Prescription for Wellness

Adult Treatment

In 1996, it was estimated that less than half of the people in the United States needing drug treatment received services (1999 National Drug Control Strategy). In Texas and Travis County, the exact number of persons needing treatment is unknown. The primary source of data statewide is TCADA. During Fiscal Year 1998 there were 3,492 adult admissions to TCADA-funded treatment programs in Travis County (TCADA, 2000). TCADA's data report the following trends:

• Male adults receiving services was 65.8 percent.
• The average age of those receiving treatment was 35 years.
• Average age of first use was 19.8.
• Average time span from first use to admission to treatment was 16 years.
• Services were received for the first time by thirty-seven percent of the adults.
• Twenty-eight percent of those treated were criminal justice referred.
• The average education was 11.6 years.
• Adults using needles was 24.9 percent.
• In 1998, there were 39 treatment sites, 934 residential beds, and 2,551 outpatient TCADA funded slots.

In summary, a little more than half of male adults receiving services have been abusing substances and participating in high-risk behaviors, such as criminal activity and needle injection for an average length of sixteen years before they enter services for the first time. The lag time between first use of substances and entry into services suggests that efforts to promote earlier interventions are important.

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Current Community Adult Treatment

Table 8-11 identifies Travis County community adult treatment resources by type and provider. For a recent survey of local providers, see Appendix G.

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Criminal Justice Treatment

One of the shared concerns of Travis County residents is the relationship between substance abuse and/or dependence and crime. Four of every five adults in U.S. prisons are incarcerated because of criminal activity linked to drug and alcohol abuse (Superville, 1998). Given the connection between abuse of alcohol, drugs and crime, decision makers seek effective strategies to break this link. The RAND Corporation (1997) asserts that community treatment is 15 to 17 times more effective in reducing crime than incarceration. This means that for each crime curtailed by incarceration, community treatment would eliminate at least fifteen. (Caulkins, J. P., Rydell, C. P., Schwabe, W. L., and Chiesa, J., 1997.) It is estimated that for every dollar spent on treatment of substance abuse, taxpayers would save seven dollars. Improved access to substance abuse services offers a "practical" and "cost saving" strategy for breaking the chain between substance abuse and crime (Close to Home, 1998).

Incarceration is disproportionate among ethnic groups. The Office of National Drug Control Policy (1999) reports that in 1997 "African-American men were twice as likely to be incarcerated in their lifetime (28.5 percent) as Hispanic men (16.0 percent) and six times more likely than Anglo men (4.4 percent)." Between 1986 and 1991 the number of women in prison for drug offenses increased 433 percent while the number of men increased 283 percent (USDHHS, 1997). Disparities between incarcerated ethnic groups underscores the need for cultural competence in the substance abuse prevention and treatment provider network. Table 8-12: Criminal Justice Adult Treatment.

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Community Court

In 1998, an innovative model for addressing misdemeanor offenses was conceptualized through a collaboration between the community and the criminal justice system. The purpose of this effort was to interrupt the sequence of criminal behavior identified at the misdemeanor level before more serious crimes were committed. A model for the Downtown Austin Community Court (DACC) was developed after more than a year of planning on the part of criminal justice and behavioral healthcare professionals, downtown business owners, members of local neighborhoods, city and county government staff and local elected officials. Implemented in October 1999, the DACC provides offenders arrested in downtown Central Austin for Class C misdemeanors with the means and encouragement to discontinue criminal behaviors while holding offenders accountable for their conduct and restores justice to victims and the community.

During 2000, 143 persons received one or more levels of substance dependence treatment. One hundred and thirty were men (90.9 percent); 117 were homeless (85.4 percent). Homelessness presented a special challenge in the rehabilitation process with 75.2 percent literally homeless and 10.2 percent marginally homeless. One hundred and eight persons (75.5 percent) were within the 20-39 year age range.

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Travis County Drug Court

System of Healthy Options for Release and Transition (S.H.O.R.T.) Program is a drug diversion program modeled after the Dade County Drug Diversion Court in Florida. Initiated in August 1993, it provides a regimented treatment alternative to traditional methods of adjudicating and/or treating drug offenders in Travis County. The intent of the S.H.O.R.T. Program is to break the cycle of drugs and crime by substituting an effective counseling alternative to traditional case disposition and incarceration. The S.H.O.R.T. Program is a minimum one-year, intensive court and substance abuse treatment program featuring individual and group counseling, case management, and judicial intervention. In general, Drug Court participants are nonviolent felony offenders who have been arrested for possession of small amounts of a controlled substance and who are assessed as being addicted to drugs. There are approximately 250 participants in the program at any given time, about 25 percent of whom are women. An average of 50 participants enter each quarter (P. Greenspan, personal communication, November 9, 2000).

The DACC and S.H.O.R.T. programs intervene at different levels of criminal behavior. These innovative approaches can be evaluated as best practices initiatives.

The Sobering Station Concept

Currently, the concept of a sobering station or a sobriety center is being evaluated as a best practice for implementation in Travis County. The establishment of a "sobriety center" or "sobering station" has been identified as an effective "harm reduction" strategy for reaching homeless persons with chronic alcoholism and addiction. The main tenets of harm reduction are (National Symposium on Homelessness Research, 1998):

• a non-judgmental and respectful approach;
• helping residents to identify harmful effects of drug and alcohol use and the benefits of decreasing and/or ceasing use;
• exploring alternate, safer routes and patterns of use, and praising small successes; and
• developing flexible plans that address substance abuse issues.

The National Health Care for the Homeless Council, Inc. in their policy paper, Addiction Services and Homelessness, recommends the establishment of harm reduction programs as a means of reaching people who are not ready to be abstinent from alcohol or illegal drugs. Harm reduction programs mitigate some of the health and safety risks associated with substance abuse, while also providing a safe and understanding environment in which persons using substances can learn about the benefits of recovery. Along with the Sobering Station or Sobriety Center concept, harm reduction strategies include needle exchange programs, methadone programs and use of mobile assessment teams.

Currently, both methadone and psychiatric emergency services (PES) are locally provided. The addition of a program encompassing the above tenets would offer a safe and supportive alternative environment for those persons not ready to accept treatment. Services offered could include crisis stabilization, medical assessment, treatment, case management and counseling services. Ultimately, such services can provide a non-threatening first step to engaging clients in long-term treatment.

Sobriety Centers or Sobering Stations have also assisted local governments by diverting costs from law enforcement and hospital facilities. Historically, the arrest and treatment of publicly intoxicated persons has placed a significant financial burden on cities and counties. The establishment of such a program can result in decreased demands on local systems, while more effectively meeting the complex needs of those with substance use disorders.

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