Behavioral triage

Which drug users need treatment? The ones who can’t quit without it. How do you identify them? By observing their behavior.

…  is an alternative to the traditional assess-and-treat model of handling criminally active substance abusers.  Instead of deciding based on clinical assessment tools (meaning chiefly self-report) what sort of formal treatment each subject needs and then mandating that treatment, behavioral triage uses the client’s actual conduct under monitoring and the threat of sanction to separate out those who need formal treatment (generally a minority)  from those who can and will abstain on their own.

Angela Hawken, who coined the phrase “behavioral triage,”  has an excellent essay on the topic just out in the Journal of Drug Policy Analysis.

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact:

7 thoughts on “Behavioral triage”

  1. Then there's the "leaving people the hell alone", but I guess that's off the table, the only question permitted is HOW the government will go about requiring people to submit to it's will.

  2. Yes, Brett, when methamphetamine addicts commit burglaries and assaults and wind up on probation, we should absolutely "leave them the hell" alone rather than trying to get them to quit.

  3. We do not, as you well know, have a drug policy which only effects people who commit malum in se offenses. We have one which falls upon burglars and people holding down jobs alike. So let's not pretend that we're talking about burglars. We're talking about people whose choice of recreational drugs offends the people running the government. Some of them happen to commit real crimes, too, of course. Far more than would if we didn't deliberately drive them into a criminal lifestyle, so this isn't about reducing real crimes, either. If we were trying to do that, we'd repeal the damn drug laws.

    When you're discussing how to force somebody to comply with your orders, the question of your entitlement to issue those orders is always germane.

  4. Although this is just a touch on the authoritarian side, if someone's connection to a drug is truly recreational, then they're going to be able to abstain for the short, well-defined period involved in a probationary testing regime. You can argue that they shouldn't have to, but that argument rests on the premise that they're making a free choice to take in a harmful substance, and the inability to abstain given powerful incentives invalidates your premise. So the only people whose rights are being violated by the process are the people whom it clears…

  5. "When you’re discussing how to force somebody to comply with your orders, the question of your entitlement to issue those orders is always germane."

    Drug prohibition is a political choice that was made long ago and still enjoys widespread support (save for cannabis) among the vast majority of citizens. So, through the political process, "we the people" have decided that our government is "entitled" to intervene here. And save me the libertarian sob story. The notion that a behavior that has the potential to create so many externalities, even under a liberal drug control regime, should be of no concern to public policy is stupid and naive. Only ideological balderdash obscures this point.

    Maybe prohibition is the wrong choice from a policy perspective (I think it PROBABLY is), and you're perfectly free to continue pounding the table in the hope that the little noise your fist makes may further swell the clamor for what is essentially cultural change. But lets not pretend that there are no consequences to your unwillingness to take seriously the reforms Kleiman is proposing. These proposals could have a positive impact on people's lives in the here-and-now, not in some distant future "after the revolution".

  6. Just to be clear: The only people subject to drug testing under HOPE are people under probation after felony convictions. So I don't see the force of Brett's objections. If you want to be able to keep smoking meth, don't get caught committing any felonies. There: how hard was that?

  7. Good data from chronic pot smokers (marijuana applicants) shows that pot, alcohol & tobacco, plus other illegal drugs have been tried aggressively by pot smokers since Baby Boomers began coming of age in the Sixties. In essence, Nixon's CSA (1970) has been providing price support for ALL illegal drug markets since its passage. Pharmaceutical amphetamines are a lot safer than meth cooked by an illiterate and people who do get hooked on meth and other illegal drugs often get off with the help of pot (which also reduces alcohol consumption by nearly all its chronic users).

    The most intriguing data of all (unpublished) shows that the shorter the gap between "trying & buying" pot (initiation and self-medication) the less likely it is a pot smoker will initiate heroin. That gap has been narrowing steadily in the 9 successive 5-year birth cohorts applying for medical approval since Prop 215 passed in '96.

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