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.



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