Sunday, December 10, 2006

The current “War on Drugs” in the U.S. is ineffective and cannot be effective because its tactics are based on a false premise - Leslie J. Somos

In this paper we show that the current “War on Drugs” in the United States is ineffective. We also show that it cannot be effective because it’s tactics are based on the Health Belief Model (HBM) (Salazar 1991), which we know to be inadequate to predict people’s behavior.

What is “The War on Drugs?”
President Richard Nixon launched the United States’ “War on Drugs” in a speech on 17-Jun-1971, saying, “America's public enemy number one in the United States is drug abuse. In order to fight and defeat this enemy, it is necessary to wage a new, all-out offensive.” (Woolley 2006a) He repeated “public enemy number one” in a speech on 22-Sep-1972, and ended that speech with the specific term “war on drugs.” (Woolley 2006b) The term was chosen to frame the debate in stark terms, to rule-out discussion and dissent from official policy. Some opponents have replied that “war is not a domestic policy,” to call attention to the framing inherent in the term itself.

Largest fraction of money is spent on enforcement
The expression “follow the money” was known earlier than 1976, however it gained widespread usage after its repetition in the 1976 movie “All The President’s Men,” which documented the Watergate affair of 1972-74 that resulted in the resignation of President Nixon. (Rich 2005)(Keyes 2006)(Safire 2003) “Follow the money” is a suggestion that the actual flow of money is a more-accurate indicator of intent than any official words spoken. We will follow the money by examining the budget of the National Drug Control Strategy. (ONDCP 2006)

The funding of the current implementation of the “War on Drugs” is described in the budget for the National Drug Control Strategy. (ONDCP 2006) The three key priorities are Prevention, Treatment, and Enforcement. However, more than half the dollars (64.5%) are devoted to the third Priority “Enforcement” rather than “Treatment” or “Prevention.” The logic is that people will rationally weigh the costs (legal penalties) against the benefits (drug usage or commerce) and then consciously decide to refrain from the proscribed behaviors. Without naming it explicitly, this is the Health Belief Model (HBM) (Salazar 1991) with the health condition to be avoided (‘disease “X”’) represented by ‘taking drugs.’ The HBM distinguishes four concepts: Perceived Susceptibility (of suffering the condition), Perceived Severity (of consequences of the condition), Perceived Benefits (of taking action to avoid the condition), and Perceived Barriers (to taking action to avoid the condition). The penalties applied by enforcement efforts perform the function of increasing the Perceived Severity of consequences, by increasing the actual severity of consequences. This does not work because fear is a weak motivator. “Scaring people [...] is an ineffective way to change their behavior [...]” (Vedantam 2006) In a comprehensive review of 46 HBM related investigations in 1984, Perceived Severity was of low significance. (Janz 1984, mentioned within Salazar 1991)

Media Campaign
Within the ONDCP budget under the first Priority “Prevention”, is: “Office of National Drug Control Policy—Media Campaign: [...] This funding will restore effective levels of advertising time and space for general and ethnic audiences and to deliver the Media Campaign’s other essential communications programs to encourage the adoption of anti-drug attitudes and strategies by the nation’s youth and their parents.” (ONDCP 2006) This refers to the National Youth Anti-Drug Media Campaign. Once again the HBM is the model followed here, and the unidirectional flow of information from top down, from program to student, is trying to increase the Perceived Severity of consequences of the condition and/or the Perceived Benefits of taking action to avoid the condition, without ever attempting to discover any other motivations or constraints that the students may have or perceive. It is common knowledge that “[t]he surest way to get teenagers to do something is to tell them not to.” (Lee 2006)

Choices
Within the ONDCP budget under the second Priority “Treatment”, are: “Substance Abuse and Mental Health Services Administration (SAMHSA) -- Expanding Choice. As part of the President’s efforts to expand choice and individual empowerment in federal assistance programs, the Administration will offer incentives to encourage states to provide a wider array of innovative treatment options to those in need of recovery [...]” and “Substance Abuse and Mental Health Services Administration (SAMHSA) -- Access to Recovery. [...] Choice is a major component of the ATR initiative. Individuals receiving treatment and recovery services under this program can choose which providers, including faith-based providers, they would like to assist them [...]” (ONDCP 2006) Having choices among treatment may make individuals feel empowered, however it is no guarantee that any of the available choices will be one that the individual would want, and furthermore no guarantee that any available choice will be effective.

Any model?
The abuse of drugs is officially considered by the government to be a public health problem (NIDA 2005), because of the adverse effect of addiction. There are many models that attempt to explain addiction, perhaps as many and varied as the behavioral models discussed in class SB721 “Behavioral Sciences and Public Health” at Boston University School of Public Health. There are “genetic theories (inherited mechanisms that cause or predispose people to be addicted), metabolic theories (biological, cellular adaptation to chronic exposure to drugs), conditioning theories (built on the idea of the cumulative reinforcement from drugs or other activities), and adaptation theories (those exploring the social and psychological functions performed by drug effects).” (Peele 1998) Without any attempt to choose one or more theories of addiction to inform strategy, the enforcement-weighted tactics of the War on Drugs are doomed to make movements which are outflanked by reality.

Ineffective in results
All the effort put into enforcement of drug laws has provably not reduced drug use, at least not to any extent commensurate with the costs. Usage of drugs is unaffected or only slightly reduced, at an enormous ongoing direct dollar cost, plus indirect costs and intangible costs.
- Usage unaffected or only slightly reduced: Between 2002 and 2005, among persons 12 or older, “Percent Using in Past Month” is essentially unchanged around 8%. (SAMHSA 2006)
- Enormous ongoing direct dollar cost: Direct costs, budgeted at $12.7Bn for FY2007, are rising faster (≈3.5%/year) (ONDCP 2006) than total U. S. population (≤1%/year) (U. S. Census Bureau 2006a).
- Enormous indirect costs: At least $8Bn in 2002 in lost wages of incarcerated persons. [265,100 prisoners for drug offenses in 2002 (U. S. Department of Justice 2005) multiplied by low estimate $30,072 annual income (U. S. Census Bureau 2006b) results in $8Bn.]
- Enormous intangible costs to the families and communities of incarcerated persons: Enumeration of statistics “[...] cannot express the financial and psychological damage endured by the children and spouses of those incarcerated. Nor does it express the damage that certain communities and racial groups experience. For example, black males born today have a nearly one in three chance of going to prison.” (Zeese 1999)

Summary
Measured by results, the War on Drugs has not been effective. Though no social and behavioral theoretical models are mentioned as a basis for the strategy of the War on Drugs, the visible tactics all fit the HBM. The HBM assumes “that all behavior is the result of a cost/benefit analysis, of calculated rational thought following the principle of self interest.” (Choi 1998) Because the HBM does not take into account the environment that people may be exposed to, or confined to, it is inadequate to inform a solution.


References

(Choi 1998) Choi K-H, Yep GA, Kumekawa E. (1998). HIV prevention among Asian and Pacific Islander men who have sex with men: a critical review of theoretical models and directions for future research. AIDS Education and Prevention, 10(Supplement A): 19-30.

(Janz 1984) Janz N and Becker M. (1984). The health belief model: A decade later. Health Education Quarterly. 11(1): 1-47.

(Keyes 2006) Keyes Ralph. (2006). The Quote Verifier: Who Said What, Where, And When. St. Martin’s Griffin, p.66.

(Lee 2006) Lee Christopher. (2006). Anti-Youth-Smoking Ads May Have Opposite Effect. [online] http://www.washingtonpost.com/wp-dyn/content/article/2006/10/31/AR2006103101158.html?nav=rss_health , accessed 01-Nov-2006.

(NIDA 2005) National Institute on Drug Abuse (2005). NIDA InfoFacts: Understanding Drug Abuse and Addiction [online]. “Drug abuse and addiction comprise a public health problem that affects many people and has wide-ranging social consequences.” http://www.drugabuse.gov/Infofacts/understand.html , accessed 27-Nov-2006.

(ONDCP 2006) National Drug Control Strategy, Fiscal Year 2007 Budget Summary [online] http://www.whitehousedrugpolicy.gov/publications/policy/07budget/budget07.pdf , accessed 16-Nov-2006.
Fiscal Year, $, calculated percent change from immediately preceding year:
FY2007 $12,655.8M 0.6
FY2006 $12,575.1M -0.5
FY2005 $12,642.3M 6.5
FY2004 $11,867.4M 7.1
FY2003 $11,083.3M 4.1
FY2002 $10,646.4M 12.4
FY2001 $9,467.0M -4.7
FY2000 $9,936.6M
Take the seventh root of the ratio of FY2007 budgeted spending divided by FY2000 actual spending: !Unexpected End of Formula = ≈ 1.035 -- trend: 3.5%/year

(Peele 1998) Peele Stanton and Alexander Bruce K. (1998), The Meaning of Addiction: Theories of Addiction [online] http://www.peele.net/lib/moa3.html , accessed 07-Dec-2006.

(Rich 2005) Rich Frank. (12-June-2005). Don’t Follow the Money [online] http://www.nytimes.com/2005/06/12/opinion/12rich.html?ex=1276228800&en=3603bd97559812d0&ei=5088&partner=rssnyt&emc=rss , accessed 27-Nov-2006.

(Safire 2003) Safire William. (2003), No Uncertain Terms: More Writing from the Popular “On Language” Column in the New York Times. Simon and Schuster, p.111.

(Salazar 1991) Salazar MK. (1991). Comparison of Four Behavioral Theories: A Literature Review. AAOHN Journal, 39: 128-135.

(SAMHSA 2006) Substance Abuse and Mental Health Services Administration Figure 2.6 Past Month Illicit Drug Use among Persons Aged 12 or Older, by Age: 2002-2005 [online] http://www.oas.samhsa.gov/nsduh/2k5nsduh/2k5results.htm#Fig2-6 , accessed 16-Nov-2006.
Description of graph:
Grouped overall (all persons aged 12 or older), and in three groups: persons 12 to 17, persons 18 to 25, and persons 26 or older. In the group of persons 12 to 17, the differences between the 2002 estimate and the 2005 estimate, and between the 2003 estimate and the 2005 estimate, are statistically significant at the .05 level (marked with “+”). No other differences compared to the 2005 estimate are significant at the .05 level.
In the group of persons 12 to 17, Percent Using in Past Month declined 15% (from 11.6% to 9.9%) between 2002 and 2005. In the other two groups, and overall (persons 12 or older), Percent Using in Past Month is essentially unchanged.

(U. S. Census Bureau 2006a) Statistical Abstract of the United States [online] http://www.census.gov/compendia/statab/population/pop.pdf , accessed 16-Nov-2006.
Table 3. Projections as of July 1. (year, number, percent change from immediately preceding year):
2006 298,217,000 0.9
2005 295,507,000 0.9
Table 2. Estimates as of July 1. (year, number, percent change from immediately preceding year):
2004 293,907,000 0.99
2003 291,028,000 0.99
2002 288,173,000 1.00

(U. S. Census Bureau 2006b) Three-Year-Average Median Household Income by State: 2000-2002 [online] http://www.census.gov/hhes/income/income02/statemhi.html , accessed 16-Nov-2006.
Three-year-average median household income (2000-2002) varies from a low of $30,072 in West Virginia to a high of $55,912 in Maryland.

(U. S. Department of Justice 2005) U. S. Department of Justice · Office of Justice Programs, Bureau of Justice Statistics, Number of persons in custody of State correctional authorities by most serious offense, 1980-2002 [online]
Graph http://www.ojp.usdoj.gov/bjs/glance/corrtyp.htm , accessed 16-Nov-2006.
Table http://www.ojp.usdoj.gov/bjs/glance/tables/corrtyptab.htm , accessed 16-Nov-2006.
1999 251,200
2000 251,100
2001 246,100
2002 265,100

(Vedantam 2006) Vedantam Shankar. (28-Sep-2006). Fear Is a Weak Motivator [online] http://www.washingtonpost.com/wp-dyn/content/article/2006/09/28/AR2006092801466.html , accessed 02-Oct-2006.

(Woolley 2006a) Woolley John and Peters Gerhard, The American Presidency Project [online]. Santa Barbara, CA: University of California (hosted), Gerhard Peters (database). Available from World Wide Web: http://www.presidency.ucsb.edu/ws/?pid=3047, accessed 16-Nov-2006.

(Woolley 2006b) Woolley John and Peters Gerhard, The American Presidency Project [online]. Santa Barbara, CA: University of California (hosted), Gerhard Peters (database). Available from World Wide Web: http://www.presidency.ucsb.edu/ws/?pid=3590 , accessed 16-Nov-2006.

(Zeese 1999) Zeese Kevin B., Lewin Paul M., et al. The Effective National Drug Control Strategy [online] http://www.csdp.org/edcs/ , accessed 16-Nov-2006.
Incarceration for Drug Arrests
Figure 1 Sources: Bureau of Justice Statistics. Trends in US Correctional Populations, 1995. US Department of Justice
“The graph cannot express the financial and psychological damage endured by the children and spouses of those incarcerated. Nor does it express the damage that certain communities and racial groups experience. For example, black males born today have a nearly one in three chance of going to prison.”

51 Comments:

Anonymous Anonymous said...

Hey, Leslie-Thanks for your paper. Very interesting. I agree that the "war on drugs" has a lot to learn from behavioral theory. As it is, it assumes that drug abuse and/or use are a rational decision or choice...which I don't believe it is. Rodney

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