With no money for drug-addiction programs and the criminal justice system swamped by drug-related cases, "We are losing our fourth generation," a prominent Baltimore lawyer told a mid-Atlantic conference of black physicians yesterday.
"We see our babies with three children; they're lost already," said George L. Russell Jr., citing a lack of treatment programs for addicted women and children.
And while 80 percent of the prison population has a history of substance abuse, the former judge and city solicitor said, the "tidal wave of drug-related cases" continues, as conservatives insist upon a law-enforcement approach to addiction.
Prison and homicide were dominant themes at the conference on "The African-American Perspective on Substance Abuse," which was sponsored by the Monumental City Medical Society and the Baltimore City Health Department at the Stouffer Hotel.
"You as physicians must be awfully discouraged to have a newborn come into the world with so few chances," Mr. Russell said.
"What else can you do but Band-Aid work?" he added.
Joshua Mitchell, president of the Maryland Academy of Family Physicians, drew murmurs of agreement in his welcoming remarks when he described a "power complex" displayed by "many addicts -- the little smart-asses -- who will sit there and say, 'Doctor, I make more money than you do!' "
Unlike white addicts, who typically start with drugs such as marijuana and move on to harder drugs, blacks often are attracted to the criminal hustling lifestyle and began selling drugs before using them, several speakers said.
"I know black males are not the only criminals, because I read the Wall Street Journal," said Dr. Therman E. Evans, of Philadelphia, vice president and medical director of CIGNA Corp.
Dr. Evans, who works with teen pregnancy and young black males, said, "Yet in America, crime has a black face on it [although] the typical cocaine user is a white male, high-school graduate with a full-time job and living in the suburbs."
But another speaker pointed out that "in white America, there are more off-ramps before addiction."
Peter Bell, an alcohol and drug- abuse consultant from Minneapolis, said drug abuse by whites is usually discovered at home or on the job. But if they're not shot on the streets, he added, the first confrontation for blacks is often with police and -- the courts.
Dr. Mitchell and others blamed television shows that glamorize drug dealers and the fast life for attracting young men to the drug culture, and for making it so difficult for addicts to accept that "they will not be able to drink or use drugs ever, ever again."
Several speakers said black addicts tend to get treatment for related health problems much later than whites, resulting in higher death rates.
And while many addicts have at least one drug-addicted or alcoholic parent, environment is as important as the genetic factor, Mr. Bell said.
Whites who kick the habit find their status increased, while blacks lose income, leadership status -- and may be accused of "trying to be white."
Thus, addicts who don't return home have greater success.
There have been successes, Mr. Bell continued, noting a decrease in overall drug use.
"But as physicians, you know the first 70 to 80 percent are the easiest, and those last ones [the hard-core addicts] cost about as much," he said. "We have to get away from this Drug-of-the-Month approach . . . in our drug and alcohol policy to deal with these difficult cases."
"There is a sickness in American that continues to hurt us all," Dr. Evans said, "to literally kill people in so many ways. We are in a struggle for our very lives."