CHESTER, Pa. -- Two of Pennsylvania's most successful drug and alcohol treatment programs offer intense therapy with a minimum 90-day stay, regardless of your income or insurance plan.

That's the good news.

THE FRAYING SAFETY NET: WAGING WAR ON ADDICTION SECOND OF TWO PARTS

Steve Mellon, Post-Gazette Inmates at the State Correctional Institution in Chester, Pa. participate in intensive drug and alcohol treatment to help them stay clean once they are released. Click photo for larger image. Related coverage After many tries, prison rehab program worked for former addict Treatment gets little help from liquor sales Inmates find help, hope in prison's drug and alcohol program Part One: State's drug problems explode as treatment options dwindle

The bad news: To get in, you must be an inmate at the Allegheny County Jail or the State Correctional Institution at Chester, near Philadelphia.

This is the state of modern drug and alcohol treatment. As governments have barely held the line on public funding for substance abuse programs in communities, they have shifted more money and attention to providing treatment after an abuser has committed a crime. Where once the debate was whether to treat addicts or imprison them, we now do both.

Nearly $3 million was cut from the state drug and alcohol budget this year, but the state is spending more than $28,000 annually per inmate -- nearly $32 million at SCI Chester alone -- for inmates' lodging, food and security as they kick their addictions and turn their lives around. More than 60 percent of new inmates to Pennsylvania's state prisons are diagnosed with a drug or alcohol dependency. And almost all the recent growth in Pennsylvania's inmate population (41,347 as of April 30, up 525 from a year ago) can be attributed to drugs and property crimes, says Jeffrey A. Beard, secretary of the Pennsylvania Department of Corrections.

"Who are most of those committing property offenses? They're people with drug problems," Beard said.

Jailing addicts rather than treating them before they commit crimes "doesn't make a lot of sense," admits Allegheny County Jail Warden Ramon Rustin.

The county program, initiated nearly three years ago by the county's Health Department, Department of Human Services, and the jail, takes an entire fifth floor pod in the Second Avenue facility. There, 24 inmates attend day-long classes, participate in group counseling and learn to redirect their lives.

It seems to be working: Only 15 percent of those completing the program have landed back in jail, program officials say, compared with nearly 70 percent of the jail population nationwide.

The stakes are even higher at Chester, a facility built in an industrial neighborhood near the Delaware River to provide drug and alcohol treatment for the 1,139 inmates whose offenses range up to third-degree murder, rape and robbery.

Program officials say fewer than 25 percent of the men have been arrested for a subsequent crime in the 18 months after their release.

SCI Chester is Pennsylvania's only state prison dedicated to drug and alcohol treatment, but 18 other prisons have partial programs, called therapeutic communities, where inmates undergo intense therapy for six to 12 months. Recidivism for those completing that program has dropped 11 percentage points, according to corrections officials.

While the state and county programs use different philosophies, they share an important common approach: effective treatment takes time.

"If you've got someone with a serious substance abuse problem, you're not going to solve that problem in a 30-day program," Beard said. "We know that they really have to immerse in the treatment for a long period of time, at least three months and preferably six months or more."

Outside those walls, meanwhile, "it's pretty rare today in the community setting to get 90 days of intensive treatment," noted Dr. Bruce Dixon, head of the Allegheny County Health Department.

The best approach for treating substance abuse is not a settled issue, at least in the court of public opinion. On average, addicts go through a half dozen or more rehabs before they stay clean, and people differ on whether addiction is more a chronic disease or the predictable result of poor personal choices and judgment.

Michael T. Flaherty, executive director of the Pittsburgh-based Institute for Research, Education and Training in Addictions, calls the punishment-versus-treatment debate "ultimately a test of our character."

When someone commits a crime, whether due to an addiction or not, the tendency is to punish, Flaherty said. Once in prison, though, that person will do whatever's necessary to survive, which often means developing criminal personality traits they'll carry with them after release.

"If we continue the philosophy we have, we're just going to perpetuate the problem."

Beard agrees, saying he would like to see Pennsylvania fund more drug courts and other diversionary programs that might combine confinement and treatment, but stop short of a state prison cell.

"There are more than 1,100 drug courts in the U.S., starting back in 1992-93. We have 11. We're really, seriously behind the curve."

One clear advantage for jail treatment programs is their literally captive audience.

Even if treatment programs offered free and unlimited stays, many addicts and alcoholics wouldn't seek them out because they're convinced they don't have a problem. At least not until the handcuffs click on their wrists.

"Is this rock bottom for me? Yeah," said David, a 33-year-old Cranberry man serving 18 to 36 months at Chester following his fourth drunk driving arrest (Department of Corrections officials allowed access to inmates only on the condition that their last names not be used).

David said he started drinking heavily at age 19, after he moved into his own apartment. He twice went through three-month rehab programs, only to start drinking again within two months, and he sometimes drove with a suspended license.

That ended once he realized he was going to prison. "I've changed every aspect of my life except my family," he said. "I've learned there's a whole lot more to life than a 12-ounce can of beer."

For now, his life begins with the 8 a.m. meeting each weekday, when the more than 60 men in each pod gather for "morning meeting" and one by one address the group, opening with the greeting, "Good morning, family" or "Good morning, community."

Identically dressed in faded purple overalls with "DOC" on the back, most of the men talk about their personal struggles. A few read poetry. When the program ends 45 minutes later, all the men stand and recite a pledge called the Gaudenzia House Philosophy that begins, "We are here because there is no refuge, finally, from ourselves."

They are in therapy groups or seminars until 10:30, then meet again at 1 p.m. for therapy and a 12-step meeting. The day ends after a "family group" meeting concludes at 7:30 p.m.

"Being here is a safe environment and I just feel myself getting healthier here. On weekends, when I'm not in program, I'm miserable," said Corey, a 34-year-old Philadelphia man serving three to six years at Chester for selling crystal methamphetamine to an undercover cop.

The Chester program is run by Gaudenzia, Inc., a private nonprofit drug and alcohol agency based in Norristown, Montgomery County, which operates about 65 drug and alcohol treatment programs, primarily in central and southeastern Pennsylvania, but also in Erie. As part of its contract with the state, Gaudenzia provides six months of outpatient care after an inmate is released, to try to make sure they won't fall back into old habits.

In addition to the treatment, Chester offers job training, in heating, ventilation and air conditioning, in automotive repair and barbering. There is also a room where inmates can construct educational games to send to their children.

SCI Chester incorporates much of the traditional Alcoholics Anonymous and Narcotics Anonymous 12-step approach, such as learning the importance of support from the group and avoiding "triggers" -- people, places or things that might tempt them to drink or use drugs.

The county jail program, run by the nonprofit Allegheny Correctional Health Services Inc., emphasizes personal awareness -- that no matter what the situation, an inmate is responsible for his own behavior.

"We focus a lot on cravings and craving control techniques," said Dana Phillips, chief operating officer of Allegheny Correctional Health. "What we say is that you have to make a conscious choice. And, if you make a bad choice, we show you what you can do to get back on track."

The Allegheny County Jail program started in the fall of 2002 with a $250,000 federal grant. At the time, program officials had little trouble making an argument for need.

Between 85 percent and 90 percent of those coming into the jail have a history of abusing drugs, alcohol or both, said Phillips. Every month, 300 to 400 new arrestees need detoxification before moving to the general population.

Inmates must voluntarily apply for the program once they have completed detox. The primary program involves a 90-to-120-day stay on the 5MC pod, but there are also education groups that meet a few hours a day. At any one time, up to 100 inmates are in some kind of program.

"There's an intensity of learning and introspection there," Phillips said. "You have to face up to some things in life that maybe you've never faced before."

Of all the program's merits, near the top is its sheer duration.

"It takes a long time to get people to understand they have the capacity to take control of themselves and have the willpower to do that. Anybody will tell you that if you could keep them long enough, you would have much better results," said Dixon.

"It's like any behavior change," added Phillips, "whether you're talking about weight loss or smoking cessation or exercising. A certain amount of it comes from developing new habit patterns, new ways of doing things and thinking about things, then doing that over and over."

The county program offers follow-up treatment after inmates' release, but it's not mandatory and few do it -- usually because they're working night shift jobs when they get out. The program still works, Phillips said, because "we teach them that you need to rely on yourself, and not rely on a group."

Everyone, from the warden to the inmates, say the individual changes are unmistakable.

"I think at the time they'd made this decision, they'd reached a critical part of their lives where they knew they had to do something. So that glimmer of hope was a positive. Then, when they got into it, they realized this was the right decision and that reinforced their effort to get well," said warden Rustin.

One inmate, Robert McWhite, 35, of the Hill District, said his goal was nothing short of a life change. Running the streets, he said he's been shot five times and stabbed three, while cycling in and out of jail the past six to seven years.

"I was always reaching out for help. I was the kind of addict that, when I picked up [a needle], I cried."

McWhite has family locally, "but I'm on their bad list," noting that family members used to follow him around at holiday gatherings to make sure he didn't steal something to support his drug habit.

"I can consider myself homeless. When I came in here, I had no clothes."

McWhite tried two different rehab programs, but there was a two-week wait to get into a drug outreach program near him. "During that time, all kinds of things can happen," he said. The jail program, he said, has taught him how to avoid relapsing.

Marquis Williams of Monroeville signed up for the program without high expectations of success. "I came up here thinking it would help me in court," he said.

"I can't even recall how many rehab programs I've been in," he continued. "My self-esteem was real low. I used crime to feel good about myself. This program gives me a sense of power. I get high off of my accomplishments."

Everyone should be happy about that, Rustin said.

"Regardless of what the public thinks, they are getting out unless they're serving a life sentence. It's important that they have some tools when they get out. If they don't, they're going to reoffend."

Yet, when county governments run into financial problems, it's programs like drug and alcohol treatment that are most likely to be cut, Rustin said, because of the fixed costs associated with keeping a jail safe and secure.

"Cutting any of these programs is scary. This county does not want to build another $147 million facility. But if they cut the programs, they are going to have to build another jail."