Piece of the puzzle: Drug courts expand across NH

It was a Monday afternoon in Concord, and Christopher Ruggles was sitting in a familiar place — in front of Judge John Kissinger at the Merrimack County courthouse. But after more than a year of regular appearances in court, this visit was cause for celebration.

Once one of Concord’s most wanted men, Ruggles was graduating from the Merrimack County Drug Court — and he was the first to cross the finish line.

Wearing a collared sweater and a close-cropped beard, Ruggles looked younger and healthier than in the mugshots posted in news reports over the years.

Nearly 100 people had crowded into the courthouse for the Jan. 28 ceremony, a mix of current participants, healthcare workers, police officers and public officials in suits and ties.

“Every cop in the room had literally arrested me at one point or another,” Ruggles, 46, said later.

His girlfriend and his daughter sat in the front row, laughing together as he remembered jokingly asking his future partner if she “Googled” him — was it a dealbreaker if the top results for his name were headlines like “Alleged meth dealer arrested in Concord hotel room”?

But his crimes belied his commitment to drug court — of the 18 people who joined the program in 2017, Ruggles was at the head of the inaugural group.

As many of the drug court team members recounted during the ceremony, Ruggles was a controversial choice to be one of the first inductees.

For nine years, he said he’d been in and out of recovery programs for substance misuse, including the Friendship House and the Farnum Center — “a couple times apiece.”

According to police reports, Ruggles was arrested at least four times over two years and charged with methamphetamine possession and distribution. He pled into drug court just as it opened in fall 2017.

“Both of my lawyers told me I’m the luckiest guy in the world,” he said. “I was going away for at least five years. The motivating factor at first was not going to prison. Get me out of jail — I’ll jump through the hoops.”

Audrey Clairmont, who is a licensed clinical social worker with Riverbend Community Mental Health and coordinator of the Merrimack County Drug Court, said some of the stakeholders building the drug court worried that allowing Ruggles out of jail and back on the streets was “a jump in the deep end” for the new program.

But they couldn’t avoid the hard cases.

“That’s who we’re looking for … [someone] incarcerated many times,” she said.

A model for criminal justice reform?

Drug courts aren’t a new solution for substance misuse. The first drug court in the country was launched 30 years ago in Miami-Dade County, Florida. Since then, problem-solving courts have gained traction in both political parties because rehabilitation focuses on personal responsibility but is also less punitive, and potentially less expensive, than the regular criminal justice system.

However, the model didn’t arrive in the Granite State until 2004, when Strafford County began a pilot program. Over the next 12 years, drug courts were added in Belknap, Cheshire, Grafton, Hillsborough (South) and Rockingham counties.

When the dual opioid and behavioral health crises engulfed New Hampshire following the Great Recession, the expansion of drug courts took on new urgency. Following an influx of state funding in 2016, four more drug courts were added over two years to the existing system, based in superior courts.

Now, drug court is the largest problem-solving court in the state and 437 people have graduated so far. (Other diversion programs and specialty dockets tackle mental health issues and serve veterans.)

Although New Hampshire drug courts must follow the best practices outlined by the National Association of Drug Court Professionals, each court has adapted the model to fit its local community — and the teams adjust policies within weeks or even days to make the system work better.

New Hampshire’s legislation also established a state Office of Drug Offender Program, which is launching a statewide database to track trends across the system. Although there isn’t enough statewide data to fully analyze yet, local advocates point to successes in New Hampshire so far, including a statewide drug court graduation rate of approximately 50%, according to Alex Casale, coordinator of the statewide drug offender program.

In 2017, NADCP compiled data on all of New Hampshire treatment courts that showed that 78% of graduates had not reoffended within two years.

However, Casale said that recidivism data reflected “hand-counting,” so it’s not as accurate as the new database.

Generally, drug courts cost about a third of incarceration, and he said those cost savings will also be tracked.

Comparatively, 60% of formerly incarcerated individuals had not reoffended within two years of leaving state prisons, according to the NH Department of Corrections as of 2014. The cost of incarceration annually per person in New Hampshire in 2017 was around $93 a day, according to the Department of Corrections, or $1.42 a day for probation/parole supervision.

The philosophies that guide drug courts are also finding increasing acceptance across the justice system as prosecutors, public defenders and judges try out the “non-adversarial” approach that hinges on understanding substance use disorder as a chronic disease, part of a larger public health problem and motivating participants with incentives to continue community-based treatment.

Casale described the best candidates as highly addicted and highly likely to re-offend. However, participants are not necessarily disqualified for having a dual diagnosis, as long as their mental health condition can be managed through medication or counseling.

These “high risk/high reward” cases are risky on both sides of the equation.

“We take a risk in accepting these cases,” said NH Superior Court Chief Justice Tina Nadeau, who oversees the drug court system. She said graduations like Ruggles’ prove that the risk is worth it.

A ‘hue and cry’

Nadeau, who described substance abuse disorder as a “pernicious chronic disease,” has been a staunch advocate for treatment courts across the state since she was a new judge in Strafford County almost 15 years ago.

“We started to see the same offenders the longer we sit on the bench, recycling through the system over and over,” she recalls. “It took a couple of years to convince all of the stakeholders to give [drug court] a try.”

One of the most significant challenges was funding. When she was appointed chief justice in 2011, Nadeau helped expand drug courts statewide with grants from the federal department of justice. She also became a supporter of medication-assisted treatment (MAT) in drug courts. She said about 90% of people with substance abuse disorder need MAT to recover.

But, by 2016, the federal grants were running out.

“It’s a tough sell and there are all kinds of competing interests,” Nadeau said. “The opioid crisis was the hue and cry for it to be extended statewide.”

She helped two Republican state senators — David Boutin and Jeb Bradley — draft legislation, but didn’t expect the Legislature to cover more than half the cost.

“The Legislature was very engaged and very interested to do whatever they could to stem this epidemic,” she said. “The debate was always, ‘Who is saving money? The county or state?’”

After unanimous approval, the new legislation was signed by then-Gov. Maggie Hassan, fully funding an adult treatment drug court or alternative drug offender program for each county.

Sullivan is the only county without a drug court, but its Department of Corrections runs a treatment center, Transitional Reentry and Inmate Life Skills, inside the jail.

What is success?

Jacki Smith, an assistant county attorney and part of the Merrimack County Drug Court team, said recidivism is the most important measure because it’s used to justify keeping drug court participants out of jail.

And graduation rates — which NADCP recommends range from 50 to 70% to ensure courts take enough “high risk” cases — show that the program helps graduates remain in treatment long enough to be “successful.”

However, it can be difficult to track sobriety once graduates leave the program and probation. And success has more than one definition.

Clairmont, the Merrimack drug court coordinator, points out that even the participants who don’t graduate from drug court improve their lives, such as one client who regained custody of their child and another who was excited to start filing taxes after finding employment.

“These are all successes,” she said. “Even clients who have been terminated, sentenced to prison [say], ‘I hope you don’t count me as a failure.’”

If the statewide drug court system will be evaluated based on cost savings, Hillsborough County’s 2020 proposed budget may be an early example of success.

According to the New Hampshire Union Leader, Valley Street Jail Superintendent David Dionne recently asked the county commission to cut the jail’s budget by $374,000, after new bail reforms at the state level and treatment courts left fewer inmates incarcerated there — 230 people in early April, compared to nearly 500 two years ago.

Casale said the graduation rate and other measures can also be useful to the drug court teams to rethink policies and approaches. For example, Strafford County was able to improve a 38% graduation rate at one point by, in part, changing the schedule for drug testing.

At the national level, advocates have long used data to gauge success. Challenges have emerged too.

Finding a balance

A warning came from the NADCP’s “Journal for Advancing Justice” in 2018, which found that while drug courts are making positive changes in local communities, the model can also perpetuate the inequalities of the national justice system:

“Treatment courts were created to improve a troubled criminal justice system, not to mirror its worst attributes; yet racial, ethnic and gender disparities exist in many treatment courts, reflecting and possibly exacerbating systemic injustices. In the United States, African American individuals are underrepresented in drug courts by approximately 15 to 20 percentage points compared with the arrestee, probation, and incarcerated populations, and Hispanic or Latino individuals are underrepresented by approximately 10 to 15 percentage points … differences in graduation rates have been as large as 25 to 40 percentage points.”

According to The Sentencing Project, a nonprofit promoting justice reform, New Hampshire’s 2014 ratio of racial/ethnic disparity in imprisonment was 5:2 for “Black:white” offenders and 2:0 for “Hispanic:white.”

Casale said the state hasn’t been tracking the racial or ethnic makeup of drug courts’ participants, but the new database will include those metrics. New Hampshire drug courts mirror the population of the state, but a much larger study would need to track the populations coming in and out of the criminal justice system to compare, he added.

“I would want my drug courts to reflect what is in the system,” Casale said.

Nadeau agreed. “We will be able to take a look at that a little more closely in a few years,” she said.

Stronger criticism has come from the medical community — in a 2017 report called “Neither Justice Nor Treatment,” Physicians for Human Rights called for the decriminalization of all drug possession to move treatment out of the criminal justice system, arguing that the “criminal justice objectives of drug courts often overrule the medical needs of the patient in ways that threaten the rights and health of participants.”

However, some of the national criticism of drug courts was based on old practices of enforcing abstinence, which has changed since MAT was incorporated as a best practice at the national level six years ago. The quick adaptation of MAT illustrates the flexibility of the model.

“We were an abstinence-based program,” said Strafford County Attorney Tom Velardi of county’s drug court. “We were wrong. We certainly re-educated ourselves.”

Merrimack Assistant County Attorney Smith has experienced both sides of the equation. After serving as a public defender in Nashua’s drug court, she’s been working as a prosecutor in Merrimack’s drug court since 2017.

As a prosecutor, Smith said public safety is now “job one,” while her concern as a public defender was “people’s rights.” Either way, she thinks drug court works.

“The reality is if you’re pulling in the high risk/high need population, this is the hardest thing people are ever going to do,” she said. “It’s amazing to watch the transformation in people’s lives.”

Catherine Flinchbaugh, one of two attorneys representing the Public Defender’s Office on the Merrimack drug court team, has a different perspective.

“The [justice] system is very much built to be adversarial,” she said. “In theory, the drug court is team-based … [but] it’s a hard role for defense … We also really have to be worried about that individual and that individual’s rights.”

Flinchbaugh added that what she might think is best for the client in terms of treatment doesn’t always fit the goals or confines of the program.

“I’m not sure if it’s the best way to deal with addiction but it’s certainly better than a lengthy sentence,” she said.

Does it matter whether people struggling with addiction get help inside or outside of the justice system?

From a medical perspective, Clairmont noted, entry into the treatment system via a courthouse instead of a “doorway” in the state’s new hub and spoke system for treatment, can be challenging for patients.

“But in a lot of different ways it can be a relief,” she said of the opportunity to start recovery. “Motivation can be extrinsic. Having the teeth of the criminal justice system is a really important thing.”

Ruggles, who is now on the board of the Merrimack County Drug Court, believes that he needed to be closely monitored to succeed — and he’s adamant that even jail time was beneficial to his recovery.

“I truly think in order to get sober you need to be monitored by somebody. For me, I needed to do jail time,” he said. “And the model they have works. I had to be ready and I had to make that commitment to want to change, to want to stop using, to want to better my life.”

Anna Berry is editor of publications at the New Hampshire Bar Association. Her spouse is a member of the steering committee for the Merrimack County drug court. This story was produced for The Granite State News Collaborative as part of its Granite Solutions reporting project. For more information visit collaborativenh.org.