Supreme Judicial Court
Standards on Substance Abuse

COMMENTARY: Some substance abusers erroneously believe that they can use alcohol or drugs in moderation without adverse consequences. Overwhelming clinical evidence demonstrates that the use of alcohol while in recovery from drug addiction, or the use of drugs while in recovery from alcohol addiction, is a clear indication that the substance abuser is not yet in recovery or has failed in recovery. ⁽⁵⁾ Accordingly, once the judge has concluded that a party's substance abuse is a factor in the case, in supervising criminal and civil cases and in establishing court ordered substance abuse conditions, the judge should specifically and unambiguously prohibit the party from all use of alcohol and illicit drugs and the abuse of prescribed drugs. Compliance with such a prohibition order should be enforced through the drug testing called for in Standard XII.

STANDARD XII. Monitoring Compliance. Every court should intensively monitor compliance with court-imposed treatment conditions. Tools available should include drug testing, verification of attendance at counseling sessions and self help recovery meetings, and communication with treatment providers. Tools for monitoring compliance, such as drug testing and breathalyzers, should be available in every courthouse and drug testing results should be made available to the court as quickly as possible. The court should inform every person who is subject to court ordered treatment conditions that non-compliance with the conditions will have consequences and the court should directly and expeditiously address any non-compliance.

COMMENTARY: The probation department should monitor compliance by means of drug and alcohol testing; verification of attendance at self help recovery meetings; frequent progress reports from the treatment provider; and, wherever possible, day and nighttime visits at the person's home, school, place of work, or treatment provider. In order to facilitate such monitoring, the probation department should obtain the person's signed consent to provide the treatment provider with relevant information in the person's probation case file, such as the person's criminal record and treatment history. ⁽⁶⁾ (See also Standard XIV, Commentary, first paragraph.) The benefits of compliance and the consequences of non-compliance with drug or alcohol testing and treatment - such as modification of the conditions of probation or probation revocation - should be clearly and emphatically made known to the party. Positive tests, failure to submit to tests, and failure to attend counseling sessions or self help recovery meetings are serious matters and should be addressed promptly by the court. See Standard XIII for further suggestions about how to address non-compliance using graduated sanctions or consequences.

Conversely, if a party is complying with treatment conditions, positive reinforcement is also a valuable aid to recovery.

STANDARD XIII. Relapse. Every court should implement strategies to prevent relapse of a substance abuser who is in recovery and be prepared to address relapse. The strategies should include a plan for imposing graduated sanctions or consequences. The court should inform every party that relapse will have consequences.

COMMENTARY: Relapse is a stalling or slowing of a person's recovery process, when a person's unmet needs lead to stress and recovery difficulties. Relapse is not an event, but a process, in which the stress keeps building and the person becomes increasingly isolated, confused, and overwhelmed. Without an intervention, the person will often return to substance abuse. Often a relapse means that a person has reached an impasse in his or her recovery, sometimes called a "stuck point." The processes of relapse and recovery are intimately related to one another. The process of relapse can be interrupted by making a needed intervention, such as the responses noted below, which may resolve the person's recovery problems.

Relapse prevention techniques can provide people with an understanding of their own relapse warning signs, so that they will know when their recovery is in trouble and that they need to address their problems immediately.

Recovery is a lengthy process, and substance abuse cannot be "cured" any more than other chronic disease, such as diabetes, hypertension, or asthma, can be cured. ⁽⁷⁾ People can, however, be taught to manage their substance abuse by remaining abstinent and following recovery principles. It is just as important to understand relapse and to support behavior change as it is to enforce treatment conditions vigilantly and supervise people closely. See Commentary to Standard XIV, sixth paragraph, for the suggestion that courts should refer parties only to treatment providers which offer comprehensive relapse prevention services.

It is of vital importance that courts understand relapse, anticipate relapse, be prepared to deal with it, and respond to it promptly. The appropriate response to a relapse must be fashioned based on each person's individual needs, history of substance abuse, and previously utilized treatment modalities. Graduated responses are generally appropriate, including ordering or increasing drug testing, increasing frequency of attendance at outpatient or day treatment services or recovery meetings, increased supervision, and ordering in-patient detoxification or residential placement. In some cases, an offender's behavior or uncooperative attitude will present such a clear or immediate threat to public safety that probation revocation and incarceration are the only appropriate responses.

STANDARD XIV. Standards for Treatment Providers. Courts should order substance abuse treatment through providers licensed by the Department of Public Health (DPH) to treat substance abuse, licensed by the Department of Mental Health (DMH) to treat mental illness, jointly licensed by DPH and DMH to treat both substance abuse and mental illness, or approved by the Probation Department or the Office of Community Corrections as qualified to provide substance abuse treatment. Subject to established rules of confidentiality, the Probation Department should require providers to communicate regularly and candidly with the court regarding a party's compliance with court-ordered behavior and treatment.

COMMENTARY: The Commissioner of Probation and the Office of Community Corrections should promulgate criteria for courts to use in selecting treatment providers to receive court referrals. These criteria should not apply to self help recovery groups such as Alcoholics Anonymous or Narcotics Anonymous. Referrals to providers should not involve even the appearance of a conflict of interest. The criteria for treatment providers should include at least the following:

1) As a condition of court-ordered treatment, the provider should require the party to sign a release authorizing the provider to disclose information to the probation department about the party's progress in treatment and compliance with treatment orders. The release should state how much and what kind of information is to be disclosed, but the release should not be unlimited: it should not call for the disclosure of all confidential communications between the party and the treatment provider. This release should be in addition to the consent kept in the files of the Probation Department under Standard XII, and, in a criminal case, neither the consent nor the release should be rescinded during the period of probation supervision. See 42 CFR Ch. 1, Subpart C, §2.35(c).

2) The provider's treatment staff should be available to consult with the Probation Department to the extent allowed by the terms of the release.

3) The provider should submit periodic, written progress reports to the probation officer which disclose the party's attendance record, compliance with treatment orders, and any drug testing results, and should submit a written report in case of any non-compliance.

4) The provider should notify the probation department immediately with respect to any serious non-compliance, including any positive drug tests of the party.

5) The provider should furnish the court with a final discharge report when the party completes the treatment. The reason for the discharge should be clearly documented.

6) The provider's treatment protocol should include comprehensive relapse prevention services delivered according to a model of proven effectiveness.

STANDARD XV. Treatment Directory. To assist in the identification of treatment resources, the Commissioner of Probation, in consultation with the Department of Public Health, should maintain an updated directory of treatment providers. ⁽⁸⁾ The directory should include each treatment provider's phone number, address, contact person and title, eligibility requirements, accepted payment methods, hours of operation, process of referral, treatment method, and procedures with respect to relapse. The directory should include services for a diverse population.

COMMENTARY: The purpose of the directory is to provide the courts with information facilitating access to comprehensive and current drug and alcohol treatment resources and services available in each community in Massachusetts. Only treatment providers which satisfy the criteria promulgated under Standard XIV should be included in the directory.

The directory should be divided into regions and the communities within each region. Probation departments in each region should compile the information on resources and services in the communities within the region. The Office of the Commissioner of Probation should update the directory at least annually. If a provider is not in compliance with the criteria established by the probation department under Standard XIV, the provider should be removed from the directory. The Office of the Commissioner of Probation may combine the directory of community treatment providers with the directory of institutional treatment programs recommended in the Commentary to Standard X.

Judges should become familiar with the resources included in the directory. Whenever possible, judges and probation officers are encouraged to make site visits to treatment providers to gain a better understanding of available treatment services and to foster stronger community collaboration between the various courts and their treatment providers.

5. "Abstinence from alcohol and other drugs is the recommended goal for all drug addiction treatment." Terence T. Gorski, John M. Kelley, and Lisa Havens, Relapse Prevention and the Substance Abusing Offender: An Executive Briefing, p.12. Technical Assistance Publication Series, Number 8, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services, Public Health Service, U.S. Department of Health and Human Services, 1993, 1995.

"Recovery involves ....abstaining from alcohol and other drugs." Relapse and Recovery, p.12, Massachusetts Probation Service, 1998

6. See Standards for Certain Office Procedures for the Probation Offices of the Superior Court Department, Probate and Family Court Department, District Court Department, Boston Municipal Court Department and the Juvenile Court Department, Commissioner of Probation, Standard 5:05.

7. See McClellan et al., Is Drug Dependence a Treatable Illness, op. cit., p.26 - 31.

8. Such a directory is called for by Standards 10:01, 10:02, and 10:03, of the Commissioner of Probation's Standards for Supervision for Probation Offices of the Superior Court Department, District Court Department, Boston Municipal Court Department and the Juvenile Court Department.

Previous Page | Top of This Page | Next Page