Tuesday, 08 September 2026 / Published in Law, Substance Use Disorder

Evidence-Based Responses to Substance Use Disorders

The first three principles establish an important foundation for evidence-based responses to substance use disorders (SUD). SUD is a chronic medical condition. It is treatable, and recovery is possible. Individuals remain accountable for their behavior, but accountability is most effective when it promotes behavior change and public safety.

The next question is practical: What should the justice system actually do?

The way the justice system responds to individuals with SUD can influence both individual outcomes and public safety.^[1] Those decisions may involve conditions of release, supervision requirements, treatment participation, drug and alcohol testing, incentives, sanctions, responses to renewed substance use, and access to medications.^[2] Experience matters in making those decisions. So does professional judgment. But neither experience nor good intentions establish that a particular practice works.

Evidence does.

In the justice system, evidence-based practice means looking to research, data, and proven practices to determine which responses are most likely to produce the outcomes the justice system seeks. It means being willing to ask not simply, “How have we always done this?” but “What does the evidence tell us works?”

evidence-based responses to substance use disorders

Tradition Is Not Evidence

The justice system is built on precedent.^[3] That is essential when courts interpret and apply the law.^[4] But precedent and tradition serve a different function when the question is how best to change human behavior.

A supervision practice does not become effective simply because it has been used for many years. A sanction does not become more effective because it is severe. A treatment requirement is not necessarily appropriate because it has been routinely ordered. And a program should not be assumed to work simply because the people operating it believe that it does.

Practices should be supported by evidence showing that they are likely to accomplish their intended purpose.^[5]

Courts must identify the practice goal first. Is the objective to increase court appearances? Reduce substance use? Improve treatment engagement? Reduce violations? Prevent new criminal behavior? Protect an identifiable victim? Support long term recovery?

Once the goal is clear, research can help identify the practices most likely to achieve it.

Match the Response to the Individual

One of the clearest lessons from research is that people involved in the justice system are not all the same.^[6]

Risk levels differ.^[7] Needs differ.^[8] The factors contributing to criminal behavior differ.^[9] SUDs differ in severity, the substances involved, and the appropriate treatment.^[10] Ignoring differences in risk and needs and applying the same approach to everyone will likely produce poor outcomes.

Evidence-based supervision generally calls for matching the intensity of intervention to the individual’s risk and needs.^[11] People at higher risk of continued justice involvement may benefit from greater structure and more intensive services.^[12] Applying unnecessarily intensive interventions to people at lower risk may provide little benefit and, in some cases, may contribute to increased substance use or criminal behavior.^[13]

The same principle applies to treatment. As discussed in Principle 2, treatment should be based on clinical need rather than imposed as a uniform response to everyone with a SUD.

Individualization is not inconsistency. Treating differently situated people differently can be an essential part of an evidence-based response.

Respond to Behavior in Ways That Change Behavior

Principle 3 discussed the importance of purposeful accountability. Evidence helps determine what that accountability should look like.

Research on behavior change demonstrates that punishment alone is not enough.^[14] Sanctions can play an important role, but how they are used matters.^[15] Responses that are timely, predictable, understandable, and proportionate are more likely to influence behavior than consequences that are delayed, arbitrary, or disconnected from the conduct involved.^[16]

Positive reinforcement matters as well.^[17]

Justice systems naturally focus attention on failure. A missed appointment, positive drug test, violation, or new arrest demands attention. Compliance often receives less notice precisely because it is what the system expects.

But evidence suggests that reinforcing desired behavior can be an important tool for changing behavior.^[18] As discussed in Principle 3, research has found better supervision outcomes when positive reinforcement substantially outweighs sanctions.

That has a practical implication. If the goal is treatment attendance, court appearances, employment, compliance with supervision, and progress in recovery, courts should not focus solely on responding to failure. They should also reinforce the behaviors they want repeated.^[19]

Drug Testing Should Provide Useful Information

Drug and alcohol testing provides another example of why evidence matters.

Testing can serve important purposes. It is one of the few sources of objective data that can identify substance use, monitor compliance, provide information relevant to treatment, and help justice professionals respond to changes in behavior.^[20]

But testing is useful only when it produces reliable information and that information is interpreted appropriately.^[21]

The type of test, the substance being tested for, the detection window, collection procedures, confirmation practices, and possibility of error all matter.^[22] A test result should only be given the meaning that the testing science supports.

Just as the science defines what can be concluded from a test result, it also places limits on what the result can tell us. A positive test may provide evidence of substance use, but it does not, by itself, explain why the use occurred or determine the appropriate response.^[23] Renewed substance use may call for a justice response, a clinical response, or both. The appropriate response should be based on the circumstances surrounding the behavior, not simply the test result itself.

Evidence-based practice requires using drug testing as information, not simply as a trigger for an automatic response.

Treatment Courts Show Why Fidelity Matters

Treatment courts provide a particularly useful example of evidence-based justice practices.

Decades of research have identified practices associated with better treatment court outcomes.^[24] Those findings have been translated into best practice standards addressing issues such as target population, treatment, drug testing, incentives and sanctions, judicial interaction, equity and inclusion, and monitoring and evaluation.^[25]

The important lesson extends beyond treatment courts.

A program’s name does not make its practices evidence based. Calling a program a treatment court, diversion program, recovery initiative, or supervision program tells us little about whether the practices being used are effective.

Implementation matters.

Programs should examine whether they are actually following the practices supported by research. Are the appropriate individuals being served? Is treatment based on assessed clinical need? Are responses to behavior consistent and proportionate? Are medications available when clinically appropriate? Are outcomes being measured? Are practices being applied fairly across participants?

Evidence-based practice requires more than adopting a model. It requires implementing that model with fidelity and examining whether it is producing the intended results.

Evidence Should Be Tested Against Outcomes

Research should guide practice, but data also matter.

Courts should know what their programs and practices are accomplishing.

How many individuals successfully complete the program? How many return to the justice system? Are court appearances improving? Are technical violations decreasing? Are participants remaining engaged in treatment? Are there differences in outcomes among racial, ethnic, gender, or other groups? Are practices producing unintended consequences?

Those questions turn evidence-based practice into a continuing process rather than a one-time decision.

A practice may have strong research support and still be poorly implemented. A program may produce excellent outcomes overall while revealing disparities or weaknesses when its data are examined more closely. New research may also challenge practices once thought effective.

Following the evidence therefore requires a willingness to evaluate, learn, and change.

What Evidence Means

Justice professionals do not need to become researchers. They do need to be informed consumers of research.

That means asking basic questions. What evidence supports this practice? How strong is that evidence? Does the research apply to the population we are serving? Are we implementing the practice in the way it was studied? What outcomes are we measuring? If the evidence changes, are we willing to change our practices?

Evidence does not eliminate professional judgment. It makes that judgment better informed.

The justice system requires that individuals with SUD change. It requires them to examine their behavior, respond to new information, and make different choices when previous choices have produced harmful results.

The justice system should be willing to do the same.

When research demonstrates that one practice produces better outcomes than another, justice professionals should pay attention. When data reveal that a program is not accomplishing its goals, the response should not be to defend the program because it has always been done that way. It should be to ask what needs to change.

Evidence-based practice is ultimately about accountability too. Just as individuals are held accountable for their behavior, justice institutions should be accountable for whether their practices actually work.

That leads to the next principle in JSI’s framework: Stigma. Reducing stigma improves engagement and outcomes. The words, assumptions, and attitudes justice professionals bring to SUD can influence whether individuals seek treatment, remain engaged in recovery, and believe that change is possible.

JSI’s Six Principles for Responding to Substance Use Disorders in the Justice System

1. Understanding — Start with the science.
Understanding what SUD is, how it affects behavior, and its chronic nature provides the foundation for an effective justice-system response.

2. Treatable — Recovery is possible.
SUDs are treatable conditions. Effective treatment is individualized, may change over time, and can help people achieve and sustain recovery.

3. Accountability — Recovery and public safety can coexist.
Accountability remains essential, but consequences and other justice responses should be designed to encourage behavior change, support recovery, and protect public safety.

4. Evidence — Use what works.
Justice-system decisions and practices should be guided by research, proven practices, and evidence about what produces better outcomes.

5. Stigma — Language and attitudes matter.
Stigma can influence decisions, create barriers to treatment, and undermine recovery. Reducing stigma supports fairness, engagement, and better outcomes.

6. Support — Recovery requires continuity and connection.
Long-term recovery depends on coordinated support across treatment, supervision, reentry, families, and communities.

^[1] Faye S. Taxman & David Soule, What Works in Residential Reentry Centers, 38 Crim. Just. & Behav. 103, 103–20 (2011).

^[2] John H. Boman IV, Thomas J. Mowen, Eric J. Wodahl, Bryan Lee Miller & J. Mitchell Miller, Responding to Substance-Use-Related Probation and Parole Violations: Are Enhanced Treatment Sanctions Preferable to Jail Sanctions?, 32 Crim. Just. Stud. 356, 356–70 (2019).

^{^[3]} Ana Elena Fierro, Overview of the Role of Precedent in the Legal System of the United States (1995) (LL.M. thesis, University of Georgia School of Law), University of Georgia School of Law Digital Commons.

^[4] Id.

^[5] Craig E. Henderson, Douglas W. Young, Jill Farrell & Faye S. Taxman, Associations Among State and Local Organizational Contexts: Use of Evidence-Based Practices in the Criminal Justice System, 103 Drug & Alcohol Dependence S23, S23–S32 (2009).

^[6] Faye S. Taxman & Meridith Thanner, Risk, Need, and Responsivity (RNR): It All Depends, 52 Crime & Delinq. 28, 28–51 (2006).

^[7] Id.

^[8] Id.

^[9] Id.

^[10] Substance Use Disorder (SUD), Cleveland Clinic (Sept. 9, 2024), Cleveland Clinic.

^[11] Taxman & Thanner, supra note 6.

^[12] Id.

^[13] Christopher T. Lowenkamp, Edward J. Latessa & Alexander M. Holsinger, The Risk Principle in Action: What Have We Learned From 13,676 Offenders and 97 Correctional Programs?, 52 Crime & Delinq. 77, 89–90 (2006).

^{^[14]} Michael Karson, Punishment Doesn’t Work, Psychology Today (Jan. 14, 2014), Psychology Today.

^[15] Eric J. Wodahl, John H. Boman IV & Brett Garland, Responding to Probation and Parole Violations: Are Jail Sanctions More Effective Than Community-Based Graduated Sanctions?, 42 J. Crim. Just. 242, 242–50 (2014).