to reduce incarceration, the programs place offenders on probation. to reduce res sid vichl and suss stance abuse, they rigorously and frequently drug test for alcohol or other illicit substances in order to determine whether or not people have stayed sober and clean. both programs have proved very successful in achieving the goals they set out for themselves. and in the meantime, both programs have also proved very cost efficient. these creative programs deserve our careful consideration, because they are reasonable and humane ways of addressing several of the problems in our criminal justice system. and i am very fortunate to say we have three experts on these type of programs here. first to my left is the honorable larry long. judge long is a native of the mount rushmore state. he graduated from south dakota

state university and the university of south dakota law school. from 1973 through 1990, he was a state's attorney and prosecuted hundreds of felony cases. he served as the chief deputy attorney general for south dakota. in 2002 was elected t eed the s dakota attorney general. he has been a judge since then. he created the 24/7 sobriety program you will hear about today. it's a zero tolerance program for alcohol abusing offenders that give them a chance to dry out and walk right without going to prison. it has been recognized as being effective, efficient and humane. in 2008, council of state governments saw the merit in the program by awarding it an innovations award. the institute for behavior and health awarded it the john p. mcgovern award in 2009.

the national highway traffic safety administration gave it the life savosaver's award in 2. to his left is the honorable stephen ohm. judge ohm is a former prosecutor and now sits as a judge in hawaii. from 1994 to 2001, he was the united states attorney for the district of hawaii. he took the bench in 2001 and has been a circuit judge in honolulu ever since. in that capacity, he established the hope program as means of using probation aggressive drug testing and the imposition of certain swift but modder at punishment. he runs the hope and adult drug court programs for hawaii. like the 24/7 sobriety program, judge ohm's program has received

numerous awards. in 2007, hope received the american special merit citation. in january 2009, judge ohm received the mcgovern award presented by the institute for behavior and health. for the most promising drug idea of the year. in 2013, the kennedy school of government at harvard named hope as one of the top 25 innovations in government. in fact, just this month, judge ohm received an award and is here now only after receiving that and will be able to tell about you that and his program. to judge ohm's left is dr. robert l. dupont. a graduate of the harvard medical school who completed his residency in psychiatrist at national institutes of health. dr. dupont was the director of community services for the district of columbia department

of corrections. from 1970 to '73 he was the founder and administrator of the d.c. narcotics treatment administration. in '73, he became first director of the national institute on drug abuse and the second white house drug chief, a position now known as the drug czar. dr. dupont left the government in 1978 to found the institute for behavior and health, a non-profit research and policy development organization devoted to the reduction of illegal drug use. dr. dupont is a clinical professor of psychiatrist and vice president of dupont associates. he has devoted his career to an analysis of the link between addiction and corrections and to the creation of opportunities to reduce drug and alcohol abuse,

recidivism and incarceration. join me in giving them a hand as well as listing to what each of them has to say, because each one will talk about very important public policies and how we can deal with them. thank you. [ applause ] >> good morning. my name is larry long. in south dakota, the criminal justice system is fuelled by alcohol and by repeat offenders. from fiscal year 1999 through fiscal year 2010, 37% of all felony convictions were drunk driving. they have at least three dui convictions within a ten-year period. that defendant has been through the criminal justice system at least twice and been convicted of drunk driving before he gets

his third offense and makes it to a felony level. that defendant is a repeat offender by any measure. after i was elected attorney general and took office in 2003, the governor asked me to serve on a work group to tackle south dakota's increasing prison population. i dusted off and proposed an alcohol testing program i had used nearly 20 years previously. that proposal became the 24/7 sobriety project. the original goal of the 24/7 sobriety project was to keep the defendants sober 24 hours a day, seven days a week. and as we started experimenting and piloting the program, our

target group was repeat dui o offend offenders. anybody arrested who had a prior conviction within the previous ten years. the tools that we used for that experiment, for that pilot were the conditions of pretrial release or bond conditions. there were five of them. first of all, the defendant was told you cannot consume alcohol at any time, any place, under any circumstances. secondly, you can't go in a bar. by a bar we define that as in i place where alcohol was available for purchase and consumption on the premises. the third condition was that you will show up at the sheriff's office every morning at 7:00 and again every evening at 7:00 and take breath tests so we can verify that you are compliant with condition number one. the fourth condition was if you skip or fail, you will go to jail. and the fifth condition then

was, you will be released the next day. we will put you in the system and you will start over. the design of the system was to operate like an electric fence. how many of you -- show of hands -- have touched an electric fence? okay. how many of you have touched it a second time? okay. it's not more complicated than that. well, so we started down the process of putting this program together. and we immediately ran into some issues. the first issue is, south dakota is a very rural state. some of our people who were testing twice a day lived more than 30 miles from the test site. that required them to travel 60 miles twice a day in order to comply with the test requirements. that was a problem.

so what we did was we adopted a tool. that tool is the ams scram bracelet which is a bracelet you wear on your leg. it gathers emissions from your sweat glands and tests them for alcohol on an hourly basis. that allowed these people to be tested as part of the program and not have to travel. the second problem we discovered was that many of the participants were switching from alcohol to some other drug in order to maintain their high or whatever, deal with their issue. but yet be able to pass the alcohol test. so then we implemented a urinalysis testing program as a supplement to our alcohol testing program. those people had to test about twice a week. but that also identified a third problem. the third problem was some of

south dakota's -- many of south dakota's counties are very small. often the sheriff's office only has one full-time sheriff and one or two part-time staff. so urinalysis requires more staff than that. so we also adopted the drug patch or the feds use this patch regularly. it has been -- federal probation uses it a lot. in any event, we adopted the drug patch also into our arsenal of tools to run our program. we were success fm enough in our pilot that by 2007, the south dakota legislature had approved our program and authorized it for use state wide. as it stands now in south dakota, the 24/7 sobriety project is available for all crimes, not just drunk driving. of course, that represents and reflects the reality that there

are lots of crimes that are alcohol-related that have nothing do with drunk driving. but yet those people are good candidates for our system. the program is available at pretrial or bond level. it is also available for judges to use at post conviction as a condition of a suspended sentence and it's available tore the parole board so they can release individuals under supervised release for alcohol and drug use as a condition of being discharged from the penitentiary. now, the question then is, are we doing any good? i will call your attention to the first slide. it may be a little difficult to read. but we have been doing twice a day testing in south dakota since february 1, 2005. to date, there have been over

$34,000 participants in south dakota. they have been tested 7.1 million times. the passing rate for that group is 99.2%. what that means is for every 100 tests that are performed, over 99 times the person shows up on time and blows a clean test. our urinalysis was implemented in july of 2007. there have been over $4,000 participant there. those people are tested on an average twice a week. that passing rate is 96%. the drug patch is not used widely. but we have had 265 participants over 2,600 tests have been administers and that passing rate is 82%. i should have another slide. all right. these two stats are for the

bracelet and for an ignition interlock that we have implemented into our system. we put the scram bracelet into affect in october of 2006. to date there have been nearly 7,000 people in south dakota who have worn the scram bracelet. they have worn that for slight sly over 1 million days. the individuals there have been fully compliant. the 77% stat is i think the one most significant. those individuals of the nearly 7,000 individuals, 77% of those people have been fully compliant, for the time that they wore the bracelet, they have had no tampers and no confirmed drinking events. the ignition interlock is a device that we have just recently put in. there's a mistake in my slide. it says october 10 of 2014. that's a little premature.

it was actually put in effect on october 10 of 2012. to date there have been 276 participants. we have a success rate there of 95%. in the short-term i think we have done some good. in the long-term i think we have done some good as well. we have done some recidivism testing within our own data to determine how we have done. and by recidivism, we identified or defined recidivism as the length of time from the completion of the 24/7 sobriety program to the next arrest for dui. we were -- the participants in this recidivism are individuals who are -- were convicted of second, third or fourth offense dui. and at all levels for all participants, there were at least a 50% reduction in the

rearrest rate for participants of the 24/7 program. so one year, at two years and at three years, each individual who participated in 24/7, irrespective of their length of time in the program, were 50% less likely to have been rearrested for dui. now my favorite slide is this one. these are alcohol-related traffic fatalities in south dakota from the years 2000 through 2013 inclusive. now, if you look at the charts, the bars in red represent 2000 through 2004, the five years before we implemented the 24/7 program. the average death rate annually there was 83. in the nine years from 2005 through 2013 inclusive, that rate has dropped to 55.3.

now, there's a lot of republicarepublican republicans for that. we wear seat belts better than we used to. we drive safer cars. i'm sure there are other factors. but i think the 24/7 program is part of that equation. we test 2,200 people a day for alcohol consumption. i am confident that that has an affect in terms of the reduced traffic deaths in south dakota. so thank you. [ applause ] >> good morning, everybody. i'm steve ohm, a judge in honolulu. i was a career prosecutor. hawaii has to be the only state

with a path to the bench was the defense bar. i was first career prosecutor appointed to the circuit court bench. i ate lunch alone at first. the last case at the prosecutor's office was the murder of of a police officer. i was the united states attorney. i bring that up because starting something like hope is a challenge. doing things differently and being a career prosecutor gave me the credibility to do it. we had 8,000 people on felony probation. lots of problems. we have good p.o.s. we have caring judges. the system is broken. this is similar across the country. at sentencing a judge will read probation. community supervision. but the judge will say, no alcohol, no drugs, see your p.o., pay your restitution. the problem is, some people will do fine on that. many people will fail at that. when they fail, the problem is the p.o. has two choices, the

probation officer, work with the problem, encourage them, threaten them, cajole them. you tested dirty for meth, our biggest illegal drug. you understand that's a violation of probation? yes. i will stop. the person leaves the office understanding this is not a serious system. i'm going to get high and i will do it until something stops me. they know it's a year or two before something happens. the choice is talking to them or writing up the violation, coming to court and asking me to give them five or ten years in prison. some judge famously said you can -- send him to prison or the beach. this is not a knock on probation officers. they do not have a tool do anything quickly. so the first week on this calendar in june of '04 i looked at motions, spend a couple of hours documenting violations,

got the person arrested, brought them back and recommended to me send him to prison for five or ten years. they are not amenable. i thought what a crazy way to change anybody's behavior. i thought to myself, this doesn't work. what would work? i thought about how my wife and i had raised our son, how were we raised? your parents tell you what the rules are. if there's misbehavior something happens immediately. it doesn't have to be severe. but it has to be swift. it has to be certain. then you and your kids learn to tie together bad behavior with a consequence and learn from it. that was the simple idea behind all this. so in the future -- this is june of '04. we kicked off the program in october of '04 with the idea if they test positive and admit it they get arrested on the spot. they go to jail. we have a hearing two days later. i will probably let them out because they came to the courthouse knowing they messed up. they have to call a random drug

test hot line. every weekday morning they have to call the hotline. if their color is listed, they have to come in and get tested. it comes up once or twice a week. drug courts are a separate conversation. drug courts are great. they can be very effective with whatever population they are working with. but drug courts deal with a pretrial population, lower risk population. we have shifted our drug court to a high risk population. it's a status conference. you see how they are doing. in hope i see them when they violate. so i'm able to supervise a large number of people. this program started in october of '04 with 34 offenders. i told them, everybody in this room wants you to succeed. your attorney does. the prosecutor does. i do. the taxpayers want you to succeed. it's $45,000 a year to lock you up. whether you get there or -- in prison for years, is up to. you control yourself.

my guess is unless somebody put a gun to your head, nobody can make you do anything you don't want to do. they said yeah. so i said, but i can control what i'm going to do. in the future, you are likely to go to prison if there are any violations of probation. you are likely to go to jail if there are violations of probation. and so you can look at hope probation and doctors started a non-profit to explain this better. we want you to be successful. if you violate, we are human beings, we can make mistakes. if you violate but admit and deal with it, the jail sanction will be short, two or three days. if you don't show up at all and the law enforcement have to look for you, it's at least 30 days. you are an adult. you will make your own choices. law schools across the country talk about procedural justice. it usually doesn't happen. the criminal justice system is really not set up for that. the more severe the consequences are, the more due process there's going to be, the longer it takes anything to happen.

hope probation is swift, certain, consistent and proportionate. we are convinced one of the chief trreasons it works is we e treating people fairly, like adults. so i thought at the beginning it just made sense. let's target the toughest population. it's not a boutique court. it's a strategy to do probation. we started with 34 owe fenders. we said, let's get the people most likely to fail or the one we want to watch the closest. sex owe ferpd, domestic violence, history of drug use, that's who we want to focus on. we don't exclude anybody from the program. we want the toughest cases. that's what we do. so we focused on the highest risk to begin with, 34 people. we started with no extra funding. we asked everybody to work smarter and harder. i was a federal prosecutor, i got the u.s. marshal to use his

fugitive task force to serve warrants. you done show up for a drug test, i will issue a warrant. you will do 30 days in jail. if you admit to it, you get a few days. we are trying to shape these fo knucklehead. you know, it takes going to jail every violation. let's be clear, the truly violent and dangerous, the ones who don't stop stealing, should be sent to prison at sentencing. i was the toughest stepser in the building, so i had that credibility to start with this. but that's a minority. probably 25%, 30% of people should get sent to prison at sentencing. but 70% should be supervised in the community. if you do that right, you can help offenders and families from going to prison and reduce crime. that's what we did. we started with 34 offenders. we went to the legislature 18 months later. they gave us $1.2 million.

by then, we had the statistics showing that the people in the program were testing positive, 80% less often, missing appointments. we thought got to lead to better results. when they gave us the money, we used most of it for drug treatment. and there's an old joke in court that expert witness is a guy from out of town with a briefcase. our attorney general's office can keep statistics. but with a grant from the smith richardson foundation, they did a study. identified 500 people with drug problems. two-thirds got put into the program. the other third were left on probation as usual. now, it had a name by then. i had a contest among the appeals and court staff. we had a lot of entries. the earliest one was yank and spank. head of the sex crimes unit. my 15-year-old son said yale and jail. hawaii's opportunity probation with enforcement.

i thought that's a good acronym. dr. hawkins did this study, violent crime, property crime, drug crime, 16 to 17 prior arrests. a year later, she looked at the results. and half as likely to be arrested for a new crime, half as likely to get revoked. 72% fewer positive drug tests. biggest number is, half as many people were sent to prison for a year. that is a system that is clear, it's transparent, it lays it all out. one of the fascinating things we've discovered about this program is, most people can stop using drugs without going to treatment. if they know -- and this is judge long has found the same thing in south dakota. people can stop going to treatment without treatment, and drugs and alcohol for us, if they know there's going to be a consequence every single time. most people will make the decision not to use.

and if so, that saves the precious treatment beds, or slots for the people that can't stop on their own. so our treatment programs love this. this is a chart that dr. hawkin did. remember the study group was 340 people in the hope study group. and they were identified, because they were active drug users, current drug users. 60% of the tests were for meth. 51% of that 340 did not have a single positive test the first year. 28% had one. most of these folks are not in treatment. if they want to go to treatment, we'll use our money. we use most of it for treatment from the legislature. if they think they can stop on their own, i give them a chance to show us that. and let them do that. that means showing up and testing clean. if they can do that, they don't have to get a reference, they don't have to get an assessment, and they don't have to go to treatment. if they use a couple of times, then i'm going to say, hey, looks like you're having

trouble, use, jail, use, jail, for a few days, and they'll say, yeah, i've got to go to treatment. then they'll be more honest in their assessment how often they use. they'll persevere because they know they'll get arrested if they leave. they say, there's a program in jail. you don't have to use a system as much. the offenders know this. and the basic sanctions are a few days if you admit it, if you deny it and we have to send it out to the lab, you're going to get 15 days. you don't show up at all, it's 30 days. some people are going to fail at hope and go to prison. the good news is, many are going to be successful. change is really hard. so this is not easy. it's spreading across the country. there are now 18 states, about 60 courtrooms doing hope. washington state has put its entire high-risk now 17,000 people into their version of

hope. parolees and probationers. so it's one of those situations that drug testing is hugely important. it's part of it. we have our drug testers come in at 6:30 in the morning. anybody who wants a drug test before going to work can get drug tested. this is males watching males, females watching females. one girl got caught, and i gave her 30 days in jail. i told her, you know, miss, you'll have to find new friends because that other sample was dirty, too. what can you do. anyway, because i only see them when think violate, i currently vie light -- if they're not on probation, they're in hope. we want them staying away from victims, we want them following through geographically and otherwise. i'm thrilled to be here. i look forward to any questions. and when you have a system that

reduces victimization and crime, it helps offenders and their families and saves taxpayers millions of dollars. it's like, this is what we're in the business for. thank you very much. [ applause ] >> i'm very, very pleased to be here. let me thank paul for making this possible in heritage. this is a tremendous opportunity to present some very exciting ideas. i'm very grateful to paul and heritage for making this possible. i began my career 46 years ago, a few blocks from here, after i had finished, paul was at the institutes of health. i decided i wanted to commit my career to helping people in prison, because i had worked with them in my residency, and i cared about those people. and i was very interested in doing what i could to help. i went to work for the d.c.

department of corrections, head office is a few blocks from here. and in that context i discovered the relationship between heroin addiction and crime in the city. it's been quite a ride since then, as paul said. but i have kept my focus on the concern that i had 46 years ago. and i want to tell you what we're talking about today. it's the best new idea in 46 years that i have seen. this is history. this is very important what we're talking about. this is not just another clever idea. this is something scaleable and profoundly important. i want to talk some more about that. but i want to talk about innovation. so you can think a little bit about what you're seeing, what you're hearing. i said to paul and -- to steve

and larry, they didn't know any experts in the field when they did this. i don't know whether you listened to that. they came from an experience working with the offenders without expertise, both of them. and i said to them, thank god you didn't know any experts like me, because you never would have done this. i would not have advised this. i would not have thought of it. and neither would any of the other experts. because it didn't happen. it came up from their experience. they had a problem and they had new ideas about what to do with it. that's one lesson. but the second lesson i want to give you is maybe even more important, because lots of people have good ideas. what you're looking at is two men who have devoted their lives for a decade to the development of this idea, and spreading it.

that -- the charisma that they have, the ideas that they have, the determination, the ability to get whole institutions involved in it, is very precious. and what we have here today is two people who have come up with this new idea, and have devoted themselves to it, and coming here today to talk about it. i am very pleased. when i left the government, it was founded with my wife, our job is to find new ideas that will reduce drug use and problems related to drug use. this is our number one priority. that's how important it is to me, and to us. i want to talk to you a little bit about what it is that makes this special. because it may not be so obvious to you. one thing is to focus on drugs and alcohol, is the absolute commitment to no use. that's rare. people talk about that.

most treatment programs -- drug treatment programs in the country have continued drug use routinely in the treatment programs. the idea that you would set that up as a standard and have consequences for it right away, that's unusual. but that's what this is. that's one thing that's important. another is the use of technology. the drug testing. they're talking about the use of a rapidly developing technology to identify drug use, and integrating that within what they're doing. that also is very striking in terms of this. the most stunning, though, is the concept that drug addicts, and alcoholics can change their behavior, can stop use with immediate consequences that are predictable, with or without treatment. no expert would say that, would have thought that.

but they have demonstrated that it is true. and with respect to the treatment, one of the things that i guess i could say, i'm an expert at treatment, we've had a lot of experience with it, the most likely thing when you refer a drug addict or chalcoholic to treatment is he doesn't go. and if he does finish it, the most likely thing is he's going to relapse. that is the reality. now, what they're doing is making treatment work. i've been to see the people who go to treatment from these programs, and the treatment people love them, because they go there. they finish the programs. they don't use. they listen. why is that? because of the context, what they have put together makes an entirely different kind of experience. so this swift, certain, moderate kind of sanctions makes a tremendous difference in the

behavior, and it sets a model that is very important. now, i'm going to end with a -- i started off with the criminal justice system. and my commitment to that, the drug and alcohol use. but i want to shift -- i call this the new paradigm. it's not just -- it's treatment, it's the managing of the care of the substance use. and there is another example that we at ibh have been studying of this model in an entirely different patient population. and that is the nation's physicians. can you think of a group demographically more different than felon, convicted felons, than practicing physicians? many of them i guess are felons too, but that's a different story. in any event, what happens with physicians in this country when they have a drug or alcohol program, they go into a state

program that involves mandatory random testing for five years. any use, any use of alcohol or drugs in the five years, and they're taken out of their practice. any use for five years. all of them. and that has set the standard for good long-term outcomes. in the five-year study, we found 78% of the doctors with random testing, every day they have to check just the way steve was talking about, where they have to go in, 78% had not a single positive test for alcohol or drugs. of the 22% who had any positive test, two-thirds never had a second positive test. these are drug addicts and alcoholic physicians. that is stunning. and that says something important about how to deal with this problem.

but anyway, i just want to say again how proud i am to be here with heritage. how grateful i am for the leadership of these two men. and how excited i am for the potential within the criminal justice system, these 5 million people on probation and parole, this is a scaleable, affordable idea we're talking about. and that is very exciting. thank you. [ applause ] >> before i ask any questions of the panel, i want to give judge long and alm an opportunity to say something about what anybody else has said. >> dr. dupont has been a great supporter of this in the very beginning, just like everyone else. the practitioners in the field get this. they know what's going on in the field, they don't get this.

judge long and i didn't know about each other. i tried to work with the folks at home to get 24/7 started. he's working, of course, in south dakota to get hope started. he started a program with juveniles which is really exciting to me. >> let me ask judge long, and judge alm, what would you say in response to someone who claims this program is soft on crime, that dealing with these people is just sending them automatically to prison? >> my experience with the public is, the public is not particularly offended by people out on probation. what they are offended by is people out on probation that they perceive are not being supervised and not being held accountable. and my program holds them accountable. and the feedback i get, at least from the families, is, you know, every time i've spoken about

hope, or about hope, about 24/7, family members come up to me and they say, gosh, larry, i wish that program had been around when my husband was drinking, or my dad, or my brother, or my son. or some variation, you saved my child's life. and so i've never apologized to anybody for the way we've structured this program. we trade jail time for sobriety. and i think that's a fair trade. if they can elect to drink, and we'll put them in jail, and if they elect to not drink, they can go home. and everybody went. >> this has been a program to try to reduce crime, reduce substance abuse, so it's not a right or a left kind of a thing. i think actually, we've never tried the court political parties. nationally, the republicans,

like the right on crime group, they can be a little more creative. if people don't understand the system, this sounds like it's soft on crime. you test positive for drugs, you get three days in jail, or two days in jail. what they don't realize in a normal probation system or parole system, there is no consequence. so when people, you know, who know the system, they instantly get it. this is not only -- not only is it a consequence, but it's a consequence every single time. so people will learn from this. it really is harder than probation is usual, or parole is usual. but the public doesn't know anything about any of this stuff. but as judge long says, they want results, they want consequences. so when they hear about this, they're all in favor of it. >> can i say something? >> certainly. >> one of the problems within the criminal justice system is concern about this aggressive testing. it's going to fill the prison.

it's going to fill the jails. the biggest sales problem that these two gentlemen had is this aggressive testing, the people in the criminal justice system, said we have so many failures now, you're going to triple our failure rate. the interesting and important finding is exactly the opposite happened. because of the change of behavior that goes on. >> dr. dupont, let me ask you a question. there's a concern that in many of the state criminal justice systems, the system itself has become the mental health system of last resort. how do you deal with that problem if and where it's true by using this program? can it be used in that sort of circumstance, or is it not usable in that circumstance? >> okay. i think you know, i am a psychiatrist. i am committed to mental health. i have a practice of my own. i'm concerned also about mental illness and its treatment. one of the biggest problems with

the seriously mentally ill in the country is just like with the drug addicts, it's compliance with treatment. which is a huge problem. and i use the term therapeutic juris prudence. i want to use the criminal justice system to achieve outcomes for people who you can't do that with without the system. it makes a difference in compliance with treatment and taking the medicine and all the rest of it. so i see this as a model, a positive model for mental health in the criminal justice system also. and i would like to see that be developed much more actively. this is the way to go, and it will work just as well with mental health issues as it does with substance abuse issues. >> and the way this translates in court is, mr. so-and-so, you may have a chemical imbalance.

if a professional wants you to take your meds, understand, this isn't burger king, we don't do this your way. you're not in prison, you're on probation. part of the rules is you take your meds. if you don't take your meds i'll put you in jail. they'll take their med, be more medication compliant. everything in their life goes better. for the most severe mental health issues, that is a real problem for people to deal with. no program is perfect. it's just when we look at it is, are they better than the current system. do they work better. and i'm convinced they do. and the defense attorneys, say this is the best thing. it's clear. the consequences are clear. they're much more likely to be medication compliant. >> and see a therapist, too. >> yep. >> let me ask a question for the whole panel. can these programs be replicated in other states, or is there something peculiar about south dakota and hawaii that allow them to work there? do you think they can be

replicated elsewhere? how would it be done? >> well, 24/7 is operational in south dakota. it's operational in north dakota. and it's operational a in montana. there are pilot projects that are currently in various stages of development in i think 10 or 12 other states. there's a pilot project going on in london, interestingly enough. i've been trying to get a free plane ticket to go to london. i haven't been able to pull that off yet. but i'm still trying. i've had this discussion with some of the folks from ntsa several times. and there is a concern that south dakota is a rural program, because it works in south dakota, it works in north dakota, it works in montana, which are large rural states.

but my advice to anybody is, pick a city and try it. start small, pick a small area in a big city, and see if you can make it work. there will be problems that you will run into that i haven't thought about. if you simply run into the problems and decide you're going to fix them, then it will work. that's how we started the 24/7 program. we knew there were going to be problems, we just couldn't anticipate what they were. we simply dealt with them as they came up. we found a drug patch which plugged a hole. you know, you can deal with them if you are committed to get the system and make it work. but that's my philosophy -- that's the philosophy we started with, and that works. >> i would echo that. like everything else in life, where there's a will there's a way. some think, oh, we're already

doing that. when you talk to them some more, you go, when is the expedited hearing in your jurisdiction? in two weeks. is the person in custody? no. you're not doing this. it has to be on the spot. that's how you tie together behavior with the consequence. i would echo, start small, get all the moving parts in place, call us, you know. i travel once or twice a month on somebody else's dime to explain this to them. including london a couple of months ago. and i would then -- [ laughter ] dave started the 24/7 first. they have a huge problem with binge drinking, fighting and the like. where we're going to try 24/7 in hawaii, hopefully, with a felony violent population. because alcohol is the biggest problem in the criminal justice system. guys stabbing each other, fighting with each other, and alcohol is replete with that. especially with certain groups. so that's what we're looking forward to. if people start small, they get

their ducks in a row, we're convinced human nature is going to be, you know, consistent, it's going to work. when i started this, people said this will never work with people who do a lot of jail time. they can do it when they have to. human nature being what it is, they don't want to do it today. i'm going to bet human nature is more similar than dissimilar. there are 18 states doing this. this is possible where there's a will, there's a way. >> let me just put an exclamation point on that. when i started, everybody thought i was crazy. the only thing i knew is that i had done this before in bennett county 20 years before, and i knew that it worked. i grew up in that community. i was putting my classmate from high school in custody. i knew these people when they were sober. and after 60 days of sobriety,

you could tell by looking at them, that they had quit drinking. their color changed, and if you've known an alcoholic, and you've seen them quit, you can tell by looking at them that they have. and when i first launched this, i literally begged and grovelled. and i was the attorney general. but i had a couple of old friends who were judges, one of whom was a recovering alcoholic, and they did this for only one reason, and that was because i was the attorney general, and they thought it was prudent to humor me for a few months. and then the thing would fall flat on its face and then they could say, larry, we gave it a try. that's the commitment that you have to make. and you just have to find someone who is as committed as you are, and if you find that person, you can get it off the ground. >> let me ask one more question before i turn it to the

audience. i'd like dr. dupont, if you could answer this first, but it's for the whole panel. what is the proper role for the federal government in this regard? >> i think facilitating the spread of this idea, and i think the federal government is already doing a lot, and can do much more. but i think there's also lots of room for the private sector, especially the philanthropic groups like pugh has taken a terrific lead in this. i've been in this for a long time. right now is a remarkable moment in history. you notice when paul introduced this program today, he talked about the heritage program to reducing incarceration. this is part of that. very understandable. the country is coming together on that purpose. right and left, and all across

the political spectrum, in an exciting way. it's a great time to be interested in corrections. the same thing is happening with drugs. the drug issue isn't the center of attention the way it never has been before right now, and there are prospects more of that, i think. i think there are opportunities now that are great. one of the things, before i let go, and that is that, the issue about the substance abuse problems is life-long. these programs are relatively short, even if it's four or five years. what happens to the people when they leave? when they're not being supervised? that is the big question to me. it's not whether while they're supervised they are better. they have shown that. most people didn't know that. but the big question is, then what? and that's an open question. we'll see. but i'll tell you this, in my time in the field, the thing that makes a difference in the stability of abstinence in stabilizing lives, is called

recovery, and it's the 12-step programs of alcoholics anonymous and narcotics anonymous. i would like to leave everybody with the understanding of how important that is in maintaining life-long sobriety. because that is the big issue in the substance abuse field. >> the federal government has been great already with this. it's in the bipartisan budget bill earlier this year. the justice department is sponsoring replications. part of the field experiment. in texas, arkansas, massachusetts and oregon they've done that. just being a bully pulpit, and talking about programs that work. and part of that budget money is going to set up a technical assistance crew to help out with that. but what we try to get a site in a state to do it, i tell them, you have to be the em sarys for this.

wendy davis is the one to train the other folks in indiana. they'll believe her. her law enforcement folks can talk to other law enforcement people. the federal government can play a great role in many ways. they're doing it already. but the real growth is going to be in the states as they spread the word. >> well, the federal government certainly helped me get mine off the ground. the national highway traffic safety administration had more faith in me than the judges that i was trying to convince ought to do this. they gave me a grant to get my program off the ground in the two largest counties in south dakota, because those sheriff's offices convinced themselves that they needed extra help in order to implement this. i didn't have an appropriation. i didn't have any money. and so ntsa was very

instrumental in getting mine off the ground. also, when we implemented the scram bracelet, they bought a hundred bracelets for me, and those are $1,400 a pop. and they haven't asked for them back yet, and i appreciate that. but they also gave us a charge we had to figure out how to pay for them ourselves, and that turned out to be a challenge that worked to our benefit. because we had to then deal with that. so i certainly owe them a large thank you. and i think they're helping me yet. >> let me see now if there are any questions from the audience. let me ask that you identify yourself, and ask the question and get right to the point. the woman back there. >> hi. angela frazo with the national association of defense lawyers.

two quick questions. one for judge alm. can you talk a little bit -- i think i may have missed it in the beginning -- about the folks who actually are able to get into hope? are they -- is everyone required to do drug testing, even if drug and alcohol was not part of these initial offenses? and the second part is, we've done a report on problem-solving courts, and in our report we found a lot of drug courts around the country do the cherry-picking, meaning they pick the people who they think will get through the system, because they're low-level folks who are not really users, they're sellers. so the program is successful because of that. but the people who really need the treatment aren't getting that. and really quick for mr. dupont. i'm of the belief we cannot solve society's ills by putting people who are addicted to drugs because it is an illness in

prison. and people who have mental illness in prison. i'd like you to just talk a little bit more about that, and why you think having that an option is a good thing, considering people who do get in the system, who have mental illness, are not getting the treatment that they need. people who have addictions to alcohol and drugs are not getting the treatment that they need in prison. that they can -- they don't have the capacity to do that. >> well, first, i wrote an article for the champion magazine a couple of years back, and our local association wrote a supported side bar as well as the vice president of the drug policy alliance. we don't add any conditions. if somebody is put on probation, in the pre-sentence report, if there's a connection, a nexus with drug and alcohol use, that's a condition of probation. that's the way we start. probably 85% of the cases in court have that. if so, they're going to get drug tested. if that's not, we don't add it.

so they're not on the hotline, they're not doing it. if during the probationary period the person shows up smelling of alcohol, or some other nexus, we'll add it. the second part is for drug courts. drug courts can be great. as you talk about often they're cherry-picked, have a veto over who goes into it, we have shifted our drug court to be for the high-risk group. and so, you know, in an article in the oregon law review, it said at the website, if you have a regular probation, the drug court should be your icu. if people are failing, they should be put in hope. if they can't stop using despite of going to a treatment program or two, that's who we're putting into our drug court. because they are headed to prison. drug court ends up being the last step on the continuum on the right-hand side. you have wrap-around services,

drug court is the best potential you have. you've got to focus on the right population for it. and that's what we're doing now. four years ago there were 52 people in our drug court. now there are 200, including 50 with a dual diagnosis problem. >> one of the things in drug policy that drives me a little wild is to think that the choice in drug policy for treatment or prison. and so people are asked, which are you in favor of? treatment or prison? about drug policy. and i think that is a very false choice. people are in prison because of some criminal behavior that they've had. many have mental illness that definitely contributes to -- or substance abuse that contributes to the criminal behavior. but they're there because of the criminal behavior. that is an opportunity for the help of those people. what i would like to come out of this concept is not to choose prison or treatment.

but to say, the goal is to make the two work together in a way that does better for those people than either alone. that's what this is about today. and i think to do it the other way, that they're somehow antithetical misses the opportunity that comes from the people who are already there, i'm not talking about putting somebody new in prison, they're already there. let's find ways to use that, and the place to start is not prison per se, but the community corrections. i think this is a model that will work very well in the interest of people with substance use disorders and mental illness. >> sir? >> i'm a retired analyst who got interested in drug policy about 43 years ago. as a matter of fact, i've never heard a better presentation. now that you mention the name of mark clineman from ucla, who i

believe was one of the original proponents of hope project, i know wrote a book on this issue, any comments about his contributions? >> he's our friend, all of us. absolutely. he's here with us today. and we wouldn't be here without him. he is the one who's gotten everybody's attention. he got paul interested in this field. so three cheers for mark clineman and his role. i had never heard of mark clineman when all this started. but six, eight months into it, we started looking around the country to see people talking about this. somebody from the attorney general's office said, you've got to read what this guy's writing. i think he had a paper called abstinence, or something. i called him up. he remembers this conversation differently today than i do. i called him up in december and said we're up to 93 people.

80%. he was thrilled. because he had been talking about this for 20 years. but couldn't get anybody to pay attention. at that time, jake horowitz and marlene beckman came out to hawaii to check it out. mark has been responsible for much of the good press that has come around this. he knows more people in the press -- the "wall street journal" did the first national story on it. it's because he knew a reporter. marlene beckman came out and i said, you're here to just see we're not making the figures up in the office. she said, yeah, we are. >> i met him at a conference at yale a few years ago. was intrigued by his work, read it. and became persuaded because it sounded to me like it was an eminently sensible way to deal with these problems. next question? john?

>> john malcolm here at heritage. two quick questions. one, you talked about the expedited process. do people who fail a drug test, or alcohol test, have to appear in your court before they're revoked, or does it happen the moment the test comes back? and my second question, which is, did you face any resistance when you implemented these programs from prosecutors, probation officers or the defense bar? >> well, first, it's a $3.75 rapid drug screen comp. if i it's an instant response. if they deny it and say, i don't know how that happened, it must be a mistake, we'll seal the sample up, send it to a lab. they are not taken into custody. they're given a court ten days later in my courtroom to show up. if they come in, they'll get 15 days, if the lab confirms it. they're in denial or they're lying. at the warning hearing i'll tell them, if you mess up saturday night, leave your car at home, don't bring your kids with you,

come in, bite the bullet and do the two or three days. don't use, but if you do, think through your next step. my challenge at the beginning, i think -- this is hard for judges. because you've got to give a consequence every single time. but as short as possible the consequence. it was just me, so that wasn't a problem at the beginning. it was a bigger problem when we went to other judges. our probation folks are the beginning, it can be an opportunity. they were willing to try something new. if you and i both smoke meth and go in and admit it, we'll both get arrested. it doesn't matter who we are, race, backgrounds, whatever. we're both in. i think that's why this program works. the offenders think they're being treated fairly. the law enforcement guys, because of my background, they were willing to serve more warrants. once we got data showing fewer arrests, fewer prison, they were sold on it at that point.

but those the three groups, judges, probation officers, and law enforcement to have to change. prosecutors typically like it, because now there's accountability and consequences. defense attorneys like it because their clients don't go to prison as much. that's been my experience. >> i got some initial blowback from the prosecutors. they thought, we're going to have all these probation hearings. you're going to flood my courtroom. i was attorney general at the time and i made a commitment, i'll send my people to take care of those hearings for you. but i promise you, it's not going to be an issue. that's how i dealt with it, because i had force in both the major communities. but the -- in the 24/7 aspect, because we're testing for alcohol, the typical holding period is only 24 hours anyway. and we streamlined it to the point where in minnehaha county

at least, for the first violation we hold them for 12 hours, and we let them go and they never see a judge. they're held for 12 hours and they're released. the second time they're held 24 hours and then they're released. now the judges don't see anybody and they don't see the judge unless it's their third offense. and then something is probably going to happen, because then they're getting into that aspect of the case where they're starting to be identified as somebody who can't quit. rather than choosing to try to beat the rules. >> any other questions? sir? >> i'm richard vaughn from the international drug control policy. this question is for judge alm and dr. dupont. in the ten years of hope, if you take a step back and look ten years forward, how much bigger

and larger can this initiative spread around the country, thinking about the 5 million people on probation and probably, 2 million people in prison? if you think about how many people you think would do well on this program, how big would you like to go and how do you go forward the next ten years? >> you get a good idea, your foot should be on the accelerator, right? we've just -- we're hopeful. we'll start a pretrial pilot. i think in ten years, there's an even chance that this will be the way pretrial, probation and parole are done in most parts of the country. we need more data. we need more randomized control studies. someone in washington looks at hawaii and think people sit under palm trees and mai-tais and they're nice criminals. as this works in other places, it's not a judge alm thing, it's

a human nature thing. i really think with -- and the drug czar in the office has been really helpful. he's been a great use of the bully pulpit, just like nij. people recognize it. but the more research you have, the better. and that's ongoing now. so i really think as we show the savings in money, washington state is showing huge dollar savings in not having people sit for three or four weeks before a hearing. as long as the crime rate doesn't go up, that is going to carry on. 17,000 people in the program. i'm very optimistic about the future. and now with good data rolling in, i think it's just going to get better. >> i would like to pick up on this, too, about rich balm, too. hope, and 4/7, have been part of the u.s. federal strategy since 2010. and so the ondcp role in this

has been very, very important. and it is very much appreciated. i also want to follow up on a comment about doing this for everybody. you know, really, the hope model, and the 24/7, are not for the person who does something once, is a relatively minor offense, comes in to probation, and does well, goes out and that's the end of it. it's for the people who have problems. who have repeat offenses. who have not gotten that message. who have serious substance abuse problems. though it's not saying everybody in probation is going to do hope. it's saying hope is for the high-risk people. hope is for the people who don't get it quickly. you notice for example, steve was talking about, he's got 8,000 people in probation. hope is 2,000. and drug courts are 200.

not everybody -- it's the tough end that we're talking about. that's where the recidivism is. that's where the high costs are. that's where this value is. and i think that's really important to think that it's not everybody who's in hope who's on probation and parole. >> following up to that, what is it, 20% of any group is responsible for 80% of the use, or the product. in probation and parole across the country, probably half of the hard drug use around the country, so we could have a real impact on the amount of use. if it went nationwide it could have a real impact on the narco terrorist type drug cartels in mexico. because we -- our demand for it is fueling their activity. >> if there are no more -- oh -- if there are no more questions,

let me ask one last one. oh, yes, sir? >> thank you very much. jeff michael with the national highway traffic safety administration. i want to thank you, all three panelists, for the very informative presentation. from my particular perspective, i'm interested in -- particularly interested in that part of the substance abuse problem which takes place on our highways. which is an important one. but not the only one. we recognize the benefits of 24/7. we don't have many programs that have that -- the potential that 24/7 has. we, of course, don't have authority to implement across the country, states and communities do that. but we're trying to lead in this direction. the scaleability issue is a big

one for us. we really need to demonstrate to other communities that are larger that handle greater volumes of serious offenders, that they can do it, too. can you say anything about the, you know, the potential outside scale of such programs? could such programs handle the potentially hundreds of thousands of offenders across the country? >> well, i -- sioux falls is the biggest community i've ever lived in for any length of time. [ laughter ] so i start from there. the largest problem they have is parking. okay? if you're going to test more than 600 people at the same site, you need to have a big

parking lot, that much i know, okay? [ laughter ] but i know there's a pilot going on in des moines, for example, which is a somewhat larger community. i've understood that there's going to be one going on somewhere in one of the communities in florida, which i'm sure is larger than des moines. and i guess i have to go back. you've got to pick a spot, with a big parking lot, and you have to try it. but you can scale back the target audience. we scaled back. we started only with duis with a prior conviction. and we knew from the numbers in south dakota how many people that was statewide. we also knew how many it was by county. so we knew the -- at least when we started, the numbers were never going to get higher than that. now, of course, what turned out was that the judges immediately started seeing the efficacy of

using it for situations other than drunk driving. the spouse abuse -- there's a huge correlation between domestic abuse and alcohol abuse. so the judges were using it there, too. and they were using it for burglaries and thefts and other alcohol related misconduct. and of course, it produces great benefits there as well. so -- and, of course, not telling stories out of school, ntsa was not particularly happy with us for using their money to deal with spouse abuse. but we worked that out. we put all that together. but the bottom line is, you've got to pick a spot, and try it. and if you want me to flag for it and speak, i'll be happy to do it. >> let me thank each of the panel members. it was a true privilege for me to sit here with people who have had such distinguished careers,

and who have devoted such a large part of their careers for coming up with an innovative way of addressing the problems of more bidity and mortality on our highways and in our communities. please join me in thanking them for coming here to give us the benefit of their knowledge. [ applause ] >> and i thank paul larkin and heritage for making this happen. [ applause ] wednesday, live coverage of a funeral service for former washington post editor ben bradlee who died last week at the age of 93. we'll have live coverage at 11:00 a.m. eastern on c-span. the heritage foundation hosts a discussion on trends in jobs, the economy, and opportunity in the u.s. live coverage wednesday starting

at 12:30 p.m. eastern here on c-span3. wednesday night on c-span3, washington journal's big ten series continues at the university of illinois at urbana. at 8:30 p.m., we look at an event about war, on war and civilians. that's followed by the legacy of afghan president hamid karzai. and finding jobs for veterans. that starts at 8:00 p.m. eastern here on c-span3. here are just a few of the comments we recently received from our viewers. >> i really appreciate the airing of all these debates. it's really giving me insight as to the diverse views, i guess, of all the other representatives. and candidates for the u.s. house. in other states, you know, in other districts. i really enjoy to see the

different viewpoints that come from different parts of the united states. and it's a really great thing to be able to watch them. >> i watched the debate. i think it was on c-span2, paula bradshaw. that's what i wanted to hear paula say is the things she said. i wish you would put it on regular c-span about 6:00 p.m. at night. please put that program on at 6:00, 7:00 every night until election day, so we can hear the truth about things. >> i just watched the nick rayhall-jenkins debate from west virginia. and i'm so tired of this campaign. i am so sick of these politicians who cannot tell the truth. continue to let us know what you think about the programs you're watching. call us at 202-626-3400, or

e-mail us at comments@c-span.org. or send us a tweet. join the c-span conversation, like us on facebook, follow us on twitter. 2014 marks the 50th anniversary of the surgeon general's report on smoking. the first time the federal government linked tobacco use to lung cancer and heart disease. next, boris lushniak discusses the latest report on tobacco use. this is an hour. [ applause ] >> good morning, everyone. welcome to the white house. i'm dr. howard koh, the u.s. of

department of health and human services. thank you so much for joining us on this historic day to honor the 50th anniversary of the surgeon general's report on smoking and health. to begin the program, it's my pleasure to introduce cecilia munoz, assistant to the president and director to the policy council. prior to this role, she served as deputy assistant to the president, and director of intergovernmental affairs at the white house. and before joining the obama administration, cecilia served as a community leader, as senior vice president at the national council of boraza, the largest latino civil rights organization. please join me in welcomie inin cecilia munoz. [ applause ] >> thank you so