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Drug Court: an Alternative Path to Justice and Rehabilitation

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Drug Courts: The Good, the Bad, and the Misunderstood

• First Online: 05 December 2021

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• Douglas B. Marlowe 2  

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Drug courts provide judicially supervised substance use treatment and other indicated services in lieu of criminal prosecution or incarceration. The Good News: Drug courts significantly reduce criminal recidivism and illicit substance use, improve the psychosocial functioning of persons involved in the justice system, and produce positive cost benefits for taxpayers. Evidence has identified the optimal target population for drug courts and a range of best practices associated with better outcomes. The Bad News: Some drug courts violate core tenets of the model by targeting the wrong participants, barring use of medication-assisted treatment, paying insufficient attention to racial and ethnic disparities, and overusing jail sanctions. Misunderstood Lessons: Current policy proposals for justice reform ignore the lessons of 30 years of research on drug courts and are unlikely to achieve their intended aims of enhancing public health and safety.

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Drug Courts

Long term effects of drug court participation: evidence from a 15-year follow-up of a randomized controlled trial

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Taylor, L. R. (2016). General responsivity adherence in juvenile drug treatment court: Examining the impact on substance-use outcome. Journal of Drug Issues, 46 (1), 24–40. https://doi.org/10.1177/0022042615610618

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Marlowe, D.B. (2022). Drug Courts: The Good, the Bad, and the Misunderstood. In: Jeglic, E., Calkins, C. (eds) Handbook of Issues in Criminal Justice Reform in the United States. Springer, Cham. https://doi.org/10.1007/978-3-030-77565-0_32

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How Drug Courts Fall Short: A New Report Investigates this Policy Model’s Performance in the Americas

The SSRC’s Drugs, Security and Democracy program has recently released a report titled Drug Courts in the Americas . Here, program manager Cleia Noia provides an overview of the report’s findings and recommendations. In discussing how drug courts became the preferred alternative to incarceration not just in the United States but Latin America and the Caribbean, she highlights their limitations—especially their continued connection to the criminal justice system.

In the last few decades, drug courts have become an increasingly popular public policy model across the Americas. Proponents assert that drug courts are cost-effective, reduce recidivism and time spent in detention (prison or jail), and offer drug treatment as an alternative to incarceration for people whose drug use underlies their criminal activity. Since 2016, the SSRC’s Drugs, Security and Democracy (DSD) program 1 The Drugs, Security and Democracy (DSD) program supports research on drugs in Latin America and the Caribbean across a variety of disciplines with a goal of producing evidence-based knowledge to inform drug policy in the region and beyond. The program seeks to foster a global interdisciplinary network of researchers engaged with drug policy, committed to policy-relevant outcomes, and who can communicate their findings to relevant audiences. has worked to expand understanding of this policy, culminating in Drug Courts in the Americas , a comprehensive scholarly examination of the effectiveness and impact of drug courts in the United States, Latin America, and the Caribbean. The report reviewed key findings from the United States’ experience and found that drug courts, as implemented in the United States, are a costly, cumbersome intervention that has limited, if any, impact on reducing incarceration. This essay presents an overview of the report’s findings, including its recommendations to address the shortcomings of these courts.

The rise of drug courts

Although drug courts are not a new concept in the United States (they were first established in Miami in 1989, having since spread to all states and territories), their dissemination to other countries in the Americas is more recent. Although we have seen this policy model replicated in Latin America and the Caribbean since the early 2000s, there has been a rapid expansion in implementation of drug courts starting in 2012. The DSD program wanted to further explore this trend, particularly considering these courts’ increasing popularity in countries in the region despite the vast institutional, legal, and cultural differences between the United States, Latin America, and the Caribbean.

It is no secret that incarceration for drug-related offenses and the significant increase in prison populations in the United States over the past decades are connected. For those working in the drug research/policy field, this has been evident for many years. Nonetheless, looking into actual numbers offers a much needed reminder of the scale. For example, according to the Federal Bureau of Prison’s statistics, of the 168,687 people incarcerated in US federal prisons in October 2018, 77,649 were imprisoned for drug offenses. 2 Statistics based on prior month’s data. “BOP Statistics: Inmate Offenses,” US Federal Bureau of Prisons, last modified November 24, 2018, accessed February 11, 2019, https://www.bop.gov/about/statistics/statistics_inmate_offenses.jsp . This number, of course, does not include those incarcerated in state prisons, local jails, juvenile correction facilities, and the like.

In light of these incarceration trends, consensus has been growing across the Americas on the need for drug law reform and alternatives to criminal sanctions for certain categories of drug offenses. These alternatives include measures that enable people to stay out of the criminal justice system in the first place, such as decriminalization of drug use and possession, and the diversion of law enforcement resources toward services outside the criminal justice system. It is within this context that drug courts have been promoted as an effective alternative to incarceration.

Exporting a flawed model

In practice, however, drug courts have become another arm of the criminal justice system, administering medical treatment and counseling via judges rather than experts. The evidence from the United States shows that drug courts can increase the supervision of individuals and expose them to more severe penalties than they would otherwise have received, thus sometimes becoming an adjunct rather than an alternative to incarceration. One of the main stated objectives of drug courts is to ensure access to comprehensive substance abuse treatment for those who need it. However, a review of the available evidence shows that, in practice, many participants in drug courts do not need treatment while, at the same time, the treatment may not be available or may be inappropriate for those who really need it. Among other limitations with this policy model, we found that the financial and human costs to drug court participants are also steep and disproportionately burdensome for the poor and racial minorities.

Further complicating this scenario is the concerted effort to export drug courts as a model that should be adopted by other countries. Despite the evidence from the United States experience cited above, the considerable influence of the United States in the region’s drug control policies and the support for the model from the Organization of American States’ Inter-American Drug Abuse Control Commission have certainly encouraged countries in Latin America and the Caribbean to embrace drug courts as a promising solution to the over-incarceration problem that plagues the region. This development is problematic not only because governments in the region apparently are not doing a proper review of the available evidence before adopting drug courts as a public policy model, but also because the very specific social, economic, and political context of Latin American and Caribbean countries immediately complicates the adoption of public policies designed by other, more developed countries with different legal systems. Furthermore, many drug courts in the region still focus on simple drug possession as a crime, contributing to the criminalization and stigmatization of people who use drugs.

Moving forward

Drug Courts in the Americas presents a series of recommendations that should be seriously considered by countries concerned with mass incarceration and that intend to move away from overreliance on criminal justice responses to drug use. We developed the recommendations with two groups in mind: countries that have not established drug courts or in which they are in early stages, and countries with established drug courts that have overwhelming support, thus making it difficult (but not impossible) to address the issues raised there.

For those in the first group, the recommendations include several of the following concrete steps:

• distinguishing between drug use and drug dependence and recognizing that not all drug use is problematic or requires treatment to address it, and
• providing financial and technical resources to expand and improve comprehensive harm-reduction services in communities, including evidence-based drug treatment programs that are not linked to the criminal justice system.
• taking the necessary legislative and other measures to ensure people who commit minor or nonviolent drug offenses and are in need of treatment are directed, prior to arrest or the opening of a criminal proceeding, to community-based services tailored to their specific needs.

For the countries in the second group, despite the report’s main conclusion that drug courts are not an appropriate solution for the issues they were ostensibly designed to address, we also present a series of measures that could be put in place to minimize the negative impacts of their implementation, including, but not limited to:

• Drug courts should target people who have been charged with serious offenses, including violent crimes, that otherwise would result in incarceration and who would benefit from drug dependence treatment.
• The existence of a criminal record and the nature of the offense should not render a potential participant ineligible, as is often the case.
• Returning to drug use is a normal part of the recovery process and should not be the basis for dismissal from a program or the imposition of sanctions, such as detention or more frequent court appearances or drug testing.
• Participation in drug courts should not be dependent on paying fines, fees, or any other costs, nor should failure to do so be criminally sanctioned.

Undoubtedly, countries should focus on moving away from an excessive reliance on incarceration as a panacea. Nonetheless, a close examination of the United States as a case study does not support the drug court model as the most appropriate solution for governments genuinely focused on addressing this issue, since in some respects it continues to criminalize drug consumption and prioritize a criminal approach to drug dependence over a health approach.

On a final note, it is important to bear in mind that this is not simply an issue of comparing drug courts and incarceration, but whether or not drug courts truly represent a public policy focused on the health of people with substance abuse problems. The countries that consider this model must take this into account and answer the following question: Is it really necessary to mediate treatment through the criminal justice system?

To read the full report (available in English, Spanish, and Portuguese), please visit: https://www.ssrc.org/publications/view/drug-courts-in-the-americas/ .

The DSD Program would like to thank the authors of the report—Rebecca Schleifer, Tania Ramirez, Elizabeth Ward, and Carol Watson Williams—as well as Coletta Youngers (project advisor) and all the specialists who reviewed early versions of the report and offered invaluable comments.

References:

Cleia Noia is the program manager of the Drugs, Security and Democracy Program. She received her law degree from Universidade Presbiteriana Mackenzie in Brazil and her master's degree in law and diplomacy, with a focus on international development and human security, from the Fletcher School at Tufts University. Prior to joining the Council in February 2014, Cleia worked as a corporate lawyer in Brazil and consulted on Brazil's drug policy for the Open Society Foundations.

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Systematic review of the impact of adult drug treatment courts

Randall t. brown.

University of Wisconsin School of Medicine and Public Health, Assistant Professor, Department of Family Medicine, PhD Candidate, Department of Population Health Sciences

The U.S. correctional system is overburdened by individuals suffering from substance use disorders. These illnesses also exact a heavy toll in individual and public health and well-being. Effective methods for reducing the negative impact of substance use disorders comprise critical concerns for policy makers. Drug court treatment programs (DTCs) are present in over 1800 county, tribal, and territorial jurisdictions in the United States, as an alternative to incarceration for offenders with substance use disorders. This review article summarizes available descriptive information on representative drug treatment court populations, summarizes observational studies of drug court participants, and specifically reviews available experimental effectiveness literature on drug treatment courts. The review concludes by examining limitations of the current literature, challenges to conducting research in drug court samples, and potential future directions for research on drug treatment court interventions. Review of non-experimental and quasi-experimental literature regarding the impact of drug treatment courts point toward benefit vs. traditional adjudication in averting future criminal behavior and in reducing future substance use, at least in the short term. Randomized effectiveness studies of drug treatment courts are scant (three identified in the literature on U.S. adult drug courts), and methodological issues arise in combining their findings. These randomized trials failed to demonstrate consistent effect upon re-arrest rates for drug-involved offenders participating in drug treatment court vs. typical adjudication. The two studies examining reconviction and reincarceration, however, demonstrated reductions for the drug treatment court group vs. those typically adjudicated.

Introduction

Drug treatment courts are a form of therapeutic jurisprudence falling under the more general modern rubric of “problem-solving courts” and have been called the most significant criminal justice initiative of the 20 th century. 1 The basic philosophy behind problem-solving courts, drug treatment courts included, is that individuals committing crime often suffer from illness or psychosocial dysfunction which predisposes them to criminal behavior. Problem-solving courts target underlying illness or dysfunction through the provision of treatment services in conjunction with judicial supervision. This model, as opposed to typical adjudication, incarceration, or more traditional forms of community supervision (e.g. probation or parole), is thought to improve not only the health and reintegration of the offender, but public health and safety by addressing root causes of criminal behavior. The provision of services, such as substance abuse treatment or anger management counseling, are hypothesized to target disturbances which motivate the criminal behavior and, hence, to reduce the likelihood of recidivism.

Societal costs of punitive drug policy

The impact of substance misuse upon the commission of crime and upon public health and safety are critical concerns for policy makers and for law enforcement. The relentless and costly expansion of the U.S. penal system is, at least in great part, the result of punitive policies intended to reduce public drug demand, but which frequently result in the confinement of addicted individuals, rather than high-level drug traffickers or manufacturers. One in four, or 509,000 inmates in the overall U.S. penal system (increased from one in eleven, or 57,975, inmates in 1983) are currently serving time or awaiting trial for a drug-related offense at an annual cost of $8 billion. 2 Estimates from large national surveys indicate that, in 2003, 1.5 million arrestees were at risk for drug abuse or dependence. 3 Fifty-eight percent of these drug offenders have no record of violent criminal activity or high-level drug trafficking. Seventy-five percent of drug offenders in state prisons have been convicted of drug possession and/or non-violent crime. 4

Bhati et al 3 merged and analyzed large national databases to provide estimates of the potential benefit, in terms of reductions in criminal behaviour, potentially achieved through the provision of substance abuse treatment to addicted offenders. This study drew together data from 3 large national datasets: the National Survey on Drug Use and Health, the Drug Abuse Treatment Outcomes Study, and the Arrestee Drug Abuse Monitoring system. Using these data, the authors specifically estimated that 9.9 million non-drug crimes, such as burglary and assault, would be averted if offenders with abuse or dependence were all treated with a 30-day residential treatment program; 6.7 million non-drug crimes would be averted if these same offenders were treated via outpatient treatment. In the same study, drug treatment courts were estimated to lead to the prevention of 34.4 million drug crimes annually. The authors further estimated that universal provision of treatment to eligible offenders would produce more than $46 billion in benefits at a cost of $13.7 billion.

Aggressive application of punitive policies also likely leads to the grossly disproportionate incarceration of low-income and minority Americans. A higher level of visibility of drug trade and use in low-income and minority communities likely contributes to the disproportionate incarceration of minorities when mandatory minimum sentences and local law enforcement are aggressively pursued. 4 – 6 Four of every five drug offenders are Black (56%) or Hispanic (23%), 4 a number far exceeding that which would be anticipated by the estimated rates of drug use in these populations (13% and 9% respectively). 7 In Wisconsin, these racial disparities in criminal justice treatment of minorities are particularly concerning. For offenses involving drug possession typically consistent with personal use (Class F-I felony possession), Black offenders are more than twice as likely to receive a prison sentence (as opposed to probation) when compared to White offenders. 8

Given an overburdened criminal justice system and evidence indicating that service provision and treatment may more effectively foster desired outcomes than incarceration, 9 Dade County Florida instituted the first drug treatment court in the U.S. in 1989. 10 Since that time, drug treatment courts have spread widely and rapidly, with nearly 2000 currently in existence and many others in planning stages. 11

A large body of literature, including studies in correctional populations, indicates that longer periods of treatment and the completion of treatment results in greater decreases in substance use and longer periods of time until relapse. 12 – 17 Drug treatment courts, likely due in part to the additional leverage of integrating treatment with the coercive power of the criminal justice system, tend to retain participants in substance abuse treatment for longer periods of time than that seen in the general population of treatment-seeking adults. 18 Drug courts, hence, may enhance treatment outcomes among addicted offenders by facilitating retention in treatment for longer periods of time

This review article will summarize available descriptive information on representative drug treatment court populations, summarize observational studies of drug court participants, present a summary of experimental effectiveness literature on drug treatment courts, examine limitations of the current literature, challenges to conducting research in the drug court population, and potential future directions for DTC research. As such, this review will contribute to current knowledge by synthesizing a broad range of literature in order to draw conclusions regarding the effectiveness of DTCs overall and for particular high risk subpopulations. Findings will be of particular interest to treatment providers and policymakers in gearing case management conditions to the needs of participants in community supervision programs such as drug court.

While there is a burgeoning literature on juvenile and family drug treatment courts, the current review will be restricted to literature related to adult drug treatment courts. DUI (driving under the influence) courts are also excluded from this review. The review is also restricted to adult drug court models in the U.S.

Review methodology

The following comprises a review of existing literature, and, as such, was deemed exempt from formal review by the University of Wisconsin Health Sciences Human Subjects Committee.

Given the overlap of multiple academic fields in the study of drug court participants and their outcomes, a wide variety of sources were searched to ensure a comprehensive and representative literature review. Traditional databases which were searched included PubMed, Sociological Abstracts, and PsychINFO. Databases focusing upon criminal justice literature were also searched including the National Criminal Justice Reference Service and Criminal Justice Abstracts. Since a good deal of drug court research is conducted by private foundations under contract by several jurisdictions, the websites of prominent agencies conducting this work were also searched, which included Northwest Professional Consortium, the Urban Institute, the National Drug Court Institute, and the Department of Justice. This allowed for the inclusion of program evaluations not published in the scientific literature. Based upon this search, appropriate literature from the bibliographies of appropriate articles was also obtained. Search terms included: drug treatment court, drug court, problem-solving court, therapeutic jurisprudence, substance related disorders AND crime, substance dependence AND crime.

Titles and abstracts were then reviewed to ascertain whether drug treatment courts were a primary intervention being examined and whether client outcomes (such as recidivism, substance abuse treatment completion and ongoing substance use) were addressed by the manuscript. Studies addressing important health determinants such as education, income, and employment were also included. Included articles were restricted to those examining adult drug treatment courts in the U.S.

For the purposes of providing a representative overview of the demographic characteristics of drug treatment court participants, data from process evaluations of DTCs in their early stages are included when describing “Epidemiological data on drug court participants.” The previously described data bases and search engines included such process evaluations as internal reports and included the demographic characteristics of early entrants to the local drug treatment courts. By their nature, however, outcomes data are not available on the populations described in these reports.

Appropriate literature was assembled and reviewed during the months of February through April of 2009. Through the previously described methods, a total of 44 reports were identified for inclusion in the current review. These publications included 29 studies or program evaluations which evaluated DTC outcomes. Three randomized trials were identified, one of which generated multiple manuscripts; and demographic data from 6 process evaluations were also included.

Epidemiological data on drug court participants

Descriptive characteristics of representative drug court populations are presented in Table 1 . To summarize, nationally among DTCs, populations are predominantly male (74%); typical age ranges from 28–40, with the most mean ages, where reported, ranging from 28–33. Ethnic make-up varies greatly by location, with a large number being predominantly (50–95%) white. Urban locations typically involve a larger proportion of minority participants. California drug courts contain a greater predominance of Hispanic participants than other locations. Many participants have prior arrest records with an average number of previous arrests ranging from 1–3 being typical. Numbers of prior arrests for participants tend to be higher in urban drug courts. (e.g. 11 – 12 in Baltimore) Polysubstance use is not generally an exclusion criteria, and many participants have alcohol use issues in addition to other drug issues (50–60%).

Demographic characteristics of representative county drug treatment courts. (NR = not reported)

Eligibility criteria for participation in drug treatment court most generally include age over 18, drug charge not involving manufacture or distribution, no history of violent felony convictions, a demonstrated need for substance abuse treatment, and must not have used a weapon during the course of the offense resulting in the drug treatment court referral. 19 – 30 Additional criteria may include lack of gang affiliation 29 , 31 facing a minimum jail sentence, 21 and the absence of significant mental health issues. 3 , 28 , 31 Capacity constraints also limit participation by all eligible offenders in the majority of jurisdictions. 3 Incentives for completion uniformly involve reduction or dismissal of charges or penalties resulting in the referral to drug treatment court.

Although frequently a criterion excluding an offender from drug court participation, mental health diagnoses and their severity are rarely presented in published or unpublished reports focusing upon potential DTC participants. Precise estimation of mental illness prevalence and severity is made more difficult by the fact that mental health status is often based upon client self-report of a mental health history and infrequently based upon validated measurements. This may be in large part due to the fact that many drug treatment courts do not have ready access to specialized mental health care for their participants, outside of substance abuse treatment. 32 Furthermore, screening instruments (such as the Beck Depression and Anxiety Inventories and the Addiction Severity Index) are more frequently used than instruments or interviews which allow for definitive mental health diagnoses (e.g. Structured Clinical Interview for DSM Disorders). Where drug court participants were recruited and mental health measures subsequently administered, 33 – 35 between 25 and 42 percent of participants were identified as having a psychiatric illness. Two studies used validated screening measures for anxiety and depression symptoms (Beck Anxiety Inventory and Beck Depression Inventory-II). Rates of moderate-severe or severe anxiety were 12% 35 and 35% 34 . Rates of depression warranting referral were 20.4% 35 and 42%. 34 Among a subset of participants reporting a history of traumatic events, 25% screened positive for post-traumatic stress disorder. 35 Studies in drug court settings indicate that mental health diagnoses are more common among female drug court participants. 33 , 36 In one study, women were 60–80% more likely to require referral for further assessment and management of symptoms of mental illness, as measured by the BDI, the Modified MINI Screen, and the SF-36. 35 Bivariate correlations in another study indicated that mental health symptoms, as measured by the Brief Symptom Inventory, relate significantly to female gender. 36

DTC program characteristics

Drug treatment courts vary greatly in the number of annual participants, with 80–120 representing typical annual participation. 3 , 20 , 21 , 26 , 27 , 30 , 31 , 37 , 38 DTCs serving larger urban areas, however, frequently have much larger case loads (e.g. New York 453 in 1999, Los Angeles 884 in 11 separate drug courts in 2001, Travis County, Texas 300 in 2002). 22 , 26 , 39

Drug courts most commonly work with multiple community agencies as providers of substance abuse treatment, 19 , 20 , 26 , 27 , 40 , 41 (3 of 9 California counties 31 ) though several, particularly smaller courts, refer to a single treatment agency (6 of 9 California counties 31 ). Outpatient and residential treatment facilities are utilized by DTCs as indicated by client need.

Urine drug screening is a component of all drug court monitoring programs, but frequency varies greatly. Programs most often include an entry phase ranging from 1–4 months during which testing was more frequent (multiple times weekly). 20 , 21 , 23 – 27 , 30 , 38 , 39 , 42 Decreased frequency for urine submission is often used as a reward for participants adhering to DTC supervisory conditions.

Other services frequently provided to participants include anger management services, 20 , 43 vocational training, 20 , 42 parenting classes, 20 adult education, domestic violence counseling, 20 , 27 , 42 and home visits. 1 , 23 – 25 , 42 While mental illness is common in this population, description of resources available to address these issues is conspicuously absent in the literature. Mental health issues often falls outside the expressed purview of drug treatment court; and budget and other resource limitations may preclude specialist mental health assessment and management. Further, complicated mental health issues requiring specialist care often constitutes an exclusion criterion for drug court participation.

Drug treatment court procedures uniformly include appearances by the participant in court in front of a dedicated drug treatment court judge. Appearances before the drug court judge (for monitoring of progress, imposition of sanctions/rewards, and determination of graduation eligibility) are generally more frequent initially (weekly to every 6 weeks) and may decrease in frequency depending upon adherence to programming. 20 , 21 , 23 – 27 , 29 , 31 , 42 Additional court and case management staff at these appearances varies between jurisdictions. Staff typically involved in the drug treatment court process include representatives of a treatment provider (or treatment case management), 19 – 21 , 26 , 27 , 30 , 31 , 38 , 42 , 44 the district attorney, 19 – 22 , 26 , 27 , 30 , 31 , 38 , 42 , 44 the public defender, 19 – 22 , 26 , 27 , 30 , 38 , 42 , 44 probationers, 19 – 22 , 26 , 27 , 30 , 31 , 38 , 44 and law enforcement. 19 , 20 , 26 , 27 , 31 , 38 Length of minimum required drug court participation ranges from 6 months 45 to 12 months 1 , 19 – 21 , 26 , 29 , 30 , 38 , 39 , with 12 months being most common.

Drug treatment courts also incorporate a system of sanctions and rewards in an effort to foster adherence to substance abuse treatment and other case management conditions. Rewards most commonly involve the praise of the drug treatment court judge. 20 , 21 , 26 , 27 , 38 Thus, the personality of the drug court judge is likely an important factor in the success of any drug treatment court. Other common rewards have included tokens representing clean time and adherence, 21 , 38 decreased frequency of appearances, 19 , 21 , 27 gift cards to local merchants. 19 , 21 , 26 , 38 , 46 Ultimately, the adherent participant is rewarded with a formal graduation ceremony often attended by family, friends, and individuals involved in the participant’s treatment. 20 , 21 , 27 , 38 Some programs require a period of continued probation after formal discharge from the drug court. 20 , 27 Sanctions during participation may include judicial reprimand, 20 , 38 community service, 20 , 21 , 38 , 46 escalation of monitoring (urine drug screens, reporting to case management), 21 , 46 or jail time. 20 , 21 , 23 – 25 , 27 , 31 , 37 , 38 , 45 , 46 Sanctions are typically imposed for behavior such as missing treatment sessions, frequent positive urine drug screens, commission of a new crime, or missing court or court-ordered appearances.

Ultimately, the participant may be terminated from the drug treatment court, which most commonly results in the sentence the participant would have received if they had not participated in drug court. 20 , 21 , 31 , 37 , 38 Actions resulting in termination typically involve new crime committed, repeated positive urine screens, drug possession, or repeated failure to attend treatment visits, court appearances, or meetings with probation officers. 21 , 38 , 47

Should a participant successfully complete substance abuse treatment and demonstrate reasonable adherence to other DTC conditions, the drug court judge may make a final determination that the participant has “graduated.” Graduation results in the dismissal or reduction of the charge which resulted in DTC participation or the dismissal or reduction of the associated sentence. Graduation requirements vary widely between jurisdictions, as well. All generally require a period of sustained drug-free time before graduation is allowed. Common durations of required abstinence, as measured by urine drug testing, range from 90 to 270 days. 20 , 21 , 27 , 31 , 38 There are requirements as great as 6 months (Douglas Co, Nebraska 29 ). Treatment adherence is a universal requirement, though specific criteria defining adherence vary widely. Additional requirements of some programs include community service hours, 21 obtaining stable employment and/or attainment of a high school equivalency degree, 19 , 21 , 27 , 29 payment of fees to the drug court, 21 , 26 completion of an autobiography or other written assignment, 21 , 38 or completion of a specified number of steps in a traditional 12-step, group self-help program, such as Alcoholics Anonymous or Narcotics Anonymous. 21 , 38 , 39

Graduation rates from drug treatment courts range from 30–70%, with the national average being around 48%. 20 , 21 , 30 , 31 , 39 , 45 Barry Co, MI 44% 20 (Texas 6 counties 47–57% 26 ) 72 percent, Harford, MD. 21 , Okaloosa, FL 53%, Escambia, FL 48% 42 , Chester Co, PA 50+% 30 , 75% retention NY 22

Outcomes research

Quasi-experimental recidivism studies.

A summary of case-control studies examining recidivism among drug court participants versus comparison groups are shown in Table 2 .

Quasi-experimental studies of drug treatment court vs. comparison group. (NR = not reported; NS = not statistically significant).

Quasi-experimental designs most often involved the use of a comparison group with similar drug-related offenses who did not participate in drug treatment court. Reasons for non-participation in the comparison group frequently involved lack of capacity to accept the members of the comparison group 20 , a group with similar charges who were not referred to drug treatment court often for unclear or undocumented reasons, 20 , 21 , 27 , 29 , 39 , 40 or a historical comparison group before drug treatment court was instituted in the jurisdiction under study. 26 , 30 , 38 , 40

Case-control studies most commonly have found that rates of recidivism and substance use are reduced for drug court participants when compared to substance misusing offenders not exposed to drug court, particularly for drug-related crime. 28 , 29 , 39 , 42 , 48 , 49 When survival analysis techniques are employed, drug court participants also demonstrate significantly longer times to re-arrest. 39 , 50 , 51 While a non-drug court group was not examined in the study, Peters and Murrin demonstrated a lower proportion being rearrested as well as a longer time to first arrest for drug court graduates vs non-graduates. 42

Other system benefits of drug treatment courts appear to be a shortening of the time from arrest to sentencing, and shortening of the time of pre-sentencing confinement. 40 , 52

Studies in populations exposed to DTCs earlier in their evolution have been less likely to demonstrate positive effects of DTC vs. typical adjudication. 40 , 45 , 53 , 54

Program Completion (‘graduation’)

The national average for program completion, or “graduation,” by DTC participants is 48%. Studies reporting associations between participant characteristics and program completion are summarized in Table 3 . The majority of manuscripts are summaries of program evaluations, where only aggregate statistics are presented, and statistical tests of correlation and significance had not been performed.

Studies examining associations between participant factors and drug court completion. Odds ratios and results of significance testing presented where available.

Minority ethnicity is associated with treatment failure in several studies. 26 , 30 , 33 , 55 African-Americans have been particularly unlikely to graduate in quasi-experimental studies. 30 , 56 , 57 However, the literature conflicts on this point, and other studies have not found minority ethnicity to adversely affect graduation rates. 58 , 59 In a study by Vito et al, where an African-American male ran the DTC, Black offenders actually out-performed White DTC participants. 59 Older age predicted successful treatment completion when examined, 21 , 26 , 27 , 55 , 60 and females have been more likely to graduate than males. 33 , 55

Substance use history and severity also likely influence the likelihood of successful graduation. 20 , 21 , 27 Measured in a variety of ways (days in last 30, history of previous treatment), a more severe or longer duration of substance use is associated with a lower likelihood of completion. Studies have also found that stimulant use disorders predict failure to complete treatment versus misuse of other substances. 55

A history of untreated depression predicted failure to complete treatment in one study which examined this indicator. Interestingly, individuals currently receiving pharmacotherapy were more likely to complete treatment and DTC requirements. 36

A single dedicated drug court judge with longer tenure on the bench has been associated with improved outcomes. 21 , 54 (Dane County’s drug treatment court, with a graduation rate of 70%, had a single drug court judge on the bench continuously from 1996–2004). Smaller programs also appear to graduate clients at higher rates. 21 , 26 , 31 , 61 The establishment of rapport with drug court clients may be an important factor in moderating these outcome effects. In studies of treatment populations, which have included those in the criminal justice system, counselor-client rapport has been an important predictor of treatment retention, substance use outcomes, and repeat criminal behavior. 62

Substance use

When examined, drug court participants engaged in significantly less drug use as measured by urine drug screens than offenders going through typical adjudication. 20 , 21 , 27 , 30 , 42 Interpretation of these results, however, is complicated by the fact that there is more often a defined protocol for obtaining urine drug screens in drug treatment courts, while probationers are more often tested when suspicion arises that they are using, thus, increasing the probability of a positive test in many comparison groups.

Randomized controlled studies

Through the review procedure previously described, three studies of a randomized-controlled design in a U.S. adult drug treatment court setting were identified. Characteristics of these studies appear in Table 4 .

Characteristics of randomized-controlled studies involving a drug treatment court and a traditional adjudication condition. (NS = not statistically significant; UDS = urine drug screen; OR = odds ratio; tx = treatment/drug court condition; NR = not reported

Upon review of pertinent methodological issues, one study stands apart from the other two and warrants special consideration. 43 In this Washington DC study, drug offenders were randomly assigned to one of 3 court “dockets:” (1) a drug treatment court condition, which included weekly urine drug testing, court-based day treatment for substance abuse; (2) a “sanctions” condition involving scheduled urine drug testing and a system of graduated sanctions for missed or for positive urine tests, and referral to community-based substance abuse treatment, or (3) a “standard” docket comprising scheduled urine drug screens with judicial monitoring and “encouragement” to obtain substance abuse treatment.

Important procedural departures for this particular court, called the Superior Court Drug Intervention Program (SCDIP), were that (1) potential participants were not necessarily addicted. Casual users were included, a significant departure from inclusion procedures in the majority of operating DTCs; (2) potential participants were not excluded based upon criminal justice history. Violent offenders and traffickers were included; (3) the intensity of the treatment track was also highly unusual: 6 hours per day, 5 days a week for 6 months. The generalizability of findings to traditional drug treatment courts is, therefore, highly questionable.

Sixty percent of those assigned to the treatment condition refused to participate (140 participated of 346 eligible). Many cited the required hours as a reason for non-participation. This also likely explains the fact that those who agreed to participate in the treatment track were more likely to be unemployed than those who refused (31% vs 44%, p < 0.05). It also likely explains the unusually low graduation rate (19%). The participating group was also more likely to have a history of violent offenses.

Gottefredson et al 23 randomized 235 drug arrestees to “usual care” or to a DTC and followed individuals for 24 months. Eligibility criteria for study participation reflected typical inclusion criteria for drug treatment court participation and included: age over 18, residence in Baltimore, a lack of prior violent felony convictions, and a need for substance abuse treatment as determined by the Addiction Severity Index. 63 Ninety-one percent of those assigned to the DTC condition were handled in this way. Ninety-three percent of those assigned traditional court were, in fact, adjudicated as such. Analyses proceeded via intention-to-treat, with subjects analyzed as participants in the condition to which they were randomized, as opposed to the condition under which they were actually treated. Chi-squared testing was used to analyze re-arrest as a binary outcome variable (yes/no) during the period of observation. DTC participants had a lower likelihood of rearrest (81.3% vs. 66.2%, p < 0.05) and a lower number of average rearrests (2.3 vs. 1.6, p < 0.05).

Deschenes et al (1995) randomized 630 offenders to drug treatment court (n = 176) or to one of three probation tracks (n = 454) involving different frequencies of formal supervision. The three probationary tracks were combined into one control group for analytic purposes. Eligibility criteria included: age over 18, first time offense for drug or drug paraphernalia possession. Those assigned to residential treatment were excluded. Whether or how a formal substance use disorder diagnosis was established was not described. A number of sample characteristics appeared to indicate a highly drug-involved population: “frequent use” or “dependency” reported by participants, and a history of prior substance abuse treatment reported by 40% of the overall sample. Indicators of socio-demographics, substance use and treatment history, and prior criminal justice involvement did not differ significantly between the study groups. Re-arrest rates did not differ for the study groups (33% for probation, 31% for drug court). The rate of incarceration during follow-up, however, was significantly lower for drug court participants (9%) vs. probationers (23%).

Summary of Findings

The predominance of non-experimental and quasi-experimental literature appears to point toward benefit for drug treatment courts (DTCs) over traditional adjudication in terms of rates of and time to re-arrest. The limited number of investigations examining the outcome also appear to indicate that drug court participants are less likely to engage in substance use during program participation than are traditionally adjudicated offenders. This latter outcome may suffer, however, from potential bias due to observational study design; drug treatment court participants are more likely to undergo a more clearly specified protocol for urine drug testing frequency, whereas probationers and other comparison groups are more likely to be subject to urine screening when non-adherent to supervisory conditions and, therefore, when case managers are suspecting active substance use. Thus, comparison groups are theoretically more likely than DTC participants to test positive when submitting a urine drug test, potentially simply due to systems issues rather than differences in actual substance use.

Experimental studies of the effectiveness of adult DTCs are scant, and, among the 3 published randomized, experimental studies, significant variation exists between studies in terms of methodology and subject population. While re-arrest was not reduced by the drug court condition in randomized studies when results were combined, incarceration did appear to be reduced. The most straightforward explanation for these results relates to options generally exercised for addressing program non-adherence in drug treatment court vs. those utilized in probationer populations. Drug treatment courts have a larger menu of conventionally used options to address program violations. Increased frequencies of urine drug testing and/or court appearances, participation in community service, and enhancement of treatment services are frequently instituted measures in drug court, whereas incarceration is a more traditional strategy for addressing program violations by typical probationers. Whether these differences in re-incarceration may be associated with improvements or decrements in downstream outcomes is not fully understood. Reductions in incarceration would be expected, however, to reduce system costs presented by drug treatment court participants due to the significant incremental costs of jail or prison as opposed to community supervision. 64 – 68 An exception may be the significant additional costs of service provision to those who suffer from co-morbid mental illness requiring significant additional specialist resources. 69 Selection of appropriate participants and matching to appropriate supervisory conditions based upon client history and needs is an important issue requiring further investigation.

The results of quasi-experimental and other observational studies reviewed suffer from serious potential for selection bias. Individuals ineligible for drug court participation do not provide an ideal comparison group due to the high likelihood of confounding factors leading to their decrements in criminal justice outcomes (e.g. history of or current violent felony offense, the presence or increased severity of co-morbid mental illness). Comparison of drug court graduates to non-graduates suffers from similar concerns.

Randomized effectiveness studies are very limited in number. 23 – 25 , 43 , 45 Additional issues such as variations between studies in sampling and target population and differences in the drug court intervention clearly indicate that further investigations of this sort are warranted. Difficulties presented by conducting community-based research in the context of a complicated criminal justice system represent a barrier to overcome. Additionally, results in the extant literature indicating potential benefit to DTC programming may create ethical concerns surrounding randomization.

Measures of independent and dependent variables are inconsistent between studies. Recidivism, the most frequently assessed outcome, may be measured in a variety of ways, and consistency has not yet been achieved in the literature. Recidivism has alternatively been operationalized as rearrest, formal charging, or conviction, with the relative timing of such events depending heavily upon systems or structural issues independent of individual offender behaviors or predisposing factors. Since re-arrest depends the least upon downstream systems factors and the most upon individual criminal behavior, this outcome may be the most logical to address in the context of short-term prospective studies. This outcome presents its own difficulties, as well. If formal charges are not filed, arrests may be missed in traditionally used public databases.

Drug use data is infrequently collected or reported centrally in a way that allows for a rigorous synthesis of ongoing drug use for drug court participants or comparison groups post-release from supervision. When examined, urine drug testing results are most frequently presented in aggregate (i.e. total number positive vs. total number collected.) Additionally, a relatively regimented protocol tends to exist for urine testing in DTC populations, as opposed to typical probation, where urine drug testing tends to be triggered by program violations. This would potentially be expected to result in a greater likelihood of positive test results in probationer populations when compared to DTC participants.

Systematic examination of time-dependent internal and external factors of importance have not been systematically undertaken; such as change in judge, changes in local statues or law enforcement practices, changes in eligibility requirements (which have been broadening in recent years to include felons), treatment providers, or the structure of other drug court program components. These remain important areas for more detailed investigation in DTC and other community supervision programs.

Finally, post-participation follow-up has rarely been conducted. Longer term studies are clearly needed. Whether drug court participants post-release continue to demonstrate reductions in criminal behavior and substance use, and whether improvements are achieved by this group in other critical areas such as employment or educational attainment remains debatable.

Abbreviations

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Overview of Drug Courts

Nij seeks research partner sites for veterans treatment court evaluation.

NIJ seeks programs that are interested in participating in the NIJ Multisite Impact and Cost -Efficiency Evaluation of Veterans Treatment Courts. To learn more, see the webinar on NIJ’s Multisite Impact and Cost-Efficiency Evaluation of Veterans Treatment Courts .

If your organization is interested in becoming a research partner site, contact us at [email protected] .

Drug courts are specialized court docket programs that target criminal defendants, juveniles who have been convicted of a drug offense, and parents with pending child welfare cases who have alcohol and other drug dependency problems.

Find a drug court using the National Drug Court Resource Center's database .

The Drug Court Model

Although drug courts vary in target population, program design, and service resources, they are generally based on a comprehensive model involving:

• Screening and assessment of risks, needs, and responsivity.
• Judicial interaction.
• Monitoring (e.g., drug testing) and supervision.
• Graduated sanctions and incentives.
• Treatment and rehabilitation services.

Drug courts are usually managed by a nonadversarial and multidisciplinary team including judges, prosecutors, defense attorneys, community corrections, social workers and treatment service professionals. Support from stakeholders representing law enforcement, the family and the community is encouraged through participation in hearings, programming and events like graduation.

For information on evidence based practices, visit  BJA-NIJ Adult Drug Court Research to Practice (R2P) Initiative . 

Read about NIJ’s Multisite Adult Drug Court Evaluation 

Learn about NIJ’s research on problem-solving courts

Also see  NIJ's webpage on Drug Court Performance Measures, Program Evaluation and Cost Efficiency . 

For information on training and technical assistance resources:

• National Drug Court Resource Center .
• Drug Courts flyer on resources supported by BJA, OJJDP and NIJ (pdf, 2 pages) . 

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• Drug Treatment Courts

Drug Courts and Detoxification: Approach to Drug Abuse Treatment Essay (Critical Writing)

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Detoxification

Today’s American society is replete with drug abuse cases among various age and social groups. Being a severe health issue, drug abuse is also a threat to people due to its illegal nature. The drug epidemic leads to high levels of imprisonment for several reasons. First of all, people who consume drugs are breaking federal law by abusing or possessing the substance. Secondly, addiction sometimes makes people commit crimes like burglary to get enough money for a dose.

Thus, millions of Americans are imprisoned because of drug-related crimes. However, since 1989, the US federal system has been providing the majority of drug abusers with proper treatment or education with the help of a drug court option (Gonzales, 2020). Such an option implies the federal court is assigning rehabilitation instead of imprisonment since jail is not capable of treating drug dependence.

Although this system is considered to be quite effective, there are still some pitfalls concerning the system of drug courts. First of all, people who are assigned to this program are often misled in terms of its seriousness because they only think about avoiding prison (Fulkenson, Keena, & Longman, 2016). Secondly, the algorithm of defining who exactly among the drug abusers should be given a chance for improvement is sometimes uncertain.

For example, people who need medical and psychological support are often left behind due to their lack of courage to ask for help. Drug court is, by all means, a major step towards an inclusive democratic society where everyone is heard, valued, and allowed to become a better version of themselves. Hence, with improvements in terms of this opportunity equality, drug court options will continue empowering drug abusers to create better lives for both themselves and their families.

Any case of drug consumption is a severe stress for the human body, as it has to cope with an alien substance that tries to modify its structure and habits. For this reason, different medical establishments and specifically created addiction centers now deal with detoxification – a process of removing these harmful substances from the body under the doctor’s surveillance (Levinthal, 2014).

The cases of “detox” are quite frequent nowadays among both licit and illicit drug abusers due to their availability and popularity among the state residents. However, nowadays, people who voluntarily ask for help in such establishments sometimes refuse the procedure, as they are told their intoxication level is acceptable for the process. Such situations, to my mind, happen because of a lack of proper education on drug prevention when people underestimate the potential consequences of the addiction.

To combat the issue, drug abusers should fully realize the responsibility of drug abuse and its effect on their behavior and organism. Moreover, people have to acknowledge that home-based detoxification will never be nearly as effective as the one provided in medical facilities (Elkins, 2020). Even if the drug rates are relatively low for the human body, detoxification is only one step towards full patient rehabilitation from dependence.

Hence, there is no need to reconsider the amount of substance in the blood to persuade people to continue the treatment. They should, first and foremost, be properly informed on the subject of any drug intoxication. In such a way, patients with the slightest signs of alcohol or illicit drug abuse will be eager to receive help to prevent dangerous implications.

Elkins, C. (2020). Medical detox . Web.

Fulkenson, A., Keena, L., & Longman, A. (2016). In or out: the drug court dilemma. Criminology, Criminal Justice, Law & Society, 17 (2), 34-45.

Gonzales, M. (2020). The history and effectiveness of drug courts in the U.S. Web.

Levinthal, C. F. (2014). Drugs, behavior, and modern society . London, UK: Pearson Education.

• Drug Abuse and Prevention Strategies
• "Adverse Health Effects of Marijuana Use" by Volkow et al.
• Drug Addiction Treatment for a Pregnant Woman
• Heroin and Marijuana Abuse and Treatment
• The Need for Affordable Drug Rehab Centres
• Drugs: Dangerous and Necessary
• Alcoholism and Schizophrenia: Interconnection
• Consequences of Drug Abuse
• Needle Exchange Programs in the US: Benefit or Harm?
• The Role of Cocaine in the Death of Len Bias
• Chicago (A-D)
• Chicago (N-B)

IvyPanda. (2022, February 10). Drug Courts and Detoxification: Approach to Drug Abuse Treatment. https://ivypanda.com/essays/drug-abuse-drug-court-and-detoxification/

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• Copy URL https://www.pbs.org/newshour/world/moscow-court-sentences-u-s-citizen-robert-woodland-to-12-5-years-in-prison-for-drug-trafficking

Moscow court sentences U.S. citizen Robert Woodland to 12.5 years in prison for drug trafficking

MOSCOW (AP) — Robert Woodland, a Russia-born U.S. citizen, was convicted of drug-related charges by a Moscow court and sentenced to 12 1/2 years in prison on Thursday, court officials and his lawyers said.

He was found guilty of attempted trafficking of large amounts of illegal drugs as part of an organized group, according to an online statement released by court officials, and sentenced to 12 1/2 years in a maxim security penal colony. His lawyers told reporters after the verdict was delivered Thursday that they will appeal the ruling because Woodland’s guilt hasn’t been proven.

READ MORE: Detention of Russian-American journalist has been extended in Russia

Lawyer Stanislav Kshevitsky also said that Woodland has been suffering from unspecified mental health issues. He didn’t provide any details, but said that the court didn’t take those issues into account.

Russian media reported that his name matches a U.S. citizen interviewed in 2020 who said he was born in the Perm region in 1991 and adopted by an American couple at age 2.

He said he traveled to Russia to find his mother and eventually met her on a TV show before deciding to move to Russia. Russian news agency Interfax has cited court officials as saying that Woodland also holds Russian citizenship.

Arrests of Americans in Russia have become increasingly common as  relations between Moscow and Washington  sink to Cold War lows. Washington accuses Moscow of targeting its citizens and using them as political bargaining chips, but Russian officials insist they all broke the law.

WATCH: As Gershkovich’s trial begins, a look at the chances of a U.S.-Russia prisoner swap

Some have been exchanged for Russians held in the U.S., while for others,  the prospects of being released  in a swap are less clear.

Woodland was arrested in January. At the time, the U.S. State Department said it was aware of reports of the recent detention of a U.S. citizen and noted that it “has no greater priority than the safety and security of U.S. citizens overseas,” but refrained from further comment, citing privacy considerations. The U.S. Embassy in Moscow issued a similar statement at the time.

There was no immediate comment from U.S. officials on the verdict.

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US citizen Woodland convicted of drug-related charges by Moscow court. He’s sentenced to 12.5 years

Robert Woodland, right, a Russia-born U.S. citizen, stands in a glass cage as he talks with his lawyer Stanislav Kshevitsky prior to a court hearing, Thursday, July 4, 2024, in Moscow, Russia. Woodland was convicted of drug-related charges and sentenced to 12 and a 1/2 years in prison on Thursday. (AP Photo/Alexander Zemlianichenko)

Robert Woodland, right, a Russia-born U.S. citizen, is escorted to the courtroom for a hearing, Thursday, July 4, 2024, in Moscow, Russia. Woodland was convicted of drug-related charges and sentenced to 12 and a 1/2 years in prison on Thursday. (AP Photo/Alexander Zemlianichenko)

Robert Woodland, a Russia-born U.S. citizen, stands in a glass cage during a court hearing, Thursday, July 4, 2024, in Moscow, Russia. Woodland was convicted of drug-related charges and sentenced to 12 and a 1/2 years in prison on Thursday. (AP Photo/Alexander Zemlianichenko)

Robert Woodland, a Russia-born U.S. citizen, stands in a glass cage prior to a court hearing, Thursday, July 4, 2024, in Moscow, Russia. Woodland was convicted of drug-related charges and sentenced to 12 and a 1/2 years in prison on Thursday. (AP Photo/Alexander Zemlianichenko)

U.S. citizen Robert Woodland is escorted to a court room prior to a court session on drug-related charges in Moscow, Russia, Thursday, July 4, 2024. Woodland was arrested on drug charges in January and faces up to 20 years in prison if convicted. Robert Woodland, a Russia-born U.S. citizen, was convicted of drug-related charges by a Moscow court and sentenced to 12 1/2 years in prison on Thursday. (AP Photo/Alexander Zemlianichenko)

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MOSCOW (AP) — Robert Woodland, a Russia-born U.S. citizen, was convicted of drug-related charges by a Moscow court and sentenced to 12 1/2 years in prison on Thursday, court officials and his lawyers said.

He was found guilty of attempted trafficking of large amounts of illegal drugs as part of an organized group, according to an online statement released by court officials, and sentenced to 12 1/2 years in a maxim security penal colony. His lawyers told reporters after the verdict was delivered Thursday that they will appeal the ruling because Woodland’s guilt hasn’t been proven.

Lawyer Stanislav Kshevitsky also said that Woodland has been suffering from unspecified mental health issues. He didn’t provide any details, but said that the court didn’t take those issues into account.

Russian media reported that his name matches a U.S. citizen interviewed in 2020 who said he was born in the Perm region in 1991 and adopted by an American couple at age 2. He was arrested in January.

He said he traveled to Russia to find his mother and eventually met her on a TV show before deciding to move to Russia. Russian news agency Interfax has cited court officials as saying that Woodland also holds Russian citizenship.

Arrests of Americans in Russia have become increasingly common as relations between Moscow and Washington sink to Cold War lows. Washington accuses Moscow of targeting its citizens and using them as political bargaining chips, but Russian officials insist they all broke the law.

Some have been exchanged for Russians held in the U.S., while for others, the prospects of being released in a swap are less clear.

The U.S. State Department said Thursday it was aware that a U.S. citizen was sentenced by a Russian court and that the embassy in Moscow was closely monitoring the case. The department, citing privacy issues, said it would have no further comment.