set them at risk for criminal activity, such as selling or using drugs. This cycle throws into high relief that the criminalization of drug offenses creates a system that can continually perpetuate negative outcomes for those involved. Conversely, drug treatment and the support system it entails can provide recovering individuals with an opportunity to break out of the negative cycle of addiction, crime, and poverty.
Obama and Changing Times
If Nixon had to tackle heroin and Regan crack cocaine, when President Obama took office, he had to take on a drug problem that included a prescription opioid epidemic and an overcrowded prison system. But change was afoot. In 2014, as TIME reported, President Obama and his administration released an updated drug policy that made treatment funding and service delivery a priority. The plan called for greater public drug education, repositioning substance abuse as a disease rather than a crime, and increased efforts to guide individuals who abuse drugs into treatment programs rather than prisons cells, such as by strengthening drug court programs. The shift in policy also meant that federal agency rhetoric would have to be updated. For example, the Department of Justice advised that it would stop referencing the need to be “tough on crime” and start saying it was “smart on crime.”
Despite President Obama’s movement toward embracing the disease model of addiction and providing a complementary drug policy, his administration is subject to criticism by those seeking greater deregulation in this area. Those who support the legalization of marijuana, for instance, continue to disagree with the Obama administration’s ongoing criminalization of the use and sale of marijuana. For those who support deregulation, the current federal treatment of marijuana is considered a vestige of thinking related to the War on Drugs. It remains to be seen, but a shift on federal drug policy with respect to marijuana could set a precedent that leads to mass legalization of drugs in the future in America. Portugal made the leap to drug decriminalization in 2001.
The aftermath of the War on Drugs has pointed President Obama to the fact that this particular strategy has not worked for America over the last 45 years and counting. However, the shortcomings of the War on Drugs does not require that the US swing dramatically in the direction of Portugal’s decriminalization approach; however, Portugal’s success makes the case for the deregulation strategy across the globe. Portugal’s policy outcomes include a decline into drug initiation in the 15-24 age group, a decrease in the number of drug-involved deaths, and a decline in HIV rates among injection drug users. If the War on Drugs is at one end of the spectrum of drug policy, the Portuguese approach is at the other. For the US, the Portuguese approach is helpful in that it drives awareness of alternatives to the War on Drugs, even if the US is far from adopting that particular approach.
Perhaps one of President Obama’s greatest legacies will be his changes to healthcare law and its impact on substance abuse treatment. Known colloquially as Obamacare, the Affordable Care Act (ACA) is one expression of President Obama’s commitment to facilitating the treatment needs of individuals who are experiencing substance abuse. The ACA brought about expansive reforms to the way Americans can obtain insurance and sought to improve access to various treatment. The ACA sets forth 10 essential health benefits that all health plans that fall under the ACA must follow. President Obama ensured that mental health services and addiction treatment would be covered by including these treatments among these essential health benefits. Low-income or no-income is no bar to addiction treatment under Obamacare. All Medicaid and Medicare plans must provide addiction treatment services (covered services vary by state).
More About the Affordable Care Act
The Impact of Addiction Research
Against the backdrop of the War on Drugs and its emphasis on incarceration, it may come as a surprise that the research and development of addiction treatment methodologies have expanded to such a remarkable degree. Today, there are two main treatment approaches (used in combination as necessary): pharmacology and therapy. Pharmacology has helped to inform modern-day drug policy by providing a scientific foundation for the disease model. More specifically, addiction science has helped the government to move away from seeing drug abuse as a matter of choice and therefore a punishable offense. The effectiveness of therapy has helped to humanize addiction as it draws attention to the individual who experiences drug abuse. Research on the therapy process and outcomes has revealed that there is often a strong connection between substance abuse and a traumatic experience, a co-occurring mental health disorder, and/or a physical deficit in brain functioning. In short, drug use is not simply a matter of choice, an insight that underscores how the “Just Say No” campaign was based on a basic misunderstanding of drug abuse.
Overall, the research findings that come out of the field of addiction treatment challenge public perception of substance abuse. In turn, it becomes more difficult for the government to defend a warrior stance vis-à-vis the drug epidemic. To be balanced, it is true that history only speaks of the road taken. Drug policymakers of today seem to agree that President Nixon’s War on Drugs was not an effective strategy, and it continued for too long; however, we will never know what the outcome of an alternative policy would have been.
The key for the US government is to be responsive to the changing needs of its populace and to exercise compassion not prejudice. In terms of helping the 23.5 million Americans currently dealing with alcohol or drug abuse, providing treatment services and not incarceration seems to be gaining the foothold in national drug laws and policies that it has long deserved.