New treatment strategy saving money and lives

A SUD clinician sits behind a desk and assesses an offender.
A SUD clinician assesses an offender.

BOISE, January 4, 2013 – You’ve heard the old adage that if you give a man a fish he’ll eat for a day, but if you teach a man to fish he’ll eat for the rest of his life. Well, a similar thing can be said about drug addicts and crime.

If you send felony offenders with drug problems to prison, it’s likely they’ll be back to their old ways soon after they’re released. But if you give them evidence-based treatment, there’s a good chance they’ll stay clean and live productive lives.

On top of that, you save money. Big money. Treatment is much less expensive than prison.

In 2011, the Idaho Legislature made a bold move aimed at teaching more felony offenders how to stay clean. The result is shaping up to be a classic example of how Idaho’s conservative approach to spending taxpayer dollars pays big dividends.

The start of SUD

In FY10 and FY11, Idaho’s system of providing drug treatment to felony offenders was plagued by long waiting lists and multi-million dollar cost overruns. So during the waning days of the 2011 legislature, weary lawmakers demanded action. They gave the Idaho Department of Correction $7.3 million and 90 days to come up with a solution. 

For IDOC program director Greg Lewis, it was a classic case of be careful what you ask for. From his earliest days as a probation and parole officer, he believed the state could do a better job providing drug treatment to offenders. Twenty years later he was stunned when the opportunity was dropped in his lap.

Under the old system, the state had little control over the front door and the back door of the treatment process. Idaho had farmed out the job of assessing offenders’ needs to private treatment providers, and it was relying on those same providers to then treat those offenders’ needs.

“Well, we have a needy population,” Lewis says. “One person could stay in care for years, and while that one person is accessing all those services you have a line of ten other offenders who receive no assistance.”

So IDOC set out to build a more efficient system. It is called SUD, for Substance Use Disorder system, and public safety was established as the program’s top priority. 

“The old system was focused on offenders’ needs; the new system has a laser-like focus on protecting the people of the state of Idaho,” says IDOC Director Brent Reinke. “The days of unspecified treatment goals are over.”

Instilling accountability

SUD has four key features that are intended to hold Idaho’s felony offender drug treatment efforts accountable.

First, IDOC took control of the front door of the treatment process by putting into place clinical teams in each district to work with the courts to assess offenders’ needs as they’re entering the system. The clinical teams identify which offenders pose the greatest risk to public safety and make sure they get treatment first.

There’s another advantage to having IDOC conduct its own assessments. The department now knows exactly what taxpayers are paying for and what they can expect in return.

Second, IDOC took control of the back door of the treatment process. The department set timelines for offenders and their treatment providers to make progress. Under the new managed care arrangement, the typical treatment episode lasts about eight months and the department monitors every offender’s progress along the way.

“We’re not so inflexible that we won’t extend some care on a case-by-case basis, but the expectation is that the majority of the offenders will get eight months of service,” Lewis says.

Third, IDOC alone now controls the budget and funds are encumbered as services are provided. Under the old arrangement, IDOC was not involved.  The result was a $4.6 million cost overrun in FY10 and a $2.45 million overrun in FY11 prior to IDOC control.

“Common sense demands that we be careful stewards of taxpayer dollars,” says Reinke. “Cost overruns for a program like this are simply unacceptable.”

Fourth, IDOC has set up a system of long-term outcome measures to determine if SUD is working and which treatment providers are getting results. 

“Under the old system there was no quality control,” Reinke says. “Nobody was keeping track of how many offenders had relapsed after getting treatment or even been convicted of new crimes.”

It will take at least two more years before the outcome measures have any meaning. But by the one standard that was tracked under the old system – the number of offenders who got treatment – SUD already appears to be a success. In its first year (FY12), SUD served about 3,500 offenders, a 32 percent increase over the year before. 

 An example of SUD in action

While IDOC has brought structure and accountability to felony offender drug treatment in Idaho, the department has allowed room for a good measure of Idaho-style pragmatism. It’s exemplified in the case of an offender we’ll call Michael. 

In October of 2011, Michael was arrested for drunk driving. A judge ordered IDOC to do an assessment. The department found that Michael needed treatment, so when he got out of jail in March 2012, he was ordered to begin a community-based, outpatient drug treatment program.

Michael was doing well. He was living with his wife, and his lawn mowing business was taking off. But in September, just before his treatment program was to wrap up, he relapsed. He got kicked out of his home and his life started spiraling downward.

Michael’s life was at a crossroads. He was facing the possibility of serving out his two– to– seven year suspended sentence. That would have been a devastating blow to Michael’s relationship with his family and to his growing business. 

It also would have been expensive. It costs an average of $21,500 a year to incarcerate an offender in Idaho, but an average of $2,300 to pay for their supervision and treatment if they’re living in the community.

Michael’s probation officer worked with the court and the SUD team to come up with a solution. They determined Michael did not pose a high risk to public safety and was a good candidate for a