Opinion: California Is Failing People With This Health Condition. Here’s a Solution

By Le Ondra Clark Harvey

California prides itself on being a state of second chances, a place where people can rebuild their lives with dignity. But are we truly living up to those values if we continue to leave incarcerated individuals behind? Nowhere is this more clear than with how we treat Californians with alcohol use disorder (AUD), one of the most underdiagnosed, underreported, undertreated and deadliest behavioral health conditions.

Approximately 9 percent, or 2.9 million, Californians age 12 and older had a substance use disorder in the past year, with 6 percent, or 2 million, reporting symptoms that met the criteria for alcohol use disorder. Justice-involved individuals, in particular, are disproportionately affected by substance use disorders.

Recent state prison data shows that 44 percent of the incarcerated population has a confirmed or possible substance use disorder, with AUD making up 25 percent of that population.  Additionally, 66 percent of Californians in jails or prisons have a need for substance use disorder treatment, yet in 2022, only a little more than 31,000 were treated. These figures underscore the urgent need for comprehensive and consistent treatment strategies, particularly for justice-involved populations. Untreated AUD increases the chance of relapse, worsens chronic conditions and raises the likelihood of recidivism.

The California Department of Health Care Services has acknowledged the importance of addressing substance use disorders in its CalAIM Justice-Involved Reentry Initiative. The program aligns with federal guidance, which requires screening for all substance use disorders, including alcohol use disorder, and providing access to all FDA-approved medication assisted treatments during incarceration and into the post-release period.

Unfortunately, access to treatment remains inconsistent and, in some places, nonexistent.

The state health care agency has encouraged use of all three FDA-approved medications for substance use disorder as a best practice, and the department set a goal for counties to provide at least two of the medications. However, because the county-to-county approach is optional — and thus fragmented — the medications aren’t available everywhere.

California policymakers must realize that health equity is at stake. People of color, who are overrepresented in jails and prisons, are also disproportionately impacted by alcohol-related illnesses. If we don’t prioritize and mandate AUD treatment during reentry planning, we are reinforcing the very inequities that CalAIM was designed to dismantle.

To truly reduce recidivism, improve health outcomes and support successful reentry into our communities, clear guidance to counties, facilities and the California Department of Corrections and Rehabilitation is needed. Screening for all substance use disorders, not just opioid use disorder, is a legal requirement, as is access to all FDA-approved forms of medication assisted treatment — both pre-release and post-release. It’s also critical that the state establish strong oversight and accountability mechanisms to track progress and address care gaps.

Our community behavioral health system, and the state’s broader safety-net, needs stronger support. A recent report from the Steinberg Institute warns that California’s hard-won progress in mental health, especially in efforts to divert individuals from jails and emergency rooms, is now at serious risk of being undone.

Fortunately, we know what works. We have the science, the policy and the tools to treat Californians with dignity and respect. What we need now is the will to follow through with clarity, consistency and compassion.

Le Ondra Clark Harvey is a psychologist and CEO of the California Behavioral Health Association.

This article first appeared on California Health Report and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

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Previously Published on calhealthreport.org with Creative Commons License

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