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

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 ). Looking inside the “black box ”of drug court treatment

services using direct observation. Journal of Drug Issues , 34, 195 –217. doi: 10.1177/

002204260403400109

Carey, S. M., Finigan, M. W., & Pukstas, K. ( 2008 ).Exploring the key components of drug courts:

A comparative study of 18 adult drug courts on practices, outcomes, and costs . Portland, OR: NPC

Research.

Fischer, M., & Geiger, B. ( 2011 ). What “works ”in drug court: A bottom-up female participants ’

perspective. Journal of Human Behavior in the Social Environment ,21, 752 –765. doi: 10.1080/

10911359.2011.615678

Gallagher, J. R. ( 2013 ). African American participants ’views on racial disparities in drug court

outcomes. Journal of Social Work Practice in the Addictions ,13(2), 143 –162. doi: 10.1080/

1533256X.2013.784689

Gallagher, J. R., & Nordberg, A. ( 2016 ). Comparing and contrasting white and African American

participants ’lived experiences in drug court. Journal of Ethnicity in Criminal Justice ,14(2),

100 –119. doi: 10.1080/15377938.2015.1117999

Gallagher, J. R., & Nordberg, A. ( 2017a ). A phenomenological and grounded theory study of

women ’s experiences in drug court: Informing practice through a gendered lens. Women &

Criminal Justice ,27(5), 327 –340. doi: 10.1080/08974454.2016.1256255

Gallagher, J. R., Nordberg, A., & Dibley, A. R. ( 2017b ). Improving graduation rates for African

Americans in drug court: Importance of human relationships and barriers to gaining and

sustaining employment. Journal of Ethnicity in Substance Abuse ,1–15. Advanced online publica-

tion. doi: 10.1080/15332640.2017.1381661

Gallagher,J.R.,Nordberg,A.,&Gallagher,J.M.( 2018 ). Participants ’views on the strengths

and limitations of drug court: Recommendations to enhance assessment and treatment of

mental illnesses. Social Work in Mental Health , 16(4), 436 –450. doi: 10.1080/

15332985.2017.1419536

Gallagher, J. R., Nordberg, A., & Kennard, T. ( 2015 ). A qualitative study assessing the e ﬀectiveness

of the key components of drug court. Alcoholism Treatment Quarterly ,33(1), 64 –81. doi: 10.1080/

07347324.2015.982453

Gallagher, J. R., Nordberg, A., & Lefebvre, E. ( 2017c ). Improving graduation rates in drug court:

A qualitative study of participants ’lived experiences. Criminology & Criminal Justice ,17(4),

468 –484. doi: 10.1177/1748895816682578

Goldkamp, J. S. ( 1994 ). Miami ’s treatment drug court for felony defendants: Some implications of

assessment ﬁndings. The Prison Journal ,74(2), 110 –166. doi: 10.1177/0032855594074002002

Goldkamp, J. S., White, M. D., & Robinson, J. B. ( 2001 ). Do drug courts work? Getting inside the

drug court black box. Journal of Drug Issues ,31(1), 27 –72. doi: 10.1177/002204260103100104

Hardin, C., & Kushner, J. N. ( 2008 ).Quality improvement for drug courts: Evidence-based practices .

Alexandria, VA: National Drug Court Institute.

Hiller, M., Belenko, S., Taxman, F., Young, D., Perdoni, M., & Saum, C. ( 2010 ). Measuring drug

court structure and operations: Key components and beyond. Criminal Justice and Behavior ,37

(9), 933 –950. doi: 10.1177/0093854810373727

920 J. R. GALLAGHER ET AL. Lindquist, C. H., Krebs, C. P., & Lattimore, P. K. ( 2006 ). Sanctions and rewards in drug court

programs: Implementation, perceived e ﬃcacy, and decision making. Journal of Drug Issues ,36(1),

119 –146. doi: 10.1177/002204260603600106

Lowenkamp, C. T., Holsinger, A. M., & Latessa, E. J. ( 2005 ). Are drug courts e ﬀective? A meta-

analytic review. Journal of Community Corrections ,15,5–28.

Marlowe, D. B. ( 2012 ).Behavior modi ﬁcation 101 for drug courts: Making the most of incentives and

sanctions . Alexandria, VA: National Drug Court Institute.

McPherson, C. M., & Sauder, M. ( 2013 ). Logics in action: Managing institutional complexity in

a drug court. Administrative Science Quarterly ,58(2), 165 –196. doi: 10.1177/0001839213486447

Miles, M. B., Huberman, A. M., & Saldana, J. ( 2014 ).Qualitative data analysis: A methods source-

book (3rd ed.). Thousand Oaks, CA: Sage Publications, Inc.

Mitchell, O., Wilson, D. B., Eggers, A., & MacKenzie, D. L. ( 2012 ). Assessing the e ﬀectiveness of

drug courts on recidivism: A meta-analytic review of traditional and non-traditional drug courts.

Journal of Criminal Justice ,40(1), 60 –71. doi: 10.1016/j.jcrimjus.2011.11.009

National Association of Drug Court Professionals [NADCP]. ( 2004 ).De ﬁning drug courts: The key

components . Retrieved from https://www.ncjrs.gov/pd ﬃles1/bja/205621.pdf

Nolan, J. L. ( 2001 ). Reinventing justice: The American drug court movement . Princeton, NJ:

Princeton University Press.

Padgett, D. K. ( 2016 ).Qualitative methods in social work research (3rd ed.). Thousand Oaks, CA:

Sage Publications, Inc.

Schneider, R. D., Bloom, H., & Hereema, M. ( 2007 ).Mental health courts: Decriminalizing the

mentally ill . Toronto, Canada: Irwin Law.

Slinger, E., & Roesch, R. ( 2010 ). Problem-solving courts in Canada: A review and a call for

empirically-based evaluation methods. International Journal of Law and Psychiatry ,33(4),

258 –264.doi: 10.1016/j.ijlp.2010.06.008

Substance Abuse and Mental Health Services Administration [SAMHSA]. ( 2018 ).Key substance use

and mental health indicators in the United States: Results from the 2017 national survey on drug

use and health (HHS Publication No. SMA 18-5068, NSDUH Series H- 53). Rockville, MD:

Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services

Administration.

U.S. Government Accountability O ﬃce. ( 2005 ).Adult drug courts: Evidence indicates recidivism

reductions and mixed results for other outcomes (No. GAO-05-219). Washington, DC: Author.

Wexler, D. B., & Winick, B. J. ( 1996 ). Law in a therapeutic key: Developments in therapeutic

jurisprudence . Durham, NC: Carolina Academic Press.

Wilson, D. B., Mitchell, O., & MacKenzie, D. L. ( 2006 ). A systematic review of drug court e ﬀects on

recidivism. Journal of Experimental Criminology ,2(4), 459 –487. doi: 10.1007/s11292-006-9019-4

Wolfer, L. ( 2006 ). Graduates speak: A qualitative exploration of drug court graduates ’views of the

strengths and weaknesses of the program. Contemporary Drug Problems ,33(2), 303 –320.

doi: 10.1177/009145090603300206

Wolfer, L., & Roberts, J. C. ( 2008 ). A theoretical exploration of a drug court program based on client

experiences. Contemporary Drug Problems ,35(2–3), 481 –507. doi: 10.1177/009145090803500213

JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT 921 Copyright

ofJournal ofHuman Behavior inthe Social Environment isthe property ofTaylor

Francis Ltdand itscontent maynotbecopied oremailed tomultiple sitesorposted toa

listserv

without thecopyright holder'sexpresswrittenpermission. However,usersmayprint,

download,

oremail articles forindividual use.