Drug Treatment Court Research Articles

The Problems (and possible solutions) of assessing risk, race and recidivism in long operating drug treatment courts

Formal criminogenic risk tools can be an important control in assessing racial inequities in access to treatment courts and in evaluating both proximal and distal outcomes from those programs. To achieve this potential, however, it is important that risk tools themselves operate in a racially neutral fashion and that they operate consistently over the period assessed. Tools that are not properly calibrated by race and changes in the tools used over the life of a program are therefore significant evaluation concerns. Our paper is the first to assess the adequacy of an important risk-needs instrument, the LSI-R, across racial groups in a drug treatment court setting. The main contribution of the current study is not as a test of that instrument, which has been widely studied in other settings. Rather, because two different criminogenic risk tools were used over the study time period, we took this opportunity to explore the use of a readily constructible “proxy” measure of risk to support analysis of risk and race interactions over the life of the program.

Substance Use Treatment for Indigenous Offenders: The Effects of Race on Drug Court Treatment Outcomes.

With drug offenders making up a large portion of cases in the criminal justice system, efforts to reduce recidivism among this population has been a sizable topic within research. Within this literature, drug courts continue to be shown to be an effective method of dealing with substance use offenders. The current study seeks to examine whether drug courts are similarly effective in treating White and Native American offenders. To do so, a quasi-experimental study with a matched comparison group is used to compare the 1- and 2-year recidivism rates of White and Native drug court participants. Results indicate that there are significant demographic differences between the two groups which lead to higher recidivism rates among Native American participants. However, once demographic and other control variables are accounted for, recidivism rates are not significantly different. Further implications of these findings are discussed in the conclusion.

The Thorny Intersection Between Adult Drug Treatment Courts and Medical Marijuana Criminal Immunity Laws

Two revolutionary developments impacted the United States criminal justice system over the past 30 years that are now primed for an institutional reckoning—the legalization of medical marijuana at the state level and the exponential rise of adult drug treatment courts across the country. The states that have legalized medical marijuana also provide criminal immunity protections for qualifying medical marijuana patients, including those serving probationary sentences. Drug treatment courts are a form of intensive probation offering treatment services for participants plagued by substance use disorders. Most drug treatment courts operate on an abstinence‐based model and do not permit the use of medical marijuana. Consequently, challenges by drug court participants to the continued prohibition of medical marijuana are on the horizon. The purpose of this article is to highlight the contours of these knotty issues from a sociolegal perspective. The material for this article stems from a review of existing judicial decisions in addition to qualitative data collected during my case studies of three different adult drug treatment courts.

The effect of drug treatment court on recidivism: a comparison with traditional court intervention

Drug treatment courts have transformed the way in which courts process drug-related cases and respond to drug-involved offenders. Established as a diversion program, drug courts help to reduce recidivism among substance-involved individuals. Given the rapid expansion of drug courts across the nation, research examining their effectiveness has also increased. While there is evidence that drug courts are successful at reducing recidivism compared to more traditional court interventions, several studies in the literature have lacked an adequate comparison group using appropriate statistical techniques to reduce selection bias. Further, questions remain whether specific types of interventions or outcomes of those interventions are more beneficial than others. The current study adds to the existing drug court literature by conducting an outcome evaluation in Milwaukee County, Wisconsin to determine whether differences in recidivism existed between individuals in a drug treatment court and a comparison group of traditionally adjudicated individuals. Within-group differences were also examined to determine whether the type of intervention (drug court graduates, drug court revoked, traditional probation, traditional incarceration) was significantly influential in the likelihood of recidivism.

Longitudinal trajectories in recovery capital and associations with substance use among adult drug treatment court clients

BackgroundRecovery capital (RC) refers to the resources individuals use to support substance use disorder (SUD) recovery. Individuals with SUD who are involved with the criminal justice system often have limited RC. Drug treatment courts (DTCs), including traditional drug treatment courts (tDTCs) and opioid intervention courts (OICs), can link clients to important sources of RC in the short-term, but few studies have assessed RC longitudinally. MethodsThe current study analyzed five waves of data from a one-year longitudinal study on substance use and RC collected from clients of tDTCs and OICs (n=165, 52% male, 75% non-Hispanic White, Age=21–67 years). Mixed-effects models examined (1) within-person trends over time in RC, (2) individual characteristics associated with differences and changes in RC, and (3) patterns of relationships between RC and substance use over time. We also tested differences by court type. ResultsFirst, OIC participants had lower RC at baseline relative to tDTC participants, and there was considerable within-person variability in RC over time. Second, the effect of a high school diploma/GED at baseline on RC change over time was greater for OIC relative to tDTC participants. Third, there was a negative concurrent within-person association between drug use and RC that became stronger over time for OIC relative to tDTC participants. ConclusionsThis study is among the first to examine longitudinal, within-person trajectories in RC. Results revealed important within-person variability over time in RC that was linked to education and drug use, particularly among OIC clients. Findings could help inform DTC treatment approaches.

Overview of the innovative Family Treatment Drug Court model in Kentucky

AbstractFamily Treatment Drug Courts (FTDCs) have been implemented to assist families involved with the child welfare system due to substance use. This article describes an enhanced version of a Family Treatment Drug Court intervention which builds on the traditional FTDC model but includes adaptations that add theoretically driven components to the basic FTDC model that aim to strengthen not only permanency outcomes but also address child well‐being including several precursors to child well‐being: parent well‐being and family well‐being so that the additional child welfare outcome of child well‐being can be met. The enhanced FTDC model described in this paper offers three phases of treatment but also utilizes data gathered for evaluation purposes as continuous quality improvement information to inform providers regarding participant engagement so that targeted re‐engagement efforts can occur to reduce dropouts. Thus, this paper also describes the measures utilized in the comprehensive evaluation. Data include 33 standardized scales from multiple sources, including clients, therapists/treatment providers, court personnel, and child welfare workers, at multiple points ranging from weekly to quarterly. Implications are discussed regarding how this enhanced FTDC model and use of evaluation/CQI data impact client engagement and multiple outcomes.

Examining the Effects of Juvenile Drug Treatment Courts: A Systematic Review and Meta-Analysis

We meta-analytically examined program graduation rates among juvenile drug treatment court (JDTC) participants, the effects of JDTCs on recidivism and substance use outcomes, and the variability in these effects. We systematically searched for controlled evaluations examining the effects of U.S.-based JDTCs relative to traditional juvenile adjudication and used mixed-effects meta-regressions with robust variance estimates. We identified 55 eligible samples (providing data from 12,310 participants); the overall certainty of evidence was low or very low. The average graduation rate among JDTC participants was 54.74% (95% confidence interval [CI] [0.50, 0.59]). JDTCs had modest beneficial effects on general recidivism assessed during court supervision (odds ratio [OR] = 1.38, 95% CI [1.03, 1.84]) but these effects did not persist after program completion. Correlational analyses suggest JDTCs may be effective when program enrollment and service provision are better tailored to youth’s treatment needs. However, due partly to implementation failures, JDTCs may have minimal to no effects on postprogram recidivism.

Motivation and accessing care among drug treatment court involved women: A sequential, mixed-methods approach.

Drug treatment courts (DTC) address substance use disorders (SUD) but not cooccurrencing HIV or hepatitis C virus (HCV). This pilot explored feasibility and preliminary outcomes of the Women's Initiative Supporting Health (WISH) intervention and health-related motivation, both based in self-determination theory (SDT) regarding HIV/HCV and SUD treatment. WISH feasibility study: 79 DTC women completed a one-time survey regarding motivation and willingness to engage in future interventions. WISH intervention: 22 women from DTC with SUD and HIV or HCV received a 6-session, peer motivational enhancement health behavior-oriented interventions. Recruitment strategies were feasible. SDT-based measures demonstrated internal consistency in this under-studied population, with perceived competence/autonomy associationed with motivation to reduce HIV/HCV/SUD risk. Women DTC participants indicated acceptance and showed internally consistent results in SDT-based motivation measures These WISH feasibility and intervention pilot studies lay a foundation for future studies addressing motivation to access healthcare among women DTC participants.

Implementing a Recovery Capital Model Into Therapeutic Courts: Case Study and Lessons Learned.

Recovery capital is a strengths-based and multi-level model for examining the process and outputs of recovery and desistance. Recovery capital posits that the more positive resources one accrues, the better the chances of recovery. Oftentimes growth of one's recovery capital must be initiated through identifying programs in the community to create supportive scaffolding: this may be especially true for individuals involved in the justice system who may experience additional barriers to accessing programming. This manuscript presents the results of a pilot evaluation of the REC-CAP, a recovery-capital oriented system of measurement, planning, and engagement in two drug treatment courts. We include a description of the implementation process and results from surveys and focus groups with the court staff. Results suggests that the trainings were useful and that court staff meaningfully engaged with the REC-CAP system. Court staff felt the REC-CAP provided important information about court clients' strengths and barriers and suggested next steps for staff to take to guide their clients. Future work should explore how the REC-CAP score profile may change with client progress through the court phases as well as how to incorporate more system level supports for a REC-CAP orientation among probation officers and other court staff.

A longitudinal analysis of PTSD and other mental health symptoms among people sentenced to drug treatment court.

Drug treatment courts offer an alternative to incarceration for people who are facing criminal charges related to addiction. Because addiction commonly co-occurs with trauma exposure and associated mental illnesses, drug treatment courts likely serve people with these difficulties. Yet whether or how mental health symptoms change over drug treatment court participation has not been studied. We sought to (1) describe the mental health symptom profiles, including PTSD, of recent drug court enrollees, (2) examine the course of these symptom profiles at baseline, 6-month follow-up, and 12-month follow-up, and (3) test posttraumatic stress symptoms (PTSS) and gender as potential moderators of any identified time effects. Participants were 983 adults sentenced to drug treatment court between 2009 and 2017. Generalized linear mixed models revealed a significant effect of time on PTSS as measured by the PTSD Checklist and on summary indices of mental health measured by the Brief Symptom Inventory (p < .05 for all the outcomes). Gender did not moderate the effect of time on either outcome. However, those with PTSS above the clinical cut-off at baseline experienced less improvement in mental health over time. Our findings suggest that drug treatment court participants' mental health, including PTSS, improved over time. However, the presence of elevated PTSS interfered with improvements in other facets of mental health. Additional work is needed to identify specific program components that may exert causal effects and to examine interventions for PTSS that can be readily integrated in drug treatment courts. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Schools and Juvenile Treatment Drug Courts: A Case Study on Treatment Access through Collaboration and Advocacy

Abstract Adolescent substance use is typically addressed from the perspectives of school personnel (e.g., teachers, school counselors, social workers, and resource officers) who interact daily with students in school settings. Consequences of adolescent substance use in the schools may include suspension or expulsion and possible legal involvement. However, many adolescents do not have access to evidence-based treatment to address drug and alcohol use. Services are often not available or fragmented, resulting in poor compliance with treatment and inadequate treatment outcomes for youth. Cross-sector collaboration among schools, community behavioral health agencies, and juvenile court service units offers an opportunity to improve access to care and efficiency in delivering care to adolescents with drug and alcohol problems. Illuminated through a single case study, embedded substance use treatment in schools through partnerships with the court service unit and community behavioral health providers can increase access to care. Counselors and social workers play a key role in advocating for joint efforts to increase service access and improve treatment outcomes. Advocacy efforts may include participation and leadership in community coalitions, training and consultation in evidence-based practices, and seamless communication across all organizations that serve youth with substance use disorders.

“If not you, then who?”: a qualitative case study of a drug treatment court

ABSTRACT This qualitative case study included 11 members of a multidisciplinary adult drug court (ADC) team who participated in semi-structured interviews that explored their understanding of how their role as an ADC team member informs their practice. Interviews were analyzed according to thematic analyses procedures. Findings suggest the physical seating of the ADC team and the participants in the courtroom may foster or hinder a therapeutic approach. In addition, the analysis pointed to the importance of taking client privacy into consideration in the reporting of client information to support drug court participant agency. The results reveal the benefit of purposeful courtroom setup and operations conducive to a therapeutic approach, enhanced inpatient treatment options, and role clarity of team members. Further, the development of matrices of services supporting access to acute treatment for drug court participants is needed.

Divining Drug Court Success: Characteristics Predicting Graduation and Recidivism Across 34 Statewide Adult Drug Courts

Limitations from prior research on predictors of adult drug court graduation outcomes were addressed by examining the largest sample to-date of 3,062 participants from 34 rural and urban drug courts. Fifty-two percent of the participants successfully completed drug court. Two-year recidivism for the drug court graduates was low (16%). Graduates were more likely to be female, Caucasian, an older age, employed, have received at least a high-school education, to have a marital relationship, to not have engaged in suicidal behaviors, and to have primarily used marijuana instead of methamphetamine or opiates. No difference emerged among predictors in rural versus urban settings. In this unique study with a large sample and a multi-year recidivism period, graduates who recidivated were more likely to be younger, and to not have a driver’s license. Implications for tailoring of drug court treatment and case management plans are discussed.

Impacts of COVID-19 on Drug Treatment Court Operations: Lessons Learned Through Normalization Process Theory

ABSTRACT This qualitative study investigates the effects of the COVID-19 pandemic on drug treatment courts through the lens of court team members. We conducted semi-structured interviews, guided by Normalization Process Theory, to learn how transitioning to remote operations impacted courts, clients, and practices. Team members gave mixed reviews of the utilization of remote technology for drug treatment court processes, citing the advantages of increased flexibility and accessibility alongside concerns about client accountability. Additionally, there was disagreement on whether remote technology promoted or hindered communication between the clients and the judge. Interviewees also endorsed the idea of keeping the remote option post-pandemic for specific categories of clients.

Final Report of the Cross-Site Evaluation of the Juvenile Drug Treatment Court (JDTC)Guidelines and Data ElementsSpecifications

Final Report of the Cross-Site Evaluation of the Juvenile Drug Treatment Court (JDTC)Guidelines and Data ElementsSpecifications

Marijuana Policies in Drug Treatment Courts

Drug treatment courts are challenged by the ongoing trend of marijuana legalization. In states where it is legal for adult citizens to consume marijuana for medical and recreational purposes, treatment courts need to determine whether participants should be allowed to consume or possess marijuana. By analyzing the written policies of treatment courts in states that have legalized recreational and medical marijuana, this study explores how treatment courts address such challenges. The review shows a large percentage of drug treatment courts have yet to clearly communicate their marijuana policies with the participants in writing. However, among the drug treatment courts that have established marijuana-specific policies, the vast majority of courts continue to ban the use of marijuana while a few courts allow medical marijuana use on an individual basis.

Identifying strategies to advance equitable implementation of co-occurring mental health and substance use disorder treatment in drug treatment courts: A study protocol.

Behavioral health treatment disparities by race and ethnicity are well documented across the criminal legal system. Despite criminal legal settings such as drug treatment courts (DTCs) increasingly adopting evidence-based programs (EBPs) to improve care, there is a dearth of research identifying strategies to advance equitable implementation of EBPs and reduce racial/ethnic treatment disparities. This paper describes an innovative approach to identify community- and provider-generated strategies to support equitable implementation of an evidence-based co-occurring mental health and substance use disorder intervention, called Maintaining Independence and Sobriety through Systems Integration, Outreach and Networking-Criminal Justice (MISSION-CJ), in DTCs. Guided by the Health Equity Implementation Framework, qualitative interviews and surveys will assess factors facilitating and hindering equitable implementation of MISSION-CJ in DTCs among 30 Black/African American and/or Hispanic/Latino persons served and providers. Concept mapping with sixty Black/African American and/or Hispanic/Latino persons served and providers will gather community- and provider-generated strategies to address identified barriers. Finally, an advisory board will offer iterative feedback on the data to guide toolkit development and inform equitable implementation of MISSION-CJ within DTCs. The paper illustrates a protocol of a study based in community-engaged research and implementation science to understand multilevel drivers of racial/ethnic disparities in co-occurring disorder treatment and identify opportunities for intervention and improvements within criminal legal settings.

Adult Drug Treatment Courts and Community-Level Drug Possession Arrests.

Though the literature largely recognizes adult drug treatment courts (ADCs) as beneficial to participants, with lower rates of recidivism and drug use, the question remains of how ADCs impact communities and how other institutions (e.g., law enforcement) react to their presence. This study extends previous work estimating higher arrests associated with ADCs, particularly for crimes involving higher degrees of law enforcement discretion. Results indicate lower drug possession arrest rates for White residents in rural communities, and higher in urban areas, generally, but especially for Black citizens. Though the exact source of these changes has yet to be determined, current analysis indicates larger effect sizes for arrests scaled per officer, as compared to per population, pointing toward changes in law enforcement behavior.

Promoting permanency in families with parental substance misuse: lessons from a process evaluation of a multi-system program

BackgroundFamilies affected by substance misuse are at increased risk for child maltreatment and child welfare system involvement. The Enhancing Permanency in Children and Families (EPIC) program uses four evidence-based and informed multi-system practices to promote safety and permanency outcomes for children involved with the child welfare system due to parental substance misuse: 1) Peer Recovery Support (PRS), 2) Family Treatment Drug Court (FTDC), 3) Medications for Opioid Use Disorder (MOUD) and 4) Nurturing Parent Program (NPP) relational skill-building. The purpose of the current study was to identify barriers, facilitators, and lessons learned in the implementation of and client engagement with the main components of EPIC.MethodsSeventeen key EPIC personnel participated in the study. Individual semi-structured interviews were conducted. Qualitative analysis involved the thematic coding of the interviews, and program facilitators and barriers were revealed.ResultsPRS were identified as a primary strength of the EPIC program, providing experiential connection to participating families and a valuable source of information. High turnover and matching PRS to families were barriers to PRS implementation. FTDC contributed to client success as judges developed interpersonal relationships with the clients that balanced support with accountability. Client attitudes toward court presented barriers to FTDC engagement. MOUD provided stabilization and was perceived by caseworkers as an engagement facilitator and a layer of client accountability; however, the lack of availability of MOUD service providers presented a barrier for some clients. Parental relational skill-building was not valued by clients and was perceived as conflicting with sobriety-focused activities.ConclusionsThe EPIC program provides comprehensive, coordinated multi-system support and care to families affected by parental substance misuse. Continued efforts to improve recruitment and retention of PRS, reframing client perceptions of FTDC, and increasing access to MOUD may contribute to increased engagement in the program. Findings highlight the utility of tracking process outcomes in community-based interventions to promote participant engagement in programs set in complex systems.Trial registrationNCT04700696. Registered January 7, 2021-retrospectively registered.

From Referral to Treatment: Implementation Processes in Juvenile Drug Treatment Court Programs

Juvenile Drug Treatment Courts (JDTCs) provide a critical opportunity to identify and treat youth with substance use disorders (SUD). Structuring JTDCs to minimize process complexity and time to treatment is important. Results across eight JDTCs indicate the number of steps between referral and enrollment varied from 2 to 7, and the potential wait time varied from 1 to 58 days. The number of steps between referral and SUD treatment varied from 3 to 8, and the potential wait time varied from 2 to 118 days. Information regarding JTDC process can inform the field about JTDC practice, including barriers to treatment as well as areas for improvement.