The following HTML text is provided to enhance online
readability. Many aspects of typography translate only awkwardly to HTML.
Please use the page image
as the authoritative form to ensure accuracy.
Informing America’s Policy on Illegal Drugs: What We Don’t Know Keeps Hurting Us
An advantage of this design is that no one would get less than the standard probation counseling, but only randomly selected subjects would receive treatment. A necessary limitation is that a self-selected group who had been randomized to treatment would refuse to participate, but since they are in the probation system, they could be followed anyway.
The criminal justice component of this design raises complex analytic, legal, and ethical issues above and beyond those in an ordinary treatment experiment. Based on the view that drug dependence is a chronic relapsing disorder, many experts believe that abstinence is inappropriate as a sole or primary evaluative criterion. Yet positive drug tests are typically used as a trigger for sanctioning in mandated treatment regimes. Thus a key concern, from both an ethical and a scientific standpoint—is whether either of the treatment regimes is more restrictive than the baseline parole regime. For example, would the parolees in all groups be subject to monitoring (e.g., drug testing) on the same terms? Would they be subject to revocation on the same terms? Variations on the proposed design might include intensity of monitoring as a treatment variation, or the use of graduated sanctions less severe than a return to prison (see Kleiman, 1997). Another question is whether program effects should be reported while the coercive leverage of parole supervision is still operative, or only after parole supervision has ended. This is both a methodological concern and a question of policy: To what extent is coercive leverage necessary (or even sufficient) for any observed treatment effect? These questions reflect the tensions inherent in a program that combines therapeutic and social control objectives. The relative restrictiveness and punitiveness of traditional vs. treatment-oriented sanctioning options is an important issue that merits careful attention.
The committee recommends that treatment researchers take greater advantage of possible opportunities for randomization to no-treatment control groups. For example, we strongly encourage studies of incarcerated and postincarcerated prisoners as outlined in this report. The committee urges federal and state agencies and private institutions to minimize organizational obstacles to such studies, within ethical and legal bounds.
TOWARD STRONGER OBSERVATIONAL STUDIES
The committee strongly recommends that treatments intended to benefit people be evaluated in carefully conducted randomized controlled experiments. At times, however, such experiments are not possible. For example, it is not possible to experiment with treatments be-