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THE GLASGOW DRUG COURT IN ACTION: THE FIRST SIX MONTHS

CHAPTER FOUR: SENTENCING AND TREATMENT

INTRODUCTION

4.1 The Drug Court has the same authority and status as other courts and, accordingly, has available to it the same range of sentences available to the Sheriff Court under summary proceedings. Similarly, the range of sentences available to the Drug Court (including Drug Treatment and Testing Orders) continue to be available to the Sheriff Court. The treatment options that the Drug Court have available to it include abstinence, methadone maintenance and methadone reduction. All Orders made by the Drug Court are subject to drug testing and regular (at least monthly) review in accordance with the relevant legislation. The same Sheriff who imposes the Order has responsibility for reviewing the Orders and responding to non-compliance, thereby ensuring the continuity of contact that has been found to be an important feature of Drug Courts in other jurisdictions. This chapter will examine factors that influence offenders to agree to the conditions of a Drug Court Order, and the practicalities of sentencing practice. It will consider the implementation of treatment options and respondents views on the efficacy of treatment and testing procedures.

4.2 Following a referral to the Drug Court, offenders will be fully assessed before being sentenced. As discussed in Chapter Three, they must be assessed as suitable for a Drug Court Order and must agree to co-operate with the requirements of the Order. The Drug Court can impose Drug Treatment and Testing Orders (DTTOs), Probation Orders with a Condition of Drug Treatment, concurrent DTTOs and Conditional Probation Orders, and deferred sentences ¹⁶ as specifically targeted treatment and supervision Orders. Information from the Drug Court Co-ordinator's monitoring database showed that by early May 2002, Drug Court Sheriffs had imposed 31 Drug Court Orders (Table 4.1). In 21 cases a non-Drug Court disposal was made, in one case the person was admonished and six further assessments were ongoing.

Table 4.1: Drug Court Orders in first six months of operation

4.3 Information held by the Supervision and Treatment Team showed that 26 of the 36 referrals and assessments that reached a first calling of the case (72%) had an outcome that matched the recommendation. The correspondence rates for men and women whose case had reached a first calling in the Drug Court were 73 per cent and 67 per cent respectively ¹⁷. There were no apparent differences in terms of gender, age, number of previous court appearances or number of previous adult custodial sentences between those whose outcome matched the social work recommendation and those whose outcome did not. However, the number of previous adult custodial sentences among those offenders for whom a full assessment was not completed was significantly higher than among those who had completed the assessment (an average of 13 compared to six ¹⁸).

4.4 Individuals who received a Drug Court Order did not differ significantly from those individuals who were referred to the Drug Court but received an alternative disposal. For both groups, the average age was 27 and the majority of individuals were male (83 per cent of those on a Drug Court Order and 91 per cent of those referrals who did not receive a Drug Court disposal). There were no significant differences in terms of marital status. Both groups had extensive histories of previous court appearances. Those who received a Drug Court Order had appeared in court between four and 47 times, prior to the offence for which they received a Drug Court Order, with an average of 24 previous court appearances. Information was not available for all individuals who received an alternative disposal ¹⁹; however, where this information was available, the average number of previous court appearances was 25. Similarly, those who received a Drug Court Order had served an average of seven adult custodial sentences (not including remands) prior to receiving a Drug Court Order compared to an average of nine custodial sentences of those who received an alternative disposal (where information was available). The average number of previous non-custodial sentences averaged five for those who received a Drug Court Order, compared to four for those who received an alternative disposal (where information was available).

EXPECTATIONS OF A DRUG COURT ORDER

4.5 Drug Court Orders require a sustained level of commitment from the clients, thus the clients require a significant amount of information before they can give their informed consent to the requirements of an Order. While offenders were referred to the Drug Court through various agencies - procurators fiscal, Sheriffs, police officers, solicitors - it was a social worker from the Drug Supervision and Treatment Team who conducted the assessment and passed on the necessary information. All of the respondents were of the view that they had been fully informed about the Orders:

"You've got to go for so many appointments, I think you have two nurses appointments, a doctor's appointment, social work appointment and addiction appointment. It's so you've got them over so many weeks and you get a lot of information. They ask you what you need, do you need counselling, what are you looking for, are you trying to get yourself back into work or whatever. And so they're actually asking you what it is you need, apart from treatment, what do you need to help yourself to get back into a normal, you know, way of life."

4.6 Drug Court clients received information verbally in the first instance (although written information was provided once they were placed on an Order) and believed that the assessment process itself gave them a very clear understanding of the requirements and opportunities afforded by Drug Court Orders. They were also informed of the sanctions that could be imposed following any non-compliance:

"So if you're not going to do your utmost to try and help yourself then at the end of the day they're going to hammer you for the original charges that you were up for and for breaking the DTTO and your probation or whatever, and the Drug Courts' time."

4.7 Whilst Drug Court Sheriffs would welcome as short an assessment period as possible they were also aware that a thorough assessment would take some time to complete and that it would be unrealistic to expect that one could be undertaken in less than two weeks. They also suggested that extra resources would need to be made available to the Drug Court Supervision and Treatment Team if the assessment period was to be reduced since the team was already working to full capacity.

AGREEING TO A DRUG COURT ORDER

4.8 Following a referral to the Drug Court, individuals will be fully assessed for their suitability and ability to co-operate with the requirements of a Drug Court Order. Subsequently, it is important that they are aware of the basis for Drug Court Orders. Drug Court clients had clear views of the purpose and objectives underpinning the Drug Court. When asked what they believed the purpose of a Drug Court Order to be, the majority of respondents stated that they believed that the primary purpose of the Drug Court was to save the taxpayer and government money:

"It's trying to stop people from stealing, breaking into people's houses, shoplifting, robbery. It's definitely saving a lot of money."

"They say it's to get you off drugs, but really it's just to cut down on crime for the taxpayer kind of thing, isn't it really?"

4.9 Respondents noted that vast amounts of money are spent dealing with drug-related crime, with imprisonment being both ineffective and expensive in dealing with drug-related problems. Two respondents commented that they had actually started to use drugs while in prison, a habit which they maintained on release. In the long term, the respondents generally thought that Drug Court Orders would be cheaper than custody, while at the same time, providing them with an opportunity to end their drug use and offending:

"(…) if they're on the Drug Court they are getting help so its helping the actual drug users, the people on the street and it's obviously helping the Scottish Prison system as well."

4.10 Before an individual is placed on a Drug Court Order, it is important that they agree to the requirements and conditions that the Order will place upon them. Drug court clients were asked to outline their reasons for agreeing to the conditions of a Drug Court Order. All of the eight drug court clients who were interviewed had served previous custodial sentences, with most having experienced frequent periods in custody. All of the respondents believed that they were facing a custodial sentence at the point of referral to the Drug Court, with some estimating that they were potentially facing custodial sentences of between 2-3 years. The main reason given for agreeing to the conditions of a Drug Court Order was a desire to avoid custody, but all respondents noted that they wished to receive some help with their drug use:

"It was a lot to do with my liberty at the time, but it was to do with getting off drugs."

"I accepted it to get my liberty to tell you the truth."

"I think with most people that start it, it's just my general opinion, when they start it they just want to get out that door…and then obviously once they are getting themselves sorted out well it's up to them at the end of the day if they're going to grab it with both hands and help themselves or they they're just going to use it to see how long they can stay out of jail for…"

4.11 Most of the respondents noted that compliance with the Order required a motivation that went beyond a simple desire to avoid imprisonment and that this commitment was necessary in order to meet the conditions imposed as part of the treatment and testing Order:

"…you need to be wanting to come off it you know, there's no use kind of kidding yourself on."

"I was already trying to get off drugs just before that…"

4.12 To be placed on a Drug Court Order requires an admission of guilt. The majority of respondents stated that they had intended to plead guilty to the charges they faced, however two respondents noted that they would have pled not guilty if they had not been offered the opportunity to be referred to the Drug Court. They were clear that a not-guilty plea would have been tendered, not because they were innocent of the offences with which they were charged, but due to their hope that this would enable them to be released on bail:

"I've never, ever pled guilty. I'd lie and I would tell them black was white and I'd take my chances in a trial…"

4.13 Several of the respondents noted that if they had not intended to plead guilty, they would have done so on hearing about the Drug Court:

"It was my drug treatment and testing worker who actually interviewed me to see if I could meet the criteria, 'cos he told me there was a lot of things I'd have to do…But he could have told me I'd have to jump in the Clyde, and I'd have jumped in the Clyde so I could get out of that door you know."

"I was pleading guilty anyway….but if I was going to plead not-guilty I would have pled guilty just to get through the court, to get me into the Drug Court to help me, because it's done great."

4.14 The Drug Court Sheriffs and others directly involved in the operation of the Drug Court were very much aware that the possibility of being referred to the Drug Court - and hence avoiding a custodial sentence - encouraged accused to tender guilty pleas at the custody court. As one Sheriff observed:

"I have no doubt about it. If an offender thinks he's not getting the jail then he will take that option, I'm quite convinced of it."

Others echoed a similar view:

"I'm not so sure if they're keen at that early stage for the sake of getting off drugs or keen because they're going to get out of jail. I suspect it's more of the latter at that stage but I just hope the enthusiasm changes to the earlier as they go through the course."

However, this respondent also suggested that the identity of the Sheriff sitting in the custody court might have a similar effect upon guilty pleas. If an accused was appearing before a Sheriff with a reputation for imposing less severe sentences, s/he might be inclined to plead guilty in the hope of attracting a more lenient sentence.

4.15 However, the Sheriffs recognised that some offenders appearing before the Drug Court were motivated from the outset to change their lifestyle, while for others, their motivation was perceived to change over time as they began to feel and look better:

"I think people just want to get some sort of life back together again and I think they see the Drug Court as perhaps a last chance of doing just that -getting a bit of self-respect and becoming to some extent a member of the community instead of complete outcasts."

SENTENCING

4.16 The Drug Court was thought by Drug Court Sheriffs to differ from the Sheriff Court in a number of respects at the sentencing stage. First, the starting point for the Drug Court was the understanding that an objective was to keep offenders out of prison in order that they might receive help with their drug problems. Second, Drug Court clients were thought to regard the Drug Court as less punitive and more constructive than a traditional court and therefore to respond more positively to the help on offer. Third, the direct dialogue between the bench and the offender was a distinctive feature of the Drug Court, allowing the Sheriff to make a better assessment of the client's motivation than would be possible if they 'hid behind' their defence agent. The Drug Court Co-ordinator also suggested that the sentencing process was longer in the Drug Court than in the Sheriff Court because more time was spent telling the offender what the Order would entail (including informing them about the research, the sharing of information between different agencies and the monthly reviews etc.).

4.17 The Drug Court Sheriffs believed that the sentencing decisions were better informed than in the Sheriff Court because the assessment reports were more comprehensive and focused than were Social Enquiry Reports prepared for the Sheriff Court. They were also content with the range of disposals available to them at the sentencing stage, which mirrored those available to sentencers in the Sheriff Court. The nature of the sentence to be imposed would be informed by the assessment report prepared by the Supervision and Treatment Team and would reflect the circumstances of the Drug Court client. For example, a probation order would be more appropriate when a client had a wider range of problems than could be addressed by a DTTO, where the social worker had a more limited role. The Drug Court Sheriffs indicated that they were happy to take advice on the length of a Drug Court Order since social workers were best placed to assess the duration of treatment required. Increasingly, however, the Sheriffs themselves were, through experience, better able to gauge for themselves what length of Order would be appropriate in individual cases.

4.18 Sheriffs also noted that they were afforded some flexibility through the ability to impose deferred sentences on one or more charges when an accused was sentenced for several offences (which was often the case). This provided an opportunity to impose a sanction in the event of further offending or, conversely, a reward if the Drug Court client was making good progress (for instance, by way of an admonition for the offence in which a deferred sentence was imposed).

4.19 The national roll out of Restriction of Liberty Orders (RLOs) will provide the Drug Court with an additional disposal. However, the Drug Court Sheriffs had reservations about how useful these Orders would be for offenders in receipt of drug treatment. The principle concerns centred on the fact that RLOs, by confining Drug Court clients to their home, would create an artificial environment, which runs counter to the philosophy of treatment. They might also increase the likelihood of Drug Court clients resorting to drug use through boredom and would increase their accessibility to those who might wish to give or sell them drugs. Sheriffs believed that RLOs might more usefully be employed to exclude offenders from particular premises or areas, or as a sanction in the event of an offender failing to comply with a Drug Court Order.

SUPERVISION AND TREATMENT

4.20 Respondents had varied experiences of supervision and treatment prior to being placed on a Drug Court Order and had exhibited differing levels of compliance. Six of the respondents had tried to obtain help for their drug use prior to being assessed for a Drug Court Order. This included accessing methadone programmes in prison and the community, and residential rehabilitation. These methods had been unsuccessful for a variety of reasons including dissatisfaction with the treatment received, and continued drug use:

"My doctor wasn't giving me anything right enough to help, he wasn't willing to give me any more that 20 mils of methadone and that's of no use to you, it wasn't doing any good to me…"

"When you get the jail, you are never out of the jail and once you come out again you are just not the same. You cannot look at people in the face…because you are paranoid when you are just out of jail so that's how you end up on the drugs. And I wanted somebody to help me, the doctor was giving me methadone, but all he was doing was saying 'are you taking drugs? No. 'Right here's your script, bye'. …I tried to talk to him a lot of times about my drug problem…and he used to say 'just say no' or something like that."

"When I came out of the rehab I was straight back onto drugs, I stayed off them for like three days or something like that and then as soon as I came out I used."

"Oh there was nothing I could do about it, I just tried everything. I'd been to psychologists, psychiatrists, nurses, doctors, social workers, probation officers, everything. I'd been through the whole cards…"

4.21 Several respondents noted that their families had tried to help them come off drugs in the past. While this may have helped them to withdraw it did not prove to be an effective method of staying drug-free in the long term:

"It gets to the stage where you've just done so much wrong to your family that your family can't take you any more."

"My ma locked me, well not locked me, but put me in the spare room and got me off it, but when I went back to my own house I was back on it again."

"To be honest, the only way I have been trying to get off is through my family. My family keeping me in the house and helping me … but through the courts and social work team this is the first time I've actually really got help."

Treatment provided

4.22 The treatment options that the Drug Court has available to it include abstinence, methadone maintenance and methadone reduction. Individual counselling is provided by the Treatment and Testing Team, while Drug Court clients may be referred to external service providers to access services which may include group work and day programmes.

4.23 In practice, substitute prescribing provided the core element of the treatment service provided. This was true even where clients opted to attend the day programme offered by the abstinence-oriented Phoenix House, since programme attenders were accepted on methadone prescriptions (provided that the level of medication did not exceed a daily dosage level of 50 mls).

4.24 The protocol for the prescribing of methadone by the health service members of the team was clearly outlined by one of the medical officers:

"We will start on a certain dose, say at 20 mls, 30 mls or whatever, depending on his situation. Then it will be gradually increased every week by 10 mls or so. Then a time will come when he has reached a saturation, in the sense that he is not feeling a strong craving and he has started also to show urine samples negative for testing. We would call that the stage of stabilisation. We would keep him stable as long as he feels he needs to be on that. With time and psychological treatment and counselling what will happen is that the time will come when he will feel confident enough to make changes and gradually come off Methadone. We don't stop Methadone overnight because of all sorts of problems. My own practice is to reduce Methadone by 2mls per week. I must emphasise that when we increase, we are increasing by 10mls per week reducing 2 mls per week so that's before they even feel the difference, so to speak".

4.25 However, this approach had caused some consternation within the social work and counselling sections of the Supervision and Treatment Team. Some felt that the regime lacked flexibility and claimed that the resulting changes in dosage were, on occasion, implemented against the expressed wishes of the client:

"There's been some issues as far as clients requesting their methadone to be reduced… and the medical staff won't reduce it."

"Even the Sheriffs are starting to question the fact that they're on the same dosage and it's not being reduced."

4.26 A number of Team members complained that these decisions about dosage appear to take little note of their professional opinions:

"It means that if the client is not happy with the level of methadone script that he's at and the worker is not happy with the level of methadone script that he's at, the doctor makes the final decisions."

4.27 Others pointed out that there was a danger that clients might attempt a reduction in dosage on the discharge of the Order and that this would undermine the value of the system in facilitating detoxification within a highly structured and supportive setting:

"What's the point of having this intensive support? Why wait until that person is finished their Order if that's what they are going to do? If they're finished their Order and the GP is taking over, they will go to their GP and say reduce me now and the GP is going to… reduce it, bang, bang, bang… massive chunks off. They're putting that person more at risk, than if a person feels they are at the stage where they want to chance it while they've got such a high level of support from the team and from existing services. That is the best time to support that person."

One Team member claimed that a client had had his dosage increased against his will. The increased dosage made him ineligible for attendance on the day programme. This decision, it was claimed, had been taken without discussion with the social work and counselling section of the Team or with the staff of the day programme.

4.28 Initial treatment plans were analysed for 30 clients placed on Drug Court Orders by April 2002 ²⁰. There was a distinct uniformity in proposed treatment options across the client group placed on Orders by April 2002. All 30 clients (100%) had been placed on a methadone substitution programme. With the exception of one Drug Court client who initially received methadone from an external health service provider, all received this methadone programme from Glasgow Drug Problem Service (Drug Court).

4.29 All 30 Drug Court clients were receiving individual counselling (two-three times per week) from the drug treatment and testing team as part of their initial treatment plan. One Drug Court client was initially receiving counselling from a social work department external to the treatment and testing team.

4.30 One Drug Court client had been referred to group-work as an initial element of treatment. The group-work was organised by Phoenix House Day Programme, and the client was expected to attend four-six times per week. This was in addition to methadone substitution and individual counselling. While it is clear that individuals were referred to groupwork and other relevant programmes as they progressed with their Order, this was not incorporated into the initial treatment plan but was introduced following reviews.

Perceptions of Treatment

4.31 Service-users accessed a range of services as part of their Drug Court Orders. This included individual counselling and support from treatment and testing workers, medical provision and social work services. Access to external treatment and support services included day programmes, group-work and rehabilitation services. Respondents were positive about these services and noted that they were able to receive additional support in relation to housing and voluntary work:

"I'm taken seriously by these people you know, so that gives me hope. It gives me hope to know that they can help to put me in the right direction…The proposed group work or proposed projects that have been put across so far sound good, they are inspirational to me."

4.32 Medication was seen as an important element of the Drug Court Order and the provision of methadone was considered to be a significantly stabilising influence on behaviour:

"There's no need for it you know (offending), when I was doing it it was only for drugs you know."

"Now that's a good part about the medicinal coverage you know because I don't wake up in the morning ill now (…) badgering my pensioner mother for money."

4.33 All of the respondents were in receipt of methadone and they expressed various levels of satisfaction with the amount of medication they were receiving. Three of the respondents stated that they wanted to reduce the prescribed methadone they were receiving but had been advised to wait, to take things slowly until they had successfully stabilised their lives more generally:

"I know for a fact within the next few months, say without being too pessimistic or too optimistic, in around six months I want to be methadone free, I want to be drug free. Because I don't want any stigma attached to anything I am doing whether it be college, university or anything."

"Methadone well, just now I am trying to stabilise on it, to get drugs away to the back of my mind and then I'm going to start thinking about coming off the methadone….I don't want to be on the methadone long term but obviously I should be…It's an addictive drug as well, the methadone and I would like to be just drug free altogether. But I know it's not that easy. I'll be truthful, if I didn't have this methadone script, on this programme, I would probably go on drugs again."

"After a while, if I can show them that I am definitely going to stay off the heroin they can start and wean me off the methadone as well until eventually I hope to get drug free completely."

4.34 However, one respondent noted that their medication had been reduced significantly and this was having a detrimental impact. Indeed this had led the respondent to return to the use of illicit drugs which were showing up in urine tests. In the small number of cases where respondents expressed dissatisfaction with the level of medication they were in receipt of, it was evident that some tensions existed between the respondents and medical staff:

"The only thing I don't like is that every time I go up my script is already written out, and I have been asking them to cut me down again…and I went up the other day and it was the same, already there. I'd not seen the doctor, it's just the script is in my folder already written out and all that."

"I think the social work side keeps separate from the GDPS, even although they work together it's like two different services in the one building, and that's the impression I get anyway."

4.35 Few members of the Supervision and Treatment Team were entirely satisfied with either the range or the quality of the treatment services they were able to provide. Some felt quite strongly that treatment options were effectively limited to the prescribing of methadone by the health service section of the team or an abstinence-based day programme offered by Phoenix House. Moreover, many in the team felt that even this was increasingly biased towards the option of substitute prescribing:

"I think that we have specialised in methadone treatment plans and we do that well, we don't do abstinence-based treatments well."

"I'd like the drug court to have more options available in terms of treatment. I think that by far the majority of treatment plans are going to be methadone-based substitute prescribing and… although I think that's very effective at dealing with heroin addiction, I think we should have more feathers to our cap."

4.36 Whilst other services were utilised by the team, including 'non drug-specialist' services like employment training and re-entry to education, even complementary therapies such as acupuncture, these tended to be viewed as additional elements to the core response.

4.37 A number of team members cited specific gaps in the range of services that were readily accessible to the project and noted that this in itself severely limited the efficacy of the Drug Court approach:

"I don't think the services we have available for clients has been appropriate to their needs, I don't think it has been good enough. I think that we've definitely done a sterling job with regard to substitute prescribing, but I think that we too often perhaps go down that road when, if there was a really high quality abstinence based treatment plan available or even a residential treatment plan… I know that's complicated in terms of the Order… but if there were alternative treatment providers on the abstinent-based side, we would have had more success with abstinent based treatment plans."

"If there is a range of limited services, then there is a danger that what you're actually doing is feeding people through what's available, rather than linking people up with what's actually… matched to their needs. I think that that is a gap we need to be working on."

4.38 Residential rehabilitative provision was identified by a number of Team members as a serious gap in services. Some pointed out that, even were they able to overcome the very real problems of geography (since most residential rehabilitation services were located outwith the City), securing funding for such an option was difficult and certainly no easier for the Team than any other referring agency:

"I just think that there should be fast-track mechanisms for anybody in this Team, any client of ours should, I feel, receive priority for access to residential services and they don't."

4.39 The lack of services for women (particularly respite and other residential services) was noted by a number of Team members:

"All female residential rehab (again!). Let's cry out the cry for that. Can we have it please? Can we have it yesterday?"

DRUG TESTING

4.40 Drug testing is a key component of the Drug Court Orders and all service-users have their urine tested for illicit drugs twice weekly at the beginning of an Order. This can be reduced if sufficient progress is made, and will be altered under the instruction of the Drug Court Sheriff, informed by treatment and testing staff. Testing is carried out at the premises of the Supervision and Testing Team, with samples being sent to an external laboratory for further analysis.

4.41 Limited data was available on drug test results. The data did not provide a clear indication of all tests carried out, nor did it identify all situations where samples tested negative for drugs. It is not possible therefore, to identify positive test results as a proportion of all tests conducted. The available information does however provide an indication of the extent of ongoing drug use and the type of drugs which continued to show up in urine tests. Some clients tested positive for more than one type of drug when tested ²¹.

Frequency and outcomes of drug testing

4.42 The figures in Table 4.2 indicate the correspondence between self-reported use of drugs at assessment and urine test results. Possible discrepancies between reported use and test results, notably in the reported use of heroin, may be related to the relatively short time that heroin takes to leave the body, hence the lower likelihood that it will be detected by a urine test carried out some time after use.

Table 4.2: Drug testing during assessment prior to first calling (n=27 offenders)

4.43 From first review to second review, the seven offenders as a group produced 54 positive tests for drugs, ranging from four positives to ten positives per individual across the time period. From second review to third review, the four offenders as a group produced 43 positive tests for drugs, ranging from 10 positives to 12 positives per individual across the time period. From third review to fourth review, the four offenders as a group produced 27 positive tests for drugs, ranging from five positives to 14 positives per individual across the time period. However, it should be noted that the positive test results included prescribed methadone. At the second review, seven Drug Court clients for whom information was available tested positive for methadone in 46 tests, other illicit opiates and benzodiazepines in 36 tests and for cocaine on nine occasions (Table 4.4).

4.44 At the third review, four drug court clients for whom information was available tested positive for methadone on 35 occasions. Levels of other illicit opiates were reduced to 17 positive test results, as were positive tests for benzodiazepines. Cocaine was detected on one occasion. The fourth review shows a significant decrease in positive test results with detected levels of methadone remaining relatively stable, but with a marked decrease in detected rates of other illicit opiates and benzodiazepines. Details were available for one drug court client's test results from 4 ^th review to 5 ^th review. The client was tested on seven occasions, all positive for methadone only. While these figures are not conclusive, they provide a significant indication of a marked reduction in illicit drug use.

Table 4.3: Drug testing from first calling to 1 ^st review (n=13 offenders)

Table 4.4: Drug testing from first review of Order onwards

Practicalities of drug testing

4.45 Views on the frequency, efficiency and practicalities on conducting frequent urine tests varied amongst the Treatment and Supervision Team. There was an acknowledgement that testing was a useful way of monitoring compliance with the Drug Court Orders and of keeping a regular contact with Drug Court Clients:

"I actually like the handle that the drug testing gives us. I think it gives us an opportunity to interact with the client on a much more frequent basis. (…) And you can demonstrate to the clients how well, or otherwise, they are doing. (…) Saliva testing would be a whole lot better, but it only reflects what's in the blood so it doesn't go far enough back."

4.46 Testing also afforded an opportunity to vary the requirements of an Order by responding to progress or non-compliance. Frequent negative test results could lead the Treatment and Supervision Team to recommend that testing was reduced, a decision that would ultimately be taken by the Drug Court Sheriff:

"If someone is in for a few weeks and has stopped taking heroin and produced negative urine-tests over a month or so, there is no reason for him to have urine tested twice a week so rigorously. But I am saying that as a matter of principle when we reduce, probably randomness should be brought in in order to tighten that full procedure."

4.47 There was support for the introduction of random tests following a reduction from twice weekly testing amongst all respondents, including drug court clients. However, the practicalities of testing, including the lack of waiting room space and other appropriate facilities, caused significant concern amongst members of the Treatment and Supervision Team:

"The physical conditions under which people are being tested are far from satisfactory and that means there is quite lengthy waiting times (…)"

"There's no dignity involved, the facilities are less than satisfactory downstairs, the clients that are in for urine testing are sitting there, clients that are around for assessment meetings or other clients that are waiting for other services…And it's such a small space everybody knows what's happening for each client…."

"…I fear it's a terrible invasion of people's privacy, I really do and I have strong feelings about that."

4.48 The lack of appropriate facilities had, until recently, meant that refreshments (including drinking water) were not easily accessible. This could be problematic for drug court clients who were unable to produce urine on demand, a problem that was recognised by Treatment and Supervision staff:

"…there should be a lot more discretion about it, I don't think people should have to stand around in a waiting room drinking copious amounts of water …and you hope they are going to produce urine, I think that is very demeaning for anybody to have to do."

4.49 If clients were unable to produce urine, a key requirement of Treatment and Testing Orders, then this could be interpreted as non-compliance although both Supervision and Treatment staff and Drug Court Sheriffs were generally sympathetic to this difficulty:

"An inability to produce a sample is seen as a refusal although its not perhaps always worded that way, and the inference is the person is choosing not to give a sample because the sample is contaminated, that's the inference."

4.50 There were also difficulties in obtaining some test results although this appeared to apply specifically to tests that were sent to external services:

"So for example if somebody is getting tested once a week and they'd shown clear urine for some time and the lab test result is positive, but it may take a fortnight to come back. You're two weeks late by the time anybody knows there is a positive urine."

"What we can experience are really quite substantial delays in getting drug test results back. That undermines it all together, the idea is that we get speedy results."

"If you need a particular result, that can be fast-tracked, but it is additional work for someone to have to go chasing that result rather than the results being readily available."

Perceptions of Drug Testing

4.51 Despite the difficulties which were clearly evident with drug testing procedures, all drug court client respondents stated that they believed that drug testing was an important part of the Order and necessary to assist them to end or reduce their use of illicit drugs:

"…it keeps you on a straight path…"

"I feel as if I need the twice a week testing now even though I'm stable, I feel as if right now that's helping to keep me stable because I know I can get caught and that."

"It's not as if you can lie about it. You give urine to see if there's any drugs in your body so if you mess them about then your urine shows you have drugs in your system, if you keep doing that you get put off it anyway and get a custodial sentence after that. You can't beat it. You need to apply the rules, it's either that or go back to prison…"

4.52 The knowledge that they were going to be tested appeared to have a positive influence on all the respondents' behaviour and meant that they had to be honest with Treatment and Testing staff about their drug use. Producing test results which showed negative for unauthorised substances was something which several of the respondents believed gave them a clear aim and objective:

"Maybe next month I'll feel that wee bit stronger to go down to once a week. But don't get me wrong, if I went down to once a week and I felt shaky then I would definitely say 'Listen I don't think I'm strong enough, can I go back to twice a week?'"

4.53 Many of the respondents noted that providing a positive test led them to feel they had let themselves and DTTO staff down:

"I feel as if I've let myself down badly, and not just myself, others who've tried to help me and who've been fair with me."

"There's no consequences to anybody apart from yourself. They're not going to jail you for one dirty or a couple of dirties. At the end of the day you're not wanting to slip up for yourself."

4.54 The Drug Court operates with a recognition that relapse is always a possibility and that some time is required to enable service-users to stabilise their drug use before going on to reduce it. This meant that positive test results did not automatically result in the imposition of sanctions, and respondents noted that Supervision and Treatment staff and the Sheriff were often understanding about their inability to stay drug free. In some cases, a relapse was acknowledged and service-users were encouraged to move forward from that point, although some respondents noted that they felt they had 'let everyone down' if it appeared that they had suffered a setback:

"I think when you have a lapse then you realise 'right, what do I want to do with my life?'…do I just want to use this like a bait to keep myself out of the jail or do I want to sort my life out? So sometimes I think that lapse works cos it makes you realise, 'do I want to be right down here in the gutter where I was six months ago or do I want to keep going?"

4.55 Several respondents noted that a relapse on their part had resulted in the Sheriff giving them a good 'dressing down'. On these occasions, they were motivated to improve their performance. All respondents were aware that repeated failures would not be tolerated.

SUMMARY

4.56 This chapter has examined the factors that influence individuals to agree to the requirements of Drug Court Orders, the practicalities of sentencing practice, and the implementation and operation of treatment and testing provisions.

4.57 It is evident that Drug Court clients are willing to accept the requirements of a Drug Court Order for a number of reasons. At the initial stage of assessment, this willingness is, for many individuals, an attempt to avoid custody (either sentence or remand) and may even increase the likelihood that an offender will plead guilty. However, it is clear that additional motivation is required to ensure compliance with the stringent demands that are made of all Drug Court Clients. The requirements of treatment and testing are stressed throughout the assessment process by service-providers to ensure that offenders are fully informed of their obligations and possible sanctions.

4.58 The range of sentences available to Drug Court Sheriffs is considered to be effective and appropriate. Although the Drug Court has the same range of disposals available to it as the Sheriff Court under summary proceedings, the ethos of the Drug Court differs significantly. It is seen by all involved to be less punitive and more constructive, a situation considerably enhanced by the direct dialogue which takes place between the Sheriff and offender. Sheriffs believed that their sentencing decisions were better informed than in the Sheriff Court due to the more comprehensive and focused Social Enquiry Reports and drug assessments which are made available to them. Deferred sentences were seen to afford some flexibility in sentencing, while reservations were expressed by Sheriffs about the introduction of Restriction of Liberty Orders (RLOs) and their suitability for offenders in receipt of drug treatment.

4.59 Treatment services included a range of provisions provided by the Drug Court Team and external service providers. The services included counselling, prescribing, access to day programmes and primary medical care. However, it was notable that substitute prescribing (using methadone) constituted the core element of the treatment service in practice. Concerns were expressed by members of the Supervision and Treatment team and drug court clients that the operational regime lacked flexibility, and that levels of medication provided were not always in compliance with the wishes of individual clients. While prescribing is clearly a matter for the medical profession, there was some suggestion that increased dialogue in monitoring and reviewing patterns of prescribing would be beneficial. There also appeared to be a broadly based desire for more comprehensive service provision and a broader range of services to be made available to the Drug Court. In particular, Treatment and Supervision staff identified the need for increased rehabilitation services and, specifically, rehabilitation and community-based services that met the needs of women.

4.60 Drug testing forms a key component of Drug Court Orders with clients tested twice weekly at the beginning of an Order. Relapse is recognised as a possibility and time is allowed to enable clients to stabilise their drug use before reducing/ending it. However there are clearly practical and ethical issues relating to the testing procedure itself and consideration needs to be given to improving this. Nevertheless, drug court clients saw testing as a largely positive element of the Order, viewing it as a significant motivating factor. Obtaining negative test results was viewed as a clearly defined goal, particularly given the prominence of this issue during reviews and the dialogue between clients and the Drug Court Sheriff.

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