Pubdate: Sun, 13 Jun 1999
Source: Standard-Times (MA)
Copyright: 1999 The Standard-Times
Author:  Timothy Egan, New York Times News service


With prisons bursting at the seams, treatment is making a comeback

PHOENIX -- A thief, a burglar, a gang member, a drug dealer and a mother
stepped into a windowless, brick-walled room here one recent afternoon,
stripped of their pride and any material possession that made them somebody
outside that room.

They were drug addicts in treatment, and each of them might well have been
in prison under federal law and the statutes of most other states. But in
defiance of Arizona's political establishment, voters took the law into
their own hands and voted twice, by large majorities, to make their state
the first to mandate treatment instead of prison for criminal offenders
whose primary legal problem is drug use.

So five people sat in that ground-floor room, talking about how tough it was
to keep away from the pills, powder and smoke that formerly dominated their
lives. Several had been heavy users of crack cocaine, once characterized as
so addictive that its users were beyond help. Each of the five has tested
clean for drugs.

"Believe me, this is harder than jail," said Albert Delatorre, the former
gang member who would have faced up to five years in prison before the new
law mandated treatment. "It's been a struggle. But treatment has helped me
become a man. I've grown up." He is 22.

A dozen years after the national alarm over crack hastened the decline of
drug treatment in favor of punitive laws that helped create the world's
largest prison system, anti-drug policy is taking another turn. Treatment is
making a comeback, driven largely by a grass-roots revolt.

Arizona has taken the boldest step, but at least 40 states have set up drug
courts to steer offenders toward treatment instead of jail. A number of
states are considering changing their mandatory prison laws for drug
offenders, most notably New York, which was the first to require long
sentences for possession of small amounts of drugs 26 years ago.

In the crack years of the 1980s, treatment programs were gutted while the
drug-fighting budget quadrupled. News reports said crack was the most
addictive substance known to man, and prisons started to fill with people
who once might have gotten help instead. The number of Americans locked up
on drug offenses grew from 50,000 in 1980 to 400,000 today.

Yet even during the height of the prison boom, when some people were
sentenced to life behind bars for possessing small amounts of a drug, a
number of treatment centers continued to have success.

While not all addicts respond to treatment -- some studies show that a
majority fail, usually in the first month -- these programs showed that
crack was less addictive than some other street drugs, or even nicotine, and
that many of its users responded to conventional group therapy. Habitual
users of crack, according to a five-year federal survey of treatment
published last year, showed greater success at staying clean than

"It was simply nonsense, this notion that crack addicts were untreatable,"
said Dr. Mitchell Rosenthal, the president of Phoenix House of New York, the
nation's largest private, nonprofit drug treatment institution, which has
worked with more than 75,000 addicts over the last 30 years.

Some of the experts who called crack the worst drug of all have done an
about face.

"I've changed my view because of the data that has come in over the last 10
years," said Dr. Charles O'Brien, chief of psychiatry at the Veterans
Administration Medical Center in Philadelphia, who in the late '80s
described crack as "by far, the most addictive drug we've ever had to deal

What changed his mind were national surveys that showed 84 percent of people
who tried cocaine -- either smoking it as crack or inhaling it in powder
form -- did not become addicted. He said he had also been swayed by a study
he co-wrote of habitual users of crack who were assigned to treatment. A
year after treatment, at least half tested free of drugs. "It turns out that
many people can, and do, stop using crack -- even those who were addicted to
it," O'Brien said.

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Locking up crack users is still the policy in the federal system. A person
caught with 5 grams of crack -- worth about $125 on the street -- and
prosecuted under federal drug laws faces a mandatory five years in prison if
convicted. Crack is the only drug that carries a mandatory prison term for

But in Arizona, because of a voter initiative, the same crack user
prosecuted under state laws cannot be sent to prison. Instead, he must
undergo drug treatment. The money for treatment comes from the offenders
themselves and from a tax on liquor.

Many states have adopted similar policies by establishing drug courts, which
sentence people to treatment as a way to keep them out of jail. Started in
Miami by judges and prosecutors frustrated by the conveyer-belt justice of
the war on drugs, these courts have grown from a handful at the start of the
decade to nearly 600 nationwide. More than 90,000 people have been sent to
treatment through drug courts.

In recent months, even some of the most punitive states have turned away
from imprisoning all drug offenders. The Legislature in Washington, a state
that helped start the policy of life in prison after three convictions,
recently passed, 97-0, a bill that would give judges discretion to send
addicts to treatment instead of jail.

Louisiana, which trails only Texas in the percentage of its population in
prison, has embarked on an ambitious drug court program, led by prosecutors
and judges who say their jails can take no more people whose only crime is
drug use.

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Drug courts have sprouted throughout New York, New Jersey and Connecticut,
though the basic laws on mandatory sentences for a host of drug crimes have
not changed. In many cases, it is prosecutors who have discretion to send
offenders to treatment, instead of filing charges that could lead to jail

"Drug courts work," said Judge John Schwartz, chief of the city court system
in Rochester, N.Y. "They treat the underlying disease of addiction. Prison
does not break the cycle of addiction."

While critics say the drug courts coddle chronic abusers who belong in jail,
the cost savings have won over many others. Treatment instead of prison
saves about $20,000 per person annually, according to a study last year by
the National Center on Addiction and Substance Abuse at Columbia University.

Gen. Barry McCaffrey, the director of national drug policy, has become a
promoter of drug courts, saying they "constitute one of the most monumental
changes in social justice in this country since World War II." After three
years as the drug czar, McCaffrey has concluded that treatment is the best
way to reduce drug use.

The Clinton administration has increased financing for treatment by 17
percent over the last four years. But President Clinton's drug-fighting
budget, at $18 billion, the biggest in history, still directs nearly
two-thirds of the money to enforcement and interdiction of the drug supply,
a proportion unchanged since the Reagan administration. Treatment will get
about $3 billion from the budget.

According to the General Accounting Office, the research arm of Congress, 70
percent of the people sent to drug courts successfully complete treatment.
People who are sent to prison instead of treatment are four times as likely
to commit another drug crime within five years of release, the report found.

"Drug treatment programs are like Madonna -- they keep reinventing
themselves after everyone has written them off," said Barbara Zugor,
executive director of one of Arizona's oldest treatment centers, the
Treatment Assessment Screening Center.

On Ms. Zugor's office wall are pictures of her with the nation's drug czars
through the years, from William Bennett, who advocated locking up casual
users, to McCaffrey, who says he has dropped the term "drug war" as

Looking at the pictures, Ms. Zugor said drug policy had essentially gone
full circle, from the hope of early treatment years to a harsh period of
prison-building and zero tolerance to a trend toward treatment but with a
coercive element.

"For all the money we've spent as a country, we haven't really had a good
debate on what works," she said. "I do know this, though: Law enforcement
and the courts and prosecutors seem to be awfully tired of picking people up
and sending them off to jail."

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Arizona might seem an odd state to turn the table on American drug policy.
Its voters are generally conservative and definitely not soft on crime. For
years, the state's imprisonment rate has ranked among the top. And under the
state's basic drug laws, it is a felony to possess even the smallest amount
of drugs like marijuana.

In the last five years, the prison population has ballooned by 50 percent,
to 26,000. State officials say drug and alcohol abuse are at the root of the
crimes of about 75 percent of the inmates, matching national surveys.

Arizona used to proclaim zero tolerance toward drugs, a policy publicized
with scare commercials showing graphic images of prison life. A tent camp
for prisoners -- nicknamed Camp Arpaio, after the tough-talking Maricopa
County Sheriff Joseph Arpaio -- was perhaps the most visible symbol of crime
and punishment in the Grand Canyon state.

But in 1996, retired millionaire Joseph Sperling started a political
rockslide that is still sending down stones. Sperling, who is 78 and calls
himself a lifetime student of British empiricism and economic history, made
his fortune by building a university system for profit and then taking
public the company that ran the system, called Apollo. But he was not ready
to retire.

"As a social scientist, I thought the drug war was one of the most
disastrous public policies I'd ever encountered," he said in an interview
from Vienna, where he was vacationing. "Three years ago, I was talking with
some Arizona politicians, and I said, 'We ought to reform the drug laws."'

Sperling was particularly incensed by how crack had been depicted in the
press and by policy-makers as something that turned people into robots or
animals. A front-page article in The New York Times in 1988, for example,
reported alarm among drug experts: "Once people become addicted, these
experts say, it is nearly impossible for them to stop using crack and never
go back to it again."

Sperling said, "It was the same thing people said about marijuana-crazed
blacks back in 1914," when the first major federal anti-drug laws were

Joined by philanthropist George Soros, who has spent millions of dollars on
efforts to overturn drug laws in several states, Sperling became a principal
financial backer of a 1996 initiative to change Arizona's drug laws,
Proposition 200.

Virtually the entire Arizona political establishment, the press and major
national anti-drug leaders campaigned against Proposition 200. Its most
controversial part could have made drugs like heroin, LSD or marijuana legal
for medical purposes when prescribed by two doctors.

But a less-discussed provision mandated treatment instead of prison for
certain nonviolent offenders, mainly criminals whose core problem was drug

Proposition 200 passed by a 2-1 margin. Then the state Legislature amended
the measure, saying voters had committed a grave error. But then supporters
of the original initiative put it up for another statewide vote in 1998 and
again it passed, with a 57 percent majority.

"It was a dirty little secret that most people understood -- the drug war
had failed," Sperling said. "The people were way ahead of the politicians on

The part of the law that allowed doctors to prescribe major drugs has been
effectively halted by federal restrictions on the medical use of such drugs.
But the treatment provision was quietly put to work more than two years ago,
and early results show that three-fourths of the people who complete
treatment test clean for drugs afterward.

Proposition 200's requirement that offenders get treatment instead of prison
infuriated Rick Romley, the prosecutor of Maricopa County, which encompasses
Phoenix, because he believes that the threat of punishment is essential.

Under a county treatment program called "Do Drugs, Do Time," drug users are
threatened with jail if they do not agree to accept treatment. Using this
coercive approach, the program has been very successful, said officials at
the prosecutor's office, with a recidivism rate of less than 10 percent.

"We believe strongly in treatment," said Barnett Lotstein, a special
assistant to the Maricopa County prosecutor. "We're not 'lock 'em up and
throw away the key' people. But you have to have something to hold over
people, a hammer if you will."

Asked about the view of experts in the 1980s that crack addiction was
untreatable, Norman Helber, Maricopa County's chief adult probation officer,
said, "We seem to have an awful lot of ex-crack addicts in Arizona who could
tell you otherwise."

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Richard Nixon was the first president to declare a "war on drugs," but he
also directed about two-thirds of all federal anti-drug money at treatment
and prevention -- particularly of heroin addiction -- with great success, as
measured by sharp drops in crimes committed by drug addicts. His policy, led
by a young psychiatrist, Dr. Jerome Jaffe, expanded federally financed
treatment facilities from 6 in 1969 to more than 300 in 1973.

"What worked for Jerome Jaffe a quarter-century ago could be just as
effective today," wrote Michael Massing, in his narrative history of drug
policy, "The Fix" (Simon & Schuster, 1998)

Discouraged by news accounts of addicts who had skipped out of treatment,
New York Gov. Nelson Rockefeller became one of the first major politicians
to turn against treatment. "Let's be frank," he said in a 1973 speech. "We
have found no cure."

Rockefeller created some of the nation's most punitive drug laws, which
locked people up for 15 years for possessing certain drugs.

For the next 20 years, the dominant sentiment among politicians and
prosecutors was that "nothing works," and treatment fell out of favor --
particularly in the crack years.

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Ever since his mother handed him a marijuana joint laced with opium at the
age of 10, said Leslie Angle, he has had a companionship with illegal drugs.
He is 39 now, gray haired, with a bit of a slouch.

"Crack is the one drug that made me see that I needed help," he said. "I hit
my bottom with that drug." He was homeless, stealing to stay high, selling
stolen property. He has been in and out of jail a half-dozen times for a
variety of petty crimes, all of them tied to his drug addiction.

Angle entered the Proposition 200 treatment program in Arizona early last
year and pays about $40 a week, using money from Social Security disability
payments for mental illness. Like others in treatment, he attends about two
sessions of group therapy a week, led by a licensed counselor.

There is no acupuncture. No synthetic substitutes such as methadone. No
shock therapy or drugs designed to mute the brain's pleasure impulses. The
treatment is aimed at getting Angle to recognize the patterns of abuses in
his life.

"This teaches me things I didn't know before," Angle said. "I'm tired of
just stumbling along through life -- sick of everything I became. This
program has taught me that I have a choice: that I can change."

In New York, Phoenix House admits about 1,000 people every year to a
residential treatment program. Many of them might otherwise go to prison
under the state's Rockefeller drug laws. The laws give judges no choice but
to sentence offenders to jail, but prosecutors often decide not to press
charges if an offenders agrees to stay in a program like Phoenix House.

New York Gov. George Pataki, a Republican, has suggested that his state's
harsh anti-drug laws could be amended to give judges discretion to send some
first-time offenders to treatment instead of jail. Critics say his proposal
is too modest, but Democrats, concerned they would be labeled soft on drug
crime if they agreed to the changes, have refused to act upon it.

A majority of the people who enter Phoenix House identify crack as their
primary drug. Treatment involves extensive group therapy for 12 to 18
months, paid for by state and federal grants, or donations. For people who
are used to instant gratification, Phoenix House is a long, slow process --
a prospect that makes many addicts balk at entering on their own.

But the program's results defy the predictions that crack addicts would
prove untreatable. About 70 percent of those who complete at least a year of
the program have tested drug-free up to five years after departing, said Dr.
Mitchell Rosenthal, the president of Phoenix House.

"Crack and me were like best friends," said Danny Servera, a 31-year-old New
Yorker who has been in treatment for eight months. He is a natty dresser who
used to manage a men's clothing store. This is his second time in treatment
for crack.

"I never woke up in the morning with the shakes or anything like that,"
Servera said. "For me, it was always mental. I'd start to think about
getting high as a way to numb myself."

Treatment is built around the person, not the drug. It involves rebuilding a
life, in contrast to prison, where the concept of rehabilitation has been
all but abandoned.

"There's a growing number of us who never walked away from the belief that
the key to bringing down drug use is trying to change behavior," said
Barbara Broderick, who administers the drug treatment fund for the state of
Arizona. "Prison should be for violent people and the recalcitrant."

Prison is where most hard-core drug users who have run afoul of the law now
reside. More than 90 percent of them have had no treatment for the
addictions that got them in prison, where drugs often remain freely

Locking up these people, in the view of some criminologists, is a main
reason why crime is down. But as many of the nation's 400,000 imprisoned
drug offenders are released in the coming years, they are likely to follow a
pattern that has already taken hold: the ones who have not been treated --
the great majority -- will commit another crime within five years.

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