Drug treatment in the criminal justice system: Lessons learned from offenders on DTTOs

The current paper formed part of a wider evaluation of a stand-alone Drug Treatment and Testing Order (DTTO) programme within a UK area probation service. One hundred forty-three semi-structured interviews were conducted over a four-year period with 107 offenders at varying stages of a DTTO in order to sample opinions on and experiences of DTTOs. Overall, offenders reported their primary aim on a DTTO was to become drug free through use of their time, gainful employment and stable housing. They appreciated the sentencing courts' view of the order as treatment for drug use rather than a punishment for offending, resulting in multiple chances for offenders on the order. Generally, interviewees found the staff support and the activities helpful and viewed drug testing and court reviews as positive incentives to reduce their substance use. The breach process was reported as positive although overly strict. Other criticisms reflected the difficulties with group interventions for such a varied group of offenders, some of whom were more motivated to change their drug use than others. In light of the findings in the current paper, the implications for the Drug Rehabilitation Requirements (DRRs), introduced under the UK's Criminal Justice Act (2003), are discussed.     

Engagement with drug treatment and testing orders: A qualitative study

Aims. To examine the experiences of offenders in engaging with Drug Treatment and Testing Orders (DTTOs). To identify the processes common to successful engagement and how those processes differ in unsuccessful engagement. Design. Grounded theory method utilising data from semi-structured interviews with DTTO participants. Participants. Fifteen informants at varied stages of DTTO participation across South Yorkshire, England. Findings. Engagement appeared to be affected by factors related to the organisation of services, intensity and relevance of activities, and relationships with staff. There was a changing emphasis in the importance of different aspects as the DTTO progressed. Factors identified relate to well-organised services and the concept of programme integrity. Conclusions. Many of the factors identified as supporting enhanced engagement with DTTOs are under the control of services and staff. There are particular implications for communication among staff and between the staff and offenders.     

Current Approaches to Drug Treatment for Women Offenders: Project WORTH

This paper reports ethnographic findings on current approaches to drug treatment for women offenders. Drug treatment programs serving women offenders have employed a range of therapeutic interventions to address drug use and criminality. However, programs have recently begun to address clients’ victimization experiences as an integral if not central feature of women’s drug use and participation in illegal activities. Treatment approaches at eight corrections- and community-based programs in New York City and Portland, Oregon are described. Data were obtained from life history interviews conducted with 60 women and observation of treatment activities. Developments in treatment approaches in corrections versus community settings and gender-specific services are described. Programs have tailored treatment approaches for women offenders by offering incest and domestic violence survivor groups, assigning therapeutic rather than punitive sanctions, and training corrections staff to support treatment goals.     

Health and well-being outcomes for drug-dependent offenders on the NSW Drug Court programme

Given the centrality of drug treatment to the drug court framework, the proliferation of drug courts in the United States, and their emergence more recently in Australia, it is surprising that such little attention has been given to assessing their therapeutic effect. This evaluation aimed to assess the health and well-being of drug-dependent offenders diverted to the New South Wales Drug Court, and monitor changes in their health and well-being throughout 12 months of programme participation. The study consisted of baseline interviews with 202 offenders accepted into the programme between February 1999 and April 2000, and follow-up interview at 4, 8 and 12 months with participants who remained on the programme. Health and well-being was assessed at each follow-up using the Short Form-36 Health Survey (SF-36) the OTI social functioning scale, and self-reported spending as a proxy for illicit drug use. The health of male Drug Court participants prior to commencing the programme was significantly poorer than Australian population norms. The results provided evidence of significant and sustained improvements in health and well-being for the 51 participants who competed each follow-up interview. Furthermore, significant improvements were found for offenders who remained on the programme for at least 4 months but less than 12 months. However, the positive health outcomes are limited by the low programme retention rate. These results indicate that significant health outcomes can be achieved for at least some heavily drug-dependent, recidivist offenders through the drug court model. [Freeman K. Health and well-being outcomes for drug-dependent offenders on the NSW Drug Court programme. _{Drug Alcohol Rev} 2003;22:409 - 416]     

Treatment retention in the Drug Intervention Programme: Do primary drug users fare better than primary offenders?

Aims: The Drug Intervention Program (DIP) was set up to reduce drug-related crime by engaging drug-using offenders in treatment. However, the limited evidence that exists would suggest that reconviction rates are high, and are linked to failure to complete the treatment programme. This study examined completion rates in one DIP programme by crime behaviours and drug use.

Method: A retrospective case-note method based on all files opened over a three-month window, examining outcomes three months after the last case was opened. A total of 123 files were examined.

Results: While less than 5% of cases were successfully completed, some form of positive outcome was reported in 14% of cases, 57% had negative outcomes (such as breaching the requirements of the order or failure to attend) and 29% were still open 6 months after the start of the programme. Negative outcomes were associated with more intensive criminal histories and lower levels of drug use in the month prior to intake to DIP. Open cases were typically associated with fewer previous incarcerations but higher levels of current drug use.

Conclusions: Relatively few cases had positive outcomes, although treatment retention exceeded expectations in around one quarter of cases. The analysis provides tentative support for the suggestion that drug users accessing treatment through the criminal justice system can be broadly split into drug-using offenders and offending drug users, and these two groups have differing outcomes in criminal justice treatment interventions.     

Treatment retention in the Drug Intervention Programme: Do primary drug users fare better than primary offenders?

Aims: The Drug Intervention Program (DIP) was set up to reduce drug-related crime by engaging drug-using offenders in treatment. However, the limited evidence that exists would suggest that reconviction rates are high, and are linked to failure to complete the treatment programme. This study examined completion rates in one DIP programme by crime behaviours and drug use.

Method: A retrospective case-note method based on all files opened over a three-month window, examining outcomes three months after the last case was opened. A total of 123 files were examined.

Results: While less than 5% of cases were successfully completed, some form of positive outcome was reported in 14% of cases, 57% had negative outcomes (such as breaching the requirements of the order or failure to attend) and 29% were still open 6 months after the start of the programme. Negative outcomes were associated with more intensive criminal histories and lower levels of drug use in the month prior to intake to DIP. Open cases were typically associated with fewer previous incarcerations but higher levels of current drug use.

Conclusions: Relatively few cases had positive outcomes, although treatment retention exceeded expectations in around one quarter of cases. The analysis provides tentative support for the suggestion that drug users accessing treatment through the criminal justice system can be broadly split into drug-using offenders and offending drug users, and these two groups have differing outcomes in criminal justice treatment interventions.     

Drug treatment courts,British style: the drug treatment court movement in Britain

There has been an uneven pattern of development of drug treatment courts throughout Britain. The Republic of Ireland has a drug treatment court and Scotland will have one by the end of 2001, but there are no drug treatment courts in England and Wales, or Northern Ireland, although in the latter there is a growing interest. It is suggested the Drug Treatment and Testing Order (DTTO) in England and Wales has acted as an impediment as this is a very weak version of drug treatment court and was proposed by the Prime Minister when Shadow Home Secretary. Drug treatment courts in Eire and Scotland have adapted their program to fit local conditions, although neither have opted for a fully fledged drug user treatment court on the Miami model.     

DRUG TREATMENT COURTS,BRITISH STYLE: THE DRUG TREATMENT COURT MOVEMENT IN BRITAIN*

There has been an uneven pattern of development of drug treatment courts throughout Britain. The Republic of Ireland has a drug treatment court and Scotland will have one by the end of 2001, but there are no drug treatment courts in England and Wales, or Northern Ireland, although in the latter there is a growing interest. It is suggested the Drug Treatment and Testing Order (DTTO) in England and Wales has acted as an impediment as this is a very weak version of drug treatment court and was proposed by the Prime Minister when Shadow Home Secretary. Drug treatment courts in Eire and Scotland have adapted their program to fit local conditions, although neither have opted for a fully fledged drug user treatment court on the Miami model.     

Are drunk-driving offenders referred for screening accurately reporting their drug use?

Several studies report that a substantial percentage of offenders arrested for impaired driving test positive for drugs of abuse besides alcohol. Current guidelines recommend screening offenders for both alcohol and other drug use, yet little is known about the accuracy of self-reports of drug use in this population. We compared drug abuse and dependence DSM-III-R diagnoses from an initial, court-ordered screening evaluation of 583 female and 495 male convicted drunk-driving offenders with diagnoses obtained via a voluntary, non-coerced interview 5 years later. At initial screening, fewer than 6% of offenders were diagnosed with drug abuse or dependence. Among offenders who did not receive an initial drug diagnosis, 28% subsequently reported having experienced drug use problems consistent with a retrospective diagnosis of drug abuse or dependence by the age at which they were screened. Half of those with a retrospective diagnosis of drug dependence reported their initial screening responses were "very accurate". We conclude that, although many drunk-driving offenders undergoing screening have diagnosable drug problems, a high proportion under-report their drug use. We suggest that certain modifications to screening procedures, such as urine drug screening, reducing barriers to treatment, and training counselors in motivational interviewing techniques, may increase accurate identification of drug use problems in this population.     

Substance use and treatment seeking in young offenders on community orders

Both international and Australian studies reveal very low rates of treatment utilization for substance abuse among young offenders despite very high problematic rates of substance abuse among this group. The current study reports on substance use patterns of a representative sample of 712 young offenders serving community orders with the New South Wales Department of Juvenile Justice (Australia) and their history of and attitudes toward treatment. Most (87%) young offenders had used marijuana, and 47% had used amphetamines in the last 12 months. One third of the sample reported problematic use of alcohol (being drunk at least weekly, on average). Forty-three percent reported that they engaged in crime to maintain their substance use. On the substance abuse scale of the Adolescent Psychopathology Scale—Short Form, 36.4% of the sample fell into the moderate to severe problem range. Despite such problems, treatment motivation was poor: 10% reported willingness to access treatment for their drug problems. Eighteen percent reported accessing some form of treatment in the past; the most common form of help seeking was approaching their family (12%). Self-reported access to other drug treatments was even lower, with the more intensive treatments revealing low rates of treatment completion. Despite almost 40% of the sample revealing significant substance abuse problems, referral for treatment was also low, with only 18% of the sample being offered an appointment with juvenile justice drug and alcohol workers. This study reveals the gap between awareness of problematic drug use and treatment-seeking behavior, and has implications for improving outreach to young offenders with substance abuse problems.     

Problem Drug Use and Probation in London: an evaluation

Drug treatment through the criminal justice system has received little attention from UK evaluators. This study involved interviews with 278 drug-misusing offenders and 15 main grade probation officers. All the offenders were supervised by the Inner London Probation Service and had been sentenced to either a probation or a combination order. Probationers were asked about: their drug use, weekly spend, and methods of raising this money, both prior to arrest and before interview; their views on the role of probation in effecting reduction in use; and their opinions on which types of intervention worked best. Results suggest large reductions in drug use and crime, especially for those whose probation order included a condition of treatment. There was also strong evidence of effective working partnerships between the probation service and the specialist drug services which helped bring these reductions about. The majority of probationers also spoke positively of the assistance offered by their supervising officer. However, a high proportion also felt that probation officers would benefit from increased drug awareness and training-a view shared by most probation officers we interviewed. The policy implications of these findings are discussed.     

Predicting nonresponse to juvenile drug court interventions

Using data from a recent randomized clinical trial involving juvenile drug court (JDC), youth marijuana use trajectories and the predictors of treatment nonresponse were examined. Participants were 118 juvenile offenders meeting diagnostic criteria for substance use disorders assigned to JDC and their families. Urine drug screen results were gathered from weekly court visits for 6 months, and youth reported their marijuana use over 12 months. Semiparametric mixture modeling jointly estimated and classified trajectories of both marijuana use indices. Youth were classified into responder versus nonresponder trajectory groups based on both outcomes. Regression analyses examined pretreatment individual, family, and extrafamilial predictors of nonresponse. Results indicated that youth whose caregivers reported illegal drug use pretreatment were almost 10 times as likely to be classified into the nonresponder trajectory group. No other variable significantly distinguished drug use trajectory groups. Findings have implications for the design of interventions to improve JDC outcomes.     

Comparing the validity of self-reported recent drug use between adult and juvenile arrestees

A large body of literature has explored the validity of self-reported drug use among criminal populations. These works have typically revealed strong underreporting of recent illicit drug use. To date, however, no studies have compared the validity of self-reported drug-using behaviors between adult and juvenile offenders. The authors overcome this limitation by assessing the validity of self-reported recent drug use with data collected from 1,425 adult and 551 juvenile Los Angeles arrestees surveyed through the Arrestee Drug Abuse Monitoring (ADAM) Program in 1997. Kappa statistics were computed and tests for specificity and sensitivity were conducted utilizing urinalysis as the reference standard. Results suggest that adult arrestees are more inclined to underreport their recent use of illicit drugs. Implications for drug use research are assessed in light of the current findings.     

Investigation of alcohol use disorders in a group of driving-while-intoxicated offenders.

This preliminary study was carried out to investigate alcohol use disorders and personality profiles in a group of driving-while-intoxicated offenders. Thirty nine volunteer offenders were assessed by CAGE, while 21 of them were assessed by SCID-I Alcohol and Drug Use Disorders module and 14 drivers completed MMPI test. According to CAGE scores, 11 was found to have an indication of alcohol problem and 7 had clinically significant alcohol use disorder. Within 21 drivers, 4 had a DSM-IV diagnosis of alcohol abuse. Independent of their diagnosis, MMPI profiles revealed the psychopathic personality characteristics which might explain drinking while driving as a risky behaviour in this group. These results suggest that, besides legal applications, referring offenders to associated centers, in order to be evaluated and informed about alcohol use disorders, would be an important step in the prevention of recurrent alcohol impaired driving as well as alcohol related incidents.     

Comparing the Validity of Self-Reported Recent Drug Use Between Adult and Juvenile Arrestees

Abstract

A large body of literature has explored the validity of self-reported drug use among criminal populations. These works have typically revealed strong underreporting of recent illicit drug use. To date, however, no studies have compared the validity of self-reported drug-using behaviors between adult and juvenile offenders. The authors overcome this limitation by assessing the validity of self-reported recent drug use with data collected from 1,425 adult and 551 juvenile Los Angeles arrestees surveyed through the Arrestee Drug Abuse Monitoring (ADAM) Program in 1997. Kappa statistics were computed and tests for specificity and sensitivity were conducted utilizing urinalysis as the reference standard. Results suggest that adult arrestees are more inclined to underreport their recent use of illicit drugs. Implications for drug use research are assessed in light of the current findings.     

Assessing the long-term impact of drug court participation on recidivism with generalized estimating equations

Drug courts are one of the most common strategies for dealing with the large proportion of criminal offenders who are drug-involved, yet methodological limitations limit the conclusions that can be drawn from many existing evaluations of their effectiveness. The current study examined the long-term impact of drug court participation compared to regular probation on the recidivism of 475 drug-involved offenders under supervision in Hillsborough County, Florida. Using a combination of self-reported data (collected through in-person interviews at baseline, i.e., the beginning of supervision) and administrative records, the study employed a repeated measures framework (examining five 6-month time periods from baseline to 30 months post-baseline) and generalized estimating equations to compare the likelihood of being arrested between drug court participants and a matched sample of comparison offenders. The results indicate that participation in drug court was associated with a significant decrease in the likelihood of being arrested in the 12-18 months post-baseline time period. Although the drug court effect was somewhat delayed (it was not significant prior to 12 months) and short-lived (it was not significant after 18 months), the fact that significant program effects were observed during a time period that coincides with the conclusion of drug court participation for graduates and a time period well beyond initial program exposure, suggests that drug court participants are more likely than comparable offenders not exposed to drug court to remain arrest free when no longer under community supervision.     

Until I get off parole … then I can swim in it if I want to: Facilitators of and barriers to drug use among formerly incarcerated Black drug offenders

Black Americans are overrepresented among those incarcerated for drug-related offenses. Drug use, postincarceration, is associated with high risk of recidivism and overdose deaths. We explored factors influencing drug use among former Black drug offenders. Qualitative interviews with 30 Black Americans released from prison within the past year explored drug behavior as well as institutional, environmental, and social factors that influence drug use. Findings show participants reentered drug-enticing environments and social networks. Being on parole, drug programs, and social support influenced abating drug use. Drug interventions postincarceration should consider the environment and social networks as leverage points for behavior change.     

Criminal justice responses to drug offences: Recidivism following the application of alternative sanctions in Belgium

Drug offences require adequate responses from the criminal justice system. In most Western European countries, including Belgium, the use of judicial alternative sanctions for drug users is on the increase. The objective of the current research was to examine the effects of judicial alternatives for drug users in Belgium. The design of this study comprises a pre and post measurement of the criminal activity, drug use and situation in different spheres of life of 565 drug-dependent offenders. Reduced offending was observed following the application of alternative sanctions. On average, the research subjects incurred fewer criminal charges and convictions after the judicial alternative than prior to it. In addition, their involvement in drug offences, property and violent crime decreased. This covaries with a remarkable reduction in problematic drug use and an improvement in other aspects of their life—including more supportive social relations and prosocial leisure time.     

Attributions for psychobiological changes in ecstasy/MDMA and other polydrug users

Ecstasy [3,4-methylenedioxymethamphetamine (MDMA)] use has been associated with a number of psychopathological problems. However, research suggests that reported symptoms might be associated more with heavy polydrug use in general rather than ecstasy per se. The current study aimed to determine the role of other drug use in reports of long-term effects by some ecstasy-polydrug users. Problematic ecstasy users (n = 53), reporting problems which they attributed to ecstasy use, were compared with non-problematic ecstasy users (n = 62), polydrug (n = 62) and alcohol/nicotine using controls (n = 111). Drug use was recorded, and positive and negative life changes were assessed along with which previous drug use, if any, they attributed these changes too. Both ecstasy groups reported higher drug use compared with polydrug controls. Polydrug and ecstasy users more often reported life changes compared with non-drug users, and ecstasy users appeared to experience more life changes than polydrug users, with problematic ecstasy users experiencing most alterations. Ecstasy users reported changes more to a combination of drugs than to one specific drug, suggesting that polydrug use in these groups has an impact on their life experiences. These findings emphasise that research into the psychological effects of ecstasy should not underestimate the role of other polydrug use.