by Kim Krisberg

When it comes to nonviolent drug offenses, systems that favor treatment over incarceration not only produce better health outcomes, they save money, too. It's yet another example of how investing in public health and prevention yields valuable returns on investment.

In a new study published in the June issue of the American Journal of Public Health (AJPH), researchers found that California's Substance Abuse and Crime Prevention Act, which diverts nonviolent drug offenders from the correctional system and into treatment, saved a little more than $2,300 per offender over a 30-month post-conviction period. In fact, researchers estimated more than $97 million in savings for the 42,000 offenders affected during the first year of the law's implementation. And even though the law resulted in spending more on treatment, health care services and community service supervision, bypassing incarceration still yielded overall savings, said study co-author M. Douglas Anglin, founding director of the UCLA Drug Abuse Research Center and associate director of the university's Integrated Substance Abuse Programs.

"In the long run, we're still saving money because we're not paying to incarcerate people," Anglin told me.

According to a 2009 report from California's Legislative Analyst's Office, incarcerating a single offender costs California approximately $49,000 per year.

California's Substance Abuse and Crime Prevention Act was enacted in 2000 as a result of a voter-approved initiative known as Proposition 36. The system change means nonviolent drug offenders who meet the law's criteria can be sentenced to probation with substance use disorder treatment instead of imprisonment or probation without treatment. The law gives offenders up to three chances to re-enter treatment without incarceration regardless of initial violations. Study authors Anglin, Bohdan Nosyk, Adi Jaffe, Darren Urada and Elizabeth Evans wrote that the law became a "statewide policy that changed the course of criminal justice processing" for all the individuals and sectors involved.

"The law represented a sea change," Evan told me. "It represented taking a real public health approach to substance abuse offenders in the state."

The AJPH study noted that in 2002, national estimates put the societal cost of substance abuse disorders at $180.9 billion, with the largest and fastest-growing contributors being criminal justice activities. In terms of public investments in substance use disorder activities, federal decision-makers in 2011 budgeted $7.6 billion for domestic law enforcement, but only $1.7 billion for prevention programs and $3.9 billion for treatment services. Study authors wrote:

Public policies regarding criminal justice interventions with drug-using offenders have largely been driven by the acknowledged association between drug use and crime. The research literature has consistently reported that (substance use disorders) intensify rates of criminal activity, especially among dependent individuals. The importance of treating offenders with a (substance use disorder) is further illustrated by the fact that both severity of drug use and recidivism rates decline during and after treatment. Consequently, a reduction or cessation of drug use has been targeted as a direct method of reducing drug-related crime and enforcement and as an indirect method of reducing other adverse social consequences associated with drug use.

To examine the impact of California's treatment diversion law, the researchers compared two different groups: one that met the law's eligibility criteria in the years before the law was enacted (this was the control group) and another made up of eligible offenders convicted within the first year of the law's implementation. The study found that treatment participation was "substantially" greater among the post-implementation group than among the control group. Researchers also found greater incremental costs savings among black and Hispanic offenders due to related disparities in conviction and incarceration rates. The study concluded that diversion from incarceration to treatment should result in long-term savings.

Evans, a project director at UCLA Integrated Substance Abuse Programs, noted that the strength of California's diversion program really stemmed from its collaborative nature and having leadership from both the criminal justice and treatment communities working together.

"It was a big step toward acknowledging substance abuse as a health issue," she said.

The study's findings also suggest that "policy concerns regarding the welfare and rehabilitation of drug users should be seen as aligned with rather than running counter to the notion of fiscal responsibility and public safety concerns," the authors wrote. The fiscal findings are especially important considering California's current budget shortfalls, Anglin said. He noted that in 2009 state lawmakers eliminated funding for the law, kicking the financial burden down to the county level.

"These findings can help policymakers when they're trying to decide if a program like this is worth our taxpayer dollars," Evans said.

To access the full study, click here.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.