UCLA’s Statewide UCLA’s Statewide Evaluation of Evaluation of

Proposition 36Proposition 36Darren Urada, Ph.D.Darren Urada, Ph.D.

UCLA Integrated Substance Abuse ProgramsUCLA Integrated Substance Abuse ProgramsAssociation for Criminal Justice Research (California) Association for Criminal Justice Research (California)

October 16, 2008October 16, 2008

TopicsTopics What is Prop 36?What is Prop 36? Show ratesShow rates Completion ratesCompletion rates ArrestsArrests CostCost Recommendations for Reducing No-ShowsRecommendations for Reducing No-Shows EmploymentEmployment Narcotic Replacement TherapyNarcotic Replacement Therapy Incentives & SanctionsIncentives & Sanctions Process ImprovementProcess Improvement

What is Prop 36?What is Prop 36? Passed by California Voters in November Passed by California Voters in November

20002000

Enacted into law as the Substance Abuse Enacted into law as the Substance Abuse and Crime Prevention Act (SACPA) of 2000. and Crime Prevention Act (SACPA) of 2000.

If an adult is convicted of a drug offense or If an adult is convicted of a drug offense or commits a drug related parole violation and commits a drug related parole violation and meets other eligibility criteria, the offender meets other eligibility criteria, the offender is given the option of receiving supervision is given the option of receiving supervision with substance abuse treatment.with substance abuse treatment.

Prop 36 Treatment Client Prop 36 Treatment Client CharacteristicsCharacteristics

Primary Drug: Meth 57.0%, Primary Drug: Meth 57.0%, cocaine/crack 13.1%, marijuana 12.5%, cocaine/crack 13.1%, marijuana 12.5%, alcohol 8.2%, opiates 8.0%.alcohol 8.2%, opiates 8.0%.

Sex: 73% maleSex: 73% male Average age: 34.8Average age: 34.8 Ethnicity: 43.9% non-Hispanic White, Ethnicity: 43.9% non-Hispanic White,

35.9% Hispanic, 13.6% African-American.35.9% Hispanic, 13.6% African-American. First time in treatment: 50.4%First time in treatment: 50.4% Probation: 86.8%, Parole: 13.2%Probation: 86.8%, Parole: 13.2%

Prop 36 Offender PipelineProp 36 Offender Pipeline2006-20072006-2007

ReferredReferred Assessed Assessed Placed in Placed in Treatment Treatment

(Step 1)(Step 1) (Step 2) (Step 2) (Step (Step 3)3)

85.6%85.6% 82.8%82.8%

48,996 48,996 Yes 41,925 Yes 41,925 Yes 34,702 Yes 34,702

No 7,071 No 7,071 No 7,223 No 7,223

All categories may include people who “opted out” laterAll categories may include people who “opted out” later

Data Data Source: SACPA Reporting Information System, Source: SACPA Reporting Information System, adjustedadjusted

Overall Show Rate:

70.8%

84.1

11.5

2.2 0.9 0.5 0.70

20

40

60

80

100

OutpatientDrug Free

Residential> 30 days

Detox Residential< 30 days

Methadonedetox

Methadonemaintenance

Per

cent

of

Pro

p. 3

6 tr

eatm

ent

clie

nts

Prop 36 Treatment Clients by ModalityProp 36 Treatment Clients by Modality(CADDS), 7/1/05 – 6/30/06(CADDS), 7/1/05 – 6/30/06

(N = 40,358)(N = 40,358)

35.0%38.0%32.2%

0%

20%

40%

60%

80%

100%

Prop. 36(N = 31,605)

Criminal justice non-Prop.36

(N = 32,005)

Non-criminal justice(N = 75,342)

Per

cent

of

clie

nts

Discharge Status by Referral SourceDischarge Status by Referral Source(CADDS admissions 2004-2005)(CADDS admissions 2004-2005)

Note: Requirements may differ - Prop 36 completers spend about 30 days longer in tx.

61.5

19.6

6.4

65.1

18.5

5.9

46.9

11.8

4.1

0

20

40

60

80

100

New drug arrest New property arrest New violent arrest

Per

cent

of

offe

nder

s

Referred but untreated (N = 6,954)

Entered but did not complete treatment(N = 7,611)

Completed treatment(N = 2,954)

New Arrests During 42 Months After OffenseNew Arrests During 42 Months After Offense Prop 36 Offenders, July 2001 – June 2002 Prop 36 Offenders, July 2001 – June 2002

(N =17,519)(N =17,519)

48.9

14.1

5.6

55.2

20.1

6.4

0

20

40

60

80

100

New drug arrest New property arrest New violent arrest

Per

cen

t of

off

end

ers

Comparison offenders(N = 42,029)

Prop. 36 eligible offenders(N = 40,368)

New Arrests During 42 Months After OffenseNew Arrests During 42 Months After Offense Prop 36 Year One vs Pre- Prop 36 Comparison Prop 36 Year One vs Pre- Prop 36 Comparison

GroupGroup

Crime Trends 2001-2005Crime Trends 2001-2005

Source: FBI Uniform Crime Reports, National Archive of Criminal Justice Data

Statewide, drug crime arrests rose Statewide, drug crime arrests rose more in California than nationally more in California than nationally (21% vs 14%).(21% vs 14%).

Statewide, property crime arrests Statewide, property crime arrests rose more in California than rose more in California than nationally (6% vs 0%).nationally (6% vs 0%).

Statewide, violent crime arrests Statewide, violent crime arrests droppeddropped more in California than more in California than nationally (12% vs 9%)nationally (12% vs 9%)

Cost Analysis by Treatment Cost Analysis by Treatment StatusStatus

42 month follow-up42 month follow-up

-$10,000

-$8,000

-$6,000

-$4,000

-$2,000

$0

$2,000

$4,000

Do

llar

s p

er o

ffen

der

No treatment Some treatment Completed treatment

No treatment -$4,598 -$2,054 $692 -$226 $1,823 -$403 $729 -$4,037

Some treatment -$5,694 -$1,749 $736 -$332 $2,799 $1,700 $747 -$1,792

Completed treatment -$8,425 -$1,723 $727 -$322 $1,161 $2,292 $454 -$5,836

Prison Jail Probation ParoleArrest and

Treatment Health Total

Hawken, Longshore, Urada, Fan, & Anglin (2008)

Cost Analysis:Cost Analysis:42 month followup42 month followup

-$4,303

-$1,862

$727

-$296

$1,974

$1,116$667

-$1,977

-$5,000

-$4,000

-$3,000

-$2,000

-$1,000

$0

$1,000

$2,000

$3,000

Prison Jail

Probation

Parole

Arrest andConviction

Treatment Health

Total

Do

lla

rs p

er

off

en

de

r

-$4,303

-$1,862

$727

-$296

$1,974

$1,116$667

-$1,977

-$5,000

-$4,000

-$3,000

-$2,000

-$1,000

$0

$1,000

$2,000

$3,000

Prison Jail

Probation

Parole

Arrest andConviction

Treatment Health

Total

Do

lla

rs p

er

off

en

de

r

Hawken, Longshore, Urada, Fan, & Anglin (2008)

RecommendationsRecommendations

Suggestions we hear most oftenSuggestions we hear most often

FundingFunding FundingFunding

FundingFunding

FundingFunding

FundingFunding

FundingFunding !!

““Classic” Classic” Recommendations for Recommendations for

Reducing No-ShowsReducing No-Shows Co-locate assessment units in/near Co-locate assessment units in/near

courtcourt Assess in a single visitAssess in a single visit Allow walk-in assessmentsAllow walk-in assessments Incorporate procedures used in drug Incorporate procedures used in drug

courtscourts

Employment: Focus Group Employment: Focus Group IdeasIdeas

Lower cost suggestions:Lower cost suggestions:

On-site “one-stop shopping” employment services, On-site “one-stop shopping” employment services, professional job counselorprofessional job counselor

““Felon-friendly” job listsFelon-friendly” job lists

Vocational education (regularly, weekly, Vocational education (regularly, weekly, evenings)evenings)

Tap into networks of alumni who can Tap into networks of alumni who can provide job search assistance, contactsprovide job search assistance, contacts

GED graduation ceremoniesGED graduation ceremonies

Funding stabilityFunding stability

Higher Cost Suggestions:Higher Cost Suggestions:

Narcotic Replacement Narcotic Replacement TherapyTherapy

Methadone: still the “gold standard” Methadone: still the “gold standard” to treat opiate addiction but there is to treat opiate addiction but there is exceptional resistanceexceptional resistance

Trainings needed, but valid concerns, Trainings needed, but valid concerns, barriers exist.barriers exist.

Suboxone (Buprenorphine + Suboxone (Buprenorphine + Naloxone) an alternative for areas Naloxone) an alternative for areas without a methadone clinic.without a methadone clinic.

Sanctions & IncentivesSanctions & Incentives Incentives work and are preferable to Incentives work and are preferable to

sanctions.sanctions.

Literature: Testing and sanctions programs Literature: Testing and sanctions programs implemented with certainty and implemented with certainty and consistency have led to reduced drug use, consistency have led to reduced drug use, recidivism.recidivism. Examples: DC Drug Court Experiment, HOPEExamples: DC Drug Court Experiment, HOPE

Literature: When sanctions were not Literature: When sanctions were not delivered with certainty, the program faileddelivered with certainty, the program failed Example: Maryland’s Break-the-CycleExample: Maryland’s Break-the-Cycle

Treatment Provider Perceptions – Treatment Provider Perceptions – would jail sanctions improve would jail sanctions improve

treatment completion?treatment completion?

19%1%

80%

0

10

20

30

40

50

60

70

80

Per

cen

t

No Maybe Yes

Source: UCLA 2007 Proposition 36 Treatment Provider Survey

Process Improvement:Process Improvement:Network for the Network for the Improvement of Improvement of

Addiction Treatment Addiction Treatment (NIATx)(NIATx)

Designed to help treatment providers Designed to help treatment providers improve their own programsimprove their own programs

Goals: Goals: Increase admissions Increase admissions Reduce waiting timesReduce waiting times Reduce no-showsReduce no-shows Increase client continuation in treatment Increase client continuation in treatment

Conduct a “walk-through” to understand Conduct a “walk-through” to understand the processes that facilitate or inhibit the processes that facilitate or inhibit treatment goals from a client’s perspective.treatment goals from a client’s perspective.

Identify a measurable goal.Identify a measurable goal. Establish a Change Team to select and test Establish a Change Team to select and test

changes to address the problem. changes to address the problem. Collect data before, during, after a change Collect data before, during, after a change

to see whether the change resulted in to see whether the change resulted in improvement. improvement.

Make adjustments to improve continuously Make adjustments to improve continuously and sustain changes.and sustain changes.

Key StepsKey Steps

2005-2006 LA County Pilot 2005-2006 LA County Pilot Project Change ExampleProject Change Example

Southern California Alcohol & Drug Southern California Alcohol & Drug Programs, Inc.Programs, Inc.

Normally assessor would call program and Normally assessor would call program and whoever answered phone scheduled intake. whoever answered phone scheduled intake. Change: When assessment center called, a Prop. Change: When assessment center called, a Prop. 36 counselor would talk with the potential client 36 counselor would talk with the potential client on the phone.on the phone.• Counselor introduced selfCounselor introduced self• Told client about the programTold client about the program• Asked if client had any specific needs that Asked if client had any specific needs that

should be addressed during treatmentshould be addressed during treatment• Motivational interviewing-type strategies used Motivational interviewing-type strategies used

No-Shows to Assessment

14.4%14%

0%

33%

11%14%

57%

0

10

20

30

40

50

60

Baseline(Nov 05-Jan 06)

Mar-06 Apr-06 May-06 Jun-06 Jul-06 Average(Mar-Jul)

Month of Admission

Pe

rce

nta

ge

Tracking Change ResultsTracking Change Results

No-Shows to Intake/Assessment Appointment (based on six OP/IOP programs)

6.8%

7.7%

2.4%

7.1%5.7%

11.2%

34%

0

5

10

15

20

25

30

35

40

Baseline Mar-06 Apr-06 May-06 Jun-06 Jul-06 Average(Mar-Jul)Month of Admission

Per

cen

tag

e

Overall ResultsOverall Results

For more infoFor more info

UCLA Prop 36 Reports:UCLA Prop 36 Reports:http://www.uclaisap.org/Prop36/html/rehttp://www.uclaisap.org/Prop36/html/reports.htmlports.html

NIATx: NIATx: http://www.NIATx.nethttp://www.NIATx.net

Comments / QuestionsComments / Questionsdurada@ucla.edudurada@ucla.edu