Approximately 60–80% of adults arrested for a criminal offense in the United States test positive for illicit drugs, and more than 40% meet diagnostic criteria for a moderate to severe substance use disorder. Continued illicit substance use is associated with a 2- to 4-fold increase in the likelihood of committing a new criminal offense. Although substance use disorder treatment can reduce recidivism significantly, only about one quarter to one half of persons referred to treatment by the criminal justice system will complete treatment successfully. Low completion rates for treatment are attributable, in part, to the fact that only about one quarter of community treatment programs offer specialized services for criminal justice populations. Most treatment providers are untrained and unprepared to deal with justice involved clients, who frequently present with serious risk factors for criminal recidivism and treatment failure, including low intrinsic motivation for change, unstable housing, poor health care, substantial trauma histories, and aggravating cooccurring conditions such as antisocial personality disorder. This article describes drug courts and other types of problem-solving courts designed to address the needs of this population and improve outcomes. Research findings are reviewed that demonstrate the effectiveness and cost-effectiveness of the programs and identify best practices that optimize outcomes.
Drug courts combine community-based substance use disorder treatment with continuous monitoring by criminal justice authorities and immediate and consistent consequences for treatment noncompliance. The first drug court was founded in Miami-Dade County, FL, in 1989. As of mid-2017, there were more than 3,000 drug courts in the United States and more than 1,300 other types of problem-solving courts serving persons with other social service needs, such as homelessness, mental health disorders, domestic violence, and gambling.
In drug courts, the judge serves as the leader of a multidisciplinary team of professionals, which typically includes a program coordinator, treatment representatives, clinical case manager, prosecuting attorney, defense attorney, probation officer, and law enforcement representative. Participants are required to complete substance use disorder treatment and other indicated services, undergo frequent and random drug and alcohol testing, and attend frequent status hearings in court during which the judge reviews their progress in treatment and may administer a range of consequences contingent upon their performance. The consequences increase gradually in magnitude in response to successive infractions or accomplishments in the program and may include rewards such as verbal praise or certificates of accomplishment, adjustments to the participant’s treatment regimen, or sanctions such as writing assignments, community service, or brief periods of jail detention (typically 1–5 days in duration). Successful graduates have their criminal charges withdrawn or reduced or receive a substantially reduced sentence in lieu of incarceration. Graduates may also have the arrest or conviction expunged from their legal record. Record expungement helps to avoid many of the collateral consequences associated with having a criminal record, such as a loss of voting rights or reduced access to public housing and educational loan subsidies.
Studies confirm that drug courts significantly reduce illicit substance use, reduce crime, improve participants’ emotional and social functioning, and return cost-benefits to taxpayers. Studies have also identified the most effective target population of participants who should be treated in drug courts as well as a range of best practices that are associated with significantly better outcomes. In light of this success, the original drug court model has been adapted to serve other justice involved populations, such as juveniles charged with delinquency offenses, parents with serious substance use disorders involved in child abuse and neglect cases, and arrestees suffering from severe mental health disorders.
Effects
Drug courts are among the most thoroughly researched programs in the criminal justice system. Hundreds of studies published in peer-reviewed scientific journals and government-sponsored evaluation reports have confirmed that drug courts significantly reduce criminal recidivism and produce other positive benefits. Leading scientific organizations such as the Campbell Collaboration, National Institute of Justice, and U.S. Government Accountability Office have synthesized the vast body of research on drug courts in meta-analyses and systematic literature reviews. In addition, National Institute of Justice sponsored a national study of 23 drug courts called the Multisite Adult Drug Court Evaluation (MADCE). The MADCE followed over 1,100 drug court participants for 18–24 months and carefully measured program impacts on illicit substance use and other indices of participants’ psychosocial functioning using saliva tests and in-person structured assessment interviews.
A consistent finding from the meta-analyses, systematic reviews, and MADCE is that drug courts significantly reduce criminal recidivism— typically measured by rearrest rates over at least 2 years—by an average of approximately 8–14%. Drug courts that received independent evaluations and concomitant training and technical assistance from experienced experts reduced recidivism by an average of 32% and by as much as 80%. The effects on recidivism have been shown to persist for at least 3 years, well after participants were discharged from the programs. Results from the MADCE further revealed that drug courts significantly reduced illicit drug and alcohol use, improved participants’ family relationships, reduced family conflicts, and increased participants’ access to needed financial and social services. Finally, drug courts have been determined to be cost-beneficial. Several meta-analyses and the MADCE reported that drug courts produced an average return on investment of approximately US$2–4 for every US$1 invested. This has translated into net economic savings of approximately US$3,000–22,000 per participant for local communities.
Target Population
Studies indicate that drug courts do not work for everyone. The greatest benefits are derived by persons who have a moderate to severe substance use disorder and other risk factors for criminal recidivism or failure in treatment, such as prior criminal convictions, previous failures in treatment, or cooccurring antisocial personality disorder. Referred to as high-risk, high-need individuals, these are the persons who require the combined regimen of treatment and supervision services embodied in the drug court model. Drug courts are approximately twice as effective at reducing crime and 50% more cost-effective when they serve high-risk, high-need participants. Individuals who do not have serious substance use disorders or other risk factors for failure in treatment can be managed as, or more, effectively in less intensive and less costly programs, such as pretrial diversion, traditional probation, or a simple referral to treatment.
This finding is consistent with a general body of evidence-based principles referred to as Risk-Need-Responsivity (RNR). Risk-Need-Responsivity is derived from decades of research indicating that the best outcomes are achieved when the intensity of criminal justice supervision is matched to participants’ risk of recidivism or likelihood of failure in treatment (risk principle), and treatment focuses on the specific disorders or conditions that are responsible for participants’ crimes (need principle). Requiring participants to receive too much treatment or supervision in light of their actual needs or risk level can make outcomes worse by interfering unnecessarily with their engagement in productive activities, like work, school, housekeeping, or parenting. Most important, studies indicate participants should not be mixed in the same treatment groups or residential treatment programs with higher risk or higher need peers. Mixing populations with different levels of risk or need has been shown to increase crime, illicit substance use, and other undesirable outcomes by exposing low-risk participants to antisocial peers and values. For these reasons, drug courts achieve the best results when they target their intensive blend of treatment and supervision services to persons who require those services and avoid overtreating or oversupervising persons with lower levels of risk or need.
Best Practices
Studies have reported a wide range of outcomes in drug courts. Although about three quarters of drug courts have been found to reduce criminal recidivism, a sizable minority of drug courts (about 15%) had no discernible impact on crime, and a small percentage (about 6%) were found to have increased crime. Researchers have looked carefully at what practices characterize effective drug courts and distinguish them from the ineffective or harmful ones. Practices that are consistently associated with better effects (typically 50– 100% greater improvements in outcomes) are referred to as best practices.
Studies have found, for example, that outcomes are significantly better in drug courts when all team members attend precourt staff meetings routinely to review participants’ progress in treatment, court hearings are held at least every 2 weeks for the first several months of treatment, judges spend at least 3 min interacting with participants in court, random drug testing is performed at least twice weekly, jail sanctions are no more than a few days in duration, and participants receive evidence-based treatment matched to their assessed clinical and social service needs. These examples are by no means exhaustive, but they demonstrate how far research has advanced in defining best practices for drug courts.
Best Practice Standards for Drug Courts
Armed with empirical knowledge of what works, the National Association of Drug Court Professionals published the Adult Drug Court Best Practice Standards to guide drug court operations. The National Association of Drug Court Professionals Standards are derived from reliable scientific evidence indicating which practices produce significantly better results in drug courts and avoid harmful side effects. Responsibility for enforcing the standards is the province of state or local courts and treatment systems; however, the standards create a measurable and enforceable standard of care against which to evaluate the policies and procedures of individual drug court programs.
Adaptations of the Drug Court Model
The success of drug courts in serving adults charged with criminal offenses has spawned a wide variety of other types of drug court programs. These adaptations of the original drug court model include, but are not limited to, driving under the influence courts for individuals charged with repeated instances of driving under the influence of drugs or alcohol, juvenile drug courts for teens charged with drug-related delinquency offenses, family drug courts for parents or guardians with serious substance use disorders facing allegations of child abuse or neglect, reentry drug courts for parolees or other persons released conditionally from jail or prison who have a moderate to severe substance use disorder, and tribal healing to wellness drug courts that apply traditional Native American healing and communal practices to serve persons charged with drug- or alcohol-related violations of tribal laws.
In addition, other types of problem-solving courts have been created to address a wider range of social service needs encountered frequently in the court system, such as domestic violence, homelessness, mental health disorders, gambling, prostitution, and school truancy. These programs deliver many, but not all, of the services delivered in drug courts, such as frequent judicial status hearings, gradually escalating rewards and sanctions, and evidence-based treatment. All problem-solving courts share a commitment to principles of therapeutic jurisprudence and believe that the courts should play a critical role in addressing some of society’s most pressing ills. As the name suggests, they seek to solve problems in their community rather than simply adjudicate controversies and punish malfeasance.
Research is identifying the appropriate target populations and best practices for these newer program models, and the lessons have been similar to those learned in adult criminal drug courts. For example, studies indicate outcomes are significantly better for driving under the influence, juvenile, and family drug courts that serve high-risk, high-need participants. In addition, outcomes are better for programs that hold frequent status hearings, perform random weekly drug and alcohol testing, apply gradually escalating incentives and sanctions, limit jail sanctions to no more than a few days, and match treatment services to the assessed clinical needs of the participants. Research is ongoing to increase confidence in the target populations for these programs and identify a wider range of best practices to enhance treatment outcomes.
References:
- Lessenger, J. E., & Roper, G. F. (Eds.). (2007). Drug courts: A new approach to treatment and rehabilitation. New York, NY: Springer.
- Marlowe, D. B., Hardin, C. D., & Fox, C. L. (2016, June). Painting the current picture: A national report on drug courts and other problem-solving courts in the United States. Alexandria, VA: National Drug Court Institute. Retrieved from http://www.nadcp.org/ sites/default/files/2014/Painting%20the%20Current%20Picture%202016.pdf
- National Association of Drug Court Professionals. (1997). Defining drug courts: The key components. Washington, DC: Office of Justice Programs, U.S. Department of Justice. Retrieved from http://www .ndci.org/sites/default/files/nadcp/Key_Components.pdf
- National Association of Drug Court Professionals. (2013). Adult Drug Court Best Practice Standards (Vol. I). Alexandria, VA: Author. Retrieved from http://www.nadcp.org/sites/default/files/nadcp/AdultDrugCourtBestPracticeStandards.pdf
- National Association of Drug Court Professionals. (2015). Adult Drug Court Best Practice Standards (Vol. II). Alexandria, VA: Author. Retrieved from https://www.nadcp.org/sites/default/files/2014/Best%20Practice%20Standards%20Vol.%20II._0.pdf
- Rossman, S. B., Rempel, M., Roman, J. K., Zweig, J. M., Lindquist, C. H., Green, M., . . . Farole, D. J. (2011). The multi-site adult drug court evaluation: The impact of drug courts (Vol. 4). Washington, DC: The Urban Institute Justice Policy Center. Retrieved from https://www.ncjrs.gov/pdffiles1/nij/grants/237112.pdf
- S. Government Accountability Office. (2011). Adult drug courts: Studies show courts reduce recidivism, but DOJ could enhance future performance measure revision efforts (GAO-12–53). Washington, DC: Author. Retrieved from http://www.gao.gov/ assets/590/586793.pdf