A constant struggle over how to fight the nation's war on drugs revolves around whether we should concentrate on blunting the supply of drugs or zero in on slowing demand.
Ideally, the war would be waged equally on both fronts. But to those who say we have overemphasized the supply side of the problem to the detriment of focusing on those who abuse and are addicted to drugs, let it be known that our government really has not given us anything that we can put our fingers on.How can we talk about expanding treatment if we do not know what works?
Reducing demand means having an adequate treatment system in place, and we are woefully inadequate in this area.
What is more disconcerting is that we do not know a whole lot about treatment.
A key report outlining some of the underlying problems with drug treatment in the United States was released last month by the General Accounting Office.
There was not a lot of attention paid to it, but the GAO study deserves airing because it hits at a fundamental problem with our treatment system - our lack of knowledge.
It is amazing that in this time of rampant cocaine abuse, a rapidly growing crack crisis, the onset of new and more dangerous drugs like methamphetamine "ice," emergency wards overflowing with drug overdose victims and newborn babies screaming in pain from inherited drug addiction that our government appears to have dropped the ball on treatment.
According to the GAO study, research on drug treatment in this country has advanced little in the past decade.
There are glaring gaps in our knowledge and the nation's leading agency responsible for drug treatment research, the National Institute on Drug Abuse (NIDA), has not taken as active an approach as is needed.
Specifically, NIDA has not conducted any large-scale evaluations of treatment in the United States in recent years.
What that says to me is that state and local treatment providers do not know whether they are doing a good job because the government has no standards and has not evaluated their programs.
Also, the GAO points out that while cocaine and crack are the principal drugs of choice in today's world, NIDA's focus in terms of new treatment continues to be turned toward opiate abuse. The thrust of the GAO report says the gaps in knowledge come from the lack of any major strategic planning approach to targeting research funds to the most critical areas.
Often, a lack of resources is cited when government fails to address a social crisis. Although NIDA's budget was relatively small throughout the early 1980s, its budget has risen fourfold in the past five years, from $85 million to about $380 million.
The key now is to get NIDA to follow through on long-term research planning that was begun just last year.
It would be easy to pounce on NIDA, laying complete blame for treatment problems at their doorstep. But the fact is these problems go back to what the Congress has been saying all along, in passing two major anti-drug bills and the creation of the Office of National Drug Control Policy: If the Federal government offers a comprehensive strategy for dealing with the drug crisis, we would be less likely to suffer from gaps in knowledge.
Treatment providers, as any others involved in the war on drugs, would be aware of what was expected and there would be a standard by which all could be measured.
Presenting a drug strategy on paper, as the administration has done, is one thing. But to follow through and make sure the right people are in touch with the overall strategy is another.
We have not heard the clarion calls from the relevant leaders indicating this is a matter of national urgency.
As secretary of health and human services, Louis Sullivan should be calling for greater use of the treatment research dollar. He should be calling for national treatment standards and demanding that we come up with answers to what works.
As chairman of the Select Committee on Narcotics, I have often absorbed criticism from those who say I am more concerned about the supply side, and that my time and efforts would be better spent on the demand side.
Until we see a different tactic by the federal government regarding treatment, my response will continue to be that we cannot expect people to arbitrarily "Just Say No" if we do not have an effective treatment for them to say yes to.
(Rep. Charles Rangel, D-N.Y., is chairman is the House Select Committee on Narcotics Abuse and Control.)