Community Mental Health Journal

, Volume 55, Issue 2, pp 222–231 | Cite as

Integrating a Co-occurring Disorders Intervention in Drug Courts: An Open Pilot Trial

  • David SmelsonEmail author
  • Ian Farquhar
  • William Fisher
  • Karen Pressman
  • Debra A. Pinals
  • Barbara Samek
  • Mary-Kate Duffy
  • Leon Sawh
Original Paper


Little research has focused on systematically integrating clinical treatment within existing drug court procedures. This could be particularly useful for clients with substance use disorders, who comprise those on court dockets and often have co-existing mental health issues. This article reports on the preliminary outcomes of integrating MISSION-Criminal Justice (MISSION-CJ), a co-occurring mental health and substance use wraparound intervention, within two Massachusetts drug courts. In this open pilot, clients completed intake and 6-month follow-up assessments. The participants were primarily Caucasian (86%), male (82%), had at least 2 prior arrests, and received outpatient treatment for mental health (54%), alcohol use (51%), or drug use (88%) prior to enrolling in MISSION-CJ. Six-month follow-up data suggested that participants showed statistically significant reductions in average number of nights spent in jail, alcohol use, and drug use, as well as an increase in full time employment.


Alternatives to incarceration Drug courts Co-occurring disorders treatment 



We thank the Gavin Foundation, the University of Massachusetts, the Massachusetts Department of Public Health, Massachusetts Department of Mental Health and the Executive Office of the Trial Court for supporting this work. Co-author Mary-Kate Duffy is no longer affiliated with the University of Massachusetts Medical School.


This work was funded by a grant from the Substance Abuse and Mental Health Services Administration (1H79TI025074-03).

Compliance with Ethical Standards

Conflict of interest

The authors report no known conflicts of interest and certify responsibility for the manuscript submitted.


The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the University of Massachusetts, the Department of Public Health, the Department of Mental Health, or the Massachusetts Executive Office of the Trial Court or United States Governments.

Ethical Approval

This open pilot was reviewed by the University of Massachusetts Medical School’s Institutional Review Board and was determined to be program evaluation rather than human subjects research.

Research Involving Human Participants

This article does not contain any studies with human participants performed by any of the authors.


  1. Andrews, D. A., & Bonta, J. (2006). The psychology of criminal conduct (4th ed.). Newark, NJ: LexisNexis.Google Scholar
  2. Andrews, D. A., Bonta, J., & Hoge, R. D. (1990). Classification for effective rehabilitation: Rediscovering psychology. Criminal Justice and Behavior, 17(1), 19–52. Scholar
  3. Belenko, S. (2001). Research on drug courts: A critical review, 2001 update. New York, NY: National Center on Addiction and Substance Abuse, Columbia University. Retrieved October 5, 2016, from
  4. Binswanger, I., Stern, M. F., Deyo, R. A., Heagerty, P. J., Cheadle, A., Elmore, J. G., & Koepsell, T. D. (2007). Release from prison—A high risk of death for former inmates. The New England Journal of Medicine, 356, 157–165. Scholar
  5. Bonta, J., & Andrews, D. A. (2007). Risk-need-responsivity model for offender assessment and rehabilitation (Corrections Research User Report No. 2007-06). Ottawa, Ontario: Public Safety Canada. Retrieved January 23, 2017 from
  6. Brown, R. T. (2010). Systematic review of the impact of adult drug-treatment courts. Translational Research, 155(6), 263–274. Scholar
  7. Case, B., Steadman, H. J., Dupuis, S. A., & Morris, L. S. (2009). Who succeeds in jail diversion programs for persons with mental illness? A multi-site study. Behavioral Sciences & the Law, 27(5), 661–674.Google Scholar
  8. Chinman, M., George, P., Doughtery, R. H., Daniels, A. S., Ghose, S. S., Swift, A., & Delphin-Rittmon, M. E. (2014). Peer support services for individuals with serious mental illnesses: Assessing the evidence. Psychiatric Services, 65(4), 429–441. Scholar
  9. Chinman, M., Shoai, R., & Cohen, A. (2010). Using organizational change strategies to guide peer support technician implementation in the Veterans Administration. Psychiatric Rehabilitation Journal, 33(4), 269–277.Google Scholar
  10. Draine, J., & Herman, D. B. (2007). Critical time intervention for re-entry from prison for persons with mental illness. Psychiatric Services, 58(12), 1577–1581. Scholar
  11. Epperson, M. W., Wolff, N., Morgan, R. D., Fisher, W. H., Frueh, B. C., & Huening, J. (2014). Envisioning the Next Generation of Behavioral Health and Criminal Justice Interventions. International Journal of Law and Psychiatry, 37(5), 427–438.Google Scholar
  12. Fox, A. D., Maradiaga, J., Weiss, L., Sanchez, J., Starrels, J. L., & Cunningham, C. O. (2015). Release from incarceration, relapse to opioid use and the potential for buprenorphine maintenance treatment: A qualitative study of the perceptions of former inmates with opioid use disorder. Addiction Science and Clinical Practice, 10, 2.Google Scholar
  13. Knudsen, K. J., & Wingenfeld, S. (2016). A specialized treatment court for veterans with trauma exposure: Implications for the field. Community Mental Health Journal, 52(2), 127–135.Google Scholar
  14. Laub, J. H., & Sampson, R. J. (2001). Understanding Desistance from Crime. Crime and Justice, 28(1), 1–69.Google Scholar
  15. Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking (MISSION). Intervention summary retrieved on November 18, 2016 from the Substance Abuse and Mental Health Services Administration’s National Registry of Evidence-based Programs and Practices.
  16. McLellan, A. T., Kushner, H., Metzger, D., Peters, R., Smith, I., Grissom, G., Pettinati, H., & Argeriou, M. (1992). The fifth edition of the addiction severity index. Journal of Substance Abuse Treatment, 9(3), 199–213.Google Scholar
  17. Ministry of Justice. (2013). Analysis of the impact of employment on re-offending following release from custody, using propensity score matching. Retrieved December 3, 2016, from
  18. O’Connor, K., Kline, A., Sawh, L., Rodrigues, S., Fisher, W., Kane, W., Kuhn, J., Ellison, M., & Smelson, D. (2012). Unemployment and co-occurring disorders among homeless veterans. Journal of Dual Diagnosis, 9(2), 134–138. Scholar
  19. Peters, R. H., Kremling, J., Bekman, N. M., & Caudy, M. S. (2012). Co-occurring disorders in treatment-based courts: Results of a national survey. Behavioral Sciences & the Law, 30(6), 800–820. Scholar
  20. Pinals, D. A., Smelson, D., Sawh, L., Harter, J., Kline, A., & Ziedonis, D. (2014). The MISSION-CJ treatment manual. Worcester, MA: UMass Medical School.Google Scholar
  21. Piquero, A. (2010). Cost-benefit analysis for jail alternatives and jail. Report to Broward Sheriffs Office Department of Community Control. Retrieved August 3, 2016, from
  22. Smelson, D., Kalman, D., Losonczy, M. F., Kline, A., Sambamoorthi, U., St. Hill, L., Castles-Fonseca, K., & Ziedonis, D. (2012). A brief treatment engagement intervention for individuals with co-occurring mental illness and substance use disorders: Results of a randomized clinical trial. Community Mental Health Journal, 48(2), 127–132.Google Scholar
  23. Smelson, D., Kline, A., Kuhn, J., Rodrigues, S., O’Connor, K., Fisher, W., Sawh, L., & Kane, V. (2013). A wraparound treatment engagement intervention for homeless veterans with co-occurring disorders. Psychological Services, 10(2), 161–167.Google Scholar
  24. Smelson, D., Losonczy, M., Ziedonis, D., Sussner, B., Castles-Fonseca, K., Rodrigues, S., & Kline, A. (2007). A brief community linkage intervention for veterans with a persistent mental illness and a co-occurring substance abuse disorder. European Journal of Psychiatry, 21(2), 143–152.Google Scholar
  25. Smelson, D., Pinals, D. A., Harter, J., Sawh, L., Kline, A., & Ziedonis, D. (2014). The MISSION-CJ participant workbook. Worcester, MA: UMass Medical School.Google Scholar
  26. Smelson, D., Pinals, D. A., Sawh, L., Fulwiler, C., Singer, S., Guevremont, N., Fisher, W., Steadman, H. J., & Hartwell, S. (2015). An alternative to incarceration: Co-occurring disorders treatment intervention for justice-involved veterans. World Medical & Health Policy, 7(4), 329–348. Scholar
  27. Steadman, H. J., Davidson, S., & Brown, C. (2001). Law and psychiatry: Mental health courts: Their promise and unanswered questions. Psychiatric Services, 52(4), 457–458. Scholar
  28. Steadman, H. J., Peters, R. H., Carpenter, C., Mueser, K. T., Jaeger, N. D., Gordon, R. B., Fisler, C., Goss, S., Olson, E., Osher, F. C., Noether, C. D., & Hardin, C. (2013). Six Steps to Improve Your Drug Court Outcomes for Adults with Co-Occurring Disorders. SAMHSA’s GAINS Center for Behavioral Health and Justice Transformation’s & National Drug Court Institute’s Drug Court Practitioner Fact Sheet, Vol. 8, No. 1. Retrieved September 27. 2016, from
  29. Substance Abuse & Mental Health Services Administration. (2006). “National Outcome Measures (NOMs) for Co-Occurring Disorders.” Substance Abuse & Mental Health Services Administration, U.S. Department of Health and Human Services. Retrieved December 14, 2016, from
  30. Substance Abuse and Mental Health Services Administration. (2010). GPRA Modernization Act of 2010. Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services. Retrieved from
  31. Susser, E., Betne, P., Valencia, E., Goldfinger, S. M., & Lehman, A. (1997). Injection drug use among homeless adults with severe mental illness. American Journal of Public Health, 87(5), 854–856.Google Scholar
  32. Taxman, F. S., & Thanner, M. (2006). Risk, need, and responsivity (RNR): It all depends. Crime and Delinquency, 52(1), 28–51.Google Scholar
  33. Tomita, A., & Herman, D. (2015). The role of a critical time intervention on the experience of continuity of care among persons with severe mental illness following hospital discharge. Journal of Nervous and Mental Disease, 203(1), 65–70.Google Scholar
  34. Trojano, M. L., Christopher, P. P., Pinals, D. A., Harnish, A., & Smelson, D. (2017). Perceptions of voluntary consent among jail diverted veterans with co-occurring disorders. Behavioral Sciences & the Law. Scholar
  35. Wolff, N. B., Frueh, C., Huening, J., Shi, J., Epperson, M. W., Morgan, R., & Fisher, W. (2013). Practice informs the next generation of behavioral health and criminal justice interventions. International Journal of Law and Psychiatry, 36, 1–10.Google Scholar
  36. Zarkin, G. A., Cowell, A. J., Hicks, K. A., Mills, M. J., Belenko, S., Dunlap, L. J., & Keyes, V. (2015). Lifetime benefits and costs of diverting substance-abusing offenders from state prison. Crime and Delinquency, 61(6), 829–850.Google Scholar
  37. Ziedonis, D., & Stern, R. (2001). Dual recovery therapy for schizophrenia and substance abuse. Psychiatric Annals, 31(4), 226–232.Google Scholar

Copyright information

© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply  2018

Authors and Affiliations

  • David Smelson
    • 1
    Email author
  • Ian Farquhar
    • 1
  • William Fisher
    • 1
  • Karen Pressman
    • 2
  • Debra A. Pinals
    • 1
    • 3
  • Barbara Samek
    • 4
  • Mary-Kate Duffy
    • 1
  • Leon Sawh
    • 5
  1. 1.Department of PsychiatryUniversity of Massachusetts Medical SchoolWorcesterUSA
  2. 2.Bureau of Substance Abuse ServicesMassachusetts Department of Public HealthBostonUSA
  3. 3.Massachusetts Department of Mental HealthBostonUSA
  4. 4.Gavin Foundation, Inc.BostonUSA
  5. 5.School of Criminology and Justice StudiesUniversity of Massachusetts LowellLowellUSA

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