The best we can do?

“If you want to treat an illness that has no easy cure, first of all, treat them with hope.”—George Vaillant

credit: Franco Folini

This is so heartbreaking. Communities should distribute naloxone to inmates as they leave prison? Really?

I’ve grown so weary of the trite responses like, “You can’t recover if you are dead.”

Of course it’s true, but what are we doing to help them recover?

In the States it’s nearly nothing.

A report released today finds that Michigan’s Prisoner Re-entry Initiative is reducing recidivism among parolees but it almost ended just a few weeks ago. Keep in mind that this program costs $33 million in a corrections budget of $1.88 BILLION. (That’s less than 2%) Also, keep in mind that Michigan is one of 4 states that spends more on corrections than on higher education.

UPDATE: The more I think about this kind of stuff the angrier I get. It’s the equivalent of  finding someone collapsing with a heart attack in the middle of a street, helping them get to a sidewalk,  leaving them there and then congratulating yourself with statements like, “They’d never survive that heart attack if they got hit by a car!”

Drug Courts – There ARE Practice Guidelines

Recently, there has been a flurry of drug court criticism.

This post points out that there is a model for drug courts and that much of what’s been criticized are deviations from the model.

Calling for the end of drug courts or dramatic reductions in their use is a little like calling for the end of an evidence-based manualized treatment on the basis of practitioners who don’t follow the manual.

There are a lot of solutions to a problem like this–accreditation, creating fidelity requirements for funding, etc.

Note that in the 69 pages of the two reports, there is exactly one sentence addressing the fact that drug court guidelines exist:

While the National Association of Drug Court Professionals and others have laid out guidelines for best practices in drug courts, not every court across the country follows these standards, and both eligibility requirements and court processes vary nationally.

Hardly seems like an unbiased analysis, no?

Putting the problem and the reports in this perspective makes it appear that the conclusions of those reports (piously calling for us to follow evidence) were reached before the reports were written.

One more example that there often is not a straight line from evidence to a conclusion. Values and preexisting beliefs play an important role.

UPDATE: The National Association of Drug Court Professionals has now responded to the two reports.

Drug Courts Are Not the Answer?

The Drug Policy Alliance has a new paper that characterizes drug courts as a failure and advocates abandoning them for all but the most serious cases.

I often disagree with the DPA, but this time I feel a little disappointed.

Basically, they poke holes in the arguments that drug courts are an effective alternative to incarceration and make the argument that drug courts are no better or worse than conventional criminal justice approaches.

They poke holes by pointing to the inconclusive nature of a lot of research frequently cited by drug court supporters. This is fair, but, of course, their challenges are also pretty equivocal. Further, they complain that the outcome measures are abstinence focused. This may be a perfectly legitimate criticism of outcome measures, but it kind of undermines the argument that drug courts are not effective—if we lower the bar to include reduced drug use, the outcomes will look better, no?

What disappointed me that the argument that they are no better or worse than conventional approaches. This is hard to swallow and they didn’t make the case, leaving one to assume that this conclusion is based on their point of view rather than evidence. (That is ok with me. I can respectfully discuss a point of view if the person acknowledges and is prepared to discuss the values that inform their point of view. The problem is that they frequently present themselves as being guided only by evidence.) My perspective of drug courts is limited to what I’ve seen in my region and clearly, some are better than others and, maybe in some communities, they’ve made the situation worse.  However, the drug/sobriety court in Ann Arbor works. I have no doubt that it results in far fewer days of incarceration overall and significant improvements in quality of life for most participants.

There were some recommendations for improvement and an acknowledgement that Prop 36 in California was an improvement, but, unless you want to talk about legalization, it’s sweeping “findings” didn’t exactly feel like a conversation starter.