Substance abuse is a long-standing problem in American society,
one closely linked to societal problems from dysfunctional families
and child abuse and neglect to unemployment, economic underdevelopment,
and crime. The numbers of Americans who abuse alcohol and other
drugs are staggering. During any given month during the last
20 years, at least 14 million and sometimes as many as 25 million
Americans used some type of illicit drug (Gerstein
and Harwood, 1990). Recent conservative estimates indicate
that about 17 million Americans suffer from some form of alcoholism
or alcohol abuse National Institute on Alcohol
Abuse and Alcoholism, 1993).
While drug-related cases have long been part of the caseloads
of the Nation's courts and other criminal justice agencies, substance
abuse problems recently have inundated the courts. In the late
1980s, as law enforcement agencies implemented or expanded strategies
that emphasized the arrest and prosecution of users and street-level
dealers, drug-related felony cases piled up in the courts. The
increased volume of cases, coupled with the enactment of laws
by the Federal Government and many States that require mandatory
terms of imprisonment for drug-related offenses, produced a sense
of crisis in many American courts. For example, according to
the report of a 1989 conference attended by court system leaders
from the Nation's nine most populous States, "the general sense
was that most trial courts are being overwhelmed by drug cases."
Conferees warned of "either an imminent or existing caseload
crisis and possible breakdown of the system if solutions are
not found soon" (Lipscher, 1989). The
well-documented increase in jail and prison populations around
the Nation is directly attributable to the upsurge in the prosecution
of drug charges and related crimes fueled by drug abuse.
The search for solutions has led State and local jurisdictions
to try a variety of approaches in handling drug-related cases.
One of the most innovative approaches is integrating substance
abuse treatment with the pretrial processing of criminal cases.
These programs are known as "drug courts" or "treatment drug
courts." No two of these programs are exactly alike, but common
threads run through them all.
While drug-related cases have long been part of the caseloads
of the Nation's courts and other criminal justice agencies, recent
developments have made substance abuse problems a pressing concern
of the courts.
While they vary widely in scope, organization, and points
of intervention, all the treatment drug courts developed in recent
years share an underlying premise that drug possession and use
is not simply a law enforcement/criminal justice problem but
a public health problem with deep roots in society. All of these
drug court programs see the court, and specifically the judge,
as filling a role that goes beyond that of adjudication.
In drug court programs, criminal justice agencies collaborate
closely with the substance abuse treatment community and other
societal institutions to design and operate the program. As
Goldkamp (1993) describes in his report
of the first National Drug Court Conference, "These courts rely
on strong collaboration among judges, prosecutors, defense lawyers
and related supporting agencies (such as case management, corrections,
pretrial services, probation, etc.), on the one hand, and a partnership
with treatment agencies (or providers) and other community organizations
and representatives on the other." These programs are based
on an understanding that substance abuse is a chronic, progressive,
relapsing disorder that can be successfully treated.
The success of these programs is built on the fact that the post-arrest
period can provide a particularly good opportunity for interventions
that will break the drug-crime cycle.
Most programs incorporate the following key principles recommended
in legislation developed by the President's Commission on Model
State Drug Laws:
- Early identification of defendants in need of treatment
and referral to treatment as soon as possible after arrest
- Early and professional diagnosis of defendant's treatment
needs
- Matching those needs to specific treatment programs
- Making treatment a court-monitored requirement and providing
for judicial review and supervision of the defendant's progress
in treatment
- Holding defendants accountable through a series of graduated
sanctions and rewards
- Providing aftercare and support services following treatment
completion.
Drug court programs involve the close collaboration of the
criminal justice system with the substance abuse treatment community
and with other societal institutions.
The recognition that treatment works -- not in every case, but
often enough to make treatment-oriented drug courts a better
alternative than conventional case processing for some defendants -- is
a key operating premise of drug courts. However, for treatment
to work, a number of individuals and institutions must cooperate
and collaborate.
When collaboration among systems works well, the benefits
to individuals and to society can be enormous. For drug-involved
defendants, the possible benefits of effective collaboration
include
- Improved physical and mental health, including recovery
from addiction
- The opportunity for education and employment
- Improved social functioning
- The opportunity to become a productive member of society
- A favorable disposition of a court case (such as dismissal
or significant reduction of the charges).
The court system benefits because of the effective disposition
of many drug cases and because caseload pressures are eased,
allowing the system more time for non-drug cases.
For society, the possible benefits of effective collaboration
include
- Reduction in criminal behavior
- An improved workforce
- Reduction in spread of substance abuse-related diseases
- Reduced medical costs
- Reduction in incarceration costs.
The public health benefits of effectively integrating substance
abuse treatment and criminal case processing are especially important.
A high proportion of the defendants in criminal cases have substance
abuse problems. Some defendants already have one or more of
the infectious diseases often associated with substance abuse,
such as human immunodeficiency virus/acquired immunodeficiency
syndrome (HIV/AIDS), tuberculosis (TB), and hepatitis.
Defendants with compromised immune systems are at risk of
acquiring TB, especially if they are confined in crowded jails
after arrest. The drug court process can help identify defendants
who have contagious diseases and thus prevent the spread of disease.
The screening process can also uncover defendants' underlying
mental health problems, which may be contributing to interpersonal
and family violence.
Programs integrating substance abuse treatment with justice
system case processing offer many opportunities for court system
leaders, trial court judges, and other justice system practitioners
who handle substance abuse-related cases. They can break new
ground, help shape policies and practices that will improve the
lives of people who are involved in criminal cases, and help
forge new relationships among courts, substance abuse treatment
providers, public health agencies, and other societal institutions.
The challenge is to do so in a fashion that is consistent with
fundamental principles of fairness and due process of law.
The benefits to society include reduction in criminal behavior,
an improved work force, improved social functioning of defendants,
reduction in the spread of substance abuse-related disease, and
reduced medical costs.
Drug courts first appeared in 1989 and have multiplied since
1992. In 1996, over 125 drug courts were operating in 45 States
and more than 100 jurisdictions, and 24 were being developed.
At least 25 had operated for two years or more, supervising
an estimated 20,000 participants.
The collaborative planning, program design, and implementation
that have taken place already in the fledgling drug courts prove
that integration of substance abuse treatment and justice system
case processing is feasible. A study of the Miami Drug Court
(the first in the nation) conducted for the National Institute
of Justice found both success in treatment and reduced re-arrests
among defendants processed in treatment-oriented drug courts.
The researchers focused on defendants over an 18-month period
and compared them to similar defendants not in the program.
They found that among Drug Court defendants, there were
- Fewer cases dropped
- Lower incarceration rates
- Less frequent arrests
- Longer times before subsequent re-arrests
- Higher failure-to-appear rates, caused mainly by the more
frequent appearances required of Drug Court defendants(Goldkamp and Weiland, 1993).
This Treatment Improvement Protocol (TIP) focuses on the integration
of substance abuse treatment with criminal justice system operations
during the pretrial stages of criminal cases. Although
these are the boundaries of the discussion in this TIP, we recognize
that some treatment drug courts work with post-adjudicated individuals
as opposed to individuals in the pretrial phase of the criminal
justice system. TIP 12 in this series, Combining Substance
Abuse Treatment With Intermediate Sanctions for Adults in the
Criminal Justice System (CSAT, 1994d), focuses on post-adjudication
treatment options for offenders, that is, those who have
been found guilty.
The consensus panel for this TIP recognizes that not all treatment
programs or all substance-abusing individuals can be neatly categorized
as either "pretrial" or "post-adjudication." The treatment drug
court concept started as an identifiable package of clear elements
that has been adapted to fit local circumstances; different locations
have attempted to address similar issues in different ways.
Many substance abuse treatment programs that accept court referrals
handle both pretrial defendants and sentenced offenders. It
is also possible for an individual to be in more than one category
at one time. For example, an offender could be participating
in a substance abuse treatment program as a condition of probation
following conviction on one offense and become a pretrial defendant
by being arrested on a new charge.
There are, however, some unique aspects to the linkage between
substance abuse treatment and the pretrial processing
of criminal cases. Defendants who have been arrested but not
yet convicted are legally presumed innocent and cannot be compelled
to participate in a treatment program. A judge can, however,
exercise significant authority over pretrial defendants, including
ordering drug testing and treatment as conditions of release
from pretrial detention. The authority of the judge to establish
conditions of pretrial release and to defer prosecution or sentencing
is critically important for the development of programs linking
substance abuse treatment and pretrial case processing.
The adoption of pretrial intervention also has implications
for decisions on who is targeted for intervention; for the nature
and timing of screening and assessment activities; for sanctions
imposed for noncompliance; and for many other program design
and implementation issues. For example, a program that dismisses
the charges of those who complete community-based drug treatment
could apply to only those defendants whose current charges do
not involve violence or other offenses imprisonable upon conviction.
And, because treatment is to be initiated and monitored during
the pretrial process, a great deal of information about the defendant
must be acquired and processed quickly to make an informed decision
on program admission. This puts a premium on accurate and reliable
information and on the ability of criminal justice agencies,
courts, substance abuse treatment providers, and public health
services to exchange information quickly.
A pretrial defendant cannot be compelled to participate in
a treatment program: The decision to participate is the defendant's.
There is no single model for the integration of treatment
and pretrial case processing; jurisdictions have developed a
wide range of drug court models. Among them are
- Use of "supervised release" or "conditional release"
mechanisms, in which the defendant is released from pretrial
custody under conditions that include regular or random urine
screening and participation in a substance abuse treatment program
- Acceptance into a treatment program shortly after arrest,
with an understanding that (a) further prosecution will be held
in abeyance; (b) if the defendant successfully completes the
program, the charges will be dismissed; and (c) if the defendant
does not complete the program, prosecution will go forward on
the original charge.
- Acceptance into a "deferred judgment" program or "post-plea
diversion" program shortly after arrest, under which the defendant
pleads guilty to a criminal charge (for example, unlawful possession
of drugs) with the understanding that (a) sentence will be deferred;
(b) if the defendant successfully completes the program, the
plea of guilty will be vacated and the charges dropped; and (c)
if the defendant fails to complete the program, sentence will
be imposed on the original charge.
- Use of jail-based treatment programs for pretrial defendants
who are not released from custody and for defendants participating
in a conditional release, diversion, or deferred adjudication
treatment program who relapse into using alcohol or illegal
drugs.
Some examples from drug courts are provided inExhibit 1-1.
The primary objective of this TIP is to help policymakers
and practitioners plan, implement, monitor, and evaluate programs
that integrate substance abuse treatment with the pretrial processing
of criminal cases.
The TIP does not advocate one type of program model. It does
emphasize the integration of court processing and treatment services common
in most recently developed programs. In those collaborative drug
courts, a defendant's case is generally diverted from the usual
course of prosecution, but the court monitors the defendant/client's
treatment progress along with the clinician. With input from
the treatment provider, the judge may impose sanctions (consequences)
when it is apparent that the defendant has failed to comply with
program requirements. By the same token, the judge may "reward"
progress by making conditions of release less stringent or by
publicly acknowledging an individual's progress in open court.
The result is a much stronger and more active partnership between
the justice system and the treatment community than existed in
earlier diversion programs.
This TIP has been developed by a panel of practitioners from
a number of different disciplines and different jurisdictions,
almost all of whom have had first-hand experience with such integrated
programs. Panel members believe that this kind of systems integration
has great potential for improving the quality of justice and
the effectiveness of substance abuse treatment. The document
is intended to assist other practitioners in conceptualizing,
planning, and implementing programs that will work for their
jurisdictions.
The remaining seven chapters address the key issues involved
in planning, implementing, and evaluating programs that integrate
substance abuse treatment and pretrial case processing.
Chapter 2, "Key Elements of Treatment Drug
Courts," describes critical components of effective multisystems
integration, taking account of the goals and perspectives of
the justice system, the treatment community, and the public
health system.
Chapter 3, "Program Planning," describes
the initial formation of a planning committee and its activities,
especially in regard to early policy decisions such as selecting
the target population.
Chapter 4, "Designing the Program," focuses
on nine key sets of operational issues, such as screening and
assessment, that must be addressed in designing the day-to-day
operations of the program. The chapter includes a broad overview
of the range of substance abuse treatment modalities and the
components that constitute effective treatment. Another section
describes types of diversion programs already in existence and
discusses the roles of the judge, prosecutor, defense counsel,
and other practitioners involved in programs that integrate substance
abuse treatment and pretrial case processing.
Chapter 5, "Implementation," focuses on
staff training and education, public relations, and other issues
that may arise in the pilot period of the program.
Chapter 6, "Program Evaluation," addresses
evaluation strategies and techniques.
Chapter 7, "Program Costs and Financing,"
focuses on identifying program costs and developing funding sources.
Approaches to estimating costs and benefits are described.
Finally, Chapter 8, "Legal and Ethical Issues,"
discusses such issues as they arise in providing substance abuse
treatment to defendants during the pretrial stages of a criminal
case.
Information about the drug court experiences is drawn from
a variety of documents, many of which are in the collection of
The Bureau of Justice Assistance Drug Court Resource Center at
American University School of Public Affairs. See especially
Cooper, Caroline, An Overview of Operational Characteristics
and Implementation Issues and Cooper, Caroline, and Joseph
Trotter, Drug Case Management and Treatment Intervention in
the State and Local Courts, Volumes I and II, published by
American University in 1995. See also John S. Goldkamp, Justice
and Treatment Innovation: The Drug Court Movement "A working
paper of the First National Drug Court Conference December 1993", a report on the First National Drug Court Conference published
by the National Institute of Justice and the State Justice Institute.
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