EDITORIAL INTRODUCTION MARCH 2003 _________________________________________________________________________________________________ DRUG COURTS CAN WORK. WOULD SOMETHING ELSE WORK BETTER? By Mark A. R. Kleiman Drug treatment courts are a relatively new version of the old drug-‐diversion idea: offering people who are drug users and who have been convicted of some crime treatment in lieu of incarceration. Drug courts promise lower cost, lower criminal recidivism, and less drug use (both during the period of supervision and thereafter) than routine criminal-‐justice processing. An alternative approach would be to mandate abstinence from drug use rather than mandating treatment, and back up that mandate with testing and sanctions. Denise Gottfredson, Stacy Najaka, and Brook Kearly provide the drug court movement with something it has hitherto lacked: evidence from a methodologically respectable study showing that, at least in one implementation for one client group (primarily African-‐American heroin users with severe drug problems), drug court treatment can actually reduce criminal activity during the period under supervision. In their study, two-‐thirds of the drug-‐court group was rearrested within two years compared to four-‐fifths of the controls, and the treatment group averaged 1.6 new charges per participant compared to 2.3 per control. Gottfredson, Najaka, and Kearly also provide a needed measure of caution: In the court they studied, the reduced recidivism was accomplished under a system that produced about as much incarceration as the alternative of routine processing through the court and probation systems. They note that, as a result, the program’s vaunted cost savings may not materialize, and that defendant’s willingness to participate may not survive the discovery that drug court is not a “Get Out of Jail Free” card. More than half of those randomly assigned to drug court failed and were resentenced; about a third succeeded; and the remainder (except for the 3% who died, reminding us of just how tough a population this court was dealing with) were still under drug court supervision after three years. Moreover, even those who eventually succeeded were subject to occasional short jail stays for violating program conditions (e.g., failing to appear for hearings). Actually, the long-‐term cost-‐and-‐incarceration picture may be even less favorable to drug courts than Gottfredson et al. suggest, because their study period was only 24 months, and the drug court participants had incarceration exposures averaging 6.7 years, somewhat longer than the exposure of those sentenced under “business as usual.” Thus, the drug-‐court participants’ remaining exposure to incarceration at the end of the study period was greater than that of the comparison group. Even under this tough implementation, the capacity of the drug court to induce its subjects to enter and comply with treatment was spectacular; only about half of those assigned to drug-‐court – all of whom were required to participate in
treatment – actually has as much as ten days’ actual participation in treatment in the community, and that group had better outcomes than the participants who never entered treatment or stayed for less than ten days. Gottfredson, Najaka, and Kearly interpret this as meaning that treatment contributes to the success of drug-‐court participants and thus as evidence that a pure testing-‐and-‐sanctions program is unlikely to work as well as the drug court coerced-‐treatment model. But surely an alternative explanation covers the facts at least as well: that those assigned to drug court who did not comply with its requirements by entering treatment (or who dropped out, managed to get themselves re-‐arrested, fewer than ten days into a treatment program) were self-‐selected to fail, while those who did enter treatment were self-‐selected to succeed. That the two groups were similar on lots of background variables only shows that those variables did not pick up whatever difference motivated one group but not the other to enter and remain in treatment. Gottfredson et al. report on the one prior study (Harrell, Cavanagh, and Roman 1998) comparing coerced treatment (admittedly in that case not very good treatment) against testing-‐and-‐sanctions. That study showed a clear advantage for the testing-‐and-‐sanctions group, which showed less drug use than the drug-‐ treatment group despite substantially lower cost-‐per-‐participant. Gottfredson et al. comment cautiously, that his study and prior study (Deschenes, Turned, and Greenwood 1995) “suggest that drug testing and sanctions may be as effective as a program that also involves mandatory treatment.” The obvious next research step would seem to be a large-‐scale random-‐ assignment trial of drug court or some other diversion model, with hig-‐quality treatment, against a testing-‐and-‐sanctions program with treatment as a backup for those who want it or who repeatedly fail their drug tests despite predictable sanctioning. Now that there are 1200 drug courts in action or on the drawing board, it’s good to know that at least one of them works. But that’s not the same as knowing that drug courts are the best way to manage drug-‐involved offenders. We know that some drug courts can reduce recidivism (somewhat) and that some testing-‐and-‐sanctions program can reduce drug use somewhat). Only a head-‐ to-‐head trial, or, better, a series of such trials using different models of coerced treatment and testing-‐and-‐sanctions, in different jurisdictions, on populations of different levels of drug abuse and criminality (including those with histories of violence, excluded from the court Gottfredson et al. studied), on a rich array of outcome measures, can tell us which is better for whom.
