Specialty Courts: What the Evidence Actually Shows

Executive Summary

Are specialty courts as ineffective as some critics suggest? This article examines that question by reviewing current research, national evaluations, and evidence-based treatment court standards. While acknowledging that treatment courts have evolved through ongoing evaluation and reform, it concludes that many criticisms rely on outdated research, isolated examples, or implementation shortcomings rather than the treatment court model itself. The evidence demonstrates that well-implemented treatment courts reduce recidivism, improve public safety, support recovery, and continue to evolve through research and nationally recognized best practices.

Why the Evidence on Treatment Courts Matters

An article published by the Prison Policy Initiative characterizes specialty courts as a “disappointing form of diversion” and concludes that they have failed to improve public safety, public health, or the lives of those they serve.^[1] Its central recommendation is that treatment courts^[2] should occupy only a limited role within the justice system, with voluntary community-based interventions replacing them as the preferred response to substance use disorders and other behavioral health conditions. 

The article raises some important questions. No justice system institution should be immune from critical examination, and treatment courts are no exception. Their effectiveness depends upon faithful implementation of evidence-based practices, appropriate oversight, and a willingness to evolve as research and clinical knowledge advance. Following evidence-based practices has played an important role in the development of treatment courts over the past three decades.

The article’s conclusions, however, are not supported by the weight of the available evidence. Throughout its analysis, it repeatedly treats implementation deficiencies as evidence that the treatment court model itself is ineffective. It relies heavily on research describing earlier generations of treatment courts, extends the conclusions of several studies beyond what their authors found, and frequently generalizes from isolated jurisdictions and individual practices to the field as a whole. As a result, it presents a picture of modern treatment courts that is inconsistent with current research, national best practice standards, and the substantial evolution of the field.

The article’s analysis is further undermined by a more fundamental problem. It treats a diverse and continually evolving group of specialty courts as though they constitute a single, uniform type of diversion program.^[3] That premise is incorrect. While a relatively small number of treatment courts operate as pre-plea diversion programs, the overwhelming majority do not. ^[4] National survey data indicate that only 6.8 percent of adult drug treatment courts operate on a pre-plea model, while more than 93 percent accept participants after a plea has been entered.^[5]

These courts were not designed primarily to divert individuals from the criminal justice system. Rather, they seek to improve public safety by combining judicial supervision, treatment, accountability, and evidence-based interventions to reduce recidivism and support long-term recovery.^[6] This distinction is more than a matter of terminology. It defines the objectives against which treatment courts should be evaluated. Measuring post-plea treatment courts by the standards of pre-plea diversion inevitably produces a distorted assessment of their effectiveness. Many of the article’s subsequent criticisms flow directly from this mistaken premise.

Although the article acknowledges the remarkable growth of treatment courts since their emergence in the late 1980s, it instead focuses on Connecticut’s claimed absence of treatment courts and suggests that other jurisdictions may eventually follow the same path.^[7]  That characterization is incomplete. A federal Drug Treatment Court continues to operate in Connecticut,^[8] and the state is actively developing a statewide Mental Health Court intended to serve as a model for future expansion.^[9]  Rather than demonstrating the decline of treatment courts, developments in Connecticut illustrate the continuing evolution of the field.

Having framed treatment courts primarily as diversion programs, the article advances six principal criticisms:

1. Treatment courts have produced mixed results in improving public safety and public health.
2. Restrictive eligibility criteria exclude many individuals who could benefit from participation.
3. Treatment courts continue to rely on outdated public health practices.
4. Treatment courts do not reduce incarceration and may instead expand the reach of the criminal justice system.
5. Judges rely too heavily on jail sanctions, undermining treatment progress.
6. The multidisciplinary team model improperly exposes personal information and compromises judicial neutrality.

Some of these criticisms identify legitimate implementation challenges that treatment court leaders have spent years addressing through research, policy reform, and national best practice standards. Others, however, are based on outdated evidence, unsupported inferences, or assumptions that do not accurately reflect how modern treatment courts operate. Each deserves careful examination.

Claim One: Treatment Courts Have Had Only Mixed Success

The article correctly observes that treatment courts have been studied more extensively than almost any other innovation within the criminal justice system.^[10] Ironically, however, it gives comparatively little weight to the strongest evidence available. Rather than focusing on systematic reviews, national evaluations, and government reports, it relies primarily on individual program evaluations and isolated examples of underperforming courts. Those studies are valuable for assessing the effectiveness of specific programs, but they cannot establish whether the treatment court model itself is successful.

Multiple systematic reviews, meta-analyses, the U.S. Government Accountability Office, and the National Institute of Justice have consistently concluded that well-implemented adult drug courts reduce recidivism and substance use compared with traditional case processing.^[11]  Even one of the studies cited as evidence that treatment courts are ineffective, demonstrates that well-implemented courts produce substantially better outcomes.^[12]

The proper conclusion is not that treatment courts “do just ok.”^[13] Rather, the evidence demonstrates that well-implemented treatment courts consistently produce better outcomes than traditional criminal case processing while identifying opportunities to improve underperforming programs.

Claim Two: Restrictive Eligibility Limits Access to Treatment Courts

The article argues that restrictive eligibility criteria place treatment courts beyond the reach of many individuals who could benefit from participation. Historically, that criticism had merit. Early treatment courts often relied on broad offense-based exclusions, categorical disqualifications, and local policies that limited access for individuals with violent offenses or extensive criminal histories. The article, however, relies primarily on studies describing treatment court practices from the early 2000s through approximately 2012 while giving comparatively little attention to the substantial changes that have occurred over the past decade.^[14]

Current national best practice standards recommend that eligibility decisions be based on validated risk assessments and clinical need rather than categorical offense-based exclusions, recognizing that individuals with the greatest criminogenic risk and treatment needs often stand to benefit the most from treatment court participation.^[15] The article, however, relies primarily on studies describing treatment court practices from the early 2000s through approximately 2012 rather than the current national best practice standards.

The article also argues that prosecutorial and judicial discretion inevitably produces arbitrary admissions and therefore concludes that treatment courts will “inevitably fail.”.^[16]  That conclusion confuses implementation challenges with the effectiveness of the treatment court model itself. Discretion exists throughout the criminal justice system and, like any discretionary authority, must be exercised within objective standards and appropriate oversight. The appropriate response is to improve by applying evidence-based criteria and transparent policies, not to reject a model whose effectiveness has been repeatedly demonstrated.

What the Evidence Says About Treatment Court Effectiveness

Claim Three: The Article Relies on Outdated Characterizations of Modern Treatment Courts

The article next argues that treatment courts continue to rely on outdated public health principles, particularly by resisting medications for opioid use disorder (MOUD).^[17] To support that claim, it relies primarily on studies conducted more than a decade ago, when many treatment courts were still developing policies regarding medication-assisted treatment. Those studies accurately described the practices of some early treatment courts, but they no longer reflect the current direction of the field. ^[18]

Advances in addiction science have fundamentally changed the understanding of substance use disorders and their treatment. National best practice standards now recognize MOUD as the standard of care for opioid use disorder and emphasize that treatment decisions should be made by qualified medical professionals, not judges.^[19] Current standards discourage blanket prohibitions on FDA-approved medications and encourage treatment courts to ensure participants have access to all clinically appropriate treatment options.^[20] Although implementation is still not universal across treatment courts, the trend has been unmistakable: toward greater acceptance of evidence-based treatment, not continued resistance.^[21]

The article acknowledges neither the substantial changes in treatment court practice over the past decade nor the national standards that have embraced current addiction science. By relying primarily on historical evidence while giving comparatively little attention to these developments, it presents an outdated picture of modern treatment courts and reaches conclusions that are no longer supported by the current state of the field.^[22]

Claim Four: The Article Overstates the Evidence for Net-Widening

The article argues that treatment courts expand the reach of the criminal justice system rather than reduce it. That conclusion rests largely on treating treatment courts as diversion programs whose principal purpose is to keep individuals entirely outside the justice system. As discussed earlier, that premise does not accurately describe most treatment courts. More than ninety-three percent of adult drug treatment courts operate after a plea has been entered and were designed to improve outcomes for justice-involved individuals through treatment, judicial supervision, and accountability, not to eliminate criminal justice involvement altogether.^[23]

To support its net-widening argument, the article relies primarily on a single historical example from Denver, Colorado, where drug filings reportedly increased after the creation of a drug court in 1994. That evidence is insufficient to support the broad conclusion the article draws. An increase in case filings following the creation of one treatment court does not establish that the court caused additional arrests, nor does it demonstrate that the Denver experience was representative of treatment courts nationally. The article elevates a decades-old local correlation and one former judge’s observation into a nationwide conclusion without demonstrating causation or showing that similar patterns occurred elsewhere. 

Most importantly, the article never addresses the proper comparison. The relevant question is not whether treatment court participants avoid all contact with the criminal justice system. Most have already entered that system before becoming eligible for treatment court. The appropriate comparison is whether treatment courts produce better outcomes than traditional prosecution, incarceration, or community supervision. On that question, the evidence is remarkably consistent.^[24] Systematic reviews have found significantly lower recidivism among treatment court participants than comparable offenders processed through conventional criminal justice systems.^[25] These evaluations report fewer rearrests, fewer crimes, fewer days incarcerated, and substantial cost savings.^[26] Likewise, the statewide evaluation cited in the article demonstrate reduced prison utilization and shorter periods of incarceration among treatment court participants.^[27] These findings directly contradict the article’s assertion that treatment courts simply expand punishment rather than improve outcomes.

Common Criticisms of Treatment Courts Examined

Claim Five: The Evidence Does Not Support the Article’s Conclusions About Jail Sanctions

The article accurately notes that some early treatment courts relied too heavily on short periods of incarceration to respond to participant noncompliance. What it fails to acknowledge is that this practice has been the subject of extensive research and substantial reform. ^[28] Once again, the article relies primarily on older studies while giving comparatively little attention to the evolution of treatment court practice over the past decade.

Modern treatment court standards recognize that substance use disorders are chronic medical conditions and that relapse, by itself, should not be viewed as willful misconduct warranting punitive sanctions.^[29] National best practice standards increasingly emphasize individualized responses, incentives, treatment adjustments, procedural fairness, and the least restrictive intervention necessary to promote recovery and protect public safety.^[30] Jail remains an available response in appropriate circumstances, but it is no longer viewed as the primary or preferred response to treatment-related behavior.^[31]

Where it goes too far is in concluding that there is “no evidence” that jail sanctions work. The principal authorities, including the 2005 GAO report, cited by the article do not reach that conclusion.^[32] Rather, they concluded, as of 2005, that the available research has not isolated the independent effect of incarceration sanctions from the many other components of treatment courts.^[33] That is not evidence that jail sanctions are ineffective; it is recognition that the question has not, at that time, been definitively answered.

The article also overstates the findings of the 2025 NPC Research national survey.^[34] The survey reported that some treatment courts continue to use jail sanctions for positive drug tests regardless of a participant’s clinical stabilization.^[35]It did not evaluate whether those sanctions improved or worsened treatment outcomes, disrupted recovery, or were imposed without regard to the participant’s individual circumstances.^[36] By suggesting that the survey demonstrates the harmful effects of jail sanctions, the article attributes conclusions to the study that the study itself does not make.

The article therefore confuses a historical practice that has been the focus of ongoing reform with a defining characteristic of modern treatment courts. The evidence supports a different conclusion: treatment courts continue to evolve as research identifies more effective and evidence-based responses to participant behavior.^[37]

Claim Six: The Article’s Critique of Information Sharing and the Multidisciplinary Team Model Is Not Supported by the Evidence

The article argues that the collaborative treatment court model improperly exposes personal and clinical information to judges, resulting in excessive scrutiny and punishment.^[38] Confidentiality is unquestionably an important concern. It does not follow, however, that the collaborative model is inherently incompatible with due process or participant privacy.

Treatment courts have long recognized the need to balance participant confidentiality with effective judicial supervision.^[39] Federal confidentiality regulations,^[40] state laws, informed consent procedures, ethical obligations, and nationally recognized best practice standards govern the sharing of treatment information among members of the treatment court team.^[41] Information is not shared without legal authority or participant consent, and disclosure is generally limited to what is necessary to support treatment, supervision, and judicial decision-making. The article identifies potential risks associated with information sharing but provides no empirical evidence that treatment courts systematically misuse confidential information or that appropriate information sharing results in poorer participant outcomes.

The article substantially overstates the findings of the Virginia qualitative study.^[42] The study explored the experiences of nine treatment court judges and recommended additional judicial training in addiction science.^[43] It did not conclude that treatment court judges compromise their neutrality, that multidisciplinary teams increase incarceration, or that judicial involvement keeps participants cycling through jail. Those conclusions are the article author’s interpretation, not the study’s findings. More fundamentally, the article overlooks one of the defining features of modern treatment courts: coordinated decision-making informed by multiple professional perspectives.^[44] National best practice standards recognize that complex substance use disorders often require collaboration among the court, treatment providers, community supervision, and other stakeholders.^[45] The purpose of the multidisciplinary team is not to increase punishment but to improve decision-making, coordinate services, promote participant engagement, and enhance public safety. 

While treatment courts necessarily involve closer collaboration among judges, attorneys, treatment providers, probation officers, and other professionals, the article offers little empirical evidence that this collaborative model produces worse participant outcomes. Instead, it simply assumes that greater judicial engagement is inherently inconsistent with fairness or effective treatment. In the end, the article substitutes speculation about the risks of collaboration for evidence demonstrating that the collaborative model itself produces poorer outcomes.

The Future of Treatment Courts

Treatment courts have not been without shortcomings, and real evaluation has played an important role in their evolution. Some of the issues raised in the article, deserve and are the subject of continued attention. Over the past three and a half decades, the treatment court field has responded to those challenges through research, national best practice standards, advances in addiction science, and the continuous refinement of policy and practice.

The article, however, repeatedly treats implementation difficulties as evidence that the treatment court model itself has failed. In doing so, it relies heavily on research describing earlier generations of treatment courts, extends the findings of several studies beyond the conclusions reached by their authors, and extrapolates from isolated jurisdictions and individual practices to the treatment court field as a whole. The result is an incomplete and outdated portrayal of modern treatment courts that gives insufficient weight to decades of empirical research demonstrating that well-implemented treatment courts improve participant outcomes, reduce recidivism, enhance public safety, and, when compared with traditional criminal case processing, reduce incarceration.^[46]

The more important question today is not whether treatment courts should exist, but how they can continue to improve. The evidence overwhelmingly supports continued efforts to expand access to treatment courts that operate in accordance with evidence-based practices, protect due process, ensure equitable access, and provide timely access to effective treatment, including medications for opioid use disorder when clinically appropriate. The goal should not be to abandon a model that has demonstrated its value, but to continue strengthening it through research, accountability, and adherence to nationally recognized best practices.

The treatment court movement has never claimed perfection. It has consistently demonstrated something more important: a willingness to evaluate its performance, acknowledge shortcomings, adapt to new scientific evidence, and improve. That commitment to continuous improvement, not resistance to fact-based evidence, is what has made treatment courts one of the most extensively studied and successful innovations in the modern justice system.

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^[1] Leah Wang, Specialty Courts: A Disappointing Form of Diversion, Prison Policy Initiative (Feb. 2, 2026).

^[2] Although the Prison Policy Initiative article uses the broader term “specialty courts,” this response generally uses the term “treatment courts” because the article’s analysis, cited research, and principal criticisms focus overwhelmingly on treatment courts, particularly adult drug treatment courts. Where appropriate, the broader term “specialty courts” is used to reflect the article’s terminology.

^[3] Wang, supra note 1.

^[4] Kristen DeVall, Christina Lanier & Lindsay J. Baker, Painting the Current Picture: A National Report on Treatment Courts in the United States (Nat’l Treatment Ct. Res. Ctr. 2023)

^[5] Id.

^[6] Steven Belenko, The Role of Drug Courts in Promoting Desistance and Recovery: A Merging of Therapy and Accountability, 27 Addiction Rsch. & Theory 3 (2019). 

^[7] Wang, supra note 1.

^[8] https://www.ctd.uscourts.gov/support-court

^[9] Chief Justice: Initiative Underway for Specialized Court Dedicated to Behavioral Health; Will Serve as Template for Expansion

^[10] Id.

^[11] See, Belenko supra note 5, Caroline I. Jalain, Paul A. Lucas & George E. Higgins, Assessing the Effectiveness of Mental Health Courts in Reducing Recidivism: A Systematic Review and Meta-Analysis, Justice Evaluation Journal (2024), U.S. Gov’t Accountability Off., GAO-12-53, Adult Drug Courts: Studies Show Courts Reduce Recidivism, but DOJ Could Enhance Future Performance Measure Revision Efforts (2011), Shelli B. Rossman et al., The Multi-Site Adult Drug Court Evaluation: Executive Summary (National Institute of Justice 2011), 

^[12] Id.

^[13] Wang, supra note 1.

^[14] Id.

^[15] All Rise, Adult Treatment Court Best Practice Standards (2d ed. Jan. 2026).

^[16] Wang, supra note 1.

^[17] Id.

^[18] All Rise, supra note 15.

^[19] Id.

^[20] Id.

^[21] Ahmed F. Z. Ahmed, Beth Andraka-Christou, Melissa H. Clark, Ria Totaram, David N. Atkins & Brandon del Pozo, Barriers to Medications for Opioid Use Disorder in the Court System: Availability, Provider “Trustworthiness,” and Cost, 10 Health & Just. art. 24 (2022).

^[22] DeVall, supra note 3.

^[23] Id.

^[24] See footnote 10.

^[25] See footnote 10.

^[26] See footnote 10.

^[27] Amanda B. Cissner, Michael Rempel, Donald Farole, Jr., Jennifer Reichert, Fred Cheesman, Rachel Swaner, Jennifer H. Magnani, Mary Kay Kane, Dana Kralstein & Joseph Lee, A Statewide Evaluation of New York Adult Drug Courts: Identifying Which Policies Work Best (Ctr. for Ct. Innovation 2013).

^[28] Id.

^[29] All Rise, supra note 15.

^[30] Id.

^[31] Id.

^[32] U.S. Gov’t Accountability Off., GAO-05-219, Adult Drug Courts: Evidence Indicates Recidivism Reductions and Mixed Results for Other Outcomes (2005).

^[33] Id.

^[34] NPC Rsch., Health Risk Prevention in Treatment Courts (2025).

^[35] Id.

^[36] Id.

^[37] DeVall, supra note 3.

^[38] Wang, supra note 1.

^[39] All Rise, supra note 15.

^[40] Standards for Privacy of Individually Identifiable Health Information, 45 C.F.R. pts. 160 & 164 (2026).

^[41] All Rise, supra note 15.

^[42] Jennifer Smith Ramey, Fred Milacci, Fred Volk & David Jenkins, “All Hands on Deck”: A Phenomenological Study of Lived Experiences of Drug Treatment Court Judges, 3 Drug Ct. Rev. 54 (2024)

^[43] Id.

^[44] All Rise, supra note 15.

^[45] Id.

^[46] See footnote 10.