Substance use disorder is a public health crisis, with 1.5 times more individuals suffering from addiction than all those suffering from cancer combined. Further, among those in prison, 46% of all violent and non-violent crimes committed, are drug-related. The larger problem arises when these two statistics intersect. What results is a large percentage of individuals being funneled through the criminal justice system who on the one hand, we want to treat, but on the other, committed crimes we can’t ignore. In 1989, a group of judges, prosecutors, defense attorneys, and treatment providers created the first alternative-to-incarceration court, or commonly referred to as “drug court,” in Miami-Dade, Florida. Drug courts approach addicts who committed drug-related crimes from a public health, non-adversarial perspective, with the goal of reducing illicit drug use and recidivism rates. Today, over 3,000 drug courts exist nationwide. Drug courts provide individuals with an alternative to prison in order to receive proper substance use disorder treatment. This is an innovative and progressive approach in the midst of the increasing rate of addiction in the U.S.
It’s safe to say that drugs and prison don’t mix. Sentencing individuals to prison forces them to stop using drugs “cold-turkey,” which is dangerous. While withdrawal symptoms are usually not life-threatening, common symptoms such as diarrhea can lead to severe dehydration, which if ignored can lead to loss of life. Some prisons are taking proactive approaches to properly treat addiction, but the progress is no match for the rapidly increasing rates of addiction and drug-related arrests. Drug courts seek to combat this issue by sentencing individuals charged with a drug-related crime to a court-ordered rehabilitation program rather than prison. However, what began as a humanitarian effort, has some people wondering if they are doing more harm than good.
Individuals who qualify for a drug court rehabilitation program must first enter a guilty plea. The program usually lasts between 12 and 24 months, ultimately ending in a graduation and an excused or diminished prison sentence. The program also employs sanctions for violating the conditions of the program. For example, if an individual fails a drug test or does not attend a mandatory progress meeting, he/she may be reduced to a previous phase of the program, or sentenced to “shock” incarceration, which is a short prison sentence. Rewards coupled with sanctions make sense for a program whose participants did indeed commit crimes. However, critics of drug courts express that in some cases when individuals violate the conditions of the program, they are sent back to the beginning of the adversarial process, and sentenced to prison for the full duration, or sometimes longer than if they had been prosecuted through the traditional process. This is because individuals are forced to plead guilty in order to participate in a drug court rehabilitation program, which effectively waives their rights to the option of a plea deal if they fail the program.
Data also suggests that drug courts are not targeting the most vulnerable populations in the justice system. Drug courts seem to be enrolling participants contrary to the current racial disparities apparent throughout the criminal justice system. While Black people are 2.5 times more likely to be arrested for drug-related crimes than White people, only 17% of participants in drug courts are Black while 62% are White. Further, studies show that high-risk individuals are those that would benefit the most from drug courts, however they do pose a greater risk of failure. As a result, critics believe that some drug court administrators “cherry-pick” low-risk participants to show higher program success rates and maintain program funding.
Another highly debated question among critics of drug courts is whether judges take on an appropriate role throughout the program. Evidence shows defendants who have judges as part of their “team” requiring regular mandatory progress meetings, show higher graduation rates than defendants whose meetings are on an as-needed basis. However, the extent of judge involvement is where the concern lies. Judges reserve the exclusive right to hand out both sanctions and rewards throughout the program. While this seems appropriate, addiction is an extremely complicated disease and not all judges are properly trained in the science and psychology of addiction. For example, they may not understand how certain sanctions, like shock incarcerations, can impede an individual’s treatment progress. Furthermore, even if judges are properly trained, the sanction and award process may still falter when uniform standards are not implemented throughout all drug courts. Perhaps creating a larger distinction between those qualified to diagnose and treat individuals suffering from substance abuse and those being the arbiter of the court should be clearly delineated. Blurring this line leads to confusion over a judge’s role – are they treatment counselors or decision-makers?
There is no doubt that drug court rehabilitation programs can result in amazing success stories. Drug courts as an alternative to incarceration are certainly a positive step in tackling addiction rates and increased incarceration for drug-related crimes. Further, due to the non-adversarial nature of the program, defendants feel as though they are part of the team of attorneys, judges, and treatment providers, which offers the defendant a sense of dignity, altering the stigma attached to addiction. A report from the Government Accountability Office revealed that drug courts are in fact showing a slight decrease in recidivism and relapse rates. Some drug courts have even reformed their practices by focusing on high-risk individuals, despite the fact that they pose a greater risk of failing the program. Unfortunately, we have yet to see data that shows this practice taking effect on a larger scale.
Drug courts also have great potential to curb the opioid epidemic. In 2016, nearly 60,000 people overdosed on opioids – 8,000 more people than in 2015. About 150,000 individuals participate in drug courts each year. Instead of 150,000 people a year being sentenced to prison to face the likelihood of recidivism, relapse, or overdose, these individuals are given a fighting chance at recovery. In September, the Department of Justice awarded $58 million to drug courts to help combat the opioid addiction crisis. This funding can also contribute to implementing more evidence-based treatment regimes, such as medication-assisted treatment, collecting and releasing better empirical data, and continuing rigorous evaluations of current drug court policies and practices. These are all viable recommendations that could turn current critics of drug courts into proponents.