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DRUG COURTS

DRUG COURTS. Benjamin Nordstrom, M.D., Ph.D. Geisel School of Medicine at Dartmouth. The Big Picture. Drug use and crime are associated Drug use  criminal activity Difficult to manage these problems Drug courts = novel approach. This Lecture Will Cover. Relationship of drugs & crime

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DRUG COURTS

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  1. DRUG COURTS Benjamin Nordstrom, M.D., Ph.D. Geisel School of Medicine at Dartmouth © AMSP 2013

  2. The Big Picture • Drug use and crime are associated • Drug use  criminal activity • Difficult to manage these problems • Drug courts = novel approach © AMSP 2013

  3. This Lecture Will Cover • Relationship of drugs & crime • How Tx affects crime • How drug courts work • Drug courts work well © AMSP 2013

  4. This Lecture Will Cover • Relationship of drugs & crime • How Tx affects crime • How drug courts work • Drug courts work well © AMSP 2013

  5. © AMSP 2013

  6. Case Study: Mr. N • 26 year old man • Cannabis, cocaine, alcohol Dx • Arrested stealing • Charged with 2 felonies • No prior crime before cocaine © AMSP 2013

  7. Substance Abuse • ≥ 1 in the same 12 months: • Interpersonal problems • Failure to live up to obligations • Legal problems • Use in hazardous situations • Lifetime dependence criteria not met © AMSP 2013

  8. Substance Dependence • ≥ 3 in the same 12 months: • Withdrawal • Tolerance • Loss of control over amount used • Unsuccessful quit attempts • Activities given up • Increasing amount time spent • Despite neg. health consequences © AMSP 2013

  9. SUD = Common + Costly • 3.9 million in US have SUD to illicit drugs • Lifetime prevalence is 3% • Use of illicit drugs = US $180 billion a year • Costs of crime the largest contributor • Imprisoning drug users: $30 billion of $38 billion © AMSP 2013

  10. 3 Types of Drug Crime • Acquisitive crime • Crime committed to get $ to buy drugs • 18% federal prisoners • 17% state prisoners • 30% for property crime • 11% for violent crime • 25% county prisoners © AMSP 2013

  11. 3 Types of Drug Crime • Acquisitive crime • Distributive crime • Crime regarding sale of drugs • 2011: 12% of 12 million arrests • 82% possession • 18% sale/ manufacture • 4% of homicides are drug related © AMSP 2013

  12. 3 Types of Drug Crime • Acquisitive crime • Distributive crime • Behavioral toxicity crime • Intoxication-related behavior • Do drugs é crime or crime é drugs? © AMSP 2013

  13. Drug Use and Crime • Crime during active drug use: • 15 x é in drug-related offenses • 54% é property offenses • 100% é in assaults committed • 88% of crimes committed © AMSP 2013

  14. This Lecture Will Cover • Relationship of drugs & crime • How Tx affects crime • How drug courts work • Drug courts work well © AMSP 2013

  15. Drug Treatment Reduces Crime • Opioid Treatment Programs  crime • Crime  with  time in program • Acquisitive crime  87% in 1st mo. • Naltrexone (opioid blocker) in parolees •  # Drug free urine screens •  Return to prison © AMSP 2013

  16. Drug Treatment Reduces Crime • SUD Tx crime in drug-using juveniles • Inpatient (residential) SUD treatment • 75%  acquisitive crime • 66%  in drug selling • SUD treatment  crime by 26 % © AMSP 2013

  17. This Lecture Will Cover • Relationship of drugs & crime • How Tx affects crime • How drug courts work • Drug courts work well © AMSP 2013

  18. Drug Courts • Began in 1980s • Response to high #s in prison • Now >2,000 drug courts in US © AMSP 2013

  19. What Are Drug Courts? • SUD treatment as an alternative to jail • Use combination • Rewards • Escalating (“graduated”) sanctions • Two types • Pre-plea • Post-plea © AMSP 2013

  20. Team Members • Judge • Prosecutor • Public defender • Court clerk • Coordinator • Case managers • Supervision • Treatment providers • Community representative © AMSP 2013

  21. Drug Courts: 10 Key Components • SUD Tx during processing • Non-adversarial • ID participants early; divert • Continuum of SUD Tx • Frequent drug/ alcohol testing © AMSP 2013

  22. Drug Courts: 10 Key Components • Justice and Tx coordinate • Ongoing judicial interaction • Monitor/ evaluate progress • Continuing education for teams • Partnerships with community © AMSP 2013

  23. This Lecture Will Cover • Relationship of drugs & crime • How Tx affects crime • How drug courts work • Drug courts work well © AMSP 2013

  24. Drug Courts Are Effective • Maricopa County, AZ • Randomized controlled trial (RCT) • N = 630 people for 12 mo. • Drug Court vs. Tx as usual (TAU) • reincarceration (9% vs. 23%) © AMSP 2013

  25. Drug Courts Are Effective • Superior Court Drug Intervention Program • Randomized controlled trial (RCT) • N = 1,022 people • Weekly drug testing/ graduated sanctions • Court-based drug Tx with weekly testing • Treatment as usual (TAU) © AMSP 2013

  26. Drug Courts Are Effective • Superior Court Drug Intervention Program • Results at 1 year: • Both exp. groups < drug use than TAU • Graduated sanction vs TAU ê rearrest © AMSP 2013

  27. Drug Courts Are Effective • Baltimore City Drug Treatment Court • RCT of 235 people • At 1 year Drug Court vs. TAU: •  rearrest (48% vs. 64%) • 3 x  reoffend © AMSP 2013

  28. Drug Courts Are Effective • Baltimore City Drug Treatment Court • At 2 years, Drug Court vs. TAU : •  rearrest (66% vs. 81%) • # arrests (1.6 vs. 2.3) • # charges (3.1 vs. 4.6) © AMSP 2013

  29. Drug Courts Are Effective • Baltimore City Drug Treatment Court • At 3 years, Drug Court vs. TAU : • # arrests (2 vs. 3) • # charges (4 vs. 6) © AMSP 2013

  30. Drug Courts Are Effective • New South Wales Adult Drug Court • RCT of 468 of Drug Court vs TAU • Drug Court vs TAU •  frequency of drug offenses •  time to reoffense •  frequencies of other offenses © AMSP 2013

  31. Drug Courts Are Effective • Meta-analyses done on Drug Courts • Large reviews of Drug Court outcomes • All show Drug Courts  reoffending • Overall Drug Courts  recidivism 26% © AMSP 2013

  32. Drug Courts = Cost Effective • GAO: can save $47K per participant • KY study • Saved $3.83 for each $1 spent • Drop-outs saved $1.13 for $1 spent • MD study: saved $5 for every $1 spent • Saves up to $150,000 per person © AMSP 2013

  33. © AMSP 2013

  34. Case study: Mr. N • Grafton Co. Drug Treatment Court • Only for non-violent felonies • Founded in 2007 • Post-plea model © AMSP 2013

  35. Grafton Co. Drug Tx Court • Well-staffed team • Referral to community-based SUD Tx • Use graduated sanctions and incentives • 18-24 months long • 54% graduation rate • 15% graduates rearrested • 4% reconvicted © AMSP 2013

  36. Case Study: Mr. N • A few “bumps in the road” • Integrated well into SUD treatment • Mandated to get a job • Used “chips” earned for gym • Reinvolved with 3 y.o. daughter • Graduated in 18 months • No further contact with justice system © AMSP 2013

  37. Conclusions • Drugs and crime are costly • Drug use can “drive” crime • Drug Tx reduces crime • Drug Courts: effective SUD Tx • Drug Courts crime and save $ © AMSP 2013

  38. Acknowledgements • Marc Schuckit, M.D. • Claire Wilcox, M.D. • Marcy Gregg • Alcohol Medical Scholars Program • Robert Gasser, J.D. • Grafton Co. Drug Treatment Court © AMSP 2013

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