Apprehension of drug users provides an opportunity to reduce drug use (and future offending) by using the threat of sanctions as a form of leverage to induce arrested or convicted users to participate successfully in treatment programs. In 1973, the National Commission on Marihuana and Drug Abuse concluded that the primary utility of criminal sanctions for consumption-related drug offenses lies in providing therapeutic leverage. During the past three decades, programs linking treatment and the criminal process have been developed and implemented with varying degrees of intensity across the country.

Not all treatment in the criminal justice system is coercive: treatment can be offered on a completely voluntary basis, without any connection to the offender’s charges or sentence. Many prison-based programs are of this type. (Conversely, it should be noted, treatment is sometimes compelled without any connection to the criminal justice system, as under a civil commitment statute.) In fact, however, most treatment provided to drug offenders is leveraged, in the sense that it is linked to case outcome or sentence severity.

In thinking about linkages between drug treatment and criminal sanctions, it is important to distinguish between questions of effectiveness and fairness. Supporters of using the criminal justice system for therapeutic leverage typically view treatment participation offered to offenders as an ameliorative device—an opportunity for mitigating the sentence that they would otherwise receive (i.e., probation with treatment is offered in lieu of incarceration, using the threat of incarceration for noncompliance). Others worry that programs of mandated treatment will actually have the effect of increasing the severity of punishment compared with what the offenders would otherwise have received (Covington, Appendix E). As an example, offenders who otherwise would have been sentenced to traditional probation could be subject to treatment conditions that create a risk of imprisonment (for noncompliance) that otherwise would not have existed. Or an offender whose case might otherwise have been dismissed could be sentenced to conditional probation. These are classic “net-widening” concerns, because they widen the reach and deepen the intensity of punishment. This issue should be kept in mind in considering research on coerced treatment.

Legal strategies to coerce drug users into treatment have been used both at the “front end” in diversionary programs and at the “back end” among parole and probation populations. However, experimental designs are rare, and it is difficult to disentangle the effects of treatment from the effects of coercion. Also, many studies have been concerned

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