MAKING PROP. 36 WORK - THE PRESSURE WILL BE ON

The State's New Anti-Drug Law Poses Many Challenges For Those Who
Provide Treatment.

California is about to revolutionize the way it deals with drug
addiction. Tom Avey is preparing to stock up on linens and silverware.

Avey is the executive director of Progress House Inc., which treats drug
addicts in Placer, El Dorado and Sierra counties. He plans to open a new
residential program near Placerville in response to Proposition 36. The
sweeping initiative goes into effect this week and sends non-violent
drug offenders into treatment programs rather than prison cells.

It's one thing to conceive a grand new approach to drug abuse, quite
another to find cheap couches, build wheelchair ramps and refurbish
kitchens to accommodate addicts.

"You'd be amazed how much money you spend on just bedding," Avey said.

The initiative approved by 61 percent of voters in November left many
questions unanswered, and its success will rest in the niggling details
being addressed by people like Avey.

"We've made all these plans based on all these numbers, but who knows?"
said Trisha Stanionis, executive director of The Effort Inc., which will
treat Proposition 36 offenders in Sacramento.

It's uncertain whether this new group of treatment-sentenced offenders
will have the same needs as the addicts traditionally seen by drug
programs. A significant number may not even be addicts.

"Everything is speculation at this point," said Joan Parnas, deputy
director for the Yolo County department that deals with drug treatment.
"We have an educated guess of how many people, but we don't know what
level of care they're going to need."

Many programs are making plans to expand, and new ones are starting. But
it will take time - perhaps years - for the treatment capacity to catch
up with demand, particularly in residential programs that take longer to
get going.

All this new treatment is expected to do nothing to alleviate
significant waiting lists for existing drug programs. And drug
counselors are likely to be in shorter supply.

Counties, meanwhile, are taking on the burden of deciding which programs
pass muster for treating offenders - and feeling the heat should these
programs go astray.

There's a lot riding on the outcome. The people who treat addicts know
the pressure will be on to show results.

"We better make sure that treatment works, because if it doesn't, in a
few years the voters are going to say, 'We gave you treatment and now
look,' " said Tim Smith, who runs drug programs in San Bernardino and
San Diego counties for Mental Health Systems Inc.

From almost the day Proposition 36 passed, drug treatment programs have
been gearing up.

Since Nov. 7, the number of applications to the state Department of
Alcohol and Drug Programs for licensing or certification has roughly
doubled. Licensing has long been a requirement for all residential
programs. Certification has previously been optional but is now required
for outpatient programs that see Proposition 36 offenders.

Many of the applications have come from outpatient programs that have
been around for years. Others are brand-new.

Most are nonprofits, but roughly one in five are profit-making
businesses. The applications as of mid-May had come from 37 of the
state's 58 counties, including eight from Sacramento, two from Placer
and one from Yolo.

Many of these programs will never get the chance to treat Proposition 36
offenders. It's up to counties to choose which ones do.

Some counties are doing this through a formal process, requesting
proposals that meet certain criteria and picking the winners. Others
will continue using programs that already handle referrals from the drug
courts and drug diversion programs.

In Sacramento, three programs that already had been taking clients
referred by courts were chosen to handle the Proposition 36 outpatient
cases.

One was The Effort, which runs a nondescript outpatient clinic on J
Street in downtown Sacramento. It consists of a warren of rooms for
group and individual counseling - inviting couches, VCRs for educational
videos and easels holding pads scrawled with advice on subjects such as
how to avoid drug-using friends.

"Never give up," says a sign hung on a wall.

The Effort and its partners offer a curriculum that follows the norm in
drug counseling: identifying the triggers for substance abuse,
developing coping skills, learning how to communicate and assert
yourself. The approach of 12-step programs such as Alcoholics Anonymous
is available, but not all addicts respond well to it, so it's not
required.

The Effort, like its partners, is setting up a desk for a county
probation officer to help monitor the Proposition 36 clients.

Sacramento County expects a 37.5 percent increase in the demand for drug
treatment because of Proposition 36, adding up to about 2,100 slots.

The Effort's outpatient program expects to see about 700 of them a year,
as many as 150 at a time. Because most clients come in for only a
session or two a week, The Effort is not expecting a space crunch.

"It's not like I have to have a room for 500 people," Stanionis said.

One of The Effort's partners is the National Council on Alcoholism and
Drug Dependence, on Ethan Way.

Program administrators already have talked to the landlord about moving
into the offices across the hall, said Kathe Pratt-Russell, chief
executive officer in the Sacramento office.

Pratt-Russell figures she eventually will have to hire eight or nine new
counselors. But like many such programs, the National Council on
Alcoholism and Drug Dependence is taking it slow and sizing up the
Proposition 36 caseload. Only a supervisor, a counselor and an assistant
to handle phone calls will be hired in the first month.

"We're being very cautious," Pratt-Russell said.

For residential programs, growing won't be so simple. They must prepare
living quarters for their clients and usually need permission from local
governments.

"Everybody thinks our services are essential and wonderful as long as
it's not next door to them, and that's going to be the challenge of
Proposition 36," said Avey, the Progress House director.

Avey knows firsthand. In 1999, Avey attempted to expand a treatment
center for addicted women and their children in Alta. Three hundred
people protested at a Placer County Board of Supervisors meeting and his
proposal was rejected.

In Gardena last month, neighbors organized a campaign against a 125-bed
substance abuse treatment center for women and their children in a
building that had been vacant for 10 years. The center expected to treat
some Proposition 36 offenders. The City Council rejected it.

Yolo County avoided the whole issue of getting approval for a new site.
It expanded a county-run residential detoxification program, putting
four beds in one of the program's group therapy rooms, county
administrator Parnas said.

The resistance from neighbors will have an effect statewide, according
to Bill Demers, president of the County Alcohol and Drug Program
Administrators Association of California. "The residential capacity is
going to lag," he said.

Some don't see that as a huge problem because for most Proposition 36
offenders, outpatient treatment makes the most sense.

"A lot of counties are going to do outpatient because it's faster and
easier, but it's also where the majority of patients need to be," Demers
said.

But others believe residential treatment is an important option whose
use will be severely constrained by capacity and cost, with counties
forced to skimp to stay within the $120 million annual Proposition 36
budget.

"A high proportion of the treatment will need to be outpatient services,
even though the severity of the drug problems may be more intense among
the Proposition 36 clients," according to a RAND Corp. report released
before the initiative was approved. The report concluded that the costs
of treatment, probation and courts could well exceed the $120 million.

Counties will have to fret not only about cost but also about quality.
It will be up to the counties to ensure that not just anyone can start
treating Proposition 36 offenders.

But some counties will likely have to allow mediocre programs to open
and expand in order to maintain enough treatment slots.

"In some cases, we try to work with the programs that are not so hot to
give them the technical assistance and try to get them up to speed,"
said Demers, the president of the county administrators association.
"We're interested in expanding capacity and bringing providers into the
fold."

Still, Demers believes that counties overall will be able to protect
quality.

"We're closest to the program," he said. "We're in the communities
they're serving. We're the ones their Uncle Joe calls (if there is a
problem)."

Others are less sanguine.

"We are depending on 58 different counties to have contract negotiators
and evaluators that are fully up to speed to answer these questions,"
said Sue North, spokesman for state Sen. John Vasconcellos, D-Santa
Clara.

Several of the state's largest counties, including Sacramento, are
dangerously unprepared to handle the Proposition 36 flood, according to
the Lindesmith Center-Drug Policy Foundation, a nonprofit drug policy
reform organization that is monitoring the implementation.

The organization graded 11 counties according to how much money was
going to drug treatment as opposed to probation and court costs, the
spectrum of treatment, whether public health professionals and the
community as a whole had been included in planning. Sacramento got a D,
the second worst grade. Although the county got high marks for a variety
of treatment options, it flunked on the share of money going to
treatment and the community involvement.

Many of the programs that will handle Proposition 36 offenders are
well-known to their counties and the state, having been in business for
years. A review of state records indicates that several of the programs
that have applied to the state for licensing or certification, or have
been chosen by counties to handle the Proposition 36 caseload, have run
into minor problems in the past.

State inspectors, for instance, found that a Progress House staff member
had an "inappropriate relationship" with a resident. Director Avey said
the staff member was a volunteer who did maintenance work, the
relationship was not sexual, and the volunteer stopped working when the
relationship was discovered.

The state found that the program director dealt with the incident
appropriately and required no further action.

In 1998, the state found that The Effort's residential program had only
one person working the night shift on some nights, when two were needed.
Director Stanionis said a worker was on disability leave, the shortage
was temporary, and the program was not operating at full capacity. The
following year, inspectors found that there had been faulty plumbing and
air-conditioning.

All complaints were dealt with promptly and didn't result in fines or
require further action, Stanionis said.

Other programs slated to get Proposition 36 clients have been cited for
allowing drunken people on the premises or failing to give clients
leaving the residential programs referrals for follow-up help.

But being in the drug treatment business means dealing with complaints,
Stanionis said, and that some are substantiated shouldn't detract from
years of positive outcomes.

"If you don't ever get complaints, you're not treating enough people,"
she said.

Another big unknown is the availability of drug counselors. Little is
known about the overall characteristics of the work force, how much
they're paid, their education, where they live. Counselors are not
licensed or certified by the state.

Several community college districts issue degrees in substance abuse
counseling. Other counselors are recovering addicts who have learned
through experience.

That network is expected by many to be stretched thin with the new
demands of Proposition 36.

Ideally, as demand increases, more people would become counselors.
"Sometimes, it actually does work that way," said Dan Carson, lead
analyst for Proposition 36 in the nonpartisan Legislative Analyst's
Office.

"But it's not always as easy as that," Carson said. "These labor
bottlenecks do occur."

Existing programs may have a leg up, because they already have networks
for recruiting counselors, such as contacts at the community college
programs.

"It's not hard to find them if you know where to look and offer an
attractive package," said Pratt-Russell of the National Council on
Alcoholism and Drug Dependence.

And with the economic downturn, Stanionis said, some people may be
looking to embark on new careers. The Effort depends on word of mouth
and recruiting from colleges.

"It's always hard, but not impossible," Stanionis said.

Perhaps the only thing certain about Proposition 36 is that this week a
lot more people will be getting some sort of treatment from some sort of
counselors in some sort of programs.

"Let's say there's been a 20-foot fish net catching people who need
treatment," Avey said. "It just got 30 feet wide.

(CHART) Existing Drug Treatment Programs In California

Beginning Sunday, California embarked on an experiment in which people
convicted of drug crimes will be sentenced to treatment instead of
jail. Before Proposition 36, the state averaged 25 monthly applications
for certification and licensing annually for residential and
nonresidential programs. In the five months following Proposition 36's
passage last November, the volume has more than doubled, to about 53 a
month.

Certified Sites: 1993-94 1999-2000 % Change
Residential: 386 425 10.10%
Nonresidential: 265 373 40.75%
Total: 651 798 22.58%

Licensed sites: 1993-94 1999-2000 % change
Residential: 561 672 19.79%
Capacity: 12,711 15,927 25.30%
Complaints: 173 212 22.54%

Detox and methadone: 217 146 -32.71%
Capacity: 26,339 39,312 49.25%
Complaints: 2 2 0%

Source - California Department of Alcohol and Drug Programs, 2000;
Sacramento Bee / Mitchell Brooks