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Article Excerpt
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?
Our primary concern here is politico-organizational reform and less with whether pre-arrest/booking strategies actually deter illegal substance use or crime. The next section will elaborate on the definitions and use of pre-arrest/booking strategies, especially as these apply to drug control, and in the context of the community policing movement overall.
Pre-arrest/booking strategies, drug policy reforms and community policing
The 1960s and 1970s saw the growth of noncompulsory diversion programs in the United States that were intended to steer certain types of offenders (e.g., juveniles, chronic inebriates, and the mentally ill) away from the criminal justice system (Klein, 1976; Treger, 1975; Nimmer, 1971). Such programs paralleled the emergence of labeling and other critical criminological theories that saw incarceration as doing more harm than good, leading to increased isolation, stigmatization, and eventual personal failure (Braithwaite, 1989; Irwin, 1985). However, skepticism about the "rehabilitative ideal" and community-based diversion models have over the last few decades inspired policies that have been ever more punitive, stressing the use of incapacitation through imprisonment (Garland, 2001; Lawrence, 1991). Subsequent critiques of these punitive policies, especially in terms of their impact on the homeless and drug-dependent populations, has recently re-invigorated an interest in pre-arrest/booking diversion and related prevention models (Goetz & Mitchell, 2003).
While compulsory diversion programs such as drug courts are rooted in formalized due process proceedings, prearrest/booking strategies fall within that vast realm of police action called "discretion," and are hence more fluid and difficult to define. Belenko (2000, p. 6) has used the term "prearrest diversion" to define a scenario whereby police officers "advise or order a suspect to a drug treatment program, perhaps even transporting the offender to a program." "Prebooking diversion" is defined as a process where an arrest is initially made but where no formal charges are filed (Broner, Borum & Gawley, 2002; Steadman et al., 2001). From the United Kingdom, Sondhi and Huggins (2005, p. 189) use the term "arrest referral" to refer to both pre-booking scenarios and more informal methods of service referral in a pre-arrest context.
Our use of the term pre-arrest/booking strategies assumes both direct and indirect policing actions, including diversion, involvement with community-based prevention programs, and decisions not to interfere with the provision of services in a public setting. Such discretionary choices on the part of the police are crucial to the success of harm reduction efforts given the legal constraints against drug use and the incentives for the police to make arrests in such situations. Indeed, law enforcement may actively work to undermine harm reduction methods (Cooper, Moore, Gruskin & Krieger, 2005; Cooper, Moore, Gruskin & Krieger, 2004; Bluthenthal, Kral, Lorvick & Waters, 1997).
Pre-arrest/ booking strategies and the mentally ill
There is a growing body of literature on collaborative relationships between the police and mental health workers aimed at linking individuals with serious mental health problems, and in some cases "co-occurring" mental health and drug abuse disorders, to remedial services as an alternative to arrest (Steadman et al., 2001, p. 219; Landsberg, Rock, Berg & Smiley, 2002, p. 2) argues that the impetus behind prearrest/booking strategies for the mentally ill is based on the realization that such populations have become increasingly and inappropriately "criminalized," under America's "tough on crime" climate. Mental health diversion has taken hold in numerous communities throughout the United States, often through the use of crisis teams made up of the police, social workers, mental health workers, nurses, and others (Steadman et al., 2001). Increasing data is emerging regarding such interventions. Steadman & Naples (2005), for example, analyzed 12 month follow-up data from a study of three pre-arrest diversion interventions for persons with serious mental illness and co-occurring mental disorders. Officers made the decision to divert at the time of initial encounter. In lieu of arrest, diverted individuals were taken by police to emergency departments or other appropriate social services. Individuals diverted at pre-booking stage were more likely than nondiverted individuals to utilize mental health services (i.e., psychotropic medication, mental health counseling) and to spend more days in the community (rather than incarceration). They were not more likely to be rearrested.
While the literature on co-occurring mental health and drug use disorders is important for documenting existing initiatives, its primary concern is with mentally ill populations and not drug users per se. There is little discussion, for example, of drug policy debates in the 1990s and how these, specifically, impacted state responses. Furthermore, while the "cooccurring" literature assumes a role for police intervention and documents operational problems of implementation, it is less concerned with the causes of these problems. Lattimore and colleagues (2003, p. 50), for example, found in a comparison of "post-booking" and "pre-booking" models that the latter approach was less often chosen for persons that were thought to be "substance involved," but did not pursue the question of why this is the case.
Pre-arrest/ booking strategies and illicit drug users
Our focus on pre-arrest/booking strategies is rooted in current debates over punitive models of drug control policy and how these have inspired the emergence of "pluralized" control approaches incorporating harm reduction and noncompulsory treatment diversion and referral mechanisms (Bunton, 2001; Cotton, 1994; DesJarlais, 1995). The City of New Haven (Connecticut) was one of the first American sites to announce its commitment to such a model promoting syringe exchange in combination with an emphasis on treatment diversion for users, and aggressive enforcement techniques to be used against traffickers (Pastore, 2000-2001; Kocieniewski, 1999). The influence of harm reduction principles is most notable, however, in non-American settings where there appears to be more consensus about their use among a wide array of public health, law enforcement and government officials. England's Advisory Council on the Misuse of Drugs (1994, p. 2), has stated that the "enforcement of laws against drug misuse cannot wholly eliminate misuse but a variety of policing approaches can have a limiting effect on the level of harm caused to individuals and society." The Council also argued (1994, p. 2) that "harm reduction principles are not incompatible with vigorous street policing, indeed in many circumstances may actually require it."
Still, support for harm reduction among law enforcement officials is forthcoming because it has been framed within larger crime prevention goals. Keith Hellawell (1995, p. 318), an officer from Yorkshire (England) writing in support of harm reduction, steadfastly opposes decriminalization and legalization but argues that "there is no simple or straightforward solution"...
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