Adjusting the frequency of mandatory drug court monitoring sessions according to offenders' risk of lapsing into criminal activity, including drug abuse, can enhance program success rates while conserving resources, according to a recent NIDA-supported study. Researchers found that high-risk drug offenders—those with antisocial personality disorder or prior histories of drug abuse treatment—achieved better outcomes when ordered to attend a judicial status hearing every 2 weeks, rather than at the 4- to 6-week intervals that drug courts typically impose. In contrast, lower risk offenders' treatment success was not compromised when courts required them to appear only if they committed serious or repeated infractions of program rules.
"Our research represents a first step in tailoring adaptive supervision interventions to drug-abusing offenders," says Dr. Douglas Marlowe of the Treatment Research Institute and the University of Pennsylvania, Philadelphia. Dr. Marlowe, Dr. David Festinger, and colleagues conducted the study as part of a broader effort to improve the efficacy and cost-effectiveness of drug court interventions by identifying which components of the model work best for various groups of drug offenders.
Custom Tailoring Court Supervision
Drug courts are intensive, community-based programs that substitute judicially supervised treatment and case management for prosecution or incarceration. Defendants who complete the drug court program and remain arrest-free for 6 months after graduation have their charges dropped and their arrest records expunged. The judicial status hearing, during which a judge rewards achievements and punishes infractions with sanctions that progressively increase in severity, is among the costliest components of drug court programs.
| High Risk | Low Risk | |||
|---|---|---|---|---|
| Biweekly Schedule | Standard Schedule | Standard Schedule | As Needed** | |
| Rate of Graduation from Treatment Program | 75% | 56% | 75% | 72% |
| Average Days of Drug Use in Past 30 Days | 8.00 | 9.51 | 3.50 | 4.32 |
| Average Days of Alcohol Intoxication in Past 30 Days | 1.40 | 2.67 | 2.02 | 1.30 |
Graduation rate assessed 12 months after beginning of treatment program; other data collected at 6-month followup.
* Participants were considered high-risk if they had antisocial personality disorder or previous treatment for drug addiction.
** Only scheduled to address serious or repeated infractions of treatment rules.
Drs. Marlowe and Festinger designed their study to answer two questions: Would high-risk drug offenders benefit from hearings held more frequently than usual, and would low-risk drug offenders still experience treatment gains if their hearings were held less often than the norm? The researchers had reason to predict the answers would be "yes" to both questions because of observations they had made in a previous study. That study's design and small participant population, however, had not allowed definitive findings on these issues.
Participants in the new study were recruited from a misdemeanor drug court in Wilmington, Delaware. Among the drugs that they reported abusing at the time of their assignment to drug court, cannabis was the most common, followed by alcohol, stimulants or cocaine, opiates, sedatives, and hallucinogens. Each participant was assigned to a clinical case manager who coordinated treatment referrals, submitted monthly reports to the judge, and appeared at the participant's judicial status hearings.
Ninety-two of the 279 participants were classified as high-risk because they had an antisocial personality disorder or had relapsed after previous treatment for drug abuse. Within the high-risk group, 42 were assigned to report to drug court biweekly, and 50 reported every 4 to 6 weeks. In the low-risk group, 92 were put on the 4- to 6-week schedule, and 95 were told to appear in court only after serious rule infringements—most commonly failure to attend counseling appointments or provide drug-free urine specimens.
Within a year, 75 percent of the high-risk participants who attended hearings every 2 weeks graduated from the program, compared with 56 percent of high-risk participants assigned to follow the standard schedule. The former group also provided more drug-free urine samples and reported less alcohol intoxication (see graph below), as well as less criminal activity.
Among the low-risk participants, outcomes were similar regardless of how often hearings took place. For example, program graduation rates were 75 percent among the offenders who appeared in drug court every 4 to 6 weeks and 72 percent among those who appeared in court only when a problem arose, averaging less than two hearings during the study year. "Reducing the number of court hearings for these individuals could permit a program to conserve costly resources without sacrificing client outcomes or public safety," Dr. Marlowe says.
Drug Court Frequency Can Affect Treatment Outcome: Participants who were considered high-risk provided more drug-free urine samples when they were required to appear in drug court every 2 weeks (gray-green) rather than according to the standard schedule of every 4 to 6 weeks (gold). In contrast, participants who were at lower risk of relapse did comparably well on the standard schedule (blue) and when court appearances were scheduled only in response to treatment-rule infractions (red).Room for Improvement
"Adjusting the frequency of court hearings to participants' risk status will make a difference, but there still will be considerable room for improvement in drug court outcomes," Dr. Marlowe notes. For high-risk participants who continue to have drug or alcohol problems, the program needs further tailoring, he explains. Those who are not compliant with the program—for example, those who fail to attend counseling sessions or to deliver urine specimens—might respond to more frequent judicial supervision or to sanctions such as home curfews. In contrast, increasing the scope of treatment services might be more effective with high-risk participants who are compliant with program rules but fail to achieve abstinence because of the severity of their drug addiction or a related difficulty, such as a co-occurring mental disorder, family problems, unemployment, or homelessness. Dr. Marlowe notes that even low-risk drug offenders need more effective interventions.
"Dr. Marlowe is helping us fill our knowledge gap about drug courts by identifying the elements that make them effective," says Dr. Redonna K. Chandler, chief of NIDA's Services Research Branch. "We may eventually be able to match criminal justice supervision and treatment services to the needs of individual offenders, making drug courts both more effective and more costeffective." Dr. Marlowe says, "We hope that drug court programs eventually become flexible enough to allow participants doing poorly to be switched to a more intensive track and allow those doing well in an intensive program to move to a lower supervision regimen."
Source
Marlowe, D.B., et al. Adapting judicial supervision to the risk level of drug offenders: Discharge and 6-month outcomes from a prospective matching study. Drug and Alcohol Dependence 88(Suppl. 2):S4-13, 2007. [Abstract]
Drug Courts Add Value
Studies have shown that drug courts significantly increase the time drug abusers stay in treatment. An average of 60 percent of drug court clients complete at least 12 months of treatment, whereas only 10 percent of probationers and parolees typically remain for a year in community-based drug treatment programs, says Dr. Douglas Marlowe of the University of Pennsylvania, summarizing several research reports. A 1998 review of 13 drug court studies found that drug court clients abuse substances less frequently than comparable probationers (10 percent of urine tests were positive, compared with 31 percent). What's more, drug courts reduce re-arrest rates by 8 to 24 percent, according to five meta-analyses in 2005 and 2006. Although drug courts tend to be more expensive than other programs, the reduction in recidivism decreases later judicial costs and financial loss to crime victims, according to a U.S. Government Accountability Office report published in 2005.* It cited net predicted benefits of $1,000 to $15,000 per participant.
*Adult Drug Court: Evidence Indicates Recidivism Reduction and Mixed Results for Other Outcomes, GAO-05-219, February 2005.