Let’s Get Your History

Preeti Menon and colleague, Zephi Francis outside of court house.On recent visits to three drug courts in three different states, the concept of moving away from a traditional cookie-cutter approach to treatment for participants came up. In several conversations, drug court teams discussed the idea of working with participants to identify and better understand their unique needs. From that inquiry and conversation, drug court teams could develop a treatment plan tailored to the participant’s unique individual history, circumstances, and needs.

Sound familiar? If you have ever been to a primary care physician or a specialist, you most likely have filled out a form where you provided details on your medical history. Your doctor then treated you based on your medical history, including family medical history and disposition to certain ailments or chronic diseases.

Given the medical disposition, substance use disorders must be treated within the framework of the medical model with treatment at its core. At a recent panel discussion on opioids at American University (AU), a physician working with substance use recovery within jails and prisons equated substance use disorder, specifically opioids, to any other chronic illness. “Chronic disease: A disease that persists for a long time. A chronic disease is one lasting three months or more, by the definition of the US National Center for Health Statistics. Chronic diseases generally cannot be prevented by vaccines or cured by medication, nor do they just disappear.”1

Substance use “addiction is a chronic disease similar to other chronic diseases such as type II diabetes, cancer, and cardiovascular disease;”2 therefore it should be treated with a medical lens rather than a criminal one.

Obtaining and verifying an individual’s medical history is basically mandatory at every physician visit. Using a similar approach in drug courts, and possibly other sectors of the justice system, could produce more positive outcomes for those suffering with substance use disorders. During the AU session, it was stressed that taking away medical treatment for a chronic illness is unthinkable for physicians and patients, similarly, not using medical treatment for opioids should be unthinkable.

I encourage drug courts to:

  • Learn from and use a medical approach of individualized treatment in treating a substance use disorder and how we address it within drug treatment courts.
  • Include a physician on your drug treatment court team.
  • Use the individualized approach that medicine utilizes when working with participants.
  • Provide a plan for drug court graduates based on individual needs and on continuing sobriety.
  • Think outside of the box and look for alternatives that haven’t been considered yet.

Drug courts teams should continue to take a collaborative approach to justice. The judge, prosecutor, defense attorney, and probation official can work collaboratively and in partnership with public health professionals, such as treatment providers, social services, and mental health specialists, to seek solutions that benefit the participant.

For drug court teams who work on individualized treatment plans, I encourage you to share your stories, lessons learned, and success with your peers and with other drug courts. Share challenges and encouragements with your peer drug courts. The best thing we can do in the drug court field is learn from each other, both from our successes and failures. And sometimes failures, and lessons learned from those failures, are more relevant than our successes.

Lastly, and perhaps most importantly, viewing a participant as unique with their own challenges not only humanizes them, it also motivates the participant towards recovery.  

1Jr, William C. Shiel. “Definition of Chronic Disease.” MedicineNet. Accessed May 08, 2019. https://www.medicinenet.com/script/main/art.asp?articlekey=33490.

2“Addiction Is a Chronic Disease.” Addiction Is a Chronic Disease | NIDA Archives. Accessed May 08, 2019. https://archives.drugabuse.gov/publications/drug-abuse-addiction-one-americas-most-challenging-public-health-problems/addiction-chronic-disease.