EFFECTIVENESS BANK BULLETIN 6 April 2009
EFFECTIVENESS BANK BULLETIN 6 April 2009The entries below are our accounts of documents selected by Drug and Alcohol Findings as particularly relevant to improving outcomes from drug or alcohol interventions in the UK. Entries were drafted after consulting related research, study authors and other experts and are © Drug and Alcohol Findings. Permission is given to distribute these entries or incorporate passages in other documents as long as the source is acknowledged including the web address http://findings.org.uk. However, the original documents were not published by Findings; click on the Titles to obtain copies. Free reprints may also be available from the authors; if displayed, click Request reprint to send or adapt the pre-prepared e-mail message. Abstracts are intended to summarise the findings and views expressed in the study. Below are comments from Drug and Alcohol Findings. Links to source documents are in blue. Hover mouse over orange text for explanatory notes.
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Pupils use substances less in attachment-generating schools ...
English drug treatment patients engage best with open, innovative services ...
Acupuncture fails to ease opiate detoxification ...
British drug courts yet to demonstrate crime or cost-benefit gains ...
Individual and contextual effects of school adjustment on adolescent alcohol use.Henry K.L., Stanley L.R., Edwards R.W. et al. Request reprint
Prevention Science: 2009 [Epub ahead of print].
Further evidence that adolescent substance use is affected not just by specific prevention activities, but by a school's overall climate, especially the affiliation it generates in its pupils.
Abstract Unusually this analysis asked not just whether a pupil's positive affiliation to their school is linked to less drinking, but whether this same pupil would drink less in a school characterised by high pupil affiliation than in one whose pupils are more alienated. In doing so it attempts to strip away factors related to individual pupils to expose the potential impact of the school's climate as a whole. In turn this gives some indication of the potential prevention impact, not of specific substance use education or policies, but of generally how well the school engages its pupils.
The analysis drew on a dataset derived from 43,465 eighth grade pupils (normally aged 13–14) from 349 schools representative of all rural schools across the US mainland. Pupils were surveyed between 1996 and 2000 using questionnaires answered anonymously in each school by 75–100% of pupils. Alcohol use was assessed through a composite measure reflecting frequency of use, self-image as a (none to very heavy) drinker, and the centrality of intoxication in the pupil's drinking. An advanced multilevel statistical model was used to disentangle relationships between drinking and individual versus whole-school (contextual) measures of school adjustment. Adjustment was measured in terms of the pupil's bonding Fondness for school and bonding to teachers measured by responses to statements such as: 'I like school,' 'School is fun,' 'I like my teachers,' and 'My teachers like me.' to school, how well they behaved at school, Measured by responses to the statements: 'I cheat in school,' and 'I do things my teachers don't want me to do.' and their impressions of how bonded their friends were.
After accounting for other potential influences, Such as school size, ethnicity, pupils' ages, rurality. all three school adjustment variables were significantly related to alcohol use both across individuals in the same school, and on average between different schools. The between-schools relationships partly reflected differences between pupil populations in their degree of bonding. This element was statistically eliminated. What was left of the school's influence remained significantly and fairly strongly related to the intensity of a pupil's drinking. The implication is that a similar pupil, similarly bonded to their school, will drink less in schools where the overall average level of bonding is higher. In other words, drinking levels are not just related to the individual, but to a school's climate as reflected in the affiliation of its pupils. The further implication is that initiatives which improve school climate may have a restraining influence on pupils' alcohol use.
This analysis follows on from a similar analysis by the same research team but using a different dataset, a different measure of alcohol use/attitudes, and a different measure of affiliation to school. Nevertheless, it came to similar conclusions: regardless of their own degree of attachment to school, pupils in the lower years of secondary schooling drink less in schools which have managed to engineer or maintain a high level of affiliation from their pupils. British findings with similar implications have previously been analysed by Drug and Alcohol Findings. As explained there and in the corresponding background notes, impacts on substance use of attempts to 'artificially' improve affiliation to school have at best been promising, perhaps partly because the improvement levers open to researchers fall far short of those 'naturally' available to authorities which can replace staff, inject resources and mandate compliance.
It is important to keep such findings in perspective. The featured analysis focused on the small amount of variation in each individual's drinking which could be attributed to the school they attended rather than their individual characteristics and circumstances. These individual variables (presumably reflecting family and broader social influences as well individual personalities) accounted for by far the greatest part of the difference in drinking between pupils. What the analysis showed was that the minor (but still potentially important) contribution of the school is substantially accounted for by how far it engages its pupils, makes them feel appreciated and liked, and promotes such feelings in return.
Last revised 27 March 2009 Comment on this entry Give us your feedback on the site (one-minute survey) Back to contents list at top of page
Substance-focused initiatives not only way schools help prevent risky substance use NUGGET 2008
It's magic: prevent substance use problems without mentioning drugs HOT TOPIC 2010
Education's uncertain saviour KEY STUDY 2000
Doing it together strengthens families and helps prevent substance use KEY STUDY 2004
Confident kids ... like to party NASTY SURPRISES 2004
Drug prevention best done by school's own teachers not outside specialists NUGGETTE 2005
Communities that Care aims for science-based community action NUGGETTE 2005
World's most evaluated education programme also effective among New York's ethnic minorities NUGGET 1999
High-risk youngsters respond to coherent, consistent and interactive after-school activities NUGGET 2005
Relating counselor attributes to client engagement in England.Simpson D., Rowan-Szal G.A., Joe G.W. et al. Request reprint
Journal of Substance Abuse Treatment: 2009, 36, p. 313–320.
The most wide-ranging investigation of the organisational health of British treatment services found clients engaged best when services fostered communication, participation and trust among staff, had a clear mission, but were open to new ideas and practices.
Abstract In collaboration with England's National Treatment Agency for Substance Misuse, this study aimed Another aim was to compare this data with similar data from the USA to test whether the relationships held across different populations and treatment systems. to profile the organisational 'health' and resources of addiction services in England and the motivation and psychosocial functioning of their clients. Further analysis related both these influences to how far clients reported actively engaging in their treatments and experienced a positive relationship with their counsellors or key workers – variables found in other studies to in turn be related to better treatment outcomes.
Data was collected through questionnaires sent to 44 voluntary and statutory agencies which volunteered to participate in the study. Recipients offered services for alcohol and other drug clients and included day care programmes, outreach services, community drug teams, and Drug Interventions Programme teams in and around Manchester, Birmingham, or Wolverhampton. Each took a 'snapshot' of their clients and service profiles during the same fortnight in 2006. During this fortnight, CEST (Client Evaluation of Self and Treatment) forms were to be handed to each client as they presented to the service; 1539 On average 33 per treatment unit, representing fewer than half the clients in many of the participating programmes. completed the forms, of whom just over two thirds had been in treatment for at least three months. The forms asked them to rate themselves on statements representing their motivation and readiness for treatment, psychological and social functioning, and engagement with treatment. At the same time, 439 counsellors An average of 10 per treatment unit, three quarters of whom were women. About the same proportion had been in their present post for no more than three years and two thirds had less than five years' experience in drug treatment. at the services completed ORC (Organizational Readiness for Change) forms assessing their perceptions of the service they worked for and of their own professional functioning and needs.
The analysis centred on two dimensions from the CEST form reflecting the client's engagement with treatment. A measure of participation in treatment combined compliance with treatment requirements, active engagement, and making therapeutic progress. Greater participation was significantly and often quite strongly related to other items on the forms reflecting the client's motivation Greater participation was related to greater desire for help with substance use problems, readiness to be helped through treatment, and feeling that more intense treatment was needed. to overcome their substance use problems through treatment, and their psychosocial functioning. Greater participation was related to greater self-esteem, feeling that you deploy good decision making skills, that you can control your life and solve your problems, and pro-social attitudes. Lower participation was related to anxiety, depression, hostility and a tendency to take risks. Similar relationships were found with the degree to which clients felt rapport with their counsellors, an amalgam of feeling understood, respected, supported and helped.
Averaged across all the clients at an agency, these same two dimensions were also related to that agency's functioning averaged across all the counsellors from that agency. Effectively this analysis sought to relate the organisation's health as perceived by its staff, to how deeply its clients engaged with its services. Some significant relationships emerged, notably between client treatment participation and rapport with their counsellor, and how far the agency's staff felt it provided opportunities for professional development and to what degree they took up those opportunities. The participation dimension was also related to staff's feelings that they had the skills to do their jobs, but were also willing to try new things and adapt, and to their perceptions that the agency had a clear mission and programme and that staff were not unduly pressured.
Relationships between these variables differed substantially from those recorded in the USA, where feelings of rapport with one's counsellor were strongly related to many more aspects of the organisation's functioning. The analysts suspected this might be due to the diversity of agencies in the English sample, some of which For example, brief HIV/AIDS outreach and criminal justice referral services. would not have been expected to develop therapeutic relationships with their clients.
To narrow in on a more homogenous set of treatment services, another analysis confined itself to 22 agencies in the Birmingham region, embracing 142 counsellors and 858 clients. Importantly, these clients could be individually linked Unlike in the broader English sample and also unlike in the corresponding US studies. to their counsellors, meaning the client's engagement with treatment could be related to their own counsellor's perceptions of themselves and the service they worked for. At this more fine grained level, client participation was greater in services whose premises were more suited to counselling and which had gone further in computerising their work, including client assessments and records. Apart from these concrete features, participation was also greater in services characterised by team working and mutual trust among staff, and which encouraged discussion and implementation of new ideas and procedures – attributes also related to greater client rapport with their counsellor. In addition, rapport was greater when staff felt services had adequate guidance on providing an effective service, were better resourced in terms of staff, training, and equipment, had a clear mission and programme, fostered open communication, and were receptive to staff suggestions, ideas and concerns.
Given the Birmingham findings, the analysts concluded that relationships between organisational functioning and quality of services were rooted in the personal interactions between clients and counsellors. The implications were that engagement might be improved by starting treatment with interventions (if needed) to rectify clients' low motivation, poor mental health, and anger-related problems, and by developing well resourced organisations which foster communication, participation and trust among staff, have a clear mission, but are open to new ideas and working practices.
This study is the most wide-ranging and systematic investigation of the organisational health of British treatment services, and of its potential impacts on the degree to which clients are enabled to benefit from treatment by deepening their engagement and strengthening their relationships with their key workers.
Despite their complexity, there is a coherence to the findings. Most striking is role of openness to change – to new ideas, new ways of working, to developing skills and knowledge among staff – and openness to change agents in the form of staff who suggest changes (facilitated by an environment which encourages open communication) and training and educational inputs. Staff working in an atmosphere of support and respect for their views, and concern for their development, tended to have clients who also felt understood, respected, supported and helped. Openness to change and respect for other people may also have been expressed in the more concrete features which characterised engaging services – premises which afforded privacy and an environment conducive to counselling, and the embracing of new technology. Importantly, also influential was the degree to which a service was clear about what it was trying to do and how it was trying to do it, and communicated this to its staff. The study provides no mandate for undiscriminating innovation or undirected change, rather for change in the context of a securely anchored foundation of mission and methods.
The analysis could only discover associations between organisational health and treatment engagement measured at the same time, not whether one actually led to the other. However, there is a growing weight of similar evidence of which only a few examples can be cited here. Clearly relevant is a UK study featured in Findings which found that openness to change Definitions differed from those in the featured study but overlapped. Clients improved most when their workers characteristically prioritised independent thought and action, an exciting and varied life, and valued pleasure, and did least well when workers prioritised conformity and security. among drug workers was strongly related to the degree of improvement in their clients' substance use and social and psychological functioning from intake to treatment exit.
Organisational openness may also be reflected in willingness to submit the agency to scrutiny from external accreditation bodies (presumably entailing readiness to change in response to that assessment) and in actively networking with other agencies, both of which render the organisation more porous to different ways of working. Studies of drug treatment services (1 2 3) have found both these variables can be quite strongly related to the adoption of evidence-based practices.
One mechanism via which organisational openness might have an impact is readiness to change in order to adopt evidence-based practices (which in turn should improve outcomes). Just such a relationship has been noted across behavioural health services. Agencies which defensively prioritised convention and conformity were least likely to be open to new practices, more dynamic agencies which prioritised achievement, individualism and self-actualisation rather than security were most likely. It also seems that staff in agencies of the kind found most engaging in the featured study are personally most able to implement new learning gained in training, and also see their agencies as more likely to adopt innovations and techniques from training.
Studies are lacking on whether it is possible to deliberately engineer organisational change along the dimensions investigated in the study in ways which actually improve treatment engagement or outcomes. Such studies are rare probably because change along dimensions like mutual trust among staff, or willingness to listen to their suggestions, cannot simply be introduced by researchers and then studied. However, at least one study has shown that feedback of scores from the organisational health scale used in the featured study can motivate less well functioning agencies to engage in an improvement programme. Agencies which scored as less open Lower scores on cohesion, communication, and openness to change were associated with a higher likelihood of further work in making improvements in the area(s) identified in an assessment and training workshop designed to improve organisational functioning. to change and staff suggestions – the ones which would normally be least likely to engage in a change process – were the ones most likely to commit to change The study was unable to report whether they actually followed through on this commitment. when faced with the evidence of their shortcomings.
The implications of the study and of allied work stretch down from the organisation to its staff and up to the national, regional and professional regulatory and other structures which influence organisations and staffing. These are capable of confusing services and staff about their mission and forcing contradictory objectives on services, or of giving a clear mission which services and staff can embrace. They may also promote responsiveness to people and ideas within a clear framework, or in effect if not intention, encourage services and staff to play safe and conform to current accepted practice, risking de-individualisation of treatment and stifling innovation and staff commitment.
Thanks for their comments on this entry to Dwayne Simpson of the Institute of Behavioral Research at the Texas Christian University, USA. Commentators bear no responsibility for the text including the interpretations and any remaining errors.
Last revised 01 April 2009 Comment on this entry Give us your feedback on the site (one-minute survey) Back to contents list at top of page
The grand design: lessons from DATOS KEY STUDY 2002
Giving the silent majority a voice IN PRACTICE 2004
Treatment staff matter as much as the drug NUGGET 1999
Improving public addiction treatment through performance contracting: the Delaware experiment STUDY 2008
Benefits of residential care preserved by systematic, persistent and welcoming aftercare prompts NUGGET 2008
The Drug Treatment Outcomes Research Study (DTORS): final outcomes report STUDY 2009
The power of the welcoming reminder THEMATIC REVIEW 2004
Prison treatment in Scotland fails to impress NUGGET 2004
Auricular acupuncture as an adjunct to opiate detoxification treatment: effects on withdrawal symptoms.Bearn J., Swami A., Stewart D. et al., Request reprint
Journal of Substance Abuse Treatment: 2009, 36, p. 345–349.
From south London, one of only a handful of randomised studies trialling acupuncture for opiate detoxification adds to the accretion of 'ineffective' verdicts, raising the question of why the treatment continues to be popular.
Abstract The issue addressed in the study was whether supplementing a standard inpatient methadone-based detoxification with acupuncture would 'add value' by further relieving craving and the severity of withdrawal symptoms. Standard treatment at the specialist unit in London was based on stabilisation on methadone then reducing doses over 10 to 14 days. Total stays were intended to last four weeks. For the study, 82 opiate dependent patients provided data Another 11 were randomly allocated but later withdrew their consent to participate in the study. after being randomly assigned to receive ear acupuncture Treatment was administered by qualified acupuncturists, trained to the same national standards, from the Gateway Clinic, the only traditional Chinese medicine clinic in the UK funded by the National Health Service to treat drug addiction. daily for two weeks during their stay, or instead to undergo a similar procedure involving attaching clips to the ear. Patients were told that this too was an active treatment, though as far as was known it did not have nor was it intended to have any impacts on withdrawal severity or craving. Daily measures of withdrawal severity and craving were taken using standard questionnaires. Urine screening was used as an objective assessment of treatment adherence. On none of the 14 days nor over the entire fortnight were there statistically significant differences between patients allocated to 'real' acupuncture and the 'sham' treatment. Such statistically insignificant differences as there were favoured the 'sham' treatment, in the last few days of which patients experienced slightly less intense craving and withdrawal symptoms than acupuncture patients during the same period. The authors commented that the results are consistent with the findings of other studies which failed to find any effect of acupuncture in the treatment of drug dependence. They expressed concern that despite negative research findings, acupuncture continues to be widely seen as an effective intervention by workers and patients.
This is one of only a handful of randomised studies trialling acupuncture for opiate detoxification. Lack of impact is particularly disappointing as if anything the
circumstances favoured
The acupuncture option was the procedure the acupuncturists had been trained in and taught was effective. Any unintended signals they transmitted to patients would presumably have been indicative of their faith in that treatment and lack of faith in the alternative. Some patients too would probably have seen acupuncture as a bona fide treatment. In contrast, in this study the alternative may not have been seen as a convincing therapy. If anything, such influences would tend to have raised patients' expectations of the effectiveness of acupuncture relative to the alternative, giving it a head start in actual effectiveness.
the 'real' protocol. Like the featured study, previous studies of acupuncture in the treatment of opiate addiction have been unconvincing, leading a reviewer to conclude that such positive findings as there have been were due to placebo effects. What seems to have been the only previous randomised trial of acupuncture for opiate detoxification available in English was conducted in an outpatient clinic in San Francisco. In a programme with dramatically poor retention in either of the studied treatments, retention was nevertheless significantly improved by assigning patients to recommended ear acupuncture as opposed to a similar, but non-recommended, 'sham' procedure. However, by the last week of the three-week treatment period there was no difference in
known
Negative urine tests with missed tests treated as positive.
heroin abstinence rates, which in both cases were around a very poor 7%. Even in respect of improved retention, it is
impossible to exclude
Care was taken to avoid the acupuncturist (who knew which was the real and which the sham treatments) influencing the outcomes but this could not entirely be eliminated. Also the locations on the ear used for the the control condition were identified by the lack of a tingling/heat sensation when touched, the real ones by the presence of such a sensation, perhaps an implicit message to patients that these were active sites.
the possibility that this was due to patients' awareness of which was intended to be the active treatment. A
second randomised study available only as an abstract found that prior body acupuncture attenuated the increase in withdrawal severity after rapid detoxification using an opiate antagonist. It seems that no 'sham' treatment was used as a comparator, leaving the possibility that simply doing something in the lead up to the detoxification which patients expected to make them more comfortable was the active ingredient, rather than acupuncture itself.
The 'ineffective' verdict on acupuncture extends to the treatment of cocaine dependence, while an attempt to replicate earlier positive findings in the treatment of alcohol dependence using a more definitive research design found no benefits in terms of drinking reductions and worse retention. Overall an exhaustive search for relevant studies concluded that there was little evidence that acupuncture improved alcohol treatment completion or outcomes.
These studies concerned patients already attracted to treatment and generally compared real acupuncture to a pretend but still convincing alternative. The possibility remains that offering something concrete like acupuncture helps attract people to services, and that doing something both clients and staff believe is worthwhile (even if it is a 'sham' procedure) helps retain patients in treatment, and in doing so could improves outcomes. Just such a role was specified Complementary therapies were defined as “Any non medical intervention which regardless of therapeutic value enhances client access and retention in services, such as auricular acupuncture.” in recent guidance from the National Treatment Agency for Substance Misuse on treatment intervention costing and on treatment systems. Such considerations may explain why despite no convincing evidence of efficacy, acupuncture continues to feature in many of the treatment plans As revealed in March 2009 by a search for term 'acupuncture' on the web site of the National Treatment Agency for Substance Misuse, http://www.nta.nhs.uk. developed by local partnerships responsible for commissioning services in England.
Thanks for their comments on this entry in draft to Jennifer Bearn, Michael Gossop and John Witton of the National Addiction Centre in London and Russ Hayton from the Plymouth Drug and Alcohol Action Team. Commentators bear no responsibility for the text including the interpretations and any remaining errors.
Last revised 14 August 2009 Comment on this entry Give us your feedback on the site (one-minute survey) Back to contents list at top of page
Traditional medicine in the treatment of drug addiction REVIEW 2009
Lofexidine safe and effective in opiate detoxification NUGGET 2003
NTORS: the most crucial test yet for addiction treatment in Britain KEY STUDY 1999
Methadone maintenance as low-cost lifesaver NUGGET 2004
High risk of overdose death for opiate detoxification completers NUGGET 2008
Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence REVIEW 2009
Rapid opiate detoxification feasible at home NUGGET 2003
Naltrexone implants after in-patient treatment for opioid dependence: randomised controlled trial STUDY 2009
Dedicated drug court pilots: a process report.Matrix Knowledge Group.
[UK] Ministry of Justice, 2008.
Following the Scottish example, England has piloted drug courts using specially trained magistrates to closely supervise treatment-based community sentences. This initial report found no major glitches but low throughput and uncertain cost-benefits.
Abstract The Dedicated Drug Court framework for England and Wales provides for specialist courts which exclusively handle cases relating to drug misusing offenders from conviction through sentence to completion (or breach) of a community order with a Drug Rehabilitation Requirement (DRR). Two magistrates' courts (Leeds Magistrates' Court and West London Magistrates' Court) have been piloting drug courts implemented in line with the Ministry of Justice's framework.
The critical factors for implementation success are an understanding of local context and scale of need, the enthusiasm of the local judiciary and partner agencies, good partnership working, availability of resources to deliver the drug court and its associated treatment services, the depth of understanding by all staff of offender motivation and, in particular, recognition of the points at which an offender is most likely to make progress in reducing or stopping drug use. Continuity of judiciary is key to successful implementation of a drug court. It provides the focus for communication between the court and the offender and across magistrate panels. Continuity of judiciary was a strong planned feature of both courts. Based on analysis undertaken with data from the Leeds pilot, there is strong evidence that continuity of magistrates has a statistically significant impact on several key drug court outcomes. Greater continuity of magistrates experienced by offenders is associated with their being less likely to miss a court hearing, more likely to complete their sentence, and less likely to be reconvicted.
Break-even analysis showed that (compared to normal adjudication) an extra 8% of offenders seen by the courts would need to stop taking drugs for five years or more following completion of the sentence to provide a net economic benefit to the wider society, and 14% in order to provide a net economic benefit to the criminal justice system. A robust quantification of impact was not possible because of the difficulties in collecting sufficient data on a comparison group of offenders not processed through drug courts.
Commissioned by the UK Ministry of Justice, the report describes the implementation rather than the outcomes of England's pilot drug courts. In line with international understandings, the courts were intended to specialise in drug-related offenders, presided over by sentencers specially trained for this task who order treatment-based sentences and closely supervise the offender's progress, aided by regular tests for illegal drug use. The aim is maximise the rehabilitative impact of the sentence by increasing compliance and engagement with treatment through criminal justice pressure (ultimately the prospect of receiving a more typical punishment-based sentence if the drug court's order fails) and rewards (of which one of the most powerful seems to be the unfamiliar experience of being congratulated by a judge or magistrate).
The report identified no critical fault lines in the implementation of the courts. However, these were particularly promising sites: the Leeds court built on a pre-existing system and in London, court staff were enthusiastic about the proposal and had already been working towards creating a drug court. Nevertheless, offender throughput was lower than expected. Over the 17 months of the evaluation, the London court sentenced just 60 new offenders while in Leeds the total was 276. Low throughput raised costs per offender. Compared to a standard 12-month drug rehabilitation requirement order implemented through normal adjudication, supervising the order through the drug courts cost £4633 extra per offender.
With no comparison group of normally adjudicated offenders, the evaluation was unable to say whether this was money well spent. They were, however, able to calculate the drug use reductions the courts would have to 'buy' in order to meet their extra costs – as noted in the abstract, the answer was 8% of offenders ceasing drug use for at least five years compared to the numbers doing so on a normally adjudicated drug rehabilitation requirement order. This calculation though excludes the base costs of normal adjudication and of a normally supervised drug rehabilitation requirement order. This seems to mean that the 8% would also have to be over and above the proportion of offenders who remain abstinent after normal judicial processing. The report gives no indication of how much success would be needed to match the total costs incurred by the criminal justice system in implementing all the elements of a drug court-supervised drug rehabilitation requirement order.
The report's emphasis on offenders seeing the same magistrate(s) for their sentencing and throughout subsequent progress reviews is backed by evidence from Leeds that continuity is substantially associated with better compliance and drug use and crime outcomes. Steps were taken to reduce the risk that continuity was caused by high compliance and good progress rather than vice versa. However, without actually allocating offenders at random to see or not see the same magistrates, it is impossible to eliminate this possibility. Assuming the effect was real, it is of concern that organising continuity was a challenge, and especially so for 'breach' hearings dealing with unacceptable failures to comply with the order, which national regulations required to occur within a set period. Unfortunately, these crucial junctures are just when continuity is most needed, requiring an understanding of whether the offender will do better on a revised order, or the order has failed and should be revoked, often resulting in imprisonment.
A final caution over any such report There is no suggestion here that the featured report in particular was subject to any such manipulations or distortions or that these accusations are valid. is that some leading criminologists accuse the UK government of manipulating and distorting criminological research for political gain, to the point where the professor of criminology at the Open University has called for a boycott of government-commissioned work. The featured report was commissioned by the UK Ministry of Justice, a ministry carved out in part from the Home Office, one of the main targets of these accusations.
Scotland preceded England in formally piloting drug courts in Glasgow from 2001 and in Fife the following year. As in England, implementation was not entirely smooth but better than might have been expected. There was a high but it was thought acceptable failure rate, The cited report observes that “Completion rates for the Glasgow and Fife Drug Courts were commendable given the high tariff nature of the Drug Court Orders. In Glasgow 47% had completed their Orders compared to a completion rate of 30% in Fife.” probably aided by Scotland's more flexible application of drug treatment and testing orders, predecessors to the drug rehabilitation requirements used later by the English courts. However, crime impacts were questionable. Within one year 50% of drug court offenders had been reconvicted and within two years 71%, and the average frequency of reconvictions only slightly dipped in the two years after the order was imposed compared to the two years before. There was no clear crime-reduction benefit from supervising the orders through the drug courts (at an average cost of nearly £18,500 per order) as opposed to normal adjudication. But, as in England, the costs imposed on society by persistent, high-rate offending and drug-related mortality and morbidity, are such that even modest improvements might be cost-beneficial overall.
International experience and research relating to drug courts suggests it is important for courts to emphasise rewards as well as punishments, see offenders frequently enough to apply these swiftly in response to progress, deploy a range of rewards and sanctions short of revocation which are consistently applied, have a strong and sure ultimate sanction when the programme fails, make these consequences absolutely clear to offenders, have rapid access to a range of treatment options, maintain continuity in the judge dealing with the case, and to attend to the range of the individual's needs. Willingness to continue despite some initial offending makes the structure imposed by stringent requirements and monitoring a positive feature rather than one which leads most offenders to fail. Consistent judicial supervision, the fact that this forces addicts (back) in to treatment, and drug testing which provides a shared measure of how treatment is progressing, probably all play their parts.Last revised 31 March 2009 Comment on this entry Give us your feedback on the site (one-minute survey) Back to contents list at top of page
Review of the Glasgow & Fife drug courts STUDY 2009
First test for the DTTO KEY STUDY 2001
Treatment with drug testing promises to cut national burden of drug-related crime NUGGET 2000
Drug court passes rare randomised trial NUGGET 2003
Treatment and testing orders should make a substantial dent in drug-related social costs NUGGET 2001
Drug courts can work in Britain NUGGET 2004
Flexible DTTOs do most to cut crime NUGGET 2005
Force in the sunshine state OLD GOLD 2000
DTTOs: the Scottish way cuts the failure rate NUGGET 2003
