A Repost to mark the passing of Nancy Reagan
March 7, 2016
In terms of health and biomedical science, the Reagan Administration left a shameful legacy of refusing to respond to (or acknowledge, really) the HIV/AIDS crisis that blew up during their tenure in office.
As many of you recall, First Lady Nancy Reagan took up drug abuse and substance dependence as one of her signature issues and this is probably one of the other larger Reagan Administration legacies on health.
To mark her passing, I thought I would repost the following which first appeared on the blog 21 July 2008.
If you are a reader of my posts on drug abuse science you will have noticed that it rarely takes long for a commenter or three to opine some version of “The (US) War on Drugs is a complete and utter failure”. Similarly, while Big Eddie mostly comments on the liberty aspects (rather than the effectiveness) of the WoD himself, a commenter to his posts will usually weigh in, commenting to a similar effect.
Now I’m open to all the arguments about personal liberty trade offs, economic costs, sentencing disparities, violations of other sovereign nations and the like. Nevertheless, I’m most interested in the fundamental question of whether the War on Drugs worked. That is, to reduce drug use in the US. For those who believe it has not worked, I have a few figures I would like explained to me.
I’m following up a story I started in a prior post by putting up the long term trends for cocaine use in the US. These data are from the 2006 Volume II monograph which focuses on the 18 yr old and older populations. As you will recall my hypothesis was / is that the Len Bias fatality had a dramatic effect on cocaine use. I still think this is the case and that this explains much of the timing of a reduction in cocaine prevalence observed consistently from the 18 yr old to 45+ age groups. However Len Bias’s death was not an exclusive effect and must be considered in the context of changes in other drug use patterns. That context is something I want to delve into just a little bit.
As always, I depend on the data from the Monitoring the Future survey (www.monitoringthefuture.org) and I am pulling the figures from the 2006 Volume I monograph which focuses on the 8th, 10th and 12th grade populations in contrast to the older age cohorts outlined in the first graph.
Cocaine
First up are the annual prevalence rates for powder cocaine, which I provide for reference to the previous graph for the older age ranges. I apologize for the blurry figures but my imaging skills are not up to any better- luckily, these reports are freely available on the MtF website. (I also encourage you to get the reports yourself because there are slight changes in the questions asked in some cases- if you see a discontinuity in the longitudinal data this is probably why.) The longest term trends are available for 12th graders, additional grades were added into the survey in the early 1990’s. Prevalence of cocaine was reasonably steady in the 1979-1986 interval and it is stunningly apparent that cocaine became less popular with 12th graders after 1986 . It is also clear that it took about 5 additional years for prevalence to drop to the most recent nadir. So it wasn’t all about Len Bias (he died of cocaine-related cardiac complications on June 19, 1986).
So, if it isn’t all about Len Bias, perhaps we should see similar effects on population prevalence of other illicit drugs?
Marijuana and Amphetamine
It seems reasonable to turn our analysis to two perennial high-prevalence drugs for high school populations; marijuana (duh!) and the amphetamines. (In MtF parlance, the amphetamine class is for tablet or other prescription preparations after 1982.) In this case, the prevalences were at peak in the late 1970s and started to decline in the very early 1980s. Interestingly, there is no evidence of a change in the established trends from 1986-1987 as is observed for powder cocaine; I think this supports the Len Bias hypothesis. Nevertheless we can also see this as additional evidence for something else driving drug use downward.
This brings us to what are illicit drugs for most of these populations but, of course, licit drugs for individuals who have reached the legal age; 21 (alcohol) or 18 (cigarettes; this may be a substantial fraction of 12th graders). In theory, we might use these data to try to dissociate the anti-drug messaging from the drug interdiction / legal penalties side of the equation. Not perfect, but at least a hint.
Alcohol
The trends for annual prevalence of alcohol were very stable from 1978-1988 whereupon a decline was observed (questions were altered in 1993, making further comparison tricky). The trends for 5-drinks-in-a-row (currently the definition of a “binge”) in the past two week interval were very stable from 1978-1983 and thereafter exhibited a slow decline until the early 1990s. Very reminiscent of the above mentioned drugs.
Cigarettes
In this case, please note that we’ve shifted to 30-day prevalence rates (any, daily); obviously this is frustrating for direct comparison but this is what they provide in the monographs. Unfortunately the more recent monographs (it is currently on a reliable annual update schedule with available pdfs, the older ones are not available) seem to only start with the 1986 data in the Tables so one is left with their figures for the earlier part of the trends. With that caveat, we can see that cigarette prevalence in the high school population was reasonably stable during the interval in which the prevalence rates for the illicit-for-all drugs mentioned above were in decline.
So Did the War on Drugs Work or Not?
I do think the jury is still out on this one and the problem of shifting definitions about goals and successes is quite difficult. I feel confident the comments will stray afield a bit and explore some of these issues. However, as I intimated at the outset,
for those of you who insist vociferously that the War on Drugs (considered inclusively with the Just Say No, D.A.R.E, main-stream media reporting, and all that stuff that is frequently rolled into a whole by the legalization crowd) is an abject failure…
for those of you who insist vociferously that you cannot tell teenagers anything about the dangers of recreational drugs and expect them to listen to you…
I would like these data explained to me.
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Update 7/23/08: Followup post from Scott Morgan at StoptheDrugWar.org
DrugMonkey 
March 7, 2016 at 1:29 pm
Come on. You proudly mention your GenX credentials. Don’t you remember that drugs were associated with the Boomer ex-hippie demographic that our generation tended to mock in the 1980s? That’s got to be part of it.
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March 7, 2016 at 1:41 pm
If nothing else, the War on Drugs has certainly put a lot of people in prison.
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March 7, 2016 at 2:14 pm
I don’t have a problem with Nancy Reagan (or anyone else) telling people to “just say no.” I do have a problem with draconian mandatory sentences for minor drug crimes. And I have a problem with using minor drug crimes as a means to criminalize entire minority neighborhoods. If those last bits were the aspects of the drug war that caused the decline in drug usage shown in the graphs, then I’d rather have less incarceration and institutionalized racism, even if it means higher drug usage.
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March 7, 2016 at 3:02 pm
Yeah, I don’t think anyone really says we shouldn’t educate students about why drugs may not be a great idea, just like we teach that promiscuous sex isn’t. But it probably has to be more than saying abstinence of either drugs or sex is the answer.
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March 7, 2016 at 3:11 pm
WH, Grumble- The point of this post was to explore whether Just Say No (and associated anti-drug messaging of the 80s) worked. As you can see from the comments on that original post, we went down this road before. The discussion of collateral damage changes if the anti-drug stuff worked / didn’t work, imo. One of the fondest sneers of the anti-anti-drug crowd is that Just Say No (etc) didn’t even work. I don’t know if it did or did not produce these trends but until someone comes up with some reasons for these data….I’m assuming Just Say No (etc) worked, despite my own personal lifelong sneering (shared by many of my Readers) at it as ridiculously transparent and ineffectual.
The reason for me to post this is for you to take your knee jerk sneering, put it aside, look at the data and come up with some plausible explanation for why this occurred.
JB- The difference, of course, is that the data reflect higher, not lower, teen pregnancy rates in highly intensive abstinence-only areas.
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March 7, 2016 at 4:18 pm
There is not one singe letter of my comment that can be taken as evidence for “knee jerk sneering.”
If you’re going to ask whether “the drug war worked,” you need also to be curious about which parts of the drug war might have worked: the drug war was much, much more than Just Say No and associated messaging.
The broader question is, “Why was there a decline in drug use from 1986 to 2002?”
Here’s one answer (or rather, two):
1. “The extraordinarily negative effects of crack use — addiction, ill health, incarceration and the loss of virtually all socially acceptable opportunities for self-advancement — were always present and perhaps always understood by users. But as with other risky behaviors indulged by youth, the negatives simply were ignored. So vulnerable were they to peer influences that death itself didn’t seem to matter to these young “crackheads.”
Once crack became unacceptable to peers, however, once the whole crack subculture became socially disreputable on the streets, it was abandoned just as quickly as it had been adopted.” [emphasis mine]
In other words, drug use went out of style among urban youth. Did Nancy Reagan have anything to do with poor urban teens deciding that it was no longer cool to be a crackhead? You are free to believe what you want, but I find it implausible that Nancy Reagan was a cultural trendsetter among this population.
2. “.. the size of police forces grew and, perhaps more important, law enforcement adopted smarter tactics. Some of the new practices — CompStat and hot-spots policing, most notably — seem to have been effective. A more recent study of crime in the Big Apple concurs. The NYPD, wrote Franklin Zimring, ‘placed successful emphasis on suppressing public open air drug markets. The first drug priority for policing was driving drug trade from public to private space. For a variety of reasons, this also may have reduced the risk of conflict and violence associated with contests over drug turf.’ ”
And the new police tactics probably also reduced drug use. What I wonder is whether they would have done so even without the concurrent imposition of draconian mandatory minimum sentences, greater penalties for crack than powder cocaine, and the more questionable aspects of the newer police tactics, such as stop-and-frisk.
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March 7, 2016 at 9:01 pm
You noticed it wasn’t just crack and that this is a national survey, right Grumble?
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March 8, 2016 at 11:55 am
Sure. Maybe the upper middle class party types whose drug of choice in the 1980s was powder cocaine were more susceptible to Nancy Reagan’s message.
Or maybe it just went out of style on the Upper East Side the same way crack went out of style in the Bronx.
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March 8, 2016 at 12:28 pm
“Went out of style” is a description, not a reason or cause.
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March 8, 2016 at 2:55 pm
It’s hard to quantify effects of the whole “Just say no” platform. However, DARE itself was studied pretty extensively, and demonstrated at best only modest, transient reductions in drug use, and at worst, increases in drug use in students who had vs those who did not go through the DARE curriculum.
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March 8, 2016 at 3:15 pm
This is why I am careful to specify the whole shebang of the anti-drug messaging of the 80s. These data reflect very broad and sustained trends. So I am looking for very broad and sustained causes.
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March 8, 2016 at 9:37 pm
If you look at the curve for “shoulder pad usage among female blouse wearers,” it would look exactly the same as the curves above. What caused shoulder pads to go out of style? A major reason why things go in and out of style is the regenerative nature of fads: a few trendsetters try it, a few more people pick it up, and the more people pick it up, the more likely still more people will pick it up. Then the reverse happens and the fad dies out.
I am suggesting that drug use is no different from any other fad. “Went out of style” suggests that cocaine use waned in the late 80s for reasons that are not attributable to a direct cause, or at least not a simple direct cause. One has to take social dynamics into consideration.
That is why I am wary of the hypothesis that “the anti-drug message of the drug war” caused the decline in drug use. I simply find it hard to believe that the government’s message-bearers (including the First Lady) had much to do with setting social trends, particularly in poor urban communities.
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March 8, 2016 at 10:47 pm
So drugs are mere shoulder pads? Could be.
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March 9, 2016 at 10:19 am
I’m not being entirely facetious about my first post. When I was in high school in the 1980s, the only illegal drug that that seemed to be common was weed. And the stoner crowd was really into the whole “flower power” thing with tie-died shirts and head bands. The scene really wasn’t attractive to me for the same reasons GenX as a whole stereotypically looks down on the Boomers. But GenY (again according to stereotype) isn’t as cynical and looks up to the hippie movement.
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