Hooked, a postscript: Treatment for addicts would be smarter than jail alone

Julia O'Malley
MARC LESTER / Anchorage Daily News

After six months following Kristin Alexander, an addict with a drug conviction, through the courts, jail, the Office of Children's Services system, probation and drug treatment, I know there has to be a smarter, cheaper way for public agencies to deal with people like her. It starts with making drug and alcohol treatment more available.

At every level, from lawyers to social workers to her probation officer, I met people who cared about what happened to Kristin. They knew that she had an addiction she couldn't control. They knew she needed treatment. But waiting lists for treatment programs were long, logistics were complicated and all of them were frustrated with a system that's expensive, inefficient and ultimately ineffective at keeping people with addictions from going back to jail.

I expected Kristin would run into bureaucratic problems and she did. Agencies don't have a good way to communicate with one another. Services get duplicated or overlooked. There isn't enough staff. There's too much red tape. Everything takes too long. But those issues were minor compared to one over-arching problem: addicts in the criminal justice system who want drug and alcohol treatment can't get it when they need it.

I'm all for criminals paying their debt to society. But as a society, we need to think critically about the money we're spending on criminals. Crime and addiction are intertwined. At least 60 percent of inmates in Alaska prisons have some kind of substance abuse problem. The majority don't get treatment. And within three years of getting out, two out of three criminals are back in jail. The prison population in Alaska is projected to grow 200 inmates a year, according to the Department of Corrections.

We could just keep putting addict-criminals in jail and build more prisons. But that's really expensive. Take the new Goose Creek Correctional Center in the Valley. Just building it costs $240 million -- around $150,000 per bed -- never mind the cost of running it.

Why not try for fewer inmates? Treating addicts can do that. Other places, including Texas, flattened growth in the prison population by diverting addict-criminals into drug treatment programs and offering treatment in jail.

Think about this: On average in Alaska, 24 hours in jail costs around $126. The same amount of time in a residential in-patient program like Akeela House, one of the most expensive types of drug treatment, costs about $93. Do the math.

It's not that simple, of course. Treatment, especially for serious addicts with mental health problems, sometimes doesn't work the first time or the second time. Heroin addicts in treatment might go a half-dozen times. But a half-dozen attempts at treatment is still cheaper than the same amount of time spent in jail.

Akeela, one of the oldest treatment centers for serious addicts in Anchorage, treats mainly people coming out of the court system. Once clients go through the program, which can last a year, a little less than a third end up back in court. That's half the recidivism rate of inmates doing jail time without treatment.

Bill Hogan, the state commissioner of Health and Social Services, told me making more treatment available for people like Kristin is a priority for the department.

"There needs to be some consequence for peoples' behavior," he said. "At the same time we need to realize that we need to have treatment available."

Addiction costs across the board. It's a factor in domestic violence. It leads children into the custody of the state because of abuse and neglect. It sends people to hospitals and jails. People need to get in to programs when they're ready to go, Hogan said, they shouldn't have to wait. He's in favor of intensive outpatient treatment, which might include a combination of half-day drug treatment and sober housing. He also likes the idea of treatment for families that includes housing and vocational programs.

Innovative intentions at the Department of Health are great. But how do we pay for it? Some federal funding should become available in 2014. Half of the $30 million or so we will be spending this year on drug treatment in Alaska comes from the state alcohol tax. Only half of the alcohol tax revenue is set aside every year for treating addiction. The rest goes into the general fund. Why not use all of it for treatment? That's a good question for the Legislature.

Another thing I noticed as I followed Kristin through the system is that prostitution is largely ignored -- and that's expensive. Anchorage has anywhere from 300 to 1,000 prostitutes, depending on who you talk to. Prostitution is a misdemeanor. Women who are picked up don't often spend much time in jail. The vast majority are addicts. They are frequently victims of violence and sexual assault.

Prostitutes get picked up for drug possession and end up in courts and jails, and many of them have children who wind up in the care of the state. They are high-risk and high-cost. Why not target them and offer treatment? A number of communities divert prostitutes out of courts and into treatment, giving them housing and vocational training. Some places pay for those programs in part with fines collected from men caught buying sex. That makes sense to me.

Another program I found that works to keep addicts from re-offending is intensive probation. Right now, if someone like Kristin who is on probation fails a drug test, they might not go right back to jail immediately. With intensive probation, a failed test or other violation brings swift consequences. They go before a judge right away. They go to jail right away. A program like this in Hawaii has had very promising results.

The state is taking some steps in the right direction. The Legislature appropriated money this year to ease the waiting lists at the state's two methadone clinics. The Department of Corrections is opening up more treatment for inmates in jail. Alaska has a small drug and alcohol court program that sets aside jail time for addicts in favor of intensive outpatient treatment supervised by the court. The program serves fewer than 100 people at a time, most who have committed alcohol-related crimes. It's working to keep some addicts out of jail and might be worth broadening.

Some people have moral objections to offering treatment to criminals, which is one reason funding for treatment has been cut by legislators. I object more to paying for things that don't work.

No matter what the state offers, addicts still have to make the effort to change. It's not easy. Not all of them will do it. Kristin's first week in treatment was a rocky one. She nearly went back to jail for good. But I'm still hoping some day I'll get to write that she got what I know she wants: to be out of the system and clean.

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