Mental Health Association of Portland

From the Portland Tribune, June 28, 2012

Substance abuse and crime are like fast food and heart disease — everybody knows they’re connected, and experts think they know how dealing with one could help solve the other. But over time, nothing much changes.

Consider Portland, where drug use is high and treatment options, even for the uninsured, are more available than in most cities.

That might help explain a bit of good news/bad news data from a federal report on nationwide drug use.

The Arrestee Drug Abuse and Monitoring report (also known as ADAM II) shows that people arrested in Portland have the highest rate of previous drug or alcohol treatment. In 2010, 41 percent of arrestees in Portland reported having been through inpatient treatment. Thirty-eight percent reported having gone through outpatient treatment.

Indianapolis, by comparison, had 11 percent and 23 percent of people arrested having been through inpatient and outpatient treatment, respectively. Minneapolis? Thirty-three percent and 26 percent. Sacramento? Twenty percent and 13 percent.

The good news appears to be that we are providing more drug and alcohol treatment to the type of people who commit crimes. The bad news? Many of those people who received drug treatment continue to get arrested.

A 1999 study found that nationally, about 95 percent of state inmates with histories of drug abuse had returned to drug use within three years of their release from custody. Many undoubtedly received some form of treatment while in prison.

“People need multiple treatment episodes, and it can take several treatment experiences before someone really can achieve long-term abstinence,” says Steven Belenko, a Temple University criminal justice professor, an expert in the field of addiction treatment in correctional settings.

People here get high. According to federal 2008 data, Oregon trails only New York, South Dakota and Colorado for the per capita number of residents admitted to substance abuse treatment programs.
Sacramento is worse.

Considering the well-established connection between addiction and crime, the bigger mystery could be why Oregon and Portland don’t have higher crime rates. Oregon ranks as the 17th safest state in the country, and Portland as the ninth safest large city.

Eric Martin, who studies addiction data as the policy and legislative liaison for the Addiction Counselor Certification Board of Oregon, says that the key to understanding the high rate of previous treatment among Portland arrestees is in the ADAM II data, which reported drug test results for arrestees in 10 cities. More than seven of 10 people arrested in Portland had at least one drug in their system when they were booked at the county jail. Three of 10 tested positive for more than one drug.

That puts Portland in the middle of the mid-sized cities studied in ADAM II. Sacramento’s arrestees were worse.

But digging deeper, Martin notes that Portland has the highest rate of the 10 cities surveyed for opiate use — mostly heroin. People who take heroin are more likely to have had prior drug treatment than people who smoke marijuana or use most other drugs, Martin says. Also, he says, heroin users generally have the highest drop-out rate in treatment.

So, Martin suggests, Portland has more than its share of heroin users, who at some point, voluntarily or by court order, start — but don’t finish — addiction treatment. Eventually, many of them get arrested, or re-arrested, pushing Portland’s rate of arrestees with prior treatment to the top.

Ineffective treatment

Martin is convinced that the ADAM II data is not an indictment of drug treatment in the Portland area. In fact, he and others believe that Oregon’s treatment programs for the uninsured, and for those on probation and parole, are better than what is offered in most states.

“Part of it could just be the epidemiology of the drug epidemic that we’re having in the city,” he says.

Much of the treatment that would show up in the ADAM II data was likely delivered to people previously arrested, especially for drug crimes. People arrested here for drug crimes tend to be given sentences of probation, with required drug treatment.

But probation officers are often burdened with heavy case loads, and reluctant to send a probationer or parolee to jail just for missing or failing a drug test. The majority of Multnomah County drug crime probationers are placed on what is called case bank probation, with no real oversight by a probation officer. They are told to attend outpatient treatment, and if re-arrested they would be showing up as having had previous treatment, but few in the local criminal justice system believe they are getting what they need to beat their addictions.

“The effectiveness of getting those persons actually into, through and completed with their court mandated treatment is not necessarily that great,” says Multnomah County Deputy District Attorney Ryan Lufkin.

More people are ordered to treatment here than in states that more frequently send people to prison for drug offenses, according to Lufkin. But, he adds, a 2010 federal report ranked Oregon 47th among U.S. states for funding substance abuse treatment. That study showed that 55 percent of Oregonians ordered to treatment completed their treatment, compared to 45 percent nationally.

Lufkin believes that in Multnomah County the criminal justice system sends more people into treatment, but that they re-offend more frequently. That might be because the treatment is ineffective, or sets too low a bar for graduation.

Or, Lufkin says, it might be a result of Oregon’s unwillingness to send people to prison for serious drug offenses. If re-offending drug offenders here had stronger consequences and more supervision, he says, there would be fewer getting arrested again.
Finding a place to live

Funding for probation and parole addiction treatment has dropped precipitously, according to an Oregon Department of Corrections report that shows state money to Multnomah County declined from $11.5 million in the 2007-09 biennium to $8.1 million in the 2009-11 biennium to $4.1 million in the current biennium.

Funding for treatment to people in prison has dropped from $11.7 million two years ago to $9.8 million in the current biennium.

According to a Department of Corrections report, three of four people in Oregon prisons have a drug or alcohol problem. With fewer dollars to work with, community justice officials are putting more probationers and parolees into outpatient programs each year. That might seem a less effective treatment, but Sarah Goforth, who oversees mental health and addiction services for nonprofit Central City Concern, says whether probationers get inpatient or outpatient treatment doesn’t matter all that much.

What matters, Goforth says, is where people live after treatment. If they don’t have a sober environment to come back to after treatment, or after prison, they rarely stay clean.

“What we’ve known for years is that residential treatment can serve as a warehouse for people,” Goforth says. “You go in and get treatment, but unless you have a clean and sober environment to put people in, they just cycle through.”

Goforth estimates that only 10 percent to 20 percent of those who go through inpatient addiction programs manage to stay clean and sober.

Some of those who don’t stay clean will end up committing crimes, and they’ll show up in the ADAM II data that says more arrested Portlanders have a history of drug and alcohol treatment.

According to data from Central City Concern, the county’s largest provider of supportive housing, in the past two years funding for recovery housing has dropped while the demand has been going up.

Karen Wheeler, until recently addiction program administrator for the state of Oregon, agrees with Goforth on the need for recovery housing. Wheeler says people getting out of jail often can’t afford rent and don’t have jobs. Getting those people into housing in a community of people committed to sobriety is critical, she says.

“If you don’t have a place to live, you’re going to use, bottom line,” says Wheeler.

• Arrestees with previous drug or alcohol treatment (outpatient)
Portland 38%
Minneapolis 26%
Indianapolis 23%
Sacramento 13%
New York 23%
Atlanta 8%

• Arrestees with previous drug or alcohol treatment (inpatient)
Portland 41%
Minneapolis 33%
Sacramento 20%
Indianapolis 11%
New York 23%
Atlanta 12%

Source: ADAM II data

John Carlgren

John Cole Carlgren bowed his head and waited for Judge Christopher Brauer to pronounce a sentence.

Carlgren pleaded guilty earlier this month to recklessly causing the deaths of four people after he smashed into their car on Cabbage Hill while drunk. Jessie Cline, 29, William Johnson, 24, Fred A. Young, Jr., 31, and Michelle Marie Sawyer, 29, died in the Oct. 19 crash.

Brauer prefaced sentencing with a statement that left little doubt the punishment would be stiff for the Carlton man, who has four prior drunk driving convictions.

“You might as well have decided to juggle with nitroglycerin in a crowded theater wearing grease-covered gloves,” Brauer said, referring to Carlgren’s trip from Utah to Eastern Oregon with stops for six-packs of beer at markets along the way.

Carlgren didn’t seem surprised when Brauer finally rendered his sentence – 130 months for each manslaughter charge, to be served consecutively – 43 years and four months. Another year for driving while intoxicated will not add extra time to the sentence.

Under Ballot Measure 11 restrictions, Carlgren will not be eligible for release for 40 years.

“Mortality data demonstrates that you are likely to be confined in prison for the rest of your natural life,” Brauer told Carlgren.

At the beginning of the four-hour sentencing, prosecutor Dan Wendel, Umatilla County deputy district attorney, described the events leading up to the early-morning crash. From the gallery, the victims’ family members listened somberly.

Carlgren, Wendel said, had worked a 60-hour week, finishing a job for Chevron in Northern Utah. He changed, showered and checked out of his motel and started driving the 700 miles home. Receipts from the journey show he stopped at two stores along the way for six-packs of Coors he kept on ice.

Witnesses reported erratic driving by Carlgren.

Just east of Pendleton on Interstate 84, Carlgren crossed the fogline and plowed into the back of the victims’ red Beretta, stopped or nearly stopped on the shoulder. The car’s occupants died instantly.

Wendel flashed an image onto a screen.

“This is what happens to a 1991 Beretta when it is slammed into by Dodge Dakota pickup truck,” he said.

The misshapen hunk of metal only vaguely resembled a car.

“The wreckage of the Beretta was such that the victims could not be extracted from the scene,” Wendel said. “The car was loaded onto the back of a flatbed truck.”

One witness at the scene, Frank Moutray, reported that Carlgren walked around the scene, dazed and wondering why the car he hit had been stopped on the highway, rather than on the shoulder where investigators determined the car actually was.

“He walked over to the red vehicle and said, ‘What the (expletive deleted) were you doing parked in the middle of the road? That’s what you get,’” Moutray said in a statement to investigators.

A blood draw two hours later showed Carlgren’s blood alcohol level was .207 percent.

Carlgren’s attorney, Kent Fisher, didn’t gloss over his client’s horrible history, but said Carlgren wasn’t so much “raging and blaming” as trying to figure out what happened. The crash happened, Fisher said, after Carlgren reached for his cell phone.

“He was still trying to put the pieces together,” Fisher said.

He quoted Carlgren as later saying, “I’m heartbroken – I just killed four people.”

Wendel and his co-counsel, Deena Ryerson, called for a long sentence.

“This defendant begs for the court’s mercy,” Wendel said, “but the blood of the victims cries out for justice, blood spilled at Milepost 219.”

Family members also spoke to the judge and to Carlgren.

John Johson, the father of William Johnson, described his son as images glowed on the screen. The photos showed William playing sports, wearing a Donald Duck hat at Disneyworld and playing Twister, his favorite game.

Johnson offered forgiveness to Carlgren, while adding justice must be done.

“He was stolen from us that night,” he said.

Jason Young, brother of Fred Young, Jr., said his brother was fun-loving and caring. He was getting ready to marry another of the victims, Michelle Sawyer.

Young read an excerpt of Michelle’s last letter to Fred.

“I could spend the rest of my life in your arms,” Michelle wrote. “You take my breath away every time you glance my way.”

She signed the letter “The future Mrs. Michelle Young.”

Alan Cline, father of Jessie Cline, said Carlgren’s crime is worthy of serious punishment.

“This wasn’t an accident,” he said. “This was the inevitable.”

Michelle Sawyer’s 6-year-old daughter, Mickey Mouse doll under her arm, approached the judge with photos of her mom.

Carlgren watched with emotion. His attorney said his client has experienced “engulfing mental pain and anguish at the enormity of the damage and destruction he has caused.”

“He never designed this,” Fisher said. “It was never his intent.”

Carlgren, tears threatening, addressed the families.

“I am very sorry,” he said. “There are no words that I can say to bring back your loved ones.”

EXTRA – 43-year prison sentence for drunk driving may set Oregon record, KGW.com
EXTRA – Repeat drunken driver who killed four receives 43-year sentence, Oregonian July 24 2009
EXTRA – Drunk Driver Gets 43 Years In Prison, KEPRTV.com