| Acknowledgments |
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xv | |
| Introduction |
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xviii | |
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1 Why Is "Drug" the Name of a Problem? |
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1 | (14) |
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1 | (1) |
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Why is drug use a problem? |
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2 | (1) |
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If abusable psychoactives can be used safely where does the problem come in? |
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2 | (1) |
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What does it mean for a drug to be "toxic"? |
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2 | (2) |
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What is behavioral toxicity? Is it the same as intoxication? |
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4 | (1) |
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5 | (1) |
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6 | (1) |
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Is addiction a disease? Is it a "chronic, relapsing brain disorder"? |
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7 | (2) |
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Does that mean that drug addicts are not personally responsible for their drug-taking? |
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9 | (1) |
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Is the risk of addiction limited to those with an "addictive personality," or to those genetically predisposed to addiction? |
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10 | (1) |
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Which drug is most dangerous or most addictive? |
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11 | (4) |
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15 | (29) |
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What is drug-abuse control policy? |
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15 | (1) |
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All those sound like good ideas. So what's the problem? |
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16 | (2) |
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Then wouldn't it be possible to have no coercive drug-abuse control policies at all? |
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18 | (1) |
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Wouldn't the results of such a "no coercion" policy be an improvement on the current mess? |
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18 | (2) |
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The damage from cocaine dealing and cocaine enforcement, and from the crimes committed by cocaine users to pay for their habit, is much greater than the damage from cocaine use. Doesn't that prove that prohibition does more harm than good? |
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20 | (1) |
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If the results of legalization are uncertain, why not just try it out, and go back to the current system if legalization doesn't work? |
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21 | (1) |
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Why would you expect newly legal drugs to be much more widely used than those drugs are now? After all, anyone who is really determined to get an illegal drug can do so |
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22 | (1) |
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Wasn't alcohol prohibition in the United States a complete failure? |
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23 | (1) |
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But everyone knows that Prohibition led to a big increase in homicides |
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23 | (1) |
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Didn't Holland and Portugal legalize drugs without any resulting disaster? |
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23 | (1) |
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Didn't Holland legalize cannabis? |
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24 | (2) |
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What's the difference between "legalization" and "decriminalization" or "depenalization"? |
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26 | (2) |
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How much of the increase in consumption after legalization would reflect increased problem use rather than increased casual use? |
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28 | (2) |
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Can't the effects of marketing be reined in by regulations and taxes? |
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30 | (1) |
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What about legal availability without free trade? Couldn't that work? |
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31 | (1) |
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Couldn't you just let users go to physicians for their recreational drugs and make it the doctor's business to try to prevent the development of problem-use patterns? |
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32 | (1) |
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Isn't it impossible to make someone better off by coercing behavioral change? If people want drugs, doesn't depriving them of drugs make them worse off by definition? |
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32 | (2) |
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If people choose to harm themselves with drugs, why is that anyone else's business? |
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34 | (3) |
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Wouldn't any increase in addiction to newly legalized drugs be matched by a decrease in alcohol abuse? Isn't everyone with an addictive personality already addicted to something? |
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37 | (1) |
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Should we go back to Prohibition, then? |
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38 | (1) |
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Does that mean that we're stuck with our current alcohol problem? |
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38 | (2) |
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Are higher taxes the only practical route to a smaller alcohol problem? |
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40 | (2) |
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If not alcohol, should we prohibit tobacco? |
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42 | (2) |
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3 How Does Drug-Law Enforcement Work? |
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44 | (28) |
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How is drug enforcement unlike enforcement of other laws? |
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44 | (1) |
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Why are illegal drugs so expensive? |
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45 | (3) |
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Does enforcing prohibition more aggressively drive up prices still higher? |
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48 | (2) |
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Do high prices discourage drug use? Or will addicts always get their high? |
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50 | (2) |
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Are higher prices good or bad? |
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52 | (1) |
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Does reduced availability discourage drug use? |
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53 | (2) |
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Does catching drug kingpins make drugs less available? |
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55 | (1) |
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What are precursor chemicals and precursor controls, and how do they affect the price of drugs? |
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56 | (1) |
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What is money laundering, and can we stop the flow of drug money? |
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57 | (1) |
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Are prisons full of nonviolent drug offenders? |
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58 | (2) |
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Do long sentences for dealers reduce drug use? |
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60 | (1) |
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Why have crack dealers been punished more harshly than powder-cocaine dealers? |
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61 | (2) |
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What is the difference between flagrant and discreet drug selling, and why does it matter? |
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63 | (1) |
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Does the existence of flagrant selling prove the police are corrupt? |
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64 | (1) |
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Can street drug markets be broken up? |
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65 | (2) |
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Can prevention and treatment help drug-law enforcement? |
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67 | (1) |
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67 | (2) |
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How does the Internet complicate drug control? |
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69 | (1) |
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Should the police be able to confiscate drug dealers' assets? |
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70 | (2) |
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4 What Prevents Drug Abuse? |
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72 | (23) |
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What are risk factors for drug use? Protective factors? |
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72 | (2) |
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Do drug "pushers" hook unsuspecting children? |
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74 | (1) |
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Can we persuade children not to use drugs? |
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75 | (1) |
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Why do high expectations for prevention persist? |
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76 | (1) |
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Can we design prevention specifically to address the next drug epidemic? |
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77 | (1) |
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How do DARE, Life Skills, and the Good Behavior Game differ? |
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78 | (2) |
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What is the Good Behavior Game? |
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80 | (1) |
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Is marijuana a "gateway drug"? |
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81 | (3) |
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Could there be a vaccine against drug abuse? |
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84 | (2) |
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What is secondary or indicated prevention? |
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86 | (2) |
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Does drug abuse spread like an epidemic disease? |
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88 | (2) |
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Should drug policy vary over the epidemic cycle? |
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90 | (1) |
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What's the point of workplace drug testing? |
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91 | (4) |
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5 What Treats Drug Abuse? |
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95 | (24) |
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Do all drug abusers need treatment? |
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95 | (1) |
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What is "behavioral triage"? |
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96 | (1) |
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Do users have to "hit bottom" before they recover? |
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97 | (1) |
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What are the Twelve Steps? |
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98 | (2) |
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100 | (1) |
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Is detoxification treatment? |
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100 | (1) |
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101 | (1) |
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Does methadone detox work? |
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102 | (1) |
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Does methadone maintenance work? |
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102 | (1) |
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Why is methadone controversial? |
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103 | (1) |
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Why not tighten up the rules in methadone clinics to require clients to abstain from drug abuse and diversion? |
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104 | (1) |
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105 | (1) |
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What is heroin maintenance, and is it treatment? |
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105 | (3) |
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Does substitution therapy work for illicit drugs other than the opiates? |
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108 | (1) |
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How well does treatment for stimulants such as cocaine and methamphetamine work? |
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108 | (1) |
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What is a Therapeutic Community? |
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109 | (2) |
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What is "contingency management"? |
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111 | (1) |
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Why is there a shortage of drug treatment? |
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112 | (2) |
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How do you treat a drug-involved teen? |
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114 | (3) |
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How about just giving addicts the drugs they crave? |
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117 | (2) |
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6 How Much Crime Is Drug-Related? |
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119 | (15) |
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Is it drugs that cause crimes, or drug policies? |
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119 | (2) |
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Wouldn't legalization eliminate most drug-related crime? |
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121 | (1) |
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Are there other ways that drugs cause crimes? |
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122 | (1) |
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How about offering drug treatment in place of prison? |
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123 | (2) |
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Why haven't treatment-diversion programs performed better? |
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125 | (2) |
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127 | (2) |
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129 | (1) |
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Can HOPE really solve the drugs-crime problem? |
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130 | (2) |
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How are drugs used in date rape? |
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132 | (2) |
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7 What Are the Benefits of Drug Use? |
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134 | (26) |
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Can abusable drugs be beneficial? |
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134 | (1) |
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Can abusable drugs be beneficial other than as medicine? |
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135 | (1) |
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Can abusable drugs be beneficial other than as medicines and other than as sources of pleasure for the user? |
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136 | (2) |
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Why should mere pleasure count as a benefit? |
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138 | (1) |
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Is medical use of abusable drugs controversial? Should it be? |
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138 | (1) |
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What medical conditions can abusable drugs treat or palliate? |
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139 | (5) |
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139 | (1) |
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140 | (1) |
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Appetite enhancement and nausea control |
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141 | (1) |
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Psychiatric diagnoses and attention deficit hyperactivity disorder (ADHD) |
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142 | (2) |
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Do any "street drugs" have potential for treating psychiatric disorders? |
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144 | (2) |
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Are drugs useful for mood management? |
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146 | (1) |
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Can drugs be used as performance enhancers for people who do not have any diagnosable deficit? |
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147 | (1) |
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Can drugs enhance athletic performance? |
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148 | (2) |
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Are there true aphrodisiacs? |
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150 | (1) |
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What about cognitive enhancers? |
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151 | (2) |
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Can drug taking enhance the appreciation of music and the visual arts? |
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153 | (1) |
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Can drugs enhance creativity? |
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154 | (2) |
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Do all performance-enhancing drugs work the same way? |
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156 | (2) |
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What role can drugs play in religious and spiritual life? |
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158 | (2) |
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8 Can Drug Problems Be Dealt With at the Source? |
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160 | (14) |
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Do international programs offer a quick fix to drug problems? |
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160 | (1) |
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Can we seal the borders to drugs? |
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161 | (2) |
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Does border interdiction have any effect on drug use? |
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163 | (1) |
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Does crop eradication help? |
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163 | (3) |
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Can alternative development woo farmers away from growing drug crops? |
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166 | (1) |
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Why not just buy the coca and poppy crops? |
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167 | (1) |
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Can we force Colombia, Mexico, and Afghanistan to stop exporting drugs? |
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168 | (2) |
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Why are drugs covered by international treaties? |
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170 | (1) |
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Are drugs really the largest component of international trade? |
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171 | (3) |
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9 Does International Drug Dealing Support Terrorism? |
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174 | (12) |
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How do terrorists get a cut of the drug business? |
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174 | (1) |
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How much money is involved? |
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174 | (2) |
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Money aside, what are the other links between drugs and terrorism? |
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176 | (1) |
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How does corruption fit into the drugs-and-terror picture? |
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177 | (1) |
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If drug dealing helps terrorists, does enforcing drug laws help control terrorism? Is counternarcotics an integral part of counterinsurgency? |
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178 | (1) |
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How does drug-law enforcement give terrorists and their clients a competitive advantage? |
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178 | (1) |
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Why does drug-law enforcement in drug-exporting countries increase the amount of money in the illicit drug trade? |
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179 | (1) |
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Why not just buy the opium crop and put the traffickers out of business? |
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180 | (1) |
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Would rural economic development provide an alternative to poppy-growing for poor farmers? |
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180 | (1) |
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Can't effective enforcement take a country out of the drug-trafficking picture entirely? |
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180 | (1) |
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Should we legalize drugs as a counterterrorist measure? |
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181 | (1) |
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Short of legalization, how can we reduce the contribution of drugs, drug laws, and drug-law enforcement to the terrorism problem? |
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182 | (1) |
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How about fighting corruption? |
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183 | (1) |
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Wouldn't prevention and treatment help? |
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184 | (2) |
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10 When It Comes To Drugs, Why Can't We Think Calmly and Play Nice? |
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186 | (11) |
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Why do arguments about drug policy get so irrational and so mean-spirited? |
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186 | (2) |
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Aren't the culture wars mostly behind us? |
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188 | (1) |
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Why can't the politicians and the culture warriors just stay out of it and let science decide on drug policy? |
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188 | (1) |
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What else keeps science from contributing more? |
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189 | (1) |
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How can we improve our evidence base? |
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190 | (1) |
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What role do the mass media play? |
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191 | (2) |
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How does race intersect with drug policy? |
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193 | (1) |
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Why are so many African Americans in prison for drug crimes? |
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194 | (1) |
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Doesn't the crack/powder disparity represent racism in action? |
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195 | (2) |
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Conclusion: What Is To Be Done? |
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197 | (10) |
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198 | (4) |
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1 Apply testing and sanctions to drug-involved offenders |
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198 | (1) |
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2 Use behavioral triage to focus treatment on those with greatest need |
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198 | (1) |
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3 Expand opiate substitution therapy |
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199 | (1) |
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4 Push drug treatment providers toward the use of evidence-based treatment practices and evidence-based management approaches |
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199 | (1) |
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5 Engage health care providers in finding problem drug use and interrupting it before it gets out of control |
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199 | (1) |
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6 Encourage "spontaneous remission" |
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199 | (1) |
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7 Don't expect the police to eliminate mature markets |
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200 | (1) |
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8 Use drug-law enforcement to reduce violence and disorder |
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200 | (1) |
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9 De-emphasize international supply control |
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201 | (1) |
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10 Stop pretending alternative development is drug control |
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201 | (1) |
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11 Use prevention programs that work |
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201 | (1) |
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202 | (2) |
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1 Be open-minded about safer forms of nicotine use |
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202 | (1) |
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2 Stop punishing former dealers and recovering drug addicts |
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202 | (1) |
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3 Reduce the number of drug dealers behind bars |
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203 | (1) |
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4 Explore the role of positive incentives in treatment |
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203 | (1) |
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5 Do not reject all types of harm reduction just because some people have hijacked the term to mean something else |
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203 | (1) |
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6 Reduce barriers to studying the medical utility of currently banned drugs |
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203 | (1) |
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A Political Bridge Too Far |
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204 | (3) |
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204 | (1) |
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2 Ban alcohol sales to convicted drunken assailants and drunken drivers |
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204 | (1) |
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3 Try to make getting drunk unfashionable |
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205 | (1) |
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4 Create ways for people to acquire cannabis without enriching criminals or creating companies that would aggressively promote sales |
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205 | (1) |
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5 Study the non-medical benefits of psychoactive drugs, and safer ways of using them |
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205 | (1) |
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6 Keep raising cigarette taxes in low-tax states |
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206 | (1) |
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Appendix: How Do Drugs Work in the Brain? |
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207 | (10) |
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How does the neuron-to-neuron communication process work? |
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208 | (2) |
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How do drugs fit into this process? |
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210 | (1) |
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Are the agonists the same as the stimulants and the antagonists the same as the depressants? |
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211 | (1) |
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How does all of this relate to addiction? |
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212 | (1) |
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Is addiction just in the neurons? |
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213 | (1) |
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Can antagonists be used to deal with addiction? |
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214 | (1) |
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Can there be vaccines against addiction? |
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215 | (1) |
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How about finding less damaging substitutes? Why can't we make nonaddictive versions of today's drugs of abuse? |
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216 | (1) |
| Bibliography |
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217 | (6) |
| Index |
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223 | |
