Addiction Treatment

How Drug Courts Save Lives in Recovery

One of the greatest privileges I have had in my career was to lead the clinical team of two local drug courts in my home state of Massachusetts.  From 2009 to 2017, I was the Program Director for a clinical team partnering with two adjacent jurisdictions with drug courts responding to the opioid crisis.  Working with the clients and court professionals was transformative for me, both professionally and personally.  I am grateful that I am still connected with drug court graduates who reach out or stop by my private practice office to share their successes and achievements.

Over the years I also went to a lot of heartbreaking funerals, and I stay connected with some of the parents of participants who overdosed; we have lost so many gifted and beloved people to the disease of addiction.  Seeing Drug court participants successfully finish college, open their own businesses, be reunited with their children, start families, and get training to work as recovery specialists is beyond rewarding.

I still collaborate with the legal professionals that I was on the drug court Team with.  I think we are forever bonded through the emotional work of helping people at some of the darkest places they have been in their addiction, including facing jail time.  Between the clients and the courts, I cannot say enough about the power of drug courts to change lives.  We used to say, candidly, that there are only three ways out of Drug court: you graduate, you go to jail, or you die.  This speaks to the level of crisis people are in when they are referred to drug courts, and how important interventions are to saving lives.

The participants and the drug court team members I worked with have become like family.  You cannot help but get deeply invested with people at a crossroads in their lives, and their need for intervention conflicts with their ability and motivation to act voluntarily on that need.  Drug courts may have saved participants’ lives, but they have also deeply enriched mine.

What is a Drug Court?

Drug courts are specialized court programs that aim to address the underlying issues of substance abuse in offenders whose crimes are driven by addiction. These courts integrate treatment and judicial oversight, focusing on recovery to prevent future criminal behavior linked to substance abuse. Individuals who commit crimes combined with compulsive addiction, if not treated, are highly likely to re-offend.  When you treat the addiction, the criminal behavior that supports the addiction can be eliminated.  Being arrested can become a cross-road event for many, and breaking the cycle of the revolving door at the courthouse is a fundamental goal of these programs.  Traditional court systems focus on the determination of guilt for behaviors, not the underlying disease of addiction.

“The criminal justice system has the unique ability to influence a person shortly after a significant triggering event such as arrest, and thus persuade or compel that person to enter and remain in treatment. Research indicates that a person coerced to enter treatment by the criminal justice system is likely to do as well as one who volunteers.”

National Association of Drug Court Professionals

Where Did Drug Courts Start and How Do They Work?

The first drug court was founded in Miami-Dade County, Florida in 1989 specifically designed to tackle the rising issue of crack cocaine abuse among offenders. Today, nearly every state has a drug court, and research shows the impact in reduced recidivism, significant cost savings for taxpayers, and lives recovered.  Participants who successfully complete a drug court program can often have their underlying criminal offenses dismissed or expunged.  If a participant fails to complete the program, their case will be processed as it normally would in the traditional court system.

Drug court participation includes phases of treatment and court appearances, often 12-16 months long.  Treatment includes a full continuum of services from detoxification and medication-assisted treatment to outpatient therapy. The requirements for weekly participation start out fairly intensive and gradually decrease as sobriety goals are achieved.

For example, weekly participation in the drug court I worked with required the following for each week of “phase one” (eight weeks):

  • Attend Therapy
  • Attend Three Recovery-Oriented Group Therapy Sessions
  • Attend three AA/NA/ Smart Recovery Meetings
  • Random Drug Screens Two to Three Times a week
  • Weekly Probation check-Ins
  • Weekly Drug Court Session Attendance

Other requirements are community service hours to be completed by the end of the phase and maintaining employment or academic enrollment.  It is a pretty intensive schedule that creates structure and accountability.  These weekly requirements decrease over time so that a phase-four participant may be more engaged in work and family responsibilities and have fewer drug tests, fewer probation check-ins, and matching treatment plans.

How Are Drug Court Programs Managed?

The drug court oversight process includes regularly scheduled court hearings. Before each weekly court session with participants, the drug court team reviews each participant’s progress to determine rewards vs. sanctions for the participants’ completion of required activities. Non-compliance (i.e., a positive drug test or missed group attendance) may earn a sanction such as increased testing, curfews, ankle bracelets, essays, and even detention for the day (or two).

Over the years, research has led drug courts to adjust what types of sanctions are effective (fewer detentions, more rewards for achieving goals), and the scientific evidence continues to drive national guidelines and policies.  Whatever the research may say quantitively, I can vouch for the qualitative transformation of actual humans in recovery and the magic of what happens when the criminal justice system partners with treatment providers with the shared goal of saving lives and restoring families.

A key aspect of drug court management is to motivate participants by recognizing and rewarding their progress in meeting recovery goals, thereby fostering a sense of personal responsibility and control over their lives. The overarching goal is to move from external control (the court) to internalized control (personal recovery). In the beginning, participants are indeed coerced into abstinence and treatment, but by the end, the rewards of recovery sustain themselves. 

The Structure of a Drug Court Is Key to Effectiveness

Drug courts are judicial programs characterized by their structured approach, blending criminal justice strategies with contemporary methods in substance use disorder treatment, focusing on the individual needs of offenders. They use the neurobiology of addictions to treat the compulsive nature of addictions and develop judicial interventions that are responsive rather than reactive. Drug courts target “high-risk” offenders who have a physical dependence on substances and, from an early age, have had prior contact with both the psychiatric and criminal justice systems.

Drug courts are not for low-risk offenders or non-addicted substance users; it is a promising alternative for well-screened and assessed high-risk offenders in high need of substance use disorder treatment instead of incarceration. In my experience, at least 75 percent of drug court participants also had a trauma history, a history of negative experiences in treatment, and had not been treated for trauma-related symptoms.

The best practice structure of drug court programs comes from nationally approved standards: “The 10 Key Components.”  These are evidence-based practices and are fundamental to ensuring that the drug court is committed to the fidelity of the model supported by research.  Without these 10 Key Components, the model gets diluted and loses effectiveness.

Overcoming Perception and Stigma

Some argue that drug courts are “punitive,” and some feel that drug courts are “soft on crime.”  I was once told that drug courts were just a “hug a thug” program.  It can be hard to think about using scarce resources for those who have committed crimes, but improving (and saving) lives and cutting costs in the big picture makes it worth it.

Quick Facts:

  • In Massachusetts, the cost of one year in jail = $55,000, whereas the cost of one year in Drug court = $3,000 to $6,000.
  • Studies demonstrated that the recidivism rate for Drug court participants was 45% compared to 55% for non-participants.
  • Drug courts save as much as $27 for every $1 invested by the offset with reduced re-arrests, law enforcement contacts, court hearings, and the use of jail or prison beds.
  • Drug courts can reduce foster care placement and health care utilization.

All Drug Court team members must be formally trained in these 10 key components.  The 10 Key Components are backed by research and recognize the role of neurobiology, behavior modification, and treatment in recovery.  Law enforcement professionals are able to expand their skills with knowledge of treatment models, stages of motivational change, and the impact of co-occurring mental health issues. A formalized drug court manual and documents that define the drug court’s mission, goals, eligibility criteria, operating procedures, and performance measures that are collaboratively developed, reviewed, and agreed upon are essential (ask to see it).  

Meet Your Drug Court Team

The drug court team consists of several key players:

  • Designated Drug Court Judge
  • Program Coordinator
  • Prosecutor
  • Treatment Representative
  • Probation/Community Supervisor
  • Defense Counsel
  • Law Enforcement Officer
  • Evaluator

Team members are united in valuing participants’ success, maintaining professional ethical obligations, and making shared decisions that combine the perspectives of all team members. Each member has a set of core competencies needed for the role, shares a commitment to the program, mission, and goals, and works as a full partner to ensure their success.  Proper training, knowledge of addiction treatment, knowledge of gender and cultural factors, and commitment to developing community partnerships are key for each team member.

Ask About Trauma-Informed Treatment and Training for Drug Court Staff

In 2012, I was the Project Director for a three-year grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) to provide an enhancement of the clinical services offered by our drug courts to include trauma screening and gender-responsive trauma-informed care (as appropriate) for all drug court participants based on the promising practice Helping Men Recover and evidence-based practice (Helping Women Recover, Stephanie Covington).  This helped us identify possible cases of trauma for drug court participants. Drug court participants consistently self-report trauma histories and connections with efforts to self-medicate and addiction.

One of my biggest takeaways from that experience was how critical it was to engage meaningfully with screening and assessing for trauma by trained professionals.  For example, simply asking if clients “have a trauma history” is a clinical question, not a client-centered question.  Clinicians need to speak to the client’s own perception of events that may have been traumatizing to them.  Our clinical team found that clients minimize their own experiences and do not always have the language to understand their personal histories, and they need time to feel safe enough to share those experiences.

Once, a female participant was asked if she had any traumatic experiences, and she answered “no” to initial screening tools.  When she was interviewed again for an assessment by a clinician, she reported having been raped while being held hostage at gunpoint, watching friends overdose and die, and witnessing serious assaults while in jail.  The client had believed that “trauma” meant only childhood abuse by parents.  Without additional assessment, these traumatic events could have been left untreated; in fact, these events were linked directly to substance use to numb and relieve emotional pain.

Substance use treatment that employs trauma-informed care and treatment proved highly relevant to the clients on a personal level and they connected with it in personal ways they could articulate.  Court staff learned from presentations about the trauma-informed treatment curriculum and ways that the criminal justice system is experienced by clients in a way that triggers past trauma.  The emphasis on trauma and addiction as a dual-diagnosis treatment need became a common language for making recommendations from the court.  As a result, clients were more often referred to programs that included trauma treatment.

Peer Support and Recovery Coaches

Incorporating peer support and recovery coaches into drug court programs can significantly enhance the treatment process, offering participants relatable guidance and support, and strengthening the overall treatment environment. Peer support staff provide non‐clinical, peer‐based activities that engage, educate, and support individuals to make life changes necessary to recover from substance use disorders. In addition to education and coaching, peer supports mentors by highlighting their lived experience of recovery.  In focus groups for our drug court, participants reported that peer support workers understand addiction in a way that no person without lived experience of addiction can.  Their comments reflect this: “It’s easier to talk to them…they don’t judge you…you can bounce things off them in ways you can’t with staff…they encourage you to tell if you have relapsed, then they go to bat for you…the peer support worker has been there…you can’t get into a drug addict’s mind unless you have been there yourself.”

A Lifeline of Support for a Fresh Start

This morning, as I went to finish this blog, I got a call from a former drug court Participant I met in 2009.  He has stayed in touch with me over the years to share achievements, setbacks, and his continued fight to live the life he imagined.  He was calling to share an accomplishment, and he and I remembered that one time his achievement was not overdosing and dying over the weekend (and my role in calling his probation officer to put out a warrant for him to keep him alive).

It may seem odd to have someone call from across the country to thank you for getting them picked up on a warrant in the past – but this is the strange miracle of drug court. He and I are pretty sure that he would have died if he hadn’t been picked up by the police (who also wanted to help him stay alive).  A decade later, he has relocated from the town that was filled with triggers for using, he is employed, he went back to school, he is staying healthy, he is living in his own apartment, he is paying taxes, and starting therapy with a new therapist where he lives.

It hasn’t been a drama-free experience, but we talked about how grateful he was for his probation officer, the drug court team, his lawyer, the police officers, and that we never gave up on him.  We can laugh now about how tough we were on him, and he can admit he needed it.  I hear from so many graduates about how happy they are now – and how hard it was to graduate because of their addiction.  I also remember the funerals and memorials and hear about some others who are back in jail.

Drug court changes the lives of everyone who takes part in it because addiction puts many on a precipice of change that is incredibly hard.  I know that many graduates go back to visit the probation officers and smile broadly when they share how well they are doing.  When I see my former Drug court team members, we all share news about different graduates, the struggles to engage them, the grief for those who died, and the joy of seeing recovery bring people back to the strengths they had all along.  I can vouch for the many who work to help treat addiction that you cannot help but get deeply invested in seeing people recover from addiction because the battle and the risks are so life-changing.

The law enforcement professionals that attend the graduation have smiles as big as the graduates – there is nothing better than seeing someone hug their arresting officer and thank them.  Community policing is a huge part of drug courts because our law enforcement officers respond to more overdoses than graduations.  It is incredibly healing to share the celebration with the parents, children, and families of graduates.  Recovery makes families of choice who create bonds that last.

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