Start Here by Greg Berman

Author:Greg Berman
Language: eng
Format: epub
ISBN: 9781620972243
Publisher: The New Press
Published: 2018-05-07T04:00:00+00:00

Fifteen years ago, the mental health side would say, well, they have a substance abuse issue. When they get cured of their substance abuse issue, then we will treat them because it makes no sense to try to treat them while they are addicted to substance and vice versa. The substance abuse people would then say, well, they have a mental health issue. They need to be in long-term treatment for their mental health issue before they become stabilized enough to deal with their substance abuse issue. It’s a complete chicken and egg [problem].

In recent years, drug courts have begun to grapple with the reality that many of their participants are dealing with serious mental health issues and histories of trauma. Judges are being trained to recognize the common signs of trauma—such as agitation, anxiety, distrust, defiance, and hostility—and understand them as coping strategies rather than character flaws. Communicating with defendants clearly and respectfully and taking an individualized approach to each case are small adjustments that judges can make to create a courtroom environment that trauma survivors will perceive as physically and emotionally safe.23

The focus extends to formal treatment as well. Even something as simple as asking the right questions in the right order during an eligibility screening can make an appreciable difference. Historically, drug court screening and assessment practices were narrowly focused on drug use. But individuals often start using drugs as an attempt to self-medicate or cope with a particularly trying situation. Asking a more nuanced set of questions can help clinicians uncover these kinds of connections. “Just the initial juxtaposition of questions like ‘How much heroin are you using?’ and ‘Were you ever the victim of a crime?’ starts catalyzing change,” explains Victoria Dexter, of the Safe Horizon Counseling Center in Brooklyn, New York. “By up-fronting questions like that, it really is a trauma-informed approach.”24

But perhaps the most important needed adjustment to the drug court model is increased clarity about the populations they are best suited to serve. Particularly in the early days of drug courts, there was a tendency to “cream” participants, selecting only those defendants with stable homes, supportive families, and relatively brief addiction histories. But, as we’ve seen, the latest research suggests that intensive interventions like drug courts are most effective when they target high-risk participants. Drug courts in New Hampshire have learned this lesson well. “We primarily accept high-risk, high-need people,” explains Alex Casale, the statewide drug court coordinator. “That’s the target population. All the drug courts now know that.”25

New Hampshire’s response isn’t unusual. According to researcher Douglas B. Marlowe, of the National Association of Drug Court Professionals, drug courts have “embraced science like no other criminal justice program. They endorsed best practices and evidence-based practices; invited evaluators to measure their outcomes; and encouraged federal agencies . . . as well as a myriad of state agencies, to issue calls to the scientific community to closely examine the model and learn what makes it tick and how it might be improved.”26

If drug courts

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