The Fix / Edition 1

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Overview


With a new preface

Looking back on the 25-year war on drugs, Michael Massing offers a blistering critique of the politics and narrow-mindedness that have made our national drug policy a failure, and he proposes what must be done--stressing treatment over imprisonment--to begin to rescue addicts from the street and diminish the hold drugs have in this country.

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Editorial Reviews

New England Journal of Medicine
...[a] provocative and meticulously researched book...
New Yorker
Two contrasting portraits frame this virtuoso investigation of the government's failed war on drugs. One is of a pioneering psychiatrist who founded the first publicly funded detox and rehabilitation program, in Chicago, in 1968; the other is of an East Harlem drug counsellor and his heroic efforts to obtain even minimal teatment for local addicts. Tracing the evolution of public policy over three decades, Massing points out that the Nixon administration's strategy — adapted from the Illinois program but later discarded — was the only demonstrably successful approach.
Daniel Casse
. . .[D]oes an admirable job of illustrating the unglamorous and destructive nature of drug abuse. . . .Yet as. . .a set of policy prescriptions [it is flawed]. . . .there is simply not much that is new in The Fix
Commentary
Publishers Weekly - Publisher's Weekly
The tabloidy, haranguing tone of the curious subtitle doesn't do justice to this book's careful research and well-written narrative. Far from being a love letter to Richard Nixon's drug policy, it discusses America's war on drugs in the context of real people suffering with addiction. Massing, a New York City-based reporter, has written about the drug trade for 10 years, so he has the knowledge and eye for detail that give this work its best moments. Believing that "the policies being formulated in Washington today bear little relation to what is taking place on the street," Massing starts his story in Spanish Harlem, following the lives of Raphael Flores, who runs a struggling drop-in center for addicts, and Yvonne Hamilton, a crack addict trying to get her life together. The middle third of the book shifts dramatically in tone as Massing chronicles the evolution of the war on drugs in Washington. During Nixon's tenure, the government spent more money on treatment (the "demand" side) than on stopping drug trafficking (the "supply" side), which led to declines in both drug overdoses and crime rates. As successive presidents felt pressure to emphasize the "war" rather than treatment, the number of chronic addicts skyrocketed. In the last section Massing returns to Harlem, where Hamilton's struggle to remain drug-free makes for gripping reading. The Washington section works as political history, but the bios of various bureaucrats can't compete with the slices of Harlem street life. While Massing may think Nixon's strategy would work again today, Hamilton's story demonstrates that the drug problem is much more complicated than any government strategy. (Oct.)
Library Journal
Massing, a reporter and MacArthur fellow who has been following national drug policy since 1988, believes that we are badly losing the long war on drugs. Instead, he would like to see a return to the 1960s drug policy put in place first by Illinois and then copied by the United States during the Nixon administration. This policy brought the drug epidemic under control by creating a national network of treatment facilities offering help to all who wanted it. In the years since, and especially during the Reagan administration, our policy swung away from helping addicts overcome their drug habits and toward criminalizing addiction. This remains the policy today. Massing contrasts the worlds of New York addicts and Washington policymakers to show how they must be brought closer together. He also explains how the Nixon-era policy fell victim to budget cuts and a changing view of addiction. Massing pulls together all the material very effectively, finally proposing a model based on the healing powers of medicine rather than the punitive powers of the law. Recommended for academic and public libraries with extensive criminal justice and social policy sections. [Previewed in Prepub Alert, LJ 6/15/98.]--Sandra K. Lindheimer, Middlesex Law Lib., Cambridge, MA
David F. Musto
Massing's powerful arguments for more treatment programs. . .must be put into a larger historical context. . . .Can a national policy that was feasible in 1970 be resurrected three decades later in a less friendly climate? . . . .Massing's recommendations are too valuable to be oversold. -- The New York Times Book Review
The New Yorker
Two contrasting portraits frame this virtuoso investigation of the government's failed war on drugs. One is of a pioneering psychiatrist who founded the first publicly funded detox and rehabilitation program, in Chicago, in 1968; the other is of an East Harlem drug counsellor and his heroic efforts to obtain even minimal teatment for local addicts. Tracing the evolution of public policy over three decades, Massing points out that the Nixon administration's strategy -- adapted from the Illinois program but later discarded -- was the only demonstrably successful approach.
Daniel Casse
. . .[D]oes an admirable job of illustrating the unglamorous and destructive nature of drug abuse. . . .Yet as. . .a set of policy prescriptions [it is flawed]. . . .there is simply not much that is new in The Fix. -- Commentary
Kirkus Reviews
This is a persuasive and well-supported argument that readily available treatment is the way to combat the massive problem of drug abuse in the U.S. Massing knows of what he speaks. As a contributing editor of the Columbia Journalism Review and frequent contributor to the New York Review of Books (he was also a 1992 MacArthur fellow), Massing has been reporting on U.S. drug policy for 10 years. He finds, as do most others studying the topic, that we are losing the war on drugs. Despite spending billions of dollars every year, drug production, distribution, sales, and use continue to flourish. Our current policy, focused on interdiction and punitive measures, has not worked; yet neither, for the author, will legalization nor harm-reduction or maintenance (how does one maintain a crack addiction?). What will work, because it has worked in the past, is a nationwide network of clinics providing treatment for all who want it. Surprisingly perhaps, this is precisely the drug policy we had under the Nixon administration, but under the Reagan administration, for ideological and budgetary reasons, a treatment approach was largely abandoned. It's the detail Massing provides that makes this such an effective work. He travels from the street world of the addict in New York's Spanish Harlem and treatment programs that work there, in particular one called Hot Line Cares, to the insulated and distant world of Washington drug policymakers. He discusses the personalities and processes that brought the Nixon policy into being and those that led to its dismantling. Massing finds that drug policies formulated in Washington have little to do with the reality of drug use in the street; his bookis an attempt to bring the two worlds together. The passion and care of the writing make this an important contribution to the debate on what our drug policy should be and how it should be formulated.
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Product Details

  • ISBN-13: 9780520223356
  • Publisher: University of California Press
  • Publication date: 5/31/2000
  • Edition description: New Edition
  • Edition number: 1
  • Pages: 343
  • Sales rank: 1,192,712
  • Product dimensions: 6.00 (w) x 9.00 (h) x 0.75 (d)

Meet the Author


Michael Massing is a contributing editor of the Columbia Journalism Review and a frequent contributor to the New York Review of Books. Named a MacArthur Fellow in 1992, he has been reporting on the drug world for the last ten years. His articles have appeared in the New York Times, the New Yorker, the Atlantic Monthly, and many other publications.
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First Chapter

Part Two: WASHINGTON<<B>Chapter Eight: To the White House

If there was one word to describe Jeff Donfeld, it was contrarian. At a time when his entire generation was tuning in, turning on, and dropping out, Donfeld liked to boast that he had never been intoxicated, even on alcohol. He was raised in an affluent Jewish household in Los Angeles not unlike Dustin Hoffman's in The Graduate, but he was not the sort to laugh at the idea of going into plastics. A brash conservative who despised long hair and psychedelic music, Donfeld attended UCLA, where he became president of the student body, then went to Berkeley law, where he opposed the Free Speech Movement. In the summer of 1967, while many of his peers were getting stoned at rock concerts, Donfeld was interning at Richard Nixon's law firm, impressing Nixon with pointed questions about Vietnam. Donfeld also began dating Nixon's daughter Tricia. That did not hurt his chances when, after Nixon was elected president in 1968, he applied for a job at the White House. Hired to serve on the domestic policy staff, Donfeld chose drugs as his portfolio -- a ready vehicle for attacking the counterculture he so loathed.

Such an attitude was close to the president's own. A product of the Anslinger era, Richard Nixon felt a reflexive disgust for illegal drugs and the people who used them. Marijuana, hashish, and LSD were, in his view, turning a generation of Americans into long-haired, love-beaded, guru-worshipping peaceniks. During the 1968 campaign, Nixon, in a speech in Anaheim, California, had called narcotics the "modern curse of the youth." "Just like the plagues and epidemics of former years," he said, drugs "are decimating a generation of Americans." If elected, Nixon promised, he would triple the number of customs agents and work with friendly nations "to move against the source of those drugs."

After the election, Nixon entrusted the drug issue to Bud Wilkinson, the former University of Oklahoma football coach. While completely unschooled in the field, Wilkinson was a gridiron legend and symbol of bedrock American values -- just the sort to publicize the evils of drugs. In the White House, Wilkinson would launch a variety of PR initiatives, such as meeting with media executives, speaking to community groups, and training youth coordinators. Jeff Donfeld, one of his assistants, specialized in organizing high-profile events in Washington. TV producers were brought to the White House and encouraged to work antidrug messages into their programs. Disc jockeys were urged not to play music with prodrug lyrics. And, in the grandest event of all, the nation's governors were convened in the State Department's auditorium to hear presentations about the menace of drugs, including an emotional address by Art Linkletter describing his daughter's suicide in the wake of an LSD trip.

Gradually, however, Donfeld's contrarian nature began to surface. For all the zest he brought to these events, he could not help recognizing them for what they were -- elaborate dog-and-pony shows. And, however much they might help deter kids from using pot, they seemed useless in dealing with more serious problems, like heroin use in the ghetto. With his hard-line views, Donfeld felt little sympathy for addicts, but, as he began reading in the field, he found himself getting caught up in the exciting developments in the treatment world. By the fall of 1969, about 2,000 heroin addicts were receiving methadone in New York, and researchers studying them were finding marked reductions in heroin use, unemployment, and criminal activity.

This last point in particular caught Donfeld's eye. If it was true that heroin addicts committed many robberies and burglaries, as was widely believed, then methadone's seeming ability to reduce recidivism endowed it with great political potential. The risks were high, too, of course. Methadone was so addictive that many users found it harder to kick than heroin. And, while normally dispensed in clinics, the drug could be easily diverted onto the street, giving rise to a black market. The idea that the federal government itself might fund methadone programs seemed farfetched, especially for a Republican administration extolling God, country, and football.

At the time, the government's efforts in the treatment area were very modest. In 1969, the federal drug budget came to just $81 million. About $43 million of that sum went for treatment, most of it for a dozen or so programs overseen by the National Institute of Mental Health. The remaining funds went for enforcement -- mainly to the Customs Bureau, which patrolled the nation's borders, and the Bureau of Narcotics and Dangerous Drugs (BNDD), which targeted trafficking organizations. Acting on his campaign promise, President Nixon nearly doubled the size of Customs and increased the number of BNDD offices abroad from twenty-five to forty-six.

Nixon was particularly intent on stopping heroin at its source. At the time, most of the heroin entering the United States originated in the poppy fields of Turkey's western Anatolia plains. Opium paste extracted from poppy flowers was sold to middlemen, who had it processed into morphine base in the Middle East, which was then shipped to southern France. There, in makeshift labs located in and around Marseilles, chemists employed by the Corsican mafia processed the morphine base into high-grade heroin. The powder was then smuggled into the United States, with New York the most common destination.

This was the famous French Connection, and Nixon was determined to break it. "I feel very strongly that we have to tackle the heroin problem regardless of the foreign policy consequences," he wrote to Henry Kissinger and several other top aides in a September 22, 1969, memo. "I understand that the major problem is with Turkey and to a lesser extent with France and with Italy. In any event, I want the group included in this memorandum to give me a recommendation as to what we can do." Plugging the heroin pipeline thus became a top priority for the White House.

In this climate, Jeff Donfeld remained virtually alone in his interest in drug treatment. That would soon change, however, as the White House became increasingly preoccupied with crime. During the presidential campaign, Nixon had frequently raised the issue, pointing out how, during eight years of Democratic rule, the nation's crime rate had doubled. After the election, Nixon named as his attorney general John Mitchell, whose steely demeanor contrasted with the bleeding hearts who had run the Department of Justice under Lyndon Johnson. At an early meeting of justice officials and White House aides, Nixon had stressed his desire to bring down the nation's crime rate. Justice officials, however, noted that, in the federal system, law enforcement was mainly the preserve of state and local government, leaving little for the administration to do.

Except in the District of Columbia. Home rule had yet to come to Washington, and both the mayor and city council served at the president's behest, giving him great leverage. In addition, the federal government had abundant enforcement resources in the District. During the campaign, Nixon himself had singled out Washington, where the crime rate had risen even faster than in the nation as a whole. "D.C. should not stand for disorder and crime," Nixon had declared. "Washington should be a model of stability and law and justice in America -- and that is what we must pledge ourselves to in a new administration."

In case the White House needed any convincing, the city was hit by a crime wave just as Nixon was taking office; in one incident, a presidential secretary had her purse snatched just outside the White House grounds. On January 31, 1969, Nixon announced a package of emergency measures, including a drastic reorganization of the city's courts, the appointment of new judges and prosecutors, and the hiring of 1,000 new cops. The president also welcomed the appointment of an aggressive new police chief, Jerry Wilson, who, on frequent visits to the White House, joined Nixon in thrashing out ways to improve the local force. The crime rate continued to soar, however, and every month, when the latest numbers came out, Nixon would call up his adviser John Ehrlichman to complain.

To the outside world, the balding, impassive Ehrlichman seemed indistinguishable from H. R. Haldeman, the dour, unswervingly loyal chief of staff. In private, however, Ehrlichman was wry, personable, and pragmatic. After serving briefly as White House counsel, Ehrlichman became Nixon's domestic policy adviser, and he assembled about him a band of like-minded aides. And, faced with the crime problem in the District, he turned to the most trusted of them, Egil Krogh, Jr.

Thirty years old, Krogh was the White House's Mr. Fix-it, the man called on to solve its most intractable problems. "Bud," as he was known, would arrive every morning at seven-fifteen at his office in the ornate, French Empire-style Old Executive Office Building (OEOB) next to the White House, and he would rarely leave before eight or nine at night. Ruggedly handsome, with a square jaw, dark eyes, and a receding hairline, Krogh had ten aides of his own, and he needed every one, so broad were his responsibilities. They included corrections, legal services, transportation, the Justice Department, and "internal security," which consisted mainly of keeping order during the large antiwar demonstrations that periodically rocked the capital. (When Nixon made his famous predawn visit to the Lincoln Memorial in May 1970 to talk with antiwar protesters, Krogh was by his side.) Paralleling his grueling work pace, Krogh jogged five miles a day, a lone figure in a gray sweatsuit circling the Ellipse behind the White House.

For all his drive, though, Krogh projected a sense of decency and earnestness that was rare in the Nixon White House. He got it from his father. A self-made Norwegian immigrant, Egil Krogh, Sr., rose to become a vice president at the Marshall Field department store in Chicago before moving the family to Seattle. When Bud was fourteen, his father, a heavy drinker and smoker who was interested in Christian Science, said he would forgo alcohol and tobacco if his son promised to do the same; Bud did so with a handshake, and in later years he would never waver. In Seattle, the Krogh family became friendly with a local zoning lawyer and fellow Christian Scientist named John Ehrlichman, and young Bud grew close to him. After graduating from Principia College in Illinois, Krogh spent three-and-a-half years in the Navy, then enrolled in the University of Washington Law School. After getting his degree in the summer of 1968, he went to work for Ehrlichman's law firm. After Nixon was elected, Ehrlichman asked Krogh to come to work for him in Washington. Just months out of law school, Krogh was on his way to the White House.

Like many Nixon aides, Krogh was young and inexperienced, but he had an aptitude for grasping the nub of a problem, then finding the right people to solve it. The objective was to get results, not pursue an agenda. When, for instance, the United States was hit by a rash of airplane hijackings, Krogh was given the job of stopping them. While some politicians favored calling out the military, Krogh put together a more measured series of steps, including the installation of metal detectors in airports, and the problem was soon brought under control.

In addition to all his other responsibilities, Krogh served as the White House's liaison to the District of Columbia. And so, when John Ehrlichman was ordered by Nixon to bring down the city's crime rate, it was natural for him to look to his young aide. Krogh knew nothing about crime, but he characteristically embarked on a crash course. "I rode around town in squad cars to see with my own eyes the kinds of things we could support the police with," he recalled. Working closely with Jerry Wilson, he helped step up recruiting efforts for the department, procured a helicopter for its use, and had sodium-vapor lights installed on the city's streets.

The more Krogh looked into the District's crime problem, however, the more he realized he would have to tackle its drug problem. Like most other large cities, D.C. was being overrun by heroin addicts. Under orders from Wilson, the police were making more drug arrests, but Krogh worried that such actions, by driving up the price of heroin, would cause addicts to commit even more crimes. And so he began investigating what might be done about them.

To that point, Krogh's involvement with the drug issue had been limited to the international side. With the White House seeking to break the French Connection, Krogh had been placed in charge of the effort. In late 1969, he had gone to Paris to see what the French were doing about the Marseilles heroin labs. Not much, he was told by the U.S. ambassador, Arthur Watson. The French, Watson said, regarded drugs as an American problem and so felt little need to act. Meeting with French officials, Krogh stressed that relations between the two nations would suffer if stronger measures were not taken. Even more troubling to Krogh were the internecine battles taking place between Customs and BNDD. In France, as in the rest of the world, the two agencies were so busy fighting one another that they had little energy left for the traffickers, and Krogh, back in Washington, had to work endlessly to patch up their differences. All the while, he was consulting with U.S. officials in Ankara, exploring ways of convincing the Turks to curtail local opium production.

Now, in addition to fighting the drug trade abroad, Krogh was having to confront it at home, too. Gradually nudging aside Bud Wilkinson (who eventually left the White House in frustration), Krogh began asking Jeff Donfeld about his research, and the young lawyer eagerly shared his findings on methadone and its seemingly miraculous ability to reduce drug-related crime.

Krogh also sought out a local treatment expert named Robert DuPont. Few people in the District knew more about heroin addicts than the tall, gangly, sandy-haired psychiatrist. A graduate of the Harvard Medical School, DuPont had come to Washington in 1966 to work at the National Institutes of Health, then had gone on to counsel inmates at the D.C. Department of Corrections. From his sessions with those inmates, DuPont became convinced of the close connection between drugs and crime, and, seeking corroboration, he hired a team of researchers to interview inmates. Of the two hundred interviewed, fully 45 percent were found to be heroin users -- strong evidence of the drug-crime link. Interested in how other cities were dealing with their heroin problems, DuPont went to Chicago to meet with Jerome Jaffe and see his multimodality system in action. Back in D.C., he convinced Mayor Walter Washington to let him set up a pilot version of that system, and in the fall of 1969 methadone for the first time became available in the nation's capital.

In early 1970, DuPont met with Krogh at his grand, high-ceilinged office at the OEOB. A man of missionarylike exuberance, DuPont (no relation to the Delaware family) gushingly described the success he was having with methadone, especially in reducing crime. When Krogh asked if he would like to expand his program, DuPont immediately said yes, and Krogh quickly found the necessary funds. On February 19, 1970, the Narcotics Treatment Administration (NTA) opened its doors. Like the Illinois Drug Abuse Program, it offered not only methadone but a variety of treatments. And, like IDAP, it was immediately swamped with applicants. With the White House's backing, the NTA soon had more than 2,000 slots.

Krogh closely monitored the results. "The District of Columbia became a laboratory in my mind," he recalled, "a place where we could put more funding into treatment and see what happened." If crime went down in the District, then a case might be made for expanding treatment nationally. "The administration's emphasis had been so overwhelmingly on the law-enforcement side," Krogh said, "that I concluded that if we could get a substantial portion of the addict population into some kind of treatment program, where they would have a chance to function and not be driven to commit street crimes, that would be a very important contribution to the law-enforcement side." For the first time, a U.S. official was thinking of the drug problem in terms of both supply and demand.

To get a sense of what a national treatment system might look like, Krogh sent Jeff Donfeld on a tour of programs. On June 9 and 10, Donfeld visited a half-dozen facilities in New York, including Daytop Village, Phoenix House, and a methadone clinic. From there, he went to Chicago -- a trip he had long anticipated. "I had been traveling around the country," he recalled, "talking with program directors and experts in the field, and all roads seemed to lead to Jerry Jaffe as the brightest, most respected guy in the field." Jaffe spent the better part of a day showing Donfeld his handiwork.

Brimming with impressions, Donfeld summarized them in a tart sixteen-page memo to Krogh. Noting at the outset that "drug rehabilitation is a virgin, yet fertile area for social and political gain," Donfeld was nonetheless dismissive of most of the programs he'd seen. "With one exception," he wrote, "personnel of each program had something disparaging to say of another program, ostensibly because they are all competing for the same dollar but probably because each is a very parochial zealot believing that his program is the true panacea."

The one exception was IDAP. "Jaffe was the most impressive man I met on the trip because he was not a dogmatist, he thinks in broad management terms, is politically sensitive and recognizes that modalities must be meticulously evaluated in order to empirically determine success," Donfeld observed. He wrote enthusiastically of IDAP's numerous innovations, including Tinley Park ("it is not the intense, moralistic, rigid approach of Daytop"), the use of computers to collect data, and the reliance on epidemiological data to locate new treatment sites. Donfeld also praised Jaffe's personal style, noting that he "maintained a low profile from day one. He always made sure he could deliver more than he promised."

As for IDAP's core feature -- the multimodality approach -- Donfeld was more cynical. "Different strokes for different folks," he flippantly called it. Narrowly focused on the need to reduce crime, Donfeld was interested in just one modality. "Methadone," he wrote, "is a benign addiction for it allows the addict to function normally, be employed, pay taxes and stay out of jail. The choice is between methadone addiction and death for some addicts, imprisonment for many more and a crime infected society."

Donfeld's memo was reinforced by the reports Krogh was getting from Bob DuPont. In one four-month period, only 2.6 percent of those enrolled in his program had been arrested, compared with 26 percent of those who had tried to become abstinent and 50 percent of those who had dropped out. Summing up these results in a memo to Ehrlichman, Krogh wrote that DuPont's progress "gives us some assurance" that the idea "to go forward with development of a nation-wide addict treatment policy is correct."

Krogh's enthusiasm for methadone was certainly ironic. As a student of Christian Science who abstained from alcohol and tobacco, he could have been expected to shun a highly addictive substance like methadone. From a pragmatic standpoint, however, the narcotic seemed to offer a way out of the administration's crime predicament, and, with the 1972 election looming, Krogh stepped up his campaign to win White House approval for a national treatment system with methadone at its core.

To do that, he had to win over John Ehrlichman. A practicing Christian Scientist, Ehrlichman felt far more constrained by his beliefs than Krogh. Because of them, he recalled, "I kind of recused myself from health issues." In the case of methadone, he added, "I felt incompetent to make a judgment on physiological questions of that kind."

As a step toward winning Ehrlichman over, Krogh convinced him to set up a task force to study the feasibility of a national treatment program. The group would consist of representatives from eight federal agencies and be chaired by Dr. Bertram Brown, the director of the National Institute of Mental Health. A thirty-nine-year-old Brooklyn-born psychiatrist, Brown was a natural to head such a group. NIMH was the government's lead agency in providing drug treatment, and Brown -- a one-time aide to President Kennedy -- was well regarded in the largely liberal mental-health field.

Krogh was dubious, however. For NIMH had shown little interest in the plight of drug addicts. The hundreds of community mental health centers it ran across the country seemed more interested in helping middle-class neurotics than inner-city junkies. Moreover, NIMH, with its psychiatric orientation, could be expected to shun a pharmacological agent like methadone.

In light of this, Krogh persuaded Ehrlichman to set up a parallel panel of experts from outside the government. And, to head it, he wanted Jerome Jaffe. Donfeld was sent to recruit him, and the two met in New York in late October. The White House, Donfeld told Jaffe, wanted him to assemble a group of experts to suggest what the government should be doing in the area of drug treatment. The report could not exceed one hundred pages, had to be completed in four weeks, and had to be kept strictly confidential.

As a registered Democrat, Jaffe felt in a quandary. "I was far more conservative than the average psychiatrist, but not enough to think that I should be a Republican, God forbid," he recalled. But, presented with an opportunity to affect national drug policy, he felt obligated to accept Donfeld's offer. Concerned that four weeks was not enough time to produce a quality report, however, he coaxed an additional two weeks out of Donfeld, and the deal was done.

Back in Chicago, Jaffe began calling around to some of his colleagues to ask them to join the project. It was a tough sell. Opposition to the war in Vietnam was at its peak, and few people in the public-health field wanted to be associated with Richard Nixon. Appealing to their sense of history, however, Jaffe managed to put together a stellar eleven-person team, including Dr. Jonathan Cole, the superintendent of Boston State Hospital, and Edward Brecher, a noted science writer who was in the process of completing his landmark book Licit and Illicit Drugs. Over the next month, the group would gather on three weekends to discuss what should go into the report. When it was time to write it, Jaffe tethered himself to the dining room table in his house, and, with editing and typing help from Faith, rushed to complete it. Finishing two days before Christmas, he sent off the 134-page manuscript to Donfeld by special courier.

Meanwhile, the government task force was completing its own report. Ignoring the White House's request for a broad interagency study, Bert Brown -- a canny, stiff-necked man -- had assigned a handful of NIMH aides to draft it, and the finished product faithfully reflected the NIMH view of the world. Praising traditional psychotherapy, the report said that creating systems "for delivering psychiatric care to drug abusers should have high priority" in any national treatment program. As Krogh had feared, the report expressed strong doubts about methadone, chiding public officials for their "pell-mell rush to get thousands of addicts on the drug without due consideration of the possible long-term consequences." Full of hip sixties-style sociologizing, the 119-page report called the extent of the drug problem in America "relatively small" and said the response to it "should probably be titrated to the need rather than the outcry." Accordingly, the report stated, any growth in spending should be "moderate" and any programs undertaken "experimental" in nature.

The Jaffe report, by contrast, termed heroin addiction a serious national problem that required bold government action. Questioning the effectiveness of psychiatry, the document stated that "for half a century, attempts have been made to treat narcotics addiction (as well as alcoholism) through various forms of psychotherapy, and even therapists themselves are almost unanimously agreed that the addictive states are peculiarly resistive to this approach." Methadone, it went on, showed far more promise. While duly noting the drug's drawbacks, the report asserted that studies of it had "uniformly indicated that significant numbers of hard-core heroin users can be changed to law-abiding, job-holding, non-heroin using citizens." The report called for spending $15 million over two years to create 15,000 new methadone slots, as well as for setting up IDAP-type systems in cities without existing programs.

After the many exhausting weeks of work, Jaffe eagerly awaited the White House's response. It came on January 6, 1971, in the form of a two-paragraph note from Richard Nixon thanking him for his "diligent leadership" in preparing the report. Other than that, Jaffe heard little, and, concluding that his handiwork had been consigned to some storage bin, he turned his attention back to his work in Chicago.

Bud Krogh was in fact distracted in this period. On the morning of December 21, 1970, Elvis Presley had suddenly appeared at the northwest gate of the White House with a handwritten note requesting a meeting with the president to offer his help in fighting drugs. Since this was Krogh's area, he was asked to handle the matter. Having grown up listening to Elvis, Krogh was thrilled at the possibility of meeting him, and, calling the president's office, he quickly arranged a meeting between the two men for twelve-thirty that afternoon. Presley showed up wearing tight dark-velvet pants, a matching cape, a flouncy white shirt open to below the chest, and a gold medallion hanging from his neck. Krogh ushered him into the Oval Office, then stood to one side and took notes as Presley showed Nixon photos of his wife and daughter, denounced the Beatles for being "anti-American," and described how he had been studying "Communist brainwashing" and the "drug culture." Then, getting at what seemed the real purpose of his visit, he asked the president if he could help him get a badge from the narcotics bureau to add to his collection. "Bud, can we get him a badge?" Nixon asked his young aide. Krogh said he thought he could, and, escorting the singer back to his office, procured for him the coveted credential. To Krogh's disappointment, Elvis never did follow up on his offer to help the administration fight drugs.

In terms of dazzle, the Jaffe report could not quite compare, but when Krogh finally got around to it, he found it exciting in its own right. A "seminal document," he would later call it. The report took on added significance when the FBI released its crime stats for 1970. While the nation's crime rate had increased by 11 percent, Washington's had fallen by 5.2 percent -- the first decline in the capital in years. In interviews, Chief Jerry Wilson and other city officials cited a host of factors, among them the increased size of the police force, the use of more aggressive tactics -- and the growing availability of drug treatment. By the end of 1970, the Narcotics Treatment Administration was treating more than 2,500 people, and, as the FBI figures showed, most of the reduction in crime occurred after the NTA had become fully operational.

The results from Krogh's D.C. lab removed any remaining doubts he had about the need for a national treatment system. Hoping to prod the White House, he asked Donfeld to draft an options paper for the president's top domestic advisers. Sitting down with both the Jaffe and Brown reports, Donfeld extracted the key recommendations of each and summarized them side by side, accompanied by pithy commentaries of his own. On methadone, he noted that, while many important philosophical and political issues remained to be worked out, "in 1972, citizens will be looking at crime statistics across the nation in order to see whether expectations raised in 1968 have been met. The federal government has only one economical and effective technique for reducing crime in the streets -- methadone maintenance."

Interestingly, John Mitchell, the attorney general, was open to the idea of expanding methadone. Elliot Richardson, the secretary of health, education, and welfare, was not. A large-scale methadone program, he wrote in reply to Donfeld's memo, "may court potential disaster. We would be forced into a posture of pushing this program without the support of a generally accepted consensus of scientific knowledge and in the face of the judgments of our professional advisers." Richardson expressed support for a $60 million increase in funding for treatment and prevention, with a small portion earmarked for a scientific evaluation of methadone's effectiveness.

The $60 million figure struck Krogh as reasonable, but, unless a generous share of it went for methadone, he believed, the desired payoff in crime reduction would not occur. To resolve the issue, Krogh arranged for a showdown on April 28, 1971, in John Ehrlichman's office. Attending were John Mitchell, Elliot Richardson, Bert Brown, Krogh, and Donfeld. It pitted the young but self-confident Donfeld against the regal Richardson and the bulldog Brown. "It was exhilarating, being up against those renowned people," Donfeld recalled. "They were advocating the psychotherapy-TC modality. I was advocating this substitute addiction that I felt would help address what was perceived to be a major problem in the United States. And Ehrlichman listened."

By the end of the meeting, all had agreed that the administration should be doing more on drug treatment, but the methadone issue remained unresolved, and Ehrlichman, engrossed in other issues, put off a final decision.


There matters would probably have rested had it not been for the actions of two members of the House Foreign Affairs Committee -- Robert Steele, a Republican from Connecticut, and Morgan Murphy, a Democrat from Illinois. In April 1971, the two congressmen went to South Vietnam to investigate reports of growing heroin addiction among U.S. troops there. According to the press, Vietnam had been flooded with cheap, 95-percent-pure heroin from the Golden Triangle region of Laos, Thailand, and Burma. "Drugs," Time stated, "are rapidly becoming as great a threat to American forces as the enemy."

On April 29, Steele, back from his trip, visited the White House to brief Bud Krogh and General Alexander Haig, deputy director of the National Security Council. Based on his interviews, the congressman said, he believed that 10 to 15 percent of all GIs in Vietnam were addicted to heroin, with as many as 25 percent in some units. And it was not just the war effort that was at stake. With the United States withdrawing 1,000 troops a day from Vietnam, many addicts were already on their way home, bringing with them their craving for drugs and experience with guns.

Krogh was not surprised by Steele's figures. He had visited Vietnam the year before and seen how widely drugs were used there. After a long period of having denied the problem, the Pentagon was now cracking down on it, stepping up interdiction efforts and importing dope-sniffing dogs. Soldiers caught using drugs were subject to arrest and court-martial. The main effect, however, had been to clog the military justice system without doing much to reduce consumption.

Clearly, something had to be done, and for advice Krogh turned to the man who seemed most knowledgeable about drugs. After months of hearing nothing from the White House, Jerome Jaffe in early May 1971 was summoned to Washington to discuss the GI drug problem. Jaffe had been nowhere near Vietnam, but, hearing Krogh's description, he made some inferences based on his own experiences in Chicago. While Steele and others were talking about tens of thousands of addicts in Vietnam, Jaffe assumed that the heroin-using population there was more diverse, including also new users as well as people in the process of becoming dependent. The key was to find a way to prevent the dabblers from becoming addicts, and to break the addicts of their habits. From Krogh's remarks, it seemed clear that the military's harsh approach was not working. The pace of military justice was too slow, and the penalties too remote. "It seemed self-evident that a small but certain consequence would change behavior more than a catastrophic but highly unlikely one," Jaffe observed. "And what might such a consequence be? You can't get on the plane." GIs were so desperate to leave Vietnam, Jaffe reasoned, that the idea of delaying their departure by even a few days could provide a powerful deterrent.

Earlier in the year, Jaffe, attending a conference in Toronto, had learned of a new process, called FRAT (Free Radical Assay Technique), that allowed for assembly-line-like urine testing, and he had ordered one of the machines for use in Chicago. If such a device was used in Vietnam, Jaffe said, soldiers could be tested as they prepared to board the plane to return home. Those who tested positive would be subject not to imprisonment or court-martial but to a mandatory stay in Vietnam of two weeks or so to be detoxed. As word of the testing spread, Jaffe said, many of those not yet addicted would probably stop on their own so as not to delay their departure. If the White House wanted, Jaffe said, he would be happy to sign over use of his machine.

Listening to his proposal, Krogh could see some immediate problems. For one thing, it would require the Pentagon to reduce the penalties for drug use -- something it was loath to do. Civil libertarians, meanwhile, would surely object to the procedure on privacy grounds. But the idea had one undeniable merit -- it might actually work. Sending Jaffe back to Chicago to await further word, Krogh sent a seven-page memo to Ehrlichman urging him to proceed on the drug issue. Referring to the "Vietnam and DoD Powderkeg," Krogh wrote that "addicted veterans must get treatment but Defense and the VA cannot agree on who has responsibility for these people. As a consequence, over-burdened treatment programs in the U.S. are sinking with additional veteran junkies." He added:

The President, on many occasions, has declared that solutions to problems of drug abuse have no higher priority in his Administration. But the reality is that much more needs to be done to bring about substantively effective programs in rehabilitation, prevention and research. Law enforcement and diplomatic overtures to other countries -- Turkey, France, and Mexico -- have been effective, but more here needs to be done. Bluntly, Mitchell has taken his job a lot more seriously than Richardson and Bertram Brown have taken theirs.

Krogh went on to urge creation of a new agency within HEW to be headed by Jaffe, "the undisputed leader in America in narcotic addict treatment programs."

Ehrlichman continued to stall. But the Vietnam issue would not go away. G.I. HEROIN ADDICTION EPIDEMIC IN VIETNAM, the New York Times declared on its front page on May 16. Shortly thereafter, Congressman Steele scheduled a press conference to release his report on Vietnam. The White House's nervousness was apparent in a memo to Krogh from White House aide Donald Rumsfeld:

I called Congressman Steele Monday before his Tuesday press conference with the thought that it might moderate anything he might say against the Administration. He was friendly and indicated that he would be interested in cooperating with the Administration on any legislative initiatives, if he agrees with them, obviously. One specific thing he mentioned was the possibility of some legislation to deal with returning veterans who are drug addicts.

Steele's report was blunt. If drug use continued to spread among the troops in Vietnam, it stated, "the only solution" would be "to withdraw American servicemen from Southeast Asia."

With the drug problem threatening to undermine the administration's Vietnam policy, Ehrlichman finally decided to act. On May 26, he and Krogh asked H. R. Haldeman for a meeting with the president, and two days later they were brought in to brief him on the drug proposal. Krogh was well aware of what he was up against. While Nixon had spoken only sporadically about the drug issue, his comments were invariably fierce. Heroin traffickers, he believed, deserved the heaviest possible penalties, including death. Marijuana, meanwhile, stood for everything that was wrong with the country. For Nixon, "marijuana was part of a larger tapestry," John Ehrlichman recalled. "The people who were demonstrating against what he was doing in Vietnam, the wearing of long hair, and the smoking of dope were all part of a picture. These were people he had no use for."

Yet, as with China and the environment, Nixon's ideological convictions on drugs were tempered by a strong dose of pragmatism. While helping to build up the Bureau of Narcotics and Dangerous Drugs, for instance, Nixon had few illusions about its effectiveness. Krogh recalled a White House meeting at which John Ingersoll, the bureau's director, briefed the president on its achievements: "Ingersoll told Nixon that seizures of heroin were up, arrests were up, more investigations were under way. He just laid out a whole list of operational indices of success. The president then said, 'Let me ask you this, are we taking one step forward and two steps back? Is there any less narcotics coming into the United States? Are we solving the problem?' And there was just silence."

Such silences left Nixon open to a new approach. And, at the May 28 meeting, Krogh briefed him on the heroin situation and the threat it posed to the administration, both in Vietnam and urban America. Already overwhelmed with junkies, the nation's treatment facilities faced the prospect of dealing with thousands of returning vets, he said. Krogh went on to describe his meetings with Jerome Jaffe and his imaginative scheme for dealing with the GI drug problem. Krogh also mentioned his idea of creating a new federal agency to set up treatment programs nationwide, an initiative that, he said, might help reduce crime.

Listening intently, Nixon immediately saw the appeal of Krogh's proposal. By setting up a new agency to deal with the drug problem as a whole, he could divert some of the attention being paid to the situation in Vietnam. In the process, he could be seen as acting dramatically to confront a serious social problem threatening the nation's young. Ehrlichman's shorthand notes of the meeting captured the president's thinking:

  • Handle so we get Jaffe for Narc generally,
  • not vets or the war -- ...
  • Use by younger people
  • Then, subsidiary, hit vets...
  • Highest level --
  • π [Ehrlichman's symbol for the president] setting up new org -- not
    • just vets...
  • $120 MM
  • Get it out of NIMH

This last notation showed that even Nixon was aware of the NIMH situation. The president wanted a dynamic new agency, headed by the outsider Jaffe. And, in agreeing to set up such an agency, Nixon was implicitly approving a government role in dispensing methadone.

Without telling him what was afoot, Krogh called Jaffe back to Washington on May 30 for further consultation on Vietnam. As expected, the Defense Department was balking at the drug-testing scheme. A briefing had been scheduled at the Pentagon, and Donfeld and Jaffe -- already an hour late -- hurried over. Expecting to meet with a few researchers, Jaffe instead found himself in a room full of generals and admirals irritated at having been kept waiting. Introduced as a consultant to the president, Jaffe described his idea for reducing drug use through urine testing. The generals sourly responded that, given the complex logistics of bringing the troops home, ordering them to provide urine specimens was out of the question. "I cannot believe," Jaffe bluntly replied, "that the mightiest army on earth can't get its troops to piss in a bottle." Perhaps something could be in place by September, the generals said. Losing patience, Jaffe snapped, "Gentlemen, the White House wants something done about the problem a little sooner than that, and I feel certain that I can find a few civilians who will be willing to aid me in getting this effort under way. If you will help me make transportation arrangements and will bring me a phone I will make a few calls." Taken aback, the officers took a brief recess, then reluctantly pledged their cooperation.

Krogh, who had dealt with the military on countless occasions, was startled when told of Jaffe's performance. Only someone unschooled in the ways of Washington could have acted so nervily in the face of so much brass. The meeting reinforced Krogh's notion that a nonbureaucrat like Jaffe should head the new treatment agency he had in mind, and that he should be able to invoke the authority of the president.

Jaffe was told none of this, however, and a week later he was called back to Washington. Only after arriving was he told that he was to see the president. "If I'd known I was going to meet him, I would have dressed better," Jaffe recalled with a laugh. "I was wearing a shleppy wash-and-wear suit and a psychedelic tie that one of my daughters had given me. And I would have gotten a haircut. I had sideburns almost down to my jaw." Arriving at the Oval Office with Krogh and Donfeld, he found waiting for him Ehrlichman, Haldeman, and, of course, the president. Awestruck at being in the White House, Jaffe collected himself enough to describe his plan for dealing with drug use in Vietnam. Nixon was more interested in the domestic aspects of the problem. According to Donfeld's notes of the meeting, Nixon raised the subject of methadone, asking if it "was worse than heroin." Jaffe described the success he was having with the substance in Illinois, with a 40 percent reduction in crime observed among those using it. For a national program, Jaffe went on, the goal should be "to make treatment available to all heroin addicts so that no one had to commit a crime to support a habit because they cannot get treatment."

Giving vent to his dour opinion of the bureaucracy, Nixon stressed the need to bring in people "from outside of the government to help run the program" and to inject "a sense of urgency." "The President," Donfeld wrote, "said that no one's feelings should be spared and that he wants this agency to have terrific clout. The President wants the Department of Health, Education and Welfare to be shaken up, he wants budgets cut and government hacks fired...."

As the session was drawing to a close, Jaffe casually mentioned some research being done on an insect that ate poppy plants. Perking up, Nixon got on the phone to Secretary of Agriculture Clifford Hardin and asked him about a drug-eating insect he had heard of that was bred in such a way as to ensure its own destruction. Hardin had no idea what he was talking about. Putting the phone down, Nixon noted that the insect "died after intercourse," which led one member of the group to crack that it should be called the "screw-worm." And on that surreal note the meeting broke up.

Still in the dark, Jaffe returned to Chicago. Meanwhile, Krogh was putting the finishing touches on the new treatment office. He was also stepping up the campaign against the French Connection. As a result of his prodding, the French government had agreed to add dozens of agents to its antinarcotics squad, and they were pursuing the Corsican traffickers with new vigor. In Turkey, a new government had been installed by the military earlier in the year, and, fearful of losing U.S. military aid, it seemed receptive to the idea of curtailing local poppy cultivation. To increase the pressure, Krogh arranged for the U.S. ambassadors to Turkey, France, and other heroin-producing nations to come to Washington and meet with the president. At the meeting, Nixon stressed his determination to secure the Turks' cooperation and said that, to get it, he was willing to pay them up to $50 million in compensation.

On June 17, Krogh called Jaffe back to Washington. Showing up at his office, Jaffe was immediately led into the Cabinet Room in the White House, where Nixon was meeting with a bipartisan group of congressmen. While Jaffe watched, Nixon announced that he was mounting a major new offensive against drug use and, to lead it, was creating a new Special Action Office for Drug Abuse Prevention, with Jaffe in charge. As Jaffe later recalled, the statement "left me too shocked to say to the president that no one had asked me."

At the end of the two-hour session, Nixon escorted Jaffe to the press room in the West Wing of the White House, where he announced that he was declaring drug abuse "public enemy number one in the United States." "In order to fight and defeat this enemy," he stated, "it is necessary to wage a new, all-out offensive." To underwrite the effort, Nixon went on, he was requesting $155 million in new funds, of which $105 million would go for treating and rehabilitating addicts. Nixon added:

I very much hesitate always to bring some new responsibility into the White House, because there are so many here, and I believe in delegating those responsibilities to the departments. But I consider this problem so urgent -- I also found that it was scattered so much throughout the government, with so much conflict, without coordination -- that it had to be brought into the White House. Consequently, I have brought Dr. Jaffe into the White House, directly reporting to me.

And so, for the first time in U.S. history, a president had declared war on drugs. And Richard Nixon, the apostle of law and order, was going to make treatment his principal weapon. As his general, he was enlisting a young Jewish Democratic psychiatrist with no experience in national politics. And so, at the age of thirty-seven, Jerome Jaffe was going to get a chance to apply to the nation as a whole the lessons he had learned during his long apprenticeship in Lexington, New York, and Chicago.

Copyright © 1998 by Michael Massing

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