- Treating Addiction or Reducing Crime?Methadone Maintenance and Drug Policy Under the Nixon Administration
The treatment of opiate addiction, most notably heroin, with fixed daily doses of methadone, termed “methadone maintenance therapy,” was developed in the mid-1960s. Methadone, a long-acting synthetic opiate, can be administered orally, and its onset of action is slower than heroin, avoiding the typical “highs and lows” of heroin injection. Internist Vincent Dole and psychiatrist Marie Nyswander, both at the Rockefeller Institute, worked with addicted individuals treated with various forms of opiates. They found that those who had received methadone behaved in a way that differed significantly from those on short-acting narcotics. In between doses, they were calm and functional and were not consumed by the need to obtain more drugs. This led the researchers to develop a maintenance program, based on the idea that addiction was a metabolic disease, with a physiological need for the narcotic, just as diabetics required insulin. This was in stark contrast to common approaches at the time, which viewed addiction as a moral failing and evidence of personal weakness.1 Dole and Nyswander began their first maintenance programs in 1964, with successful results published the following year in the [End Page 58] Journal of the American Medical Association.2 They particularly noted the “dramatic effect” of the “disappearance of drug hunger,” leading them to the optimistic belief that methadone could “block” the effects of heroin.3 Although methadone did not block the pleasurable effects of heroin, it did reduce the craving for the drug, and repeated studies reported that providing oral methadone at fixed doses could maintain addicts and prevent their relapse into addiction.4
Dole and Nyswander’s early results gained national awareness while simultaneously inciting controversy as to the advisability of providing addicts with the substance of their addiction. At a time in which abstinence-only programs such as therapeutic communities were popular, emphasizing a triumph of individual willpower over the allure of drugs, many saw methadone maintenance as a cop-out.5 For instance, psychiatrist Herbert Kleber recalled a 1966 meeting in which a wary speaker quipped: “I think methadone maintenance is a great idea: we should give money to bank robbers, women to rapists, and methadone to addicts.”6 Still, as early results with methadone maintenance aroused public and professional interest, addiction specialists across the nation developed similar programs that involved the use of methadone as a therapeutic measure. Furthermore, there was a dearth of effective treatments for addiction, most of which included a measure of detoxification and counseling, though some therapists attempted psychoanalysis. Most treatment facilities were targeted at individuals already within the justice system, and there were few options available to individuals in the community.7 Therapeutic communities, residential programs derived from the twelve-step AA model, which advocated personal growth, responsibility, and group therapy, were the major modality prior to methadone maintenance treatment, and individuals could expect to stay from months up to two years in the program.8 Thus methadone maintenance was quickly adopted because it showed potential in addressing the problem of addiction and its social ramifications. The first programs were developed in the mid-1960s in New York City, and were soon followed by programs in Chicago, New Haven, Philadelphia, Washington, D.C., and other major cities across the nation.9
In this article, I focus on one D.C. program, begun by psychiatrist Robert DuPont with inmates in D.C. jails, which within a year developed into a large-scale, federally funded program, the Narcotics Treatment Administration (NTA). Due to its unique status, the District was the only local jurisdiction in which federal funding could be made available for municipal crime-reduction programs. Accordingly, the federal government could fund drug addiction [End Page 59] treatment programs in D.C., billing these programs as a method of crime control.10 Between 1969 and 1973, under DuPont’s leadership, this program expanded to become an influential model for treating addiction, and perhaps more saliently, for combating crime. DuPont published extensively in leading medical journals and gave testimony in multiple federal hearings. His work was closely followed and respected by Nixon’s advisers. In 1973, DuPont...