The Moral Logic of Harm Production

My last post argued that welfare dependence and drug-use are linked less by empirical evidence than by the just-world bias of conservative ideology.

But that link isn’t the only premise of Scott Walker’s plan to drug-test recipients of state aid which merits scrutiny.

Walker has said that denying drug users access to food stamps is “not a punitive measure” but a way of “getting people ready for work.” Thus, the plan is premised on the idea that by providing impoverished drug-users basic nutrition, the state enables them to remain intoxicated and unemployed.

This runs counter to the logic of the modern GOP’s most successful anti-poverty program.

One of the few bright spots for progressives in the legacy of Bush II, was a sharp decline in the nation’s rate of chronic homelessness. That decline was widely attributed to the administration’s adoption of a “housing first” policy.

For a longtime, the paradigm in homeless care was to target those behaviors that seemed to perpetuate the helplessness of the homeless individual. This was done by conditioning the provision of housing on enrollment in sobriety and job-training programs.

“Housing first” disrupted this model, suggesting that a more effective and affordable approach to reducing homelessness was to provide immediate, unconditional housing to the most dysfunctional sector of the homeless population. The theory’s proponents argued that it was cheaper to house these individuals than to keep them on the street, where they were wracking up irredeemable debts to state shelters, hospitals and jails. Further, they argued that once comfortably housed, these individuals would be more receptive to self-improvement programs offered as elective opportunities, rather than coercive obligations.

The second Bush administration adopted the approach in 2002. Between 2005 and 2007, chronic homelessness fell by an unprecedented 30 percent, and continued to decline through the recession, buoyed by the Obama administration’s $1.5 billion investment in “Homelessness Prevention and Rapid Re-Housing.”

Chronic homelessness and malnutrition are discrete deprivations. The fiscal costs imposed by the homeless are greater than those imposed by the hungry. Still, the success of “housing first” challenges the idea that the most effective and thrifty way for the state to reform dysfunctional poor people is to exacerbate their poverty.

But what makes Walker’s idea truly dangerous is that it’s immune to empirical challenge, because it proceeds from moral principle .

After being elected Milwaukee County Executive in 2002, one of the first fights Walker picked was against harm reduction approaches to drug policy. In his first budget, he eliminated $230 million in funding for a needle exchange program run by the AIDS Resource Center in Wisconsin. Defending his position against unanimous opposition from the county board’s Finance and Audit Committee, Walker said “I have a hard time believing that a majority of Milwaukee County taxpayers want their tax dollars going to pay to continue the habits of illegal drug users.”

Walker didn’t base his opposition on (non-existent) scientific data linking needle-exchange programs with increased rates of heroin use. He didn’t attempt to grapple with overwhelming evidence of the efficacy of needle-exchange programs in combating the spread of HIV. His opposition was premised on the same moral principle that compels him to deny food assistance to drug users: The state mustn’t inoculate individuals from the consequences of their illegal behavior.

That principle has broad political resonance and policy implications.

Facing an epidemic of heroin related deaths, legislators in Kentucky and Maine are trying to expand access to an overdose antidote called naloxone. They are butting up against other legislators who are compelled by Walker’s principle to oppose any measure that would reduce the incidence of heroin fatalities without reducing the incidence of use.

In a recent longform investigation, The Huffington Post showed how an iteration of this principle may be at the root of that very epidemic. In the piece, reporter Jason Cherkis documents how rehab facilities across the United States have resisted the medical consensus that replacement therapy via drugs like methadone and Suboxone is the most effective treatment for heroin addiction. These facilities are ideologically committed to an “abstinence-only” paradigm that can’t accommodate such findings.

Their paradigm is reinforced by that of many drug court judges, who prohibit addicts from pursuing recovery via methadone. The jurisprudence of Kenton County Judge Gregory Bartlett illustrates their ideology’s proud disinterest in medical science:

“Bartlett thinks one solution to the heroin epidemic might be a mandatory stint in a detox facility…But when it was suggested that detoxing without medication can lead to overdoses, Bartlett came up short. “I’ll take your word on that,” the judge replied. “I’m not an expert on what works and what doesn’t work.”

The cost of prizing ideology over “what works” can be measured in the lives of countless addicts who were desperate to get well. As Cherkis explains, abstinence-only treatment has a habit of killing those it doesn’t cure:

“A sober addict leaves a treatment program with the physical cravings still strong but his tolerance gone. Shooting the same amount of heroin the addict was used to before treatment can more easily lead to a fatal overdose.”

Following Cherkis’ report, the Obama administration announced that they would withhold federal funding from any drug court that denied addicts access to methadone.

It’s difficult to imagine President Walker putting public health ahead of moralism.

It’s a difficult to imagine President Walker.

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