Book Review

Drug War Politics: The price of denial

N Engl J Med 1997; 336:299-300January 23, 1997

Article

Drug War Politics: The price of denial
By Eva Bertram, Morris Blachman, Kenneth Sharpe, and Peter Andreas. 347 pp. Berkeley, Calif., University of California Press, 1996. $17.95. ISBN: 0-520-20598-7

Drug policy in America appears to have originated from two competing conceptions of addiction. The “criminal model,” which originated many generations ago, views addiction as one of the many deviant types of behavior exhibited by the large and worrisome “dangerous classes” of predatory and violent criminals. By contrast, the “medical model” considers addiction to be a chronic and relapsing disease that should be addressed in the manner of other physical disorders by the medical and other healing professions. For well over a century, the criminal model has been dominant, and it has a legacy of limited success.

Most likely, few Americans would dispute the statement that something is terribly wrong with U.S. drug policy. Expenditures to control drug use and availability keep increasing and courts and prisons become more cluttered with persons involved in drug-related offenses, but illegal drugs remain available and the number of users continues to grow. The authors state that their book is not just another book about the failure of U.S. drug policy but rather an examination of the politics of the war against drugs, the politics of denial, and the struggle for drug-policy reform. The term “politics of denial” refers to the reasons why the fatal flaws and collateral damage caused by the war against drugs are for the most part ignored.

Part 1 examines the pattern of denial and the reasons why many Americans fail to see how the war against drugs creates and exacerbates drug abuse and crime. Part 2 examines the nature of drug-war politics. Part 3 discusses alternatives, such as legalizing drugs and implementing a public health paradigm.

The book is extremely well written and contains material that will interest many who have had limited exposure to the great debate on drugs. Of special interest is the history of the war against drugs, from the early struggles during the first three decades of this century through the entrenchment of the “punitive paradigm” in midcentury, followed by the “presidential drug wars” and the emergence of the “narco-enforcement bureaucracy.”

However, for those who have been following this war over the years, there is little in this book that is new. Many other monographs and scholarly papers have said essentially the same things. Many others have detailed how the strategy of drug control involving a reduction in supply (which includes interdiction, enforcement, forfeiture of assets, and foreign-assistance initiatives designed to keep drugs out of the United States and drug dealers off the streets) just does not work. Much has also been written decrying the fact that the strategy involving a reduction in the demand for drugs (which includes prevention, education, and treatment) has been underfunded over the years in federal budgets.

The authors' main point, which they argue quite forcefully, is that the use of illegal drugs should be treated not as a crime but as a public health problem. According to this approach, the targets of enforcement would become subjects of treatment and assistance; drug dependence would be viewed much the same as alcoholism is; drug education would not only discourage drug use but also teach how to use drugs more safely; and treatment would not necessarily focus on abstinence or cure but instead would help addicts reduce their use to less dangerous levels. This approach is certainly not a new one. It has been called different things by different people — the medical approach, the disease model, demand reduction, and the harm-reduction paradigm — but it has been suggested for generations, and parts of it have actually been implemented as part of the war against drugs.

Although Drug War Politics is well written, it was disappointing because of its failure to offer any new insight into America's great war against drugs.

James A. Inciardi, Ph.D.
University of Miami School of Medicine, Miami, FL 33136