Informing America's Policy on Illegal Drugs What We Don't Know Keeps Hurting Us (2001) / Chapter Skim
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Appendix E: Linking Treatment to Punishment: An Evaluation of Drug Treatment in the Criminal Justice System
Appendix E: Linking Treatment to Punishment: An Evaluation of Drug Treatment in the Criminal Justice System
Pages 349-381
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From page 349... ...
However, some clients are referred to these same programs by the criminal justice system and can therefore be punished or threatened with punishment if they fail to respond to treatment and abstain from drugs. For example, court-based offender management programs, such as Treatment Alternatives to Street Crime and drug courts draw on populations of probationers and refer them to treatment programs in the community.
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From page 350... ...
If drug addiction is indeed a chronic relapsing condition that requires multiple treatment episodes before rehabilitation can occur, then the abstinence orientation of criminal justice treatment programs may not be in keeping with the recovery process. Indeed, it might even be said that the For the purposes of this paper, drug addiction is defined as a chronic relapsing condition.
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From page 351... ...
Particular attention is paid to research on four programs: in-prison treatment, prison after-care programs, Treatment Alternatives to Street Crime (TASC) , and drug courts.
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From page 352... ...
However, in some evaluation research on system-based treatment programs, clients are randomly assigned to two different types of treatment. This is considerably less desirable than a study design that creates a no-treatment control group, because comparisons between two different types of treatment can determine only if one treatment program works better than another; such study designs cannot establish whether treatment works better than no treatment at all.
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From page 353... ...
Evaluations of drug treatment programs in the criminal justice system often make use of inappropriate follow-up periods, as they only follow clients in the short term, while they are on probation or parole. However criminal justice treatment programs have two components: the therapeutic component, which attempts to change or rehabilitate the client (e.g., counseling, therapeutic community)
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From page 354... ...
Yet because probation supervision involves large caseloads, probation programs for drug users are often confined to monitoring and punishing drug-using probationers rather than treating them. Special offender management programs like TASC and drug courts often have to be set up to recruit proba
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From page 355... ...
In particular, evaluations of one of the betterknown prison therapeutic communities, called Stay'n Out, seem to indicate that participants in this prison treatment program experience a number of positive postrelease outcomes when they are compared with a control group that is not exposed to treatment (Wexler et al., 1992, 1996; Landry, 1997~. In an evaluation of Stay'n Out, study subjects were drawn from a waiting list of inmates who had volunteered to participate in the prison therapeutic community.
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From page 356... ...
After all, the effectiveness of in-prison therapeutic communities depends on their ability to change treatment clients in ways so that they will be less likely to use drugs after leaving prison. However, the outcome measures used in the evaluation of Stay'n Out are too global to gauge the impact of prison treatment on postrelease drug use as they include rearrests and parole violations for both drug crimes (drug use, drug sales, etc.)
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From page 357... ...
Apart from the problem with the use of questionable outcome measures, certain of these analyses raise questions about the oft-cited link between longer retention in treatment and more positive outcomes. Prison treatment staff recommend that participants in the prison therapeutic community remain in treatment for 9-12 months to complete each phase of therapy.
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From page 358... ...
The fact that the study shows that prison treatment has little to no impact on posttreatment outcomes raises doubts about the effectiveness of treatment in prison. However, some have argued that prison-based programs are more likely to bring about improvements if prison treatment participants continue to be involved in a therapeutic community after their release from prison (Inciardi, 1996; Martin et al., 1999; Wexler et al., 1999; Knight et al., 1999~.
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From page 359... ...
In this sense, the Amity program was different from the Key-Crest program as study subjects were not randomly assigned to prison treatment in the Key-Crest study (Wexler et al., 1999~. Hence the Amity program controls for selection bias for those who participate in their prison program, whereas the Key-Crest program does not (see Table E.1 for study designs for both Amity and Key-Crest)
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From page 360... ...
For while they randomly assign study subjects to prison treatment or a no-treatment control group in the first phase of treatment, they do not randomly assign study subjects in the second phase of treatment when they enter the after-care therapeutic community (see Table E.1~. Instead, all those who complete the prison therapeutic community are eligible to volunteer to participate in the after-care program.
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From page 361... ...
Urine tests were also used as outcome measures in a study of the Texas in-prison therapeutic community and its after-care program (Knight et al., 1999~. Here again, there were problems with the way in which urine tests were administered, as study subjects in the treatment group were subject to more urine testing than subjects in the comparison group (see Table E.1 for the study design of the Texas program)
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From page 362... ...
But if urine tests were voluntary in a post-parole follow-up, then it is likely that study subjects who used drugs in the follow-up would refuse to submit a urine test because they might fear they would be subjected to additional punishment. None of the studies cited in this review grapple with the problem of developing long-term outcome measures for a postparole follow-up, as each of these studies confine their follow-ups to the period when study subjects are on parole (see Table E.1~.
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From page 363... ...
With prison treatment, the program offers individual and group counseling and isolation in a therapeutic community that is meant to resocialize the client to lead a drug-free life. In prison after-care programs, these services can be offered along with staff assistance in helping clients prepare for a job interview, open a checking account, and learn how to budget (Inciardi, 1996~.
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From page 364... ...
Traditional Probation and Intensive Supervision Probation Mandating treatment in the community is hardly a novel idea, as many drug users and low-level drug sellers are in fact currently being supervised by the criminal justice system in the community because they are on probation. Many persons arrested for drug law violations are either diverted to probation before they are prosecuted, or they are con
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From page 365... ...
Because traditional probation programs are likely to remain overextended for the foreseeable future, some have argued for an enhanced form of probation called intensive supervision probation (ISP)
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From page 366... ...
Although the ISPs had low recidivism rates for serious violent crimes, they had very high rates of technical violations, such as testing positive for drugs or failing to participate in a drug treatment program or failing to meet with a probation officer for a scheduled appointment. As many as 40-46 percent of the offenders in the California ISPs studied had technical violations as their most serious new offense, compared with 26 percent of offenders in traditional probation.
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From page 367... ...
Another fairness issue involves meting out real punishments for technical violations such as failing to attend drug treatment, in some cases, even when no local treatment programs are available (Petersilia, 1997~. An additional concern has to do with whether effective treatment is available, as the effectiveness of self-help programs (e.g., Alcoholics Anonymous, Narcotics Anonymous)
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From page 368... ...
It might be wise, then, to consider other system-based programs that do a better job of consistently linking criminal justice sanctions to traditional treatment. Two such programs that were specifically set up to identify probationers, refer them to treatment, monitor their progress, and punish relapses are Treatment Alternatives to Street Crime and drug courts.
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From page 369... ...
First, TASC identifies drug users who come into contact with the criminal justice system and then refers them to appropriate community-based treatment programs (Cook and Weinman, 1988; Inciardi et al., 1996~. It then monitors client progress in treatment to determine if the referred clients reduce their crime and drug use and make improvements in their personal and social functioning.
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From page 370... ...
The inconsistent findings, the differences between the criminal justice system-referred and the self-referred clients prior to treatment, and group differences in the services received make it difficult to draw any conclusions regarding differences in post-treatment outcomes among the three groups. These problems also make it difficult to understand the link between the longer stays of the criminal justice system-referred clients and any of their successful posttreatment outcomes.
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From page 371... ...
However, the other two sites in Canton and Portland did use an experimental design. At the Canton and Portland sites, study subjects were randomly assigned either to treatment programs that used the TASC offender management model or to a treatment program that did not use the TASC model.
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From page 372... ...
With recent increases in the number of drug users brought before the courts, this notion that client recovery is more likely to occur when punishment is linked to treatment is once again a matter of some importance. DRUG COURTS Linking treatment to punishment is an issue that is once again garnering some attention as there has been a near tripling of drug arrests in the last 20 years (Flanagan and McLeod, 1983; Bureau of Justice Statistics, 1999~.
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From page 373... ...
Much like TASC, drug courts identified the drug users in the criminal justice system and referred them to community-based treatment programs. They also monitored participants' progress in treatment and had the option of returning them to court for further sanctions if they failed in treatment.
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From page 374... ...
Indeed, the Maricopa County study compared drug court participants with those on traditional probation in terms of a number of outcome measures, including rearrests for drug crimes and non-drug crimes as well as for convictions or reincarceration in jail or prison during the 3-year follow-up. As noted previously, it is doubtful that outcome measures such as rearrests, convictions and reincarcerations can provide accurate counts of drug use levels or criminal behavior in a follow-up period.
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From page 375... ...
If drug courts mainly draw people who would otherwise go to prison or jail for extended periods, and if they succeed in reducing their criminal behavior and drug use, then they are likely to generate very impressive cost savings. If they mainly draw people who might otherwise undergo supervision with traditional probation, then they will have to be very successful in reducing post-program drug relapses and criminal recidivism to justify higher costs than those associated with traditional probation.
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From page 376... ...
Yet it is not entirely clear whether longer retention translates into more positive outcomes. Retention certainly has had a close association with positive posttreatment outcomes in earlier literature on voluntary treatment programs that are disengaged from the criminal justice system.
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From page 377... ...
For one thing, study subjects are not always randomly assigned to treatment or no-treatment control groups, making it difficult to know whether client successes are due to program effects or to a client's commitment to abstain from drug use. Equally worrisome is the problem of identifying valid outcome measures of drug use and criminal behavior in the follow-up period.
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From page 378... ...
Belenko, S 1998 Research on drug courts: A critical review.
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From page 379... ...
Inciardi, J 1996 The therapeutic community: An effective model for corrections based drug abuse treatment.
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From page 380... ...
Haas, and M Murrin 1999 Predictors of retention and arrest in drug courts.
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From page 381... ...
1996 Evaluation of prison substance abuse treatment programs.
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