Addiction, Drug Courts, and Informed Consent

Addiction, Drug Courts, and Informed Consent

    It’s early in the morning, and I receive the alert to meet a potential client in court.  As I stand outside of the courtroom, I watch the chaos of confused people and attorneys quickly consulting with each other.  Then I am called over by the attorney for the Department of Family and Children, DCF, to meet their new client.  The client is scared, confused, and unsure of what is going on.  All she knows is her children are in the custody of DCF, and she now must go through the prescribed steps to have them back with her.  I introduce myself, explain my program, and ask if she wants to sign on to Dependency Drug Court.  She nods and is hustled into the courtroom to hear what the judge has to say.  When asked if she has spoken to a representative of the Dependency Drug Court program she says yes and consents to become a part of the program.  After this a time to meet with me is arranged, attorneys swarm nearby while, in some cases, concerned family members appear like ghostly apparitions to take my new client home.  Her life has changed immeasurably because of one positive test or one anonymous phone call, and there is no going back to what it once was.

    During the first appointment with the client, I explain the program and how successful completion of each section will grant her more rights and access to her children.  There are no forms for her to sign, nothing for her to read and no further explanation on my side of what Dependency Drug Court fully entails and how it will impact her life for at least the next 18 months.  Her consent in court placed her in my office and the program.  We briefly discuss her concerns with addiction, both DCF- and life-based, and work on setting up a treatment plan.  It all seems straightforward, but I often wonder how a person can consent to a program when in all likelihood one does not have the full capacity of their facilities at that time?  

    People thrust into the court system are often unprepared and, as is the case for many of my clients, often undereducated.  The information, the timing of the consults, and the lack of pamphlets create an ethical dilemma: was informed consent to join the program given when asked by the judge?  I don’t believe it was.  The confusion, barrage of questions and information, and the shock of being in a courtroom are overwhelming for anyone, but for someone charged with child endangerment and neglect due to drug use it can be sensory overload.  There is no time to stop, think, and consider all the options, and there is no pamphlet to read later.  Ethically, it is impossible to contend the new client was aware of the possible consequences of the program or had full knowledge of the risks and benefits.  To give permission means to understand, and in the case of those ushered into a Dependency Drug Court program, full knowledge is often lacking due to the circumstances surrounding their enrollment.

    Instead of consent while facing a judge, the potential client should meet with the Dependency Drug Court Clinician, have the program re-explained, a brochure given and a second appointment set up to go over any questions they may have.  It is only at this point a consent form of their rights and responsibilities in the program should be signed, and the new client is then a part of the program.  Informed consent is imperative for both the client and the program.  Giving the potential client time to gather their thoughts, talk to people, and read the information before consenting to be in a rigorous program helps to ensure their success within the program and in establishing their sobriety.

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