What's the Problem?


Suppose you're concerned about speeding on the nation's highways. You might reason as follows: All speeders are drivers; if we could reduce the number of drivers, the number of speeders would also decline. So you'd implement a set of programs—an ad campaign, heavy car taxes, fines for people caught behind the wheel—to discourage driving. You'd track the number of drivers from year to year to judge your success at curbing speeding, a.k.a. "the driving problem."

This is the logic of the war on drugs, implicit in the federal government's report on its latest survey of drug use. As expected, the 1990 Household Survey by the National Institute on Drug Abuse found a continued decline in the use of illegal drugs, tobacco, and alcohol. "The drug problem, even in some of its most difficult aspects, is now getting better," acting drug czar John P. Walters said.

For Walters, the "drug problem" is this: People use drugs. (The "most difficult aspects" of the problem, presumably, are those proportionately rare cases where drug use actually harms someone.)

You might expect that attitude from Bill Bennett's temporary successor, but it's also the view of the public-health establishment. Hence Secretary of Health and Human Services Louis Sullivan was especially pleased by the declines in "current" cocaine use (during the previous month) and "frequent" cocaine use (weekly or more often). The latter, Walters explained, "has come to serve as a basic measure of addictive behavior."

Yet someone who has a few beers on Saturday night is not necessarily an alcoholic; why is someone who snorts cocaine once a week an addict? At the very least, addiction entails a strong urge to use a drug and continued use despite unpleasant consequences. Weekly use, let alone monthly use, is not in itself evidence of such feelings and behavior.

But wait. HHS is also worried about Americans who have smoked marijuana in the past year; 15-to-44-year-old women who have used any illegal drug in the past month; and 18-to-34-year-old workers who have taken an illicit substance in the past year. Furthermore, Sullivan approvingly noted a decline in the number of Americans who drink alcohol (a "gateway drug") weekly or monthly.

The gist of Sullivan's message is this: The less drug use, the better. For NIDA Director Charles Schuster, who still sees the nation progressing toward the chimerical goal of "a drug-free society," this is self-evidently true. For the rest of us, it's not so obvious.

People who get stoned or drunk every day are probably in trouble. And it's generally a bad idea for children to use drugs, so the drop in the number of teenagers who report pot or cocaine use is encouraging. But when the government subsumes an adult's occasional joint or glass of wine under the category of a public-health problem, the appropriate response is: Please. Get real.

It's not just that most of the activities that NIDA tracks are not troubling in themselves. As the agency's own statistics show, they're not even good proxies for things that are worthy of concern. In recent years, the figures show casual use and heavy use moving in opposite directions. Studies of drinking have found that abuse is not necessarily proportional to use. Targeting the wider behavior is not only inefficient; it may actually make the problem worse by eliminating examples of moderate consumption.

Sullivan invokes "the power of personal responsibility." But responsibility is based on distinctions—between use and abuse, self-regarding behavior and behavior that affects others. Sullivan ignores these, instead promoting a fuzzy-minded abstinence that evades responsibility.