The National Drug Court Institute More on Corrections
 The Efficacy of Coercion in Drug Treatment

• Coercion is the key to admitting addicts into treatment quickly and for a period of time that is long enough to make a difference.  This is proposition is unequivocally supported by the empirical data on drug treatment programs.

• Data consistently show that treatment, when completed, is effective.  Indeed, even during brief exposures to treatment, almost all addicts will use fewer drugs and commit less crime than without having been exposed to treatment.  This means that even the slightest exposure to treatment produces beneficial results. 

• However, most addicts, given a choice, will not enter a treatment program voluntarily.  Those addicts who do enter programs rarely complete them.  About half drop out in the first three months, and 80 to 90 percent have left by the end of the first year.  Among such dropouts, relapse within a year is the norm.

• Accordingly, if treatment is to fulfill its considerable promise as a key component of drug control policy, addicts not only must enter treatment but must remain in treatment and complete the program.  If they are to do so, most will need incentives that may be characterized as “coercive.”

• In the context of treatment, the term coercion - used more or less interchangeably with “compulsory treatment,” “mandated treatment,” “involuntary treatment,” “legal pressure into treatment”- refers to an array of strategies that shape behavior by responding to specific actions with external pressure and predictable consequences. 

• Coercive drug treatment strategies are common.  In many programs in both the criminal justice system and in the workplace, for example, individuals with drug problems can be identified and appropriate leverage (e.g., the risk of jail or the threat of job loss) can be exerted over them, providing powerful incentives to start and stay in treatment. 

• Moreover, evidence shows that addicts who get treatment through court orders or employer mandates benefit as much as, and sometimes more than, their counterparts who enter treatment voluntarily.[1]

National Outcome Studies on Coercion

• Four national studies beginning in 1968 and ending in 1995, assessed approximately 70,000 patients, 40 to 50 percent of whom were court ordered or otherwise mandated into residential and outpatient treatment programs.  Two major findings emerged.[2] 

• The first was that the length of time a patient spent in treatment was a reliable predictor of his or her post-treatment performance.  Beyond a 90-day threshold, treatment outcomes improved in direct relation to the length of time spent in treatment, with one year generally found to be the minimum effective duration of treatment. 

• The second major finding was that coerced patients tended to stay in treatment longer than their “non-coerced” counterparts. 

• In short, the longer a patient stays in drug treatment, the better the outcome. 

• Since coerced patients stay longer than those who volunteer for treatment, coerced patients do much better after treatment, as they have had time to benefit from the services they received.  A 1990 report from the Institute of Medicine summarized that “contrary to earlier fears among clinicians, criminal justice pressure does not seem to vitiate treatment effectiveness, and it probably improves retention.”[3]

Specific Drug Court Outcome Studies

• A Portland, Oregon, evaluation conducted in 1998 by the State Justice Institute made careful efforts to match drug court participants with other arrestees having similar demographic characteristics and criminal histories who had either refused drug court or were ineligible for administrative reasons. 

• Two years after adjudication, drug court program participants had 61 percent fewer arrests than offenders who were eligible but did not participate, and drug court graduates performed better than their drug court counterparts, with 76 percent fewer arrests.  The longer the retention, the better the outcomes.  Those who stayed for less than one-third of the program duration had three times as many arrests as those who had graduated and twice as many as those who had completed at least one-third of the regimen.[4]

• A Maricopa, Arizona, drug court was the subject of a 1996 evaluation by the RAND Corporation, which found that among a random sample of those assigned to the drug court, rates of rearrest for any crime were significantly lower than for  those randomly assigned to probation alone.[5]

• An independent evaluation found the Dade County, Florida, drug court superior to “disposition as usual.”  Between June 1989 and March 1993, the Dade County program enrolled 4,500 defendants, 20 percent of all arrestees in the county who were charged with drug related offenses.  During the same time period, 60 percent of the enrollees graduated or remained in the program.  A year after graduation, only 11 percent were rearrested in Dade County on any criminal charge. 

• By contrast, the rearrest rate was some 60 percent for a matched sample of drug offenders in 1987, two years before the institution of the drug court.  Furthermore, the time that elapsed between graduation and first reoffense was two to three times longer in the drug court group than in the non-drug court group.[6]

·        A Polk County, Iowa evaluation used two comparison samples: one consisted of offenders who were referred to the drug court but never enrolled (rejects or refusals) and the second comparison sample was comprised of offenders deemed eligible for the drug court during a pilot phase to assess drug court program needs prior to implementation.  The follow-up period varied but averaged 416 days. 

·        Using reconviction as the recidivism measure, 37% of drug court participants were reconvicted after leaving the drug court, compared to 75% of the pilot group sample.  Felony reconviction prevalence was 6% for the drug court and 25% for the pilot comparison.

·        In Salt Lake County, Utah, drug court participants were compared to a group of offenders who were screened for the drug court but did not enroll.  In the 12 months following drug court completion, participants had an average of 3.2 new bookings and 29.2 new jail days compared to 6.6 new bookings and 54 new jail days for the comparison sample. 

·        The National Institute of Justice funded the evaluations of the Escambia County, Florida and Jackson County, Missouri drug courts and tracked rearrests for a two-year period following drug court participation.  The comparison samples were matched groups of offenders adjudicated before the drug courts were implemented.  Looking at felony rearrests only, participation in the Escambia County drug court decreased felony recidivism from an expected 40% to 12% within two years of leaving the drug court.  In the Jackson County drug court recidivism for felonies was reduced from 50% to 35%, and for any type of rearrest from 65% to 45%.[7]