Drug Treatment Program

SACRAMENTO, April 3 — Recent media reports on California’s treatment-instead-of-incarceration law, Proposition 36, have called into question whether that program has been successful enough. Treatment advocates counter that the program has saved the state over $1 billion while reducing drug-related incarceration. They complain that the state is failing to implement policies to further enhance program outcomes.

Margaret Dooley, Prop. 36 statewide coordinator for the Drug Policy Alliance, said, “By all measures, Prop. 36 has exceeded expectations: it has successfully intervened in the lives of tens of thousands of drug-addicted Californians, significantly reduced the prison population, and saved taxpayers over a billion dollars. The best news of all is that, with the right policy changes, outcomes and savings could be still better.”

According to University of California at Los Angeles researchers, Prop. 36 has graduated over 60,000 Californians and saved taxpayers at least $850 million in just five years. Nearly six years into Prop. 36, the number of people incarcerated for drug possession has fallen by 32% (5,000 people). More than 1,000 Californians on parole complete treatment under Prop. 36 each year instead of going back to prison. By diverting so many into treatment, Prop. 36 rendered unnecessary the construction of a new men’s prison (saving another $500 million) and also resulted in the shuttering of a women’s prison.

Dave Fratello, co-author of Prop. 36, said “No program in California has done more to slow prison population growth than Prop. 36. Rather than turn our backs on this success, the state should fully fund the program. It needs over $200 million, but the governor is proposing cuts instead. His plan is short-sighted and self-defeating. Adequate funding for Prop. 36 will improve treatment outcomes and save taxpayers even more money.”

One area that could be improved significantly is “show” rates; that is, the number of people who elect Prop. 36 who actually enroll in treatment. Currently, about one-quarter do not enroll. Data suggest that many get lost in the system, while others simply choose jail time after they learn what Prop. 36 requires — a year or more of treatment, with the threat of incarceration for failure to complete the program. Advocates also note that the state has failed to implement any of the policy changes proposed by UCLA to help bring more people into treatment after their initial choice to try Prop. 36.

UCLA recommendations include co-locating services to reduce the time and distance–often weeks and miles–between court, addiction assessment, probation orientation and treatment enrolment. UCLA also notes that inability to secure transportation to and child-care are other factors that must be mitigated to help people get to treatment.

“Although there is general acknowledgement that removing barriers is essential to improving success rates, the resources just aren’t there. Due to insufficient funding, Prop. 36 participants are often placed on long waiting lists or in an inappropriate but cheaper level of care. Until the state will commit to spending what is necessary to ensure rapid progression from court into treatment, the state is setting up addicted Californians for failure,” worried Ms. Dooley.

Currently, 34% of people who enter treatment through Prop. 36 complete it. According to UCLA, this is comparable to treatment outcomes of other groups, both those who enter treatment voluntarily and those otherwise ordered to treatment by criminal justice. According to the California Society of Addiction Medicine, it is also comparable to treatment compliance with other chronic conditions, including diabetes and hypertension.

To improve retention rates, UCLA recommends that Prop. 36 participants be placed in an appropriate level of care–one that matches their severity of addiction. UCLA found that in practice cost, rather than need, often drives placement of Prop. 36 participants. Due to budget cuts, for example, Sacramento County will not offer any residential treatment for Prop. 36 participants next year. According to UCLA, only 11% of participants are referred to inpatient services, which is more expensive than outpatient, even though over half of program participants have been using drugs for over a decade.

UCLA has also repeatedly recommended that narcotic replacement therapies, such as methadone and buprenorphine, be made more available to individuals addicted to heroin, OxyContin and other opioids. Studies describe NRT as the “gold standard” of treatment and consistently shown that it improves chances of treatment success, and yet most opioid-addicted Prop. 36 participants are not provided this level of care. Not surprisingly, they have the lowest program completion rates.

All of these policies are proven to improve program outcomes. Counties have adopted them to varying degrees, but the state has never used its power of the purse strings to demand widespread adoption of best practices.

Instead, the governor has proposed a return to incarceration. The administration’s plan, which now seems likely to be rejected by the courts, would punish those who experience a drug relapse with short stays in jail (assuming jails had beds for these nonviolent offenders). Advocates note that this amounts to punishing an individual for confirming his diagnosis, while at the same time denying treatment.

What’s worse, the governor proposes slashing Prop. 36 funding for the second year in a row. Advocates note that with the program already seriously starved, less funding will mean even longer waiting lists, shorter treatment durations, and treatment placements even more dictated by what’s available rather than what’s needed.

“Slashing funding would doom Prop. 36, because it would make it impossible for counties to provide adequate care. If this is allowed to happen, counties will not have the resources they need to improve Prop. 36 completion rates and we could begin a vicious cycle of funding cuts attributed year after year to poor results,” observed Mr. Fratello.