In a groundbreaking study funded by a CDC grant, Professor Elizabeth Van Nostrand from Temple University’s College of Public Health (CPH) is shining a new light on how treatment courts could be the key to addressing the opioid crisis in a way that promotes recovery instead of punishment. "This study highlights the power of rehabilitation over incarceration," she explains, "and the impact it can have on both public health and public safety." The five-year, $1.8 million study explores the effectiveness of treatment courts in improving health outcomes and reducing crime—offering a potential blueprint for tackling the opioid epidemic across the U.S.
How Treatment Courts Work
There are over 4,000 treatment courts across the country, and they span various types, including adult drug courts, mental health courts, and veteran treatment courts. These courts aim to address the root causes of criminal behavior by offering rehabilitation and therapeutic interventions instead of incarceration. However, as Van Nostrand points out, "Very little research has been done to assess if these programs are associated with good outcomes beyond reducing re-arrests."
Despite existing evidence that treatment courts reduce recidivism, the question of whether they impact health-related factors—like emergency room visits, EMS calls, or even death—had never been adequately studied. This gap in research led Van Nostrand to launch her study.
Study Design and Key Insights
To investigate the effectiveness of treatment courts, Van Nostrand assembled an interdisciplinary team and partnered with 30 treatment courts in Indiana. The goal was to follow participants for one year after their release from treatment court programs, tracking four key outcomes: Emergency department visits, EMS calls, re-arrests, and deaths.
"We approached this study without a hypothesis," says Van Nostrand. "We simply wanted to see if there were any patterns or associations between participation in treatment courts and these outcomes."
Indiana was chosen, in part, due to its access to a rich data repository through the state's Management Performance Hub. "We created legal datasets from treatment court records. Indiana has a government-run data warehouse that includes health and corrections data, which made it possible for us to link our legal datasets with outcomes like ER visits and EMS calls," she explains. "But as with any large-scale study, the process was incredibly challenging—acquiring and standardizing all that data was difficult. The data sources from the courts, the health department, and EMS services were collected in different ways, so our team had to find a way to align it all. And our study took place in the middle of the COVID-19 pandemic.”
Despite these challenges, the team ended up with a robust dataset that included 530 participants, split between those who participated in treatment programs (350 people) and those who were eligible but did not participate (180 people). "We found some very interesting patterns," says Van Nostrand.
Impact on Health and Crime
While the study couldn’t prove causality, Van Nostrand and her team discovered powerful associations that suggest treatment courts have a significant impact on both health and criminal justice outcomes. "For those in our study who participated in treatment court programs, the results were striking," she says.
Participants were 83% less likely to die than those who did not engage in the program.
They were 34% less likely to visit the emergency department for drug-related issues.
They were 83% less likely to require EMS for a drug-related emergency.
And perhaps most remarkably, participants were 93% less likely to be re-arrested.
"For the 180 people who were eligible to participate in a treatment court program but, for some reason they did not, we know they probably didn’t just go home and live their lives—they likely faced probation or even incarceration," Van Nostrand explains. "That contrast really illustrates just how much of a difference treatment courts can make."
Interestingly, the study found no significant difference in outcomes based on sociodemographic factors. "Men, women, Black or White—each of these groups seemed to benefit equally from participation," says Van Nostrand. "This speaks to the broad applicability of treatment courts as a solution for people from all walks of life."
Rethinking the War on Drugs
Perhaps the most profound takeaway from this research is the message that the current "war on drugs" is not working. "We continue to incarcerate people who have a disease, which, absent criminal activity, has been determined by the Supreme Court in the 1960’s to be unconstitutional," Van Nostrand argues. "What we’ve shown is that keeping people out of jail and providing them with support and rehabilitation, instead of punishment, leads to far better health and societal outcomes."
In the face of overwhelming evidence that incarceration only exacerbates the opioid crisis, this study suggests a different approach—one that focuses on rehabilitation, support, and healing. "Treatment courts offer accountability, therapeutic support, and a holistic environment that can lead to far better results than simply locking people up," she says. “Arrest in and of itself can be traumatizing but that’s the status quo for many people who use substances in the U.S.”
While the study was conducted in Indiana, Van Nostrand is quick to point out that the implications could potentially be far-reaching. "What we found here is not just relevant to Indiana—it could be highly relevant to the whole country," she says. "The opioid crisis is a national issue, and incarceration only exacerbates the problem; this study has shown that treatment courts can offer an effective solution."