6. The National Drug Court Survey
To fill the gap in knowledge on drug courts, the National Drug Court Survey was administered to drug court coordinators and treatment providers across the United States as a project of the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) research cooperative. The focus of this study was to provide a more accurate picture of the characteristics of courts and their administrators and employees, the types of treatment services offered within drug courts, arrangements with treatment and other service providers, the integration of evidence-based practices, as well as a host of other information. With this data, more focused and informed improvements for drug courts can be designed.
The sampling frame for the National Drug Court Survey was composed of drug court coordinators and the agencies that provide treatment services to these courts. The first portion of the sample, drug court coordinators, was generated in two parts. First, the sampling frame from another CJDATS study, the National Criminal Justice Treatment Practices Survey (NCJTP), was used. The NCJTP sampling frame was drawn from a representative sample of prisons and community correctional facilities using a two-staged stratified sampling technique.1 This left 72 counties from which all active adult drug courts were selected. The second portion of the coordinator sample consisted of all adult drug courts that have received an implementation or enhancement grant from the Office of Justice Programs since 2002. The final coordinator sample consisted of 208 adult drug courts. Each coordinator was then asked to give the contact information for the treatment agencies providing services to their clients, and surveys were mailed to each of these agencies. A response was received from 68% of courts (141 of 208), and a matching pair of coordinator and treatment surveys was received for 75% of courts in the sample (100 of 141).
6.2. Characteristics of Drug Courts
On average, drug courts had 102 participants on any given day.2 Thirty-two percent of courts had an average daily population of under 40 drug court participants (DCPs), while 41% ranged from 41 to 100 DCPs, and 27% had over 100 DCPs on any given day. The average court graduates 38 DCPs on an annual basis, while discharging an average of 29 due to noncompliance with program requirements. Sampling weights were applied to the NCJTP portion of respondent data to generate a national estimate of drug court participants. This resulted in an estimate of 49,000 DCPs across the county on any given day. This figure is higher than the last estimate of DCPs generated by Huddleston and colleagues (Huddleston, Freeman-Wilson, Marlowe, & Roussell, 2005), a result of the continued increase in the number of drug courts across the country.
6.3. Administrators and Staff
A total of 87% of drug courts reported having a singularly focused coordinator, while the remaining courts used existing positions (judges, case managers, etc.) to administer the program. On average, coordinators or those in charge of drug courts reported having been in their position for just over 4 years. The majority were between the ages of 36 and 55 (65% of coordinators fell within this range) and were women (65%). A total of 32% reported having a bachelor’s degree, while 44% reported having a master’s degree or higher.
On average, courts had 12 full-time and part-time staff members working with the drug court, with an average of 3.2 new hires in the past year. Courts had an average of 2.8 treatment counselors assigned to the court, and 1.2 treatment coordinators on staff.
6.4. Determining Eligibility and Admission
In determining eligibility for drug court, legal criteria are far more integral in making admission decisions than issues related to severity of offenders’ substance use problems or treatment needs. Furthermore, legal staff, such as prosecutors, defense attorneys, and judges, are far more influential in reaching admission decisions than other members of the drug court team. Whereas members of the legal team are involved in reaching admission decisions in over 92% of courts, coordinators and case managers are involved in 79% of courts, and only 48% of courts involve treatment providers in making this decision.
6.5. Screening and Assessments
Overall, 68% of drug courts reported using a standardized substance abuse screening tool. The most commonly used tools are the Addiction Severity Index (ASI) (used in 45% of courts) and the Substance Abuse Subtle Screening Inventory (SASSI) (23%). Only 21% use risk assessment tools, most commonly, the Level of Service Inventory- Revised (LSI-R) (18%) and the Wisconsin Risk and Needs (WRN) tool (4%), and less than 4% use mental health screening tools. Thirty-three percent of courts use a tool created by the state or a tool of their own design.
Policy-based reassessments are extremely rare, with only 4% of courts having written protocol for doing so. On the other hand, 77% of courts reassess as a reaction to DCPs’ performance or compliance. A total of 18%of courts do not reassess for severity of substance use disorders.
6.6. About Phases and Treatment within Drug Courts
Though the phase approach is a hallmark of drug courts, this structure is not universally adopted. Roughly three quarters of drug courts reported using formal phases, with approximately half using a four-phase structure and 25% using a three-phase structure. The remaining 25% of courts do not have a set phase structure. The typical drug court program lasts approximately one year.
“Low-impact” services such as drug testing, self-help meetings, and group counseling are those most frequently integrated within drug courts. While these less intensive services are pervasive across all courts, more intensive, treatment-oriented services are not as common, particularly as participants move further along within the phase structure. Though clinical treatment services such as motivational enhancement, psychosocial education, individual counseling sessions, or family therapy sessions are offered in 61% of programs’ Phase 1, by Phase 3 only 54% of programs provide clinical services. By Phase 4, only one third of programs (36%) provide clinical treatment services.
The same trend is seen in regard to attendance at status review hearings. Though in earlier phases, DCPs are required to attend status review hearings in front of a judge twice per month or more (88% of courts require such attendance in Phase 1, and 80% in Phase 2), as they move further along within the program, their required attendance decreases substantially. By Phase 3, only 21% of courts require appearances in front of judges every 2 weeks or more frequently, and by Phase 4, this drops to 15%. In addition, by Phase 4 over half (53%) of courts have no set schedule for DCPs’ attendance at status review hearings.
These low rates of continuous attendance at status review hearings are symbolic of an overall pattern of a lack of judicial involvement across the drug court process. Though it is one of the “key components” of drug courts, ongoing judicial interaction with DCPs is practiced in less than 10% of courts (7.8%). In addition, nearly half (45%) of courts reported that judges do not review or modify treatment plans.
6.7. Service Delivery in Drug Courts
Coordinators and case managers are more frequently involved in case planning and treatment activities than members of the legal team. Where nearly 80%of coordinators and case managers maintain contact with treatment providers, 25% of judges, 14% of defense attorneys, and 13% of prosecutors engage in this activity. Coordinators and case managers are also far more likely to contact other service providers in the community, to identify short- and long-term goals for the DCP, and to adjust the treatment plan when the DCP is doing poorly.
Overall, the legal team is less involved than its drug court or treatment counterparts in such treatment activities, engaging in an average of 1.3 (of 8) activities, as compared to 4.5 for the core drug court team and 6.3 for treatment agencies and providers. This pattern also holds true for legal teams’ involvement in drug-court-related activities as a whole. Whereas judges, defense attorneys, and prosecutors are involved in an average of 4.9 (of 19) activities, coordinators and case managers are involved in an average of 11.3, and treatment providers in an average of 12.5.
6.8. Treatment Arrangements with Outside Agencies
Most courts reported having an agreement or contract for treatment services with an outside treatment agency (23% had no such arrangements). One third (33%) of courts reported having a formal agreement for services, which often laid out the types of services to be provided (62%) or dealt with issues related to confidentiality (53%). In addition to formal agreements, 43% of courts reported also having contracts with treatment providers, through which money changes hands in exchange for services. Within these arrangements, 13% required the drug court to pay service fees, 20% required the DCP, and 68% had some combination of court and DCP fees. Nearly half (46%) of courts had formal written agreements with up to three treatment service providers, while 27% had agreements with more than three providers.
6.9. Treatment Agencies and Staff
Treatment agencies reported serving an average of 75 clients. Though over three quarters of agencies reported being licensed, only 32% reported accreditation by the Commission on the Accreditation of Rehabilitation Facilities (CARF) or the Joint Commission on the Accreditation of Health Care Organizations (JCAHO).
A total of 57% of respondents fall between the ages of 36 and 55, 55% are female, and on average they have spent 7 years with their agencies and 3 years in their positions working with the drug court. A total of 20% of respondents reported having a bachelor’s degree, and 55% have an advanced degree, with the most common fields of education being counseling (30%), social work (27%), and psychology (16%).
Staff in treatment agencies have an average caseload of 25 clients (both drug court clients and their general client caseload). Sixty percent of staff have credentials in substance abuse treatment (such as CADC, CASAC), while 75% have specialized training in substance abuse treatment (credits toward CADC, CASAC), and 30% have certification in a general mental health specialty. Seventy-six percent of agencies allow staff to be in recovery, with 37.5% of staff actually in recovery, while 46% of agencies allow ex-offenders on staff, though only 12% of staff are ex-offenders. Roughly one third (34%) of staff have a bachelor’s degree, one third (34%) have a master’s degree or higher, and the remaining staff have a 2-year degree (17%) or less (15%).
6.10. Characteristics of Treatment Services Provided by Outside Agencies
Only 56% of agencies reported using a standardized substance abuse screening or assessment tool, while 54% use a state- or agency-designed tool. Slightly over half (52%) of agencies reported using a written treatment protocol or curriculum, with 26% of these agencies using the Martix model, while others tended to develop their own protocol. One third (33%) of agencies trained staff on their protocol for up to 2 days, while 23% of agencies trained staff by having them watch other counselors. Ten percent of agencies do not train staff on their treatment protocol.
A total of 31% of agencies provide specialized services for co-occurring disorders, while 42% provide specialized services for adult offenders. Roughly 60% of agencies reported providing cognitive-behavioral services 2–3 times per week or more, though only 23% offer short-term residential programs (28 days or less), and less than 20% offer detoxification (19%) or long-term residential programs (18% offered programs that were 6 months or longer). Mental and physical health services are more common across treatment agencies. Roughly half of agencies reported providing counseling or assessment for mental health problems, whereas 32% provide HIV/AIDS testing, and 38% provide counseling for HIV/AIDS.
Pharmacological services are rarely provided by treatment agencies. Only 17% of agencies prescribe buprenorphine, while 16% report prescribing Antabuse, 15% report prescribing naltrexone, and 12% prescribe methadone. More troubling is the fact that very small percentages of DCPs in treatment agencies are recommended for these medications, with no more than 6% (Antabuse) being recommended for any of those listed.
6.11. Utilization of Evidence-Based Practices
Compared to national findings on their use in community correctional settings (Friedmann, Taxman, & Henderson, 2007), drug courts are more likely to implement consensusdriven, evidence-based practices (EBPs). On average, drug courts utilize 5.5 (of 11) EBPs, compared to 4.6 for probation and parole agencies.
Addressing co-occurring disorders is the most commonly utilized EBP (present in 96% of treatment agencies), followed by the use of incentives for positive DCP behavior (89%) and the presence of a continuum of care (84%). The use of standardized risk tools (21%) is quite low. Other important EBPs are also widely uncommon, as only 38% of agencies use engagement techniques, and 41% involve family in treatment. Less than three quarters (72%) of agencies report planned service durations of over 90 days, while half (53%) report that the staff in their agencies are qualified to address the needs of DCPs.
An important difference in the use of EBPs is found between agencies that have a written agreement or contract for services with outside treatment agencies and those that do not. In particular, agencies with agreements or contracts are much more likely to implement standardized substance abuse tools, to involve family in treatment, to report systems integration, and to use graduated sanctions.
6.12. Adherence to Key Components
On average, drug courts implement 6 of the 10 key components, with nearly all courts reporting drug and alcohol treatment with case processing (99%), 87% supporting continued staff training or education, 77% establishing partnerships with other community agencies to enhance effectiveness, and 77% monitoring substance use through frequent drug testing. However, only 25% of courts identify eligible participants early on in the criminal justice process, 22% report that a coordinated strategy determines responses to DCPs’ compliance, and 8% report ongoing interaction with the drug court judge.
Perhaps the most innovative aspect of drug courts is their unique position within the criminal justice system. Bringing together key players from the legal, treatment, and corrections communities, drug courts have the ability to bridge the services and functions of these agencies to more effectively supervise offenders and target their specific needs. With this, meaningful integration among these agencies becomes critical.
Drug courts collaborate with treatment agencies on an average of 7.2 (of 12) activities—activities such as sharing DCPs’ needs for types of treatment, developing joint policy and procedures manuals, cross-training staff, holding joint staffing, pooling funding, and so forth. While this degree of integration indicates relatively formal working relationships with substance abuse agencies, a more informal system exists in regard to working relationships between the drug courts and prosecutorial agencies, in which these agencies collaborate on an average of 4.7 of the aforementioned activities.