Standards on Substance Use Disorders and Mental Health Conditions: Standard VIII. Monitoring compliance and responses to recurrence of use or symptoms

Standards adopted by the Supreme Judicial Court, acting on the advice of the Working Group on Substance Use and Mental Health.

Standard VIII

Probation should monitor compliance with court-imposed conditions related to substance use disorders and mental health conditions using evidence-based supervision tools. Judges and court personnel should understand that recurrence of use or symptoms is common with chronic substance use disorders, mental health conditions, and co-occurring disorders, and should implement strategies to prevent and address recurrence episodes.

Commentary

Monitoring Compliance. The Massachusetts Probation Service should monitor compliance with court-ordered treatment conditions for substance use, mental health, and co-occurring disorders as per court order and probation standards. The court should inform all parties who are 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.

Available compliance tools per MPS policies, standards, and training are drug and alcohol testing; verification of attendance at and participation in counseling sessions and recovery support meetings; communication with and frequent progress reports from treatment providers; and, whenever possible, day and nighttime visits at the defendant’s home, school, place of work, or treatment provider. Drug and alcohol testing is available in every courthouse, and testing results are made available to the court as quickly as possible. To facilitate treatment monitoring, MPS requests the defendant’s signed consent, both to provide the treatment provider with relevant information in the defendant’s probation case file, and to obtain progress reports back from the treatment provider.

MPS supports compliance by offering voluntary, stabilizing services to ensure that the party has access to adequate food, housing, healthcare, and other supports, where those services align with conditions of probation. Such supports enable the defendant to engage better with treatment and other court-ordered conditions. Additionally, positive reinforcement is a valuable aid to progress where a party is complying with treatment conditions. MPS also provides evidence-based behavior change work, as well as establishing assistance that will continue recovery and support post-sentence.

Responding to Recurrence of Use or Symptoms. Relapse, which is the recurrence of use or symptoms, is common with substance use disorders and mental health conditions and can be one step toward recovery and often an integral part of what can be a lengthy process. Substance use disorders, mental health conditions, or co-occurring disorders cannot be "cured" any more than other chronic disease. Treatment of chronic conditions involves changing deeply rooted behaviors, and recurrence of use or symptoms does not indicate that treatment has failed. Chronic and persistent mental health disorders may reappear in regular or unpredictable patterns. When a person has a recurrence of use or symptoms, it indicates a need for clinical reassessment and reevaluation of the treatment and recovery support plan. ⁽¹¹⁾ People can be educated and supported to manage their substance use, mental health, or co-occurring disorders by engaging with evidence-based treatment and by following recovery principles. Relapse prevention education and strategies can provide people with an understanding of their own relapse warning signs, so they will know when their recovery is challenged, and will signal to them that they need to address any issues immediately.

It is vital that courts understand relapse, anticipate relapse, have access to an individual’s relapse plan, be prepared to deal with relapse, and respond to it promptly. The appropriate response to a relapse should be tailored to each person's individual needs, history of substance use disorders, mental health conditions, and previously utilized treatment modalities. Graduated responses are generally appropriate, including increasing the frequency of drug testing, increasing treatment level of care, and/or increasing supervision. In some cases, the individual’s behavior will present such a clear or immediate threat to public safety that the court should consider probation revocation and incarceration.

11. National Institute on Drug Abuse, Drugs, brains, and behavior: The science of addiction (2020), https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery.