It might come as a surprise to you that there is a fantastic transformation programme focusing on an aspect of chronic disease emerging from judges. Based on an American model and championed by the National Association of Drug Court Professionals,, the Alcohol and Other Drug Treatment Court (AODTC) uses a multidisciplinary model that combines input from judges, lawyers, police and social support workers to help offenders remain drug and alcohol free and return to a productive life.

This model has now been adopted in New Zealand where more than 80% of all offences are committed under the influence of alcohol or drugs and the cost of imprisonment for one year is close to NZ$100,000. Of those prisoners, a significant number reoffend because of a variety of issues including drug and alcohol dependence on top of a background of challenging social circumstances.

Our traditional approach to punishment has been to fine and imprison offenders but you cannot punish away addiction. The folly of that approach has now been accepted and a new model is being piloted in New Zealand in the Auckland and Waitakere District Courts.

Although only half way through the 5-year pilot addressing high risk-high needs offenders, early results are impressive: as of 1 July 2013, in the 2 years prior to entering the Court, this cohort of offenders committed 900 offences; in the 12 months since entering the Court, only 11 offences have been committed.

The intervention is a multidisciplinary one led by individual judges. The teams comprise of judge, case managers, a court coordinator, Pou Oranga (Maori Cultural Advisor), defence lawyers, police prosecutor, and peer support workers. The case manager works with others to identify the appropriate treatment and support for the individual and liaises closely with the various providers.

All team members work to the same common purpose: to support the offender to remain in treatment and drug and alcohol free; to ensure that the offender addresses other significant rehabilitative issues and does not reoffend; and to help them live a productive life with a drivers license and a job.

Each sitting day, all of the AODTC team meets together in closed court to go through all of the issues and challenges faced by each of the participants before seeing them in open court later in the day. These appearances are intimate, very personal, deeply challenging and exceptionally moving.

One of the objectives in providing this alternative to imprisonment was to address the gross over-representation of Maori people in the imprisoned population. It appears to be working, as over half of the participants in the Court are Maori. Further, the Court appears to be developing its own tikanga, or cultural practices, which are based on Maori tikanga and which process has been greatly enhanced by the role of Pou Oranga. This can be seen in the opening and closing of the Court and in the graduation ceremony.

Let’s think about the analogies in health, particularly supporting those with chronic conditions.

The traditional consequence for those who become unwell because their condition has got out of kilter is visits to the family doctor or practice nurse or even to hospital. Once restored to health they go home. Support may be provided but sometimes that is not enough, so they ‘reoffend’. How could we learn from the early success of the Alcohol and Other Drug Treatment Courts who are providing a comprehensive blanket of support and reaping rewards for their clients?

As many of you will recognise, as we delve deeper into people’s lives in order to help them, it is like peeling back layer after layer of an onion exposing many issues that need to be addressed. This is the complexity of real life, something all of us engaged in helping people with long-term conditions need to embrace.

Also watch this video on Vimeo: Password Drug Court