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4. Two Case Studies

How Drug Courts Reform Criminal Addicts Who Don't Want to Be Reformed

Drug courts do not wait for addicts to acknowledge they need help before drug courts initiate treatment. Drug courts admit non-violent hard core repeat offenders whose addiction contributes to their criminality. They move addicts from forced compliance to self-directed compliance. Drug courts do not wait for addicts to acknowledge they are using or backsliding before initiating relapse prevention. To prevent relapse, drug courts test frequently and randomly for drug use, monitor for slurring of speech and addiction-friendly behavior, regularly shares such information within the treatment team and react quickly. Sanctions and reactions in drug court are focused on being "quick and certain."

Al and Baker, real people with fictional names, were multiple offenders who had resisted and failed at all of many attempts at drug and alcohol rehab, who only wanted to be left alone with their drugs and booze. Despite their initial resistance, they (like 75% of similar offenders who finished drug court) recovered themselves, became drug free, exited the revolving door of crime and never went back. Their histories demonstrate how court-directed rehab modalities succeed when traditional voluntary rehab fails. Their histories demonstrate why Tea Party conservatives and other conservatives across the political spectrum endorse drug courts as a means to save taxpayer money.

Al was furious that he was being put in drug court as part of his probation. So much so, he wrote a 20-page manifesto to read to his new audience. Al's document explained why drug court should just leave him alone. His North Carolina record included some 20 assaults, driving while license revoked and multiple DWI's. Baker was furious that drug court personnel were trying to force him to stay home at night, to have no booze in the refrigerator, to know a drug dog was likely to accompany a probation officer to his house, to stay out of bars and drug houses, to have his movements reported to Judge and Probation by law enforcement, to go to meetings, to test clean and sober and to submit a drug screen on demand. When Al was called on in court, he commenced to read from his multi-page manifesto. After he read a few pages I was able to divert him from his reading, but I was unable to stem the tide of his anger. When he wheeled around to leave court, he tossed this comment over his shoulder as he stormed out: "Frankly, Judge, there is nothing you have to offer me that is in the least bit interesting to me."

Al did not like the program, but, after a few sanctions and overnights in jail, he concluded that as little as he liked the program, he liked going to jail even less. He concluded that unlike his previous probation, drug court sanctions were likely to be quick and certain. It did not take him long to determine that compliance was the lesser of the evils facing him. He grudgingly began to comply, and after a few weeks he was avoiding using, complying with rules and testing clean. At this stage of his recovery, he was not happy, but he was compliant. With time he moved toward self-motivation as will be shown below.

Baker, we will call him, was not as assertive as Al about his misgivings, but, as he told us after drug court graduation, he did not want to be in treatment either. A judge had required drug court as a condition of not going back to prison, but the judge had not even bothered to ask if he wanted to stop drugging. When Baker came to drug court, his history of drug abuse and his felony record followed him like a puppy who will not go home. He had been caught yet again for felony larceny, and (since he was a career felon) the Department of Prisons was oiling up the revolving door. Again. At first, Baker seemed to me as if (but for drug court) he was one of those hopeless cases whose life was most likely to be ended by one of those shootings, stabbings, prison homicides, overdoses, accidents or suicides that typically befall the addicted incorrigible.

The first difference between drug court and voluntary drug therapy: The drug court target population seeks (1) multiple failures at rehab; and (2) criminal records should show them to be hard core multiple offenders. When I say we seek "multiple offenders," I point out that 1,388 crimes were charged and resolved by the 57 graduates of my District 9A between Jan. 1, 2006 and Dec. 31, 2010. They were evaluated in a 2016 report that revealed that these 57 graduates averaged 24 crimes per graduate before the graduates entered drug court.

I counted the number of charges against the graduates in the five-year period from 2006 to 2010 so that I could check for reoffending for five years ending April 2016. The 57 graduates accounted for 1,388 pre-drug court charges per graduate of District 9! Drug court program. That averages out to 24 charges per graduate immediately before entering drug court. I counted 34 non-re-offending graduates. Before they entered drug court. the 34 non-reoffending graduates who did not offend after graduation racked up an average of 18.14 crimes each, totaling 617 jailhouse-worthy crimes charged against them in the courts In the last three years, the 34 non-reoffending participants who had no convictions after they graduated each averaged 10.02 crimes charged, before they entered drug court, a total of 341 charges.

The second difference between drug court and traditional voluntary rehab is drug court does not wait for addicts to acknowledge they need help before drug courts initiate treatment. Despite Al's and Baker's lifetimes of crime and addiction, the drug treatment court went to work. Baker's recovery was more like a roller coaster than Al's. It took Baker a longer time to start moving toward compliance than with Al. For months Baker believed that the drug court personnel were treating him unfairly, as he told us in his exit interview. Why, he was thinking, was the drug court team checking his curfew, searching his home for alcohol and drugs, making him go to treatment, reporting on him when he was seen by local police in crack houses and bars, testing him for drugs, punishing him quickly when he failed to comply? Since his youth, Baker had never stopped using except when he was behind bars. In his first months in the program, (he told us later) he distrusted everyone in the program from therapists to probation officers to the judge. Drug courts have succeeded with hard core, resistant addicts like Al and Baker and drug courts do not see their resistance as a reason to wait before beginning treatment.

When inpatient treatment was needed but not wanted: Baker was unable to quit using even after months in the program. The treatment team decided he needed an enhanced level of supervision--a residential program (Dart Cherry at Cherry Hospital) which gets him away from his dealers, and gets him off the street. Baker did not want to go, but drug treatment court was able to make sure he went. He was, after all, on probation.

The third difference between drug court and traditional drug therapy: Drug court is unlike traditional therapy in that with drug court, enhanced treatment is provided even if the addict resists. Such a requirement is unavailable to traditional therapists. Consider Whitney Houston, whose therapists, whose family, and the whole world saw she needed treatment. Had she been in court-directed rehab modalities, the enhanced treatment would have occurred. Drug treatment court can require the addict go to residential rehab, go to secure lock up rehab, go to residential detox or go to child-accompanied rehab even if the addict prefers to be left alone. Drug Court addicts are on probation, and can mandated to the program regardless of what their brain wants them to do.

Drug court moves addicts from forced compliance to self-directed compliance. When Baker returned from 90 days' inpatient residential treatment, he was more clear-headed than before. Still, he was not happy that drug treatment court was forcing compliance by monitoring his behavior, his curfew, his friends, his attendance and participation at treatment, his Narcotics Anonymous (NA) attendance, his drug and alcohol use and his drug screen results. After three or four months in treatment, he still didn't like being forced to change his behavior.

He did not like all of the attention, but he liked trips to jail even less. So he began to comply, and he began testing clean. As Baker tells it, somewhere around the fifth or sixth month of forced sobriety, (not always clean and sober) the fog began to lift, and he acquired some level of mental clarity that came from having been forced to stay clean and sober. As he came out of his drug induced fog, he realized that following the drug court's rules (the same rules that he had so hated so much) made it possible for him to avoid using. He was surprised to realize that his life was better--that his life could be changed if he followed the rules. Baker, like Al, was learning how to avoid his triggers and how to control his urges.

RELAPSE PREVENTION IS ESSENTIAL TO EVENTUAL RECOVERY: Before Baker graduated, he tested dirty again, as did Al and the majority of participants who eventually successfully complete the program. If an addict in recovery starts to use again, it is imperative to intercede immediately. If not, the use tends to spiral down into full blown relapse. I'll say it again: drug court does not wait for addicts to acknowledge they are using or backsliding before initiating relapse prevention initiatives. Baker's use was caught quickly, sanctions imposed and Baker was nudged back into compliance. More than half of the graduates in the program test clean for a period of time, only to slide back into using at least once before cleaning up and succeeding.

Relapse prevention: The treatment team must be on constant lookout for signs that a patient is about to backslide or to relapse. Sometimes members of the treatment team sense a participant is in danger of relapsing. Partners on the team and the Judge are all informed. If a particular reason can be identified, (lost job, girlfriend troubles, arguments with family members) the team is informed and additional attention is applied with this information in mind. To Baker, as with most of the people in drug treatment court, the fact that people in authority showed genuine interest in his case was beneficial to his recovery. It seemed he worked out his problem and his outlook and demeanor improved for a matter of weeks. Then with no apparent warning, he tested dirty. He was expecting to be sent to the jail for a short term after testing dirty. He took his jail time as an opportunity to learn from his mistake and to strategize how to avoid similar mistakes in the future. We increased the frequency of testing and the intensity of monitoring. He returned to testing clean. He never had a full blown nosedive. He quickly regained his sobriety and re-entered treatment. He never fully relapsed.

Positive reinforcement is the proven way to encourage recovery-friendly behavior. As Baker's and Al's behavior improved, drug treatment court encouraged and rewarded sobriety-friendly behavior. We praised and congratulated them for clean tests. Positive reinforcement is used in traditional modalities. Participants have their own pro sobriety behavior recognized and enforced, and they watch as others had good behavior and clean tests recognized and encouraged. Here the courts have a chance to make peer pressure work for us. The court recognizes, encourages and congratulates clean drug screens, curfew compliance, attendance at NA/Alcoholics Anonymous and treatment, improved attitude, improved physical appearance and skin tone, positive results in Abuse Neglect Dependency hearings, well written letters to the court about plans to correct past mistakes, and more. The addict must eventually learn to live clean and sober without monitoring from the court. Positive reinforcement of improvements, at first small then greater, moves the participant toward clean and sober living independent of a high level of supervision. Drug testing, however, continues throughout.

The fourth difference between court-directed rehab model and voluntary traditional rehab: Sanctions in drug court are focused on being "Quick and Certain." Both Al and Baker had previously faced threats of punishment for violation of probation rules, but drug treatment court was the first time they realized that punishment for violating the rules would be quick and certain. The courts routinely convey the message that "if you break probation rules, there are consequences." Traditional probation's problem with conveying the notion of "consequences" is that in the mind of the resistant addict "consequences" were weeks--sometime months--in coming. This is because probation violations do not come to trial until the probation officer: (1) observes the violation; (2) writes it up: (3) confers with supervisor and gets permission to file a violation report: (4) gets a judge to sign an order for arrest: (5) the defendant is arrested and appears at a first hearing: (6) counsel is procured and the case continued until counsel can prepare: (7) a hearing is held before a judge.

To the mind of addicts, consequences that are weeks-months away do little to modify behavior today. If the courts wish to modify behavior of a resistant addict, they must convince the addict that sanctions are quick and certain. This is not a criticism of probation. They are doing the best they can with the resources available to them. In drug courts, the violator can be in front of the judge on the day of the rule violation, or (more frequently) the next twice-monthly drug court session. The principle of quick and certain was applied to Al and Baker so that (like others in the program) they came to believe that, like it or not, if they broke the rules, there was a good chance he would be caught quickly, and it was pretty certain that something unwanted would happen. When evidence appears of dirty drug screens, of curfew violations, of failure to attend meetings, of presence of participants in bars or drug houses, of behavior indicative of use, of statements indicative of weakening of resolve, the team would impose a sanction, would increase drug testing, would send a participant to jail, would send a participant to a residential facility or to a secure facility. This would usually happen at the twice monthly drug court session or occasionally sooner.

Had it not been for Drug Court, Baker would have gone back to prison at $28,000 per year. There was nothing to lead one to think that his inclinations to break and enter would be changed, for he had been imprisoned so many times before without changing his outlook. He graduated from the program and now, nearly 10 years later, he remains drug free, law abiding, and tax-paying citizen. No longer stealing for a living, he now has a job working for a Piedmont-area factory, has gotten his license back, has a home, has a respectable car, has a wife, is supporting her child and has a life. Al's drunk driving history predisposed him to tragic death behind the wheel of a car involved in death or serious injury of others, but he found himself. More than six years since his graduation, he is recovering his employability, is a deacon in his church, and is a beacon of light to those who know him.

If an addict is put in a treatment program before his addiction evolves from pursuit of drug-induced ecstasy to avoidance of pain, the likelihood of success is diminished. An addict's responsiveness to rehab depends in part on whether his primary motive is sheer pleasure, or whether his primary motive is using drugs to keep from feeling like he wants to die. If an addicts' drug use is all about pleasure and nothing about withdrawal, therapists will have a hard time convincing him to walk away from "the best sensation of his life." It will be difficult in the extreme talk an addict away from his drug when he thinks, "That crack was like all the orgasms I ever had all rolled into one." Or, "I never felt as calm and relaxed as when I was on opiates." When the addict is pursuing and sometimes achieving ecstasy the therapist can offer the user precious little motivation. On the other hand, if the addict's motivation is to mitigate his withdrawal symptoms, therapists have something to offer. The therapists has something to offer when the addict's motivation is that he/she feels like he/she will die of pain and discomfort if he/she does not get another hit. There is little the therapist can offer to the user who wants the sensation of a lifetime, but an addict who has grown "sick and tired of being sick and tired" might be more ready to consider a life without withdrawal pains.