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CORK Bibliography: Compulsory Treatment

51 citations. January 2009 to present

Prepared: September 2012

Amaro H; Ahl M; Matsumoto A; Prado G; Mule C; Kemmemer A et al. Trial of the university assistance program for alcohol use among mandated students. Journal of Studies on Alcohol and Drugs Supplement 16: 45-56, 2009. (68 refs.)

Objective: The aim of this study was to investigate the effectiveness of a brief intervention for mandated students in the context of the University Assistance Program, a Student Assistance Program developed and modeled after workplace Employee Assistance Programs. Method: Participants were 265 (196 males and 69 females) judicially mandated college students enrolled in a large, urban university in the northeast United States. All participants were sanctioned by the University's judicial office for all alcohol- or drug-related violation. Participants were randomized to one of two intervention conditions (the University Assistance Program or services as usual) and were assessed at baseline and 3 and 6 months after intervention. Results: Growth curve analyses showed that relative to services as usual, the University Assistance Program was more efficacious in reducing past-90-day weekday alcohol consumption and the number of alcohol-related consequences while increasing past-90-day use of protective behaviors and coping skills No significant differences in growth trajectories were found between the two intervention conditions on past-90-day blood alcohol concentration, total alcohol consumption, or weekend consumption. Conclusions: The University Assistance Program may have a possible advantage over service as usual for mandated students.

Copyright 2009, Alcohol Research Documentation Center

Berger K; Rotermund P; Vieth ER; Hohnhorst A. The prognostic value of the PCL-R in relation to the SUD treatment ending. International Journal of Law and Psychiatry 35(3, special issue): 198-201, 2012. (24 refs.)

Scientific research about patients with substance use disorders (SUD) treated within the context of forensic compulsory addiction treatment is seldom available. Scientifically supported surveys regarding the treatability of SUD patients are rare. Some authors claim that the Psychopathy-Checklist-Revised (PCL-R) has value for predicting therapeutic success. PCL-R scores rely on extensive interview data and a detailed review of criminal records and social history. The scores reflect 1) the affective and interpersonal psychological traits: and 2) socially deviant conduct. This study was conducted by the forensic professional clinic at the hospital for Psychiatry and Neurology Hildburghausen. We assessed 102 male patients using the PCL-R. This investigation evaluated the Total score of the PCL-R and the score of Factor 1 and Factor 2 in relation to the end of treatment by court order. The results showed significant differences between patients who completed treatment and those who did not. Patients that dropped out of treatment had a higher score in PCL-R. With the use of the PCL-R it is possible to make a quantitative statement about which patients will complete treatment.

Copyright 2012, Elsevier Science

Best D; Walker D; Aston E; Pegram C; O'Donnell G. Assessing the impact of a high-intensity partnership between the police and drug treatment service in addressing the offending of problematic drug users. Policing & Society 20(3): 358-369, 2010. (28 refs.)

While there is a considerable evidence base showing links between drug use and offending and clear evidence of the impact of treatment engagement on drug-related offending, there is a much smaller UK evidence base on 'what works' in treatment and criminal justice partnerships, particularly in the UK. The current study used police arrest data to measure changes in offending behaviour in 116 drug-using offenders who had tested positive for opiates or cocaine in custody suites on at least three occasions in the previous year. Participants were assigned to either an intensive form of 'quasi-coercive' treatment (the High Crime Causing Users, HCCU) or to treatment as usual from the community Drug Interventions Programme team. The study compares changes in offending in a high-rate offending group with a standard treatment intervention. The assessment of the effectiveness of the intervention was based on arrest rates in the 12 months before and after engagement with the programme, supplemented by data collected from treatment case notes. Data analysis showed a significant reduction in offending in those engaged in the HCCU, who had higher pre-entry offending, but no change in offending for those accessing treatment as usual. There was some indication that greater retention in treatment was linked to better outcomes, and that medical sessions were associated with greater reductions in crime. The results provide some support for intensive partnership working between criminal justice drug services and the police, and suggest that intensive community work with high-rate drug-using offenders can be effective.

Copyright 2010, Taylor & Francis

Best D; Wood K; Sweeting R; Morgan B; Day E. Fitting a quart into a black box: Keyworking in quasi-coercive drug treatment in England. Drugs: Education, Prevention and Policy 17(4): 370-387, 2010. (47 refs.)

Aims: The aim of this article is to assess what goes on in treatment sessions in court-mandated drug treatment in the UK. Methods: The study used a case note audit involving interviews with drug workers about each of their active cases, assessing client characteristics and their reports on what activities had taken place in treatment sessions. Findings: The average session lasts just under 30 minutes and typically at least three different types of worker-led activity are engaged in per session, often including time spent on compliance with treatment, with prescriptions and with the testing requirements of the court mandate. The amount of time dedicated to evidenced psychosocial interventions is typically less than 10 minutes. Conclusions: The tensions reported elsewhere for drug workers engaged in criminal justice services are evidenced in the study given the range of tasks (potentially conflicting) that drug workers are required to engage in and the limited opportunity for them to engage in effective psychosocial drug treatment.

Copyright 2010, Taylor & Francis

Bowser BP; Lewis D; Dogan D. External influences on drug treatment interventions: East Palo Alto's Free-at-Last. Journal of Addiction Medicine 5(2): 115- 122, 2011. (25 refs.)

External influences on community-based drug treatment program outcomes have not been adequately accounted by either treatment providers or evaluators. In 2001-2003, a cohort of 197 African American and Latino crack cocaine and heroin users was interviewed at intake into the Free-at-Last's treatment program in East Palo Alto, California. Objective: The goal of this research was to identify, and then measure, the impact of a series of theory-based, hypothesized external influences on 3 client treatment outcomes: (1) program completers, (2) dropouts, and (3) referrals to more intensive inpatient treatment. Methods: All program clients were interviewed using the Government Performance and Results Act and the California Alcohol and Drug Data System questionnaires. Supplemental questions hypothesized the external influences and were based on prior research and staff focus groups. Results: There were statistically significant differences in treatment outcomes based on employment status, homelessness, living situation, and jail time. Regression analyses indicated that the strongest outcome predictors were treatment intensity, followed by prior crack use, homelessness, income, and number of illegal drugs used. Path analysis showed that former crack use and time in jail formed a particularly strong cluster of external influences on treatment outcomes. This cluster was the result of court-mandated treatment of arrested crack users who chose treatment over incarceration. If users failed treatment, they went back to jail. In a community such as East Palo Alto, court-mandated referrals had a powerful external influence on treatment and, therefore, need to be considered when evaluating a treatment program.

Copyright 2011, Lippincott, Williams & Wilkins

Brown R. Associations with substance abuse treatment completion among drug court participants. Substance Use & Misuse 45(12): 1874-1891, 2010. (73 refs.)

Subjects in the study included all participants (N = 573) in drug treatment court in a mid-sized U.S. city from 1996 through 2004. Administrative data from the drug court(1) included measures of demographics and socioeconomics, substance use, and criminal justice history. Stepwise multivariate logistic regression yielded a final model of failure to complete drug treatment. (2) Unemployment, lower educational attainment, and cocaine use disorders were associated with failure to complete treatment. The limitations of administrative data should be considered in the interpretation of results.

Copyright 2010, Taylor & Francis

Buckman JF; White HR; Bates ME. Psychophysiological reactivity to emotional picture cues two years after college students were mandated for alcohol interventions. Addictive Behaviors 35(8): 786-790, 2010. (39 refs.)

This study examined alcohol use behaviors as well as physiological, personality, and motivational measures of arousal in students approximately 2 years after they were mandated to a brief intervention program for violating university policies about on-campus substance use. Students were categorized into serious (medical referrals, n = 13) or minor (residence advisor referrals, n = 30) infraction groups based on the nature of the incident that led to their being mandated. Self-report measures of arousal, sensation seeking, reasons for drinking, and past 30-day alcohol use were completed. Physiological arousal during exposure to emotional picture cues was assessed by indices of heart rate variability. The minor infraction group reported significantly escalating alcohol use patterns over time and a pattern of less regulated psychophysiological reactivity to external stimuli compared to the serious infraction group. The serious infraction group was higher in sensation seeking and there was some evidence of greater disparity between their physiological and self-reported experiences of emotional arousal in response to picture cues than in the minor group. Thus, the two infraction groups represent different subsets of mandated students, both of whom may be at some risk for using alcohol maladaptively. The findings suggest that intervention strategies that address self-regulation may be beneficial for mandated college students.

Copyright 2010, Elsevier Science

Carey KB; DeMartini KS. The motivational context for mandated alcohol interventions for college students by gender and family history. Addictive Behaviors 35(3): 218-223, 2010. (32 refs.)

Objective: Alcohol interventions to reduce drinking for college students sanctioned for alcohol use reduce drinking and/or problems. However, intrinsic motivation to change cannot be assumed if students are mandated to receive interventions. The purpose of this study was to explore the influence of both gender and family history on motivational variables prior to a mandated intervention. Method: Participants were 677 students (63% male) who violated residence hall alcohol policy and were mandated to participate in an alcohol abuse prevention intervention. During a baseline assessment, students described their drinking patterns and completed an assessment of biological risk for alcohol problems; they also reported attitudes regarding the sanction event, perceived peer norms regarding sanctions, resistance to influences on their alcohol use, motivation to change alcohol use, and decisional balance regarding current alcohol use. Results: Many gender differences emerged on the motivational variables suggestive of more motivation to change among female students; family history was related only to drinking patterns and decisional balance. Conclusions: If motivational factors influence receptivity and response to mandated interventions, then these finding suggest that greater attention to enhancing motivation to change in male students is warranted.

Copyright 2010, Elsevier Science

Csete J; Kaplan K; Hayashi K; Fairbairn N; Suwannawong P; Zhang R et al. Compulsory drug detention center experiences among a community-based sample of injection drug users in Bangkok, Thailand. BMC International Health and Human Rights 11: 12, 2011. (33 refs.)

Background: Despite Thailand's official reclassification of drug users as "patients" deserving care and not "criminals," the Thai government has continued to rely heavily on punitive responses to drug use such as "boot camp"-style compulsory "treatment" centers. There is very little research on experiences with compulsory treatment centers among people who use drugs. The work reported here is a first step toward filling that gap. Methods: We examined experiences of compulsory drug treatment among 252 Thai people who inject drugs (IDU) participating in the Mitsampan Community Research Project in Bangkok. Multivariate logistic regression was used to identify factors independently associated with a history of compulsory treatment experience. Results: In total, 80 (31.7%) participants reported a history of compulsory treatment. In multivariate analyses, compulsory drug detention experience was positively associated with current spending on drugs per day (adjusted odds ratio [AOR] = 1.86; 95%CI: 1.07 - 3.22) and reporting drug planting by police (AOR = 1.81; 95%CI: 1.04 - 3.15). Among those with compulsory treatment experience, 77 (96.3%) reported injecting in the past week, and no difference in intensity of drug use was observed between those with and without a history of compulsory detention. Conclusion: These findings raise concerns about the current approach to compulsory drug detention in Thailand. Exposure to compulsory drug detention was associated with police abuse and high rates of relapse into drug use, although additional research is needed to determine the precise impact of exposure to this form of detention on future drug use. More broadly, compulsory "treatment" based on a penal approach is not consistent with scientific evidence on addressing drug addiction and should be phased out in favor of evidence-based interventions.

Copyright 2011, BioMed Central

Cusack KJ; Steadman HJ; Herring AH. Perceived coercion among jail diversion participants in a multisite study. Psychiatric Services 61(9): 911-916, 2010. (21 refs.)

Objective: Although jail diversion is considered an appropriate and humane response to the disproportionately high volume of people with mental illness who are incarcerated, little is known regarding the perceptions of jail diversion participants, the extent to which they feel coerced into participating, and whether perceived coercion reduces involvement in mental health services. This study addressed perceived coercion among participants in postbooking jail diversion programs in a multisite study and examined characteristics associated with the perception of coercion. Methods: Data collected in interviews with 905 jail diversion participants from 2003 to 2005 were analyzed with random-effects proportional odds models. Results: Ten percent of participants reported a high level of coercion, and another 26% reported a moderate level of coercion. Having a drug charge was associated with lower perceived coercion to enter the program. In addition, an interaction between sexual abuse and substance abuse indicated that recent sexual abuse was associated with higher levels of perceived coercion, but only among those without current substance abuse. At the 12-month follow-up (N=398), variables associated with higher perceived coercion to receive behavioral health services included spending more time in jail and higher perceived coercion at baseline. The amount of behavioral health service use was not predicted by perceived coercion at baseline. Rather, being older, having greater symptom severity, and having a history of sexual abuse but no substance abuse and no history of physical abuse were associated with higher levels of outpatient service use. Conclusions: Overall, one-third of jail diversion participants reported some level of perceived coercion. Important determinants of perceived coercion included charge type, length of time in jail, and sexual abuse history. Engagement in treatment was not affected by perceived coercion.

Copyright 2010, American Psychiatric Association

Darbro N. Overview of issues related to coercion and monitoring in alternative diversion programs for nurses: A comparison to drug courts: Part 2. Journal of Addictions Nursing 20(1): 24-33, 2009. (97 refs.)

Substance abuse is the most preventable health problem in the United States and has become the most common disease encountered by health care providers. Nurses and other health care professionals who abuse substances are hesitant to admit it, to seek help for it and to enter treatment for it. Those who do enter treatment for substance abuse generally do so at the instigation of others, usually from workplace interventions or complaints filed for impaired practice. Alternative diversion programs for nurses and drug courts for offenders offer initial diversion into treatment and rehabilitation for substance abuse in lieu of more formal sanctions. Even though both drug courts and alternative diversion programs are voluntary programs, legal or formal coercion is a component of the referral process. The perception of coercion may also be present in both populations because of the potential consequence of sanctions for noncompliance with the treatment and monitoring program. Issues related to internal motivation that also influence treatment entry and program participation are considered. Alternative diversion programs for nurses and drug court programs for offenders offer rehabilitative justice through social contracting principles and the application of sanctions and rewards via compulsory supervision of participants. Research has verified the value of drug courts and effectiveness of legal coercion in improving retention and outcome in treatment. Research has also verified the effectiveness of alternative diversion programs. Research is lacking on the impact of formal coercion, the influence of perceived coercion, and the outcome of nurses entering and participating in alternative diversion programs.

Copyright 2009, Taylor & Francis

Darbro N. Overview of issues related to coercion in substance abuse treatment: Part I. Journal of Addictions Nursing 20(1): 16-23, 2009. (78 refs.)

Various options for treatment entry, engagement and retention for substance abuse problems have been proposed but none is more controversial than the issue of coercing or pressuring substance abusers into treatment. Most people who need treatment won't get it, and most people who enter treatment will not complete it. The use of coercion to persuade reluctant substance abusers to enter and remain in treatment has a long history, especially in the criminal justice system. The use of coercion with other populations is also promising. This paper provides an overview of some of the current arguments for and against the use of coercion in substance abuse treatment. The three types of legal, formal and informal coercion are discussed. Issues related to motivation and intervention techniques are also reviewed. Most people cycle through a wide range of motivational influences to enter treatment. Some argue that substance abusers must choose treatment on their own for it to be effective. Others argue that coercion is effective in getting people into treatment and keeping them there long enough for it to be effective. Both internal motivation and external pressures from various sources are independent and powerful influences to enter treatment. The effectiveness of coercion in treatment retention and pervasiveness of coercion in treatment is also reviewed.

Copyright 2009, Taylor & Francis

DiFulvio GT; Linowski SA; Mazziotti JS; Puleo E. Effectiveness of the Brief Alcohol and Screening Intervention for College Students (BASICS) program with a mandated population. Journal of American College Health 60(4): 269-280, 2012. (38 refs.)

Objective: This study evaluated the effectiveness of a large-scale intervention designed to reduce alcohol abuse among adjudicated college students. Participants: Participants were college students mandated to attend a Brief Alcohol Screening and Intervention for College Students (BASICS) program and a randomly selected comparison group of high-risk drinkers. Methods: Data were collected from January 2006 through December 2008. A total of 1,390 (67%) students in the intervention group and 508 (61%) students in the comparison group completed baseline and 6-month follow-up surveys. Results: Male students in the intervention group significantly decreased their drinking at follow-up, whereas those in the comparison group increased their drinking. Women in both the intervention and comparison groups decreased their drinking at 6 months. Conclusions: When implemented with fidelity, BASICS is a generally effective intervention, especially for male adjudicated college students. The intervention was most effective for moderate- and high-risk drinkers.

Copyright 2012, Taylor & Francis

Ekendahl M. Alcohol abuse, compulsory treatment and successive aftercare: A qualitative study of client perspectives. International Journal of Social Welfare 18(3): 260-269, 2009. (40 refs.)

In Sweden, the social welfare boards have a statutory duty to provide aftercare for compulsorily treated substance abusers. However, there are no data on how the aftercare is organised and how clients perceive this phase of the compulsory treatment process. The aim of the study is to analyse how a sample of compulsorily treated alcohol abusers (n = 12) characterise the current coercive treatment episode and evaluate previously experienced and forthcoming aftercare interventions. Qualitative interview-data were coded into themes and sub-themes encompassing relevant client perspectives. Results show that the alcohol abusers claimed to want (but be denied) adequate help for their problems, both during primary treatment and after discharge. Their perspectives on coercive care and aftercare interventions appeared related to their views on their own problems and on being incarcerated. For instance, those who recognised their own alcohol problems emphasised the importance of quitting consumption and were dissatisfied with interventions offered during and subsequent to compulsory treatment referrals.

Copyright 2009, Wiley-Blackwell Publishing

Evans E; Anglin MD; Urada D; Yang J. Promising practices for delivery of court-supervised substance abuse treatment: Perspectives from six high-performing California counties operating Proposition 36. Evaluation and Program Planning 34(2): 124-134, 2011. (80 refs.)

Operative for nearly a decade, California's voter-initiated Proposition 36 program offers many offenders community-based substance abuse treatment in lieu of likely incarceration. Research has documented program successes and plans for replication have proliferated, yet very little is known about how the Proposition 36 program works or practices for achieving optimal program outcomes. In this article, we identify policies and practices that key stakeholders perceive to be most responsible for the successful delivery of court-supervised substance abuse treatment to offenders under Proposition 36. Data was collected via focus groups conducted with 59 county stakeholders in six high-performing counties during 2009. Discussion was informed by seven empirical indicators of program performance and outcomes and was focused on identifying and describing elements contributing to success. Program success was primarily attributed to four strategies, those that: (1) fostered program engagement, monitored participant progress, and sustained cooperation among participants; (2) cultivated buy-in among key stakeholders; (3) capitalized on the role of the court and the judge; and (4) created a setting which promoted a high-quality treatment system, utilization of existing resources, and broad financial and political support for the program. Goals and practices for implementing each strategy are discussed. Findings provide a "promising practices" resource for Proposition 36 program evaluation and improvement and inform the design and study of other similar types of collaborative justice treatment efforts.

Copyright 2011, Elsevier Science

Evans E; Huang D; Hser YI. High-risk offenders participating in court-supervised substance abuse treatment: Characteristics, treatment received, and factors associated with recidivism. Journal of Behavioral Health Services & Research 38(4): 510-525, 2011. (51 refs.)

High-risk offenders treated by California's Proposition 36 court-supervised drug treatment initiative account for a disproportionate number of re-arrests (Hawken 2008) undermining the many successes of the program, yet little is known about their characteristics, treatment experiences, or factors that influence re-arrest. To better understand this group, self-reported and administrative data were analyzed on 78 high-risk (five or more convictions in the previous 5 years) and 1,009 low-risk offenders enrolled during 2004. At intake, high-risk offenders were younger, more were male, and more had prior contact with psychiatric and criminal justice systems. Treatment received and the proportion recidivated during the 30-months after treatment assessment were similar across groups, but high-risk offenders had a greater number of re-arrests. The number of re-arrests was increased by high-risk classification, but decreased by receipt of more treatment services and longer treatment length. Moreover, the number of re-arrests was highest among high-risk offenders with shorter treatment lengths, whereas it was similar to that among low-risk offenders if treatment length was longer. To reduce recidivism among high-risk offenders in court-supervised drug treatment, consideration of psychiatric problems and criminal history is needed, as is receipt of sufficient treatment.

Copyright 2011, Springer

Evans E; Li LB; Hser YI. Client and program factors associated with dropout from court mandated drug treatment. Evaluation and Program Planning 32(3): 204-212, 2009. (53 refs.)

To examine why court mandated offenders dropout of drug treatment and to compare their characteristics, treatment experiences, perceptions, and outcomes with treatment completers, we analyzed self-reported and administrative data on 542 dropouts (59%) and 384 completers (41%) assessed for Proposition 36 treatment by thirty sites in five California counties during 2004. At intake, dropouts had lengthier criminal histories, lower treatment motivation, more severe employment and psychiatric problems, and more were using drugs, especially heroin. Relatively fewer dropouts received residential treatment and their retention was much shorter. A similar proportion of dropouts received services as completers and the mean number of services received per day by dropouts was generally more, especially to address psychiatric problems, during the first three months of treatment. The most commonly offender-reported reasons for dropout included low treatment motivation (46.2%) and the difficulty of the Proposition 36 program (20.0%). Consequences for dropout included incarceration (25.3%) and permission to try treatment again (24.0%). Several factors predicting drug treatment dropout were identified. Both groups demonstrated improved functioning at one-year follow-up, but fewer dropouts had a successful outcome (34.5% vs. 59.1%) and their recidivism rate was significantly higher (62.9% vs. 28.9%) even after controlling for baseline differences. Understanding factors associated with drug treatment dropout can aid efforts to improve completion rates, outcomes, and overall effectiveness of California's Proposition 36 program. Findings may also aid a broader audience of researchers and policy analysts who are charged with designing and evaluating criminal-justice diversion programs for treating drug-addicted offenders.

Copyright 2009, Elsevier Science

Garey L; Prince MA; Carey KB. Alcohol policy support among mandated college students. Addictive Behaviors 36(10): 1015-1018, 2011. (11 refs.)

Background: Alcohol consumption on college campuses is high, and often dangerous. College administrators have created policies to control alcohol consumption, but student body support or opposition of specific policies has been relatively unexplored. Method: The current study examined the relations of alcohol policy support with gender and alcohol consumption. Mandated students (N=229; 44% women) completed self-report assessments of alcohol policy support and alcohol consumption. Results: Women supported policies to a greater extent than did men, as did lighter drinkers relative to heavier drinkers. Drinks per drinking day fully mediated the relation between gender and alcohol policy support. Conclusion: While alcohol policy support differs by gender, this covariation is explained by differences in alcohol consumption. Findings have implications for addressing alcohol policy support among mandated college students.

Copyright 2011, Elsevier Science

Greaves A; Best D; Day E; Foster A. Young people in coerced drug treatment: Does the UK Drug Intervention Programme provide a useful and effective service to young offenders? Addiction Research & Theory 17(1): 17-29, 2009. (31 refs.)

Although clear relationships have been identified between dependent drug use and crime, the relationship is less evident in young offenders, particularly for less physically dependent users. This study investigated a sample of young drug-using offenders (aged 18-24; n = 36) accessing drug treatment through the criminal justice system in Birmingham, UK, using structured interviews for the collection of both qualitative and quantitative data. It identified high levels of heroin dependence, with frequency of use linked to both acquisitive crime and willingness to engage in treatment. The relationship between crack cocaine use and offending was less clear with more client ambivalence regarding desire to stop using the drug. Whilst most praised their treatment, and their workers, substitute prescribing was less positively endorsed. The study offers some support for diverting young dependent opiate users from criminal justice services into drug treatment, but presents a less positive prognosis for primary stimulant users.

Copyright 2009, Taylor & Francis

Hall EA; Prendergast ML; Roll JM; Warda U. Reinforcing abstinence and treatment participation among offenders in a drug diversion program: Are vouchers effective. Criminal Justice and Behavior 36(9): 935-953, 2009. (52 refs.)

This study assessed a 26-week voucher-based intervention to reinforce abstinence and participation in treatment-related activities among substance-abusing offenders court referred to outpatient treatment under drug diversion legislation (California's Substance Abuse and Crime Prevention Act). Standard treatment consisted of criminal justice supervision and an evidence-based model for treating stimulant abuse. Participants were randomly assigned to four groups, standard treatment (ST) only, ST plus vouchers for testing negative, ST plus vouchers for performing treatment plan activities, and ST plus vouchers for testing negative and/or performing treatment plan activities. Results indicate that voucher-based reinforcement of negative urines and of treatment plan tasks (using a flat reinforcement schedule) showed no statistically significant effects on measures of retention or drug use relative to the standard treatment protocol. It is likely that punishment and reinforcement operating within the criminal justice context had a stronger impact on participants' treatment retention and drug use than the relatively low-value vouchers awarded as part of the treatment protocol.

Copyright 2009, Sage Publications

Hampton AS; Conner BT; Albert D; Anglin MD; Urada D; Longshore D. Pathways to treatment retention for individuals legally coerced to substance use treatment: The interaction of hope and treatment motivation. Drug and Alcohol Dependence 118(2-3): 400-407, 2011. (50 refs.)

Background: Although several states have adopted policies diverting individuals convicted of non-violent drug offenses to substance use treatment, in lieu of incarceration or as a condition of probation, previous research has produced inconsistent findings on the effectiveness of such programs when comparing outcomes for legally coerced individuals to more voluntary entrants. Less studied in these populations is within group variation in treatment expectations and motivation influences, which have been shown to affect retention as well. Methods: As motivation has traditionally been viewed as contributing to treatment retention and higher levels of hope (the perception that goals can be met) are viewed as an asset in treatment, the role of these factors in predicting better retention between legally coerced and more voluntary clients were examined in a sample of 289 treatment admissions in California. Results: Results found that motivation mediates the relationship between hope and retention for participants in general. Although the differences in mediation between the legally coerced and the non-legally coerced were not significant, when examining the groups separately, there was a significant mediation of the relationship between hope and retention by motivation only for those individuals who were not legally coerced into treatment (p < .05). Conclusion: The findings imply that while being legally coerced may lead to different pathways to treatment retention, for individuals who were not legally coerced, higher levels of hope may play an important role in determining treatment retention.

Copyright 2011, Elsevier Science

Houser-Marko L; Curry SJ; Mermelstein RJ; Emery S; Pugach O. A comparison of mandated versus volunteer adolescent participants in youth tobacco cessation programs. Addictive Behaviors 36(9): 937-940, 2011. (14 refs.)

A national evaluation of community-based youth cessation programs delivered in group format provided the opportunity to compare mandated and volunteer program participants on demographics, smoking patterns, other health behaviors and motivation to quit. A total of 857 youth participants completed surveys prior to the start of their treatment program. Mandated youth comprised 24% of the sample (n = 202). Both bivariate and multivariate comparisons were conducted. Mandated participants reported lower levels of stress, higher extrinsic motivation and lower intrinsic motivation to quit, and were more likely to be in the earlier (precontemplation) stage of readiness to quit. Mandated and volunteer smokers did not differ in their smoking patterns, school-related smoking behaviors, or binge drinking. Rates of smoking, school problems, and binge drinking were higher among cessation program participants than in general samples of youth. Programs with mixed voluntaty-mandatory participation may benefit from extra attention to motivational issues.

Copyright 2011, Elsevier Science

Hustad JTP; Short EE; Borsari B; Barnett NP; Tevyaw TO; Kahler CW. College alcohol citations result in modest reductions in student drinking. Journal of Substance Abuse Treatment 40(3): 281-286, 2011. (22 refs.)

College students who are cited for violating campus alcohol policy are often fined or sanctioned to complete an intervention or public service. Although some interventions have been found efficacious for mandated students, it is possible that being cited for an alcohol-related incident alone may be sufficient to reduce alcohol consumption. The purpose of this study was to investigate the course of alcohol consumption patterns following a citation for an alcohol policy violation. Participants were college students (N = 445) who received a citation for a campus alcohol policy violation at a small northeastern liberal arts college. Participants completed a Timeline Follow-Back indicating their daily alcohol use 2 weeks prior to the citation through 2 weeks after the citation. Results indicated that participants decreased their alcohol use following a citation event. However, the reduction in alcohol consumption was modest, suggesting that the citation event itself has a very temporary influence on the drinking of college students. Additional research is needed to reconcile these findings with those from other studies that found a more meaningful citation effect.

Copyright 2011, Elsevier Science

Ilgen MA; McLouth C; Barry KL; Walton M; Cole PA; Dabrowski MP et al. Pain interference in individuals in driver intervention programs for driving under the influence offenders. Substance Use & Misuse 45(9): 1406-1419, 2010. (26 refs.)

Pain-related problems among individuals in court-mandated Driver Intervention Programs (DIPs) for "driving under the influence" (DUI) offenders have not been well studied. This project examines 3,189 individuals from a DIP in Dayton, Ohio. Over 11% of participants reported significant pain-related interference in the past 4 weeks. Pain was significantly more likely in those with depression, more childhood conduct problems, and recent use of multiple illicit drugs. Many individuals seen in court-mandated DIP programs for DUI offenders also report difficulties with pain. DIP programming should address pain in relation to substance use and mental health issues.

Copyright 2010, Taylor & Francis

Israelsson M. Welfare, temperance and compulsory commitment to care for persons with substance misuse problems: A comparative study of 38 European countries. European Addiction Research 17(6): 329-341, 2011. (52 refs.)

Aims: The study explores the existence and types of law on compulsory commitment to care (CCC) of adult substance misusers in Europe and how such laws are related to variations in demographics, alcohol consumption and epidemiology in misuse of opiates, cocaine, amphetamines, temperance culture heritage, health and welfare expenditure, and involvement and role of the state in welfare distribution. Material and Methods: Legal information on laws on CCC of misusers was obtained primarily through a survey of 38 European countries. Predictors of laws on CCC, and types of such, were analyzed from country descriptors in multivariate models. Results: A majority (74%) of the explored countries have a law concerning CCC. The most common type of CCC law is within criminal justice legislation (45%), but civil CCC is almost as frequent (37%). These two models of CCC legislation are related to differences in cultural heritage and welfare distribution models. Conclusions: Temperance cultures, i.e. countries with a history of a strong temperance movement, and countries with a Beveridgean distribution of welfare, i.e. through the state, tend to favor civil CCC, while countries with a Bismarckian distribution of welfare, i.e. through insurance with less state interference, tend to favor CCC within criminal justice legislation.

Copyright 2011, Karger

Johnson JE; Friedmann PD; Green TC; Harrington M; Taxman FS. Gender and treatment response in substance use treatment-mandated parolees. Journal of Substance Abuse Treatment 40(3): 313-321, 2011. (53 refs.)

Well-controlled, randomized studies of correctional interventions examining gender effects are rare. This study examined gender main effects and gender x treatment interactions in a multisite randomized trial (N = 431) comparing a new form of correctional supervision for drug-involved offenders (collaborative behavioral management [CBM]) to standard parole. Outcomes included repeated measures of yes/no use of primary drug, alcohol use, and recidivism during 9 months postrelease. Generalized estimating equation analyses indicated that despite using harder drugs at baseline, women were less likely than men to use their primary drug and to use alcohol during the follow-up period. No gender-related differences in recidivism were found. Treatment interacted with gender to predict alcohol use, with women in CBM reporting the best alcohol outcomes (only 5% of women used alcohol during the follow-up period). The clear expectations, positive reinforcement, recognition of successes, fairness, and support present in CBM may be particularly important for women parolees.

Copyright 2011, Elsevier Science

LaChance H; Ewing SWF; Bryan AD; Hutchison KE. What makes group MET work? A randomized controlled trial of college student drinkers in mandated alcohol diversion. Psychology of Addictive Behaviors 23(4): 598-612, 2009. (92 refs.)

Nationally, college drinkers exhibit the highest rates of alcohol consumption and represent the largest percentage of problem drinkers. Group motivational enhancement therapy (GMET) has been found to catalyze problem drinking reductions among college student samples. Although research supporting the use of single-session GMET in college samples (general and mandated) is emergent, no studies have evaluated a comprehensive model of the potential active ingredients of this group intervention. College students (N = 206; 88% White; 63% men; M age = 18.6) mandated to a university alcohol diversion program were randomly assigned to 1 of 3 conditions: the standard-of-care 2-session "Focus on Alcohol Concerns" education group (FAC), a single GMET, or a single alcohol information-only control group (AI) to evaluate the role of 5 putative mediators: readiness to change, self-efficacy, perceived risk, norm estimates, and positive drinking expectancies. At 3- and 6-month follow-ups, GMET students demonstrated greater reductions in problem drinking outcomes (drinks per drinking day, hazardous drinking symptoms, and alcohol-related problems). Of the 5 mediators proposed, only self-efficacy emerged as a significant mediator.

Copyright 2009, Educational Publishing Foundation

Lapham S; England-Kennedy E. Convicted driving-while-impaired: Offenders' views on effectiveness of sanctions and treatment. Qualitative Health Research 22(1, special issue): 17-30, 2012. (66 refs.)

In this article we analyze qualitative data from a multiple-method, longitudinal study drawn from 15-year follow-up interviews with a subsample of 82 individuals arrested for driving while intoxicated in a southwestern state (1989-1995). We explore reactions to the arrest and court-mandated sanctions, including legal punishments, mandated interventions, and/or participation in programs aimed at reducing recidivism. Key findings include experiencing certain negative emotional reactions to the arrest, reactions to being jailed, experiencing other court-related sanctions as deterring driving-while-intoxicated behavior, and generally negative opinions regarding court-mandated interventions. We discuss interviewees' complex perspectives on treatment and program participation and their effects on lessening recidivism, and we offer suggestions for reducing recidivism based on our findings.

Copyright 2012, Sage Publications Inc

Lindahl ML; Ojehagen A; Berglund M. Commitment to coercive care in relation to substance abuse reports to the social services. A 2-year follow-up. Nordic Journal of Psychiatry 64(6): 372-376, 2010. (14 refs.)

Background: In Sweden, a person with substance abuse can be reported to the social services for an investigation about commitment to coercive care. After a change in legislation, municipalities varied greatly in the ratio of commitments/reports compared with the period before the legislation was amended. Aims: The primary aims of this study were first, to investigate whether subjects from municipalities with a high ratio of commitments/reports have a better outcome compared with subjects from municipalities with a low ratio and second, if a high ratio has an impact on mortality. Methods: The study involved two municipalities with high ratio of commitments/reports with 56 cases reported for substance abuse including 31 committed cases (55%). It also included two municipalities with a low ratio, 50 reported cases including six committed cases (12%). Two social service inspectors at the country administrative board assessed the cases in terms of severity of addiction according to legal criteria (kappa(s)=0.66), indicating good inter-rater agreement. A global index based on information about substance abuse, employment and housing was used as outcome measure at the 2-year follow-up. Results: Global outcome did not differ between cases from high- and low-ratio municipalities. Seven subjects had deceased because of causes related to substance abuse. None of the deceased had been committed to coercive care. Conclusions and clinical implications: In conclusion, the different ratios of commitments/reports did not influence global outcome. Commitment may reduce substance-related deaths.

Copyright 2010, Taylor& Francis

Lowmaster SE; Morey LC; Baker KL; Hopwood CJ. Structure, reliability, and predictive validity of the Texas Christian University Correctional Residential Self-Rating Form at intake in a residential substance abuse treatment facility. Journal of Substance Abuse Treatment 39(2): 180-187, 2010. (36 refs.)

This study examined the structure and predictive validity of the Texas Christian University Correctional Residential Self-Rating Form at Intake in a court mandated inpatient substance abuse treatment facility (N = 729). Client characteristics such as treatment motivation and psychological and social functioning were examined as predictors of prospective behavioral outcomes including compliance with treatment program rules and guidelines as well as completion of the treatment program. Results suggest that a broad indicator of individuals' pretreatment motivation predicted their ability to complete the program. Treatment noncompliance, as measured by the number of rule infractions committed during the inpatient treatment, was significantly predicted by individuals' propensity to externalize their symptoms. Implications for the effective use of the CR SRF-Intake as a screener for potential treatment problems are discussed as well as possible targets for interventions in substance abuse populations.

Copyright 2010, Elsevier Science

Lundgren L; Brannstrom J; Armelius BA; Chassler D; Moren S; Trocchio S. Association between immigrant status and history of compulsory treatment in a national sample of individuals assessed for drug use disorders through the Swedish public welfare system. Substance Use & Misuse 47(1): 67-77, 2012. (38 refs.)

In-person interview data from 13,903 individuals assessed for a drug use disorder in the Swedish welfare system from 2002-2008, were analyzed using logistic regression methods. Second generation immigrants with non-Scandinavian parents were 41% more likely to report a history of compulsory treatment compared to those born in Sweden to Swedish parents after controlling for age, gender, education, mental health treatment homeless status history, and criminal justice history. Implications include the need to study acculturation, stigma, and discrimination-related factors as well as to promote culturally competent outreach to immigrant populations.

Copyright 2012, Informa Healthcare

Mackain SJ; Lecci L. Perceived coercion in substance abuse treatment: The eye of the beholder? Journal of Substance Use 15(1): 24-30, 2010. (26 refs.)

Aims: To examine potential differences in subjective perceptions of coercion between substance abuse professionals and clients in how they view events that trigger entry to treatment. Such differences may influence both the clinician's approach and the client's response to treatment. Participants, measurement and findings: Seventy-four substance abuse treatment outpatients and 75 certified substance abuse clinicians rated 15 treatment entry-related events based on the degree of choice an individual would have in entering treatment. Clients perceived internal sources of coercion as more coercive, whereas the clinicians perceived external items as more coercive. Furthermore, clients' views of external coercive events appeared to be more uni-dimensional than for internal events, whereas clinicians perceived internal events as more cohesive relative to external events. Conclusions: Discrepant perceptions of treatment entry triggers may impact the development of a working alliance and the use of motivational strategies intended to enhance readiness to change. Further investigation into these divergent perceptions is needed to untangle the relationships among client and clinician assumptions, readiness for change, and treatment outcome.

Copyright 2010, Informa Healthcare

Magyar MS; Edens JF; Lilienfeld SO; Douglas KS; Poythress NG. Examining the relationship among substance abuse, negative emotionality and impulsivity across subtypes of antisocial and psychopathic substance abusers. journal of criminal justice 39(3, special issueI): 232-237, 2011. (47 refs.)

Growing evidence suggests that individuals with Antisocial Personality Disorder (ASPD) can be categorized into theoretically meaningful subtypes. This study builds on earlier cluster-analytic research (Poythress et al., 2010) that identified four subtypes of ASPD in a large sample of prison inmates and offenders ordered into mandatory substance abuse treatment. These four subtypes ( primary, secondary, and "fearful" psychopathic and non-psychopathic ASPD) differed in theoretically important ways on various criterion measures. Of those participants in substance abuse treatment (N = 571), we compare the four clusters, as well as non-ASPD substance abusers, in terms of (a) the severity of their self-reported alcohol and drug problems and (b) whether the severity of their substance abuse is predicted by similar etiologically important correlates (i.e., negative emotionality, impulsivity). There were modest subgroup. differences in abuse, although as expected secondary psychopaths reported more severe misuse than primary psychopaths. Associations between impulsivity and negative emotionality and drug use for the total sample were in the expected direction, though relatively modest in magnitude. Unexpectedly, these associations were weaker among psychopathic subtypes relative to the non-psychopathic subgroups. These findings suggest that the etiology of drug use may differ across subgroups of chronically antisocial individuals.

Copyright 2011, Elsevier Science

Mendelevich VD. Bioethical differences between drug addiction treatment professionals inside and outside the Russian Federation. Harm Reduction Journal 8: article 15, 2011. (31 refs.)

This article provides an overview of a sociological study of the views of 338 drug addiction treatment professionals. A comparison is drawn between the bioethical approaches of Russian and foreign experts from 18 countries. It is concluded that the bioethical priorities of Russian and foreign experts differ significantly. Differences involve attitudes toward confidentiality, informed consent, compulsory treatment, opioid agonist therapy, mandatory testing of students for psychoactive substances, the prevention of mental patients from having children, harm reduction programs (needle and syringe exchange), euthanasia, and abortion. It is proposed that the cardinal dissimilarity between models for providing drug treatment in the Russian Federation versus the majority of the countries of the world stems from differing bioethical attitudes among drug addiction treatment experts.

Copyright 2011, BioMed Central

Merlo LJ; Greene WM; Pomm R. Mandatory naltrexone treatment prevents relapse among opiate-dependent anesthesiologists returning to practice. Journal of Addiction Medicine 5(4): 279-283, 2011. (26 refs.)

Objective: Anesthesiologists with opioid use disorders are at high risk for relapse. In 2005, the impaired professionals monitoring program of the State of Florida implemented a policy whereby anesthesiologists referred for opiate use disorders were contractually obligated to take naltrexone for 2 years. Naltrexone ingestion was witnessed and verified via random urine drugs screens or administered via intramuscular injection. Method: Charts were reviewed for the 11 anesthesiologists who underwent mandated pharmacotherapy with naltrexone, and 11 anesthesiologists who began monitoring immediately before implementation of this policy. Results: Eight of 11 anesthesiologists who did not take naltrexone experienced a relapse on opiates. Only 1 of 11 anesthesiologists experienced a relapse on opiates after taking naltrexone, whereas another relapsed on an inhalant (nitrous oxide). It is noteworthy that 5 of the 11 anesthesiologists who took naltrexone had relapsed before naltrexone treatment, and 7 of the 11 anesthesiologists who did not take naltrexone experienced multiple documented relapses. Only 1 of the 11 anesthesiologists who did not take naltrexone successfully returned to the practice of anesthesiology. This individual suffered primarily from alcohol dependence, and suspected opiate abuse was never verified. Others who attempted return to anesthesiology (n = 7) suffered a relapse. In comparison, 9 of the 11 anesthesiologists who took naltrexone have returned to the practice of anesthesiology without a relapse (as verified by continued random urine and hair testing). Conclusion: Mandatory naltrexone treatment may provide anesthesiologists with an additional safeguard to successfully return to work.

Copyright 2011, Lippincott, Williams & Wilkins

Mohamed S. Mandatory assessment of drug users in Malaysia: Implications on human rights. Drugs: Education, Prevention and Policy 19(3): 227-233, 2012. (18 refs.)

Aim: The study is founded upon a critical analysis of the extent to which the mandatory drug assessment in funneling drug users under Malaysia's compulsory treatment and rehabilitation programme is consistent with the principles of human rights guaranteed under the Malaysian Constitution. Method: Empirical qualitative data from a case study encompassing direct observations of natural sites, a focus group comprising former and recovering drug users, secondary data from official documents and case files. Results: Findings show that the mandatory drug assessment of drug users is subject to arbitrary arrest, unnecessary prolonged detention, lack of medical assistance and non-compliance to due process. Conclusions: The mandatory drug assessment of drug users in Malaysia entails serious infringements of the principles of human rights.

Copyright 2012, Informa HealthCare

Novins DK; Spicer P; Fickenscher A; Pescosolido B. Pathways to care: Narratives of American Indian adolescents entering substance abuse treatment. Social Science & Medicine 74(12): 2037-2045, 2012. (46 refs.)

Using data from 89 American Indian adolescents and guided by the Network Episode Model, this paper analyses pathways to residential substance abuse treatment and their correlates. These adolescents were recruited at admission to a tribally-operated substance abuse treatment program in the southern United States from October 1998 to May 2001. Results from the qualitative analyses of these adolescent's pathways to care narratives indicated that 35% ultimately agreed with the decision for their entry into treatment; 41% were compelled to enter treatment by others, usually by their parents, parole officers, and judges; and 24% did not describe a clear pathway to care. In the multinomial logistic regression model examining correlates of these pathways to care classifications, adolescents who described pathways indicative of agreement also reported greater readiness for treatment than the adolescents who described compelled or no clear pathways to care. Adolescents who described a Compelled pathway were less likely to meet diagnostic criteria for Conduct Disorder and described fewer social network ties. We were unable to find a relationship between pathways classifications and referral source, suggesting these narratives were subjective constructions of pathways to care rather than a factual representation of this process. In the final logistic regression model examining correlates of treatment completion, articulating a pathway to care, whether it was one of agreement or of being compelled into treatment, predicted a greater likelihood of completing treatment. Overall, these narratives and their correlates are highly consistent with the Network-Episode Model's emphasis on the interaction of self, situation, and social network in shaping the treatment seeking process, demonstrating the applicability of this model to understanding the treatment seeking process in this special population and suggests important considerations for understanding the dynamics of service utilization across diverse communities.

Copyright 2012, Elsevier Science

Oser CB; Harp KLH; O'Connell DJ; Martin SS; Leukefeld CG. Correlates of participation in peer recovery support groups as well as voluntary and mandated substance abuse treatment among rural and urban probationers. Journal of Substance Abuse Treatment 42(1): 95-101, 2012. (41 refs.)

This study explores the correlates of probationers' participation in 12-step programs, voluntary treatment, and mandated treatment, with respect to the geographic location of where the services are being provided as the primary covariate of interest. Data were derived from face-to-face interviews with rural and urban probationers (N=1,464). Results of the three logistic regression models suggested that even when all the covariates are taken into account, urban probationers were significantly more likely to have been involved in 12-step programs, voluntary treatment, and mandated treatment over their lifespan. Despite high levels of self-reported substance use among all participants, treatment services were underused by rural probationers. These data suggest that individuals residing in rural communities may face additional barriers to receiving treatment services and that criminal involvement is associated with participation in peer recovery support groups and treatment. Future studies can investigate criminal involvement as an avenue to enhance recovery and how to overcome treatment barriers in rural areas.

Copyright 2012, Elsevier Science

Powell C; Christie M; Bankart J; Bamber D; Unell I. Drug treatment outcomes in the criminal justice system: What non-self-report measures of outcome can tell us. Addiction Research & Theory 19(2): 148-160, 2011. (46 refs.)

Coerced drug treatment has become a common route for drug users to enter drug treatment in the UK and has been shown to be effective in reducing drug use and offending. This article presents the non-self-report measures of offending and drug use for one such treatment. The results support the findings of other studies in that those with lower offending rates prior to starting treatment and lower drug use during treatment show reduced offending following treatment commencement. More serious drug-using offenders showed limited changes in their offending following drug treatment. Possible explanations for this are discussed.

Copyright 2011, Informa Healthcare

Prendergast M; Greenwell L; Farabee D; Hser YI. Influence of perceived coercion and motivation on treatment completion and re-arrest among substance-abusing offenders. Journal of Behavioral Health Services & Research 36(2): 159-176, 2009. (67 refs.)

The effects of perceived coercion and motivation on treatment completion and subsequent re-arrest were examined in a sample of substance-abusing offenders assessed for California's Substance Abuse and Crime Prevention Act (SACPA) program. Perceived coercion was measured with the McArthur Perceived Coercion Scale; motivation was measured with the subscales of the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). At treatment entry, clients were more likely to believe that they had exercised their choice in entering treatment than that they had been coerced into treatment. SACPA clients scored relatively low on Recognition and Ambivalence regarding their drug use but relatively high on Taking Steps to address their drug problem. Correlations between perceived coercion and motivation measures at treatment entry indicated that these are separate constructs. In logistic regression models, the Recognition subscale of the SOCRATES significantly predicted "any re-arrest," and Ambivalence and Taking Steps predicted "any drug arrest.".

Copyright 2009, Springer

Robbins PC; Callahan L; Monahan J. Perceived coercion to treatment and housing satisfaction in housing-first and supportive housing programs. Psychiatric Services 60(9): 1251-1253, 2009. (5 refs.)

Objectives: This study of five housing programs across the United States examined whether the type of program-housing first or supportive housing-is related to an explicit requirement that residents adhere to mental health and substance abuse treatment, to residents' subjective perceptions that treatment adherence was being coerced, and to residents' housing satisfaction. Methods: Interviews were conducted with 136 residents of housing programs at five sites. Results: Results showed that compared with residents in supportive housing programs, those in housing-first programs were significantly less likely to report that mental health treatment adherence was an explicit requirement of obtaining housing and less likely to report that mental health and substance abuse treatment was a requirement of retaining housing. There was no difference between the programs in residents' satisfaction with their housing. Conclusions: Housing-first programs achieved a level of client satisfaction comparable to that of supportive housing programs while apparently staying consistent with their guiding "no coerced treatment" philosophy.

Copyright 2009, American Psychiatric Association

Schaub M; Stevens A; Berto D; Hunt N; Kerschl V; McSweeney T et al. Comparing outcomes of 'voluntary' and 'quasi-compulsory' treatment of substance dependence in Europe. European Addiction Research 16(1): 53-60, 2010. (50 refs.)

Aim: This study evaluates quasi-compulsory drug treatment (QCT) arrangements for substance-dependent offenders receiving treatment instead of imprisonment in comparison to voluntary treatment within five European countries. Methods: Participants were interviewed with the European Addiction Severity Index, the ASI-crime module, questions on perception of pressure and self-efficacy, and the Readiness-to-Change Questionnaire at treatment entry and after 6, 12, and 18 months. Results: Reductions in substance use and crime as well as improvements in health and social integration were observed in QCT and voluntary treatment groups. After controlling for various factors, subjects in the QCT and the comparison group showed similar reductions in substance use and crime over time. Study retention was comparable in both groups. Conclusion: QCT is as effective as voluntary treatment provided in the same services in reducing substance use and crime.

Copyright 2010, Karger

Scott MC; Edwards L; Lussier LR; Devine S; Easton CJ. Differences in legal characteristics between Caucasian and African-American women diverted into substance abuse treatment. Journal of the American Academy of Psychiatry and the Law 39(1): 65-71, 2011. (29 refs.)

In this exploratory study. we examined differences in the legal characteristics of Caucasian and African-American female offenders (n = 122) who were diverted into substance abuse treatment, to identify any racial disparities. We also examined the differences between groups in demographics and in substance abuse, family, and violence histories. In terms of legal characteristics, the results showed that African-American female offenders were significantly more likely to have been incarcerated at the time of their substance dependency evaluation than were Caucasian female offenders. Also, African-American women were more likely to have served 13 months for the current legal charge in comparison to the 4 months served by Caucasian women, although no differences were found between groups in the severity of the current legal charge. Comparison of demographics and substance abuse, family, and violence histories indicated that African-American women were more likely to be undereducated, crack cocaine dependent, and overly exposed to violence. Overall, the sample of female offenders evidenced severe substance dependency problems, a strong need for inpatient substance abuse treatment, and chronic legal and social difficulties. Implications of these findings are discussed in relation to unbalanced sentencing policies and increasing awareness of the treatment needs of this unique population.

Copyright 2011, American Academy of Psychiatry and the Law

Snyder CMJ; Anderson SA. An examination of mandated versus voluntary referral as a determinant of clinical outcome. (review). Journal of Marital and Family Therapy 35(3): 278-292, 2009. (109 refs.)

A literature review was undertaken to examine evidence for the effectiveness of psychotherapy with mandated clients. The primary question addressed was whether or not clients mandated to therapy, whether by court order or by order of their employers, show poorer outcomes than clients who enter therapy voluntarily. To this end, research on client resistance and motivational readiness to change was reviewed. This was followed by an examination of research on the effectiveness of mandated treatment. The question of the potential influence of relationship factors such as the therapeutic alliance was also addressed. The literature review was followed by suggestions for future research on the effectiveness of treatment for clients with mandated or voluntary referral status.

Copyright 2009, American Association of Marriage and Family Therapy

Soliman S; Pollack HA; Alexander JA. Who cares for involuntary clients? Substance Abuse 30(1): 1-13, 2009. (25 refs.)

The objectives of this study were to compare characteristics of outpatient substance abuse treatment (OSAT) units that serve high proportions of involuntary clients (ICs) with those that serve a low percentage of such clients. The authors analyze unit-level 1995-2005 data from the National Drug Abuse Treatment System Survey (NDATSS). Approximately 1/6 of OSAT units draw the dominant majority of their clients from involuntary referrals. OSAT units that treat a high proportion of ICs are less likely to be accredited by professional organizations, have fewer treatment staff with advanced degrees, and have shorter average treatment duration than do OSAT units that serve few ICs. OSAT units that serve ICs are more likely to offer legal and domestic violence services but are less likely to offer mental health services or aftercare. OSAT units that serve ICs are less likely to be hospital-affiliated than are other units. Clients at such facilities are more likely to be convicted of driving while intoxicated (DWI), are younger, are less likely to have received prior treatment, are more likely to remain abstinent after treatment, but are more likely to be remanded back to courts. The authors conclude that ICs are an important market niche in OSAT care. DWI is by far the most common offense reported in units that specialize in ICs. Aside from legal and domestic violence services, units with a high proportion of ICs appear to offer somewhat less intensive and professionalized services than do other facilities; however, clients at these units are more likely to be abstinent at the end of treatment and but more likely to be remanded.

Copyright 2009, Taylor & Francis

Terlecki MA; Larimer ME; Copeland AL. Clinical outcomes of a brief motivational intervention for heavy drinking mandated college students: A pilot study. Journal of Studies on Alcohol and Drugs 71(1): 54-60, 2010. (39 refs.)

Objective: The aim of this study was to evaluate a brief motivational intervention (BMI) for reducing risky alcohol use and alcohol-related problems among mandated (M) and voluntary (V) student drinkers to determine (a) whether BMI-mandated students report greater decreases in alcohol use and related problems, relative to no treatment; (b) whether a BMI is comparably effective for mandated and voluntary students; and (c) whether a mandated control group shows greater changes in alcohol use and related problems relative to a voluntary control group. Method: Participants were undergraduate student research volunteers (62% male) who met heavy drinking criteria and completed measures of alcohol use and alcohol problems at baseline and 4 weeks after intervention. Participants (N = 84) were randomly assigned to treatment (T) or assessment-only control (C) conditions (mandated students were assigned to a brief wait list). Results: Participants assigned to treatment reported consuming fewer drinks after the intervention (MT: M = 14.11 drinks; VT: M = 14.05) relative to control groups (MC: M = 20.71; VC: M = 16.53). Evaluation of alcohol-related problems indicated a significant effect of referral status, such that mandated students reported significantly fewer problems at the follow-up assessment relative to volunteers. Conclusions: BMIs are comparably effective for mandated and voluntary students and may result in larger reductions in alcohol use than disciplinary attention alone. More longitudinal research is needed to evaluate the long-term impact of a BMI among mandated students.

Copyright 2010, Alcohol Research Documentation

Terplan M; Smith EJ; Kozloski MJ; Pollack HA. "Compassionate coercion": Factors associated with court-mandated drug and alcohol treatment in pregnancy 1994-2005. Journal of Addiction Medicine 4(3): 147-152, 2010. (17 refs.)

Objectives: To describe trends in court-mandated treatment in pregnancy. In particular, to determine whether pregnant women who enter treatment via the criminal justice system differ from women who enter voluntarily. Methods: Data were obtained from the Treatment Episode Data Set, an administrative data set that captures admissions to federally funded treatment centers in the United States. Demographic and treatment-related measures were examined among pregnant women comparing referral source and stratified by year of admission to assess trends over time. Results: Throughout the study period, the proportion of pregnant women entering substance abuse treatment via the criminal justice system increased more rapidly than the increase observed among men or nonpregnant women reaching 30.9% by 2005. Compared with voluntary admissions, admissions originating in the criminal justice system were more likely to be white, young, and employed. The primary substances compelling court-mandated treatment for pregnant women were alcohol and cocaine in 1994, and by 2005 it had shifted to amphetamine and marijuana. Conclusion: The increase in criminal justice referrals parallels the growth of drug courts. The demographic characteristics of the pregnant referrals, however, suggest the presence of gaps in both screening and treatment in pregnancy.

Copyright 2010, American Society of Addiction Medicine

Tiger R. Drug courts and the logic of coerced treatment. Sociological Forum 26(1): 169-182, 2011. (42 refs.)

This article examines the social and historical significance of coerced drug treatment within the criminal justice system. Drug courts, the most prominent example of this approach, serve as a case study to explore how seemingly contradictory perspectives on substance use-therapeutic and punitive-are merged to justify increased criminal justice oversight of defendants in the name of facilitating recovery. Drawing on an analysis of drug court organizational documents and interviews with key advocates, this article (1) examines the punitive, therapeutic, and medical knowledge drug court advocates draw on and construct to justify an increased role for the courts in solving the problem of addiction, and (2) links these theories historically to broader discussions about the causes of crime and the courts' role in solving social problems. Overall, this article considers how scientific theories are fused with moral considerations in the name of an "enlightened" criminal justice approach to complex social problems.

Copyright 2011, Wiley-Blackwell

Urbanoski KA. Coerced addiction treatment: Client perspectives and the implications of their neglect. (review). Harm Reduction Journal 7: article 10, 2010. (128 refs.)

Recent work has criticized the evidence base for the effectiveness of addiction treatment under social controls and coercion, suggesting that the development of sound policies and treatment practices has been hampered by numerous limitations of the research conducted to date. Implicit assumptions of the effectiveness of coerced treatment are evident in the organization and evolution of treatment, legal, and social service systems, as well as in related legislative practices. This review builds upon previous work by focusing in greater detail on the potential value of incorporating client perspectives on coercion and the implications for interpreting and applying existing research findings. Reviewing the existing empirical and theoretical literature, a case is made for greater accuracy in representing coercive experiences and events in research, so as to better align the measured concepts with actual processes of treatment entry and admission. Attention is given to studies of the effectiveness of treatment under social controls or pressures, the connections to coercion and decision-making, and theoretical perspectives on motivation and behaviour change, including Self-Determination Theory in particular. This synthesis of the available research on coerced addiction treatment suggests that it remains largely unclear to what extent many of the commonly employed methods for getting people into treatment may be detrimental to the treatment process and longer-term outcomes. The impact of coercion upon individual clients, treatment systems, and population health has not been adequately dealt with by addiction researchers to date.

Copyright 2010, BioMed Central

Weisner C; Lu Y; Hinman A; Monahan J; Bonnie RJ; Moore CD et al. Substance use, symptom, and employment outcomes of persons with a workplace mandate for chemical dependency treatment. Psychiatric Services 60(5): 646-654, 2009. (42 refs.)

Objective: This study examined the role of workplace mandates to chemical dependency treatment in treatment adherence, alcohol and drug abstinence, severity of employment problems, and severity of psychiatric problems. Methods: The sample included 448 employed members of a private, nonprofit U. S. managed care health plan who entered chemical dependency treatment with a workplace mandate (N=75) or without one (N=373); 405 of these individuals were followed up at one year (N=70 and N=335, respectively), and 362 participated in a five-year follow up (N=60 and N=302, respectively). Propensity scores predicting receipt of a workplace mandate were calculated. Logistic regression and ordinary least-squares regression were used to predict length of stay in chemical dependency treatment, alcohol and drug abstinence, and psychiatric and employment problem severity at one and five years. Results: Overall, participants with a workplace mandate had one- and five-year outcomes similar to those without such a mandate. Having a workplace mandate also predicted longer treatment stays and improvement in employment problems. When other factors related to outcomes were controlled for, having a workplace mandate predicted abstinence at one year, with length of stay as a mediating variable. Conclusions: Workplace mandates can be an effective mechanism for improving work performance and other outcomes. Study participants who had a workplace mandate were more likely than those who did not have a workplace mandate to be abstinent at follow-up, and they did as well in treatment, both short and long term. Pressure from the workplace likely gets people to treatment earlier and provides incentives for treatment adherence.

Copyright 2009, American Psychiatric Association

Worrall JL; Hiromoto S; Merritt N; Du D; Jacobson JO; Iguchi MY. Crime trends and the effect of mandated drug treatment: Evidence from California's Substance Abuse and Crime Prevention Act. Journal of Criminal Justice 37(2): 109-113, 2009. (20 refs.)

The Substance Abuse and Crime Prevention Act (SACPA), implemented statewide in California in July 2001, mandates drug treatment rather than incarceration for certain nonviolent drug offenders. Critics of the legislation suggest that crime increased as a result of the legislation, but researchers have largely ignored this issue. Utilizing time series methodology applied across several independent data sets from Orange County, California, the effects of SACPA on crime were assessed. Results indicate that significant increases in commercial burglaries and paraphernalia arrests may have been attributed to SACPA, but the overall pattern does not support a conclusion that crime increased markedly.

Copyright 2009, Elsevier Science