Pre-arrest/booking drug control strategies: diversion to treatment, harm reduction and police involvement.

The American drug control agenda has long been dominated by policy "hawks," who have argued that harsh criminal penalties are the answer to deterring illegal drug use and related criminality (Reuter, 1992, p. 15). The US incarcerated population has nearly tripled since 1980, largely a result of the "war on drugs" (Harrison, 2001, p. 462). By 2003, drug offenders comprised about 55 percent of all federal prisoners and one out of five of all state prisoners (Harrison & Beck, 2005).

Recently, however, elements of a "pluralized" drug policy have been emerging that augment punishment with an emphasis on enhanced public health and therapeutic measures (Bunton, 2001, p. 1; O'Malley, 1992). Writing in support of drug treatment courts, for example, Judges William Schma and Peggy Hora have argued that "drug possession and use is not simply a law enforcement/criminal justice problem but a public health problem" (Hora, Schma & Rosenthal, 1999, p. 453). Attitudes have been changing within the law enforcement community as well. A survey of urban police chiefs found that they were "more likely to view drug use as a public health problem better handled by prevention and treatment programs than as a crime problem better handled by the criminal justice system" (Drug Strategies, 1996, p. 5).

Drug courts and related legal-compulsory diversion models (e.g., Proposition 36 in California) where treatment is ordered by the court but is administered and supervised outside of a jail or prison have emerged as the most popular therapeutic alternatives to traditional prosecution (Stevens, Berto & Heckman et al., 2005; Young & Belenko, 2005). Drug courts, for example, represent a blending of social welfare and criminal justice measures, or "therapeutic jurisprudence," where judges, prosecutors, and probation officers work cooperatively with health and human service officials to assure rehabilitation of the drug user (Hora, 2002, p. 1469; Nolan, 2001). Such "post-booking" approaches stand in contrast to therapeutic diversion at the "pre-arrest" or "pre-booking" stages (Broner, Borum & Gawley, 2002, p. 88). Less well-documented than post-booking programs, pre-arrest/booking strategies have become increasingly important as a method of therapeutic diversion for the mentally ill, some domestic and juvenile offenders, and some drug and alcohol offenders (Steadman, Stainbrook, Griffin, Daine, Dupont & Horey, 2001; Morash & Robinson, 2002; Wyrick, 2000; Nimmer, 1971). Unlike post-booking interventions, however, pre-arrest/booking strategies are designed to minimize the use of "traditional criminal justice pathways" to gain access to treatment services, while at the same time placing the police (as opposed to the courts) at the center of the decision-making process (Lattimore, Broner, Sherman, Frisman & Shafer, 2003, p. 32).

The reasons for employing pre-arrest/booking strategies may be pragmatic, such as avoiding the high costs of court processing or imprisonment. (1) At the same time, pre-booking activities can especially highlight tensions among drug policy stakeholders (public health officials, criminal justice officials, treatment providers and so on) regarding the social outreach role of police, appropriate levels of coerciveness in treatment regimes, and the need for advocacy for marginalized populations (Massing, 1998). Drug courts and compulsory diversion models have been criticized for requiring judicial processing as a prerequisite for treatment, labeling recreational drug users as addicts, and stressing abstinence as the only legitimate course of therapy (Peele, 2000-2001, p. 20; Lewis 1999). In contrast, harm reduction advocates oppose legal-compulsory measures and have promoted alternative policy approaches in which "no moralistic judgment is made either to condemn or support the use of drugs" (Riley & O'Hare, 1998, p. 9). Harm reduction has been defined as an approach that focuses on "minimizing the potential hazards associated with drug use" rather than use itself (Duncan, Nicholson, Clifford, Hawkins & Petosa, 1994, p. 281). The state's role is to provide a variety of public health measures designed to reduce risk to users and the community at large, including syringe exchange to fight HIV/AIDS and other diseases associated with intravenous drug use, methadone or related drug maintenance programs, and the containment versus the eradication of psychoactive drug use, sometimes through the use of "tolerance areas" (Riley & O'Hare, 1998, p. 10; Bok, 1998). Harm reduction policies commonly incorporate an emphasis on noncompulsory treatment diversion initiatives, sometimes called "treatment on demand" or "treatment on request," which aim to provide users immediate and open access to a variety of treatment therapies, including detoxification and drug maintenance programs (Guydish, Moore, Gleghorn, Davis, Sears & Harcourt, 2000; Lewis, Duncan & Clifford, 1997).

Critics of harm reduction argue that it sets the stage for decriminalization and legalization (Massing 1998). Nevertheless, those governments that have adopted harm reduction activities have done so within otherwise prohibitionist contexts, supplementing rather than replacing traditional enforcement. Riley & O'Hare (1998, p. 8), for example, point out that "a harm reduction approach in the short term does not rule out abstention in the long-term." Control policies that feature harm reduction may also include elements of coercion (MacCoun & Reuter, 2001; Bunton, 2001; Kubler & Walti, 2001). As a result, harm reduction approaches have been subject to redefinition in the policy implementation process (Hellawell, 1995).

Thus, the adoption of outreach philosophies (including harm reduction) in the drug policy domain has created ambiguous terrain for law enforcement as well as other stakeholders in drug policy reform as legal restrictions are expected to be relaxed in the interest of tolerance towards illicit drug users (Goetz & Mitchell, 2003; Hellawell, 1995). Here we will focus on the pre-arrest/booking strategies that have emerged as an alternative "political technology" of social control that attempts combine the interests inherent in pluralized drug control models, in particular, those that involve a role for the police in support of harm reduction programs and noncompulsory treatment diversion (Bunton, 2001, p. 1). Pre-arrest /booking strategies emerged during the 1990s as critics of America's drug war advocated harm reduction as a "middle ground" to reform between criminalization and legalization (Cotton, 1994, p. 1641; DesJarlais, 1995). The ability of the police to support pre-arrest/booking strategies for drug users was viewed as especially possible during the 1990s because they coincided with the community policing movement and its emphasis on social outreach and problem-solving (Loader & Walker, 2001; Uchida & Forst, 1994).

Our focus here will be on two localities, Baltimore, Maryland and San Francisco, California. We will be concerned with addressing the following sets of questions. First, what types of pre-arrest/booking strategies have been possible within the context of otherwise prohibitionist drug control models in our case cities? Second, how do relevant stakeholders, defined here as primarily the police, politicians, public health officials, and community organizations, engage themselves in this process? To what extent have they supported and resisted implementation and how as this shaped policy outcomes? Third, what are the implications of this research for understanding the contradictions of applying pluralized models of drug control that attempt to combine enforcement with the principles of harm reduction and noncompulsory treatment diversion?