Some progressives want to change our approach to drugs to recognize that there will be continuing use, and to accept the need to protect users through providing them with clean needles, non-injectible drugs taken orally, medical care, good diets and places to live. This is called harm reduction. Others -- those in the recovery movement -- seek and accept only abstinence treatment, a la the 12 steps. These two perspectives are at war.
The conflict reflects our confusion about how to address drugs and substance abuse in the United States. Once the policy debate was over whether drug interdiction or prevention/treatment was the best approach. Now the debate is between harm-reduction and disease-oriented treatments and policies. These divergent perspectives appear within the progressive wing of the Democratic Party, and are battling over the naming of Barack Obama's drug czar.
Maia Szalavitz, speaking on behalf of drug policy reformers, has urged rejection of Minn. Republican Rep. Jim Ramstad, the front runner for the position. The reason for the opposition to Ramstad is that he opposes needle exchange and methadone maintenance, key drug reform policies. For his part, Ramstad is a passionate recovering alcoholic and Alcoholics Anonymous member who believes in abstinence uber alles.
And who can oppose AA in America? Certainly not Patrick Kennedy, Democratic Rep. from Rhode Island and son of Ted Kennedy. The younger Kennedy and Ramstad are great Congressional friends who lead a meeting of recovering legislators. Kennedy and his father are, of course, liberals. The Kennedy's and Ramstad have together pushed for insurance parity for addiction treatment.
In the United States, this treatment is almost exclusively 12-step, AA, and disease-oriented. (Disclosure: I have developed the Life Process Program, a non-disease recovery program. I oppose disease-oriented treatments because they are ineffective for most and because they disrespect individual choice, responsibility, and integrity.) But the reform community has sought to make AA and the treatment community allies.
This hope is being dashed by progressive groups like Wellstone Action, which has endorsed Ramstad. Wellstone Action is the legacy of progressive Minn. Senator Paul Wellstone for which his son David serves as co-chair. For Wellstone, the Kennedy's, and many other progressives, the idea of treating substance abusers as disease sufferers is tremendously appealing - indeed, one thrust of the drug policy reform movement is to shift from incarcerating addicts to treating them!
But, for reformers, courting treatment advocates has come a cropper as addiction-as-disease proponents back a man who stands against drug policy reform's basic value of finding new, pragmatic approaches to drugs in America. Like other such disagreements steeped in divergent values, there's no getting around this one.