Treatment With Teeth

In the acclaimed movie “Traffic,” Michael Douglas plays a U.S. anti-drug czar whose 16-year-old daughter spirals into ever more debilitating drug addiction. In this fable of the futility of the drug war, drug treatment takes its lumps as well but mostly comes off as the hero.

The movie is but one sign of how, after spending several decades and billions of dollars on helicopters, border patrols and other military methods to curb the supply of illegal narcotics, the United States has begun to embrace treatment programs to curb demand instead. Last November, for instance, Californians decisively passed Proposition 36, the measure that will put most nonviolent drug-possession offenders into treatment rather than prison. Proposition 36, however, carries no inherent guarantees of success. It will assuredly change sentencing laws, starting July 1. But it won’t have a chance to actually curb illegal drug use unless probation officers, drug treatment counselors and other professionals now designing county-based treatment programs manage to reconcile a number of disagreements, which they openly expressed at a conference on implementing the measure in Sacramento last month.

One key disagreement concerns whether some of the $120 million in Proposition 36 funding should be used to help county probation officers monitor users in treatment. While the measure technically prohibits its funds from being used for random drug testing, it does explicitly allow the money to “reimburse . . . probation department costs” and it does nothing to bar counties from, for example, requiring offenders to pay for testing. Some state legislators have considered seeking revision of the prohibition on funds for testing.

Drug treatment providers say they are fully capable of monitoring relapse rates on their own, but they have an inherent conflict of interest: Each relapse or treatment failure they detect will lower their program’s success rate and its chance of getting future Proposition 36 business. Probation officers are more neutral observers and better able than drug counselors to report relapses to prosecutors and judges, who can use the threat of criminal sanctions to motivate clients to continue treatment.

The Chief Probation Officers of California recently suggested that probation officers working on Proposition 36 have no more than 50 clients each--just under the cap in a drug treatment program that Arizona voters passed four years ago. This would consume more than half of the $120 million in annual funding that the measure provides and deprive drug treatment programs of their rightful lion’s share. The most pragmatic solution for cash-strapped counties like Los Angeles, which received $15.7 million of the state’s initial $60-million allocation, is to differentiate hard-core addicts, who need intensive drug treatment, from people caught experimenting with drugs.

One model to follow is San Diego County, which is already planning a super drug court that would offer “a continuum of treatment,” beginning with minimal supervision and ratcheting up oversight with subsequent offenses.

Neither drug treatment nor drug testing is a magic bullet, and Proposition 36 will inevitably have some failures. However, its chance of success will be greatly enhanced if counties set up systems now for spending their money wisely.