Drug courts aim to broaden their scope

There are about 3,000 drug courts in the United States, and as the number of courts increases, experts are recommending that the models become broader in scope as well as more nuanced in their interactions with program participants. A number of professionals offered ideas on best practices at the annual meeting of the National Association of Drug Court Professionals (NADCP) in Washington, D.C., this week.

For example, Dan Griffin, MA, behavioral healthcare author and educator, discussed trauma and its effect on men in particular. Often, the rules of recovery fundamentally conflict with the messages men have heard all their lives, making recovery inherently more difficult. If men are conditioned societally to be stoic and to never allow themselves to cry or be emotional, they are less likely to be successful in treatment modalities that call for vulnerability or personal examination.

"When we help men see that, as providers, as courts, we reframe behavior and use that information to do things differently and give them new tools for recovery," Griffin said.

The main reason why men hold on to the old beliefs is to ensure their feelings of safety, he said. Griffin recommends participants in treatment write out new “rules of recovery” and keep them handy for reference. Allowing themselves to get emotional might be one new rule that helps men move forward toward program graduation.

More than 1 million people have graduated from drug courts nationwide, according to NADCP.

Warm turkey is okay

Brian Meyer, PhD, an addiction specialist at McGuire VA Medical Center, challenged drug court professionals to rethink their models to avoid mistakes. For example, Meyer noted that offenders who go straight to jail might experience immediate detox by virtue of their location, but those in drug court programs should have the benefit of a more nuanced approach.

“The goal is always abstinence, but the trouble is asking them to get there immediately,” Meyer said.

In fact, sudden abstinence in the case of alcohol misuse can be dangerous, putting participants at risk of stroke and other serious or life-threatening conditions, and Meyer believes “courts can contribute to that malpractice.”

Instead, he recommends what he calls the “warm turkey” approach, allowing for a transition time of harm reduction where a participant might aim to experiment with his or her own ideas for reducing substance use, perhaps cutting down the number of days a substance is used or cutting down the amount by 50% each time. For those with polysubstance use, cutting out one substance at a time allows a more gradual path to abstinence.

Meyer said addressing pain and insomnia right from the intake also will help people reduce their reliance on drugs or alcohol and set them up for better outcomes in the program.

Hiding places

Helen Harberts, a retired parole officer and founder of the Butte County Adult Drug Court in California, shared her insight on the clever ways that people in court programs might hide alcohol when faced with an unannounced home visit. Keeping an eye out for such items can help any professional address the reality of a participant’s homelife.

Some of the hiding places for alcohol include:

• Hollow neckties and hairbrushes;
• Sports bras with liquid pouches;
• Small cylinder flasks that are packaged to look like tampons;
• Ice packs; and
• Rigged-up automobile windshield-washer systems.

“You must do the field work to know your client,” Harberts said.

She also recommended giving praise often to keep the participant’s motivation on the upswing. Just hanging on one more day is a reason to offer positive feedback, she said.