Chat with us, powered by LiveChat Reflect on the different approaches for treating drug offenders in forensic populations. Review the Week 5 Case Studies document, provided in the introduction area of this week' | Wridemy

Reflect on the different approaches for treating drug offenders in forensic populations. Review the Week 5 Case Studies document, provided in the introduction area of this week’


  • Review Chapter 17, "Drug Courts," in the course text Handbook of Forensic Mental Health with Victims and Offenders: Assessment, Treatment, and Research. Reflect on the different approaches for treating drug offenders in forensic populations.
  • Review the Week 5 Case Studies document, provided in the introduction area of this week's discussion, and select one of the scenarios to use.


  • Review or familiarize yourself with the types and classifications of drugs on the SAMHSALinks to an external site. Web site.
  • In 250-300 words, post a brief description of the case study and provide details on the treatment approach you selected to use. Explain why this treatment approach best addresses the issues in the case study. Then describe one limitation of this treatment approach, explain why it is a limitation, and explain how you would address it. 



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17 Drug Courts

Steven Belenko David DeMatteo

Nicholas Patapis

Scope of the Problem

Changes in U.S. drug policy initiated in the early 1980s led to a rapid in- crease in the numbers of individuals incarcerated for drug-related offenses (Belenko, 1990, 2000a; Zimring & Hawkins, 1991). As a result, prison and jail admissions more than quadrupled over the past 2 decades to more than 2 million inmates (Harrison & Karberg, 2004), with drug violations accounting for approximately 60% of the increase in the federal inmate population and one third of the increase in the state inmate population (Belenko & Peugh, 1999; Harrison & Beck, 2003). At the end of 2001, drug offenders composed 55% of federal prison inmates and over 20% of state prison inmates in this country (Harrison & Beck, 2003).

Drug Use and Crime

The connections between illegal drug abuse and crime have been well documented (Brad- ford, Greenberg, & Motayne, 1992; Goldstein, 1985), and substance abusers are dispro- portionately represented in criminal justice populations. Approximately 80% of state and federal prison and jail inmates (Belenko & Peugh, 2005), 67% of probationers (Bureau of Justice Statistics [BJS], 1998), and 80% of parolees (BJS, 2001; Travis, Solomon, & Waul, 2001) were arrested for a drug- or alcohol-related offense, were intoxicated at the time of their offense, reported committing their offense to get money to buy drugs, or have a demonstrated history of a substance abuse problem. A range of 42 to 86% of adult male arrestees (39 sites) and 52 to 82% of female arrestees (25 sites) tested positive for marijuana, cocaine, opiates, methamphetamine, or PCP (Zhang, 2004). Among male ar- restees, a range of 24 to 50% was at risk for drug dependence (31–63% of females). Illicit drug use by the offender has been implicated in 50% of violent crimes (National Institute


C o p y r i g h t 2 0 0 7 . S p r i n g e r P u b l i s h i n g C o m p a n y .

A l l r i g h t s r e s e r v e d . M a y n o t b e r e p r o d u c e d i n a n y f o r m w i t h o u t p e r m i s s i o n f r o m t h e p u b l i s h e r , e x c e p t f a i r u s e s p e r m i t t e d u n d e r U . S . o r a p p l i c a b l e c o p y r i g h t l a w .

EBSCO Publishing : eBook K-8 Collection (EBSCOhost) – printed on 3/28/2023 1:05 PM via WALDEN UNIVERSITY AN: 194775 ; David W. Springer, PhD, LCSW, Albert R. Roberts, DSW, PhD, BCETS, DACFE.; Handbook of Forensic Mental Health with Victims and Offenders : Assessment, Treatment, and Research Account: s6527200.main.eds


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386 Handbook of Forensic Mental Health

on Drug Abuse [NIDA], 1993; National Institute of Justice [NIJ], 2000), 50% of domestic violence crimes (Center for Substance Abuse Treatment, 2000), 80% of substantiated child abuse and neglect cases (Child Welfare League of America, 1990), 50 to 75% of theft and property offenses (French et al., 2000; NIJ, 2000), and 75 to 99% of prostitution and drug dealing/manufacturing offenses (Hunt, 1990; NIJ, 2000).

Inmates who regularly use drugs have higher recidivism rates than other inmates (Belenko, 2002). Within 3 years, 95% of released state inmates with drug use histories return to drug use (Marlowe, DeMatteo, & Festinger, 2003; Martin, Butzin, Saum, & Inciardi, 1999), 68% are rearrested, 47% are reconvicted, and 25% are sentenced to prison for a new crime (Langan & Levin, 2002). Without treatment interventions, about 85% of drug-abusing offenders relapse within the first 6 to 12 months (Beck & Shipley, 1989; Hanlon, Nurco, Bateman, & O’Grady, 1998; Marlowe, 2002; Martin et al., 1999; McLellan, 2003; Nurco, Hanlon, & Kinlock, 1991).

Other Offender Health and Social Service Needs

Drug-involved offenders typically present with other problems in addition to drug abuse or dependence (Belenko & Peugh, 1999; Hammett, Gaiter, & Crawford, 1998; Hammett, Roberts, & Kennedy, 2001). For example, given the connections among crime, poverty, and poor health, many offenders need medical services (Anno, 1991; Hammett, Harmon, & Maruschak, 1999; Marquart, Merianos, Hebert, & Carroll, 1997). Health services of particular relevance for drug-involved offenders include treatment and pre- vention of HIV and other infectious diseases (Hammett et al., 1998). The large numbers of at-risk offenders suggest a need to educate them about reducing their HIV risk behav- iors and to give them the tools to lower HIV infection incidence after release (Belenko, Langley, Crimmins, & Chaple, 2004; Braithwaite & Arriola, 2003). Offenders under probation or parole supervision are also at high risk for HIV but receive few effective interventions to reduce risk (Belenko, Langley, et al., 2004; Martin, O’Connell, Inciadi, Beard, & Surratt, 2003). Offenders also have high rates of mental health conditions and comorbid substance abuse/mental health disorders (Belenko, Lang, & O’Connor, 2003; Ditton, 1999; Lamb & Weinberger, 1998); 32% of regular drug users and 28% of alcohol-involved inmates had indications of a mental health problem (Belenko, 2002). In addition, high rates of psychopathy, including antisocial personality disorder, have been linked to reoffending (Festinger et al., 2002; Gendreau, Little, & Goggin, 1996; Marlowe, Festinger, & Lee, 2003) and treatment failure (Peters, Haas, & Murrin, 1999). But treatment for comorbid mental health and substance abuse problems presents sub- stantial complications that are seldom addressed (Belenko et al., 2003; Broner, Borum, & Gawley, 2001; Hoff & Rosenheck, 1999). Offender treatment retention studies have found that mental health disorders are predictive of early termination (Lang & Belenko, 2000), and those with a comorbid psychiatric diagnosis are less likely to enter substance abuse treatment in the first place (Claus & Kendleberger, 2002).

Employment problems can affect long-term recovery and complicate community transition (Belenko & Peugh, 2005; Leukefeld, McDonald, Staton, & Mateyoke-Scrivner, 2004; Travis et al., 2001). Offenders with few marketable skills and job opportunities are more susceptible to relapse and reoffending (Laub & Sampson, 2001; Platt, 1995). Further, for many offenders their physical or mental health problems make it difficult to sustain employment or successfully complete educational programs (Belenko, 2002). Accordingly, an important goal of an effective intervention is to identify employment and

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Drug Courts 387

training needs; to provide the skills training that enables the offender to be reintegrated into the legitimate labor market; or to provide basic literacy skills, GED certification, and life skills. Offenders who receive vocational training, or have higher employment and earnings rates, have lower reoffending risk (Finn, 1999; Needels, 1996; Seiter & Kadela, 2003). In addition, lack of access to health insurance or other benefits limits offenders’ access to housing, health care, and treatment (Hammett et al., 2001; Nelson & Trone, 2000). Offenders also have poor education: 39% of regular drug users in prison have less than 4 years of high school and no GED, and only 38% of all inmates received some academic education within prison since their admission (Belenko, 2002).

Many drug-involved offenders grow up in families with high rates of substance use and dysfunction (Belenko & Logan, 2003; Henggeler, Clingempeel, Brondino, & Pickrel, 2002). Family drug use and criminal activity and low levels of parental involvement are risk factors for juvenile substance abuse and delinquency (Loeber & Farrington, 1998) and entry into the juvenile justice system (Farrington, 1998; Sampson & Laub, 1993). Offenders have limited access to programs that prepare parents to reintegrate with their children, families, or community, or to improve parenting skills (Petersilia, 2000). Taxman, Young, Byrne, Holsinger, and Anspach (2003) point to the importance of strengthening family and community support for released inmates (Beckerman, 1998), as do NIDA’s principles of effective treatment (NIDA, 1999).

Substance-involved offenders also have social networks of peers with high rates of drug use and criminal behavior (Belenko & Peugh, 1999; Friedman, Curtis, Neaigus, Jose, & Des Jarlais, 1999), an important risk factor for initiation into and maintenance of substance abuse and criminal behavior (Keenan, Loeber, Zhang, Stouthamer-Loeber, & Van Kammen, 1995; Wills & Cleary, 1999). Conversely, association with prosocial peers may protect substance-involved offenders from relapse and recidivism (Carvajal et al., 1999; Hoge, Andrews, & Leschied, 1996); social networks must be considered in designing effective offender supervision and service plans. Because at-risk offenders are likely to belong to a peer group with lower social status, simply changing peer groups may be difficult (La Greca, Prinstein, & Fetter, 2001). Educating offenders about peer group risk for substance use and criminal behavior may be important, but help- ing them gain more positive friendships may be equally critical for sustaining treatment effects (McBride, VanderWaal, Terry, & VanBuren, 1999; Prinstein, Boergers, & Spirito, 2001).

Finally, access to affordable, stable drug-free housing is important for offenders (Rossi, 1989; Travis et al., 2001). Many of them face obstacles to finding adequate, stable, and sober housing due to poor family ties, lack of financial resources for a rental deposit, ineligibility for public housing, or discrimination by landlords (Hammett et al., 2001). Public housing may be denied because of their criminal records or history of drug involvement. Offenders also tend to come from low socioeconomic strata and have relatively high rates of prior homelessness (Belenko, 2002).

The Economic Consequences of Drug-Related Crime

Substance abuse and dependence and their consequences are associated with substantial health and social costs in the United States (Belenko, Patapis, & French, 2005). Large numbers of Americans continue to suffer from the effects of substance abuse, and it remains one of the nation’s most serious health and social problems (Office of National Drug Control Policy [ONDCP], 2001). As a result, federal, state, and local governments

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388 Handbook of Forensic Mental Health

have invested substantial amounts of money over the past 35 years for prevention and treatment programs aimed at reducing the impact of alcohol and illegal drug use. Yet, despite this spending, only a small percentage of the 24 million Americans with alcohol or drug problems are actively engaged in treatment (Office of Applied Studies, 2003).

The health and social costs of illegal drug and alcohol use in this country are sub- stantial, reflecting the effects of substance abuse on crime, productivity, health problems, premature death, underemployment, and family stability. The ONDCP (2001) estimated the total societal costs of illegal drug use in 1998 at $143.4 billion ($168 billion in 2004 dollars). Nearly two thirds of these costs (62%) are related to the enforcement of drug laws and the effects of illegal drug use on criminal behavior, including $31.1 billion in public criminal justice costs (in 1998 dollars), $30.1 billion in lost productivity due to incarceration, $24.6 billion in lost productivity due to crime careers, and $2.9 billion in other costs including property damage and victimization. Other large costs are due to drug-related illness ($23.1 billion), premature mortality ($16.6 billion), drug abuse treatment and prevention ($7.1 billion), HIV/AIDS ($3.4 billion), and other medical consequences or hospitalization ($4.1 billion).

The costs to society of alcohol abuse and its consequences are even greater (Rice, Kelman, Miller, & Dunmeyer, 1990). The most recent estimate of the overall eco- nomic cost of alcohol abuse was $185 billion in 1998 (Harwood, 2000). More than 70% of the estimated costs of alcohol abuse for 1998 were attributed to lost productivity ($134.2 billion), including losses from alcohol-related illness ($87.6 billion), premature death ($36.5 billion), and crime ($10.1 billion). The remaining costs include health care expenditures ($26.3 billion, or 14.3% of the total), such as the cost of treating alcohol abuse and dependence ($7.5 billion), the costs of treating the adverse medical conse- quences of alcohol consumption ($18.9 billion), property and administrative costs of alcohol-related motor vehicle accidents ($15.7 billion), and criminal justice system costs of alcohol-related crime ($6.3 billion).

In general, recent reviews of the economic impacts of substance abuse treatment are consistent in finding that substance abuse treatment interventions yield net economic benefits to society (Belenko et al., 2005; Cartwright, 2000; Harwood et al., 2002; Mc- Collister & French, 2003). Cost–benefit studies of different treatment modalities and client populations continue to report significant cost savings and positive returns on treatment investments; a primary component of the economic benefit is the reduction in crime and victimization following treatment.

Drug Treatment and the Criminal Justice System

Traditional correctional or punitive approaches have had little influence on drug use or criminal recidivism among offenders (for reviews, see Marlowe, 2002, 2003). Between 50% and 70% of probationers fail to comply with applicable conditions for drug test- ing and attendance in drug treatment (Langan & Cunniff, 1992; Nurco et al., 1991). Moreover, no incremental benefits are obtained from intensive supervision probation programs,1 and some studies have found worse outcomes because infractions were more likely to be detected (Gendreau, Cullen, & Bonta, 1994; Petersilia & Turner, 1993). Finally, results of dozens of evaluations have revealed no effects on criminal recidivism or drug use for “intermediate sanctions” such as boot camps, electronic monitoring, house arrest, or shock incarceration (e.g., Gendreau, Goggin, Cullen, & Andrews, 2000; Gendreau, Smith, & Goggin, 2001; Sherman et al., 1997; Taxman, 1999a).

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Drug Courts 389

Community-Based Drug Treatment Outcomes

Success rates for drug-involved offenders are also limited in traditional community treatment settings, largely because offenders fail to remain long enough to receive a min- imally adequate dosage of services. Results from national treatment studies suggest that 3 months of drug treatment may be a threshold for detecting dose–response effects for the interventions, and 6 to 12 months may be a threshold for observing meaningful re- ductions in drug use (Simpson, Joe, Fletcher, Hubbard, & Anglin, 1999). Approximately 50% of clients who complete 12 months or more of drug treatment remain abstinent for an additional year following completion of treatment (McLellan, Lewis, O’Brien, & Kleber, 2000). Unfortunately, few drug-abusing offenders reach these thresholds. For example, between 40% and 70% of probationers and parolees drop out of treatment or attend irregularly within 3 to 6 months (Langan & Cunniff, 1992; Nurco et al., 1991; Taxman, 1999a; Young, Usdane, & Torres, 1991), and over 90% drop out within 12 months (e.g., Satel, 1999). Yet reductions in drug use have been found to be associated with significant reductions in future crime and violence among offenders (e.g., Chaiken & Chaiken, 1990; Newcomb, Galaif, & Carmona, 2001; Nurco, Kinlock, & Hanlon, 1990).

Treatment Alternatives in the Criminal Justice System

Given the high rates of substance involvement among offenders, various initiatives have been devised to provide community-based supervision and treatment to drug offend- ers in lieu of criminal prosecution or incarceration. Prior to the late 1980s, there were few systematic efforts to divert or otherwise link drug-involved offenders to treatment programs, especially felony offenders (Belenko, 2000b). However, over the past decade a number of different treatment alternatives have been developed, implemented, and tested with varying degrees of success. These range in intensity from true diversion pro- grams, to probation-supervised treatment, to judicially supervised programs such as the Treatment Accountability for Safer Communities case management programs (Anglin, Longshore, & Turner, 1999), to drug courts. Treatment alternatives can be implemented at almost any stage of the criminal justice process: prior to adjudication (diversion), during the pretrial period, as a condition of probation, in lieu of incarceration, or as a condition of parole.

True diversion programs permit low-level misdemeanor offenders to have their charges dropped and their arrest record expunged contingent on completion of a pre- scribed regimen of supervised drug treatment and perhaps community supervision by a probation or pretrial services officer. Record expungement permits the individual to respond truthfully on an employment application or similar document that he or she has not been arrested for a drug-related offense. Although prosecutorial resistance means that most diversion programs serve low-level misdemeanor or first-time offenders, a few exceptions exist. Notably, the Drug Treatment Alternative to Prison program (DTAP), operated by the Kings County (Brooklyn, NY) District Attorney’s Office, diverts of- fenders charged with drug sale who are facing mandatory state prison time because of a prior felony conviction (Hynes & Swern, 2002). DTAP participants enter long-term residential drug treatment in therapeutic communities for 18 to 24 months and upon completion withdraw their guilty plea, have the charges dropped, and avoid incarcera- tion. Research on this program has found that it achieves high retention rates (Lang & Belenko, 2000), reduces recidivism (Belenko, Foltz, Lang, & Sung, 2004), and results in

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390 Handbook of Forensic Mental Health

substantial cost savings to the criminal justice system (Zarkin, Dunlap, Belenko, & Dynia, 2005).

A few states, including Arizona, California, the District of Columbia, and Hawaii, have enacted laws expanding eligibility for a probation-without-verdict model of diver- sion to all nonviolent drug-possession offenders who are not currently charged with another felony or serious misdemeanor offense and who have not previously been con- victed of or incarcerated for such an offense within a specified time period. Pursuant to California’s Proposition 36 (California Substance Abuse and Crime Prevention Act of 2000), for example, if an offender violates a drug-related condition of probation or commits a new drug-possession offense, the state can revoke probation only if it can prove by a preponderance of the evidence that the offender is a “danger to the safety of others.” For a second drug-related violation of probation, the state must prove that the offender is either a danger to the safety of others or is “unamenable to drug treatment” to accomplish a revocation (e.g., In re Mehdizadeh, 2003).

The Drug Court Intervention

Over the past 15 years, drug courts have become an increasingly important model for linking drug-involved offenders to community-based treatment. Although drug courts existed as far back as the early 1950s (Belenko, 2000b; Lindesmith, 1965), the current in- terest in drug courts emerged from various drug case management programs established in the late 1980s (Belenko & Dumanovsky, 1993; Jacoby, 1994) as a result of surging drug caseloads (Goerdt & Martin, 1989) fueled by the law enforcement response to the crack epidemic (Belenko, 1993; Belenko, Fagan, & Chin, 1991; Zimring & Hawkins, 1991). Some of these programs added treatment referral components that eventually evolved into some of the early drug courts (Belenko, 1999a; Cooper & Trotter, 1994). The first program began in Dade County, Florida, in 1989 (Finn & Newlyn, 1993; Goldkamp & Weiland, 1993).

Drug courts have expanded rapidly and in many jurisdictions are now the preferred mechanism for linking drug-involved offenders to treatment. As of December 31, 2004, there were 1,621 operational drug court programs in the United States, a 37% increase from 2003 (Huddleston, Freeman-Wilson, Marlowe, & Roussell, 2005). Drug courts are now operating in all 50 states, 3 U.S. territories (Guam, Puerto Rico, and the Virgin Islands), and 8 countries. Adult drug courts compose the majority of drug court programs in the United States, with 811 programs as of December 31, 2004 (Huddleston et al., 2005). In addition, there were 357 juvenile drug courts, 153 family or dependency drug courts, 54 tribal drug courts, 176 DUI courts, 68 reentry drug courts, and 1 campus drug court. Moreover, drug courts are now serving as a model for several new breeds of “problem-solving courts,” including mental health courts for chronically and persistently mentally ill offenders, dependency courts for child abuse and neglect cases, reentry courts for parolees, and domestic violence courts for domestic violence offenders. This chapter will focus on adult drug courts, the predominant model in the United States. Descriptions of the other types of drug courts can be found in Huddleston et al. (2005).

Drug courts are separately identified criminal court dockets that provide long- term, judicially supervised drug abuse treatment and case management services to

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Drug Courts 391

nonviolent, drug-involved offenders in lieu of criminal prosecution or incarceration. The key operational components of drug courts typically include:

1 Judicial supervision of structured community-based treatment. 2 Timely screening, assessment, and enrollment of eligible defendants and referral

to treatment and related services as soon as possible after arrest. 3 Regular status hearings before a judge to monitor treatment progress and program

compliance. 4 Progressive sanctions for program infractions and positive rewards for program

accomplishments. 5 Mandatory periodic or random drug testing. 6 Establishment of specific treatment program requirements. 7 Dismissal of the charges or reduction in sentence upon successful program

completion (Belenko, 1998; National Association of Drug Court Professionals [NADCP], 1997).

There are two basic drug court models: pre-plea and post-plea. In “pre-plea” drug courts, prosecution is deferred and offenders can have their charges dropped upon successful program completion; in many jurisdictions they may have their current arrest record expunged (or erased) if they remain arrest free for an additional waiting period. Graduates of “post-plea” drug courts may avoid a sentence of incarceration, have their probation sentence reduced, be allowed to plead guilty to a misdemeanor rather than a felony, or receive a sentence of time-served in the program. Terminated clients have their original case prosecuted (pre-plea drug courts) or have the sentence imposed (post-plea courts). Figure 17.1 is a flow chart showing how cases are typically processed in plea drug courts.

The structure and underlying philosophy of drug courts represent a dramatic shift in jurisprudence and treatment–criminal justice linkages (Belenko, 2001; Hora, Schma, & Rosenthal, 1999) and are substantial departures from standard practices in criminal courts (Eisenstein & Jacob, 1977; Kamisar, LaFave, & Israel, 1995). The relative popular- ity of drug courts and the support for the drug court model across the political spectrum may have had other effects on the criminal justice system and antidrug policy. The shift- ing view toward drug offenders, the acceptance of treatment interventions and treatment efficacy, the adoption (explicit or implicit) of a “therapeutic jurisprudence” model (Hora et al., 1999; Slobogin, 1995), and an increasing discomfort about soaring incarceration rates among drug offenders may in part be attributed to the visibility and popularity of drug courts. Because drug courts emphasize both accountability and treatment, they are attractive both to those favoring “just deserts” and those favoring a “utilitarian” approach to criminal punishment, and this represents a rare consensus of opinion re- garding appropriate strategies for addressing drug-related crime. The two case examples that follow illustrate the two main types of drug courts, the processes involved in both successful and unsuccessful treatment outcomes, and their associated jurisprudential results.

Case Example of a Pre-Plea Drug Court Process for an Unsuccessful Client

Nineteen-year-old TY was cited for public intoxication and possession of alcohol by a minor outside of a college sporting event. Before releasing TY at the scene with

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392 Handbook of Forensic Mental Health

17.1 Figure Arrest

Continue in drug court

Defendant is offered drug court

Prosecutorial review of offense Eligible charge

Prosecutorial review of offender Criminal history review

Defense attorney reviews case with defendant

Guilty plea entered (post-plea drug court)

Client enters drug court

Monthly status hearings

Treatment / urinalysis

Noncompliant Graduated sanctions

Compliant Rewards / phase advancement

Graduation Plea withdrawn/charges


Verdict entered as guilty Sentence imposed (post-plea)/

Prosecution resumes (pre-plea)

Return to CJ “as usual”


Drug court flow chart

a citation, the officer noted that TY’s pupils were fully dilated and his attention span was vigilant to his surroundings, conditions inconsistent with alcohol intoxica- tion. Having probable cause, the officer inspected TY’s backpack and found a small (>2 grams) bag of a white powder. A field-reagent test indicated that the substance was cocaine, and TY was arrested for possession of narcotics. In addition, 40 pills (subsequently identified as a Schedule IV prescription sedative) were found on TY’s person.

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Drug Courts 393

The assistant district attorney (ADA) agreed to modify the charges if TY pled no contest to possession of cocaine and entered the city’s drug court program in lieu of prosecution. TY initially refused the ADA’s offer, retained private defense counsel, and was strongly against any plea bargain, especially one requiring drug treatment. However, prior to his preliminary hearing TY was unable to produce verification that the pills he possessed at his arrest were prescribed by a physician. The ADA used this fact as additional leverage to encourage TY into treatment by deferring referral of TY’s prescription charges to the U.S. Attorney pending entry to drug court. Under advice of counsel TY agreed.

During the drug court admission hearing, TY strongly denied having a drug problem. Despite this denial he was assessed by the caseworker as needing intensive outpatient services (IOP); TY was also required to attend Narcotics Anonymous (NA) meetings at least three times per week. Based on TY’s college schedule and part-time employment, the judge modified the caseworker’s recommendations and entered an order for outpatient services two times per week, as well as the NA meetings.

Prior to TY’s first judicial status hearing, TY attended only half of his scheduled treatment appointments and provided no clean urine samples. He produced an NA attendance slip, but its authenticity was suspect. The judge angrily confronted TY with his performance during the previous 4 weeks and highlighted TY’s testimony at his entry hearing when he denied dru

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