The L.A. Times recently ran a front page story on California’s treatment-instead-of-incarceration law, Proposition 36, calling into question whether that program has been successful enough. It is certainly a success: Data show that Prop. 36 has graduated more than 60,000 Californians and saved taxpayers between $850 million and $1.3 billion in just five years. In Los Angeles County alone, successful program graduates exceed 18,000.
No program in California has done more to slow prison growth than Prop. 36. After the first five years of the program, there were 5,000 fewer people incarcerated for drug possession, a 32% drop. Another 1,000 paroled Californians complete treatment under Prop. 36 each year instead of going back to prison.
So, what hasn’t the program done? According to the L.A. Times, it hasn’t done enough good for enough people. As someone who works closely with Prop. 36 grads, I agree.
Currently, 34% of people who enter treatment through Prop. 36 complete it. This is comparable to treatment outcomes of other groups, both those who enter treatment voluntarily and those who are otherwise ordered to treatment by the criminal justice system. It is also comparable to treatment compliance with other chronic conditions, including diabetes and hypertension.
But we know we can do better.
Although already hugely successful, Prop. 36 is indeed a work in progress. In their five years studying the state’s treatment law, researchers at UCLA have consistently made the same recommendations to improve program participation and retention rates.
These include co-locating services to reduce the time and distance between court, assessment, probation orientation and enrolment in treatment. In many counties, addicted individuals are ordered to wait days or weeks at home or on the street between court referral and actual treatment entry.
Further, UCLA recommends that Prop. 36 participants be placed in an appropriate level of careone that matches their severity of addiction. This seems obvious, but in practice cost, rather than need, often drives placement. 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 all program participants have been using drugs for over a decade.
For individuals addicted to heroin, Oxycontin and other opioids, UCLA has consistently recommended that the gold standard of treatmentnarcotic replacement therapies, such as methadone and buprenorphinebe made more available. NRT has proven in study after study to improve 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 retention. 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.
Even in a time of prison crisis, the governor wants instead to give up on a proven public health approach to addiction and 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 have beds for these nonviolent offenders). Incarceration for a relapse amounts to punishing an individual for confirming his diagnosis, while at the same time denying treatment.
What’s worse, for the second year in a row, the governor proposes slashing Prop. 36 funding. The program is already seriously starved. With even less funding, waiting lists will lengthen, treatment durations will shorten, and treatment placements will be even more dictated by what’s available rather than what’s needed. If this is allowed to happen, counties will not have the resources they need to improve Prop. 36 completion rates.
The issue of addiction is one that touches all Californians. We can choose to do the right thing and continue to implement improvements to Prop. 36 and expand access to treatment for all Californians, or we can watch as the governor turns back the clock to a time when we responded to the treatable condition of addiction primarily through costly and ineffective incarceration.
Margaret Dooley is the Prop 36 statewide coordinator for the Drug Policy Alliance. For more information, visit www.Prop36.org.