Christopher Ruggles receives a congratulatory hug at his graduation from the Merrimack County Drug Court in Concord on January 28. He was the first person to graduate from the program.

Christopher Ruggles receives a congratulatory hug at his graduation from the Merrimack County Drug Court in Concord on January 28. He was the first person to graduate from the program.

April 17, 2019

 By Anna Berry

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 January 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” — 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.

After all, 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.”

By 2015, he was spiraling, selling meth to support his addiction.

“He knew he was a wanted man,” Concord Police Chief Bradley Osgood says.  “… We knew he was on the run.”

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 says. “… 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, says 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 says.

Although Osgood says frequent overdose calls made him acutely aware of the opioid crisis when he began leading the Concord police department six years ago, he didn’t know much about drug court.

“I was really uneducated,” Osgood says. “[Drug court] had not existed before.”

Now, he describes the model as a key piece of the puzzle needed to solve the epidemic.

“I think it has to be a collaborative effort,” he says.. “… I think that it’s part of our services to the community.”

 

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 (See chart, page 17). 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, which have included Medication Assisted Treatment (MAT; read more about it at www.nhbar.org/publications/BarNews) since 2013, each drug court has adapted the model to fit its local community — and, acting as laboratories of justice, the teams adjust policies within weeks or even days to make the system work better.

With 65 percent of all U.S. inmates experiencing addiction, NACDP backs treatment courts as a holistic approach that saves lives: “The average national completion rate for treatment courts is nearly 60 percent, approximately two-thirds higher than probation and more than twice the rate of probationers with substance use disorders.”

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.

And 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 percent, according to Alex Casale, coordinator of the statewide drug offender program.

Nationally, 75 percent of graduates of the country’s 3,000 drug courts are arrest-free at least two years after leaving the program, according to NADCP.

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

However, Casale says 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 says those cost savings will also be tracked.

Comparatively, 60 percent 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 describes 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,” says NH Superior Court Chief Justice Tina Nadeau, who oversees the drug court system. She says graduations like Ruggles’ prove that the risk is worth it.

 

A Hue & Cry for Drug Court

Nadeau, who describes 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 MAT in drug courts — she says about 90 percent 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 says. “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-Governor Maggie Hassan, fully funding an adult treatment drug court or alternative drug offender program for each county.

The legislature allocated $1,635,000 for the first full fiscal year ending in June 2017. The judicial branch received $333,000 for that year to provide administrative support, estimating at the time that judges spent about four hours per week on drug court at an average hourly rate of $141.60. The branch agreed to absorb the cost if it was fully staffed.

“The judges appreciate that all of these cases they would see anyway and maybe several times over the years so it’s worth the investment of a full day every week of managing the drug court docket,” Nadeau says. “Judges are incredibly motivated by this approach.”

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 Does Success Mean?

Nationally, drug courts track recidivism — whether a graduate commits a new crime within two years of leaving a program — and savings from reduced incarceration, as well as compliance.

Jacki Smith, an assistant county attorney and part of the Merrimack County Drug Court team, says 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 percent 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 says. “… 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 the 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 at the jail — 230 people in early April, compared to nearly 500 two years ago.

Casale says 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 percent graduation rate at one point by, in part, changing the schedule for drug testing.

Nadeau agrees — regular collection of information on the ground and the new statewide drug court database will mean that program leaders could quickly see whether, for example, they’re using too much jail time as a sanction.

And, she’s always watching other national developments as the model continues to evolve.

“A lot of these concepts can apply broadly to criminal justice anyway — incentives, sanctions, motivational interviewing …” Nadeau says.

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 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.”

NADCP directed treatment courts back in 2010 to correct racial and ethnic disparities, reinforced in the 2013 and 2015 “Best Practice Standards.” But, “progress toward meeting these obligations has been unsatisfactory,” wrote Dr. Douglas Marlowe, chief of science, law and policy for NADCP in the 2018 “Journal.”

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 says 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 adds.

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

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

Catherine Flinchbaugh, one of two attorneys representing the NH Public Defender’s Office on the Merrimack drug court team, says she’s also interested in the issue.            “There’s not any overt discrimination but at the end of the day, the drug court team itself is not a diverse group of people so obviously implicit bias is a real thing,” she says. “We are trying to make sure we don’t exacerbate the issue of discrimination in the criminal justice system but obviously sometimes best efforts don’t even work …”

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.”

Indeed, there is an inherent push and pull between the criminal justice system and the healthcare system even at the local level.

Clairmont describes it as a “clash of the titans” with two different views on the right approach to treatment.

“Both sides need to give a little,” she says.

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,” says Strafford County Attorney Tom Velardi of county’s drug court. “We were wrong. We certainly reeducated ourselves.”

Meanwhile, the Merrimack team is still working on what a non-adversarial approach looks like in court.

Merrimack Assistant County Attorney Jacki 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 says. “It’s amazing to watch the transformation in people’s lives.”

Flinchbaugh has a different perspective.

“The [justice] system is very much built to be adversarial,” she says. “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 adds 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 says.

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

From a medical perspective, Clairmont notes that 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 says 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 says. “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 Bar Association. (Disclosure: Berry’s spouse is a member of the steering committee for the Merrimack drug court.) This ongoing series, examining the overlap between the justice system and the state’s behavioral health crises, continues next month.

New Hampshire’s Drug Courts by County

*Data from 2017 & 2018 annual reports from the State of New Hampshire’s Drug Offender Program

New Hampshire’s Drug Courts by County *Data from 2017 & 2018 annual reports from the State of New Hampshire’s Drug Offender Program

Granite State News Collaborative

Learn more about behavioral health in New Hampshire as part of the Granite State News Collaborative’s Granite Solutions reporting project.

The New Hampshire Bar News is a founding member of the collaborative. Stay tuned for additional coverage at www.collaborativenh.org 

Related Coverage of Behavioral Health Issues

From Abstinence to Harm Reduction: Advocates Say Medication Assisted Treatment is Saving Lives
https://nhbar.org/abstinence-harm-reduction-mat/

NH’s Hub and Spoke System: Traction or Just Spinning Wheels?
https://manchesterinklink.com/nhs-hub-and-spoke-system-traction-or-just-spinning-wheels/

Second Act: Former Chief Justice Reinvents Himself as Mental Health Advocate
https://www.nhbar.org/former-chief-justice-reinvents-himself-as-mental-health-advocate/

Watch: Former Chief Justice John Broderick speaks to students at Laconia High School
https://video.nhpbs.org/video/change-direction-stigma-p0z53k/

We are One: Stories of Hope, Power, Connections
https://www.collaborativenh.org/news/2019/1/16/we-are-one-stories-of-hope-power-connections-derry-forum-offers-youth-perspectives-on-mental-health-struggles

A Journey Through NH’s Mental Health System
https://www.laconiadailysun.com/news/a-journey-through-nh-s-mental-health-system-part-of/article_cc9a152e-07cc-11e9-b23c-1f08564fdf18.html

Roads to Recovery
https://nhpbs.org/recovery/

Two Roads Diverged: Reconnecting Substance Abuse Disorder and Mental Health
https://www.collaborativenh.org/news/2019/1/14/two-roads-diverged-reconnecting-substance-abuse-disorder-and-mental-health

Behavioral Health Resources

https://www.collaborativenh.org/resources

 

Concord Police Chief Bradley Osgood speaks at Ruggles’ graduation.

What is Drug Court?

12-18 month voluntary program

can operate pre- or post-plea with violent crimes  reviewed on a case-by-base basis.

Team-based, non-adversarial approach

includes treatment provider, case manager, probation/parole officer (PPO), judge, prosecutor, public defender and police officer.

Participant has regular hearings at courthouse

plus frequent drug tests, substance abuse treatment including MAT, cognitive therapy, monitoring by a PPO, and  incentives or sanctions.

Goal: to reduce recidivism and enhance community safety.