The Fraying Safety Net: Waging War On Addiction

Second Of Two Parts

ADDICTS GET TREATMENT -- BEHIND BARS

CHESTER, Pa. -- Two of Pennsylvania's most successful drug and alcohol
treatment programs offer intense therapy with a minimum 90-day stay,
regardless of your income or insurance plan.

That's the good news.

The bad news: To get in, you must be an inmate at the Allegheny County Jail
or the State Correctional Institution at Chester, near Philadelphia.

This is the state of modern drug and alcohol treatment. As governments have
barely held the line on public funding for substance abuse programs in
communities, they have shifted more money and attention to providing
treatment after an abuser has committed a crime. Where once the debate was
whether to treat addicts or imprison them, we now do both.

Nearly $3 million was cut from the state drug and alcohol budget this year,
but the state is spending more than $28,000 annually per inmate -- nearly
$32 million at SCI Chester alone -- for inmates' lodging, food and security
as they kick their addictions and turn their lives around. More than 60
percent of new inmates to Pennsylvania's state prisons are diagnosed with a
drug or alcohol dependency. And almost all the recent growth in
Pennsylvania's inmate population (41,347 as of April 30, up 525 from a year
ago) can be attributed to drugs and property crimes, says Jeffrey A. Beard,
secretary of the Pennsylvania Department of Corrections.

"Who are most of those committing property offenses? They're people with
drug problems," Beard said.

Jailing addicts rather than treating them before they commit crimes
"doesn't make a lot of sense," admits Allegheny County Jail Warden Ramon
Rustin.

The county program, initiated nearly three years ago by the county's Health
Department, Department of Human Services, and the jail, takes an entire
fifth floor pod in the Second Avenue facility. There, 24 inmates attend
day-long classes, participate in group counseling and learn to redirect
their lives.

It seems to be working: Only 15 percent of those completing the program
have landed back in jail, program officials say, compared with nearly 70
percent of the jail population nationwide.

The stakes are even higher at Chester, a facility built in an industrial
neighborhood near the Delaware River to provide drug and alcohol treatment
for the 1,139 inmates whose offenses range up to third-degree murder, rape
and robbery.

Program officials say fewer than 25 percent of the men have been arrested
for a subsequent crime in the 18 months after their release.

SCI Chester is Pennsylvania's only state prison dedicated to drug and
alcohol treatment, but 18 other prisons have partial programs, called
therapeutic communities, where inmates undergo intense therapy for six to
12 months. Recidivism for those completing that program has dropped 11
percentage points, according to corrections officials.

While the state and county programs use different philosophies, they share
an important common approach: effective treatment takes time.

"If you've got someone with a serious substance abuse problem, you're not
going to solve that problem in a 30-day program," Beard said. "We know that
they really have to immerse in the treatment for a long period of time, at
least three months and preferably six months or more."

Outside those walls, meanwhile, "it's pretty rare today in the community
setting to get 90 days of intensive treatment," noted Dr. Bruce Dixon, head
of the Allegheny County Health Department.

The best approach for treating substance abuse is not a settled issue, at
least in the court of public opinion. On average, addicts go through a half
dozen or more rehabs before they stay clean, and people differ on whether
addiction is more a chronic disease or the predictable result of poor
personal choices and judgment.

Michael T. Flaherty, executive director of the Pittsburgh-based Institute
for Research, Education and Training in Addictions, calls the
punishment-versus-treatment debate "ultimately a test of our character."

When someone commits a crime, whether due to an addiction or not, the
tendency is to punish, Flaherty said. Once in prison, though, that person
will do whatever's necessary to survive, which often means developing
criminal personality traits they'll carry with them after release.

"If we continue the philosophy we have, we're just going to perpetuate the
problem."

Beard agrees, saying he would like to see Pennsylvania fund more drug
courts and other diversionary programs that might combine confinement and
treatment, but stop short of a state prison cell.

"There are more than 1,100 drug courts in the U.S., starting back in
1992-93. We have 11. We're really, seriously behind the curve."

One clear advantage for jail treatment programs is their literally captive
audience.

Even if treatment programs offered free and unlimited stays, many addicts
and alcoholics wouldn't seek them out because they're convinced they don't
have a problem. At least not until the handcuffs click on their wrists.

"Is this rock bottom for me? Yeah," said David, a 33-year-old Cranberry man
serving 18 to 36 months at Chester following his fourth drunk driving
arrest (Department of Corrections officials allowed access to inmates only
on the condition that their last names not be used).

David said he started drinking heavily at age 19, after he moved into his
own apartment. He twice went through three-month rehab programs, only to
start drinking again within two months, and he sometimes drove with a
suspended license.

That ended once he realized he was going to prison. "I've changed every
aspect of my life except my family," he said. "I've learned there's a whole
lot more to life than a 12-ounce can of beer."

For now, his life begins with the 8 a.m. meeting each weekday, when the
more than 60 men in each pod gather for "morning meeting" and one by one
address the group, opening with the greeting, "Good morning, family" or
"Good morning, community."

Identically dressed in faded purple overalls with "DOC" on the back, most
of the men talk about their personal struggles. A few read poetry. When the
program ends 45 minutes later, all the men stand and recite a pledge called
the Gaudenzia House Philosophy that begins, "We are here because there is
no refuge, finally, from ourselves."

They are in therapy groups or seminars until 10:30, then meet again at 1
p.m. for therapy and a 12-step meeting. The day ends after a "family group"
meeting concludes at 7:30 p.m.

"Being here is a safe environment and I just feel myself getting healthier
here. On weekends, when I'm not in program, I'm miserable," said Corey, a
34-year-old Philadelphia man serving three to six years at Chester for
selling crystal methamphetamine to an undercover cop.

The Chester program is run by Gaudenzia, Inc., a private nonprofit drug and
alcohol agency based in Norristown, Montgomery County, which operates about
65 drug and alcohol treatment programs, primarily in central and
southeastern Pennsylvania, but also in Erie. As part of its contract with
the state, Gaudenzia provides six months of outpatient care after an inmate
is released, to try to make sure they won't fall back into old habits.

In addition to the treatment, Chester offers job training, in heating,
ventilation and air conditioning, in automotive repair and barbering. There
is also a room where inmates can construct educational games to send to
their children.

SCI Chester incorporates much of the traditional Alcoholics Anonymous and
Narcotics Anonymous 12-step approach, such as learning the importance of
support from the group and avoiding "triggers" -- people, places or things
that might tempt them to drink or use drugs.

The county jail program, run by the nonprofit Allegheny Correctional Health
Services Inc., emphasizes personal awareness -- that no matter what the
situation, an inmate is responsible for his own behavior.

"We focus a lot on cravings and craving control techniques," said Dana
Phillips, chief operating officer of Allegheny Correctional Health. "What
we say is that you have to make a conscious choice. And, if you make a bad
choice, we show you what you can do to get back on track."

The Allegheny County Jail program started in the fall of 2002 with a
$250,000 federal grant. At the time, program officials had little trouble
making an argument for need.

Between 85 percent and 90 percent of those coming into the jail have a
history of abusing drugs, alcohol or both, said Phillips. Every month, 300
to 400 new arrestees need detoxification before moving to the general
population.

Inmates must voluntarily apply for the program once they have completed
detox. The primary program involves a 90-to-120-day stay on the 5MC pod,
but there are also education groups that meet a few hours a day. At any one
time, up to 100 inmates are in some kind of program.

"There's an intensity of learning and introspection there," Phillips said.
"You have to face up to some things in life that maybe you've never faced
before."

Of all the program's merits, near the top is its sheer duration.

"It takes a long time to get people to understand they have the capacity to
take control of themselves and have the willpower to do that. Anybody will
tell you that if you could keep them long enough, you would have much
better results," said Dixon.

"It's like any behavior change," added Phillips, "whether you're talking
about weight loss or smoking cessation or exercising. A certain amount of
it comes from developing new habit patterns, new ways of doing things and
thinking about things, then doing that over and over."

The county program offers follow-up treatment after inmates' release, but
it's not mandatory and few do it -- usually because they're working night
shift jobs when they get out. The program still works, Phillips said,
because "we teach them that you need to rely on yourself, and not rely on a
group."

Everyone, from the warden to the inmates, say the individual changes are
unmistakable.

"I think at the time they'd made this decision, they'd reached a critical
part of their lives where they knew they had to do something. So that
glimmer of hope was a positive. Then, when they got into it, they realized
this was the right decision and that reinforced their effort to get well,"
said warden Rustin.

One inmate, Robert McWhite, 35, of the Hill District, said his goal was
nothing short of a life change. Running the streets, he said he's been shot
five times and stabbed three, while cycling in and out of jail the past six
to seven years.

"I was always reaching out for help. I was the kind of addict that, when I
picked up [a needle], I cried."

McWhite has family locally, "but I'm on their bad list," noting that family
members used to follow him around at holiday gatherings to make sure he
didn't steal something to support his drug habit.

"I can consider myself homeless. When I came in here, I had no clothes."

McWhite tried two different rehab programs, but there was a two-week wait
to get into a drug outreach program near him. "During that time, all kinds
of things can happen," he said. The jail program, he said, has taught him
how to avoid relapsing.

Marquis Williams of Monroeville signed up for the program without high
expectations of success. "I came up here thinking it would help me in
court," he said.

"I can't even recall how many rehab programs I've been in," he continued.
"My self-esteem was real low. I used crime to feel good about myself. This
program gives me a sense of power. I get high off of my accomplishments."

Everyone should be happy about that, Rustin said.

"Regardless of what the public thinks, they are getting out unless they're
serving a life sentence. It's important that they have some tools when they
get out. If they don't, they're going to reoffend."

Yet, when county governments run into financial problems, it's programs
like drug and alcohol treatment that are most likely to be cut, Rustin
said, because of the fixed costs associated with keeping a jail safe and
secure.

"Cutting any of these programs is scary. This county does not want to build
another $147 million facility. But if they cut the programs, they are going
to have to build another jail."