5. Workings of a Drug Court Team
How drug court's "Quick and Certain" reactions prevent relapse like no other therapy can do
With resistant addicts, there will be no meaningful change in behavior unless the addict believes that the drug court team's reaction to dirty tests or addictive behavior will be "quick and certain." Drug courts work better with resistant addicts than do other modalities because drug courts do not wait for the addict to agree to undertake treatment or to return to treatment. Drug treatment courts are designed to observe addictive behavior quickly to correct it in order to prevent full blown skid row relapse. Typically addicts on the way to recovery backslide or use drugs or otherwise regress at times during recovery. Drug courts focus on relapse prevention. They make use of the hook" on the Good Shepherd's staff to pull the backsliding addict back toward recovery.
Team approach: The treatment team consists of:
1. A judge.
2. A prosecuting attorney, an Assistant District Attorney who seeks to assure that non-compliant addicts are appropriately punished or ejected from the program.
3. A substance abuse therapist who facilitates and directs treatment meetings and reports the addict's progress, or lack thereof, to the Court.
4 A mental health agency representative who coordinates or provides services to addicts with need for treatment for disorders other than addiction.
5. A probation officer who monitors compliance with Court rules and meets with the addict in his home and community.
6. An attorney for defendants.
7. A reporter to grant provider or funding provider.
8. An administrator who assures that information is shared between team members and who monitors whether or not team members are meeting their responsibilities.
On occasion, these responsibilities are assumed by more than one of the team members. Treatment team members conduct most of their duties independent of the other team members, and their interactions with the addict are reported at team meetings. The treatment team meets before every court session, usually every two weeks. Each addict in the program is discussed at every meeting, and the observations of each team member and reports from team members and others are shared. The team confers on whether or not the addict is succeeding in his/her treatment plan, what needs to be done to meet challenges or to encourage compliance. The team's observations are used by the judge in planning for the judge's interaction with the participant in courtroom. The judge should consider the input of all of the team members, but the final decision about what to do is the judge's.
Data collection and transmission using Management Information System (MIS): Drug treatment courts operating in the state must report admissions, completions, removals from the program, drug screening results, sanctions imposed for non-compliance, rewards granted for compliance, hospitalizations, pregnancy, and health of the baby, events creating challenges for addicts, training events undertaken and completed and a variety of events of compliance or non-compliance. Reports go on line via MIS to the Administrative Office of the Courts (AOC) and to agencies who gave grants to individual programs. Around middle of 2015, MIS experienced technology problems and the contractor responsible for the program was unable to get the system to accept data for a matter of months. The local courts as well as AOC were unable to collate, retrieve and organize data as before. As of this writing, much of the MIS data transmission has been operationalized, but some reporting of some data remains unavailable as of March 2016.
How are addicted offenders sentenced to criminal justice drug courts? In criminal justice drug courts, sentencing judges have a mix of options whereby offenders might end up in drug court. Drug court is usually one of several conditions of probation. Drug court probation frequently follows a term in jail or in prison. In the final analysis, it is always a Judge who initiates referral of an offender to drug treatment court. The process might be started by probation officers, prosecuting attorneys, law enforcement officers, defense lawyers, or judges doing sentencing. The Judge and any persons involved in the referral process should make an initial determination that the offender would qualify for participation in the drug treatment court. The judge's decision to refer the addict to the court means that the addict must undergo an initial intake process to determine whether, in fact, the addict is appropriate for the drug treatment court. Occasionally a defendant is found not appropriate for admission after the intake process, and the offender is referred back for possible resentencing.
Initial intake inquiry is done by trained drug court personnel to determine whether the offender fits the target population of resistant addict and habitual offender. Is this offender appropriate for drug treatment court? Facts learned during intake might demonstrate that the offender would be detrimental to the program or that the program is not appropriate for the offender. If the drug court judge learns from the intake process that the prospect is not a good fit for drug treatment court, the sentencing judge is typically notified by the drug court judge, and the trial judge might countermand the referral to drug court.
Reasons to decline an offender at the intake stage include: Does the offender fit the target population of resistant addict, habitual offender? Will the prospect sell to participants? Is the prospect so violent as to jeopardize participants? Is the prospect a casual user rather than a resistant addict? Is the prospect's sentence of insufficient duration?
(1) If the offender remains active in sale of drugs, he could be expected to victimize other participants in the program. (2) Tendency toward violence would interfere with others in the program. (3) Drug use which is only casual: Drug courts are designed for hard core resistant addicts, not casual users. (4) Short suspended sentence: If the length of the criminal sentence is too short, the prospect would frequently rather take his time rather than undergo the supervision of drug court.
What about the addict who is also mentally ill? The recovery community uses terms like "dual diagnosis" and "co-occurring disorders" to describe the individual with both a mental illness and a drug addiction. What are the special challenges? If a local drug court has limited access to mental health treatment for dual diagnosed addicts, its effectiveness will be diminished.
As a nation we see have strong and natural compassion toward the wounded warrior whose PTSD does not show up on a physical or a scan. As a judge of juvenile abuse, neglect, dependency cases, I see infants who, through no fault of their own, will bedevil teachers, doctors and police officers as long as they live. My awareness of their challenges does not mean I do not hold them accountable for their behavior. It does mean, however, as protectors of the community, we place our neighbors at greater risk if we fail to deal with them as they are, rather than as they should be. We in our neighborhoods and highways will reap the whirlwind if we merely tell them to "get a grip" and get on with living.
Now, about the question: What are the special challenges? I would categorize the challenges into treatment and training. I would say we need adequate therapy by persons trained in treating the conditions in question. Locating and interfacing with trained professionals has proven far more difficult than should be the case. I have witnessed this to be true even when I have been trying to secure needed therapy to prevent a needless death or victimization of an innocent person. If the mental health therapist is unavailable, the substance abuse therapy proves to be of minimal benefit. Regarding training, I would say the team members need training in how to avoid making a condition worse. Even the best of intentions can lead to bad results. If the probation officer never got "trauma informed training" the probation officer might never know the PTSD patient is put in a fearful condition when being followed, and the probation officer will not know that the patient's fearful condition is suddenly and greatly multiplied when the patient is shown into a darkened room before the light is switched on. The Probation officer will mistake a flashback for sudden and undeserved rage.
Relapse prevention requires close monitoring and quick reaction by drug court team: Offenders are monitored closely so that they can be quickly directed back into sobriety and treatment if they show behavior that is averse to recovery. Monitoring is done by probation officers. Addicts are tested at least two times a week for alcohol and drug use. Probation officers search the addict's premises and persons when appropriate. Curfew is frequently checked. When participants are observed by law enforcement spending time with unsavory individuals or frequenting drug houses, drug court probation officers are informed. In a small town, this is more likely to happen than in a larger town where there are so many participants that law enforcement does not know them all. Probation officers check addicts' cell phones for indications of a participant's drug purchase or sale. Drug court monitors attendance at group therapy, individual drug therapy and support groups. Regular staffing meetings share information about participants' behavior. Provable violation of drug treatment court rules is sanctioned. Second hand reports (sometimes from angry girlfriends or boyfriends, sometimes legitimate) on addicts that do not constitute clear and provable violations are noted, and additional attention, drug testing or monitoring is directed to the addict in question.
When I say we seek "multiple offenders", I mean participants had long and substantial criminal records. Before the eventual 57 graduates entered drug court, 1,388 crimes were charged and resolved by them.
I counted the number of pre-drug court charges against the graduates in the five-year period from 2006 to 2010. I ended the group of graduates in 2010 so that I could check for reoffending for five years ending April 2016. There were 57 who graduated, and the 57 graduates accounted for 1,388 charges disposed of before they entered the drug court program. That averages out to 24 pre-drug court charges per graduate in the five-year period. I also calculated prior charges for graduates who did not reoffend. Of the 34 graduates who did not re-offend in the five years between January 1, 2011 and December 31st, this group had 617 crimes charged and resolved before they entered drug court. That's an average of 18.14 crimes for each non re-offender. In the three years before they went in drug court, they averaged 10.02 crimes each. Remember, these are the people who graduated, turned over a new leaf and had no new charges.
Target population excludes casual users. Drug Treatment Courts are not for everyone, and many offenders who are infrequent users should not be placed in them. The target population is offenders who are high risk to re-offend. This Court should not mix high risk confirmed offenders with offenders who do not need such intensive programming as this. One might think that an advocate of the program like I would say every offender needs a dose. Not so. Data indicates that offenders who have not penetrated deeply into criminality might be encouraged to do so if put in a highly regimented program with long-term offenders. Secondly, from a statistical point of view, it is important to be able to point out that the nationwide 75% recovery rate that drug courts boast is the result of the programming, not of "newbies" who have been cherry picked to improve recovery statistics.
Monitoring, enforcing and mandating: Hard core addicts will not recover if their behavior predisposes them to use, so the Court requires recovery-friendly behaviors like: submitting to drug tests when demanded; going home at night and staying there; keeping one's home, pockets, refrigerators and automobiles free of alcohol and substances; attending meetings; arriving on time; participating; and staying until the end of the meeting; meeting with probation officers in the home and office; staying away from people and places that attract alcohol and substances; wearing a GPS transmitter if the addict can't stay home; avoiding communication with addicts and sellers, letting the probation officer check your cell to see if wrongful contact has occurred; getting to court on time; getting and maintain employment. Probation officers check curfews, check attendance at treatment, check appearance in treatment, report failure to meet probation officers, require a drug test three times a week, note whether probationers hang in the bars or hang out with other users. GPS is required as appropriate. Addicts learn that the probation officer might check his room or his pockets for drugs, his refrigerator for alcohol. Probation officers check cell phones for contacts with persons in the drug culture. An addict's behavior, his conversation or his complexion in meetings with probation officers or treatment provider can tip off the treatment team that more attention is required and drug testing should be performed more frequently.
Court proceedings: Sobriety and compliance are rewarded from the bench. Drug court sessions look much like one would expect a court to appear. There is a courtroom, a judge in a robe, a bailiff, clerk, counsel tables and a courtroom with participants. Every participant is recognized, and rewards or sanctions are imposed, usually as was decided in staffing. When situations call for findings of fact or presentation of evidence, matters are presented like one sees on Perry Mason. Data and research confirm that rewarding participants for sobriety and compliance is much more effective than imposing sanctions for non-compliance. Drug courts reinforce positive behavior with congratulations from the bench, tangible rewards (e.g., the judge's ballpoint pens with his name on them, judge-purchased dollar coins, $5 gift cards to local groceries) relaxing of curfews, and liberalization of supervision rules. It is surprising and rewarding how much participants come to desire to be recognized for good behavior, and how they will correct me for failing to identify them as "perfect" in meeting all their goals for the past 2 weeks.
As addicts move into increased ability to control addictive behavior, the treatment team gives participants less supervision, and addicts learn to regulate their behavior. While some supervision is relaxed, drug testing never stops. The drug court team seeks to increase a participant's ability to self-regulate by reducing the intensity of supervision as the participant demonstrates recovery-friendly behavior. The speed with which participants move toward independent recovery varies and the team must monitor each addict individually. After months of clean testing and recovery-friendly behavior, the frequency and intensity of curfew checks and house checks is reduced. Curfews and other behavior curbs are relaxed, but drug and alcohol testing never stops. Never. Some addicts are so fearful of relapse that they ask for more supervision-and it is granted. As the brains of addicts recover, addicts who had thought for years that they could not recover come to realize that they can recover, and they become energized with the process-with receiving recognition in court that they had no violations since the last court-that they were "perfect" in meeting all goals since last court session. This recognition of the "perfects" is witnessed by the participants who are not-yet-compliant, who in turn, knowing the "perfects" from the streets and from meeting, come to realize they too might succeed.
Drug Treatment Courts (aka drug courts) are less than 40% "treatment" and are more than 60% monitoring and reaction. The latter 60% is supervision, monitoring, correcting, refocusing, drug testing, information sharing and promptly responding to addictive behavior and applying the hook of the Good Shepherd's staff. The drug court team focuses on determining whether addictive behavior is occurring and correcting it quickly. Addictive behavior includes, among other things hanging out with or communicating with users; communicating with sellers; appearing disoriented or sleepy in public or at meetings; missing required meetings; tardiness or early leaving of required meetings; missing required tests; possessing alcohol or controlled substances in their dwelling, car or person; violating curfew; admitting use; testing positive for prohibited substances. The observations of all team members are shared at team meetings before court sessions and more frequently when necessary. Sanctions or increased scrutiny or other corrections come out of the team meetings. More than 60% of the work of the team revolves around observing the addict, sharing information and making corrections that will modify the addict's behavior
An addict's cost benefit analysis focuses on what is immediate. Therefore, monitoring must be perceived by participants to be quick and certain. Even the resistant addict is capable of making a cost benefit analysis, even if the analysis ignores facts that only an addict would ignore. The addict's analysis is about what will happen right now. To the mind of the resistant addict, the threat of prison months hence is not as meaningful a threat, but the threat of unpleasant consequences right now is powerful. A threat, right here, right now, is substantially more likely to change behavior right now than a threat of a more draconian but delayed consequence. This thought is probably foreign to most folks, but consider the heroin addict who chooses to shoot up in private, not in public. A crack addict determined to steal his parents' goods will wait to steal from them when no one is around. His addictive-thinking brain doesn't consider the certainty that since he has been caught stealing before his family will figure out it was him. But his addictive-thinking brain does know he might go to jail right now if they see him do it. So he waits. If the threat of an unpleasant consequence is not believed to be quick and certain, the threat is not a meaningful threat to the mind of the resistant addict.
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.