September 23, 2025 • 21 mins
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Health Affairs' Rob Lott interviews Elizabeth Van Nostrand of Temple University about her recent paper exploring how Indiana adults participating in treatment court program tended to have better health outcomes than individuals who applied and were accepted but chose not to participate.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Rob Lott (00:00):
Hello, and welcome to a health podocy. I'm your host,
(00:04):
Rob Lott. A few years ago,health affairs had some tote
bags made to give away pledgedrive style to various
subscribers and contributors.Our logo, was imprinted on these
(00:24):
bags, and so are these words inbig red letters. All policy is
health policy.
Another common version of thisrefrain is, quote, health in all
policies, and it's a prettyintuitive concept. It's the idea
that even if we're not talkingabout typical topics in health
(00:46):
services research and publichealth policy like insurance or
drug prices, even if we lookfurther afield, there's always,
always a health angle. And ourcriminal justice system is a
great example of this, I think.For years, we've studied these
systems in terms of the law andenforcement and their effects on
(01:09):
things like crime rates andpublic safety. And while we know
those factors are, of course,shaped by policy choices, it's
just as clear that those verysame choices inevitably affect
people's health in fundamentalways.
Fortunately, we have researcherslooking at that intersection in
(01:31):
thoughtful ways and asking ifit's possible to craft a
criminal justice policy thatalso prevents harm and maybe
even drives positive healthoutcomes? That's the subject of
today's health policy. I'm herewith Elizabeth von Nostrandt, an
associate professor in theDepartment of Health Services
(01:52):
Administration and Policy atTemple University. Together with
co authors, she has a new studyin the pages of Health Affairs
September issue, a theme issuededicated entirely to the opioid
crisis. The article's title isalso one of its main findings.
Quote, Indiana adults whoparticipated in treatment court
(02:15):
programs had better healthoutcomes than those who did not.
I cannot wait to hear all abouttheir findings from Indiana and
the implications for statesacross the nation. Elizabeth von
Nonstrand, welcome to A HealthOdyssey.
Elizabeth Van Nostrand (02:31):
Thank you so much for having me.
Rob Lott (02:34):
Well, let's start with some background. Maybe you can
tell us a little bit about thetypical relationship between,
substance use and criminaljustice. What are the proportion
of arrests, for example, thatare connected to substance
related crimes? And what do weknow about the typical
(02:54):
experience of those individuals?
Elizabeth Van Nostrand (02:57):
So I was very surprised when I started
doing research for my article tofind that in The United States,
there are more people arrestedfor substance use or substance
related crimes such as, like,selling drugs or committing
crimes to get money to buy drugsthan any other offense. It's in
fact, it's about four in tenpeople in federal
(03:20):
penitentiaries, and about one inten people in state prisons fit
into this category of offenses.Although the goals for
incarcerated people includerehabilitation and deterrence of
criminal behavior, researchshows that incarcerating these
people does not achieve thesegoals. On the contrary,
(03:42):
incarcerating people forsubstance use and substance
related crimes does not improvestate crime statistics, nor does
it reduce substance use.
Rob Lott (03:53):
So the disconnect there between sort of the
intention and whether or notwe're achieving that goal of
rehabilitation, how did thatcome about? Was it just simply
that substance use was not asbig of an issue when we were
creating these policies or itwasn't a priority? What's
changed there?
Elizabeth Van Nostrand (04:12):
Well, I think you have to look
historically back to the Reaganadministration, actually, and
the war on drugs. For a longtime, our society did not look
at substance use as a disease.It viewed substance use as a
crime. And so, what do we do topeople who commit crimes? We
(04:34):
punish them, either to imposesanctions on them themselves or
to protect society in some way.
Rob Lott (04:41):
Okay. So after all that, here we are today. What is
the sort of typical experienceof someone with a substance use
disorder who is incarcerated?
Elizabeth Van Nostrand: Incarceration is especially (04:52):
undefined
detrimental for individuals witha substance use disorder. And
people who are incarcerated arealmost four times more likely to
have a substance use disorderdiagnosis than people who are
Overdose is the third leadingcause of death for people who
(05:13):
are incarcerated, and it is theleading cause of death after
they're released from prison,especially if they didn't
receive adequate treatment likemedication for substance use
disorder, while they wereincarcerated. And the two week
period post release after theyget out of the criminal justice
(05:33):
system is especially a dangeroustime frame for these folks.
Rob Lott (05:37):
Okay. So it's against this backdrop that we have an
intervention known as treatmentcourts or treatment court
programs that have emerged as analternative. And I'd love it if
you could say a little bit abouthow the programs work. And I
assume not all treatment courtsare created equal. So what do we
know about the variation fromintervention to intervention or
(06:00):
program to program?
Elizabeth Van Nostrand (06:01):
So I'm a former litigator. So I can tell
you from personal experiencethat courts can be very
adversarial. You have youropponent coming after you.
Sometimes you have the judgecoming after you. You can even
have your client coming afteryou.
But treatment court isdifferent. I had the opportunity
to observe four different courtsin Indiana during the course of
(06:25):
our study. And to be honest, Iwas really moved by what I saw.
Treatment courts, as opposed tothe traditional judicial system,
adopt a team approach. They haveteams composed of judges and
prosecuting attorney, thedefense attorney, behavioral
health folks, mental healthprofessionals, all pulling for
(06:46):
the treatment court participantto succeed.
Currently, are about 4,200treatment courts across The
United States. And that is anumbrella term that includes
courts such as veteran treatmentcourts and mental health courts,
adult drug courts, juvenile drugcourts, tribal healing to
wellness courts. Each year about150,000 people participate in
(07:09):
one of those types of treatmentcourt programs. Typically,
treatment court programs adopt apublic perspective
Rob Lott (07:18):
and recognize that substance use is a disease, and
they attempt to address theunderlying causes or issues
associated
Elizabeth Van Nostrand (07:26):
with Treatment substance use. There
are best practices that areestablished for treatment
courts. There's a group inAlexandria called All Rise,
Alexandria, Virginia called AllRise, which put together these
best practices. But in reality,treatment courts have a lot of
autonomy, they have a lot ofleeway in what they can do in
(07:49):
terms of deciding who's eligibleto participate, and what
services are offered, what sortsof sanctions they want to impose
for noncompliance, andincentives for completing
different phases of thetreatment court program.
Typically, treatment courts usea phased approach, where
(08:09):
participants come to court everyweek or every other week or some
sort of timeframe where theypresent what's going on in their
lives, where they are in theirsubstance recovery to the court.
When people apply to treatmentcourt, they plead guilty. They
plead guilty, but the courtshold that plea in abeyance. They
(08:32):
don't move forward with thatplea unless the person fails in
their participation of thetreatment court program. If they
do, they go back to thetraditional judicial system, and
they can ultimately beincarcerated.
Rob Lott (08:47):
Got it. Okay. So very helpful context about treatment
courts. Now, tell us a littlebit about your study in that
context.
Elizabeth Van Nostrand (08:55):
So what we wanted to find out was
whether treatment courtparticipation was associated
with health outcomes. So ourstudy took place in the state of
Indiana. We selected Indianaeven though we're researchers
from Pennsylvania, becausenumber one, it has a history of
(09:16):
high rates of overdosefatalities. In 2022, Indiana had
the fourteenth worst overdosedeath rate in the country.
Second, we picked Indianabecause it has a wide variety of
treatment courts.
In 2018, it had eight differenttypes of treatment courts in 52
(09:37):
of its 92 counties. And third ofall, we selected Indiana because
it has a governmentally run datawarehouse called the management
performance hub. The managementperformance hub has data sets
from a variety of Indianaagencies all in one place. Data
acquisition is a real issue, anegative issue in The United
(10:00):
States. And having all the datasets that we were interested in
being housed in one centralrepository was really critical
for our study.
Under Indiana law, though,unlike typical criminal records,
treatment court records areconsidered to be privileged,
kind of like medical records. Sobefore we started our study, we
(10:22):
had to get the permission of theIndiana Supreme Court to have
treatment court records releasedto the management performance
hub. It was the first time thatthey received such a request. We
also had to get permission fromindividual treatment courts to
allow their participant recordsto be released to the management
(10:43):
performance hub. We approached77 of them in Indiana.
And, after two informationalwebinars that that we hosted, we
were delighted that 30 of theeligible Indiana treatment
courts or about 39% agreed toparticipate in our project. So
(11:03):
from those courts, theManagement Performance Hub
received treatment court recordsof five thirty people who
applied to treatment court andwere accepted. Of those five
thirty people, three fiftyactually participated and
completed programs, and 180 wereaccepted, but for some reason
(11:27):
decided not to go. So those wereour two comparison groups,
people who were eligible toparticipate in treatment court
programs who went through theprograms, versus people who are
eligible for the programs butdid not go through the programs.
So the first thing we did was weinterviewed judges to see what
sorts of therapies and programsthey provided to their treatment
(11:51):
court participants.
We also got information from theprescription drug monitoring
program, which is a centralrepository of prescriptions for
controlled substances such asthose that are used to treat
substance use disorder. So wewere able to create individual
profiles of these five thirtypeople, we knew for person
(12:14):
number one, which treatmentcourt program they applied to,
whether they were accepted andcompleted their program or were
accepted and decided not to go,what sorts of interventions the
courts offered, what kinds ofprescriptions they were provided
to treat their substance usedisorder. And, we followed them
(12:36):
for a year, and we looked atwhether they had EMS calls,
whether they presented in anemergency department, whether
they were alive, and whetherthey were rearrested.
Rob Lott (12:48):
Well, in just a minute, I wanna ask you about
your findings. But first, let'stake a quick break. And we're
(13:49):
back. I'm here talking withElizabeth Van Nostrand about,
the research of her and hercolleagues published in the
September issue of HealthAffairs all about treatment
court programs in Indiana.Alright.
Well, you just described thecomplex but relatively precise
(14:09):
and targeted approach to yourstudy. What did you find?
Elizabeth Van Nostrand (14:15):
We were very surprised, to be honest,
with what we found. Because whenyou looked at the socio
demographic characteristics, or,the profiles of the two groups,
people who participated intreatment court program versus
those who did not, the peoplewho participated in the programs
(14:36):
had many more characteristicspointing to poor health outcomes
than the non participants. Forexample, they were more than
twice as likely to beunemployed, they were more than
twice as likely to be disabled,they were more than twice as
likely to have a substance usedisorder diagnosis than the non
participants. And each of thosecharacteristics is associated
(14:59):
with a higher likelihood of poorhealth outcomes and overdose.
So, we expected them to havepoor health outcomes.
But the reverse was true.Compared to the nonparticipants,
the participant group with ahigher risk profile were thirty
(15:20):
four percent less likely topresent at an emergency
department, seventy four percentless likely to use EMS for a
substance related issue, andeighty three percent less likely
to die than the non participantgroups. And we followed these
two groups for a year after theyeither completed their treatment
(15:41):
court programs, or they decidednot to participate in treatment
court. And those results werepretty much the same across
races and ethnicities as well asgenders.
Rob Lott (15:52):
What do we know about the crime related outcomes of
programs like these, outcomeslike recidivism and the like?
Elizabeth Van Nostrand (16:01):
So we actually did study rearrest in
in our in our in our study. Wedid not include those results in
the paper for a couple ofreasons. Number one, we had word
constraints. We didn't we had acertain amount of or a certain
number of words that we wereallowed to use.
Rob Lott (16:20):
Alright. Note to the health affairs editors there.
Elizabeth Van Nostrand (16:23):
We also didn't include it. We also
didn't include it because it'sbeen pretty well studied. There
have been plenty of otherstudies that support the notion
that treatment courtparticipation lessens the
chances of being rearrested. Andin our study, we found that,
(16:45):
people who were involved in theprograms were about ninety three
percent less likely to berearrested.
Rob Lott (16:53):
Oh, wow. And, so these findings are pretty compelling.
And in your discussion, you saythat they can they quote, can be
used to expand the number oftreatment courts in underserved
areas. What are some of theobstacles, to expansion, and
(17:14):
what should policymakers bedoing to overcome them?
Elizabeth Van Nostrand (17:17):
Well, let me say at the outset, that
the act of arrest in and ofitself can be a very
traumatizing experience. And Ido not suggest that arresting
people for substance usedisorder is the way to go. But
we as a society continue toarrest people for substance use
and substance use related,offenses. So treatment courts
(17:41):
offer services that might nototherwise be made available to
these folks who use substances.And I think that there are some
barriers currently with respectto expanding treatment court
programs.
Number one, ours is one of thefirst studies to show the
(18:01):
results of treatment or anassociation between treatment
court participation and healthoutcomes. So, more research
needs to be done in that area.Also, the courts vary
tremendously with respect toeligibility requirements, like a
lot of courts will not acceptyou into their treatment court,
if you have a history ofviolence, or if you have serious
(18:26):
mental or physical healthissues. So that's one barrier.
And one way to work around thatis to beef up treatment court
teams to allow them to acceptmore individuals into their
programs.
Another common barrier forparticipants is not having
housing or transportationbecause they have to come and go
(18:52):
to these programs. And if theycan't get there, they can't
participate. Not everyone knowswhat a treatment court is or
what a treatment court does. Andas I said, except for rearrest,
few research studies have shownthe benefits that treatment
courts do provide. Not everybodyembraces the notion that
(19:13):
substance use is a disease.
So, they subscribe to the ideathat people who use substances
need to be punished. It alsocosts money to set up a
treatment court and to run atreatment court. But if you look
at it, in the long term, or overthe long term, it's economically
beneficial. Treatment Courtparticipation costs per
(19:37):
participant somewhere between$2,504,000 per participant,
whereas to incarcerate anindividual costs upwards of
$43,000 So it actually is a costeffective way to treat people
with a substance use disorder.You know, we need to as a
(20:02):
society accept the fact thatsubstance use impacts much more
than just an individual, itreally impacts entire families,
entire communities.
There's a lot of stigma stillassociated with substance use,
which needs to be mitigated byproviding people with treatment
so they can return to beproductive, healthy, members of
(20:25):
society.
Rob Lott (20:26):
Wow. Well, a great roadmap for future potential
efforts. You said a moment agothat not everyone knows what
treatment courts are. Andhopefully, with your research,
our conversation here todayeven, we might be able, to help
expand people's understandingand and appreciation of those
(20:49):
programs and their impact. SoElizabeth von Nastran, thank you
so much for taking the time totalk with us today.
It was a lot of fun.
Elizabeth Van Nostrand (20:57):
Thank you for having me.
Rob Lott (20:59):
And to our listeners, thanks for tuning in. If you
enjoyed this episode, pleaserecommend it to a friend. Leave
a review, and, of course, signin next week. Thanks, everyone.
Thanks for listening.
If you enjoyed today's episode,I hope you'll tell a friend
about a health policy.
Hello, and welcome to a health podocy. I'm your host,
(00:04):
Rob Lott. A few years ago,health affairs had some tote
bags made to give away pledgedrive style to various
subscribers and contributors.Our logo, was imprinted on these
(00:24):
bags, and so are these words inbig red letters. All policy is
health policy.
Another common version of thisrefrain is, quote, health in all
policies, and it's a prettyintuitive concept. It's the idea
that even if we're not talkingabout typical topics in health
(00:46):
services research and publichealth policy like insurance or
drug prices, even if we lookfurther afield, there's always,
always a health angle. And ourcriminal justice system is a
great example of this, I think.For years, we've studied these
systems in terms of the law andenforcement and their effects on
(01:09):
things like crime rates andpublic safety. And while we know
those factors are, of course,shaped by policy choices, it's
just as clear that those verysame choices inevitably affect
people's health in fundamentalways.
Fortunately, we have researcherslooking at that intersection in
(01:31):
thoughtful ways and asking ifit's possible to craft a
criminal justice policy thatalso prevents harm and maybe
even drives positive healthoutcomes? That's the subject of
today's health policy. I'm herewith Elizabeth von Nostrandt, an
associate professor in theDepartment of Health Services
(01:52):
Administration and Policy atTemple University. Together with
co authors, she has a new studyin the pages of Health Affairs
September issue, a theme issuededicated entirely to the opioid
crisis. The article's title isalso one of its main findings.
Quote, Indiana adults whoparticipated in treatment court
(02:15):
programs had better healthoutcomes than those who did not.
I cannot wait to hear all abouttheir findings from Indiana and
the implications for statesacross the nation. Elizabeth von
Nonstrand, welcome to A HealthOdyssey.
Elizabeth Van Nostrand (02:31):
Thank you so much for having me.
Rob Lott (02:34):
Well, let's start with some background. Maybe you can
tell us a little bit about thetypical relationship between,
substance use and criminaljustice. What are the proportion
of arrests, for example, thatare connected to substance
related crimes? And what do weknow about the typical
(02:54):
experience of those individuals?
Elizabeth Van Nostrand (02:57):
So I was very surprised when I started
doing research for my article tofind that in The United States,
there are more people arrestedfor substance use or substance
related crimes such as, like,selling drugs or committing
crimes to get money to buy drugsthan any other offense. It's in
fact, it's about four in tenpeople in federal
(03:20):
penitentiaries, and about one inten people in state prisons fit
into this category of offenses.Although the goals for
incarcerated people includerehabilitation and deterrence of
criminal behavior, researchshows that incarcerating these
people does not achieve thesegoals. On the contrary,
(03:42):
incarcerating people forsubstance use and substance
related crimes does not improvestate crime statistics, nor does
it reduce substance use.
Rob Lott (03:53):
So the disconnect there between sort of the
intention and whether or notwe're achieving that goal of
rehabilitation, how did thatcome about? Was it just simply
that substance use was not asbig of an issue when we were
creating these policies or itwasn't a priority? What's
changed there?
Elizabeth Van Nostrand (04:12):
Well, I think you have to look
historically back to the Reaganadministration, actually, and
the war on drugs. For a longtime, our society did not look
at substance use as a disease.It viewed substance use as a
crime. And so, what do we do topeople who commit crimes? We
(04:34):
punish them, either to imposesanctions on them themselves or
to protect society in some way.
Rob Lott (04:41):
Okay. So after all that, here we are today. What is
the sort of typical experienceof someone with a substance use
disorder who is incarcerated?
Elizabeth Van Nostrand: Incarceration is especially (04:52):
undefined
detrimental for individuals witha substance use disorder. And
people who are incarcerated arealmost four times more likely to
have a substance use disorderdiagnosis than people who are
Overdose is the third leadingcause of death for people who
(05:13):
are incarcerated, and it is theleading cause of death after
they're released from prison,especially if they didn't
receive adequate treatment likemedication for substance use
disorder, while they wereincarcerated. And the two week
period post release after theyget out of the criminal justice
(05:33):
system is especially a dangeroustime frame for these folks.
Rob Lott (05:37):
Okay. So it's against this backdrop that we have an
intervention known as treatmentcourts or treatment court
programs that have emerged as analternative. And I'd love it if
you could say a little bit abouthow the programs work. And I
assume not all treatment courtsare created equal. So what do we
know about the variation fromintervention to intervention or
(06:00):
program to program?
Elizabeth Van Nostrand (06:01):
So I'm a former litigator. So I can tell
you from personal experiencethat courts can be very
adversarial. You have youropponent coming after you.
Sometimes you have the judgecoming after you. You can even
have your client coming afteryou.
But treatment court isdifferent. I had the opportunity
to observe four different courtsin Indiana during the course of
(06:25):
our study. And to be honest, Iwas really moved by what I saw.
Treatment courts, as opposed tothe traditional judicial system,
adopt a team approach. They haveteams composed of judges and
prosecuting attorney, thedefense attorney, behavioral
health folks, mental healthprofessionals, all pulling for
(06:46):
the treatment court participantto succeed.
Currently, are about 4,200treatment courts across The
United States. And that is anumbrella term that includes
courts such as veteran treatmentcourts and mental health courts,
adult drug courts, juvenile drugcourts, tribal healing to
wellness courts. Each year about150,000 people participate in
(07:09):
one of those types of treatmentcourt programs. Typically,
treatment court programs adopt apublic perspective
Rob Lott (07:18):
and recognize that substance use is a disease, and
they attempt to address theunderlying causes or issues
associated
Elizabeth Van Nostrand (07:26):
with Treatment substance use. There
are best practices that areestablished for treatment
courts. There's a group inAlexandria called All Rise,
Alexandria, Virginia called AllRise, which put together these
best practices. But in reality,treatment courts have a lot of
autonomy, they have a lot ofleeway in what they can do in
(07:49):
terms of deciding who's eligibleto participate, and what
services are offered, what sortsof sanctions they want to impose
for noncompliance, andincentives for completing
different phases of thetreatment court program.
Typically, treatment courts usea phased approach, where
(08:09):
participants come to court everyweek or every other week or some
sort of timeframe where theypresent what's going on in their
lives, where they are in theirsubstance recovery to the court.
When people apply to treatmentcourt, they plead guilty. They
plead guilty, but the courtshold that plea in abeyance. They
(08:32):
don't move forward with thatplea unless the person fails in
their participation of thetreatment court program. If they
do, they go back to thetraditional judicial system, and
they can ultimately beincarcerated.
Rob Lott (08:47):
Got it. Okay. So very helpful context about treatment
courts. Now, tell us a littlebit about your study in that
context.
Elizabeth Van Nostrand (08:55):
So what we wanted to find out was
whether treatment courtparticipation was associated
with health outcomes. So ourstudy took place in the state of
Indiana. We selected Indianaeven though we're researchers
from Pennsylvania, becausenumber one, it has a history of
(09:16):
high rates of overdosefatalities. In 2022, Indiana had
the fourteenth worst overdosedeath rate in the country.
Second, we picked Indianabecause it has a wide variety of
treatment courts.
In 2018, it had eight differenttypes of treatment courts in 52
(09:37):
of its 92 counties. And third ofall, we selected Indiana because
it has a governmentally run datawarehouse called the management
performance hub. The managementperformance hub has data sets
from a variety of Indianaagencies all in one place. Data
acquisition is a real issue, anegative issue in The United
(10:00):
States. And having all the datasets that we were interested in
being housed in one centralrepository was really critical
for our study.
Under Indiana law, though,unlike typical criminal records,
treatment court records areconsidered to be privileged,
kind of like medical records. Sobefore we started our study, we
(10:22):
had to get the permission of theIndiana Supreme Court to have
treatment court records releasedto the management performance
hub. It was the first time thatthey received such a request. We
also had to get permission fromindividual treatment courts to
allow their participant recordsto be released to the management
(10:43):
performance hub. We approached77 of them in Indiana.
And, after two informationalwebinars that that we hosted, we
were delighted that 30 of theeligible Indiana treatment
courts or about 39% agreed toparticipate in our project. So
(11:03):
from those courts, theManagement Performance Hub
received treatment court recordsof five thirty people who
applied to treatment court andwere accepted. Of those five
thirty people, three fiftyactually participated and
completed programs, and 180 wereaccepted, but for some reason
(11:27):
decided not to go. So those wereour two comparison groups,
people who were eligible toparticipate in treatment court
programs who went through theprograms, versus people who are
eligible for the programs butdid not go through the programs.
So the first thing we did was weinterviewed judges to see what
sorts of therapies and programsthey provided to their treatment
(11:51):
court participants.
We also got information from theprescription drug monitoring
program, which is a centralrepository of prescriptions for
controlled substances such asthose that are used to treat
substance use disorder. So wewere able to create individual
profiles of these five thirtypeople, we knew for person
(12:14):
number one, which treatmentcourt program they applied to,
whether they were accepted andcompleted their program or were
accepted and decided not to go,what sorts of interventions the
courts offered, what kinds ofprescriptions they were provided
to treat their substance usedisorder. And, we followed them
(12:36):
for a year, and we looked atwhether they had EMS calls,
whether they presented in anemergency department, whether
they were alive, and whetherthey were rearrested.
Rob Lott (12:48):
Well, in just a minute, I wanna ask you about
your findings. But first, let'stake a quick break. And we're
(13:49):
back. I'm here talking withElizabeth Van Nostrand about,
the research of her and hercolleagues published in the
September issue of HealthAffairs all about treatment
court programs in Indiana.Alright.
Well, you just described thecomplex but relatively precise
(14:09):
and targeted approach to yourstudy. What did you find?
Elizabeth Van Nostrand (14:15):
We were very surprised, to be honest,
with what we found. Because whenyou looked at the socio
demographic characteristics, or,the profiles of the two groups,
people who participated intreatment court program versus
those who did not, the peoplewho participated in the programs
(14:36):
had many more characteristicspointing to poor health outcomes
than the non participants. Forexample, they were more than
twice as likely to beunemployed, they were more than
twice as likely to be disabled,they were more than twice as
likely to have a substance usedisorder diagnosis than the non
participants. And each of thosecharacteristics is associated
(14:59):
with a higher likelihood of poorhealth outcomes and overdose.
So, we expected them to havepoor health outcomes.
But the reverse was true.Compared to the nonparticipants,
the participant group with ahigher risk profile were thirty
(15:20):
four percent less likely topresent at an emergency
department, seventy four percentless likely to use EMS for a
substance related issue, andeighty three percent less likely
to die than the non participantgroups. And we followed these
two groups for a year after theyeither completed their treatment
(15:41):
court programs, or they decidednot to participate in treatment
court. And those results werepretty much the same across
races and ethnicities as well asgenders.
Rob Lott (15:52):
What do we know about the crime related outcomes of
programs like these, outcomeslike recidivism and the like?
Elizabeth Van Nostrand (16:01):
So we actually did study rearrest in
in our in our in our study. Wedid not include those results in
the paper for a couple ofreasons. Number one, we had word
constraints. We didn't we had acertain amount of or a certain
number of words that we wereallowed to use.
Rob Lott (16:20):
Alright. Note to the health affairs editors there.
Elizabeth Van Nostrand (16:23):
We also didn't include it. We also
didn't include it because it'sbeen pretty well studied. There
have been plenty of otherstudies that support the notion
that treatment courtparticipation lessens the
chances of being rearrested. Andin our study, we found that,
(16:45):
people who were involved in theprograms were about ninety three
percent less likely to berearrested.
Rob Lott (16:53):
Oh, wow. And, so these findings are pretty compelling.
And in your discussion, you saythat they can they quote, can be
used to expand the number oftreatment courts in underserved
areas. What are some of theobstacles, to expansion, and
(17:14):
what should policymakers bedoing to overcome them?
Elizabeth Van Nostrand (17:17):
Well, let me say at the outset, that
the act of arrest in and ofitself can be a very
traumatizing experience. And Ido not suggest that arresting
people for substance usedisorder is the way to go. But
we as a society continue toarrest people for substance use
and substance use related,offenses. So treatment courts
(17:41):
offer services that might nototherwise be made available to
these folks who use substances.And I think that there are some
barriers currently with respectto expanding treatment court
programs.
Number one, ours is one of thefirst studies to show the
(18:01):
results of treatment or anassociation between treatment
court participation and healthoutcomes. So, more research
needs to be done in that area.Also, the courts vary
tremendously with respect toeligibility requirements, like a
lot of courts will not acceptyou into their treatment court,
if you have a history ofviolence, or if you have serious
(18:26):
mental or physical healthissues. So that's one barrier.
And one way to work around thatis to beef up treatment court
teams to allow them to acceptmore individuals into their
programs.
Another common barrier forparticipants is not having
housing or transportationbecause they have to come and go
(18:52):
to these programs. And if theycan't get there, they can't
participate. Not everyone knowswhat a treatment court is or
what a treatment court does. Andas I said, except for rearrest,
few research studies have shownthe benefits that treatment
courts do provide. Not everybodyembraces the notion that
(19:13):
substance use is a disease.
So, they subscribe to the ideathat people who use substances
need to be punished. It alsocosts money to set up a
treatment court and to run atreatment court. But if you look
at it, in the long term, or overthe long term, it's economically
beneficial. Treatment Courtparticipation costs per
(19:37):
participant somewhere between$2,504,000 per participant,
whereas to incarcerate anindividual costs upwards of
$43,000 So it actually is a costeffective way to treat people
with a substance use disorder.You know, we need to as a
(20:02):
society accept the fact thatsubstance use impacts much more
than just an individual, itreally impacts entire families,
entire communities.
There's a lot of stigma stillassociated with substance use,
which needs to be mitigated byproviding people with treatment
so they can return to beproductive, healthy, members of
(20:25):
society.
Rob Lott (20:26):
Wow. Well, a great roadmap for future potential
efforts. You said a moment agothat not everyone knows what
treatment courts are. Andhopefully, with your research,
our conversation here todayeven, we might be able, to help
expand people's understandingand and appreciation of those
(20:49):
programs and their impact. SoElizabeth von Nastran, thank you
so much for taking the time totalk with us today.
It was a lot of fun.
Elizabeth Van Nostrand (20:57):
Thank you for having me.
Rob Lott (20:59):
And to our listeners, thanks for tuning in. If you
enjoyed this episode, pleaserecommend it to a friend. Leave
a review, and, of course, signin next week. Thanks, everyone.
Thanks for listening.
If you enjoyed today's episode,I hope you'll tell a friend
about a health policy.
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