At the national level, research is showing that even relatively costly, high-end treatment can save money by helping to stop both drug use and its associated crime. A five-year evaluation of Brooklyn's Drug Treatment Alternative-to-Prison program found participants 87 percent less likely to return to prison than those who were simply incarcerated and released. The program provides repeat offenders with as much as two years of residential treatment -- more than six times the national average -- as well as vocational training and social and mental health services. Even this intensive level of service, researchers found, costs about half what it would have to incarcerate the same offenders. (By way of contrast, a study by a consortium of the Claremont colleges found that California's harsh three-strikes law has done absolutely nothing to reduce drug offenses.)
More broadly, a much cited RAND Corp. report concluded that every dollar spent on drug treatment saves more than seven in drug-related costs. There is mounting evidence that drug treatment can have a tremendous impact on the lives of the children of drug users -- and on the costs associated with their care. Researchers at the University of Chicago, for example, recently concluded that child welfare costs added $18.8 million to the $147.5 million spent to lock up women from Cook County alone in 2000.
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Zina Carse perches on the couch of the Oakland home she shares with her boyfriend CJ and his grandmother while CJ brings her breakfast -- bacon, ham, raisin toast. When Carse was using methamphetamine, she would disappear for days, coming home haggard and skin and bones. CJ, a limousine driver, cared for her in the intervals and tried to "fatten her up." Carse has put on 20 pounds since she got clean, but CJ has yet to break the habit of making sure she eats.
An aqua-eyed 39-year-old with feathered, red-tinted hair, Carse pulls out a photograph of herself taken right before she went into treatment less than six months earlier, when she was arrested with methamphetamine in her purse. She is gaunt, pale, with stringy cropped hair, saucer eyes, drawn mouth. The only thing recognizable is her bright pink lipstick, the same shade she wears today.
Being arrested saved her, Carse believes -- she calls it her "God shot" -- but so did being released. "I don't think staying in jail would ever have gotten me clean," Carse said. "What did it was my program."
"Fake it till you make it" is one of several aphorisms ubiquitous in drug treatment settings. That's what Carse did. She was assigned under Prop. 36 to a weekly Thursday afternoon outpatient meeting. She got high on weekends and then stayed clean for three days so her urinalysis would come out negative. That worked fine until she and CJ got in a fight and she used on a Wednesday to console herself. Knowing she would test dirty, she stopped going to rehab.
At that point, CJ gave her an ultimatum: drugs or me. Her probation officer put out a warrant for her arrest. The combination was enough to bring her back in. This time, she was assigned to the Ozanam Center, a drug treatment program in Contra Costa. Her experience there is a testament to the power of intensive residential care in a well-run facility -- the kind of care only a minority of Prop. 36 clients receive.
At "Oz," Carse was introduced to an iconography of healing -- a collection of stories and symbols that helped her understand what had happened to her and what she had to do next. Her addiction was her "red dog," her recovery her "blue dog" -- it was up to her to choose which one to feed. A paper heart torn to pieces represented what she did to those who loved her every time she used.
Carse saw a therapist who helped her deal with the childhood sexual abuse that Carse believes triggered her initial descent into drugs. She took parenting and anger management classes, a class on codependency and another on relapse prevention. She cooked and cleaned and learned to get along with her housemates. She discovered how to relax without drugs, by meditating or swinging on the swing set in the spacious back yard.
After a few weeks, Carse called CJ and told him, "I cannot think of a single reason why I would want to do any dope right now." She couldn't remember the last time she had felt that way.
Next, Carse reached out to her children, who live with their father. When she completed her time at the Ozanam Center, they came to the awards ceremony. Now Carse sees her kids every weekend, asks them how school is going, checks up on their grades. "They're proud of me," she said. For now, that's enough.
Carse is well aware that many Prop. 36 clients are "perpetrating" -- manipulating a system they perceive as permissive and going back to drugs at the earliest opportunity. They're just not ready yet, she says -- but Prop. 36, unlike the system that preceded it, gives them the time and opportunity to get there.
"Prop. 36 is a big opportunity to save a lot of lives," Carse says, "where jail wouldn't."
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There is no question that the California model is a work in progress. For every Zina Carse, there is another user with a story of bureaucratic chaos, conflicting requirements, unhelpful or even unnecessary treatment. One Prop. 36 client tells of going through treatment in one county only to be required subsequently to serve six months' jail time in another county on a bad-check charge related to her by-then-defunct habit. Another complains that Prop. 36 and the child welfare department couldn't agree on which rehab she should go to; when she followed the orders of one system, she was penalized by the other.
A public defender tells of a client who tried meth once and had the bad luck to be caught; the treatment program to which he was referred was about as useful to him as traffic school. Two teenage girls tell parallel stories: Their addicted mothers were released under Prop. 36 but months passed and they never received the paperwork they needed to begin treatment. One is using heavily again; the other recently received a long prison sentence for a new charge.
Prop. 36, because it requires both addicts and bureaucrats to change long-term habits, faces considerable hurdles. Its impact, and that of the related changes taking place across the nation, is still a drop in the bucket: The nation's prisons remain filled to overflowing with people who are there because they use drugs.
But the hypothesis that Prop. 36 is testing -- drug treatment can save the money, lives and families that incarceration squanders -- is a crucial one. As President Bush's latest round of tax cuts threatens to intensify already dire budget crises across the country, it may finally get the large-scale trial it has long deserved.
If California's Proposition 36 can demonstrate better results than the policy that preceded it, it might do more than save local lives and dollars. It might herald the end of a decades-long drug war -- rife with wastefulness, fiscal as well as human -- that an ailing economy will no longer support.