Studies carried out in Ireland suggest that the majority of offenders detected in Ireland present with some form of drug dependency.1,2,3 The study reported on here evaluates one approach that has been used within the justice system to treat drug dependency – drug treatment courts (DTCs).4

Origins

Broomfield describes how DTCs emerged in the United States (US) in response to the growing drug crisis in the 1980s. According to Broomfield, the DTC model brings together the ‘powers of court’ and drug treatment, with the aim of supporting steps to sobriety via regular contact with the user, monitoring substance use, evaluating responses to interventions and close supervision. Studies evaluating the effectiveness of DTCs in the US suggest that:

• • reoffending and drug dependency are lower among DTC participants,
  • progress is impacted by ‘severity of misuse’, previous history, and use of stimulants,
  • programme completion was higher in users receiving pharmacotherapy, and
  • more completions occurred when the presiding judge was there longer and when the court was smaller.5

However, Broomfield notes that other reviews provide evidence contradicting these findings. When pre-trial release and drugs testing were compared with parole and probation, effect sizes demonstrated that the latter were better.6 Another review suggested that the impact of diversions reducing drug dependency was small.7  

Dublin DTC

The Dublin DTC (DDTC) pilot programme started in 2001. Similar to the US DTC, the aim was to reduce offending and drug dependency with help from addiction nursing, education and probation supervision. There were three stages: bronze, silver and gold. Participants were required to:

• attend court regularly (weekly, fortnightly or monthly),
• attend education programmes daily,
• meet with a probation officer regularly, and
• engage in treatment relating to their drug of choice. 

During the programme, progress was reviewed by the DTC judge. Following successful completion of the DTC, charges were ‘struck out’. Broomfield casts doubts on the merits of using completion rewards, in particular for those with extensive offences, no desire to travel or live abroad, or those who were not afraid of having a criminal record. Despite this, he argues that the DDTC programme provides a structure which can reduce destructive behaviour.

Not everyone can be helped through the DDTC. Broomfield points out that the combination of drug dependency, crime and other difficulties such as coming for a disadvantaged socio-economic background or a dysfunctional family background (e.g. drug-abusing parents or siblings), homelessness or mental illness, result in challenging environments for addiction treatment, making it necessary to adapt interventions accordingly.

Completers

Two separate evaluations of the effectiveness of the DDTC have indicated that the number of completers was low but offending behaviour had declined. A review in 2002 gained insights from completers regarding the DTC process, and the pros and cons of sticking with the programme.8 No information was reported on attitudes or quality of life changes or on the progress of non-completers. A second review in 2010 aimed to determine why referrals were low and to identify how ‘increased throughput’ could be attained.9 As in 2002, the main finding was the low number of completers; again, the progress of non-completers was not considered. Broomfield argues that it is concerning that evidence about participants in the 2010 evaluation appears to have been obtained from professionals rather than participants themselves.

Drawing on the work of Butler,10 who examined how the DTC policy transferred from the USA to Ireland, Broomfield noted that (1) the development of the DTC in Ireland was politically driven; (2) therapeutic jurisprudence (an active, problem-solving judiciary) and the ability to buy addiction treatment evident in the US were not present in the Irish system; (3) although professionals viewed participation as beneficial, they were uncertain that credit for the positive outcomes should be attributed to the DDTC; and (4) disparities were evident in the socio-economic backgrounds of participants in the US and in Ireland – Irish participants were economically deprived and addicted to opiates while American participants were more affluent.

Non-completers

Research on DTCs has focused on completers, which could suggest that non-completers are failures. To redress this gap, grounded theory has been used to examine the benefits (including intention-to-treat and harm reduction) of the DTC programme for non-completers.11 Five themes emerged from semi-structured interviews:

• relationships with others,
• changes in substance misuse,
• changes in education and employment,
• costs and consequences of drug court participation, and
• benefits of attending drug court. 

A significant harm reduction effect was identified, which led to the authors to conclude that the provision of a harm reduction model alongside the abstinence-based model would be beneficial. Despite the limited sample size, Broomfield argues that this research has provided valuable insights.

Using narrative inquiry with DTC participants

The main finding from DTC research has been that the majority of participants are non-completers. Determining the reasons for this has been neglected by researchers. Broomfield suggests that a lot of information could be gleaned from the narratives or stories of non-completers regarding why programmes did not work for them and what adjustments would enable them to complete. A narrative inquiry approach would be the most apt approach to examine ‘internal and external dialogues’ that occur when deciding to remain or leave.

Additionally, obtaining descriptions of the offending, lifestyle and addiction of non-completers would provide insights into how other individuals with similar experiences might be helped. It would allow individual stories to be heard. Reasons to support this argument are put forward, such as:

• Life stories of individuals would include not only the story about the addiction and treatment but also insight into their experiences of marginalisation and resilience.
• The transition into drug dependency often co-occurs with a life changing event. Broomfield suggests it is not just the importance of the event but also whether resources are available to manage it.
• Narratives of those with addiction occur within larger narratives of emotive, financial and social systems.
• Narratives that unpack the thoughts, needs and risks faced by drug users involved with crime would provide greater knowledge and understanding to those not affected by drug use and crime.

1. Hickey C (2002) Crime and homelessness. Dublin: Focus Ireland, PACE. Available from https://www.drugsandalcohol.ie/5440/
2. Drummond A and Codd M (2014) Drugs and health in Irish prisons 2011: a report for prisoners. Dublin: National Advisory Committee on Drugs and Alcohol. Available from https://www.drugsandalcohol.ie/21752/
3. Martyn M (2012) Drug and alcohol misuse among adult offenders on probation supervision: findings from the Drugs and Alcohol Survey 2011. Irish Probation Journal (9): 75–93. Available from https://www.drugsandalcohol.ie/21636/
4. Broomfield D (2015) Drug treatment courts: refining successes and failures through participant narratives. The Irish Social Worker (Spring): 36–40. Available from https://www.drugsandalcohol.ie/24713/
5. Brown RT (2010) Systematic review of the impact of adult drug-treatment courts. Translational Research (155/6): 263–274. Available from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2886018/pdf/nihms190930.pdf
6. Perry AE, Darwin Z, Godfrey C, McDougall C, Lunn J, Glanville J et al. (2009) The effectiveness of interventions for drug-using offenders in the courts, secure establishments and the community: a systematic review. Substance Use & Misuse (44/3): 374–400. Available from http://www.tandfonline.com/doi/full/10.1080/10826080802347560
7. Hayhurst K, Leitner M, Davies L, Flentje R, Millar T, Jones A et al. (2015) The effectiveness and cost-effectiveness of diversion and aftercare programmes for offenders using class A drugs: a systematic review and economic evaluation. Health Technology Assessment Database (Internet). (2). Available from http://onlinelibrary.wiley.com/o/cochrane/clhta/articles/HTA-32011000672/frame.html
8. Farrell, M (2002) Final evaluation of the pilot drug court. Dublin: Courts Service. Available from http://www.justice.ie/en/JELR/finalevalpilotdrug.pdf/Files/finalevalpilotdrug.pdf
9. Department of Justice, Equality and Law Reform (2010) Review of the drug treatment court. Dublin: Department of Justice, Equality and Law Reform. Available from https://www.drugsandalcohol.ie/13113/
10. Butler S (2013) The symbolic politics of the Dublin drug court: the complexities of policy transfer. Drugs: Education Prevention and Policy (20/1): 5–14. Available from https://www.drugsandalcohol.ie/18888/
11. Francis TR and Able EM (2014) Redefining success: a qualitative investigation of therapeutic outcomes for noncompleting drug court clients. Journal of Social Service Research (40/3): 325–348. Available from http://www.tandfonline.com/doi/abs/10.1080/01488376.2013.875094