1. Misdiagnosis of a Problem: Why Can’t We Solve the Problem of Addiction Jon Caulkins RAND Drug Policy Research Center Carnegie Mellon University Heinz School of Public Policy & Management

2. Bottom Line Drug problems do not fit any pigeon hole
Vary by substance
Vary by perspective/objective
Not just a criminal justice problem
Not just a medical problem either
They are hard problems; no silver bullets

3. What Drugs Are Dangerous?
Smoking
Heroin
Cocaine
Alcohol MJ
Intoxication/ Accidents No
Yes some
Some
Yes
Acute Health
Rare
Chronic Health
Low
Violence-inducing?
Risk it will dominate life
Yes, but …
Yes, severe
Some, but …

4. Drug-Related Deaths**
Scaling the Problems
Hardcore
Users (millions)
Occasional Users
(millions)
Drug-Induced Deaths*
Drug-Related Deaths**
Alcohol 12 93
20,000
100,000
Tobacco 50 20
500,000
Marijuana
2.3 19 3 ?
Cocaine
5,000
10,000?
Heroin
1.0
0.5
*Acute, single-cause only
** Multiple-drug, delayed, or indirect result of drug use (accidents, illness, etc.)

5. Illegal Markets Tobacco and Alcohol Marijuana
Sale to minors usually done at cost or as a favor
Marijuana
High-prevalence but low cost so “only” ~$10B per year
Retail distribution within social networks; little violence
“Expensive drugs” (Cocaine, heroin, meth)
Low-prevalence but remarkably expensive so ~$50B per year
High levels of crime and violence
Half is “systemic” (transaction-related conflicts)
One-third is “economic-compulsive” (committed to finance purchases)
One-sixth is “psychopharmacological” (induced by intoxication/withdrawal)

6. Summary of Sources of Harm
Tobacco
Not a big problem except that chronic effects kill 400,000 or 500,000 people per year
Externalities are primarily through health insurance and second-hand smoke, some from productivity losses
Alcohol
Harms from intoxication, addiction, & chronic use
Expensive illicit drugs
Harms from black markets, control efforts, & addiction
Marijuana
Harms are modest; productivity effects may dominate

7. Nature of Drug Problem Varies by Perspective
Health insurers: smoking and alcohol
Typical employer: alcohol (& others)
Parents’ short-term fears: marijuana & alcohol
Parents’ long-term fears: (should be) smoking
Childrens’ fears: parents’ addiction (to anything)
Govt budget balancers: alcohol & drug enforcement
Violent death: alcohol & expensive drugs’ markets
Infectious disease: injecting drugs

8. Controlling the Problems
Illicit Drugs
Alcohol
Tobacco
Source Country
Weak NA
Border Interdiction
Maxed
Law Enforcement
Major Focus
~NA
Supply Regulation
Useful
Taxes
School Prevention
Cost-Effective
But not very
Effective
Treatment
High recidivism
But Highly CE
Success
Harm Reduction
Untapped potential
Success (e.g. vs. DWI)

9. Bottom Line Drug problems do not fit any pigeon hole
Vary by substance
Vary by perspective/objective
Not just a criminal justice problem
Not just a medical problem either
They are hard problems; no silver bullets