July 13, 2001

Drug Diversion — Shortchanging Voter-Mandated Plan May Doom it to Failure

By Lonny Shavelson

SAN FRANCISCO — Starting July 1, California courts must direct those convicted of certain drug offenses to drug rehabilitation programs instead of jail.

Counties have had seven months to prepare since the state's voters made this the law — as Proposition 36 — in last November's election. But across the state, their efforts have more often concerned booking and arraignment than treatment.

It's time for our officials to pay attention to the rehab system where the addicts are heading — not the court system where they're coming from.

My own two-year long investigation of that system shows that there is much to be worried about.

If addicts are to stay free of drugs, they need help with more than drug issues alone. As Dr. Alan Marlatt, director of the Addictive Behaviors Research Center at the University of Washington, says, "Putting people into drug programs without dealing with housing, education, job training, health problems, family and marital problems, and mental health issues, won't work any better than putting them in prison, where they didn't get those things either."

Yet in San Francisco, which is considered one of the better-prepared counties, there is no concrete plan for crucial services to aid addicts in anything other than getting off drugs.

Not one of the 200 or so addicts I interviewed here could name his or her assigned case manager, and there is no plan on the table that would improve this.

Other California cities and counties, financially strained even with additional Prop 36 funds, are not likely to do better.

Los Angeles County Superior Court Judge Michael Tynan says that paying for comprehensive services for the 17,000 people predicted to be eligible for the program would drive the county into debt.

Consider, for example, mental health needs. At least 50 percent of drug addicts have problems with clinical depression, post-traumatic stress disorder (often from childhood sex abuse), and other emotional illnesses.

The standard "treatment" of such addicts is simple. Anyone appearing at a substance abuse treatment intake center with a "dual diagnosis" (substance abuse plus mental health disorders) is told to go to mental health services.

"We can't get you off drugs," the intake counselors say, "until you get your mental health problems under control."

At the mental health centers, they were told, "We can't deal with your mental health issues, until you're off drugs."

This will not change unless we train drug counselors and mental health workers to provide skilled care to people suffering from addictions and mental illnesses — and no such training is offered by Prop 36.

Moreover, the majority of drug counselors now working in rehab programs lack significant experience and training, and there is no state licensing requirement. Most are ex-addicts whose predominant method is to repeat for others what worked for them.

The vast majority of these ex-addicts-now-counselors came up through a system based on humiliation and abuse to shame and punish addicts until they give up drugs.

"Many techniques are used to break through an addict's armor of defenses, including some that embarrass," says Dr. Brian Greenberg of Walden House, which treats 10,000 addicts annually.

But he readily agrees that such techniques can do more harm than good.

"Some who have serious mental illnesses are as fragile as eggs, and may emotionally crack," he says. "These individuals should never be engaged in a way that embarrasses or humiliates."

Yet these are the predominant therapeutic techniques, and counselors have virtually no education in distinguishing who might crack from an in-your-face boot camp approach.

"Moving drug rehab programs from addiction into mental health issues has created a lot of anxiety for the counseling staff," says Dave Seymour, a licensed therapist who worked at Walden House. "They're not ready for it, and they're not trained for it."

Is Prop 36 doomed to fail? Not necessarily.

Proper drug treatment is highly effective in getting addicts off drugs, or substantially reducing drug use — and even more effective at decreasing the rate of robberies and mayhem attributable to drugs.

Californians have to realize that they must augment Prop. 36 with resources for counselor training, mental health and case management In the end, this will save the state money — money now spent on robbery, child abuse, foster care, HIV disease, and more.

Only if we succeed in changing the programs can we achieve what the voters demanded at the polls last November: that we rehabilitate addicts and help them stay drug free.

Lonny Shavelson, a Berkeley physician and journalist, is the author of "Hooked: Five Addicts Challenge Our Misguided Drug Rehab System."

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