John P. Walters was sworn in as the Director of the White House Office of National Drug Control Policy (ONDCP) on December 7, 2001. As the nation's "Drug Czar," Mr. Walters coordinates all aspects of federal drug programs and spending.
In a February, 2002 White House ceremony, President Bush and Mr. Walters released the National Drug Control Strategy, which set aggressive goals of a 10 percent reduction in teen and adult drug use in two years and a 25 percent reduction in five years. The latest Monitoring the Future Study, released in December, 2004, showed a 17 percent reduction in teen drug use over three years, exceeding the President's goal and bringing drug use to its lowest levels since the early 1990s.
Since taking office, Mr. Walters has directed critical changes to the National Youth Anti-Drug Media Campaign, making the ads harder-hitting and more effective. Award-winning ads linking drug trafficking with terrorism and ads focusing on the harms of marijuana have been credited with helping change youth attitudes and behavior toward drugs. Mr. Walters also led a restructuring of the federal drug control budget so that it more accurately reflects the actual dollars spent on programs aimed at reducing drug use, making it a more useful tool for policymakers.
Under Director Walters's leadership, counterdrug efforts in Colombia have generated dramatic progress, with a 33 percent decline in coca cultivation over the past two years. Overall, coca cultivation in the Andean region (Colombia, Bolivia, and Peru) has declined by 22 percent since 2001, preventing the production of over 500 metric tons of cocaine. This reduction also removed over $100 million of the illicit income that supports narco-terrorism in Colombia.
Director Walters has overseen the creation and implementation of the "Access to Recovery" treatment initiative announced by President Bush in his 2003 State of the Union address. This innovative approach to drug treatment funding provides vouchers for hundreds of thousands of Americans struggling with addiction.
Director Walters has extensive experience at ONDCP. From 1989 to 1991, he was chief of staff for William Bennett and was Deputy Director for Supply Reduction from 1991 until leaving the office in 1993. During his service at ONDCP, he was responsible for helping guide the development and implementation of anti-drug programs in all areas.
From 1996 until 2001, Mr. Walters served as president of the Philanthropy Roundtable. The Roundtable is a national association of over 600 foundations and individual donors, providing publications and programs on American charitable giving.
During the Reagan Administration, he served as Assistant to the Secretary at the U.S. Department of Education, and was responsible for leading the development of anti-drug programs. He was also the Secretary's representative to the National Drug Policy Board and the Domestic Policy Council's Health Policy Working Group.
Mr. Walters served as Acting Assistant Director and Program Officer in the Division of Education Programs at the National Endowment for the Humanities from 1982 to 1985. He has previously taught political science at Michigan State University's James Madison College and at Boston College. He holds a BA from Michigan State University and an MA from the University of Toronto.
A compassionate and effective drug policy
Against the backdrop of steeply rising drug use (particularly by young people) during the mid- to late 1990s, and in the context of increasing drug use in nearly every nation of the world—including the nations of Western Europe—the United States in 2001 set an ambitious goal for its drug control policy.
In that year, President Bush determined to reduce teen drug use by 10 percent in two years, and 25 percent in five years. The Administration has exceeded the two-year goal, with an 11 percent reduction, and over the past three years there has been an historic 17 percent decrease in teenage drug use. Pursuing a strategy focusing on prevention and treatment, as well as law enforcement and international programs, there are now 600,000 fewer teens using drugs than there were in 2001. This is real progress, and we intend to build on this dramatic success.
Important features of our drug control policy that make it unique and effective are its balanced approach (emphasizing Prevention, Treatment, and Supply Reduction approaches and funding them accordingly), its determination to use a public health understanding of how drug use spreads, and its insistence that recovery from drug use is a reality and a responsibility that can be met. Further, we have determined to attack the drug trade as a business, one that can be disrupted by undermining its organization and by denying its profits.
A Balanced Strategy
Insisting on a balanced strategy has been central to our efforts. Though many critics in the world make a caricature U.S. drug control efforts as moralistic, or excessively punitive, or insufficiently supportive of prevention and treatment, in reality we have formed a comprehensive approach where each element of our strategy augments the others, and we have been guided by sound medical understanding of the problems of addiction. Effective prevention programs are helped when adults and individuals in positions of responsibility are clear an unambiguous in their opposition to drug use. In turn, when prevention works, the load on the treatment system is eased. Drug treatment programs are more effective when the market for illegal drugs is disrupted and drugs are not pure, inexpensive, and ubiquitous. Interdiction programs take drugs off the market in tandem with the success of treatment and prevention efforts, preventing what could otherwise be a glut in availability that could draw in new initiates.
Healing America's Drug Users
As risky behavior goes, drug use ranks among the worst. The likelihood that an adult who uses drugs at least on a monthly basis will go on to need drug treatment is approximately one in four—high enough to constitute a substantial risk, which draws millions of people to self-destruction, but low enough that many individuals are able to deny the obvious risks or convince themselves that they can "manage" their drug using behavior.
To assist those who would benefit from drug treatment, we focus on expanding access to effective treatment programs, as well as interventions through the criminal justice system. In addition to these avenues, we support approaches in a variety of settings to encourage drug users to seek the treatment they need. These include hospital emergency rooms, where doctors are now screening individuals for evidence of drug dependence and referring them to treatment as needed. They also include nonprofit organizations serving the needs of formerly addicted prisoners reentering society. These groups support their clients' first tentative steps in freedom, steering them away from established patterns of crime and drug use and into recovery after what for too many has been a life of addiction.
Throughout our efforts, we learn that we must confront an underlying feature of drug addiction–denial. Far too many drug users fail to acknowledge the seriousness of their plight, and decline to take actions that could lead to their recovery. We must mobilize our community resources to a compassionate calling–getting drug users to confront their problem, and then leading them to pathways of recovery and re-integration into that community.
Screening and Intervening
The first priority of our policy is stopping drug use before it starts. Robust efforts involving community action and public education are central to an effective drug control program—one that seeks to de-normalize drug use by creating a climate of public intolerance toward the drug using behavior that all too often leads to addiction.
What is considerably less obvious is how to target drug users still on the pathway to addiction—those individuals whose drug use is on the verge of causing noticeable levels of difficulties with work and relationships. It is never easy to identify individuals with such an incipient problem. But a new approach holds much promise, using the reach of physicians to identify problems as early as possible.
This approach, known as Screening Brief Intervention Referral and Treatment (SBIRT)—and more informally as "Screen and Intervene"—is being fielded in medical facilities as varied as major city hospital emergency rooms and a system of rural health clinics. The SBIRT approach places drug screening resources where the users are likely to be. In an SBIRT setting, for instance, a motorist involved in an accident may be asked about his drug use history before discharge, and this screening in turn may unearth a developing drug use problem.
Overall, early intervention accomplishes two tasks. First, it interrupts the continued worsening of a person's drug use trajectory, getting them help at a time when that help is most likely to be successful. Second, by getting a drug user into treatment, our approach interrupts the primary vector of contagion by which drug use is spread to others. Most often, it is the early, non-dependent user, yet to manifest the debilitating symptoms of his or her disease, who draws others into the eventual trap of addiction with them. By disrupting the spread of drug use as a behavior from youth to youth, we achieve both treatment and prevention goals.
Access to Recovery
In addition to the billions of dollars that the federal government has provided for drug treatment programs, most often directed through the various States, we have embarked on a new program that seeks to make more accessible, accountable, and effective the treatment system. Empowering individuals by allowing them to choose among various drug-treatment programs is a goal of President Bush's Access to Recovery initiative, which allows drug dependent individuals who are so inclined to turn to faith-based programs in time of need. Access to Recovery also is intended to serve some of the approximately 100,000 individuals who seek drug treatment each year and are put on a waiting list or are otherwise unable to get help. In total, Access to Recovery will provide care to more than 187,500 individuals over the three-year life of the program.
The Access to Recovery program is the result of the convergence of numerous forces demanding customer choice as well as increased cost-effectiveness, accountability, and results. ATR seeks to leverage the twin benefits of client choice with careful federal oversight and performance measurement, rewarding high-performing providers.
Research has established that drug treatment provided under supervision and sanction can be far more effective than in unmonitored circumstances. It is important to recognize the central role of the criminal justice system as an agent of successful recovery. Drug courts use the authority of a judge to coerce abstinence through a combination of clear expectations and careful supervision—a remarkable example of a public health approach linked to a public safety strategy.
The good news for the individual who is arrested and referred to a drug court is the possibility of avoiding prison entirely, and possibly having his or her arrest record expunged after the fact. The bad news, from the perspective of a long-time drug user, is that the best drug courts are more demanding than prison, with intensive requirements including frequent treatment sessions, regular public hearings, and of course, frequent mandatory drug tests.
Drug court programs have a real effect on criminal recidivism. A National Institute of Justice study compared re-arrest rates for drug court graduates with individuals who were imprisoned for drug offenses, and found significant differences. The likelihood that a drug court graduate would be rearrested and charged for a serious offense in the first year after graduation was 16.4 percent, compared with 43.5 percent for non-drug court graduates. By the two-year mark, the recidivism rate had grown to 27.5 percent, compared to 58.6 percent for non-graduates.
The drug court movement continues to grow rapidly. There were just a handful of courts operating in 1991, when the President's National Drug Control Strategy first called attention to the idea. Today there are 1,621 courts currently in operation in all 50 states—an increase of more than 400 courts just in the past year.
Prevention programs come in all varieties, including school-based programs, community-based programs, student drug testing programs, and public service advertisements. Among these critical programs, the National Youth Anti-Drug Media Campaign is the most effective drug education and prevention program, leading our efforts to reduce youth drug use. The Media Campaign is an integrated effort that combines advertising with public communications outreach. It has drawn on these insights, developing in the process a series of advertisements that change youth attitudes of drug use and coach parents in monitoring teen behavior and promoting early intervention against signs of early drug use.
We are convinced that the Media Campaign has been a major contributor to our success. Exposure to anti-drug advertising has had an impact on improving youth anti-drug attitudes and intentions. Among all three grades surveyed by the Monitoring The Future over the course of the Media Campaign, such ads have made youth to a "great extent" or "very great extent" less favorable toward drugs and less likely to use them in the future. Further, more than half of the increase in most of these outcomes among all three grades has occurred in the past three years. This is particularly striking among 10 th graders, our primary target audience. With these results, the Media Campaign will continue as our primary drug prevention program.
Student Drug Testing
Student drug testing programs are an excellent means of protecting kids from a behavior that destroys bodies and minds, impedes academic performance, and creates barriers to success and happiness. Drug testing is powerful, safe, and effective, and it is available to any school, public or private, that understands the devastation of drug use and is determined to confront it. Many schools urgently need effective ways to reinforce their anti-drug efforts. Drug testing can help them.
Indeed, student drug testing is that rare tool that makes all other prevention efforts more effective. By giving students who do not want to use drugs an "out," testing reduces the impact of peer pressure. By giving students who are tempted by drugs a concrete reason not to use them, testing amplifies the force of prevention messages. And by identifying students who are using illegal drugs, testing supports parental monitoring and enables treatment specialists to direct early intervention techniques where they are needed.
Importantly, drug testing can be done effectively and compassionately. The purpose of testing, after all, is not to punish students who use drugs, but to prevent use in the first place, and to make sure users get the help they need to stop placing themselves and their friends at risk. Random drug testing is not a substitute for all our other efforts to reduce drug use by young people, but it does make all those efforts work better.
Disrupting the Market: Attacking the Economic Basis of the Drug Trade
Perhaps the only good thing one can say about the enormous social consequences of drug use—an acid that eats away at relationships with family, friends, coworkers—is that things would be far worse were the price and availability of illegal drugs not so successfully circumscribed by the activities of interdiction and law enforcement.
The strategy of the U.S. Government is to disrupt the market for illegal drugs—to do so in a way that both reduces the profitability of the drug trade and increases the costs of drugs to consumers. In other words, we seek to inflict on this business what every licit business fears—escalating costs, diminishing profits, and unreliable suppliers.
To disrupt effectively major drug markets, it is not possible to attack everywhere simultaneously. U.S. law enforcement and our allies must approach this problem strategically, as a market. Drug trafficking organizations are complex, far-flung international businesses, often compared to multinational corporations. Many successful international trafficking organizations function as networks, with business functions accomplished by loosely aligned associations of independent producers, shippers, distributors, processors, marketers, financiers, and wholesalers. Such networked organizations pose special challenges to law enforcement and interdiction forces, since by the very nature of a network, the system is resistant to the disruption or dismantling of individual elements. Networked organizations can be attacked, disrupted, and dismantled. But an organization that is not vertically integrated and lacks significant physical infrastructure cannot be dismantled component by component.
The best promise of severely damaging a networked organization is repeatedly to damage or destroy most of the elements in one horizontal layer of the network—especially a layer requiring critical contacts or skills—at a rate higher than the organization's ability to replace them.
Our policy is for the United States Government, in concert with international allies, to target networks by attacking entire business sectors, such as the transporter sector. Our experience to date shows several examples, including destroying the economic basis of the cocaine production business in South America by fumigating the coca crop; seizing enormous and unsustainable amounts of cocaine from transporters; and selectively targeting major organization heads for law enforcement action and, ultimately, extradition and prosecution in the United States.
Supply Reduction Internationally: The Andes
After years of steady increases, cocaine production in the Andes is—for the third straight year—headed in the right direction: down. An aggressive program of eradication, begun in earnest with the election in mid-2002 of Colombian President Alvaro Uribe, has cut Colombia's potential cocaine production by one-third as compared with the year before he took office. And while final production estimates for last year are not yet available, 2004 was the third consecutive record year for eradication, with 120,713 hectares sprayed by the eradication forces of the Colombian National Police against coca plantations that totaled 113,850 hectares at the end of 2003. In other words, Colombian forces sprayed enough herbicide to cover more than the entire coca crop as it stood at the beginning of 2004, leaving many growers in the unenviable position of replanting at a furious pace to maintain production, relocating to other areas, or getting out of the business altogether.
Crucially, progress in Colombia has not been offset by increases in Peru or Bolivia. There was a net decrease in the total area cultivated in those countries in 2003, including a remarkable 15 percent drop in Peru. Only trace amounts of coca are cultivated in neighboring Venezuela, Ecuador, Panama, and Brazil.
Coca eradication remains the most strategic element of our strategy in Colombia because of the crop's inherent vulnerability. We can locate the coca fields and destroy them before the raw material is harvested and processed and becomes invisible in the illicit smuggling world. Large-scale eradication is an effective means of targeting trafficker networks because most growers are affected, reducing the production available to all traffickers. When Colombia is producing one-third less cocaine than it was just two years earlier, there simply is less to go around.
Further, the Government of Colombia continues its relentless attack on poppy cultivation and heroin production. Eradication programs supported by the United States Department of State sprayed or manually eradicated 2,899 hectares during 2004—an amount equal to two-thirds of the entire poppy crop planted in 2003, the most recent year for which cultivation data are available. To put additional pressure on heroin traffickers, President Uribe has advanced an initiative to seize farms involved in the cultivation of illicit crops, especially poppy.
What we are seeing in Colombia is a country being freed from decades of narco-trafficking and narco-terrorism. We are seeing the restoration and the expansion of democracy, the rule of law, and human rights. Further, we are witnessing the economic revitalization of a nation too long under the threat of drug organizations that threatened the country's future. This is a tough fight that is not yet over, but we are on the winning path, and surely the fight must not be abandoned now. At stake is the Colombian future, as well as the well-being of generations of Americans who will benefit from the destruction of the drug trade in the Andes.
Emerging Challenges: Synthetic Drugs and Prescription Drug Abuse
Globally, the production and use of the synthetic drugs amphetamine, methamphetamine, and MDMA (Ecstasy) remain a serious problem. There are numerous foreign sources for synthetic drugs and their precursors, including countries in Asia, Europe, and North America. Use patterns are strongly regional, with methamphetamine consumed in the United States and Asia. Amphetamines and Ecstasy are the drugs of choice in Europe. U.S. law enforcement continues to act in cooperation with law enforcement officials worldwide to disrupt foreign sources of the bulk pseudoephedrine and ephedrine that are used to produce methamphetamine consumed in the United States.
Our policies will continue their emphasis on confronting and disrupting the synthetic drug markets through both organizational attack activities targeting major synthetic drug trafficking organizations and chemical control initiatives focused on keeping the essential precursors out of traffickers' hands. In combination, the aggressive application of organizational attack and chemical control programs can disrupt the illicit synthetic drug market.
Prescription Drug Safety
Surveys show that the non-medical use of prescription drugs, particularly narcotic painkillers, continues to rise in several populations. The number of people who had used pain relievers non-medically at least once during their lifetime increased 5 percent, to 31.2 million Americans, from 2002 to 2003. Among young adults, the non-medical use of any psychotherapeutics in the past month increased from 5.4 percent to 6 percent. Also among young adults, current non-medical use of pain relievers increased by 15 percent, from 4.1 percent to 4.7 percent.
While this is an emerging drug abuse problem, the challenge it presents is of a different order from the traditional drug threats. Existing as they do in every pharmacy in every city and town in America, prescription drugs are both more ubiquitous and at the same time more susceptible to regulatory control, with the mechanisms to reduce the threat of prescription drug misuse substantially within the scope of state and federal regulatory authority. Further, prescription drugs are increasingly acquired over the Internet, often without a doctor's supervision. What is needed is continued improvement in the surveillance of practices like "doctor shopping" coupled with more careful and responsible medical oversight, preserving legitimate access to needed medicines while at the same time deterring unlawful conduct.
We have several tools available to us to respond to this challenge. Among the most effective is to gain cooperation of the medical community, the pharmaceutical manufacturers, law enforcement, treatment providers, and regulatory agencies to develop monitoring programs for prescription misuse. Such programs can help assure continued access to substances for legitimate medical needs, and serve to identify and refer problem users to treatment. State-level prescription drug monitoring programs have taken a leading role in detecting and deterring the diversion of popular prescription controlled substances, such as OxyContin and Vicodin. PDMPs, as they are known, are operational or plan to be operational in 24 states in 2005, with Ohio, Alabama, Wyoming, and New Mexico all establishing programs in the past year. Additionally, at least six states—New Jersey, Tennessee, South Carolina, Iowa, Missouri, and New Hampshire—are contemplating legislation to establish programs of their own. Some states, notably Mississippi and Oregon, expect to implement the program through administrative rule rather than legislation.
Conclusion: Pushing Back Against the Drug Problem
Other nations have harkened to voices that all too often amount to a counsel of despair for drug use. Under the rubric of "harm reduction," they offer what is in effect an acquiescing to the disease of addiction, and suggest that we turn away from our responsibility to fight against the suffering. What we are proposing, in stark contrast, is the political vision and the strategic means that will yield continued success. Together, we can achieve the kind of progress that will improve the lives of our children and make us all proud. As President Bush indicated in releasing the National Drug Control Strategy last year: "Our Strategy proposes a remarkable and unprecedented array of drug control programs, treatment initiatives, and media campaign efforts. But more than any program, it seeks to engage the desire of all Americans to make this a better Nation, facing down the lie of addiction, and offering the hope of recovery."