Mandated Treatment and Mandated Abstinence: Diversion, Drug Courts, and Swift-and-Certain Sanctioning Mark A.R. Kleiman OAS July 12, 2013
THE TREATMENT GAP Problem Most dependent drug users aren’t in treatment Solutions Supply-side Availability, quality, acceptability Demand-side Persuasion, coercion
THE PROMISE OF OFFENDER DEMAND REDUCTION Drug-abusing criminals persist in crime if they persist in drug use. Drug abusers in treatment reduce drug use while in treatment. Reducing drug use tends to reduce crime. User-offenders in consumer countries account for most illicit drug demand.
ALTERNATIVES TO TREATMENT • Most problem users recover without formal treatment: “spontaneous desistance” • Self-help groups (Twelve-Step programs) are as effective as formal treatment for those who persist in the programs. • Abstinence mandates consistently out-perform treatment mandates
MANAGING DRUG-INVOLVED OFFENDERS JUDGE INVOLVEMENT TREATMENT Standard MANDATE drug court DESISTANCE DC Drug Court MANDATE Sanctions Track HOPE
NO JUDGE Treatment diversion WISP
MANDATED TREATMENT • Diversion programs – “Assess and treat” spreads treatment thin – Compliance problem
• Drug courts Judicial involvement can Improve compliance
DESISTANCE MANDATE PROGRAMS • • • •
DC Pretrial DC drug court (randomized trial) HOPE (randomized trial) WISP (randomized trial)
DESISTANCE MANDATES • • • •
Warning to probationers in open court. Required abstinence from illicit drugs. Randomized drug testing using a “hot line.” Short jail stays (days) for each violation. (Mean 6 days for a first violation, 14 days for a second violation.) • Prompt and reliable sanctions delivery. • Formal treatment only on request or as a last resort before incarceration.
PRINCIPLES OF EFFECTIVE DESISTANCE MANDATES • • • •
Clear warning Required abstinence from illicit drugs Randomized drug testing using a “hot line” Short jail stays (days) for each violation. Prompt and reliable sanctions delivery. • Formal treatment only on request or as a last resort before incarceration.
THERAPEUTIC PRINCIPLES • • • • • • •
Transparent fairness and goodwill. Respect for client as a responsible adult. Contingency management. Establishing internal locus of control. Predictable environment. Breaking through denial. Creating a therapeutic alliance.
3-month followup outcomes 100%
Missed Appointments 76.5%
80% Change over 3 month baseline
Dirty Urinalysis
60% 40% 20.6%
20% 0% -20% -40% -60% -80%
-70.3% -85.4%
-100%
HOPE (n=595)
Comparison (n=72)
Percentage of probationers revoked
Revocations 35% 30.6%
30% 25%
20% 15%
10%
8.8%
5% 0%
HOPE
Comparison