State Health Lawmakers' Digest: Substance Abuse Treatment and Diversion Programs (Vol. 2, No. 2), Cover Story

INTRODUCTION

Although for decades alcoholism and drug addiction have been recognized as chronic illnesses that respond to treatment, policies about how to handle the complex problems related to addictive behavior have varied considerably. Many legislators are willing to acknowledge that alcoholism and drug addiction are illnesses and to devote tax dollars to fund treatment programs, but they have been much less tolerant of crimes committed by people while under the influence. Crimes such as burglary, driving while intoxicated, prostitution, and possession and sale of illegal drugs are often committed by people suffering from alcoholism or drug addiction, either to fuel their addictions or as a result of them. According to the Office of National Drug Control Policy, almost 60 percent of federal prisoners and 21 percent of state prisoners-or 293,000 of the 1.25 million people in federal and state prisons-have been sentenced for drug offenses.

Many local jurisdictions and a few states have begun to realize that the revolving door of untreated addictions is extremely expensive not only in repeated court, jail and prison costs, but also in terms of poor health, damaged family relationships and lost productivity. One estimate of the total cost to society of drug dependence was $67 billion per year. Policymakers who are seeking savings in state budgets have had to look critically at the spending in the criminal justice system and ask if it makes sense to prosecute rather than provide treatment for people who are arrested for drug offenses. In the last 10 years, more than 600 drug courts have been established that allow judges to mandate and oversee substance abuse treatment for people convicted of a drug-related crime. Evaluations have shown that drug courts have reduced drug use and criminal behavior among the more than 175,000 people who have entered them.

Yet another approach-diversion-is being tried in Alabama, Arizona and California: diversion (see What Works: A Look at Diversion Programs in Alabama and Arizona). Diversion differs from drug courts in that it steers into treatment people who have been arrested for a non-violent drug-related crime before they are sentenced and judges do not remain involved to oversee treatment and completion as they do in drug courts. Proponents of diversion say that the current policies have failed and society is better served if the addiction is treated and a productive citizen is returned to society. A major argument for diversion is the potential for cost savings (for details, see On the Horizon: Will Diversion Programs Result in Cost Savings?). Opponents say that diversion lacks the teeth of drug courts, lets criminals off the hook and does not provide effective treatment. (For two viewpoints, see Who Knows: Interviews with Judge Stephen Manley and John Schwarzlose.)

The success of diversion and drug court programs is predicated on the assumption that substance abuse treatment works. But does it work? Legislators have long been frustrated when they learn that people who enter substance abuse treatment do not always complete it, and people who complete treatment do not always remain sober. A substantial body of literature documents the effects of substance abuse treatment (see In the Abstract for summaries). Addiction used to be considered an acute illness that could be "cured" by a course of treatment. Increasingly, treatment professionals and researchers think of addiction as a chronic disease, such as diabetes and hypertension, for which treatment and ongoing monitoring are necessary and occasional relapse is part of the pathology.

Source: U.S. Department of Justice, National Institute of Justice, "1999 Annual Report on Drug Use among Adult and Juvenile Arrestees." Washington, DC, June 2000.

By definition, alcoholism and drug addiction are chronic, progressive and potentially fatal disorders that are characterized by a loss of control over consumption and continued use, despite negative consequences. The federal Center for Substance Abuse Treatment says that the goal of treatment is to reduce consumption; increase periods of sobriety; improve physical and mental health and employability; and reduce crime, homelessness and risky sexual behavior. The success of drug courts and diversion programs may hinge upon the quality of the treatment provided. Depending on the type, treatment can have many components: detoxification; education about alcoholism and drug addiction; individual and group counseling; job training and education; parenting classes; health services; help with transportation, housing, legal problems and child care; relapse prevention and aftercare. States are hoping that diversion programs will offer an alternative to incarceration that treats the underlying problem, yields long-term benefits to the individual and society, and saves taxpayers' money.

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