Transcript No Slide Title

Misdiagnosis of a Problem:
Why Can’t We Solve the
Problem of Addiction
Jon Caulkins
RAND Drug Policy Research Center
Carnegie Mellon University Heinz
School of Public Policy & Management
1
Bottom Line
Drug problems do not fit any pigeon hole
Vary by substance
Vary by perspective/objective
Not just a criminal justice problem
Not just a medical problem either
They are hard problems; no silver bullets
2
What Drugs Are Dangerous?
Smoking Heroin Cocaine Alcohol
Intoxication/
Accidents
Acute Health
No
MJ
Some
Yes
Some
Rare
Yes
some
Yes
Yes
Yes
Rare
Chronic Health
Yes
No
Low
Yes
Some
Violenceinducing?
Risk it will
dominate life
No
No
Yes
Yes
No
No
Yes,
but …
Yes,
severe
Yes
Some,
but …
3
Scaling the Problems
Hardcore
Users
(millions)
Occasional
Users
(millions)
DrugInduced
Deaths*
DrugRelated
Deaths**
Alcohol
12
93
20,000
100,000
Tobacco
50
20
0
500,000
Marijuana
2.3
19
3
?
3
3
5,000
10,000?
1.0
0.5
5,000
10,000?
Cocaine
Heroin
*Acute, single-cause only
** Multiple-drug, delayed, or indirect result of drug use (accidents, illness, etc.)
4
Illegal Markets
• Tobacco and Alcohol
– Sale to minors usually done at cost or as a favor
• Marijuana
– High-prevalence but low cost so “only” ~$10B per year
– Retail distribution within social networks; little violence
• “Expensive drugs” (Cocaine, heroin, meth)
– Low-prevalence but remarkably expensive so ~$50B per year
– High levels of crime and violence
• Half is “systemic” (transaction-related conflicts)
• One-third is “economic-compulsive” (committed to finance purchases)
• One-sixth is “psychopharmacological” (induced by
intoxication/withdrawal)
5
Summary of Sources of Harm
• Tobacco
– Not a big problem except that chronic effects kill
400,000 or 500,000 people per year
– Externalities are primarily through health insurance and
second-hand smoke, some from productivity losses
• Alcohol
– Harms from intoxication, addiction, & chronic use
• Expensive illicit drugs
– Harms from black markets, control efforts, & addiction
• Marijuana
– Harms are modest; productivity effects may dominate
6
Nature of Drug Problem Varies
by Perspective
•
•
•
•
•
•
•
•
Health insurers: smoking and alcohol
Typical employer: alcohol (& others)
Parents’ short-term fears: marijuana & alcohol
Parents’ long-term fears: (should be) smoking
Childrens’ fears: parents’ addiction (to anything)
Govt budget balancers: alcohol & drug enforcement
Violent death: alcohol & expensive drugs’ markets
Infectious disease: injecting drugs
7
Controlling the Problems
Illicit Drugs
Alcohol
Tobacco
Source Country
Weak
NA
NA
Border Interdiction
Maxed
NA
NA
Law Enforcement
Major Focus
~NA
~NA
Supply Regulation
NA
Useful
Weak
Taxes
NA
Useful
Useful
Cost-Effective
But not very
Effective
School Prevention
Treatment
Harm Reduction
High recidivism But Highly CE
Untapped
potential
Success (e.g.
vs. DWI)
Success
NA
8
Bottom Line
Drug problems do not fit any pigeon hole
Vary by substance
Vary by perspective/objective
Not just a criminal justice problem
Not just a medical problem either
They are hard problems; no silver bullets
9