Bob Houston, 52, has a job in the mental health field.

He has four children, a marriage of five years, an active role in his church, a GED — obtained more than 30 years after dropping out of high school — and plans to become a minister.

Houston had something completely different a decade ago: a drug addiction that caused him to spend most of his adult life in jail, stopped him from getting an education and led to prostitution.

“Heroine, PCP, cocaine, pills. Every drug they made, I think I did,” Houston says. “The longest clean time I had was a month or two. I just couldn’t stay clean. I tried though.”

After an arrest in 2002, Houston was admitted to the drug court program in Prince George County, Va. The program, like many other drug court programs throughout the country, utilizes a special court docket to deal with nonviolent criminal offenses committed by drug-addicted offenders.

A year after entering a program that combines substance abuse treatment, job counseling, the development of social skills and the possibility of jail if the offender relapses, Houston graduated. He has been clean ever since.

“Before, when things came up that I couldn’t handle, I’d pick up a drug or a drink,” Houston says. “Drug court gave me a chance to take a hard look at myself. I got spiritual help. I got professional help. I got a different mind-set.”

Melding of two models

Drug courts have been functioning since 1989 when, in response to a rampant crack-cocaine problem, Miami-Dade County, Fla., started this country’s first drug court to deal with the drugs, the offenders, the social costs and the very, very heavy monetary weight of simply prosecuting drug offenders and throwing them in jail.

Now, some two decades later, more than 2,000 drug courts are in operation nationwide. Measured by reduced rates of recidivism, monetary savings and effective recovery from substance abuse, proponents proclaim drug courts a success story. President Barack Obama’s drug czar, Gil Kerlikowske, views drug courts as a way to “break the cycle of addiction and crime.” The president’s proposed 2010 budget reflects this thinking, earmarking $50 million more for drug courts than was allocated in 2009.

Drug courts essentially meld two different approaches for dealing with substance abuse: the traditional criminal justice model, in which drug addiction is an antisocial behavior best handled by the legal system, and the medical model, in which substance abuse is viewed as a disease to be treated therapeutically so that those afflicted can eliminate drug use and change their lives for the better.

Melding the two models has worked. A National Drug Court Institute study has shown that judge-supervised drug programs lower prison costs and prison overcrowding. A study conducted by the Urban Institute estimated that an expenditure of nearly a half-billion dollars by the United States on more than 50,000 nonviolent drug offenders who went to drug court in 2005 resulted in more than $1 billion in reduced law-enforcement and prison costs.

From a therapeutic standpoint, drug courts help recovering addicts stay clean.

“It’s hard as a counselor to get alcoholics and addicts to stay in treatment long enough to effect change,” says Ellyn Joan Essic, past president of the International Association of Addictions and Offender Counselors, a division of the American Counseling Association. “People might not want to be in drug court, but they’d rather be there than in jail. It gives you time. And once you break that barrier, you see change.”

Change is effected by bringing members of the legal and mental health communities — judges, attorneys, probation officers, case managers and mental health counselors — together. Judges preside, and the efficacy of the process, according to a Department of Justice report published in 2006, depends greatly on the judge’s informal, flexible and hands-on style, the “nonadversarial nature of the proceedings, the frequency of required hearings and the opportunity for direct communication between defendants and the bench.”

A model outlined by the National Association of Drug Court Professionals and the Justice Department in a 1997 report lists the following as key components in the success of drug courts: a coordinated strategy between legal and mental health workers, the integration of substance abuse treatment with justice system processing, use of a nonadversarial approach, early identification and placement of eligible participants, access to continued treatment and rehabilitative services, frequent testing for alcohol and drugs, a coordinated strategy between legal and mental health workers, ongoing judicial action with participants, monitoring of program goals, continued education and partnerships with public and community-based organizations.

“Folks in drug court get a lot of assistance nobody else gets,” Essic says. “You get a full court assessment. You get treatment. You can get housing if you need it and assistance with employment.”

What mental health therapists get is additional time to work with recovering addicts, a luxury not often enjoyed when the incentive to stay out of jail does not exist.

“I know I have longer to work with this person,” says Essic, who advocates the use of cognitive behavioral and reality-based therapy in substance abuse treatment. “I know I can go deeper. I know I can push harder and use more confrontation if needed. They can’t get away from me.”

The bigger picture

Malinda Lamb, the clinical services director for the 6th Judicial District of Correctional Services in Iowa, and ACA member Nicole Pizzini presented on drug courts at the 2008 ACA Annual Conference in Honolulu. Lamb figures that the average client in her district’s drug court program stays 12 to 18 months. She emphasizes rewards, such as birthday cards, 30-day cards for staying clean and certificates for completing various phases of the program, as incentives in her program.

Of course, there is also another major source of motivation. “All of our clients either face prison or do drug court,” Lamb says. “This is the last resort for some people who are longtime users. Under supervision, they get clean time, they do well, they transition. Then we make sure their recovery continues.”

Lamb’s program includes six months of supervised aftercare. “We look at the bigger picture,” she says. “We look at mental health, housing, giving back to the community.”

“It certainly beats the alternative, which is jail,” says Carolyn Hardin, director of the National Drug Court Institute. “You can do jail sitting on your hands. But it’s different going into treatment and addressing issues that led to drug and alcohol abuse. I don’t believe kids, when they grow up, want to be on crack. But something happened along the way. This is something that drug court addresses: what happened along the way.”

Mental health professionals play a vital role in drug court programs, often stepping into settings that address co-occurring mental health and substance abuse disorders. The treatment, a part of clients’ probation, focuses on substance abuse, recovery from substance abuse, issues underlying substance abuse and the intertwined relationship between substance abuse and mental health issues.

Drug court gives substance abusers the incentive or, depending on the speaker’s semantic preference, the disincentive of jail. It gives the therapist additional support. “The therapist knows he has a team,” Hardin emphasizes.

Joe Madonia is the director of the Brooklyn Treatment Court, one of the first drug courts in the state of New York. Madonia’s style? Accentuate the positive.

“Counselors need to focus on a client’s strengths,” says Madonia, a licensed clinical social worker and teacher at New York University who maintains a private practice in Manhattan. “They need to look at the positive aspects of their lives.”

Brooklyn’s drug court emphasizes education, skill building and vocational services. “Some of our graduates have become counselors,” Madonia says.

Madonia says his court follows a “carefully designed list of sanctions and incentives, the last sanction being jail.” He prefers to deemphasize the possibility of jail with clients, but he is fully aware that it provides a hammer that helps him pound home other aspects of his program.

Drug court professionals take incentive where they can find it. “The old saying is, ‘You can lead a horse to water, but you can’t make him drink.’ We try to get them thirsty,” Madonia says.

Bob Houston doesn’t reach for alcohol when he is thirsty these days. Instead, he reaches for his 3-year-old son, Joshua. He reaches for his Bible. He reaches out to others who are battling addiction the way he once battled addiction.

“I’m accountable today,” Houston says. “I take responsibility as a husband and a father. I have steady work. I’m active in the church and in a lot of community projects. My life has changed dramatically. People trust me now.”

Houston gives much of the credit for his solid footing to his experience in drug court. “I wouldn’t be like this [without it],” he says. “I’d probably have the same mind-set that I had then: that I could use drugs and live. But I can’t get high and live. It’s impossible.”

Chris Morkides is a mental health therapist in Wilmington, Del., specializing in co-occurring disorders and anger management. Contact him at cmorkides@aol.com.

Letters to the editor: ct@counseling.org