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Sunday, December 22, 2013

The "Unbroken" Scioto County Drug Court -- Who Suffers the Perceived Perfection?




I am critical of the Scioto Drug Court and the decision of Judge Marshall to turn down the State of Ohio's offer of a $1 million grant as its share of $5 million from House Bill 59. The judge used this philosophy to defend his decision: "His drug court is not broken, so there is no need to fix it."

Let me have an entry to defend my position.

In 2011, the National Institute of Justice (NIJ) and a team of researchers from The Urban Institute’s Justice Policy Center, RTI International, and the Center for Court Innovation completed a five-year longitudinal process, impact and cost evaluation of adult Drug Courts. 

The Multisite Adult Drug Court Evaluation (MADCE) compared the services and outcomes in twenty-three adult Drug Courts from seven regions in the U.S. against those of six comparison sites in four regions. The comparison sites administered diverse programs for drug-involved offenders, including Treatment Alternatives for Safer Communities (TASC), Breaking the Cycle (BTC), and standard court-referred, probation-monitored treatment.

Offender-level data were obtained from 1,157 Drug Court participants and 627 comparison offenders who were carefully matched to the Drug Court participants on a range of variables that influenced outcomes.

(Shelli Rossman, M.A. and Janine M. Zweig, Ph.D. "The Multisite Adult Drug Court Evaluation." National Association of Drug Court Professionals. May 2012)

First of all, the evaluation found that drug court participants were significantly less likely than the matched comparison offenders to relapse to drug use, and those who did relapse used drugs
significantly less.

In addition, the study found that participants in drug courts reaped psychosocial benefits in areas of their lives other than drug use and criminal behavior. Drug court participants reported significantly less family conflict than the comparison offenders at eighteen months. 

Drug court participants were also more likely than the comparison offenders to be enrolled in school at six months and needed less assistance with employment, educational services, or financial issues at eighteen months.

The largest cost benefits were achieved by reducing serious offending on the part of a relatively small subset of the drug court participants. Drug courts are potentially cost-effective. On average, the drug courts in the study returned net economic benefits to their local communities of approximately $2 for every $1 invested; however, this did not represent a statistically significant improvement over the comparison programs. (Please note the selection process as it pertains to great cost effectiveness in the "Recommendations" below.)



Recommendations of the Study

* "The absence of statistical significance may have been influenced by the nature of the target populations. Many of the Drug Courts in the MADCE reduced low-level criminal offenses that are typically not associated with high incarceration or victimization costs. 

"This suggests drug courts will need to target more serious offenders to reap significant cost benefits for their communities."

* "Government agencies should continue to spend resources funding drug court programs. They should sponsor training and technical assistance to encourage the implementation of evidence-based practices and to ensure Drug Courts target the most appropriate offender populations for their programs."

* "Providing substance abuse treatment is integral to the Drug Court model. Drug courts that offer treatments of short duration may not allow participants sufficient time to tackle their substance use
problems and alter their attitudes and behaviors accordingly. 

"Treatment must be of sufficient length and dosage to achieve sustained success. Drug courts work, so ensure provisions are made to fund their continued existence."

* "It takes innovation, teamwork and strong judicial leadership to achieve success when addressing drug-using offenders in a community.

* "Drug courts work, so ensure provisions are made to fund their continued existence. The research evidence clearly establishes the effectiveness and potential cost-effectiveness of drug courts.
 

"Government agencies should continue to spend resources funding drug court programs. They should sponsor training and technical assistance to encourage the implementation of evidence-based practices and to ensure Drug Courts target the most appropriate offender populations for their programs."

* "Drug courts should avoid suitability determinations. Drug court teams are not very successful at predicting who will succeed in their program. Therefore, they should avoid allowing entry only to offenders they believe will be better suited to the services. Drug courts achieve higher reductions in recidivism and greater cost savings when they treat high-risk, prison-bound populations. 

"As a condition of public sponsorship, federal funders and local policymakers should require drug courts to expand their eligibility criteria to include more serious offenders."
 



Taking the Grant

Our money is spent to insure drug courts work. I believe they do work: the courts are relatively cost-efficient solutions to lowering the relapse of drug abuse. They also encourage participants to continue educational and employment endeavors.

The point is: Drug courts should and must work better. Consider the recommendations of the extensive research and let me explain why even controversial, expensive Vivitrol may help, especially since a large grant would fund its existence in the Scioto County Drug Court.

1. Drug courts should target more serious offenders. It is obvious many serious offenders with severe drug dependency exist in our county. The general public opinion is that these criminals must pay stiff sentences for their crimes. I believe that too: I have talked with so many parents who have lost loved ones to drug abuse who wish they had been educated in the value of "tough love." Jail has a positive punishment effect for some. But, it lacks tremendously in rehabilitating inmates, especially those who are addicts.

New factors have emerged that require consideration. The correctional population has expanded more than 4.5 fold between 1978 and 2004—from 1.5 million to almost 7 million as a result of tougher sentencing laws and the war on drugs.

 (Bureau of Justice Statistics (BJS). 1997. Human Rights Watch (HRW) 2003. M. Jacobson. Downsizing Prisons: How to Reduce Crime and End Mass Incarceration. 2005)

Let's face it -- serious offenders are often addicts, and many of them have mental disabilities due to a variety of issues. Should we deny these offenders treatment for mental issues while incarcerated? If not, why would we deny those who may benefit from Vivitrol the opportunity to become sober?

Nothing -- prison, counseling, education, religion, treatment drugs -- works every time to cure an addict. If limited counseling and monitoring of traditional drug courts convert serious offenders without other needed treatments, then drug courts would have better success rates. Vivitrol, given with expert diagnosis and under proper control, can save lives. Serious offenders need more help.

Overall, three of four state prisoners and four of five federal prisoners are characterized as alcohol- or drug-involved offenders, according to a BJS report. Mental health problems? “Prisons are the largest mental health institutions in our country,” stated Darrel A. Reiger, M.D., M.P.H., deputy medical director of the American Psychiatric Association. Six in 10 mentally ill prisoners received treatment while incarcerated in a state or federal prison. Only 4 in 10 in local jails received treatment.

The truth is, as a society. we have no clear mandate for our prisons: we expect next to nothing, and, in most cases, they deliver what is expected. If prisons and jails do not want to use every means available to rehabilitate inmates, what is the real goal of incarceration? America has the highest rate of incarceration in the world.


2. Government agencies should continue to spend resources funding drug court programs. The $1 million grant was available and Scioto County said "no." In essence, the drug court denied the implementation of an evidence-based practice. Vivitrol has shown great promise for alcoholism and opioid dependency when combined with psychosocial therapy.

"Recent research published by the Journal of Addiction Medicine shows little difference between support groups receiving counseling alone and those receiving Vivitrol, dispelling the fears that medicine to treat alcohol dependence discourages client participation in therapy or support groups. Six hundred patients were involved in the study. Of the 600 participants, some were given the injections of 380 mg of Vivitrol, 190 mg Vivitrol while others were given a placebo as well as 12 sessions of psychosocial therapy. The data not only showed a greater percentage of Vivitrol patients attending all sessions as opposed to the placebo group, but it also showed the higher Vivitrol group had improved drinking outcomes. According to the research, 'This data provide the first systematic assessment of the impact of pharmacotherapy on participation in psychosocial therapy.'"

(Cisler, Ron A. PhD; Silverman, Bernard L. MD; Gromov, Irina MD, PhD; Gastfriend, David R. MD. "Impact of Treatment With Intramuscular, Injectable, Extended-Release Naltrexone on Counseling and Support Group Participation in Patients With Alcohol Dependence." 
Journal of Addiction Medicine. Volume 4, September 2010)

"'Robust data from an Alkermes extension study confirms vivitrol's efficacy and safety profile over an 18-month period and support its clinical utility as a treatment option for opioid dependence, following opioid detoxification,' stated Evgeny Krupitsky, M.D., Ph.D., Professor of Psychiatry, St. Petersburg State Pavlov Medical University and Head of the Department of Addictions at the Bekhterev Research Psychoneurological Institute. 'Vivitrol is the first and only once-monthly medication that offers patients and physicians a non-narcotic treatment option to help fight this challenging disease.'"

 ("Positive Results From Alkermes Vivitrol Addiction Study." 
news-medical.net. November 10, 2011)
 
The National Institute on Drug Abuse is continuing to support research on Vivitrol's effectiveness in this country, including a focus on criminal justice involved populations transitioning back into the community. This is an especially vulnerable period, associated with a high risk of relapse, overdose, and re-arrest.
 (Nora D. Volkow, M.D., Director. "Important Treatment Advances for Addiction to Heroin and Other Opiates." The National Institute on Drug Abuse. October 2010)



3. Drug courts must fund their continued existence. Where in the State of Ohio or where in the nation, for that matter, does unbridled poverty persist? It exists in Appalachia. Scioto County is in Appalachia and it the unhealthiest area in the State. It is also among the most impoverished and least healthiest parts of the United States. We should take available funding. 

Here are the 2009 Census Poverty Levels for Scioto County and a comparision with Ohio and the United States:

 <18 years of age in poverty: Scioto County 33.9%   Ohio 21.6%   U.S. 20.0%

All ages in poverty: Scioto County 23.5%  Ohio 15.1%  U.S. 14.3

 (Federal Poverty Level as issued by the U.S. Department of Health and Human Services, 
and published in the Federal Register.)

The Rate of Dependency on Income Supports is the total amount of income support provided by taxpayer dollars (e.g. Retirement and Disability payments, Unemployment Compensation, Worker's Compensation, TANF, SSI, etc.) divided by total personal income. (Note: Ranking based on highest (1) Rate of Dependency to lowest (88) Rate of Dependency.

The Rate of Dependency on Income Supports is 35.3% in Scioto County. The county ranks 3rd (of 88 counties) in Ohio for the highest rate.


4. Traditional, inattentive, indifferent, and ignorant wishful thinking patterns have contributed most to the problems faced by Scioto County. The prescription drug epidemic, the pill mill congregation, the high crime rate, the unbelievable rate of babies born addicted to substances, the inexcusable deaths of youth related to opiate addiction and overdose, the decay of business, the high rate of unemployment, the skyrocketing number of mental health patients, and now the increased introduction of heroin dependency and addiction have happened because we, in Scioto County, slept through taking proactive measures.


Hell, I taught high school students for decades and I am guilty of not "seeing" the advance of the flood. Of course, now I, like the rest of Scioto Countians, am responsible for my environment. I am ashamed to say for a period of time I was content to let fate and the Scioto County defeated mentality rule my mind.

I believe in education and in change. Stagnation and "mine is good enough" are not attitudes I support. As far as what is "broken," in my eyes, the county is "broken" when we look a gifted horse in the mouth. Pardon the cliche.

After being elected, Governor Kasich came to Portsmouth to begin his war on drug abuse. He led a wonderful assembly gathered at the Counseling Center and began his speech by saying "the devil is loose" in Scioto County. He pledged his utmost help but only with the full support of the citizenry. I was there at the meeting along with politicians, judges, enforcement officials, health officials, city government leaders, and others. The air was electric -- everyone vowed to fight the evil in our county.

I have taken steps to activate myself and help correct some of the problems. I have had great zeal and also times when I thought it best to step away. But, despite my periods of "getting pissed at stopgap actions" and walking away for a time to gather a new perspective, I want to see a new, better home ground. With "good old boy" control and "business as usual" attitude, little will change.

I have attended memorial services, training exercises, task force meetings, protests, town hall discussions, and searches for missing people. I have listened and been educated from various points of view. I understand one thing that never wavers in discussion. Those who know the problem of addiction and work the hardest to defeat it always agree.

I have heard them state this over and over: "One life saved can start a new direction and a new beginning. ONE LIFE. Saving one life is the answer every time." We must never diminish this attitude, whether that ONE LIFE is an addict, a criminal, or someone considered refuse. We must not judge the value of another human being.

I do not support the inactivity of those who would deny a person in need a chance for living. And, who knows how productive that life may become once saved? What works and doesn't work for addicts -- whether the substance abused is alcohol, heroin, or prescription drugs? I sincerely believe it depends upon the person who is addicted.

The Governor offered the money for Scioto Drug Court to expand its role and save that ONE LIFE. If the drug court is not "broken" in some manner, I would like to understand how certain problems persist. It is up to us to strengthen the status quo, not be satisfied with marginal success. I am sure denial of the funding was an "educated" decision. I am not sure who or how the education was conducted. And, I am damn not sure of WHY.

I must end by confessing that I am "broken" in definite ways, and I do rely upon professionals employing clinically-based procedures and medications to provide my "normal" existence. I am a victim of a mental disease and a few physical problems. I have learned through experience not to be adverse to new treatments. If that makes me an addict, and, in a way I think it does, I confess I am dependent upon these substances for my perceived benefit. I hate to be considered irreparable but I also wish health clinicians could find something better for others like me in order that they could avoid clinical depression.


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