Pubdate: Sun, 01 Jul 2001
Source: Sacramento Bee (CA)
Copyright: 2001 The Sacramento Bee
Contact:  http://www.sacbee.com/
Details: http://www.mapinc.org/media/376
Author: Laura Mecoy, Bee Los Angeles Bureau
Note: Staff writer John Hill contributed to this report.
Bookmark: http://www.mapinc.org/rehab.htm (Treatment)
Bookmark: http://www.mapinc.org/prop36.htm 
(Substance Abuse and Crime Prevention Act)

STATE BRACES FOR NEW DRUG LAW

A Strapped Treatment System Faces An Increased Burden As Proposition 36
Begins Today.

LOS ANGELES -- Proposition 36, California's sweeping new drug law that
takes effect today, will place unprecedented demands on a state agency
and treatment system already afflicted with untrained workers, lax
regulation and inattention.

The initiative requires treatment instead of prison for non- violent
drug offenders to rehabilitate rather than punish them. But a Bee
investigation found a system with problems and, some experts say, in
need of rehabilitation itself.

It found drug counselors and administrators who used illegal drugs
themselves, supplied illicit substances to the people they were supposed
to help and had sex with their clients.

The Bee also found the state agency overseeing these programs has such
lax regulations that operators can violate state rules for years without
losing their licenses and there's little measurement of a program's
quality or effectiveness. In fact, outpatient treatment can consist of
just two counseling sessions a month.

Before Californians overwhelmingly approved Proposition 36 in November,
drug treatment experts said state leaders were so focused on locking up
addicts that they paid little attention to substance abuse programs and
the agency overseeing them: the state Department of Alcohol and Drug
Programs.

As a result, the experts said California fell behind other large states
in its standards for counselors, drug treatment and program licensing
and certification.

"California is one of the few big states where you can be a shoe
salesman yesterday and a drug counselor today," said Rick Rawson,
associate director of the University of California, Los Angeles,
Integrated Substance Abuse Program.

State officials said they've never shut a drug treatment program; they
wait for troubled programs to close on their own or for the counties to
cancel their contracts.

The state counts on the counties to check for quality. But there, too,
enforcement is uneven because many of California's smallest counties run
the drug treatment programs themselves or don't have the staff to
monitor the services.

Now Proposition 36 is expected to bring 36,000 new addicts into a system
that treats 214,000 a year and is in such demand that 5,000 remain on
waiting lists every month. Even before its passage, the state estimated
it needed nearly twice as much money as it spent on treatment last year
to take care of all of California's addicts.

Proposition 36 will add $120 million each year over a five-year period
to the state's treatment system -- the biggest cash infusion ever for
California drug programs, but not enough to pay for the services needed
to carry out the new law, according to county administrators.

"The overriding concern everybody has is this: Is this going to be a
failed social experiment?" said Superior Court Judge Ana Maria Luna,
chairwoman of Los Angeles County's Proposition 36 implementation task
force. "If we are not seeing the results we hope to see, people are
going to feel this was a horrible waste of taxpayers' dollars."

The boom in business is expected to attract many newcomers to treatment
jobs, creating the potential for even more untrained workers and
mismanagement.

"You are going to have lots of mom-and-pop places springing up because
there's money available, and it doesn't take much to get licensed or
certified," said Howard Friend, director of adult services at the
Phoenix House's Orange County residential treatment center.

Counties will decide which programs convicted drug users must attend.
Those sentenced under the initiative get just two chances to
successfully complete treatment before the courts can put them in jail.

Kathryn Jett, appointed director of the state Department of Alcohol and
Drug Programs just two days after Proposition 36's adoption, said most
new clients would go to existing programs that have expanded, rather
than to new ones with unproven track records. Applications to offer
treatment are pouring in at a rate of about 53 a month, or twice the
average before the initiative's passage.

Jett said her staff is working overtime to ensure things go smoothly,
and she believes the state can handle the increased demand.

"California is envied by every other state in the union," she said.
"California has been thoughtful in this arena. We probably could have
invested more in treatment, but I think we do a better job than most
states."

At least 20 other states, however, license or certify drug counselors,
while California does not.

Those states have educational and experience requirements, ranging from
a high school diploma with 4,000 hours of supervised experience in Texas
to a master's degree and three years of experience in Connecticut.

"Right now, the only test required to work in this field in California
is a TB test," said Sherry Daley, public policy coordinator for the
California Association of Alcohol and Drug Abuse Counselors.

LICENSING BILL IN THE WORKS

Born in the self-help movement created by Alcoholics Anonymous,
California's drug treatment community has always relied on recovering
addicts for most of its counselors. But with relapse rates of about 60
percent, counselors occasionally slip back into drug and alcohol use.
And sometimes, they take their clients with them.

Last year, for instance, a state investigator found that the program
administrator of Cooper Fellowship Inc. and two staff members used
methamphetamine with clients at the Santa Ana center and at employees'
homes.

On one occasion, the investigator reported that the two employees had
sex with two residents, while the administrator watched.

Bernard Barnes, Cooper Fellowship's director, said all three employees
are gone.

"It was just something that happened," he said. "It got out of hand."

Tommy Roberts said her youngest daughter, Chris, smoked marijuana with
her counselor three years ago at the Gospel Rescue Mission in Stockton
- -- and wound up losing custody of her two children.

Roberts, of Lodi, said Chris was in danger of losing her children when
she tried to beat her methamphetamine addiction. After drug tests showed
Chris had smoked pot, the courts turned her daughters over to another
family for adoption.

"I went to see my granddaughters up until the day they wouldn't let me
see them anymore," Tommy Roberts said.

The counselor Roberts identified has left the mission, and its executive
director, Bill Brown, would only say that her departure involved a
drug-screening test. He said the counselor helped many women before she
left and is working in another drug treatment program.

"It is a system trying to do the best job it can," Brown said. "And it
is not always perfect."

Proposition 36 won't solve the underlying problem: Because the state
licenses programs instead of people, it can't stop the hiring of
counselors who caused trouble at another facility.

A state investigator, for instance, said he could do nothing about the
Newport Beach Narconon program that hired three employees who misbehaved
at another Narconon program.

One had been fired for being under the influence of illegal substances
at the other facility. Another had been fired for having sex with a
resident, and the third had been reprimanded for using drugs with a
resident.

The investigator's 1996 report said the facility where the employees got
into trouble no longer had a state license.

Many drug treatment programs prohibit sexual relations with residents,
and they often will fire a counselor for that type of misconduct. But
the program sponsors aren't always aware of sexual misconduct.

At First Step in Oakland, the program's legal counsel, Adrionne Beasley
said she didn't know about a state investigation that found First Step
staff had set up sexual encounters between a resident and two male
transvestite prostitutes in 1995.

The state investigator said the employees pressured the resident to
participate, watched the sexual encounters through the facility's
windows, and then a staff member paid for one of the prostitutes.

His report said he contacted Beasley, but she said she didn't recall
that. She said First Step closed last year after it lost its lease, but
she didn't know whether any actions were taken against the staff for the
misconduct.

State investigators also found instances where administrators and
counselors verbally abused and exploited residents, provided poor
medical care, ran filthy facilities that represented a "life-endangering
situation" and even provided no services at all. They cited them for it
and, in some instances, fined them, too.

Daley, of the counselors' association, said state licensing would give
regulators additional power, so they could sanction individuals for
these acts. They could suspend or take away a license, as can be done
for other health professionals.

"Why is this disease treated any differently than any other disease?"
she asked.

She also believes licensing would elevate the status of the counselors,
who work long hours for low wages in a profession plagued by high
turnover.

California counselors can voluntarily seek licensing through several
state and national groups, including Daley's -- the California
Association of Alcohol and Drug Abuse Counselors. If they lose one
group's license, though, they can seek one from another group.

As a result, Daley's association is backing a bill the Senate sent to
the Assembly June 5 on a 24-9 vote that would establish a state
licensing board for counselors. The board would dictate the training and
experience necessary to get a license and the acts that would lead to
the loss of that license.

Jett, the state drug programs director, said she's waiting for the
industry to agree on a licensing scheme before endorsing any proposal.
But she warned that licensing could drive up costs because programs
would have to pay more for more qualified counselors. She also said new
training requirements could eliminate qualified counselors at the very
moment when the state needs more.

"There's bad actors in any field," she said. "And certainly, we find
them in our field."

Daley countered that people treated by professionals in other fields
aren't as vulnerable as those seeking drug treatment.

"The addicts don't walk away and say they got lousy treatment," she
said. "They say, 'Why did I fail again? I am doomed. I can't do this.' "

Authors of Proposition 36 were aware of the problems, but campaign
manager Bill Zimmerman said they didn't want to "overturn more apple
carts than we had to." So they tried to work within existing laws and
regulations -- with one notable exception: They required outpatient
programs to be certified to qualify for Proposition 36 funds.

Until now, outpatient programs didn't have to undergo state inspection
or hold a state license to operate. Some counties, such as Sacramento,
did require certification for outpatient programs to get public funds.

Certification is the state's toughest standard, yet it requires just two
counseling sessions a month for outpatient programs, and the state helps
programs meet this standard.

David Feinberg, the state drug programs licensing branch manager, said
the agency has never denied certification or taken it away. Instead, he
said it either helps programs achieve it or the operators give up
because the agency takes so long to award it.

Under Proposition 36, county administrators expect to use outpatient
programs more than any other. For one thing, they're cheaper. Outpatient
services cost an average of $2,600 a year compared to $20,900 for
residential treatment.

Quality Of Services A Key

Even though addicts are held responsible for their success or failure,
the quality of services they receive can make a huge difference -- and
ultimately determine Proposition 36's success or failure.

Vivian Holland, 44, of Santa Ana is a vivacious grandmother of nine. She
said she's been through more drug programs than she can remember. None
of them worked.

She said she finally found her salvation in the state's most intensive
form of treatment: a residential facility where she is spending a year
getting intensive counseling and other help.

In the past, she said she failed because she was "barely detoxed" before
she had to leave the short-term programs. With longer programs, she said
she either got high while she was in them, or she failed shortly after
her release.

"Outpatient or a 28-day program won't work for me because I will find a
way to manipulate around it," she said.

UCLA's Rawson said scientific studies show what does work: proper
assessment of addicts' needs and longer-term, structured treatment that
teaches them how to achieve sobriety and stay clean when they leave.

But California regulations governing the licensing of residential
treatment facilities give virtually no guidance on how this should be
done. And Proposition 36 won't fix that.

Residential programs can volunteer for higher standards by seeking the
same sort of certification that outpatient programs must get under the
initiative.

But residential programs don't have to do that to get Proposition 36
funds. They only need to be licensed. And, for licensing, agency
officials said they focus almost entirely on health and safety -- which
rankles Rawson.

"It's absurd that we are allowing anybody to do anything and call it
treatment as long as they have fire extinguishers and a sign over the
door," he said. "We're not doing anything to assure that the system is
pushed ... to use some of that scientifically supported treatment."

Even the executives who must comply with state drug program regulations
say they aren't tough enough. The California Association of Alcohol and
Drug Program Executives Inc. has assembled standards it wants used to
implement Proposition 36.

"The system has lacked teeth," said Elizabeth Stanley-Salazar, a member
of the board. "A certain amount of teeth need to be put in."

Feinberg said California hasn't adopted tougher regulations for its
residential programs because residents voluntarily seek treatment and
can choose whether to stay in a program.

That will, of course, change with Proposition 36.

Jett, the state's drug program director, agrees the regulations should
be strengthened and has formed a task force to make recommendations.

But Douglas Anglin, director of the UCLA Drug Abuse Research Center,
said Jett is "just repeating history" because the department has already
had several task forces on the subject. "We know what the standards
should be."

Jett said the department must move cautiously because, in face of the
state's shortage of treatment services, "we can't afford to put people
out of business." That concern is evident in the state's record of
investigating complaints. It has substantiated -- in whole or in part --
more than 40 percent of the complaints it received about residential
programs in the last three years. But it's never closed a program.

Feinberg, the state drug programs licensing branch manager, said the
agency knows "where our bad apples are."

"I can pick five or six programs where we get more complaints," he said.
"They are our bottom feeders, if you would."

Rather than close these programs, he said the department tries to turn
them around. If it can't, he said the operators usually shut down on
their own to avoid state fines. But he couldn't say how many have closed
because the state doesn't keep track of it. Even methadone clinics,
which get the closest scrutiny because they provide a controlled
substance to addicts, can run afoul of state regulations for years yet
stay in business.

At Bay View Hunters Point Methadone Program, seven separate
investigations dating to 1977 found sloppy record-keeping, lax security
and poor accounting for the drug. It had so many lapses that the U.S.
Attorney's Office filed a lawsuit in 1990.

The program remains open today but settled the lawsuit by agreeing to
pay a $20,000 fine and give up its license if it fails its next audit.

Some Counties Lack Staff

State officials said they also count on the counties to monitor
programs. The counties issue contracts for publicly funded treatment,
and some, such as Sacramento County, impose specific program
requirements. The counties also can cancel the contracts of wayward
programs -- but not shut them down.

Sacramento County, for instance, canceled the contract of a poorly run
program, and San Benito County used the threat of ending a contract to
turn around a program that discriminated against lesbians.

But counting on 58 counties to monitor programs produces spotty
enforcement, said Sue North, spokeswoman for state Sen. John
Vasconcellos, D-Santa Clara. Vasconcellos is the author of the counselor
licensing bill.

Some counties don't have the staff to monitor or run the programs.

"I look at other human services programs where we have let that sort of
system bury what we are trying to do," North said. "What do you do with
a county that doesn't do this -- that just puts money on a tree stump
and walks away?"

In San Joaquin County, for instance, officials had been told that the
head nurse in a county-run methadone program in French Camp reduced
doses without a doctor's approval -- a decision that could have driven
patients back to heroin.

The state investigated and found county officials weren't aware of how
often the nurse entered the wrong amount into the program's computers.

The investigator also said county workers were so afraid of retaliation
from the head nurse that they hadn't reported all they knew to the
county.

The nurse, who still works there, denied reducing the dosages. Dan Bava,
the county's substance abuse director, said the nursing board is still
investigating the allegations. But he said the staff caught the mistakes
when they were made and gave patients their proper dosages.

With Proposition 36, each county will ultimately determine how the
initiative will be carried out through the decisions of its judges,
prosecutors, defense attorneys, drug program administrators and
probation officers.

Zimmerman, the initiative's campaign manager, said the sponsors expect
Proposition 36 will lead to 58 experiments in the state's 58 counties.
The initiative requires each county to collect data about those
sentenced to treatment under Proposition 36.

With that information, Zimmerman said the state can eventually upgrade
the quality of treatment by providing the money for counties to follow
in the footsteps of the programs with the best records for keeping
people sober.

"No one expects to cure 100 percent of the people we treat," he said.
"This is a harm-reduction approach. Let's do the best we can with the
resources we have. If we do that, it's hard for me to believe
Proposition 36 wouldn't succeed."

Sidebar:

WHAT IS PROP. 36?

Proposition 36 generally applies to three groups of people caught with
drugs: 

1) Those with new convictions for drug possession or being under the
influence, 

2) people on probation for drug possession or under-the-influence
offenses, and 

3) persons on parole with no prior convictions for a serious or violent
felony.

Beginning today, instead of ordering jail time, judges must place the
person on probation and require completion of a drug treatment program
lasting up to one year. The judge may set a range of probation
conditions, including regular check-ins with a probation officer, a
requirement to pay a share of treatment costs, drug testing and other
restrictions on the offender's place of residence, associations or
lifestyle.

At the end of the required treatment regimen, if the court finds that
the person complied with the probation conditions and that treatment was
"successful," charges may be dismissed.

COMMON TYPES OF SUBSTANCE ABUSE TREATMENT

Detoxification

Outpatient: Used primarily for people addicted to methamphetamine, crack
cocaine, tranquilizers and other drugs that require some supervision
during detoxification. There are no time limits for the program, and the
average participation time is seven to 10 days.

Residential: Used primarily for people addicted to alcohol. Clients are
often brought to this type of program by a law enforcement agency, where
they are held for an average of 72 hours and encouraged to enter a
recovery program.

Methadone: A 21-day outpatient program that utilizes a tapered dosage of
methadone to help clients overcome addiction to heroin. This method of
treatment is required for most clients before they are allowed to
receive long-term services through a Narcotic Treatment Program
provider.

Recovery

Outpatient Drug Free: The least intensive service provided to clients,
offering group and individual counseling sessions. Participants average
five counseling sessions per month and are encouraged to stay in
treatment at least 120 days to achieve the best results. There is no
limit to the number of counseling sessions a participant may attend.

Residential Drug Free: This service removes clients from the environment
that promotes or enables their addictive behavior, replacing it with a
recovery environment promoting sobriety. The average length of stay is
90 days, although many providers include a formal aftercare program that
includes return visits to the facility and ongoing counseling. Most
resident drug free programs focus on pregnant and postpartum women and
include parenting skills and other life skills as part of their
curriculum.

Day Treatment Drug Free: Participants generally attend counseling
sessions and classes three to four days a week for four to five hours
per day. The most common participants in these programs are pregnant and
postpartum women and children under 21.

Narcotic Treatment Program: An outpatient service that utilizes
methadone or levo-alpha-acetylmethadol (LAAM) to help clients remain
free of narcotics. Narcotic treatment clinics are also required to
provide medical evaluations, treatment planning and counseling.
Methadone generally is taken daily, while LAAM is taken every 72 hours.
This is considered a long-term treatment method, with an average
participation of one year.

Source - State Legislative Analyst's Office, Campaign for New Drug
Policies
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MAP posted-by: Doc-Hawk