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.
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)
New York 23%
• Arrestees with previous drug or alcohol treatment (inpatient)
New York 23%
Source: ADAM II data