by Kim Krisberg
When it comes to nonviolent drug offenses, systems that favor treatment over incarceration not only produce better health outcomes, they save money, too. It's yet another example of how investing in public health and prevention yields valuable returns on investment.
In a new study published in the June issue of the American Journal of Public Health (AJPH), researchers found that California's Substance Abuse and Crime Prevention Act, which diverts nonviolent drug offenders from the correctional system and into treatment, saved a little more than $2,300 per offender over a 30-month post-conviction period. In fact, researchers estimated more than $97 million in savings for the 42,000 offenders affected during the first year of the law's implementation. And even though the law resulted in spending more on treatment, health care services and community service supervision, bypassing incarceration still yielded overall savings, said study co-author M. Douglas Anglin, founding director of the UCLA Drug Abuse Research Center and associate director of the university's Integrated Substance Abuse Programs.
"In the long run, we're still saving money because we're not paying to incarcerate people," Anglin told me.
According to a 2009 report from California's Legislative Analyst's Office, incarcerating a single offender costs California approximately $49,000 per year.
California's Substance Abuse and Crime Prevention Act was enacted in 2000 as a result of a voter-approved initiative known as Proposition 36. The system change means nonviolent drug offenders who meet the law's criteria can be sentenced to probation with substance use disorder treatment instead of imprisonment or probation without treatment. The law gives offenders up to three chances to re-enter treatment without incarceration regardless of initial violations. Study authors Anglin, Bohdan Nosyk, Adi Jaffe, Darren Urada and Elizabeth Evans wrote that the law became a "statewide policy that changed the course of criminal justice processing" for all the individuals and sectors involved.
"The law represented a sea change," Evan told me. "It represented taking a real public health approach to substance abuse offenders in the state."
The AJPH study noted that in 2002, national estimates put the societal cost of substance abuse disorders at $180.9 billion, with the largest and fastest-growing contributors being criminal justice activities. In terms of public investments in substance use disorder activities, federal decision-makers in 2011 budgeted $7.6 billion for domestic law enforcement, but only $1.7 billion for prevention programs and $3.9 billion for treatment services. Study authors wrote:
Public policies regarding criminal justice interventions with drug-using offenders have largely been driven by the acknowledged association between drug use and crime. The research literature has consistently reported that (substance use disorders) intensify rates of criminal activity, especially among dependent individuals. The importance of treating offenders with a (substance use disorder) is further illustrated by the fact that both severity of drug use and recidivism rates decline during and after treatment. Consequently, a reduction or cessation of drug use has been targeted as a direct method of reducing drug-related crime and enforcement and as an indirect method of reducing other adverse social consequences associated with drug use.
To examine the impact of California's treatment diversion law, the researchers compared two different groups: one that met the law's eligibility criteria in the years before the law was enacted (this was the control group) and another made up of eligible offenders convicted within the first year of the law's implementation. The study found that treatment participation was "substantially" greater among the post-implementation group than among the control group. Researchers also found greater incremental costs savings among black and Hispanic offenders due to related disparities in conviction and incarceration rates. The study concluded that diversion from incarceration to treatment should result in long-term savings.
Evans, a project director at UCLA Integrated Substance Abuse Programs, noted that the strength of California's diversion program really stemmed from its collaborative nature and having leadership from both the criminal justice and treatment communities working together.
"It was a big step toward acknowledging substance abuse as a health issue," she said.
The study's findings also suggest that "policy concerns regarding the welfare and rehabilitation of drug users should be seen as aligned with rather than running counter to the notion of fiscal responsibility and public safety concerns," the authors wrote. The fiscal findings are especially important considering California's current budget shortfalls, Anglin said. He noted that in 2009 state lawmakers eliminated funding for the law, kicking the financial burden down to the county level.
"These findings can help policymakers when they're trying to decide if a program like this is worth our taxpayer dollars," Evans said.
To access the full study, click here.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.
Here's a "modest proposal," if anyone reads this and wants to take it up:
License individuals to use various psychoactive substances, subject to specified conditions.
Start with alcohol and cannabis. This will immediately solve a few serious problems that are screaming to be solved.
One: DUIs. Anyone who gets a DUI is either suffering from alcoholism or at high risk of it. Don't pull the driving license, pull the drinking license. Take away the real problem, not the side-effect. (Same case for pot, and the really interesting finding is that the stereotype of "driving too slowly" is NOT true: it's due to the same time-distortion effect of pot, that enables e.g. jazz musicians to improvise brilliantly.)
Everyone would be carded when they want to purchase, universally, at restaurants and at stores. No more wait-staff & checkout clerks guessing ages and risking insulting patrons. You want to buy, you show your card.
If you provide a licensed substance to someone who is not licensed to use it, you lose your license for that substance (and on a second offense, all substances). This is the strongest deterrent in the book, and it can be applied immediately by a police officer on the scene by taking a simple hole-punch to the circled A for alcohol or C for cannabis on your driver's license or state ID card ("administrative suspension"), subject to the option of reinstatement by the judge. (Similar to arrest, the officer can book you into the city lockup until the judge sees you and determines what to do with your case.)
The biggest problem this solves, for which there is presently no real solution, is the effect of alcoholism (and other substance abuse problems) on the population at large. For every person who has alcoholism, there are a handful of family members whose lives are made absolutely unbearable as a result. Also impacts at work/school and in their social circles. Removing access to alcohol (or whatever substance) solves the problem. Some alcoholics will seek to buy illegally, but the supply will be limited by virtue of the "sell to a non-licensed user, lose your licenses" provision.
Thus if someone is involved in a domestic abuse incident and their breath test shows alcohol, or blood test shows whatever-substance, they get "administrative suspension" right on the spot. Combine this with mandatory inpatient treatment (California 51-50, "danger to self or others") and you're on the way to getting a lot of these folks into permanent recovery.
The system could subsequently be extended to cover other substances to the extent that public health considerations demonstrate is viable. Licensing conditions would be developed on the basis of minimizing abuse risk per the characteristics of each substance. Some substances such as crack cocaine, would remain prohibited entirely since they are extreme public health risks.
And if you've bothered to read to this point, I have one more modest proposal on a slightly different topic: Put all antibiotics, including their veterinary analogues, on FDA Schedule II, "recognized medical uses but severe potential for abuse."
Though I like the general direction this discussion is going, the remedies are very incomplete.
"Some alcoholics will seek to buy illegally, but the supply will be limited by virtue of the “sell to a non-licensed user, lose your licenses” provision."
By this logic, there would no problems in the country with crystal meth, heroine, etc. All are illegal, yet people can get their hands on them quite easily. This license system you devise would not stop alcoholics from acquiring alcohol any more than it stops a cocaine addict from getting their hands on cocaine.
Also, I think your statement that cutting off an alcoholic's access to alcohol is just flat out wrong. The research on this subject points to much greater issues than liking booze and getting drunk.
Again, I think this general direction warrants more consideration, but the remedies are far more complex than you give them credit. The study -- and the literature -- indicates that these are combination health and public safety issues but your solution is 100% public safety, an approach that was discarded decades ago.
This is what I have been questioning for years, why are they sending addicts to jail and/or prison for being addicts?
My son became an addict over 10 years and as a result, which is usually the case, he got into trouble, spent time in jail and prison. He has now been on probation then parole for years, not because he keeps commiting crimes but because he is an addict. It's been a vicious circle for way too long; he starts using, violates his parole, they throw him into a "facility" and when he get's out. it starts all over again because he isn't getting the help he so badly needs.
Just last week, he went to his parole officer and asked to be placed in a particular rehab for drugs. The parole officer asked him to write dates down that he had been using. My son told him that he didn't remember the dates but the parole officer said it didn't matter if they were correct or not. He said if he didn't cooperate that he would "make things very rough for him," so my son wrote down dates and signed a paper. His parole officer then violated him and threw him in jail. That's what he get's for asking for help.