Kinks in California's shift to drug treatment

Raul bares two forearms dotted with needle marks from wrist to elbow.

"They were going to send me back to jail for the fifth time," says the warehouse worker and father of two. "Then the D.A. [district attorney] saw these scars and said, 'This man needs help.'"

That district attorney's kinder, gentler approach has been much more in vogue in California since July, when a voter-approved program that emphasizes treatment over incarceration for drug offenders went into effect.

So instead of doing jail-yard chores in a prison-orange jump suit, Raul (not his real name) spends his days surrounded by manicured lawns and spurting fountains at a sprawling rehab center in Pasadena. He follows a rigorous schedule of physical labor and group therapy designed to end his heroin addiction.

"I'm learning about integrity and honesty and facing myself and my emotions," says Raul. "It's difficult."

The transition is proving difficult on a number of fronts. In abolishing jail time as a way to punish most nonviolent drug users, Californians have embarked on a massive experiment in drug treatment. Three months into it, the sheer scale of the undertaking - coupled with what some critics see as underfunding - is causing both celebration and consternation.

Approved by voters last spring and in effect since July 1, Proposition 36 clears drug charges from the records of criminals such as Raul, if he can graduate from the six-month program at the state-certified treatment center here.

Voters embraced the idea that the 36,000 convicted drug users - who made up about one-third of the state's prison population - could be diverted to rehab, saving as much as $250 million annually in prison costs and perhaps much more in medical, welfare, and other social costs. The new tack has been touted by top federal antidrug figures - such as Asa Hutchinson, chief of the Drug Enforcement Administration - as an approach that bears watching.

A problem of oversight

But so far, as many as one-quarter of drug users sent by court officers to treatment centers are not showing up. Others begin treatment and disappear, or continue their drug habit undetected. Some critics complain of insufficient funding and oversight of those who do remain enrolled.

"This is nonsense. It is the biggest waste of money," says James Stillwell, a former addict and now executive director of Impact Drug and Alcohol Treatment Center. His center is a state leader in drug rehabilitation, treating celebrities such as James Caan and Robert Downey Jr. Mr. Stillwell's biggest problem with Proposition 36 is that it offers no threat of jail time or other consequence if clients are not motivated to change their drug habits.

"Under this law, all you do is answer to a probation officer who has no power except to put you in another program if you fail the one you are in," says Stillwell. "We tried that approach in the '60s and '70s. It didn't work then and doesn't work now." On top of this, he and others say, the law includes no provision to test clients while they are in rehab to know if they have stopped using drugs.

Others say the program is also siphoning drug offenders away from another approach that has a proven degree of success over the past decade: drug courts.

"The people going into Prop. 36 give it a try because they have nothing to lose," says Judge Michael Tynan, a Los Angeles Superior Court judge who runs a drug court but also serves on a county commission that has studied Proposition 36. He says drug courts across the US have achieved low rates of repeat offending (roughly 25 percent nationwide) because the threat of jail time motivates many offenders to quit using.

In drug court, offenders get the maximum jail sentence, but it is suspended while they undergo detox, drug counseling, self-esteem workshops, and job-seeking. A judge has the power to reinstate jail time if an offender is making insufficient progress, says Judge Tynan.

Prop. 36, by contrast, leaves the offender in the hands of probation officers, many of whom lack the training to know if the participant is getting appropriate treatment. As result, says Tynan, the new system "has removed the hammer from the law. We have a carrot and no stick."

A dropoff in the number of

offenders moving through drug courts concerns others, as well.

"Such courts rely on a team bond between participants, from the judge to D.A. to rehab services and other program coordinators," says Jeffrey Tauber of the Center for Problem-Solving Courts and a founder of the National Association of Drug Court Professionals. "Prop. 36 has not shown itself to be up to such coordination."

Costs of treatment

Some observers say one reason for these problems is inadequate funding. Without more money, they say, treatment personnel won't have the manpower to see that clients are getting proper care.

"The system of oversight at this point is severely lacking," says Lonny Shavelson, an author who spent two years following addicts through San Francisco's drug-rehab system. "It's not geared up to do the good work the law promises."

California's allotment of $120 million annually amounts to about $2,000 per client, according to estimates. That's about $1,500 short, critics say. Tynan and others say the state is spending about half of what is required.

Dr. Shavelson also complains that a confrontational "boot camp" rehab system is the norm, but that its virtues are outdated. "The voters rightly decided that rehab is a better alternative for healing than jail," he says. "But we are ... putting them into rehab that humiliates them and doesn't give them the services they need."

State officials say that some drawbacks were to be expected and that counties need more time to figure out how to implement their programs. More funding is forthcoming for drug-testing clients, they say, in an $18 million bill now before state lawmakers.

Counties, which administer the program, are figuring out ways for caseworkers to keep better tabs on their clients, according to Kathryn Jett, the state administrator whose department oversees Proposition 36.

"We expected different jurisdictions to have different challenges, and they have," says Ms. Jett, who has convened a task force to learn how implementation is going.

On the positive side, say supporters, the program is forcing counties to devise fresh ideas for grappling with the prickly issues of drug use and rehabilitation. More money could follow, they say, as well as refined techniques on shepherding clients through the labyrinth of drug treatment, educational and vocational training, and counseling.

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