Out of the project’s participants, 20 percent stop treatment within a year because of an inability to pay, and many, says McKenzie, probably end up in prison again. “That’s how it works,” she says. “People who don’t have the resources [to treat their addictions] end up in the criminal justice system.” (After Project MOD’s funding ran out in September, it got a one-year extension that expires this fall.)
Yet even if the state were to boost funding levels to transfer significant numbers of inmates into treatment, many providers are already at capacity, so it would be very difficult, if not impossible, to meet the new demand. “There’s no way we could do it,” says DMRH’s Rebecca Boss.
In part, says Boss, the lack of capacity stems from the nationwide shortage of treatment providers. Over the past nine years in Rhode Island, the number of certified substance-abuse professionals has decreased from 380 to 300. “It’s not a glamorous or financially rewarding profession” says Boss, citing the paperwork, emotional challenges, and low payment characterizing the field.
The state could adopt steps to entice more providers, such as a loan-forgiveness program for those entering the field, says Neil Corkery, executive director of Rhode Island’s Drug and Alcohol Treatment Association. But given the state’s fiscal straits, says Corkery, it’s a challenge: “There just aren’t enough resources there.”
The hope of a new approach
Yet while cost remains a major barrier, a fiscal argument for expanding treatment is among the most persuasive. After all, it costs $39,000 to keep someone incarcerated for a year, $20,000 to fund a bed in residential treatment for a year (which could be used by more than one individual), $11,500 a year for intensive outpatient treatment, and $2900 a year for methadone treatment. The National Institute on Drug Abuse estimates every dollar invested in treatment saves $4 to $7 in drug-related crime.
More compellingly: substance abuse treatment works. Here in Rhode Island, a two-year study published last fall indicated that, of inmates who complete substance abuse treatment in prison, only 23 percent return to prison within a year. Similar studies have also found that offenders who complete treatment are less likely to commit new crimes.
To achieve significant savings, the ACI would have to transfer the equivalent of a 115-person cellblock into treatment, to recoup fixed costs. But with 42 percent of inmates incarcerated on nonviolent charges, candidates for such treatment are not lacking, offering the potential of long-term savings.
By contrast, as Wall told lawmakers earlier this year, approving an early-release package like the one backed by the House in March would do little more than “buy the state two years” before the overcrowding issue would surface again.
A 44-year-old Providence man, who has been addicted to heroin for more than half his life, notes that many people still don’t consider drug addiction as a bona fide disease. “That’s not a crutch or excuse,” he says. “You still have to take responsibility and get help.” But it’s a lot harder when, he says, “you’re homeless, hopeless, scraping and scratching for your meals — or in jail.”
Te-Ping Chen can be reached firstname.lastname@example.org.