Preparing for the Rush

New California law may overburden drug-treatment programs in state

In two months, nonprofit drug-treatment centers throughout California will probably be inundated with clients seeking help kicking their addictions. The clients will be sent to them instead of the state’s prisons, courtesy of a new state requirement approved by voters in November.

It’s far from clear whether the centers will be prepared, financially or otherwise, for the influx. The state’s 58 counties are now deciding how to divvy up the $120-million that will be allocated annually for treating Californians convicted of illegal drug possession, and many are worried that there are not enough resources to take care of all who need help.

Throughout the country, nonprofit groups are grappling with the effects of state mandates like the one in California. In recent years, more and more citizens groups have succeeded in getting voters to consider ballot questions on such issues as dog racing, school vouchers, gun restrictions, tax cuts, and physician-assisted suicide. The measures have become a growing force in American politics: In the 1960’s, just 78 measures backed by citizens groups were on the ballot nationwide, compared with 317 during the 1990’s.

Many nonprofit groups have become directly involved in the process. The Humane Society of the United States has backed several animal-protection initiatives in different states, while environmental groups have supported land-protection measures, for example.

A ‘Shortcut’ of Legislative Safeguards

Citizens groups say it is often faster and cheaper to persuade the public to take a stand on a particular issue when they go to the ballot box than it is to lobby for policy changes in state legislatures. But such measures can be short on details.

Craig Lambdin, executive director of MFI Treatment Centers, in Los Angeles, says that such measures “shortcut a lot of legislative safeguards that might get set up.” But at the same time, he says, one man’s safeguards are another’s “legislative roadblocks.”

Mr. Lambdin is one of many nonprofit leaders who argue that the best way to help drug users is to show them how to kick their addictions for good — and that putting such people in jail rarely ensures that they will stay clean. As a result, he and many other nonprofit leaders say they share the goals of California’s Proposition 36, which specifies that first- and second-time offenders convicted of drug possession may not be sent to jail on drug charges. Instead, convicted abusers will be placed on probation and sentenced to mandatory treatment. But few nonprofit leaders were involved in shaping the measure, and many are worried that not all of the practical logistics were taken into account.

The measure was promoted by a trio of multimillionaires: Peter Lewis, head of Progressive Corporation, the country’s fifth-largest auto insurer; George Soros, the international financier; and John Sperling, founder of the for-profit University of Phoenix system.

The men also put money into six drug-related measures in other states, and voters have passed four. Some of those measures involved legalizing the use of marijuana for medicinal purposes. Arizona also passed a measure in 1996 that was similar to California’s Proposition 36.

The three donors hope to pursue additional ballot referendums next year in other states, including Florida, Michigan, Ohio, and possibly Oregon and Washington.

Says Mr. Sperling: “We intend to keep passing initiatives until the political community wakes up to the fact that the drug war is a failure.”

Big Headaches for Charities

Putting ballot measures into practice can cause big headaches for charity and government leaders, as California is proving.

Mr. Lewis, Mr. Soros, and Mr. Sperling focused last year on California partly because it had the highest number of people imprisoned for drug possession of any state: 19,000, or one in every eight people in prison. The three men created the Campaign for New Drug Policies to lead the effort, and together donated most of the $4-million the group spent to promote, pass, and now help carry out Proposition 36.

Voters approved the California initiative by more than 60 percent.

But some treatment providers are unsure how to interpret the vote. “It would be wonderful to think that people voted for this because they believe in treatment over incarceration,” says Susan Blacksher, executive director of an association of some 150 nonprofit groups known as the California Association of Addiction Recovery Resources. But she says the materials used to promote the ballot measure focused on the money that could be saved in prison costs. “A lot of people may have voted for it in the belief that it would lower their taxes,” she says.

California’s Legislative Analyst, the legislature’s nonpartisan research arm, has calculated that every dollar spent on treatment saves $7 by reducing other costs such as law-enforcement efforts, jail costs, and emergency-room visits. The office estimated that Proposition 36 would save taxpayers $100-million to $150-million a year. Because the change in policy is expected to reduce the prison population so greatly, the state will already save the cost of building a proposed $500-million prison that no longer would be needed.

But Ms. Blacksher and many other nonprofit leaders say much more of the money currently slated as savings needs to be put into expanding treatment if the state wants to put such a major policy shift into practice in a way that truly accomplishes the goal of curing drug addiction.

Figuring out just how much money is available to cover what kind of treatment for how many people is proving challenging.

Different agencies have been put in charge of setting up the program at the county level. The initiative does not specify how much of the money allocated through Proposition 36 should pay for treatment, leaving treatment agencies to compete with probation officers and others for a share of the dollars to add staff for enforcement and supervision.

Backers of the measure say they had intended for five-sixths of the money to go toward treatment. But in some counties, probation officers and courts are seeking more than half the money, says Glenn Bacchus, director of the Sacramento office of the Lindesmith CenterDrug Policy Foundation, an operating fund financed largely by Mr. Soros and Mr. Lewis that seeks to become “the N.R.A. of drug-policy reform.”

Mr. Bacchus says he has tried to be a voice for drug-treatment providers in state and county meetings held to determine how to put Proposition 36 into practice. “In some counties, you see one treatment guy trying to hold his own against six badges,” Mr. Bacchus says.

Uncertain Prospects

While demand for additional treatment services is expected to be high once Proposition 36 takes effect, many nonprofit groups say they are reluctant to take on the expense of expanding their programs until they get a better sense of just how many — or how few — positions will be needed. Some estimates are that treatment centers will be asked to find spaces for an additional 40,000 people a year.

But some people question whether the number of arrests of first- and second-time drug offenders in previous years will really prove good predictors of the number of people that will be referred by the criminal-justice system to treatment centers under Proposition 36. William Demers, president of the County Alcohol and Drug Program Administrators Association of California, which represents county agencies that supervise treatment, says it’s not clear whether police officers will be as quick to arrest drug abusers if they know those people won’t go to jail for a first or second offense.

Even those treatment centers that want to expand to meet growing demand say they are having trouble figuring out how to do so. Many centers are already filled to capacity and carry long waiting lists. Quite a few of the treatment centers, particularly those that offer residential-care programs, run small operations with tiny budgets and have little ability to expand their services any time soon.

“It’s the most wonderful thing to make substance abuse a priority,” says Barbara Farrell, executive director of Ohloff Treatment Centers, which serves some 900 people a year with programs in Marin, Sonoma, and San Francisco Counties. But “you have to be careful what you wish for. Where are we going to put all of these people?”

Ms. Farrell says she is expanding her services as much and as quickly as she can. She has asked for about $125,000 of the $60-million made available for program expansion under Proposition 36. In her center in Novato, Calif., for example, she expects to get $16,000 to turn two offices into patient bedrooms, for a total of six new beds. In all, Ms. Farrell says, she plans to add 32 new residential and outpatient slots to her treatment centers next year.

In addition to money, treatment centers say they could also use help from governments in getting zoning permits for new facilities.

Ms. Blacksher of the California Association of Addiction Recovery Resources says she expects that residents will continue to object to the building of new treatment centers, despite the passage of Proposition 36. “People may vote for treatment — but not in their neighborhood. They want it in the next county over,” she says.

David Fratello, political director of the Campaign for New Drug Policies, agrees that big obstacles exist to making the ballot measure work. But he believes that treatment can overcome them. “The fact that it must be done, and done quickly, is forcing some very creative solutions,” he says.

For example, Mr. Fratello says some nonprofit groups now plan to use space at hospitals as a way to add drug-treatment services, in part because such arrangements would not require getting new zoning permits.

At the same time, Mr. Soros says he will continue to work to try to free up money, both in California and around the country, to expand drug-treatment services. “Tens of billions in dollars have to be reoriented from law enforcement to drug prevention to make it work,” Mr. Soros says. Treating instead of incarcerating illegal drug users is “a huge commitment that requires a lot of public funding.”

Mr. Sperling says he has little patience for many of the concerns raised by nonprofit groups trying to carry out Proposition 36. He says that the Campaign for New Drug Policies is lobbying the legislature for additional money, but that nonprofit treatment providers need to take more responsibility for showing that they can provide effective treatment to help all of the drug abusers who need help.

“People don’t get A’s for effort,” he says, adding that instead of “whining,” nonprofit groups should be making themselves heard. “Give me a strategy and the tactics to go with it.” Treatment-center leaders, he says, should consider “chaining themselves to fences around the state legislature” to get the money they need.

New Entrants

The promise of new money for drug-treatment programs has also encouraged a rash of new players to enter the field and seek certification as treatment providers. Steven Loveseth of the Contra Costa County Community Substance Abuse Services division, who is overseeing the Proposition 36 efforts there, says he feels like “a human piñata” being shaken for money. “I’m getting calls from people who want to start a sober-living program in their brother-in-law’s house,” he says. The state has received about 1,300 applications for certification or licensing since passage of the law.

Some established service providers worry that expanding treatment services too quickly with too many new providers could open the door to serious problems, both from dishonest people following a trail of government money and from well-intentioned people who might have inadequate training.

Even with many questions yet unresolved, David E. Smith, author of a book on substance treatment and founder of the Haight-Ashbury Free Clinic in San Francisco 34 years ago, says that Proposition 36 will ultimately advance rather than hinder the cause of treatment by bringing in new resources and by raising the profile of drug-treatment work. “The time is right,” Dr. Smith says. “There are so many families affected now. We’re in the middle of a big shift” in drug-abuse policy.

Evaluating the Results

Evaluation will be key in determining the ultimate success or failure of Proposition 36. Some nonprofit leaders helped persuade the state to set aside additional money for drug testing of the people who undergo treatment as part of the new requirement.

The Robert Wood Johnson Foundation has also financed two studies of Proposition 36. One will examine the impact of the measure on the existing treatment-delivery system, while the other will look at ways to expand treatment, particularly whether the probation and corrections system can add treatment services to its work.

Albert Senella, president of the California Association of Alcohol and Drug Program Executives, which represents 100 treatment centers, says his members know all too well how much is at stake in making Proposition 36 a success.

“We’re going to be the folks held responsible,” he says. “If we don’t pull it off successfully, critics will point the finger and say, see, treatment doesn’t work.”