After viewing the module video, review the list of readings for this module. This list contains articles on Participant experiences in legal system interventions for SUDDiversion options for people ex
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After viewing the module video, review the list of readings for this module. This list contains articles on
- Participant experiences in legal system interventions for SUD
- Diversion options for people experiencing SUD
- Drug Court programs and options
- Civil commitment for substance use
Note that some readings may pertain to more than one topic.
, select two articles from the list of readings that pertain to one of these topics. After reading both articles, summarize them for your peers, making sure to note any disagreements in their authors’ perspectives, unanswered questions, or recommendations made.
After viewing the module video, review the list of readings for this module. This list contains articles on Participant experiences in legal system interventions for SUDDiversion options for people ex
A behind-the-scenes perspective on the key components of drug court: A narrative analysis John R. Gallagher a, Anne Nordberg b, Sydney Szymanowski c, and Steven E. Malone d aSchool of Social Work, Indiana University South Bend (IUSB), South Bend, Indiana, USA; bSchool of Social Work, Research Associate, Center for African American Studies, University of Texas at Arlington, Arlington, Texas, USA; cSchool of Social Work, Indiana University South Bend (IUSB), South Bend, Indiana, USA; dProblem Solving Court Director, Monroe County (Indiana) Drug Court, Bloomington, Indiana, USA ABSTRACTDrug courts continue to expand throughout the United States; however,little is known about participants ’lived experiences in the program, particularly as it relates to the key components of the drug courtmodel. Fifteen participants of the Monroe County (Indiana) drug court completed surveys where they answered ﬁve open-ended questions related to key components of the drug court model. Participants reported mixed feelings related to the quality of counseling they received, and some felt that their individualized treatment needs were not being met. Overall, participants viewed the drug court team as supportive, and they felt that praise from the judge was one of the most helpful incentives they received. Some participants noted that thefrequent and random drug testing system deterred them from using drugs and resulted in positive, cognitive changes that supported their recovery. The most common challenges associated with frequent and random drug testing were that some participants thought that it was too expensive and time-consuming which they felt could delay theirprogress in the program, or even their graduation. The ﬁndings are discussed in reference to drug court practice. KEYWORDSCounseling; drug court; narrative analysis; substanceuse disorder; qualitativeresearch Introduction Substance use disorder (SUD) is a complex disease that can negatively impact many areas of an individual ’s life, including employment, family relationships, physical and mental health, and overall well-being. The most devastating consequences of SUD are drug overdoses and premature deaths. SUD has behavioral, cognitive, and physiological symptoms. Hallmark symptoms of a severe SUD include developing a tolerance where an individual needs a higher dose of a drug to achieve the desired e ﬀects, experiencing withdrawal symptoms when attempting to discontinue or reduce drug use, and continuing to use drugs despite experien- cing negative consequences (American Psychiatric Association, 2013 ). An individual could have a SUD related to a variety of drugs, such as illicit drugs (e.g. heroin, cocaine), prescription drugs (e.g. hydrocodone, alprazolam), alcohol, tobacco, and cannabis (e.g. marijuana). According to the Substance Abuse and Mental Health Services Administration [SAMHSA] ( 2018 ), it is estimated that 19.7 million Americans met the diagnostic criteria for a SUD in 2017, and the most common were alcohol, cannabis, and opioid use CONTACT John R. Gallagher [email protected] Indiana University South Bend (IUSB), Wiekamp Hall 2221, 1800 Mishawaka Ave., PO Box 7111, South Bend, IN 46634-7111 JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT2019, VOL. 29, NO. 7, 909 –921 https://doi.org/10.1080/10911359.2019.1635550 © 2019 Taylor & Francis Group, LLC disorders. SUD is often co-occurring with mental illnesses, such as depression, which adds additional complexities to developing e ﬀective, individualized treatment plans that pro- mote recovery. Additionally, it is not surprising that individuals involved in the criminal justice system commonly have SUDs, considering 11.2% of Americans (aged 12 or older) reported recent illicit drug use and approximately 25% of 18 to 25 year olds reported current illicit drug use (SAMHSA, 2018 ). These data highlight the need for ongoing collaboration between criminal justice and SUD treatment providers. For the past 30 years, drug courts have played a key role in treating SUDs in the criminal justice system. The ﬁrst drug court, introduced in 1989 in Miami, Florida (Nolan, 2001 ), recognized that traditional, punitive-centered approaches to processing drug possession charges did not eﬀectively treat individuals who root cause of their criminal o ﬀense was personal drug use. Thus, the Miami drug court diverted people before the court away from the traditional judicial route and into the court-centered, rehabilitative treatment paradigm (Schneider, Bloom, & Hereema, 2007 ; Slinger & Roesch, 2010 ). By accepting this diversion, drug court participants agreed to plead guilty, remain drug-free, participate in periodic drug testing, follow treatment recommendations, and report to drug court for supervision (Wexler & Winick, 1996 ). Assessments reported recidivism rates of 32% among drug court graduates compared with 48% to 55% among comparison groups (Goldkamp, 1994 ). There is much evidence that upholds Goldkamp ’s( 1994 ) promising results regarding recidivism rates, including a large- scale federal government study (U.S. Government Accountability O ﬃce, 2005 ) and several meta-analyses and systematic reviews (Lowenkamp, Holsinger, & Latessa, 2005 ;Mitchell, Wilson, Eggers, & MacKenzie, 2012 ; Wilson, Mitchell, & MacKenzie, 2006 ). As drug courts expanded throughout the United States, as well as internationally, there was a need to provide guidance for creating new drug courts and to promote model ﬁdelity. Therefore, in 1997 the 10 key components of drug court were articulated by the National Association of Drug Court Professionals (NADCP, 2004 ). Since their publication, the key components have been the focus of both quantitative and qualitative investiga- tions. Quantitatively, Goldkamp, White, and Robinson ( 2001 ) reported that appearance before the judge, sanctions, and treatment positively impacted likelihood for re-arrest and likelihood of graduation. Hiller et al. ( 2010 ) developed a self-report instrument to oper- ationalize the 10 key components. They sampled 141 drug court administrators nationally to identify subscales for comparative purposes. Though relevant for drug court structure and organization, they could not identify which of the key components were important for positive drug court outcomes from a client point of view (Hiller et al., 2010 ). Their work helped identify a gap in the literature best ﬁlled by qualitative approaches. Speci ﬁcally, there is a need to develop an in-depth understanding of drug courts from participants ’ perspectives. There is a small, but growing, number of drug court studies that employ qualitative methods, singly or as part of a mixed methods design (Bou ﬀard & Taxman, 2004 ; Gallagher, 2013 ; McPherson & Sauder, 2013 ; Wolfer & Roberts, 2008 ). For example, Wolfer ( 2006 ) analyzed 55 exit interviews and found that program structure and urine drug testing were bene ﬁcial aspects of the program, according to drug court graduates. Lindquist, Krebs, and Lattimore ( 2006 ) qualitatively compared the sanctions and rewards of ﬁve drug courts in comparison with traditional court. They found that, although higher in number, sanctions imposed in drug courts compared to traditional courts were more 910 J. R. GALLAGHER ET AL. treatment oriented and more individually attuned. In a multi-drug court study comparing and contrasting common practices of the programs, Carey, Finigan, and Pukstas ( 2008 ) found that the practices of comprehensive training for drug team members and the inclusion of an assigned judge for more than two years were related to reduced criminal recidivism rates and cost savings (Carey et al., 2008 ). Among 11 women graduates of a drug court, Fischer and Geiger ( 2011 ) determined that appropriate sanctions for noncompliance, accurate drug testing, and treatment services with child care facilities increased the women ’s self-e ﬃcacy and con ﬁdence in remaining drug-free. Gallagher ( 2013 ) explored the factors that might contribute to racial disparities in drug court graduation rates. Speci ﬁcally, among African American participants in Texas, he found that sanctions were not always provided in a culturally appropriate manner, which may have negatively impacted graduation rates for African Americans in that court (Gallagher, 2013 ). Gallagher and Nordberg ( 2016 ) found that the support and compassion of the drug court team motivated participants to be successful, though some participants, mostly African American, reported dissatisfaction with the quality of treatment they received for their SUD. Gallagher and Nordberg ( 2017a ) have also explored the experiences of drug court through a gendered lens. Focused exclusively on women ’s experiences in drug court, Gallagher and Nordberg ( 2017a ) found that the drug court team was viewed as compassionate and empathetic, most women reported histories of trauma and suggested that additional trauma-focused care would be helpful, and some women identi ﬁed the unique challenges of being successful in drug court while being a single parent. To our knowledge, the current study is only the second qualitative study to speci ﬁcally explore participants ’thoughts, opinions, and lived experiences related to key components of the drug court model (Gallagher, Nordberg, & Kennard, 2015 ) and the ﬁrst qualitative study to explore the phenomenon with a narrative analysis approach. Gallagher et al. (2015 ) interviewed 41 drug court participants about the e ﬀectiveness of six of the ten key components. Participants reported that frequent contact with the judge and random drug tests were e ﬀective in helping them be successful in drug court (Gallagher et al., 2015 ). Conversely, some participants felt that their experience in drug court would have been improved if they were o ﬀered more individual counseling and were able to develop a trustworthy, therapeutic relationship with key stakeholders, such as their counselors (Gallagher et al., 2015 ). The research question for this study is: How do drug court participants view the program, regarding the quality of substance abuse counseling they receive, the supportiveness of the drug court team, the e ﬀectiveness of sanctions and incentives, the e ﬀectiveness of frequent contact with the judge, and the e ﬀectiveness of frequent and random drug tests? Methodology Participants were recruited from the Monroe County (Indiana) drug court in late 2018. The problem solving court director invited each drug court participant to complete an open-ended survey related to their experiences in drug court. The survey, titled the Drug Court Participant Satisfaction Survey , was developed by the researchers and includes basic demographic questions (e.g. age, sex, race, month and year he or she began drug court) and ﬁve open-ended questions. The ﬁve questions are based on key components of the drug court model. Speci ﬁcally, drug courts are guided by 10 key components (National JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT 911 Association of Drug Court Professionals [NADCP], 2004 ) and drug court participants are directly a ﬀected by 6 of the 10 key components (one, two, four, ﬁve, six, and seven). Key components one and four are similarly focused on substance abuse counseling, so they were combined into one question. The open-ended questions are noted in Table 1 . Each participant was provided with a copy of the survey, encouraged to take it home and answer the questions, and return it at their earliest convenience. To assure anonymity and con ﬁdentiality, the surveys did not include names and were returned in a sealed, blank envelope. Only the researchers doing the data analysis had access to the completed surveys; no member of the drug court team viewed the completed surveys. 15 drug court participants completed surveys. No incentive was provided to those who chose to participant in this study. A narrative analysis of the answers provided on the satisfaction surveys was completed. Narrative analysis was an e ﬀective 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, 2016 ). Narrative analysis is also designed to capture the behind-the-scenes aspects of participants and their role in a particular pro- gram, such as drug court (Padgett, 2016 ). This data analysis was also guided by phenom- enology. According to Padgett ( 2016 ), phenomenology is recommended when you have a research sample with similar characteristics, such as being a participant in drug court and having a substance use disorder, 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 11 for analysis. The data analysis followed a three-step process, as suggested by Miles, Huberman, and Saldana (2014 ) and Padgett ( 2016 ). First, consistent with narrative analysis, and to promote immersion in the data, the researchers read all of the data on three occasions during a two-week period. During this process, a phenomenological approach was used 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 demonstrated con- sistent responses were identi ﬁed as themes; themes were summarized and conceptualized by extracting direct quotes from participants ’satisfaction surveys. Finally, strategies were used to increase the rigor of the data analysis and validity of the qualitative ﬁndings. First, observer triangulation and interdisciplinary triangulation were used (Padgett, 2016 ). Observer triangulation was used to o ﬀer more than one perspective Table 1. Drug court participant satisfaction survey. (1) Could you please describe your experiences with the strengths and limitations of the substance abuse counseling you receive in drug court? (Key Components 1 and 4) (2) Could you please describe your experiences with whether or not you view the drug court team as being supportive? (Key Component 2) (3) Could you please describe your experiences with whether or not sanctions and incentives are given appropriately in drug court? (Key Component 6) (4) Could you please describe your experiences with whether or not having frequent contact with the judge helps you be successful in the program? (Key Component 7) (5) Could you please describe your experiences with whether or not having frequent and random drug testing helps you be successful in the program? (Key Component 5) 912 J. R. GALLAGHER ET AL. on interpreting the data, with the goal of increasing the objectivity of the ﬁndings. Interdisciplinary triangulation was accomplished by having professionals from four dis- ciplines, anthropology, social work, psychology, and criminal justice, collaborate on the data analysis and ﬁndings, which again o ﬀers another method to increase the objectivity of the ﬁndings and reduce researcher bias. Additionally, peer debrie ﬁng and support were used to assist the researchers in bracketing preconceived thoughts about the phenomenon being evaluated, which is an essential part of phenomenological analysis (Padgett, 2016 ). This was accomplished through consultation with colleagues who have expertise in qualitative research and were not directly involved in this study. The consultations involved o ﬀering colleagues portions of the data analysis to assess the logic of the themes developed. Findings Fifteen drug court participants completed surveys. In regard to sex, 8 were men and 7 were women. Nearly the entire sample identi ﬁed their race as White (14 White and 1 Hispanic). At the time the surveys were completed, the average age of participants was 36 years old, and their average time in drug court was 11 months. Throughout the surveys, a number of major thoughts and experiences were shared consistently among the drug court participants. The ﬁndings are presented in reference to each question asked in the survey. 1. Could you please describe your experiences with the strengths and limitations of the substance abuse counseling you receive in drug court? Please give speci ﬁc examples from your experiences. Overall, participants reported mixed feelings related to the strengths and limitations of the counseling they received while in drug court. Some participants, for instance, reported that counseling was helpful because it addressed both their substance use disorders and mental health symptoms. This is a promising ﬁnding because it is common for individuals who have substance use disorders to also have mental illnesses, such as depression or anxiety, and treating both disorders concurrently is best practice. It appears that some of the agencies and counselors that the Monroe County (Indiana) drug court refers partici- pants to are trained in treating dual diagnoses. It is important to mention, though, that some participants felt that their individualized counseling needs were not being met because all, or the majority of, their counseling was in groups. Some participants did not feel comfortable discussing certain topics, like trauma and relapse, in a group setting. In regard to the strengths of counseling, a male participant who had been in drug court for nearly a year-and-a-half emphasized the importance of treating his substance use disorder and mental illness concurrently. He noted: Before I started the program, I was already in the IOP [intensive outpatient program] group so it was easy for me to continue into the next phases of the program with my counselor. I was able to get the best answers to my concerns and bring up any situations that were bothering me at the time, like dealing with my OCD [obsessive-compulsive disorder]. We talk about staying clean and sober, but also how to manage my mental health and overcome my OCD. My counselor says I have a dual diagnosis, and I know that I drink and use drugs to self-medicate. So, for me, it ’s important to go to counseling where I can discuss my abstinence from drugs and improve my mental health. JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT 913 Similarly, a male participant who had been in drug court for nearly two months reported that he had a history of trauma and counseling was an opportunity for him to treat both his substance use disorder and trauma symptoms. He commented: The strength is that counseling helped me with my past issues related to drugs and trauma, bad things that have happened to me in the past. I learned a lot about trauma and how it’s impacted my behaviors and why I use drugs. The counselors are nice and it’ s a safe place to open up about that kind of stu ﬀ. I never really talked about my past before, but I ’m glad I did. Additionally, a female participant who had been in drug court for approximately 14 months shared how participating in counseling has helped her become more empa- thetic. Speci ﬁcally, she shared: I think that attending group IOP [intensive outpatient program] had some strengths. I was forced to interact with other people struggling with addiction and that made it easier to move into a friendship status as time went on. Stereotypes may exist for a reason, true, but to learn the reason behind a person ’s struggle was key. I thought of myself as a pretty empathetic person prior to this, but I have gained a new respect for the way some people struggle and why. My favorite requirement is AA [alcoholics anonymous]. My life is in ﬁnitely better for all aspects of AA, what I have allowed my life to become based on the experience, strength, and hope I have found in the rooms [of alcoholics anonymous]. As mentioned previously, some participants felt that their individualized treatment needs were being met; however, this was not the consensus for all participants. Actually, some participants felt that a limitation of the counseling they received was that they did not have a private, safe place to process certain topics that were important to their recovery, such as relapse and mental health symptoms related to childhood traumas. While these topics could have been discussed in group counseling, some participants felt most comfortable discussing them in individual counseling. In their experience, however, individual counseling was not o ﬀered or not oﬀered enough to meet their treatment needs. For example, a male who had been in drug court for over a year shared that he preferred individual counseling over group counseling, but the majority of his counseling was in groups. Speci ﬁcally, he noted: The limitation with counseling is that I don ’t enjoy the groups as much as when I meet with my counselor one-on-one. The groups are more generic. They teach us a lot, but don ’t get to the core of why we use drugs and continue to relapse. When I relapsed, I didn ’t bring it up in group because sometimes they look down on you and it’ s just not helpful. The feedback isn’t helpful when you already feel bad for relapsing. We should all be required to do individual counseling because that is where I learn the most. Similarly, a female participant who had been in drug court for over a year also reported that she bene ﬁted most from individual counseling, as compared to group counseling. She stated: The counseling helps me stay sober, treat my addiction, and do what drug court wants me to do, but the limitation is that it doesn ’t cover the whole picture of what’ s going on in my life. I have PTSD [posttraumatic stress disorder] and anxiety because of abuse when I was younger. I don ’t like talking about that with my case manager or judge or even at IOP [intensive outpatient program]. It ’s a private matter, and I wish I could see my counselor more too just help me do better, feel better about myself. 914 J. R. GALLAGHER ET AL. 2. Could you please describe your experiences with whether or not you view the drug court team as being supportive?Please give speciﬁc examples from your experiences. Overall, participants viewed the drug court team as supportive, and they gave examples of supportiveness for multiple team members, including the judge, case managers, attor- neys, and treatment providers. The most common example of supportiveness was the drug court team being ﬂexible with participants ’schedules when situations outside of drug court occurred, such as family emergencies, medical issues and doctor ’s appointments, con ﬂicts with work schedules, and childcare. For example, a male participant who had been in drug court for over a year gave an example of how the drug court team supported him during a family emergency. He noted: Ever since the beginning, the team was very supportive. When I ﬁrst ﬁlled out the documents, everything was very clear and was explained to me clearly. Before I started the program, when I was scheduled as an ‘observer ’, I had a family emergency out of town and I had to take care of it. The team was very supportive and understood the situation, allowing me to take care of the problem and come back to start the process. I had the same experience all throughout the program with other situations and I was able to communicate with the team to look for a solution. Being in this program has taught me that the team really cares about me and wants me to do well. Additionally, a female participant also identi ﬁed the drug court team as supportive, ﬂ exible, and caring when it came to balancing the demands of drug court with the responsibilities of mothering. Speci ﬁcally, she shared: Yes, the team can be very supportive, especially when it comes to my kids. The biggest challenge I face is ﬁnding childcare when I have to go to counseling and seeing the judge and the other stu ﬀin the program. This is the most stressed I have been in a long time, but I found out that if you are honest with the team, they actually do care about you and will work around your schedule. As long as you are honest, they will work with you. 3. Could you please describe your experiences with whether or not sanctions and incentives are given appropriately in drug court? Please give speciﬁc examples from your experiences. Overall, participants felt that sanctions and incentives were given appropriately in drug court. The most common and helpful incentive mentioned was the judge praising a participant ’s progress in the program. It is common and useful for drug courts to give tangible incentives (e.g. gift cards to local restaurants, recovery-based books). The ﬁndings from this study, however, also emphasize the importance of verbal praise from the judge and other members of the drug court team. Some participants reported that verbal praise from the judge enhanced their internal motivation for change, helped them sustain their recovery, and, overall, improved their mood and wellbeing. As for sanctions, the most common theme to emerge from the data was the importance of providing a rationale for each sanction given. The majority of participants felt that the sanctions they received or witnessed others receive were fair, but they were most helpful if a rationale was given. Participants continuously mentioned the need to be treated individually, and they felt that this need was met when sanctions were tailored to their speci ﬁc needs or challenges they were experiencing in drug court. A female participant, for instance, who had been in drug court for nearly one month shared her initial impressions with sanctions and incentives. Speci ﬁcally, she noted: JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT 915 I am new to the program, but from what I have seen, the incentives help motivate people to continue doing well and the sanctions do the same thing. For me, just hearing that the judge is proud of me and that she thinks I am doing well is incentive enough to continue doing what I need to do. The sanctions are not too hard or too soft, they are just right. I have seen people get a little punishment or incarceration, and that is what we need to motivate us to get back on track and not end up in jail for a long time. If the sanctions were too harsh, we would probably give up. I think the sanctions are deliberately not too harsh to re-motivate us. Furthermore, a male participant who had been in drug court nearly two years also reported that praise from the judge was a helpful incentive, and he felt sanctions were best received if the rationale for the sanction was explained. He commented: The judge is always encouraging, while also being the authorityﬁgure. They often give incentives, and knowing that the judge is happy with me is the best incentive. I have received my share of sanctions and what I think is most important is having a reason for each sanction. I don ’t want to view it as a punishment. If sanctions are supposed to help me, I want to know how. My case manager ensures I understand the judge’ s reasons for sanctions. I don ’t always agree with the reasons, but at least I know they have given it some thought and do want to try to help me. Additionally, a female participant who had been in drug court for over a year also discussed the importance of providing rationales for incentives and sanctions. She shared: I have seen and received sanctions, as well as incentives, during my time in drug court and I must say they ’re well deserved when they have to be applied. When I earned my incentives, I was doing well. When I earned my sanctions, I was not following through with what I said I was going to do. Each time I got an incentive or sanction, I knew why I got them and the judge explained it to me. That was helpful to have the judge explain the sanctions and explain how it was in my best interest. 4. Could you please describe your experiences with whether or not having frequent contact with the judge helps you be successful in the program? Please give speciﬁc examples from your experiences. Overall, participants felt that having frequent contact with the judge supported them in being successful in the program. They o ﬀered a range of experiences with the judge, but all were positive experiences that supported their recovery. Some participants, for instance, reported that they looked forward to seeing the judge so they could process with her what was going well in their lives and seek her feedback on certain topics related to their recovery. Other participants felt that seeing the judge frequently provided structure and accountability into their lives. They respected the judge’ s opinion of them and felt empowered to be honest and have a candid conversation with her during their status hearings. For example, a male participant who had been in drug court for over a year highlighted the importance of being honest with the judge, and being honest has also positively impacted his relationships with family and friends. Speci ﬁcally, he noted: If I should relapse, which I have once, then I ’m held responsible for my actions. Facing the judge, going to jail, and being required to restart IOP [intensive outpatient program] has made me reevaluate my choices I make. I have learned to trust more. The judge and drug court team is always there for me when I have a problem, as long as I ’m honest and upfront with them. I have also been more honest with myself, friends, family, and everyone involved in my life. 916 J. R. GALLAGHER ET AL. Another male participant who had been in drug court for nearly 10 months emphasized the importance of incorporating accountability and structure into his recovery. He shared: I feel it does. One problem all of us have coming into the program is the lack of account- ability and structure in our lives. Seeing the judge frequently gives us that, as well as shows how much the judge cares about each of our situations. To maintain recovery, we need to be held accountable for our good and bad behaviors and have a daily routine and structure in our lives. Additionally, a female participant who had been in drug court for approximately three months shared how seeing the judge weekly motivated her to do well in the program, and as a result of doing well, she is actively involved in her child’s life. She commented: I believe the judge is very supportive and I like seeing her each week. I came into drug court eight months pregnant. When the time came for me to have my baby, and after the fact and up until now, they have been supportive on that aspect, along with everything else. I feel like I can have a real conversation with the judge about my life and parenting. She gives good advice and I enjoy checking in with her each week. I feel like I can reach out to her and know she will be there and be super supportive. 5. Could you please describe your experiences with whether or not having frequent and random drug testing helps you be successful in the program? Please give speciﬁc examples from your experiences. Overall, participants shared mixed feelings related to the e ﬀectiveness of frequent and random drug testing. On a positive note, some participants clearly noted that frequent and random drug testing deterred them from using drugs, and perhaps even more important, some participants reported positive, cognitive changes that they associated with the drug testing system. Speci ﬁcally, some participants reported that they did not use drugs at the beginning of drug court because they feared consequences, such as incarceration. However, as a result of maintaining abstinence from drugs and alcohol, after some time in the program, their motivation to not use drugs changed from external motivation (e.g. avoid incarceration) to internal motivation for change. This is a promising ﬁnding because internal motivation for change is one of the strongest predictors of someone sustaining their recovery during and after drug court. Conversely, the most common challenges associated with frequent and random drug testing was that, for some, it was too expensive and time-consuming. Some participants felt that they did too many drug tests each week and the subsequent costs could delay their progress in the program, or even their graduation. A female participant, for instance, who had been in drug court for approximately one year, discussed the bene ﬁts and challenges associated with frequent and random drug testing. Speci ﬁcally, she noted: I think the random drug tests are important. They work in that they help us not use drugs or alcohol and be aware of our triggers, like people, places, and things that could make us use. I also think they cost too much and are too frequent. Drugs and alcohol stay in our systems long enough to make them needed less frequently. Some poor people have their ‘time in ’but it’ s my understanding the only thing keeping them in is they still owe the court money. How can people get out of debt when they keep getting charged for more [drug] tests? We did this to ourselves but it seems unfair to keep someone in the program because they can ’ta ﬀord all the [drug] tests. JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT 917 Another female participant who had been in drug court for nearly nine months shared a similar belief related to the ﬁnancial impact of drug testing on her life. She, however, also highlighted that drug tests deterred drug use, especially when she was contemplating using drugs. She commented: Yes, it helps, but it is too expensive and that ’s frustrating. Some of us can ’ta ﬀord it and I think some people just give up hope, like what ’s the use in trying to change if I ’m never going to graduate anyways. I don ’t want to get in trouble, so I won ’t use and I do all my drug tests. I do have a desire to stay sober, but sometimes that desire lessens. It ’s then that the drug tests are very helpful to me because, although I want to get high, I know I have a test coming up so I stop thinking about getting high and start thinking about all the good stu ﬀin my life, like not being in jail and spending time with my kids. Additionally, a male participant who had been in drug court for approximately eight months discussed the positive, cognitive changes he experienced as a result of frequent and random drug testing. He shared: It makes you think di ﬀerently about your recovery and using drugs. If I didn ’t have frequent and random drug testing, I would start thinking I can manipulate the system and try to get by with using [drugs] occasionally, and I know that using occasionally eventually turns into using every day. You start thinking di ﬀerently about several months into the program. You start telling yourself that you can do this. The random testing helps, but I am not getting high because I like recovery and freedom. Discussion The ﬁndings from this qualitative study were promising and suggest that the Monroe County (Indiana) drug court is a valuable resource for individuals who have substance use disorders. Common themes suggested that the drug court team was supportive and caring, which helped participants do well in the program. This ﬁnding is consistent with other qualitative studies (Gallagher & Nordberg, 2017a ; Gallagher, Nordberg, & Dibley, 2017b ). Gallagher and Nordberg ( 2017a ) found that women in a Midwestern drug court viewed the drug court team as compassionate and empathetic, and women in a California drug court found the drug court team to be caring, respectful, and honest (Fischer & Geiger, 2011 ). In another Midwestern drug court, African Americans reported that the respect and compassion they received from the drug court judge and their case managers was important in helping them be successful in the program (Gallagher et al., 2017b ). This trend in the drug court literature highlights that a compassionate, non-adversarial approach to treating substance use disorders in the criminal justice system is working, as reported by some drug court participants. As mentioned previously, drug courts are guided by 10 key components, and key component two focuses on the use of a non- adversarial approach that balances meeting participants ’treatment needs and public safety (National Association of Drug Court Professionals [NADCP], 2004 ). Key components one and four are similarly related to substance abuse counseling, and participants in this study had mixed feelings related to the quality of counseling they received. Some participants reported that they were satis ﬁed with the counseling they received because their counselors treated their substance use disorders and mental health symptoms concurrently. Conversely, other participants felt that their individualized needs were not being met because all, or the majority of, their counseling was in groups. This 918 J. R. GALLAGHER ET AL. ﬁnding is consistent with Gallagher et al. ( 2015 ) who found that some drug court participants only received group counseling and some were even denied individual counseling when they asked for it. In this study, some participants did not feel comfor- table discussing certain topics, like trauma and relapse, in a group setting. Interestingly, the quality of counseling provided to drug court participants seems to be criticized often in the literature. Some participants have shared that their mental health needs have not been met in drug court (Gallagher, Nordberg, & Gallagher, 2018 ), although that was not the case for this study, which is promising. Additionally, some participants reported that their counselors were judgmental and counseling often seemed punitive, as compared to rehabilitative in nature (Gallagher, Nordberg, & Lefebvre, 2017c ). Over a decade ago, Hardin and Kushner ( 2008 ) emphasized the importance of provid- ing multiple modalities of treatment. Relying too heavily on group therapy may prevent some participants from meeting their individualized treatment needs, particularly as it relates to treating trauma or other sensitive, intrapersonal issues that may require indivi- dual therapy. Evidence from this study, however, suggests that more progress may need to be made to meet the individualized counseling needs of drug court participants. Drug court should not refer participants to treatment providers who only o ﬀer group therapy. It is important for the drug court to refer participants to treatment providers who o ﬀer a range of services (e.g. individual and group counseling), treatment providers who collaboratively develop treatment plans with participants, and, treatment providers who use evidence-based interventions, such as Integrated Dual Disorder Treatment (IDDT), to treat the common occurrence of substance use disorders and mental illnesses. Another notable ﬁnding from this study was that participants felt that receiving praise and encouragement from the judge was one of the most helpful incentives they received that supported them in maintaining abstinence from drugs and sustaining internal motivation for change. The interesting and important aspect of this ﬁnding is that praise and encouragement from the judge can be incorporated into every drug court and it does not cost anything. Common incentives, such as gift cards or providing participants with free drug tests, have a monetary value, but praise and encouragement from the judge was the preferred and most helpful incentive. Marlowe ( 2012 ) shared that it may not be ﬁnancially feasible for many drug courts to purchase tangible incentives, so the use of verbal praise and encouragement seems ideal. Furthermore, it is important to note that the positive impact of incentives can diminish in a short period of time (Marlowe, 2012 ). Therefore, it is essential to provide praise and encouragement on a continuous basis to sustain positive behavioral change. In conclusion, it is important to note the limitations of this study. As is the norm with qualitative research, the ﬁndings are not generalizable to other drug courts. The ﬁndings can be used to inform drug court practice, but drug courts are encouraged to complete their own qualitative evaluations to assess participants ’thoughts, opinions, and lived experiences in their speci ﬁc programs. Also, the majority of the sample was White (93%); therefore, the experiences of other races and ethnicities are not captured in this study. Future qualitative research should recruit participants from drug courts that serve diverse populations, as this will allow researchers to compare and contrast ﬁndings across race and ethnicity. Last, no study to date, that we are aware of, has facilitated focus groups with drug court participants to ask them questions speci ﬁc to key components of the drug court model. All qualitative methodologies have strengths and limitations. A strength of JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT 919 narrative analysis, for example, is the potential minimization of social desirability bias, as participants answer open-ended questions privately. However, this method does not allow researchers to ask probing questions, which can be valuable technique to get getting speci ﬁc data to answer research questions. Perhaps focus groups would be a useful methodology because participants can add to each other ’s experiences, which may provide an even more comprehensive understanding of drug court programming. References American Psychiatric Association. ( 2013 ).Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. Bou ﬀard, J., & Taxman, F. ( 2004 ). 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