Sobering Reality

In November 2000, 61 percent of us said yes to Prop. 36—an initiative that, for non-violent drug offenders, puts a fork in the road out of addiction. On July 1, 2001 when Prop. 36 took effect, users convicted solely of possession had a choice: treatment or incarceration. Prisons aren't built for intensive rehab, making the former choice more appealing. And so far, out of 3,226 possible Prop. 36 candidates who've filtered through the San Diego County criminal justice system, 2,324 individuals have been admitted into treatment.

To put this into perspective, there's an estimated 25,000 to 28,000 intravenous drug users in San Diego County; this county ranks first in the nation for female arrestees on methamphetamine, second in the nation for males.

At best, then, Prop. 36 is a fast track to recovery for hardcore addicts who wouldn't have otherwise opted to get clean (voluntary treatment programs tend to have a six-month waiting list). At worst, the program dumps fresh-out-of-treatment addicts, some with a 10 or 20 year history of drug use into a world they're ill equipped to handle sober.

Since its birth a year ago, Prop. 36 has brought to attention an ignored population with needs more severe than the people who voted it in could have imagined. Ancillary services such as basic health care, employment training, literacy programs and family counseling have proven to be essential.

It's is a tool for recovery, not a silver bullet, said Whitney Taylor, director of Prop. 36 implementation for the Drug Policy Alliance, the organization largely responsible for the ballot measure.

The most basic need for full recovery resonates strongly with a current countywide (and certainlyly nationwide) concern: lack of affordable housing. A bed and a roof should be the last of a recovering addict's worries, said Taylor. And often addicts need to get out of the environment they've been living in where family, friends and the guy on the street corner complicate recovery.

So here's the rub: the county's state-allocated Prop. 36 funds (almost $9 million for the 2002-03 fiscal year) cover detox, in-patient and out-patient treatment and administrative costs, but they do not finance housing, save for a limited number of residential treatment slots, where 23 percent of Prop. 36 referrals find room for three to six months. The county, Prop. 36 or otherwise, doesn't fund what's known as sober living environments, where recovering addicts can stay either during or post-treatment, and this fact has some health care advocates concerned.

“Most of these people [in the Prop. 36 program] have been homeless,” explained Thomas Brewer, program associate with the Alliance Healthcare Foundation, a San Diego-based nonprofit fundraising and advocacy organization. “People with years of hard addiction have really lost their social norms,” he said. “Sober living houses give people a safe place to live and help them learn how to live in society.”

Alliance Healthcare has been funding two successful drug treatment programs-the McAlister Institute's Harm Reduction IDU program and Community Connection Resource Center's Living Free program, both of which use sober living to get recovering addicts stabilized, both of which have proven highly successful in treatment outcomes, and both of which will see their two-year grants end next month.

Funding sources for nonprofits have become tight these days, and in looking for other resources for clients in need of sober living, Linda Lloyd, Alliance Healthcare's vice president of programs, was surprised to find out that the county doesn't fund these types of facilities.

“I didn't realize sober living wasn't funded at all by the county,” she said. “So if McAlister took the same project they came to us with and went to the county, it would not be eligible for funding.”

Eric Mosley, who heads the criminal justice program at McAlister Institute, said he gets calls all the time from Prop. 36 clients who need help finding a temporary place to live. His concern, and Lloyd's as well, lies with medium-level clients-those not serious enough for residential/in-patient treatment but who might need a place to live while undergoing day treatment.

“They could be on the verge of [being] a residential candidate, but residential programs are so full,” said Mosley. “In a medium setting, the person is required to seek treatment, but they still need a place to stay and there is what's called sober living.”

This alternative—day treatment combined with sober living-is far more cost-effective than residential treatment, added Lloyd. And the benefit is an added sense of independence. “It can help [the client] reconnect with what they want to do with their life,” she explained.

San Diego is not the only county where lack of housing for Prop. 36 clients is a concern. In a report to the Little Hoover Commission, a watchdog group for state-funded programs, John D. Larsen, manager of criminal justice, outpatient and homeless services for the Santa Clara Valley Health and Hospital System, cited overall lack of sober living environments as detrimental to recovery. “Without them,” Larsen said, “treatment outcomes will be sharply limited.”

County officials say the reason for the lack of sober living houses locally is the same story plaguing healthcare programs up and down the state.

“Prop. 36 is an under-funded initiative,” said Susan Bower, Prop. 36 coordinator for county alcohol and drug services. “If we could do everything for these people that they need, we'd be hugely over budget.”

Other counties, Bower added, have been able to drum up additional money from their general fund to support sober living houses. In San Diego, “we do not have that luxury,” she said.

The solution? “It comes down to politics,” Bower explained. “...[T]he county and the city deciding that there needs to be additional resources through other revenue streams.” Bower added that there have been “very preliminary” discussions with other agencies about potential sources of housing. Overall, she said, the lack of housing for Prop. 36 clients “feeds into the larger problem of housing.”

Until a solution comes up, Al Medina, a county drug and alcohol services program administrator, said clients needing sober living must pay their own way, either through employment income, Section 8 vouchers or some other source of state or federal funding, such as disability. Medina admitted that the county is short on residential beds and needs more for the upcoming year. To the county's credit, however, it has put together a set of standards for sober living environments so that clients who need and can pay for them will at least have a decent place to go after treatment.

Write to kellyd@sdcitybeat.com or editor@sdcitybeat.com