- Treatment courts, also known as drug courts, have been around for about 25 years
- Veterans treatment courts are newer but show success in rehabilitating people
- Half of veterans prescribed medical opioids continue to use them chronically
Nicholas Stefanovic did not one but two tours overseas, in Iraq and Afghanistan.
Military brass considered the Marine the bravest of the brave. He won several medals for valor in combat. But the enemy that came closest to defeating him wasn't hiding in some remote cave or crouching alongside a desert road. It was an enemy he encountered much closer to his home in Rochester, New York:
Illegal pain pills.
War left its mark
When Stefanovic came home, he struggled with sleep. Out of the blue, he'd be hit with feelings of sheer panic. To this day, he doesn't talk about his war experience, but he will speak publicly about what life was like for him at home.
"The only thing I cared about was peace," Stefanovic said in a speech in 2011. "I wanted peace and relief from these symptoms of these experiences I had gone through."
He felt like he shouldn't have come home from war. At home, he cut himself off from society and severed ties with the Marines. He started living out of his car.
"I was alone, and I had nothing," Stefanovic said. "I had fully accepted that I would never be a contributing member of society."
So he turned to opioids. He says he was prescribed them only once that he could remember when in combat, but it was for something minor. It wasn't a regular thing. He didn't even bother with a doctor's note for the drugs at home. He says they were easy to find on the street. When he didn't find them there, he bought heroin instead.
"People don't use these substances for no reason. It becomes a matter of controlling the pain," Stefanovic said.
In order to feed his addiction, he continued to break the law. Eventually, the police caught up with him. He got caught with a stolen check.
And into his life walked Judge Patricia Marks.
When he stood before her, Marks gave him an ultimatum.
" 'Go to jail or give me a year,' " Stefanovic recalled the judge saying. "That's what saved my life."
As a Marine, he felt there was nothing worse than "losing your freedom."
"I didn't really care if I died that day," he said. "I was that low. But losing my freedom was worse. So I chose to spend the year with this judge."
The judge was a member of a veterans treatment court.
More proactive than punitive
Treatment courts, also known as drug courts, have been around for about 25 years. Unlike in a standard courtroom, where a person accused of a crime is tried on charges and then sentenced to a particular punishment, the focus of a drug court is to offer a kind of treatment for addicts as an alternative to sending them to prison.
The key components (PDF) of drug courts include a multidisciplinary team approach to help someone with their addiction. There is an ongoing schedule of judicial hearings. A standardized treatment program is a requirement. There's weekly drug testing and monitoring. There are incentives for those who stay clean, like moving from an inpatient treatment to an outpatient program.
For those who don't, there are punishments that may not be as extreme as jail.
The program is set aside for nonviolent offenders, although there are some exceptions. There is often also a requirement that the person further their education, there are employment goals, and there's often a community service requirement.
The program is free to participants. The money typically comes from a combination of state and federal funds. President Obama's fiscal year 2012 budget request included approximately $101 million for drug, mental health and other court problems like veterans treatment courts.
The government estimates that "every $1 spent on drug courts yields more than $2 in savings in the criminal justice system alone," according to a fact sheet (PDF) put out by the Office of National Drug Control Policy.
In veteran courts, all participants take a plea and sign a contract stating what the disposition of the criminal charges will be if successful or unsuccessful.
The court then uses a system of graded sanctions and incentives to make sure the veteran complies with the guidelines of the program. It does not automatically terminate a vet from the program without due process.
Most who go through the program graduate after 12 to 18 months.
"The holistic approach seems to really work, because not only do they have to be clean, they have to learn coping skills and independence," said Christopher Deutsch, communications director for the National Association of Drug Court Professionals.
Studies show that these treatment courts in general have made remarkable progress in helping people with drug or alcohol addictions stay out of trouble. Seventy-five percent of drug court graduates remain arrest-free at least two years after leaving the program. A federal investigation found that drug court participants who completed their programs had rearrest rates 12% to 58% below those of other groups.
Some critics (PDF) of drug courts in general have said that the courts are too expensive and offer treatment plans that may not always be the most effective (PDF).
Vet specific help
Veterans treatment courts are relatively new. And there aren't as many numbers on their effectiveness yet, but the people involved in the program are passionate advocates for it.
The veteran courts are an unique combination of a drug court and a mental health court, focusing on military veterans with substance abuse problems who have gotten in trouble with the law.
In 2007, Judge Robert Russell of Buffalo, New York, noticed that there were a lot of veterans showing up on his docket with addiction and mental health problems. He was having a hard time connecting with a particular Vietnam veteran.
"The vet had his head down and was monotone in his answers. In a moment of exasperation, the judge said to a coordinator in the courtroom, who he knew had served in the military, 'Can you take him out in the hall and talk to him, vet to vet?' " Deutsch said.
After about 45 minutes, the two came back, and the judge called the case. The man was transformed.
"He stood at parade rest with his head up and answered the judge with 'Yes, sir' and 'No, sir' and said he did want to be a part of the drug court program."
That's when the light bulb went off for Russell.
The judge worked with others in the court system and at the Veterans Administration to create a complementary program that would provide the usual elements of drug court plus military mentors to all veterans. Each vet would have a representative from the VA in court so they could get connected with services that would help.
In six years, there's been strong growth in the number of courts. There are federal funds and state support to train new personnel.
"It really has been incredible to see how far this has gone and to also see what a need there is for this specific system," Deutsch said.
Prescription drug addiction is a particular problem for veterans. A recent study found that combat veterans were disproportionally struggling with the addiction compared with the rest of the population. Half of veterans prescribed medical opioids continue to use them chronically, according to a new study by the American Academy of Pain Medicine.
Part of the problem may be that some veterans who suffer from chronic pain conditions get opioids to treat them, but when they get home, they can't break away from the peace they think the drugs bring. Cut off from military doctors who could help them, they often turn to illegal substitutes and wind up in the court system.
"I've talked to a number of veterans who have shoe boxes filled with pain pills kept just in case," Deutsch said. "It's a particularly hard addiction to beat, especially since so many suffer from chronic pain that does need to be treated."
The veterans courts are still too new to have solid data on how well they are working nationally, but Deutsch says some local studies have showed that they are a huge help. In the Buffalo system, there have been only two or three rearrests of drug court graduates.
A process people believe in
"It really does work and is a great alternative," said Judge John DeMarco, presiding judge of the Veterans Court in Rochester, New York. He's seen enormous changes in the men and women who have gone through the program. "Instead of being solely punitive, you can become proactive and treat the real problem here. We always say if you are coming to our graduation and you don't like public crying, don't go."
DeMarco has seen many families reunited. He's seen veterans become their own selves again. They have jobs. They have an education. And they are drug-free.
"There is a real ripple effect here that I don't see in other traditional courtrooms where I see so many families break down. The opposite happens here. This is one of the most rewarding things I've done," DeMarco said. "You see it in the veterans' eyes and the way they stand they are new people. This is really remarkable, and it truly works."
Stefanovic credits the court system with saving his life. He said he tried at least half a dozen other drug treatment programs for his prescription drug addiction, but none of them worked for him.
At first, when he was in veterans treatment court, he stayed sober because he knew he would be checked. But after about six months, he started to like what he was getting out of the program and felt like he no longer needed the addiction to get him through the day. He started to see the other rewards the program brought him, as well.
"I started feeling happy in my life for the first time in a long while," he said.
He believed so much in the system, he became a part of it. He now works as an addictions counselor and travels around the country spreading the veterans court gospel. It has become such an important part of his life, the judge he credits with saving him will now be presiding over something else in his life: his wedding. In September, he'll also become a stepfather to two young children.
"This is the first real court system that helps people not by penalizing them but by doing the complete opposite," Stefanovic said. "I was hopeless in the beginning, and now I am looking forward to at least five major things right now."
He still struggles with the sleeplessness and still does feel some of the panic that the war left with him. But now he handles them in a totally different way.
"I am able to deal with all of that, and they don't control me or prevent me from my living my life. This system can give anyone hope. This program makes life possible."