Over the past three decades, the United States criminal justice system and mental health treatment providers have collaborated in ways to support more than 20.3 million individuals who are struggling with a substance use disorder (SUD), and who may also be facing drug-related offenses due to their ongoing challenges combatting addiction. Through collaborative efforts we have been fortunate to witness the establishment of adult drug treatment courts, as well as other problem-solving court processes. With more than 1,500 active adult drug treatment court programs in this country, there is a critical need to better understand the working alliance between counselors and clients who have been mandated to receive SUD treatment. Adult drug treatment court programs have been shown to have discrepant success outcomes (8% to 80%) in terms of reducing criminal recidivism; moreover, the existing literature examining the lived experiences of participants in these programs is both minimal and disheartening. This lack of empirical data is problematic for the counseling profession given that they serve as key change agents in this process. What we do know is that the process of creating treatment goal and modalities, which should be in the hands of the clients and their counselors, can be complicated by court-mandated requirements. This bi-level structure has the potential to create ruptures in the working alliance between clients and counselors providing SUD treatment to this population. Accordingly, additional research is needed to explore the client experience within the working alliance, and in so doing reveal the influences at play when working with clients who are mandated to receive SUD treatment. This qualitative study was guided by one central research question: How do clients experience the working alliance with counselors during drug court-mandated addictions treatment? Interview data from eight individuals in court-mandated SUD treatment led to the development of a constructivist grounded theory model: From compliance to alliance: A grounded theory of building rapport in mandated treatment. This model and it's components describe and define key factors when working with this population. More research is needed to understand counselors' perspectives of the working alliance with court-mandated clients. / Doctor of Philosophy / With more than 1,500 active drug court programs throughout the United States, there is a pressing need to better understand the working alliance between counselors and clients who have been mandated to receive SUD treatment. While adult drug treatment court programs have been shown to have positive outcomes in terms of reducing criminal recidivism, the existing literature examining the participants' lived experiences receiving SUD treatment is minimal and disheartening. Due to the nature of the mandated treatment relationship, the confidentiality which has historically bound and secured the therapeutic working alliance is less defined than it is in fully voluntary treatment settings. This shift in understanding what creates a healthy working alliance for mandated clients to work through presenting treatment issues is something that has yet to be explored by current research. The current study sought to explore clients' experiences of the working alliance with counselors during drug court-mandated addictions treatment. Interview data from eight individuals in court-mandated SUD treatment led to the development of a constructivist grounded theory model: From compliance to alliance: A grounded theory of building rapport in mandated treatment. This model and it's components describe and define key factors when working with this population. More research is needed to understand counselors' perspectives of the working alliance with court-mandated clients.

The decision to establish a mental health court in Utah's First District was largely a political one prompted by the growing popularity of problem-solving courts throughout the country. Because this motivation was policy-driven and not needs-driven, the court was established without an ongoing data collection schedule. As a result, barring anecdotal evidence from program participants, the current impact of the court on two key goals-- reducing recidivism and increasing community-based treatment contact--is entirely unknown. The current study aims to provide a summative program evaluation of the first sixty-eight months of specialty court operation by (1) estimating basic demographic and clinical information about program referrals, participants, and graduates; and (2) measuring program effectiveness by examining between-group differences in key outcome measures (e.g., new charges, use of therapeutic services, time to rearrest, etc.) for those referrals who are accepted into the program as participants versus those referrals who are rejected from the program and sentenced to treatment-as-usual. Ideally, the current study will not only provide an evidence-based assessment of local practices at the current study site but will also empirically inform the greater community of mental health practitioners, researchers, and policymakers who are operating in smaller, more rural districts.

Drivers under the influence of alcohol cause nearly one third of all fatal motor vehicle accidents. Ambulatory outpatient alcohol abuse treatment has been clinically shown to increase abstinence, which could decrease the chance of subsequent DWI offences. A barrier to successful completion is extended waiting periods prior to treatment engagement. The theory of patient waiting supports the longer a patient waits to begin treatment the lower the likelihood of successful completion. By exploring the impact of waiting times on DWI court mandated clients, referral courts and treatment facilities can work together to create a successful completion strategy for offenders. The research question focused on if days waiting can predict successful outpatient treatment completion in court mandated adults. The TEDS-D archival data set was used, consisting of data collected between 2006-€”2011 from federally funded substance abuse treatment centers throughout the USA. The variables time awaiting treatment, treatment level, gender, race, employment status, and age were used as controls. A logistic regression using a random sample of 4,947 participants determined days waiting was significant but weak in nature. The variables of employment status and age are stronger predictors of treatment completion. An interaction effect analysis of days waiting and age results in clients over 45 years old being significantly impacted by days waiting while younger clients are not. Court and treatment agencies can use this information to give priority intake appointments to older clients to increase chances of treatment completion.

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