Saturday, December 27, 2008

Funding Programs That Don’t Work

Here is another news story validating what most well-informed criminal justice practitioners already know, there is no evidence that substance-abuse treatment programs work (though there is evidence that some programs actually make the problems worse) and that the vast sums of money spent on them could very well be wasted, merely supporting the staff bureaucracy that maintains the programs, a story familiar with many social service structures.

One that made the problem worse and was a very costly failure, was California’s Department of Corrections and Rehabilitation—$1 billion for all prisoner and parolee programs since 1989, and $278 million of that for in-prison programs—substance-abuse program that was audited by the Office of the Inspector General (2007), which found:

“Unfortunately, as presently operated, the in-prison substance abuse treatment programs managed by the Office of Substance Abuse Programs are ineffective at reducing recidivism and in that regard represent both a waste of money and a missed opportunity to change lives. Numerous university studies of the programs over the past nine years consistently show little or no difference in recidivism rates between participants of the in-prison programs and inmates who received no substance abuse treatment. In fact, a five-year university of California, Los Angeles study of the two largest in-prison programs found that the 12-month recidivism rate for inmates who had received in-prison treatment was slightly higher than that of a nonparticipating control group.” (2007). Special review into in-prison substance abuse programs managed by the California Department of Corrections and Rehabilitation. Sacramento, California. State Printing Office. p. 1, highlighting added)

An excerpt from the news story.

“Every year, state and federal governments spend more than $15 billion, and insurers at least $5 billion more, on substance-abuse treatment services for some four million people. That amount may soon increase sharply: last year, Congress passed the mental health parity law, which for the first time includes addiction treatment under a federal law requiring that insurers cover mental and physical ailments at equal levels.

“Many clinics across the county have waiting lists, and researchers estimate that some 20 million Americans who could benefit from treatment do not get it.

“Yet very few rehabilitation programs have the evidence to show that they are effective. The resort-and-spa private clinics generally do not allow outside researchers to verify their published success rates. The publicly supported programs spend their scarce resources on patient care, not costly studies.

“And the field has no standard guidelines. Each program has its own philosophy; so, for that matter, do individual counselors. No one knows which approach is best for which patient, because these programs rarely if ever track clients closely after they graduate. Even Alcoholics Anonymous, the best known of all the substance-abuse programs, does not publish data on its participants’ success rate.

“What we have in this country is a washing-machine model of addiction treatment,” said A. Thomas McClellan, chief executive of the nonprofit Treatment Research Institute, based in Philadelphia. “You go to Shady Acres for 30 days, or to some clinic for 60 visits or 60 doses, whatever it is. And then you’re discharged and everyone’s crying and hugging and feeling proud — and you’re supposed to be cured.”
“He added: “It doesn’t really matter if you’re a movie star going to some resort by the sea or a homeless person. The system doesn’t work well for what for many people is a chronic, recurring problem.”

“In recent years state governments, which cover most of the bill for addiction services, have become increasingly concerned, and some, including Delaware, North Carolina, and Oregon, have sought ways to make the programs more accountable. The experience of Oregon, which has taken the most direct and aggressive action, illustrates both the promise and perils of trying to inject science into addiction treatment.”