John R. Gallagher, PhD Licensed Social Worker (LSW) Licensed Clinical Addiction Counselor (LCAC) Assistant Professor

Transcription

1 John R. Gallagher, PhD Licensed Social Worker (LSW) Licensed Clinical Addiction Counselor (LCAC) Assistant Professor

2 Training Objectives Synthesize the history of racial inequality in criminal justice and the role of drug court in reducing disparities in outcomes for Latino, and other minority group, participants. Assess the factors that may contribute to racial disparities in drug court outcomes. Comprehend the effectiveness of evidence-based, culturally competent drug court interventions for Latino, and other minority group, participants. Giving Hope and Changing Lives

3 Findings from the Arrestee Drug Abuse Monitoring (ADAM II) Program (Office of National Drug Control Policy, 2010) 56% to 82% tested positive for at least one drug 12% to 28% tested positive for multiple drugs 78% to 93% reported at least one prior arrest 1% to 10% received outpatient substance abuse treatment during the past year 2% to 10% received inpatient substance abuse treatment during the past year Giving Hope and Changing Lives

4 What are drug courts? In an attempt to manage large dockets that contained an overwhelming number of drug cases, the first drug court began in 1989 in Dade County (Miami), Florida There are currently 2,734 drug courts and 1,122 other specialized problem solving courts operating throughout the U.S. and U.S. territories (National Association of Drug Court Professionals, 2014)

5 Drug Court Staff Drug Testing Agencies Case Management Sessions Drug Court Logic Model Inputs Outputs Outcomes Total case management sessions Short Medium Long (Cognitive & Social) (Behavioral) Increased motivation to change Maintain Employment Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) Meetings Substance Abuse Education and Counseling Agencies Funding Location Drug Court Sessions Drug Tests AA and NA Meetings Substance Abuse Education and Counseling Total drug court sessions Total drug tests Total meetings Total education and counseling completed Increased knowledge on substance abuse and recovery Improved peer relationships Improved family relationships Reduced drug and alcohol use Earn at least a high school diploma or G.E.D. Reduced criminal recidivism rate for arrestees who have a history of substance abuse

6 Summary of the Literature Drug courts appears to be effective at reducing criminal recidivism; however, studies suggest that racial disparities exist in drug court outcomes. (Gallagher, 2013a, Marlowe, 2012) In a California drug court, for example, 68.9% of Caucasian drug court participants graduated, whereas only 42.1% of Hispanic and 31.6% of African American participants completed the program. (Sechrest & Shicor, 2001)

7 Summary of the Literature The drug court literature consists predominately of program evaluations using quantitative methods to predict graduation and recidivism outcomes. Studies using qualitative methods to evaluate drug courts are less common, and no studies were located that used qualitative methods to explore the factors that may contribute to racial disparities in drug court outcomes. Research completed by my colleagues and I (Gallagher, 2013b, Gallagher, Nordberg, & Kennard, in press) contributes to the drug court literature by using qualitative methods to explore the factors that may contribute to racial disparities in drug court outcomes.

8 Research Question (Texas) How do drug court participants from historically disadvantaged groups view the program, in regards to the most helpful aspects of the program, how the program can be more helpful, the challenges they face to participating in the program, and how the program can be improved?

9 Graduation Rates (Texas) Giving Hope and Changing Lives

10 1) What aspects of the drug court are most helpful to you? Supportive drug court team One day I was mad about something and my case manager looked at me and I could tell she cared, it was real, it was beyond doing her job. I forget what I was on sanctions for, but she cared, nothing counterfeit about it. It s not always business, she s real with me. Random drug testing system The drug testing is the most helpful aspect of the program, it keeps you on your toes. I haven t been clean and sober for 2 years so the drug testing works. You ll find ways to beat the drug testing if you have set days, the random system works. Some people don t get there drug tests sent to the lab, all drug tests should go to the lab. Randomly lab a drug test once a week, the in-house drug tests are easy to beat, but I fear the lab. Giving Hope and Changing Lives

11 2) How can the drug court be more helpful to you? Individualized treatment I wish the program saw participants as individuals and did not lump everyone's background together. There are some ways to motivate individuals and other ways to not motivate individuals. The case managers need more discretion; they need wiggle room to develop case plans more specific to the client. Resources for employment Don t require AA (Alcoholics Anonymous) and NA (Narcotics Anonymous) meetings, a job is more helpful than hearing about people s drug problems. A job provides me structure. Other participants shared that the program could be more helpful by helping them learn how to manage a job and do all the requirements of the program and by offering referrals to employers that hire people with a felony arrest. Giving Hope and Changing Lives

12 3) What challenges are you facing to participating in the drug court? Resiliency (refused to identify challenges or make excuses) I make my own challenges and I refuse to make the program harder than it is. I want to be the first man in my family to achieve something. If I can t be a police officer, I will do something else. I want to make my grandparents proud. I want to do something positive. My parents were not great role models; they were into drugs and guns. I grew up in the projects where there was nothing but drugs and guns; we slept on the ground at night because of gunfire...we tend to adapt to our culture. I will not adapt. I will change for my children. I will rise above it. My kids are my motivation. I need to be a better person for them. I am strong. I won t get high. All I know is drugs. My uncle used crack, my mom used coke, my whole family smokes pot. I am strong. I won t get high. I love my girl, she wants a man so I don t want to run the streets anymore. Before my daddy died, he said he wants me to get my G.E.D. so I am going to get it. Giving Hope and Changing Lives

13 4) How could the drug court be improved? Dissatisfaction with AA and NA meetings In my culture, you don t talk about your personal problems in public. At these AA and NA meetings these people are talking about how they were abused as a child and how they tried to kill themselves. I can t relate. I have problems but I don t share them there, I share them with my family. Lack of representation of African American and Latino participants When I walk into court, all I see is White people and a few Hispanics. I like to see other black people. Black people like to see other black people. I sometimes talk with the black guys who are always on sanctions and I told them, stop making excuses, do the f*****g program. We like being around and hearing from other black people. Have me be a mentor for the other black kids, I know their culture, I know where they are from, I ve been there. Have a one-on-one. I understand, I know there language, I ve been there, I understand what they re saying. There are only a few other Mexicans in this program with me, it is kind of frustrating at times because we hang out together, but the court doesn t really get to know us and what we are about. You could improve the program by getting more Hispanics in the program. People from my neighborhood are always getting arrested so it shouldn t be hard to find them. Giving Hope and Changing Lives

14 Research Question (Indiana) How do drug court participants view the program, in regards to the quality of substance abuse counseling they receive, the supportiveness of the drug court team, the effectiveness of sanctions and incentives, the effectiveness of frequent contact with the Judge, and the effectiveness of frequent and random drug tests?

15 Quality of Substance Abuse Counseling? Need for individual counseling Giving Hope and Changing Lives All of my counseling has been in groups. While I do like the groups, I do not feel that all of my issues are being addressed. I have been diagnosed with PTSD [post traumatic stress disorder] because I was abuse as a kid. I was sexually and physically abused. I want to discuss those issues with the counselor, but I will not discuss those in front of other people. I am not sure why they do not offer individual counseling; I do not feel that I will ever resolve my issues until I meet with a counselor for individual therapy. I probably use drugs because of the abuse. It would be nice to talk with someone on a oneon-one basis.

16 Forced to be an addict or alcoholic The biggest limitation with the counseling is that they force you to say you are an addict or alcoholic, even if you are not. When we check-in at the beginning of group, everyone has to say their name and call themselves an addict or alcoholic. One time, I said I was a user of marijuana and the counselor told me I was in denial and resistant, or something like that, because I did not accept I was an addict. I am not an addict. I use marijuana, and it s illegal, but that does not make me an addict. The counselor spent nearly the entire group having everyone else give me feedback to change my mind. I didn t. I m not going to put a label on me if I don t want to.

17 Counseling more like an AA or NA meeting Giving Hope and Changing Lives Counseling is the same as going to an AA or NA meeting. It is just a bunch of people sitting around complaining about their problems and bitching about the criminal justice system. We are always talking about the 12 steps and told to get a sponsor. We have to show this list each week that proves we are going to [AA or NA] meetings. They spend more time talking about AA than doing counseling. I don t actually know what counseling is supposed to look like, but I have a lot of problems that I want to talk about but there is never time in group. When I brought up once in group that my girl was using drugs, I was told to talk about it at a 12 step meeting because there was not enough time left.

18 Lack of trust of treatment providers Counseling is useless because I do not trust them. When you come in, they tell you to be honest but if you are honest, you will get in trouble. Why would I tell my counselor about a relapse if I know he will call drug court and tell on me? It makes no sense. They give mixed messages. They say be honest, but if you are honest, you get in trouble, it makes no sense to me. If I relapse, I will never talk about it in group. I think some people in drug court never get better and continue to relapse because the judge thinks people are getting good counseling, but actually they are just put into an environment where they are forced to lie.

19 Frequent contact with the judge helpful? Judge as a role model of support She [the judge] gets to know you as a person. She calls you by your name and knows all about you. She knows your history and what is going on in your life. I have been to other courts and they only know you as a case number, and they never talk to you, they always talk directly to your attorney, it's like you re not even there. I look forward to seeing the judge; she cares and wants you to succeed. I want to make her proud of me.

20 Drug court team as supportive? Nonadversarial and compassionate Absolutely, the most important thing is that they know addiction. They are dealing with addicts and alcoholics and get it; they understand the struggles we go through and the challenges we face. I relapsed twice in the program and had a dilute UA [drug test] and they were very understanding. They didn t let me off the hook, I did get a punishment each time, but you could tell that the punishments were designed to help me. They care about us.

21 More face-to-face time with case managers My case manager is very supportive. I once had a family issue and she totally understood and worked with my schedule so I didn't get in trouble with drug court. When I first met her, I was expecting her to be real strict or something like that. But actually, she was very friendly. It is nice to go to her office and vent. I have a lot of drama in my life and it is just nice sometimes to talk with someone that listens. We have a lot to do in drug court. We go to counseling and court a lot, and do a lot of drug tests, but I wish we had more time with our case managers. It would be an extra requirement, but I wouldn't mind sometimes we talk quickly at court, but that is not enough time. I like to talk in her office face-to-face.

22 Sanctions and incentives given appropriately? Do sanctions first The court should start each time with sanctions. Sanctions should be moved to the beginning of court, before 'head of the class'. People in 'head of the class' probably won t want that because they want to leave early, but seeing others in trouble with the judge is a good thing for me. When I see people on sanctions, I think to myself that I never want to be up there in front of the judge. It reminds me that I am one bad decision away from going to jail.

23 Sanctions and incentives not equivalent Sanctions and incentives are not equal. I could get a dirty UA [drug test] and go to jail for the weekend, but if I do really good, I only get a gift card. Going to jail and a gift card is not the same. I appreciate the gift card, but it would be better if they gave you money for an incentive. Not actual cash, but maybe they could say if you do good this week, your drug test is free or we will take five bucks off your bill. Money is a good incentive to people.

24 Drug testing system effective? Alcohol use early in drug court The drug tests are good at getting people to not use illegal drugs, but we still use alcohol. The tests for alcohol are easy to beat because alcohol is in and out of your system quickly, it does not stay in your body for 4 or 5 days like other drugs. But I think the drug testing system works because we stopped using drugs. For me, heroin was the problem, not alcohol. When I have a craving for heroin now, I just use alcohol and that seems to work.

25 Cognitive changes related to illicit drug use I never wanted to stop getting high. That was all I knew, was wake up in the morning, get my fix and go on with my day. I was pissed when I got arrested and found out that I couldn t use drugs any more, even beer. I did all the drug tests only because I didn t want to go to jail. I tried to hang around my friends, but that didn t work because they all still get high and I was tempted. After a while, my thinking just changed. I was like, this ain t that bad, I can do this. If I was never forced to stop using drugs, I never would quit. Now, I don t even think about getting high that much. I spend more time thinking about how my life is good, how my life has improved, how my relationship with my daughter is better. So, yes, I think the drug testing system they have works. It does something to your thinking, in a positive way.

26 Factors that may contribute to racial disparities in drug court outcomes: Participants dissatisfaction with being mandated to attend AA and NA meetings, and belief that the format of AA and NA is not consistent with their culture; Participants perceptions that they were not offered enough resources to gain and maintain employment; Participants views that they were not receiving individualized treatment from drug court case managers;

27 Factors that may contribute to racial disparities in drug court outcomes: Participants beliefs that they can relate better to individuals from their same ethnicity; however, they did not have ample opportunities to develop these relationships because minority participants are underrepresented in some programs. Participants felt that they were not receiving effective substance abuse counseling, did not trust treatment providers, and did not value being forced to say they are an addict or alcoholic.

28 Social Policy Implications (see Gallagher, 2012) What is House Bill 530? A Texas state law that.. House Bill 530 states that drug court can charge a reasonable admission fee not to exceed $1,000, and the state law does not require drug courts to offer scholarships. Recommend developing a formal application process for scholarships. Some participants from my studies felt that the drug court was underrepresented with African Americans and Latinos simply because it cost more than probation or jail. Advocate for specific guidelines as to what drug courts can charge, and require drug courts to offer scholarships. Clearly establishing an admission fee and scholarship options may increase participation of individuals from lower socioeconomic backgrounds, some of which may be from historically disadvantaged groups. Giving Hope and Changing Lives

29 Social Policy Implications (see Gallagher, 2012) House Bill 530 does not have guidelines to assure that culturally competent, evidence-based interventions are being offered in drug courts. Some studies have found that drug court participants are not always receiving substance abuse treatments that were consistent with evidence-based practices. For example, in an evaluation of the Baltimore, Maryland drug court, only 51.8% of the treatment received by drug court participants was certified through the state. Advocate for future amendments to House Bill 530 that require drug courts to refer participants to licensed treatment providers. Giving Hope and Changing Lives

30 Practice Implications Being employed is, perhaps, the most predictive variable of successful drug court outcomes. It is recommended that drug court professionals familiarize themselves with employment options within their community, and invite employers to become part of the multidisciplinary judicial team. Participants felt that the drug court could be more helpful by referring them to employers that hire individuals with a felony arrest and by assisting them in managing employment with the demands of drug court.

31 Revisiting the format of substance abuse counseling Drug court participants had unfavorable views towards the quality of substance abuse counseling they were receiving. It is imperative to consider the views of participants, as this is the way they perceive their counseling. A National Drug Court Institute (NDCI) publication offers guidelines to the most effective methods to treat substance use disorders within drug court settings. The authors state, Group counseling has not been shown to be effective and yet group counseling is a staple of most addiction programs. Programs that offer only group counseling and not individual counseling should be considered carefully prior to referral. (Hardin & Kushner, 2008, p. 19). It is recommended that counseling programs offer drug court participants the option of individual counseling, or a combination of group and individual therapy.

32 Thank you! John Gallagher Indiana University School of Social Work Giving Hope and Changing Lives

33 References Gallagher, J. R. (2012). A policy analysis framework for drug courts. Southwest Journal of Criminal Justice, 8, Gallagher, J. R. (2013a). Drug court graduation rates: Implications for policy advocacy and future research. Alcoholism Treatment Quarterly, 31, Gallagher, J. R. (2013b). African American participants views on racial disparities in drug court outcomes. Journal of Social Work Practice in the Addictions, 13, Gallagher, J. R., Nordberg, A., & Kennard, T. (in press). A qualitative study assessing the effectiveness of the key components of drug court. Alcoholism Treatment Quarterly. Hardin, C., & Kushner, J. N. (2008). Quality improvement for drug courts: Evidence-based practices. Alexandria, VA: National Drug Court Institute. Marlowe, D. B. (2012). Achieving racial and ethnic fairness in drug courts. Court Review, 49, National Association of Drug Court Professionals. (2014). About NADCP. Retrieved from Office of National Drug Control Policy. (2010). Adam II 2009 annual report. Retrieved from Sechrest, D. K., & Shicor, D. (2001). Determinants of graduation from a day treatment drug court in California: A preliminary study. Journal of Drug Issues, 31, Giving Hope and Changing Lives