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the conventional tools of drug policy, only treatment has much relevance
to controlling the problems of this group. A mountain of data shows
that treating a hard-core addict, even if with only partial success,
creates very large benefits. Although long-term cessation is a highly
desirable goal, even imperfectly successful treatment episodes greatly
reduce drug consumption and drug-related harm both while treatment
lasts and for some time thereafter: gains more than adequate to
cover the cost of treatment.
hard-core hard-drug users into treatment and keeping them there
remains a major problem. This is the group least likely to enter
treatment voluntarily, most expensive to treat and least likely
to succeed by the standard of total abstinence. Many prefer drugs
to treatment, as long as they can get the drugs.
choice, however, need not be left entirely up to the addicts. Sooner
or later, most wind up under the jurisdiction of the criminal-justice
system. About three-quarters of all heavy cocaine users, for example,
are arrested in the course of a year. The criminal-justice system
can become a powerful tool for changing drug-taking behavior.
is the idea underlying drug diversion, drug courts and coerced-abstinence
programs. The central idea of all three is to make staying out of
jail conditional on staying off hard drugs. The key to success is
frequent testing and automatic, but not severe, sanctions for each
detected instance of drug use, combined with treatment as necessary.
these three programs offer the best prospects for actually shrinking
the hard-drug markets, reducing the criminal activity of hard-core
users and improving addicts' lives by keeping them out of prison
and reducing, if not ending, their drug abuse. Since drug courts
and diversion programs rely on the limited capacity of the treatment
system, the only version of this idea that could rapidly be brought
to full scale is coerced abstinence: testing and sanctions alone,
with treatment as a backup for those who repeatedly fail.