State Court Administrative Office
Trial Court Services
Problem-Solving Courts
Michigan Association of Treatment
Court Professionals
Adult Drug Court
Standards, Best
Practices, and
Promising Practices
March 2017
Chapter 8: Treatment
Carol M. Smith, MA, LPC, CCS, CAADC
March 14, 2017
Treatment in Drug Court
• Substance Abuse & Mental Health Treatment
in Drug Court
1.
2.
3.
4.
5.
6.
General & Definition of Drug Treatment Courts
Treatment Entry
Treatment Services
Evidence-based Models of Treatment
Treatment Duration
Medication-assisted Treatment
DEFINITIONS
• Standard:
Courts must implement
Required by drug court statue, The 10 Key
Components, or case law and precedent that are
binding on Michigan courts
State grant funds tied to court’s adherence to
standards
DEFINITIONS
• Best Practice:
Courts should implement
Supported by scientific research and data or
non-binding case law to produce better outcomes
State grant funds tied to the implementation of
best practices
Strong suggestions
DEFINITIONS
• Promising Practice:
Courts should consider
Not yet supported by scientific research or data,
but anecdotal evidence and experience suggests
they are helpful
Suggestions that will aid in building higher quality
programs
General & Definition Standards
i. “Drug treatment court” means a court
supervised treatment program for
individuals who abused or are dependent
upon any controlled substance or alcohol. A
drug treatment court shall comply with the
10 Key Components promulgated by the
National Association of Drug Court
Professionals. [MCL600.10068(1)(a)]
Drug Court 10 Key Components
1. Drug Courts integrate alcohol and other drug treatment
services with justice system case processing. justice system
case processing.
2. Using a non-adversarial approach, prosecution and defense
counsel promote public safety while protecting participants'
due process rights.
3. Eligible participants are identified early and promptly placed
in the drug court program.
4. Drug courts provide access to a continuum of alcohol, drug
and other related treatment and rehabilitation services.
5. Abstinence is monitored by frequent alcohol and other drug
testing.
Drug Court 10 Key Components
6. A coordinated strategy governs drug court responses
participants compliance.
7. Ongoing judicial interaction with each drug court
participant is essential.
8. Monitoring and evaluation measure the achievement of
goals and gauge effectiveness.
9. Continuing interdisciplinary education promotes effective
drug court planning, implementation, and operations.
10. Forging partnerships among drug courts, public agencies,
and community-based organizations generates local
support and enhances drug court effectiveness.
General & Definition Standards
ii. If the individual being considered for admission to a
drug treatment court is charged in a criminal case
or, in the case of a juvenile, is alleged to have
engaged in activity that would constitute a criminal
act if committed by an adult, his or her admission is
subject to all of the following conditions:
•
The offense or offenses allegedly committed by the
individual must be related to the abuse, illegal use, or
possession of a controlled substance or alcohol.
[MCL600.1068(1)(a)]
General & Definition Best Practices
i. Treatment Should Address Major
‘Criminogenic Needs’. Eight major
criminogenic needs have been identified that
contribute to the risk for recidivism among
offenders and that are dynamic, or
changeable, via programmatic interventions.
(Peters, 2011)
Major Criminogenic Needs
1.
2.
3.
4.
5.
6.
7.
8.
Antisocial attitudes
Antisocial friends and peers
Antisocial personality pattern
Substance abuse
Family and/or marital problems
Lack of education
Poor employment history
Lack of prosocial leisure activities
Major Criminogenic Needs
• Contribute to the risk for recidivism
• Reduction in recidivism is proportional to the
number of criminogenic needs addressed
within offender treatment programs
• Criminogenic needs are dynamic, or
changeable through programmatic
interventions
General & Definition Best Practices
ii. One or two treatment agencies are primarily
responsible for managing the delivery of
treatment services for drug court
participants.
• Drug courts that worked with two or fewer
treatment agencies were able to reduce recidivism
by 74 person over drug courts that used more
agencies. (Carey, Mackin, & Finigan, 2012)
General & Definition Best Practices
iii. Clinically trained representatives from these
agencies are core members of the drug court
team and regularly attend team meetings
and status hearings.
• Recidivism may be reduced twofold when
representatives from the drug court’s primary
treatment agencies regularly attend staffing
meetings and status review hearings. (Carey,
Mackin, & Finigan, 2012)
General & Definition Best Practices
• Better outcomes due to regular attendance at
staff meetings and court hearings.
• This ensures that timely information about
progress is communicated and treatmentrelated issues are taken into consideration
when decisions are made.
General & Definition Best Practices
• If more than two agencies provide treatment
to drug court participants, communication
protocols are established to ensure accurate
and timely information about each
participant’s progress in treatment is
conveyed to the drug court team. Outcomes
may be enhanced by having those treatment
providers communicate frequently with the
court via email or other similar electronic
means.
Treatment Entry Best Practices
i. Drug courts should link participants to
treatment as soon as possible.
•
Family dependency drug court participants are
linked to treatment more quickly than those
who experience traditional dependency court
system, stay in treatment longer, and are more
likely to complete treatment. (Bruns, Pullmann,
Wiggins, & Watterson, 2011)
Treatment Entry Best Practices
• People mandated to treatment by the criminal
justice system experience similar outcomes
related to substance abuse and recidivism as
those seeking treatment voluntarily. Retention in
treatment is often higher among those coerced
into treatment. Such participants perform as well
as voluntary participants across a range of intreatment indicators of progress (e.g., selfefficacy, coping skills, clinical symptoms, 12-step
involvement, motivation for change). (Peters
2011)
Treatment Entry Best Practices
• Participants who enter drug court quickly tend to
enter treatment more quickly (Worcel, Furrer,
Green, & Rhodes, 2006)
Treatment Entry Best Practices
ii. Drug courts should consider using the Risk
Needs Responsivity (RNR) Model.
•
The RNR model has led to better risk assessment
instruments to predict criminal behavior, and
better treatment programs that match services
to the level of risk and needs. As a result, the
RNR model, when properly applied, has led to a
reduction in recidivism. (Bonta & Andrews,
2007)
Risk Needs Responsivity (RNR) Model
• Risk principle: Match the level of service to the
offender’s risk to re-offend.
• Need principle: Assess criminogenic needs and
target them in treatment.
• Responsivity principle: Maximize the offender’s
ability to learn from a rehabilitative intervention
by providing cognitive behavioral treatment and
tailoring the intervention to the learning style,
motivation, abilities and strengths of the
offender.
Risk Principle
• The risk principle states that offender
recidivism can be reduced if the level of
treatment services provided to the offender is
proportional to the offender’s risk to reoffend.
• The principle has two parts to it:
1) level of treatment and,
2) offender’s risk to re-offend.
Need Principle
• The focus of correctional treatment should be on
criminogenic needs.
• Criminogenic needs are dynamic risk factors that
are directly linked to criminal behavior.
• Criminogenic needs can come and go unlike static
risk factors that can only change in one direction
(increase risk) and are immutable to treatment
intervention.
• Criminogenic needs are considered the major
predictors of criminal behavior, referred to as
“central eight” risk/needs factors
Responsivity Principle
• Refers to the fact that cognitive social learning
interventions are the most effective way to teach
people new behaviors regardless of the type of
behavior.
• Effective cognitive social learning strategies
operate according to the following two principles:
1) The relationship principle: establishing a warm,
respectful and collaborative working alliance with
the client
2) The structuring principle: influencing the direction of
change towards the prosocial through appropriate
modeling, reinforcement, problem-solving, etc.
RNR Model in Treatment
Major Risk/Need Factor
Indicators
Intervention Goal
Antisocial personality
pattern
Impulsive, adventurous
Build self-management
pleasure seeking, restlessly skills, teach anger
aggressive and irritable
management
Procriminal attitudes
Rationalizations for crime,
negative attitudes towards
the law
Counter rationalizations
with prosocial attitudes;
build up a prosocial
identity
Social supports for crime
Criminal friends, isolation
from prosocial others
Replace procriminal friends
and associates with
prosocial friends and
associates
RNR Model In Treatment, cont.
Major Risk/Need Factor
Indicators
Intervention Goal
Substance abuse
Abuse of alcohol and/or
drugs
Reduce substance abuse,
enhance alternatives to
substance use
Family/marital
relationships
Inappropriate parental
monitoring and
disciplining, poor family
relationships
Teaching parenting skills,
enhance warmth and
caring
School/work
Poor performance, low
levels of satisfactions
Enhance work/study skills,
nurture interpersonal
relationships within the
context of work and school
Prosocial recreational
activities
Lack of involvement in
prosocial
recreational/leisure
activities
Encourage participation in
prosocial recreational
activities, teach prosocial
hobbies and sports
Treatment Services Standards
i. A drug treatment court shall provide a drug
court participant with all of the following:
•
Substance abuse treatment services, relapse
prevention services, education, and vocational
opportunities as appropriate and practicable.
[MCL 600.1072(1)(e)]
Treatment Services Standards
ii. A drug treatment court shall comply with the
10 Key Components promulgated by the
National Association of Drug Court
Professionals, which include all of the
following essential characteristics…Access to
a continuum of alcohol, drug, and other
related treatment and rehabilitation
services. [MCL 600.1060(c)(iv)]
10 Key Components
4. Drug courts provide access to a continuum of
alcohol, drug and other related treatment
and rehabilitation services.
Treatment Services Best Practices
i. The drug court offers a continuum of care for
substance abuse treatment including
detoxification, residential, sober living, day
treatment, intensive outpatient and
outpatient services.
Treatment Services Best Practices
•
•
Outcomes, including graduation rates and
recidivism, are significantly better in drug courts
that offer a continuum of care for substance
abuse treatment which includes residential
treatment and recovery housing in addition to
outpatient treatment. (Carey, Mackin, & Finigan,
2012) (Koob, Brocato, & Kleinpeter, 2011)
Community aftercare treatment for offenders
can significantly reduce rates of substance use
and recidivism. (Peters, 2011)
Treatment Services Best Practices
ii. The drug court offers trauma-informed
services.
•
Please see Section F of Chapter VI in the
National Association of Drug Court Professionals
Adult Drug Court Best Practice Standards,
Volume II. (National Association of Drug Court
Professionals, 2015)
Treatment Services Best Practices
F. Trauma-Informed Services
• Participants are assessed using a validated instrument
for trauma history, trauma-related symptoms, and
posttraumatic stress disorder (PTSD). Participants with
PTSD receive an evidence-based intervention that
teaches them how to manage distress without
resorting to substance abuse or other avoidance
behaviors, desensitizes them gradually to symptoms of
panic and anxiety, and encourages them to engage in
productive actions that reduce the risk of
retraumatization…..
Treatment Services Best Practices
F. Trauma-Informed Services, Continued…
• …..Participants with PTSD or severe trauma-related
symptoms are evaluated for their suitability for group
interventions and are treated on an individual basis or
in small groups when necessary to manage panic,
dissociation, or severe anxiety. Female participants
receive trauma-related services in gender-specific
groups. All drug court team members, including court
personnel and other criminal justice professionals,
receive formal training on delivering trauma-informed
services.
Treatment Services Best Practices
iii. The drug court offers gender-specific
substance abuse treatment groups.
•
A study of approximately seventy drug courts
found that programs offering gender-specific
services reduced criminal recidivism significantly
more than those that did not. (Carey, Mackin, &
Finigan, 2012)
Treatment Services Best Practices
iv. The drug court offers mental health
treatment.
•
Programs that excluded offenders with serious
mental health issues were significantly less costeffective and had no better impact on recidivism
than drug courts that did not exclude such
individuals. (Carey, Mackin, & Finigan, 2012)
Treatment Services Best Practices
v. Participants are not incarcerated to achieve
clinical or social service objectives such as
obtaining access to detoxification services or
sober living quarters.
•
Relying on in-custody substance abuse
treatment can reduce the cost-effectiveness of a
drug court by as much as 45 percent. (Carey,
Mackin, & Finigan, 2012)
Treatment Services Best Practices
• Some drug courts may place participants in jail as
a means of providing detoxification services or to
keep them “off the streets” when adequate
treatment is unavailable in the community. This
practice is inconsistent with best practices, unduly
costly, and unlikely to produce lasting benefits.
(National Association of Drug Court Professional,
2013, p.42)
Evidence-Based Models Best Practices
i. Treatment providers use evidence-based
models and administer treatments that are
documented in manuals and have been
demonstrated to improve outcomes for
addicted persons involved in the criminal
justice system.
Evidence-Based Models Best Practices
• Outcomes from correctional rehabilitation are
significantly better when evidence-based models
are used, and fidelity to the model is maintained
through continuous supervision of the treatment
providers. (National Association of Drug Court
Professionals, 2013)
Evidence-Based Models Best Practices
• Examples of manualized CBT curricula that have
been proven to reduce criminal recidivism among
offenders include Moral Reconation Therapy
(MRT), Reasoning and Rehabilitation (R&R),
Thinking for a Change (T4C), relapse prevention
therapy (RPT), and the Matrix Model. (National
Association of Drug Court, 2013)
• SAMHSA’s National Registry of Evidence-based
Programs and Practices (NREPP)
nrepp.samhsa.gov
Treatment Duration Best Practices
i. Participants receive a sufficient dosage and
duration of substance abuse treatment to
achieve long-term sobriety and recovery
from addiction.
Treatment Duration Best Practices
•
•
Providing continuous treatment for at least one
year is associated with reduced recidivism.
(Warren, 2007)
The longer participants remain in treatment and
the more sessions they attend, the better their
outcomes. (National Association of Drug Court,
2013)
Treatment Duration Best Practices
ii. Participants ordinarily receive six to ten
hours of counseling per week during the
initial phase of treatment and approximately
200 hours of counseling over nine to twelve
months; however, drug court allows for
flexibility to accommodate individual
differences in each participant’s response to
treatment.
Treatment Duration Best Practices
• The best outcomes are achieved when addicted
offenders complete a course of treatment
extending over approximately nine to twelve
months. (Peters, 2011) (Cobbina & Huebner, 2007)
Treatment Duration Best Practices
• Assuming drug courts are treating individuals who
are addicted to drugs or alcohol and at a high risk for
criminal recidivism or treatment failure; studies show
that on average, participants will require six to ten
hours of counseling per week in the first phase and
200 hours over the course of treatment. (National
Association of Drug Court, 2013)
MAT Best Practices
i. Drug courts should allow the use of
medically assisted treatment (MAT) when
appropriate, based on a case-specific
determination and handle MAT very similarly
to other kinds of treatment.
MAT Best Practices
• Numerous controlled studies have reported
significantly better outcomes when addicted
offenders received medically assisted treatments
including opioid agonist medications such as
methadone, and partial agonist medications such
as buprenorphine. (Chandler, Fletcher, & Volkow,
2009) (Finigan, Perkins, Zold-Kilbourn, Parks, &
Stringer, 2011)
MAT Best Practices
• Buprenorphine or methadone maintenance
administered prior to and immediately after
release from jail or prison has been shown to
significantly increase opiate-addicted inmates’
engagement in treatment, reduce illicit opiate use,
reduce rearrests, and reduce mortality and
hepatitis C infections. (National Association of
Drug Court, p.44)
MAT Best Practices
• Courts repeatedly emphasize that they do not do
things differently for MAT participants. (Friedman
& Wagner-Goldstein, 2016)
MAT Best Practices
ii. Drug courts should engage in a fact-sensitive
inquiry in each case to determine whether
and under what circumstances to permit the
use of medically assisted treatments. This
inquiry should be guided in large measure by
input from physicians with expertise in
addiction psychiatry or addiction medicine.
•
The purpose of probation is to provide an
individualized program of rehabilitation.
(Roberts v United States, 1943)
MAT Best Practices
iii. A valid prescription for such medications
should not serve as the basis for a blanket
exclusion from a drug court.
•
Because numerous studies have shown better
outcomes when MAT are used, a valid
prescription should not exclude a defendant
from drug court. (National Association of Drug
Court, 2013, p.8)
MAT Promising Practices
i. Courts should monitor medication use to
minimize misuse and diversion.
ii. Medically assisted treatment programs
should integrate behavior health treatment
and wraparound services from a licensed
treatment provider.
iii. Courts should consider all clinically
appropriate forms of treatment.
MAT Promising Practices
iv. Judges rely heavily on the clinical judgment
of treatment providers as well as the court’s
own clinical staff.
v. Courts develop strong relationships with
treatment providers and require regular
communication regarding participant
progress.
vi. Courts are selective about treatment
programs and private prescribing physicians.
Thank you.