Findings

4.1 Relevance

4.1.1 Relevance of Program to Federal Priorities

The DTCFP is relevant to and aligns with federal priorities. The DTCFP contributes to the CDSS (treatment pillar), and is in alignment with the Minister of Justice and Attorney General of Canada’s mandate letter.

The DTCFP is relevant to and in alignment with federal priorities:

Key informant interviewees further noted that the program responds to the priority for an efficient justice system by reducing recidivism and contributing to address systemic racism in the criminal justice system, including taking steps towards reducing the over representation of marginalized and vulnerable people in the criminal justice system by offering an alternative to incarceration.

4.1.2 Alignment with Trends in the Canadian Justice System

While the impact of substance use on crime remains a concern, DTCs reflect the growing societal recognition that addiction is a health issue. The opioid crisis is highlighting the need for and appropriateness of alternatives to the traditional justice system for those with substance use disorders.

Data have begun to emerge pointing to an increase in problematic substance use during the COVID-19 pandemic.11 Literature and case study interviews suggest that some Canadians have turned to drugs to help them cope with the psychological and emotional impacts of the virus and of quarantine. Others, including DTC participants, have experienced difficulty accessing harm reduction sites and/or treatment centres as a result of COVID-related closures and/or changes in services due to the pandemic. Moreover, literature and case study interviews indicate that pandemic conditions (e.g., restricted air travel and crossing of borders) have contributed to a change in the prevalence of different types of illegal drugs used due to changes in drug routes, as well as greater uncertainty as to the origin and quality of illicit drug supply available.12 Together, these trends have contributed to an increase in overdose and overdose deaths among Canadians over the period of the pandemic.13

At the height of the opioid crisis, in 2017, the annual mortality rate for accidental poisonings was 10.2 deaths per 100,000 people (3,230 deaths), the highest observed prior to 2020. The mortality rate in 2020, based on March 2020-April 2021 provisional data from the Canadian Vital Statistics Death Database, was 11.3 deaths per 100,000 people (3,705 deaths).14 Statistics Canada also suggests that disruptions in harm-reduction programs, supervised consumption services, and in-person support services for substance use during the pandemic may be factors in the increased mortality.15

According to Health Canada, the opioid crisis in Canada continues to represent one of the most serious public health crises in Canada's recent history. Recent data and accounts from several jurisdictions across the country and the Public Health Agency of Canada indicate that the opioid crisis has worsened during the pandemic with many communities across Canada reporting record numbers of opioid-related deaths, emergency calls and hospitalizations.16, 17 In response to the opioid crisis, the Canadian Government has focused on prevention, treatment, harm reduction and enforcement, and has invested in awareness, evidence, project funding, access to treatment, and access to harm reduction.18 The CDSS, of which the DTCFP is a component, is connected to these efforts.19 The DTCFP is aligned with the Treatment Action Plan of the CDSS, the objective of which is to support effective treatment and rehabilitation systems and services by developing and implementing innovative and collaborative approaches.

Key informants observed that the DTCFP is responsive to Canada’s deepening opioid crisis, the need to address the root causes of criminal behavior involving drug use (i.e., addictions), and the need to support effective treatment. All key informants noted that the DTCs are widely accepted as an effective criminal justice response to charges involving Criminal Code offences with a link to problematic substance use. The DTCFP represents a collaborative response to the criminal justice impacts of substance use disorders. The Program promotes an alternative to incarceration, contributes to reducing stigmatization and is also aligned with a growing recognition societally that addiction is a health issue. There is a growing agreement in Canada that problematic substance use is a health issue that can be prevented, managed, and treated, and that requires a health focused response.20 Studies also suggest that most Canadians support harm reduction, which is a health-based approach.21 In line with the views of Canadians, the Government of Canada has recognized that there is an opportunity to do a better job of protecting and supporting Canadians who are affected by substance use.22

Also supporting the alignment of the DTCFP with broader trends, the ‘What we heard’ report, which summarized roundtable discussion held to inform the 2019 Justice review of Canada’s criminal justice system, suggests that justice system partners are supportive of therapeutic approaches and alternatives to formal entry into the criminal justice system. Among the suggestions, some called for more to be done to bring ‘alternative’ courts into the mainstream and make them more widely accessible to all.23 Two of the four areas later identified in the Department’s Review of Canada’s criminal justice system24 as areas around which future reform of the criminal justice system could focus had connections with the objectives of DTCs and the DTCFP:

  • #2. More concrete and specific steps taken to reduce the overrepresentation of vulnerable populations and specific demographic groups in the Canadian criminal justice system; and,
  • #3. Further sentencing reform, including strengthening the use of alternatives to incarceration.

Finally, a recent report25by the Canadian Association of Chiefs of Police on the findings and recommendations related to its exploration of the potential impacts on public safety and policing resulting from the decriminalization of simple possession of illicit drugs stated the following (list not exhaustive):

We the Canadian Association of Chiefs of Police (CACP):

  • recognize substance use disorder as a public health issue;
  • agree that evidence suggests, and numerous Canadian health leaders support, decriminalization for simple possession as an effective way to reduce the public health and public safety harms associated with substance use;
  • agree that evidence from around the world suggests our current criminal justice system approach to substance use could be enhanced using health care diversion approaches,26 proven to be effective;
  • endorse alternatives to criminal sanctions for simple possession of illicit drugs, requiring integrated partnerships and access to diversion measures; and,
  • agree that diversion provides new opportunities to make positive impacts in communities. These impacts may include reducing recidivism, reducing ancillary crimes and improving health and safety outcomes for individuals who use drugs.

4.1.3 Trends and Flexibility to be Responsive to Trends

A key trend highlighted by DTCs is an increase in the complexity of addictions and mental health challenges among participants. DTCFP-funded DTCs have some flexibility to adapt to trends and local conditions.

Reflecting on the last five years, many DTCs identified common trends. Survey respondents identified that the most significant trend related to their DTC over the last five years was an increase in the complexity of addictions and mental health challenges among DTC participants (see Table 2, below, for a list of other identified trends in DTCs). All DTCs that participated in case studies reported seeing an increase in fentanyl and crystal meth poly substance use disorders, more severe levels of addictions, as well as a higher prevalence of co-occurring mental health issues. Together, these factors contribute to an increasingly complex profile of participants as well as new challenges. Fentanyl or crystal meth users tend to be more difficult to engage and to stabilize and are also at high risk of mental health or other health issues.

When individuals with substance use disorders also have co-occurring disorders (often related to mental health), treating one without treating the other can negatively impact treatment effectiveness.27 Respondents, both through stakeholder surveys and case study interviews, described the efforts of their DTCs to integrate more flexibility, seek more individualized approaches with participants, and adapt services and treatment to better meet the individual needs of participants complex profiles. In the stakeholder survey, a majority (67%) of respondents agreed that their DTC has flexibility to adapt to local conditions.

Table 2: Observed Trends Related to Drug Treatment Courts in the Last five Years
Responses Decreased (1-2) (%) Stayed about the Same (3) (%) Increased (4-5) (%)

Complexity of addiction, health or mental health challenges experienced by DTC participants
(n = 132)

1%

23%

77%

Volume of applications to the DTC
(n = 96)

31%

34%

34%

Availability of health and social supports for DTC participants
(n = 129)

27%

43%

29%

Waitlist for the DTC program
(n = 60)

23%

57%

20%

Source: Survey of DTC Stakeholders

4.2 Design and Delivery

4.2.1 Profile of Drug Treatment Court Participants

Due to expansion in capacity, participation in DTCFP-funded DTCs has increased over the study period. The profile of DTC participants has been stable over the study period, with participants overall being predominantly Caucasian males.

During the time period under study, there was a rise in the number of participants in DTCFP-funded DTCs from 188 to 225 participants in 2019, the last full year of operations prior to the COVID-19 pandemic (Table 3). This is due largely to an increase in capacity such as at the Vancouver DTC, as well as the addition of new DTCs such as in St. John’s.

Table 3: Number of Participants Started in Program-Funded Drug Treatment Courts 2015-16 to 2021 28
Start Year Number of Participants

2016

188

2017

181

2018

188

2019

225

Source: DTCIS.

The DTCIS data show that an average of 21 participants per site started in 2016, increasing to an average of 23 participants per site in 2019. The number of participants can vary year to year at the sites based on the number and nature of applications, the capacity of the DTC and the decision of the Crown and the judge to admit.

According to DTCIS data, the majority of DTC participants are men (74%). This proportion is relatively stable across the years examined in the evaluation and is slightly higher than was found in the 2015 evaluation where 68% of DTC participants were men (2009-10 to 2013-14) (Figure 2). The mean age of participants across DTCs and for each of the years under study was very similar at between 31 to 39 years of age, depending on the DTC site.

Figure 1: Percentage of Drug Treatment Court Participants by Sex, 2015-2021

Figure 1: Percentage of Percentage of Drug Treatment Participants by Sex, 2015-2021
Text version

The above Figure 1 represents the ratio by sex of 1,053 DTC participants between 2015 and 2021.

The percentage of DTC male participants is significantly higher than female participants throughout the seven years of data collections. The variance in percentages between male and female participants also remains consistent throughout the years. The smallest percentage difference of 40% is in 2020 and largest percentage difference of 54% was in 2019.

The percentages, by year are as follows:

  • 2015: Men 72, Women 28
  • 2016: Men 73, Women 27
  • 2017: Men 72, Women 28
  • 2018: Men 76, Women 24
  • 2019: Men 77, Women 23
  • 2020: Men 70, Women 30
  • 2021: Men 74, Women 26

Source: DTCIS, N = 1,053. 2015 and 2021 data are partial years. 2020 and 2021 data reflect the impact of the COVID-19 pandemic, included interrupted data capture during this time.

A slight majority of DTC participants during the years examined by the evaluation were Caucasian (55%). About one in four DTC participants (27%) were Indigenous, 3% Black and 15% of participants were classified as other (Figure 2). The profile of participants varies based on the location and community context of the DTCs. For instance, the proportion of Black participants is higher for the Toronto DTC, whereas the majority of participants in the Yellowknife DTC are Indigenous. Compared to the last evaluation of the DTCFP, the proportion of Caucasian participants has decreased slightly (from 59% to 55%), while the proportion of Indigenous participants has increased slightly (from 21% to 27%).

Figure 2: Percentage of Drug Treatment Court Participants by Race, 2015-2021

Figure 2: Percentage of Percentage of Drug Treatment Participants by Race, 2015-2021
Text version

The above Figure 2 represents the ratio by race of 1,053 DTC participants between 2015 and 2021.

55% of DTC participants were Caucasian. 27% or approximately one quarter were Indigenous and only 3% of the participants were Black. 15% of the participants were listed as other.

Source: DTCIS, N = 1,053. 2015 and 2021 data are partial years. 2020 and 2021 data reflect the impact of the COVID-19 pandemic, included interrupted data capture during this time.

4.2.2 Equitable Access to Drug Treatment Courts

Access to DTCs among different groups (women, racialized, rural) may vary due to differences in eligibility criteria across DTCs, demand at some DTCs, access to community support services, and lack of access to DTCs outside urban centres.

The target group for DTCs is adults who have been charged with offences that were linked to a substance use disorder. While each DTC may establish their own eligibility criteria, these must be acceptable to the Crown counsel and align with the Public Prosecution Service of Canada (PPSC) Deskbook guidelines for DTCs.29 Based on the review of DTCFP funding agreements with provinces and territories (PTs), the eligibility criteria and admittance process for most DTCs receiving DTCFP funding were quite similar. Persons eligible to be admitted to DTCs typically include applicants who meet the following criteria:

Criteria that are viewed as putting public safety at risk include:

  • The person has been charged with a significant crime of violence;
  • The drug offence was committed in circumstances that raise concerns about drug-impaired driving;
  • The person has a recent and/or significant history of violence; or,
  • The person used or threatened to use a weapon during the commission of the offence.

Source: Public Prosecution Services of Canada Deskbook

Within these criteria, the case studies found that DTCs typically prioritize applicants who are assessed as high-risk (to re-offend) and high needs (have multiple challenges such as a serious addiction and mental health concerns, inadequate housing).

The only significant differences noted among DTCs in terms of stated eligibility criteria was the Whitehorse Community Wellness Court which accepts offenders with alcohol addictions (and have committed offence as a result of or to support their addiction). Across these criteria, the survey of stakeholders and case studies indicated that referrals to the program are most often screened out due to risk to public safety (i.e., nature of the charge or history of violent offences). Over 75% of stakeholders indicated nature of the charge or violent offence history as common reasons referrals are screened out of the program (though in some cases, exceptions can sometimes be made; see textbox on next page). The next most common reason applicants are screened out is that the eligibility review finds a lack of commitment to the program (mentioned by 27%) or other concern that would inhibit full participation in the program (19%).

Case study findings indicated that DTC personnel would like to see greater flexibility related to eligibility criteria in order to permit greater tailoring to their local context as well as to be able to be more inclusive (i.e., taking more deeply into account contextual factors, identity factors, and individual circumstances of candidates when deciding on their eligibility for DTC participation). At some sites, some flexibility was already being incorporated into the eligibility criteria. For example, as Regina is experiencing important fentanyl and meth challenges, it has extended its eligibility criteria to better encompass charges involving fentanyl trafficking. Also, at the Edmonton DTC, there is case-by-case consideration of charges involving violence.

Despite the overall similarity of the eligibility criteria, the evaluation found that there are four factors that inhibit equitable access to DTCs:

At the Edmonton DTC, there is case-by-case consideration of charges involving violence. In its eligibility assessment, the DTC has incorporated a review of violence-related charges for applicants’ circumstances to be considered. Participants with residential and commercial break and enter charges may be accepted into the program with a review of circumstances of the charge. Also in Edmonton, the sentencing eligibility criterion was expanded from sentences of 1-4 years to sentences of 1-5 years to better encompass the lengthier sentencing practices for fentanyl trafficking.
Case study excerpt

4.2.3 Service Utilization and Gaps

DTCs facilitate the access to and utilization of a variety of support services. However, the evaluation found that some gaps exist, particularly in the areas of housing, mental health services, and aftercare.

Comprehensive supports are critical for the success of DTCs. Participants use a wide variety of services that address their needs for addictions treatment and other programming, based upon the requirements of their individual treatment plans and the availability of those services in the community.

Among those programs and services most utilized by survey respondents, addictions treatment was used by almost all (93%), followed by housing services (85%), and mental health programs and services (83%) (Table 4). Reflecting earlier findings, these services are most effective when tailored to better meet individual needs of participants.

Table 4: Drug Treatment Court Programs and Service Utilization and Gaps (Survey Response)
Responses Programs and Services Utilized (%) Gaps in Programs and Other Services (%)

Addictions treatment

93%

19%

Housing services

85%

42%

Mental health programs/services

83%

29%

Employment programs/services

75%

19%

Educational programs/services

69%

13%

Other health programs/services

65%

16%

Services that are tailored for women/female participants

57%

28%

Services that are tailored to Indigenous persons/participants

44%

29%

Child care services

24%

18%

Services tailored for gender diverse groups

22%

27%

Services tailored for individuals/participants who are racialized

17%

33%

Other (please specify)

4%

12%

Don't Know

4%

19%

None of the above

0%

4%

Total

100%

100%

n = 139; Source: Survey of DTC Stakeholders

Among the gaps most commonly identified through this evaluation was housing services. This was the most frequently cited gap among survey respondents, with 42% of stakeholders noting their shortage. The case studies confirmed these concerns, and additionally highlighted the value of tailoring housing for women and men. For example, in Regina, specific housing for women is in place, and DTC interviewees indicated that the success and graduation rate of women has greatly increased since making this housing option mandatory. In a counter example, women participants were seen to be at a disadvantage in Yukon, where there is no halfway house or supervised housing available for women in Whitehorse. Across the cases studies, the stabilizing influence of appropriate housing was underscored.

About 30% of survey respondents also noted gaps in mental health programs/services. The literature review validates the importance of mental health supports, noting that many individuals with substance abuse disorders also have co-occurring disorders, often related to mental health. According to the literature, treating one without treating the other can reduce treatment effectiveness. In case study interviews, some stakeholders noted that more programs focused on trauma could be helpful for DTC participants.

Many underlined that the issues of many participants come from trauma and their using substances as a means of trying to cope with trauma. Even when participants’ addictions problems are addressed, their root issues of trauma will still remain. Thus, more could be done to ensure more trauma work and trauma-focused programs and services are made available to participants.
- Case study excerpt

About the significance of aftercare, one DTC graduate had this to say: “Addiction is a tricky thing. You can never get rid of it entirely, but it can get quieter. Life is hard though and you know you will get triggered so it’s important to have a plan and know who your supports are going to be when you need them.
- Case study excerpt

Aftercare supports were also a gap that many noted they would like to see addressed. Aftercare was considered by some interviewees to be a strong predictor of ongoing health and stability. In sites where it is possible, it is not uncommon for program graduates (and even non-completers) to continue wanting to attend group sessions after leaving the program. Given the enduring nature of addiction, having access to continued support if and when needed was viewed as key in sustaining the effectiveness of treatment.30

4.2.4 Underrepresentation among DTC (Drug Treatment Court) Participants

Some DTC stakeholders suggested that Indigenous and racialized individuals, as well as women, are under-represented among DTC participants. DTC eligibility criteria or potential barriers may unintentionally impact access to DTCs or exclude some groups more than others.

The extent to which the profile of DTC participants is representative of the target group for the DTCs is difficult to estimate. Statistics are not collected that would profile the number or characteristics of offenders with the eligibility profile for DTCs. As well, the DTCIS captures profile information on participants only, not the profile of those who applied and were subsequently screened out of the program and why.

Most surveyed stakeholders perceived that some groups are under-represented among DTC participants. Most commonly, stakeholders identified that Indigenous men and women (52% of respondents) and racialized individuals (46% of respondents) may be under represented among DTC participants.

The case studies provided some insights into the potential reasons that some groups may be under-represented including distrust on the part of potential applicants to the program, perceived bias in the justice system, and/or of certain groups being more likely to face types of charges (assault, gang related, violence etc.) that are ineligible for DTC admission. Additional information from case studies is summarized below:

Other barriers to access noted in surveys and case studies included:

Although data was not available to confirm, key informants and case study interviews noted that other specialized courts (Indigenous courts, mental health courts) are also serving under-represented groups in DTC jurisdictions which may be providing other suitable alternative programs (other than DTCs) to under-represented groups.

4.2.5 Responsiveness of DTCs to Identity Factors of Participants

DTCs utilize individualized treatment plans and participant-centred services that are generally accepted as being responsive to the needs and identity factors of participants.

While the evaluation found that some groups appear to be under represented among DTC participants (women, racialized groups), there were positive views about the responsiveness of the DTCs to diverse participants. There was evidence that treatment plans are tailored for individual DTC participants. Most surveyed stakeholders (70% or more) agreed that there is adequately tailored programming in their DTC (e.g., based on age, gender, different needs of participants). Some stakeholders expressed that work still remains to further tailor programming to better meet the needs of Indigenous and racialized participants.

In the survey, many stakeholders indicated that the best approach to increase connections with under represented groups is to partner with community-based organizations who serve the under-represented groups in question. Case studies confirmed that DTCs connect with community-based organizations that offer specialized programming intended to better meet distinctive needs of particular target groups. Documents and the case studies showed evidence of culturally relevant and safe programming, including for Indigenous participants. For example, in Whitehorse, in the development of individualized wellness plans for participants, the DTC works with First Natiosn communities and with the Council of Yukon First Nations to incorporate family, friends, and appropriate community resources offered in the First Nations communities.32

In Toronto, many stakeholders spoke very highly of the service options available for Indigenous participants. Among the key strengths of these services are that they are designed to be barrier-free. Indigenous services tend to operate through drop-in models (i.e., not appointment based) which means that participants can be welcomed any time. CAMH therapists talked about walking participants over to Aboriginal Services to introduce them to staff and the many supports available including addiction support and cultural and spiritual connection programs. There is also housing support options specifically for Indigenous people that participants may be connected with as well.
– Case study excerpt

In Regina, the DTC has a strong partnership with Kate’s Place, a community organization that provides furnished supportive housing for women enrolled in the Regina DTC. All women who are admitted to the Regina DTC are asked to live at Kate’s Place even if they already have housing available and may keep living there as long as needed. Regina DTC staff indicated that the success and graduation rate of women greatly increased since this approach was implemented.

4.2.6 Drug Treatment Court Operations

Stakeholders are generally satisfied with the structure, and design and delivery of DTCs. Although each DTC varies somewhat in its structure, the design and operation of DTCFP funded DTCs incorporate accepted best practices, such as health-based approaches, clear and predictable rewards and sanctions, and the treatment of co-occurring disorders.

Evidence supports that stakeholders are generally satisfied with the operations of the DTC(s) in their jurisdiction. Survey respondents reported a high degree of satisfaction with the design and operation of the DTCs. About 80% or more of stakeholders surveyed agreed that DTC structures and processes are collaborative, clear and evidence-based. Furthermore, most respondents (70-80%) indicated various DTC program processes are working well (e.g., court appearances, intensity/duration of treatment). In the case studies, high levels of satisfaction with design and delivery were generally reported across all stakeholder groups.

Each DTC varies somewhat in its structure, design and delivery. The document review noted variations related to governance structure, composition of DTC teams, and service provision models which are matched to local culture and unique local contexts. Minor differences were also noted in terms of program length and specific graduation requirements.

Overall, DTC designs appear relatively similar by incorporating typical characteristics of DTC best practices. Some of the best practices and overall trends identified through the evaluation included harm reduction/health-based approaches, decriminalization of the possession of small amounts of drugs, predictable and clear rewards and sanctions, and the treatment of co-occurring disorders such as mental health issues. While some aspects of these best practices are clearly outside of the control of DTCs, such as decriminalization, these trends do interact with the program. In general, respondents stated there has been a downplaying of possession charges within the criminal justice system and a greater focus on trafficking instead; this is shifting the profile of applicants to the DTC. As the discussion surrounding drug decriminalization continues, this may bring additional changes to the operating context for DTCs. Case study interviewees reported an increasing perception of drug use as a health issue (i.e., a substance use disorder) requiring therapeutic responses. In some of the case studies, respondents talked about how they apply principles of harm reduction, although abstinence continues to generally be thought of as the intended goal of and preferred definition of success for DTC participants.

DTCs may use rewards and/or sanctions (i.e., penalties) to help motivate behaviour change; rewards are given to reinforce positive progress in the program and sanctions to correct slip-ups. The literature review and interviewees were in agreement that it is important that participants have advance notice about sanctions; that they have the chance to explain their perspective in any case when sanctions may be applied; and that sanctions are applied equivalently for everyone. Case studies described sanctions that come in various forms including, but not limited to: warnings from the Judge and court team, no rewards/gift cards, written assignments or apology letters, stricter curfew, more volunteer hours, extra time in the program, and additional meetings. More serious sanctions may also include a short period in jail (i.e., bail revocation) or termination from the program.

The majority of survey respondents thought the use of rewards (67%) and sanctions were working well (59%). While only a minority (14%) indicated sanctions were working poorly, this program approach received the lowest rating across the different DTC features that were examined in the survey. The most common open-ended responses also had to do with the use of sanctions and rewards in the program. Survey respondents commented that there was a need for more creative and meaningful sanctions and rewards. There were two types of comments: that sanctions are weak, not applied or that rewards are too infrequent; or there is not enough funding for a meaningful reward. This area of concern may further be worth noting as it was also mentioned as an issue area in the previous evaluation of the DTCFP. Specifically, although sanctions were considered a useful component of the court process and helped participants stay “on track”, there is a perception that they are not always consistently applied.33

4.2.7 Impact of COVID-19

While COVID-19 had a largely negative impact on DTC participants and programming, the operation of the DTCs during the pandemic also offered some lessons on incorporating virtual elements in the future where appropriate.

The evaluation found that all DTCs were impacted by COVID-19 and most stakeholders reported that their DTC had to reduce or suspend referrals or the intake of new participants for at least a period of time during the pandemic. Pandemic restrictions required all DTCs to adapt in a number of ways. According to the findings of the stakeholder survey, the most common impacts of COVID-19 were having to shift court appearances (81% of respondents) and treatment provision to remote or virtual means (81%) (Table 5).

Overall, the consequences of the pandemic environment were seen as having been predominantly negative for participants. Two-thirds of survey respondents noted negative impacts on participants’ ability to access supports and 63% indicated a negative impact of the pandemic on participant relapses. Case studies supported these conclusions with stories of new hardships and struggles brought on in the lives of DTC participants as a result of the threat of COVID-19 and pandemic conditions. Moreover, both Toronto and Edmonton stakeholders reported that overdoses among participants increased during the COVID-19 lockdown These accounts reflect recent studies that have found that overdoses have increased in Canada during the pandemic.34

Table 5: Impact of COVID-19 on Drug Treatment Courts according to stakeholder survey data
Responses %

Adjustments to format court appearances (remote)

81%

Adjustment to how treatment services are provided (virtual, phone)

81%

Difficulties in accessing health, employment or social supports for participants

67%

Reduced/suspended referrals or intake of new participants

64%

Participants relapsing due to pandemic (stress, isolation)

63%

Adjustments to interactions among the court and treatment teams

63%

Greater inconsistency in the contacts with judges, treatment team members

45%

Reduced (e.g., graduates only)/suspended urine screening

45%

Other impacts

17%

Source: Survey of DTC Stakeholders; n = 139

The document review, case studies and key informant interviews indicated that DTCs were impacted in different ways by COVID-19 depending on local circumstances. DTCs also responded differently based on local pandemic conditions, their unique operational contexts, and consideration for the needs of participants in their DTCs. For instance, some DTCs put a suspension on mandatory drug testing, while others found new ways to have drug testing done differently (e.g., less frequently, by drop-off). All DTCs had to modify their usual processes and identify new ways to communicate with and keep in contact with participants. As the program is strongly based on personal interactions (i.e., court sessions, treatment programming), COVID-19 required these contacts to be conducted using remote or virtual means.

Case studies revealed that virtual interactions presented barriers for some participants who do not have access to a phone and/or the internet. Virtual interactions also presented difficulties for some participants who are less technological savvy as well as introduced privacy problems for participants lacking access to a private space from which to check-in, participate in treatment, or attend court. However, for some participants, the experience of operating virtually brought benefits in the form of more flexibility (e.g., not having to travel in to check-in or attend court). In some cases, introducing virtual means of interactions also introduced some new possibilities. For example, in Saskatchewan, going virtual allowed for some joint programming to be delivered to participants in both Regina and in Moose Jaw (a non-DTCFP funded DTC). In Yukon, phone and Skype check-ins are also introducing greater future possibilities for more flexible virtual check-ins for participants who work outside of Whitehorse and struggle with requirements of frequently having to travel to check-in with their case managers in Whitehorse.

Though the move to more online meetings and programming has introduced new possibilities and permitted some insights to be gained on different strategies that can work well for some participants, all stakeholders agreed that in-person interactions are more impactful than virtual and remote interactions. Many highlighted that DTC participants experienced a loss in much needed consistency that the DTC’s schedule helps bring into their lives. Participants also expressed that they missed not being able to interact more personally with DTC treatment and court team members, and missed the sense of community they had with peers, including through appearing in court together. Thus, while some elements of changes made to accommodate the Covid-19 environment may be sustained beyond the pandemic, including more flexibility for virtual and/or remote interactions, findings suggest that when it will become possible, it is likely that all DTCs will be working to return quite closely to their former pre-pandemic model.

“There were a few months when there was nothing. That was hard because I was used to doing something every day with the program. I had a routine - then the lockdown! Groups are back now though. I also usually phone in every day too.

- Participant reflection on being a DTC participant in 2020 through the COVID-19 pandemic

4.2.8 Scaling and Expansion

Almost all jurisdictions indicate they are exploring DTC expansion. Common challenges to expansion include insufficient funding, insufficient necessary supports in the community, and a need for more awareness and support from stakeholders that can impact DTC efforts.

While most jurisdictions indicated interest in DTC expansion, the document review, stakeholder survey and case studies confirmed that a key challenge associated with DTC operation and expansion is a lack of predictable and sustainable funding. All case study DTCs expressed a desire for increased funding to scale and expand the work in their jurisdiction. Access to more funding would permit DTCs, among other things, to be able to hire additional and more specialized staff. Key informants also pointed to a lack of resources as a primary challenge associated with DTC operation and expansion. They also noted that there is significant interest in DTCs in virtually all jurisdictions.

Among the chief challenges to expansion noted by DTCs is the availability of appropriate withdrawal management services and other key community supports, and often, a scarcity of appropriate, safe and affordable housing options for participants. Some jurisdictions also noted geography as posing a challenge to expansion, including the availability of services in more remote areas as well as the accessibility of transportation. Finally, beyond resource challenges, many DTCs expressed that, to be successful, DTCs require awareness, understanding and buy-in among key stakeholders (court, community, legal), related to the way DTCs work.

Stakeholders identified best practices to be considered in expanding existing DTCs or creating new DTCs such as:

Some stakeholders indicated interest in or suggested new DTC streams that could be explored including: an early intervention DTC (diversion prior to guilty plea), DTCs for lower risk participants or those with less serious offences, an Indigenous focused DTC, and, a harm-reduction focused DTC (e.g., different success criteria, different graduation criteria).

4.2.9 Program Reporting Requirements

The DTCIS is the primary vehicle for DTCFP-funded DTCs to report on their activities and outcomes on a national/federal basis; however, there are numerous data limitations.

As was also signalled in the 2015 DTCFP evaluation, the Drug Treatment Court Information System (DTCIS) review conducted for this evaluation found that the DTCIS continues to have several data limitations including:

Findings from both the stakeholder survey and case studies indicate that only a small number of people are involved in reporting to Justice using the DTCIS. However, half of those who use the DTCIS and were surveyed indicated having challenges with the System. In open-ended responses, these challenges included (identified by one or two respondents each):

Both survey and case study respondents who had experience with the System generally viewed the DTCIS in a neutral way or as being only somewhat effective with respect to various dimensions (supporting operational or management decision-making, supporting reporting requirements, inclusion of relevant program information, ease of access and use, and tracking participant consent for post-evaluation). The System was rated less useful for providing an accurate picture of impacts.

While also underlining that the program is fortunate to have an electronic reporting system, key informants and the experience of the evaluators working with the data point to a number of system limitations. However, the DTCIS data are used for other purposes such as broader policy development and analysis of who is accessing the DTC.

The analysis conducted for the evaluation identified challenges such as the fact that some DTCs do not use the DTCIS at all, inconsistent data capture practices and missing or delayed data entry. Case study and key informant interviews indicated that some DTCs have concerns about protecting personal information; there can be turnover at the DTCs and/or a lack of capacity to report regularly; and, misalignment of reporting cycles between Justice and the DTC which creates burden. Capacity challenges have been exacerbated through 2020-21 due to additional COVID-19-related disruptions. Some case study interviewees also suggested that as some DTCs are already collecting and entering data in their own databases, collecting or extracting data for DTCIS purposes can be perceived as performing a duplicate task.

Key informants noted that though PTs are required to take part in DTCFP studies, there is no requirement in the DTCFP funding agreement related to reporting. It was suggested that reporting might be strengthened by adding it as a requirement in the DTCFP PT funding agreements. However, before such a step is considered given concerns, it would likely be beneficial to hold further discussion with DTCs/PTs to identify mutually agreeable solutions in regard to DTC reporting capacity challenges and DTC concerns surrounding threats to the privacy of DTC participants’ personal information.

4.2.10 Facilitating Information Sharing

While there are opportunities for information sharing through the Federal/Provincial/Territorial (FPT) Working Group (WG), there is a desire among stakeholders for increased sharing of best practices and lessons learned.

FPT WG members participate in well-attended meetings approximately four times per year. The purpose of the FPT WG meetings, to which representatives from all PTs are invited to attend, are to provide a forum for knowledge exchange and to discuss DTCIS information. Members of the WG are operational level officials with expertise in and responsibility for criminal justice issues. The Group includes up to three federal representatives, and representatives selected by each province and territory with responsibility for existing DTCs and/or interested in establishing one. Interviews confirm that these meetings are well received and considered highly valuable and helpful. Information and experience among WG members may also be shared through other means and informally. For example, new jurisdictions are connected with WG members, and WG members may informally reach out to each other.

Depending on the jurisdiction, DTC managers and staff may not be members of the FPT WG and thus either receive information through relay from the WG member in their jurisdiction, through other contacts/email groups, or their own independent research. This can result in information sharing gaps. Some DTC stakeholders who are not members of the WG reported attending different individual events through the years as available (for example, a recent online webinar held by the Human Services & Justice Coordinating Committee) as well as often seeking information through professional associations – in particular, the American National Association of Drug Court Professionals.

Of the survey respondents for whom information sharing would be applicable to their work, there were mixed views about the effectiveness with which lessons learned among DTCs are shared. The percentage of stakeholders who perceived that sharing lessons learned was effective (37%) has decreased compared to the same question asked on the survey conducted for the evaluation of the program in 2015 (46%).

Figure 3: Rated Effectiveness of Sharing of Lessons Learned Among Drug Treatment Courts

Figure 3: Rated Effectiveness of Sharing of Lessons Learned Among Drug Treatment Courts
Text version

The above Figure 3 represents the rated effectiveness of sharing of lessons learned among 82 DTCFP Stakeholders.

Survey respondents were essentially divided in rating the effectiveness among the federally-funded DTCs. 37% of respondents rated it ineffective and 34% of respondents rated it effective. 21% of stakeholders rated it neither effective or ineffective.

Source: Survey of DTCFP Stakeholders, n=82

Stakeholder survey and case study findings supported that there is a strong desire among stakeholders for more connections and sharing of experiences and learnings. Survey and case study respondents named various ways this could be achieved including: regular conferences; a regular newsletter; creating a repository of shared documents and resources; and/or a community of practice or other forum for discussion for sharing best practices.

4.3 Achievement of Expected Outcomes

4.3.1 Program Retention

Among those who started the program during the period under study, about one-third of participants completed the program. Retention rates are variable across DTCs due to differences in the profile of typical participants admitted, individual differences in DTC participants, and diverse local delivery contexts.

Based on documents reviewed, the successful completion criteria of DTCs receiving DTCFP funding share the same broad components. These include:

Specific requirements within each component vary by location. For instance, the minimum proven abstinence period varies between three and six months across DTCs and different DTCs require that participants have no new criminal charges for between three and six months.

Overall, 29% of participants completed the program during the study period (excluding those who are still active) and the average duration of the program was 15 months. The last evaluation found that between 2009 and 2014, 27% completed the program. While there are some variations in program completion rates by socio-demographic characteristics of participants, these are small and not statistically significant.

While all DTCs target high risk/high needs participants, the completion rate varies across jurisdictions. For instance, based on DTCIS data, the completion rate is over 40% in Whitehorse and Edmonton and less than 20% for DTCs located in the large urban centres of Toronto and Vancouver. A recent evaluation of the Calgary DTC found that 47% of participants completed the program.35 The different community contexts (different local challenges related to substance use, social services and other support options), typical profile of participants admitted (for example, Whitehorse admits many participants who have alcohol addictions and/or who have Fetal Alcohol Spectrum Disorder, while Toronto focuses on high-need participants with often complex co-occurring disorders), specifics of criteria for graduation, as well as inconsistent data capture practices may all contribute to explaining some of the differences.

The retention rate for DTCs is within the range of retention rates for this type of court, although the range is very wide. For example, Weinrath et al. (2018), citing various studies, writes that: “Retention is a consistent concern of DTC programs, which have varying attrition…Graduation rates fluctuate wildly, with reports ranging from a low of 11% to a high of 89%.”36 Weinrath and others such as Gorkoff et al. (2018) found that retention in DTCs is influenced by the nature and framing of the treatment program and the DTC interventions themselves. Needs-based models were found to be particularly effective in retaining participants. 37

This finding was echoed in the evaluation. According to DTC stakeholders surveyed or interviewed for the case studies, the most important factors related to program retention include the support of the DTC team, feeling connected, individualized supports, and individual readiness/motivation. Relational characteristics of the DTC environment, such as non-judgement and respect, were also noted as contributing very importantly to establishing and maintaining DTC participant trust as well as supporting the efforts and success of DTC participants. Participants interviewed stressed the importance of a non-adversarial and supportive approach as being essential to their trusting their program and their retention in the program. Some participants also stressed possibilities for flexibility as playing a factor in their retention (for example, in Whitehorse, participants being able to coordinate their case worker check-ins with their work schedule as to better not upset their employment).

From the literature and case studies, other important factors considered important to predict retention include:

According to DTCIS data, among those who do not graduate, the average length of time in the program was eight months. The information system indicates that non-compliance with program requirements (e.g., participating in treatment, attending court sessions, urine testing) is the most frequent reason that participants are terminated. The case studies indicate that DTCs tend to take a harm reduction approach, in the sense that non-compliance will not automatically lead to the participant being ejected from the program unless issues become persistent and the participant is dishonest.

The survey and case study input suggests that the most common reported challenges to completion are: lack of motivation or readiness on the part of the participant; a lack of access to stable housing or lack of access to other supports (especially residential treatment and quickly available and appropriate withdrawal management supports); and relapses/no movement towards a reduction in substance use.

It is important to note that the case studies point to positive and lasting benefits of DTC participation even if participants do not fully meet the criteria for graduation established by the DTC. Research also shows that DTC participation can have benefits for participants who fail to graduate from DTCs,38 although not as extensively as for those who do graduate. Devall et al. (2017) found that the length of time spent in the program contributes to reductions in recidivism, with longer time in the program resulting in less recidivism.39

4.3.2 Recidivism

The DTCFP-funded DTCs are widely believed to be effective in reducing recidivism, and the literature confirms that participation in DTCs reduces recidivism, although the estimated extent of this impact varies somewhat.

Reduced recidivism is one of the most common measures of the effectiveness of DTCs. However, determining the incremental impact of the program on recidivism is a methodologically demanding measure of performance. The evaluation found that other measures of program success are also relevant and the literature includes some more nuanced measures, such as the nature of re-contacts with the criminal justice system, impacts on substance use and an array of potential health and social outcomes.

The DTCFP recidivism study could not be completed in time to inform the evaluation. As a result, this evaluation report does not include an empirical study of the impact of the DTCs on recidivism.40 However, according to DTCIS data, there is limited recidivism during the program, where release from the DTCs is not typically due to new charges, with only a minority of participants (17%) being released for this reason.

Anecdotally, DTC stakeholders strongly believe in the effectiveness of the DTCs. Almost all surveyed stakeholders (90% or more) rate the DTCs as somewhat or very effective in terms of in-program outcomes (e.g., reducing drug use and risk of re-offending while the participant was in the program). The four DTC case studies also indicated that there has been a reduction in recidivism based on their internal tracking and ongoing contacts with participants after they complete the program. DTC team members observed participants make progress both in terms of how often they offend as well as notable decreases in the seriousness of new offences.

The anecdotal evidence from this evaluation is confirmed in more rigorous systemic reviews of the impacts of DTCs in peer-reviewed literature. However, it should be noted that there are a number of methodological challenges in many DTC recidivism studies. These are notably: ensuring that the comparison group is truly comparable to DTC participants; that methodological issues such as attrition and adequate follow-up data are addressed;41 and how concepts such as substance abuse and recidivism are operationalized.42 The definition of recidivism often differs between studies, with different lengths of time post-graduation examined and different criteria used for what constitutes re-offending. Other criticisms of the DTC literature include that studies have, to date, been theoretical, producing limited evidence on the factors or features of DTCs that contribute to successful outcomes.

Though their specific research design needs to be taken into consideration, many studies show a reduction in recidivism among DTC participants. A 2012 meta-analysis by Mitchell et al. (2012) reviewed 92 evaluations of DTCs in the United States and found there was an average drop in recidivism from participation in drug courts of 12% and the effects last for up to three years. Other studies show a similar impact of participation in DTCs reducing recidivism:

4.3.3 Substance Use and Other Outcomes

There is evidence that DTCs reduce substance use during the program, as well as provide other positive outcomes (social, employment) for participants.

The analysis of the DTCIS suggests that DTCs have a positive impact on substance use during the program. These data indicate that participants were administered an average of 32 urine drug tests during their time in the program, and 79% were found to be clean. Anecdotally, the case studies also supported the positive impact of the program in this area. The harm reduction approach within the DTCs insists on honesty, not abstinence during the program, and there were many examples of successes where participants’ substance use disorder was effectively addressed or managed by treatment services and consistent accountability before the court and DTC treatment team. Other empirical studies confirm this impact. In a multi-year longitudinal study of DTCs in the US (Rossman, 2011), the researchers found that in contrast to the comparison group, drug court participants were significantly less likely to report using any drugs, and if they had used drugs in the post-program period, participants used less serious drugs and less frequently. These self-reports were confirmed by testing.47

Participants talked about the many ways in which their physical health, relationships with family, and social skills had improved as a result of their time in the program. A few explicitly mentioned their program’s requirement to go to the gym; another discussed the lasting changes from a nutrition class. Many spoke about repairing relationships with family that had been damaged in the course of their addiction.
- Case study excerpt

The Whitehorse DTC (the Community Wellness Court) has helped connect homeless or unsuitably housed participants with stable housing, helped connect participants with chronic or other neglected health or dental issues with healthcare, and helped provide all participants with tools to comprehensively address their personal struggles with substance-use and mental health and wellness issues. All stakeholders, including participants interviewed, agreed that the health of participants improve through their engagement in the program.
- Case study excerpt

The case studies provided further illustrations of positive impacts of the program in other areas such as re-established relationships with family, including regaining custody of children, physical health, improved perceptions of the justice system and employment. Rossman (2021) found that drug court participants reported significantly less family conflict than comparison offenders; however, differences on other elements such as employment, homelessness, depression and family support were not significant.48  A systematic review of studies related to quality-of-life outcomes of DTCs found that there were “moderately positive results” in relation to substance use during the program (less use, less use of serious drugs). The review found few examples of studies that examined quality of life effects, although the review mentioned some positive impacts on participants’ employment when the DTC offered employment related interventions.49

4.3.4 Unintended Outcomes

While few unintended outcomes of the program were identified overall, the DTCs were seen to positively contribute to advancing the use of collaborative sentencing alternatives in the criminal justice system. For participants, a potential negative outcome of participation in the DTC is accumulating additional charges during the program.

Federal key informants viewed the DTCs as having a positive impact on the criminal justice system as a whole through the court’s collaborative and non-adversarial processes. The integrated nature of the DTC services was further perceived to act as a catalyst for thinking about how health and social services and the criminal justice system can work together.

Due to the rigours of the program, participants who are not ready or motivated to comply with DTC requirements may accumulate more charges (particularly administrative charges) when judicial conditions are breached, such as failure to appear in court and/or being caught breaching curfew or boundaries restrictions. The fact that DTC participants are required to be in court frequently, have strict bail conditions, and are generally subject to more scrutiny, makes them more susceptible to collecting administrative charges. Accumulating charges can result in disincentivizing participants to continue in the program or even apply to the program. The literature on DTCs also notes this phenomenon in the United States, where DTC programs can act as an add-on to incarceration when participants who are terminated from the DTC then begin their conventional sentence.50

4.4 Efficiency

4.4.1 Management of Grants and Contributions Funds

The DTCFP is efficiently delivered, with almost all of the funds being expended between 2016-17 and 2020-21.

During the years covered by the evaluation, the DTCFP expended $18.6M (99%) of the total $18.7M in Gs&Cs allocated (see Table 6 below). There was a small lapse in funding in 2018-19, but no other lapses occurred during the evaluation period. DTCFP direct program operations/administration account for a small proportion of total program costs during the study period.

Table 6: Gs&Cs Program Budget and Expenditures by Category
  2016-17 2017-18 2018-19 2019-20 2020-21 2016-17 to 2020-21

Budgeted

$3,646,000

$3,781,276

$3,725,000

$3,767,000

$3,746,000

$18,665,276

Expended

$3,646,000

$3,781,276

$3,725,000

$3,692,000

$3,746,000

$18,590,276

Lapse

0

0

0

$75,000

0

$75,000

Lapse %

0%

0%

0%

2%

0%

0.4%

Source: Justice Financial Management System

Funding for the DTCs is allocated after receipt of an application from PTs and a Departmental review process. Following approval, funding to PTs for their DTCs is transferred through five-year signed contribution agreements.

Following reception of financial claims by PTs and their review and acceptance by the Department, funds are transferred to cover the eligible operational/unique/direct costs of the DTCs (e.g., salaries, costs of urine testing and treatment costs).

Agreements under the DTCFP with the PTs range significantly in value from between $75K to $1M per year, and agreements can include multiple DTCs. The federal contribution cannot exceed $750,000 per site per fiscal year for the period of funding agreements. The PTs are not required to contribute to the budget line items per site supported by the DTCFP (and outlined in the contribution agreements), but they do cover costs associated with DTC operation.

4.4.2 Cost Effectiveness

Literature suggests that DTCs are a cost effective alternative to the traditional criminal justice response. This is achieved through addressing underlying addiction and criminogenic factors which, in turn, reduces the revolving door of contacts with the criminal justice system.

The evaluation of the DTCFP did not directly assess the cost effectiveness of the program due to the inability to conduct a recidivism study within the timeframe of the evaluation and lack of information on the total costs of the DTCs which also includes PT contributions.

The literature review found that the cost effectiveness of DTCs depends on factors such as the success and operational design and costs of the DTC, as well as the methodological approach used to calculate the costs and benefits. Studies that calculate cost effectiveness often do so on the basis of incarceration (not diversion or community-based sentences which are less expensive alternatives compared to incarceration) being the alternative to the DTC. The costs of incarceration are far higher than supervision of community-based sentences.51 Studies also look at the avoided justice system response costs when recidivism is reduced for DTC participants and some methodologies include indirect cost savings, such as reduced reliance on health and social services for participants in recovery.  

Studies and systematic reviews in the US indicate variable cost effectiveness ratios – for every $1 invested in DTCs, there is a return of between $2 and $10. 52, 53  The cost effectiveness of the program was found to be contingent on program fidelity to the key components of the DTC approach: “multidisciplinary team approach, an ongoing schedule of judicial status hearings, weekly drug testing, contingent sanctions and incentives, and a standardized regimen of substance abuse treatment.” 54 Rossman (2011) found a less compelling cost effectiveness ratio in a multi-site, multi-year DTC evaluation. According to this study, “the net benefit of drug courts is an average of $5,680 to $6,208 per participant, returning $2 for every $1 of cost, but these findings are not statistically significant.55  Rossman and others (Marlowe, 2010) found that there is greater DTC cost effectiveness for more serious offenders.

During the period under study, two DTCFP-funded DTCs conducted evaluations of their program that included an analysis of cost effectiveness. While the evaluations did not include a control group, the reported findings fall within the range of impacts identified in the literature.


Footnotes

8 Office of the Prime Minister (2019). Minister of Justice and Attorney General of Canada Mandate Letter.https://pm.gc.ca/en/mandate-letters/2019/12/13/minister-justice-and-attorney-general-canada-mandate-letter

9 Government of Canada (2021). Budget 2021. Part 3: A Resilient and Inclusive Recovery. https://www.budget.gc.ca/2021/report-rapport/p3-en.html

10 Government of Canada (2019) Delivering on Truth and Reconciliation Commission Calls to Action. https://www.rcaanc-cirnac.gc.ca/eng/1524502695174/1557513515931

11 Sparkman, D. (August 2020).“Drug Abuse on the Rise Because of COVID-19”, EHS Today website. https://www.ehstoday.com/covid19/article/21139889/drug-abuse-on-the-rise-because-of-the-coronavirus

12 Zaami S, Marinelli, E. and Varì ,M.R. (2020) New Trends of Substance Abuse During COVID-19 Pandemic: An International Perspective. Front. Psychiatry 11:700.

13 CTV News (2021). Overdoses, alcohol-related deaths increased in Canadians under 65 during pandemic: StatCan. https://www.ctvnews.ca/health/coronavirus/overdoses-alcohol-related-deaths-increased-in-canadians-under-65-during-pandemic-statcan-1.5506375

14 Statistics Canada (2021). Provisional death counts and excess mortality, January 2020 to April 2021. https://www150.statcan.gc.ca/n1/daily-quotidien/210712/dq210712b-eng.htm

15 CTV News (2021). Overdoses, alcohol-related deaths increased in Canadians under 65 during pandemic: StatCan. https://www.ctvnews.ca/health/coronavirus/overdoses-alcohol-related-deaths-increased-in-canadians-under-65-during-pandemic-statcan-1.5506375

17 CBC Radio (2021). 'No one's listening': As opioid-related deaths surge in Canada, advocates say there's little gov't support. https://www.cbc.ca/radio/thecurrent/the-current-for-may-20-2021-1.6033867/no-one-s-listening-as-opioid-related-deaths-surge-in-canada-advocates-say-there-s-little-gov-t-support-1.6036735

18 Government of Canada (2021). Responding to Canada’s opioid crisis. https://www.canada.ca/en/health-canada/services/opioids/responding-canada-opioid-crisis.html; Government of Canada (2021). Federal actions on opioids to date. https://www.canada.ca/en/health-canada/services/opioids/federal-actions/overview.html#a3

19 Government of Canada (2021). Canadian drugs and substances strategy. https://www.canada.ca/en/health-canada/services/substance-use/canadian-drugs-substances-strategy.html

20 Government of Canada (2021). Strengthening Canada’s Approach to Substance Use Issues. https://www.canada.ca/en/health-canada/services/substance-use/canadian

21 Wild, T.C, Koziel, J., Anderson-Baron, J., Asbridge, M., Belle-Isle, L., Dell, C.., Elliott, R., Hathway, A., MacPherson, D., McBride, K., Pauly, B., Strike, C., Galovan, A., and Hyshka, E. (2021). Public support for harm reduction: A population survey of Canadian adults. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0251860

22 Government of Canada (2021). Strengthening Canada’s Approach to Substance Use Issues. https://www.canada.ca/en/health-canada/services/substance-use/canadian

23 Department of Justice (May 2019). What we heard – Transforming Canada’s criminal justice system. https://www.justice.gc.ca/eng/rp-pr/other-autre/tcjs-tsjp/p1.html

24 Department of Justice (August 2019). Final report on the review of Canada’s criminal justice system. https://www.justice.gc.ca/eng/cj-jp/tcjs-tsjp/fr-rf/p1.html

25 Canadian Association of Chiefs of Police (2020). Findings and recommendations report: Decriminalization for Simple Possession of Illicit Drugs: Exploring Impacts on Public Safety and Policing. https://www.cacp.ca/index.html?asst_id=2189

26 Such as for example, supervised consumption sites.

27 Smelson, D., Shaffer, P.M., Posada Rodriguez, C., Gaba, A., Harter, J., Pinals, D.A. and Casey, S.C. (2020). "A co-occurring disorders intervention for drug treatment court: 12-month pilot study outcomes", Advances in Dual Diagnosis, Vol. 13 No. 4, pp. 169-182. 

28 Please note that 2015 and 2021 were excluded due to incomplete data, and 2020 was excluded due to the impact of COVID-19 and the implementation of government restrictions reducing the number of participants.

29 Public Prosecution Service of Canada (2020). Public Prosecution Services of Canada Deskbook, Part VI, 6.1 Drug Treatment Courts. https://www.ppsc-sppc.gc.ca/eng/pub/fpsd-sfpg/fps-sfp/tpd/p6/ch01.html

30 This concern was not often mentioned among survey respondents, but it was noted by a few respondents in an open-ended question on gaps.

31 In the Edmonton case study, it was also reported that Indigenous people are systematically offered bail less frequently and therefore, more likely to have pled guilty than other groups in the population which can contribute to the appearance of greater histories of entanglement with the law.

32 Department of Justice Canada (2018). Funding Agreement with YK / CWC and JWC, 2018-2023.

33 Department of Justice Canada (2015). Drug Treatment Court Funding Program Evaluation Final Report.

34 CTV News (July 2021). Overdoses, alcohol-related deaths increased in Canadians under 65 during pandemic: StatCan. https://www.ctvnews.ca/health/coronavirus/overdoses-alcohol-related-deaths-increased-in-canadians-under-65-during-pandemic-statcan-1.5506375; Statistics Canada (2021). Provisional death counts and excess mortality, January 2020 to April 2021. https://www150.statcan.gc.ca/n1/daily-quotidien/210712/dq210712b-eng.htm

35 Hoffart, I. (2020). Calgary Drug Treatment Court – 2019 Evaluation Report. http://calgarydrugtreatmentcourt.org/wp-content/uploads/2020/09/Calgary-Drug-Treatment-Court-2019-Evaluation-July-2020.pdf

36 Weinrath, M., Gorkoff, K., Watts, J., Smee, C., Allard, Z., Bellan, M., Lumsden,S., and Cattini, M. (2018). Accessing Diversion from Custody: Retention and Classification in a Drug Treatment Court. The Annual Review of Interdisciplinary Justice Research, Volume 7, 2018, pp.315-345.

37 Gorkoff, K., J. Watts, C. Smee, Z. Allard, M. Bellan, S. Lumsden, & M. Cattini. “Retention and Classification in Drug Treatment Court”, Annual Interdisciplinary Review of Criminal Justice, 2018.

38 DeVall, K.E., Gregory, P.D., and Hartmann, D.J. (2017). Extending Recidivism Monitoring for Drug Courts: Methods Issues and Policy Implications.  International Journal of Offender Therapy and Comparative Criminology 2017, Vol. 61(1) 80–99.

39 Ibid.

40 An upcoming recidivism study to be conducted by Statistics Canada will examine the impact of the DTCs on recidivism more thoroughly.

41 Drug Policy Alliance. (2011). “Drug Treatment Courts are Not the Answer.” https://drugpolicy.org/sites/default/files/Drug%20Courts%20Are%20Not%20the%20Answer_Final2.pdf

42 Logan, M. & Link, N.W. (2019). Taking Stock of Drug Courts: Do They Work?, Victims & Offenders, 14:3, 283-298, DOI: 10.1080/15564886.2019.1595249 https://www.tandfonline.com/doi/full/10.1080/15564886.2019.1595249?scroll=top&needAccess=true

43 Ibid.

44 Marlowe, D.B. (2010) Research Update on Adult Drug Courts. https://www.huntsvillebar.org/Resources/Documents%20CLE/2013/adc_research_update.pdf

45 Gutierrez, L., and Bourgon, G. (2012). Drug Treatment Courts: A Quantitative Review of Study and Treatment Quality. Justice Research and Policy. https://journals.sagepub.com/doi/10.3818/JRP.14.2.2012.47

46 Latimer, J., Morton-Bourgon, K., & Chrétien, J. A. (2006). A meta-analytic examination of drug treatment courts: Do they reduce recidivism?

47 Rossman, S.B., Roman, J.K., Zweig, J.M.,Rempel, M., and Lindquist, C.H. (2011). The Multi-Site Adult Drug Court Evaluation: Executive Summary. https://www.ojp.gov/pdffiles1/nij/grants/237108.pdf

48 Ibid.

49 Wittouck, C., Dekkers, A., De Ruyver, B., Vanderplasschen, W., and Vander Laenen, F. (2013) The Impact of Drug Treatment Courts on Recovery: A Systematic Review, The Scientific World Journal, vol. 2013, Article ID 493679, 12 pages, 2013. https://doi.org/10.1155/2013/493679

50 Drug Policy Alliance. (2011). “Drug Treatment Courts are Not the Answer.” https://drugpolicy.org/sites/default/files/Drug%20Courts%20Are%20Not%20the%20Answer_Final2.pdf

51 In Canada, the federal average the annual average cost of keeping an inmate incarcerated was $125,466 in 2017-18 (higher for men compared to women and costs fluctuate across PTs with higher costs associated with smaller and Northern jurisdictions). The cost associated with a community sentence was $32,327 (74% less). https://www.publicsafety.gc.ca/cnt/rsrcs/pblctns/ccrso-2019/index-en.aspx#b3

52 Legislative Services Agency of Iowa. “Cost-Benefit Analysis of Drug Courts”, Issue Review, December 20, 2013. https://www.legis.iowa.gov/docs/publications/IR/24325.pdf

53 Hazeldean Betty Ford Foundation website. https://www.hazelden.org/web/public/ade60612. Page accessed March 2021.

54 Marlowe, D.B. (2010) Research Update on Adult Drug Courts. https://www.huntsvillebar.org/Resources/Documents%20CLE/2013/adc_research_update.pdf

55 Rossman, S.B., Roman, J.K., Zweig, J.M., Rempel, M., and Lindquist, C.H. (2011). The Multi-Site Adult Drug Court Evaluation: Executive Summary. https://www.ojp.gov/pdffiles1/nij/grants/237108.pdf