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Milwaukee’s Adult Drug Treatment Court Saves Lives Through Long-Term Recovery

Aug. 22, 2017
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Laura Haas’ message is simple: “People addicted to drugs are not ‘junkies’ or society’s throwaways.” Many work hard to achieve recovery, she says. “But they can’t do it alone. They need community support.” And Haas should know: She’s in long-term recovery from a substance use disorder. In large measure, her recovery is due to support from Milwaukee County’s Adult Drug Treatment Court (DTC). Since its inception in 2009, the DTC has enrolled 602 participants. All, including Haas, committed non-violent offenses stemming from substance use disorders.

“I stole stuff [to sell] so I could buy heroin,” Haas recounts, “and I got caught.” Instead of leading her to prison, arrest led Haas to DTC, which Haas describes as a life-saving journey. Today, two-and-a-half years into her recovery, Haas is not only a drug-free DTC graduate, she holds a full-time job as a peer specialist at the United Community Center (UCC). At UCC, Haas is “giving back” by helping others recover from substance use disorders. She employs an approach she experienced at DTC: letting people know they’re cared for and holding them accountable.

Presiding Judge Carl Ashley would likely agree with Hass’ assessment of the Drug Treatment Court’s approach. “I do hold people accountable,” he says, “but I also care about them.” Early on, as a new judge, Ashley focused primarily on accountability. Over time he came to realize that understanding personal situations and the traumatic events and histories that often contribute to criminal offense makes a difference. “Now I don’t look just at the incident, I peel away the onion and learn the story,” he says, “and that makes me have more [of an] impact.” People are more likely to change when they’re understood as well as held accountable, Judge Ashley explains. He adds that DTC’s approach is not “soft on crime,” a criticism he sometimes hears. “DTC is extraordinarily difficult to navigate,” he says. “Many participants tell me it’s the hardest thing they’ve ever done.”

 

An Evidence-Based Approach

Recovering from a substance use disorder can be difficult in and of itself, but being held accountable by the county’s DTC also entails complying with numerous rules and many procedures. They reflect an evidence-based approach to ensuring public safety and providing effective recovery treatment—both part of DTC’s mission. To be eligible for DTC, participants must be at least 18 years old, reside in Milwaukee County and face a sentence recommendation from the district attorney’s office of at least nine months straight time. Their criminal history cannot include violent offenses. Participants also submit to frequent drug testing, appear before Judge Ashley for regular hearings and, as ability permits, pursue job training, work or perform volunteer service.

Ongoing substance abuse treatment is a non-negotiable DTC requirement. The treatment type depends on addiction severity as well as other participant needs, as determined by one of Milwaukee County Behavioral Health Division’s comprehensive intake units. Treatment can be residential, intensive or standard outpatient substance abuse counseling and can include family counseling, anger management and mental health services. Participants needing residential treatment sometimes have to wait for it. Haas endured nearly two months in jail before a bed opened for her. “It was frustrating,” she says, especially because “the light bulb had gone on” and she knew she was ready for treatment. Judge Ashley says the DTC is constantly “banging on doors” in search of appropriate resources, especially bridge or short-term housing that helps people stabilize while they undergo treatment. “The resource issue is extraordinarily difficult,” he adds.

All DTC participants are expected to work hard at changing their harmful behaviors, and Haas did just that. “But,” she says, “a whole bunch of people had my back, and that made it easier.” Her supporters included DTC graduate peer mentors as well as a DTC team led by Judge Ashley. The team meets weekly to monitor DTC participants’ progress and includes their defense attorneys, treatment providers, district attorneys, DTC coordinators and case managers, as well as law enforcement representatives.

 

Points for Positive Behavior

At one early morning team staffing, Judge Ashley placed a fish bowl on the table. He announced that one of the more creative team members had decorated the bowl by painting it and covering it with colorful plastic fish. Everyone understood that participants who had earned points for positive behavior could draw a gift certificate from the bowl during their hearing with the judge. Haas loved the rewards. They made her feel proud of her progress and fond of Judge Ashley. She thinks she was the first DTC participant to give him a hug, which at first took him aback. “Now,” she says, “he’s as much of a hugger as I am.” 

Judge Ashley may give hugs when warranted, but he also gives sanctions—consequences intended to hold participants accountable and change their behavior. Depending on the severity of the participant’s infractions, sanctions can range from a reading assignment or a curfew to more frequent drug testing or even program termination. At times, the DTC approach falls somewhere in between incentives and sanctions.

During the team staffing session, members talked about a participant who had missed a drug test. They deliberated for about 10 minutes, searching for reasons behind the lapse; was it manipulation or merely miscommunication? They questioned whether the participant needed more support or maybe a sanction. Ashley listened carefully, asked incisive questions and brought deliberations to a close. He decided more context and information were needed and asked the DTC case manager to check in with the participant’s residential treatment provider and report back. “Then we’ll see what we can do for this young woman,” he concluded. The aim, he conveyed, was to provide judicious help.

The overall DTC approach—balancing of incentives and sanctions, attentive monitoring and wrap-around social services—is designed to ensure participants progress through DTC’s four phases. At a minimum, completing all four of the phases takes 12 months, but it can take up to 18 months depending on such factors as addiction severity and treatment engagement. To progress from phase one to phase two, for example, participants must remain drug or alcohol free for 21 days following two negative tests, meet weekly with Judge Ashley and attend and engage in all treatment sessions. By the time participants are ready to finish the fourth and final phase, DTC Coordinator Meagan Winn says they’re “in the driver’s seat.” They proudly complete an application summarizing their progress and accomplishments related to their treatment: their education, training, employment and family relations; they also have a relapse prevention plan in place.

 

Some Don’t Make It

Completing the four DTC phases isn’t easy, but Haas made it through in 12 months. “I never failed a drug test or missed a court appearance, and I always kept my treatment appointments,” she says with noticeable pride. Such success, however, is not universal: Some participants don’t make it through, which means they face sentencing because they previously pled guilty. 

According to Winn, termination reasons vary. For one thing, the disease of addiction is characterized by relapse, treatment notwithstanding. Hence, for some people whose disorders are severe, the program requirements exceed their abilities. Other participants face particularly tough mental health challenges that can complicate or prolong recovery beyond the program’s capacity. Using evaluation data compiled by the UW-Milwaukee Helen Bader School of Social Welfare as well as recent scientific research results, the DTC has been restructured in recent years, and completion rates have increased. The new structure recognizes that, early on in the recovery process, DTC participants need particularly close monitoring, and goals need to reflect recovery realities. 

Low participation of African Americans in DTC has engendered criticism, and Judge Ashley (who is African American) acknowledges the complaints are well founded. The majority (67%) of current DTC participants are white, while 27% are African American and 6% are classified as “other.” Fifteen percent of enrollees specify their ethnicity as Hispanic, and 85% specify it as non-Hispanic. According to Ashley, under-representation of African Americans in drug courts is a nation-wide problem, and the reasons for it aren’t clear. In Milwaukee County, he says, “we’re trying to dive into [the reasons] and trying to evolve. We don’t have all the answers yet.”

 

Measured Successes

Across the nation, drug treatment courts are seeing measured success. Data from the National Institute of Justice Multi-site Adult Court Evaluation show that participants in the country’s approximately 1,550 adult drug treatment courts report less criminal activity (40% vs. 53%) and fewer arrests (52% vs. 62%) than comparable offenders. Participants reported less drug use (56% vs. 76%) and were less likely to test positive for drug use (29% vs. 46%) than comparable offenders. While drug treatment costs were higher for participants, less recidivism resulted in an overall average savings of $5,680 to $6,208 per offender.

Anyone who hears DTC participants’ stories, day in and day out, which frequently feature trauma and multiple losses, could be forgiven for sometimes feeling weary, and the most enthusiastic DTC champions could grow discouraged after repeated exposure to the worlds of hurt caused by the ever-escalating drug epidemic. Judge Ashley might feel it from time to time, but if so, he doesn’t show it. He appears to be all one could want in a DTC judge—energetic, impassioned, informed and convinced the evidenced-based DTC team approach is not only effective, but worth emulating.

“We need more [such courts],” he says. “Seeing DTC participants graduate is a blessing. Some become case managers and help improve the system,” he adds, and “that’s incredible. I’m very encouraged.” 

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