And Now, Back in the Real World …

Seth Norman, a criminal court judge in Nashville, doesn't know a lot about dopamine receptors or glutamate. A cure for addiction? "I'd love to see it," he says. But Norman is too busy dealing with a docket full of drug addicts—largely meth and crack-cocaine users—to think much about the science behind their behavior. The judge does believe that drug addiction is a disease, however, and he is adamant about moving nonviolent drug offenders away from prison and into treatment. In 1997 he opened a unique residential addiction program, which has offered intensive rehab instead of incarceration to more than 1,000 men and women. "We got tired of the revolving door, seeing the same person coming through court all the time," says Norman.

Since the United States stepped up efforts to crack down on drugs—with Nixon's war on drugs, declared in 1971, and the creation of the Drug Enforcement Administration two years later—jail cells have been the landing pad for addicts. Between 2000 and 2006, the number of drug offenders in federal prison jumped 26 percent, to 93,751. An additional 250,000 are incarcerated in state facilities and thousands more sit in local jail cells. This year the government has budgeted close to $13 billion for drug control, treatment and prevention. The DEA—whose mission is to stop drug trafficking—is certainly not going soft. But when it comes to the individual user, the addict who just can't quit, law-enforcement officials acknowledge that the old lock-'em-up approach is not only burdensome and expensive, it doesn't solve the problem. Addiction, says John P. Walters, director of the White House's Office of National Drug Control Policy, "is not fundamentally about a moral failing, it's about something that really changes the way the brain functions."

Laws still treat drug use as a crime, but from Maryland to Hawaii, states are looking for new ways to steer drug offenders away from prison cells and into treatment. In the process, they hope to save millions of taxpayer dollars. The most ambitious program so far is California's Proposition 36, which offers convicted nonviolent drug offenders family counseling and job training in addition to treatment. Since the initiative was approved by voters in 2000, more than 36,000 people have been diverted into treatment every year. Still, Prop 36 advocates have fought to maintain adequate funding and the program has struggled with "very, very high rates of dropout," says Angela Hawken, a UCLA researcher.

One critical question: should addicts be held accountable for sticking with treatment? Judges like Norman believe the criminal justice system must have the upper hand. In his court and in some 2,000 other drug courts nationwide, drug offenders must appear before a judge to make sure they're complying. If not, says Norman, "I'm going to send you back to jail."

Drug courts reduce crime rates substantially, says West Huddleston of the National Association of Drug Court Professionals. About one quarter of offenders who go through drug courts are rearrested two years after treatment compared with two thirds of those who don't. Opponents say drug courts are coercive. But "treatment is rarely truly voluntary," says Peter Reuter, a drug-policy researcher at the University of Maryland. Be it a spouse, an employer or the criminal justice system, "some degree of coercion is necessary," he says.

The problem is that even when treatment is provided, it often isn't very good. The key challenge is funding. Even as attitudes shift, the federal government still budgets far more for stopping drug flow and enforcing drug laws ($8.3 billion this year) than it does for treatment and prevention ($4.6 billion). Treatment programs are understaffed. Medications like methadone help some addicts, but harm others. Quitting is a grueling proposition. As a result, less than 10 percent of people who need treatment actually get it. And the proportion of people staying in treatment is "horrendously low," says David Gustafson of the Network for the Improvement of Addiction Treatment. New science may change all that one day. But for now, the battle goes on.

With Tina Peng and Karen Springen

© 2008