FOCUSING ON REHAB, NOT INCARCERATION

Florida Could Benefit

This November, voters may be asked to amend the Florida Constitution
to give rehabilitation priority over imprisonment for drug offenders.
California and Arizona have approved similar initiatives. Michigan and
Ohio might, too.

So, does rehab work? The question was pursued at length in a recent
New York Times Magazine article. The conclusion was "yes and no," or
"it depends on what 'work' means."

Something, obviously, has to slow Florida's incarceration juggernaut.
The so-called drug war's political, bureaucratic and corrections
constituency has more sway over the governor and legislators than do
even proponents of public education. A politician would rather be
called anti-education than soft on crime.

At this time, more reasonable drug laws seem unlikely. The November
initiative would not lessen the inequities but it could substantially
lessen their cost.

An addict's single trip to the emergency room can cost as much as a
month in rehab, the Times reported. Moreover, jail time can be easier
than rehab for repeat offenders, and experts dismiss in-jail rehab as
no more effective than incarceration alone.

But, does rehab work? It does not work under conventional medical
definitions of "treatment," as if someone were being treated for
diabetes or hypertension. Like diabetes and hypertension, though, the
"re" is no long-lasting magic pill. The most effective "treatment" is
a change in behavior.

Like diabetes and hypertension, relapse not only is common but might
as well be a symptom. We don't know why those afflicted so desperately
crave what gets them in such trouble.

Rehab works better when the addiction is diagnosed. That is, certain
rehab programs work better for heroin addicts than for cocaine
addicts. Yet another approach is more effective in overcoming
addiction to methamphetamine, or to painkillers.

Unfortunately, treatment centers, overall, are not that sophisticated.
They are pressed to take anyone and apply a one-size-fits-all program.
Amending the Florida Constitution would increase that pressure.

The rehab industry largely is unregulated. Its track record is poor
unless followed up by a sustained abstinence program such as
Alcoholics Anonymous.

From a public safety and budget perspective, however, rehab seems to
work, or at least pay off.

"Although addicts may relapse, a year after treatment their drug use
decreases by 50 percent ... and their illegal activity drops as much
as 80 percent," the Times reported. They are also less likely than
before to require emergency room care or be on welfare.

That's a strong argument for change, and a strong indictment of
wasteful Florida legislators for not doing it themselves.