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A question of risk 

Long waiting lists are hampering treatment for drug offenders in California

Every Tuesday afternoon people line up outside the last room in a long hall on the bottom floor of the SLO County Courthouse. On a recent Tuesday, the line stretched out the door and far down the hall. The people in line weren’t dope dealers or career criminals, but they had been caught for possession or being under the influence. It was a line of ordinary faces, many locked in nervous expressions. A week later two women sat outside the locked doors of that room consoling one another as they waited for loved ones to come out who never did; one woman left in tears. By law, treatment should be a ready option for everyone in the line—at least, that’s the way things are supposed to work. And before the state began lopping funding for court-run drug treatment programs, that’s the way they did work.

In SLO County, as in many counties throughout California, people who ordinarily would receive treatment instead of jail for drug and alcohol offenses are placed on a list and told to wait. Historically, drug offenders who took the treatment option were allowed to enroll in treatment almost immediately. Now, they wait a month on average but the delay often stretches to two months, or more.

People who are in the program and those who run it say it’s not a get-out-of-jail-free card, but treatment, the alternative to incarceration, is in very many cases too long delayed. Those who await the program are left on their own, expected to stay clean until help becomes available: Though they they’ve committed to the treatment option, nothing really changes beyond some paper shuffling.

 In 2000, Californians passed the Substance Abuse and Crime Prevention Act, or Proposition 36, with a strong 61 percent of the vote. California’s law went into effect in 2001 following the example of a similar successful treatment program Arizona started in 1996. Proposition 36 gives nonviolent drug offenders an option to go into treatment instead of jail. The state originally pumped $120 million annually into the program through the 2005-06 fiscal year. And the program works.

Annual studies by the University of California at Los Angeles found conclusive data that Proposition 36 treatment successfully curbed repeat drug offenses by people who completed the program. Graduates from the program are less likely to commit crimes, the research showed, and the state saves millions of dollars by treating offenders instead of sending them to jail or prison.

But the economy went south and the state budget began to tank. First the Proposition 36 budget was reduced from $120 million to $100 million. Last year, the budget was further reduced to $90 million. This year, the funding was eliminated completely and no one knows whether it will be funded again.

In SLO County, those cuts resulted in the loss of four drug and alcohol counselors. According to one state official, most counties had to cut services in half. SLO County was one such county and going into this fiscal year, the local services are operating with about the same number of staff as when Proposition 36 began.

 

click to enlarge THE COUNSELOR :  Trevor Hardcastle of SLO County Drug and Alcohol Services is one of the counselors on Proposition 36 cases. Budget cuts, he said, have decimated the county’s ability to treat drug users. - PHOTO BY STEVE E. MILLER
  • PHOTO BY STEVE E. MILLER
  • THE COUNSELOR : Trevor Hardcastle of SLO County Drug and Alcohol Services is one of the counselors on Proposition 36 cases. Budget cuts, he said, have decimated the county’s ability to treat drug users.
Getting off the list

New Times met with Steve in a small, dim conference room in one of the county’s Drug and Alcohol Services offices in Grover Beach. He was wearing a black Fender T-shirt and spoke with a groggy lisp through swollen cheeks. He had just had teeth pulled, but took only over-the-counter pain killers because he had to refuse narcotics the dentist offered, he said. Steve is a recovering methamphetamine user who, like many in his position, was placed on the waiting list to receive treatment.

After getting picked up for being under the influence, Steve took the treatment option offered by the court. He was told the next day to go to SLO County Drug and Alcohol Services for an assessment; basically a quick meeting with a counselor. That was on a Wednesday. At his assessment, Steve was told he would have to wait almost two weeks to begin treatment. Before budget cuts most local clients were able to begin treatment the day after assessment.

“So as soon as you walked through the door right then on that Wednesday you know well, gee, how long am I going to be waiting?” Steve said. “So the demon in the back of your head starts talking.”

He knew he had a court appearance the following Tuesday, six days before his first treatment appointment. And he thought it would be a routine appearance.

“So I decided I was going to get loaded one last time because I figured I was going to have to just go to court, show them the paperwork that yeah, I’m signed up to go come down here and meet with a counselor and start the program,” he said “So I got loaded over the weekend, showed up Tuesday at court, and they said, ‘We’ve got a pee test.’”

It takes three days for meth to clear the system, Steve said, and he knew there was no way he’d pass the drug test that day—he’d banked on passing the test when he went in for treatment. Steve admitted to the judge he’d used. By law, he had violated the terms of his probation, which meant he would have to spend three days in jail and devote 20 hours to community service. More disheartening, he said, was that testing dirty counted as a first strike; if he has two more strikes, he loses the treatment option.

“And then, after the weekend was up, I came in and met with Trevor and then started the program,” Steve said. Trevor Hardcastle is a county drug and alcohol counselor.

When New Times met with Hardcastle a few weeks ago, he said there were 23 people on the waiting list to start 12 to 18 months of treatment. Only four had come off the list and received treatment. Steve was one of the four. Hardcastle couldn’t say for sure what happened to the others.

“We know if we can just get people in, that the outcome is good,” Hardcastle said. “But we know that because of budget cuts and the wait-list scenario, we’re losing people who came in. They already decided they were ready; now we’re losing them. They’re picking up new charges, sitting out in the jail, losing custody of their kids.” He smacked his hand on the table, “And that’s a frustrating thing.”

By the end of the last fiscal year, before the cuts went into effect, 94 percent of the people who appeared for a Proposition 36 assessment made it into treatment. The county “no show” rate was 10 percent, compared to a statewide rate of about 25 percent. But between July and September, 83 percent of the people on the list hadn’t shown up for treatment.

“I have a family and I’ve been off and on using for 20 years,” Steve said. “And I’m done. I’m done using and I just don’t have the money, and health wise—there’s a lot of other reasons.”

By most accounts, Steve is the exception to the rule because even after his first probation strike, he went back for treatment.

“People make it on the wait list, most of them don’t make it off the wait list,” Hardcastle said. “And so when people come in the door they’re ready, for whatever reason, whoever decided, either them or the judge that they’re ready. That’s a critical time in treatment. We need to get those people immediately in because [Steve] said it well: The little demon or the last hurrah comes in if people have a lag time and they don’t make it. That’s why our wait list has been pretty much decimated.”

 

click to enlarge THE DEFENSE :  Attorney Matt Guerrero is the public defender for Proposition 36 defendants. He said people test dirty on drug tests in court all the time, particularly now because of a waiting list. - PHOTO BY STEVE E. MILLER
  • PHOTO BY STEVE E. MILLER
  • THE DEFENSE : Attorney Matt Guerrero is the public defender for Proposition 36 defendants. He said people test dirty on drug tests in court all the time, particularly now because of a waiting list.
Graduation day

A blare of laughter and voices bounced off the tile floor and echoed against high ceilings and wood-paneled walls as more than 100 people poured into the SLO Veterans Memorial Hall. Some looked like little-league soccer coaches. There were old men and women, middle-aged men and women, teenagers with bleached hair wearing T-shirts and baggy jeans, and bubbly teenage girls. Two women sat on one side of the room laughing and pointing as they scrolled through pictures on one of the girl’s pink laptop. A woman sat in a folding chair bouncing a little girl on her knee while in another corner of the room a young woman gently rocked a cradle on the ground next to her. Many mingled and laughed, a few hugged each other excitedly like long-lost friends. A young man insisted to a reporter, “This isn’t a program; it’s a family reunion.”

Above a stage at the front of the room hung a large white vinyl sign sporting the words, “Prop 36. It Works!”

Hardcastle walked through the room wearing a neatly pressed black suit over a green shirt and blue-and-yellow striped tie. He zipped around greeting people like a beaming teacher about to watch his favorite class accept diplomas. The noises quelled and Hardcastle walked on stage speaking to the crowd through a wireless microphone.

“I’ve been here four years and each year we fill the house,” he said.

SLO County’s Proposition 36 program has a 46 percent success rate and another 16 percent leave treatment in good standing, meaning they move and continue their treatment elsewhere, for example. Statewide the average success rate is 41 percent. Though the numbers may seem bleak to outsiders, those involved with Proposition 36 treatment say it’s overwhelmingly successful. As one official put it, the treatment success rate in jail or prison is about 0 percent.

Since 2000, there were 695 felony drug arrests per year in SLO County on average, according to the California Department of Justice. There were an average of 968 misdemeanor drug arrests per year during the same time period.

“It’s easier to sit in jail than to completely change everything in your life,” Hardcastle told the crowd.

Those graduates—people who were caught when treatment was more readily available—were fortunate. Shortly before the graduation ceremony, there were 38 people on the waiting list, according to a county report. In 2008-09, an average of 49 people were admitted to county Proposition 36 every three months. According to UCLA’s cost analysis, the state saves $2 for every $1 spent on someone in treatment. For people who complete treatment, the state saves $4 for every $1.

Probation officers, counselors, and a county judge paraded across the stage. Each was met with exuberant applause and cheering.

Judge Dodie Harman has presided over SLO County’s Proposition 36 cases for about six years. Asked why a judge would be applauded by people she’s convicted, Harman said most people facing a Proposition 36 sentence come to court feeling as though everybody’s against them. But the longer they’re in the program, the more they appreciate the system is geared to helping them.

“With drug addicts you’ve got to get to them right away … and if you don’t do that, they don’t have the tools and they’re going to use,” Harman said.

After her morning cases recently, Harman slinked through the narrow maze of courthouse hallways and sat behind a large wood desk in her chambers. She said sometimes people need a few days in jail “because it dries them out.” Every week someone comes to court and tests dirty, which counts as one of their three allowed probation violations and an automatic trip to jail.

People on the waiting list still must check in with the court regularly and they’re often drug tested on the spot.

In court, before Harman sat down for an interview, one man wearing a security guard uniform tried to explain why he hadn’t reported to the court when he was supposed to. Harman ordered him to submit to a drug test. His shoulders slumped and he quietly muttered, “Shit.” A bailiff took the man to a back room and a few minutes later there was the sound of a toilet flushing. The man had tested positive for cocaine. Though his was not a Proposition 36 case, Harman said it’s a regular occurrence.

Matt Guerrero said he sees people test dirty all the time, especially now when people are caught in limbo before treatment is available. He’s been practicing criminal law for nearly 10 years and is the assigned public defender for Proposition 36 cases.

“It’s like, dude, you’re coming to court—you can’t even be clean and you know you were coming?” Guerrero said. “That’s how bad the addiction is?”

But it’s not surprising, he added: “The phrase ‘just say no’ just makes sense to the non-addict, because they’ll [addicts] say, ‘How do I say no when my body is saying yes, yes?’”

 

click to enlarge THE JUDGE :  Judge Dodie Harman will soon retire as the Proposition 36 judge. During her time on the bench she’s tried to coordinate all things Proposition 36 to prevent people from slipping through the cracks between court and drug treatment. - PHOTO BY STEVE E. MILLER
  • PHOTO BY STEVE E. MILLER
  • THE JUDGE : Judge Dodie Harman will soon retire as the Proposition 36 judge. During her time on the bench she’s tried to coordinate all things Proposition 36 to prevent people from slipping through the cracks between court and drug treatment.
Does it work?

“To boil it down, yes, I think it’s done a lot of good and the people who do complete treatment, for them it’s made a lot of difference in their lives,” said Darren Urada, one of the UCLA researchers who conducts the annual research and reports on Proposition 36 programs. “I do think it could be better but right now with the funding being cut we’re not going to have a chance to do that.”

According to the 2008 UCLA report, of the 48,996 offenders who were referred to Proposition 36 between July 2006 and June 2007, about 71 percent entered treatment. Of those in treatment, most by far—57 percent—were in recovery from meth, 13.1 percent were in treatment for cocaine or crack, marijuana (12.5 percent), alcohol (8.2 percent), and heroin (8 percent).

Urada said there are plans to study the effects of cutting Proposition 36 funding, but funds for that research have been eliminated, too.

“It’s bad,” he went on. “These are people who need treatment and if they’re on a waiting list they’re going to go back and start using drugs again, and that shouldn’t surprise anybody.”

There’s hope the state will receive a $45 million Band-Aid from federal stimulus money for Proposition 36 programs. Still, most counties only have enough resources to treat about half as many patients as before the cut, explained Tom Renfree, executive director of the County Alcohol and Drug Program Administrators’ Association of California.

“You’re talking about trying to keep people out of prison, out of jail, and here we’re cutting a program that was one of the more effective ways of keeping people out of incarceration,” Renfree said.

So why cut a program that was proven effective and shown to save the state money in other ways?

“Frankly, drug addicts are not a popular constituency, to be honest,” Renfree said. Perhaps, he added, going easy on drug offenders can be seen as being weak on crime. “I think what people are a little bit short sighted about is, well, even if you feel that way, if these people don’t get treatment they do become a public safety problem.”

Walter Ling agreed. Ling is a professor of psychiatry at UCLA and the director of Integrated Substance Abuse Programs there.

“When things are good, we put [addicts] in treatment—with lots of barriers—and when things are bad we put them in jail,” Ling wrote to New Times. “Sometimes we advocate ‘prison treatment.’ We have always studied addiction as a disease and treated addicts as sinners; it’s the American way.”

Staff writer Colin Rigley can be reached at crigley@newtimesslo.com.

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