Drug and Alcohol Findings home page in a new window EFFECTIVENESS BANK BULLETIN 10 April 2012

The entries below are our accounts of documents collected by Drug and Alcohol Findings as relevant to improving outcomes from drug or alcohol interventions in the UK. 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 prepared e-mail to adapt the pre-prepared e-mail message or compose your own message. The Summary is intended to convey the findings and views expressed in the document. Below may be a commentary from Drug and Alcohol Findings.


Contents

Therapeutic sentencing for drug-related offenders

All the entries in this bulletin are about reducing crime and drug use among drug-related offenders. First two show probation officers can be trained to implement risk-need-responsivity principles with consequent crime reductions. Next two review the evidence for specialist courts dealing with drug using offenders. Finally, one reason why this evidence is variable – how courts operate does make a difference.

Crime lower among clients of probation officers trained to tailor supervision ...

Adjusting sentencing to offender need and risk reduces crime ...

Extensive review bemoans evidence quality but supports drug courts ...

US Congress expenditure watchdog endorses drug courts ...

Ways to make drug courts more effective and more cost-effective ...


An experimental demonstration of training probation officers in evidence-based community supervision.

Bonta J., Bourgon G., Rugge T. et al.
Criminal Justice and Behavior: 2011, 38, p. 1127–1148.
Unable to obtain a copy by clicking title? Try asking the author for a reprint by adapting this prepared e-mail or by writing to Dr Bonta at Jim.Bonta@ps.gc.ca. You could also try this alternative source.

For the first time this Canadian randomised study has shown that training probation officers in the risk-need-responsivity model of offender supervision can not only improve their skills and sharpen their practice, but also reduce the recidivism of the offenders they supervise, among whom substance use was a major issue.

Summary The risk-need-responsivity model has been very influential in guiding treatment interventions with criminal offenders. The model's three core principles are:
• Risk: providing intensive services to clients at higher risk of reoffending and minimal services to lower risk clients;
• Need: target criminogenic needs or the dynamic risk factors which underlie or drive criminal behaviour such as pro-criminal attitudes and substance use;
• Responsivity: match the style and mode of intervention to the abilities, motivation, and learning style of the offender; cognitive-behavioural interventions are generally the most effective.
A synthesis of research findings found that as adherence to these principles increased, there was a stepwise increase too in the reduction in recidivism.

Paucity of evidence that supervising offenders in the community reduces recidivism may be related to the fact that probation officers do not implement these principles and rarely use cognitive-behavioural techniques. The featured study which took place in Canada was the first randomised trial to evaluate whether training for probation officers based on risk-need-responsivity principles changes how they deal with offenders and reduces their recidivism.

A three-day training programme featuring interactive teaching and role plays was developed which incorporated all three core principles, with a particular emphasis on targeting problematic attitudes and thoughts using cognitive-behavioural techniques. Audiotapes of offender supervision sessions were used to assess adherence to the principles targeted by the training and other features of the interaction between probation officers and offenders which might influence recidivism. Training was supplemented by a refresher course a year later and ongoing clinical support, including exercises based on audiotape extracts and feedback and coaching from the trainers.

Of the 80 probation officers who volunteered for the study, 51 were randomly assigned to be trained and 29 to an untrained control A group of people, households, organisations, communities or other units who do not participate in the intervention(s) being evaluated. Instead, they receive no intervention or none relevant to the outcomes being assessed, carry on as usual, or receive an alternative intervention (for the latter the term comparison group may be preferable). Outcome measures taken from the controls form the benchmark against which changes in the intervention group(s) are compared to determine whether the intervention had an impact and whether this is statistically significant. Comparability between control and intervention groups is essential. Normally this is best achieved by randomly allocating research participants to the different groups. Alternatives include sequentially selecting participants for one then the other group(s), or deliberately selecting similar set of participants for each group. group against whom findings from trained officers could be benchmarked. Following training, all 80 were asked to submit audiotaped sessions with accompanying information on new clients, but only 52 did so, contributing the 295 audiotapes analysed by the study. Of the offenders they supervised, 183 (56%) agreed to join the study but 40 later became unavailable, leaving 143 whose reconvictions were tracked for on average two and a fifth years from the first audiotape recording. Also obtained was the reconviction rate of a random sample of each officer's pre-training clients – 185 in all whose convictions records were obtained for on average three and a half years after their first sessions with their probation officers.

This data – available from 46 of the 52 officers – enabled the researchers to tell whether offenders whose officers had been trained went on to be reconvicted less often than the same officers' pre-training caseload, and (crucially) whether this reduction exceeded that among clients of untrained officers. Any excess reduction could be attributed to the effects of the training. If this happened, analysis of the tapes might shed light on what made the difference. Trained officers' uptake of post-training support was also monitored to check if this was related to their performance.

Main findings

Did training improve the quality of the officers' work?

As well as identifying whether a topic was addressed at all in a session, each five-minute segment of each session was analysed and coded for the different topics addressed at least twice To eliminate casual references. within a segment. The tapes revealed that training had substantially affected how the officers conducted supervision. As intended, training had focused sessions on underlying causes of crime, while untrained officers spent more time on the probation conditions the offender had to comply with, and needs not identified as related to the offender's criminality.

In particular, pro-criminal attitudes were rarely raised by untrained officers (mentioned in just 2% of sessions and occupying 8% of session time) but were significantly more prominent in sessions by trained officers (35% of sessions occupying 13% of session time). On average, The main exception was criminogenic needs specifically related to employment and education, which untrained officers were more likely to raise in a session and spent more time on. trained officers spent more time in each session discussing the criminogenic needs (58% of segments v. 43%) and pro-criminal attitudes (13% of segments v. 3%) identified as possibly underlying the offending of that offender. Substance use as a criminogenic need was discussed in over 60% of sessions and in about a quarter of segments, but in this case no more often and for no longer after training.

As well as the content of each session, raters judged the skill with which the officers addressed these and other issues within four categories. Under all four headings, trained officers were judged more skilful, in three cases significantly so. The three were how well they structured a session (for example, checking for crises and prioritising needs), fostering a good client-officer relationship (for example, by actively listening to the client), and the application of cognitive-behavioural techniques, especially when targeting pro-criminal attitudes. Also non-significantly better were their 'behavioural' techniques including use of reinforcement and disapproval to shape the offender's behaviour. Together these four summed to significantly better correctional skills among the trained officers.

Training had focused especially on applying cognitive-behavioural techniques to pro-criminal attitudes and ways of thinking, so these skills were further analysed. As expected, many more trained officers – three quarters versus just one in ten – had discussed pro-criminal attitudes with their clients, and 70% versus just 5% had employed cognitive techniques.

Did offenders supervised by trained officers offend less often?

% of offenders reconvicted in 2 years

The first set of recidivism analyses focused on the subset of offenders for whom there were two years of follow-up data on reconvictions. Over these two years, 25% of offenders supervised by trained officers had been reconvicted. Before training, 47% of clients of the same officers had been reconvicted chart. This post-training reduction in reoffending was statistically significant. In contrast, among untrained officers, in both time periods the reconviction rate was just over 40%. Though differences between trained and untrained officers were not statistically significant, these figures reveal a post-training reduction in offending apparent among trained but not untrained officers, a finding suggesting that training had made the hoped-for difference.

A second set of analyses adjusted Also adjusted for were the offenders' age and risk of re-offending. for different follow-up periods, so could include the reconviction records of all the offenders. Again, the proportion of offenders supervised by trained officers who were reconvicted was significantly lower after they had been trained, but there were no significant difference between them and offenders supervised by control group officers.

Another way to segment the offenders was to contrast those supervised by officers after they had been trained, with offenders supervised by the same or different officers not (or not yet) trained. Over two years the difference in the proportions reconvicted was a statistically significant 25% versus 44%. This finding was confirmed by an analysis which adjusted Also adjusted for were the offenders' age and risk of re-offending. for different follow-up periods, so could include the reconviction records of all the offenders.

These analyses suggest that reoffending was reduced when offenders were supervised by trained officers. Digging deeper, the researchers probed what it was about how the officers behaved which might have made the difference. Using cognitive techniques to alter pro-criminal attitudes was the sole factor. In the two years after training, 10% of the 42 offenders (all but one supervised by trained officers) subject to these techniques had been reconvicted compared to 37% of the 70 offenders with whom they had not been used. Also, the more these techniques had been used, the less likely was an offender to be reconvicted. No such links were found with the other types of skills assessed by the study – forging relationship, structuring sessions, or behavioural techniques.

The authors' conclusions

For the first time at the level of the offender being supervised one-to-one by a probation officer, the study has confirmed that adherence to risk-need-responsivity principles is associated with decreased recidivism, and that correctional staff can effectively be trained to apply these principles during offender supervision. The probation officers in the study improved their targeting of criminogenic needs, especially pro-criminal attitudes, and learnt and used specific cognitive-behavioural intervention skills to help clients change their attitudes, beliefs and ways of thinking, which in turn decreased the likelihood of a return to crime.

Compared to their untrained colleagues, trained officers spent more time and/or addressed these issues in more sessions, while untrained officers spent more time on non-criminogenic needs and probation conditions. It meant that after training, the balance of the sessions was more in tune with risk-need-responsivity principles. Moreover, training improved skills needed to effectively address these issues, including building a relationship and the use of cognitive-behavioural techniques. These techniques were evident in the work of only one of the untrained officers but 7 in 10 of those trained.

Random allocation of officers to be trained or not means it can confidently be concluded that these improvements were due to the training. However, crediting the training with reducing recidivism is complicated by the fact that monitored offenders were selected by the officers, who chose to include them in the study by submitting audiotapes and data. But if this biased the findings, there is no reason to believe any such bias would have differed between trained and untrained officers, yet lower recidivism was only apparent among offenders supervised by trained officers. Consistent findings across several different types of analyses all indicate that training officers reduced recidivism among their supervisees, findings in line with the association between risk-need-responsivity principles and recidivism in studies which observed real-world practice.

The data suggest two possible links between how the training affected the officers and criminality among probationers. First, use of cognitive techniques was associated with lower recidivism and seems to have been one mechanism via which training reduced crime. Second, but in the opposite direction, the more that probation officers discussed probation conditions, the higher the recidivism rate. It seems that preoccupation with the conditions of probation, or the enforcement role of the probation officer, interferes with the establishment of a therapeutic relationship, obstructing more directive intervention. Trained officers spent less time on this enforcement role.

Finally, the findings suggest that ongoing skill development is important. Officers who received more clinical feedback and attended more of the monthly meetings and the refresher courses were more likely to demonstrate the skills taught in training and to focus their discussions on matters of importance, such as criminogenic needs.

The fact that none of the recidivism differences between offenders supervised by trained and untrained officers reached statistical significance was probably due to small sample sizes, but this would need confirming in a larger study. It should also be borne in mind that the officers volunteered for the study and therefore too for the training. Whether such training would have a similar impact if routinely implemented remains to be seen.


Findings logo commentary The featured study should be distinguished from those of specialist drug or alcohol interventions for offenders such as the ASRO group programme for problem substance users (itself based on cognitive-behavioural principles) or referral to specialist treatment. Instead it is about improving core probation supervision by the general run of officers. While the study was not specifically about substance use or users, the fact that substance use as a contributor to offending was discussed in over 60% of sessions and in about a quarter of session segments suggests it was a common and important issue among this caseload.

The authors are commendably cautious about attributing recidivism reductions to the consequences of the training, but the fact that offenders seen by untrained officers were reconvicted at the same rate before and after other officers had been trained, yet these trained officers saw a near halving in the proportion reconvicted, is strong evidence that training was the active ingredient. Training seems to have embodied effective methods including interactive exploration of the topic, role play practice, feedback on actual performance, and continued support 'pushed' to the officers rather than left for them to access on their own initiatives.

While fewer reconvictions can fairly confidently be claimed to be the consequences of training the officers in the study, the reservation that they self-selected participation is potentially an important limit on the generalisability of the findings. Training which looks effective among trainees already in tune with its messages can look less effective if it falls on stonier ground in the form of unreceptive trainees. However, the Canadian province of British Columbia was sufficiently convinced to implement the training tested in the featured study across its probation service.

The conclusion that cognitive-behavioural methods were the key mechanism via which training improved probation's impact on crime rests on shakier foundations than the impact of the training itself. Since with just one exception only trained officers used these methods, their use was effectively coincident with training overall. This makes it impossible to disentangle the impact of training overall with the impact of this specific element in the training. Similarly, the fact that the more often officers used these methods, the more recidivism was affected, could reflect the probability that it was these officers who had benefited most from training overall or were best able due to their predispositions and work situations to put it in to effect. The same factors may have improved their recidivism outcomes regardless.

Even when in a controlled study a cognitive programme been found effective, this has not necessarily been maintained in a larger scale roll-out, as found in British prisons. Interventions for offenders are, it has been argued, highly context-specific; what works in one culture at one time may well be ineffective in other settings and at other times. The intervention tested by the featured study may have sidestepped this limitation to a degree, because the training was not about implementing a set 'programme', but applying broad principles and ways of fostering change.

The featured study's characterisation of the relatively ineffective untrained officers as focusing more on probation conditions is worryingly reminiscent of the findings in a British study of services probably sampled in the mid-2000s. Perfunctory brief encounters focused on dose, prescribing and dispensing arrangements, attendance records, and regulatory and disciplinary issues were the main features of keyworking service offered by some British criminal justice teams to offenders on opiate substitute prescribing programmes.

Thanks for their comments on this entry in draft to Tim McSweeney of the Institute for Criminal Policy Research at Birkbeck College in London. Commentators bear no responsibility for the text including the interpretations and any remaining errors.

Last revised 11 April 2012

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Top 10 most closely related documents on this site. For more try a subject or free text search

REVIEW 1999 Barriers to implementing effective correctional drug treatment programs

REVIEW 2006 Motivational arm twisting: contradiction in terms?

REVIEW 2006 My way or yours?

STUDY 2012 Alcohol screening and brief intervention in probation

REVIEW 2011 Evidence-based therapy relationships: research conclusions and clinical practices

STUDY 2012 The effectiveness of Prisoners Addressing Substance Related Offending (P-ASRO) programme: evaluating the pre and post treatment psychometric outcomes in an adult male category C prison

STUDY 2011 Evaluation of the Addressing Substance-Related Offending (ASRO) program for substance-using offenders in the community: a reconviction analysis

REVIEW 2005 The motivational hallo

STUDY 2009 Therapist behavior as a predictor of black and white caregiver responsiveness in multisystemic therapy

REVIEW 2012 Assessing the effectiveness of drug courts on recidivism: a meta-analytic review of traditional and non-traditional drug courts





Targeting dispositions for drug-involved offenders: a field trial of the Risk and Needs Triage (RANT).

Marlowe D.B., Festinger D.S., Dugosh K.L. et al.
Journal of Criminal Justice: 2011, 39, p. 253–260.
Unable to obtain a copy by clicking title? Try asking the author for a reprint by adapting this prepared e-mail or by writing to Dr Marlowe at dmarlowe@tresearch.org.

Drug-involved offenders have different needs related to their offending (in particular for addiction treatment) and pose different levels of risk for a return to crime after usual sentencing options. This US study confirmed that needs and risk are independent dimensions which can be measured and used to adjust sentencing to reduce recidivism.

Summary No single sentencing option is adequately suited to all drug-involved offenders. The most effective and cost-efficient outcomes are achieved when offenders are matched to appropriate dispositions based on their:
criminogenic needs: disorders, deficits or impairments which if rectified substantially reduce the likelihood of recidivism; most common include substance dependence, psychiatric disorders and serious functional deficits such as brain injury or a lack of basic employment or daily living skills; and
prognostic risk: characteristics of offenders associated with poorer outcomes in standard correctional programmes. Among drug offenders, the most reliable and robust include being younger, male, early onset of substance abuse or delinquency, prior felony convictions, unsuccessful attempts at treatment or rehabilitation, antisocial personality disorder, and antisocial peers. To succeed in treatment and cease substance abuse and crime such individuals must usually be closely supervised and held to account for their actions. Low-risk offenders, on the other hand, are apt to improve following arrest; intensive intervention may be costly yet offer little further benefit.

Classification of offenders and associated sentencing options

The featured study assigned drug-involved offenders to sentencing options based on their criminogenic needs and prognostic risks as measured by a 19-item interview schedule called the Risk and Needs Triage (RANT), administered by community corrections officers in 'real world' criminal justice practice. RANT items were derived from local findings on variables associated with successful pre-trial supervision or probation, and variables found by research syntheses to predict success among drug-involved offenders on community supervision. Criminogenic need is assessed by factors including substance dependence, serious mental illness, and chronic drug-related ill-health. Prognostic risk is assessed by factors including age, how early substance abuse and delinquency started, criminal and treatment histories, antisocial associates, and employment and living stability. Scoring allocates offenders to one of four quadrants: high risk and high need; low risk and high need; high risk and low need; low risk and low need.

Each quadrant is associated ( figure) with what research suggests are appropriate sentencing options. The intention was to assign offenders to these options based on their RANT classifications. The intense supervision and treatment of the drug court was to be reserved for high risk and high need offenders. At the opposite poles, low risk and low need offenders would be subject to minimal reporting requirements or monthly check-ins and group psycho-educational sessions. In between are offenders who are high risk but low need, for whom intensive probation supervision was indicated, and those with high needs but a low risk of failing usual sentencing options, who were to be assigned to traditional probation. However, judge and defence lawyers (for pre-trial cases) and probation officers (for sentenced cases) could override these indicated dispositions, and slots were not always available in the intended programmes.

Of 3289 offenders potentially eligible for the study, 666 were identified as substance abusers and were available and agreed to be assessed using the RANT system, of whom one-year recidivism data was available for 459, about in 8 in 10 charged with drug offences.

Main findings

A few RANT items which did not aid consistent classification were dropped. Analysis of the remainder confirmed that prognostic risk and criminogenic need are coherent and independent dimensions; offenders can be high on one and low on the other or at the same extreme on both. Probably because relatively serious offenders were most likely to be referred for further evaluation using RANT, 85% of offenders who had been referred to and joined the study were classified as at high risk of failing usual probation.

As expected, high risk and high need offenders were most likely to be re-arrested over the following year (44% were), while least likely (14%) were low risk and low need offenders. In between were high risk and low need (38%) and low risk and high need (29%) offenders. However, only the level of risk of failing usual probation was significantly associated with re-arrest rates; level of need was also associated with arrest, but this finding was not statistically significant. Comparable results were observed for re-conviction rates, which ranged from 31% to 10%. These associations were not significantly affected by the race or sex of the offenders.

Often due to the unavailability of these options, only a minority of offenders for whom intensive supervision (in the form of a drug court or neighbourhood probation) was indicated were actually assigned to these. Virtually all were instead given less intensive sentences. Offenders who were assigned their matched options were less likely to be re-arrested (35%) than those assigned to a less intensive alternative (41%), though this finding was not statistically significant. Clearest was the lower chance (41% v. 56%) of re-arrest when high risk/need property offenders were assigned as intended to the drug court rather than traditional or neighbourhood probation, a finding replicated in respect of convictions.

The authors' conclusions

Results of this field trial lend initial support to the RANT as a triage tool for drug-involved defendants and probationers at or near the point of arrest. It appears to significantly predict re-arrest and re-conviction rates and does not reveal evidence of sex or racial bias in the prediction of recidivism. This study also suggests outcomes might improve if drug-involved offenders were matched to appropriate dispositions based on their risk and need profiles, though small numbers representing some combinations of risk, need and sentence meant that – despite substantial apparent impacts – statistical significance was not usually reached. Also, too few offenders were sentenced to 'over-intensive' options for the consequences to be assessed.

It should however be borne in mind that only about a fifth of potentially eligible offenders received a RANT assessment, so it cannot be assumed that the results would generalise to all drug and property offenders. In particular, offenders referred for assessment were overwhelmingly at high risk of failing probation. It can be expected that RANT would have greater predictive power in a more varied caseload. Finally, the possibility cannot be excluded that relatively incorrigible offenders were more likely both to refuse the indicated dispositions and to reoffend. If so, then poorer outcomes for those given 'under-intensive' sentences might not be due to this lack of intensity, but to the type of offenders who strive to avoid intensive supervision and treatment.


Findings logo commentary This is one of the latest in an impressively coherent and persistent attempt to evidence how US courts (and drug courts in particular) can do more to reduce drug use and crime, including ways to conserve resources by reserving intensive intervention for offenders who need it. Within the ambit of drug courts, these studies have shown that triaging on the basis of initial risk and then adjusting in the light of experience, based on simple and clear criteria and feasible treatment and supervision enhancements, are both possible for US drug courts and effective in promoting abstinence from illegal drugs. The featured study extends this perspective by positioning drug courts themselves as an option best reserved for offenders with a need for addiction treatment and who are likely to fail usual probation due to their criminal tendencies, and possibly too those whose addiction has led them to commit property crimes.

This finding from one US county is partially confirmed by a major study funded by the US Department of Justice of 23 drug courts., which found their anti-crime impacts were greater for offenders with more serious prior drug use and criminal histories, but smaller for younger, male, black, or mentally ill offenders.

See this Findings analysis for more from the same research team on adjusting drug court regimens to the risk level and actual progress of offenders and an analysis of the relevance of such findings to the UK context.

Last revised 08 April 2012

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STUDY 2012 Adaptive programming improves outcomes in drug court: an experimental trial

REVIEW 2012 Assessing the effectiveness of drug courts on recidivism: a meta-analytic review of traditional and non-traditional drug courts

STUDY 2009 Review of the Glasgow & Fife drug courts

STUDY 2011 An experimental demonstration of training probation officers in evidence-based community supervision

STUDY 2011 The family drug and alcohol court (FDAC) evaluation project: final report

REVIEW 1999 Barriers to implementing effective correctional drug treatment programs

STUDY 2009 Managing drug involved probationers with swift and certain sanctions: evaluating Hawaii's HOPE

REVIEW 2011 Adult drug courts

STUDY 2013 Criminal justice responses to drug related crime in Scotland

STUDY 2012 The effectiveness of Prisoners Addressing Substance Related Offending (P-ASRO) programme: evaluating the pre and post treatment psychometric outcomes in an adult male category C prison





Assessing the effectiveness of drug courts on recidivism: a meta-analytic review of traditional and non-traditional drug courts.

Mitchell O., Wilson D.B., Eggers A. et al.
Journal of Criminal Justice: 2012, p. 60–71.
Unable to obtain a copy by clicking title? Try asking the author for a reprint by adapting this prepared e-mail or by writing to Dr Mitchell at omitchell@usf.edu. You could also try this alternative source.

Synthesising the results of 154 studies, the most thorough and extensive investigation of the crime-reduction credentials of drug courts finds the evidence bulky but lacking quality, yet sufficient to support courts for adult illegal drug users if not (or not yet) teenagers or drink-drivers.

Summary Drug courts specialise in closely supervising (through regular urine tests and court appearances) and ordering the treatment of suitable drug-related offenders to improve compliance with treatment as an alternative to prosecution or imprisonment. In what is intended to be a non-adversarial environment, judges impose sanctions or offer praise or more tangible rewards and adjust treatment depending on progress. The incentive for suspects or offenders is that charges or penalties will be reduced or dismissed upon successful completion of the court's orders, which typically takes at least a year, a point reached by about half the caseload.

In just two decades, drug courts have grown from a single court to an international movement with over 2400 operative in the USA and others in the UK, Canada, New Zealand, Australia, South Africa, Bermuda, and Jamaica. Most US courts (which account for most of the evidence of their impacts) restrict their intake to non-violent, substance dependent 'clients' and many exclude drug dealing offenders or those with extensive and serious criminal histories or serious mental health problems. As a result, most eligible offenders have been charged with drug or property crime and have relatively few prior convictions for serious offences.

The featured review and meta-analysis A study which uses recognised procedures to combine quantitative results from several studies of the same or similar interventions to arrive at composite outcome scores. Usually undertaken to allow the intervention's effectiveness to be assessed with greater confidence than on the basis of the studies taken individually. aimed to pool the results of many more drug court evaluations than previous reviews, while distinguishing between drug courts targeting adult illicit substance users, those for juvenile offenders, and those for adults convicted of driving while under the influence of drink. It also aimed to discover what makes drug courts more or less effective, whether their impacts last, and whether their effectiveness is supported by the most rigorous trials.

To this end the analysts sought studies which compared the subsequent criminality of offenders adjudicated by drug courts with those adjudicated in usual court systems. Pooling of results from these studies was done in a way which did not assume there was one 'true' degree to which drug courts affected recidivism which varied only by chance, but that features of the study, court, offenders or other factors might create real differences in impact. Where available, results in terms of actual drug use were also analysed. In all 154 such studies were obtained, all but eight of US courts.

Main findings

The analysts found this body of work generally methodologically weak. Just eight of the 154 studies had randomly allocated offenders to drug courts versus alternative judicial procedures, the securest way to eliminate bias due to differences in offenders who do or do not choose and/or get referred to and accepted by drug courts. Most studies obtained their comparison groups in ways (such as offenders tried before the courts opened or those turned down by the courts) which do not convincingly eliminate risk of bias due to the selection of offenders for the courts or other factors.

Courts for adult drug users

Across all 92 studies of courts for adult drug users, those processed through drug courts were moderately but significantly less likely to later reoffend – and in particular to commit drug crimes – than offenders subject to usual judicial procedures. Assessed by just four studies, drug use itself was also reduced, but not significantly. The figures meant that if 50% of offenders reoffended after normal procedures, 38% would have done so had they been through a drug court. This effect was not significantly attenuated among non-US studies or over follow-up periods beyond one year and up to three years, and nor was it significantly less when the follow-up period extended partly or wholly beyond the offender's sentence.

However, the most methodologically rigorous studies registered the lowest impacts. Across the three to have randomly allocated offenders to drug courts versus alternative procedures, recidivism over the next year was lower among drug court offenders, but the finding was not statistically significant. This was perhaps because one of the studies atypically randomised offenders to a comparison condition which entailed more intensive drug testing than the drug court. In this study too, while ineffective at one year, the drug court was associated with reduced offending at the three-year follow-up. Findings in the remaining two studies, or including the exception's three-year follow-up, were statistically significant, and recidivism reductions were about as great as across all studies.

The next most sound studies typically attempted instead to match drug court and comparison offenders on key variables, or to adjust the findings for their relative risks of offending. Across these 20 studies, recidivism was modestly and significantly lower among drug court offenders, but such research designs have limited power to iron out important potential differences between offenders who are or are not referred to (or choose to be tried by) drug courts.

Enough suitable studies were available to assess which features of adult drug courts (or studies of them) were associated with the greatest success. In respect of both general and drug offending, courts in which over half the offenders successfully completed their orders had the best records. Of the 18 remaining tests (nine each for reoffending in general and drug offending), two features were associated with lower rates of drug crime: being tried by a court which sees offenders at least twice a month, or by one which could hold out the prospect that success would expunge the original offence. The same was not true to of recidivism in general; instead, the minority of courts which accepted violent offenders had less impact than the remainder.

Juvenile and drink-driving courts

Across the 34 relevant studies, only general offending was significantly (but modestly) reduced by juvenile drug courts, figures which implied that if 50% of offenders reoffended after normal procedures, 42% would have done so had they been through a drug court. But across the most rigorous studies, findings were less impressive (equivalent to a reduction from 50% to about 44%) and not statistically significant. There was essentially no impact on drug offending in particular, and pooled results from the three studies to assess drug use recorded modest reductions which did not reach statistical significance.

Across the 28 relevant studies, offenders supervised by drink-driving courts were moderately but significantly less likely to later reoffend – and in particular to commit drug/alcohol crimes – than offenders processed through usual judicial procedures. Drug use itself – assessed by just two studies – was reduced but not significantly. The figures meant that if 50% of offenders reoffended after normal procedures, 38% would have done so had they been through a drink-driving court. Again the strongest effects were seen in the weaker studies. Across the four randomised trials, effects were small and non-significant, heavily influenced by one study which found the courts tended The finding was not statistically significant. to be counter-productive. [Editor's note: Due to legal requirements, this study in California was forced to compare drug court extensions to sentencing and supervision against what already was an intensive treatment programme and regular court hearings. The drug court also had little leverage over offenders due to an inability to waive charges on successful completion and to prison overcrowding, which meant jail terms were rarely implemented.]

The authors' conclusions

Drug using offenders adjudicated by drug courts are less likely to reoffend than those normally adjudicated, but how much varies with the type of drug court. In adult drug courts, the average effect is equivalent to a reduction in general and also specifically drug recidivism from 50% to 37–38%, reductions which persist for at least three years after the start of the sentences. Thus, the accumulated evidence supports the continued funding, development, and operation of adult drug courts. Drink-driving drug courts have comparable impacts on recidivism but findings from the most rigorous, randomised trials are ambiguous, and more such trials are needed to definitively demonstrate effectiveness.

In contrast to the moderate effects of drug courts for adult illicit drug users and drink-drivers, juvenile drug courts have a minor impact on recidivism. Possible reasons are that, unlike many adult courts, these courts see relatively high risk offenders, and that their requirements (eg, in terms of drug testing, court hearings, programme duration) are less demanding.

Even if overall effective, the effects of different courts vary greatly. Exploring the possible reasons uncovered some evidence supporting the importance of 'leverage' and intensity, in that drug courts which dismissed charges for successful participants and courts with more frequent hearings had larger reductions in recidivism, but these findings were statistically significant only in respect of drug-related recidivism.

Courts which dealt only with non-violent offenders were more effective in reducing crime than those which extended to violent offenders. At first this seems to contradict analyses which have found that violent offenders do as well in drug courts as non-violent offenders. But these analyses reported on offenders, the featured analysis on courts. It remains possible that courts which admit violent offenders are for some reason less effective than other courts, and at the same time, that within each court violent offenders do as well as non-violent.

An important issue (which goes beyond the data collected for the featured analysis) is whether in other ways drug courts unduly restrict eligibility, for example, by excluding people charged with supplying drugs. Many supply to support their own drug use and may benefit from drug court treatment. Likewise, many courts also exclude offenders with extensive criminal histories and serious mental health issues. Though more of a risk to public safety, offering effective drug treatment to such offenders promises to reduce reoffending. Outside a drug court context, some evidence (of which the Breaking the Cycle evaluation is the most prominent) suggests that expanding the drug court model to broader populations of offenders can be effective.


Findings logo commentary This analysis shows there is no simple answer to the question, 'Do drug courts reduce crime?' The answer is – 'It depends'. What it depends on is partly what the court is compared against. Weaker studies which cannot exclude the possibility that more promising offenders find their way to drug courts also find the largest effects. Presumably crucial variables – like how committed the offenders is to succeed, their social and family support, or professional assessments of how well suited they are to a drug court regimen – are rarely available to researchers so cannot be adjusted for. Effects remain even in randomised trials which should eliminate this source of bias, but perhaps partly because these are so rare, pooled results from these trials are not statistically convincing.

Results also vary with another feature of the comparator – the degree to which it is like the drug court it is being compared against. This probably works both ways: the gap between the two may be narrowed because the drug court is unable to fully implement a drug court model, or because the comparator already incorporates features of this model. Both influences may account for the lack of impact of Scottish drug courts in the main UK study to report on recidivism.

The two features found by the featured analysis to be associated with increased drug court effectiveness – seeing offenders at least twice a month and holding out the prospect that success would expunge the original offence – were among the effective ingredients also identified in a major study funded by the US Department of Justice of 23 drug courts. However, in the featured analysis these were among three significant findings to emerge from 16 tests Excluding graduation rate and whether the study was formally published. of different features of drug courts. Had the analysis adjusted for the possibility Especially if multiple outcomes tend not to covary, the more are measured, the more likely it is that some will reach the threshold for a statistically significant difference purely due to chance variations in the samples rather than any real impact of the interventions being tested. For example, by convention, if a difference would happen only 1 in 20 times by chance, it is considered a non-chance occurrence possibly due to the intervention. But if, say, 20 independent outcomes are measured, more often than not one would cross this threshold purely by chance. To cater for this, it is recommended1 that researchers consider raising the threshold (in the example, according to some adjustment methods to as high as 1 in 400) before each of the outcomes is considered to have reflected a statistically significant difference.
1 International Conference on Harmonisation Of Technical Requirements for Registration of Pharmaceuticals for Human Use. "ICH harmonised tripartite guideline statistical principles for clinical trials." Statistics in Medicine: 1999, 18, p. 1905–1942.
that some of these tests might have been found statistically significant purely by chance, it could be that none would have crossed this more stringent threshold. Though across a caseload they may on average reduce recidivism, the benefits of frequent hearings have been found to be limited to high risk In the linked example, those characterised by antisocial personality disorder or with a history of treatment for drug abuse problems. offenders.

Selected recent reviews

The featured analysis is the newest, most recent and perhaps too the most probing of recent reviews of drug courts. Its findings largely accord with other recent reviews which find the bulk of the evidence on the side of drug courts, but also that this evidential weight is not matched by methodological quality in sufficient amounts to be confident that drug courts causes the overall recidivism reductions, as opposed to other factors the studies were unable to eliminate.

A review of interventions for drug using offenders produced for the Scottish Government accepted that research on Scottish drug courts had shown these cost more than normal procedures (which themselves embodied some drug court features including drug testing and treatment) yet did not further reduce crime. Like the featured analysis, the review warned that the most rigorous international trials which had randomly allocated offenders to drug courts versus other judicial options found only weak crime reduction impacts which fell short of statistical significance.

Reservations in the Scottish review cited above over the evidence for drug courts from randomised trials were echoed in a review conducted by British experts for the Swedish Council for Crime Prevention. It was able to synthesise crime-reduction results from just two high quality trials. Together these registered an advantage for drug courts versus comparison judicial options, but not one which was statistically significant. According to this analysis, treatment in general had been shown to reduce drug-related crime, but the same could not yet be said of treatment delivered via a drug court.

Mandated by US law, in 2011 the US Government Accountability Office investigated how well US adult drug courts have reduced crime and substance use and their associated costs and benefits. They reported that compared to alternative dispositions, generally studies found drug courts were associated with lower rates of criminal recidivism and relapse to drug use, but few studies were free of possible bias arising from non-random selection of drug court versus comparison offenders. Due mainly to reduced future victimisation and justice system expenditures, benefits to society expressed in financial terms usually but not always outweighed costs. This balance was partly dependent on the expense of the alternative disposal; if community sentences supervised by a drug court replaced prison, the cost savings were likely to be positive and substantial.

See a related Findings analysis for a summary of British policy and experience in relation to drug courts. For all Findings drug court analyses run this search. In particular see these background notes with a detailed consideration of one of the most methodologically rigorous studies to date, conducted in Baltimore with a caseload unusually relevant to the UK because it consisted mainly of heroin addicts with extensive criminal records. Though methodological concerns remained, it found that over the three years after offenders had been allocated to the court or to normal proceedings, the average numbers of new arrests and charges were significantly fewer among drug court offenders and drug use was lower.

Last revised 09 April 2012. First uploaded

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STUDY 2012 Adaptive programming improves outcomes in drug court: an experimental trial

DOCUMENT 2012 Will intensive testing and sanctions displace treatment?

REVIEW 2006 Motivational arm twisting: contradiction in terms?

HOT TOPIC 2015 Will intensive testing and sanctions displace treatment?

STUDY 2011 Targeting dispositions for drug-involved offenders: a field trial of the Risk and Needs Triage (RANT)

REVIEW 2011 A new paradigm for long-term recovery

STUDY 2011 An experimental demonstration of training probation officers in evidence-based community supervision

STUDY 2012 The effect on reconviction of an intervention for drink-driving offenders in the community

STUDY 2009 Review of the Glasgow & Fife drug courts

STUDY 2012 Alcohol screening and brief intervention in probation





Adult drug courts.

United States Government Accountability Office.
United States Government Accountability Office, 2011.

Recent US drug court studies reviewed for the US Congress by its audit and evaluation office support their crime-reduction credentials, though most studies are methodologically weak. Generally too, benefits outweigh costs, but not consistently.

Summary Drug courts specialise in closely supervising (through regular urine tests and court appearances) and ordering the treatment of suitable drug-related offenders to improve compliance with treatment as an alternative to prosecution or imprisonment. In what is intended to be a non-adversarial environment, judges impose sanctions or offer praise or more tangible rewards and adjust treatment depending on progress. The incentive for suspects or offenders is usually that charges or penalties will be reduced or dismissed on successful completion of the court's orders, which typically takes at least a year.

Most US courts (which account for the bulk of the evidence of their impacts) restrict their intake to non-violent, substance dependent defendants or offenders. Many exclude drug dealing offenders or those with extensive and serious criminal histories or serious mental health problems. As a result, most eligible offenders have been charged with drug or property crime and have relatively few prior convictions for serious offences.

In 2010 there were over 2500 drug courts in the USA including 1400 for adult offenders. Mandated by US law, in 2011 the US Government Accountability Office issued the featured report updating its previous assessments of how well adult courts have reduced crime and substance use and their associated costs and benefits. Its report takes in evaluations of 32 court programmes and 11 cost-benefit studies issued from February 2004 to March 2011.

Main findings

Compared to alternative adjudication options, generally studies found drug courts were associated with lower rates of criminal recidivism and relapse to drug use, but few were free of possible bias arising from non-random selection of drug court versus comparison offenders. Due mainly to reduced future victimisation and justice system expenditures, benefits to society expressed in financial terms usually but not always outweighed costs. Further information below.

Across the 32 evaluated court programmes, participants were generally less likely to be re-arrested than comparison group members drawn from criminal court. In 18 studies these differences were statistically significant. Among studies showing re-arrest differences, proportions of drug court participants re-arrested were 6% to 26% lower than comparison offenders; among drug court participants who completed their programmes, re-arrest rates were 12% to 58% lower. Across the eight programmes where this was measured, offenders sentenced by drug courts were less likely than comparison offenders to use drugs, though differences were not always statistically significant.

Cost-benefit analyses showed mixed results, net benefits ranging from plus $47,852 to minus $7,108 per participant. This balance was partly dependent on the expense of the alternative disposal; if community sentences supervised by a drug court replaced prison, the cost savings were likely to be positive and substantial.

Among the reviewed evaluations was the MADCE study, a major study funded by the US Department of Justice of 23 adult drug courts. This reported a two-year re-arrest rate for drug court participants 10% below that of the comparison group: 52% of drug court participants were later re-arrested compared to 62% of the comparison group. However, this difference was not statistically significant. The study also reported that drug court participants were significantly less likely than the comparison group to self-report having committed crimes when they were interviewed 18 months after the baseline (40% v. 53%), and drug court participants who did report committing crimes committed fewer than comparison group members.


Findings logo commentary This analysis and another more extensive recent review show there is no simple answer to the question, 'Do drug courts reduce crime?' The answer is – 'It depends.' What it depends on is partly what the court and the offenders are compared against. Weaker studies which cannot exclude the possibility that more promising offenders find their way to drug courts also find the largest effects. Effects remain even in randomised trials which should eliminate this possibility, but perhaps partly because these are so rare, pooled results from these trials have not been found to be statistically significant. Also, results vary with another feature of the comparator – the degree to which it replicates drug court processes. This probably works both ways: the gap between the two may be narrowed because the drug court is unable to fully implement a drug court model, or because the comparator already incorporates features of this model. Both influences may account for the lack of impact of Scottish drug courts in the main UK study to report on recidivism.

Two features appear to enhance the anti-crime effectiveness of drug courts: frequently seeing offenders to check on their progress, and being able to hold out the prospect that success will expunge the original offence. These were among the effective ingredients identified by an extensive review ( below) and by the large US MADCE study highlighted by the featured review. However, frequent hearings have been found to help only with high risk In the linked example, those characterised by antisocial personality disorder or with a history of treatment for drug abuse problems. offenders.

In its cost-benefit findings which highlighted the expense of the alternative sentence as a factor, the featured review touched on a fundamental criticism of US drug courts – that most exclude violent or drug dealing offenders or those with extensive criminal histories and serious mental health issues. The upshot is often a caseload of low-level drug offenders who are otherwise generally law-abiding, many of whom might have been more cheaply and appropriately diverted out of the criminal justice system altogether.

Selected recent reviews

Findings from the featured review largely accord with other recent reviews which find the bulk of the evidence on the side of drug courts, but also that this evidential weight is not matched by enough methodological quality to be confident that drug courts caused recidivism reductions, as opposed to other factors the studies were unable to eliminate. Generally the more sound the set of studies, the less likely they are to find substantial recidivism reductions due to drug courts.

A review of interventions for drug using offenders produced for the Scottish Government accepted that research on Scottish drug courts had not shown these reduced crime yet cost more than normal procedures, which themselves embodied some drug court features including drug testing and treatment. It warned that the most rigorous international trials which had randomly allocated offenders to drug courts versus other judicial options found only weak crime reduction impacts which fell short of statistical significance.

Reservations in the Scottish review cited above over the evidence for drug courts from randomised trials were echoed in a review conducted by British experts for the Swedish Council for Crime Prevention. It was able to synthesise crime-reduction results from just two high quality trials. Together these registered an advantage for drug courts versus comparison judicial options, but not one which was statistically significant. According to this analysis, treatment in general had been shown to reduce drug-related crime, but the same could not yet be said of treatment delivered via a drug court.

How far most studies fall short of the gold standard randomised controlled trial was commented on by (at the time of writing) the latest synthesis of drug court studies. Among this "methodologically weak" body of work, just three of 92 studies of courts Other than those dealing with drink-driving offences. trying adults had randomly allocated offenders to these versus alternative judicial procedures. Across these three, recidivism was lower among drug court offenders, but the finding was not statistically significant, perhaps because in one atypical study the comparator featured even more intensive drug testing than the drug court. The next most sound studies typically attempted instead to match drug court and comparison offenders on key variables, or to adjust the findings for their relative risks of offending. Across these 20 studies, recidivism was modestly and significantly lower among drug court offenders, but such research designs have limited power to iron out the most important differences between offenders who are or are not referred to (or choose to be processed by) drug courts. Presumably crucial variables – like how committed the offenders is to succeed, their social and family support, or professional assessments of how well suited they are to a drug court regimen – are rarely available to researchers. This synthesis found that drug offence recidivism was lowest in courts which supervised offenders at least twice a month and which could hold out the prospect that success would expunge the original offence. The same was not true to of recidivism in general.

See a related Findings analysis for a summary of British policy and experience in relation to drug courts. For all Findings drug court analyses run this search. In particular see these background notes with a detailed consideration of one of the most methodologically rigorous studies to date, conducted in Baltimore with a caseload unusually relevant to the UK because it consisted mainly of heroin addicts with extensive criminal records. Though methodological concerns remained, it found that over the three years after offenders had been allocated to the court or to normal proceedings, the average numbers of new arrests and charges were significantly fewer among drug court offenders and drug use was lower.

Last revised 08 April 2012

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STUDY 2008 Dedicated drug court pilots: a process report

STUDY 2009 Review of the Glasgow & Fife drug courts

STUDY 2013 Criminal justice responses to drug related crime in Scotland

REVIEW 2012 Assessing the effectiveness of drug courts on recidivism: a meta-analytic review of traditional and non-traditional drug courts

STUDY 2011 The family drug and alcohol court (FDAC) evaluation project: final report

STUDY 2012 Adaptive programming improves outcomes in drug court: an experimental trial

STUDY 2001 First test for the DTTO

STUDY 2011 Targeting dispositions for drug-involved offenders: a field trial of the Risk and Needs Triage (RANT)

STUDY 2005 Flexible DTTOs do most to cut crime

STUDY 2014 Drugs: international comparators





Adaptive programming improves outcomes in drug court: an experimental trial.

Marlowe D.B., Festinger D.S., Dugosh K.L. et al.
Criminal Justice and Behavior: 2012, 39(4), p. 514–532.
Unable to obtain a copy by clicking title? Try asking the author for a reprint by adapting this prepared e-mail or by writing to Dr Marlowe at dmarlowe@tresearch.org.

Latest in an impressively coherent and persistent series of studies of how US courts specialising in supervision and treatment of drug-related offenders can do more to reduce drug use and crime. Triaging offenders to more or less intensive programmes and then adjusting based on actual progress made significant differences.

Summary Drug courts specialise in closely supervising (through regular urine tests and court appearances) and ordering the treatment of drug-related offenders to improve compliance with treatment as an alternative to prosecution or imprisonment. Judges impose sanctions or offer praise or more tangible rewards and adjust treatment depending on progress. However, in the USA this intensive process is available to only a small minority of potentially suitable offenders. Extending the reach of drug courts may be more feasible if intensive supervision and treatment are reserved for offenders who need them in order to do well, and if these decisions can to a degree be routinised rather than made on an individual basis.

Background to the study

One step towards this is to match intensity to the risk that the offender will fail to meet the requirements of the court, imposing stricter supervision on offenders assessed as high risk before the start of their sentences. As described by Findings, this has been trialled by the research group responsible for the featured study. They found that high risk (antisocial personality disorder or a history of treatment for drug abuse problems) offenders were more likely to test negative for drugs and to complete their court orders when they had been randomly assigned to fortnightly court progress hearings rather than hearings 'as needed' in response to infractions. A further trial implemented this matching procedure and again found better outcomes among high risk offenders matched to fortnightly hearings.

However, predicting in advance how offenders will react to different drug court requirements is an imperfect science. Another step forward is to adapt these to how offenders actually do respond, if possible based on pre-set criteria derived from research findings. For example, if a participant misses a set number of counselling sessions, an 'adaptive' regimen might stipulate a motivational enhancement intervention. Treatment staff retain authority to override or alter an adaptation, but typically have to explain their decisions. The featured study was the first major test of adaptive programming in a drug court.

Deciding who needs more supervision or treatment

The criteria for adapting the drug court regimen and the adaptations were developed by the drug court team and research staff with a view to being feasible as well as effective. As in earlier studies in the series, first offenders were categorised as high or low risk and assigned on this basis to fortnightly or as-needed hearings. Monthly assessments identified those who did not comply with the court's requirements, indicated by two or more unexcused missed counselling sessions or failures to provide a valid urine specimen. In these instances it was assumed that judicial supervision was inadequate and it was stepped up to fortnightly or, if already fortnightly, further infractions would result in conviction for the original offence.

At other times offenders might attend treatment and comply with tests, but still carry on using illegal drugs, indicated by two or more positive urine tests. In these instances it was assumed that the treatment A minimum of four months (approximately 18 weeks) of weekly group psychoeducational counselling sessions covering the pharmacology of drug and alcohol use, progression from substance use to dependence, the impact of addiction on the family, treatment options, HIV/AIDS risk reduction, and relapse prevention strategies. Participants could also attend group or individual treatment sessions based on clinical need. was inadequate and its intensity was stepped up to include clinical case management entailing an additional two therapeutic group sessions per week and one individual session per month focused on motivational enhancement and relapse-prevention techniques.

A pilot study demonstrated the feasibility and promise of this approach, paving the way for the featured study.

About the study

Essentially the featured study tested whether in addition to triaging based on starting risk levels, adjusting treatment and supervision based on the offender's actual progress improved outcomes. Both the pilot and the featured study were conducted in a drug court in the city of Wilmington, the largest in the US state of Delaware. It accepted adult local residents charged with a misdemeanour Less serious offences such as possession or use of cannabis or possession of equipment related to drug use. without a history of a serious violent offending, and who drug court treatment staff assessed as meeting criteria for substance abuse or dependence. Defendants plead guilty but will be absolved if they satisfactorily complete Minimum requirements are attending at least 12 weekly group counselling sessions, providing at least 14 consecutive weekly drug-negative urine specimens, remaining arrest free, obeying programme rules and procedures, and paying a $200 court fee. the drug court programme and are not arrested for the next six months. Failing this they are convicted, have a criminal record, stand to lose their driving licences, and to be sentenced to a period on probation.

In 2009 and 2010 researchers approached 335 consecutive drug court defendants of whom 130 agreed to join the study (risking allocation to more intensive supervision and treatment than usual) and 125 actually started the programmes it tested. All were triaged based on their risk levels As in previous studies, antisocial personality disorder or prior treatment for drug problems indicated high risk and fortnightly hearings. to fortnightly or as-needed hearings and their progress was monitored monthly by researchers and reported back to the drug court.

Using the criteria outlined above, for a randomly selected 62 offenders, these monthly assessments determined Unless the drug court team or judge decided otherwise. whether those failing to comply with attendance and testing requirements were subject to more frequent or stricter supervision, and whether those still using drugs were directed in to more intensive treatment. Remaining offenders were subject to the court's usual procedures.

Primarily at issue was whether adapting treatment/supervision to progress reduced drug use, as indicated by weekly urine tests over the first 18 weeks of the drug court sentence, the minimum needed to complete it.

Main findings

The key finding was that offenders subject to the predetermined adaptations were less likely to use illegal drugs. Of the urine tests they took, 68% indicated they were drug free compared to 49% of comparison offenders. Assuming missed tests would have indicated drug use, the figures were 61% and 46%. Under either assumption, offenders whose supervision and treatment were adapted to their progress were over twice as likely as other offenders to submit a urine test negative for illegal drugs, a statistically significant difference, and one which was apparent over the entire 18 weeks.

In contrast, the proportions of offenders who satisfactorily completed the drug court programme within 18 weeks (31% in the adaptive regimen, 23% of the remainder) or within a year (68% and 67% respectively) did not significantly differ.

Just over a third of both sets of offenders at some time failed to meet criteria for complying with attendance or urine test requirements. These infractions were much more likely (64% v. 30%) to be responded to by the court when offenders were subject to the adaptive regimen and the court had been alerted to the infraction by the researchers. Also, roughly the same proportions (a fifth to a quarter) of offenders continued to use illegal drugs, though in this case the court was no more likely impose consequences on offenders in the adaptive programme.

There was a (not statistically significant) tendency for more offenders in the adaptive programme to see the drug court's procedures as fair, but otherwise no differences in perceptions of how effectively these acted as deterrents, attitudes to the judge, and satisfaction with drug court services, all of which were generally positive.

The authors' conclusions

Findings confirmed that adaptive programming can promote abstinence from illegal drugs among misdemeanour offenders sentenced by a drug court. This improvement in drug abstinence rates appears to have been attributable to more intensive supervision of offenders who failed to comply with attendance and testing requirements, rather than to more intensive and individualised treatment in response to continued drug use.

As intended, the criteria set for adapting the regimen, alerts to when these were breached, and the clear structure for how the court should respond, seem to have helped staff identify and rectify mismatches between offenders and the supervision schedule they had been assigned to on the basis of their anticipated risk of failure. In theory, drug court staff could have made these adjustments on their own initiatives, but were much less likely to do so without the guidance and assistance of the adaptive structure. Lacking this, they imposed consequences in respect of less than one in three of the times when offenders failed to show up for treatment or testing, a ratio unlikely to optimally promote compliance with supervision requirements. The adaptive regimen meant fewer offenders 'slipped through the cracks' to continue noncompliant behaviour with relative impunity. There was no indication (if anything, the reverse) that this greater strictness jaundiced offenders' views of the court or its procedures.

Strangely, while offenders whose programmes were adapted were more likely to test abstinent, they were no more likely to satisfactorily complete the drug court programme, despite the fact that a run of 14 'clean' urine tests was perhaps the primary requirement. It could be that the adaptive regimen failed to affect the other criteria offenders had to meet to satisfy the court and expunge their offence, or that the court took other factors in to account in making these decisions.

One methodological concern is that under 4 in 10 of the offenders asked to join the study did so, reducing the degree to which the findings can be assumed to be representative of what would happen if such procedures were applied across the board. It seems likely that refusers were less motivated to comply with the court's requirements or felt (perhaps due to their addiction) that they would be unable to satisfy the court if more intensively supervised. Also, rather than persisting impacts, these findings reflected periods when many offenders had recently ended or were still on drug court sentences.

There may be scope to improve criteria used to adapt supervision and treatment. For example, the assumption that non-attendance for counselling or testing does not require more intensive treatment may be false if offenders who have lapsed try to hide this by not turning up. And while supervision and treatment could be intensified in response to poor progress, there was no mechanism for good progress to trigger the reverse.


Findings logo commentary This is the latest in an impressively coherent and persistent attempt to evidence how US drug courts can do more to reduce drug use and crime, including ways to conserve resources by reserving intensive intervention for offenders who need it. These studies have shown that triaging on the basis of initial risk and then adjusting in the light of experience, based on simple and clear criteria and feasible treatment and supervision enhancements, are both possible for US drug courts and effective in promoting abstinence from illegal drugs. In turn this finding confirms that some kind of courts are more effective than others. Generally drug court sentences are associated with lower crime and drug use rates than comparison sentencing options, but there are not enough rigorous and convincing studies to be sure that this is due to drug court procedures as opposed to the type of offenders seen by drug courts or some other factor. Feeling more the weight than the quality of the evidence, generally reviewers have cautiously concluded that drug courts are more effective then conventional sentencing, but this largely US evidence is of doubtful relevance to the UK, where negative findings from Scotland may have contributed to a waning in enthusiasm at a national level for extending the drug court model to more offenders. Details below.

About the study

While the strategies tested by the featured study and its predecessors may seem obvious, deciding on the criteria for risk, the dividing line between poor versus good progress, and corresponding adjustments to supervision and treatment, is not straightforward. In the US context, and particularly in the context of a court trying less serious offences, triaging on the basis of antisocial tendencies and prior drug treatment and then adjusting on the basis of two missed appointments or urine tests had in some respects the desired impact. As the authors pondered, the puzzle is why this impact did not extend to what for the offender is probably the critical outcome – successfully completing the sentence.

For society and Britain in particular, crime-reduction is probably the critical outcome. Whether the full adaptive regimen reduced criminal recidivism is as yet unreported, but a prior study found that the first step – triaging high-risk US misdemeanour offenders to fortnightly supervision – did not do so to a statistically significant degree. According to their confidential accounts to researchers, among high-risk offenders in this study the reduction in the proportion who offended was greater (down by 23% v. 7%) when they had been left to the court's usual (roughly monthly) hearings.

The authors of the featured study suggest that rather than intensified treatment, imposing tighter supervision and more certain sanctions was how the adaptive regimen helped offenders avoid illegal drug use. This raises the issue of whether for these types of offenders, treatment can be dispensed with altogether and supervision and sanctions relied on to enforce compliance. For what seems to have been a mainly methamphetamine using caseload, this was essentially the proposition tested in Hawaii. Where the featured study reserved more intensive treatment for offenders with positive urine tests, in Hawaii they took this a step further by reserving treatment as such. There intensive urine testing allied with swift and certain but not severe sanctions for non-compliance dramatically curbed drug use, prison time and re-arrest rates among a high risk group of drug using offenders. Treatment was available for offenders who wanted it or whose repeat positive drug tests suggested it was needed, but few did want or need it – perhaps 1 in 10.

British policy and experience

In the featured study's drug court it seems that most offenders confined their regular illegal drug use to cannabis. In Hawaii, a stimulant was the main problem drug and opiate use was rare. These caseloads are very different from the dependent heroin users who have committed serious and/or repeated offences who constitute the major part of the caseload in drug courts in England and Scotland. It seems unlikely that many in the UK would be considered at low risk of reoffending, that fortnightly classes would be considered an adequate treatment for their addictions, or that many could sustain four months without registering some form of illegal drug use in at least two weekly urine tests. Generally they would be considered to warrant at least the intensity of treatment reserved for the minority of poor responders in the featured study. Though this means that in the British context, risk criteria and adaptive responses would have to be different, the principle of establishing these, and doing so on the basis of evidence rather than intuition, is likely to be applicable. If costly sentence failure and imprisonment are to be avoided, it seems critical that such adjustments are made before offenders get to the point where their breaches lead the court to revoke the drug court order and re-sentence for the original offence.

Drug courts have operated in England and Scotland for several years but are not widespread. In six pilot English courts, involved offenders and professionals felt the courts were a useful addition to the range of initiatives aimed at reducing drug use and offending. They set concrete goals for offenders to meet, raised self-esteem, and imposed a degree of accountability for their actions on offenders. They were also seen as facilitating partnership working between agencies. However, Scottish courts too were seen as useful and effective, yet there was no reliable evidence that (despite costing substantially more per order and per successfully completed order) their sentences were any more effective than similar orders made by other courts, as assessed by the proportions of offenders reconvicted and the frequency of convictions.

The 2010 English drug strategy made no specific mention of drug courts. For more details on criminal justice policy it referred to a Ministry of Justice green paper, which warned that drug courts "will only be continued if they genuinely make a difference and are cost effective". Evidence gathered for the paper was equivocal about the applicability of international evidence to England and Wales and did not list drug courts among its "promising approaches". The applicability of reasonably promising evidence from overseas (primarily the USA) was also questioned by the UK Drug Policy Commission in its review of programmes for problem drug-using offenders.

Scotland's drug strategy published in 2008 looked forward to the assessment of the country's pilot drug courts cited above, which found no reliable crime-reduction impact but increased cost. A review of interventions for drug using offenders produced for the Scottish Government accepted these findings, and warned that the most rigorous international trials which randomly allocated offenders to drug courts or other judicial options found only weak crime reduction impacts which fell short of statistical significance.

Given the negative crime reduction findings in Scotland, the lack of evidence in the rest of Britain, and doubts about the validity and applicability of mainly US international evidence, the national-level impetus apparent a few years ago for trying drug courts in Britain may have waned. Treatment allied with urine or other biological tests for drug use remain high on the UK agenda, but drug courts no longer appear to be seen as a prime means of ensuring and supervising such programmes. Nevertheless, such courts could be seen as one way to ensure offenders enter and comply with the treatment programmes (and specifically addiction treatment) the Ministry of Justice saw as effective in reducing the costs of crime, or one way local areas may choose to pursue the crime reductions which it suggested could attract financial rewards in 'payment by results' schemes.

Recent reviews

Reservations in the Scottish review cited above over the evidence for drug courts from randomised trials were echoed in a review conducted by British experts for the Swedish Council for Crime Prevention. It was able to synthesise crime-reduction results from just two high quality trials. Together these registered an advantage for drug courts versus comparison judicial options, but not one which was statistically significant. According to this analysis, treatment in general had been shown to reduce drug-related crime, but the same could not yet be said of treatment delivered via a drug court.

Mandated by US law, in 2011 the US Government Accountability Office investigated how well US adult drug courts have reduced crime and substance use and their associated costs and benefits. They reported that compared to alternative dispositions, generally studies found drug courts were associated with lower rates of criminal recidivism and relapse to drug use, but few studies were free of possible bias arising from non-random selection of drug court versus comparison offenders. Due mainly to reduced future victimisation and justice system expenditures, benefits to society expressed in financial terms usually but not always outweighed costs. This balance was partly dependent on the expense of the alternative disposal; if community sentences supervised by a drug court replaced prison, the cost savings were likely to be positive and substantial.

In hedging its cost-benefit findings, the Government Accountability Office touched on a fundamental criticism of US drug courts – that most exclude violent or drug dealing offenders or those with extensive criminal histories and serious mental health issues. The upshot is often a caseload of low-level drug offenders who are otherwise generally law-abiding, many of whom might have been more cheaply and appropriately diverted out of the criminal justice system altogether. The report also echoed a general finding in other research syntheses – that the more sound the study, the less likely it is to find any substantial recidivism reductions due to drug courts.

How far most studies fall short of the gold standard randomised controlled trial was commented on by (at the time of writing) the latest synthesis of drug court studies. Among this "methodologically weak" body of work, just three of 92 studies of courts Other than those dealing with drink-driving offences. trying adults had randomly allocated offenders to these versus alternative judicial procedures. Across these three, recidivism was lower among drug court offenders, but the finding was not statistically significant, perhaps because of one atypical study in which the comparator featured even more intensive drug testing than the drug court required. The next most sound studies typically attempted instead to match drug court and comparison offenders on key variables, or to adjust the findings for their relative risks of offending. Across these 20 studies, recidivism was modestly and significantly lower among drug court offenders, but such research designs have limited power to iron out the most important differences between offenders who are or are not referred to (or choose to be processed by) drug courts. Presumably crucial variables – like how committed the offenders is to succeed, their social and family support, or professional assessments of how well suited they are to a drug court regimen – are rarely available to researchers. Echoing the featured study, this synthesis found that drug use was lowest in courts which supervised offenders frequently and which – like the court in the study – could hold out the prospect that success would expunge the original offence. These too were among the effective ingredients identified in a major study funded by the US Department of Justice of 23 drug courts.

For Findings drug court analyses run this search. In particular see these background notes with a detailed consideration of one of the most methodologically rigorous studies to date, conducted in Baltimore with a caseload unusually relevant to the UK because it consisted mainly of heroin addicts with extensive criminal records. Though methodological concerns remained, it found that over the three years after offenders had been allocated to the court or to normal proceedings, the average numbers of new arrests and charges were significantly fewer among drug court offenders and drug use was lower.

Thanks for their comments on this entry in draft to Douglas Marlowe of the University of Pennsylvania in the USA. Commentators bear no responsibility for the text including the interpretations and any remaining errors.

Last revised 30 March 2012

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