March 2007

Grant Results

SUMMARY

In separate studies conducted from 2001 to 2002, researchers at the RAND Corporation and at the Public Health Institute collected and analyzed data related to the implementation of California's Proposition 36, the Substance Abuse and Crime Prevention Act.

The act, which was implemented in July 2001, diverts large numbers of nonviolent drug offenders from incarceration to treatment programs.

Key Findings
The RAND researchers reported that:

  • Criminal justice clients were a large component of the population served in the public treatment system prior to Proposition 36 implementation.
  • These clients were more challenging to treat, more likely to be methamphetamine users and more likely to use expensive residential treatment than the clients served outside the criminal justice system.

The Public Health Institute researchers reported that:

  • California's public drug treatment system is heterogeneous and more decentralized than in other states.
  • During initial implementation, many first-time offenders preferred other, less burdensome legal options to treatment under Proposition 36.

Key Conclusions

  • RAND researchers concluded that treating the Proposition 36 population might be difficult and expensive and result in a demand for different treatment services if the mix of clients changes.
  • The Public Health Institute researchers noted that Proposition 36 potentially shifts the debate over drug abuse policy toward greater consideration of public health outcomes.

Funding
The Robert Wood Johnson Foundation (RWJF) supported this project with a $49,285 grant to the RAND Corporation and two grants totaling $74,197 to the Public Health Institute.

 See Grant Detail & Contact Information
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THE PROBLEM

Over the last three decades, federal and state policies have regarded alcohol and drug addiction as a criminal justice issue. Convicted drug offenders often received harsher and less flexible sentences than those convicted of felonies involving personal injury and major loss of property.

These policies have resulted in a national rate of incarceration for all offences of 476 per 100,000 in 2002, up from 139 per 100,000 in 1980, according to U.S. Department of Justice statistics. Typically, drug offenders occupy 80 percent of local and county jail and prison beds and 40 percent of federal prison beds.

Corrections department budgets have skyrocketed (from $15.8 billion in 1986 to $49 billion in 1999, according to U.S. Department of Justice Statistics — more than a threefold increase), and recidivism rates have climbed for convicted offenders returned to the community without treatment, according to the project director at the RAND Corporation.

A number of states have recognized the costs and limits of incarceration as well as the effectiveness of treatment and have enacted or seriously considered legislation to channel more drug offenders into treatment.

In the most wide-reaching effort to address the issue, California voters, on November 7, 2000, overwhelmingly approved Proposition 36, the Substance Abuse and Crime Prevention Act. Proposition 36 authorizes the diversion of nonviolent offenders (as many as 45,000 annually) convicted of possession, use or transportation of illegal drugs, from prison sentences to probation-supervised treatment programs.

The implementation of Proposition 36 occurred on July 1, 2001, with the state appropriating an initial $60 million in start-up funding and implementation funding of $120 million per year for each of the first five years. California's 58 county governments and associated public drug treatment services were responsible for working out the details of the actual implementation.

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RWJF STRATEGY

RWJF has a long record of funding a range of substance abuse-related programs, including a national program, Fighting Back®: Community Initiatives to Reduce Demand for Illegal Drugs (see Grant Results) and the Substance Abuse Policy Research Program.

At the time these projects began, the RWJF alcohol and drug abuse strategy was shifting toward increasing the amount and quality of treatment. The Proposition 36 projects afforded the opportunity to be at the forefront of a closely watched new state initiative in substance abuse treatment, and it fit into RWJF's emerging, and as of 2003, current, strategy, which focuses on evidence-based practices in treatment settings.

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THE PROJECT

Researchers at the RAND Corporation and at the Public Health Institute took advantage of the opportunity presented by the passage of Proposition 36 to conduct a natural experiment on the diversion of drug offenders to treatment, rather than incarceration. In separate studies, they established baseline data prior to the implementation of Proposition 36 and documented the implementation process just before and soon after it occurred.

Researchers at RAND, under grant ID# 041311, documented the characteristics of the clients of California's publicly funded, community-based drug and alcohol treatment services prior to the implementation of Proposition 36. This provided a benchmark against which to measure changes to the treatment system resulting from Proposition 36.

RAND researchers also determined the capacity of the public treatment system in terms of numbers of programs and treatment facilities. With funding from the John Randolph Haynes and Dora Haynes Foundation of $50,000, RAND researchers studied the same factors within Los Angeles County. RAND is a nonprofit policy analysis and research organization headquartered in Santa Monica, Calif.

Researchers at the Public Health Institute, under grant ID#s 041468 and 043857, addressed the early implementation experiences of a diverse group of eight California counties as they planned for increases in both their capacity to provide treatment and access to treatment for court-referred clients.

Under grant ID# 041468, the researchers collected data from the eight counties prior to the Proposition 36 implementation date. Under grant ID# 043857, researchers collected a second wave of data after implementation of Proposition 36. The Public Health Institute (Oakland, Calif.) conducts research, demonstration and training programs that address the health and well-being of people throughout California.

Researchers from both organizations met with other researchers and funders in November 2001 to discuss plans for future research on Proposition 36. RWJF, the Charles and Helen Schwab Foundation and the California Endowment were co-sponsors and co-funders of this meeting (see Grant Results on ID# 043933). RWJF also supported a follow-up meeting in January 2002 with funds from the same grant and from the Substance Abuse Policy Research Program.

Methodology

The RAND researchers analyzed the population receiving treatment from California's public substance abuse treatment system using data from the California Alcohol and Drug Data System, which collects data on participation in all community alcohol and drug treatment programs supported by federal or State of California funds. The California Department of Alcohol and Drug Programs also provided data on licensure and certification of treatment programs, which the researchers used to determine the availability of treatment programs and facilities prior to and after Proposition 36 passage.

Researchers at the Public Health Institute conducted two waves of interviews with county officials in eight California counties. The team conducted 58 interviews in May and June 2001, prior to the July 1 implementation date, and 42 re-interviews in October 2001, using a semistructured interview guide. They also examined documents and media reports and observed state and local meetings on Proposition 36. See the Appendix for more information on methodology.

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FINDINGS

The researchers at RAND reported findings in a "Project Memorandum" for RWJF and the Haynes Foundation.

  • Criminal justice clients made up a large proportion of the population served in the public treatment system prior to Proposition 36 implementation. At the time of admission to public drug treatment programs, 53 percent of all adult client admissions statewide and 42 percent of those in Los Angeles County were involved with the criminal justice system, through probation, parole or other involvement.
  • Differences between the criminal justice and noncriminal justice populations were significant and consistent across both statewide and Los Angeles County data during the year prior to the implementation of Proposition 36. In comparison with the noncriminal justice population, those involved with the criminal justice system are more challenging to treat, are more likely to be methamphetamine users, stay in treatment longer and receive more expensive residential rather than outpatient services.
  • There were important differences by type of criminal justice involvement among those using the treatment system prior to Proposition 36 implementation. Parolees exhibited more extensive drug and other problems than probationers and others; yet, they remained in treatment for a shorter period of time and more frequently left treatment without satisfactory progress.
  • Funding for public treatment services began to expand prior to the passage of Proposition 36. Immediately after passage, capacity continued to expand, especially residential program bed capacity.

The researchers at the Public Health Institute reported findings in a paper published in the Journal of Psychoactive Drugs and in a paper submitted for publication.

  • California's public drug treatment system is heterogeneous and more decentralized than in other states, with an October 2000 (just prior to the Proposition 36 passage) capacity to treat 79,000 clients throughout its 58 counties. Like other states, California relies on community-based organizations to provide drug treatment services, primarily small nongovernmental nonprofit facilities that specialize in alcohol and drug abuse treatment. California's lack of centralized control over treatment, however, "adds complexity to the planning and evaluation of Proposition 36."
  • All eight counties planned to allocate the majority of funding to treatment-related expenses rather than to criminal justice expenditures (such as prosecution, public defense, the courts and probation supervision). The percentage of Proposition 36 funding related to treatment activities ranged from a high of 95 percent to a low of 61 percent. The percentage of funding allocated to direct treatment services (i.e., excluding administration, case management, overhead and other expenses) ranged from 33 percent to 88 percent.
  • Most county planners reported that Proposition 36 funds had the potential to make a significant impact on overall treatment capacity; they expected increases of up to 75 percent. Counties planned most expansion for outpatient treatment, with some limited increases in specialized services.
  • Many policy-makers and service providers expressed concern about the adequacy of services for specialized populations. These included individuals with mental illness, those with particular cultural or language needs and parents with small children. The populations of concern tended to be the most medically underserved, the most economically disadvantaged and at the highest legal risk.
  • The sample counties planned for pathways to treatment that would ensure wide and prompt treatment access. The steps include: determination of legal eligibility, motions and pleas by the defense, court adjudication and conviction, probation risk assessment, treatment need assessment and program placement.
  • County planners favored centralization of the steps leading to treatment. The planners expect centralization to provide the benefits of uniform eligibility criteria, staff specialization and inter-agency coordination. At the same time, centralization could pose transportation problems and cause access barriers in remote areas.
  • There were no reports, in any of the sample counties, of prosecutors bringing excessive charges against offenders so that they would be ineligible for Proposition 36-sanctioned treatment. In fact, some prosecutors allowed defendants to plead guilty to drug possession despite having other, minor, nondrug possession charges.
  • In most of the sample counties, first-time offenders were more likely to prefer deferred prosecution or diversion under the California Penal Code Section 1000, when eligible, than the more burdensome treatment requirements of Proposition 36. However, most defendants chose Proposition 36 over drug court since the outcome of drug court was often conviction, with intensive court or probation supervision and the threat of jail.
  • Counties failed to predict accurately the severity of the Proposition 36 clients' substance abuse, which was more serious than expected. Several sample counties placed offenders into the lowest level of care and used the higher and costlier levels as backup for those in danger of failing.
  • A particularly controversial element of Proposition 36 is its mandate that clients who are not succeeding in their initial placement be allowed two re-referrals to another placement before incarceration. This mandate is consistent with health services research, which views alcohol and drug addiction and dependence as chronic conditions with regular relapses. The criminal justice system has traditionally viewed treatment as a privilege, however, using the threat of incarceration to keep offenders in treatment. Some counties elected to handle re-referrals through treatment staff, while others relied on criminal justice staff.

Limitations

The RAND project director reported the following limitation to its study.

  • The researchers were interested in who obtained what types of services, and they analyzed the individuals receiving treatment rather than the treatment admissions (some individuals may have multiple admissions). Thus, a comparison of these results with others that use treatment admissions as the unit of analysis will yield differences.

The Public Health Institute project director reported the following limitations to its study.

  • While the study sample was broad, and cooperation from county officials was strong, the inclusion of additional counties and interviewees may have yielded different results.
  • Findings relied on the perspectives of the interviewees, rather than on the observations of the researchers. An observation study, which would have taken much longer and been more expensive to field might have produced different results.

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CONCLUSIONS

The RAND researchers offered several conclusions about the inclusion of Proposition 36 clients into the public drug treatment system.

  • "Treating the Proposition 36 target population, like the criminal justice population that was already a large component of treatment utilization, may be difficult and expensive."
  • Demand for particular types of treatment may change if the mix of clients changes, for example, from a higher percentage of heroin users to a higher percentage of methamphetamine users.
  • "If future admissions deviate substantially from the past in both severe drug use and other conditions that are barriers to recovery, treatment outcomes, on which both the criminal justice system and the community are counting, could be expected to erode."

The researchers from the Public Health Institute drew several conclusions from their study of counties' implementation of Proposition 36.

  • "[Proposition 36,] by explicitly incorporating clinical objectives into penal drug law, potentially shifts the debate over drug abuse policy toward greater consideration of public health outcomes."
  • "In the debate over the benefits and drawbacks of various resource allocations, procedures and outcomes, Proposition 36 is opening up important and previously concealed fault lines between public health and criminal justice approaches [to substance abuse treatment]. These fault lines emerge over issues spanning whether to include in the continuum of care nonabstinence programs such as methadone maintenance, which defendants to make eligible for Proposition 36 and how to respond to clients' noncompliance."

Communications

The RAND researchers reported findings in a report prepared for RWJF and the Haynes Foundation. The Public Health Institute project team reported findings in a paper published in The Journal of Psychoactive Drugs and in a paper submitted for publication.

The team also presented study findings at three meetings: the semiannual meeting of the California Substance Abuse Research Consortium held July 2002 in Sacramento, Ca.; the annual conference of the National Association of Sentencing Commissions held August 2002 in Williamsburg, Va., and the annual meeting of the American Society of Criminology held November 2002 in Chicago.

The Public Health Institute researchers also distributed data reports from each set of interviews to the county officials participating in the interviews. See the Bibliography for details.

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AFTER THE GRANT

RWJF's Substance Abuse Policy Research Program (SAPRP) that addresses states' fiscal crises in funding for treatment services supports two RAND research projects, led by other principal investigators, on the implementation and impact of Proposition 36.

Under ID# 044121, RAND researchers are collaborating with Orange County on the implementation and evaluation of Proposition 36 at the county level. Under ID# 046304, RAND researchers are investigating a variety of issues regarding racial disparities that may influence participation in Proposition 36.

The Public Health Institute research team conducted a third wave of interviews with county officials in two previously studied counties and a third county as part of a National Institute on Drug Abuse funded study entitled "Public Sector Managed Care: A Comparative Evaluation of Three Counties." The team is preparing a paper incorporating the new data.

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GRANT DETAILS & CONTACT INFORMATION

Project

Documenting Baseline and Implementation Data for California Proposition 36 to Divert Drug Offenders to Treatment

Grantee

RAND Corporation (Santa Monica,  CA)

  • Establishment of State Baseline Data for California Proposition 36 to Divert Drug Offenders to Treatment
    Amount: $ 49,285
    Dates: April 2001 to April 2002
    ID#:  041311

Contact

Patricia Ebener
(310) 393-0411, ext. 7905
pateb@rand.org

Grantee

Public Health Institute (Oakland,  CA)

  • Documenting County Implementation Data for California Proposition 36 to Divert Drug Offenders to Treatment
    Amount: $ 49,979
    Dates: April 2001 to March 2002
    ID#:  041468

  • Publication of Initial Implementation Data on California Proposition 36 to Divert Drug Offenders to Treatment
    Amount: $ 24,218
    Dates: October 2001 to March 2002
    ID#:  043857

Contact

Richard Speiglman, D.Crim.
(510) 238-8432
richards@phi.org

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APPENDICES


Appendix 1

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Methodology for Public Health Institute Project (ID#s 041468 and 043857)

The team selected sample counties to obtain two types of variability:

Proposition 36-related variability

  • Degree of voter support for the law.
  • Agency locally designated as county "lead" agency for Proposition 36.

Other variability

  • Population size.
  • Total geographic size.
  • Population density.
  • Economic resources.

Interviewees included:

  • Judges.
  • Court administrators.
  • District attorneys or representatives.
  • Public defenders or representatives.
  • County alcohol and drug treatment administrators.
  • Chief probation officer or representatives.
  • Local treatment directors.
  • Officials from county executives' offices.

The semistructured interviews addressed the following topics:

  • The character of current relationships between local treatment and criminal justice.
  • The organizational structure, process and funding for Proposition 36 implementation.
  • Perceived goals and outcomes of the law.
  • Changes to existing local practices and procedures.
  • Expected client flows and changes to the system of care.
  • Challenges, conflicts and unresolved issues.

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Articles

Speiglman R, Klein D, Miller R and Noble A. "Early Implementation of Proposition 36: Criminal Justice and Treatment System Issues in Eight Counties." Journal of Psychoactive Drugs, 35(May): Special Supplement: Proceedings of the California Substance Abuse Research Consortium Conference, 2003.

Klein D, Miller RE, Noble A and Speiglman R. "Incorporating a Public Health Approach in Drug Law: Lessons from Local Expansion of Treatment Capacity and Access Under California's Proposition 36." Milbank Quarterly, 83(4): 723–757, 2004. Abstract available online.

Reports

Ebener PA and Kilmer B. Anticipating Impacts of Proposition 36 on Treatment Systems in Los Angeles and California. Santa Monica, Calif.: RAND Corporation, July 2003.

Public Health Institute Proposition 36 Implementation Study — Summary Site Data — Preliminary Wave 1 Report. Berkeley, Calif.: Public Health Institute, 2001.

Public Health Institute Proposition 36 Implementation Study — Summary October 2001 Site Data — Preliminary Wave 2 Report. Berkeley, Calif.: Public Health Institute, 2001.

Survey Instruments

"Proposition 36 Implementation Study, Wave 1 Interview Guide, 4/9/01 Version." Public Health Institute, fielded May–June 2001.

"Proposition 36 Implementation Study, Wave 2 Interview Guide, 10/3/01 Version." Public Health Institute, fielded October 2001.

Presentations and Testimony

Richard Speiglman, Robin E. Miller and Amanda Noble, "Initial Implementation of California's Proposition 36: Stakeholder Expectations About Treatment Capacity and Client Access to Treatment in Eight Counties," at the Semi-Annual Meeting of the Substance Abuse Research Consortium, July 11, 2002, Sacramento, Calif. Presentation materials available from project director.

Richard Speiglman, "California's Proposition 36: Early Stakeholder Expectations and Observations," at the Annual Conference of the National Association of Sentencing Commissions, August 5, 2002, Williamsburg, Va. Presentation materials available from project director.

Dorie Klein, Robin E. Miller, Amanda Noble and Richard Speiglman, "Differences in Implementing California's Proposition 36: An Eight-County Study," at the Annual Meeting of the American Society of Criminology, November 16, 2002, Chicago. Abstract available online.

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Report prepared by: Mary B. Geisz
Reviewed by: Kelsey Menehan
Reviewed by: Molly McKaughan
Program Officer: Victor Capoccia

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