Standards on Substance Abuse
VI. Indications of Substance Abuse. All judges and court
personnel should look for indications of substance abuse that may
be a factor related to a case before the court.
of Substance Abuse in Criminal and Delinquency Cases
There can be at least seven
sources of information which suggest that substance abuse may be
a factor related to the case:
1. The offense title.
Any criminal offense can involve substance abuse. For some offenses,
however, substance abuse generally appears more likely - a drug
or alcohol related offense, disorderly conduct, disturbing the peace,
assault and battery, malicious destruction of property, leaving
the scene of an accident, breaking and entering, larceny, prostitution,
2. The actual allegations.
The statement that an offense was committed while the defendant
was under the influence of drugs or alcohol or was otherwise related
to substance abuse may appear in the information provided by the
District Attorney, such as the police report, or in the clerk's
file, among allegations presented at the hearing on an application
for a criminal complaint.
3. The criminal record.
In general, a history of offenses which probably involve substance
abuse may be discerned from a defendant's criminal record. Even
a first offense, however, may merit inquiry regarding substance
4. Abuse prevention
order. In cases when an order against domestic violence
is sought in connection with the criminal complaint or has been
issued previously, the affidavit in support of the application may
allege substance abuse or reveal facts suggesting substance abuse.
5. A party's demeanor
or physical appearance. Substance abuse may be indicated
if the party appears agitated, glassy-eyed, unkempt, or unsteady,
or if the party smells of alcohol. Judges and other court personnel
should be aware, however, that slurring of speech or tremors can
also be symptoms of neurological or metabolic illnesses.
6. A party may identify
himself or herself as a substance abuser, and request referral
to a detoxification center or treatment program.
7. The victim
of a crime, the police officer, a family member, or others may provide
information about an offender's substance abuse.
Indications of Substance Abuse in Civil Cases
In cases involving divorce
or paternity-related custody, termination of parental rights, guardianship
of minors, or applications for restraining orders under G.L. c.
209A, factors similar to those listed for criminal cases may indicate
that substance abuse is involved. In addition, substance abuse may
be present if the parents are alleged to have left children unattended
or to have frequently left children with friends or neighbors while
staying out late, or if parents are charged with a criminal offense.
In other kinds of cases, substance abuse may be indicated by sudden
or persistent financial difficulties.
Determination That Substance Abuse Is a Factor.
Judges and court personnel
should be alert to other interpretations of the indications listed.
Counsel may wish to be heard on the issue of whether substance abuse
is a factor in the case.
STANDARD VII. Screening.
If there is an indication that substance abuse is a factor in a
case, at the earliest stage and at any stage, the court is encouraged
to use tools for prompt screening. Screening is a mechanism for
rapid initial determination whether it is appropriate for a person
to undergo a substance abuse assessment (as provided in Standard
VIII) or to participate in a treatment program. In performing
screening, courts should observe applicable constitutional and statutory
safeguards, including the right to counsel and the privilege against
The purpose of screening is to provide the court rapidly with information
regarding any drug or alcohol factor in a case. Screening results
usually provide a sufficient clinical basis for a court order directing
a person to appear for a substance abuse assessment (as provided
in Standard VIII) and to undergo treatment,
but in some cases the judge may prefer to refer the person for a
substance abuse assessment before ordering treatment. The probation
department is responsible for conducting screening and recommending
whether a substance abuse assessment is appropriate.
Screening is the first stage
of the diagnostic process, but an assessment is necessary for full
and clear understanding of a party's substance abuse. Screeners
look for possible abuse of alcohol or other drug; primary substance
used, if any; symptoms of acute mental health problems; signs of
acute intoxication or withdrawal; other medical problems, particularly
infectious diseases such as HIV/AIDS or tuberculosis; motivation
or readiness for treatment; criminal history; prior involvement
in treatment; and use of psychotropic medication.
Judges and other court personnel
should be aware that a defendant or party who is shaking or suffering
from flu-like symptoms may need detoxification, a medical intervention
to manage withdrawal symptoms caused by abstinence from alcohol
or drugs. Since such withdrawal can cause very serious medical problems,
and can be life-threatening in the case of alcohol, the judge should
initiate an appropriate response, such as directing the probation
department to refer the person to a treatment facility or, if involuntary
commitment is necessary, initiating a commitment for detoxification
pursuant to G.L. c. 123, §35. If the person is remanded to the House
of Correction, the mittimus should make a clear statement
concerning the need for detoxification.
Even if a screening cannot
be performed, courts should consider the indications of substance
abuse to the extent allowed by law.
STANDARD VIII. Assessments.
When the court has determined as a result of a screening that substance
abuse is a factor in the case and has issued or is considering a
court order of substance abuse treatment, a substance abuse assessment
should be conducted under the direction of the probation department,
in order to determine which form of treatment will be most appropriate
The purpose of this standard is to assure that court-ordered treatment
will be based on comprehensive information regarding a party's drug
or alcohol abuse. An assessment should be done and considered by
the court at each stage of a case when the court is considering
a change in a party's status. An assessment is an in-depth process
to determine a person's specific treatment needs, which takes much
longer than a screening. An assessment is an evaluation performed
under the direction of the probation department by a qualified clinician
or other qualified substance abuse professional. In general, the
probation department should refer parties to treatment providers
for substance abuse assessments, but some probation officers have
the requisite training and experience to conduct substance abuse
assessments. Probation officers should be alert to mental health
problems which compound substance abuse problems, and, in cases
involving major mental illness in addition to substance abuse, the
probation department should use the court clinic or an outside vendor
with mental health expertise to conduct the assessment. The treatment
provider to which the party is eventually referred should always
conduct its own clinical assessment, in order to confirm that the
referral is appropriate, design a treatment plan, and engage the
party in the treatment.
A court-ordered substance
abuse assessment should determine whether and to what extent a party
is using substances, evaluate the party's suitability for treatment,
determine whether and what treatment is appropriate, and establish
the degree of risk to the community due to the substance abuse of
a defendant or convicted offender in a criminal case. If treatment
is appropriate, the assessment should result in a recommendation
for treatment appropriate to the party's needs, for a specific time
in a designated residential facility or community placement, with
proposed monitoring requirements. The assessment should include
information regarding any insurance coverage available to the party,
including coverage, or eligibility for coverage, by the Massachusetts
Medical Assistance program. The assessment should consider all available,
relevant information regarding the party, including, where applicable,
substance abuse history; mental health history; other areas of psychosocial
history and functioning, such as medical and health status; employment
and job status; social and family relationships; educational status;
legal status (current case and other pending or active cases); treatment
history, including responses to and compliance with treatment; prior
experience with self help recovery groups; motivation or readiness
for treatment; resources and limitations affecting ability to participate
in treatment; learning or other developmental disabilities; and
family history of mental health and substance abuse disorders.
STANDARD IX. Treatment
Matching. Court-ordered treatment should match
the party's treatment needs, and should be selected on the basis
of expert information about what type of treatment will work best
for the party, with full consideration of public safety.
treatment should be based on the court-ordered assessment and the
treatment recommendation resulting from the assessment, including
the manner of payment for the treatment recommended. The treatment
recommendation should address the party's needs, if any, for educational
assistance, psychological or psychiatric services, vocational services,
and social skills training. If an assessment is conducted before
the issuance of the treatment order, the probation department, with
the judge's approval, should make all relevant information and recommendations
available to the court, the parties, and their attorneys, within
a reasonable time prior to the issuance of a treatment order. See
Massachusetts Rules of Criminal Procedure 28(d)(3) regarding access
to pre-sentence reports. The objective of matching treatment to
the party's treatment needs is to match the intensity of the intervention
to the severity of the substance abuse problem. It involves consideration
not only of the individual qualities addressed by the assessment,
including the severity of the dependency and the support structures
available to the person through family, work, school, and peers,
but also of the latest available information about the effectiveness
of treatment programs. Appropriate matching, using only those resources
and restrictions called for by the substance abuser's problem, greatly
enhances the effectiveness of treatment, is essential in addressing
relapse and reducing recidivism, and promotes the efficient use
Self-help recovery groups,
such as Alcoholics Anonymous and Narcotics Anonymous, are typically
part of a good, comprehensive treatment plan. For example, if a
treatment program slot is not immediately available, the judge may
order that the party abstain from alcohol or drugs (as provided
in Standard XI) and suggest
that he or she should participate in a self help recovery program
in order to comply with the abstinence order. Such participation
can be a valuable interim action. Participation in a self-help recovery
group can also be an essential adjunct to treatment and a means
of sustaining recovery. The judge should allow the party the option
of attending either AA/NA meetings or other daily self help recovery
meetings that do not conflict with his or her religious beliefs.
STANDARD X. Recommendations
to Correctional Authorities. Criminal courts should indicate
to correctional authorities on the mittimus when a defendant
has a substance abuse problem, to assist in classifying the inmate
and addressing treatment needs. Judges are encouraged to recommend
a particular treatment program or a particular institution on the
mittimus. Courts should also provide correctional authorities
with the results of court-ordered assessments and any other relevant
information that will assist in the classification of the inmate.
The purpose of this standard is to encourage courts to make recommendations
directly on the defendant's mittimus to the sheriff's department
or Department of Correction in an effort to provide correctional
authorities with information about a defendant's substance abuse
problem and to promote the placement of a defendant in an appropriate
substance abuse treatment program operated by correctional authorities.
Since most defendants are released eventually, public safety is
served and recidivism is less likely when treatment is provided
in the institution. Judges and probation officers should familiarize
themselves with treatment programs in jails and prisons, including
eligibility requirements, and, if possible, waiting lists, in order
to recommend a particular treatment program or institution on the
mittimus. Whenever possible, judges and probation officers
are encouraged to obtain personal knowledge about available treatment
programs. This knowledge will not only inform sentencing decisions,
but also will permit judges to explain sentences more accurately
to the public. This standard will also help to expedite the classification
of offenders held without bail or sentenced to short terms of incarceration.
The Office of the Commissioner
of Probation, in consultation with the Standing Committee on Substance
Abuse, should develop, distribute, and maintain a directory of substance
abuse treatment programs run by correctional institutions that includes
each program's address, contact person and title, eligibility requirements,
duration, process of referral, treatment method, and program capacity.
The directory of institutional treatment programs should be organized
by regions. The Office of the Commissioner of Probation may combine
the directory of institutional treatment programs with the directory
of community treatment providers recommended in Standard
One way of assuring that correctional
authorities are alerted to substance abuse issues would be to add
a check-off box for substance abusers to the mittimus form.
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