4.3. The Role of Treatment in Drug Courts
While participation in drug courts would seem to imply access to substance abuse treatment, this component of drug courts is perhaps the most difficult to generalize or expand upon. From state to state and court to court, the type of treatment services available to offenders varies greatly. This is a function of the resources available in particular communities, as well as factors such as treatment programs’ allowance of criminal justice clients. Treatment services are even proscribed differently from case manager to case manager, or counselor to counselor, making an accurate depiction of the role of treatment in drug courts and how it is delivered to clients even more of an exercise in imprecision. Regardless, evidence points to the positive impact that treatment has on drug court outcomes, making a more definitive understanding of this concept critical.
Taxman, Pattavina, and Bouffard (2005) examined use of a manualized treatment curriculum in drug courts in Maine. The Differentiated Substance Abuse Treatment (DSAT) curriculum formalized the treatment process in the participating courts by implementing screening for substance abuse, employing a multiphase approach to treatment, and providing staff with training on the curriculum. The researchers observed reductions in various risk factors, as well as changes in attitudes and behaviors that would position the offenders to be more open and ready for treatment.
In another study, Taxman and Bouffard (2005) examined how treatment impacts graduation rates. The researchers cite evidence that the graduation rate in drug courts sits in the 35% to 40% range (Belenko, 1998, 1999, 2001; Taxman & Bouffard, 2003), but underscore the critical point that there is little evidence to explain the differences between those who complete drug court versus those who do not. In this study, they looked at the effect of treatment on graduation rates in four drug courts and found that individuals participating in more treatment had a greater likelihood of graduating. However, they are careful to point out that even graduates had a hard time following the complex drug court program requirements.
As noted above, various factors can influence the type and dosage of treatment delivered to clients. One such factor is the staff members within agencies. Taxman and Bouffard (2003) examined the philosophies of treatment counselors and how they impact the services delivered to drug abusers. In this study of four adult drug courts, the researchers administered surveys, conducted in-person interviews, and observed treatment sessions led by counselors. The counselors were found to support several causes for substance abuse, did not have a strong affiliation with any one model of treatment, and were observed employing various approaches to treatment during counseling sessions. Counselor characteristics, such as education or recovery status, were found to have some influence on their beliefs regarding the causes and solutions for substance use problems, and these factors in turn have a role in influencing the types and effectiveness of treatment services provided to clients.
On one hand, the researchers found these diverging opinions on the causes and means of dealing with substance abuse problems to acknowledge the complicated nature of offender addiction (Taxman & Bouffard, 2003). On the other hand, counselors’ “eclectic” approach to providing services may further muddy an already elaborate situation, as these methods (or lack thereof) do not give the client a clear picture of how to deal with their problems, and the messages given by counselors from one session to the next may vary considerably. The authors conclude by recommending a manualized approach and the implementation of proven techniques to help standardize care to make it more lasting and effective.
Similar findings on the beliefs of staff in correctional facilities were uncovered by Taxman, Simpson, and Piquero (2002). While the authors did observe more consistency in beliefs than they had hypothesized, there was still a disconnect between the theories that impact causation and those that are the basis for interventions. In other words, while there was semblance in terms of their opinions of the separate ideas of the causes and responses to substance abuse, there was little connection between these ideas.
The problem of differing messages and approaches is further compounded by what is often a systemic disconnect between criminal justice agencies and those providing treatment services to drug court clients. While a driving principle behind drug treatment courts is that participation will result in decreased substance use and a decrease in substance use will result in reductions in criminal behavior, little research has focused on the delivery of these treatment services and how they are interconnected with the overall programmatic features of drug courts. Taxman and Bouffard (2002) cite previous research illustrating the great variation in the types and amounts of treatment services offered in treatment facilities, but point to the lack of consistency in messages and goals between these facilities and criminal justice agencies as the major issue facing effective programming.
In assessing the integration of goals and activities between treatment and criminal justice agencies, the authors identified what appears to be a “compartmentalized” system of care, in which treatment is not generally integrated into overall drug court philosophy, and when it is, it is integrated with specific segments of court operations, as opposed to throughout the process as a whole. Screening and assessing for substance abuse problems are often done separately by treatment and criminal justice agencies, and there does not appear to be integration at the “key decision point” of determining clients’ appropriateness for treatment. Further complicating the issue is that most treatment services are rerouted into existing community treatment networks, meaning that the criminal justice agencies often have little knowledge of what type of treatments take place and, just as important, how frequently. Add this to the discussion from above, where findings showed great variance in the methods and intentions of treatment services, and another layer is added to this ever-growing problem of effective service delivery in drug courts.
To help deal with these issues, Taxman and Bouffard (2002) recommend formalizing integration of treatment and criminal justice agencies at several critical points. First, a shared philosophy of substance abuse is recommended. Though cooperating agencies may differ in terms of their roles in dealing with these problems, fostering a shared view of the causes of substance abuse problems is vital for working out fluid and effective responses to them. Along these lines, unified or joint policy decisions are beneficial, as they solidify these shared philosophical views and establish means for dealing with the problem itself. The most important recommendation, however, is information sharing across these agencies. With this, criminal justice agencies will be better informed of the extent of offender problems and the response given to them, and likewise, treatment agencies will have a better understanding of the other risk factors associated with the offenders’ substance abuse needs.