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Informing America's Policy on Illegal Drugs: What We Don't Know Keeps Hurting Us (2001)

Chapter: Appendix E: Linking Treatment to Punishment: An Evaluation of Drug Treatment in the Criminal Justice System

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Suggested Citation:"Appendix E: Linking Treatment to Punishment: An Evaluation of Drug Treatment in the Criminal Justice System." National Research Council. 2001. Informing America's Policy on Illegal Drugs: What We Don't Know Keeps Hurting Us. Washington, DC: The National Academies Press. doi: 10.17226/10021.
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Appendix E
Linking Treatment to Punishment: An Evaluation of Drug Treatment in the Criminal Justice System

Jeanette Covington

Drug treatment takes place in a number of different modalities, including therapeutic communities, outpatient drug-free programs, chemical dependency programs, and methadone maintenance programs. The majority of clients who enter and leave these programs do so voluntarily (Substance Abuse Mental Health Services Administration, 1999). 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. Drug treatment in the criminal justice system takes place among populations of incarcerated prison inmates who are encouraged or required to seek treatment in prison. At least some of these prison-based treatment programs are affiliated with community-based after-care programs that allow inmates to continue therapy when they return to the community on parole. Hence, drug treatment programs in the criminal justice system can in part be distinguished from voluntary programs by the clients they serve. In short, drug treatment programs in the criminal justice system are distinct in that they recruit clients from what are referred to as “captive” populations of prisoners, parolees, or probationers and encourage or require those that they supervise to enter treatment in prison or in the community.

Suggested Citation:"Appendix E: Linking Treatment to Punishment: An Evaluation of Drug Treatment in the Criminal Justice System." National Research Council. 2001. Informing America's Policy on Illegal Drugs: What We Don't Know Keeps Hurting Us. Washington, DC: The National Academies Press. doi: 10.17226/10021.
×

Because treatment clients in criminal justice programs are recruited from these captive populations, they can be distinguished from voluntary treatment clients in that punishment or the threat of punishment is very much a part of any treatment they receive. Presumably, by linking treatment to punishment, criminal justice drug programs can make the consequences of continued drug use more costly for their clients and thereby deter them from continuing drug use once they complete the program. Indeed, it is widely asserted that by linking treatment to punishment or its threat, these programs have done at least as well as voluntary programs in terms of getting users off drugs (Hubbard et al., 1988, 1989).

Not only do criminal justice system-supervised clients differ from voluntary clients because they face punishment or the constant threat of punishment, but they also differ in that system-based programs more narrowly define client success in terms of abstinence. Certainly abstinence is the ideal for programs that treat voluntary clients as well, but staff in these programs typically find that even their most promising graduates routinely relapse and return to treatment. A more significant problem for treatment staff offering therapy to voluntary patients is high dropout rates as many voluntary clients enter treatment, stay very briefly, and then leave without stopping their drug use. In fact, because their clients are voluntary, they cannot be forced to stay in treatment long enough for it to take effect, nor can they be stopped from leaving if they have not achieved abstinence.

Yet in the view of some, a cycle of treatment-seeking followed by relapse and then more treatment-seeking is to be expected, because addiction is a chronic relapsing condition (O’Brien and McClellan, 1996). Thus, there is a presumption that some users will stop and restart their drug use many times before they are able to sustain abstinence. Because recovery after a single treatment episode is rare, therapists who treat voluntary clients often stress other, more modest goals along with abstinence. For example, voluntary clients may be deemed successful if they manage to sustain longer drug-free intervals after a single treatment episode, or if they manage to reestablish ties with nonusing significant others. In fact, both these changes can be important preliminary steps on the road to recovery.

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.1 Indeed, it might even be said that the

1  

For the purposes of this paper, drug addiction is defined as a chronic relapsing condition. The author is not confident that drug addiction qualifies as a disease.

Suggested Citation:"Appendix E: Linking Treatment to Punishment: An Evaluation of Drug Treatment in the Criminal Justice System." National Research Council. 2001. Informing America's Policy on Illegal Drugs: What We Don't Know Keeps Hurting Us. Washington, DC: The National Academies Press. doi: 10.17226/10021.
×

probationers, parolees, and prisoners who participate in criminal justice system treatment are being set up to fail because recovery after a single treatment episode is demanded of them. If they fail to sustain abstinence after they leave the program, then they risk additional punishment.

In fact, by linking treatment to punishment, these programs risk having a countertherapeutic effect because they stigmatize the user. Drug users who participate in criminal justice treatment programs are stigmatized because their drug relapses can be punished with short stints in jail or longer stretches in prison. Since would-be employers may refuse to hire users with a record of incarcerations and law-abiding significant others may ostracize such users, punishing drug relapses in these ways may ultimately slow recovery. After all, securing stable employment and establishing ties to law-abiding significant others are crucial in the recovery process (Peters et al., 1999; Biernacki, 1986; Waldorf et al., 1991).

Yet despite these concerns about the limits of criminal justice treatment programs in speeding the recovery process, there is a good deal of research on system-based programs that seems to suggest that they are effective in getting their clients to abstain after a single episode of treatment. Since any claims that system-based programs are effective depend on how these programs are evaluated, this appendix examines the evaluation research on treatment programs in the criminal justice system. 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.

To determine if these programs are effective in bringing about client recovery in a single treatment episode requires some focus on how studies that evaluate these programs are designed. Hence the next section discusses the elements of an appropriate study design that will guide this review.

GUIDELINES FOR EVALUATING SYSTEM-BASED DRUG TREATMENT

To determine if treatment works or not requires that evaluations of treatment effectiveness be well designed. What follows is a list of the elements that contribute to a well-designed study.

Controlling self-selection bias. Among other things, appropriate study designs allow researchers to separate treatment effects from other factors that might influence client outcomes. For example, clients may abstain from drug use after a treatment episode because the program was effective in changing them, or because they themselves are so committed to

Suggested Citation:"Appendix E: Linking Treatment to Punishment: An Evaluation of Drug Treatment in the Criminal Justice System." National Research Council. 2001. Informing America's Policy on Illegal Drugs: What We Don't Know Keeps Hurting Us. Washington, DC: The National Academies Press. doi: 10.17226/10021.
×

getting off drugs that they persevere in demanding treatment programs, graduate, and abstain. Hence, clients who successfully abstain may succeed due to treatment effects, or they may be self-selected and succeed independent of treatment effects. Some researchers make an effort to control for this self-selection bias by randomly assigning subjects in their study to either a treatment group or a no-treatment control group. In this way, committed clients will end up in either the treatment group or the control group at random. Often study subjects in evaluation studies of system-based programs are randomly assigned to either a treatment group or a no-treatment control group from a waiting list.

Studies based on comparisons between treatment and no-treatment control groups are important because they can demonstrate if treatment works better than no treatment at all. 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.

Other commonly used study designs in the evaluation research on system-based programs do not use random assignment at all. Instead they set up comparison groups that are matched to the treatment group on a few broadly defined demographic characteristics. Because these studies do not control for self-selection bias, it is often difficult to know how to interpret any findings that are based on such research.

Controlling for a stake in conformity. Apart from a study design that controls for differences in client motivation, there is a need to control for other client characteristics that might influence outcomes, independent of treatment effects. For example, some clients fare better in treatment than others because they have more of a stake in conformity. In particular, clients who have steady jobs or are married tend to fare better in treatment than those who are not because these conventional roles give them some additional incentive to persevere in the difficult recovery process and eventually abstain from drugs (Peters et al., 1999; Biernacki, 1986; Waldorf et al., 1991). Consistent with this research, studies on general populations of drug users indicate that getting married or taking one’s first real job figures heavily in users’ natural desistance from drugs even without treatment or punishment (Bachman et al., 1997). Fortunately, client characteristics like marital status and employment status are external and easily measured and therefore can be controlled in evaluation studies.

It is important that these individual characteristics be controlled in

Suggested Citation:"Appendix E: Linking Treatment to Punishment: An Evaluation of Drug Treatment in the Criminal Justice System." National Research Council. 2001. Informing America's Policy on Illegal Drugs: What We Don't Know Keeps Hurting Us. Washington, DC: The National Academies Press. doi: 10.17226/10021.
×

order to determine how much client success is due to incumbency in these roles prior to treatment and how much is due to treatment program effects. However, it is not enough to simply isolate and control these effects for those who have them before treatment; they should also be controlled in posttreatment follow-ups. After all, some clients may abstain in the posttreatment period because they suddenly acquire a stake in conformity by getting married or beginning to work steadily and not simply due to any previous treatment effects.

Use of credible outcome measures. Apart from controlling for clients’ internal commitments and external incentives to recover, it is also important that a study make use of credible outcome measures. Success in most system-based treatment programs is defined in terms of whether or not clients abstain from drugs after they leave treatment, and levels of client abstinence in the follow-up period are variously measured in terms of self-reports, rearrests or reincarceration for the resumption of drug use. Yet there may be reason to question whether these measures provide accurate estimates of drug relapse in the follow-up period. Regular and random urine testing in the follow-up period would seem to be the most accurate method for estimating what percentage of clients relapse.

Identifying appropriate follow-up periods. Apart from the problem of identifying credible outcome measures, a related problem has to do with whether an appropriate follow-up period is selected for measuring client outcomes. 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) and the punitive component which attempts to make the client conform to the therapeutic regimen long enough to make needed changes. Hence, criminal justice clients can be said to have completed treatment only after both therapy and the risk of punishment have ended. This means that the appropriate follow-up period for programs that link treatment and punishment only begins after both the therapeutic and punitive components of treatment have ended. Probation and parole should not be used as follow-up periods because criminal justice clients are still in the punitive component of the treatment program. It is only after parole and probation, when all program interventions have ceased, that it is possible to tell if the combination of therapy and punishment have somehow changed clients so that they are able to sustain abstinence on their own in the long term.

Linking retention to outcomes. In past research, when program participants have been able to sustain abstinence from drugs after they leave

Suggested Citation:"Appendix E: Linking Treatment to Punishment: An Evaluation of Drug Treatment in the Criminal Justice System." National Research Council. 2001. Informing America's Policy on Illegal Drugs: What We Don't Know Keeps Hurting Us. Washington, DC: The National Academies Press. doi: 10.17226/10021.
×

treatment, longer stays in treatment have traditionally predicted these successful outcomes. There is a good deal of evidence that treatment programs in the criminal justice system have been highly effective in using punishment or the threat of punishment to induce their charges to stay in treatment long enough for it to take effect (Wexler et al., 1992; U.S. General Accounting Office, 1997; Belenko, 1998; Hubbard et al., 1988; Hubbard et al., 1989). Hence, evaluations of system-based treatment programs should go a step further and determine whether the longer retention of criminal justice treatment participants somehow translates into positive posttreatment outcomes.

Identifying treatment components that promote recovery. Finally, some evaluation researchers have focused on teasing apart those components of treatment that work. For example, some treatment programs treat clients in several different stages. Prison treatment programs, in particular, are sometimes associated with after-care programs in the community. These multistage programs enable an inmate to begin recovery in the prison treatment program and continue the recovery process in a community-based after-care unit while they are on parole. In such multistage treatment programs, it is important to determine which stage in the treatment process has a greater effect on successful client outcomes.

Teasing apart the components of treatment that work may also involve an effort to identify which therapeutic services contribute most to favorable client outcomes. Some programs can offer an array of services, including counseling, job training and referral, 12-step programs, and group therapy. If certain therapies consistently fail to change clients, that tendency points to a need to explore whether some types of clients might resist particular therapies. In such cases, an effort needs to be made to identify the reasons for client resistance and begin a search for appropriate therapies that might lead to better outcomes.

In the next section, evaluations of in-prison drug treatment and community-based prison after-care programs are reviewed. An effort is made to determine if study designs employed in the evaluations of these programs make it possible to draw firm conclusions about their effectiveness in treating drug-using inmates and parolees. This is followed by a section on system-based treatment programs in the community. Since most drug users in system-based programs in the community are on probation, the section on drug treatment in the community begins with some background on how drug users are supervised on probation. 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-

Suggested Citation:"Appendix E: Linking Treatment to Punishment: An Evaluation of Drug Treatment in the Criminal Justice System." National Research Council. 2001. Informing America's Policy on Illegal Drugs: What We Don't Know Keeps Hurting Us. Washington, DC: The National Academies Press. doi: 10.17226/10021.
×

tioners and then link their monitoring and punishment to treatment. Hence, after some background about probation, the evaluation research on these programs is reviewed to determine if they are effective in helping their participants to achieve abstinence.

TREATING DRUG USERS IN PRISON AND AFTER-CARE PROGRAMS

In the past 20 years, prison populations have grown tremendously. The largest increase in the inmate population has occurred due to the rise in the number of persons incarcerated for drug possession and other nonviolent crimes related to drug use. For example, in 1980 there were 23,900 prisoners who had been incarcerated for drug use and drug sales. By 1998, that number had risen tenfold to 236,800 prisoners incarcerated for drug law violations (Blumstein and Beck, 1999; Beck, 2000). Presumably, many of these drug law violators could benefit from treatment while in prison.

Prison-Based Programs

A number of studies of prison-based programs seem to demonstrate positive postrelease outcomes when inmates who have gone through prison treatment programs are compared with those who have not (Wexler et al., 1992, 1996; Inciardi, 1996; Landry, 1997; Mullen, 1996; Wexler, 1996; Field, 1984). In particular, evaluations of one of the better-known 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. These volunteers were either randomly assigned to the treatment group (who actually enrolled in the therapeutic community) or to the control group who remained on the waiting list and never received treatment. The no-treatment control group included not only those randomly assigned to the waiting list, but also those who volunteered for treatment and were not admitted because they did not have enough time left to serve to complete the 12 months recommended for prison treatment.

Because study subjects in both the treatment and no-treatment control groups volunteered for treatment, any findings from the study can be generalized only to inmates willing to volunteer for prison treatment pro-

Suggested Citation:"Appendix E: Linking Treatment to Punishment: An Evaluation of Drug Treatment in the Criminal Justice System." National Research Council. 2001. Informing America's Policy on Illegal Drugs: What We Don't Know Keeps Hurting Us. Washington, DC: The National Academies Press. doi: 10.17226/10021.
×

grams (Wexler et al., 1999). The subjects in this study cannot be said to represent those inmates who do not volunteer for in-prison programs.

Both the treatment group and the no-treatment control group were followed after their release from prison. Outcomes were measured while they were on parole for a period of about 3 years after their release from prison.

When comparisons were made between the male treatment participants and males in the no-treatment control group, subjects in the treatment group were significantly less likely to be rearrested while on parole than the no-treatment controls (Wexler et al., 1992, 1996). However, the findings were mixed as the subjects in the no-treatment control group actually delayed time until arrest longer than the treatment participants (15 months versus 13.1 months), although the differences were not significant. Moreover, the no-treatment control group was more likely to experience a positive parole discharge without technical violations, arrests, or revocation than the treatment group. Again, differences were not significant. The fact that the no-treatment control group fared as well as the treatment group on some measures of success indicates that this in-prison program did not change participants in ways so that they were any more likely to desist from criminal behavior and drug use upon release than a control group who had not received treatment.

Additional problems with this study have to do with the outcome measures selected. Ideally, outcome measures should gauge the impact of in-prison drug treatment on reductions in drug use after release. 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.) and nondrug crimes (robbery, assault, etc.). To measure the impact of prison drug treatment on postrelease rearrests and parole violations for drug crimes requires that drug crimes be singled out.

Separating drug crimes from nondrug crimes also makes it possible to gauge how much harm paroled prisoners do upon their return to the community. If prisoners are reincarcerated for predatory nondrug crimes like robbery, then it suggests that they continue to pose a threat to the community. If they are rearrested or have their parole revoked for technical violations, like failing a urine test or refusing to attend a drug treatment program, then it is not clear that they necessarily endanger the community. Indeed some have raised questions about the fairness of reincarcerating drug users for such technical violations largely because

Suggested Citation:"Appendix E: Linking Treatment to Punishment: An Evaluation of Drug Treatment in the Criminal Justice System." National Research Council. 2001. Informing America's Policy on Illegal Drugs: What We Don't Know Keeps Hurting Us. Washington, DC: The National Academies Press. doi: 10.17226/10021.
×

these violations do not indicate that such users pose a threat to the community (Petersilia and Turner, 1985; Clear and Terry, 2000).

Also problematic from the standpoint of measurement is the use of rearrests and parole discharge as outcome indicators. Because so few episodes of drug use end in an arrest or parole revocation, it is doubtful that counts of study subjects rearrested or deemed parole violators accurately represent all incidents of relapse to drug use in the 3-year post-prison period. (The outcome measures and elements of the study design used in the Wexler et al., 1992 evaluation of Stay’n Out are summarized in Table E.1.)

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. And, as expected, those who stayed 9–12 months and com-

TABLE E.1 Evaluations of Prison Treatment Programs

 

Random Assignment to Prison Treatment

Random Assignment to Aftercare

Outcome Measures

Drug Outcome Measures

Unsupervised Follow-Ups

Stay’n Out Wexler et al., 1996

Yes

Not apply

—Rearrest

—Months till rearrest

—Positive parole discharge

No

No

Key-Crest Inciardi, 1996 Martin et al., 1999

No

No

—Rearrests (excludes parole violations)

—Self-reports and urine tests are voluntary

No

Amity Wexler et al., 1999

Yes

No

—Reincarceration

—Days till incarceration

No

No

Texas In-Prison TC Knight et al., 1999

No

No

—Reincarceration

Urine test for parole supervision

No

Suggested Citation:"Appendix E: Linking Treatment to Punishment: An Evaluation of Drug Treatment in the Criminal Justice System." National Research Council. 2001. Informing America's Policy on Illegal Drugs: What We Don't Know Keeps Hurting Us. Washington, DC: The National Academies Press. doi: 10.17226/10021.
×

pleted treatment were more likely to experience positive outcomes upon release. In particular, they delayed the time until arrest longer than those who had stayed less than 9 months (Wexler et al., 1992). However, ever-longer stays in treatment did not always mean more positive outcomes. While those retained in the prison program for 9–12 months delayed rearrest for 18 months, those who stayed even longer—14 months—actually delayed arrest for only 12 months. Hence, those retained in treatment 9–11 months actually fared better than those retained longer at 14 months. Similarly, those who stayed in treatment 9–11.9 months fared better in terms of positive parole outcomes than those who stayed in treatment more than 12 months. Fully 77 percent of those retained for 9–11.9 months were positively discharged from parole, compared with only 57 percent of those who were retained for more than 12 months (Wexler et al., 1992).

These findings raise questions regarding the time-tested link between retention and positive outcomes, as longer stays do not always translate into less posttreatment criminal behavior. In fact, these inconsistent findings are important enough that replication may be necessary to see if these surprising results show up in evaluations of other system-based treatment programs.

Influence of Community-Based After Care

The findings from the evaluation of Stay’n Out have enormous significance because they are based on comparisons between subjects randomly assigned to treatment or a no-treatment control group. 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). Indeed, it is possible that after-care programs may have more influence on inmate improvements than prison treatment alone. If positive posttreatment outcomes are primarily due to treatment in the community-based after-care unit, it raises the possibility that the very expensive prison-based component is not really necessary.

There may be some support for the notion that the community-based after-care unit is more important than the prison-based component of treatment. In a study of the Key-Crest program that combines a prison therapeutic community and a community-based therapeutic community for after care, Inciardi (1996) was able to determine the importance of prison treatment relative to the after-care program.

Suggested Citation:"Appendix E: Linking Treatment to Punishment: An Evaluation of Drug Treatment in the Criminal Justice System." National Research Council. 2001. Informing America's Policy on Illegal Drugs: What We Don't Know Keeps Hurting Us. Washington, DC: The National Academies Press. doi: 10.17226/10021.
×

As might be expected, the data showed that clients who graduated from both the prison-based Key therapeutic community and the community-based Crest therapeutic community had the most positive outcomes in terms of drug-free and arrest-free status in a 6-month follow-up (Inciardi, 1996; Martin et al., 1999).

The second most successful group included those with no prison treatment who underwent work release in the Crest therapeutic community after-care unit only. They were much more likely to be drug free and arrest free than those inmates who participated in the prison treatment program but underwent work release in the community in a unit without a therapeutic community. (The comparison group was the least likely to be arrest free and drug free of the four groups.)

These rankings held in the preliminary 6 month follow-up. In a second follow-up after 18 months, the drug-free and arrest-free scores for all four groups were much lower; however, the rankings remained the same (Landry, 1997; Martin et al., 1999).

The fact that those with community-based after care only outper-formed those with prison treatment only raises questions about how much influence prison-based therapeutic communities have on positive outcomes. On the basis of these findings, one could argue that the community-based after-care program was more instrumental in reducing relapse and recidivism than the prison-based program.

Indeed, after examining the follow-up data, the Key-Crest researchers concluded that participation in a prison treatment program alone was not effective in bringing about drug-free or arrest-free status after release. In their view, successful outcomes depended on participation in the community-based after-care program (Martin et al., 1999).

This finding that prison treatment alone was considerably less important than community-based after-care was borne out by research conducted on another prison treatment program called Amity (Wexler et al., 1999). Much like Key-Crest, the Amity program combined a prison-based therapeutic community with a community-based after-care program. Hence it was possible for Amity participants to begin their recovery in the prison-based therapeutic community and continue it in a community-based therapeutic community upon release.

In the Amity program, volunteers for prison treatment were randomly assigned from a waiting list to either treatment or a no-treatment control group (Wexler et al., 1999). 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).

Suggested Citation:"Appendix E: Linking Treatment to Punishment: An Evaluation of Drug Treatment in the Criminal Justice System." National Research Council. 2001. Informing America's Policy on Illegal Drugs: What We Don't Know Keeps Hurting Us. Washington, DC: The National Academies Press. doi: 10.17226/10021.
×

The Amity treatment group and no-treatment controls were both followed for 12 months and then 24 months. In both these follow-ups, those who completed both the prison therapeutic community and the after-care component were significantly less likely to be reincarcerated in the 12-month and 24-month follow-ups than the no-treatment controls and those who had not completed both programs. This is consistent with findings from Key-Crest that also show that those who complete both in-prison and after-prison treatment phases do significantly better than all other study subjects (Martin et al., 1999).

However, Wexler et al. (1999) question whether the successes of those who complete both phases of treatment in Amity are due solely to program effects. 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. This means that while self-selection bias is controlled in phase one of the program, it is not controlled in phase two (Wexler et al., 1999). The failure to randomly assign study subjects at phase two means that a self-selection bias is introduced for those participating in the after-care program.

It is possible, then, that prison treatment graduates who self-select to volunteer for after-care and then complete it may be much more motivated to make changes in their lives than those who do not complete both phases of treatment. The possibility exists that such clients might have succeeded due to their own motivation rather than due to the combined effects of in-prison and after-care treatment (Wexler et al., 1999).

All in all, both the Amity and Key-Crest studies seem to suggest that community based after-care programs may be more important than inprison treatment in helping clients to effect positive changes. This may be so because the after-care programs can help clients while they are in the community and at greatest risk of resuming drug use and criminal behavior. However, the influence of the after-care programs has not yet been demonstrated, as those eligible for after-care were not randomly assigned to treatment and no-treatment control groups in phase two of therapy (see Table E.1).

The effectiveness of the Amity program is also difficult to interpret because global outcome measures are used that include reincarceration for all crimes—both drug crimes and nondrug crimes alike (see Table E.1). In a study such as this in which the effectiveness of drug treatment is being examined, separate measures of reincarceration for drug crimes would have provided more appropriate indicators of drug relapse.

Moreover, there is reason to question the use of reincarceration as an

Suggested Citation:"Appendix E: Linking Treatment to Punishment: An Evaluation of Drug Treatment in the Criminal Justice System." National Research Council. 2001. Informing America's Policy on Illegal Drugs: What We Don't Know Keeps Hurting Us. Washington, DC: The National Academies Press. doi: 10.17226/10021.
×

outcome measure, since so few incidents of drug relapse end in reincarceration. In fact, on the face of it, self-reports of drug use or urine tests might seem to provide more accurate estimates of drug relapse than reincarceration.

Self-Reports and Urine Tests as Outcome Measures

At least one study cited in Table E.1 makes use of self-reports of drug relapse. In follow-ups of the Key-Crest program, while study subjects were on parole, they were asked to report on their drug relapses (Martin et al., 1999). However, such self-reports may not provide accurate estimates of drug relapses. After all, while study subjects are on parole, they may be inclined to underreport, since reporting a relapse while on parole could mean additional punishment.

Mindful of the potential for underreporting, Martin et al. (1999) confirmed parolee self-reports with a urine test. However, urine tests were administered only to study subjects who volunteered for follow-up interviews. Urine tests were not administered to those who did not volunteer, which means that the resumption of drug use was not accurately measured for all study subjects.

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). Indeed, the researchers acknowledged this problem and argued that the treatment group seemed to relapse more than the comparison group only because they were subject to more urine testing (Knight et al., 1999).

It is conceivable that urine tests in both these studies could have yielded more accurate estimates of relapse were it not for problems in the way they were administered. Indeed, urine testing of parolees has the potential to provide accurate estimates of relapse. However, even urine testing may have its limits if long-term follow-ups are conducted after parole.

Identifying Appropriate Follow-Up Periods

All the studies cited in this review follow study subjects only while they are being supervised on parole, in work release, or in an after-care therapeutic community. However, none of these studies extends follow-ups to the all-important period after criminal justice supervision has ended. This is unfortunate because the period in which study subjects are

Suggested Citation:"Appendix E: Linking Treatment to Punishment: An Evaluation of Drug Treatment in the Criminal Justice System." National Research Council. 2001. Informing America's Policy on Illegal Drugs: What We Don't Know Keeps Hurting Us. Washington, DC: The National Academies Press. doi: 10.17226/10021.
×

on parole is best seen as a part of treatment rather than as a posttreatment follow-up period. In other words, actual or threatened punishment are just as much a part of a program that links treatment to punishment as traditional therapies like therapeutic communities or counseling that are meant to change the client. Hence a client’s participation in the program ends only when parole supervision and the risk of punishment ends.

It is important to conduct a follow-up when parole and all other criminal justice treatment interventions have ceased for several other reasons. First, if programs that link treatment to punishment are effective, they have to work in the long term, when drug users are no longer subject to any intervention—either traditional therapy or punishment. Limiting follow-up periods to parole means that program effects are being monitored in the short term while the client is still partially in treatment.

Second, looking at client outcomes after parole also makes comparisons between programs that link treatment to punishment and voluntary programs much simpler. After all, follow-up studies in voluntary programs are typically conducted after the client has left the program and is no longer subject to any therapeutic interventions. Because clients in prison after-care programs are followed only while they are on parole, follow-up comparisons between parolees and voluntary clients after treatment are comparisons between nonequivalent groups. Indeed, such comparisons risk inflating the successes of those being followed on parole, as parolees are still in treatment as long as they are subject to criminal justice supervision. Hence, any claims that parolees in prison after-care programs fare as well or better than voluntary clients will have to await studies based on matching follow-up periods.

Finally, knowing whether prison after-care clients reduce their drug use after leaving parole makes it possible to see if these programs are cost-effective in the long term because of their capacity to change behavior even when clients are no longer subject to parole supervision.

Ideally, urine tests would be conducted after study subjects were released from parole in order to determine how many treatment and control subjects were able to sustain abstinence in long-term follow-ups. However, such tests would probably have to be voluntary in post-parole follow-ups, as clients would no longer be subject to criminal justice supervision. 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 post-parole follow-up, as each of these studies confine their follow-ups to the period when study subjects are on parole (see Table E.1).

Suggested Citation:"Appendix E: Linking Treatment to Punishment: An Evaluation of Drug Treatment in the Criminal Justice System." National Research Council. 2001. Informing America's Policy on Illegal Drugs: What We Don't Know Keeps Hurting Us. Washington, DC: The National Academies Press. doi: 10.17226/10021.
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Identifying Services That Promote Recovery

In part, the above findings speak to problems in trying to identify which phase in a multiphase treatment process actually works. A related problem has to do with which recovery services offered by a treatment program have the greatest effect. 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). Hence, many of the clients may be working by the time they leave the after-care program. As a variety of services are offered, it is unclear whether the positive outcomes of after-care program completers are due to counseling and resocialization by the therapeutic community or more prosaic services, like job counseling and securing actual employment. If job counseling and actual employment explain positive outcomes, then the therapeutic community component may not be central for client recovery.

It is important to determine exactly which services promote client recovery, because some services may meet with less client resistance than others. In general, the rigorous treatment regimen of therapeutic communities is not very popular in the community, as indicated by the high dropout rates associated with this form of therapy (Institute of Medicine, 1990; Hubbard et al., 1989). Prison-based therapeutic communities may also not be very popular among inmates. This is because inmate subcultures tend to emphasize macho posturing, like being tough and streetwise (Inciardi, 1996). Hence, by prison subcultural standards, the constant confession of personal problems and emotional outpourings, required in therapeutic communities, may seem effeminate. Moreover, low-income and minority clients may resist therapies that require them to reveal intimate details about their lives to a therapist or a group of near strangers (Currie, 1993). This is important, because prison after-care programs draw heavily from low-income and minority populations. If very few inmates are willing to embrace these services, these programs can have only a limited impact on reducing posttreatment crime rates and drug use. By contrast, if much of the success of these programs is due to job training and referral and other services not likely to meet with client resistance, then such services might be deserving of greater emphasis.

Failure to Control for a Stake in Conformity

Both the treatment and criminology literatures consistently show that a stake in conformity speeds recovery from drug use and aging out of

Suggested Citation:"Appendix E: Linking Treatment to Punishment: An Evaluation of Drug Treatment in the Criminal Justice System." National Research Council. 2001. Informing America's Policy on Illegal Drugs: What We Don't Know Keeps Hurting Us. Washington, DC: The National Academies Press. doi: 10.17226/10021.
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crime (Peters et al., 1999; Sampson and Laub, 1993; Steffensmeier and Allan, 1995). Yet the studies reviewed in this section typically fail to control for the effects of employment and marriage. This omission is especially troubling for the posttreatment period, in that it makes it impossible to know if client improvements in the post-treatment period are due to treatment or a client’s newly acquired stake in conformity. However, because these studies did not conduct follow-ups that begin after criminal justice supervision has ended, little can be learned about whether prison treatment and after-care help these stigmatized populations to become reintegrated into society independent of their securing a stake in conformity.

SYSTEM-BASED TREATMENT IN THE COMMUNITY

Given the mixed findings, the failure to consistently control for self-selection bias, the problematic outcome measures, and the absence of follow-ups after parole, it is difficult to draw any firm conclusions on whether prison treatment and after-care programs are effective in the long term. Yet even in the absence of firm conclusions, some have soured on treating drug offenders in prison, simply because prison is so expensive (Covington, 2000). For example, even though the costs of a prison-based therapeutic community are modest—$10 to $18 per day—prison itself costs an average of $20,261 per person per year (Mullen, 1996; Camp and Camp, 1999). This makes prison-based treatment the most expensive drug rehabilitation program of all.

The high cost of prison itself is less of a factor with regard to some drug-using offenders who would otherwise be in prison for serious violent crimes. For them, the only relevant expense is the modest added cost of in-prison treatment. However, the more pressing question is whether the large population of drug users imprisoned for drug possession or other nonviolent offenses might be successfully treated in a community-based program. Since they do not represent a threat to the community, requiring them to participate in a treatment program outside prison walls could well lead to reductions in drug use and drug-related crime without the expense associated with incarceration.

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-

Suggested Citation:"Appendix E: Linking Treatment to Punishment: An Evaluation of Drug Treatment in the Criminal Justice System." National Research Council. 2001. Informing America's Policy on Illegal Drugs: What We Don't Know Keeps Hurting Us. Washington, DC: The National Academies Press. doi: 10.17226/10021.
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vie ted and receive probation as punishment for their crimes. Furthermore, probation is much less expensive than prison, as supervised probation averages a modest $3,000 per person per year (Donziger, 1996).

In theory, at least, probation should be taken seriously as an alternative to prison, since probation officers should be able to mandate treatment or require abstinence of their charges as a condition of probation. For example, they could require probationers to submit to random urine tests to confirm that they are abstaining from drugs. They could also mandate that probationers enter and remain in treatment programs and monitor their progress in the program. If probationers fail to remain abstinent on their own or in treatment, probation officers could make use of graduated punishments, like requiring fines or community service or requiring them to spend two or three days in jail. As the ultimate sanction, they might even send them to jail or prison for much longer.

In practice, however, probation officers cannot conduct routine urine checks or monitor progress in treatment because their caseloads are so large. On average, a single probation officer has an average caseload of 100–300 offenders (Clear et al., 1997; Petersillia and Turner, 1985; Petersilia and Turner 1992). With such large caseloads, many probation officers are reduced to trying to supervise those they deem to be most dangerous and have little to no contact with other probationers defined as less serious.

Because traditional probation programs are likely to remain overex-tended for the foreseeable future, some have argued for an enhanced form of probation called intensive supervision probation (ISP). While they vary enormously, the one thing these programs should share is a much smaller caseload than traditional probation programs, although in many places there is little difference in caseloads between traditional probation and ISP programs. Smaller caseloads, averaging 30–50 probationers, are important because they allow for much more monitoring and surveillance of probationers. Indeed, in three California counties with such small ISP caseloads, ISP officers met with their charges face-to-face 1–5 times per week and conducted urine tests on a weekly or biweekly basis (Petersilia and Turner, 1985). Clearly, these officers were in a far better position to monitor their offenders’ abstinence than traditional probation officers in the same California counties. Due to their smaller caseloads and enhanced surveillance, these ISP programs were more expensive ($6,957–$7,654) than traditional probation ($4,024–$6,122).

Since ISP programs with small caseloads should be capable of engaging in much more surveillance than traditional probation programs, probationers in ISPs should have lower recidivism rates. However, it is often difficult to make comparisons between ISPs and traditional probation because their client populations are so different (Clear, 1999; Clear et al.,

Suggested Citation:"Appendix E: Linking Treatment to Punishment: An Evaluation of Drug Treatment in the Criminal Justice System." National Research Council. 2001. Informing America's Policy on Illegal Drugs: What We Don't Know Keeps Hurting Us. Washington, DC: The National Academies Press. doi: 10.17226/10021.
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1997; Petersillia and Turner, 1985). Traditional probation programs can include the full range of offenders, from drug users only to drug-using petty criminals to drug-using, serious, repeat offenders. By contrast, because of its enhanced supervision, ISPs should, in theory, include only high-risk offenders, although this is not always the case.

In one California study, probationers were randomly assigned to ISPs or traditional probation, making comparisons easier. Fewer than 10 percent of the offenders in ISPs were rearrested for violent crimes, whereas 15 percent of adult felons on traditional probation throughout the entire state were rearrested for violent crimes (of course, recidivism rates for violent crimes tend to be low) (Petersilia and Turner, 1985; Morgan, 1993).

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.

Since testing positive for drugs was one of the technical violations, these findings may suggest that traditional probation programs, with their lower levels of supervision, were actually better than ISPs at preventing drug relapse. However, a more accurate interpretation of these findings is that ISPs were involved in significantly more monitoring and supervision (e.g., urine testing) of their probationers than traditional probation programs, so they were much better able to discover infractions (Petersilia and Turner, 1985). Since the more intensive monitoring of probationer behavior makes ISPs much more likely to find out about continued drug use, it is impossible to determine whether enhanced supervision leads to more or fewer drug relapses than traditional probation.

Fairness Issues

Some question the fairness of punishing probationers for technical violations (Clear and Terry, 2000; Walker, 1994; Petersilia and Turner, 1985). After all, infractions like missing a meeting with a probation officer, testing positive for drugs, or failing to attend drug treatment can be met with real punishments in the form of incarceration or reincarceration (Covington, 1997; Clear and Terry, 2000; Walker, 1994; Petersilia and Turner, 1985). While such infractions certainly violate ISP program rules, they may not indicate that the violator is a danger to the community; hence incarceration or reincarceration may not be justified. Yet as it stands, a burglar can be sentenced to probation and left in the community for his

Suggested Citation:"Appendix E: Linking Treatment to Punishment: An Evaluation of Drug Treatment in the Criminal Justice System." National Research Council. 2001. Informing America's Policy on Illegal Drugs: What We Don't Know Keeps Hurting Us. Washington, DC: The National Academies Press. doi: 10.17226/10021.
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burglary yet find himself being sent to jail or prison on a technical violation for a lesser crime like drug use (Clear and Terry, 2000; Petersilia and Turner, 1985; Petersilia, 1997; Walker, 1994). This is much more likely to happen in an ISP with its enhanced supervision.

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) and some outpatient drug-free programs has not yet been demonstrated (Landry, 1997; Institute of Medicine, 1990). Since the effectiveness of many system-based treatment programs has not yet been demonstrated, the possibility exists that many of the available programs may not be able to rehabilitate probationers. If so, referral to these programs, in essence, sets them up to fail, and failure can result in punishment.

These concerns about the fairness of probation have become more important in the past 20 years as the probation net has widened to include more and more petty offenders and casual drug users who would have been released in previous years (Walker, 1994; Covington, 1997; Mauer and Ruling, 1995). In fact, the population on probation grew by 41.3 percent between 1990 and 1999, and these 1990s increases came after significant growth in the probation population in the 1980s (Bureau of Justice Statistics, 2000; Donziger, 1996). Expanding probation to include more minor offenders means more use of criminal justice resources on nonviolent criminals with little impact on serious crime. Yet as it stands, criminal justice supervision may be expanding to include more and more such people whose offenses do no harm to the community.

Net Widening and the Evaluation of No-Treatment Control Groups

Typically the research on probation does not make use of control groups but rather compares populations subjected to more or less supervision (ISPs versus traditional probation) or samples of probationers with different characteristics (Morgan, 1993; Petersilia and Turner, 1985). Hence it is impossible to determine if those on probation are more likely to age out of using drugs than those not subjected to any criminal justice supervision at all. The need for such comparisons—between those on probation and a no-supervision control group—becomes more relevant as the net is widened to include drug users who would not have been arrested or put on probation in previous years. The possibility exists that any seeming improvements in the success rates of drug-using probationers over the

Suggested Citation:"Appendix E: Linking Treatment to Punishment: An Evaluation of Drug Treatment in the Criminal Justice System." National Research Council. 2001. Informing America's Policy on Illegal Drugs: What We Don't Know Keeps Hurting Us. Washington, DC: The National Academies Press. doi: 10.17226/10021.
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years could be wrongly attributed to probation itself rather than to a net widened to include those with less severe drug and crime problems.

As it turns out, most drug users discontinue drug use on their own after a few years of experimentation, and the vast majority of them do so without being arrested or placed on probation (Bachman et al., 1997; Johnston et al., 1997; Covington, 1997). Since those untouched by the criminal justice system may be little different from those on probation, it may be useful to treat those at large in the community as a comparison group. Comparisons of noncontinuation rates between those who avoid arrest and probation and those on probation may be one way to determine if supervision and coercion really have much impact on desistance from drug use (Walker, 1994).

Another way to determine if supervision and coercion have much impact on reductions in drug use would be to randomly assign a sample of arrestees to either probation or release. The no-supervison control group would be those released, as they would not be subject to monitoring or the threat of punishment that comes with supervision on probation. Comparisons could then be made between those on probation and the no-supervision control group, not subject to either monitoring or coercion, in a follow-up period after probation. If monitoring and coercion alone are sufficient to induce drug users to abstain in the long term, then those subjected to probation supervision should be more likely to abstain from drugs after probation than their age-mates in the control group who could be expected to naturally mature out of drugs at that age without monitoring or the threat of punishment. Of course, such a study might be difficult to implement because sample attrition in the follow-up period would probably be high, especially for the no-supervision controls.

The fact that an authentic control group for probation is one not subject to control, surveillance, or punishment underscores the fact that probation means control, surveillance, and punishment of those who get caught in the criminal justice net. And, while probation programs sometimes link these controls to treatment, they do not do so in any reliable fashion. In fact, if probation supervision expands much more quickly than treatment slots, the real possibility exists that system-based programs for drug users will increasingly come to mean punishment without treatment. 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. Evaluations of these two offender management programs are reviewed in the next two sections.

Suggested Citation:"Appendix E: Linking Treatment to Punishment: An Evaluation of Drug Treatment in the Criminal Justice System." National Research Council. 2001. Informing America's Policy on Illegal Drugs: What We Don't Know Keeps Hurting Us. Washington, DC: The National Academies Press. doi: 10.17226/10021.
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TREATMENT ALTERNATIVES TO STREET CRIME

Established in 1972, Treatment Alternatives to Street Crime (TASC) is explicitly designed to link the coercive tools of the criminal justice system to treatment programs in the community in several ways. 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. If the referred clients fail in treatment, they are returned to the criminal justice system for further sanctioning. If the referred clients successfully complete treatment, then their court cases can be dropped or dismissed. It is hoped that clients who successfully complete treatment will abstain from drugs or reduce their drug intake and thereby their drug-related criminal behavior. Hence, successful treatment outcomes benefit the criminal justice system as they make users, who graduate from treatment, less of a burden.

The effectiveness of TASC was examined using a subsample of clients enrolled in 41 publicly funded treatment programs in the Treatment Outcomes Prospective Study (TOPS), from 1979 to 1981. Hubbard et al. (1988) compared three groups of the TOPS study clients in residential treatment and outpatient drug-free programs: (1) clients referred to treatment by TASC, (2) clients not in TASC who were referred by the criminal justice system (clients on probation, bail, etc.), and (3) self-referrals or clients who had entered residential treatment or outpatient drug-free programs without criminal justice pressures.

As might be expected, the TASC and non-TASC criminal justice referrals stayed in treatment longer than the self-referrals. On average, TASC clients stayed 45 days longer than self-referred clients in outpatient drug-free programs, and the non-TASC criminal justice referrals stayed 17 days longer than the self-referrals (Hubbard et al., 1988, 1989). However, longer treatment retention did not always translate into more successful posttreatment outcomes.

TASC and other criminal justice system-referred clients did report lower levels of drug use following treatment than the self-referred clients. Still, it is difficult to interpret this finding, as the TASC clients, the non-TASC clients referred by the criminal justice system, and the self-referred clients were not randomly assigned to these three groups (see Table E.2 for study design). In addition, no effort was made to match the three groups on background characteristics. Since the three groups were not matched comparison groups, they differed in terms of important pretreatment characteristics. For example, the TASC and non-TASC clients re-

Suggested Citation:"Appendix E: Linking Treatment to Punishment: An Evaluation of Drug Treatment in the Criminal Justice System." National Research Council. 2001. Informing America's Policy on Illegal Drugs: What We Don't Know Keeps Hurting Us. Washington, DC: The National Academies Press. doi: 10.17226/10021.
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TABLE E.2 Evaluations of TASC Programs

 

Random Assignment

Was there a no-treatment control group?

Outcome Measures

Drug Outcome Measures

Hubbard et al. 1988

Hubbard et al. 1989

No

No

Self-reports of predatory crime

Self-reports of drug use in 1-yr. follow-up

Anglin et al.

Yes; in 2 of 5 sites, subjects were assigned to TASC or alternative treatment program

No

Self-reports of crime and arrest records in 6-month follow-up

Self-reports of drug use in 6-month follow-up

ferred by the criminal justice system actually had lower drug use levels in the year before treatment than the self-referred clients. Moreover, the TASC and criminal justice system-referred clients were more likely to be users of alcohol and “softer” drugs like marijuana than the self-referrals.

In fact, the two groups of criminal justice system-referred clients differed from the self-referred clients in a number of ways that make differences in posttreatment outcomes difficult to interpret. Both groups of referred clients were younger, included more males, and had more extensive criminal records than the self-referred clients. The referred clients also received fewer medical, psychological, and family services while in outpatient drug-free programs than the self-referred clients, perhaps because their drug problems were less severe. This makes it difficult to argue that their greater success in reducing their drug intake following treatment—relative to the self-referred clients—was due to program services. The self-referred clients received more services and yet were more likely to continue their drug use after treatment.

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. Indeed, these findings suggest that some caution should be exercised in using retention as a proxy measure of successful posttreatment outcomes.

Suggested Citation:"Appendix E: Linking Treatment to Punishment: An Evaluation of Drug Treatment in the Criminal Justice System." National Research Council. 2001. Informing America's Policy on Illegal Drugs: What We Don't Know Keeps Hurting Us. Washington, DC: The National Academies Press. doi: 10.17226/10021.
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Finally, the fact that the TASC and non-TASC criminal justice system referrals had less severe drug problems and more use of alcohol and marijuana than clients who entered treatment without legal pressures raises questions about the way in which TASC and other criminal justice agencies screen drug clients for referral to treatment.

A more recent study by Anglin et al. (1999) also examines the effectiveness of TASC programs, while avoiding many of the problems of the earlier research. Anglin et al. (1999) evaluated the effectiveness of TASC in five programs across the country that at least followed the TASC protocol. Of these five programs, three sites compared TASC clients with a comparison group that had not been randomly assigned. Evaluations in these three sites are difficult to interpret due to the potential for self-selection bias. 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. (The alternative program may not have monitored users in treatment as effectively as those in TASC-monitored programs.) Hence Anglin et al. (1999) were comparing clients in two different types of treatment rather than examining TASC clients side by side with a no-treatment control group (see Table E.2).

At one of the two sites located in Portland, TASC clients did no better than those in the non-TASC alternative treatment group. However, TASC clients at the second site in Canton fared better than the clients in the non-TASC treatment alternative on one measure of drug use. TASC clients who reported heavy drug use in the six months prior to intake reduced their drug use much more between intake and follow-up than heavy users in the non-TASC alternative treatment group. On the basis of this finding, Anglin et al. (1999) concluded that TASC could bring about significant reductions in drug use. However, it is important to remember that TASC clients were being compared with clients in the non-TASC alternative treatment group. The TASC clients were not compared with a no-treatment control group, so this study says little about whether TASC is more effective than no treatment at all.

These findings are difficult to interpret for another reason. Measures of drug use for both the intake and follow-up interviews are based on self-reported levels of drug use. This makes it difficult to figure out which group was actually more successful. It is conceivable that the TASC clients actually reduced their drug use more between intake and follow-up than the non-TASC alternative treatment group, as the authors concluded. It is also possible that the TASC clients were simply more likely to report large reductions in drug use than those in the non-TASC alternative group. Certainly the TASC clients would have been well aware of the

Suggested Citation:"Appendix E: Linking Treatment to Punishment: An Evaluation of Drug Treatment in the Criminal Justice System." National Research Council. 2001. Informing America's Policy on Illegal Drugs: What We Don't Know Keeps Hurting Us. Washington, DC: The National Academies Press. doi: 10.17226/10021.
×

high risk of being punished for repeated drug relapses, in light of their ongoing involvement in the TASC program. This could have easily made them more reluctant to report. In other words, when respondents are asked to report on their drug use in a setting in which they are being heavily monitored and reports of drug use can lead to punishment, the potential for underreporting is quite substantial (Harrison, 1997). This makes it difficult to know what to make of the significant declines in drug use reported by the TASC subjects.

Despite the questionable nature of these two studies on TASC, this research did demonstrate that the program could induce drug users to stay in treatment longer than voluntary clients. This led to renewed interest in the use of punishment or threats of punishment to induce drug users to remain in treatment. 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). Nearly 80 percent of drug arrests are for possession, and half of current possession arrests involve those caught with small amounts of marijuana. By the late 1980s and early 1990s, the courts became overwhelmed by this huge influx of new drug cases, and some judges began to look for a solution in the form of drug courts. The first drug court was established in Florida in 1989 and, since that time, there has been a rapid expansion in the number of jurisdictions with these courts (U.S. General Accounting Office, 1997; Belenko, 1998). Like TASC, drug courts aim to combine treatment and punishment in an effort to speed client recovery.

Judges were motivated to urge the development of drug courts since they were seeing the same people over and over as they were returned to court for their repeated relapses for drug use or for their rearrests for recurring criminal acts potentially caused by drug use. It was also clear that punishment alone had failed to stop these drug relapses or criminal recidivism, and so there was a renewed emphasis on linking the courts to treatment (Belenko, 1998). The hope was that if the courts required drug offenders to enter and remain in treatment, many would be rehabilitated. If their drug use and their drug-related criminal behavior could be stopped or reduced, they would cease to be a burden on the courts. Moreover, if drug courts could mandate treatment that brought about such positive outcomes, then they could also reduce jail and prison overcrowd-

Suggested Citation:"Appendix E: Linking Treatment to Punishment: An Evaluation of Drug Treatment in the Criminal Justice System." National Research Council. 2001. Informing America's Policy on Illegal Drugs: What We Don't Know Keeps Hurting Us. Washington, DC: The National Academies Press. doi: 10.17226/10021.
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ing. To address these problems, drug courts were set up as designated courtrooms that were specifically geared toward linking drug users to treatment and monitoring their therapeutic progress (Belenko, 1998).

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. And like TASC participants, drug court participants could see their cases dropped if they completed treatment.

While there are a number of similarities between drug courts and TASC, drug courts are more judge-centered. Drug court participants are regularly required to appear before a judge in a status hearing, in which judges and other court personnel try to help participants address problems with drugs, work, and family life. Drug courts also determine if participants are regularly attending treatment and take reports from treatment providers regarding client progress. Drug court participants are also regularly required to submit urine tests so the courts can determine if they are remaining drug free. If drug court participants miss court hearings, fail to go to treatment sessions regularly, have an excessive number of positive urine tests, or get rearrested while in the drug court program, a number of sanctions are at the judge’s disposal (U.S. General Accounting Office, 1997; Belenko, 1998).

Judges can make use of “motivational jail time,” in which a participant serves a short stint in jail as punishment for these infractions. The judge may also terminate an errant client from the program and send them back to court. Termination from treatment can have serious implications for the relapsing drug user, as it can mean reinstatement of the original criminal charges. For some users, this could lead to an extended period of incarceration in jail or prison.

Although there have been approximately 20 evaluations of drug court programs (U.S. General Accounting Office, 1997; Belenko, 1998), the programs vary so much in terms of their eligibility requirements, the specified program length, the types of treatment offered, and the degree of coercion they apply, that it is almost impossible to generalize about whether they are effective or to estimate an effect size. Because the data needed to evaluate these programs are often sketchy and incomplete, it is perhaps best to settle on identifying issues that might be addressed in future evaluations rather than attempting to draw any conclusions about their effectiveness based on the data that are currently available:

Measuring Drug Court Effectiveness. Very few studies look at post-program effects. Moreover, many studies simply compare drug court par-

Suggested Citation:"Appendix E: Linking Treatment to Punishment: An Evaluation of Drug Treatment in the Criminal Justice System." National Research Council. 2001. Informing America's Policy on Illegal Drugs: What We Don't Know Keeps Hurting Us. Washington, DC: The National Academies Press. doi: 10.17226/10021.
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ticipants who graduate from the program with drug court participants who drop out. Comparisons between drug court graduates and drug court dropouts introduce self-selection bias, as graduates may fare better than dropouts because of their own commitment to abstaining from drugs rather than program effects. The more appropriate way to measure effectiveness is to compare all drug court participants—graduates and dropouts—to a control group that did not participate in a drug court program (Belenko, 1998; U.S. General Accounting Office, 1997).

Even in the handful of studies that make appropriate comparisons between all drug court participants (dropouts and graduates) and a control group, no mention is typically made of what percentage of those eligible for these programs were willing to participate. Yet if very few persons brought before the courts are willing to volunteer to participate in these programs, they will ultimately do little to relieve overburdened courts. Furthermore, since the willingness to volunteer for a drug court program may vary from court to court, depending on what other options are available with standard adjudication, it may be difficult to generalize any findings on the willingness to volunteer from one court to another.

In addition, very few studies make use of experimental designs in which drug court participants are compared with a no-treatment control group. However, in one study of the Maricopa County drug court, study subjects were randomly assigned to either a drug court or traditional probation and followed over a 3-year period (Turner et al. 1999). In the 3-year follow-up, drug court participants were less likely to be rearrested than those on traditional probation. 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. After all, many of the subjects in this study could have easily managed some episodes of drug use or criminal behavior in the follow-up period without being rearrested or reincarcerated. Hence it is difficult to know what to make of the drug court participants’ lower overall rearrest rates for all crimes.

Not only did the Maricopa County study rely on some of the same questionable outcome measures used in other evaluation studies, but it likewise confined its follow-up period to the 3 years that the subjects were subjected to criminal justice supervision (Turner et al., 1999). Yet follow-ups that occur after criminal justice supervision is over are important because they make it possible to determine if drug court participants are

Suggested Citation:"Appendix E: Linking Treatment to Punishment: An Evaluation of Drug Treatment in the Criminal Justice System." National Research Council. 2001. Informing America's Policy on Illegal Drugs: What We Don't Know Keeps Hurting Us. Washington, DC: The National Academies Press. doi: 10.17226/10021.
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more likely to stay off drugs than those who underwent traditional probation, even when they are not being monitored or subject to the threat of punishment.

Finally, while it is understandable why study subjects in Maricopa were randomly assigned to either a drug court or traditional probation, it should be noted that traditional probation does not qualify as a no-intervention control group. After all, the study subjects on traditional probation were being monitored and punished for any infractions. Hence, this study compares drug court participants, who receive treatment, monitoring, and sanctions, with a traditional probation group that receives the monitoring and sanctions associated with probation. The study does not include a no-treatment/no-supervision control group who experience no criminal justice interventions. This is unfortunate given the fact that the criminal justice net has been widened in recent years to include many minor drug users who look little different from their age-mates who manage to mature out of drugs without treatment or supervision. This study can cast little light on whether any reductions in drug use made by either drug court study subjects or study subjects on traditional probation are due to punishment or treatment or both, or simply the process of maturing out of drug use that occurs at that age.

Cost Savings. It is likely that future evaluations will make an effort to determine if drug courts can achieve cost savings. To achieve cost savings, these programs must significantly reduce the drug use and criminal behavior of program participants. If they succeed, drug court program graduates will be less likely to be sent to jail for extended periods of incarceration, and they will be less likely to be sent to more expensive prisons for longer sentences (Inciardi et al., 1996).

To date, no systematic analysis exists to determine whether drug courts generate cost savings (U.S. General Accounting Office, 1997; Belenko, 1998). However, any attempt to assess cost savings will require some understanding of what types of people end up in drug courts. 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. Given the preliminary nature of much of the drug court data, it is difficult to determine if alternative court dispositions for drug court participants would be more or less expensive.

Suggested Citation:"Appendix E: Linking Treatment to Punishment: An Evaluation of Drug Treatment in the Criminal Justice System." National Research Council. 2001. Informing America's Policy on Illegal Drugs: What We Don't Know Keeps Hurting Us. Washington, DC: The National Academies Press. doi: 10.17226/10021.
×

Treatment Effectiveness. Because all drug courts refer clients to treatment and monitor their progress, they do a better job of linking the criminal justice and drug treatment systems than older forms of community supervision, such as traditional probation or intensive probation supervision programs. However, this can be considered a desirable feature only if they link them to effective forms of treatment.

Many drug courts refer clients to self-help programs like Alcoholics Anonymous, Cocaine Anonymous, and Narcotics Anonymous (U.S. General Accounting Office, 1997). Of these three 12-step programs, only Alcoholics Anonymous (AA) has been subjected to a fair amount of evaluation (Landry, 1997). The research on AA suggests that it could be effective; however, efforts to evaluate it are typically stymied by self-selection biases. In short, it is simply not clear whether those involved in A A improve because of their participation in the program or whether they participate in A A because they are already committed to making improvements. The same potential for self-selection bias also limits the capacity to determine the effectiveness of the less-evaluated 12-step programs like Narcotics Anonymous and Cocaine Anonymous.

Drug courts also refer a large number of clients to outpatient drug-free programs (Belenko, 1998). However, the term “outpatient drug-free” refers to a miscellany of programs that vary in terms of the services they offer and may include individual or group counseling, addiction or AIDS education, acupuncture, and/or training in social skills (U.S. General Accounting Office, 1997; Belenko, 1998). This makes it very difficult to determine if the treatment component of drug courts has any lasting and positive effect on outcomes, since it is often unclear which services are offered by different outpatient drug-free programs.

Not only is it unclear which services ensure positive post-program outcomes, but it is also unclear whether retention in drug courts is a predictor of post-program successes. In part, this is because it has been difficult to define retention rates in drug courts (U.S. General Accounting Office, 1997; Belenko, 1998). Estimates suggest that, on average, 43 percent of drug court participants are retained in treatment (U.S. General Accounting Office, 1997). This figure is quite high for treatment programs—especially outpatient drug-free programs, which generally have high dropout rates (see Belenko, 1998). 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. But with system-based programs that link treatment and punishment, the meaning of retention may change. It is simply not known whether legal sanctions ad-

Suggested Citation:"Appendix E: Linking Treatment to Punishment: An Evaluation of Drug Treatment in the Criminal Justice System." National Research Council. 2001. Informing America's Policy on Illegal Drugs: What We Don't Know Keeps Hurting Us. Washington, DC: The National Academies Press. doi: 10.17226/10021.
×

ministered by the courts will have the effect of “manufacturing” commitment in people who were not previously committed.

Moreover, there is a possibility that some of the therapeutic services offered by drug courts may actually generate client resistance to treatment. In particular, the individual and group counseling offered by a number of outpatient drug-free programs and therapeutic communities may be inappropriate for some clients. Working-class and low-income clients, in particular, have been known to resist this type of therapy because they find it difficult to confide personal matters to a stranger or a group of strangers in counseling sessions (Currie, 1993; Covington, 1997). For these clients, treatment may be wholly ineffective and yet, if they fail to attend sessions, they may be punished with “motivational” jail time or be returned to court to be prosecuted for their original crime. In such cases, requiring clients to participate in these potentially alienating therapies may set some up to fail in treatment and be subjected to further sanctions.

Finally, preliminary research suggests that drug courts may do well with those who already have a stake in conformity. It also suggests that they are not very effective with those who lack such a stake. In other words, they fail with the clients who are most likely to fail in other types of treatment, including the unemployed, the less educated, and those using hard drugs like cocaine (Peters et al., 1999). If this is borne out in future research, it means that drug courts may ultimately be incapable of changing those who are most likely to burden the courts.

CONCLUSION

Clear-cut answers to questions as to whether programs that link treatment to punishment can effect long-term changes in client drug-using and criminal behavior are difficult to come by. Evaluations of these programs have not been very revealing because many of these studies have been hobbled by poor study designs. 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. While client self-reports of drug use and crime have been used to measure outcomes in the follow-up, using self-reports with respondents who have recently been punished for their drug use may result in severe problems with client underreporting. Rearrests, convictions, or reincarcerations are also questionable measures, because so few episodes of drug use or criminal behavior come to the attention of the criminal justice system and get re-

Suggested Citation:"Appendix E: Linking Treatment to Punishment: An Evaluation of Drug Treatment in the Criminal Justice System." National Research Council. 2001. Informing America's Policy on Illegal Drugs: What We Don't Know Keeps Hurting Us. Washington, DC: The National Academies Press. doi: 10.17226/10021.
×

corded in these official statistics. Furthermore, much of the evaluation research on criminal justice programs makes use of inappropriate follow-up periods while clients are still on probation or parole. It is important that clients in system-based programs be followed after criminal justice supervision has ended because such post-supervision follow-ups make it possible to determine if these programs actually induce users to abstain when they are not being monitored. Design flaws in much of this research preclude any definitive answers regarding program effectiveness.

ACKNOWLEDGMENT

The author wishes to thank Richard Bonnie, Robert MacCoun, and two anonymous reviewers for their comments on earlier drafts of this paper. She is especially grateful to Faith Mitchell at the National Research Council for her participation in this project.

REFERENCES

Anglin, M.D., D.Longshore, and S.Turner 1999 Treatment alternatives to street crime. Criminal Justice and Behavior 26(2):68–195.


Bachman, J., K.Wadsworth, P.O’Malley, L.Johnston, and J.Schulenberg 1997 Smoking, Drinking, and Drug Use in Young Adulthood: The Impacts of New Freedoms and Responsibilities. Mahwah, MJ: Lawrence Erlbaum Associates

Beck, A. 2000 Prisoners in 1999. Bureau of Justice Statistics Bulletin.

Belenko, S. 1998 Research on drug courts: A critical review. National Drug Court Institute Review

Biernacki, P. 1986 Pathways from Heroin Addiction: Recovery Without Treatment. Philadelphia: Temple University Press.

Blumstein, A., and A.Beck 1999 Population growth in U.S. prisons, 1980–1996. Pp. 17–61 in M.Tonry and J. Petersilia, eds., Crime and Justice, Vol. 26, Prisons.

Bureau of Justice Statistics 1999 Drug and Crime Facts—Drug Law Violations. Available online at http://www.ojp.usdoj.gov/bjs/dcf/enforce.htm

2000 U.S. Correctional Population Reaches 6.3 Million Men and Women, Represents 3.1 Percent of the Adults U.S. Population. Press Release. Available on-line at http://www.ojp.usdoj.gov/bjs


Camp, G.M., and C.G.Camp 1999 The Corrections Yearbook, 1998. Middletown, CT: Criminal Justice Institute.

Clear, T.R. 1999 Leading from and leading toward. Corrections Management Quarterly 3(1):14–18.

Suggested Citation:"Appendix E: Linking Treatment to Punishment: An Evaluation of Drug Treatment in the Criminal Justice System." National Research Council. 2001. Informing America's Policy on Illegal Drugs: What We Don't Know Keeps Hurting Us. Washington, DC: The National Academies Press. doi: 10.17226/10021.
×

Clear, T., V.Clear, and A.Braga 1997 Correctional alternatives for drug offenders in an era of overcrowding. In L. Gaines and P.Kraska, eds., Drugs, Crime and Justice: Contemporary Perspectives. Prospect Heights, IL: Waveland.

Clear, T., and K.Terry 2000 Correction beyond prison walls. In J.Sheley, ed., Criminology: A Contemporary Handbook, Third edition. Belmont, CA: Wadsworth.

Cook, L., and B.Weinman 1988 Treatment Alternatives to Street Crime. In C.Leukefeld and F.Tims, eds., Compulsory Treatment of Drug Abuse: Research and Clinical Practice. National Institute on Drug Abuse Research Monograph 86. Rockville, MD: National Institute on Drug Abuse.

Covington, J. 1997 The social construction of the minority drug problem. Social Justice 24(4):117–147

2000 Incapacitating Drug Offenders. Unpublished paper prepared for the Committee on Data and Research for Policy on Illegal Drugs.

Currie, E. 1993 Reckoning: Drugs, The Cities and The American Future. New York: Hill and Wang.

Donziger, S. 1996 The Real War on Crime: The Report of the National Criminal Justice Commission. New York: HarperCollins.


Field, G. 1984 The Cornerstone Program: A client outcome study. Federal Probation 48(2):50–55.

Flanagan, T., and M.McLeod 1983 Sourcebook of Criminal Justice Statistics—1982. Bureau of Justice Statistics. Washington, DC: U.S. Department of Justice.

Fletcher, B., and F.Tims 1992 Methodological issues: Drug abuse treatment research in prison and jails. In C. Leukefeld and F.Tims, eds., Drug Abuse Treatment in Prisons and Jails. NIDA Research Monograph 118. Rockville, MD: National Institute on Drug Abuse.


Harrison, L. 1997 The validity of self-reported drug use in survey research: An overview and critique of research methods. In L.Harrison and A.Hughes, eds., The Validity of Self-Reported Drug Use: Improving the Accuracy of Survey Estimates. National Institute on Drug Abuse Research Monograph 167. Rockville, MD: National Institute on Drug Abuse.

Hubbard, R., J.Collins, J.Rachel, and E.Cavanaugh 1988 The criminal justice client in drug abuse treatment. In C.Leukefeld and F.Tims, eds., Compulsory Treatment of Drug Abuse: Research and Clinical Practice. NIDA Research Monograph 86. Rockville, MD: National Institute on Drug Abuse.

Hubbard, R.L., M.E.Marsden, J.V.Rachal, H.J.Harwood, E.R.Cavanagh, and H.M. Ginzberg 1989 Drug Abuse Treatment: A National Study of Effectiveness. Chapel Hill: University of North Carolina Press.


Inciardi, J. 1996 The therapeutic community: An effective model for corrections based drug abuse treatment . In K.Early, ed., Drug Treatment Behind Bars: Prison-Based Strategies for Change. Westport, CT: Praeger.

Suggested Citation:"Appendix E: Linking Treatment to Punishment: An Evaluation of Drug Treatment in the Criminal Justice System." National Research Council. 2001. Informing America's Policy on Illegal Drugs: What We Don't Know Keeps Hurting Us. Washington, DC: The National Academies Press. doi: 10.17226/10021.
×

Inciardi, J., D.McBride, and J.Rivers 1996 Drug Control and the Courts. Thousand Oaks, CA: Sage.

Institute of Medicine 1990 Treating Drug Problems, Vol. 1. D.Gerstein and H.Harwood, eds. Washington, DC: National Academy Press.

Johnston, L., P.O’Malley, and J.Bachman 1997 National Survey Results on Drug Use from The Monitoring the Future Study, 1975– 1995, vols.1, 2. Rockville, MD: National Institute on Drug Abuse.


Knight, K., D.Simpson, and M.Hiller 1999 Three year re-incarceration outcomes for in-prison therapeutic community treatment. Prison Journal 79(3):337–351.


Landry, M. 1997 Overview of Addiction Treatment Effectiveness. Rockville, MD: Substance Abuse and Mental Health Services Administration.


Martin, S., C.Butzin, C.Saum, and J.Inciardi 1999 Three year outcomes of therapeutic community treatment for drug-involved offenders in Delaware: From prison to work release to after-care. Prison Journal 79(3):294–320.

Mauer, M., and T.Huling 1995 Young Black Americans and the Criminal Justice System. Washington, D.C.: The Sentencing Project.

Morgan, K. 1993 Factors influencing probation outcome: A review of the literature. Federal Probation (June):23–29.

Mullen, R. 1996 Therapeutic communities in prison: Dealing with toxic waste. In K.Early, ed., Drug Treatment Behind Bars: Prison Based Strategies for Change. Westport, CT: Praeger.

Mumola, C. 1999 Substance Abuse and Treatment, State and Federal Prisoners, 1997. Special Report. Washington, D.C.: Bureau of Justice Statistics.


O’Brien, C., and A.McLellan 1996 Myths about the treatment of addiction. Lancet 347:237–240.


Peters, R., A.Haas, and M.Murrin 1999 Predictors of retention and arrest in drug courts. National Drug Court Institute Review 2(1):33–60.

Petersilia, J. 1997 Probation in the United States: Practices and challenges. National Institute of Justice Journal (September):2–8.

Petersilia, J., and S.Turner 1992 An evaluation of intensive probation in California. The Journal of Criminal Law and Criminology 82(5):610–658.

1985 An evaluation of intensive probation in California. Criminology 31:18–32.


Sampson, R., and J.Laub 1993 Crime in the Making: Pathways and Turning Points Through Life. Cambridge, MA: Harvard University Press.

Suggested Citation:"Appendix E: Linking Treatment to Punishment: An Evaluation of Drug Treatment in the Criminal Justice System." National Research Council. 2001. Informing America's Policy on Illegal Drugs: What We Don't Know Keeps Hurting Us. Washington, DC: The National Academies Press. doi: 10.17226/10021.
×

Steffensmeier, D., and E.Allan 1995 Criminal behavior: Gender and age. In J.Sheley, ed., Criminology: A Contemporary Handbook. Belmont, CA: Wadsworth.

Substance Abuse, Mental Health Services Administration 1998 Treatment Episose Data Set (TEDS): 1992–1997. Rockville, MD: Substance Abuse, Mental Health Services Administration.

Turner, S., P.Greenwood, T.Fain, and E.Deschenes 1999 Perceptions of drug court. National Drug Court Institute Review 2(1):61–85.


U.S. General Accounting Office 1997 Drug Courts: Overview of Growth Characteristics and Results. Washington, D.C.: U.S. Government Printing Office.


Waldorf, D., C.Reinarman, and S.Murphy 1991 Cocaine Changes. Philadelphia: Temple University Press.

Walker, S. 1994 Sense and Nonsense About Crime and Drugs. Belmont, CA: Wadsworth.

Wexler, H. 1996 Evaluation of prison substance abuse treatment programs. In K.Early, ed., Drug Treatment Behind Bars: Prison Based Strategies for Change. Westport, CT: Praeger.

Wexler, H., G.DeLeon, G.Thomas, D.Kressel, and J.Peters 1999 The Amity Prison TC evaluation. Criminal Justice and Behavior 26(2):147–167.

Wexler, H., G.Falkin, D.Lipton, and A.Rosenblum 1992 Outcome evaluation of a prison therapeutic community for substance abuse treatment. In C.Leukefeld and F.Tims, eds., Drug Abuse Treatment in Prisons and Jails. NIDA Research Monograph 118. Rockville, MD: National Institute on Drug Abuse.

Wexler, H., D.Lipton, and B.Johnson 1988 A criminal justice system strategy for treating cocaine-heroin abusing offenders in custody. In L.Siegel, ed., American Justice: Research of the National Institute of Justice. St. Paul, MN: West Publishing.

Wexler, H., R.Williams, K.Early, and C.Trotman 1996 Prison treatment for substance abusers: Stay’N Out revisited. In K.Early, ed., Drug Treatment Behind Bars: Prison Based Strategies for Change. Westport, CT: Praeger.

Wilson, W.J. 1987 The Truly Disadvantaged. Chicago: University of Chicago Press.

1996 When Work Disappears. New York: Alfred Knopf.

Suggested Citation:"Appendix E: Linking Treatment to Punishment: An Evaluation of Drug Treatment in the Criminal Justice System." National Research Council. 2001. Informing America's Policy on Illegal Drugs: What We Don't Know Keeps Hurting Us. Washington, DC: The National Academies Press. doi: 10.17226/10021.
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How should the war on drugs be fought? Everyone seems to agree that the United States ought to use a combination of several different approaches to combat the destructive effects of illegal drug use. Yet there is a remarkable paucity of data and research information that policy makers require if they are to create a useful, realistic policy package-details about drug use, drug market economics, and perhaps most importantly the impact of drug enforcement activities.

Informing America's Policy on Illegal Drugs recommends ways to close these gaps in our understanding-by obtaining the necessary data on drug prices and consumption (quantity in addition to frequency); upgrading federal management of drug statistics; and improving our evaluation of prevention, interdiction, enforcement, and treatment efforts.

The committee reviews what we do and do not know about illegal drugs and how data are assembled and used by federal agencies. The book explores the data and research information needed to support strong drug policy analysis, describes the best methods to use, explains how to avoid misleading conclusions, and outlines strategies for increasing access to data. Informing America's Policy on Illegal Drugs also discusses how researchers can incorporate randomization into studies of drug treatment and how state and local agencies can compare alternative approaches to drug enforcement.

Charting a course toward a better-informed illegal drugs policy, this book will be important to federal and state policy makers, regulators, researchers, program administrators, enforcement officials, journalists, and advocates concerned about illegal drug use.

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