War on People

The US Drug War was fabricated and escalated for political utility, not public good. It was more about criminalizing groups of people who were political threats than about safety and order.

The Nixon campaign in 1968, and the Nixon White House after that, had two enemies: the antiwar left and black people. You understand what I’m saying? We knew we couldn’t make it illegal to be either against the war or black, but by getting the public to associate the hippies with marijuana and blacks with heroin, and then criminalizing both heavily, we could disrupt those communities. We could arrest their leaders, raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course we did.

John Ehrlichman, domestic policy advisor to President Richard Nixon

The Drug War is a total failure. It has cost taxpayers more than $1 trillion so far. Its outcomes are literal death and the socioeconomic destruction of millions of people’s lives. Its effects are highly entangled across life domains of housing, employment, public benefits, immigration, child welfare, and education, and have rippled throughout the world.

The War on Drugs is a War on People. It is inhumane. It must stop. Politically diverse policy-oriented think tanks (Americans for Prosperity, Brookings Institution, CATO Institute, Center for American Progress) fundamentally agree.

Punishment

Because one of the main tactics of the Drug War is law enforcement, one of its main functions is incarceration.

Drug-Related and Overall Incarceration Numbers

In theory, incarceration is intended as a deterrent, in this case to deter people from drug use and abuse. However, incarceration does not reduce drug use or abuse. Incarceration does not even stop drug use while incarcerated. Moreover, overdose deaths in prisons have risen dramatically in recent years and risk of overdose death upon release from prison is staggeringly high. Incarceration is not only an ineffective intervention, but also discriminatory. The whole pipeline is racist, actually. For example, despite similar rates of drug use, Black people are more likely than are White people to be targeted for drug testing; are more likely to be stopped, searched, arrested, charged, incarcerated, and serve longer sentences for drugs, and are thus more likely to carry criminal records with them that block pathways to wellbeing and success.

We really like to punish people. The US incarcerates vastly more people per capita than any nation on Earth. We continue to invest heavily in incarceration – annually, $182 billion overall. With 1 in 5 people incarcerated for drug-related offenses at federal, state, and local levels combined that comes out to about $36.4 billion spent annually on drug-related incarceration.

Punishment vs Support

States, in particular, are overinvesting in incarceration relative to mental health. On average, states spend 22% more on incarceration ($193 per capita) than on mental health ($155 per capita). And states spend 8% more on drug-related incarceration ($25 per capita) than on substance use disorder treatment ($23 per capita). This is our money, by the way. Tax dollars at work.

Spending on Incarceration and Mental Health

Incarceration is punishment. Nothing more. Not a deterrent. Not a treatment. Not effective. Only destructive. Some things may deserve punishment. Drug abuse is not one of those things. It is especially undeserving of such a devastating punishment as incarceration.

Drug abuse is a health issue, not a criminal justice issue. Yet we spend an obscene amount of money on punishing people, generally. And we spend a whole lot just on punishing a subset of those people for something that does not deserve punishment.

It also seems like we’re punishing people for being poor. States with high poverty rates incarcerate more people for drugs (ρ = .73) and spend less on mental health (ρ = -.56). There are a lot of potential explanations for those relationships, but explanations aside, those relationships do help identify which states are more into punishment and which are more into support.

Expenditure on mental health by number incarcerated for drugs by poverty rate

Toward Support

The federal government has started to invest more heavily in mental health care and it is now illegal for insurers to make access to mental health and substance abuse treatment services more difficult than to physical health services. That is good progress. However, our health care system is broken. It costs much more than in any other high-income nation, we are the only high-income nation that does not guarantee coverage, and we have worse health outcomes than in any high-income nation. So, mental health care spending is higher than it should be and is not producing the outcomes it should be. In part, that means people are still not receiving the support they need due to access barriers. One in five people who need treatment cannot afford it, and there often are not enough low-cost or free options available.

Substance Use Treatment Accessibility

We should not just force people into treatment, though. Mandated treatment does not work and unethically denies people dignity. Plus, our current healthcare system is broken. The market needs major disruption to both destigmatize treatment and make it accessible. When accessible and accessed, substance abuse treatment is cost effective. It is also effective in terms of outcomes when it is evidence-based (e.g., cognitive behavioral therapy, contingency management). Meanwhile, incarceration may increase the risk of subsequent drug abuse.

Strategies

Apart from evidence-based substance abuse treatment, there are other effective intervention strategies, all of which are far more humane than incarceration: harm reduction, diversion, and drug courts.

Harm reduction is a strategy and philosophy that extends well beyond drugs. For example, seat belts and life jackets are a harm reduction tactics. We don’t ban driving cars and boats. We make doing so safer. In the drug arena, harm reduction involves a set of tactics directed at drug users who are not ready for treatment, intended to minimize the negative consequences of their use. They include syringe access and exchange programs; supervised injection facilities; overdose reversal training and supplies; HIV and hepatitis prevention, testing, and treatment; safe ride programs; safer sex education and supplies; drug checking, and more. They are effective in terms of both cost and outcomes (see here, here, here, here, and here). They are neither coercive nor punitive and are thus humane.

Diversion programs, also known as pretrial interventions, are a strategy that involves a set of tactics mostly directed at nonviolent, first-time offenses of many sorts, including drug-related offenses. They are intended to unburden courts, law enforcement, carceral facilities, and other criminal justice functions and to produce better outcomes than traditional routes of the criminal justice system. They allow people to avoid conviction and carrying a criminal record by requiring various actions that may include education, rehabilitation, restitution, or community service. They are cost effective (see here and here). The evidence for effectiveness in terms of outcomes is mixed though mostly positive (see here, here, and here). However, diversion programs are also generally coercive, in that the alternatives to prosecution are required. Additionally, pleading guilty and paying fees are sometimes required. Thus a substantial portion of diversion programs are inhumane. A prominent humane counterexample that is effective in terms of cost and outcomes (see here and here) is Seattle’s Law Enforcement Assisted Diversion program, participation in which is voluntary and involves referral to a network of supportive services.

Drug courts are a strategy that might be best thought of as a special kind of diversion program. The major differences are:

1. Drug courts are part of the adjudication phase of the criminal justice pipeline, whereas the sort of diversion described above happens before trial and sentencing.
2. Drug courts are focused on treatment-related actions of defendants, whereas pretrial diversion also includes restitution-related actions like community service.
3. Drug courts typically involve a broader array of supportive services than do pretrial diversion programs.
4. Drug courts are targeted at more than first-time offenders and specifically at drug-related offenses, including parents with pending child welfare cases, which disproportionately target Black women. Child welfare programs, also called family policing, have various mechanisms for punishing families as well.

Drug courts are the same as diversion in that treatment is required. In that way, drug courts are coercive and thus inhumane. Some aspects of drug courts are also discriminatory and punitive. So, drug courts appear to be the least humane of the alternative strategies. They are nonetheless effective in terms of both cost (see here and here) and outcomes (see here, here, and here).

In sum, harm reduction, diversion, and drug courts are effective strategies, in terms of both cost and outcomes. Although there are problems with and a lot of variability in implementation, and some aspects are racist and inhumane, these alternatives to incarceration are far more humane than incarceration is. They are generally support-focused rather than punishment-focused. Incarceration is not cost effective, it is not effective at producing positive outcomes for individuals or society, and it is egregiously inhumane. It is punishment, nothing more. Drug use and abuse do not deserve punishment.

Why We Still Punish

Given all the evidence and opposition against the Drug War, why has it not stopped already? The answer is complicated and parts of it are the subject of full books. There are at least three big components in the US context summarized below: Perseveration, Puritanism, and Politics.

Though they share a root, perseveration is not the same as perseverance. Perseverance is continued effort to do something despite failure. Perseveration is the inability to shift ideas or responses. Some may argue that continuing a half century’s worth of failed policies and practices is perseverance. We assert that it is perseveration. It is not anything lofty or noble or virtuous. The Drug War is a behemoth, it is difficult to reverse course on such a massive pursuit, and reversing course is not as simple as decriminalizing drugs, though that is a necessary condition.

The US may be big and diverse, but the Puritan roots run deep and their manifestation through present-day evangelical Protestantism is potent. The Puritan ethos is prejudiced against, among many things, using psychoactive substances to alter consciousness. It is also enthusiastically pro punishment. For a thorough review of how Puritanism and related causal forces historically contribute to our extreme penchant for punishment, see here.

Although Nixon officially declared the “War on Drugs,” the US has been criminalizing drugs for politically racist ends since 1875 and one crook of a President did not singlehandedly make it one of the greatest forces of punishment and destruction the Western hemisphere has ever seen. Escalating the drug war has been politically useful – and has had selfish and systemic functions – for politicians who have held office well before and during the half century since the Drug War’s declaration. In other words, for many of those who wield political power, the Drug War is working exactly as intended.