By Mary Stover, CFCC Student Fellow (2016-2017)
On a recent Wednesday I, along with other CFCC Student Fellows, observed an uplifting morning in the Adult Drug Treatment Court at the Baltimore City District Court. At the conclusion of each of seven brief status hearings, the presiding judge, the Honorable Martin Dorsey, congratulated the compliant participant, calling him or her a member of the “A team.” We all applauded seven times. Even in the two non-compliant participants’ cases, the status hearings appeared collaborative and governed by therapeutic justice. In short, we observed a problem-solving court in action.
Nevertheless, while many drug court programs — which combine mandated treatment and close judicial oversight — have been found to be more effective at combating drug use and criminal recidivism than traditional incarceration and probation, they are not a panacea. In 2014-2015, nearly half of Maryland’s 885 drug court participants did not graduate from the program, consistent with drug court program failure rates of 40 to 64 percent across the country. Research on post-program results is mixed and suggests that the positive impact of participation in a drug court program may not be long-term in a significant number of cases. A study of Baltimore’s adult drug court program indicates that over 78 percent of drug court participants had been arrested for a new offense within three years after program entry and re-arrest rates for participants had dwindled to a 10-point differential as compared to those who went through the traditional court process. Similar three-year differentials were found for self-reported drug and alcohol use. The Baltimore researchers noted that, at three years after program entry, the positive effects of drug treatment court did not extend to other physical and mental health status indicators, family and social connections, or employment status.
The drug treatment court’s problem-solving approach seems more effective than incarceration and probation in addressing the reasons why an individual is involved with the criminal justice system. Why, then, are graduation rates and positive long-term effects not more pronounced? The proceedings that we observed last Wednesday morning and subsequent discussion with court personnel illuminated some of the roadblocks faced by drug court participants during and after completing the program. Increased access to appropriate, affordable housing stood out to me as a necessary, yet often missing, part of the solution.
Two of Wednesday’s compliant participants alluded to their previous living situations when they commented on the need to “get out of Baltimore” in order to manage their addictions. I do not know from which aspects of their previous lives these individuals felt they needed to escape, but I do not think that moving is always advantageous. Some participants, such as a woman who noted the critical role that the support of her family had played in her success, may fare better when they remain close to positive family and community relations. Regardless of whether participants prefer to stay in a supportive neighborhood or want to distance themselves from unhealthy personal relationships, widespread drug use in their neighborhoods, or other negative factors, they often need housing assistance. The Baltimore Drug Treatment Court coordinator confirmed that lack of access to housing, both during and after participation in the program, is one of the most substantial barriers to long-term success.
Housing and neighborhood conditions are generally known to affect people’s mental and physical health. For drug court participants whose pre-treatment living situation was in close proximity to drug activity, research has shown “that moving away from drug-using friends and acquaintances supports the maintenance of abstinence.” For all drug court participants, “permanent housing is associated with a reduction in recidivism.” The drug court uses a holistic approach to identify and address participants’ needs, including housing. But the Baltimore region, like many other areas in the U.S., suffers from an affordable housing crisis and concentrations of neighborhood disadvantages that disproportionately affect our most vulnerable populations, including drug court participants.
The annual income needed to afford an average priced modest studio or a one-, two- or three-bedroom apartment in the Baltimore metropolitan region is $34,040, $41,320, $51,920 and $66,520, respectively. A minimum-wage worker would have to work at least 79 hours per week to afford a modest studio apartment in the Baltimore area. The drug court participant population typically “is very low on the socioeconomic scale, and has a lower level of educational achievement compared to the general population.” Even assuming optimistically that a drug court program graduate would be able to earn Baltimore City’s estimated median renter income of $28,665, she or he would face a $6,375 annual housing affordability gap for a studio apartment. A program participant earning 30 percent or less of the median income faces a gap of at least $8,000.
Baltimore City District Court Drug Treatment Court personnel are working with assisted housing providers and others to increase the court’s ability to identify and secure supportive housing for participants during and after residential treatment. Housing assistance, however, is extremely scarce. Twenty-five thousand households in Baltimore City are on wait lists for federal housing assistance, where the wait can take as long as ten years. Another 50,000 households have applied but were turned away. Furthermore, drug court participants may be barred from some types of housing assistance because of their criminal records, and many landlords refuse to accept housing assistance vouchers. Without assistance, a program participant is unlikely to be able to rent decent housing anywhere in the region, let alone in a neighborhood that meets his or her needs.
Concluding on a hopeful note, very low-income Baltimoreans’ access to housing may improve after tomorrow’s election. Question J on the ballot asks whether the Baltimore City charter should be amended to establish an Affordable Housing Trust Fund, a legal mechanism that will allow the City Council and mayor to designate funds for housing assistance programs for “the city’s neediest residents.”  Once established, the trust fund would receive ongoing public funding to support the preservation and production of affordable housing units and services aimed at individuals and families at 50 percent or below the area median income (AMI), with most of the funding being targeted to those at 30 percent or below the AMI.
Of course, housing assistance alone will not guarantee drug court participants’ long-term success. For those who suffer from addiction, ongoing access to health-centered treatment seems to me to be the most important key to sustained recovery. My hope is that improved housing will provide an environment that optimizes the chances of continued treatment success for Baltimore’s drug court participants. That is one of the reasons I plan to vote “yes” on Question J.
What barriers to success do you think drug court participants face? Do you think increased housing assistance would help? What do you think of Question J?
 See Randall T Brown, Systematic Review of the Impact of Adult Drug Treatment Courts, 155 Translational research 263 (2010). See also Ojmarrh Mitchell et al., Assessing the effectiveness of drug courts on recidivism: A meta-analytic review of traditional and non-traditional drug courts, 40 Journal of Criminal Justice 60 (2012), available at http://www.courtinnovation.org/sites/default/files/documents/Assessing_Efectiveness.pdf.
 For a critical review of drug courts and drug court research from a health policy perspective see Drug Policy Alliance, Drug Courts Are Not the Answer: Toward a Health-Centered Approach to Drug Use (March 2011), available at https://www.drugpolicy.org/docUploads/Drug_Courts_Are_Not_the_Answer_Final2.pdf.
 Kathleen Seifert, Review of Problem-Solving Courts in Maryland, Sayra and Neil Meyerhoff Center for Families, Children and the Courts (Oct. 18, 2016), https://ubaltlawcfcc.wordpress.com/2016/10/18/review-of-problem-solving-courts-in-maryland/.
 See Mitchell, supra note 1, at 61.
 Christopher P. Krebs et al., Assessing the Long-Term Impact of Drug Court Participation on Recidivism with Generalized Estimating Equations, 91 Drug and Alcohol Dependence 57 (2007). A 2005 GAO review of recidivism identified 17 drug courts for which post-program recidivism was analyzed. “For the 9 drug court programs reporting significant reductions, the differences in reconviction rates between drug court participants and comparison group members ranged from 5 to 25 percentage points.” U.S. Gov’t Accountability Office, GAO-05-219, Adult Drug Courts: Evidence Indicates Recidivism Reductions and Mixed Results for Other Outcomes, 52 (2005), available at http://www.gao.gov/new.items/d05219.pdf.
 Denise Gottfredson et al. The Baltimore City Drug Court: 3-Year Self-Report Outcome Study, Evaluation Review, February 2005, at 42, 47, available at https://ccjs.umd.edu/sites/ccjs.umd.edu/files/pubs/Gottfredson2005.pdf.
 See id. at 52-58. The researchers urge caution in interpreting differentials between drug court and regular court outcomes unambiguously as true treatment effects because of differences in pretreatment characteristics.
 Id. at 61.
 See e.g., Center on Social Disparities in Health at the University of California at San Francisco and the Build Healthy Places Network, Making the Case for Linking Community Development and Health, 6 (2015), available at http://www.phi.org/resources/?resource=making-the-case-for-linking-community-development-and-health (“A large body of literature has linked different kinds of conditions in neighborhoods with health; these include physical conditions, the services available and social conditions”). Living in a disadvantaged neighborhood (i.e., a neighborhood with high rates of poverty, female-headed households, unemployment and public assistance recipients) has been found to have a positive relationship with drug use, regardless of individual-level socioeconomic status. Causation, however, is unclear. See Jason D. Boardman et al., Neighborhood Disadvantage, Stress, and Drug Use among Adults, 42 Journal of Health and Social Behavior 151 (2001).
 Ciska Wittouck et al., The Impact of Drug Treatment Courts on Recovery: A Systematic Review, The Scientific World Journal, at 1, 10 (2013), available at https://www.hindawi.com/journals/tswj/2013/493679/.
 See e.g., Center on Social Disparities in Health at the University of California at San Francisco and the Build Healthy Places Network, supra note 9 (“Healthy and unhealthy neighborhood conditions are not distributed randomly. Extensive research shows that low-income and minority neighborhoods are more likely to experience harmful conditions and to lack health-promoting conditions”). See also e.g., Alan Berube and Brad McDearman, Good fortune, dire poverty, and inequality in Baltimore: An American story, The Avenue, Brookings (May 11, 2015), https://www.brookings.edu/blog/the-avenue/2015/05/11/good-fortune-dire-poverty-and-inequality-in-baltimore-an-american-story/.
 Housing cost and income estimates National Low Income Housing Coalition Out of Reach 2016 http://nlihc.org/oor. NLIHC uses HUD Fair Market Rents and a housing (rent and utilities) affordability cap of 30 percent of household income in its estimates.
 NPC Research, Baltimore City Drug Treatment Court (Adult Offenders in District Court) Process Evaluation Final Report, 22 (2007), available at http://www.courts.state.md.us/opsc/dtc/pdfs/evaluationsreports/balt_city_drug_treat_court_dist-adult.pdf.
 See NLIHC, supra note 13.
 See id.
 See e.g., Pamela Wood, Baltimore County Council Rejects Housing Anti-discrimination Bill, Baltimore Sun (Aug. 1, 2016), http://www.baltimoresun.com/news/maryland/baltimore-county/bs-md-co-housing-policy-vote-20160801-story.html.
 See Colin Campbell, Baltimore Will Vote on Affordable Housing Trust Fund in November, Baltimore Sun (Aug. 29, 2016), http://www.baltimoresun.com/news/maryland/baltimore-city/politics/bs-md-ci-housing-charter-amendment-20160829-story.html.