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GUIDELINE FOR DRUG COURTS ON SCREENING AND ASSESSMENT

Roger H. Peters1 and Elizabeth Peyton2

Prepared for the American University, Justice Programs Office, in associationwith the U.S. Department of Justice, Office of Justice Programs,

Drug Courts Program Office

May 1998

1Associate Professor, Department of Mental Health Law and Policy, the Louis de la Parte Florida Mental Health Institute, University of South Florida.2Executive Director, National TASC — Treatment Accountability for Safer Communities.

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Acknowledgments

The authors express sincere appreciation to the following persons who volunteered their valuabletime and expertise to the development of this document:

Hon. William G. Meyer Jody FormanDenver Drug Court Project Charlottesville, VADenver, CO

Marc Pearce Hon. Richard S. GebeleinNational Association of Drug Delaware Superior Court Court Professionals Wilmington, DEAlexandria, VA

Martin O. Conoley Joseph CarloniSanta Barbara County Probation Pathway Treatment ServicesSanta Barbara, CA Pensacola, FL

Ed Brekke Valerie MooreLos Angeles Superior Court IN ACT, Inc.Los Angeles, CA Portland, OR

Caroline CooperThe American UniversityWashington, DC

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FOREWORD .................................................................................................................. 1

INTRODUCTION .......................................................................................................... 3

What are the differences between screening and assessment? ................................ 3

Goals of screening and assessment. .......................................................................... 4

Characteristics of screening and assessment ............................................................ 5

What factors help to shape the drug court screening andassessment process? .................................................................................................. 6

Importance of drug court screening and assessment ................................................ 6

Performance benchmarks for drug court screening and assessment........................ 8

DRUG COURT SCREENING ....................................................................................... 9

Who should conduct screening? ............................................................................... 9

Steps in conducting screening .................................................................................. 9

What information should be included in a drug court screening? ......................... 11

Core screening elements ......................................................................................... 11

Screening issues for women ................................................................................... 12

Screening for mental health problems .................................................................... 13

Screening for suicide............................................................................................... 14

Screening for motivation and readiness for treatment ........................................... 14

Use of self-report information ................................................................................ 15

What instruments should be used in drug court screening? ................................... 16

Key issues in selecting screening instruments ....................................................... 17

Substance abuse screening instruments .................................................................. 17

Table of Contents

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Mental health screening instruments ...................................................................... 18

Motivational screening instruments........................................................................ 18

What screening information is most relevant to the court?.................................... 18

DRUG COURT ASSESSMENT .................................................................................. 21

When should drug court assessment be conducted? .............................................. 21

Who should conduct assessment?........................................................................... 21

What information should be included in a drug court assessment? ....................... 22

Areas for detailed assessment ................................................................................. 22

What instruments are available for assessment ofparticipants in drug court programs? ...................................................................... 24

What assessment information is most relevant to the court? ................................. 25

Obtaining release of confidential information........................................................ 25

SUMMARY ................................................................................................................... 27

REFERENCES.............................................................................................................. 29

OTHER RELATED RESOURCE MATERIALS ......................................................... 33

APPENDIX A: Selected Instruments ........................................................................... 35

APPENDIX B: Availability and Cost of Screening Instruments ................................. 43

APPENDIX C: Addiction Severity Index .................................................................... 47

APPENDIX D: Single State Alcohol and Drug Agency Directors ............................. 63

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Foreword

This guideline is written to help drug courts develop effective policies, procedures, andtechniques for screening and assessing treatment needs of drug court participants. Thisdocument describes the principles and methods of screening and assessment of adultdrug court participants, and gives drug courts specific tools and information to establishand sustain screening and assessment processes. While much of the information herewill be helpful for juvenile drug courts, specific guidance for juveniles should beobtained from other sources.3

Several key principles and strategies for conducting effective screening and assessmentdescribed in the guideline are derived from experiences of existing drug courts andother community-based substance abuse treatment programs for offenders. Several usefulguidelines and monographs on screening and assessment for criminal justice and non-criminal justice populations are included as references in the back of this guideline.Readers interested in additional information on this subject are encouraged to use theseresources. This publication is one of several technical assistance monographs for drugcourts that the U.S. Department of Justice, Office of Justice Programs, has developed.

This document presents general issues related to screening and assessing drug courtclients, describes the processes and elements of screening and assessment in detail,summarizes key issues for drug courts to consider as they screen and assess partici-pants, and provides resource materials for those seeking additional information.

3See for example Center for Substance Abuse Treatment (1993) Screening and Assessment of Alcohol- and Other Drug-Abusing Adolescents. Treatment Improvement Protocol Series, #3. Rockville, MD.

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Introduction

What Are the Differences BetweenScreening and Assessment?

Screening and assessment are often describedas discrete events completed by using specificinstruments. In fact, screening and assessmentare part of an ongoing decision-making processthat examines information on substance abuseand criminal history, motivation for treatment,educational and employment factors, and otherproblem areas. Information gathered duringscreening and assessment is used to develop atreatment plan that will be updated over timeto reflect participant progress, significant lifeevents (e.g., relapse, changes in living arrange-ments), and changing service needs. While useof structured instruments is a core element ofscreening and assessment, this activity mustbe supplemented by an individual interview,review of archival materials (e.g., criminaljustice records, treatment records, drug testresults, employment records), clinicalobservation, and discussions with probationofficers, family members, or significant others.

Although part of a continuous process, screen-ing determines eligibility and appropriatenessfor participation in drug court, while assessmenthelps to identify specific types of services anddetermine the intensity of treatment needed.Screening is conducted in the very early stagesof drug court involvement and typically precedesassessment and other diagnostic activities.Drug court screening typically consists of twosteps: (1) justice system screening to decide ifthe prospective participant meets predeterminedeligibility requirements related to criminalhistory, offense type and severity, etc.; and(2) clinical screening to determine if theprospective participant has a substance abuseproblem that can be addressed by availabletreatment services, and if there are other clinicalfeatures (e.g., serious mental health disorders)

that would interfere with an individual’sinvolvement in treatment. Once the initialscreening decision is made, assessment helpsto determine which types of services shouldbe provided, and in what sequence these ser-vices should be provided. Diagnosis is partof the more detailed assessment process, andsummarizes the pattern of current symptomsand functional impairment for several types ofdisorders (e.g., substance use disorders, mentalhealth disorders).4

Several different drug court professionalssuch as prosecutors, public defenders, treatmentstaff, probation officers, court administrators,and pretrial services/TASC (Treatment Account-ability for Safer Communities) staff, are ofteninvolved in screening.5 A nationwide surveyof drug court programs (Cooper, 1997) foundthat, for pretrial drug court programs, initialjustice system screening is usually conductedby the prosecutor and either pretrial services orother drug court staff. Justice system screeningis usually conducted by the prosecutor andprobation officer in post-conviction programs.In most drug courts, the judge and prosecutorprovide the final review of program eligibility,although the defense counsel is also involved inidentifying and screening eligible cases. Oncejustice system screening is completed, a clinicalscreening is provided. In 38 percent of drugcourts surveyed (Cooper, 1997), more than oneagency is used to conduct clinical screening.These agencies include the drug court program,probation, private treatment agencies, the countyhealth department, pretrial services, and TASC.

4This is typically accomplished through the use ofthe Diagnostic and Statistical Manual of MentalDisorders, Fourth Edition (DSM-IV), and special-ized diagnostic instruments.

5Several jurisdictions, including San Diego, NewHaven, Seattle, and Jacksonville use police as areferral source to drug court, and police officers arepart of the screening process.

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Staff who provide screening may not haveextensive experience in assessment, diagnosis,and treatment issues. In contrast, assessmentis typically conducted by substance abusetreatment professionals who have specializededucation and training in these areas. Whilejustice system and clinical screenings are usuallycompleted in 5-30 minutes, assessment requiresat least 1-2 hours. Assessment is more compre-hensive in scope and provides much moredetailed information, including examinationof specialized areas such as diagnosis ofmental health disorders. Assessment andrelated diagnostic information contributedirectly to developing an individualized drugcourt treatment plan. The treatment plan foreach participant enables the drug court to trackproblem areas, services provided, and progresstoward program completion.

Some drug courts provide assessment insteadof an initial screening. Although this approachprovides more comprehensive information toguide initial placement in different types ofservices (e.g., residential versus outpatient),it is very time-consuming to provide a fullassessment for all potential participants.Potential participants are also more likely toprovide accurate self-disclosure of assessmentinformation after they have been admittedto the drug court program. As an alternative toproviding a full assessment at the time of initialscreening, drug court programs may choose toimplement a brief screening process. Manyother drug courts have found that clinicalscreening before full admission to a drug courtprogram serves several important functions,and screening is also an important function ofmany pretrial services, TASC, and other clientmanagement programs.

Goals of Screening and Assessment

The goals of screening are to:

■ Determine if legal and statutory eligibilityrequirements are met;

■ Determine the presence of substance use,mental health disorders, and medicalconditions, including infectious disease;

■ Define major areas of strengths and deficits;

■ Determine if the severity of substanceabuse problems is appropriate to the levelof available drug court services;

■ Weed out persons who do not havesubstance abuse problems;

■ Identify individuals with a history ofviolent offenses/behavior;

■ Identify environmental factors (e.g.,employment, residential stability, relation-ship issues) or other disorders (e.g., mentalhealth problems, cognitive deficits) thatmay undermine the individual’s involve-ment in the drug court program or createan unacceptable public safety risk;

■ Identify minimum level of security orsupervision needed to promote publicsafety;

■ Identify motivation, including perceivedbenefits and disadvantages of participationin the drug court program;

■ Orient the potential client to programrequirements; and

■ Obtain consents for records and access tocollateral contacts.

The goals of assessment are to:

■ Examine the scope and nature of substanceabuse problems;

■ Identify the specific psychosocialproblems to be addressed in treatment,including mental health disorders;

■ Understand the impact substance abusehas had on the individual, including itsinfluence on criminal involvement;

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Time and CostPurpose Key Components By Whom Considerations

Legal To determine legal • Current charge Criminal Justice System These activities areScreening eligibility • Criminal history • Prosecution conducted under

To examine public • Circumstances • Defense normal criminalsafety risk of offense • Probation proceedings; cost is

• Pretrial Services minimal.• TASC• Court• Police

Clinical To determine • Program explained • Drug court Typically 5-30Screening appropriateness • Releases signed case manager minutes. Costs

of treatment and • Brief assessment • Pretrial Services are associatedthe individual’s of substance use, • Probation with instruments,willingness and social history, • TASC staff time,readiness for other disorders • Treatment Provider and staff trainingtreatment • Motivation/

willingness to participate

Clinical Diagnosis, • Examine scope • Clinically trained 1-2 hours or more,Assess- admission and and nature of and qualified depending on thement treatment substance abuse counselor, nature of problems.

planning problem psychologist, Costs are• Identify full range psychiatrist, social associated with of service needs, worker, nurse instruments, staff pursuant to time, and staff treatment planning training• Match participants to appropriate services

■ Identify specific physical problems to beaddressed in treatment planning;

■ Identify the full range of service needs,pursuant to treatment planning;

■ Match participants to appropriate typesof drug court services; and

■ Identify specific employment andeducational deficits.

Characteristics of Screeningand Assessment

The following chart summarizes issues toconsider in developing drug court screening andassessment activities, and illustrates severaldifferences between these activities.

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What Factors Help to Shape theDrug Court Screening andAssessment Process?

Several program features often determine thescope and context of screening and assessmentactivities. They are:

■ Treatment options that are available to thedrug court program. If several options fortreatment services exist, more informationis needed to guide participant placement.

■ Number of referrals to the program. If thenumber of potential participants is largecompared with the number of participantsthat actually enter the program, a separatescreening process is a cost-effective way to“screen out” inappropriate candidates andfocus resources on eligible participants.

■ Qualifications of screening staff.Screening can often be conducted bystaff members who do not have extensiveclinical training. If non-clinical staff makeinitial eligibility decisions, a brief screenwill help them identify appropriateparticipants, while clinical assessments areconducted by professional treatment staff.

■ Eligibility criteria. If the drug courtaccepts all persons who meet legalrequirements whatever their level ofinvolvement with substance abuse, thenclinical screening might be an unnecessarystep. However, it is important to note thatalthough this approach expedites the drugcourt admissions process, it may ultimatelywaste time by processing individualswho may not benefit from treatmentinterventions.

■ Client placement criteria in a particularjurisdiction. There has been a recentmovement to institute guidelines forreferral and placement for various levelsand durations of treatment. These “patientplacement criteria” are influenced by theneed to ration services and to standardize

the referral and placement process. Thismovement is being driven by managedcare, a variety of strategies that many statesare using to allocate Medicaid and otherfunding for behavioral health (substanceabuse and mental health) and other healthcare services. One widely used example ofpatient placement criteria has been devel-oped by the American Society of AddictionMedicine (ASAM, 1996).6

Note: The above features should beexamined by the drug court managementteam when developing policies and proce-dures related to screening and assessment,and should be reviewed periodically.

Importance of Drug Court Screeningand Assessment

Candidates for drug court programs typicallyhave a wide range of substance abuse, mentalhealth, and other health-related disorders, inaddition to many psychosocial problems relatedto employment and financial support, housing,family and other social relationships, transporta-tion, and unresolved legal issues such as childcustody. Many of these deficits are not clearlyapparent through examination of criminal justicerecords alone, but can be revealed through anindividual interview, drug testing, and use ofspecialized instruments. The rates of substanceabuse disorders, mental health and personalitydisorders, suicidal behavior, physical and sexualabuse, and other health-related disorders such asTB and AIDS are much higher among criminaljustice populations than among generalcommunity samples (National GAINS Center,1997; Peters and Bartoi, 1997), and often goundetected in criminal justice settings. (Teplinand Schwartz, 1989). Non-detection of thesedisorders often leads to:

6Similar placement criteria have been adapted foruse with criminal justice populations, includingplacement criteria developed by the ColoradoJudicial Department, which are in use by theColorado Departments of Correction, Probationand Community Corrections.

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■ Misdiagnosis;

■ Neglect of appropriate interventions;

■ Inappropriate treatment planning andreferral;

■ Over- or under-treatment of mental healthsymptoms with medications;

■ Disruption of treatment services anddemoralization of other participants; and

■ Poor treatment outcomes (Drake et al.,1993; Peters and Bartoi, 1997).

An effective screening and assessment systemhelps to integrate this diverse information toform a comprehensive picture of each individualparticipant. Such integrated screening andassessment approaches are associated with morefavorable treatment outcomes among individualswith multiple problem areas (Kofoed et al.,1986). An integrated screening and assessmentsystem provides an important foundation thatsupports other drug court functions, includingtreatment planning, placement in treatment, andidentification of the need for ancillary services.Screening and assessment marks the beginningof the drug court process and provides the coreinformation needed to identify prospective drugcourt participants, evaluate their eligibility andappropriateness for participation, and begin theprocess of applying the services and sanctionsthat characterize drug courts. Informationgathered during screening and assessmentprovides the basis for productive involvementof participants in the drug court program.

Participants in drug court programs and othersubstance abuse programs have reported thatscreening and intake interviews are amongthe most important of all treatment servicesthat they receive. Screening and assessmentactivities provide a structured way for the courtand the treatment provider to become familiarwith the participant, and for the participant to

become familiar with the goals and expectationsof the program. Screening and assessmentprovide an important opportunity to developmotivation and commitment to the drug courtprogram. This development is accomplishedthrough the sensitivity of the drug courtscreener/assessor in expressing concern forand understanding of the psychosocial problemsthat have developed over time, discussing therelationship between substance abuse-relatedproblems and recent criminal activity, elicitingthe individual’s goals (e.g., sobriety, employ-ment), and emphasizing the benefits that canbe achieved through participation in the drugcourt program (e.g., reunification with children,vocational training, avoidance of incarcerationor criminal record).

Information gathered during the screening andassessment process describes the unique charac-teristics of each participant. It forms the basisfor personal interaction with drug court staff,enables decision makers to place the participantin the most appropriate program available, andenables staff to determine if additional supportsand services are needed to promote theparticipant’s progress and success. In addition,the information provides a basis from which tomeasure participant progress, to identify theneed for program enhancements, and to identifyareas in which the program is effectivelyaddressing participant needs.

Providing timely and integrated screening andassessments requires significant coordinationamong clinical and non-clinical staff, as well asthe sharing of key pieces of information that cancontribute to well-informed decision-making.Case staffings are used to share informationregarding results of screening and assessment.Staff roles and responsibilities for screeningand assessment should be clarified by drugcourt programs. In addition, training is neededto ensure that screening and assessmentinformation is interpreted appropriately. Forinstance, screening personnel who have not been

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trained in substance abuse issues may excludepotential participants if no history of drugoffenses exists, while in reality, some criminaldefendants support their drug use by committingproperty offenses. For many drug court pro-grams, designing a comprehensive screeningand assessment system often takes a year ormore. Once established, the system should bemonitored and reevaluated periodically toensure that it is appropriate for the targetpopulation, that staff is adequately trained, thatprotocols are followed, and that baseline datarelated to progress and outcome measures areadequately captured and analyzed.

Performance Benchmarks for DrugCourt Screening and Assessment

Guidelines were developed by the NationalAssociation of Drug Court Professionals(NADCP) and the U.S. Department of Justice,Office of Justice Programs (Defining DrugCourts: The Key Components, 1997) that de-scribe the best practices in developing andimplementing drug court programs. Two of the“key components” contained in the guidelinesrefer to screening and assessment, includingrecommendations that “eligible participants areidentified early and promptly placed in the drugcourt program,” and that “drug courts provideaccess to a continuum” of services that includescreening and assessment.

Performance benchmarks for each of the keycomponents were developed to provide morespecific guidance. Benchmarks that relate toscreening and assessment include:7

■ Eligibility screening is based onestablished written criteria. Criminaljustice officials or others (e.g., pretrialservices, probation, TASC)8 are designatedto screen cases and identify potential drugcourt participants.

■ Eligible participants for drug courtare promptly advised about programrequirements and the relative merits ofparticipating.

■ Trained professionals screen drug court-eligible individuals for AOD9 problemsand suitability for treatment.

■ Initial appearance before the drug courtjudge occurs immediately after arrestor apprehension, to ensure programparticipation.

■ The court requires that eligible participantsenroll in AOD services immediately.

■ Individuals are initially screened and laterperiodically assessed by both court andtreatment personnel to ensure that treat-ment services and individuals are suitablymatched:

• Ongoing assessment is necessary tomonitor progress, to change the treatmentplan as necessary, and to identify relapsecues.

• If various levels of treatment areavailable, participants are matched toprograms according to their specificneeds. Guidelines for placement invarious levels of treatment should bedeveloped.

• Screening for infectious diseases andhealth referrals occurs at an early stage.

The benchmarks set standards that drug courtsshould strive to meet. This guideline is intendedto provide additional detail needed to supportthe achievement of these benchmarks.

7The following material is quoted directly from theKey Components, referenced above, pp. 13, 16-17.

8Treatment Accountability for Safer Communities(TASC) is a program model for assessing, referringto treatment, and providing case managementservices to substance abusers in the criminal justicesystem.

9AOD is an abbreviation for Alcohol and OtherDrugs.

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Drug Court Screening

Who Should Conduct Screening?

As this guideline indicated previously, severaldifferent drug court professionals may beinvolved in the clinical screening process.These individuals should be familiar withcriminal justice processes, substance abusetreatment, admission criteria for the drug courtprogram, the key components, and the require-ments of the program. The screening interviewis likely to be the potential participant’s firstcontact with the drug court program, and itprovides an important opportunity for staff todispel myths about the program, to discussambivalence about recovery, to clarify potentialtreatment goals, and to mobilize optimism aboutinvolvement in the drug court program. Staffshould be prepared to address a wide range ofquestions from potential program participants.

Although screening staff need not haveextensive experience or training in assessmentor diagnosis, they should receive training insubstance abuse and treatment issues, basicinterviewing skills, identification of mentalhealth symptoms and warning signs for suicide,techniques for exploring motivation for treat-ment (e.g., motivational interviewing), andreferral/triage to jail and community services.Knowledge of common “street” drugs, their use,and associated terminology is also important.

Training in substance abuse, interviewing,and basic counseling is often available throughthe Single State Agency that administersfunding for drug and alcohol treatment.(A listing of Single State Alcohol and DrugAgency Directors is included as Appendix D.)In addition, local criminal justice agencies oftenprovide training to their staff in substance abuse,drug testing, and interviewing techniques.Local universities also may be a resourcefor staff training.

Steps in Conducting Screening

Drug court screening should be completed at theearliest possible point after arrest, to expediteinvolvement in treatment and to capitalize onmotivation for behavior change associated withthe arrest. Program eligibility requirementsshould be written, clearly defined, and reviewedby all drug court staff. Once developed, eligibil-ity criteria are sometimes translated into check-lists for use by various screening staff. Drugcourts that receive federal funding through theU.S. Department of Justice, Drug Courts Pro-gram Office, are also prohibited from admittingviolent offenders. (Section 2201 of the OmnibusCrime Control and Safe Streets Act, 42 U.S.C.3796ii). Eligibility criteria may also restrictadmission of persons who have characteristicsthat may inhibit their successful involvement ina drug court program, such as infectious diseaseor active mental health symptoms.

Key aspects of the drug court program shouldbe discussed at the time of the initial screeninginterview, including the duration of the program,the need for immediate detoxification services,the possibility of involvement in residentialtreatment, frequency of required treatmentactivities, specific hours that treatment servicesare offered, location of treatment facilities,drug testing, and the consequences ofnonparticipation and unsuccessful termination.A written description of the services and re-quirements of the drug court program shouldalso be provided. Discussion of program ser-vices, consequences of prior substance abuseand criminal justice involvement, and individualrecovery goals provides an important opportu-nity to develop commitment to treatment. If theindividual shows interest in the drug courtprogram, a written consent should be signed.The consent form should include a descriptionof information that will be shared, names of

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staff who will receive this information, andunder what circumstances information will beshared.

If the screening interview occurs beforeformal acceptance into the drug court program,appropriate releases should be signed to enablescreening staff to communicate with the courtand other relevant individuals or agencies, togather additional information, and to discuss thecase. A properly executed and signed releaseof information must be completed for all drugcourt participants. A more detailed discussionof release of information is provided later in thismonograph.

Several steps for screening participants in thedrug court program are described as follows(see Belenko, 1996; Cooper, 1997; Peters et al.,1994), although the sequence may differ byprogram.

Justice System Screening

■ Review new jail admissions or new arrestrecords for legal and statutory requirementsto determine program eligibility. Theprosecution and defense usually makeinitial legal screening decisions based oneligibility criteria developed by the drugcourt team. Areas commonly reviewedinclude:

• Current charge(s),

• Criminal history,

• Circumstances of the current offense(e.g., defendant culpability, mandatoryincarceration statutes, plea bargainingrestrictions), and

• Outstanding warrants, detainers,additional charges, or previous diversionsthat would disqualify the individual fromparticipation in the drug court program.

This information is available from policeand other criminal justice records. Otherfactors such as bail status of the individual,history of failure to appear in court, andhistory of incarceration may also influencethis first-level eligibility determination.Potential participants who do not pass thisfirst level of screening are not ordinarilyreviewed further for the drug courtprogram.

■ Review by the defense attorney of com-plaint and discovery materials, the need fortreatment, and the client’s desire to seektreatment. The defense attorney will alsodescribe the legal ramifications of partici-pation in the drug court program, and willreview waiver of rights to speedy trial.

■ In most jurisdictions, the prosecutor anddefense attorney sign off on the placementof a client in the program. In other juris-dictions, the judge or other team membersmay be involved.

Clinical Screening

■ Interview of potential participant by pre-trial services, probation, TASC, treatmentstaff, or other screening staff. Criminaljustice records and other archival recordsmay be reviewed before the interview.Screening instruments are often adminis-tered at the time of the interview. Theinterview should examine whether theindividual has a substance abuse problem,if these problems can be meaningfullyaddressed within the drug court program,and if the individual is willing to complywith the requirements of the drug courtprogram. Recommendations to the courtshould be presented in a neutral and unbi-ased way that balances a defendant’s needfor treatment with public safety and othergoals of the criminal justice system.

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Several issues that are often addressedduring the interview include:

• The severity of the substance abuseproblem, and whether treatment iswarranted. The majority of drug courtprograms surveyed (Cooper, 1997) reportthat individuals who do not have anaddictive disorder, or who only have aminimal substance abuse problem arenot eligible for admission to the program.

• Whether the individual is a drug dealer ormanufacturer. If the individual is either,and if individuals with these charges areeligible for the drug court, whether thiswould adversely affect involvement intreatment or would otherwise affect thetreatment program or constitute too greata public safety risk.

• Willingness to participate in the drugcourt program, and agreement to complywith program requirements.

Note: The drug court management teamshould discuss issues involving eligibilityof persons who may be selling drugs.Some drug courts choose to includepersons who are selling drugs as partof a drug-consuming lifestyle; otherjurisdictions choose to include onlypersons charged with possession.

• Availability of services to meet theindividual’s needs for substance abusetreatment.

• Overriding issues that would preventthe individual’s participation in the drugcourt program (e.g., pending chargesthat would require incarceration, mentalillness or retardation that seriouslyimpairs functioning) or other factorsthat cannot be addressed in availableservices.10

Placement in Drug Court

■ Final eligibility review by the judge and/ordrug court staff.

■ Referral of eligible participants to the nextdrug court session.

What Information Should BeIncluded in a Drug Court Screening?

Screening often includes a brief interview, theuse of self-report instruments, and a review ofarchival records. When possible, it should alsoinclude recent results from drug tests. The typeof screening information compiled by drugcourts depends on the stage at which screeningis conducted. Many programs use a short self-report instrument to document the frequency ofdrug and alcohol use over the past 30 days, andover a longer interval.

The following section describes several typesof information that may be examined duringscreening for drug court programs, includingcore elements and other more specializedinformation.

Core Screening Elements

Background and Demographic Information

■ Name, address, age, race/ethnicity, andgender

■ Identifying numbers used by the court orthe treatment provider

Criminal Justice Information

■ Criminal history (prior felonies, violentoffenses)

■ Most recent offense of record

■ Outstanding warrants, detainers, previousdiversions, or other charges

10Potential candidates with some of these attributesmay be good candidates for admission to drug courtprograms that are structured for sentenced offend-ers, and that have access to comprehensive treatmentand case management services. (See Peyton, E.and R. Gebelein, TASC and Drug Courts: NaturalAllies, National TASC, Silver Spring, MD, 1995.)

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Substance Use

■ Signs of acute drug or alcohol intoxication

■ Acute signs of withdrawal from drugs oralcohol

■ Drug tolerance effects

■ Results of recent drug testing

■ Self-reported substance abuse

• Age and pattern of first substance use

• History of use

• Current pattern of use (e.g., quantity,frequency, method of use)

• “Drug(s) of choice” (including alcohol)

• Motivation for using

■ Negative consequences associated withsubstance use. For women, this mayinclude changes in physical appearance.

■ Prior involvement in treatment

■ Family history of substance abuse (includefamily of origin as well as current family)

■ Other observable signs and symptoms ofsubstance abuse (e.g., needle marks/injection sites, impaired motor skills)

Note: Drug courts should develop clearpolicies regarding the use of alcohol byparticipants in drug court programs, aswell as regarding the use of prescriptiondrugs such as antidepressants andpainkillers.

Mental Health

■ Acute mental health symptoms (e.g.,depression, hallucinations, delusions)

■ Suicidal thoughts and behavior

■ Other observable mental health symptoms

■ Age at which mental health symptomsbegan

■ Prior involvement in mental health treat-ment, and use of psychotropic medication

■ Cognitive impairment

■ Past or recent trauma such as sexual/physical abuse

■ Family history of mental illness

Other Indicators

■ Motivation and readiness for substanceabuse treatment

■ Perceived level of substance abuseproblems

■ Infectious disease

■ Social factors (e.g., primary responsibilityfor children, living with an abusive orsubstance-involved partner, sole economicprovider responsibilities) that may presentobstacles for treatment participation

Screening Issues for Women

Women present several unique issues thatrequire additional consideration during screen-ing and assessment. Many female offendershave a history of physical and sexual abuse, andhave relationships characterized by unhealthydependencies and poor communication skills(American Correctional Association, 1990;Lord, 1995). Mental health problems occurdisproportionately among female offenders,particularly depression and post-traumatic stressdisorder (Peters et al., 1997; Teplin et al., 1996).Many women also have responsibility for minorchildren (Bureau of Justice Statistics, 1994).Despite these unique needs, few jurisdictionsoffer specialized treatment services for women.

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Key Points

■ Many screening instruments were devel-oped for males, and may not includequestions that address issues relevant towomen.

■ Barriers to treatment participation shouldbe identified, including responsibility forthe care and support of minor children andother child custody issues.

■ Circumstances related to housing andrelationships should be examined to ensurethat the woman is safe in her current livingsituation and that there are no pressuresfrom significant others to continue drug oralcohol use. If the woman is in a situationwhere she is at risk for abuse, steps shouldbe taken to develop a safety plan.

■ Factors that led to prior relapses should beexplored.

■ Current and prior mental health diagnosesand treatment needs should be identified,and women should be asked if they arecurrently taking medication for anxiety,depression, etc.11

Screening for Mental Health Problems

Due to the high rates of mental health disordersamong criminal justice populations, mentalhealth symptoms and status should be routinelyexamined in drug court screenings.

Key Points

■ Drug court programs should strive to beinclusive in admitting individuals withmental health disorders and other poten-tially disabling conditions (e.g., physicaldisabilities).

■ Many individuals with mental healthproblems have successfully participatedin drug court programs throughout thecountry.

■ Drug courts should not restrict admissionsolely based on mental health symptomsor a history of mental health treatment,but should instead consider the degree towhich mental health or other disorders leadto functional impairment that inhibitseffective program participation.

■ Key mental health indicators that mayinhibit functioning in the drug courtprogram include the following:

• Paranoia, hallucinations, delusions,severe depression, or mania (i.e.,hyperactivity and agitation) that occursfrequently, is obvious to others, isdisruptive to group activities, or other-wise prevents constructive interactionwith drug court staff or participants;

• Lack of stabilization on psychotropicmedication, or failure to followmedication regimes; and

• Suicidal thoughts or other behavior.

■ Each drug court should evaluate itscapacity to work with participants withmental health problems. This evaluationshould include examining existing programresources and other community mentalhealth services, and identifying levelsof functioning needed to participateeffectively in those programs.

■ Screening staff need to be trained tobe knowledgeable in the identificationof mental health symptoms, the natureand course of mental health disorders,commonly prescribed psychotropicmedications, and referral proceduresfor mental health services.

11For additional information on substance abuse andwomen, see Covington, S., Helping Women toChange in Correctional Settings, San Francisco,CA: Jossey-Bass. In press.

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Screening for Suicide

Screening for suicide risk should be a priorityin all drug courts, because individuals who haverecently been arrested and have substance usedisorders have higher rates of suicidal behavior.

Note: Drug courts should have clear policiesand procedures for handling participants whoexhibit suicidal behavior. Substance abuse andmental health treatment programs, the SingleState Agency, the State Mental Health agency,and local correctional and behavioral healthagencies can provide guidance in this area.

Key Points

■ Ongoing suicide screening should beprovided for all potential drug courtparticipants. While suicide screening isimportant for all drug court participants,it is particularly important for those withmental health disorders and those with ahistory of childhood abuse.

■ All suicidal behavior (including threatsand attempts) should be taken seriouslyand assessed promptly to determine thetype of immediate intervention needed.

■ Suicide screening is particularly importantamong participants who have severedepression or schizophrenia, or who aresuffering from stimulant withdrawal.

■ Screening should address the followingareas:

• Current mental health symptoms,

• Current suicidal thoughts, and

• Previous suicide attempts and theirseriousness.

Useful Questions in Screening for Suicide

■ How specific is the plan?

■ What method will be used?

■ When will it happen?

■ How available are potential instruments(drugs, weapons)?

Screening for Motivation andReadiness for Treatment

Drug court screening and assessmentshould address an individual’s motivation andreadiness for treatment. Motivation may beaffected by perceived sanctions and incentives,and may increase when continued substanceabuse threatens current housing, involvementin mental health treatment, vocationalrehabilitation, family (including loss ofchildren), or marriage, or may lead toincarceration. Apparent lack of motivationshould not, as a singular factor, be used todisqualify candidates from admission to thedrug court program or to treatment, unless thecandidate refuses to participate.

Research has shown that treatment outcomes forpersons coerced or court-ordered to treatmentare as good as or better than for participants involuntary treatment (DeLeon, 1988; Hubbard etal., 1989; Leukefeld and Tims, 1988; Platt et al.,1988). Although some offenders may initiallyagree to participate in treatment to reducenegative consequences, motivation for treatmentis expected to become internalized over time.Individuals often cycle through the following“stages of change” during the treatment andrecovery process (Prochaska et al., 1992):

■ Precontemplation (unawareness ofproblems),

■ Contemplation (awareness of problems),

■ Preparation (reached a decision point),

■ Action (actively changing behaviors), and

■ Maintenance (practices ongoing preventivebehaviors).

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Individuals in the earliest stages of change havelittle awareness of substance abuse (or other)problems, and no intentions of changing theirbehavior. Awareness of problems increases inlater stages, as the individual begins to considerthe goal of abstinence. Due to the chronicrelapsing nature of substance abuse problems,movement through stages of change is not alinear process.

One function of the drug court program isto motivate participants toward recovery.By using sanctions and rewards, the judge canuse the leverage of the criminal justice systemto facilitate reductions and cessation of druguse. Although participants may enter drugcourt programs to avoid criminal penalties, theprocess of treatment can help to instill internalmotivation needed for long-term change.While drug court participants will frequentlyreturn to previous stages of change beforeachieving sustained abstinence, drug courtmethods can reduce the likelihood that relapsewill go unchecked and can encourage movementto more advanced stages of recovery.

Key Points

■ Treatment is likely to be ineffective untilindividuals accept the need for treatmentof substance abuse problems.

■ Placement in different types of drug courtservices based on the participant’s currentmotivation level is likely to enhancetreatment compliance, retention, andoutcomes.

• Assessment of stages of change is usefulin treatment planning, and in matchingthe individual to different types oftreatment.

• For individuals in early stages of change,placement in treatment that is tooadvanced, and that does not address aparticipant’s ambivalence regardingbehavior change, may lead to drop outfrom treatment.

• For individuals in later stages ofchange, placement in services that focusprimarily on early recovery issues mayalso lead to drop out from treatment.

■ Several instruments have recently beendeveloped to examine motivation andreadiness for treatment.

Useful Questions in Screening forTreatment Motivation and Readiness

■ Do you have problems related to youralcohol or drug use? How serious do youthink your alcohol or drug problems are?

■ Do you want to make changes in youralcohol or drug use?

■ Have you taken any steps to reduce youralcohol or drug use?

■ How important is it for you to get treat-ment for your alcohol or drug problems?

Use of Self-Report Information

Most screening and assessment in drug courtsis based on self-reported information. Whileself-reported information has generally beenfound to have good reliability and specificity,with criminal justice populations it is widelyaccepted that collateral information and chemi-cal testing should supplement self-reportedinformation. Self-reported information may belimited due to the following considerations:12

■ Individuals in the criminal justicesystem may underreport mental healthor substance abuse problems if theybelieve that accurate reporting may lead toinvolvement in highly structured, lengthy,or otherwise difficult treatment programsor criminal sanctions;

12Adapted from Peters and Bartoi (1997).

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■ Current and past use may be minimizedbecause of denial and failure to perceivethe relationship between substance use andrelated problems;

■ Mental health disorders may interfere withthe accuracy of responses;

■ Cognitive impairments may impedescreening and assessment;

■ Effects of acute intoxication, withdrawaleffects, or chronic substance abuse maylimit the ability to provide accurateself-reported information; or

■ A chronic history of substance abusecontributes to difficulties in rememberingdates, onset, and effects of the disorder.

Strategies to Enhance the Accuracy ofSelf-Reported Information

■ Supplement interview and test results withinformation from collaterals.

■ Examine archival records to determine theonset, course, diagnoses, and responses totreatment of substance use and mentalhealth disorders.

■ Provide regular drug testing.

■ Wait to use self-report instruments until itis determined that an individual is not inwithdrawal or intoxicated.

■ Provide repeated screening and assessmenton a regular basis.

■ Provide a supportive interview setting.

• Self-reported information should becompiled in a non-judgmental manner,and in a relaxing setting when possible.

• The interview should be prefaced with adiscussion of the limits of confidentiality.

■ Use motivational interviewing techniques,including:

• Express empathy.

• Develop discrepancy between statedgoals and current behaviors (e.g., desireto keep a steady job vs. “binge” druguse).

• Avoid arguing.

• Roll with resistance by offering newideas and finding new ways to encouragebehavior change.

■ Support self-efficacy, or self-confidence.

What Instruments Should Be Used inDrug Court Screening?

Drug courts should use standardized substanceabuse screening instruments to enhance theconsistency and validity of results. Approxi-mately 75 percent of drug courts use standard-ized instruments for clinical screening andassessment, according to a recent nationwidesurvey (Cooper, 1997). The most commonlyused instruments were the Addiction SeverityIndex (ASI), the Substance Abuse SubtleScreening Inventory (SASSI), the MichiganAlcoholism Screening Test (MAST), and theOffender Profile Index (OPI). Several of theseinstruments are discussed in more detail in thefollowing sections.

Screening instruments should be administeredconcurrently with an individual interview, drugtesting (if possible), and examination of collat-eral information. As described previously, drugcourt screening instruments should address thefollowing key components: (1) symptoms ofalcohol and drug abuse/dependence, (2) patternsof recent and current substance abuse, (3) signsand symptoms of major mental health disorders(e.g., depression, bipolar disorder, schizophre-nia), (4) suicide risk, and (5) other motivationaland health factors that may affect involvement

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in treatment. Use of objective “risk assessment”scales to examine public safety risk may also beadministered at the time of screening.

Given the absence of current instruments thataddress each of these components, severalindependent instruments are often combined inscreening. Examples of selected instrumentsin several different content areas are describedin the section to follow.

Key Issues in Selecting ScreeningInstruments

Instruments used in screening for substanceabuse treatment programs differ significantly intheir coverage of substance abuse symptoms andmental health symptoms, validation for use incriminal justice and other settings, cost, scoringprocedures, and training required for administra-tion and scoring. Several key issues that shouldbe addressed in selecting screening instrumentsinclude the following:

■ Reliability. Reliability refers to theconsistency of results obtained over time.

■ Validity. In the area of screening, validityrefers to the extent to which instrumentscan identify substance abuse problemseffectively. The validity of screening andassessment instruments varies significantly.For example, many standardized substanceabuse instruments do not adequatelyidentify individuals with substanceabuse problems, or are unable to identifyindividuals who do not have substanceabuse problems.

■ Use in Criminal Justice Settings. Fewsubstance abuse instruments have beenvalidated within criminal justice settings(Peters, 1992; Peters and Greenbaum,1996).

■ Cost. Several commercially availablescreening instruments have been heavilymarketed to the substance abuse treatment

community in recent years. However,recent research (see section to follow)shows that several public domaininstruments are among the most effectivefor use with criminal justice populations.

Substance Abuse ScreeningInstruments

Many screening instruments are currently inuse in drug courts. While numerous instrumentsare available, few studies have examined thevalidity of different substance abuse screeninginstruments in criminal justice settings. Inthe most comprehensive study of this type(Peters and Greenbaum, 1996), three screeninginstruments were found to be the most effectivein identifying prison inmates with substancedependence problems:

■ ADS/ASI – Drug (a combined instrument,consisting of the Alcohol DependenceScale and the Addiction Severity Index –Drug Use section; Skinner & Horn, 1984;McLellan et al., 1980)

■ TCU Drug Dependence Screen (DDS;Simpson et al., 1997)

■ Simple Screening Instrument (SSI; Centerfor Substance Abuse Treatment, 1994a)

These instruments outperformed several othersubstance abuse screens, including the MichiganAlcoholism Screening Test (MAST) — Shortversion; the ASI — Alcohol Use section, theDrug Abuse Screening Test (DAST-20); and theSubstance Abuse Subtle Screening Inventory(SASSI-2) on key validity measures. The ADS/ASI, DDS, and SSI appear to hold considerablepromise for use with participants in drug courtprograms. Copies of the DDS and SSI, alongwith instructions for use are included in Appen-dix A.13 Information regarding availability andcost of additional instruments has been includedin Appendix B.

13 The ADS has not been included because it is a commercially available instrument.

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In community settings,14 several screeninginstruments have been found to have adequatevalidity for use with substance-abusingpopulations (McHugo et al., 1993; Peters andGreenbaum, 1996; Ross et al., 1990; Staley andEl Guebaly, 1990). These include the AlcoholDependence Scale (ADS), the Drug AbuseScreening Test (DAST; and DAST-20, a shortversion of the DAST), the Michigan AlcoholismScreening Test (MAST; and SMAST — a shortversion of the MAST), and the CAGE.

Mental Health Screening Instruments

Several brief mental health screens are available(e.g., BSI, RDS, SCL-90-R) that examine abroad range of mental health symptoms, whileothers focus on symptoms of a single disorder,such as depression (e.g., BDI). Informationrelated to cost and availability is included inAppendix B. Several commonly used screeninginstruments that have been validated for usein detecting mental health symptoms15 aredescribed as follows:

■ Beck Depression Inventory (BDI; Beckand Beamesderfer, 1974)

■ Brief Symptom Inventory (BSI; Derogatisand Melisaratos, 1983)

■ Referral Decision Scale (RDS; Teplin andSchwartz, 1989)

■ Symptom Checklist 90 — Revised(SCL-90-R; Derogatis et al., 1974)

Motivational Screening Instruments

Several instruments are available that examinemotivation and readiness for treatment. Theseinstruments are designed primarily to identifyindividuals for whom admission to substanceabuse treatment is inappropriate. Two of theseinstruments (SOCRATES, URICA) are basedon the “stage of change” model. As describedpreviously, information regarding motivationand readiness for treatment has been found topredict drop out from treatment and treatmentoutcome, and may be particularly useful inmatching individuals to different types oftreatment services provided by drug courtprograms. Instruments that examinemotivation and readiness for treatmentinclude the following:

■ Circumstances, Motivation, Readiness,and Suitability Scale (CMRS; DeLeon andJainchill, 1986)

■ Stages of Change Readiness and TreatmentEagerness Scale (SOCRATES; Miller,1994)

■ University of Rhode Island ChangeAssessment Scale (URICA;McConnaughy, et al., 1983; DiClementeand Hughes, 1990)

What Screening InformationIs Most Relevant to the Court?

The report prepared after completion of screen-ing often contains the first set of descriptiveinformation that the court will receive. As such,it gives the judge the opportunity to engage withparticipants in a meaningful way. In addition,information from the screening process willenable the judge and other members of the drugcourt team to decide whether the drug courtprogram is appropriate for the participant, orwhether another criminal justice interventionmight be more appropriate. Screening

14Instruments developed for incarcerated offendersattempt to account for the interruption in drug usethat occurs due to incarceration.

15See also, Peters and Bartoi (1997) for a morecomplete description of mental health screeninginstruments used in criminal justice settings,Allen and Columbus (1995), Center for SubstanceAbuse Treatment (1994b), and Rounsaville et al.(1996).

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information that is most relevant to the courtincludes:

■ Whether the defendant meets criminaljustice criteria for admission, includingcurrent offense and criminal history;

■ Whether the defendant is a good risk forcommunity placement;

■ Psychosocial history, including employ-ment status, educational status, significantrelationships, and living arrangements;

■ Level of substance abuse involvement,and whether or not there is appropriateand available treatment to address thesubstance abuse problems;

■ Willingness to comply with therequirements of the drug court program;

■ Mental health symptoms that may preventeffective program participation; and

■ History of failure to appear for court; priorprobation and substance abuse treatmenthistory.

Note: Additional information may berequired or may be useful in certainjurisdictions. The drug court managementteam should develop policies andprocedures regarding information to bepresented to the court at the time of theinitial drug court appearance, and regard-ing who will provide the information.In addition, the court’s response to keyissues identified in the screening processshould be discussed. For instance, priorfailure in treatment need not disqualify anindividual from participation in the drugcourt program; multiple treatment episodesis sometimes necessary to accomplishsustained recovery.

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Drug Court Assessment

Assessment explores many of the same issuesas screening does, but in much more depth andwith a particular emphasis on problem areashighlighted during screening. The purpose ofassessment is not to determine eligibility butto develop a treatment plan and to decide thetiming and application of specific services andprograms. Assessment provides the basis fordevelopment of an individualized treatmentplan or case management plan and for matchingparticipants with different types of drug courtservices. Key elements of drug court assess-ment include substance abuse history, currentpatterns of use, mental health history andcurrent symptoms, criminal justice history andstatus, other areas of psychosocial functioning,current skills deficits, and types of treatmentand ancillary services needed. Standardizedassessment instruments and methods should beused by drug court programs (National Instituteof Corrections, 1991; Peters, 1992; U.S. Depart-ment of Justice, 1997).

When Should Drug Court AssessmentBe Conducted?

Assessment is usually accomplished followingcompletion of screening and following initialadmission to the program. Sufficient timeshould be provided before initial assessment toensure that an individual is detoxified and sober.Time will also show if any mental health symp-toms are related to withdrawal from substanceuse (Weiss and Mirin, 1989). Although theinitial assessment is often conducted in the firstseveral weeks of the drug court program, assess-ment is an ongoing process, and must considernew issues that arise, and new informationobtained during treatment. For example, priorphysical and sexual abuse are often not reporteduntil an individual is comfortable in revealingsensitive information to treatment counselors

and other treatment participants. Relapsesthat occur during treatment, changes in livingarrangements and employment, and other newissues are often reviewed by a drug court treat-ment team, with modifications then made tothe treatment plan to reflect new problem areasand related services provided to address theseproblems.

Note: Drug courts should develop a planfor managing participants or potential partici-pants who have not achieved sobriety prior toadmission. Many drug courts have access toresidential or outpatient detoxification facilities;some defendants are detoxified in jail if they areunable to achieve sobriety in the community.

Who Should Conduct Assessment?

Over half of drug court assessments are con-ducted by a private treatment agency affiliatedwith the program, and 38 percent of drug courtsuse more than one agency to conduct assess-ments (Cooper, 1997). Drug court assessmentsshould be conducted by professionals withexperience and training in substance abusetreatment, diagnosis, and basic counselingtechniques. These individuals should alsohave experience and training in criminaljustice processes and in working with offenders.Assessments are typically conducted by certifiedsubstance abuse or addiction counselors, socialworkers, psychologists, and clinical nursespecialists. Licensed medical practitioners canprovide assessment and diagnosis of health-related disorders, and can conduct routinephysical examinations. For example, psychia-trists may provide consultation in examiningindividuals for mental health disorders anddetermining the need for psychotropic medica-tion. States vary in their requirements regardingthe qualifications of those who may conduct

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clinical assessments. The Single State Agencythat administers federal funds for alcohol anddrug treatment can provide information regard-ing these regulations. It is important for drugcourts to use programs and counselors that meetlocal criteria for licensing and certification.

What Information Should Be Includedin a Drug Court Assessment?

The following types of information shouldbe examined in a drug court assessment,with particular emphasis given to those areasidentified as problematic during screening:

■ Criminal justice history and status

■ Substance abuse history, currentsymptoms, and level of functioning

■ Mental health history, current symptoms,and level of functioning

■ History of interaction between mentalhealth and substance use disorders

■ Family history of substance use disorders(including birth complications and in uterosubstance exposure)

■ Medical and health status

■ Social/family relationships (includinginvolvement in domestic violence andchild abuse or neglect)

■ Employment/vocational status

■ Educational history and status

■ Literacy, IQ, and developmentaldisabilities

■ Treatment history and response to/compliance with treatment

■ Prior experience with peer support groups

■ Cognitive appraisal of treatment andrecovery

• Motivation and readiness for treatment

• Self-efficacy in adopting lifestylechanges (e.g., maintaining abstinence,complying with medication)

• Expectancies related to substance use(both positive and negative)

■ Participant conceptualization of treatmentneeds

■ Resources and limitations affecting theability to participate in treatment (e.g.,transportation problems, homelessness,child care needs)

■ Interpersonal coping strategies, problemsolving abilities, and communication skills

Areas for Detailed Assessment

Substance Abuse History and Status

■ Substance abuse information shouldinclude the drug(s) of first preference;other secondary drugs; misuse of pre-scription drugs; age of onset; frequency,amount, and duration of current andpast use; patterns of high and low usage;reasons for substance abuse; contextof substance abuse, including methodsof financing substance use; periods ofabstinence and how they were attained;and information regarding prior relapses(e.g., antecedents, warning signs, and highrisk situations).

■ Assessment should examine the numberand type of prior treatment experiences(e.g., whether treatment was voluntaryor was the result of civil or criminalcommitment), and treatment outcomes.

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Mental Health History and Status

■ Approximately 40-50 percent ofsubstance-abusing offenders have a majormental illness (National GAINS Center,1997; Teplin, 1994; Teplin et al., 1996).

■ Mental health information should includecurrent and past symptoms (e.g., suicidalbehavior, depression, anxiety, psychosis,paranoia, stress, self-image, inattentive-ness, impulsivity, hyperactivity), treatmenthistory, use of psychotropic medications,and patterns of denial and manipulation.

■ Mental health symptoms should be exam-ined to determine whether the individualcan function adequately in a drug courtsetting, the level of supportive servicesneeded (e.g., mental health counseling,psychiatric consultation), and the need fora more thorough mental health assessmentby a psychologist or psychiatrist.

Family and Social Relationships

■ Assessment should examine social interac-tions and lifestyle, effects of peer pressureto use drugs and alcohol, and availablepeer and family support for involvementin treatment. This area of assessment isparticularly important with juveniles.

■ The history of abuse and neglect withinthe family should be examined, in additionto the family history of substance abuse,mental illness, and criminal justiceinvolvement.

■ The stability of the home and socialenvironment should also be assessed,including violence in the home and effectsof the home and other relevant socialenvironments (e.g., work, school) onabstinence from substance use.

■ The history of marital and other significantrelationships, important life events, andchildhood history should be examined.

Medical/Health Care History and Status

■ Key areas to examine include history ofinjury and trauma, chronic disease, physi-cal disabilities, substance toxicity andwithdrawal, impaired cognition, neurologi-cal symptoms, and prior use of medication.

■ If a history of Attention Deficit or Hyper-activity Disorders (AD/HD) is suspected,the assessment should examine attentionand concentration difficulties, hyperactivityand impulsivity, and the developmentalhistory of childhood AD/HD symptoms.

Criminal Justice History and Status

■ The complete criminal history should bereviewed. The pattern of prior criminaloffenses may reveal important informationregarding the effect of substance abuse oncriminal behavior, the need for case man-agement services, and potential relapseprevention strategies (e.g., avoidance ofspecific high-risk situations that may elicita return to criminal behavior and substanceabuse). The self-reported history providedduring assessment should be corroboratedthrough inspection of official criminaljustice history records.

Key assessment information related tocriminal history includes the following:

• Prior arrests (including age at firstarrest, type of arrest)

• Juvenile justice history

• Involvement with the civil justice system,including domestic violence, child abuseor neglect, custody issues, etc.

• Alcohol and drug-related offenses(e.g., DUI/DWI, drug possession orsales, reckless driving)

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• Level of intoxication at the time ofprevious offenses (either reported orunreported offenses)

• Felony convictions

• Number of prior jail and prisonadmissions, duration of incarceration

• Disciplinary incidents in jail and prison

• Use of isolation management in jail andprison

• Probation or parole violations

■ The current criminal justice status shouldalso be examined. This information willhelp in coordinating treatment and manage-ment issues with courts and communitysupervision staff.

Key assessment information related to currentcriminal status includes the following:

• Court orders requiring assessment andinvolvement in treatment, including thelength of involvement in treatment(if specified)

• Duration of criminal justice supervision(e.g., pretrial release, probation, parole)

• Supervision arrangements (e.g.,supervising probation/parole officer,frequency of court or supervisionappointments, reporting requirements)

• Consequences for noncompliance withtreatment guidelines

What Instruments Are Availablefor Assessment of Participants inDrug Court Programs?

Few comprehensive instruments have beenvalidated for use in assessing individuals with

substance abuse disorders, and no instrument isperfect. Moreover, few studies have attemptedto validate the use of assessment instrumentsin criminal justice settings. A comprehensiveapproach should be developed to assessparticipants in drug court programs. Thisapproach should include review of substanceuse and other disorders, examination of criminaljustice history and status, and drug screens.One example of a comprehensive assessmentapproach is the Addiction Severity Index(ASI),16 which is one of the few availableinstruments that measures several differentfunctional aspects of psychosocial functioningrelated to substance abuse. The ASI providesa concise review of the history of substanceabuse and recent use. The ASI is described inmore detail in the following section. Severalpreviously described screening instrumentsare often used as part of an assessment battery(e.g., to examine diagnostic symptoms ofalcohol or drug abuse and dependency).

Addiction Severity Index (ASI)

The ASI (McLellan et al., 1980; McLellan et al.,1992) is currently the most widely used sub-stance abuse instrument, and is used for screen-ing, assessment, and treatment planning. TheASI is a “public domain” instrument developedthrough the National Institute on Drug Abuse(NIDA). The instrument provides a structuredinterview format to examine seven areas offunctioning that are commonly affected bysubstance abuse, including drug/alcohol use,family/social relationships, employment/supportstatus, and mental health status. Many agencies,including those in criminal justice settings,have modified the ASI for use as a screeninginstrument for substance abuse. Two indepen-dent sections of the ASI examining drugand alcohol use are frequently used asscreening instruments.

16 Appendix C includes a copy of the ASI instrument.

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Key Features and Considerations

■ The ASI has been found to be reliable andvalid for use with a range of substance-abusing populations, including offenders,and is highly correlated with objectiveindicators of addiction severity (McLellanet al., 1985).

■ Severity ratings are provided in eachfunctional area assessed, which may beuseful for clinical and research purposes.

■ Staff training is needed to administer andscore the ASI. Administration of the entireASI requires 45-75 minutes.

■ Although developed for use in aninterview, a self-report version of the ASI(SA-ASI) has recently been developed.The psychometric properties of thisself-report instrument have not yet beenestablished.

What Assessment InformationIs Most Relevant to the Court?

Assessment information can provide importantguidance to the court regarding a participant’sadaptation to treatment; strengths and weak-nesses; supervision, management, and treatmentstrategies; and potential pitfalls to avoid duringinvolvement in the program. This uniqueinformation is often pivotal in cementing therelationship between the drug court participantand the judge. Assessment information alsohelps identify key areas to monitor and reviewduring drug court status hearings, and allowsthe judge to develop individualized sanctionsand incentives.

The following assessment information isparticularly useful to the court:

■ Current placement and status or adjustmentin treatment

■ Treatments attempted, and the outcomesof these interventions

■ Whether the participant lives in a drug-freeand stable residence

■ Whether significant others (e.g., spouses,coworkers, girlfriends/boyfriends, familymembers) are active substance abusers;whether significant others support recoverygoals

■ High-risk situations for substance abuserelapse

■ Personal recovery goals

■ Employment status and skills

■ Mental health problems

■ Medical problems

■ History of violence or abuse (either asperpetrator or victim)

■ Additional services that will be requiredby the participant

■ Obstacles to participant progress

■ Issues that may affect the participant’sability to remain or succeed in the program

Obtaining Release ofConfidential Information

Federal Confidentiality Regulations (42 CFRPart 2) prohibit the release of informationabout participants in substance abuse treatmentwithout a written consent from the individual (orthe parent, if the participant is a minor, in areasin which treatment is contingent on parentalconsent). Confidentiality laws are fairlyrestrictive, and are designed to protect theprivacy rights of participants in substance

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abuse treatment.17 Violations of these regula-tions can result in substantial fines. All drugcourts should become familiar with federal andstate confidentiality regulations, and shoulddevelop procedures to ensure that cooperatingagencies comply with these regulations.

Confidentiality regulations are generally not asstrict for treatment participants who are super-vised by the criminal justice system, and do notprohibit the exchange of information betweenaffiliated drug court agencies, or with othercriminal justice or community agencies. Onceconsent for release of information is providedwithin criminal justice settings, it generallycannot be rescinded until the participant gradu-ates or leaves the program. Individuals whoreceive confidential information may discloseand use it only to carry out their official dutieswith respect to the release.

In general, release of information forms com-pleted for participants in drug court programsshould describe the following:

■ The name of the participant in the drugcourt program

■ The name or general designation of theindividual who is permitted to discloseinformation

■ Criminal justice staff who may receive theinformation in connection with their dutyto monitor the participant’s progress

■ The purpose of the disclosure

■ The type of information to be released

■ The period during which the releaseremains in effect (e.g., anticipated lengthof participation in drug court treatment,anticipated duration of criminal justicesupervision)

■ The signature of the drug court participantand/or of the parent, as needed

■ The date on which the release form wassigned.

17For additional information, see Center for Sub-stance Abuse Treatment (1994c), Confidentialityof patient records for alcohol and other drugtreatment. Technical Assistance Publication (TAP)Series, #13, and Center for Substance AbuseTreatment (1994d), Combining substance abusetreatment with intermediate sanctions for adults inthe criminal justice system. Treatment Improve-ment Protocol (TIP) Series, #12.

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Summary

The number of drug courts implementedthroughout the country has increased dramati-cally in the past five years. Drug courts offersignificant new opportunities to effectivelymanage, supervise, and treat individuals withsubstance abuse problems, and to discouragetheir return to the criminal justice system, byblending criminal justice interventions witheffective treatment methods and programming.

Screening and assessment activities are impor-tant to drug courts in identifying participantswho meet eligibility criteria, and in selectingindividuals who are likely to benefit from drugcourt intervention. Screening refers to therelatively brief examination of program eligibil-ity criteria (both criminal justice and clinical),while assessment involves a more detailedreview of psychosocial problems and treatmentneeds. Screening and assessment activities formthe basis of the ongoing, individualized dialoguebetween the participant and the drug court teamthat characterizes drug courts.

Failure to provide appropriate screening andassessment can lead to misidentification ofproblems, ineffective treatment planning, andplacement in services that are inconsistent withthe needs of participants. An effective screeningand assessment system can give drug courts thedata they need to augment services, strengthenprogram weaknesses, and identify and build onprogram strengths.

Drug court programs should develop writteneligibility criteria to guide the screening process.Policies and procedures should be developedthat describe roles and responsibilities of staffinvolved in screening and assessment, informa-tion sharing, and methods to safeguard partici-pant confidentiality. Eligibility criteria should

be designed to permit participation ofindividuals with mental health and otherpotentially disabling disorders. Criteria relatedto these disorders should focus on functionalimpairment that would inhibit meaningfulparticipation in the drug court.

Screening should be conducted as soon afterarrest as possible, to expedite involvement inthe drug court program. Both screening andassessment should be based on multiple sourcesof information, including interview, self-reportinstruments, and review of records. Screeningand assessment for participants in the drug courtprogram should examine various types ofinformation related to substance abuse andmental health disorders and criminal justiceinvolvement to form a comprehensive andintegrated description of each participant’ssupervision and treatment needs.

Several instruments are available for bothscreening and assessment. Use of standardizedscreening and assessment instruments by drugcourts will enhance the consistency and accu-racy of results. Several substance abuse screen-ing instruments have been validated recentlyfor use in criminal justice settings, and appearto hold considerable promise for use in drugcourts. Other instruments have been validatedfor use in examining mental health disorders.

Staff training is needed in the areas of interview-ing strategies, identification of key indicatorsand problem areas, use of instruments, andreferral to services, as well as other areas.Training is often available through Single StateAgencies, local universities, providers of treat-ment programs for substance abuse or providerassociations, and criminal justice agencies.

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Center for Substance Abuse Treatment (1994).Confidentiality of patient records for alcoholand other drug treatment. Technical AssistancePublication (TAP) Series, #13. Rockville, MD.

Center for Substance Abuse Treatment (1994b).Screening and assessment for alcohol and otherdrug abuse among adults in the criminal justicesystem. Treatment Improvement Protocol (TIP)Series, #7. Rockville, MD.

Center for Substance Abuse Treatment (1994c).Simple screening instruments for outreach foralcohol and other drug abuse and infectiousdiseases. Treatment Improvement Protocol(TIP) Series, #11. Rockville, MD: U.S.Department of Health and Human Services.

Center for Substance Abuse Treatment (1994d).Combining substance abuse treatment with

30

Kivlahan, D.R., Sher, K.M., and Donovan, D.M.(1989). The Alcohol Dependence Scale:A validation study among inpatient alcoholics.Journal of Studies on Alcohol, 50, 170-175.

Kofoed, L., Dania, J., Walsh, T., and Atkinson,R.M. (1986). Outpatient treatment of patientswith substance abuse and coexisting psychiatricdisorders. American Journal of Psychiatry, 143,867-872.

Leukefeld, C.G., and F.M. Tims [eds.] (1988).Compulsory Treatment of Drug Abuse:Research and Clinical Practice. Rockville, MD:National Institute on Drug Abuse.

Lord, E. A prison superintendent’s perspectiveon women in prison. The Prison Journal75(2):257-269, 1995.

McConnaughy, E.A., Prochaska, J., andVelicer, W.F. (1983). Stages of change inpsychotherapy: Measurement and sampleprofiles. Psychotherapy: Theory, Research,and Practice, 20, 368-375.

McHugo, G., Paskus, T.S., and Drake, R.E.(1993). Detection of alcoholism inschizophrenia using the MAST. Alcoholism:Clinical and Experimental Research, 17 (1),187-191.

McLellan, A.T., Kushner, H., Metzger, D.,Peters, R.H., Smith, I., Grissom, G., Pettinati,H., & Argeriou, M. (1992). The Fifth Editionof the Addiction Severity Index. Journal ofSubstance Abuse Treatment, 9, 199-213.

McLellan, A.T., Luborsky, L., Cacciola, J.,Griffith, J., Evans, F., Barr, H.L., & O’Brien,C.P. (1985). New data from the AddictionSeverity Index: Reliability and validity inthree centers. Journal of Nervous and MentalDisease, 173, 412-423.

McLellan, A.T., Luborsky, L., Woody, G.E., andO’Brien, C.P. (1980). An improved diagnostic

evaluation instrument for substance abusepatients: The Addiction Severity Index. Journalof Mental and Nervous Disease, 168 (1), 26-33.

Miller, W.R. (1994). SOCRATES: The Stagesof Change Readiness and Treatment EagernessScale. Albuquerque: University of NewMexico, Department of Psychology.

National GAINS Center (1997). The prevalenceof co-occurring mental and substance disordersin the criminal justice system. Just the Factsseries. Delmar, NY.

National Institute of Corrections (1991).Intervening with Substance-Abusing Offenders:A Framework for Action. Washington, DC:U.S. Department of Justice.

Office of Justice Programs (1997). Definingdrug courts: The key components. Drug CourtsProgram Office, in collaboration with theNational Association of Drug Court Pro-fessionals, Drug Court Standards Committee.Washington, DC: U.S. Department of Justice.

Peters, R.H. (1992). Referral and screening forsubstance abuse treatment in jails. Journal ofMental Health Administration, 19 (1), 53-75.

Peters, R.H., and Bartoi, M.G. (1997).Screening and assessment of co-occurringdisorders in the justice system. Delmar, NY:The National GAINS Center.

Peters, R.H., and Greenbaum, P.E. (1996).Texas Department of Criminal Justice/Centerfor Substance Abuse Treatment PrisonSubstance Abuse Screening Project. Milford,MA: Civigenics, Inc.

Peters, R.H., Pennington, B., Wells, J.D.,Rosenthal, L., and Meeks, J. (1994).Treatment-based drug courts: Gearing upagainst substance abuse. Alexandria, VA:State Justice Institute.

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Peters, R.H., Strozier, A.L., Murrin, M.R.and Kearns, W.D. (1997). Treatment ofSubstance-Abusing Jail Inmates: Examinationof gender differences. Journal of SubstanceAbuse Treatment, 14 (4), 339-349.

Peyton, E. and R. Gebelein, TASC and DrugCourts: Natural Allies, National TASC, SilverSpring, MD, 1995.

Prochaska, J.O., DiClemente, C.C., andNorcross, J.C. (1992). In search of how peoplechange: Applications to addictive behaviors.American Psychologist, 47, 1102-1114.

Ross, H.E., Gavin, D.R., and Skinner, H.A.(1990). Diagnostic validity of the MAST andthe Alcohol Dependence Scale in the assessmentof DSM-III alcohol disorders. Journal ofStudies on Alcohol, 51 (6), 506-513.

Rounsaville, B.J., Tims, F.M., Horton, A.M.,and Sowder, B.J. (Eds.). (1996). Diagnosticsource book on drug abuse research andtreatment. Rockville, MD: National Instituteon Drug Abuse.

Skinner, H.A., and Horn, J.L. (1984). AlcoholDependence Scale: User’s Guide. Toronto:Addiction Research Foundation.

Simpson, D.D., Knight, K., and Broome, K.M.(1997). TCU/CJ Forms Manual: DrugDependence Screen and Initial Assessment.

Fort Worth: Institute of Behavioral Research,Texas Christian University.

Staley, D., and El Guebaly, N. (1990).Psychometric properties of the Drug AbuseScreening Test in a psychiatric patientpopulation. Addictive Behaviors, 15, 257-264.

Teplin, L.A. (1994). Psychiatric and substanceabuse disorders among male urban jail detain-ees. American Journal of Public Health, 84 (2),290-293.

Teplin, L.A., Abram, K.M., & McClelland,G.M. (1996). Prevalence of psychiatric disor-ders among incarcerated women, I: Pre-trial jaildetainees. Archives of General Psychiatry, 53,505-512.

Teplin, L.A., and Schwartz, J. (1989).Screening for severe mental disorder in jails.Law and Human Behavior, 13 (1), 1-18.

U.S. General Accounting Office (1995).Drug courts: Information on a new approachto address drug-related crime. Briefing reportto the Committee on the Judiciary, U.S. Senate,and the Committee on the Judiciary, House ofRepresentatives, #GAO/GGD-95-159BR.Washington, DC.

Weiss, R.D., & Mirin, S.M., (1989). The dualdiagnosis alcoholic: Evaluation and treatment.Psychiatric Annals, 19 (5), 261-265.

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33

Other Related Resource Materials

Center for Substance Abuse Treatment (1994).Screening and Assessment for Alcohol andOther Drug Abuse Among Adults in theCriminal Justice System. TreatmentImprovement Protocol Series, #7.Rockville, MD.

Center for Substance Abuse Treatment (1993).Screening for infectious diseases amongsubstance abusers. Treatment ImprovementProtocol Series, #6. Rockville, MD.

Center for Substance Abuse Treatment (1993).Screening and assessment of alcohol- and otherdrug-abusing adolescents. Treatment Improve-ment Protocol Series, #3. Rockville, MD.

Donovan, D.M., and Marlatt, G.A. (1988).Assessment of addictive behaviors. New York:The Guilford Press.

Miller, W. R., & Rollnick, S. (1991).Motivational interviewing: Preparing peopleto change addictive behavior. New York:The Guilford Press.

National Institute on Alcohol Abuse andAlcoholism (1995). Assessing alcoholproblems: A guide for clinicians andresearchers. NIAAA Treatment Handbookseries #4. Bethesda, MD.

National Institute on Drug Abuse (1994).Mental health assessment and diagnosis ofsubstance abusers. Clinical Report Series.U.S. Department of Health and Human Services,NIDA Office of Science Policy, Education andLegislation. Rockville, MD.

Allen, J.P., and Columbus, M. (Eds). (1995).Assessing alcohol problems: A guide forclinicians and researchers. Bethesda, MD:National Institute on Alcohol Abuse andAlcoholism.

American Psychiatric Association (1996).Practice guidelines. Washington, DC.

Center for Substance Abuse Treatment (1996).Treatment drug courts: Integrating SubstanceAbuse Treatment With Legal Case Processing.Treatment Improvement Protocol Series, #23.Rockville, MD.

Center for Substance Abuse Treatment (1995).Combining alcohol and other drug abusetreatment with diversion for juveniles in thejustice system. Treatment ImprovementProtocol Series, #21. Rockville, MD.

Center for Substance Abuse Treatment (1995).Planning for alcohol and other drug abusetreatment for adults in the criminal justicesystem. Treatment Improvement ProtocolSeries, #17. Rockville, MD.

Center for Substance Abuse Treatment (1995).The role and current status of patient placementcriteria in the treatment of substance usedisorders. Treatment Improvement ProtocolSeries, #13. Rockville, MD.

Center for Substance Abuse Treatment (1994).Assessment and treatment of patients withcoexisting mental illness and alcohol and otherdrug abuse. Treatment Improvement ProtocolSeries, #9. Rockville, MD.

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Appendix A:

Selected Instruments

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37

38

39

40

41

42

43

Appendix B:

Availability and Cost of Screening Instruments

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Mental Health, Substance Abuse, andMotivational Screening Instruments

Mental Health Screening InstrumentsHealth Screening Instruments

Instrument Time to Administer Cost Source

Beck Depression 5 mins., 21 items Basic kit Psychological CorporationInventory (BDI) is $45 (800) 211-8378

Brief Symptom 10 mins., 53 items Basic kit NCS AssessmentsInventory (BSI) is $87 (800) 627-7271

Referral Decision 5 mins., 14 items No cost Published inScale (RDS) Law and Human Behavior,

1989; (13) 1, 1-18.

Symptom Checklist 15 mins., 90 items Basic kit NCS Assessments90-Revised (SCL-90R) is $87 (800) 627-7271

Substance Abuse Screening InstrumentsAbuse Screening Instruments

Instrument Time to Administer Cost Source

Alcohol Dependence 5 mins., 25 items Basic kit Marketing ServicesScale (ADS) is $15 Addiction Research Foundation

33 Russell Street Toronto,Ontario M5S 2S1(416) 545-6000

Addiction Severity 10-15 mins., 24 items No cost DeltaMetrics/TRIIndex (ASI) – Drug (800) 238-2433, orUse section QuickStart Systems

(214) 342-9020. Alsopublished in various TIPmonographs by the Center forSubstance Abuse Treatment

Drug Dependence 5 mins., 15 items No cost TCU/CJ Forms ManualScreen (DDS) Texas Christian University

Institute of BehavioralResearch(817) 921-7226Instrument can be downloadedat: www.ibr.tcu.edu

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Instrument Time to Administer Cost Source

Simple Screening 5 mins., 16 items No cost Published in Center forInstrument (SSI) Substance Abuse Treatment

TIP #11. Order TIP throughNCADI Clearinghouse at(800) 729-6689

Motivational Screening InstrumentsScreening Instruments

Instrument Time to Administer Cost Source

Circumstances, 10 min., 42 items No cost Center for TherapeuticMotivation, and Community Research,Readiness Scales National Development(CMRS) and Research Institutes

(212) 966-870011 Beach StreetNew York, NY 10014-2114

Stages of Change, 5 mins., 19 items No cost Scott Tonigan, Ph.D.Readiness, and University of New MexicoTreatment 2350 Alamo SWEagerness Scale Albuquerque, NM 87131(SOCRATES) (505) 768-0214

University of 15 mins., 32 items No cost University of Rhode IslandRhode Island Cancer PreventionChange Research CenterAssessment Scale Kingston, RI 02881(URICA) (401) 874-2830

Instrument can be downloadedat: www.uri.edu/research/cprc/measures.htm.Instrument is published inMcConnaughy, DiClemente,Prochaska, and Velicer (1989),Psychotherapy, 26, 494-503

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Appendix C:

Addiction Severity Index

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Appendix D:

Single State Alcohol and Drug Agency Directors

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SINGLE STATE ALCOHOL ANDDRUG AGENCY DIRECTORS

ALABAMAMr. O’Neill PollingueDirectorDivision of Substance Abuse ServicesAlabama Department of Mental Health and Mental RetardationRSA Union Building100 N. Union StreetMontgomery, Alabama 36130-1410TEL (334) 242-3953FAX (334) 242-0759

ALASKAMr. Loren A. JonesDirectorDivision of Alcoholism and Drug AbuseAlaska Department of Health and Social Services240 Main StreetSuite 701Juneau, Alaska 99811

Mailing Address

P.O. Box 110607Juneau, Alaska 99811-0607TEL (907) 465-2071FAX (907) 465-2185

ARIZONAMs. Christy DyeActing Program ManagerOffice of Substance AbuseDivision of Behavioral Health ServicesArizona Department of Health Services2122 East HighlandPhoenix, Arizona 85016TEL (602) 381-8999FAX (602) 553-9143

ARKANSASMr. Joe M. HillDirectorArkansas Bureau of Alcohol and Drug Abuse Prevention5800 West 10th Street, Suite 907Little Rock, Arkansas 72204TEL (501) 280-4500FAX (501) 280-4519

CALIFORNIAAndrew M. Mecca, Ph.D.DirectorDepartment of Alcohol and Drug ProgramsCalifornia Health and Welfare Agency1700 K Street, Fifth FloorExecutive OfficeSacramento, California 95814-4037TEL (916) 445-1943FAX (916) 323-5873

COLORADOMs. Janet WoodDirectorAlcohol and Drug Abuse DivisionColorado Department of Human Services4300 Cherry Creek Drive, SouthDenver, Colorado 80222-1530TEL (303) 692-2930FAX (303) 753-9775

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CONNECTICUTThomas A. Kirk, Jr., Ph.D.Deputy CommissionerDepartment of Mental Health and Addiction Services410 Capitol Avenue, MS 14COMP.O. Box 341431Hartford, Connecticut 06134TEL (860) 418-6958

DELAWAREMs. Renata HenryDirectorDelaware Health and Social Services Division of Alcoholism, Drug Abuse, and Mental Health1901 North DuPont HighwayNew Castle, Delaware 19720TEL (302) 577-4461

FLORIDAKenneth A. DeCerchio, MSW, CAPAssistant SecretaryFlorida Department of Children and FamiliesSubstance Abuse Program Office1317 Winewood BoulevardBuilding 3, Room 101YTallahassee, Florida 32399-0700TEL (904) 487-2920FAX (904) 487-2239

GEORGIAElizabeth M. Howell, M.D.Substance Abuse Program ChiefDivision of Mental Health, Mental Retardation, and Substance AbuseGA Department of Human ResourcesTwo Peachtree Street, NW, Fourth FloorAtlanta, Georgia 30303-3171TEL (404) 657-6419FAX (404) 657-5681/6424

HAWAIIMs. Elaine WilsonChiefAlcohol and Drug Abuse DivisionHawaii Department of Health1270 Queen Emma Street, Suite 305Honolulu, Hawaii 96813TEL (808) 586-3962

IDAHOPatricia Getty, M.Ed.State DirectorBureau of Mental Health and Substance AbuseDivision of Family and Community ServicesIdaho Department of Health and Welfare450 West State StreetBoise, Idaho 83720

Mailing Address

PO Box 83720, Fifth FloorBoise, Idaho 83720-0036TEL (208) 334-5935FAX (208) 334-6699

ILLINOISMr. Nick GantesActing DirectorIllinois Department of Alcoholism and Substance AbuseJames R. Thompson Center100 West Randolph Street, Suite 5-600Chicago, Illinois 60601TEL (312) 814-2291/3840FAX (312) 814-2419

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INDIANAPatrick Sullivan, Ph.D.DirectorBureau of Addiction ServicesDivision of Mental HealthIndiana Family and Social Services Administration402 West Washington Street, Room W-353Indianapolis, Indiana 46204-2739TEL (317) 232-7816FAX (317) 232-3472

IOWAMs. Janet ZwickDirectorDivision of Substance Abuse and Health PromotionIowa Department of Public Health321 East 12th StreetLucas State Office Building, Third FloorDes Moines, Iowa 50319-0075TEL (515) 281-4417FAX (515) 281-4535

KANSASMr. Andrew O’DonovanCommissionerAlcohol and Drug Abuse ServicesDepartment of Social and Rehabilitation Services300 SW Oakley, Biddle Building, Second FloorTopeka, Kansas 66606-1861TEL (913) 296-3925FAX (913) 296-0494

KENTUCKYMr. Michael TownsendDirectorDivision of Substance AbuseKentucky Department of Mental Health and Mental Retardation Services275 East Main StreetFrankfort, Kentucky 40621TEL (502) 564-2880FAX (502) 564-3844

LOUISIANAMr. Alton HadleyAssistant SecretaryOffice of Alcohol and Drug AbuseLouisiana Department of Health and Hospitals1201 Capitol Access Road, Fourth Floor

Mailing Address

P.O. Box 2790, BIN #18Baton Rouge, Louisiana 70821-3868TEL (504) 342-6717FAX (504) 342-3931

MAINEMs. Lynn DubyDirectorMaine Office of Substance AbuseAugusta Mental Health ComplexMarquardt Building, Third Floor159 State House StationAugusta, Maine 04333-0159TEL (207) 287-2595/6330FAX (207) 287-4334

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MARYLANDMr. Thomas DavisDirectorAlcohol and Drug Abuse AdministrationMaryland Department of Health and Mental Hygiene201 West Preston Street, Fourth FloorBaltimore, Maryland 21201-2399TEL (410) 225-6925FAX (410) 333-7206

MASSACHUSETTSMs. Mayra Rodriquez-HowardDirectorBureau of Substance Abuse ServicesMassachusetts Department of Public Health250 Washington StreetBoston, Massachusetts 02108TEL (617) 624-5111FAX (617) 624-5185

MICHIGANMs. Karen SchrockChiefCenter for Substance Abuse ServicesMichigan Department of Community Health3423 N. Martin L. King, Jr. BoulevardP.O. Box 30195Lansing, Michigan 48909TEL (517) 335-8808FAX (517) 335-8837

MINNESOTACynthia Turnure, Ph.D.DirectorChemical Dependency Program DivisionMinnesota Department of Human Services444 Lafayette Road NorthSt. Paul, Minnesota 55155-3823TEL (612) 296-4610FAX (612) 296-6244/297-1862

MISSISSIPPIMr. Herbert LovingDirectorDivision of Alcohol and Drug AbuseMississippi Department of Mental Health1101 Robert E. Lee State Building239 North Lamar Street, Eleventh FloorJackson, Mississippi 39201TEL (601) 359-1288FAX (601) 359-6295

MISSOURIMr. Michael CoutyDirectorDivision of Alcohol and Drug AbuseMissouri Department of Mental Health1706 East Elm StreetP.O. Box 687Jefferson City, Missouri 65102-0687TEL (573) 751-4942FAX (573) 751-7814

MONTANAMr. Dan AndersonAdministratorAddictive and Mental Disorders Division1400 BroadwayRoom C-118Mailing AddressP.O. Box 202951Helena, Montana 59620-2951TEL (406) 444-2827FAX (406) 444-4920

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NEBRASKAMr. Malcolm HeardDirectorDivision of Alcoholism, Drug Abuse, and Addiction ServicesNebraska Department of Health and Human Services SystemsFolsom and Prospector Place

Mailing Address

P.O. Box 94728Lincoln, Nebraska 68509-4728TEL (402) 471-2851, ext. 5583FAX (402) 479-5162

NEVADAMs. Marilynn MorricalChiefBureau of Alcohol and Drug AbuseRehabilitation DivisionDepartment of Employment, Training, and Rehabilitation505 East King Street, Room 500Carson City, Nevada 89710TEL (702) 687-4790FAX (702) 687-6239

NEW HAMPSHIREMs. Denise DevlinDirectorOffice of Alcohol and Drug Abuse PreventionNew Hampshire Department of Health and Human ServicesState Office Park South105 Pleasant StreetConcord, New Hampshire 03301TEL (603) 271-6104FAX (603) 271-6116

NEW JERSEYMr. Terrence O’ConnorAssistant CommissionerDivision of Alcoholism, Drug Abuse, and Addiction ServicesNew Jersey Department of Health, CN 362Trenton, New Jersey 08625-0362TEL (609) 292-5760FAX (609) 292-3816

NEW MEXICOMs. Lynn BradyDirectorBehavioral Health Services DivisionNew Mexico Department of HealthHarold Runnels Building, Room 3200 North1190 St. Francis StreetSanta Fe, New Mexico 87501TEL (505) 827-2601FAX (505) 827-0097

NEW YORKMs. Jean Somers-MillerCommissionerNew York State Office of Alcoholism and Substance Abuse Services1450 Western AvenueAlbany, New York 12203-3526TEL (518) 457-2061FAX (518) 457-5474

NORTH CAROLINAJulian F. Keith, M.D.DirectorSubstance Abuse Services SectionDivision of Mental Health, Developmental Disabilities, and Substance Abuse ServicesNorth Carolina Department of Human Resources325 North Salisbury StreetRaleigh, North Carolina 27603TEL (919) 733-4670

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NORTH DAKOTAMr. Don WrightUnit ManagerSubstance Abuse ServicesDivision of Mental Health and Substance Abuse ServicesNorth Dakota Department of Human ServicesProfessional Building600 South Second Street, Suite #1EBismarck, North Dakota 58504-5729TEL (701) 328-8922/8920FAX (701) 328-8969

OHIOMs. Luceille FlemingDirectorOhio Department of Alcohol and Drug Addiction Services280 North High StreetTwo Nationwide Plaza, Fifteenth FloorColumbus, Ohio 43215-2537TEL (614) 466-3445FAX (614) 752-8645

OKLAHOMAMr. Dennis DoyleDeputy CommissionerSubstance Abuse ServicesOklahoma Department of Mental Health and Substance Abuse Services1200 NE Thirteenth StreetOklahoma City, OK 73117

Mailing Address

P.O. Box 53277, Capitol StationOklahoma City, Oklahoma 73152TEL (405) 522-3858FAX (405) 522-3650

OREGONMs. Barbara CimaglioDirectorOffice of Alcohol and Drug Abuse ProgramsOregon Department of Human ResourcesHuman Resources Building, Third Floor500 Summer Street, NESalem, Oregon 97310-1016TEL (503) 945-5763FAX (503) 378-8467

PENNSYLVANIAMr. Gene BoyleDirectorOffice of Drug and Alcohol ProgramsPennsylvania Department of Health

Mailing Address

P.O. Box 90, Room 933Seventh and Forester Streets, Room 933Harrisburg, Pennsylvania 17108TEL (717) 787-9857FAX (717) 772-6959

RHODE ISLANDSherry Knapp, Ph.D.,C.A.S., C.M.H.A.Associate Director of HealthDivision of Substance AbuseRhode Island Department of HealthCannon Building, Suite 105Three Capitol HillProvidence, Rhode Island 02908-5097TEL (401) 277-4680FAX (401) 277-4688

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SOUTH CAROLINABeverly G. Hamilton, M.Ed., M.H.A.DirectorSouth Carolina Department of Alcohol and Other Drug Abuse Services3700 Forest Drive, Suite 300Columbia, South Carolina 29204-4082TEL (803) 734-9520FAX (803) 734-9663

SOUTH DAKOTAMr. Gilbert SudbeckDirectorDivision of Alcohol and Drug AbuseSouth Dakota Department of Human ServicesHillsview Plaza, East Highway 34c/o 500 East CapitolPierre, South Dakota 57501-5070TEL (605) 773-3123/5990FAX (605) 773-5483

TENNESSEEStephanie W. Perry, M.D.Assistant CommissionerBureau of Alcohol and Drug Abuse ServicesTennessee Department of HealthCordell Hull Building, Third Floor426 Fifth Avenue, NorthNashville, Tennessee 37247-4401TEL (615) 741-1921FAX (615) 532-2419

TEXASMs. Terry Faye BlierExecutive DirectorTexas Commission on Alcohol and Drug Abuse9001 North IH 35Austin, Texas 78753-5233TEL (512) 349-6600FAX (512) 837-0998

UTAHMr. Leon PoVeyDirectorDivision of Substance AbuseUtah Department of Human Services120 North 200 West, Room 413Salt Lake City, Utah 84103TEL (801) 538-3939FAX (801) 538-4696

VERMONTMr. Tom PerrasDirectorOffice of Alcohol and Drug Abuse ProgramsVermont Agency of Human Services108 Cherry StreetBurlington, Vermont 05402TEL (802) 651-1550FAX (802) 651-1573

VIRGINIALouis Gallant, Ph.D.Acting Director Office of Substance AbuseServices Virginia Department of Mental Health, Mental Retardation, and Substance Abuse Services109 Governor Street

Mailing Address

P.O. Box 1797Richmond, Virginia 23214TEL (804) 786-3906FAX (804) 371-0091

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WASHINGTONMr. Kenneth D. StarkDirectorDivision of Alcohol and Substance AbuseWashington Department of Social and Health Services

FedEx ONLY

612 Woodland Square Loop, SE, Building CLacey, Washington 98503-5330

Mailing Address

P.O. Box 45330Olympia, WA 98504-5330TEL (360) 438-8200FAX (360) 438-8078

WEST VIRGINIAMr. Jack Clohan, Jr.DirectorDivision of Alcohol and Drug AbuseOffice of Behavioral Health ServicesWest Virginia Department of Health and Human ResourcesCapitol Complex1900 Kanawha BoulevardBuilding 6, Room 738Charleston, West Virginia 25305TEL (304) 558-2276FAX (304) 558-1008

WISCONSINMr. Philip S. McCulloughDirectorBureau of Substance Abuse ServicesDivision of Supportive LivingDepartment of Health and Family ServicesOne West Wilson Street

Mailing Address

P.O. Box 7851Madison, Wisconsin 53707-7851TEL (608) 266-3719

WYOMINGMarilyn Patton, MSWDeputy DirectorDivision of Behavioral HealthDepartment of Health447 Hathaway BuildingCheyenne, Wyoming 82002TEL (307) 777-6494FAX (307) 777-5580

DISTRICT OF COLUMBIAMr. Jasper OrmondAdministratorAddiction, Prevention, and Recovery Administration1300 First Street, NE, Suite 300Washington, DC 20002TEL (202) 727-9393FAX (202) 535-2028

TERRITORIES

PUERTO RICOMr. Jose Acevdo MartinezAdministratorPuerto Rico Mental Health and Anti-addiction Services AdministrationP.O. Box 21414San Juan, Puerto Rico 00928-1414TEL (787) 764-3795FAX (787) 765-5895

VIRGIN ISLANDSCarlos Ortiz, Ph.D.DirectorDivision of Mental Health, Alcoholism, and Drug Dependency ServicesU.S. Virgin Islands Department of HealthCharles Harwood Memorial HospitalChristiansted, St. Croix, Virgin Islands 00820TEL (809) 773-1311, ext 3013 or 773-1992FAX (809) 773-7900

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INDIAN NATION

RED LAKE BAND OF THECHIPPEWA INDIAN TRIBEMr. Bobby Whitefeather, Sr.ChairmanTribal CouncilRed Lake Band of the Chippewa Indian TribeP.O. Box 574Red Lake, Minnesota 56671TEL (218) 679-3341FAX (218) 679-3378

PACIFIC BASIN JURISDICTIONS

AMERICAN SAMOAMr. Faafetai I’aulualoChiefDivision of Social ServicesDepartment of Human ResourcesGovernment of American SamoaPago Pago, American Samoa 96799TEL (684) 633-2696FAX (684) 633-7449

GUAMMs. Elena I. Scragg, MS, MHR, IMFTDirectorDepartment of Mental Health and Substance AbuseGovernment of Guam790 Governor Carlos G. Camacho RoadTamuning, Guam 96911TEL (671) 647-5445FAX (671) 649-6948

COMMONWEALTH OF THENORTHERN MARIANA ISLANDSDr. Isamu AbrahamSecretary of HealthDepartment of Public Health ServicesCommonwealth of the Northern Mariana IslandsP.O. Box 409 CKSaipan, MP 96950TEL (670) 234-8950 ext 2001FAX (670) 234-8930

REPUBLIC OF PALAUThe Honorable Masao UedaMinister of HealthMinistry of Human ServicesPalau National HospitalRepublic of PalauP.O. Box 6027Koror, Republic of Palau 96940-0504TEL (680) 488-2813FAX (680) 488-1211

REPUBLIC OF THEMARSHALL ISLANDSMr. Donald CapelleSecretaryMinistry of Health ServicesP.O. Box 16Majuro, Marshall Islands 96960TEL (692) 625-3355/3399FAX (692) 625-3432

FEDERATED STATES OF MICRONESIAEliuel K. Pretrick, MO, MPHSecretaryDepartment of Health Services, FSMP.O. Box PS 70Palikir, Pohnpei FM 96941TEL (691) 320-2619FAX (691) 320-5263

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