Challenges Facing People With Substance Use Disorders in California Criminal Courts

When a person struggling with addiction enters California’s criminal court system, the case is rarely limited to the conduct described in the police report. The defendant may also be dealing with withdrawal, unstable housing, untreated mental illness, unemployment, family problems, medical needs, and difficulty accessing appropriate treatment.

California courts increasingly recognize that substance use disorders require treatment rather than punishment alone. The state offers drug diversion, collaborative courts, treatment-based probation, mental health diversion, and other alternatives to incarceration. At the same time, these programs can be difficult to access and even harder to complete.

Understanding these challenges is essential for judges, prosecutors, defense attorneys, treatment providers, and families who want to achieve lasting recovery while protecting public safety.

Addiction Is Often Treated as Misconduct Rather Than a Medical Condition

One of the most fundamental problems is the conflict between the medical understanding of addiction and the structure of the criminal court system.

The National Institute on Drug Abuse describes substance use disorders as chronic, treatable conditions that affect the brain and behavior. Like other chronic conditions, recovery may include setbacks or a return to substance use. A relapse may indicate that treatment should be modified or intensified rather than abandoned.

Criminal courts, however, are built around rules, deadlines, orders, and consequences. A missed appointment, positive drug test, or failure to complete a program may therefore be viewed as defiance or dishonesty. For someone in active addiction, the very symptoms of the condition can become the basis for additional sanctions.

Accountability remains important. But accountability is most effective when the court distinguishes between intentional refusal to participate and a clinical setback that requires a different level of care.

Withdrawal and Impairment Can Affect the Defendant’s Case From the Beginning

The effects of addiction may appear immediately after arrest. A person experiencing withdrawal can suffer from pain, nausea, anxiety, agitation, confusion, depression, insomnia, or an inability to concentrate. These symptoms can interfere with the person’s ability to understand the charges, communicate with counsel, evaluate a plea offer, or make informed decisions.

The first several days of a criminal case are often critical. Bail and release conditions may be addressed, protective orders may be issued, and prosecutors may make early settlement offers. Yet the defendant may be making these decisions while physically ill, emotionally unstable, or deprived of medication.

Defense attorneys must therefore determine whether an apparent lack of cooperation is actually the result of withdrawal, intoxication, cognitive impairment, trauma, or a co-occurring mental health disorder.

Pretrial Detention Can Interrupt Existing Treatment

Incarceration frequently disrupts treatment that was already helping the defendant. A person may lose contact with a counselor, miss appointments at an opioid treatment program, or experience delays in receiving prescribed medication.

Medication treatment is particularly important for people with opioid use disorder. Methadone, buprenorphine, and naltrexone are recognized medications for treating opioid use disorder.

California’s Justice-Involved Reentry Initiative now requires participating correctional systems to provide eligible individuals with certain prerelease services, including medication-assisted treatment, medications upon release, care management, and connections to community providers.

Those reforms are significant, but implementation depends on coordination among jails, medical providers, Medi-Cal plans, treatment programs, probation departments, and community organizations. Even a short interruption can destabilize someone who had been making progress.

Eligibility for Diversion Is Often More Complicated Than It Appears

California Penal Code section 1000 permits pretrial diversion for certain specified drug-related offenses. Eligibility is not automatic. The statute is limited to listed offenses and generally excludes cases involving violence, additional disqualifying drug conduct, certain recent drug convictions, or a recent felony conviction. Referrals must also be made to qualifying programs.

This creates several practical problems. A defendant whose conduct was motivated by addiction may be charged with theft, burglary, resisting arrest, fraud, or another offense not covered by traditional drug diversion. A person with the most serious and longstanding addiction may also have a record that makes that person less likely to qualify for a program.

In other words, the people who need treatment most may be the most difficult to place into a traditional diversion program.

Proposition 36 Has Added New Choices—and New Risks

California’s legal approach changed significantly when Proposition 36 took effect on December 18, 2024. Among other changes, it created Health and Safety Code section 11395, commonly referred to as the Treatment-Mandated Felony Act. The law applies in certain cases involving possession of specified “hard drugs” when the defendant has at least two qualifying prior drug convictions.

A qualifying defendant may elect treatment instead of an immediate jail or prison sentence. However, the person must plead guilty or no contest, admit the alleged prior convictions, waive time for sentencing, and agree to complete a court-approved treatment plan. If treatment is successfully completed, the charge is dismissed. If the court later determines that the defendant is performing unsatisfactorily, refusing treatment, not benefiting from treatment, or otherwise falls within the statute’s failure provisions, the court may enter judgment and impose sentence. The court retains some ability to refer the person back to treatment when doing so serves the interests of justice.

This procedure can provide an important path to recovery, but it also presents a difficult decision. The defendant must weigh the benefits of treatment against the consequences of entering a plea before knowing whether the available program will adequately address the person’s needs.

A treatment option is meaningful only when appropriate treatment is actually available.

Treatment Availability Differs From County to County

California does not operate one uniform statewide criminal treatment system. Programs are frequently administered through individual counties, courts, probation departments, behavioral health agencies, and contracted providers.

A defendant in one county may have access to residential treatment, sober housing, medication, transportation, case management, and a dedicated collaborative court. A similarly situated defendant in another county may face long delays, limited program choices, or no available residential bed.

The California Department of Health Care Services maintains a system specifically designed to track substance use treatment capacity and waiting lists. The existence of that reporting system reflects the importance of treatment availability as a statewide concern. California residents seeking publicly supported treatment are also generally directed through their county substance use disorder access system.

This variation can produce unequal outcomes. A person’s chance of receiving effective treatment may depend not only on clinical need or legal eligibility, but also on where the case was filed.

Court-Ordered Programs May Be Unrealistic for People Without Stability

A typical treatment-based sentence may require the defendant to attend counseling, complete classes, report to probation, submit to testing, appear for frequent court reviews, attend recovery meetings, pay program fees, and avoid any new violation.

Those requirements may appear reasonable individually. Together, however, they can become overwhelming for someone who lacks housing, transportation, identification, childcare, a working telephone, or a stable schedule.

Consider a defendant who sleeps in a shelter, must travel across the county for treatment, reports to probation in another location, works irregular hours, and has no reliable way to receive appointment reminders. A missed appointment may be recorded as noncompliance even though the real problem is poverty or instability.

Successful court treatment plans must address these practical barriers. Ordering treatment without providing a realistic method of attending treatment sets the participant up to fail.

Relapse Can Trigger Punishment Instead of a Clinical Response

Drug courts and other collaborative justice courts combine treatment with close judicial supervision, regular reviews, testing, and accountability. California describes adult drug courts as alternatives to traditional case processing for high-risk and high-need individuals with substance use disorders. The state has developed hundreds of collaborative courts, including drug courts, DUI courts, mental health courts, homeless courts, veterans courts, and reentry courts.

These courts can produce meaningful results, especially when judges, attorneys, probation officers, and treatment professionals work as a coordinated team. But problems arise when every positive test or missed appointment receives the same response.

A positive test may indicate that the current treatment level is insufficient. The person may need residential treatment, medication, trauma therapy, mental health care, or a different provider. Immediate termination from a program can return the person to jail without resolving the condition that contributed to the criminal behavior.

The better response is individualized. Courts should consider the participant’s overall progress, honesty, clinical condition, safety risk, and willingness to continue treatment.

Co-Occurring Mental Health Conditions Are Frequently Overlooked

Many defendants with substance use disorders also experience depression, anxiety, post-traumatic stress disorder, bipolar disorder, psychosis, or other mental health conditions. Substance use may be an attempt to manage untreated symptoms, while continued drug or alcohol use may worsen those same symptoms.

California Penal Code section 1001.36 permits pretrial mental health diversion for eligible defendants when a qualifying mental disorder was a significant factor in the charged offense and the statutory suitability requirements are satisfied. The court must consider whether the person’s symptoms would respond to treatment, whether the person agrees to comply, and whether community treatment would create an unreasonable public-safety risk. Services remain dependent on available resources and the willingness of an appropriate agency or program to accept the defendant.

A substance use evaluation that ignores mental health may therefore miss half the problem. Effective advocacy often requires a comprehensive assessment that examines addiction, trauma, psychiatric symptoms, medical history, cognitive limitations, and the relationship between those conditions and the alleged offense.

Stigma Can Affect Credibility and Sentencing

People with addiction are often described as manipulative, irresponsible, or unwilling to change. Their statements may be discounted because they previously relapsed, failed treatment, or made promises they could not keep.

That stigma can influence charging decisions, bail arguments, plea negotiations, probation recommendations, and sentencing. It can also prevent defendants from being honest. A person who fears punishment for admitting a relapse may conceal it until the situation becomes more serious.

Respectful representation does not require minimizing harmful conduct. It means recognizing the difference between holding someone accountable and defining that person entirely by the worst period of their life.

Housing Instability Can Keep the Criminal Case Alive

Recovery is difficult without a safe place to live. A person leaving jail may return to the same environment where drugs are readily available, where others are using, or where the person previously experienced violence or exploitation.

Without stable housing, it becomes harder to store medication, maintain hygiene, sleep regularly, charge a telephone, attend appointments, or comply with probation searches and curfews. Court orders that assume the person has a stable residence may be nearly impossible to follow.

This can create a repeating cycle: substance use leads to arrest, arrest leads to housing or employment loss, instability makes treatment more difficult, and treatment failure results in another warrant or jail sentence.

Treatment, housing, employment assistance, and case management should therefore be viewed as connected parts of the same public-safety strategy.

Release From Custody Can Be a Particularly Dangerous Time

A person’s tolerance to opioids may decrease while incarcerated. Returning to the same amount previously used can result in a fatal overdose. Research has consistently found that the period immediately following release from incarceration carries an especially high overdose risk.

California’s prerelease Medi-Cal initiative attempts to reduce this danger by offering eligible individuals care management, medication-assisted treatment, medications upon release, and warm handoffs to community providers during the period before release. But these protections work only when release planning begins before the person leaves custody. Handing someone a list of telephone numbers at the jail door is not the same as arranging an appointment, confirming transportation, providing medication, and connecting the person directly with a treatment professional.

The Need for Individualized Advocacy

No single program works for every defendant. Some people need outpatient counseling while others require residential treatment. Some benefit from medication, while others need dual-diagnosis care, trauma treatment, sober housing, employment assistance, or intensive case management.

Effective representation requires more than requesting the standard drug program. Attorneys should learn about the client’s history, obtain appropriate evaluations, investigate available programs, preserve access to medication, identify practical barriers, and present the court with a treatment plan that is specific and realistic.

Courts must also remain willing to measure progress rather than demand immediate perfection. Recovery may involve setbacks, but a setback does not necessarily mean that treatment has failed or that incarceration is the only remaining option.

Conclusion

California has made substantial efforts to incorporate treatment into the criminal justice system. Drug diversion, collaborative courts, mental health diversion, medication-assisted treatment, Proposition 36 treatment procedures, and prerelease Medi-Cal services all reflect an understanding that addiction cannot be solved through punishment alone.

Nevertheless, significant barriers remain. Limited program availability, county-by-county differences, unstable housing, interrupted medication, stigma, co-occurring mental illness, overly rigid compliance requirements, and the possibility of punishment following relapse can prevent defendants from receiving the help they need.

A more effective approach combines accountability with careful assessment, evidence-based treatment, practical support, and respect for the person standing before the court. When the system addresses the underlying disorder rather than merely processing the latest offense, it has a better chance of reducing future crime, improving public safety, and helping individuals rebuild their lives.

This article provides general information and is not legal advice. Eligibility for diversion or treatment depends on the charges, criminal history, county practices, available services, and the individual circumstances of each case.