Pubdate: Sat, 23 Feb 2002
Source: San Mateo County Times (CA)
Copyright: 2002, ANG Newspapers
Contact:  http://www.mapinc.org/media/392
Website: http://www.sanmateotimes-ang.com/
Author: Jean Whitney and Susanne Hilty
Bookmark: http://www.mapinc.org/rehab.htm (Treatment)
Bookmark: http://www.mapinc.org/prop36.htm 
(Substance Abuse and Crime Prevention Act)

PROP. 36 MOVING ADDICTS TO RECOVERY 

Since Last July, County Has Sent One Person To Treatment Every Day 

Most of them come in kicking and screaming and by the end they've come to
realize there is another life besides using drugs. 

Feeling awful is part of being an addict, said Nancy Contreras, 40, who is
now walking the talk of recovery under the eight-month-old Proposition 36
measure that kept her out of jail and in treatment for the past four months. 

Since California voters overwhelmingly approved the Substance Abuse and
Crime Prevention Act of 2000 -- putting Proposition 36 into effect last July
- -- San Mateo County has sent an average of one person a day into treatment
for addiction, instead of to jail. The majority of those were men. Thirty
percent were women. 

Contreras, a Millbrae grandmother of three with a 13-year-old son at home,
had a methamphetamine habit and was facing jail for the third time on a
"driving under the influence" charge when she opted for Prop. 36 treatment
in a South San Francisco outpatient center. 

"It's better than jail," Contreras said. "I wasn't too sure about it at
first. But yes, I'm getting something out of it." 

Contreras said she found that treatment is about owning up to addiction and
learning to cope with life's stresses without drugs and alcohol. In the
County, methamphetamine is the most commonly abused substance, followed by
alcohol, marijuana, cocaine and heroin. 

The treatment center where Contreras goes five days a week, four hours a
day, finds many clients learning for the first time key life skills needed
for recovery -- budgeting, cooking, parenting, cleaning. Many seek job
training and pursue educational goals. Acupuncture soothes the detox
process. Regular counseling and group therapy can help make treatment a home
run for clients. 

San Mateo County has put $2.1 million to work since last year, implementing
the new Prop. 36 law and paying for the treatment of non-violent drug
offenders like Contreras who are looking for the chance to make good.
Counties statewide have spent a total of $120 million to implement the
voters' will. 

Rocky Road 

The program has the potential of turning around the lives of substance
abusers who have run afoul of the law. But the process of moving non-violent
drug offenders from the criminal justice system over to the social services
system for addiction treatment has not been without its glitches. 

In San Mateo County, administrators on both sides of the equation admit the
opening months were rocky. The court system proved confusing to participants
and legal wrangling over how to carry out the law was yet to be decided. 

But progress was made and many admit that the most recent months have been
ones of learning to streamline the route to addiction treatment. 

When the rate of drug offenders failing to show up for court -- where the
process begins -- may have soared as high as 80 percent by some accounts,
two judges were designated to handle every one of the County's Prop. 36
cases. 

With that one change, the no-show rate of defendants was cut by more than
half -- to under 30 percent -- according to Deputy District Attorney Steve
Wagstaffe. 

The County's Probation Department, which tracks offenders after conviction
and sentencing, soon found the workload from Prop. 36 overwhelming. The
County has tallied 287 Prop. 36-eligible cases since July. The Probation
Department doubled the number of staff tracking drug treatment cases. 

And Prop. 36-eligible drug offenders were found to have much more serious
addictions than administrators had anticipated. Nearly half of the Prop. 36
cases were felonies. To qualify for treatment under Prop. 36, the crime must
involve possession for personal use, not for sale. Still, possession of some
drugs -- like cocaine -- is automatically a felony. 

"We felt we'd have a higher number of misdemeanors," said Supervising
Probation Officer Cliff Rubenstein. Over one-quarter of defendants required
the most intensive and costly residential treatment -- dubbed Level 3. 

Over half -- 55.6 percent -- required Level 2 outpatient treatment like
Nancy Contreras, a full regimen of five-day-a-week out-patient care. 

Another 8.8 percent were in Level 1 early intervention out-patient treatment
that includes periodic sessions focusing on education about substance abuse. 

Another 10 percent refused treatment or failed to show up and may have opted
to sit out 30 days in jail, the maximum term under the Prop. 36 law. 

Administrators say the reckoning over the cost of treatment versus the cost
of time in jail is still at least another year out. San Mateo County spends
$93.24 per day for male inmates incarcerated at the Maguire Jail Facility in
Redwood City. For female inmates, the cost is $83.34 per day. The state
Department of Drug and Alcohol Programs is compiling data from county Prop.
36 programs statewide and expects to release the results in April. A $3.3
million long-term study of the effects of Prop. 36 is also provided for
under the law. 

In the meantime, local administrators fret over proposed cuts in the state
budget that could spell financial disaster for fledgling Prop. 36 treatment
programs. 

Legal questions surrounding Prop. 36 treatment in the first few months since
July also found experts claiming the law was not clear about who was
eligible under Prop. 36 and who was not. 

The San Mateo County District Attorney's Office -- and others around the
state -- believed that only offenders whose drug-related crimes were
committed after July 1 -- the cutoff date -- were eligible for treatment
under Prop. 36. Defense attorneys tended to disagree. However, the dispute
was ultimately ended by a decision handed by the California Court of Appeals
Second District on Oct. 31, 2000. That court decided convictions for
non-violent drug-related crimes must occur after July 1, 2001, regardless of
when the crime was committed, in order to be eligible for Prop. 36
treatment. 

The 'Hammer' Question 

Additionally, the criminal justice community was skeptical about the value
of offering addiction treatment without the so-called "hammer" of random
urine drug testing. How effective would treatment be? Critics charged that a
lack of consequences for failure looked like a "free ride" for drug
offenders. 

"If there is no coercive element, addictive behavior doesn't change," said
Loren Buddress, chief probation officer in the County. "You need anxiety to
make change." 

However, Prop. 36 said no to funding for urine tests that would show
evidence of a relapse into drug use. Some feared the testing would undermine
the Prop. 36 goal of treatment and land drug offenders back in jail. 

"We're talking about treatment here, not punishment," pointed out Yvonne
Frazier, head of the County's Alcohol and Drug Services and one of the chief
architects of the County's Prop. 36 implementation plan. "We have a lot of
people who want treatment," she added. 

And while treatment for addiction under Prop. 36 is essentially coercive in
that it often comes down to a choice of jail or treatment, voluntary
treatment can be just as effective, according to some experts. 

"I've never known anybody who wasn't coerced into treatment some way or
another," said Pablo Stewart, chief of psychiatry at San Francisco's Haight
Ashbury Free Clinic and who has worked in drug treatment for two decades.
Family, friends, work, dire circumstances or the law can provide the
motivation for addicts to get clean and sober. 

Regardless, the County has now been promised $155,000 in state funding for
urine drug testing, allowing treatment providers to verify whether clients
have relapsed into drug use. Some relapse is considered a part of recovery. 

Additionally, if offenders fail to participate in treatment or violate
court-mandated probation in other ways, they can be hauled into court for a
"strike" hearing. If an offender racks up three strikes, they face jail
time. 

"(Prop. 36) is not a responsibility-avoidance statute," according to
Superior Court Judge Richard Livermore, who handles two-thirds of the
County's Prop. 36 defendants. "They will find themselves in just as much
trouble if they don't take recovery seriously." 

Livermore said that although the initial "no-show" rate in court of Prop. 36
drug offenders was troubling, only a handful of strike hearings had been
held so far. In San Mateo County, none of the offenders had accrued three
strikes or been sentenced to time in jail. 

Future of Treatment 

So if voters are looking for immediate returns on the investment in Prop. 36
treatment, they may be disappointed. Administrators said to count on
addiction treatment for offenders lasting at least one full year, and plan
on a second year to show whether treatment was successful. 

"Realistically, a year or so from this summer, in 2003, there might be
enough information to say we no longer see people in Prop. 36 treatment
getting into the same kind of trouble," Livermore said. 

Furthermore, Livermore said that mental illness played a significant role in
many cases of substance abuse. He said treatment for drug addiction may not
have long-term success without addressing mental health issues. 

Defining the role of mental health in drug treatment is an approach still in
its infancy, according to psychiatrist Stewart, who 12 years ago began
looking at the relationship of mental health to drug-related crime. 

Stewart claimed that half of alcohol abusers and 70 percent of drug abusers
have a concurrent mental illness. 

Mental illness may be a result of years of drug use, according to Stewart,
or it may be a pre-existing condition that patients treat with illicit drugs
- -- a form of self-medication. 

"Everybody who comes into a treatment program should be assessed for mental
illness," said Stewart. "There's no way in hell they are going to get
straight without addressing the mental illness." 

Regardless of any kinks in the Prop. 36 process, Stewart applauds the new
measure because it forces treatment providers to respond to the substantial
need in their communities. 

"The more substance abusers who are in treatment, the more we are going to
reduce the strain on our criminal justice and social services," Stewart
said. 

And some could find another life besides using drugs.
- ---
MAP posted-by: Doc-Hawk