Research Aims to Optimize the Drug Court System

Pictured: front row, from left: Michele Gassman, Project Coordinator; Sarah O'Brien, Dane County Drug Court Judge; Lila Schmidt, Program Manager, Mental Health Center of Dane County. Back row, from left: Randall Brown, MD, Principal Investigator; Todd Campbell, Dane County Substance Abuse Services Manager; James Sauer, Drug Court Liaison, Mental Health Center of Dane County; Ken Farmer, Assistant District Attorney

When people with substance use disorders commit a crime, one alternative to incarceration may be participation in a drug treatment court (DTC).

Drug courts, which have rapidly spread throughout the US in the past 20 years, provide community-based substance abuse treatment, individual case management, drug testing, and ongoing progress assessments under the supervision of a dedicated drug court judge. Individuals who successfully complete the program may then receive a reduced sentence or even dismissal of charges.

But how effective are drug courts? What factors influence a participant's likelihood to complete the program? What are the specific needs of the different populations being served?

Department of Family Medicine (DFM) Assistant Professor Randall Brown, MD, is finding answers to those questions. Through research studies conducted in collaboration with the Dane County DTC, he is contributing data and analyses that can in turn be used to improve DTCs throughout Wisconsin and the nation.

Identifying Factors Associated with Program Dropout

Dane County established its drug court treatment program in 1996. Between 1996 and 2004, 573 people participated in the program. In one study, published in the Journal of Offender Rehabilitation, Dr. Brown analyzed case management data from the 97 African Americans who participated in the program during that time period.

According to Dr. Brown, African Americans are a subpopulation of interest because they are often disproportionately incarcerated when compared to white counterparts committing similar crimes. Previous research has also found that African Americans often graduate from DTCs at lower rates than white participants.

In his study, Dr. Brown found that although the dropout rate for African Americans (52%) was not significantly different from that of Caucasians (42%), the factors most associated with program failure among African Americans were:

• Unemployment;
• Previous criminal history; and
• Cocaine use.

In a related study, soon to be published in Substance Use and Misuse, Dr. Brown analyzed data from all 573 program participants. He found that the same factors listed above—plus one additional factor, lower educational achievement—were also associated with program failure.

According to Dr. Brown, these findings may indicate a need for additional services in the drug court program. "All DTC participants receive substance abuse treatment, but some may need educational assistance or employment retraining to become fully re-integrated into society," he said.

He also noted that even outside the criminal justice system, cocaine users who seek substance abuse help often have more difficulty completing treatment programs than marijuana or opioids users. "It's tied to issues of impulse control," he said. "What we don't yet know is whether this is a result of the drug itself or the inherent personality traits of people drawn to the drug."

Evaluating Recidivism Rates and Opioid Addiction Treatment Options

With those studies complete, Dr. Brown has just launched two new research projects. The first is a case-control study comparing rates of recidivism, or re-arrest, among drug-related offenders who participate in the drug court program versus those who receive more traditional forms of corrections.

The second is a randomized trial examining whether drug court participants with opioid dependence can be treated in a primary care setting as effectively as in a specialty clinic setting. "If we find that primary care clinics can help clients manage their dependence and get back into society, that could be really important from a capacity standpoint," Dr. Brown said.

Effective Drug Courts, Effective Rehabilitation

Each of Dr. Brown's studies share the same common goal: to find the best way to rehabilitate people with substance abuse issues so they can lead productive lives in the community.

"In general, there is agreement in the criminal justice system that the majority of addicted offenders who are in jail probably don't need to be there," he said. "Prisons are overcrowded, so when drug courts were first established as alternatives, they spread very quickly. Unfortunately, there isn't a lot of knowledge about the kinds of services needed for optimal outcomes."

And that's where his research comes in. "We want to refine the drug court system so it works more effectively. We hope to accomplish this through services that promote an individual's well-being without causing any public safety problems."