Alcoholism & Drug Abuse Weekly
May 10, 2010

Leaked strategy further exposes weaknesses of ONDCP

"Until we double treatment funding and add new beds and facilities… we will never address the huge treatment gap of some 20 million which has remained essentially constant for decades." -- Bob Weiner

Last month was a bad month for the Office of National Drug Control Policy (ONDCP). Amidst calls for release of the delayed drug strategy, due out February 1, a Congressional subcommittee lambasted ONDCP director Gil Kerlikowske for the administration’s proposed budget which, like past budgets, gives two thirds of drug funding to interdiction and law enforcement, and only one third to treatment and prevention. Deputy Director A. Thomas McLellan, Ph.D., who had promised to bring a new era to the ONDCP, told ADAW the day after the hearing that he would leave within weeks (see ADAW, April 19).

Also, on April 30, Michael Isikoff of Newsweek published a leaked draft of the strategy on his blog. Nobody even seemed to care: the budget already told the story. There was virtually no press pickup of the leaked draft. ONDCP spokesman Doug Richardson said there would be no comments until the final strategy comes out, and added that was expected to be this week.

Kerlikowske, who is well liked, is also seen as being in a very uncomfortable position — abandoned by his deputy, seemingly ignored by the President, and not even well prepared by his own staff for a Congressional hearing. Few people wanted to go on the record in discussing the ONDCP situation, not wanting to “rub salt into the wounds,” as one insider put it.

The fact that the budget favored interdiction and law enforcement over treatment and prevention has been known since the President proposed his budget in February (see ADAW, Feb. 8). Legally, the ONDCP director can appeal to the President for budget changes, and can go to the Office of Management and Budget asking that some supply reduction money be cut, for example.

The ONDCP did not respond to questions about whether Kerlikowske had done either of these. However, Kerlikowske told Newsweek that the reason the drug strategy had not been released was that he couldn’t get on the President’s schedule. This, on top of the fact that President Obama has placed the responsibility for drug strategy issues to Vice President Joe Biden, has prompted speculation that drug strategy — and the ONDCP — is not a top priority for the White House.

“We are missing an opportunity,” McLellan told Newsweek. McLellan was on vacation last week, according to Richardson.

Failure of supply reduction

At the April 14 hearing before the Domestic Policy Subcommittee of the Oversight and Government Reform Committee, chaired by Rep. Dennis Kucinich (D-Ohio), Kerlikowske had to face tough testimony from John T. Carnevale, Ph.D., former director of planning and budget at the ONDCP, and currently under contract with the ONDCP to evaluate it. Carnevale criticized the Administration for viewing addiction as a public health problem, but continuing to “over-allocate funds to where research says they are lest effective: interdiction and sourcecountry programs.” Mexico’s drug problems as a supplier are due to America’s demand for drugs, for example, he said. Even if it’s not possible to trade off money from supply reduction to demand reduction, at least less should be spent on wasteful supply reduction, he said.

Even more recently, overall drug use has stayed the same over the 2002-2008 period, noted Carnevale, adding that “drug policy stalled under the Bush Administration because it funded a drug budget that supported ineffective supply reduction programs rather than effective programs that target demand reduction.” This is a common failure of drug strategies, said Carnevale, noting that President Reagan, for example, thought that by cutting off the supply of cocaine in source countries, Americans would stop using it.

Money for treatment

Treatment needs to be expanded “in the near term,” said Carnevale, adding that programs like Access to Recovery, the block grant, SBIRT (Screening, Brief Intervention, and Referral to Treatment) and other targeted treatment programs must be increased.

Bob Weiner, former spokesman for ONDCP and now a D.C.-based public affairs and strategy support consultant, agreed. “Until we double treatment funding and add new beds and facilities for outpatient and residential needs, and until we figure out how to get the massive numbers in denial to seek treatment, we will never address the huge treatment gap of some 20 million which has remained essentially constant for decades,” he told ADAW.

For the ONDCP to function effectively, it must be “highly visible,” said Weiner. “One way to make that not happen is to have it be directly responsible to the Vice President rather than the President.” In addition, the Obama Administration for the first time made the ONDCP a non-cabinet office.

When Barry McCaffrey was ONDCP director, then President Clinton saw that he had independence and a “bully pulpit,” said Weiner. “American people need to see the message about the importance of prevention, education, and treatment,” said Weiner. Rahm Emanuel, White House Chief of Staff who was then the ONDCP mentor at the White House, told Weiner when he was ONDCP spokesman that “they knew McCaffrey would be independent when the President brought him in and that’s one of the things they liked best about him.”

Weiner said the draft might change as a result of the “McLellan departure message,” which could result in more funding for treatment and prevention. Meanwhile, the ONDCP is still promising the final strategy will be out this week or next. Until then, the 98-employee, $400 million ONDCP is going to be busy coming up with a strategy to defend its strategy.