Miami, Florida's "Drug Court"
a template for success in the criminal justice system By the office staff of Judge Stanley Goldstein and Miami's Dade County personnel |
Reprinted with permission from the
Journal of Oriental Medicine in America
The so called "Drug Court" in Miami is one of the first of its kind in the United States. The objective is to divert nonviolent drug users from the traditional path of streets to court to jail and toward a productive, drug-free lifestyle. Approximately 89% of defendants who successfully complete the Miami program remain unarrested for at least one full year.
Dade County attorney Sam Mones has been involved with Judge Goldstein's program for the past 5 years. Approximately 15 clients of Mr. Mones have been processed through the judge's acupuncture program. In all cases, success with this program has been achieved.
One difficult case involves a male with a pharmaceutical opiate addiction of 12 years. The patient literally went from the high rent district in Miami to a crack hotel, eventually hit bottom and was arrested. Two years after entering the program, he graduated and has remained substance free while reclaiming his life.
Another case involved a 31 year old we'll call "John." John claims to have been a casual user of marijuana and cigarette smoker, both for 18 years. His arrest brought him to Stanley Goldstein's courtroom. He faced jail time for his offense, so when he was offered an alternative to serving time, John leapt at the opportunity. Though John insisted that his was not a serious case involving addiction, Judge Goldstein answered in typical fashion, "Congratulations! Then you'll have a real easy time with the program." Judge Goldstein is careful to explain the program to all new defendants, making clear that they should expect a year of treatment, that it will be difficult to succeed, but that everyone involved will provide them with all the assistance they need and keep pushing them to do better. Regular urine tests and monthly court appearances stand as the review process of progress. Unless improvement is satisfactory, prosecution may resume. John knew nothing about acupuncture before he accepted the judge's terms of compliance, but figured it was a "can't lose" proposition. Judge Goldstein's dedication to helping the participants succeed afforded John the chance he needed, and 13 months after beginning the program he graduated. Along with losing his appetite for marijuana, John stopped smoking. In over 2 years since completing the program, he reports no cravings for either marijuana or cigarettes, and he believes that there is no reason to return to substance abuse. He truly has reformed. John is now focused on his work and has straightened out his life. He expresses gratitude to Judge Goldstein for his patience and support in successfully seeing him through the transition.
John believes that acupuncture worked a miracle in his case and recommends it to others who are serious about controlling addictions. He now has his life on track, though the process did force him to take a hard look at his social associations. For many, leaving the influences which supported the addiction lifestyle is an important step to the commitment to change. Cravings have psychological and physical components which acupuncture has been demonstrated to have an effect in controlling.
One additional case study follows, in which acupuncture played a major role in patient recovery. "Yvonne" was 42 when arrested in a sting operation for cocaine purchase and possession. She is a college educated, unemployed immigrant, separated from her husband. Yvonne works as a freelance translator and teacher. Her use of cocaine was considered "infrequent" (less than once a week) and she regularly consumed alcohol. At the time of admission, she tested positive for both cocaine and amphetamines.
Yvonne was motivated and cooperative throughout her treatment. Approximately three months after admission, she tested positive. Acupuncture and individual counselling helped her through this period. Her attendance and attitude continued good and her binge did little to slow her progress in the program. Slightly less than a year after beginning the program, she was recommended for graduation and her case was later nolle processed. File notes state that in addition to helping her with her drug problem, counselors tried to help her address problems related to employment and her marital situation.
Overcrowding in the prison system is a major issue in virtually every American urban center. This program's efficacy has given hope to all concerned with the financial and social costs of drug and alcohol abuse. Officials in law enforcement, the court system, the prison system and the general public need to take a good look at this program. It is functional and successful. Its impact is immeasurable to society as a whole.
Clients are offered daily acupuncture as an aid in detoxification, with about 85% electing for this approach. China and other Far Eastern countries have used acupuncture for centuries to treat a variety of illnesses and provide anesthesia during surgery. Acupuncture has also been used for drug detoxification in these countries and, more recently, in some clinics in the United States. The treatment is said to reduce cravings, mitigate withdrawal symptoms and ease the anxiety that clients typically experience during the first several days or weeks after they stop using drugs.
According to acupuncture theory, people have a myriad of pressure points that affect specific organs in the body. During a Miami program acupuncture session, a certified acupuncturist inserts five tin, sterile, disposable needles beneath the surface of the outer part of the ear at specific acupuncture points. The needles are inserted quickly, and clients report feeling at worst a slight pinch upon insertion. This procedure is said to release detoxification by causing the release of endorphins, the body's pain killers. Each session lasts 45 minutes, during which the clients appear very relaxed.
Proponents of acupuncture say that the treatment is more effective than other detoxification methods (for example, use of drugs like methadone), is inexpensive, can be administered on an outpatient basis, and makes it possible for a large number of clients to be treated simultaneously by only two or three staff members. A panel of acupuncture researchers and drug abuse treatment experts at a recent National Institute on Drug Abuse technical review meeting criticized the methods used to evaluate whether acupuncture really helps addicts maintain abstinence. Many panel members believed there were enough positive reports of acupuncture's benefits to justify conducting additional studies of its value as a supplement to other drug abuse treatment, particularly in light of its low cost and ease of delivery. (From Swan, N. "Experts Divided on Effectiveness of Acupuncture as a Drug Abuse Treatment." NIDA Notes, Sept-Oct. 1992, p. 8-9).
While acupuncture is only one of several important components of this program, it may be of interest to our readers to see in greater detail how acupuncture is integrated into this program as an indicator of how it may be plugged into mainstream health care and our culture. An overview of the criteria and program structure follows.
In this program, acupuncture is recognized to reduce cravings of substance dependence, making it possible to better prepare the patient for addressing the many accompanying problems inherent in addiction.
For 12 consecutive days, needling (45 minutes per session) and urine drops are performed. During this time, patients are expected to attend fellowship meetings and engage with caseworkers as determined.
A psychosocial assessment at the end of this phase includes extensive histories of patient drug and alcohol activity, prior treatment, family and social background, educational and/or vocational achievements, legal problems, emotional balance and testing, along with a summary of findings and treatment recommendations.
The patient's contract goals, which must be successfully achieved before graduation to Phase II, include: 5 of 12 negative urine tests, completion of 12 required acupuncture and/or meditation sessions and perfect attendance at all scheduled group, fellowship and counselor meetings. Failure to meet the requirements results in the participant's recycling through Phase I, an outside referral or discharge back to the pre-trial caseworker.
Should the patient achieve 12 clean urine tests, he/she may move directly to Phase III if history of drug use is shown to be minimal and intensive treatment is not deemed necessary.
The goals of Phase II include: patient education regarding substance abuse, assistance in modification of drug seeking behavior, support group involvement, development of self-motivation and social skills and an internalization of drug free philosophy.
Interventions for this phase include acupuncture, individual therapy, fellowship meetings, meditation, 2 of 3 negative weekly urinalyses over a four week period and a flexible treatment planning approach with a sobriety contract which is developed in the first thirty days.
After six weeks, participants are expected to remain substance free. Perfect attendance at support meetings and a thorough understanding of the fellowship as a support system must be demonstrated. Significant progress towards treatment goals must be made as well.
This module requires weekly attendance with urine sampling for a period of 8 months. NA/AA attendance verification must be provided by participants. Needling will be provided as requested.
The other Phase III module option at Metro Dade Community College (MDCC) involves educational opportunities and has four primary goals:
Emphasis is on sobriety maintenance and life skill or vocational development. Substance abuse treatment, including support groups and counseling, is provided. Urine testing is required as in the other Phase III option. In addition, a variety of educational offerings are available to participants, including literacy classes, GED preparation, parenting skills and numerous vocational tracks with job placement.
Typically, if someone tests positive twice during the program, they are sentenced to 14 days and are allowed to begin the program again. It is generally recognized that there is a lower recidivism rate with acupuncture treatments when combined with other modalities. Acupuncture is employed in the Dade County Drug Court's treatment program on a volunteer basis as an adjunct therapy for attending defendants. As such, acupuncture has not been viewed by the program as a specific treatment modality. Instead, it is employed as a resource for stabilizing defendants, particularly during the early phases of treatment, and for increasing amenability to treatment.
Use of acupuncture in the program was applauded and statistically supported, and a miss rate of as little as 17% has been estimated. This finding indicates that if prospects are properly interviewed and assessed, a high degree of success in this program is likely. Many states have adapted the Miami model and are reporting similar results, with lessened case loads due to repeat offenders and a hope that some of the overcrowding in prisons may be relieved as more people are processed through this innovative program. While optional, the role of acupuncture in this program is an important one. There is much supporting statistical evidence which shows it enhances the Drug Court's program and obtains the desired results. Readers are encouraged to refer to the National Institute of Justice Research in Brief publications for more information.
This article was prepared with the assistance of the office staff of Judge Stanley Goldstein and Miami's Dade County personnel. Some additional information was obtained from the National Institute of Justice's Research in Brief publications profiling the Drug Court. Miami attorney Sam Mones and his staff were also instrumental in gathering information. Many thanks to all who contributed.
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