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SHERIDAN — People in Sheridan County who make the mistake of driving under the influence of alcohol are sent to only one independent counselor to be evaluated for addiction and, if applicable, have a treatment plan identified.
While the process initially looks like an insider network between the court and the business, the policy is derived from an ambition to remove bias from diagnoses and treatment recommendations.
Sheridan County Attorney Matt Redle said there are several reasons the county dictates which provider should perform forensic assessments in the aftermath of a run-in with the law.
He said it started in the 1990s with an initiative of the Wyoming Department of Health that called on each community to determine therapeutic treatments locally available for addiction and what was needed to increase efficacy. One of the results of Sheridan’s Comprehensive Substance Abuse Community Survey was the identification of the need for independent assessments for people undergoing court-directed evaluations.
“We found that if a person was assessed by someone who works in a facility where inpatient treatment was available, a large number of people who were assessed there were given a recommendation for inpatient treatment,” he said. “If a person was assessed at a facility where they offered intensive outpatient treatment, that was then recommended more frequently.”
Redle added providers were likely not consciously aware of a bias when recommending the types of treatments available in-house.
“It just worked out that way,” he said.
From those findings, the task force agreed future Alcohol Severity Index assessments should be completed by a provider that did not have financial stake in the outcome of the person’s diagnosis and treatment plan.
The court presently accepts ASI assessments from only one local mental health provider — Mountains Edge Counseling owned by Jennifer Jones — when ordered by the court. While the practice is sometimes perceived as favoritism, Redle said the process prevents a conflict of interest within the referring party.
“We want a service that matches the individual’s needs, not the needs of the provider,” he said, adding it’s also a primary obligation to promote objectivity in the process of mandating treatment for substance abuse.
“This goes to the heart of what we’re trying to do,” he said. “If we’re going to intervene in people’s lives, we have a moral and legal obligation to do something that is likely to lead to positive change,” Redle said. “It should be effective.”
That’s why if someone is convicted of an alcohol-related crime in Sheridan County and are ordered to get an ASI, they must go to Mountain Edge Counseling, which costs $200, due at the time the appointment is made.
“People get mad,” Jones said, indicating everyone does not immediately understand the attempt to offer non-bias treatment recommendation. “One guy said the judge must own the business.”
Jones does not provide any form of addiction treatment for adults she determines to have dependency or abuse problems.
“If someone comes in for an eval, I don’t have a vested interest in their evaluation,” Jones said.
As far as the $200 up-front fee for the ASI, Jones said it’s a control mechanism to avoid no-shows that has proven effective. If financial hardship is truly an issue, individuals can petition the court for an extension to have time to get the money together. Also, Jones said the evaluation fee can end up being applied to the sentencing fine and court fees. However, if there’s no financial hardship, Jones is still OK with the hefty fee.
“If you’re going to go violate the law knowing what we know about DUIs, there should be a little bit of sting to it,” she said.
Jones added that she does provide some treatment options for adolescents with addiction problems, and in those instances, she is forthright with the clients about the situation and their options.
“I believe in independent assessments,” she said. “But, it’s hard to turn people down.”
A case considered in Sheridan County Circuit Court Monday highlighted the principal of objectivity for court-mandated substance abuse assessments. A Sheridan man petitioned Judge Shelley Cundiff to allow him to attend an outpatient treatment program at Northern Wyoming Mental Health Clinic in lieu of the county-run Drug Court after a NWMHC provider disagreed with a treatment plan recommended by the county’s evaluator.
Judson Flint received an initial ASI assessment from Jones, who determined Flint would benefit from intensive outpatient treatment provided by the county’s Drug Court program, which entails attending nine hours of treatment weekly during traditional daytime business hours.
Flint also had another opinion from Dr. Linda Rice at NWMHC because some areas of the original ASI evaluation were unmarked by Jones. Rice said Flint was not dependent on alcohol, but was rather an abuser, which is a lesser degree of addiction severity and qualified Flint to receive a less-intensive treatment regimen that took place in the evenings, although NWMHC also offers a similar, more intensive outpatient treatment program. Rice’s diagnosis was based off of Flint’s self-reported use indicators compared to a set of seven recognized indicators of alcohol dependency.
Flint petitioned the court via his attorney, Hardy Tate, stipulating the hours required to participate in daytime Drug Court would cause him to miss too much work and asked if he could instead follow the treatment plan suggested by Rice.
The court determined through testimony from Rice that she did not account for a blood alcohol content reading that coincided with a functional level the night of Flint’s arrest that is generally considered to be indicative of accumulated tolerance to alcohol. Furthermore, court records suggest Rice did not account for the possibility of intentional deception when self-reporting alcohol use.
Jones later clarified the unmarked portion of Flint’s original evaluation was intentionally left blank because of the potential for resistance, which would make that portion of the evaluation invalid.
Flint’s biggest argument was that nine hours of drug court during the regular business day would have a significant impact on his work as a landscaper.
“The way the Drug Court is set up, my job is gone,” Flint said. “And in this case, my heat is gone. My animals are gone. Everything is gone.”
Cundiff ultimately denied the request to accept the alternative treatment regimen, even though the sentence would likely strain Flint’s employment at a local landscaping company, which provides inconsistent work during the winter months.
“This is a criminal situation, not just a person who came in off the street without contact with law enforcement,” Cundiff said, rationalizing that a “shopped” evaluation is less likely to produce an accurate representation of a subject.
“This is set up for your benefit and to help you,” Cundiff told Flint. “I know you’ve seen what drinking does to people’s lives.”
Sheridan County Justice Office Administrator Neal Madson said Drug Court is an option to keep repeat substance offenders out of jail. He said the program lasts at least eight months, and is intense for a reason.
“Much is and should be expected of each of the participants, as many aspects of their lives have been impacted by their continued substance abuse and criminal behavior,” Madson said. “When they make the positive decision to address the underlying substance abuse issues they also are then able to have a positive affect on themselves, their family, and the community as a whole.”
In this case, Flint had at least five previous alcohol-related convictions.