DRUG TREATMENT TAKES TIME TO SUCCEED

Relapses Are All Too Common Among Addicts

If there's anything backers and opponents of Proposition 36 agree on, it's
that most of the drug treatment funded under the measure will fail -- at
least in the short term.

Many of the measure's most ardent defenders are quietly trying to dampen
expectations that its hundreds of millions of dollars in counseling
services will help addicts kick their habits fast.

Get used to failure, they say. In California and across the nation, the
vast majority of people getting treatment relapse into drug use after
leaving the programs.

All too typical is actor Robert Downey Jr., who has made countless
headlines for his repeated drug-possession arrests despite stints of treatment.

"Downey has the same problems as people who have much, much less going for
them in terms of money and support," said Barbara Garcia, the San Francisco
Public Health Department's director of Population, Health and Prevention.

"Proposition 36 won't change that. . . . It's perfectly normal for people
to relapse one or many times," she said.

Exactly how many people relapse is a mystery. No one keeps such statistics,
say officials of the federal, state and county governments. It would be too
complicated and expensive to try.

Garcia declined to estimate San Francisco's rate but suspected that it far
exceeds 50 percent.

In fact, Proposition 36, which received 61 percent of the vote in November,
explicitly states that none of the measure's $120 million annually for
treatment may be used for urine tests, which are used to check whether drug
users have relapsed. The measure's authors said the ban is necessary to
ensure that counties spend the new funds on treatment, not probation costs.

Critics say relapsing is Proposition 36's dirty little secret.

"Overall, treatment has failed," said Kern County District Attorney Edward
Jagels, a leader of the campaign against the ballot measure. "I expect that
additional treatment that is woefully underfunded, as it is in Proposition
36, will prove as inadequate as it has until now."

Jagels' argument makes some people livid.

"It's ridiculous to expect instant recovery," said Steven Loveseth, a
substance abuse program manager and chair of Contra Costa County's task
force to oversee implementation of Proposition 36.

Loveseth said his own experience is proof that the demons of addiction
cannot be shaken easily. A former heroin addict, Loveseth went through five
bouts of treatment over a period of several years, relapsing again and
again into drug use until he went permanently "clean and sober" in 1983.

"I'm a great success story, but people could look at my five times in
treatment and say, 'Oh, those programs failed, they're no good.' But they
didn't fail. They arrested my acute disorder. I didn't walk out of there
with all the tools I needed to go clean, but it was a start," Loveseth said.

"Addiction is cunning, baffling and powerful. (Ending it) is all about
patience. I still occasionally sit in on a 12-step (Narcotics Anonymous)
program, and one guy said to me, 'While I'm here in the group treating my
disease, it's out in the hallway doing push-ups.' "

Among health authorities throughout California, consensus is growing that
treatment providers should not pressure drug users to go clean immediately;
instead they should try to prevent acute problems -- overdoses, skin
infections, HIV and hepatitis. Such a strategy, known as "harm reduction,"
was adopted last September as official policy in San Francisco, the first
city nationwide to do so.

Harm reduction advocates say its benefits are much more important than just
getting people to stop drugs.

"For example, if you have an injection drug user who winds up in an
emergency room with flesh-eating necrosis, that could cost the health
system anywhere from $10,000 to $100,000," Loveseth said.

"But if you open up a methadone program, where a doctor is there to say,
'Hey, let's look at your arm,' if you get people to use less drugs, if you
give them information, if you tell them 'Don't share your works (needles),'
then they won't show up in your emergency room anymore. They may still
continue to use drugs, but they won't have to go out and steal. On a fiscal
basis, whatever you spent on harm reduction are dollars well spent."