Drug courts address issues such as employment and housing, but largely miss the opportunity to address important healthcare issues. The current study examined the prevalence and correlates of chronic medical conditions among a sample of drug court clients who were participating in a clinical trial of an intervention to reduce HIV risk. A total of 256 clients completed a health survey at entry into the drug court program and 9-months post-entry. The baseline health survey included a comprehensive list of chronic medical conditions, and participants were asked to indicate which, if any, they had ever been diagnosed as having. They were also asked to indicate whether or not they were currently receiving treatment for each chronic condition that they endorsed. The follow-up survey was identical to the baseline survey with the exception that it contained items reflecting (1) whether or not any member of the drug court team engaged in discussion with the client about each of the chronic conditions reported and (2) whether the client received a referral to medical care for endorsed conditions while in the drug court program. Results indicated that over 50% of clients reported at least one chronic condition and 21% reported more than one condition. Among those with chronic conditions, 71% reported having chronic conditions for which they were not currently receiving treatment. Unfortunately, drug court clients reported that the drug court team did little to address these unmet health needs. Findings from this study suggest clients could benefit if drug court programs began to widen their focus to include addressing health-related issues.

This chapter reviews the extant literature to identify empirically proven strategies that pre-arrest diversion (PAD) programs could employ to improve outcomes. PAD programs generally refer low-risk individuals who use drugs to community-based services and rehabilitation in lieu of formal entry into the criminal justice system. Preliminary data indicate that these programs can reduce incarceration rates, recidivism, and drug use, and that they result in cost savings relative to standard engagement in the criminal justice system. Although the early verdict is that these programs reduce public harm, existing programs often use arbitrary criteria for determining eligibility, making evaluation and replication unreliable. PAD programs may serve to improve both public health and public safety by utilizing empirically proven practices. Nevertheless, there are still many challenges to the development, implementation, and operations of PAD programs. Although preliminary data from these programs support their utility, continued research is necessary to identify what practices facilitate their short- and long-term success.