Substance Abuse Care: From the Clinic to the Courtroom

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WE KNOW from our data that two out of three first-time offenders don’t ever get another DWI. However, one in three does and with each subsequent arrest, the risk for injuries or deaths increases. The likelihood of the repeat offender having addiction or substance use disorders also increases.

Might there be a way to assess the first-time DWI recipient to identify whether they are likely to repeat the offense, steer them toward help and potentially prevent a second DWI? Could the courts provide this help without over-responding to those who are not likely to repeat the offense?

To find out, Minnesota’s Sixth District Court in Duluth started a new intervention that offers important information and coaching for all first-time offenders and may break the DWI cycle early on for those at risk to repeat the offense. They are using the Screening, Brief Intervention and Referral to Treatment (SBIRT) model as an early intervention for people with risky alcohol use. The SBIRT model consists of screening to identify risk for developing substance use disorders; brief intervention to raise awareness of risks and consequences, motivate change and help set healthier goals; and referral to treatment to aid access to treatment and coordinate services for people with high risk and/or dependence.

The assumption is, based primarily on evidence from the primary care medical setting, that screening and brief counseling on reducing alcohol consumption or adopting safer drinking behaviors will reduce future risks (legal, social and medical) associated with drinking alcohol.

With funding from the Minnesota Department of Public Safety, consulting from the Institute for Clinical Systems Improvement and unique partnerships with several community organizations, a demonstration project was created and implemented in 2014. St. Louis County Health and Human Services, the Center for Alcohol and Drug Treatment, Arrowhead Regional Corrections, court administration, public defenders and law enforcement worked together to create this new program.

HOW THE PROGRAM WORKS

Anyone arrested for a first-time DWI in Duluth is summoned to court within a few weeks of his or her arrest. Right after going before the judge, the client meets with an interventionist who walks them through a screening tool that asks about the amount and frequency of alcohol use. The interventionist then talks with them about their results. Clients set goals for changing their behavior and are referred to treatment if needed. The interventionist contacts them about a month later to see how they’re doing and can make a new referral to treatment if needed.

The information about the client’s screening and goal setting is confidential between them and the interventionist and is not part of their court file. There is value in creating a space where clients can speak freely with the interventionist and their own goals. The court knows the process is happening, that the client is being referred when needed and that the interventionist will follow up. Confidentiality supports the process.

PROMISING RESULTS

We don’t yet know the full impact of inserting the SBIRT model into the court process for first-time DWI clients and it’s too early for recidivism data. Not surprisingly, the majority of clients fall into the low risk category. A few have scored as higher need with either harmful or dependent alcohol use. They have been referred to services and the interventionists are following up.

Many participants are reporting changes in their behaviors in response to goal setting, including drinking less frequently, drinking less on occasions when they do drink and changing their decision making around alcohol and driving. One client said, “There’s a normalcy surrounding drinking in Minnesota. I’m so glad there’s a program in place like this that educates people on their alcohol use. I had no idea how easy it was to get to a .08.”

Word has spread and we actually have folks coming to court looking forward to talking with an interventionist! They’ve heard about it from friends who viewed it as a positive experience. Also, as surprising as it seems given the level of information available, we see a lot of people who really need education on alcohol and driving. One client commented, “This was amazing. I thought I could have four drinks and still drive. This stuff should be taught in high school.”

Another client said, “This wasn’t the first time I had driven drunk, but it was the first time I’d been caught. I believe I have a problem and now, I am starting to face it.” Might he have been the one in three likely to reoffend? Could this intervention make a difference in his trajectory? That’s our hope and the impetus behind this program.

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