Diane Jackson used to have a one-track mind driven by heroin and finding her next hit.
It was a road she started on 10 years ago, sniffing with friends to "deal with my family problems." The occasional weekend high soon turned into a daily addiction. She managed to keep working - most of the time - as a nurse's assistant. But she lost her dignity, she says, and ended up living in an abusive situation that fed her hunger for the pure high of heroin - though she knew it was destroying her.
"You lose your thinking, the skills you were brought up with," she says, her wide brown eyes filled with regret.
Now, clean and sober and in treatment for almost a year, Ms. Jackson is at the heart of a bold experiment in Baltimore that may give America a new way of dealing with illicit drugs.
Fed up with the failure of the criminal justice system to get heroin, cocaine, and the crime they breed out of its neighborhoods, Baltimore has decided to help addicts overcome their problem, instead of putting them in jail. The city is determined to provide treatment to any addict who requests it or is required by the court to get it - something unheard of in any other city in the country, except San Francisco, which recently set similar goals.
The efforts are part of a national rethinking of the so-called war on drugs that has packed the nation's prisons with hundreds of thousands of nonviolent drug offenders, draining resources from state and local budgets while the drug problem persists, particularly in inner cities.
Earlier this month, the Clinton administration's drug czar, Barry McCaffrey, calling the current criminal-justice system a "disaster," outlined a strategy to provide addicts treatment at every stage from their initial incarceration to probation. While skepticism about drug treatment's effectiveness remains high, dozens of states from Connecticut to Arizona are increasingly offering it as an alternative to incarceration. But only Baltimore and San Francisco are working toward the goal of providing what they're now calling "treatment upon request."
"The facts are that the impact of treatment is quite remarkable," says Dr. Jerome Jaffe, who was the top drug official during the Nixon administration. "You can demonstrate fairly substantial reductions in drug use while they're in treatment If you look at it a year later, you can still see effects, sometimes also substantial."
History of treatment
In the late 1960s and early 1970s, as another heroin epidemic ravaged the country's cities and thousands of soldiers came home from Vietnam addicts, the Nixon administration set "drug treatment upon demand" as a national goal. But it was never fully implemented, and as the drug problem persisted and the economy faltered, resources for public treatment were cut dramatically, particularly during the Carter administration.
By the time a particularly violent crack epidemic hit the cities in the 1980s, the public was fed up and had little or no empathy for addicts. Treatment was discredited and the tough law-enforcement approach, which included long, mandatory sentences for drug offenses, became the norm.
The result: The prison population has more than tripled since 1980, and while drug use is down only slightly, the problem continues to hurt inner cities.
"The current war on drugs doesn't work," says Peter Beilenson, Baltimore's health commissioner. "It's incredibly costly, and the consequences are huge - we have arrested and basically disenfranchised an entire [segment] of our population."
According to one study, 54 percent of Baltimore's 18- to 34-year-old African-American men are now in the criminal-justice system - on probation, parole, with a warrant out for their arrest, or incarcerated. And according to Mr. Beilenson, almost 90 percent are there on drug-related offenses.
Nationally, 1.8 million people are in prison, and McCaffrey estimates that between 50 and 85 percent are there because of a drug problem.
But science, too, has helped the return to favor of treatment as an alternative. Studies in the past 20 years have documented treatment's effectiveness in reducing drug use by as much as 60 percent. They have also recorded that reductions in crime and other societal complications while the addict is in treatment more than cover the cost of the therapy - whether it is an intensive in-patient program or an out-patient methodone-maintenance clinic.
"A study done by the state of California showed that for every dollar spent in treatment, it saved $7 in public money from hospital costs and incarcerating them," says Dr. Robert Schwartz of the University of Maryland's division of alcohol and drug abuse.
There's also been a change in the way drug addiction is viewed. Once thought of as a product of an individual's weak will and personal failings, addiction is increasingly viewed as a chronic medical problem that needs regular attention.
That's at the heart of the philosophy driving Baltimore's efforts. In the past two years, the city has doubled the number of treatment slots available. It needs to double them again to meet its goal. The city has paid for the increases so far by diverting funds from its own budget to match federal dollars and by getting support from foundations Dr. Beilenson, who has just been reappointed by the new mayor, hopes the state will kick in more funds in the future.
More addict problems today
They're needed. At the Glenwood Life Center, the methadone maintenance clinic where Jackson goes each day, director Frank Satterfield says he could double the 260 slots he's currently funded for and they'd be filled immediately. He also says today's addicts have a lot more to cope with than those he first worked with at Glenwood in 1972.
"The resources were more plentiful then, and the problems were less severe," says Mr. Satterfield. "Then there was no cocaine or crack epidemic, the quality of heroin was much lower than it is today, there was no AIDS, and jobs were plentiful [for unskilled workers]."
Jackson was an early beneficiaries of Baltimore's new philosophy. When she decided she needed treatment, she had to wait only a month, instead of the usual six weeks or six months most addicts face. She believes that's one thing that has helped her stay clean and rebuild her life.
She's now thinking about finishing college and becoming a licensed nurse. "It's a hard battle. I have to fight to stay clean, every day of my life," says Jackson. "I'm still having problems, but I have my dignity back."
(c) Copyright 1999. The Christian Science Publishing Society