It’s no secret that substance use disorders are linked to mental health issues. According to SAMHSA, over 7.9 million Americans experience co-morbidity (two or more conditions at a time) with a mental and substance use disorder.[i] Drug courts are designed to bridge the gap between substance use treatment and the criminal justice system, but mental health treatment is often an overlooked link. For participants in drug courts nationwide, between one-quarter and one-half are referred to a mental health treatment provider for a co-occurring mental disorder.[ii] Unless drug courts begin to properly 
address the mental health of the participants, they will not be resolving all underlying problems that led to criminal justice involvement for people with co-occurring disorders.
There are several theories about why mental illness and substance use are connected. One popular theory in the medical community is that people with mental illness are particularly vulnerable to developing a substance use disorder because alcohol and street drugs are used as self-medication to cope with the symptoms of mental illness.[iii] While recreational substance use may temporarily ease symptoms, it can make them worse over time, which in turn fuels more drug use. The best way to break this cycle of mental health and substance use disorders is through treatment of both disorders concurrently. Treating both mental health and substance use disorders equally is more effective than only addressing one disorder because they are deeply connected and will continue to feed into each other without treatment, causing impairment and additional criminal justice involvement.
To effectively address the role mental health plays in substance use, drug courts should assess all participants for mental health disorders at intake or within the first phase of the program. Subsequently, the court’s treatment provider should tailor a dual diagnoses participant’s treatment plan to reflect their mental health needs. The treatment clinicians should be able to explain to the rest of the court team how a participant’s mental illness may affect their receptivity to interventions and their behavior. Not sure if your treatment provider has the capacity to meet the needs of co-morbidity clients? Use this reference guide to assess your provider’s capabilities.
Another way to ensure mental health needs are fully addressed and integrated into treatment services is to establish a hybrid court model. Hybrid courts are designed to specifically treat people with comorbidity. Setting up a specific program for people with mental health disorders and substance use disorders may help to ease the stigma of mental health treatment. It also provides more opportunities for mentorship and group therapy.
People aren’t one-dimensional, so their treatment shouldn’t be either. Treatment courts should be multifaceted, treating substance use, mental health, and criminal justice involvement issues simultaneously. With such high rates of co-morbidity within drug courts, mental health treatment should be a top priority for drug court professionals who hope to improve results for participants with dual-diagnoses and ultimately prevent future involvement with the criminal justice system.
[i] https://www.samhsa.gov/disorders