The alcohol and drug treatment population in California, a microcosm of the country as a whole, is heterogeneous. Treatment participants who received welfare, were women, lived with children, lost custody of their children, or entered treatment due in part to parenting concerns, each comprised a minority relative to those who lacked these characteristics. Those with more than one of these characteristics were an even smaller group: for example, women with children in the household who received welfare were about 11 percent of the overall treatment population. However, among women in treatment specifically, the raising of children, losing and regaining custody of them, and supporting them with welfare benefits were very important and highly clustered: nearly two-thirds of women in treatment who had children in the household were recipients of welfare.
Even though the treatment programs were not as a rule oriented heavily toward these particular subsets of concerns, it is important to know whether treatment was effective with these subgroups, particularly since welfare programs and other social services are now being cut loose from older regulatory moorings. Decision makers need empirical compasses to help direct them in steering scarce resources toward the best interests of the clients they are charged with serving and the taxpayers who are footing the bill.
CALDATA provides some conclusions that should prove useful in this decision making. Treatment populations proved to be heterogeneous in a number of ways. No one substance was dominant. Heroin, alcohol, cocaine (including crack), and amphetamines were the most common problems, and the programs treated them all with some degree of success cocaine most successfully, heroin least so. Success in treatment, as most commonly measured, meant reducing substance use and other criminal behavior that was strongly associated with it, particularly drug sales and acquisitive crimes. Treatment also affected medical and housing status, yielding declines in homelessness and hospitalization.
On all these measures, treatment was productive. Not everyone improved, but many did. Not everyone stopped using drugs or committing crimes entirely, but a significant number did, and others cut back substantially. Those who stayed longer in treatment, reaching more of the therapeutic goals set out at the beginning, improved more than those who left after briefer exposures. The picture on measures of income and earnings was not quite as good. It appeared that treatment could more easily help the client change his or her own behavior, as symbolized by drug consumption, than affect market outcomes such as employment and economic dependency.
With regard to most measures of treatment outcome reducing substance use and crime, homelessness, and hospitalization treatment worked as well for women with children, women on welfare, and women in general as it did for men. Overall, treatment paid for itself and then some, paying taxpayers back about 7 to 1. The major benefits were in reducing the burden of crime. Lower but still positive ratios of benefits to costs (between 2 and 3 to 1) accrued for women who received welfare and women with children who were on welfare. The economic benefits were lower largely because these women did not engage in as much pre-treatment criminal behavior. None of these calculations took into account the effects on children of living with parents who were in recovery rather than continuously addicted or of not living with these parents at all. Treatment studies to date have not undertaken the very complex task of estimating these intergenerational benefits and costs.