The addiction-treatment system in California falls far short of being able to meet the needs of inmates currently in state prisons, to say nothing of the influx of treatment candidates expected as a result of Proposition 36.The California prison system has made some progress in building treatment slots, but the drug-related arrest rate and prison construction have proceeded even faster, according to statistics offered by experts at the recent American Society of Addiction Medicine annual meeting in Los Angeles.
Joe Ossmann, director of the California Department of Corrections' Office of Substance Abuse, noted that therapeutic community (TC) beds in state prisons have grown from 400 in 1997 to more than 5,000 today. Over roughly the same period, however, the state built 15 new prisons, according to David Panush, legislative aide to the President Pro Tem of the California Senate.
Built in part as a response to the passage of California's "three strikes" law, these prisons have rapidly filled with drug offenders. David Deitch, Ph.D., director of the Pacific Southwest Addiction Technology Transfer Center at the University of California at San Diego and cofounder of the Daytop Village TC, said that drug offenders accounted for 63.7 percent of all arrests between 1990 and 1999.
Panush said that only 5 percent of California's 161,000 inmates and 3 percent of the state's 120,000 parolees get treatment. The reasons that the numbers in treatment are not higher are diverse, said Panush. "Treatment is expensive if you want to do it right," he said, noting that each treatment slot in California costs $10,000, and aftercare is $70 per day. "It's also difficult to make the case on payback," he added. "[The legislature] budgets in the short term; we're not looking at the long-term savings, but the short-term impact of the program."
There also is an "abiding skepticism" about treatment effectiveness, said Panush. And even when these hurdles are overcome, NIMBY ("Not in My Backyard") can sink proposals to increase treatment resources. "People say you can't site these programs, so let's not do them," he said.
These attitudes, along with a shortage of facilities and trained staff, will need to be overcome if implementation of Proposition 36 -- which mandates treatment instead of incarceration for all low-level drug offenders -- is to succeed. The Proposition 36 referendum earmarked $120 million annually to support implementation, but many experts say that far more will be needed to meet the increased demand for services. "There is a severe treatment shortage for Proposition 36," said Deitch.
The good news, speakers at the ASAM meeting said, is that California's existing network of TCs has been proven effective in cutting crime -- a critically important indicator -- particularly when linked with a comprehensive aftercare program. Deitch pointed out, for instance, that a Texas study found that just 35 percent of inmates who participated in a TC and received aftercare committed another crime within three years of release from prison, compared to 50 percent of the non-treatment population.
California also has had some success in expanding prison-based treatment. Nineteen of the state's 33 prisons now have addiction treatment programs, typically 200-300 bed facilities located on prison grounds, said Ossmann. California also has made a substantial investment in community-based corrections, including aftercare programs for parolees.
Inmates typically begin involvement with the TC 18 months before their scheduled release -- often involuntarily -- said Ossmann. The Department of Corrections subcontracts with groups like Amity, Inc., and Phoenix House to operate the TCs, which are required to adhere to the treatment principles laid down by TC pioneer George DeLeon.
The success of a TC run by Amity at the R.J. Donovan Correctional Facility in San Diego helped convince state prison officials that treatment was worth investing in, said Panush, and it didn't hurt that the recent economic boom meant a bigger pie for state lawmakers to divvy up when considering different approaches to fighting crime. Advocates also did a good job of linking treatment to the hot issue of prison construction, arguing that if there were going to be more prisons, there had to be more treatment, Panush said.
Proposition 36 "shows that the voters are probably ahead of the policymakers" when it comes to using treatment to fight crime, Panush said. But that's no guarantee that treatment will ultimately achieve the pre-eminence it deserves in the California prison system. Supporters of treatment are especially concerned that budget constraints will prompt policymakers to redefine treatment downward in order to meet the letter of the Proposition 36 law -- much as managed care has achieved its budgetary objectives by limiting access to addiction services and capping benefits.
To ensure that California builds on its current success with TCs and aftercare, rather than forcing inmates into self-help meetings and calling it treatment, experts at the ASAM conference said that advocates need to continue to stress treatment's positive impact on recidivism, drug consumption, tax-consumptive behavior (such as utilization of welfare benefits), tax-productive behavior (like employment), and personal well-being.
Treatment supporters also need to continue to win the trust of prison officials. Ossmann points out that unlike the general prison population, the atmosphere in a prison-based TC is relaxed, racially mixed, and focused on positive change. "It's mutual responsibility versus mutual victimization," he said. Among other things, the TC environment makes prison guards' jobs easier, experts say, and treatment advocates would be well-advised to stress the improved quality of life for prison employees working in TCs as opposed to the general prison setting.
California Must Build on Treatment Successes to Make Prop 36 Work. Feature article by Bob Curley for Join Together Online (www.jointogether.org), May 25, 2001.
Boston University School of Public Health 
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