The Efficacy of Drug Courts
Meredith Emigh, University of New Haven
Drug courts were designed to divert drug-involved offenders with less serious charges into treatment instead of prison. It is estimated that 78% of property crimes and 77% of public order offenses are related to drug or alcohol abuse, which costs the United States $74 billion a year (CASA, 2010). This includes the cost of police, court, prison, probation and parole services. Substance-involved offenders are more likely to recidivate than their sober peers (CASA, 2010). Proponents of the drug court model claim that it prevents recidivism while also saving a considerable amount of money. However, evaluation research is necessary to determine whether drug courts are truly effective.
There have been many evaluation studies of drug courts in the last two decades, most of which suggest that drug courts are at least somewhat effective. Unfortunately, these studies relied on methodology that does not provide the most scientifically rigorous results, including quasi-experimental and retrospective designs. This paper will review the current research on drug court effectiveness to determine whether these courts meet the dual goals of saving money while lowering rates of recidivism and substance use.
History and Design of Drug Courts
The first drug court in the United States was established in Miami, FL in 1989 (Goldkamp, White, & Robinson, 2001). Over the next two decades, drug courts were implemented at a rapid pace in all 50 states (Carey & Finnegan, 2004). By 2012, there were an estimated 2400 drug courts in the United States (Mitchell, Wilson, Eggers, & MacKenzie, 2012). Unfortunately, there is no centralized record keeping for drug courts, making it very difficult to know exactly how many people attend drug courts each year.
Drug courts were designed to put treatment and rehabilitation ahead of punishment. They are based on a psychosocial theory of crime as something that can be treated (Brown, 2011). There is empirical evidence that treatment improves long-term outcomes compared to incarceration, because it addresses the causes of crime and improves an individual’s ability to reintegrate into his/her community (Brown, 2011). Approximately 65% of prison inmates in the United States meet the medical criteria for addiction, but only about 11% of them receive treatment (CASA, 2010). In comparison, 68% of drug court participants receive treatment (Gottfredson, Najaka, & Kearley, 2003).
The exact type of treatments offered varies widely between drug courts. Behavioral treatments include cognitive behavioral therapy (CBT), as well as individual, group, and family therapy. Some programs include medical detoxification treatments, whereas others offer acupuncture, 12-step programs, or behavioral relapse prevention programs (Gottfredson et al., 2003). In addition, some drug courts offer ancillary services such as education and job training; medical care and education; assistance with housing, finances, and legal matters; and social or athletic activities (Lutze & van Wormer, 2007; Peters & Murrin, 2000).
For most drug courts, the target population is offenders who are being charged with a substance-involved offense (Mitchell et al., 2012). These are usually drug charges, but may include other non-violent offenses committed by defendants with substance abuse issues (Peters & Murrin, 2000). Drug court participants are often first-time offenders, frequently juveniles, but are sometimes chosen due to a history of substance-involved offenses. The screening criteria vary between drug courts and depend on local policies, but most include some measure of how motivated the offender is to be treated, in addition to considerations of criminal and substance use histories (Evans, Li, Urada, & Anglin, 2014). Purposively choosing offenders with higher levels of treatment motivation, while likely leading to better outcomes, presents a challenge to evaluation research because it introduces a systematic bias into the sample. This is discussed in further detail below.
Goals and Objectives
The goals of drug courts are to reduce substance use and to reduce recidivism (Goldkamp et al., 2001; Lutze & van Wormer, 2007). Most drug courts also strive to help offenders reintegrate into their communities, especially if they have participated in inpatient treatment or served a prison sentence (Brown, 2011; Lutze & van Wormer, 2007). Finally, drug courts seek to reduce the prison population and reduce the costs spent on corrections (Brown, 2011; Evans et al., 2014; Lowenkamp, Holsinger, & Latessa, 2005; Peters & Murrin, 2000). A well-designed and implemented program can achieve these goals, as discussed below.
The Role of Court Personnel
Offenders are typically selected for inclusion in the drug court program by the prosecutor (Drug Courts Program Office, 1997). The defense attorney, in addition to protecting their client’s rights, generally explains the program to the defendant and encourages his/her participation (Drug Courts Program Office, 1997; Lutze & van Wormer, 2007). A referral to drug court can occur either before or after the offender makes a plea (Marlowe, Festinger, Lee, Dugosh, & Benasutti, 2006; Mitchell et al., 2012). If the offender agrees to enter a drug court pre-plea, the charges are usually dropped; s/he also waives the right to a speedy trial by beginning treatment in place of the normal court process (Mitchell et al., 2012). A post-plea decision to enter drug court usually involves a suspended sentence pending successful completion of the treatment program (Gottfredson et al., 2003; Marlowe et al., 2006).
The judge is the central figure in a drug court and, unlike a regular courtroom, interacts directly with the offender (Carey & Finnegan, 2004; Drug Courts Program Office, 1997; Goldkamp et al., 2001). The judge supervises program participation through frequent status hearings, providing rewards for offenders who attend treatment sessions and pass the drug screening tests, and issuing sanctions to offenders who do not (Lutze & van Wormer, 2007; Marlowe et al., 2006; Peters & Murrin, 2000).
Evidence-Based Treatment Methods
Status hearings with the judge contribute to behavior modification using the principles of operant learning, which include reinforcement through punishment and reward (Goldkamp et al., 2001; Turner et al., 2002). Rewards can include praise and encouragement from the judge, tokens, and graduation certificates. Sanctions should be graduated, starting with a warning from the judge and increasing to short jail stays (48 hours) or termination from the program for persistent repeat infractions (Mitchell et al., 2012). Some drug courts provide general deterrence through observational learning techniques, by requiring offenders to attend status hearings in groups (Goldkamp et al., 2001). This allows offenders to see each other being rewarded and sanctioned, so that they understand which behaviors will earn them rewards or sanctions.
Most drug courts involve three phases of treatment (Mitchell et al., 2012; Peters & Murrin, 2000). The first phase is stabilization, which may involve treatment for medical or psychological disorders in addition to detoxification from substances. The second stage is intensive treatment, which usually lasts for several months, up to a year. During this period, offenders participate in the substance abatement treatments offered by their program. Other services may be offered to help participants maintain their sobriety, such as education and assistance to find a job (Lutze & van Wormer, 2007; Peters & Murrin, 2000). Some programs require participants to find and keep a job for the duration of treatment (Peters & Murrin, 2000). Status hearings with the judge occur during the intensive treatment phase, and participants may have a case manager in the probation department (Lutze & van Wormer, 2007). The program should end with a period of transition, to help the offender stay sober and continue being pro-social once the period of intense supervision is over (Mitchell et al., 2012; Peters & Murrin, 2000).
Drug court treatment should be individualized as much as possible, to address the specific needs of each offender (Drug Courts Program Office, 1997; Lutze & van Wormer, 2007). Every participant will have somewhat different needs and will respond differently to various types of treatment. Additionally, offenders should be chosen to participate in drug courts based on the risk principle (Marlowe et al., 2006). The risk principle states that only moderate and high-risk offenders should be referred to treatment; low-risk offenders can be harmed by intensive treatment efforts (Andrews & Bonta, 2010; Lutze & van Wormer, 2007). Finally, as discussed above, any barriers to treatment should be addressed to give participants the best chance of success (Lutze & van Wormer, 2001). These three guidelines are known as the Risk, Need, Responsivity (RNR) model and there is substantial empirical evidence that when the principles of RNR are followed, treatments are more likely to be effective (Andrews & Bonta, 2010).
However, it should also be noted that at least one study found that drug court participants were not always participating in certified or empirically proven treatments. Gottfredson and colleagues (2003) found that half of the participants in the Baltimore drug court were receiving non-certified treatment such as acupuncture. As yet, there is no scientific evidence that acupuncture is an effective treatment for substance abuse or crime.
In addition to frequent hearings, drug court participants are required to submit to frequent urinalysis. The Department of Justice’s Drug Courts Program Office (1997) recommends testing every two weeks for the first few months of treatment. The tests should be randomly scheduled, so that offenders are not able to prepare for them (Marlowe et al., 2006). The Drug Courts Program Office (1997) recommends that the court should make allowances for the fact that early relapses are common in substance use abatement programs, meaning that the response should be more encouraging than punishing, especially if the offender has passed urine screens in the past.
Approximately half of drug court participants complete the full course of treatment (Mitchell et al., 2012; Turner et al., 2002). Most drug courts require participants to remain sober for a certain length of time before they can graduate, ranging from 14 weeks to six months (Marlowe et al., 2006). Participants who were required to take more drug tests each month were more likely to stay in treatment and to fulfill the conditions of the drug court (Turner et al., 2002), which is consistent with other findings that the most effective drug courts use frequent drug testing in combination with evidence-based therapies (Drug Courts Program Office, 1997; Goldkamp et al., 2001; Lowenkamp et al., 2005).
Research on Effectiveness
The Drug Courts Program Office (1997) recommends that all drug courts should include a method of data collection and storage in their design. Data should be collected on participant demographics and program compliance, as well as their future arrests and convictions after graduation. Participants should be followed for as long as possible after program completion, preferably several years. This data can then be used to assess how effective the drug court is in preventing recidivism and relapse. The Drug Courts Program Office also recommends that drug courts bring in an outside researcher with expertise on rehabilitation to facilitate the design and implementation of the data collection and analysis.
In the first decade of the 21st Century, many studies of drug courts were conducted. Some used a retrospective design, collecting data on drug court graduates and then checking official records for arrests and substance use since they completed the program. Others used quasi-experimental designs, with current drug court participants and comparison groups who matched the characteristics of the treatment group as much as possible. In evaluating the effectiveness of drug courts, it is important to consider the strengths and weaknesses of this research as well as the findings.
The main goal of any rehabilitation and treatment program in the criminal justice system is to reduce recidivism. Most of the available studies found that drug court participation had at least a small effect on preventing recidivism. A meta-analysis found that, on average, drug courts reduced recidivism by 7.5% (Lowenkamp et al., 2005). Another study found that the recidivism rate for drug court participants was 45% compared to 55% for non-participants (Mitchell et al., 2012). Drug court participants have been found to be arrested and booked fewer times than their peers and to have longer times to recidivism after treatment. In one study, 66% of drug court graduates were rearrested during a two-year follow-up – significantly fewer than the 81% of non-participants (Gottfredson et al., 2003). The same study found that drug court graduates were arrested an average of 1.6 times compared to 2.3 for non-participants. Over a 30-month follow-up, drug court participants were more likely to be employed and less likely to be arrested than non-participants (Peters & Murrin, 2000). Graduates also tend to have shorter periods of incarceration for subsequent offenses (Brown, 2011; Carey & Finnegan, 2004).
The comparison of drug court graduates to non-participants without consideration of offenders who enter a drug court but do not complete the treatment is a methodological weakness. It ignores any confounding factors that may have predisposed the graduates to be more successful, such as personality or life history. A randomized study design, in which qualified candidates are randomly selected for the treatment and control groups, would control for these external factors and provide additional support for the finding that drug courts are effective.
Interestingly, most studies found that the difference in recidivism rate for drug court participants compared to non-participants increased over time. That is, the longer the follow-up period for drug court graduates, the lower their rate of recidivism becomes compared to non-participants. Therefore, it is important to continue to collect follow-up data for as long as possible. The full extent of recidivism reduction seems to be realized around three years after program completion (Goldkamp et al., 2001; Turner et al., 2002). A true experiment with a longitudinal design could help add weight to these findings.
Reducing Substance Use
Like the recidivism results above, drug courts to appear to be effective in preventing further substance abuse. Drug court participants demonstrate lower rates of substance use after program completion than comparison groups (Peters & Murrin, 2000; Turner et al., 2002). They also require shorter periods of treatment if they do relapse (Carey & Finnegan, 2004). These improvements also appear to last for several years after program completion. Additionally, drug courts have better retention rates than other types of treatment offered to offenders – 60% compared to 35% (Peters & Murrin, 2000). However, it must be noted again that there is often an element of bias when selecting offenders for participation in a drug court, and that those who finish the program may systematically differ from those who do not.
Several studies have examined the costs of drug courts and whether they save the criminal justice system money in the long-term. A 2004 study of the Multnomah County, OR drug court determined that for each participant the county saved $1,442 compared to “business as usual” (Carey & Finnegan, 2004). “Business as usual” means the typical court and prison process that most offenders experience in the United States. The study included the costs of arrest, booking, time in court, jail and prison, treatment, and probation services, as well as material costs. Specifically, in the drug court model the public defenders, law enforcement, and probation departments saved money compared to business as usual. The prosecutors, courts, and treatment services spent more on drug court participants than business as usual, but there was a net gain for the county.
More recently, the Washington State Institute for Public Policy (2016) estimated that it costs approximately $5,000 to treat adults with the drug court model and $2,226 to treat juveniles. These costs are balanced by savings, which increase over time if the offender remains substance free and does not recidivate. For adults, after ten years of non-offending and non-using, the savings increase to $12,000 a year over the cost of incarceration. For juveniles, the savings are slightly less per year – about $5,000 after ten years – but will accumulate for a longer period.
The costs to treat an offender in a drug court setting will depend on the location of the court, as will the actual amount saved compared to typical incarceration. Costs of incarceration vary widely between states and depend on such factors as medical and mental health treatments required, programming offered in the prison, and whether the inmate spends time in solitary confinement or not. However, it does seem that drug courts are significantly cheaper than incarceration regardless of the location. Additionally, the total lifetime savings per drug court participant will depend on whether they truly stay out of the system for the rest of their lives. Findings that drug court graduates have shorter terms of both treatment and incarceration for subsequent offenses suggest that it is still overall cheaper for the system even if they do recidivate (Brown, 2011; Carey & Finnegan, 2004). These savings could be increased by finding a way to help more eligible offenders succeed in drug court treatment.
Factors that Influence Effectiveness
Several studies of drug court effectiveness identified the factors that contribute to success. In general, participants who complete the program in less than one-year have better outcomes than those who remain in treatment for a longer period (Lowenkamp et al. 2005). This is likely because additional time in treatment is due to frequent relapses and perhaps to interrupting treatment with jail time for non-compliance. Outpatient programs tend to be more effective than inpatient programs, which is true of other types of treatment as well (Lowenkamp et al., 2005). Younger, white, female participants with moderate levels of addiction tended to have better outcomes than older, male, minority participants with severe addictions (Lowenkamp et al. 2005; Lutze & van Wormer, 2007; Peters & Murrin, 2000; Roman, Townsend, & Bhati, 2003). However, drug courts in which most participants had prior criminal records performed better than those with all first-time offenders. This follows the risk principle, which states that high and moderate risk offenders have better treatment outcomes, suggesting that first time offenders present a low-level of risk and a higher likelihood of recidivism after treatment (Marlowe et al., 2006).
Smaller drug courts tended to have more successful graduates than larger ones (Roman et al., 2003), likely due to less severe addictions to less serious drugs and to the ability for the judge to form a better relationship with individual offenders (Lutze & van Wormer, 2007). Additionally, participants who completed at least 50% of their treatment, attended at least 30% of their sessions, and had eight or more status hearings had better long-term outcomes than participants who completed less of the program (Goldkamp et al. 2001). More frequent status hearings (more than two a month) may also contribute to better outcomes (Mitchell et al., 2012). One study found that drug courts had better long-term outcomes than similar, but less rigorous, programs largely due to careful selection criteria, which does introduce bias into the efficacy studies, and the use of ancillary services (Evans et al., 2014). Finally, the most effective results were seen in programs with an appropriate treatment intensity, meaning enough sessions offered for a sufficient period, and those with the best fidelity to their design (Lutze & van Wormer, 2007; Mitchel et al., 2012).
Conclusion: Are Drug Courts Effective?
Drug courts are an attempt to rehabilitate substance-involved offenders while keeping them out of prison. They are based on a psychosocial view of crime as something that can be treated, and often pair medical treatment with behavioral therapy. The goals of drug courts are to reduce recidivism, reduce substance use, reduce the costs of drug-involved crimes, and decrease prison crowding. Based on several retrospective and quasi-experimental studies, it appears that drug courts are accomplishing most of their goals. Graduates have lower rates of recidivism and substance use, and the treatment is far more cost effective than incarceration. Drug courts also tend to enjoy support from the communities in which they are implemented (Lowenkamp et al., 2005).
However, it should also be noted that most studies on the effectiveness of drug courts point out that the methodology used is somewhat weak (Brown, 2011; Mitchel et al., 2012). Most of the studies tend to be retrospective and to have some difficulty finding accurate records for all past drug court participants. Similarly, using a comparison group of ineligible offenders may not provide the best results because there may be a systematic difference between eligible and ineligible offenders that would bias the study (Brown, 2011). This does not necessarily suggest that results are inaccurate, but that the drug courts may be less effective than proponents believe. Drug courts have now been operating in some areas for over 20 years, meaning it should now be possible to assess whether there is any difference in recidivism and substance use, though more rigorous methodology, including randomized studies, is needed.
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