Seth Norman, J.D. Judge, Davidson County Division IV Criminal Court Roland Gray, M.D.

1. 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

3. 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).

4. 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).

5. 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).

6. 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.

7. 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.

8. Brief History • 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

9. THE ORIGINAL FACILITY THE BUILDING WE STARTED IN HAD ROOM FOR EIGHT MALES

10. WHERE WE ARE NOW A LONG TERM RESIDENTIAL FACILITY THAT ACCOMODATES 40 FEMALES AND 70 MALES

11. THE FRONT ENTRANCE

12. FRONT RECEPTION AREA

13. RESIDENCE HALL FOR WOMEN

14. THE FEMALE RESIDENCE HALL

15. RESIDENCE HALL FOR MEN

16. CLASS ROOM

17. KITCHEN THE RESIDENTS PREPARE AND SERVE ALL MEALS

18. THE OLD COURTROOM

19. THE NEW COURTROOM CONSTRUCTED BY RESIDENTS

20. ONE OF THE TWO RESIDENCE HALLS ADDED FOR THE METH PILOT PROJECT

21. DC-4 GRADUATES LINE THE HALL TO WELCOME A VISITOR

22. ATTORNEY GENERAL, DRUG CZAR AND SECRETARY OF HEALTH VISIT DRUG COURT

23. THE SOFTBALL FIELD CONSTRUCTED ENTIRELY BY THE RESIDENTS

24. RESIDENTS REHAB AN OLD ANIMAL SHELTER BUILDING TO BE USED FOR VOCATIONAL TRAINING

25. EQUIPMENT ROOM

26. THE WOOD WORKING SHOP

27. EQUIPMENT SHED

28. FARMING EQUIPMENTTHIS WAS SURPLUS PROPERTY

29. RESIDENTS WORKING THE GARDENS

30. ANOTHER GARDEN PLOT

31. MORE FARM EQUIPMENTWE OBTAIN MOST OF OUR FARM EQUIPMENT FROM STATE SURPLUS

32. RESIDENTS WHO VOLUNTEERED TO DO PUBLIC SERVICE HELPING FLOOD VICTIMS

33. RESIDENTS DOING PUBLIC SERVICE WORK IN FLOOD AREAS

34. Roland W. Gray, M.D., FAAP, FASAM

35. Repeat criminal offenders Significant history substance abuse Unemployed Dual diagnosis Prior Treatment failure

36. Treatment In house • 12 Step Philosophy • Group Individual • DBT CBT RET

37. Support Services Substance Abuse Mental Health Physical Health

38. Four Phases Individualized Behavioral relapse Chemical relapse

39. Phase I Assessment Orientation Support Services Four weeks to three months

40. Phase II Stabilization and Rehabilitation Recovery Support Community Steps I-V AA Relapse Prevention Plan Three to six months

41. Phase III Transition to community Obtain employment 300 hours community service 450 hours employment Sober living facility Three to six months

42. Moral character – Self esteem Landscaping schools 60,000 hours Community Service

43. On-Site Vocational Training Assessment Résumé assistance Interview skills

44. Small mechanics Garden Painting Automotive body shop Upholstery Woodshop Culinary Vocation (cont.)

45. Phase IV Aftercare DC-4; 4/week UDS Twice a week Probation officers Monitor housing employment Nine to twelve months

46. Sustained monitoring Consequences

47. Samuel MacMaster, Ph.D

48. Program Results • Data was available for nearly fifteen hundred individuals (1,409) who entered treatment during a fifteen-year period of time between April of 1996 and May of 2011. • All participants had received residential services; average length of stay was 492 days (s.d.=305). • At the time of program entry, participants’ average age was 32.6 years, (s.d.=8.8), nearly two-thirds, (63.1%), were under the age of thirty-five, and more than a quarter, (25.3%), were under the age of twenty-five. • The majority of participants were male (75.4%) and African Americans (52.8%).

49. 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 nearly twelve (11.9), and on average the number of arrests in the last two years is more than four (4.3). • Drug offenses made up the majority (61.0%) of the offenses that brought individuals to the program; followed by other drug-related offenses of theft (12.9%) burglary (8.5%) and aggravated burglary (8.1%). • Participants had been sentenced to serve an average of 2,301 days, or approximately six and a half years.

50. Substance Use Backgrounds • On average, participants had used substances for 17.9 years. • The majority of participants (59.5%) 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 (57.2%) followed by marijuana (14.0%) methamphetamines (8.6%) alcohol (8.2%), and prescription pain pills (7.1%). • First average reported drug use was 14.7 years, and the majority of participants (52.1%) had used prior to age fourteen.