After 'Rock' Reform: What Happens To Rehab?

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Now that New York state's Rockefeller drug laws have been reformed, mandatory prison sentences no longer come with convictions for any but the highest level of non-violent offenders found guilty of drug possession. Now judges can send drug addicts who would have gone to prison to treatment programs instead. Viewing addiction more often as an affliction rather than a crime – better treated through rehabilitation than confinement – will mean a stream of new clients at drug rehab centers, which are planning for the influx.

Under the reforms, an additional 1,000 to 2,000 offenders per year could be diverted from prison to drug treatment, raising questions around the state about how to handle the increased caseload. Gov. Paterson recently announced the creation of a group called ACTION – the Addictions Collaborative to Improve Outcomes for New York – a council of commissioners from 20 state agencies as well as the nonprofit and private sectors. Its mandate is to identify “ways in which statutes, regulations, rules and policies may be revised in order to promote addiction prevention, treatment and recovery efforts.”

Accompanying the planning group is an additional $50 million appropriation for treatment to be disbursed through the state Office of Alcoholism and Substance Abuse Services (OASAS,) which regulates and certifies all operating drug treatment centers in the state. Over 1,500 certified treatment centers work with an estimated 110,000 New Yorkers every day. The state currently spends close to $2 billion annually – across a number of agencies – on substance abuse, treatment, and recovery, and the new funding is an addition to OASAS’ current $713 million budget. The $50 million will be distributed over the next three years to help build and improve residential and outpatient capacity, to help treatment networks to meet the increased demand that's anticipated.

OASAS Commissioner Karen Carpenter-Palumbo praised the changes to the Rockefeller laws, congratulating the governor in an interview for “leading the country,” calling the changes a “landmark reform.” Carpenter-Palumbo expressed confidence that the additional funding would cover increased use of the treatment system, saying, “I’m confident we have the resources we need to make it real.”

While recidivism for those who successfully finish a course of treatment is on average far lower than for those who have been imprisoned, the commissioner called addiction “a chronic illness.”

“There is no magic bullet,” she said. “Some people do relapse.”

It is organizations like Phoenix House that will be recipients of the additional funding. Phoenix House is a network of treatment centers spread across nine states, including New York. It runs more than 120 programs for drug and alcohol treatment and prevention and serves about 7,000 individuals every day, treating everyone from adolescents to the homeless; in New York alone it serves 2,400 individuals per day.

Norwig Debye-Saxinger, vice president and director of public policy and government relations at the New York office, said it's too early to tell what effect the changed policies will have on his organization. Of the increased funding, he said, “Percentage-wise it’s not a big increase, but it’s hard to tell how many additional people will be diverted.” Debye-Saxinger has heard estimates ranging from as few as 600 to as many as 3,000 additional offenders entering treatment.

As rehab facilities acclimate, OASAS may be urged to consider temporarily waiving space regulations to help increase capacity faster. “The only regulations that might need tweaking are the physical plant standards that require a certain square footage per client,” he said, suggesting that returning to the lower standard from before 2002 would help build additional treatment space faster.

Working in an advisory capacity to ACTION will be the National Association of Drug Court Professionals, who help in the training, startup, and organization of drug courts across the country. Judge John Schwartz, founder of New York’s first drug court in Rochester and former chairman of the drug court association's board, reached out to the governor to be a part of the council in helping with ACTION. Schwartz says that while New York has a drug court for every county – one of the largest systems in the country – he anticipated that his group would be advocating to improve and expand the drug court system. “Everyone who fits the criteria should be given the opportunity” to be assessed for treatment, he said.

Drug courts function as the intermediary between the criminal justice system and the drug treatment network, strategizing side by side with treatment professionals to determine the best course of action for those diverted from prison. “It’s not the normal courtroom that one thinks of,” Schwartz said. “It’s really a treatment court. Treatment services are provided right through the court system.”

Schwartz said increasing the capacity of the drug court system, making more courts, making them larger, and thus making them able to divert more people from prison would actually save the state money. “It costs about $6,000 for a drug court placement compared to $30,000 for staying in prison,” he explained.

Dr. David Deitch, senior vice president and chief clinical officer of Phoenix House, explained his concerns for those in need of treatment but already imprisoned. He called the Rockefeller reforms “enlightened legislation” but warned that the effort could be “tossed on its rear end if indeed people are released and commit crimes simply because they are returning to a lifestyle of drug-seeking and drug-taking behavior.”

Deitch was adamant that a part of preventing this sort of cycle would be treatment options for those nearing the end of their sentence. He said, “Providers like Phoenix ought to be given the opportunity to case manage those who are due for release” – thus helping an individual re-enter society and deal with issues like welfare, mental health, employment, housing, and family reunification.

This is the sort of cooperation with the prison system that Deitch and others would like to see expanded even further by the ACTION council, particularly for those individuals who may achieve retroactive release if their crimes fall under the guidelines for a diversionary treatment program. The transition of taking people out of prison and into treatment can be a difficult one, he said. “Most offenders after years in prison are not interested in being committed to a mental health program.”

Deitch is not the only one thinking long-term. When discussing aftercare and case management, Commissioner Carpenter-Palumbo made it clear that effective drug treatment was a long and involved process. “The science tells us that after any treatment involvement, the person has to maintain contact [with the program] for at least one year, many even longer. The reason they say 'one day at a time' is that it is truly one day at a time.”

– Casey Samulski