Observational Study of

Courtroom Dynamics

In Selected Drug Courts

##### By Sally L. Satel, MD[^1] 

In this ground breaking article, Dr. Sally Satel (93) reviews the
literature in the field, interviews drug court judges and program
participants and observes 15 courtroom settings in an attempt to
describe and analyze the role of the drug court judge. This far ranging
article of first impression looks at what makes a good drug court judge,
the psychological implication of the drug court judicial model and how
the drug court environment can effect program outcomes.

*Dr. Satel* *is a practicing psychiatrist as well as a lecturer at Yale
University School of Medicine. She has written extensively on drug abuse
and cocaine addiction. Her clinical and research expertise is in
addiction medicine. She has worked in the Washington, DC Drug Court* as
*a Staff Psychiatrist and consultant.*

##### ARTICLE SUMMARIES

### [[Judge-Role]{.underline}]{.smallcaps}

**\[10\]** Unlike the traditional judge, the current drug court judge is
directly involved in the treatment and supervision of offenders.

## [[Judge-Role Codified]{.underline}]{.smallcaps}

**\[11\]** NADCP "Key Components" describe the role of the drug court
judge.

## [Judge-]{.smallcaps}

## [["Judge Effect"]{.underline}]{.smallcaps}

## \[12\] A study illustrates the significance that involving a judge in an already established treatment program may have on the success of the participants. Another assessment revealed that conviction rates varied each year depending on which judge presided over the court.

### 

**[Judge-]{.smallcaps}**

**[[Self Assessment]{.underline}]{.smallcaps}**

**\[13\]** Twelve drug court judges are surveyed on "what are the six
most important characteristics of an effective drug court judge."

# [Judge-]{.smallcaps} {#judge--1 .unnumbered}

# [[Counter Transference]{.underline}]{.smallcaps} {#counter-transference .unnumbered}

**\[14\]** The judge's attitudes toward participants can be complicated
by the judge's

subconscious feelings triggered by the participants.

### 

### [Judge-]{.smallcaps}

### [[Participant Attitude]{.underline}]{.smallcaps}

**\[15\]** Participants generally believe that the involvement of the
drug court judge is critical to their success in the program.

# [Judge-]{.smallcaps}  {#judge--3 .unnumbered}

# [[Participant Psychology]{.underline}]{.smallcaps} {#participant-psychology .unnumbered}

**\[16\]** Insight into the mental life of the addict is necessary for
drug court practitioners.

### [Judge-]{.smallcaps} {#judge--4 .unnumbered}

### [[Court Environment]{.underline}]{.smallcaps} {#court-environment .unnumbered}

**\[17\]** The author isolated 17 courtroom and process variables
believed to promote successful drug court interactions and applied them
to 15 drug court environments.

### [Judge-]{.smallcaps} {#judge--5 .unnumbered}

### [[Court Environment]{.underline}]{.smallcaps} {#court-environment-1 .unnumbered}

**\[18\]** The judge helps communicate the message by controlling the
court environment, including the order of calling participants, the
seating arrangement, amplification of dialogue and the like.

##### INTRODUCTION

The judge is considered the symbolic and functional centerpiece of the
drug court program. Intuition dictates that, the more effective the
judge, the more successful the drug court in curbing crime and drug use.
Just how significant is the drug court judge in the process? How
different are the interactions of the drug court judge with offenders
before the court from that of the traditional judge?

This article will examine these questions and provide a first impression
of a very practical issue. It will define the drug court judge's role,
describe the nature of his or her relationship with the participant and
in turn, the participant's relationship with the judge. It will also
consider the therapeutic impact of the judge's actions on the
participant. Finally, it will provide an empirical assessment of the
interactional and environmental variables of the drug court setting in
15 drug courts.

###### THE JUDGE'S ROLE

**\[10\]** In the pre-drug court era, when judges ordered offenders into
drug treatment as a condition of sentencing or probation, they were
largely uninvolved with monitoring the offender's compliance with
treatment conditions. In fact, it was typical for offenders to be
terminated from treatment without the judge being made aware of it.^1^

Drug courts are a significant departure from that past system. The
process has been transformed by involving the judge directly in the
treatment and supervision of the defendant. During regularly scheduled
status hearings, which take place in an open courtroom, the judge holds
the defendant publicly accountable for his progress in treatment. The
judge uses progressive sanctions and incentives to reward success and
discourage certain behaviors. Sanctions follow violations and are
applied as close to the time of failure as possible. Ideally, the
sanctions become incentives to compliance.

[The View From the Field:]{.underline}

To date, the peer-reviewed literature on drug courts is scant, but
conferences and agency publications been have been host to considerable
discussion about the role of the drug court judge.^2,3,4^ In fact, many
observers and judges themselves have attributed the success of drug
courts in large part to the investment of the judges and the nature of
their relationships with defendants. However, until now, there has been
no systematic effort to characterize the judge-participant relationship.
When a search of the post 1983 PsycINFO database for articles containing
the words "drug" and "court" was queried, no mention of any article that
touched on the topic of judge-defendant interaction was found. Nor was
there any mention of mental health professionals empirically examining
the dimensions or variations of such a relationship.

In drug court, the judge works to keep participants engaged in
treatment.^4^ Every dirty urine drug screen or missed appointment is met
with a sanction, with the severity of these sanctions escalating if
infractions recur. This conforms to what behaviorists have long
appreciated, that behavior is shaped most effectively when punishments
are swift and sure but not necessarily severe. The strategy demonstrates
to the participant that his actions are taken seriously and that he
predictably controls his fate. The judge is guided in this process by an
algorithm that may be rigid or flexible depending upon the particular
drug court.

Traditional court-mandated treatment, on the other hand, is generally a
few unacknowledged, strikes-and-you're out affair. That is, the first
few dirty urine drug screens go unpunished, but the next one lands the
defendant in jail or prison to serve out his or her deferred
sentence.^1^ Ignoring lapses and then, in a seemingly capricious way,
coming down hard is a notoriously poor way to shape accountability.

The drug court judge's role is unconventional in other ways. First, the
depth of involvement with the defendant is unprecedented. Not only does
the judge review the progress of defendants many times over the course
of the treatment, but he or she engages the defendant directly. These
exchanges may take the form of praise or encouragement. If the
participant has committed an infraction (*e.g*., a dirty urine drug
screen or missed appointment) the judge may seek an explanation and then
admonish the participant and impose a sanction. The judge, unlike a
clinician explicitly, represents moral authority.

According to psychiatrist and drug court consultant Michael Smith of New
York's Lincoln Hospital, "the drug court model creates a very healthy
and transparent system of authority. The actions of the judge depend
directly on the patient's own performance; it's all observable: the
urine screens, the attendance, how the patient relates to staff and
other patients."^5^ "The symbolic impact of the black robe can't be
underestimated; it shows defendants that the system takes the
defendant's conduct seriously," explains former Judge Jeff Tauber, now
President of the National Association of Drug Court Professionals. A
survey conducted by the Drug Court Clearinghouse, American University
confirms this. From its surveys, it found that "eighty percent of
participants indicated they would not have remained if they did not
appear before a judge as part of the process."^2^

Second, the nature of the relationship challenges the time-honored role
of judicial impartiality. Traditional judges may bristle at the thought
of developing a cooperative relationship with the defense, prosecution
and treatment provider -- not to mention with the defendant himself or
herself. They see their job as determining guilt or innocence and meting
out punishment, rather than collaborating with other court personnel for
a therapeutic purpose. Judges Peggy Hora and William Schma find this
limiting. It is "judging in a non-traditional form," they write, "that
becomes an invigorating, self-actualizing and rewarding exercise instead
of an isolating, unsatisfying experience of watching the same people
repeatedly cycle through."^6^

Third, the drug court judge has the latitude to shape a courtroom drama.
He or she can orchestrate the timing and sequencing of cases heard and
perhaps most dramatic, can arrange for these dynamics to have an impact
on participants seated in the courtroom and -- more important -- on
those defendants who are sitting in the jury box as a sanction.

**[[Judge's Role Codified:]{.underline}]{.smallcaps}**

**\[11\]** In January 1997, the Office of Justice Programs (OJP) at the
U.S. Department of Justice released a key document called "Defining Drug
Courts: The Key Components."^4^ The OJP was assisted in this effort by a
committee formed by the National Association of Drug Court Professionals
called the Drug Court Standards Committee. The purpose of the "Key
Components" is to provide benchmarks...."describing the very best
practices, designs and operation of drug courts." "Because drug courts
are evolving," the committee writes, "the field would benefit most from
general, practical guidance on how to get established, what to consider,
whom to include and how to proceed."

Key Component \# 7 is especially relevant to this paper. It states:
"Ongoing judicial interaction with each drug court participant is
essential." It reads as follows*:*

-   A drug court judge must be prepared to encourage appropriate
    behavior and to discourage and penalize inappropriate behavior.

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-   Ongoing judicial supervision also communicates to participants --
    often for the first time -- that someone in authority cares about
    them and is closely watching what they do.

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-   Frequent status hearings give the participant a sense of how he or
    she is doing in relation to others.

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-   Having a significant number of drug court participants appear at a
    single session gives the judge the opportunity to educate both the
    offender at the bench and those waiting as to the benefits of
    program compliance and consequences for noncompliance.

**[[Evidence of a "Judge Effect":]{.underline}]{.smallcaps}**

**\[12\]**The drug court judge's non-traditional role is assumed to be
critical to the process and thus, to the outcome of the court. Indeed,
several quasi-natural "experiments" suggest that different drug court
judges may have demonstrably different effects on participant outcome.

A study of the Stillwater, Oklahoma drug court experience illustrates
the significance that involving a judge in the program may have on the
success of participants.^7^ Before its drug court was established in
March 1995, Payne County, Oklahoma, had a district attorney-run
treatment program (ATTAC). Treatment program philosophy and content
remained constant through the transition from ATTAC to a drug court
format. The major innovations associated with the drug court were a
single judge dedicated to drug court cases and the imposition of
intermediate sanctions. Preliminary pre and post-data analysis shows
impressive reductions of over 50% in dropout rate, dropout recidivism
and graduate recidivism rates. Follow-up data for the ATTAC program and
the drug court were available for two years and one year, respectively.
The addition of a drug court judge to the existing sanctions program
appears to be very significant in terms of improving the overall
outcome.

An assessment by the National Center for State Courts of the Oakland
Drug Court from 1991 (the first full year of the drug court program)
through 1994 revealed that conviction rates varied each year depending
on which judge presided over the court. A different judge presided over
drug court each year, while no other significant changes in the program
occurred during the study period. The assessment found that in 1991,
there was a 1.6% participant conviction rate, in 1992, the conviction
rate was 10.2%, in 1993, 5.8% of participants were convicted and in
1994, 7.0%.^8^

Another study illuminates the variability of judicial attitude and
response to drug court participants. Under one Denver Drug Court judge,
66% of participants got "good and passable reviews" and 14 % were sent
to jail over the course of a year. Under his successor, only 40%
received "good and passable reviews" and 40% went to jail. This drug
court program was stable over the years examined, save for the switching
of judges. It is possible that the second judge was more strict than the
first, but because the program used a fairly rigid sanctions algorithm,
the influence of judicial discretion was minimal.^9^

**[[Judicial Self-Assessment:]{.underline}]{.smallcaps}**

**\[13\]**With drug courts in 49 states, the District of Columbia, Guam
and Puerto Rico, there exists considerable variability in drug court
environment and style of proceeding. This ranges from crowded dockets in
huge courtrooms where participants are managed in a brisk, assembly-line
fashion, to more intimate courts where the atmosphere resembles a
fellowship meeting. Regardless of the variability, judges tend to see
their roles similarly.

In preparation for an advisory meeting that took place last February at
the home office of the National Association of Drug Court Professionals
(NADCP), the Association asked a dozen judges to answer the question:
"What are the six most important characteristic of an effective drug
court judge?" There were 21 classes of responses from nine individuals,
but a few appeared regularly on the lists. In order of descending
frequency these were:

-   The ability to be empathic or to show genuine concern;

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-   Knowledge about drug addiction and pharmacology;

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-   Team leadership (consensus building; team player, leader or
    motivator);

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-   Acceptance of an unconventional role;

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-   Consistency in applying sanctions (or in explaining rationale);

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-   Knowledge of the addict community and street life in your
    jurisdiction;

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-   Sense of humor;

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-   Ability to communicate;

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-   Commitment to the enterprise;

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-   Willingness to learn/ humility;

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-   Ability to impose sanctions, comfort with "tough love" approach; and

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-   Having experienced personal crises.

Other responses, mentioned once each were awareness that the traditional
system was ineffective; displaying a judicial bearing; ability to sell
the program to the community; ability to balance interests of the client
with public safety; patience; knowledge of local social service referral
options; ability to spot a "con artist"; ability to work with diverse
clientele; and an awareness that the impact of drug court was made in a
public venue.

Results from the author's non-representative interviews complement this
list in some ways and depart from it in others. For example, no judge
spontaneously mentioned that knowledge of addiction or pharmacology was
a particularly important attribute, yet it was often ranked first in the
NADCP questionnaire. Judges chiefly valued the relationship between
themselves and the participant. The notion that drug court participants
have few "honest, straightforward and caring relationships" in their
lives was mentioned as an impetus for the judge to be engaged with them.
One judge said he did not see himself as "imposing punishment but as
providing help. Through judicial coercion, I try to get them to be sober
for a long period of time. If it's long enough, and they can figure out
how to lead productive lives during that time, then hopefully they can
translate that into a lifelong knowledge." Another said, "I am a
cheerleader. My job is to motivate people."

Being the leader of a team was also emphasized. In almost all cases, the
bench and treatment providers experienced initial friction (*i.e.,*
struggles over the treatment staff relinquishing control over the
participant and disclosing clinical information to the judge). However,
this was resolved within one to two years. One judge saw his primary
function as "keeping people interested in the drug court program so that
they would continue to go to treatment." All judges interviewed were
invested in treatment but not necessarily in acupuncture. None, however,
was opposed to the use of acupuncture and most had volunteered to
undergo the procedure to see what it was like.

The third most common function of a drug court judge was to organize a
community of recovering people. Meting out sanctions and shaping
behavior with incentives and punishments were not cited as prominent
functions of the judge, though, as activities, they were taken seriously
by the judges. "Keeping the addicts going to treatment is the purpose of
the drug court judge," said one judge.

[Judicial Perceptions of Treatment:]{.underline}

A 1990 study by the New York City Criminal Justice Agency examined
factors and perceptions affecting judges' decisions regarding the
adjudication of crack and powdered cocaine offenders.^10^ Eighty two
percent of the 71 judges interviewed agreed that diversion of selected
crack cocaine, related defendants would be a reasonable option "if
effective treatment existed." Among judges who identified a preferred
type of treatment referral, 77% named residential programs. They felt
that those most likely to benefit were defendants who showed
"motivation" to receive treatment. Interestingly, data does not support
this all-too intuitive belief. Indeed, numerous studies have shown that
patients coerced into treatment do as well or better than those who
volunteer for it.^11^ Furthermore, judges had expressed disappointment
with treatment, citing its failure to follow up with the court, verify
patient participation and administer urine drug screens. It is no
coincidence, then, that integration of information and collaboration
between criminal justice and treatment services are substantial
departures for the judiciary and the very hallmark of drug court
programs.

**[[Psychological Implications for the
Judge:]{.underline}]{.smallcaps}**

**\[14\]** Judges' attitudes toward participants can be complicated. The
Freudian concept of transference refers to the patient's "transferring"
tightly held attitudes (beliefs) and emotional dispositions forged in
childhood onto new individuals in their lives. Since parent-child
relationships are the first attachment that a child develops, they
almost always influence all later relationships, including formal
helping relationships in adulthood. The therapist's interpretation of
the transference allows the patient to better distinguish between
remnants of past relationships and the real association between himself
or herself and the therapist.

Counter-transference is the inverse of transference; it describes the
therapist's reaction to the patient. In the context of drug court,
"judicial" countertransference would thus refer to the personal
reactions that are invoking in the judge by the participant (in the
clinical setting, by analogy, it would refer to the therapist's response
to the patient). Classically, these reactions are unconscious -- that
is, outside the awareness of the judge (or therapist) -- but are
manifested in ideas, feelings or behaviors that are inappropriately
intense (in the positive or negative direction) or somehow not fully
rational.

For example, a female participant who is flirtatious and seductive may
"convince" the judge to give her a light sanction for a transgression.
He does so, but when she fails again, the judge is not simply annoyed,
but furious. Why? As it happens, this participant unwittingly re-enacted
the behavior of the judge's own teenage daughter who, too, acts like
"daddy's little girl" when she misbehaves. Against his better judgement,
the father (our judge) will let her off easy only to be faced with the
daughter's subsequent acting out. This leaves him feeling helpless,
betrayed and enraged.

Indeed, drug court is fertile ground for the unfolding of psychological
drama. Perhaps, for example, the judge is a recovering alcoholic or has
loved a one who is addicted to drugs. This could stir up inappropriately
strong feelings of sympathy, impatience or even hostility toward a
participant who happens to remind him of his or her former self (or his
or her loved one). Consider the participant who casts the judge in the
parental role. He or she may elicit deep feelings in the judge, rooted
in the latter's own experience as a parent or a once-needed child. Or
consider the participant who related to the judge in a provocative
manner -- or, more precisely, in a manner that the judge finds
provocative -- stemming from an (unconscious) desire to be punished or
controlled or to elicit concern through censure.

These kinds of psychodynamic scenarios are more likely to get played out
in a drug court, with its somewhat relaxed structure, than in a standard
court where proceedings, expectations and personnel roles are clear,
traditional and fairly predictable. The expression of the participant's
psychological conflicts and needs naturally find outlet in a setting
where a potent figure (the judge) actively probes for personal details
and takes a visible interest in their lives. While it would be a grave
mistake for the judge to fashion himself or herself as a therapist --
better to be seen as a moral authority with the flexibility to be
practical and compassionate while demanding accountability -- the judge
should be aware that the unconventional nature of his or her
relationship with participants can engender complex reactions in himself
or herself.

> **[[Participant's Assessments of Their Relationships with the
> Judge:]{.underline}]{.smallcaps}**

**\[15\]** As important as the drug court judge is to the court process,
dynamics and outcome, there remains a variable that plays an equally
paramount role in drug court -- the participants. Focus groups, surveys
and exit interviews allow us to learn about the participant's
impressions of the drug court experience. Urban Institute researchers
conducted focus groups with participants of the Washington, DC Drug
Court.^12^ The researchers found, not surprisingly, that the certainty
of consequences was psychologically powerful and important to the
participants. "The reason the sanctions track people did so well is
because they knew what the judge would do. And he did it," said senior
researcher Adele Harrell who conducted focus groups with study
participants. She also credited the "swiftness of the penalties -- they
had to report to court immediately for a urine drug screen failure --
and their fairness." That is, they understand that there are
consequences for their behavior, a truly important realization for
permanent change. Furthermore, Harrell learned from the focus groups
that "the defendants believe that the judge takes a personal interest in
them." As one man summed it up for her, "you get a dirty urine, man,
you're going to jail. They're letting you know... you know the chances."

In some cases, when participants tell evaluators that the judge "really
cares," the true meaning of this superficial endorsement is not always
clear. In optimal instances, this means that the judge is genuinely
engaged with the participants and has become a central and respected
figure in their drug court and recovery experience. In these situations,
motivation to succeed may stem partly from a desire to "make the judge
proud of me." A participant in the Denver Drug Court told evaluators
that, "\[When\] the judge recognized that I've been here so long it was
like he was proud, it was strange, like a father kinda. There's no doubt
in my mind that his is different \[from other court experiences\]. When
I relapsed and got disciplined, he said, 'well, you still owe me a day.'
But he didn't do it out of vindictiveness, you know, like a spanking or
something. Actually, it was what I needed."^13^

On the other hand, some participants have indicated to this author that
a caring judge is a lenient judge. Judicial credibility can be severely
damaged when, in effect, the judge invites defendants to pull the wool
over his eyes. "When a judge gets into the buddy-advocate role he can be
reluctant to impose sanctions. Also, believe it or not, I've seen judges
underestimate how manipulative addicts are and get tricked into being
too lenient," a case manager at treatment court in New York told me.
Oftentimes, when a participant states that a judge "really cares", these
participants have made the all too common mistake of confusing the
failure to demand accountability with compassion. Yet another
interpretation of "caring" is simply that the drug court judge is more
involved in their personal situation than a traditional judge who
sentences them and/or sends them to jail.

It is clear in the American University 1997 Drug Court Survey Report
that drug court participants identify the purpose and importance of
sanctions. It queried 256 participants from 53 drug courts and found
that the highest percentage (82%) responded that "the possibility of
sanctions (being) imposed if you didn't comply with the program" was
"very important." Seventy-five percent said it was "very important" that
"a judge monitors my progress." Unfortunately, there was no elicitation
of spontaneous comments; the participants were limited to five
responses, none of which referred to their interaction with the
judge.^6^ However, as mentioned earlier, 80% said that they would not
have remained in the drug court program if they were not required to
appear before a judge as part of the process.

####### The Mind of the Addict:

**\[16\]** Insight into the mental life of the addict is helpful to the
drug court judge and other criminal justice personnel whose aim is to
reduce subsequent crime through changing offenders' behaviors. Partly,
this change will be effected through behavior modification (sanctions,
consequences and rewards), but it will also be influenced, to some
degree, by the relationship with the judge. Nevertheless, there are
aspects of the addicts' attitudes and actions that can make it difficult
for the judge to form a relationship. It is not uncommon, for example,
for a participant to choose drug court simply because he or she wants to
avoid jail and to imagine that he or she will simply go through the
motions ("get over and get by"). This kind of gaming, while not specific
to drug addicts, is a classic manipulation which judges are used to
dealing with, but until they preside over a drug court, are unaccustomed
to breaking through and working with.

Psychiatry does not recognize a so-called "addictive personality type,"
yet some psychological traits are fairly typical of addicts; among them
(1) low tolerance for stress and emotional turmoil, and (2) poor
behavioral control. While not unique to addicted individuals, such
traits and associated features are likely manifested as poor impulse
control, inability to delay gratification, action-orientation (rather
than reflection), poor ability to plan and anticipate consequences of
actions, misreading of interpersonal situations and damaged capacity to
trust. Commonly, addicts have frustrated, hurt and disappointed family
and friends to the point where few people have faith in their capacity
to transform.

The profound problems of self-governance suggest that limit-setting,
consistency and firmness are critical aspects of judicial behavior. From
the clinical standpoint, the constellation of frailties described above
explains why most therapists avoid classical insight-oriented therapy
(*i.e.,* in-depth, anxiety-provoking, psychodynamic psychotherapy) with
individuals who are currently using drugs or who are recently recovered:
they usually cannot tolerate the intensity of the treatment and may turn
to drugs to "medicate" the stress it produces.

Also, gaining immediate control of an addict's day-to-day behavior
requires a here-and-now orientation, practical problem solving and the
acquisition of cognitive-behavioral relapse prevention skills. For
addicts -- as well as some other individuals whose behavior is
self-destructive -- insight can follow change, it need not precede it as
conventional psychodynamic theory has it -- and thus formal exploration
of deep-seated psychological conflicts is contraindicated. To put it
another way, it often takes a period of abstinence for the addict to
understand why he or she needed drugs in the first place.

This key point may conflict with the popular notion that addiction is a
primary illness rather than a symptom of deeper personal distress.
Nonetheless, it is important for judges (and treatment providers) to
recognize that drugs once played an adaptive role in the participants'
lives. This so-called "self-medication hypothesis" of addiction, which
holds that drugs provide some kind of relief -- from loneliness,
boredom, depression, anxiety, guilt, feelings of failure -- explains why
addicts are usually so ambivalent about giving them up in spite of the
damage they eventually cause.^14^

One important function of treatment, therefore, is to help patients
understand what his or her drug did for them so that they can meet those
psychological needs of gratification, self-soothing or self-stimulation,
in other, more constructive ways. Gradually, as the participant realizes
that the costs of drug use outweigh the benefits, they become
"motivated" to change. Yet, motivation is not critical for change. Many
drug court participants have no desire to be in treatment; it was chosen
on the basis of expediency. They are resistant to treatment.
Nevertheless, they remain in treatment because of the threat of
sanctions and/or jail, and while they are literally captive in the
program, they acquire genuine, internal motivation. They come to
recognize that there are alternative lifestyles and they too have the
capacity to change.

######## 

######## DESCRIPITVE ANALYSIS OF THE INTERACTIONAL AND ENVIRONMENTAL VARIABLES OF THE DRUG COURT SETTING

###### Methodology:

**\[17\]** The goals of this descriptive analysis are to (1) identify
interactional variables between judge and drug court participant, (2)
identify environmental variables in a drug court setting and (3)
document variability within a sample of drug court programs.

*[Selection of Drug Courts]{.underline}*

Given travel budget limitations, the investigator chose drug courts
based on proximity to home or other locales frequented. These sites were
(1) District of Columbia Drug Court (Pretrial Services). This site had
the added advantage of rotating judges, so the courtroom dynamics of two
judges could be examined; (2) Brooklyn Treatment Court, Kings County,
New York; (3) New Haven Drug Court, New Haven County, Connecticut; (4)
Fort Lauderdale Drug Court, Broward County, Florida; (5) Miami Drug
Court, Dade County, Florida; (6) Marathon Drug Court, Marathon Key,
Florida. Filmed sessions were obtained from Bakersfield Court,
California; San Diego; Denver; Kalamazoo, Michigan; and interviews with
judges from Los Angeles County, Oakland; Pensacola; and Richmond,
Virginia. This provided an opportunity to observe 15 courtrooms and to
interview 14 judges. In all, over 500 judge-participant interactions
were observed.

*[Process Evaluation]{.underline}*

Specific variables relating to the judge-participant interaction are
listed in Table 1. The investigator sat in the front row of each
courtroom and completed the check list for each participant reviewed by
the judge as well as for the judge's engagement with participants seated
in the jury box.

*[Procedural Characteristics]{.underline}*

The investigator met with the judges to (1) solicit their opinions as to
the importance of the variables being examined in this study; (2)
collect suggestions for new ones; and (3) inquire about their impression
of their relationship to the participant, guiding models and
understanding of addiction.

*[Interview with Judges by Phone]{.underline}*

To complement the observational data, nine judges were contacted by
phone and/or interviewed in person when they attended a two-day meeting
at the offices of the National Association of Drug Court Professionals.

*[Variables]{.underline}*

Seventeen courtroom characteristic and process variables believed to
promote successful drug court interactions were chosen based on many
discussions with judges and observations of drug court environments and
interactions. Listed below are the variables and the rationale for their
inclusion. (See Table 1)

######### **[Results of Observations and Interviews:]{.smallcaps}**

Table 1 presents the range of variables in this non-representative
sample. Interviews with the judges suggested that drug court processes
were often dictated more heavily by the magnitude of the workload than
by the judge's conception of how a drug court should be run.

For example, all judges appreciated the idea that participants could
benefit from remaining throughout the entire session, but only three
judges, all with modest-sized drug courts, felt they could require them
to stay for the period that their court was in session. Also, all but
one judge endorsed the idea of ordering cases to achieve a psychological
impact, but only a little over half did so. (See Table 2) Among the
other half, judges either planned to do so soon or felt that the
caseload was so big that it would be impractical to do more than take
cases as they come in or by alphabetical order. Also, all judges wanted
to be able to call a participant in to see him or her the day after a
significant infraction, but since some courts met

+-------------------+---------------------------------------------------+
| # [Table I:       |                                                   |
|  Variables and Ra |                                                   |
| tionale for Inclu |                                                   |
| sion]{.smallcaps} |                                                   |
+-------------------+---------------------------------------------------+
| # [Vari           | # [Rationale]{.smallcaps}                         |
| able]{.smallcaps} |                                                   |
+-------------------+---------------------------------------------------+
| Ambient noise,    | Impediments to engagement of individuals and      |
| distraction       | community.                                        |
+-------------------+---------------------------------------------------+
| Participant miked | Emphasizes primacy of participant.                |
+-------------------+---------------------------------------------------+
| Closeness to      | Relevant to intensity of judge-participant        |
| bench             | exchange.                                         |
+-------------------+---------------------------------------------------+
| Participant next  | Dilution of judge-participant exchange.           |
| to lawyer         |                                                   |
+-------------------+---------------------------------------------------+
| Who is first      | Emphasizes primacy of participant.                |
| addressed by      |                                                   |
| judge             |                                                   |
+-------------------+---------------------------------------------------+
| Level of eye      | Intensity of exchange.                            |
| contact           |                                                   |
+-------------------+---------------------------------------------------+
| Physical contact  | Aspect of exchange.                               |
+-------------------+---------------------------------------------------+
| Remain throughout | Opportunity to educate by example, reinforce      |
| session           | norms and solidify group cohesion.                |
+-------------------+---------------------------------------------------+
| Arranged seating  | Vehicle for setting example.                      |
+-------------------+---------------------------------------------------+
| Order to cases    | Opportunity to reinforce norms.                   |
+-------------------+---------------------------------------------------+
| Fixed sanction    | Aspect of consistency.                            |
| algorithm         |                                                   |
+-------------------+---------------------------------------------------+
| Review on short   | Capacity for immediate response, emphasizes sense |
| notice            | of judicial watchfulness.                         |
+-------------------+---------------------------------------------------+
| Time spent with   | Level of engagement, opportunity to develop       |
| participant       | relationship.                                     |
+-------------------+---------------------------------------------------+
| Frequency of      | Opportunity to develop relationship.              |
| courtroom         |                                                   |
| sessions          |                                                   |
+-------------------+---------------------------------------------------+
| Judge addresses   | Reinforces sense of court as a community.         |
| gallery           |                                                   |
+-------------------+---------------------------------------------------+
| Participant       | Reinforces community.                             |
| addresses gallery |                                                   |
+-------------------+---------------------------------------------------+
| Outside contact   | Level of engagement.                              |
+-------------------+---------------------------------------------------+

**[Table 2: Variables by Drug Court:]{.smallcaps}**

<table>
<colgroup>
<col style="width: 21%" />
<col style="width: 9%" />
<col style="width: 8%" />
<col style="width: 8%" />
<col style="width: 8%" />
<col style="width: 8%" />
<col style="width: 8%" />
<col style="width: 8%" />
<col style="width: 8%" />
<col style="width: 8%" />
</colgroup>
<tbody>
<tr class="odd">
<td><strong>Variable:</strong></td>
<td><h3 id="court-a">Court A<a href="#fn1" class="footnote-ref"
id="fnref1" role="doc-noteref"><sup>1</sup></a></h3></td>
<td><h3 id="court-b">Court B</h3></td>
<td><h3 id="court-c">Court C</h3></td>
<td><h3 id="court-d">Court D</h3></td>
<td><h3 id="court-e">Court E</h3></td>
<td><h3 id="court-f">Court F</h3></td>
<td><h3 id="court-g">Court G</h3></td>
<td><h3 id="court-h">Court H</h3></td>
<td><h3 id="court-i">Court I</h3></td>
</tr>
<tr class="even">
<td>Ambient noise, distraction (1-5)</td>
<td>4</td>
<td>5</td>
<td>2</td>
<td>3-4</td>
<td>1</td>
<td>1</td>
<td>1-2</td>
<td>3</td>
<td>2</td>
</tr>
<tr class="odd">
<td>Participant miked</td>
<td>No</td>
<td>No</td>
<td>No</td>
<td>No</td>
<td>No</td>
<td>No</td>
<td>Yes</td>
<td>No</td>
<td>No</td>
</tr>
<tr class="even">
<td>Closeness to bench</td>
<td>12 Ft</td>
<td>12 Ft</td>
<td>6-8 Ft</td>
<td>20 Ft</td>
<td>10-12 Ft</td>
<td>10-12 Ft</td>
<td>6 Ft</td>
<td>12 Ft</td>
<td>12 Ft</td>
</tr>
<tr class="odd">
<td>Participant next to lawyer</td>
<td>No</td>
<td>No</td>
<td>No</td>
<td>Yes</td>
<td>No</td>
<td>Yes</td>
<td>No</td>
<td>Yes</td>
<td>Yes</td>
</tr>
<tr class="even">
<td>Who is first addressed</td>
<td>Personnel</td>
<td>Participant</td>
<td>Participant</td>
<td>Personnel</td>
<td>Participant</td>
<td>Participant</td>
<td>Participant</td>
<td>Personnel</td>
<td>Participant</td>
</tr>
<tr class="odd">
<td>Level of eye contact</td>
<td>Intermittent</td>
<td>Sustained</td>
<td>Sustained</td>
<td>Sustained</td>
<td>Sustained</td>
<td>Sustained</td>
<td>Sustained</td>
<td>Intermittent</td>
<td>Sustained</td>
</tr>
<tr class="even">
<td>Physical contact</td>
<td>Graduation</td>
<td>Graduation</td>
<td>Yes</td>
<td>Yes</td>
<td>Graduation</td>
<td>Graduation</td>
<td>Yes</td>
<td>NA</td>
<td>YES</td>
</tr>
<tr class="odd">
<td>Remain throughout session</td>
<td>No</td>
<td>Yes</td>
<td>Yes</td>
<td>No</td>
<td>No</td>
<td>No</td>
<td>New Clients</td>
<td>No</td>
<td>No</td>
</tr>
<tr class="even">
<td>Arranged seating</td>
<td>Jury Box</td>
<td>Jury Box</td>
<td>Jury Box</td>
<td>Jury Box</td>
<td>No</td>
<td>No</td>
<td>Jury Box</td>
<td>No</td>
<td>Jury Box</td>
</tr>
<tr class="odd">
<td>Order to cases</td>
<td>Yes</td>
<td>Yes</td>
<td>Yes</td>
<td>No</td>
<td>No</td>
<td>Yes</td>
<td>Yes</td>
<td>No</td>
<td>Yes</td>
</tr>
<tr class="even">
<td>Fixed sanction algorithm</td>
<td>No</td>
<td>No</td>
<td>No</td>
<td>No</td>
<td>No</td>
<td>No</td>
<td>No</td>
<td>Yes</td>
<td>Yes</td>
</tr>
<tr class="odd">
<td>Review on short notice</td>
<td>Yes</td>
<td>Yes</td>
<td>No</td>
<td>Yes</td>
<td>Yes</td>
<td>Yes</td>
<td>yes</td>
<td>Yes</td>
<td>Yes</td>
</tr>
<tr class="even">
<td>Time spent with participant</td>
<td>1 min.</td>
<td>1-2 min.</td>
<td>1-2 min.</td>
<td>1-5 min.</td>
<td>2-10 min.</td>
<td>1-7 min.</td>
<td>5-10 min.</td>
<td>1-10 min.</td>
<td>1-5 min.</td>
</tr>
<tr class="odd">
<td>Frequency of sessions</td>
<td>Monthly</td>
<td>Weekly/BI.</td>
<td>Monthly</td>
<td>Monthly</td>
<td>Monthly</td>
<td>Monthly</td>
<td>Biweekly</td>
<td>Monthly</td>
<td>Monthly</td>
</tr>
<tr class="even">
<td>Judge addresses gallery</td>
<td>No</td>
<td>Yes</td>
<td>Yes</td>
<td>Yes</td>
<td>No</td>
<td>Yes</td>
<td>Yes</td>
<td>Yes</td>
<td>Yes</td>
</tr>
<tr class="odd">
<td>Participant addresses gallery</td>
<td>No</td>
<td>Yes</td>
<td>Yes</td>
<td>No</td>
<td>No</td>
<td>No</td>
<td>Yes</td>
<td>No</td>
<td>No</td>
</tr>
<tr class="even">
<td>Outside contact</td>
<td>No</td>
<td>No</td>
<td>Yes</td>
<td>No</td>
<td>No</td>
<td>No</td>
<td>No</td>
<td>No</td>
<td>No</td>
</tr>
</tbody>
</table>
<aside id="footnotes" class="footnotes footnotes-end-of-document"
role="doc-endnotes">
<hr />
<ol>
<li id="fn1"><p>Court Identities (A)-Ft. Lauderdale, (B) San Diego, (C)
Marathon, (D) Miami, (E) Pensacola, (F) New Haven, (G) Kalamazoo, (H)
DC-Fox, (I) DC-Lopez, (J) Bakersfield, (K) Denver, (L) Oakland, (M)
Richmond, (N) Brooklyn, (O) Los Angeles<a href="#fnref1"
class="footnote-back" role="doc-backlink">↩︎</a></p></li>
</ol>
</aside>

**[Table 2: Variables by Drug Court Continued:]{.smallcaps}**

+------------------+-------+-------+-------+-------+-------+-------+
|                  | #     | #     | #     | #     | #     | #     |
|                  | ## Co | ## Co | ## Co | ## Co | ## Co | ## Co |
|                  | urt J | urt K | urt L | urt M | urt N | urt O |
+------------------+-------+-------+-------+-------+-------+-------+
| Ambient noise,   | 3-4   | 5     | 2     | 1     | 3     | 3-5   |
| distraction      |       |       |       |       |       |       |
| (1-5)            |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| Participant      | Yes   | Yes   | No    | Yes   | No    | No    |
| miked            |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| Closeness to     | 6-8   | 10 Ft | 12 Ft | 15 Ft | 15 Ft | 4-5   |
| bench            | Ft    |       |       |       |       | Ft    |
+------------------+-------+-------+-------+-------+-------+-------+
| Participant next | No    | No    | No    | No    | No    | No    |
| to lawyer        |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| Who is first     | Pers  | P     | P     | P     | P     | P     |
| addressed        | onnel | artic | artic | artic | artic | artic |
|                  |       | ipant | ipant | ipant | ipant | ipant |
+------------------+-------+-------+-------+-------+-------+-------+
| Level of eye     | Sust  | In    | Sust  | In    | No    | Sust  |
| contact          | ained | termi | ained | termi |       | ained |
|                  |       | ttent |       | ttent |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| Physical contact | Yes   | Gradu | Gradu | Gradu | Gradu | Yes   |
|                  |       | ation | ation | ation | ation |       |
+------------------+-------+-------+-------+-------+-------+-------+
| Remain           | No    | No    | Yes   | No    | No    | New   |
| throughout       |       |       |       |       |       | Cl    |
| session          |       |       |       |       |       | ients |
+------------------+-------+-------+-------+-------+-------+-------+
| Arranged seating | Jury  | Jury  | Jury  | Jury  | Jury  | Jury  |
|                  | Box   | Box   | Box   | Box   | Box   | Box   |
+------------------+-------+-------+-------+-------+-------+-------+
| Order to cases   | No    | No    | Yes   | No    | Yes   | Yes   |
+------------------+-------+-------+-------+-------+-------+-------+
| Fixed sanction   | No    | Yes   | Yes   | No    | Yes   | Yes   |
| algorithm        |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| Review on short  | Yes   | Yes   | Yes   | No    | Yes   | Yes   |
| notice           |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| Time spent with  | 1-5   | 1-5   | 1-3   | 1-5   | 1-5   | 3-8   |
| participant      | min.  | min.  | min.  | min.  | min.  | min.  |
+------------------+-------+-------+-------+-------+-------+-------+
| Frequency of     | W     | Mo    | Biw   | Mo    | Mo    | Bimo  |
| courtroom sess.  | eekly | nthly | eekly | nthly | nthly | nthly |
+------------------+-------+-------+-------+-------+-------+-------+
| Judge addresses  | Yes   | No    | Yes   | No    | No    | Yes   |
| gallery          |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| Participant      | Yes   | No    | Yes   | No    | No    | Yes   |
| addresses        |       |       |       |       |       |       |
| gallery          |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| Outside contact  | Yes   | No    | Yes   | No    | No    | No    |
+------------------+-------+-------+-------+-------+-------+-------+

only weekly or even monthly, that kind of swift response was not always
possible.

Almost all judges sought to make sustained eye contact with
participants, to minimize ambient noise so that everyone could hear the
exchange and to spend as much time as they could with someone who was
not doing well in the program. If there were physical contacts, most
preferred that it be limited to graduations. Male judges were wary about
any contact with female participants, noting that breaching
personal-space boundaries could complicate their work with women who
were already confused about the meaning of male contact.

There was disagreement on the virtue of fixed sanction algorithms. Most
said that they did not want to be constrained, but four felt that a
relatively fixed schedule was most fair. These were also the judges with
some of the busiest courts.

*[Directing Courtroom Theater]{.underline}*

**\[18\]** One of the virtues of drug court, according to Judge Jeffery
Tauber of NADCP, is that "the drug court is theater and the drug court
judge has the opportunity to tell a story." Accordingly, the courtroom
proceedings can be shaped to reify and reinforce the essence of drug
court: individual accountability and restorative justice. By engaging
the drug court "audience" and setting examples, the judge can
communicate certain principles, namely, that behaviors have consequences
and that he or she has faith in the participants' abilities to change.

The judges interviewed directed the drama of their courtroom in various
ways. Only one said he paid little attention to the organization of the
proceedings or to the arrangement of judicial symbols and actions. The
others identified the following as features of the drug court
environment that were designed and executed with their psychological
impact in mind: (1) the order in which cases were called; (2) the order
in which the judge addressed the "players" (*e.g.,* the participant, his
lawyer and treatment provider); (3) assignment of those to be sanctioned
or rewarded to a special section of the courtroom; (4) the use of video
recording.

> *[Order of Cases]{.underline}*

The ordering of cases helps determine the composition of the audience
and what information is imparted at any given time. Ordering cases has a
practical side, (*e.g.,* those in custody may have to return to jail at
a certain time and must be disposed of first), but it can also be a
deliberate arrangement designed to impart meaning. By dealing with those
in custody first (often absconders) everyone sees that the judge will
indeed set limits and penalize individuals. "Those who are doing well
can't afford to get cocky. They have to know that I will give out
sanctions when they are called for," said one judge. Clearly, the judge
who rarely sanctions, violates participant expectations and thereby
erodes trust in the relationship and in the drug court mission overall.
Calling sanctions cases first enhances the aversiveness -- the shaming
quality -- of sanctions. A stable audience is present and the message
that "bad behavior results in bad consequences" is reiterated to all.
The following are examples of other case ordering scenarios:

-   A drug court in California calls employed participants first in
    order to minimize the amount of time they are absent from work and
    to reward them for re-entry into society. Next to come before the
    judge are the "success stories" (those who are doing well and/or
    being advanced to the next phase of their programs). Then the judge
    sanctions the participants who have been out of compliance and,
    finally, he takes the remainder of the calendar (offenders who are
    newly entering the drug court program, etc.).

```{=html}
<!-- -->
```
-   In the Reno, Nevada Drug Court, the graduates go first, then those
    in custody (offenders who were newly arrested or absconders brought
    back on warrants), then others.

```{=html}
<!-- -->
```
-   In the New Haven, Connecticut Drug Court, the judge imposes no
    particular order on cases.

```{=html}
<!-- -->
```
-   In the Marathon, Florida Drug Court, everyone remains, and the
    participants who are to be sanctioned are seated in the jury box. At
    the end of the session, the judge has each come before her, and she
    imposes a sanction.

*[Illuminating the Judge-Participant Dialogue]{.underline}*

A number of judges indicated that this exchange is the main event of the
drug court session. Thus, minimizing noise and distraction is a
priority. In some courtrooms the participant, as well as the judge,
speaks into a microphone. Not only does this signify respect for the
process, but it helps the participant focus -- especially when personal
and sensitive matters are being discussed -- and enables other
participants to follow along more easily. To this end as well, some
judges discourage the presence of the attorneys. When attorneys are
present, these judges always address the participant first and maintain
eye contact.

*[Creating a Sense of Community]{.underline}*

While some judges confine themselves to their relationship with the
participants, others take a more expansive approach, which involves
members of the entire courtroom. This is why, for example, some feel
strongly that the participant should have a microphone to ensure that
everyone can hear. Along these lines, one judge expressed unease with
the current arrangement in his court wherein participants stand directly
in front of him with their back to the spectators. He would prefer the
participant to be "off to the side so the placement would allow us to be
more open to the view of the audience."

When drug court jurisdictions are small and participants are familiar
with one another from their neighborhood, it is easier to create the
kind of "AA atmosphere" that judges sometimes seek. One judge actively
welcomed members of the public and described friendly exchanges between
himself and a recovered addict from the neighborhood. This judge would
occasionally call on the gentleman to act as an "on-site crisis sponsor"
for participants who were wavering in their commitment to drug court.

> *Seating Arrangement*
>
> The jury box often seats participants who are being sanctioned. "Jury
> duty" itself constitutes a sanction in many courts though the box may
> also hold other individuals in custody that have just been arrested,
> returned to court on a warrant or who are waiting to be admitted to
> the program or to receive a sanction.
>
> *Video*
>
> The Denver, Colorado, Drug Court has two, large split-screen
> television sets mounted near the gallery so that the audience can see
> both judge and participant and hear the proceedings. The Bakersfield,
> California, Drug Court routinely videotapes all sessions for purposes
> of educating other judges. At graduation, participants receive
> "before" (addict and criminal) and "after" (drug-free, employed,
> law-biding) still-photos of themselves taken off of the video. For
> promotional and educational purposes, the judge made a half-hour
> videotape that chronicles the progression of an individual participant
> using footage of sessions filmed over her tenure in drug court.
>
> *Use of Language*
>
> Although a number of judges said they viewed addiction as a disease,
> they universally adopted the language of will and personal
> responsibility when talking to participants.
>
> *[Other Activities Intended to Strengthen the Judge-Participant
> Bond]{.underline}*
>
> *Physical Contact* -
>
> Judges sometimes hug participants after graduation. During the course
> of a session, some judges may call the participant up to the bench,
> exchange a few words and shake hands.
>
> *Out-of-Courtroom Activities* -
>
> Judges may attend or arrange picnics or Christmas parties. One judge
> leads participants on a one-mile run after the monthly court.

*Individual Meeting* -

> One judge meets with each graduate in his chambers to congratulate him
> or her, talk about their future and so on. Some judges meet with
> participants seated in the jury box after everyone else has been
> dismissed. Others invite the participant up to the bench to talk
> privately or meet with him along with other court staff afterward in
> their chambers.

### [[Conclusion:]{.underline}]{.smallcaps}

The drug court has ushered in a new model of judge -- one who can
exercise a more flexible and consciously therapeutic rapport with the
drug-using offender.

Clearly, further analysis and study of this new model is needed. For
example, once aspects of the judge-participant relationship are
elucidated, they could be manipulated and tested in drug court settings
by future investigators. Researchers could employ focus groups to assess
the impression of the judge's actions on participants and, ultimately,
correlate this with outcome. The ideal set-up for comparison evaluations
would be a stable drug court treatment program with an explicit sanction
algorithm overseen either by judges who rotate or by more than one judge
simultaneously presiding over status and sanctions hearing. Though the
"drug court model" does create concerns that some judges may attempt to
act as therapists, the seemingly extraordinary potential of this model,
warrants its continued development and study.

**REFERENCES**

1.  Anglin, Douglas, Longshore, Douglas, Turner, Susan, McBride, Duane,
    Inciardi, James and Michael Prendergast. "Studies of the Functioning
    Effectiveness of Treatment Alternatives to Street Crime (TASC)."
    U.C.L.A. Drug Abuse Research Center 1996.

2.  Cooper, Caroline S. "Drug Court Survey Report: Executive Summary."
    Office of Justice Programs,

3.  National Drug Court Institute Judicial Advisory Meeting. "In your
    own opinion, what are the six most important characteristics of an
    effective drug court judge, in order of importance?," Survey.
    February 28 -- March 1, 1998.

4.  Drug Court Standards Committee, National Association of Drug Court
    Professionals, "Defining Drug Courts: the Key Components." Office of
    Justice Programs, U.S. Department of Justice, National Institute of
    Justice, Washington, D.C., January 1997.

5.  Michael Smith, MD, Personal Communication. September, 1997

6.  Hora, Peggy Fulton and William G. Schma. "Drug Treatment Courts:
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    press.

7.  Nichols, William and Travis Nelson. "An Evaluation of the Freedom
    Ranch, Inc. C.B.T.I. drug court programs and the Impact of Moral
    Reconation Therapy and Quality Control Systems." ND Enterprises.
    Oklahoma City, Oklahoma, March, 1997

8.  Access to data through NADCP: data on file with author
    (confidential)

9.  Data from Denver drug court, years 1996-1997, on file with author

10. Belenko, Steven, Nickerson, Gary and Tina Rubenstein. "Crack and the
    New York Courts: a Study of Judicial Responses and Attitudes." New
    York City Criminal Justice Agency, New York, December 1990.

11. Drug Court Clearinghouse and Technical Assistance Project. "Summary
    Assessment of the Drug Court Experience." Office of Justice
    Programs, U.S. Department of Justice, national Institute of Justice,
    Washington, D.C., October, 1996.

12. Harrell, Adele and Barbara Smith. "Evaluation of the District of
    Columbia Superior Court Drug Intervention Program: Focus Group
    Interviews." Urban Institute, Washington, D.C., January 1997

13. Gransfield, Robert and Cindy Eby. "An Evaluation of the Denver Drug
    Court; The Impact of a Treatment-Oriented Drug Offender System."
    Department of Sociology, University of Denver, Denver, Colorado,
    January 1997.

14. Shaffer, Howard J. "Denial, Ambivalence, and Countertransference
    Hate." The Dynamics and Treatment of Alcoholism. Edited by Levin, J.
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[^1]: This article was supported by the Robert Wood Johnson Foundation