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Date: November 22, 2024 Fri
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2 results foundAuthor: Scottish Government Title: Rights, Respect and Recovery: Scotland's Strategy to Improve Health by Preventing and Reducing Alcohol and Drug Use, Harm and Related Deaths Summary: Ministerial Foreword In the ten years since the publication of Scotland’s previous alcohol and drugs strategies we have seen a lot of positive change. I am proud of the successes achieved over this period, driven by Alcohol and Drug Partnerships, our nationally commissioned organisations, Health Boards, Councils, Integration Authorities, Third Sector Organisations, Mutual Aid Organisations, but also, crucially, by individuals, their families and wider communities. A key success to improving outcomes for individuals, families and communities has been the introduction of minimum unit pricing for alcohol, the establishment of recovery oriented systems of care, and the growth of over 120 recovery communities throughout Scotland. The introduction of a waiting times standard is also a worthy achievement, as is the introduction of the world’s first take home naloxone programme, an initiative which we are confident has saved lives. We have also provided a vision that recovery is possible, recognising that each recovery journey is unique. But we also recognise that through an increasing visibility of recovery, we can begin to tackle some of the issues of stigma and discrimination that affect so many individuals and family members. Despite our other successes, over the last five years we have, tragically, seen a sharp increase in drug related deaths across Scotland. Although alcohol deaths are not rising at such a rate, any loss of life weighs heavily on me personally, but it also takes a toll on Scotland’s communities and all of us as a nation. Everyone has the right to health and to live free from the harms of alcohol and drugs. Everyone has the right to be treated with respect and dignity and for their individual recovery journey to be fully supported. This strategy is, therefore, about how we best support people across alcohol and drug issues - taking a human rights-based, public health approach to ensure we are delivering the best possible care, treatment and responses for individuals and communities. There is a growing awareness that those experiencing problematic alcohol and drug use are often carrying other burdens such as poverty, inequality and health challenges. This means they need to be supported rather than be stigmatised. Treatment services and organisations in Scotland are already jointly tackling the harms caused by alcohol and drugs and this new strategy reflects that - bringing together our approach to tackling the problematic use of alcohol and drugs for the first time. We live in a changing landscape in which fewer young people are using alcohol and drugs. However, a significant number of the group of people who need our urgent help are older and less healthy. Consequently, they are more vulnerable. That's why the commitment of additional investment of £20m a year mustn't simply lead to more of the same – it must unlock innovation and ways of opening up services and making them attractive to those for whom the current support isn’t right. All our investment must be seen to be working for the benefit of the people we serve. It is vital that we recognise the challenges still faced by people and families. We know that quick access to treatment is crucial and that, for the huge majority, being in treatment has a protective effect. It is, therefore, important that we have a range of services for different people with different needs - from harm reduction measures which can help the most vulnerable, through to treatment and recovery services that support not only individuals, but also their children and families. It is also vital that we recognise the challenges that services and frontline workers are meeting in 2018. The dedication and commitment of front-line workers needs to be celebrated and commended. Together we need to build on that, to reduce the numbers of people who require services and to achieve better outcomes for those who are currently using them. Achieving the outcomes set out in this strategy will be a challenge and one we can only achieve by working together – people with lived and living experience, delivery partners, service providers, decision-makers, funders and the research community. Adopting a public health approach also requires us all to think about how best to prevent harm, which takes us beyond just health services. This, requires links into other policy areas including housing, education and justice. It also means supporting responses which may initially seem controversial or unpopular, such as the introduction of supervised drug consumption facilities, but which are driven by a clear evidence base. Supporting a better response to those harmed by alcohol and drugs is one of the hardest and most complex challenges we face as a country. The harms are real and will persist alongside the often inspiring stories of lives saved. It ought to be the work of all of us, together, to improve our response – recognising: the rights of people, their families and their communities; the need to treat people with respect; and that all individuals will be supported on their own, unique, recovery journey. Joe FitzPatrick, MSP Minister for Public Health, Sport and Wellbeing Details: Edinburgh, Scotland: Scottish Government, 2018. 65p. Source: Internet Resource: Accessed January 9, 2019 at: https://www.gov.scot/binaries/content/documents/govscot/publications/publication/2018/11/rights-respect-recovery/documents/00543437-pdf/00543437-pdf/govscot%3Adocument Year: 2018 Country: United Kingdom URL: https://www2.gov.scot/Publications/2018/11/6342 Shelf Number: 154057 Keywords: Alcohol Use Drug Related Deaths Drug Use Harm Reduction Human Rights Approach Inequality Poverty Recovery Scotland Substance Abuse Treatment |
Author: Schleifer, Rebecca Title: Drug Courts in the Americas Summary: Executive Summary Drug courts in the United States are presented as an alternative to incarceration for people arrested for minor drug offenses where drug use is considered an underlying cause of the crime, thus theoretically serving as a tool for reducing prison and jail populations. The United States has nearly thirty years of experience with these courts, which have spread to all fifty states as well as US territories. Many countries around the world have looked to the United States' experience with drug courts as a model to be adopted, and the US government has also promoted them abroad as an alternative to incarceration. Perhaps the most organized efforts to expand this policy are those currently underway in Latin America and the Caribbean. The considerable influence of the United States on the region's drug control policies has certainly encouraged many of its countries to view drug courts as such an alternative, and the growing number of countries implementing them signals that these efforts are moving ahead with full force there. The Canadian government has also worked to support the expansion of drug courts, particularly in the Caribbean, but this report does not focus on the Canadian model. Proponents of drug courts assert that they are cost-effective; they reduce recidivism as well as time spent in detention (prison or jail); and they offer drug treatment as an alternative to incarceration to people whose drug use fuels their criminal activity. To evaluate these assertions, this report reviews key findings from the United States' experience which, despite major institutional, legal, and cultural differences, may usefully inform debates about drug courts, along with other alternatives to incarceration for low-level drug crimes, in other countries - in particular, in countries in Latin America and the Caribbean that have either established, or are looking to establish, drug courts. This report also presents a brief overview of where and how drug courts have been implemented in Latin America and the Caribbean to identify, to the extent possible, the different experiences and challenges faced by those countries. One main difficulty in this exercise is the limited availability of data that would allow strong parallels to be drawn. As is the case with the United States, with rare exceptions, drug courts in Latin America and Caribbean are not independently monitored and evaluated, and most were established relatively recently. Nevertheless, we have found the information available points to fundamental problems with the implementation of drug courts; the findings from the United States experience could, at the very least, offer insight into whether and under what circumstances they provide a more desirable option than incarceration. The US section is based on review of the existing research on drug courts and treatment for substance use disorders and evaluations of drug court efficacy conducted and published by the US government, major research institutions, advocacy organizations, and leading scholars whose work focuses on drug courts specifically or on criminal justice, substance use disorders, drug treatment, and drug policy more broadly. The Latin America and Caribbean sections are based on a review of their available information on drug courts (which is significantly more limited than the vast literature available in the United States), as well as on research on criminal justice, incarceration, drug treatment, and drug policy, responses to requests for information, and interviews. Also reviewed for each country are laws, official documents (including memoranda of understanding, government documents and web pages, judiciary reports, PowerPoint presentations made by authorities, and international organization documents, among others), studies and evaluations (when available), and, in a few cases, news reports. The substantial diversity among drug court models complicates efforts to evaluate their impact on the problems they aim to address, but our review of the existing evidence shows the claim that drug courts provide an alternative to incarceration is debatable. We found that drug courts, as implemented in the United States, are a costly, cumbersome intervention that has limited, if any, impact on reducing incarceration. Indeed, for many participants, they may have the opposite effect by increasing criminal justice supervision and subjecting those who fail to graduate to harsher penalties than they might otherwise have received, thus becoming an adjunct rather than an alternative to incarceration. Moreover, evidence about their effectiveness in reducing cost, recidivism, and time spent in prison is mixed. The financial and human costs to drug court participants are also steep and disproportionately burdensome to the poor and racial minorities. The evidence also does not support drug courts as an appropriate public health intervention. Drug court judges are empowered to make treatment decisions that should be the domain of health care professionals, choosing from limited or counterproductive options that may threaten the health and lives of participants as well as expose confidential information about their health and drug use. One of the main stated objectives of drug courts is to ensure access to comprehensive substance abuse treatment for those who need it. Our review of the available evidence shows, however, that, in practice, many drug court participants do not need treatment; at the same time, treatment may be unavailable to or inappropriate for those who do. Evidence we have found indicates the resort to drug courts may be an appropriate measure for certain offenders - that is, people charged with serious crimes linked to their drug dependence who would otherwise serve prison terms. What is often not considered is that most drug courts do not meet this definition. More important, we must remember that drug dependence treatment is a type of medical care. People who are dependent on drugs have a right, under international human rights law, to relevant health care services that are available, physically and economically accessible without discrimination, gender appropriate, culturally and ethically acceptable, designed to respect confidentiality, scientifically and medically appropriate, and of good quality. By mediating treatment through the criminal justice system, drug courts aggressively insert the penal system into people's private and family lives and into their decisions about their health and medical care, reproducing and perpetuating the criminalization of people who use drugs and those involved in low-level drug-related crimes. As an overall framework through which to think about drug courts, we should not lose sight of the fact that no individuals, regardless of their criminal records, should be punished for their medical conditions, nor should they have to allow courts to make their medical decisions for them or rely on the criminal justice system for access to treatment that could perhaps have prevented their incarceration in the first place. The primary lessons learned from US drug courts that should be considered by other countries in the Americas as they look at this model are the following: Drug courts are not an alternative to incarceration: - Defendants remain in criminal proceedings at every step in the drug court program, risk incarceration, both as a sanction while in the program and for failure to complete it, and, in some cases, spend more time behind bars than they would have had they chosen to pursue criminal justice proceedings instead of drug court. Drug courts may increase the number of people under supervision of the criminal justice system in the following ways: - By requiring them to plead guilty as a condition of getting access to drug court. - By processing discretionary crimes that police might have not enforced had drug court not been an option. - By mediating treatment through the criminal justice system. Drug courts are not a rights-based health intervention: - Drug court judges maintain control over treatment decisions for drug court participants, in some cases ordering treatment that is at odds with accepted medical practice. - Participants who fail drug court risk incarceration and face abrupt interruption of treatment and other health risks attendant to incarceration. - Access to treatment comes at the cost of forfeiting fundamental legal and human rights. Drug courts may perpetuate racial bias in the criminal justice system: - Drug courts point to drug dependence as the factor that puts people at risk of criminal justice involvement, ignoring the racial bias in drug policing and prosecution in the United States that leads African Americans and Latinos into long-term criminal justice supervision at much higher rates than their white counterparts. Further complicating this scenario is the concerted effort to export drug courts as a model that should be adopted by other countries. Despite the evidence from the United States experience cited above, countries in Latin America and the Caribbean have embraced drug courts as a promising solution to the over-incarceration problem that plagues the region. This development is problematic not only because governments in the region apparently are not conducting proper investigations before adopting drug courts as a public policy model, but also because the very specific social, economic, and political context of Latin American and Caribbean countries immediately complicates the adoption of public policies designed by other, more developed countries with different legal systems. The lack, for example, of scientifically and medically appropriate treatment options and the reliance on private providers is a serious issue in the Latin America and Caribbean region, where numerous cases of abuse and human rights violations by treatment providers have been documented. Furthermore, health systems do not have enough capacity to provide health and social services to all the people who need them; in these cases, private and religious institutions with scarce knowledge about drug dependence, treatment, and medical standards are used. A reliance on abstinence-based treatment programs and drug testing is also of concern. On the criminal justice side of the issue, many drug courts in the region still focus on simple drug possession as a crime, contributing to the criminalization and stigmatization of people who use drugs. Research about drug courts in Latin America and the Caribbean also underscores the need for a more rigorous data management system that can provide sufficient information for a comprehensive assessment of their effectiveness in the region. Currently, research is too dependent on anecdotal evidence and not focused on evidence-based analysis. This report's main findings about drug treatment courts in Latin America are as follows: - Generally speaking, detailed and current data are lacking in almost all the Latin American countries studied, and independent evaluations are scarce. - The model is more advanced in three countries (Chile, Mexico, and Costa Rica) and in a pilot phase in four others (Argentina, Panama, Dominican Republic, and Colombia). Ecuador and Peru are also considering whether to establish drug courts. - Most programs in the region were established in 2012 or later, except for the Chilean model, which was implemented in 2004. - Drug courts in Latin America function as specific programs within the legal jurisdictions where they have been established rather than as special courts. They function under the conditional suspension of criminal proceedings mechanism and adopt a pre-plea approach that diverts participants before conviction. - Candidates must meet two basic requirements to enter the programs: they must be prosecuted for an eligible offense, and they must receive a diagnosis of problematic drug use related to the commission of the crime. - Only people charged with what the local jurisdictions consider to be minor and/or nonviolent rimes (charges carrying sentences of no more than three to five years in prison) are accepted in the programs. - Many programs carry harsh penalties as sanctions during the course of treatment. - In most programs, participants must be first-time offenders. - In contrast to the US experience, Latin American drug treatment courts graduate few participants. - The drug courts in the region most commonly address crimes against property, domestic violence, and drug possession. Based on available information, simple possession is one of the most frequent crimes in drug court programs that include drug offenses (those in Chile, Dominican Republic, Mexico, and Panama). - Most participants in drug court programs are male. - Juvenile courts have been established in Chile, Colombia, Costa Rica, and Mexico, and other countries plan to create such programs. - Much as in the United States, participation in Latin American drug courts typically requires that participants remain drug free and sometimes sanction them for positive drug tests. - Most countries clearly lack the capacity to provide appropriate treatment to all program participants. This report's main findings about drug treatment courts in the English-speaking Caribbean are as follows: - Much as in Latin America, detailed and current data are lacking in almost all the Caribbean countries studied, and no independent evaluations of drug courts have been done. The information available is mostly from government sources. - The earliest drug court programs in the Caribbean were established in 2001 in Bermuda and Jamaica (making these the oldest programs in the Latin America and Caribbean region), with other countries (the Cayman Islands, Trinidad and Tobago, Barbados, and Belize) establishing drug courts in 2012 or later. - The drug court model is more advanced in three countries (Bermuda, Jamaica, and the Cayman Islands) and in an initial phase in three others (Trinidad and Tobago, Barbados, and Belize). The Bahamas seems to be interested in establishing drug courts. - Drug courts in the Caribbean are not specialized courts as in the United States but, rather, operate as specific programs under local lower (parish/magistrate’s) courts, as in Latin America. The drug treatment courts in Caribbean countries operate under different legal structures. Bermuda, the Cayman Islands, and Jamaica have enacted specific legislation, while Barbados, Belize, and Trinidad and Tobago have signed memoranda of understanding with the Organization of American States' Inter-American Drug Abuse Control Commission (CICAD). The Canadian government has directly supported the implementation of drug courts in a few Caribbean countries. - The basic requirements for admission to drug court are to be charged with an eligible offense and receive a diagnosis of problematic drug use related to the commission of the crime. - Only people charged with what the local jurisdictions consider to be minor and/or nonviolent crimes are accepted in the programs, with the exception of Jamaica, where people charged with certain more serious crimes may be eligible. Participants must be first-time offenders. - Jamaica is the only country in the English-speaking Caribbean where a guilty plea is not a requirement for admission. - The information available suggests that few participants graduate from Caribbean drug courts. - The drug courts in the region most commonly address crimes against property and drug possession. Based on available information, simple possession is one of the most frequent crimes in drug court programs that include drug offenses. - Most participants in drug court programs are male. - Juvenile courts have been established in Jamaica, and reports indicate the Cayman Islands and Trinidad and Tobago are exploring the possibility of establishing such programs. - Many programs carry harsh penalties as sanctions during the course of treatment. - Participation in Caribbean drug courts typically requires that participants remain drug free, and they rely on drug testing to assess compliance, with sanctions imposed for positive drug tests. - Information about treatment standards and options available is scarce, but our research suggests most countries in the region lack the capacity to provide appropriate treatment to all program participants. Undoubtedly, the creation of alternatives to the criminal justice system for drug-related offenses is urgently needed, and countries should focus on moving away from an excessive reliance on incarceration as a panacea. Nonetheless, a close examination of the United States as a case study does not support the drug court model as the most appropriate solution for governments genuinely focused on addressing this issue, since in some respects it continues to criminalize drug consumption and prioritize a criminal approach to drug dependence over a health approach. Hence, this report presents a series of recommendations that should be seriously considered by countries concerned with mass incarceration and intent on moving away from over-reliance on criminal justice responses to drug use. We developed the recommendations with two groups in mind: countries that have not established drug courts or in which they are in early stages, and countries in which drug courts are more established and their continuation is overwhelmingly supported, thus making it difficult (but not impossible) to address the issues raised here. Details: New York, NY: Social Science Research Council, 2018. 126p. Source: Internet Resource: Accessed January 20, 2019 at: https://www.ssrc.org/publications/view/drug-courts-in-the-americas/ Year: 2018 Country: International URL: https://s3.amazonaws.com/ssrc-cdn1/crmuploads/new_publication_3/DSD_Drug+Courts_English_online+final.pdf Shelf Number: 154312 Keywords: Alternatives to IncarcerationCaribbeanData Management SystemDrug CourtsDrug CrimesDrug OffensesDrug PossessionDrug Treatment CourtsInter-American Drug Abuse Control Commission (CICAJail PopulationLatin AmericaPrison PopulationPublic Health InterventionRacial BiasRecidivismSubstance UseSupervisionTreatment |