|The Cultural Evolution of Drug Treatment Programs|
t is a common observation that there is a "lag time" in a government's response to a social problem of an acute or "epidemic" sort: the problem wreaks havoc on the society for some time before the political system rouses itself to finance measures to deal effectively with the problem. And the funds continue to flow at full force for some time after the problem itself has declined in intensity, since it requires time for the political system to become aware of and to respond properly to the absence of further need for intervention. Patrick Hughes noted this pheonomenon in the heroin-use epidemic of Chicago of the late 1940's. The city's media, law enforcement agencies, and medical system reached their peak intensities of effort about two years after the actual use of heroin had peaked and begun its decline. I suggest that this pattern of delayed response can be displayed graphically and related to familiar sequential patterns for whole societies:
The two curves show the rise and fall of the "problem situation" and the somewhat later rise and fall of the institutional response to that situation. The first line of dates shows the approximate extent of the four periods for Classical Greece, and the second line, for Classical Rome. The relationship between the two curves gives rise to four qualitatively different phases or "ages", to wit:
I. The Heroic phase. In the United States' recent hard-drug epidemic, this phase occupied the middle 1960s and saw a rapidly spreading abuse of amphetamines, barbiturates, and opiates, but very little government outlay of money to deal with the situation. However, this was the period of free clinics founded on shoestring budgets, with volunteer doctors and other professionals and paraprofessionals working 12-hour days in a brave effort to ameliorate the pain and distress of the hordes of youthful victims. Their efforts did little to halt the burgeoning growth of the use of dangerous drugs, but at least these early free-clinic workers found themselves imbued with high morale and a finely-tuned sense of purpose. The typical street clinic of those days was a picture of chaos, high humor, peripatetic energies, and makeshift attempts to handle the overwhelming problems at hand. [Ancient Greece went through this period during the Homeric Age: the siege of Troy, the Odyssey, the great Heroes, and the formation of Hellenic law and social order all date from this period, about the Ninth to the Sixth Centuries BC.] (see Illustration 1)
II. The Classical phase. In this period, the social problem is reaching its peak, but government support is rising swiftly to deal with it. Much progress is being made in organizing the society's resources to deal with the (now clearly envisaged) problem. Morale is quite high and there is less of a sense of being overwhelmed, because funds are now flowing rapidly and in increasing amounts to the right places. Government agencies are working hand-in-hand with the original makeshift street programs to develop well-funded, well-organized means of dealing with the hard-drug problem. Many former volunteers find themselves placed in charge of large sections of this effort, and institutionalization proceeds rapidly as the society organizes and systematizes its response to the social problem. The successful early drug programs become "classic" models for orthodox imitation by newly-funded programs: the "Synanon Model", the "Free Clinic Model", and the "Methadone Maintenance Model" reproduce themselves apace. [In Greece, this corresponds to the period of the successful defense against the Persian invasions and the Golden Age of Pericles and the great philosophers.] (see Illustration 2)
III. The Imperial phase. This phase occurs when the problem begins to decline in significance, but while government support is belatedly peaking. Organizations to deal with the problem are now large, established, and intent upon further growth. In the case of the drug problem, each department of each treatment agency has now been fat with funds for a considerable period, and the employees are more concerned with the ease, familiarity, and security of their positions, and with the luxuries available as a result of their salaries, than with the Spartan, exacting rigors of a great and challenging task. The strategy of the great Imperial planners is simple: spend vast sums in constructing wholesale imitations of the established Classical program models. The system becomes ever more rigid as program directors, increasingly submerged in an immense, interdependent bureaucratic order, lose their ability to function with initiative and imagination. Many fiefdoms make their appearance as various agencies commence struggling for the (now no longer expanding) supply of funds. [Greece went through this period during the late Fourth and early Third centuries B.C., as the empire of Alexander, having finally vanquished the Persians, established itself and organized the civilized world on the Greek pattern.] (see Illustration 3)
IV. The Decadent phase. The social problem is now completely a thing of the past, but the organizations created to deal with it still exist-- though on ever-declining budgets, the government having begun to realize that there is no further need for support. A period of great demoralization and discouragement sets in. Internal strife over the dwindling funds becomes nastier and nastier. In the case of drug programs, this phase witnesses agencies in a complete state of entrenchment, paralyzed by their routine, stiff, almost ceremonial way of carrying out their work. Long familiarity with wealth and power has sapped the agencies of all their former flexibility and spirit, and most of the more talented employees move on to other work, leaving the field to the untalented and bureaucratically-minded. The whole effort comes to an end not with a bang but with a whimper: people's attention and energy simply drift away, and a sense of despair and emptiness settles over all. [The Decadent phase in Greece followed shortly after the Alexandrine Age, and witnessed a progressive breaking-up of the Greek Empire into warring fiefdoms, and the eventual conquest of the exhausted remnants by the Roman Republic.
Illustration 1. Here is portrayed an event during the Heroic Period in San Francisco: David Smith shielding the Flower Children during the disastrous Battle of Amphetamaea. Dr. Smith's brave stand saved a great many of the children from the ravages of the savage Methedrae, but could not prevent the field from being utterly lost to the enemy. Note the primitive costume worn by Dr. Smith, exemplefying the Spartan economic level of those early days (November of '67).
Illustration 2. Here we see a typical scene from the Classical Period: Skip Gay addressing the federal medical authorities at the Council of Nimha (Summer '70). The spirit of cheerful cooperation between street program worker and government funding agency can be clearly seen here. Dr. Gay is best known as the victor of the great battle of the Morphian Fields ('71), after which the invading Junquian tribes were gradually contained and integrated into the Republic's civil order.
Illustration 3. This scene shows the Emperor Jero presiding over his court at the Saodine Palace in the Spring of '73. During this period Emperor Jero, known as "The Great Maintainer", came to have absolute power over a gigantic amount of resources. Note the Emperor's elegant garb and his supremely confident gesture as he directs yet another million in funds toward the provinces. A grateful Methadone Baby can be seen at the Emperor's feet. A palace coup in the Summer of '73 unseated Jero and replaced him by Dupontius Dilate, a favorite of the Praetorian Guard.(printer friendly version)