Adult drug courts
Drug courts, also called treatment courts, are specialized courts that offer individuals charged with an offense who have substance use disorders an alternative to adjudication or incarceration. These courts intensively supervise those convicted of an offense, require drug testing and treatment1, and impose graduated sanctions for failed drug tests or program non-compliance2. Drug courts can specialize in subpopulations. Adult drug courts, also called adult treatment courts, offer treatment and rehabilitation for adults who are charged with one or more offenses and have substance use disorders. Eligible individuals may choose to enroll in adult drug court programs.
Other specialized drug courts include juvenile drug courts, impaired driving treatment courts (also called DUI/DWI courts), family treatment drug courts, mental health courts, veterans treatment courts, and Tribal Healing to Wellness Courts3.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Reduced recidivism
Reduced drug use
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
Reduced incarceration
What does the research say about effectiveness?
There is strong evidence that adult drug courts reduce general and drug-related recidivism among adult participants compared to traditional adjudication4, 5, 6, 7, 8, 9. Evidence is slightly stronger for general adult drug courts than for courts that specialize in drunk driving offenses4.
Adult drug court participation can reduce recidivism among those at high risk of reoffending more than probation10. Adult drug court program participants who complete their program are less likely to reoffend, especially for felony offenses, than participants who do not complete their program11; the impact on reduced recidivism lasts in the long term6, 7, 12. Female-specific drug courts may lower recidivism among women participants who complete drug court programs13. Generally, those convicted of an offense who graduate from adult drug courts face little incarceration, while those who do not graduate face longer sentences than their counterparts in traditional courts14.
Adult drug courts that can dismiss or expunge charges upon graduation appear more effective than those that cannot4. Adult drug courts may not impact participants’ mortality in the long term15. In Massachusetts, probationers in drug courts show a similar likelihood of substance use relapse and recidivism compared to those in traditional courts16. Research suggests that a number of other program characteristics are associated with better outcomes, such as: limiting participation to those convicted of a nonviolent offense, having longer treatment periods, conducting weekly staff meetings, or requiring restitution but not fines, community service, Alcoholics Anonymous/Narcotics Anonymous attendance, and employing a therapeutic model5, 8. Evidence suggests that participants who have felony-level charges, fewer prior charges, longer employment and are older are more likely to complete adult drug court programs than their peers who have misdemeanor-level charges, more prior charges, shorter employment, and are younger17, 18, 19, 20.
Effects of juvenile drug courts on recidivism and drug use are unclear21. Juvenile drug courts appear to benefit program graduates the most; youth who graduate from juvenile drug courts are substantially less likely to re-offend than youth who participate, but do not complete drug court programs22. Juvenile drug courts have potential to reduce recidivism, cannabis use, and mental health problems among participants, especially for those at high risk of recidivism and substance disorders23. Participants with a greater number of offenses and antisocial attitudes are more likely to re-offend than participants with fewer offenses24. Minorities, boys, and adolescents with histories of delinquency, emotional and behavioral problems22, or caregivers who use drugs appear least likely to graduate from juvenile drug court25. Overall, juvenile drug courts that admit participants promptly and courts that build academic or job skills appear to have higher graduation rates than courts that do not22. Researchers recommend consistent implementation guidelines for juvenile drug courts23; more studies with stronger designs are also needed to confirm effects on participating youth compared to youth in traditional juvenile courts4, 21, 26, 27.
Inadequate communication and low confidence in program providers are barriers to effective collaboration between drug courts and community-based agencies that provide substance use treatment programs28. Experts suggest implementation should address low access to treatment for individuals with opioid use disorder among drug court participants29. Wraparound services, community partnership, family-centered case management, and peer support are recommended to improve participants’ program engagement and behavioral outcomes30, 31, 32.
A Washington-based analysis estimates that drug courts cost about $3,226 per participant in 2016, with a benefit to cost ratio of $1.5333. A Virginia-based study indicates that adult drug courts can save an average of $20,000 per participant8.
How could this strategy advance health equity? This strategy is rated inconclusive impact on disparities.
It is unclear what impact adult drug courts have on disparities in recidivism and substance use among participants by race and ethnicity, age, gender, urbanicity, and socio-economic status. Available evidence shows that drug court programs may be effective in both urban and rural areas38. Female-specific drug court programs may reduce recidivism among female participants13.
Studies indicate disparities in drug court program participation and graduation rates across populations. White individuals appear more likely to participate in drug court programs than Black individuals7, 39: this may be due to screening criteria (e.g., having any prior criminal history) that exclude non-white eligible individuals from drug courts7. Participants who are Black, female, younger, have less employment experience, fewer years of education, and more prior charges appear to be less likely to complete drug court programs18, 19, 20, 40. A study suggests drug court implementation appears to increase drug arrests of Black residents41.
What is the relevant historical background?
American policing, behavior criminalization, and justifying incarceration have stemmed from racist practices since the 1700s42. In 1965, Congress’s Law Enforcement Assistance Act marked the beginning of federal government involvement in criminal justice and law enforcement and the Johnson Administration declared a “war on crime” a year later, with increasingly harsh and punitive sentencing laws alongside aggressive policing43. The U.S. justice system was designed to deter crime through aversive control and social isolation, not to support socially significant behavior change and reinforce prosocial behavior42. Additionally, as it relates to drug use, the U.S. policing and justice system have worked disproportionately against people of color: Black people are more likely to be arrested for drug law violations than white people, although their rates of illicit drug use are similar44. Significant disparities in enforcement of marijuana laws have imposed arrests, prosecutions, and convictions on individuals and communities, separated families, and deprived individuals of child custody, immigration status, voting rights, eligibility for public housing, financial aid for education, and access to employment45, 46.
As a result of zero-tolerance drug policies in the 1980s, state courts experienced the burden of increased drug-related caseloads and financial strain. In attempts to curb the increasing number of drug offenses, the first drug court was created in Miami-Dade County, Florida in 198912. The Bureau of Justice Assistance supported the expansion of drug courts through grants and spotlighting effective drug courts in the nation47. In 2020, the National Center for State Courts (NCSC) developed the Equity and Inclusion Assessment Tool (EIAT) to assess equivalent access, retention, treatment, sanctions, and dispositions in drug court programs in response to elevated concerns about unfair implementation in the drug court processes toward individuals from racial and ethnic minorities48. Researchers recommend additional research on strategies to enhance racial and ethnic equity in behavioral health interventions and drug court graduation49.
Equity Considerations
- Who is participating in adult drug courts in your community? What barriers exist to participating?
- How can adult drug court service providers engage participants of color more and help them complete the drug court program?
- Is there trauma-informed training available for service providers and staff in your community? Does the training help recognize stereotypes and biases?
Implementation Examples
As of December 2023, over 4,200 drug courts were operating throughout the United States. More than half of these target adults charged with offense; the rest target individuals convicted of driving under the influence (DUI), juveniles charged with offense, families in the child welfare system, and other special populations such as tribal communities34, 35. The National Treatment Court Resources Center offers best practice resources and evaluation tools for different types of drug courts36. The Tribal Law and Policy Institute provides resources and practice models for Tribal Healing to Wellness Courts (THWCs)37.
Implementation Resources
‡ Resources with a focus on equity.
TCI - All Rise. Treatment Court Institute (TCI).
NCSC-EIAT‡ - National Center for State Courts & National Drug Court Institute. (2020, July). User guide | Equity and inclusion assessment tool (EIAT). Retrieved April 23, 2025.
NTCRC - National Treatment Court Resource Center. (n.d.). Retrieved April 23, 2025.
All Rise-Guidelines - All Rise. (n.d.). Adult treatment court best practice standards. All Rise. Retrieved April 23, 2025.
US NIJ-Drug courts - U.S. National Institute of Justice (NIJ). Drug courts.
OJP-Treatment courts - U.S. Department of Justice. (2024, April 11). Treatment Courts | Overview. Office of Justice Programs. Retrieved April 22, 2025.
THWC-Resources‡ - The Tribal Law and Policy Institute. (n.d.). Tribal healing to wellness court publication series. Tribal Healing to Wellness Courts. Retrieved April 23, 2025.
RHIhub-Rural drug courts - Rural Health Information Hub (RHIhub). Rural prevention and treatment of substance use disorders toolkit: Drug courts.
Footnotes
* Journal subscription may be required for access.
1 US GAO-Maurer 2011 - Maurer DC. Studies show courts reduce recidivism, but DOJ could enhance future performance measure revision efforts. Washington, D.C.: U.S. Government Accountability Office (U.S. GAO); 2011: GAO-12-53
2 Messina 2012 - Messina N, Calhoun S, Warda U. Gender-responsive drug court treatment: A randomized controlled trial. Criminal Justice and Behavior. 2012;39(12):1539-58.
3 OJP-Treatment courts - U.S. Department of Justice. (2024, April 11). Treatment Courts | Overview. Office of Justice Programs. Retrieved April 22, 2025.
4 Campbell-Mitchell 2012 - Mitchell O, Wilson D, Eggers A, MacKenzie DL. Drug courts' effects on criminal offending for juveniles and adults. Campbell Systematic Reviews. 2012:4.
5 Shaffer 2011 - Shaffer DK. Looking inside the black box of drug courts: A meta-analytic review. Justice Quarterly. 2011;28(3):493-521.
6 Kearley 2020 - Kearley, B., & Gottfredson, D. (2020). Long term effects of drug court participation: Evidence from a 15-year follow-up of a randomized controlled trial. Journal of Experimental Criminology, 16(1), 27–47.
7 Gallagher 2020 - Gallagher, J. R., Wahler, E. A., & Lefebvre, E. (2020). Further evidence of racial disparities in drug court outcomes: Enhancing service-delivery to reduce criminal recidivism rates for non-white participants. Journal of Social Service Research, 46(3), 406–415.
8 Cheesman 2016 - Cheesman II, F. L., Graves, S. E., Holt, K., Kunkel, T. L., Lee, C. G., & White, M. T. (2016). Drug court effectiveness and efficiency: Findings for Virginia. Alcoholism Treatment Quarterly, 34(2), 143–169.
9 Bruns 2012 - Bruns, E. J., Pullman, M. D., Weathers, E. S., Wirschem, M. L., & Murphy, J. K. (2012). Effects of a multidisciplinary family treatment drug court on child and family outcomes: Results of a quasi-experimental study. Child Maltreatment, 17(3), 218-30.
10 Koetzle 2015 - Koetzle, D., Listwan, S. J., Guastaferro, W. P., & Kobus, K. (2015). Treating high-risk offenders in the community: The potential of drug courts. International Journal of Offender Therapy and Comparative Criminology, 59(5), 449-465.
11 Gibbs 2020 - Gibbs, B. R., & Lytle, R. (2020). Drug court participation and time to failure: An examination of recidivism across program outcome. American Journal of Criminal Justice, 45(2), 215–235.
12 Jewell 2017 - Jewell, J. D., Rose, P., Bush, R., & Bartz, K. (2017). The long term effectiveness of drug treatment court on reducing recidivism and predictors of voluntary withdrawal. International Journal of Mental Health and Addiction, 15(1), 28–39.
13 Myer 2018 - Myer, A. J., & Buchholz, M. M. (2018). Examining the impact of a gender-specific drug court on recidivism. Journal of Crime and Justice, 41(2), 206–221.
14 Rempel 2012 - Rempel M, Green M, Kralstein D. The impact of adult drug courts on crime and incarceration: Findings from a multi-site quasi-experimental design. Journal of Experimental Criminology. 2012;8(2):165-92.
15 Kearley 2019 - Kearley, B. W., Cosgrove, J. A., Wimberly, A. S., & Gottfredson, D. C. (2019). The impact of drug court participation on mortality: 15-year outcomes from a randomized controlled trial. Journal of Substance Abuse Treatment, 105, 12–18.
16 Rodriguez-Monguio 2021 - Rodriguez-Monguio, R., Montgomery, B., Drawbridge, D., Packer, I., & Vincent, G. M. (2021). Substance use treatment services utilization and outcomes among probationers in drug courts compared to a matched cohort of probationers in traditional courts. The American Journal on Addictions, 30(5), 505–513.
17 Ruiz 2019 - Ruiz, B., Ulibarrí, B. J., Lomelí, A. S., Guerra, R. S., & Longoria, R. R. (2019). The relative influence of legal pressure on outcomes in a rehabilitation aftercare drug court. American Journal of Criminal Justice, 44(5), 727–745.
18 Sheeran 2022 - Sheeran, A., Knoche, V. A., & Freiburger, T. L. (2022). Identifying predictors of drug court graduation: Findings from an evaluation of the Milwaukee County adult drug treatment court. Criminal Justice Studies, 35(1), 57–73.
19 Dannerbeck 2021 - Dannerbeck, A., & Yu, M. (2021). An exploratory study examining differences in drug court graduation rates for Black and White women. Criminal Justice and Behavior, 48(12), 1827–1841.
20 Shannon 2016 - Shannon, L. M., Jackson Jones, A., Perkins, E., Newell, J., & Neal, C. (2016). Examining individual factors and during-program performance to understand drug court completion. Journal of Offender Rehabilitation, 55(5), 271–292.
21 Tanner-Smith 2016a - Tanner-Smith, E. E., Lipsey, M. W., & Wilson, D. B. (2016). Juvenile drug court effects on recidivism and drug use: A systematic review and meta-analysis. Journal of Experimental Criminology, 12(4), 477–513.
22 Stein 2013 - Stein DM, Deberard S, Homan K. Predicting success and failure in juvenile drug treatment court: A meta-analytic review. Journal of Substance Abuse Treatment. 2013;44(2):159-68.
23 Belenko 2022 - Belenko, S., Dennis, M., Hiller, M., Mackin, J., Cain, C., Weiland, D., Estrada, B., & Kagan, R. (2022). The impact of juvenile drug treatment courts on substance use, mental health, and recidivism: Results from a multisite experimental evaluation. The Journal of Behavioral Health Services & Research, 49(4), 436–455.
24 Konecky 2016 - Konecky, B., Cellucci, T., & Mochrie, K. (2016). Predictors of program failure in a juvenile drug court program. Addictive Behaviors, 59, 80-83.
25 Halliday-Boykins 2010 - Halliday-Boykins CA, Schaeffer CM, Henggeler SW, et al. Predicting non-response to juvenile drug court interventions. Journal of Substance Abuse Treatment. 2010;39(4):318-28.
26 Stein 2015 - Stein DM, Homan KJ, DeBerard S. The effectiveness of juvenile treatment drug courts: A meta-analytic review of literature. Journal of Child & Adolescent Substance Abuse. 2015;24(2):80-93.
27 Sullivan 2016 - Sullivan CJ, Blair L, Latessa EJ, Sullivan CC. Juvenile drug courts and recidivism: Results from a multisite outcome study. Justice Quarterly. 2016;33(2):291-318.
28 Pivovarova 2023 - Pivovarova, E., Taxman, F. S., Boland, A. K., Smelson, D. A., Lemon, S. C., & Friedmann, P. D. (2023). Facilitators and barriers to collaboration between drug courts and community-based medication for opioid use disorder providers. Journal of Substance Use and Addiction Treatment, 147, 208950.
29 Csete 2020 - Csete, J. (2020). United States drug courts and opioid agonist therapy: Missing the target of overdose reduction. Forensic Science International: Mind and Law, 1, 100024.
30 Shaffer 2021 - Shaffer, P. M., Rodriguez, C. P., Gaba, A., Byrne, T., Casey, S. C., Harter, J., & Smelson, D. (2021). Engaging vulnerable populations in drug treatment court: Six month outcomes from a co-occurring disorder wraparound intervention. International Journal of Law and Psychiatry, 76, 101700.
31 Lloyd Sieger 2021 - Lloyd Sieger, M. H., Cohen, J. B., & Nano, X. (2021). Family-centered practice in adult treatment courts: What can we learn from the family treatment court best practice standards? Juvenile and Family Court Journal, 72(1), 95–118.
32 Belenko 2021 - Belenko, S., LaPollo, A. B., Gesser, N., Weiland, D., Perron, L., & Johnson, I. D. (2021). Augmenting substance use treatment in the drug court: A pilot randomized trial of peer recovery support. Journal of Substance Abuse Treatment, 131, 108581.
33 WSIPP-Benefit cost - Washington State Institute for Public Policy (WSIPP). Benefit-cost results.
34 NTCRC-TC 2023 - National Treatment Court Resource Center. (n.d.). Treatment courts across U.S. States/Territories (2023). Retrieved April 23, 2025.
35 US NIJ-Drug courts - U.S. National Institute of Justice (NIJ). Drug courts.
36 NTCRC - National Treatment Court Resource Center. (n.d.). Retrieved April 23, 2025.
37 THWC-Resources - The Tribal Law and Policy Institute. (n.d.). Tribal healing to wellness court publication series. Tribal Healing to Wellness Courts. Retrieved April 23, 2025.
38 Wadkins 2021 - Wadkins, T., & Campbell, J. (2021). Drug court recidivism in the rural midwest: A 3-year post-separation analysis. Journal of Drug Issues, 51(3), 407–419.
39 Sheeran 2021 - Sheeran, A. M., & Heideman, A. J. (2021). The effects of race and ethnicity on admission, graduation, and recidivism in the Milwaukee County adult drug treatment court. Social Sciences, 10(7), Article 7.
40 Shannon 2020 - Shannon, L. M., Jones, A. J., Newell, J., Nash, S., & Nichols, E. (2020). Examining contextual differences in participant characteristics and during-program occurrences with drug court program completion. Journal of Drug Issues, 50(2), 191–208.
41 Lilley 2019 - Lilley, D. R., DeVall, K., & Tucker-Gail, K. (2019). Drug courts and arrest for substance possession: Was the African American community differentially impacted? Crime & Delinquency, 65(3), 352-374.
42 Leland 2022 - Leland, W., & Stockwell, A. (2022). Anti-oppressive restorative justice: Behavior analysis in alternatives to policing. Behavior Analysis in Practice, 15(4), 1232–1236.
43 NASEM 2014 - National Academies of Sciences, Engineering, and Medicine (NASEM), National Research Council. (2014). The growth of incarceration in the United States: Exploring causes and consequences. The National Academies Press.
44 SP-Ghandmoosh 2023 - Ghandmoosh, N. & Barry, C. (2023, November 2). One in five: Disparities in crime and policing. The Sentencing Project (SP).
45 Crawford 2021 - Crawford NN. We’d go well together: A critical race analysis of marijuana legalization and expungement in the United States. Public Integrity. 2021;23(5):459-483.
46 Schlussel 2017 - Schlussel D. The mellow pot-smoker: White individualism in marijuana legalization campaigns. California Law Review. 2017;105(3):885-928.
47 BJA-DC - Bureau of Justice Assistance (BJA). (2022, May 3). 30 years of drug courts: Justice reform that works. Retrieved April 23, 2025.
48 NCSC-EIAT - National Center for State Courts & National Drug Court Institute. (2020, July). User guide | Equity and inclusion assessment tool (EIAT). Retrieved April 23, 2025.
49 Gaba 2023 - Gaba, A., LoVette, A., Pridgen, B., Taylor, M., Woodward, E., Rosal, M. C., Anderson, M., & Smelson, D. (2023). Identifying strategies to advance equitable implementation of co-occurring mental health and substance use disorder treatment in drug treatment courts: A study protocol. Journal of clinical and translational science, 7(1), e80.
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