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Sunday, Nov 22, 2009
Legislators and voters finally seem to be figuring out that the old approach to drug use -- wholesale incarceration -- is literally bankrupt. At the same time, decriminalization is not in the cards. Last year's marijuana legalization initiative in Nevada flopped. The Bush administration, while paying some lip service to the notion of treatment (particularly for close relatives of the president), has displayed a steadfast loyalty to the guiding tenets of the old war on drugs -- raiding the homes of elderly and frail medical marijuana patients; sending John Ashcroft north to try to scare the Canadian prime minister out of legalizing marijuana; and straining to update the drug war's image by tying it to the more popular war on terrorism. Even hardcore reformers have concluded, through focus groups and polling, that Americans still want the police and the courts in charge of drug offenders; they are not interested in setting drug users free entirely, or in handing them over to the health department.
"We don't run initiatives to lose them," says Daniel Abrahamson, director of legal affairs for the Drug Policy Alliance, who drafted Prop. 36. "The public would not have gone at this point for ending prohibition, but treatment vs. incarceration was an easy one for them."
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In a small conference room at the Contra Costa County Department of Probation, Prop. 36 clients struggle to explain themselves to a probation officer, a treatment provider, and two representatives of the Recovery Gateway Unit, the county office that coordinates Prop. 36 care. Prop. 36 clients come before this hybrid tribunal -- a cross between an encounter group and the principal's office -- at the beginning and end of their treatment, and whenever they slip up in between.
Christopher (all participants' names are changed), is the first to appear. He looks like a college kid in jeans and a white T-shirt, his straight brown hair in a shaggy layered cut. His bad teeth are the only visible sign of his long-term addiction to methamphetamine. Users' drugs of choice vary from county to county -- in Contra Costa, 60 percent of clients use meth as their primary drug. Meth is also the most popular drug among Prop. 36 clients statewide, at 44 percent. Cocaine and crack are next at 15 percent, followed by heroin at 14 percent.
"I know I was supposed to set up an appointment" to resume treatment after a lapse, he begins, launching into what will be a familiar refrain, "but I didn't know how to go about getting the phone number." The excuses, while plentiful, are also fairly credible. Each Prop. 36 client is responsible to several authorities -- probation, a treatment provider, the Recovery Gateway Unit, sometimes the child welfare department -- and drug users' lives are often chaotic enough to make fulfilling these simultaneous mandates a genuine challenge.
"We didn't know where you were," says Prop. 36 program manager Lenny Williams, a sunburned man with the ice-blue eyes of a Marlboro cowboy. "You have two treatment failures. I wonder if you are still confused as to what you have to do?"
The proceedings are immensely polite, as ritualized as typical courtroom behavior but several degrees milder, designed to instill trust rather than respect and fear. But if Williams can afford to speak softly, it may be because ultimately, the court still carries a big stick: One more treatment failure and Christopher will find himself behind bars.
"I'm sick of going to jail," Christopher concedes.
"It's really important, Christopher, that this time you follow through," Williams scolds gently.
"I will," promises Christopher, as solemn as a groom. He dutifully recites the date and time of his next appointment, then asks to borrow a phone so he can call his mother for a ride.
For others, the stick is not quite big enough to induce such docility. Lester enters carrying bottled water and a leather-bound planner, a pair of sunglasses hanging from his neck. He had been close to completing an outpatient program when he tested positive for meth. He uses the drug, he informs the group, to manage his depression-- "to get my ass out of bed, take a shower if need be."
In recent weeks, Lester's mother set him up with a chiropractor who specializes in "nervous system things." His doctor has put him on Wellbutrin. That, he implies, ought to be sufficient.
Williams has a different plan for Lester: His probation will be extended and he will be referred back to outpatient.
"Can I ask what you're doing over there for treatment?" Lester asks with exaggerated politeness, directing his question to a representative from the program he previously attended. "Has anything changed over time? Because I don't consider listening to a meditation tape for 45 minutes treatment."
"We don't do that anymore," she says flatly.
Lester's impertinent question ---what exactly qualifies as treatment? -- goes to the heart of the challenge California faces as it scrambles to serve the 36,000 users who have poured into rehab since Prop. 36 went into effect. For the initiative to demonstrate the kind of long-term success that will ensure its survival ---not to mention its replication -- those funding and implementing it will have to ensure that clients get high-quality treatment tailored to their individual needs. That will take not only planning and oversight but also money, a commodity in increasingly short supply.
