urban institute nonprofit social and economic policy research

Reducing Drug Use and Crime

Strategies that Work

Document date: April 01, 2003
Released online: April 01, 2003

ROBERT REISCHAUER, Urban Institute: (In progress)—drug treatment to reduce crime and drug use. Of course, over the last decades courts have been inundated by drug-using offenders and have turned to developing a variety of programs, from drug courts to diversion programs, that are aimed at both stopping drug use among offenders and reducing crime. Today we're going to hear some evidence from a decade of research here at the Urban Institute and at other institutions that has examined the effectiveness of these various approaches. You'll also learn a bit about the limitations of these initiatives as well.

We're going to start the session with opening remarks by David Murray, who is the special assistant to the director of the White House Office of National Drug Control Policy. And he will explain a few of the new federal initiatives and the promise that they hold. Dr. Murray is a social anthropologist who was trained at the University of Chicago, taught at various institutions, including Brown and Brandeis, before coming to Washington. And his research interests include ethnography of scientific practice and other things.

After Dr. Murray's opening remarks we're going to have a panel discussion, and that panel will be moderated by Adele Harrell, who is the founding director of the Urban Institute's Justice Policy Center, and she stepped down from that position within the last year. She has been studying drug abuse issues since 1975 and has directed a number of evaluations of these programs. She, by training, is a sociologist.

Adele will be followed by Sarah Hart, who is the director of the National Institute of Justice and previously served as the chief counsel for the Pennsylvania Department of Corrections and a prosecutor in the Philadelphia District Attorney's Office. She currently serves on Pennsylvania Supreme Court's Appellate Procedural Rules Committee, and is a graduate of Rutgers Law School.

Alan Leshner will follow her. He is the CEO of the American Association for the Advancement of Science and the executive publisher of the journal, Science. He was, as we all know, previously the director of the National Institute of Drug Abuse at NIH, and he brings the perspectives of a psychologist and neuroscientist.

Last but not least is Peter Reuter, who is a professor at the University of Maryland in both the School of Public Affairs and the Department of Criminology, but most notable is, I believe, within the last 12 or so hours he got off a plane from New Zealand, so he is forgiven if he falls asleep during this presentation or others. He also is a senior economist at RAND and a member of the Office of National Drug Control Policy Committee on Data Research and Evaluation. Since 1999 he also has been the editor of the Journal of Policy Analysis and Management, and he brings, of course, the perspective of an economist.

After the panelists have finished their presentation we will open the floor to questions. And I ask you to wait until you have a microphone handed to you to ask your question, and when you begin to speak, the first thing you do is identify yourself and your affiliation, if any.

David, it's an honor to have you here and we look forward to hearing your remarks.

DAVID MURRAY, Office of National Drug Control Policy: Thank you very much for that very kind introduction. It is a pleasure and an honor to be here—invited here. The Urban Institute is a place which I have read about many, many times in the course of my career, and it is an honor to be here today. I am unfortunately a poor stand-in. The director, John Walters, who has a deep and abiding interest in issues of treatment, of recovery and the criminal justice system in particular and new approaches to it, unfortunately could not be here today. And the second most appropriate person to appear, Dr. Andrea Barthwell, who is our deputy director for Demand Reduction, who knows a great deal about these issues, was also pre-committed to another event. Looking deeper into the barrel—(laughter)—there was Murray, and I'm pleased to be here and try to represent them.

And I'm delighted, again, to see Peter Reuter, whom I have met on several occasions, fresh from New Zealand. I hope you're able to drive out of the news of another New Zealander who seems to have made front-page news today—(laughter)—Mr. Arnett. It's a small country; perhaps you knew each other. Dr. Leshner of course, and the other illustrious panel members who I have heard of, known, and in some instances worked with.

I'll try to be brief. The national drug control strategy has three components. It's supposed to be a balanced approach. We are obviously known worldwide for our efforts in law enforcement and supply reduction. They are forward leaning; they are international objectives; they work in places such as Afghanistan, Colombia, the Andean Ridge generally, our border security. We try to stop the flow of drugs into the United States. We try to stop the cultivation of drugs. That's one component that we cannot dismiss. It's an extraordinarily important component for national security and for the well-being of our culture, and indeed makes a worldwide contribution.

Second of course is the extraordinary role of prevention. And I think to some extent that's one of the most difficult challenges we face. How do we stop drug use before it starts? How effectively do we reach into communities and the lives of young people and create a context in which they can resist succumbing to drug use, to substance abuse properly? We have a federal and a national role in that that complements community and state investments, and it's a difficult task.

A third component however—and these work together when they work effectively—is reducing the demand for drugs, and reducing the demand for drugs has a strategic dimension. There is a marketplace model that fits very much in our national drug control strategy. There is a supply and demand. The drug trade is a business. We seek to undermine that business, to disrupt it organizationally, to disrupt its capacity to make profits. By reducing the demand for drugs we gain leverage over our capacity to effect supply reduction and to create a climate in which people do not start into substance abuse.

But demand reduction also involves something that I think has a moral dimension and an obligation upon us, which is to get people who are currently using drugs into treatment, not just because it has strategic implications for us and for our hope of changing the trajectory of substance abuse in American life, but because there are lives at risk, and we wish to recover those people, to offer them available resources, to provide to them the means by which they can turn away from the substance abuse dependencies that are increasingly dragging them further under, and we have that obligation as well as a strategic initiative involved.

That is becoming an important dimension for us because it works together with our other activities, but also because we've been commanded to do it, particularly by this president who has a personal, abiding, focused and very serious dedication to the notion of treatment and recovery for people who have substance abuse problems, and we've taken that charge very seriously and it is reflected in the interests of the director whom I serve, John Walters, who likewise has visited an enormous number of treatment facilities in the United States, in the criminal justice system and in community settings, with the same message: recovery is possible, treatment can change, you need help, you must seek it and we must find some way to provide access to those resources.

We take very seriously as well, in our mental approach to this, a contagion model. We take seriously the charge that there is a public health dilemma out here that we must address in those terms, and even in epidemiologic terms: how does the contagion that is drug abuse spread within a community? Very often it is the dependent user, early in their career, who is yet to suffer the ravages of drug and substance abuse generally, who becomes the vector through which this contagion spreads. Very few young people say, there is a junkie on the street corner; there is a blighted life. Say, I'd like to be like that. But many young people do get drawn into the circumstance when there are people who are using drugs in the community and do not yet show the ravages that that can occasion. It's our hope to intervene in a way that breaks the cycle and the contagion.

A very significant component of our being able to do this is of course the criminal justice system, and increasingly we've seen the development of an understanding of the complexity of substance abuse in criminal activity. Obviously it's there when we look at those who are arrested for substance abuse. We know there are studies in virtually every major city that established somewhere between 60 to 80 percent of those who get incarcerated in the system had drugs in their system at the time that they were arrested. Substance abuse was a fundamental contributor to the criminal activity, both in the marketplace sense—people were engaged in the drug trade—and in terms of disrupting their judgment and their capacity to make sound decisions about their own lives.

Every time we peel back the face of any social pathology, the likelihood is extremely high we're going to find an underlying role for substance abuse: domestic violence, child abuse and neglect, school failure, criminality in the streets, the need for welfare, homelessness, the spread of HIV and other public health pathologies. Every time we look closely at these we see a fundamental contribution from substance abuse as a major player in this. We have an obligation to respond to this by leveraging all of our other social activities, every investment we make in reforming the life of Americans by virtue of addressing their needs. We need to address substance abuse simultaneously.

The court system is increasingly becoming effective in this regard. With the development of drug courts—we now stand at about 940 of them nationwide, on an upward trajectory to somewhere over 1,100 anticipated—where they have played a role it has been a very powerful role for moving away from the automatic incarceration of people into a circumstance where teams are now showing up in courtrooms, teams that involve the judiciary itself, a public defender, a district attorney, a treatment counselor, a social worker, a probation officer, and they are forming the best response possible, given the correct diagnosis of what that person's circumstance is with regard to the reason that they are in front of a criminal justice court.

In the best of circumstances, the diversion programs that we are seeing can change the trajectory of not only this individual's next year or two years, they can change the trajectory of that individuals' repeating—recidivism into the life of crime. That's an extraordinary outcome if it can be achieved.

Unfortunately, data on drug courts are not as hard and not as well established at the nationwide level as we have liked. We don't have good, solid data yet that are utterly convincing on the national scope as to what's happening, but we know that something good is happening in many instances, and we have a variety of city approaches that have told us that drug courts can be extremely successful when compared to those who do not participate in reducing recidivism, reducing the life of crime, and reducing the pathologies that attach to continuous substance abuse.

What do they do when they work well? They divert people. They do so most often and successfully with sanctions and supervision involved, oftentimes involving appropriate objective testing to ensure that someone is drug free. Oftentimes they depend upon something, either pre-sentencing diversion, which has its need for sanctions and time limits and requirements to go into treatment, but also a post-sentencing one seems to be extremely useful where we find people genuinely have over them the concern that a more serious response will be forthcoming. They do not take seriously the obligation to get themselves clean and to move into recovery.

There are difficulties with those who move into diversion, as we well know. One of the difficulties is, do they get matched to the appropriate treatment? It's an extremely complex thing, diagnosing accurately what exactly is the diagnostic need of this individual; what treatment service is the most appropriate match for them?

Second, we have to be careful that we don't disrupt the treatment systems themselves by inappropriately diverting people who are not going to benefit all that much from it because they don't wish to be there because we perhaps inaccurately diagnosed what their need was when we sent them there and who may have histories that are actually quite troubling, including violent offenders whose impact on the treatment system is oftentimes extremely disruptive for both the treatment provider, who can be put at risk, and other people seeking treatment. We need great discretion here in our capacity to divert appropriately people who can benefit.

Lastly, there's the problem of co-occurring disorders. A significant proportion of people who come into the court system who manifest something like a substance abuse problem are in fact suffering from a variety of mental disorders that are underlying. Sometimes substance abuse treatment on a short-term basis, even a 90-day or a six-month residence, may not be the most appropriate response to somebody who is also suffering from a co-occurring mental disruption.

We have to address these things in complex ways. We think that the rise of drug courts is an important dimension. This administration fully supports those things. We currently spend $68 million in the '03 budget on these things. We are expanding that. We are requesting $16 million additional over that. What would really help us at this point is getting better nationwide data on how drug courts operate and demonstrated efficacy for the outcomes, compared to other populations.

Let me segue from that into a realization. However, there are some populations that are simply hard to treat. There are people who are repeat offenders, who are deeply involved in substance abuse and addiction. That is a problematic circumstance. We must ameliorate those lives as best we can. But the message that comes through is very clear: we need to get in earlier. We need to intervene sooner in the trajectory and career of someone moving into substance abuse and dependency. We need early intervention and we need an expansion of the capacity and access to move people into treatment before they get into serious difficulty through the criminal justice system.

And that's the other major commitment we're seeing from this administration, which has called forth for $1.6 billion over five years for treatment initiatives, going through state block grants, targeted capacity expansion grants. These are services that build the infrastructure of treatment. But we recognize the scope of this problem is really quite extraordinary. According to the National Household Survey most recently received, roughly 6.1 million Americans meet the diagnostic criteria, the DSM4 criteria of the American Psychiatric Association, for needing treatment services. It's a large group of people. Only about 1.1 million of them actually receive treatment, and in many instances, far too many instances unfortunately, they didn't get the right kind of treatment, they didn't get it long enough, and it wasn't necessarily effective in terms of the outcomes. That's a problem.

But even worse is the problem that of that 6.1 million people, around 4.5 (million), maybe a little more, 4.7 million people, did not think that they needed substance abuse treatment. Call that a denial gap problem, a large group of Americans who, by diagnostic criteria, are in fact in need of services but weren't seeking it, did not recognize it. We need community outreach. We need it at the employer level, we need it in the school system, we need it in the family, we need it in religious services, we need it in neighborhoods for people to reach out and say, this is our problem, we cannot turn our back on this, we cannot close our eye to it. Treatment services are available. These people can be turned away from denial and into acceptance of the recovery that they need.

There is also, however, around 100,000 people who every year report that they sought treatment and were unable to access it for whatever reason. That's unconscionable and that can be remedied, but it's going to take hard work. The treatment system is out there, but it isn't always providing the right services, it isn't always monitoring outcomes as carefully as it should, but most importantly, it isn't always accessible to everyone.

And hence we've seen from the president in the State of the Union address the last component that I'll mention now: a $200 million a year additional new money expansion of the treatment system, totaling for three years $600 million, the point of which is to speak to that treatment gap, to try to find a way to provide expanded capacity, the capacity that matches the needs of those who are seeking. At the rural area, at the adolescent level, services for women and pregnant people in particular, are simply inadequate and not evenly matched. It's our hope by this $600 million in new money to provide a way for providing access to the people who are currently seeking treatment to get immediate help.

We also have another objective with the $600 million. It's not just spending more federal money in the usual pattern, coming down through block grants and structures. That must be maintained, but there have to be novel ways of spending the money that help transform and help strengthen and expand the treatment system itself. The president has proposed putting this in the form of vouchers, where someone who needs treatment services and cannot afford it, someone who does not have medical insurance, someone who needs recovery can use this system to access the appropriate treatment for them and have it covered by our investment in their need so that they are getting the services and we find that this investment will be valuable.

We believe that will help tune the system towards a better match of need and response. We think it can expand the number of providers who show up. We think it can provide, through access and treatment capacity expansion as well, a dimension of accountability. And one of the things we're going to try to put into place here to reward that which is effective, find the treatment systems that work, and those that work will be reimbursed fully and more providers will go to them.

It is a complex challenge. The Substance Abuse Mental Health Administration of HHS is working very diligently at how to implement this. It is, I think, an appropriate vision for speaking to the multiple needs we have out there. If we tune this structure up, if we strengthen and expand the treatment capacity system, if we link it in with the criminal justice system through drug courts we can then be stronger and more ready for the 4.7 million people we intend to move into this system as they overcome their denial and recognize their need. That is a large challenge. The monies are never fully adequate, but we have every hope that we can convince Congress and that we can tell the American people the urgent necessity for this kind of response to substance abuse, and that we have a commitment to it, we have a presidential backing for it so far for getting the money for it, we have a concept as to how it's going to work. And our hope is that we can make this effective, for the urgency is there for our strategy; the urgency is there for our society.

Thank you.

(Applause.)

ADELE HARRELL, Urban Institute: Thank you very much. I want to review briefly the role the courts are playing in this strategy in controlling drugs. As David mentioned, we have drug courts, we have diversion programs, and more recently we have system-wide intervention which was demonstrated as breaking the cycle, which we've recently completed an evaluation of.

The goal of all of these court initiatives is very straightforward. It is to move forward in the criminal justice system the point at which drug users are identified and begin immediately to get them into drug treatment as needed and use the authority of the criminal justice system in the courts to keep them there.

Drug courts and diversion programs are voluntary. They are typically targeted as selected eligible defendants who meet certain eligibility rules. In diversion programs, the district attorney offers to suspend prosecution or sentencing while addicted offenders try to complete treatment. Sometimes it's first-time offenders, sometimes it's very seriously affected defendants, even in Brooklyn—predicate repeat felony defendants.

In drug courts, judges offer addicted defendants who've been charged with drug offenses, sales or possession to have a chance to have their case dismissed or the sentence reduced in exchange for successfully completing the program. The drug court program is typically intensive and includes the mix of supervision by case managers and treatment professionals and treatment that lasts a year or more.

In system-wide intervention, some of the principles of diversion programs and drug courts have been taken system-wide. In this model, courts participate with other justice agencies in an overall strategy in which the goal is to identify the defendants regardless of the charge against them, the criminal history, or the level of addiction, and each one that uses drugs should get an appropriate drug intervention. So the options typically include drug court, diversion programs, in-jail treatment, intensified pre-trial supervision—a range of options. In all of these programs, though, there are three similar core components. One is an early assessment of the drug need and placement in appropriate treatment. The second is that offenders will be held accountable through regular drug testing and monitoring. And the third component is penalties swiftly and consistently applied for failure to attend treatment or to successfully pass drug tests.

The strategies can be used—and they've been demonstrated in a variety of settings—and David's problem, and all their problems with the drug court evaluations, is there is so much variation in the programs and how they're administered that no one evaluation speaks to all the possible outcomes. But programs have been effective with serious and first-time offenders, with the severely addicted and with the casual drug user. A recent experiment, for example, in Baltimore, found significant reductions in recidivism, although half of those eligible were daily users of cocaine and heroine and had a long criminal history. In Breaking the Cycle, about a third of the felony defendants did not meet the diagnostic criteria for treatment and they were placed in drug treatment and aggressive monitoring of their drug test results. So there's a range of things that can be done.

What we've learned from these programs is, across the board, defendants who participate are less likely to be rearrested. For example, in Birmingham's Breaking the Cycle, the likelihood of arrest in the year following program entry was cut from 22 percent to 12 percent for the typical participant. In Brooklyn, the district attorney's diversion program DTAP, which is for the very serious offender, cut the likelihood of rearrest within two years from 58 percent to 43 percent. And a recent meta analysis announces a cross-synthesis of 40 strong drug court evaluations found that 85 percent of them reported significantly lower rearrest rates.

But none of these programs is a magic bullet. Many participants failed. Our recent study of over 2,000 drug court graduates from a national sample found that 16 percent had been rearrested within a year—this is the graduates—and 27 percent within two years. Analyses of 30 drug court evaluations estimate that nearly 40—that with a drug court, 40 percent would be rearrested within eight years, and without a drug court 46 percent would be rearrested.

So that brings up the question, do reductions in arrest rates of this magnitude justify the shift of the courts to court intervention? Is the cup half full or half empty? There are really two ways to think about the answer to that. One is cost—cost benefit. Drug courts cost about $4,000 per participant in up-front money compared to traditional case processing. This is mostly in the court monitoring and drug treatment expense. However, a variety of cost benefits have been done and meta-analysis of them shows that the typical drug court returns $3 for every dollar spent, and that in terms of crime prevented. Our Breaking the Cycle, which was a less intensive intervention, cost about $700 to $1,400 per participant but it yielded savings in terms of future costs of crime of $3 to $7 per dollar spent. I think these are conservative cost saving estimates because they strictly look at the value of the reduced crime. And we all know that there are significant benefits to health, family functioning and employment that also follow recovery from addiction.

The second way to look at the effectiveness of these programs is on our administration of justice. Are they fair? Opponents of drug courts argue generally—they fall into two camps. One camp says they're soft on crime; they allow offenders to get away with their crimes without a penalty. The other camp says it's unfair to coerce offenders into treatment; setting up these strict program requirements will increase the risk of incarceration for participants, a group in which minorities are over-represented.

The recent Baltimore drug court experiment should allay both camps' fears. They found, in this randomly assigned group, there was absolutely no difference, or almost no—no significant difference in the amount of time they spent in jail for the offense that sent them to court. They didn't spend more time; they didn't spend less time. But the drug court offenders also had to attend treatment, go to drug tests, attend court review hearings. So they certainly didn't get away with no penalty for their crimes. On the other hand, there was no evidence that it increased their time in jail. They didn't get more time. Their time was spent in jail, though, in short-term incarceration for violating the program rules. And by some standards this could be perceived as fair and good use of public funds because it was the ones who were continuing to use drugs that were getting most of the jail time and therefore protecting the public safety, which is a goal of all of these programs.

The lesson that emerges, I think, from the research and experience of the past decade is that drug intervention by the courts can prevent crime, it can improve our administration of justice, and it can reduce the public cost of crime. But to take advantage of these lessons we have a lot of work to do. The courts need support and the treatment network needs to be supported if we are really to take these lessons to scale and generate these returns.

Now I'd like for Sarah—and Alan will be talking about the views of these from the court and from the treatment network perspective.

SARAH HART, National Institute of Justice: Thanks, Adele. Adele asked me to talk a bit today about what are some of the impediments that are out there for court systems and criminal justice systems to implement, and I'm going to start from the premise that appropriate drug treatment for appropriate offenders is going to make our community safer, but despite that, there still are, frankly, impediments to court systems adopting this—having these kind of programs go to scale, and I think that in order to have these kinds of programs go to scale and be used more in our criminal justice systems throughout state and local governments we have to be mindful of what are those particular kinds of impediments that are out there.

First and foremost—I mean, what you've heard David talk about here was a remarkable commitment of federal dollars for this kind of intervention programs for offenders. But the reality is that this is a criminal justice system that also involves a lot of state and locals, and it also requires a commitment from state and local governments to a similar sort of commitment in order to have comprehensive programs. In this day of shrinking budgets, it's difficult to do that. Most state and local governments are facing significant shortfalls in their budget and they're being asked to cut programs, not increase them.

So how do we deal with that? Well, one of the things that Adele has mentioned is that we certainly have a lot of information about what the kind of public safety returns are and the crime reduction benefits from this, but I don't think we've quite captured, what are the government savings here? One of the things that I have always found is that the easiest way to sell a program is if you say, if you invest X number of dollars you will save this number of dollars. Sometimes that is the kind of case that needs to be made in order to get governments to invest in particular programs, and I don't think at this point—I think David's point is also a good one that we need better data nationwide about the efficacy of some of the treatment and some of the benefits of these types of programs.

I think also one has to recognize that with specialized programs there are potential collateral costs that court systems may be resistant to. A judge is an expensive person to operate. I mean, they cost a lot of money. They get paid more than anybody else in the court system, usually, and it's an expensive resource. There is sometimes reluctance to devote a judge to doing work that may not be considered traditional case decisions sorts of work. There may be a reluctance, especially in high-volume areas, to pull judges away from a very crowded court docket and devoted to this. It's certainly something that in order to convince people to go into these types of programs and invest in them one has to recognize that that is something that is out there and has to be addressed.

One of the other things that Adele mentioned here, too, is this issue with some of these treatment programs. Historically, they seem to be reserved for times when there has been a history of failure. One of the things that I think was particularly good about the Breaking the Cycle program that you mentioned here was the fact that there was an attempt to identify people right as they came into the system and intervene while it's still early-on in the system. It's much easier to get someone into a program like this to allow them to go into a program that lets them perhaps not go to jail if they don't have a long criminal history or a lot of open charges. Oftentimes if these programs are reserved for more serious offenders later in the system, they're missing the opportunity to get people early on in their addiction when they're first starting their life of crime, and also it may be tougher, given the sentencing schemes, to have somebody go into that program.

One of the things that certainly has been seen by the research here is the benefits of having a cooperative model, that it's a much more effective program where you have the judge working with the prosecutor, working with the treatment program, and even the defense attorney involved. But sometimes there is a tension there because of the traditional adversarial model that you have in criminal justice. For example, let's suppose you are [a] defense attorney and you have a client that you know needs treatment—he's got a serious drug addiction problem—but you know that the search that led to the seizure of drugs was clearly illegal and that you have a winning suppression motion. Well, there's a real tension there because, yes, he's somebody who needs treatment and if you don't file that suppression motion he's going to get it, but if you file the suppression motion you win. There are tensions on all different sides here that sometimes, in some jurisdictions, people are particularly reluctant to become involved in this kind of a cooperative model.

One of the things that we've also seen in these types of programs is that the continuity of the approach is very important. In other words, like suppose you have a treatment facility, the offenders who are in that treatment facility need to know that if they violate that there are going to be swift sanctions and pretty darn certain. Sometimes if you don't have—if you have change in court staff you have a lack of continuity with that kind of approach that can greatly undermine the treatment program. If offenders in a program see that somebody has committed a violation that they all know about and absolutely nothing happens to him, it's not going to help that particular program.

So the need for having good court staff, continuity of approach, and not having constantly changing court staff is often a difficult thing to do. And it's also often very difficult to convince some of the best people to be involved in these programs. Sometimes judges do not perceive this to be the best kind of judicial assignment. It may not be seen as prestigious to be dealing with what they might see as lower level drug offenders. That is something that the quality of these programs is very much dependent upon the quality of the staff that are working with them.

So that, in my six minutes that I was told to do, it was my quick thoughts on that.

ALAN LESHNER, American Association for the Advancement of Science: Thank you. For those of you who know me, this will be an interesting test whether I can speak without slides. The answer is probably no, but I only get six minutes so you won't notice. I'm going to make a series of points, some of them in the form of an assertion, and I hope that it's sufficiently interesting and provocative to lead to some further discussion.

First, addiction is a chronic relapsing illness. It comes about because of what drugs and the act of using drugs do to the brain, and thus it's a brain disease. Very few people, in contrast to the popular view, recover on their own by dint of will, and sadly, most people experience relapses over time.

Being a brain disease does not mean that the addict is a hapless victim, however. As with many illnesses, the addict's behavior has played a part in the development of the disease and the individual must participate actively in his or her own recovery.

Number three. In contrast to the popular belief, you don't have to want treatment. It is not true that anybody actually ever wants treatment. People only go into treatment because they're either court mandated or mommy mandated. What you need is sheer exposure and then over time people become engaged in the treatment process.

Number four. There is no such thing as drug treatment as a unitary concept. There is no one-size-fits-all. Drug treatment is an extremely complex array of processes. It has many different elements and stages to it. The array needs to be tailored to the individual to accommodate or deal with his or her individual needs. So although we use the term "drug treatment" as if there is some generic unitary concept, what the data show is that is not true.

Next. In prison situations in the criminal justice system, post-release treatment follow-up is absolutely essential, and there has to be effective planning for re-entry into society for the individual and it has to be accompanied by active steps during that whole process.

Does treatment work? Yes. But having said that, life is relative. Compared to fixing a broken bone, the success rates are poor. But compared to other chronic relapsing illnesses like asthma or hypertension, the success rates, on the order of 60 to 70 percent, are quite good and comparable. However, being a chronic relapsing illness, occasional boosters are often needed over time.

Can you predict for whom it will work? The answer is, not really. Even treatment matching by modality is extremely difficult and it's not nearly as effective as most people claim it to be. It is easier to guess which people treatment won't work for than it is which people treatment might work for, but the belief in treatment matching, which I share, is not supported by practice in most treatment settings, and real treatment matching means, as Dr. Murray suggested, matching the individual service needs of an individual to those services that are actually ultimately provided.

And my last point: Courts need access to an array of effective treatment modalities and they have to be able to bring to bear an array of support services simultaneously. Judges and drug courts are not treatment providers; they are not treatment workers. They have to have around them people who can make sure that treatment in the broadest sense is available and that they can be tailored to the situation of the individual.

Sadly, my own belief is that the treatment system in this country is not organized in a way that it can meet the kinds of needs that we are imposing on it, and as time goes by we are going to have to bring it to a much more sophisticated level and it's going to have to be integrated in a far better way with the rest of the treatment systems that we offer—the service systems we offer in our country.

That's the shortest I've ever spoken in my life. (Laughter.) There was no slides. I have them for later if—(inaudible).

PETER REUTER, University of Maryland: I'd like to start by saying I think Adele somewhat undersells the importance of innovation that she's examining. Mark Kleiman used to do back-of-the-envelope calculations, which is about all you can do in this area, about the share of cocaine and heroine consumption that's accounted for by people who are currently under the control of the criminal justice system—pretrial, release, probation and parole—and typically came out with about half of all consumption occurring in that group, which is not a small number of people, by the way. So that whenever one—if you sort of ask, what can we do that gets at the nub of consumption of these drugs, a program that aims at reducing the consumption of this particular population has great promise.

Now, the evaluation, though, I think is also slightly undersold in a second sense, which is that the emphasis tends to be on treatment, but in fact—again, barring Mark Kleiman's notions—coerced abstinence, which is simply giving people predictable adverse consequences of drug use while they are in the grips of the criminal justice system, turns out to be comparably effective. There's an earlier Urban Institute study and evaluation of a program in the District of Columbia, which was a very important evaluation, which found that when comparing coerced abstinence, the notion that whenever you're detected with drugs in—having used drugs, that there is an immediate and sort of short penalty, that that turns out to be substantially better than the sort of—what was the standard treatment at that stage in terms of judicial supervision of the defendant.

And Adele tells a story—which she didn't have time to tell here, so I'll tell it for her—about why coerced abstinence seemed to work well, which is that for the first time it suggested to the offenders that the system was serious about its rules. Up to that stage it was, roughly speaking, you're not supposed to do it; the second time, I told you you weren't supposed to do it; the third time, I noticed that you didn't do it; and eventually, the seventh time, you're off to prison for three years. Instead of which, with the graduated sanctions and the coerced abstinence, what you got was fairly immediate responses, and—Adele told me at the time—the focus group said, oh, we suddenly understood the rule was serious.

Now, the reason that I emphasize coerced abstinence is precisely all our concerns about the availability of treatment and the quality of treatment. If David Murray is right that the National Household Survey on Drug Abuse estimates were right that there were 6 million people in need of treatment, then we would indeed have a terrible crisis. I think that number is substantially overstated. Half of those estimated are dependent only on marijuana, and very few of them are dependent on cocaine or heroine, and I think it's just sort of—it's a number that doesn't belong here, but for the moment assume that it's correct, that there is substantial excess demand for treatment. Then finding ways of helping this population of criminal offenders cut their drug use that doesn't involve having to use scarce treatment resources is a very attractive notion indeed.

And to push the point a little further, this is a population predominantly male who will be competing for treatment resources with another population about whom we care for quite different reasons, which is women with substance abuse problems who are pregnant. And a condition that we sort of avoid—a dilemma that we avoid confronting in these discussions is often how to set up systems to sensibly allocate those treatment resources amongst those different populations.

So I do believe that these diversion programs are important because they focus on a population which accounts for a large share of the drug problem in this country, and secondly, they may actually be able to do it relatively cheaply if we can figure out ways of making coerced abstinence rather than treatment the center of the program.

Thanks.

ADELE HARRELL, Urban Institute: We'd like to now open it up for discussion. And please wait until a mike gets to you and identify yourself when it does. Who's got the mikes? We've got a question up front. Right here.

DAVE SPEIGHTS, Drug Detection Report: I have a question for Dr. Murray. A week ago today I received the news from Secretary Ridge and John Walters announcing the designation of Roger Mackin to be Counternarcotics officer and U.S. Interdiction coordinator at the Department of Homeland Security. How is this new office going to fit into the existing scheme of things, and will this be a helpful, unique contribution or another layer of bureaucracy?

DAVID MURRAY, Office of National Drug Control Policy: The part of the Homeland Security being set up is obviously going to be an additional dimension of government services. It has a notion of an integrated need to regard our border security and our internal security. Roger Mackin, a figure known to me, is [a] very accomplished individual who will continue to serve in the Office of National Drug Control Policy and jointly with the Department of Homeland Security in his new position as Counternarcotics officer.

There will be an integration and a liaison function across those agencies. I don't see a particular problem other than we face problems and we're trying to respond to them by building appropriate structures that meet them.

ADELE HARRELL, Urban Institute: Another question?

J.J. SMITH, Substance Abuse Funding News: In the current fiscal year, SAMHSA [Substance Abuse and Mental Health Services Administration] is not accepting applications for new drug courts; they are funding drug courts from applications from the previous fiscal year. But what is this signal sending to programs who wanted to get set up and were gearing up to submit applications? Also, there was a cut in DOJ funding for fiscal year '03 for drug courts. I believe they're funded at $52 million right now.

DAVID MURRAY, Office of National Drug Control Policy: We have $68 million for '03, with an additional $16 (million) we requested, but I would guess that Sarah Hart knows best about SAMHSA not receiving new applications for drug courts. We are expanding the drug court system wherever possible, to the best of my knowledge.

ADELE HARRELL, Urban Institute: I think most drug court applications go into OJP rather than to SAMHSA, so SAMHSA's support for drug courts was on a trial basis. Their service is clinical—what is it called?—Criminal Justice Network, and they were pilot or demonstration programs. I believe most of the drug court funding goes from OJP. It was in the Office of Drug Court Programs; it's now been moved to BJA, right?

SARAH HART, National Institute of Justice: Yes, drug court programs is under the Bureau of Justice Assistance, but I don't have any facts that -

ADELE HARRELL, Urban Institute: And I'm not sure what they're funding but I think that's where they are.

Another question?

OPIO SOKONI, Drug Policy Alliance: We didn't mention—or you guys did not mention the Treatment Instead of Jail initiatives that are actually working in California and Arizona, as well as some have been passed through the legislative bodies of a couple of states, that are actually saving money.

The drug courts came in as a reform type of movement, and it's doing a decent job, but because of coercion—which actually there is no support that coercion works but actually when you jail someone because they're sick it provides another situation the individual has to recover from. So you have the Treatment Instead of Jail initiatives that actually open up treatment to everyone, and it's working in California with amazing numbers.

So if there's a model to be looked at, I think the Treatment Instead of Jail initiatives that have been passed by the population, who seems to be way out in front of politicians on drug policy reform, I think that's a model that should be studied.

ADELE HARRELL, Urban Institute: I don't know if that's a question, but Peter?

PETER REUTER, University of Maryland: Prop. 36 in California does seem to be doing well as compared to the very pessimistic expectations of the professionals in the field. That is to say there are actually large numbers going through Prop. 36 rather than being diverted through charging decisions, you know, away from where the—anyway, the flow is much larger than expected and the sense is that the treatment system has been able to accommodate a large share of those coming through the system. I don't think one can make any stronger statement than that at this stage about how well it works.

And it's not an alternative to the programs that Adele has been describing; it's a complement to them. There is one class of offender you may want to handle through this kind of treatment as a substitute rather than diversion—substitute for incarceration—and there are others that may be facing—you know, other classes of offenders for whom it may be that you offer it as an alternative in the context of potential incarceration.

ADELE HARRELL, Urban Institute: I think what we have learned is that using the pressure of the criminal justice system does increase—when you say there's no effective coercion, I think a number of studies have indicated that the extra coercion provided by the court increases entry into treatment, increases treatment retention, and when you increase exposure to treatment you increase your treatment success rate. It's not that courts are doing treatment, it's that they have a convincing way of making treatment attractive for people who can benefit from it.

And I also share Alan's opinion that very little drug treatment participation is totally voluntary. It is typically in response to life circumstances that are getting out of control. It's the employer, the spouse, the family, or simply the person. We did a number of focus group interviews with drug court participants here in Washington and you would hear, typically, comments like, I knew it was time—I knew it was time; it was ruining my life and this is the push I needed. And you hear that kind of statement when you talk to people who are caught up in the system.

ALAN LESHNER, American Association for the Advancement of Science: Also there is a database that shows that if you increase legal pressure, it does in fact increase the probability people will stay in treatment, it increases the probability that they won't relapse. So there is a database to support the counterintuitive belief that you don't have to want it in order to enter it.

ADELE HARRELL, Urban Institute: Now, I agree with your other path of what you were saying, which is it's unfortunate to give people criminal histories that don't need to have criminal histories, and so the earlier that we get into this, the identification of people right when they come into the criminal justice system and trying a drug treatment program early rather than later, it's certainly a good idea.

DAVID MURRAY, Office of National Drug Control Policy: I think this question has gone—obviously each of us has had something to say about this, but Proposition 36 in particular—similar initiative in Ohio that was defeated—I think in general, at this point, we would judge as inferior to a drug court outcome, I believe, for three quick reasons.

One of them is California Proposition 36 definitely did not properly diagnose the sort of client who's going to be coming forward. They had anticipated one population and they found a very different population actually showing up. A very strong percentage of people who were older than anticipated, who were methamphetamine users with far more serious drug problems, were coming into the system and that created difficulties for them because the proposition had had the effect of removing judicial discretion. And by not having judicial discretion in the system you ended up sometimes with inappropriate people going into diversion who had actual criminal histories that were quite troubling and difficulty with their substance that was far greater than anticipated, and the impact on the treatment system was rather problematic.

And third, the proposition did not provide for funding for treatment while people were in prison itself. As a matter of fact, it prohibited the expenditure of those funds for people currently in prison, and we find we need a more comprehensive both prison-based program, parolee probation program, not a mandated expenditure that goes to the taxpayer and judicial discretion, which are features that drug courts can bring to bear. We think it's a more flexible system.

ADELE HARRELL, Urban Institute: Yes?

CHRISTIAN BOURGE, UPI: Various people have made the comment about the need for further data. Can any of you address just how far along in that process we are? Are there significant efforts underway to address that problem?

ADELE HARRELL, Urban Institute: What was the problem? I couldn't hear it.

CHRISTIAN BOURGE, UPI: Both Mr. Murray and others so far spoke about the lack of data proving, to an absolute, the effectiveness of these programs. Can anyone address in terms of where that process is in terms of having that data? Are there significant studies underway, et cetera?

ADELE HARRELL, Urban Institute: Well, I—we may differ on that. To my mind, we don't have one single national drug-court evaluation that demonstrates their collective efficacy, but we have a number, though, of experimental evaluations now that are coming out that indicate—or strong quasi-experiments, and those are indicating, one at a time, effectiveness. In the META analysis of those, which the quantitative synthesis is pretty convincing.

The problem with it, which I think—I know that the National Institute of Justice plans such an evaluation—the problem is the drug courts vary widely in who they target and how they operate and what their requirements are. So when you come out with what is the treatment that you are evaluating, it's not so easy to do a little dose response experiment.

SARAH HART, National Institute of Justice: I'll tell you, I'm going to—Tom Feucht, who is the director of NIJ's Office of Research and Evaluation is in the crowd here, and Tom, can you just—in response to that question, tell him what the status of the drug court evaluation is, where exactly we are right now? The gentleman all the way in the back.

TOM FEUCHT, National Institute of Justice: NIJ solicited grant applications for a national evaluation, and those applications were received and empaneled and are going through peer review. So the clock ticks on a 60- and 90-day time frame, so some time in the next six months we should have a decision on that.

ADELE HARRELL, Urban Institute: And that's a decision, so Christian, your answer will be years in coming. (Laughter.) As a professional—

(Cross talk, inaudible.)

SARAH HART, National Institute of Justice: And the other—one of the other things that was mentioned here, and certainly I mentioned it, was—you know, we have done some cost-benefit kinds of analysis, but it has been primarily focused on the kind of reductions of crime. And I think that this is something that we continue to work at at NIJ to really improve that kind of an analysis because the bottom line is if you want people—policymakers in state and local governments to invest in a particular program, you've got to be able to tell them what it's going to cost and what they can expect to get for it in terms of public safety benefits and also any financial savings they can expect. And unless you give them that information, oftentimes they will not invest in a program.

ADELE HARRELL, Urban Institute: I saw some other hands up—one is back there and then Jeremy.

BARBARA SOLT, Institute for the Advancement of Social Work Research: I'm sorry Dr. Murray has left because my question is more directed to him, but my concern is about the capacity of the workforce. I mean, if you have a voucher but no one picks it up, or if there aren't people specially trained to do the interdisciplinary nudging, treating, connecting—as social workers very often do.

Could you—could someone on the panel speak to the need for and what is being done to research the development of that kind of workforce and the training of those people? The GAO recently—I think it was this week—just released a report on the child welfare workforce addressing this very thing, and I'm wondering if something for this population is also perhaps in the offing.

ADELE HARRELL, Urban Institute: I really can't answer it—sorry.

SARAH HART, National Institute of Justice: I'm unaware of anything like that that—there could be, there are other—there are other research entities that could be doing it.

ADELE HARRELL, Urban Institute: Jeremy, you had a question? Jeremy?

JEREMY TRAVIS, Urban Institute: I'd like to get a sense of scale here. Dr. Murray, in his opening remarks, talked about the really remarkable growth in drug courts, that there would be 1,000-plus whenever. Peter Reuter, end of the panels, cited Mark Kleiman's back-of-the-envelope calculation about the percent of drug consumption that occurs within this population. So we have this one statement that's very provocative, that if we could do something to reduce drug use within this population we might have an effect on national consumption levels, which has effect on—presumably on supply and the like, and a growth in a technology that appears to be effective.

Who can help us understand, back-of-the-envelope, how far we are away from reaching a sort of intervention treatment or not for the population that comes through the criminal justice system? How many people are being served by drug courts? What's the shortfall? Are we close? Are we far? Is this—you know, are we going to—even if we kept at this level of growth -

ADELE HARRELL, Urban Institute: We're really far because the typical drug court handles about 2 to 300 cases—clients a year and so—just back-of-the-envelope—if there are a thousand of them, you've got—what's that? You know, 30,000 people a year. I can't do the math.

PETER REUTER, University of Maryland: Two hundred thousand -

ADELE HARRELL, Urban Institute: Two hundred thousand if the—it's not—it's not reaching the problem.

PETER REUTER, University of Maryland: Yeah, I mean, it's not reaching the problem but, you know, let's play it out and assume that everybody who was sort of eligible went through the system—I mean, the kinds of numbers that Adele was suggesting as sort of—I'm not sure whether to take the eight-year or the two-year -

ADELE HARRELL, Urban Institute: Reduction.

PETER REUTER, University of Maryland:—reduction.

ADELE HARRELL, Urban Institute: Oh, they're all from different programs. I'm sure, you know -

PETER REUTER, University of Maryland: Yeah, I got—but anyway, you know, a reduction of—in recidivism of 15 percent over a two-year period is a lot, and so that would sort of give you a sense about, you know, if half of the consumption is in this population and every one of them went through this program, you'd sort of see a reduction of, you know, 7 percent or so in total consumption. Now, you know, that's very crude, but it gives you a—I mean, on the one hand, it says, you know, this is far from making a big dent in the problem; on the other hand, there is very little else that you can suggest that we know could produce even that much of a decrease. And the remarkable thing about drug programs, particularly cocaine and heroin, which are the ones I'm most interested in and which are, I think, still the most—cause the most harm in this country, is just how stable they've been over a long period of time. What you see is sort of a gradual decline in the number of people who use frequently, very modest, increasing—sort of—some increase in the morbidity and mortality, but basically it's [a] very stable problem. This is a program, which is one of the few I know of, that offers realistically a chance at making a noticeable decrease.

ADELE HARRELL, Urban Institute: But I think the real answer is that drug courts are one part of what we should be doing in an across-the-board approach where some people don't need the whole year of treatment that drug court entails, but that they can have a much more coerced abstinence focus.

I did want to challenge in that statement he made earlier because I think while we—we did find that coerced abstinence in the Graduated Sanctions Program in Washington was effective, I think both the detailed analysis in that subject and also Joan Petersilia's —(audio break, tape change)—access to treatment for those who need it, those for whom the coercion alone doesn't work, that's when you get your biggest bang. So you've really got to develop a range of options that people can fit themselves into.

Jay Carver, a former director of Pretrial Services here in Washington, said, "We let them fail into treatment," and they did. They did—they tested them, and when they couldn't get clean with the sanctions, then they would, you know, put them into treatment.

SARAH HART, National Institute of Justice: I think the other thing to keep in mind too in terms of drug courts, that's one way of having coerced abstinence but that model isn't going to work everywhere. If you've got a rural jurisdiction where you've got one judge for two counties, you're not going to be able to have a specialized drug court. It is something that is as—you know, you have to think about different options. The specialized drug courts are not going to work in your smaller jurisdictions.

ADELE HARRELL, Urban Institute: Which increasingly are places with serious drug problems.

ALAN LESHNER, American Association for the Advancement of Science: One of the things that I'm always concerned about is that when we engage different programs working with drug offender populations, and when we just deal with folks who have drug conditions, we often hear there's no available bed space unless you have insurance or, unless you get in some kind of trouble with the law, you just can't get treatment. So treatment is, one, first of all, poorly lacking in availability. And, two, the most important thing for me, though, is that unless that person gets in trouble there are many folks who have drug problems who commit crimes but never come in contact with the justice system, and would really want to be able to get treated, but back to that, there's no available treatment program unless you have some kind of resources available to you. And I would dare say, especially with cocaine users and heroin users, resources are lacking, so they go untreated and feeling like even if they wanted it, they couldn't get it without being involved in the criminal justice system.

ADELE HARRELL, Urban Institute: I wish David were still here because it's my understanding that that's—the voucher program that they're proposing is intended to address that gap. I think there's another problem that I—or personal complaint of mine which is that many drug courts won't use methadone maintenance, which is an effective treatment for heroin users, and they don't use it. I mean, I think there's some misconceptions around in the criminal system about how best to treat people.

ALAN LESHNER, American Association for the Advancement of Science: There also is a misunderstanding frequently about what constitutes treatment in the comprehensive sense of the term, and one of the things that's going to have to happen is not only do we develop principles of effective drug courts from the criminal justice point of view, but principles of effective drug courts or the blending of criminal justice and health approaches from the health point of view. And sadly, we've gotten nowhere along that dimension.

ADELE HARRELL, Urban Institute: (Inaudible)—in the court's point of view of how do we know if this is an effective treatment or not? There is no sort of quality standards that court judges who don't know much about this topic can go to for reference.

ERIC STERLING, Criminal Justice Policy Foundation: What about the role of alcohol in crime? Is that something that is addressed in drug courts? Is that something that the panel could discuss? Second, in order to reduce drug use, what is the role in tobacco use and the prevention of tobacco as a gateway to illegal drug use? Third, to follow up on Jeremy Travis's questions about scale, what fraction of the people in drug courts do we think might be primarily presenting as marijuana users or people whose substance abuse problems are marijuana, and how does that contrast with the law enforcement emphasis nationwide of about 800,000 marijuana arrests per year?

ADELE HARRELL, Urban Institute: That's a lot of questions. (Laughter.) Do you want to go?

PETER REUTER, University of Maryland: Let me—an important question in this regard—I mean, they're all important. Since I remember the last one, I'll deal with that.

The marijuana issue is a very troubling one. Marijuana uses—despite the increase in marijuana use amongst adolescents, total marijuana use in this country has been flat for—since 1990; I mean, just sort of amazingly flat—fewer adults using, more kids. The number of arrests has gone up probably 150 percent since 1992. The risks of being arrested for marijuana use have gone up very substantially, but marijuana use has stayed stable. The system is now being flooded with marijuana arrestees, most of whom get flushed out fairly early, but not all. And one of the ways they sort of get out of the system is by going into treatment. And the number of treatment admissions for—with marijuana as the primary drug of abuse in the hierarchy—that means basically I think only alcohol is below it—is about 150,000. It's about the same number as for heroin.

And when we've talked to people in the treatment system, they sort of don't recognize that they have a lot of marijuana patients, and it's fairly—I mean, I—I think it's a reasonable inference that there are a lot of people who are in the treatment system being treated for a legal problem, not for a substance abuse problem.

And drug courts probably are going to assist in that respect because one way of getting these clients out quickly is to refer them to treatment, and they'll probably do well in treatment in the sense that they don't start with a very serious—with any—maybe any substance abuse problem, but just with a legal problem. And so drug courts may do well with marijuana offenders. Whether it matters is another matter.

ADELE HARRELL, Urban Institute: Now I recall your question about alcohol and tobacco. Most courts don't tackle those problems because use of those substances is not against the law. Now most treatment programs that they send them to, on the other hand, will require total abstinence—I don't think cigarettes, but from alcohol as one of the program criteria for success. So they get some emphasis on it, but the courts are not prepared to enforce that, given the legal status of those drugs.

ALAN LESHNER, American Association for the Advancement of Science: Although it is, just from a clinical point of view, it's an interesting observation that if you treat the addiction to nicotine simultaneously with the addiction to other substances, you do in fact increase the success rate in the treatment experience.

SARAH HART, National Institute of Justice: One of the things that we're also starting to see in the criminal justice arena with the shrinking budgets and with the lack of resources for drug treatment is that there are some very hard calls that are being made about what offenders should be—you know, what offenders should they be seeking court intervention to go to—to force them into treatment. And in a major metropolitan city, for example, I know where they had far more probationers than they could ever possibly handle. They were concerned that when they would test them they would get a number who would test positive for marijuana but no other drugs, and other than that, they did not appear to be presenting a particular harm to the community. In other words, they weren't able to say that this person was likely to be out, you know, robbing people or whatever.

And the concern that was expressed to me by the person involved in this was that—the concern was that if I bring that to a judge, the judge is going to use that treatment bed for this marijuana user who may not be the biggest threat to the community. And so you are starting to see some jurisdictions who are making a deliberate decision not to test for marijuana on their probationers or parolees because they want to be able to reserve those very limited resources for their highest-risk offenders and the ones that pose the greater public safety risk. It's not that they don't think that the drug problem is a problem; it's just they're having to make some very hard calls, and when forced to make the hard call, they're looking at the public safety one first.

ADELE HARRELL, Urban Institute: Got a question here?

ROB FLEMING, Progress Notes: I'm a local recovery advocate, and I publish a newsletter on local addictions policy.

I have two related questions. One is what's being done to expand the capacity of the system, both quantitatively and qualitatively, so we have more treatment so you don't have to be either rich or a felon to get treatment? And the second question is how do we translate this—and it's probably related—how do we translate all those nice return-on-investment numbers into the political will to spend the money? The problem around here is that the savings are in the criminal justice system and the child welfare system and the employment and training system. The costs are all in the Addiction, Prevention and Recovery Administration, which has got a totally separate oversight committee, a totally separate budget committee, et cetera, et cetera. There's no transfer mechanism.

ADELE HARRELL, Urban Institute: Yes, and all the cost[s] really aren't in even savings in the criminal justice system. A lot of those savings are the public cost of victimization, costs to the public. So it really doesn't even sell well in the criminal justice system to say you really should spend $4,000 a year more per person on this drug court when that's not coming into their—these downstream savings are not coming into their coffers.

PETER REUTER, University of Maryland: Al Leshner spent eight years trying to get that message across to Congress—(laughter)—and he—

ALAN LESHNER, American Association for the Advancement of Science: It shows you how effective I am. (Laughter.)

PETER REUTER, University of Maryland: No, but it really is striking that the "Treatment Works" message just does not get heard. And I—my own sense—and I think this is Mark Moore's (ph) insight—is—and there's a kind of moral calculus problem here, which is that treatment services are services for people who have caused great harm to the rest of the community. And even if you make the argument that giving them services will help the rest of the community, there's a resistance at giving them services. And I don't know—I don't know a good way around that, and Alan doesn't either, I gather.

ALAN LESHNER, American Association for the Advancement of Science: I do science. (Laughter.)

ADELE HARRELL, Urban Institute: Well, the president's budget requests increase. I think that's one of the more remarkable things in the budget, and perhaps that means that eventually the message is sinking in, and maybe we can look forward to that in the future.

I want to thank you all very much for coming, and I appreciate it. Follow-up questions—if you want to e-mail us or get in touch with—my e-mail is [email protected]. I'll try to get back to you if you have questions.



Topics/Tags: | Crime/Justice


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