Improving graduation rates in drug court: A qualitative study of participants’ lived experiences

Abstract

For nearly three decades, drug courts have provided a rehabilitative approach within the criminal justice system for individuals who have a substance use disorder. The goal of drug courts is to reduce criminal recidivism, and research has consistently suggested that participants that graduate drug court are less likely to recidivate than those who are terminated from the program. This qualitative study adds to the literature by asking drug court participants (N = 42) their views on the most helpful aspects of the program that support them in graduating and how the program could be more helpful to support them in graduating. Two themes emerged from the data: (1) participants felt that interventions that are common to drug courts, such as drug testing and having frequent contact with the judge, were most helpful in supporting them in graduating the program; (2) participants felt that the agencies that offered treatment for their substance use disorders used punitive tactics and judgmental approaches that compromised the quality of treatment they received, and they felt that this was a barrier to them graduating the program. The findings are discussed in reference to drug court practice.

Keywords

Drug court phenomenology problem-solving courts qualitative research substance use disorder

Introduction

According to the National Institute on Drug Abuse (NIDA) (2015), it is estimated that 9 percent of Americans need treatment for their substance use disorders, while only about 1 percent actually receive treatment. In 2013, for example, only about three million out of the 23 million Americans who were in need of treatment for their substance use disorders actually received some intervention (NIDA, 2015). European countries are experiencing similar trends. For example, the most commonly used illicit opioid in Europe is heroin, and despite an increase in heroin overdoses and deaths, barriers still exist in providing treatment to all those in need (European Monitoring Centre for Drugs and Drug Addiction [EMCDDA], 2016). It is likely that this lack of treatment is a significant factor as to why so many individuals are being sent to the criminal justice system for reasons related to illicit drug use. More alarming, is the notion that drug offenders are likely to recidivate if they do not receive treatment for their substance use disorders while incarcerated. For example, Cooper et al. (2014) found that roughly 77 percent of drug offenders, from 30 states, were arrested for a new crime within five years of being released from state prisons. Additionally, the National Association of Drug Court Professionals (NADCP) (2016) estimates that, once released from prison, 95 percent of offenders will return to illicit drug use. Clearly, simply incarcerating individuals who have a substance use disorder has not been an effective method to eliminate illicit drug use and drug-related crimes.

High criminal recidivism rates, continued illicit drug use, and failure to provide the necessary treatment for individuals who have a substance use disorder are only three of the shortcomings that have been associated with the criminalization of drug policy (Seddon et al., 2008), and these shortcomings are seen globally. Consistent with the United States, recent British drug policy, for example, has focused heavily on utilizing the criminal justice system as an avenue to treat substance use disorders, relying on coercive treatments and having treatment providers in courts, probation offices, and prisons, for instance (Seddon et al., 2008). This approach, however, is not without limitations, namely that British research has provided little evidence that coercive treatment is effective (Seddon et al., 2008) and the approach is limited to the relationship between illicit drug use and crime, which does not address the many other societal contexts influencing this social problem (Stevens, 2011). Despite the many limitations with global drug policies, interventions, such as drug courts, continue to expand globally and it is important to increase our knowledge base on these programs.

In 1989, in Miami-Dade County, the first drug court was established to help address the lack of treatment available in the criminal justice system and high recidivism rates (NADCP, 2016; Nolan, 2001). Drug courts are conceptualized through 10 key components (NADCP, 1997). These key components are what distinguish drug courts from other common criminal justice interventions, such as probation. Examples of the key components include referring participants to treatment for their substance use disorders, requiring frequent, sometimes weekly, contact with the drug court judge, the use of a nonadversarial approach to treat substance use disorders and promote public safety, random and frequent drug testing, providing incentives to enhance motivation for change, forging partnerships with the community to meet the individualized needs of participants, and completing program evaluations to assess whether or not drug court goals and objectives are being achieved. It is important to note that drug courts in the United States operate under a total-abstinence model and recovery is often associated with abstinence from drugs and alcohol. This is not universal, however. Actually, it is common for drug courts outside of the United States to operate under a harm reduction model and equate recovery beyond merely abstinence, such as improved educational and vocational skills, which is evident in the Dublin, Ireland drug court (Loughran et al., 2015).

Since their establishment, drug courts have proven to be effective in reducing both criminal justice costs and recidivism. Decreased recidivism rates among drug court participants have deep support in the literature (Mitchell et al., 2012; US GAO, 2005; Wilson et al., 2006). For every dollar put into drug court programs, taxpayers save approximately three dollars just from avoided criminal justice expenses, making drug courts cost-effective alternatives. Furthermore, reducing recidivism has many benefits; it reduces drug use and crime, saves money, increases public health and safety, and restores individual lives and families (NADCP, 2016). The NADCP (2016) estimates that after graduating from a drug court program, 75 percent of participants do not recidivate for a minimum of two years. There are an estimated 1538 adult drug courts in the United States (National Institute of Justice [NIJ], 2015). Because of the large and expanding number of programs, it is important to develop an in-depth understanding of the factors that increase graduation rates in drug courts.

Research on drug courts has greatly expanded in recent years. The majority of research, however, has been quantitative. While quantitative studies are important, it is also imperative to understand how participants perceive their drug court experience and the factors they believe may aid or hinder their successful completion of the program. This study adds to the existing body of knowledge by using qualitative methods to develop an in-depth understanding of the factors that impact graduation rates from participants’ perspectives.

Literature Review

Evidence of the impact of drug courts on recidivism outcomes has been mixed. Bavon (2001) was unable to find a statistically significant difference in recidivism patterns between drug court participants and a comparison group. Wolfe et al. (2002) also found that rearrest rates for nonparticipants and drug court participants were not significantly different, but they did find that the rearrest rates for drug court graduates was significantly less than those who were terminated from the program. Conversely, Gottfredson and Exum (2002) found that drug court participants were three times less likely to recidivate than a comparable control group within a 12-month follow-up period. Brown (2011) and Gallagher et al. (2014) both also found a decrease in recidivism rates between drug court participants and nonparticipants. According to a study completed by Krebs et al. (2007), drug court participants were less likely to recidivate within 12 to 18 months of completing the program, although that effect disappears after 18 months. However, another study showed that adult drug court participants had lower recidivism rates than nonparticipants for up to three years after entering the drug court program (Mitchell et al., 2012).

In drug courts, recent studies have been conducted to show the differences in recidivism between those that graduate the program and those who are terminated. For instance, Gallagher (2014) found that drug court graduates were significantly less likely to recidivate than those who were terminated from the program. In another study, not only were terminated participants more likely to recidivate than graduates within 12 months of participation, they also had a quicker rate of rearrest after involvement in drug court (Taxman and Bouffard, 2006). Based on the research, there is an obvious difference in recidivism rates between those that graduate and those who are terminated from drug court. Because of this difference, it is imperative to know what factors might affect whether a participant graduates or is terminated from the program.

The literature on factors affecting graduation and termination rates is extensive. Drug of choice is a common variable measured. Several studies have shown that amphetamines or stimulants as a drug of choice lowers the likelihood of participant graduation (Gallagher et al., 2015a; Hartley and Phillips, 2001; Hickert et al., 2009; Mateyoke-Scrivner et al., 2004; Wu et al., 2012). From a different perspective, those that identify alcohol as their drug of choice are more likely to graduate than those who identify other substances (Mendoza et al., 2013). However, there are studies that were unable to find a significant difference between those who graduate and those who are terminated based on drug of choice (Gallagher, 2013b; Roll et al., 2005; Shaffer et al., 2011).

Other factors that have been studied extensively are participants’ employment status, age, education, and race. Having employment while participating in drug court has consistently proven to be positively correlated with graduation rates (Gallagher et al., 2015a; Hohman et al., 2000; Roll et al., 2005; Wu et al., 2012). With regards to age, several studies have shown that older participants are more likely to graduate than younger participants (Hickert et al., 2009; Mateyoke-Scrivner et al., 2004), while others have shown no statistical significance between the age of those who graduate and those who are terminated (Gallagher, 2013b; Gallagher et al., 2015a). As education increases, so does the likelihood of graduating drug court (Gallagher et al., 2015a; Hartley and Phillips, 2001; Mateyoke-Scrivner et al., 2004). Although, Gallagher (2013b) found no significant difference between participant graduation rates based on education level. Race is another variable that has been studied with regards to graduation and termination rates of drug court participants. Multiple studies have shown that white participants are more likely to graduate from drug courts than non-white participants (Brewster, 2001; Gallagher, 2013b; Sechrest and Shicor, 2001). There are, however, exceptions to this pattern. For example, Vito and Tewksbury (1998) found graduation rates among African American participants to be higher than white participants.

While demographic factors play an important role in determining who will successfully complete a drug court program, it is equally important to understand factors that may affect successful outcomes from the perspective of the participants. With regards to participants’ views on drug court outcomes, previous research is limited. However, there are some studies that have qualitatively assessed the views of drug court participants and factors that they believe contributed to their successful or unsuccessful completion of the program. For example, Wolfer (2006) noted that graduates found the structure of drug court and the random urine screens to be helpful in their completion of the program. However, participants in this study also acknowledged some factors that hindered their success. One consistent deterring factor was a lack of respect for their time, especially if they were employed. Participants often became frustrated when they would show up for appointments on-time and then had to wait until it was their turn (Wolfer, 2006). Several graduates from this study also expressed that they believed there was favoritism in the program and that sanctions were not always fairly implemented.

Other qualitative studies with regards to participants’ views exist, and they tend to focus on racial and gender differences. Gallagher and Nordberg (2016), for example, found both white and African American participants were motivated to be successful based on the supportive and compassionate nature of the drug court team. They also found that white participants were able to consume alcohol while in the program and not get caught due to testing insufficiencies. A lack of adequate treatment also seemed to be an issue from the participants’ perspectives (Gallagher and Nordberg, 2016). Another study done by Gallagher (2013a) focused on African American participant beliefs as to why racial disparities in drug court outcomes existed. From this study, African American participants believed that these disparities existed due to a lack of cultural sensitivity when delivering sanctions, a lack of access to employment, being required to attend NA and AA meetings, a lack of individualized treatment, and a lack of diversity among staff members and other participants. From a gender standpoint, Fischer and Geiger (2011) conducted a study exploring the views of female participants. Females in this study identified several key aspects that helped increase their confidence in remaining abstinent from drug use and promote self-efficacy. These factors included staff dedication, supervision, accurate drug screens, wraparound treatment, having therapists that were female and ex-addicts, individualized treatment, and service agencies that accepted children (Fischer and Geiger, 2011). Although there is limited qualitative research from participants’ perspectives, the knowledge available does offer insights into ways to increase graduation rates in drug court.

Methodology

The research question for this study is: how do drug court participants view the program, in regards to the most helpful aspects that support them in graduating the program and how the program could be more helpful in supporting them in graduating the program? This research was approved by an Institutional Review Board (IRB). Research participants were recruited from a drug court located in a Midwestern state. In 2015, the first author attended four drug court hearings where he introduced himself to the participants, described the research, and invited them to complete the Drug Court Participant Satisfaction Survey. Drug court participants do not attend every court hearing; therefore, it was necessary to attend four separate court hearings to assure that every participant in the program had an opportunity to participate in this research. The satisfaction survey was developed by the researchers and included brief demographic information and open-ended questions. Specifically, participants were asked their age, gender, race and ethnicity, and how long they had been in the drug court. Then, participants answered the following two open-ended questions. First, could you please describe what aspects of drug court are most helpful to you in supporting you in graduating the program? Second, could you please describe how drug court could be more helpful to you in supporting you in graduating the program? Participants were provided with a pen and the satisfaction survey, and a private location for them to answer the questions. No incentive was provided by the researchers for participating in this study.

A narrative analysis of the answers provided on the satisfaction surveys was completed. Narrative analysis was an effective approach to answer the research question for this study, as the goal was to provide participants with an anonymous environment to freely express their experiences in drug court (Padgett, 2008). Narrative analysis is also designed to capture the behind-the-scenes aspects of participants and their role in a particular program, such as drug court (Padgett, 2008). This data analysis was also guided by phenomenology. According to Padgett (2008), phenomenology is recommended when you have a research sample with similar characteristics, such as being a member of drug court, and when research questions can be answered best through participants’ sharing their own personal lived-experiences with a particular phenomenon.

The data were transcribed verbatim and uploaded to NVivo 10 for analysis. The data analysis followed a three-step process, as suggested by Miles and Huberman (1994) and Padgett (2008). First, consistent with narrative analysis, and to promote immersion in the data, the researchers read all of the data on seven occasions during a two-week period. During this process, a phenomenological approach was utilized by paying particular attention to examples of participants’ lived experiences in the drug court. Second, data focused on participants’ lived experiences within the context of drug court were extracted and grouped together. Third, the grouped data were reviewed to assess for consistent responses from participants. Grouped data that did not demonstrate consistent responses were considered outliers and utilized for negative cases analyses. Grouped data that did demonstrate consistent responses were identified as themes; themes were summarized and conceptualized by extracting direct quotes from participants’ satisfaction surveys.

Last, several strategies were used to increase the rigor and validity of the qualitative findings. First, observer triangulation and interdisciplinary triangulation were used (Padgett, 2008). Observer triangulation was used to offer more than one perspective on interpreting the data, with the goal of increasing the objectivity of the findings. Interdisciplinary triangulation was accomplished by having professionals from three disciplines – social work, psychology, and criminal justice – collaborate on the data analysis and findings, which again offers another method to increase the objectivity of the findings and reduce researcher bias. Second, peer debriefing and support was used to assist the researchers in bracketing preconceived thoughts about the phenomenon being evaluated, which is an essential part of phenomenological analysis (Padgett, 2008). This was accomplished through frequent consultation, at least weekly, with colleagues who have expertise in qualitative research and were not directly involved in this study. The consultations involved offering colleagues portions of the data analysis to assess the logic of the themes developed. Third, negative case analysis was used to explore personal biases that the researchers may have had and to present a balanced, fair interpretation of the data (Padgett, 2008). The negative cases are presented in the findings section following each theme.

Findings

Participants for this study were recruited from a drug court located in a Midwestern state. All participants had a substance use disorder and were required to participate in treatment. Typically, participants were first referred to intensive outpatient treatment (IOP), which consisted of counseling three days a week, and after they completed IOP, participants attended an aftercare group one day a week. Additionally, they were required to submit urinalysis drug screens one to three times a week and attend drug court hearings, which ranged from weekly to monthly hearings, depending on how the participant was doing in the program. The response rate was 100 percent. Forty-two participants were recruited and all completed a satisfaction survey. The ages of the participants ranged from 19 to 60 years old. The average age was 31 years old. In regards to gender, 69 percent (n = 29) were male and 31 percent (n = 13) were female. The majority were white (n = 29; 69 percent), followed by African American (n = 9; 22 percent), Hispanic (n = 3; 7 percent), and multiracial (n = 1; 2 percent). Participants’ length of time in the program ranged from approximately two weeks to 20 months, and the average length of time in the program was approximately 10 months. Throughout the analysis, a number of major thoughts and experiences were shared consistently by participants of the drug court. Two themes emerged from the data.

Key components of drug court promote recovery

The first theme to emerge from the data was key components of drug court promote recovery. Thirty-three of the 42 participants (79 percent) shared experiences that contributed to this theme. Drug courts are conceptualized by 10 key components (NADCP, 1997). Two of the key components require participants to have random and frequent drug testing and to have frequent contact with the judge. Participants felt that these two interventions, random and frequent drug testing and having frequent contact with the judge, were most helpful in supporting them in graduating the program. As noted previously, the drug court for this study requires participants to complete random drug testing on a weekly basis, typically one to three times a week, and when they begin the program, they meet with the judge for a formal drug court hearing on a weekly basis. Meetings with the judge then decrease to biweekly and eventually monthly based on participants’ progress throughout the program. While participants offered a range of compliments about the drug court team and process, the most frequent compliments that supported the development of this theme were directed toward the drug testing procedures and having frequent contact with the judge. A 27-year-old, female participant who had been in drug court for approximately a month, for example, shared her experiences with drug testing. She stated:

I am new to this court, and I have seen a lot of people go up to the judge on sanctions for using drugs. I’m not going to lie, I have cravings at times to use my drug of choice, but they drug test us so much that I don’t even try and think about getting high. They drug test so much more than probation, and I think that is a good thing because without the drug tests I would be getting high. I hope to graduate this program, and if I do, I know the drug testing was probably the most helpful aspect.

A 36-year-old, male participant who had been in drug court for a little over 11 months shared his experiences with having frequent contact with the judge. Specifically, he commented:

I will graduate drug court because I know the judge cares about me. At first, I had to see her every week and I was annoyed by that because it took up a lot of time, but I now know why they make us do that. She holds us accountable for what we agreed to do, and even when I was on sanctions for a positive drop, she didn’t yell at me or make me feel bad, she talked to me like I was a real person with a real addiction. I think more people would do better in the justice system if they saw their judges more and more judges cared like she does.

A 28-year-old, pregnant, female participant who had been in drug court for nearly 13 months discussed how being required to submit random and frequent drug tests and seeing the judge on a weekly basis supported both her recovery and the health of her unborn child. This participant shared:

I am grateful for this program and for the judge and my PO [probation officer]. I am pregnant and have gotten high before with my other children. This disease has not made me the best mom, but this time I am doing something different. I am going to graduate from this program, get my case dismissed, and live recovery one day at a time. I am due in January and my baby will be clean and I owe that to me, and the judge for having faith in me as a mom, and for all the stuff they make us do here, like all the drug tests and court hearings. They really deter me from getting high, but now I don’t get high because I want a better life for me and my children.

Other participants added to the theme by sharing their experiences on the effectiveness of the random and frequent drug testing system and seeing the judge on a frequent basis. One participant stated, “[h]aving all those drug tests and having to see the judge is what works in drug court. It’s what will help me graduate.” Another participant discussed his experience with being head-of-the-class, which is an incentive the drug court provides to participants who are doing well in the program. The incentive provides participants with praise from the judge, applause from the audience, and the opportunity to leave court early, once they have talked with the judge. The participant shared, “I never thought I would stop using opiates, but I did, and I owe that to the judge and her continuous support and help. I like seeing her when I’m head-of-the-class because it makes me proud.” Last, a participant discussed how the EtG alcohol drug test supported his recovery. Specifically, he noted, “[w]hen I stop using heroin, I always turn to alcohol. But now I’m totally abstinent from all drugs because the EtG test works. I want to graduate and make the judge proud, not go on sanctions for using alcohol.”

The negative case analysis revealed three of the 42 participants (7 percent) shared experiences that differed from that of the theme. The negative cases, however, did not suggest that the drug testing process or seeing the judge frequently was ineffective. Rather, the cases suggested that the weekly requirements of drug testing and seeing the judge were time consuming. A 22-year-old, male participant who had been in drug court for a little over eight months reported, “[t]here is too much to this program. Seeing the judge weekly and doing all these drug tests are good, but if I don’t make it through this program it’s because I don’t have enough time to do it all.” Other participants shared, “[t]he drug tests are too expensive and take too much time. I don’t have the time to do all these drug tests and wait in the line, especially because I work and have to keep my job” and “I suggest they have more flexibility with the drug tests and seeing our case manager and the judge and going to treatment. I have a lot on my plate and am doing well, but it’s overwhelming at times.”

Overall, it was promising to see that nearly eight out of 10 (79 percent) participants felt that key components of the drug court model were being effectively implemented. Specifically, participants felt that the random and frequent drug testing and having frequent contact with the judge supported their recovery and helped them with meeting their goal of graduating drug court. None of the participants felt that these two interventions were ineffective or did not support them in graduating the program. The negative case analysis only revealed that 7 percent of the participants felt that these interventions were time consuming, which could potentially jeopardize their progress in the program.

Treatment offered through a punitive and judgmental lens

The second theme to emerge from the data was treatment offered through a punitive and judgmental lens. Twenty-eight of the 42 participants (67 percent) shared experiences that contributed to this theme. All drug court participants were court-ordered to complete treatment for their substance use disorders, which is a key intervention in the problem-solving court model. Participants, however, felt that the treatment they were receiving was punitive in nature, as compared to rehabilitative. They also felt that treatment providers treated them in a judgmental manner, especially following a relapse. The drug court from this study refers their participants to numerous treatment providers in the community, and it is important to note that the findings are specific to the agencies and counselors from these agencies, not the drug court itself. Actually, participants viewed the drug court staff as the ones who offered rehabilitative interventions, whereas the counseling agencies and counselors from these agencies were the ones that were implementing punitive, judgmental interventions. Overall, participants felt that using punitive, judgmental interventions in treatment did not support them in graduating drug court. A 26-year-old, male participant who had been in the drug court for a little over a year, for example, stated:

The one thing that I think would help me and others graduate drug court is not getting sanctions from our counselors. When we go out for a cigarette break during group, we all talk about some of the struggles we are having in recovery and some of us relapse, but we do not discuss that in group with our counselors because they make you start the program over again or judge you for relapsing. I think the court, drug court, is good at not judging us, but the counselors make you feel lousy if you don’t do recovery perfect like they want. I’m not perfect and I should be able to talk about my problems in group and not get judged or punished for them. Just because I may relapse does not mean I have to start treatment the whole way over. I thought they were there to help us, not make things more difficult.

A 45-year-old, female participant who had been in the drug court for approximately eight months shared mixed feelings about her treatment experience. Specifically, she commented:

I will admit that attending aftercare and treatment opened my eyes to areas of my disease that needed to be addressed. I am grateful for that. However, having my aftercare extended for no apparent reason was very frustrating. Often, I felt like I had no voice at the sessions. If I were to speak, it was just opening the door to being degraded and demeaned in front of the class. I don’t judge others and I don’t want to be judged, especially by people who are supposed to help us. I saw others getting extended sessions for using drugs or missing class without calling or having an excuse. I always had either a doctor’s note or cleared it through drug court if I had to miss. I never relapsed and had excuses for the few classes I missed, and I still had classes extended. The counselor punishes us more than the drug court. What would help me graduate? Have the treatment people treat us with compassion and respect like the judge does.

A 29-year-old, male participant who had been in drug court for approximately four months shared his concerns related to being honest in treatment because he felt that he may receive a punitive response from his counselor. He shared:

I have stopped using pills for the most part. I have slipped up a few times and it would be nice to discuss that at treatment, but I will never do that. People told me before I started treatment and I have seen it, if you relapse, never talk about it with your therapist because you will get in trouble with them and they will try and make things more difficult for you with the drug court. I do feel comfortable being real at the AA [Alcoholics Anonymous] meetings I go to because they don’t try and get you in trouble, but I am very selective with what I say to my therapist because she runs and tells my probation officer everything, and sometimes in a way that is inaccurate and judging. I should be able to be honest in counseling and not be judged or get in trouble for being honest. I like AA, but the counseling for the most part is useless, it doesn’t help us complete drug court, we do that on our own.

Other participants added to the theme by sharing their experiences on how they felt that counselors used coercion to keep them in treatment. One participant stated, “[m]y counselor told me that I needed to do more treatment and if I didn’t then he was going to call drug court and I would go to jail or get kicked out of the program”. Another participant commented, “[t]hese counselors use the criminal justice system against you. I have to do what they say or I will get locked up. I have no voice in the kind of treatment I receive.” Last, a participant shared, “[i]n treatment, I try to tell them what they want to hear because if you say the wrong thing, they make you do more classes or they even threaten you that you will go back to prison”.

The negative case analysis revealed eight of the 42 participants (19 percent) shared experiences that differed from that of the theme. One example, from a 39-year-old, male participant who had been in drug court for nearly nine months, is:

The most helpful thing to graduating drug court is the counseling. They understand the struggles we go through in addiction and have been there themselves. My counselor has been the most supportive of my recovery and when I graduate drug court, I’m going to thank him. When I relapsed, he helped me learn from that and not beat myself up with shame and guilt.

A 19-year-old, female participant who had been in drug court for nearly two months, commented:

If it wasn’t for the counseling, I would never complete this program or be clean and sober today. I look forward to seeing my therapist and she understands my addiction, as well as my depression. The best part of drug court is the therapy we receive.

Other participants stated: “[c]ounseling is a good place to share the struggles you are having, I learned a lot about my disease and how to treat it”; “IOP [intensive outpatient program] was tough at first, but the counselors really care about you and want you to do well”; and “I met many good people and counselors by going to group therapy. It’s nice to be around people that want to see you be happy and healthy and make good decisions for you and your family.”

Overall, 67 percent of the participants interviewed felt that one of the barriers to them graduating drug court was the quality of treatment they received for their substance use disorders. Participants described a model of treatment that seemed to be a one-size-fits-all approach, which did not promote individualized treatment or a trusting therapeutic relationship. They expressed concerns related to trusting their treatment providers, as they felt that counselors would use their criminal justice involvement against them in a punitive manner and they felt that they could not be honest with their counselors about certain aspects of treatment, such as relapsing on drugs. Conversely, the negative case analysis revealed that 19 percent of the participants had favorable views toward the quality of treatment they received for their substance use disorders. Actually, some mentioned that treatment was the most helpful aspect of drug court.

Limitations

There are several limitations with this study that are important to mention. First, the findings from this study are only generalizable to the research sample and the specific drug court where the data were collected. While the findings may be used to guide future research or assist other drug courts in their program evaluations, it is not recommended that programming changes be made simply on the findings from this study. Additional research is needed to develop a body of knowledge on the factors that support participants and the barriers they face in graduating from drug court. Second, the findings may have been impacted by social desirability bias, or the likelihood that participants answered the questions in a selective, or favorable, manner. Third, the data were collected through a survey. By collecting data through a survey, the researchers were not able to ask probing questions which may have provided more data on the lived experiences of drug court participants, potentially resulting in additional themes. It is recommended that future research utilize other qualitative methods, such as individual interviews or focus groups, to allow participants to expand on their thoughts and experiences through probing questions. Fourth, this study analyzed the data as a whole, which did not allow for comparisons and contrasts among important demographic variables that may influence how drug court is perceived by participants. It would be helpful if future research completed comparative and contrastive analyses based on participants’ demographics, such as gender, race and ethnicity, employment status, education status, to name a few.

Discussion

This study asked drug court participants their views of the program, and specifically to identify the most helpful aspects that support them in graduating the program and how the drug court could be more helpful in supporting them in graduating the program. Overall, positive features of the drug court were found by some participants. Specifically, 79 percent of study participants identified that random and frequent drug testing and having frequent contact with the judge promoted their recovery and were most helpful in supporting them in graduating the program. Conversely, some participants reported negative experiences. Specifically, 67 percent considered the treatment they received as part of the program punitive and judgmental and was effectively a barrier to success in the program.

Optimizing graduation rates is a demonstrated means of reducing recidivism (Gallagher, 2014; Taxman and Bouffard, 2006). The components of the drug court that supported recovery and program success in this study are consistent with the literature about drug courts and the NADCP’s (1997) identified 10 key components. Specifically, they are consistent with findings by Wolfer (2006) that the structure of the court and the random urine screenings were identified by participants as helpful. Seven percent of participants in this study identified that the time-consuming aspect of the drug court program was undesirable, a finding that is also consistent with Wolfer’s (2006) research. Drug court operations, structure, and a considerable amount of research (Gallagher et al., 2015b; Hiller et al., 2010, for example) are guided by 10 key components that define drug courts (NADCP, 1997). The findings of our study add to the body of knowledge concerning which of these components works well for participants. Our study reinforces the importance of key components number five (abstinence is monitored by frequent alcohol and/or drug testing) and seven (ongoing judicial interaction with participant) (NADCP, 1997). In particular, it was promising to see that participants valued their ongoing judicial interaction with the drug court judge, as individuals recovering from substance use disorders tend to value supportive relationships. They viewed her as caring, respectful, empathetic, and encouraging, all of which are characteristics that promote sustained recovery, regardless of the setting. At the same time, however, it is important to encourage participants to develop additional supportive relationships beyond the drug court, as the drug court is a temporary resource.

The conceptual basis of drug courts, namely therapeutic jurisprudence, aims to stress the therapeutic potential of the court experience by holding people accountable for their actions while transforming the power of the judge to a less punitive and remote agent to a fully engaged partner in recovery (Winick, 2003). Participants in this study valued the engagement with the judge with this less punitive approach. It is ironic that the traditionally punitive aspect of the judicial process was perceived as therapeutic and the therapy delivered by professional therapists was perceived as punitive, as revealed by our second theme. Participants found the therapeutic treatment that was part of the program, but delivered by community partners, to be judgmental and punitive. This finding has policy and drug court practice implications. Recent research has also noted the irony of therapeutic interventions being perceived as punitive and ineffective, and this has further oppressed historically disadvantaged groups. In the United States, for example, African American drug court participants were dissatisfied with the quality of treatment they received for their substance use disorders, a factor that may have contributed to African Americans graduating drug court at a lower rate than their white counterparts (Gallagher and Nordberg, 2016). In the UK, Du Rose (2015) described the experiences of female drug users and how oppressive, male-based interventions exacerbated problems common to female drug users, such as poverty. Du Rose elaborated on how ineffective drug policies can further oppress already marginalized populations.

Drug courts began in the United States; however, they continue to expand globally and are in countries such as Australia, Belgium, Brazil, Canada, Ireland, New Zealand, the UK, to name a few. With the global expansion of drug courts comes a need to advocate for drug policies that are aligned with therapeutic jurisprudence and policies that do not lead to punitive, oppressive approaches to treating substance use disorders. As a starting point, it is important to advocate for drug policies that require treatment providers to use evidence-based, culturally competent, and gender-informed interventions. It is essential that drug policies reflect interventions that have demonstrated effectiveness at treating substance use disorders. Motivational interviewing, for example, has a plethora of evidence demonstrating success in minimizing drug use, improving function in major areas of one’s life, such as employment and family relationships, and enhancing motivation for change (Miller and Rollnick, 2013). It is recommended that drug policies require treatment providers to be trained in and use motivational interviewing. Motivational interviewing would be particularly helpful to the participants in this study, as the intervention is designed to eliminate judgment and punitive tactics, and promote a trusting therapeutic relationship between the counselor and participant.

Our findings have additional implications for policy advocacy and drug court practice. For example, several of the key components (NADCP, 1997) relate directly to the constellation of agencies, professionals, and institutions that come together to produce and sustain a drug court including professional treatment. So while key component number one (integration of treatment services with justice system case processing), four (access to a continuum of treatment and rehabilitation services), six (a coordinated strategy for participants’ compliance), eight (monitoring and evaluation to gauge effectiveness), and 10 (forging partnerships between the court and community agencies to enhance effectiveness) include therapeutic professionals and the agencies that employ them, they do not specify adherence to evidence-based interventions or quality assurance specifically. The lack of quality assurance is problematic. The NADCP and the International Association of Drug Treatment Courts (IADTC) are the main organizations that advocate for funding to expand and begin new drug courts, educate courts on how to implement the drug court model, disseminate research to inform practice, and, as mentioned previously, developed the key components for the drug court model. A major limitation with these organizations, however, is that there is no international certification board to assure fidelity to the drug court model which may result in many unintended consequences, such as the ones noted in this study where participants were not receiving treatment that they viewed as effective in treating their substance use disorders. It is recommended that drug court professionals, policymakers, and any other stakeholders that are invested in effectively treating drug users in the criminal justice system, advocate for policies that require all drug courts to be certified through a governing board, such as the NADCP or IADTC, to assure fidelity to the model and potentially enhance the effectiveness that drug courts have demonstrated already.

Furthermore, inconsistencies of mental health and substance use disorder treatment delivery by professionals in numerous fields including social work, psychiatry, nursing, public health, and psychology have formed the basis for an extensive, recent report by the Institute of Medicine (IOM) (2015). Although the evidence base for psychosocial interventions is strong, there is concern about the quality of delivery of evidence-based psychosocial interventions, a benchmark that is not specified in the NADCP’s (1997) key components. The IOM (2105) report is recent and may stimulate an expansion of the targeted outcomes recommended by the NADCP (1997). This highlights one of the strengths of qualitative research – its ability to capture important perspectives that may be obscured by quantitative outcome-focused research and evaluation. Finally, in light of this study and the IOM (2015) report, there may be implications for augmenting the training of social workers, psychologists, and others in forensic practice settings, given the explosion of drug courts and other problem-solving courts that attempt to operationalize therapeutic jurisprudence and the complexity and double-binds that may arise for therapeutic professionals engaged with forensic clients.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author biographies

John Robert Gallagher is an assistant professor at Indiana University school of social work where he teaches in the mental health and addictions concentration. His research agenda involves exploring the factors that may contribute to racial disparities in drug court outcomes and completing program evaluations for problem-solving courts.

Anne Nordberg is an assistant professor at the University of Texas at Arlington school of social work. Her current research agenda is related to problem-solving courts, critical analyses of police–civilian encounters, and addressing racialized and gendered disparities in the criminal justice system.

Elyse Lefebvre is a graduate student at Indiana University school of social work. She is pursuing her Master of Social Work with a concentration in mental health and addictions. She has collaborated on quantitative and qualitative research projects related to the efficiency and effectiveness of drug courts.

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