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Middle Ground
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Winter 1998
Middle Ground
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Of 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.

Getting 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.

The 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.

That 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.

Together, 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.

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