During most of the campaign, President-elect Donald Trump’s main strategy for preventing drug abuse in the United States seemed to center on stopping drug trafficking at the Mexican border.
But in New Hampshire weeks before Election Day, Trump promised to do more for people with substance-use disorders than build a wall. He offered several strategies for helping people recover from drug addiction.
While he advocated a tough-on-crime approach to stop drug trafficking, he also appeared to favor a treatment-first approach for people addicted to drugs.
The president-elect said he would expand access to treatment and provide incentives for states to use drug courts and mandatory treatment programs.
That’s one election promise he should fulfill.
The number of drug courts in the United States has been increasing for two decades. In 2015, more than 3,400 drug courts across the country served 55,000 defendants annually, according to a recent report from the surgeon general.
They were a key component of the Obama administration’s drug control policy, receiving nearly $100 million in annual funding throughout his years in office.
Numerous studies indicate that court-ordered addiction treatment reduces relapse and recidivism rates. Inmates receiving treatment are less likely to exhibit conduct problems, and they’re more likely to pursue education or employment after leaving incarceration.
A coalition of mental health organizations, including the American Psychological Association and the National Association of Social Workers, recently advocated for an increased focus on the link between mental health issues and substance abuse within the criminal justice system at a meeting in Washington, D.C.
Key members of the coalition met with Sen. Al Franken (D-MN) who has advocated for expanding access to mental health courts.
The coalition’s recommendations included increasing financial and technical assistance for local governments, providing integrated treatment for co-occurring mental health disorders and improving communication between law enforcement and health providers.
Drug courts can be an effective forum for communication because they rely on partnerships between community health care providers, law enforcement agencies and social service programs. The effectiveness of the programs varies by state and county because they’re administered locally.
In 2014, the Los Angeles Times reported that many drug courts were overwhelmed with defendants facing marijuana charges. One consequence of this, the Times reported, was that expensive treatment designed for people with severe substance use disorders was administered to individuals arrested for possessing small amounts of marijuana.
Court-ordered treatment programs have also been criticized for not accepting people with co-occurring mental health disorders or suicidal thoughts. Critics add such programs haven’t done much to reduce the prison population.
But these criticisms conflict with the promising statistics provided by the National Association of Drug Court Professionals (NADCP). On its website, the NADCP says 75 percent of drug-court graduates don’t get arrested within two years of graduation. Moreover, drug courts save taxpayers more than $3 in criminal justice costs for every $1 invested.
These figures are backed up by studies cited by the Office of National Drug Control Policy, which found drug courts reduced crime by between 8 and 26 percentage points. The most effective drug courts reduced crime by up to 35 percent compared to traditional criminal justice efforts.
Surgeon General Vivek Murthy’s recent report on alcohol, drugs and health said DUI courts reduced recidivism at rates similar to adult drug courts. It also found that nonviolent offenders were the most likely to avoid incarceration after being accepted into a drug court.
The surgeon general recommended that criminal justice systems continue to take less punitive approaches and more health-focused approaches to addressing offenders with substance use issues.
It’s unclear how the Trump administration will balance a tough-on-crime approach with its promises to expand treatment access.
Trump’s advisors will play a large role in developing the details of drug policy. But it’s hard to tell whether “hard” or “soft” approaches will prevail until we learn the names of key appointees in the Department of Health and Human Services and the Department of Justice, which work together to coordinate technical assistance and federal funding for local drug court programs.
Those appointees will likely be vetted by Vice President-elect Mike Pence, whose record on drug policy is ambiguous. As Indiana governor, Pence advocated for tougher penalties on drug traffickers. His decision to sign an Indiana law requiring mandatory minimum sentences of 10 years for anyone convicted of dealing meth or heroin was supported by Trump.
But Pence also wanted expanded access to an overdose-reversal drug called naloxone, and he supported Medicaid reform to cover inpatient detoxification in the state.
Trump’s nominee for Attorney General, Sen. Jeff Sessions (R–Ala.) has adamantly opposed marijuana decriminalization and legalization. He’s condemned President Obama’s lax approach to enforcing federal laws banning the use of marijuana.
In 2002, Sessions said he supported tough mandatory minimums for drug dealers, but he acknowledged that sentencing laws involving crack and powder cocaine had failed. In August 2016, Sessions criticized Obama for commuting the sentences of non-violent drug offenders, saying the president had acted recklessly.
Sessions did support drug courts in his home state of Alabama and on the national level, but he has also criticized the DOJ for failing to adequately evaluate the effectiveness of the programs. Thus, it’s unclear how he would approach mandatory minimums and the use of drug courts as attorney general.
Drug courts aren’t the only way to incorporate treatment into the criminal justice system, though.
Mandatory treatment can be a condition of probation or parole. It can also be administered during a prison sentence. But authorities have to be careful with the type of treatment that they mandate. Individuals whose substance-use disorders are not severe enough to warrant inpatient treatment can benefit from peer support groups, but most groups have spiritual components.
Participation in 12-step programs such as Alcoholics Anonymous (AA) and Narcotics Anonymous are common conditions of probation or parole for offenders with a history of substance abuse, but they require a belief in a higher power.
Law enforcement can’t require people to participate in programs that conflict with their religious beliefs.
In 1997, the U.S. Court of Appeals for the Second Circuit ruled that Orange County couldn’t require Robert Warner, a chronic DUI offender, to participate in AA meetings to complete his probation because he was an atheist.
In 2010, the U.S. Court of Appeals for the Ninth Circuit said that John Pirtle’s due process rights were violated when the California Board of Prison Terms denied him parole because he wouldn’t participate in a 12-step program. Pirtle, an atheist, had a history of alcohol abuse.
In 2013, the same court ruled that Barry Hazle’s parole officer couldn’t fine him for refusing to participate in a residential program that required him to accept the existence of a higher power.
Drug courts usually only accept offenders without a history of violence, but the prison system has a number of treatment options for inmates with a history of substance abuse.
The federal Bureau of Prisons (BOP) runs 89 residential drug abuse programs at prisons across the country. The treatment programs use a therapeutic community model approach to teach inmates social and vocational skills. Analyses of the programs indicate they reduce relapse and recidivism rates.
The BOP also offers a 12-week nonresidential program for offenders who don’t meet the criteria for residential treatment or who are transitioning back to the community. Participants receive cognitive behavioral therapy, recognized as one of the most effective therapies, to improve communication and critical thinking skills.
Like all government programs, drug courts have challenges that have to be addressed.
But drug courts and mandatory treatment programs can be effective. If implemented properly, they can reduce the cycle of relapse and recidivism among individuals with histories of substance abuse.
It would be tragic if President-elect Trump and his team ignored their record of success.
Editors Note: On Dec 7, Congress passed the 21st Century Cures Act, which included provisions for spending on drug treatment and prevention, as well as drug courts.
Chris Elkins is a senior writer for DrugRehab.com, an online resource that provides the latest information about addiction-related topics. DrugRehab.com publishes news articles and comprehensive guides covering evidence-based prevention, treatment and recovery strategies. Readers’ comments are welcome.