Substance Abuse Treatment
March 2004

“Too many Americans in search of treatment cannot get it.”
- George W. Bush, State of the Union Address, January 28, 2003

Delaware should capitalize on the potential for substance abuse treatment to:

• Improve the lives of citizens.
• Increase public safety.
• Reduce future requirements for more expensive prisons.

Treatment Works!
In study after study in Delaware and around the nation, drug treatment is an effective public safety alternative to building more costly prisons.  Treatment works in many environments to reduce the pressure on the prison system:  

• In the community to get people off drugs before they become caught up in the criminal justice system
• In the drug courts as an alternative path to incarceration for non-violent offenders
• Within the prison system to break the drug habit and prevent future recidivism

And It’s Cost-Effective…
Publicly Supported Community Treatment:  

• According to the Center for Substance Abuse Treatment, the average benefits of substance abuse treatment exceed the costs by 3 to 1.
• A study that evaluated the cost-effectiveness of publicly supported treatment programs in California concluded that approximately $7 in future savings costs are being gained for every dollar being spent on treatment programs in that state.

 Quality Treatment Is A Public Safety Investment 

• Average illegal income in the year following treatment was reduced by nearly two thirds among 11,750 clients entering treatment for drug abuse in 41 programs throughout the United States according to a national study. The study concluded treatment is economically effective, because the cost of treatment was more than recovered by the savings in crime reduction.
• The Department of Correction’s Key, Crest, and aftercare treatment programs for offenders are research-proven and nationally recognized.
   

      "The Delaware study shows that offenders receiving substance abuse treatment in a work release setting spend 49 fewer days in reincarceration, compared to those who only receive standard work release…”

 -January 22, 2004 press announcement of evaluation of Delaware’s Crest inmate work release program made by Kathryn McCollister, Clifford Butzin, James Inciardi, and Steven Martin.

Illicit Use of Drugs is Widespread in Delaware

40.9% of White Delawareans and 39.5% of Non-White Delawareans are estimated to have used illicit drugs at some time in their life according to a survey performed for the State’s Division of Substance Abuse and Mental Health. 

26% of Delaware’s teenage student population used marijuana during the previous month according to the Department of Education’s 2001 Youth Risk Behavior Survey, and 6% admitted ever using cocaine at such a young age. 

Such behavior places persons at health risk for addiction and at risk of becoming a criminal justice statistic.  Indeed, arrest on a drug charge is often a “teachable moment” for illicit drug users to decide to make a change…but is treatment available? 

Among those incarcerated in Delaware, Correction Commissioner Taylor has estimated that up to 80% have a treatable substance abuse problem. 

Treatment Gap Versus Shoveling Up

“There is no other medical condition for which we would tolerate such huge numbers unable to obtain the treatment they need.” 

-Secretary Tommy G. Thompson, U.S. Department of Health and Social Services
DHSS News Release, September 5, 2003

The 1999 DHSS report on alcohol and drug abuse in the State of Delaware includes information on the need for treatment for the general population (The Dimensions of Alcohol and Drug Abuse in the Sate of Delaware, Robert A. Wilson, October 1999).  Comparing those in need of treatment against those who actually received treatment the report indicates that: 

• 1of 17.8 residents of Wilmington in need of treatment received it; compared with
• 1 of 4.1 residents in New Castle County outside of Wilmington;
• 1 of 8.8 residents in Kent County; and
• 1 of 8.9 residents in Sussex County.

The report goes on to indicate that: 

• Approximately 50,000 Delawareans abuse alcohol or drugs to the degree that they manifest the clinical criteria for abuse or dependence;
• Less than 8,000 persons are treated for alcohol or drug abuse during the average year;
• About 4,000 people are treated through the State system;
• About 4,000 are treated through private or voluntary programs;
• A conservative estimate is that about 25,000 people comprise the Delaware “treatment gap”.  (p. 37)

The “gap” manifests itself in other ways as well: 

• Delaware judges often sentence offenders to incarceration because of their perception that prison-based treatment is more certain than community-based services; and yet
• Of the 14,984 sentenced releases in 2003, the vast majority received no drug treatment in spite of the fact that up to 80% have an identified substance abuse need;
• Those sentenced to treatment at the work release level (IV) often wait at the prison level (V) for an available treatment slot to open.

In terms of priorities for the State’s substance abuse expenditures according to a national study: 

• 94 % goes for “shoveling up” the consequence of substance abuse (prisons, health, welfare); but only
• 6 % is spent on prevention, treatment, research.

No Shortage of Recommendations for Improving Treatment for the Offender Population

There is a gap in alternatives to incarceration, primarily a lack of community-based substance abuse and mental health treatment beds in Delaware.  Because of these gaps in community-based supervision options, the Court has little choice but to use jail or prison for women offenders. 

- Delaware Department of Correction Female Offender Master Plan, April 1, 2000, p. 29.

Serious and thoughtful recommendations for realizing substance abuse treatment as an alternative to ever-larger Delaware prisons continue to be made.  In addition to the many research studies on effective treatment programs, those looking for solutions need look no further than reports readily available:

• Department of Correction Male and Female Offender Master Plans, April 2000 which include many treatment recommendations for reducing prison demand;
• Sentencing Accountability Commission report Sentencing Trends and Correctional Treatment in Delaware, April 2000.  This national award-winning report documents the success of the DOC Key and Crest programs and makes extensive recommendations for further improvements;
• Substance Abuse Treatment Task Force Report pursuant to Senate Joint Resolution 4, March 2002, makes systematic recommendations for improved treatment.

Substance Abuse Alternatives - Ten Recommendations for Action In 2004

1. Remove the “exclusion” from state employee health insurance that voids coverage for substance abuse treatment when it is “court directed” by any state court, including the drug court;

2. Provide parity for substance abuse and mental health coverage in insurance plans by implementing HB 100, and specifically fund the cost of parity in employee health insurance coverage;

3. Pass the Governor’s Correction treatment budget recommendations of $374,900 for drug treatment at the new Women’s Work Release Center, and $500,000 for community corrections for drug treatment for probationers (relieving need for incarceration to get treatment);

4. Pass SB 56 (Senators Henry, Blevins, Marshall, Peterson, Amick, Bonini, Sorenson; Representatives Hudson, Keeley) to reduce the loss of driving license for drug felony conviction from three years to one year, facilitating access to treatment and employment;

5.  Resolve the pending funding crisis with the drug court’s Treatment Access Committee (TASC) by the General Assembly’s raising of court fines;

6. Add performance measure (through Joint Finance Committee action) for the TASC to provide court-ordered clinical treatment assessments to the drug court judge prior to sentencing in 95% of cases;

7. Pass SB 136 (Senators Henry, Sokola, Sorenson; Representatives George, Maier, Houghton, Viola) that would provide, on a pilot basis, drug screening and treatment for low level drug offenders taken into custody;

8. Close the treatment gap for low income citizens served by the Division of Substance Abuse and Mental Health;

9. Adopt (through DOC action) American Correctional Association Standards for Therapeutic Communities to ensure that all treatment community graduates in the Department of Correction (DOC) receive transitional care and aftercare; and

10. Authorize and resource the Delaware Statistical Analysis Center (DelSAC) to annually report on recidivism of released DOC offenders to monitor treatment and other programming effectiveness.