WHO KNOWS
Stephen Manley, a Superior Court Judge in Santa Clara County, and John Schwarzlose, president and CEO of the Betty Ford Center in California, discuss California's Proposition 36.
Do drug and alcohol treatment programs work?
Manley: Yes. Treatment works when the client stays in treatment, completes treatment and is involved in recovery. One addict helping another addict works. Groups such as Alcoholics Anonymous and Narcotics Anonymous-where addicts are together, staying clean and sober one day at a time-work.
Schwarzlose: Treatment works overwhelmingly well. However, it is a misleading question and a misleading answer. It works, but it is misleading because it lumps together all [treatment] centers and patient groups. For example, for airline pilots, dentists and physicians, our statistics show that close to 90 percent never touch drugs or alcohol again. These groups are successful because they sign an agreement with the Federal Aviation Administration (FAA) or state licensing board saying that they can be tested at any time. If you compare this with a drug treatment program in a state prison, you don't even get a 10 percent success rate because the people don't want to be in treatment. In programs where there is no motivation to get well, the success rate is abysmal.
What are the pros and cons of mandated versus voluntary treatment?
SM: There are tremendous advantages to mandated treatment, as opposed to voluntary treatment, particularly in the criminal justice system when the cost to society is so great. When clients are not in the criminal justice system, they do not face any adverse personal punishment or restrictions from voluntary treatment. People who are truly addicted to drugs may hurt themselves or hurt their family. However, they are never held accountable by the criminal justice system. I have been doing this for many years, and I am now sentencing the children and grandchildren of people I sentenced years ago. Addiction is a lifelong disease. It will be perpetuated. I think we would have gotten a lot further if addicts had been held accountable.
JS: There aren't pros and cons about whether treatment is voluntary or mandated. It is the same thing when someone comes to treatment as a result of a family intervention or if someone just decides they want help. All 50 states now have drug courts. Drug courts have remarkable track records. Why? Because when you come into drug court you either follow the court's ruling or you to go jail. People say to me, "How come actors and actresses seem to go to treatment every other month and they don't get well? How come major league baseball players that go to treatment end up in jail two months later?" The reason is that there are no consequences. Unfortunately, the people who wrote Proposition 36 didn't understand that.
A number of states are considering ballot initiatives similar to Proposition 36 in 2002. Based on your experiences, what words of wisdom can you offer state legislators?
SM: The most important thing to understand is that the public wants to give treatment a try. The public is tired of the war on drugs. It makes good policy sense for states to consider treatment as an alternative to prison. However, in considering other options to prison, states will want to determine what works best in their state. I think you need the objectives to be clear. The public may have an expectation that there will be a cure. I think that it is unrealistic. I do see people again. I don't see them all again, and that is the success. Legislators will need learn to have reasonable expectations. Also, they need to have enough funding in it to make it work. In my county, we do not have adequate residential treatment. Although Proposition 36 was meant as a diversion statute for possession offenses, the people who come into the program-far more than were expected-are hard-core addicts who have substantial criminal records. We need more funding because, for the hard-core addicts, we have to allow for more residential treatment and for supervision after treatment.
JS: It is on the ballot in a couple of states and those states have approached me for help. I suggest that these states be careful in how the proposition is worded. I suggest that people be proactive. My message to legislatures is that they realize that this is coming to every state and to look at the drug courts in your state because in most states the drug court system is very successful. The problem is that [drug courts] aren't well funded. In California, everyone agreed they were very successful, but they were only reaching 15 percent of the people with drug arrests. I'm suggesting that states look at the funding issue and increase the funding to drug courts.
Based on your experiences with Proposition 36 to date, is it meeting its goals?
SM: I think it is. The goals of the legislation are to reduce recidivism and to generate savings by decreasing prison and other social costs related to drug use. We will not know whether it is meeting those goals for a long time. However, the more times that I can get an addict into treatment and the longer I can keep him in treatment, the better my chances are of never seeing him again. To me, that is success. My concern is that diversion, by itself, will not work. Under Proposition 36, once a client has failed three times, you have prison. It will be a problem because you can't say three strikes and you are out with addicts. Sometimes, it takes five times. There is no magic number with treatment attempts.
JS: I don't think so. For example, from the reports that I am hearing from San Francisco County, there is a "no show" rate of more than 75 percent. That means that the courts told people where to go for treatment and people just didn't show up. Under the old drug courts, you'd be arrested and put in jail. They can't do that easily under Proposition 36. As a result, the judges feel that some of their power has been taken away. Again, globally putting addicts in treatment is a good thing but, if we are going to do it, let's do it the right way. My hope is that after Proposition 36 has been going for a year people will discuss how to improve the system. I hope we get the chance to do that.
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