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Systematic review of the impact of adult drug-treatment courts

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The U.S. correctional system is overburdened with individuals suffering from substance use disorders. These illnesses also exact a heavy toll on individual and public health and well-being. Effective methods for reducing the negative impact of substance use disorders comprise critical concerns for policy makers. Drug treatment court (DTC) programs are present in more than 1800 county, tribal, and territorial jurisdictions in the United States as an alternative to incarceration for offenders with substance use disorders. This review article summarizes the available descriptive information on representative DTC populations and the observational studies of drug court participants, and it specifically reviews the available experimental effectiveness literature on DTCs. The review concludes by examining the limitations of the current literature, challenges to conducting research in drug court samples, and potential future directions for research on DTC interventions. A review of nonexperimental and quasi-experimental literature regarding the impact of DTCs points toward benefit versus traditional adjudication in averting future criminal behavior and in reducing future substance use, at least in the short term. Randomized effectiveness studies of DTCs are scant (3 were identified in the literature on U.S. adult drug courts), and methodological issues develop in combining their findings. These randomized trials failed to demonstrate a consistent effect on rearrest rates for drug-involved offenders participating in DTC versus typical adjudication. The 2 studies examining reconviction and reincarceration, however, demonstrated reductions for the DTC group versus those typically adjudicated.

Section snippets

Societal Costs of Punitive Drug Policy

The impact of substance misuse upon the commission of crime and upon public health and safety are critical concerns for policy makers and for law enforcement. The relentless and costly expansion of the U.S. penal system is, at least in great part, the result of punitive policies intended to reduce public drug demand but frequently result in the confinement of addicted individuals rather than high-level drug traffickers or manufacturers. One in 4, or 509,000 inmates, in the overall U.S. penal

Review Methodology

The following comprises a review of existing literature and, as such, was deemed exempt from formal review by the University of Wisconsin Health Sciences Human Subjects Committee.

Given the overlap of multiple academic fields in the study of drug court participants and their outcomes, a wide variety of sources were searched to ensure a comprehensive and representative literature review. Traditional databases that were searched included PubMed, Sociological Abstracts, and PsychINFO. Databases

Epidemiological Data on Drug Court Participants

The descriptive characteristics of representative drug court populations are presented in Table I. To summarize, nationally among DTCs, populations are predominantly men (74%); their typical age ranges from 28 to 40 years, with the most mean ages (where reported) ranging from 28 to 33 years. Ethnic makeup varies greatly by location, with a large number being predominantly (50%–95%) White. Urban locations typically involve a larger proportion of minority participants. California drug courts

DTC Program Characteristics

DTCs vary greatly in the number of annual participants, with 80–120 representing the typical annual participation.3, 20, 21, 26, 27, 30, 31, 37, 38 DTCs serving larger urban areas, however, frequently have much larger case loads (eg, 453 in New York in 1999, 884 in Los Angeles in 11 separate drug courts in 2001, and 300 in Travis County, Tex, in 2002).22, 26, 39

Drug courts most commonly work with multiple community agencies as providers of substance-abuse treatment19, 20, 26, 27, 40, 41 (3 of 9

Quasi-experimental recidivism studies

A summary of case-control studies examining recidivism among drug court participants versus comparison groups are shown in Table II, Table III.

Quasi-experimental designs most often involved the use of a comparison group with similar drug-related offenses who did not participate in DTC. Reasons for nonparticipation in the comparison group frequently involved a lack of capacity to accept the members of the comparison group,20 a group with similar charges who were not referred to DTC often for

Summary of Findings

The predominance of nonexperimental and quasi-experimental literature seems to point toward benefit for DTCs over traditional adjudication in terms of rates of and time to rearrest. The limited number of investigations examining the outcome also seem to indicate that drug court participants are less likely to engage in substance use during program participation than are traditionally adjudicated offenders. This latter outcome may suffer, however, from potential bias resulting from the

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    Randall T. Brown, MD is an Assistant Professor in the Department of Family Medicine at the University of Wisconsin School of Medicine and Public Health. His article is based on a presentation given at the Combined Annual Meeting of the Central Society for Clinical Research and Midwestern Section American Federation for Medical Research held in Chicago, III, April 2009.

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