Using the Drug Court Model to provide
Residential Treatment Services within a
Criminal Justice Facility.
Seth Norman, J.D.
Judge, Davidson County Division IV Criminal Court
Roland Gray, M.D.
Medical Director, Tennessee Medical Foundation
Jeri Thomas, M.A.
Executive Director, Nashville Drug Court Support Foundation
Samuel A. MacMaster, Ph.D.
Associate Professor, University of Tennessee
CAPTASA 14th Annual Conference
Embassy Suites – Lexington, Kentucky
January 24 – 25, 2014
Incarceration
 There are currently more than 2.2 million incarcerated
individuals in the United States, almost all of whom will
return to the community (BJS, 2011).
 An estimated eighty percent of incarcerated individuals have
serious substance abuse problems (CDC, 2001).
 Individuals charged specifically with drug offenses constitute
the majority of federal prisoners (51%), and a significant
proportion of state prisoners nationwide (18%) (Guerino,
Harrison and Sabol, 2011).
 Additionally, significant proportions of state prisoners (19%)
and federal inmates (16%) reported committing their current
offense to obtain money for drugs (Mumola and Karberg,
2006).
Recidivism
 Unfortunately despite incarceration, most individuals who
are released to the community return to prison within a
short period of time.
 While recidivism rates vary widely by state, within three
years, almost half (43.3% to 45.4%) of all prisoners
nationwide return to prison (Pew Center on the States,
2011).
 Recidivism rates in the state of Tennessee are even
higher. Three-year recidivism rates in Tennessee are
46.1%, and four-year rates are 54.8% (TDOC, 2010).
Cost of Incarceration
 The financial cost of incarceration is significant, particularly
for state governments.
 Nationwide, the estimated cost of a year of state
incarceration is $26,000 per person (Schmitt, Warner, and
Gupta, 2010).
 Last year, alone, states collectively spent over fifty-one
billion dollars on corrections (NASBO, 2011).
The Drug Court Model
 Due to the poor outcomes and the high cost of
incarceration, the Drug Court Model was developed as a
more effective alternative.
 Typically, drug courts work with the court system,
community corrections, and community-based substance
abuse treatment providers to provide sustained monitoring
and consequences for relapse to ensure that individuals
engage in, and benefit from, community-based substance
abuse treatment.
Overview of the Nashville Innovation
 By utilizing this model and applying it to a residential
setting, the Davidson County Drug Court Residential
Program (DC4) was developed as a two-year program
targeted to substance dependent felons who are not
eligible for community release.
Brief History
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Established in 1996
Originally had capacity to house seven men
Added Women’s component in 1997
Current facility was built in 2000
Added Methamphetamine Program in 2005
Added Mental Health Component in 2008
THE ORIGINAL FACILITY
THE BUILDING WE STARTED IN HAD ROOM
FOR EIGHT MALES
WHERE WE ARE NOW
A LONG TERM RESIDENTIAL FACILITY THAT
ACCOMODATES 40 FEMALES AND 70 MALES
THE FRONT ENTRANCE
FRONT RECEPTION AREA
RESIDENCE HALL FOR WOMEN
THE FEMALE RESIDENCE HALL
RESIDENCE HALL FOR MEN
CLASS ROOM
KITCHEN
THE RESIDENTS PREPARE AND SERVE ALL MEALS
THE OLD COURTROOM
THE NEW COURTROOM CONSTRUCTED
BY RESIDENTS
ONE OF THE TWO RESIDENCE HALLS ADDED
FOR THE METH PILOT PROJECT
DC-4 GRADUATES LINE THE HALL TO
WELCOME A VISITOR
ATTORNEY GENERAL, DRUG CZAR AND
SECRETARY OF HEALTH VISIT DRUG COURT
THE SOFTBALL FIELD CONSTRUCTED
ENTIRELY BY THE RESIDENTS
RESIDENTS REHAB AN OLD ANIMAL SHELTER
BUILDING TO BE USED FOR VOCATIONAL
TRAINING
EQUIPMENT ROOM
THE WOOD WORKING SHOP
EQUIPMENT SHED
FARMING EQUIPMENT
THIS WAS SURPLUS PROPERTY
RESIDENTS WORKING THE GARDENS
ANOTHER GARDEN PLOT
MORE FARM EQUIPMENT
WE OBTAIN MOST OF OUR FARM
EQUIPMENT FROM STATE SURPLUS
RESIDENTS WHO VOLUNTEERED TO DO
PUBLIC SERVICE HELPING FLOOD VICTIMS
RESIDENTS DOING PUBLIC SERVICE WORK IN
FLOOD AREAS
Roland W. Gray, M.D., FAAP,
FASAM
Repeat criminal offenders
Significant history substance
abuse
Unemployed
Dual diagnosis
Prior Treatment failure
Treatment
In house
 12 Step Philosophy
 Group Individual
 DBT
CBT RET
Support Services
Substance Abuse
Mental Health
Physical Health
Four Phases
Individualized
Behavioral relapse
Chemical relapse
Phase I
Assessment
Orientation
Support Services
Four weeks to three months
Phase II
Stabilization and Rehabilitation
Recovery Support Community
Steps I-V AA
Relapse Prevention Plan
Three to six months
Phase III
Transition to community
Obtain employment
300 hours community service
450 hours employment
Sober living facility
Three to six months
Community Service
Moral character – Self esteem
Landscaping schools
60,000 hours
On-Site Vocational Training
Assessment
Résumé assistance
Interview skills
Vocation (cont.)
Small mechanics
Garden
Painting
Automotive body
shop
Upholstery
Woodshop
Culinary
Phase IV
Aftercare DC-4; 4/week
UDS Twice a week
Probation officers
Monitor housing employment
Nine to twelve months
Sustained monitoring
Consequences
Samuel MacMaster, Ph.D
Program Results
 Data was available for nearly seventeen hundred
individuals (1,684) who entered treatment during a fifteenyear period of time between April of 1996 and November of
2013.
 All participants had received residential services; average
length of stay was 482 days (s.d.=323).
 At the time of program entry, participants’ average age was
33.1 years, (s.d.=9.1), nearly two-thirds, (62.4%), were
under the age of thirty-five, and nearly a quarter, (24.2%),
were under the age of twenty-five.
 The majority of participants were male (74.8%) and
Caucasian (50.5%).
Criminal Backgrounds
 Participants are reflective of the program’s focus on the
needs of hard to reach, repeat criminal offenders who have
long-term histories of criminal justice involvement and
chronic substance use problems.
 The average number of lifetime arrests is more than twelve
(12.7), and on average the number of arrests in the last
two years is more than four (4.1).
 Drug offenses made up the majority (58.0%) of the
offenses that brought individuals to the program; followed
by other drug-related offenses of theft (13.0%) burglary
(7.7%) and aggravated burglary (7.1%).
 Participants had been sentenced to serve an average of
2,364 days, or approximately six and a half years.
Substance Use Backgrounds
 On average, participants had used substances for 18.4
years.
 The majority of participants (62.1%) had received substance
abuse treatment in the past, but none had been able to
initiate or maintain their recovery.
 Participants were most likely to identify their current drug of
choice as cocaine (50.6%) followed by marijuana (13.2%),
methamphetamines (12.6%), prescription pain pills (10.0%),
and alcohol (8.2%).
 First average reported drug use was 14.7 years, and the
majority of participants (53.1%) had used prior to age
fourteen.
Social Functioning Backgrounds
 None of the participants were employed, and more than a
third (37.4%) had never held the same job for a year.
 Only a quarter (27.6%) currently had a valid drivers license.
 As a group, participants averaged 11.3 years of formal
education. Nearly two-thirds (61.9%) had not graduated
from high school.
 Less than a third (32.1%) lived in their own home or
apartment at the time of their arrest.
 In terms of marital status, nearly two-thirds (62.8%) had
never been married and few (12.7%) were currently married.
 More than a third of participants (36.3%) reported that they
had a mental illness, and only 14.0% had received any
mental health treatment in the past year.
Results: Recidivism
 In terms of arrests and convictions after completing and
graduating from the two-year program, the majority of
individuals who completed the program (61.7%) were not
rearrested and convicted for any new offenses.
 More than two-thirds of program completers (76.7%) were
not rearrested and convicted for new violent or drug
offenses.
 Almost all program completers (94.8%) were not rearrested
and convicted for new violent offenses.
 More than three-fourths (81.9%) were not rearrested and
convicted for new drug-related offenses.
Results: Substance Use and
Employment
 All program participants were employed full-time at the
time of graduation and had maintained that employment for
approximately a year.
 This is a significant increase from the time of program
entry, during which no one was employed.
 As a requirement of graduation, all program participants
must be completely abstinent for one-year.
 Substance use is also monitored by regular urine drug
screens, which were negative at a rate greater than 99%.
Cost Savings
 Savings on incarceration were calculated comparing the
costs of DC4 versus continued incarceration in jail or
prison.
 These calculations do not account for any of the other
potential financial benefits the community may have
incurred due to the program, i.e. the number of individuals
working and paying taxes, the number of individuals
regaining custody or making financial contributions for their
children, or the potential cost savings for individuals who
are no longer engaged with the criminal justice system.
Calculations for Cost Savings
 Costs savings were calculated using three different
comparisons:
– the savings compared to the cost of incarcerating
individuals for their complete sentence,
– the savings compared to the cost of incarcerating
individuals for half of their sentence, and
– the daily cost savings based on housing individuals in
DC4 only for the days they were residents.
 A day of services at DC4 has been calculated to cost
$48/day by an outside auditor (Farmer, 2006).
 The cost of state incarceration is reported to be $65/day by
the Tennessee Department of Corrections (TDOC, 2011).
Savings vs. Complete Sentence
 The average length of the sentence for a DC4 resident was
2,364 days.
 Assuming that each individual served their entire sentence,
the total cost to the community would be $153,660 on
average to incarcerate each individual.
 The average length of time in the DC4 program was
shorter, at 482 days, with a total cost of $23,136.
 Assuming that each individual completed their sentence,
the community experienced a cost savings of $130,524 per
person, for the 1,296 individuals who have completed the
residential portions of the program, i.e. phases one through
three. Cost savings are $169,159,104
Savings vs. Half Sentence
 The assumption that individuals serve their entire sentence
behind bars does not necessarily reflect reality, as
individuals often receive reduced sentences for a reward
for good behavior.
 Even assuming that each individual would have only
served half of their sentence, 1,182 days as opposed to
2,364 days, the community would still realize significant
cost savings.
 Incarceration costs would be calculated to be $76,830 per
person, saving the community $53,694 per person or a
total of $69,587,424.
Savings on daily rate
 At a minimum, the community saved significant amounts of
money simply by placing individuals in the DC4 program as
an alternative to a county or state facility.
 For the 1,296 individuals who have completed the
residential portions of the program a total of 624,672 days
have been served at DC4.
 This is clearly an underestimate of the total savings cost,
as the significant cost savings for individuals still
participating, or who dropped out before completing, are
not included in this calculation.
 For these individuals alone, the community has saved a
total of
$10,619,424.
Jeri Thomas, M.S.