Welcome to the Department of Justice, Iowa Attorney General Tom Miller

Using Drug Treatment to Promote Public Safety in Iowa
A proposal by Attorney General Tom Miller
January 9, 2003

 

"The number one thing we can do to fight crime is fight drugs and the number one thing we can do to fight drugs is to do a better job with drug treatment," Iowa Attorney General Tom Miller.

1 As a State, We Are Not Making the Desired Progress in the War on Drugs.

2 A Three-prong Approach Is Needed To Deal With Drugs: Prosecution, Prevention and Treatment.

A Prosecution.

B Prevention.

C Treatment.

3 Drug Treatment Reduces Crime And Is Cost Effective.

A Substance Abuse is Directly Correlated with Criminal Behavior.

B Substance Abuse Treatment Works.

C Substance Abuse Treatment Reduces Crime.

D Substance Abuse Treatment Increases Employment.

E Economic Benefits of Substance Abuse Treatment are Greater than the Costs.

4 The Stigma: Not A Behavior, But A Disease.

5 The State System for Substance Abuse Treatment.

A Community Programs funded through Iowa Department of Public Health.

B State Correctional Institutions funded through the Department of Corrections.

6 Proposal: The Single Best Thing We Can Do To Fight Crime.

A Community-based Treatment.

B Prison Treatment.

C Adult and Juvenile Drug Courts.

D Diversion to Treatment Pilot Projects.

E Jail-based treatment programs.

F Knoxville Secure Drug Treatment Program for Probationers.

G Statewide Comprehensive Prevention Programming Grants.

H Tobacco Control.

7 Fund By Raising The Tobacco Excise Tax.

1 As a State, We Are Not Making the Desired Progress in the War on Drugs.

Undoubtedly Iowa remains one of the safest places in America in regard to crime but we are seeing a persistent and growing threat to that security. Drug crimes, or drug-related crimes, continue to occupy a large proportion of time and resources for Iowa law enforcement, prosecutors, and those who provide services to families in need. The number of people who sought treatment for Methamphetamine use in Iowa has hit an all time high.

Seizures of illegal drugs such as Cocaine and Ecstasy are increasing dramatically. While some of this increase reflects an increased ability by police to make seizures, it remains true that there appears to be a plentiful supply of illegal drugs on our streets. Cocaine seizures increased to 31,382 grams through mid-December of 2002 from 5,647 in 2001. There were 14,818 grams seized in 2000 and 15,577 seized in 1999. Ecstasy seizures have shown a similar increase, rising from 208 pills in 2000 to 5,509 through mid-December of 2002.

2 A Three-prong Approach Is Needed To Deal With Drugs: Prosecution, Prevention and Treatment.

A Prosecution.

Law enforcement and prosecutors in Iowa are doing a fine job dealing with an almost intractable problem. Drug shipments across the state on our Interstate highways are being intercepted. Meth labs in Iowa are being discovered. Drug dealers and users are being arrested and prosecuted. However, most law enforcement officers, prosecutors will agree that prosecution alone will not solve the drug problem.

  • Drug Charges Adjudicated. There has been a 34.8 % increase in the number of indictable misdemeanor and felony drug charges adjudicated by the Iowa District Court from 1999 to 2001.

    1999 18,236

2000 20,808

2001 24,588

  • Drug related convictions in Iowa increased during this period by 22.1 %

    1999 9,708

2000 10,519

2001 11,857

  • Drug cases constitute a significant proportion of the court docket in Iowa, representing 19.3 % of the charges and 21.8 % of the convictions for indictable misdemeanors/felonies in 2001.
  • The Iowa Division of Narcotics Enforcement was involved in 416 state drug prosecutions in 2001 and 495 in 2002. This figure does not include local or federal cases where DNE was not involved.
  • The Criminal Appeals Division of the Iowa Attorney General's Office handled more criminal appeals from those convicted of drug law violations. The division handled 139 drug appeals cases in 2001 and 2002 - up from 91 in 2000.

B Prevention.

We are dong a fair job in the area of prevention. Efforts to control demand through education are prevalent throughout the state. Comprehensive prevention grants from the Iowa Department of Public Health cover the entire state and provide core prevention services in areas such as mentoring, community coalitions and workplace initiatives. In addition a three-year state incentive grant promoting the use of the best practices in prevention for targeting 12-17 year-olds to reduce alcohol, tobacco, and marijuana use. These are good programs but they need strengthening. The total budget for prevention programs in Iowa for 2003 is $7.2 million, with only $936,000 coming from state funding, the rest is federal.

C Treatment.

Treatment is inadequately funded. Overall, we are doing a good job with the funding that is available but it is not adequate for the numbers needing treatment and for the proper length of stay to get the job done.

This is true in Iowa and across America. The Federal Government estimated that 3.5 million people in America need treatment but are not seeking help - roughly the population of Iowa. As many as 70 % of criminal offenders have substance abuse problems.

3 Drug Treatment Reduces Crime and is Cost Effective.

Increasing the money available for substance abuse treatment will reduce crime and make Iowans safer.

A Substance Abuse is Directly Correlated with Criminal Behavior.

About 80 % of those in prison have been identified as having a substance abuse problem.

There are generally considered to be three specific links between crime and drugs. First, there is the violence due to the direct effects of a drug on the user (Psychopharmacological). Second, there is the violence committed in order to generate money to buy expensive drugs. (Economic-Compulsive). Third, there is the violence associated with the marketing of illicit drugs such as turf wars (Systemic).

These theories are demonstrated in data from Iowa police and corrections officials. The Arrestee Drug Abuse Monitoring Program (ADAM) report, "Drug Use and Related Matters Among Adult Arrestees, 2001" showed that in Des Moines 56.6 % of arrestees tested positive for drugs and 35 % were at risk for alcohol dependence. In addition, the Iowa Department of Corrections reports that 75-80 % of all correctional clients admit to a history of substance abuse.

This association between drugs and crime is also shown by several other studies:

  • Nearly one-quarter (22 %) of federal prison inmates and one-third (33 %) of state prison inmates reported being under the influence of drugs at the time of their offense [Bureau of Justice Statistics]
  • Among state and federal prison inmates, 27% of those serving sentences for burglary said they committed their offense to buy drugs. [Bureau of Justice Statistics]
  • In the 70% of cases in which the victim formed an opinion, 31% believed the offender was under the drugs or alcohol. [National Crime Victimization Study, 2000]

B Substance Abuse Treatment Works.

Research involving numerous large-scale studies consistently demonstrates that treatment has beneficial outcomes. These federally funded and independently evaluated studies include the Drug Abuse Treatment Outcome Study (DATOS), the National Treatment Improvement Evaluation Study (NTIES), the Treatment Outcome Prospective Study (TOPS), and the Drug Abuse Reporting Program (DARP). They have all confirmed drug abuse treatment efficacy through 1-year followup.

According to the National Clearinghouse for Alcohol and Drug Information, U.S. Department of Health and Human Services (HHS), Substance Abuse and Mental Health Administration (SAMHSA), clients served by Federally-funded substance abuse treatment programs were able to reduce their drug use by about 50% for as long as one year after leaving treatment. Use of the clients primary drug declined from 73% to 38%. Cocaine from 40% to 18%. Heroin from 24% to 13%, Crack from 50% to 25%.

C Substance Abuse Treatment Reduces Crime.

National Results:

The National Treatment Improvement Evaluation Study (NTIES) is a Congressionally- mandated five year study of the impact of drug and alcohol treatment on thousands of clients in hundreds of treatment centers that received support from the U.S. Department of Health and Human Services (HHS), Substance Abuse and Mental Health Administration (SAMHSA). The results showed:

  • Selling drugs declined by 78%,
  • Shoplifting declined by almost 82%,
  • "Beating someone up" declined 78%,

  • Arrest for drug possession dropped 51%,
  • Arrests for Any Crime declined 64%.

More study data indicates that the number of clients receiving the majority of their income illegally declined after treatment. 34% of men earned a majority of their income illegally before treatment and 8% after. Among women the decline was from 30% to 9%.

Iowa Results:

The Iowa Consortium for Substance Abuse Research and Evaluation at the University of Iowa conducts research for the Iowa Department of Public Health using an Outcome Monitoring System (OMS). The most recent report describes 278 randomly selected Iowa clients who had treatment admission dates from January 1, 2001 through December 31, 2001. The report shows that clients responding to "no arrests" increased by 51.0 %. Clients responding to "1-3 arrests" decreased by 50.6 %.

D Substance Abuse Treatment Increases Employment.

While the primary emphasis of this proposal is on public safety, there are also important implications for the Iowa workforce. All Iowans benefit from having more happy and productive employees in our workforce. We are more productive as a state and there are more of us contributing to society through taxes and other means.

But there are special implications for employment in the area of substance abuse. We

must be able to offer a positive alternative to drugs. If we are to appeal to youth to stay away from the destruction of drugs, we must offer them a vision of a productive and happy life without drugs. Employment is an important part of that vision.

According to the National Clearinghouse for Alcohol and Drug Information, the

proportion of both male and female clients unable to work due to substance abuse declined after treatment.

  • 14% of men were unable to work before treatment, 7% after
  • 31% of women declined to 10%

Similarly the proportion of both male and female clients currently employed increased after treatment:

  • Men 20% employed before and 47% after,
  • Women 10% before and 29% after.

The Iowa Consortium for Substance Abuse Research and Evaluation at the University of Iowa conducts research for the Iowa Department of Public Health using an Outcome Monitoring System (OMS). Their most recent report describes 278 randomly selected Iowa clients who had treatment admission dates from January 1, 2001 through December 31, 2001. The report shows:

  • Clients responding to "not in the labor force" category decreased by 12.5 %. Clients responding to "employed part-time" category increased 9.0 %.
  • Clients responding to "no months employed" category decreased by 26.6 %. Clients responding to "4 or more months" category increased by 23.0 %.
  • Clients responding to "no income" category decreased by 18.5 %. Clients responding to "$1001 to $2000 for taxable monthly income" increased by 16.7 %.

E The Economic Benefits of Substance Abuse Treatment are Greater than the Costs.

According to research funded by the Center for Substance Abuse Treatment of HHS, drug treatment saves money. "A review of cost benefit studies examining a broad scope of client behavior and associated economic impacts have shown that the benefits of substance abuse treatment outweigh the costs." The following studies assessed benefits in the first year of treatment.

  • Studies in two Washington state clinics demonstrated that each dollar invested in full continuum care (inpatient treatment) and partial continuum care (intensive outpatient treatment) yielded an average return of $9.70 and $23.33 respectively.
  • Economic returns of about $7 for every $1 spent were also found in studies in California and Oregon state treatment systems.
  • Smaller but still notable estimates of $4 to $1 returns were found in a representative sample of Federally funded substance abuse treatment demonstration programs.

4 The Stigma: Not a Behavior, but a Disease.

Some people believe that drug and alcohol addiction is simply a matter of choice and that people can "just stop". It is important to understand substance abuse addiction as a disease instead of a result of personal weakness and moral failing.

Addiction is a chronic, ongoing health problem that is not easy to cure. Recovery is a multi-step on-going process. It assumes that relapse will occur. 6.7 million Americans are affected by drug addiction and 13.8 million by alcoholism. These numbers are approximately equal to the number of Americans affected by heart disease (21 million).

The stigma is a barrier both to good public policy and also to good treatment. "To cope with stigma, addicted individuals and those in recovery may withdraw, exhibit denial or ambivalence, avoid getting the help they need, discontinue their recovery process, or 'pass' by hiding their status as individuals in recovery." [ Iowa Department of Public Health Report: "Reducing the Stigma of Alcohol and Other Drug Addiction in Iowa"]

This prejudice is in some ways understandable. As a society, we do not want to do anything to condone addiction. The use of stigma creates comforting emotional distance from the issue and simplifies the complexity of the condition. Until we can come to grips with talking about this issue, we will continue to pay a large social cost in crime, medical costs and lost productivity.

5 The State System for Substance Abuse Treatment.

A Community Programs Funded through the Iowa Department of Public Health.

There are about 80 local treatment programs in communities and hospitals across Iowa. About 30 of these are funded with money from the Iowa Department of Public Health while the remainder are funded through Medicaid and private insurance. All 80 are regulated by the IDPH. These numbers include community based programs to which an inmate might be referred after discharge but they do not include programs at the state corrections institutions.

42,000 persons reported to alcohol and drug centers in Iowa FY01-02, 63.9% of these referrals came from the criminal justice system. Most treatment is for alcohol followed by marijuana and meth. About 20% of new clients are under the age of 18 which provides special problems in funding and treatment.

These programs provide a continuum of care including:

  • Inpatient hospital type setting for detoxification,
  • Residential 24-hour care for intensive treatment,
  • Halfway House,
  • Outpatient intensive day treatment,
  • Outpatient less intensive treatment,
  • Continuing care.

The programs are facing several challenges because of funding issues. All of these challenges are funding-related.

  • Keeping up with best practices such as the use of more individualized treatment and wraparound treatment services
  • Maintaining quality staff because of inadequate pay levels.
  • Finding adequate treatment space to meet the demand
  • Preventing clients from moving through the system too quickly so that they can receive effective treatment. This is especially true for meth

In FY2003, $1.7 million in state funding for community programs was transferred from

an ongoing tobacco fund were transferred to a one-time tobacco fund. If this money is not replaced in FY2004, it will be a decrease in state funding. If the $1.7 million is not replaced, there will be a corresponding loss of $1.7 million in Federal Fiscal Year 2006. In Federal FY2004, there is also an additional loss of approximately $.5 million in federal funds. These cuts will compound the challenges described. Some say they will "dismantle the system."

B State Correctional Institutions Funded through the Department of Corrections.

Seventy-five to eighty percent of all correctional clients admit to a history of substance abuse. However, the capacity of Iowa's prison system to deliver substance abuse treatment has been reduced by 20% in the past two years. The Department of Corrections is capable of treating just over half of all those who should receive substance abuse treatment while still incarcerated. Despite on-going increases in the cost of delivering treatment service, the estimated amount of state and federal funds expended for licensed substance abuse treatment has been reduced by nearly 14% in the past year alone.

Corrections officials should be commended for maintaining this level of treatment services while still meeting the other needs of the institutions. In the Corrections budget, funds are not earmarked for treatment but are instead considered part of operations. It is to the credit of corrections officials that they have maintained the level of treatment they have in the face of budget cuts.

Summary of Corrections Institutions Cuts End of FY01 October, 2002
Licensed Prison Program Beds/Slots 843 696
Licensed Prison Program

FTE

62.5 52.5. Real reduction is greater since duties have shifted away from RX to other duties for some staff.
Number of Offenders who could receive Licensed substance abuse treatment services 2276 1743. Real reduction is greater since two prisons reduced the length of treatment to accommodate more numbers.

These cuts are particularly damaging to the level of intensity needed to provide effective treatment. Some inmates are best served in more cost-effective community based corrections. Others need to receive intensive services while still in prison. It is no bargain to provide diluted, ineffective services. Unfortunately, some of that intensity is being lost because of program eliminations and staffing reductions. For example therapy staff are performing other duties instead of spending full time on therapy.

One particularly impressive example of intensive programming is the 9-month intensive Therapeutic Community approach. The Anamosa State Penitentiary and the Iowa Correctional Institution for Women at Mitchellville each have programs that provide an living environment which is somewhat isolated from the regular prison population and with programming that is approximately nine months in length. This intensive program is funded under a federal grant.

6 Proposal: The Single Best Thing We Can Do To Fight Crime.

Drugs are our single biggest crime problem and treatment is the best way to fight drug use. The best public policy tool to reduce crime in Iowa is to increase the availability and duration of substance abuse treatment for adult and juvenile addiction to illicit drugs and alcohol. The Attorney General proposes that resources for substance abuse treatment and related programs should be increased in the amount of approximately $29 million. These funds would be used to get more people into treatment, and let them stay in treatment long enough to get the maximum benefit.

In addition , $15 million would be used to supplement the current appropriation ($5 million) for the comprehensive tobacco control and prevention program and bring Iowa within the range recommended by the Centers for Disease Control.

Estimated Funding Outline:

Community Based Treatment $10 million

Correction Treatment $5 million

Other Programs, including: $12 million

Drug Courts $3 million

Diversion Programs $1 million

Jail Programs $4 million

Knoxville Program $4 million

Prevention Grants. $2 million

Increased tobacco control funding to CDC minimum. $15 million

Total: $44 million

A Community-based Treatment. (Estimated $10 million increase)

The State Capacities Work Group in 2001 with task of determining capacity and

estimating costs for increased capacity. The most effective scenario recommended by the group called for an increase in both the number of beds and the length of stay. The increased cost for that maximum scenario was $13.9 million. We believe that the current system could not absorb that size of increase in a single year because of workforce issues and so we recommend $10 million in the first year, $10 million in the second, and $15 million by the third.

B Prison Treatment. (Estimated $5 million increase)

The current estimated expenditure for licensed substance abuse treatment in Iowa prisons is $4.3 million. This provides "residential" level of care treatment for about 1,100 offenders and "outpatient" level of care for about 575 offenders. A $9 million annual budget targeted for licensed substance abuse treatment could adequately address the need for treatment within the prisons. An additional $300,000 could be used to reinstate a centralized substance abuse treatment needs assessment process at the Oakdale reception center.

C Adult and Juvenile Drug Courts. (Estimated $3 million)

Drug Courts for adults, juvenile or both exist in Des Moines, Sioux City, Mason City, Marshalltown, and the in the Fourth Judicial District. These programs are funded primarily through federal grants and they are proving their effectiveness. The state should ensure their continuation and expansion.

Drug Courts are one of the most effective things we can do in part because of the intersection that is created between the criminal justice system and the treatment system. The Court serves as a particularly effective incentive for requiring treatment. Defendants hear the message that failure to comply will result in sanctions. Because of this feature, judicial cooperation is crucial to success.

The Des Moines Register noted in an editorial in regard to the Polk County Juvenile Drug Court".... one program that benefits the entire state. It's a bargain for taxpayers. It works." And as the Register noted that it's also in jeopardy because the Federal grant that has funded the program has run out, as has other sources of funds.

The Polk County Juvenile Drug Court has a 70% graduation rate and few referrals back to juvenile court the following year. The program costs as little as $14 per day.

Similarly an evaluation of the Polk County Adult Drug Court by the state Criminal and Juvenile Justice Planning agency found that graduates had a lower post-program

recidivism than comparison groups. The study found that the program reduced overall correction costs.

The Iowa Department of Public Health estimates that placing drug courts to serve 40 adults and 40 juveniles in each of the states eight judicial districts would cost $2.92 million.

D Diversion to Treatment Pilot Projects. (Estimated $1 million)

The idea of this program is to use a screening tool to identify treatment-ready offenders immediately after arrest so that diversion to treatment occurs prior to the expenditure of legal and correctional resources. Eligible offenders accused of non-violent drug and property crimes would plead guilty enabling them to go the front of the line for full evaluation, treatment, and CBC supervision.

There are two keys to success: first, the use of a treatment-eligibility screening tool by pre-trial release interviewers; and second, priorities set by the prosecutors, public defenders, judges, DCS, and treatment programs to "fast track" these cases.

E Jail-based Treatment Programs. (Estimated $4 million)

The programs that provide treatment within the confined are effective and reliable in part because of the benefits of treating a confined population. This program is currently being implemented in Polk County and has potential for other of the states larger counties. The Polk County program budget is $400,000 and serves 30-40 men and 10 women. Placing such a program in ten of the larger counties of the state would cost $4 million.

F Knoxville Secure Drug Treatment Program for Probationers. (Estimated $4 million)

This funding would establish a secure drug treatment program at Knoxville for

probationers who also have a substance abuse problem. The program would provide specialized treatment in a secure setting without increasing demands on the prison system.

G Statewide Comprehensive Prevention Programming Grants. (Estimated $2 million increase)

Additional funding for the Iowa Department of Public Health's Statewide

Comprehensive Programming Grant Program will provide an important complement to the increased emphasis on treatment. Under this program 23 grantees provide drug prevention services to all 99 counties of the state on a per capita basis. The programs engage in local alcohol and drug prevention activities such as working to reduce college binge drinking habits, or the strengthening families to discourage the use of alcohol and drugs. Current funding for the program is $2.8 million.

H Increased Funding for Tobacco Control. ($15 million increase.)

Our most effective tool to fight the addictive effects of nicotine in tobacco is a comprehensive program with counter-marketing, community programs, youth programs, enforcement and cessation. In proper combination, these programs save lives. The Centers For Disease Control has set a targeted range for each state spending on this comprehensive package. Iowa's recommended spending level is $19.3 to $48.7 million Current funding is $5 million, a reduction from $9.3 million the prior year. An additional $15 million would bring Iowa to roughly to the CDC recommendation. This is an especially appropriate use of money from the state tobacco tax. As a state, we should commit ourselves to spending the money necessary to prevent the loss of more than 5,000 Iowans per year from tobacco.

7 Fund By Raising The Tobacco Excise Tax.

The drug treatment / public safety proposals described in this document could be funded by a twenty-five cent increase in the tobacco tax which would raise approximately $50 million in new state revenue. Attorney General Miller has long supported a higher Iowa tobacco tax because of the lives that can be saved through the reduction and cessation that comes from the increased price. In this regard, Attorney General Miller also supports the efforts of the Iowa Health Initiative for a significant increase in the cigarette tax.

It is particularly appropriate to use tobacco tax revenues to fund this drug treatment initiative because nicotine addiction it is a frequently occurring co-addiction with other drugs. While there is no evidence of a direct, causal connection between addiction to nicotine and addiction to other drugs, there is an extremely high correlation between the two. Having one addiction greatly increases the probability of having another. The best practice for drug treatment includes treatment for nicotine addiction.

The current Iowa cigarette tax is 36 cents. It has not increased since 1991 when it was increased 5 cents. Sixteen states raised cigarette taxes in 2002. Iowa is currently 29th in the nation regarding cigarette tax level. A number of neighboring states raised their tobacco tax in 2002. Illinois raised its tax 40 cents to 98 cents per pack. Nebraska raised its tax 30 cents to 64 cents per pack and Kansas raised its 55 cents to 70 cents per pack. Three other neighboring states considered such increases: Minnesota (48 cents currently), Wisconsin (77 cents currently) and Missouri (17 cents currently).

Each pack of cigarettes sold in this county costs the economy $7.18 in health care and related expenditures. Smoking costs the U.S. approximately $150 billion each year in health-care costs and lost productivity. In Iowa the estimated cost is $1,618,000,000.

Perhaps most important a tax increase is a deterrent to young people starting and

encouragement for smokers to quit. Economists estimate that a 10% increase in the price of cigarettes would reduce teenage smoking by 7% and overall consumption by 4-6%.

Such a decline would help reduce the loss of life each year from tobacco. Smoking related disease claims an estimated 440,000 American lives each year including more than 5,000 Iowans.

For Further Information: News Inquiries:

Iowa Attorney General's Office Bob Brammer 515-281-6699

Hoover State Office Building


Legislative Inquiries:

1305 East Walnut Street John Pederson 515-281-6898

Des Moines, Iowa 50319 Anne Sheeley 515-281- 6736


Policy and Program Inquiries:

Bill Roach 515-281-5536

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