How Courts Have Shaped Addiction, Mental Health & Treatment in the US

The entire history of the US, post-Columbus, is built into the current legal system. The US follows the federalist system of government. Power is consolidated in one centralized government authority but states have power over local matters; however, how the federal government and state governments share power is an ongoing legal issue that must often be adjudged on a case-by-case basis.This system is an outgrowth of the 18th century colonies, which the country’s forefathers created. The sheer land mass of the US necessitated that the colonies have powers in order to manage day-to-day life and law and order.

The enactment of the US Constitution was a way that the forefathers ensured that the federal government would hold more power than the states. In terms of the legal system, the Constitution made clear that the US Supreme Court was the ultimate authority in certain areas, such as copyright law, bankruptcy, and taxation. However, each of the states, and their courts, have the power to create laws that are not specifically given to the federal government per the Constitution. This system has resulted in a hierarchy of authority within the US court system. The federal courts, like the state courts, are divided into three levels: the trial court, the appellate court, and the supreme appellate court. Trial courts resolve questions of fact and then apply those facts to established laws (either the presiding judge or jury does this). Appellate courts only consider questions of law.

Against this backdrop, consider the application of laws related to substance abuse in the US court system. At the state level, courts are most involved in matters like involuntary commitment to a recovery program, criminal trials and sentencing for drug offenses, and serving as a drug court. A state’s appellate courts can interpret certain laws to provide clarification to the trial courts, practicing attorneys, lawmakers, and the public. The federal court system, headed by the US Supreme Court, receives approximately 7,000 case hearing requests each year but only accepts about 80. Sometimes, though rare, there is a decision that relates to some aspect of substance abuse treatment. More often than not, when the US Supreme Court hears a drug-involved case, it is related to a criminal case. Since the US Supreme Court only considers questions of law, it’s decisions are rules that can be applied to analogous situations and cases throughout the country.


The Supreme Court on Addiction & Treatment

supreme court of the united states has 7,000 case hearing requests each year and only accept about 80A Landmark Case Held Addiction Is Not a Crime

In 1962, in Robison v. California, the US Supreme Court ruled that California could not imprison a person solely for being addicted to narcotics. Today, we may think the ruling was obvious, but this reaction only demonstrates how far the country has come in its understanding of substance abuse and addiction. The law at issue in Robinson v. California was a California statute that made narcotic addiction a punishable misdemeanor offense. The California statute reflects the old way of thinking about addiction, that people were “addicts.” By criminalizing this status, under this law, an individual could be arrested, tried, and imprisoned even if they didn’t do anything otherwise criminal. In contemporary times, we understand that addiction is a disease that is treatable. It is well accepted that anyone can experience substance abuse.

The court’s ruling did not go so far as to excuse criminal acts committed while under the influence of drugs. However, there are certain legal defenses that individuals may be able to raise if they commit crimes while under intoxicated with drugs. These defenses derive from the US Constitution, or they are based on case law. As a general rule of thumb, it is unlikely that a law that punishes a status will be upheld, but laws that criminalize behaviors against the public interest likely will be.

Clarifying the Role of the Courts in Drug Treatment

supreme court of the united states on addiction and treatment, addiction: robison v. california. Treatment: tapia v. united states. Again, at the level of the US Supreme Court, laws are made based on the cases that the court rules on after a thorough deliberation process. In 2011, the court issued an opinion in Tapia v. United States that helped to clarify the role that courts can play in the recovery process for a defendant who is convicted of a crime and is experiencing substance abuse. The facts of Tapia involve a woman who was engaged in illegal immigration practices. When it came time for her sentencing, the trial court recognized that she was experiencing substance abuse. In an effort to help her recover while incarcerated, the court imposed a sentence of 51 months on this defendant. The 51-month sentence was selected so as to qualify her for the Bureau of Prisons’ Residential Drug Abuse Program (RDAP).

The defendant appealed the trial court’s decision first to the 9thCircuit (a federal appellate court) and then ultimately to the Supreme Court. In its ruling, the Supreme Court clarified what the trial court had done wrong in the face of the law. The court held that neither state nor federal courts can impose a prison sentence on a defendant, nor lengthen a prison sentence, just so the defendant can receive drug recovery services or complete a program for inmates. What makes this case important and interesting is that it lets the public know that prisons should not be used chiefly as rehab centers. If an individual has been convicted of a crime and the appropriate sentence is handed out, and that sentence happens to fall within the terms of RDAP or other prison rehabilitation program, then the incarcerated person can reap the benefits of the program. A person dealing with substance abuse cannot be sent to prison to get help, but can still get help once in prison.

When Americans picture a drug recovery program, it’s likely that they picture therapy services within a rehab center, not a prison. However, prisons do provide recovery services to inmates, though the National Institute on Drug Abuse (NIDA) believes treatment services need to be expanded. According to NIDA, one survey found that 49 percent of federal inmates and 40 percent of state inmates participated in a drug program. However, the drug program was typically based on a self-help platform, such as peer counseling. The survey revealed that only 15 percent of state inmates and 17 percent of federal inmates were involved in a drug treatment program in which a professional addiction specialist provided recovery services.

The Supreme Court Upholds the ACA

The laws around substance abuse treatment can relate to different critical areas, including rights, funding, or access to services. In 2012, the Supreme Court upheld the constitutionality of the Affordable Care Act, known in the mainstream as Obamacare. Notes Thomas McLellan, former Deputy Director of the White House Office of National Drug Control Policy, this decision was a major coup for the all stakeholders in the field of addiction treatment.

According to McLellan, the ACA, as upheld, confers the following benefits related to substance abuse:

  • Substance abuse is one of the 10 essential health benefits, which means all ACA plans, including Medicaid, must provide a minimum level of recovery services.
  • More than ever in the history of US healthcare, there are coverage and reimbursement options for substance abuse treatment.
  • The ACA signals a new era, one in which healthcare services can provide prevention services, early treatment, and greater physician-based care.
  • The ACA can help people to get healthcare coverage and therefore intercept substance abuse before it progresses to addiction.

It is important to note that insurance coverage terms vary according to insurance policies. While the ACA requires coverage minimums, it may not be comprehensive enough to provide for all the substance abuse treatment needs any given person may have. Still, the ACA’s commitment to providing recovery services reflects that the government is moving in a helpful direction on the drug rehabilitation front.

More About the Affordable Care Act

The Supreme Court and the Fair Sentencing Act

In 2010, the Fair Sentencing Act (FSA) was enacted into Law. A main goal of the FSA was the reduction in sentencing for crack cocaine offenses, so that terms in prison would more closely match those for powdered cocaine offenses. It’s necessary to put the FSA into context, which requires that we go back in time to the Reagan era. When President Reagan took office in 1981, he faced a crack cocaine epidemic. To address that problem, President Reagan and his administration helped to push laws through congress that imposed harsh sentencing on crack-cocaine sales and use.

Reagan’s drug policy and laws came under fire for a host of reasons. First, criminalization was not as humane of a response as an effort to provide rehabilitation services would have been. Second, the criminalization approach didn’t quash the drug epidemic and overburdened the prison system. Third, the harsh crack-related laws disproportionately impacted impoverished African Americans and were therefore discriminatory in practice. The FSA changed the legal landscape. After the FSA, convictions related to crack cocaine must not deviate too much from the same offenses related to powdered cocaine. It is hoped that this law balance out the racial disparities – ultimately that African Americans who tend to abuse crack won’t serve as substantially disparate sentences as Caucasians who are more closely associated with the abuse of powdered cocaine.

More On Presidential Action

judicial branch, reduction in sentencing, fair sentencing act (FSA)The Supreme Court has played an important role in the administration of the FSA. In 2012, the court considered a narrow legal issue in Dorsey v. United States. If a person commits a crack-involved crime before the FSA but was sentenced after the FSA, should the tougher or more lenient sentencing guidelines apply? In a 5-4 decision, the court held that the more lenient sentencing terms apply to this situation. In this way, the court acted with considerable fairness and gave effect to the spirit of the FSA. The ruling meant that there would be fewer people in prison for long terms due to crack-involved offenses. While only a small subset of the prison population may have benefitted from this particular ruling, it put the quickest end possible to long sentences for those individuals who had experienced crack abuse.

The Role of State Drug Courts

The state court system is designed in a way that trial court orders do not make new law (if they’re not appealed to the higher appellate courts) but they do have a very large impact on the individual litigants. State drug courts do not issue rulings that change the laws around substance abuse, but they can help individuals experiencing substance abuse to get meaningful help. According to a review of drug court programs, in 2014, there were over 3,400 operating throughout the state court system across the US.

A drug court is a program that is housed in a court that may otherwise be dedicated to family, civil, or criminal matters. Typically, if individuals who are experiencing substance abuse land in the judicial system, a judge, attorney, or other professional may refer them to drug court instead of the traditional criminal court system.

3,400 operating drug courts throughout the state court system across the United States can make referrals to rehab programsDrug courts can provide the following services to help an individual recover from substance abuse instead of going to jail or prison:

  • Make a referral to a rehab program (one that accepts the person’s insurance or Medicaid if the person is eligible for this fully subsidized healthcare program)
  • Usually monitor the recovering person for at least a year
  • Test the recovering person for drugs both regularly and randomly through the monitoring process and rehab program stay
  • Legally order the recovering person to appear in court so the judge may monitor the recovery process


Drug courts are widely considered to be one of the most effective ways that the legal system can help individuals who need help recovering from substance abuse. Harkening back to the Tapia case for a moment, drug courts complement the US Supreme Court’s decision. Courts, in general, can play an active role in helping people to get into a structured treatment plan outside of the legal system rather than sending people to prison to get them into a penitentiary drug treatment plan.

More About State and Local Help

The following are some noted highlights of drug court program effectiveness:

  • Across the nation, 75 percent of individuals who graduate from drug court programs have not been arrested again at the two-year mark.
  • Per different research studies, drug courts can reduce crime by as much as 45 percent compared to other approaches, such as criminal sentencing.
  • Compared to other programs, drug courts are six times more likely to ensure than an individual remains in treatment long enough to make a meaningful recovery.
  • Parents who participate in family drug court are twice as likely to enter a rehab and complete treatment.

In view of the potential benefits of a drug court program, legally ordering an individual to attend a drug rehab program is one of the most important decisions a state court judge can make. But states don’t act alone. State court drug programs exist, in part, with the help of federal aid. In 2013, the federal government reportedly increased federal funding for drug court programs by 250 percent.

drug courts can play an active role in helping people to get into a structured treatment planThe drug court approach provides an important alternative to criminalizing substance abuse. Consider how drug courts work based on a real-life example from an article on this topic published online for The Fix. Derrick, a man in his 20s, was appearing in the Drug Treatment Court in Brooklyn, New York, for possession of heroin, a felony charge. Judge Jo Ann Ferdinand advised Derrick’s public defender that if Derrick would plead guilty to a lower offense, a misdemeanor possession charge, and agree to treatment, the court would refer him to a rehab center. Derrick accepted this offer rather than face a year in jail, the sentence associated with a felony possession charge. By accepting to go into treatment, Derrick avoided the felony charge and therefore preserved his right to vote and other important benefits. The judge advised Derrick that if he completed the drug recovery program, his misdemeanor offense could be purged from his record. Derrick could get recovery services and, in time, a clean slate. There’s no available update on Derrick but his situation in drug court is not entirely unique, as these programs offer many people an opportunity to recover from substance abuse and have a future free of drugs and a criminal record.

The judicial acts discussed in this article reflect some of the ways in which the US is moving away from the criminalization of substance abuse and toward a more compassionate model that is on point with scientific findings (i.e., that substance abuse is a disease). The rulings referenced reflect that the legal system is not merely paying lip service to helping to find a solution to the drug epidemic. Traditionally, the greatest power courts have is to impartially interpret and apply laws in a way that is most supportive of the public good and constitutionally fair to the litigants. The hope is that the future will bring more federal and state legislation and court rulings that are pro-rehabilitation and that veer away from punishing those in need of drug recovery services.