Evaluating the Efficacy of New York City Drug Court Treatment Programs Shivani Mantha Swarthmore College Class of 2014 Senior Public Policy Thesis

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1 Evaluating the Efficacy of New York City Drug Court Treatment Programs Shivani Mantha Swarthmore College Class of 2014 Senior Public Policy Thesis

2 Table of Contents Summary.3 Introduction...3 Part I. New York City Drug Courts: Policies and Procedures..5 Part II: Drug Court Outcomes...12 Part III: Analysis of Drug Court Procedures and Policies..20 Part IV: Policy Implications...24 Part V: Policy Recommendations..28 Conclusion 32 Works Cited..34 2

3 Evaluating the Efficacy of New York City Drug Court Treatment Programs Summary: The New York City Drug Court Initiative was founded as a response to the punitive Rockefeller Drug Laws to decrease the number of drug using defendants in the criminal justice system. The Drug Court Initiative seeks to divert drug-using defendants into treatment programs to eliminate the revolving door between drug-addicted defendants and the criminal justice system. This paper determined the ability of the Drug Court Initiative to achieve its goal by analyzing the policies and procedures of the New York City Drug Courts and discussing the outcomes of New York State and nationwide drug court evaluations. The outcomes of past evaluations suggest that drug courts can produce lower recidivism rates than the conventional criminal justice system, although the successes of drug courts seem to be attributed solely to drug court graduates. Drug court graduates also tend to have milder drug addictions than drug court dropouts, indicating that drug court treatment programs are not suited to deal with more highly addicted defendants. This paper argues that the punitive philosophies informing drug court policies and procedures result in disparate outcomes experienced by defendants of varying levels of addiction. In order for drug courts to truly serve as an alternative to incarceration for all defendants, policies that impede the success of more severely addicted individuals must be abolished. Introduction: The New York City Drug Court Initiative was founded in response to the effects of the national War on Drugs, which resulted in the mass incarceration of individuals convicted of drug possession, use, and sales. The War on Drugs was initially announced by President Richard Nixon in 1971, but was intensified under the presidency of Ronald Reagan. As such, national drug policy during the 1980 s and the 1990 s was characterized by zero-tolerance drug policies that resulted in the harsh penalization of low-level drug crimes such as drug possession 3

4 ( Background on Drug Law 2). The conceptualization of drug use as a crime that must be curtailed by strict incarceration penalties resulted in an overflow of defendants in the criminal justice system, incurring massive expenses and imposing an enormous burden on society. The effects of punitive national drug policy were further compounded in New York State by the establishment of the Rockefeller Drug Laws in The Rockefeller Drug Laws required mandatory prison sentencing of any individual convicted of unlawful possession or sales of controlled substances (Siegel, Perry, and Carey 3). For example, sale of more than one ounce of heroin or possession of more than two ounces of heroin resulted in a minimum fifteen-year prison sentence ( Nation s Toughest Drug Law 3). These disproportionately harsh sentences resulted in a total of nearly 200,000 individuals who were imprisoned for drug offenses in New York State since Currently, nearly 20 percent of New York State remains incarcerated for drug offenses, costing the state nearly 500 million dollars a year ( Background on Drug Law 2). Importantly, the Rockefeller drug laws were reformed in 2009 to eliminate the mandatory prison sentences, expand judicial discretion in sentencing, and create more treatment alternatives to incarceration ( Assessing the Efficacy 3). Yet the remnants of severe criminalization policies still pose a significant burden on the criminal justice system. The New York City Drug Court Initiative was established to shift drug policies to a health centered approach by diverting drug-using offenders to treatment. The focus of the Drug Court Initiative is to decrease the costs borne by the criminal justice system by treating qualifying drug-using offenders of their drug addictions, thereby addressing the disease that might result in criminal behaviors. Question: Are the drug court policies and procedures conducive to decreasing the number of drug addicted defendants in the criminal justice system? 4

5 In order to answer this question, I will first discuss the policies and procedures of the New York City drug courts. Next, I will analyze the outcomes of the New York City Drug Courts, determined by the difference in re-incarceration rates between drug court participants and defendants who proceeded through the traditional court system. I will discuss the underlying assumptions of the NYC Drug Court policies and treatment programs, and determine how these could inform the outcomes of the drug courts. Finally, I will provide policy recommendations for the drug court programs to achieve the ultimate goal of eliminating the revolving door between drug-addicted defendants and the criminal justice system. Part I. New York City Drug Courts: Policies and Procedures: The New York City drug courts were established in 1998, as a part of the citywide Drug Court Initiative to make treatment available to nonviolent, substance abusing offenders with the goal of decreasing criminal behavior and improving public safety. There are six drug courts in New York City, although each court has different policies and procedures. The Manhattan, Brooklyn, and Queens misdemeanor drug courts cater to persistent misdemeanor offenders, while the Manhattan, Brooklyn, and Staten Island Felony drug courts target nonviolent first-time felony offenders, as well as probation violators and persistent misdemeanor offenders. The details of the eligibility requirements of the six drug courts are listed in the table below. 5

6 MBTC MMTC MTC QMTC SITC STEP Target population Drug Sale- Felony Persistent Misdemeanor Offenders Persistent Misdemeanor Offenders Nonviolent first felony offenders + probation violators Persistent Misdemeanor Offenders Nonviolent first felony offenders + persistent misdemeanor N N Y N Y Y Non violent first felony, adolescents Drug N N Y N Y Y Possession- Felony Drug Y Y N Y Y Y* Possess.- Misdemeanor DWI N N N N N N Non Drug Felony Non Drug Misdemeanor Violation of Probation N N N N Y Y Y Y N Y Y Y* Y Y Y Y N Y Prior Y Y N N Y** N Felonies Ages Figure 1. Eligibility requirements for the six New York City Drug Courts, by type of offense. The table also shows the target populations of each of the drug courts. a. modified from Kamins, B., Barry, J., Lindsay, L. Criminal Court of the City of New York. Drug Court Initiative Annual Report New York, New York: Web. b. * when prosecutor decreases charges. c. **only misdemeanor Screening Procedures: In 2003, the NYC drug courts established the Comprehensive Screening Project, which mandated that every criminal defendant be screened for court monitored substance use treatment programs eligibility. By screening every defendant that enters the NYC criminal justice system, the drug courts sought to decrease the number of substance using defendants that slipped through the criminal justice system, thereby maximizing the potential effects of the drug court system. Prior to the implementation of comprehensive screening, the system was uncoordinated, and many eligible defendants were not referred to treatment quickly, or were denied treatment This section is based on the report: Kamins, Barry, Barry, Justin, Lindsay, Lisa. Drug Court Initiative Annual Report New York: Criminal Court of the City of New York, Web. 6

7 entirely. Additionally, the NYC Drug Court Initiative argues that under the prior screening system, resources were wasted on cases that were eventually deemed ineligible for participation. By increasing the efficiency of the referral process, the Drug Court Initiative hopes to reach the addicted offender at a moment of crisis and decrease the amount of wait time between the arrest and treatment initiation. Finally, the new screening procedure seeks to improve the validity of the process by using urine toxicology and clinical review procedures to determine eligibility. The screening process is as follows: First, cases are screened at arraignment, and cases that seem to be eligible on paper for drug court participation are sent to the treatment court for further review. The district attorney then acquires preliminary consent from the potentially eligible defendant. If the defendant expresses interest in the treatment alternative to incarceration, the case is forwarded to the court clinical staff, who conduct urine toxicology tests, and in some cases, psychosocial assessments of addiction severity. At this stage, if defendants are determined to be addicted to drugs, they must plead guilty to their charges, and their sentence is deferred until the completion of the drug court program. Drug Court Policies: Though the policies for felony and misdemeanor drug courts are different, the policies within each class of drug courts are relatively similar. Misdemeanor Courts: There are three misdemeanor drug courts in the NYC Drug Court System: the Manhattan Misdemeanor Treatment Court (MMTC), the Misdemeanor Brooklyn Treatment Court (MBTC), and the Queens Misdemeanor Treatment Court (QMTC). For the most part, participants must have been convicted for a nonviolent and non-marijuana Class A misdemeanor offense to be eligible for the misdemeanor drug courts. Additionally, defendants must have had eight or more 7

8 prior convictions and/or must be on probation or parole to participate in the misdemeanor drug courts. The minimum length of participation in the drug courts is nine months, although the average length of participation ranges from 12 months to 18 months. * The treatment program is divided into four phases, and participants must submit an application to progress to the next phase. The goals of the first treatment phase are to successfully detoxify from drugs, to secure health insurance, and attend at least eight self-help meetings. In order to move on to the next phase, participants must remain abstinent and avoid sanctions for at least 30 days. Once they provide proof that they are following their treatment plan, they can submit an application for advancement to the next phase. The goals of the second treatment phase are to set goals for education and employment, and to begin attending at least two to three self-help meetings per week. Additionally, participants must attend parenting, anger management, or domestic violence classes according to the mandates of their treatment advisors. In order to move on to the next phase, participants must have completed an additional 60 days of clean time without any sanctions. Participants must also submit a written application for advancement to the next phase. Phase three of the treatment program requires participants to use recovery skills, and follow their vocational and educational goals. Participants must continue to attend two to three self-help meetings per week. To advance to the next phase, participants must have completed an additional 90 days of clean time without sanctions and must submit a written application. Finally, the last phase of the treatment program requires participants to continue to use recovery skills, get a job, and attend two to three self-help meetings per week. In order to * This section is based on the document: Manhattan Misdemeanor Treatment Court. New York City Drug Courts Initiative. New York City Drug Court Initiative, Web. 13 Dec

9 graduate, participants must have completed an additional 60 days in a row of abstinence without sanctions and must submit a written application for graduation. Importantly, the Manhattan Misdemeanor Treatment Court (MMTC) allows the use of methadone, a medical treatment to control withdrawal symptoms. Methadone binds to the same receptors as heroin, and therefore serves to manage withdrawal symptoms while making it impossible for patients to simultaneously get high on heroin ( Methadone Maintenance Treatment 2002). MMTC has a methadone reduction program, which requires participants to decrease their methadone usage to two-thirds of their original dose, and to submit a plan to fully detoxify from methadone by the final phase of the program. The reports published by the NYC Drug Court Initiative and the Manhattan and Brooklyn Misdemeanor Drug Courts do not clarify how many defendants are enrolled in the methadone programs. Upon graduation from the misdemeanor drug courts, all charges against the participants are dismissed. The participants receive certificates after maintaining abstinence for 30, 60, 90, and 150 days. Sanctions in the misdemeanor drug court treatment programs are graduated, and become more punitive with each infraction. The tables below show the sanctions for phases I&II and III&IV, respectively. Severity of the sanctions depends on the gravity of the infraction; infractions that are more serious, such as adulteration of urine samples, result in more jail time. For example, Class A infractions, such as absconding from the program or substituting urine samples result in at least one to fourteen days of jail, and three sanctions result in failure from the program. Class B infractions, such as missing appointments, breaking rules at the program, and being late for meetings result in less severe sanctions such as increased treatment attendance and increased court appearances. Five Class B infractions will result in failure from the drug court program. Importantly, any use of drugs is considered grounds for sanction. 9

10 Phases I and II: Infraction Court Imposed Sanction Possible Consequences Abscond or termination from program with involuntary return to court Substituted or tampered urine 1 st Sanction: 1-14 Days Jail Change in Treatment Modality 2 nd Sanction: 1-14 Days Jail 3 rd Sanction: Failure: Jail Sentence At every Sanction: Full Treatment Level Review Involuntary return may result in termination Judge has discretion to increase jail alternative by 60 days. Two of the following result in a sanction: Positive or missed urine Missed appts. Rule breaking Pattern of lateness Abscond or termination from court with voluntary return after 3 days 1 st and 2 nd Sanctions: 2 days penalty box, essay writing, detox/rehab, increase in urine testing, increased court appearances, increased case management visits, increased treatment visits, 1-7 Days Jail 3 rd Sanction: 1-14 Days Jail; Program Change 4 th Sanction: 1-14 Days Jail 5 th Sanction: Failure, alternate sentence At every sanction, full treatment review and return to beginning of phase. Failure to remain abstinent results in loss of clean time. Figure 2. Sanctions schedule for phases I and II of the Manhattan Misdemeanor Treatment Court program. The infractions are divided into two categories of increasing severity. The sanctions depend on the type and frequency of infractions. As participants commit more infractions, the sanctions become more severe, until the participant is terminated from the program. This table is modified from: Manhattan Misdemeanor Treatment Court. New York City Drug Courts Initiative. New York City Drug Court Initiative, Web. 13 Dec Phases III and IV: Infraction Court Imposed Sanction Possible Consequences Abscond or termination from program with involuntary return to court Substituted or tampered urine 1 st Sanction: 1-14 Days Jail Change in Treatment Modality 2 nd Sanction: 1-14 Days Jail 3 rd Sanction: Failure: Jail Sentence At every Sanction: Full Treatment Level Review Involuntary return may result in termination Judge has discretion to increase jail alternative by 60 days. Two of the following result in a sanction: Positive or missed urine Missed appts. Rule breaking Late twice for meeting Abscond or termination from court with voluntary return after 3 days 1 st Sanction: 2 days penalty box, essay writing, detox/rehab, increase in urine testing, increased court appearances, increased case management visits, increased treatment visits, 1-7 Days Jail 2 nd, 3 rd, 4 th Sanction: 1-24 Days Jail 5 th Sanction: Failure, alternate sentence, jail At every sanction, full treatment review and return to beginning of phase. Failure to remain abstinent results in loss of clean time. Figure 3. Sanctions schedule for Manhattan Misdemeanor Treatment Court participants. The infractions are divided into two categories of increasing severity. The sanctions depend on the type and frequency of infractions. As participants commit more infractions, the sanctions become more severe, until the participant is terminated from the program. This table is modified from: Manhattan Misdemeanor Treatment Court. New York City Drug Courts Initiative. New York City Drug Court Initiative, Web. 13 Dec Felony Drug Courts: There are three felony drug courts in NYC: the Screening and Treatment Enhancement Program (in Brooklyn), the Manhattan Treatment Court, and the Staten Island Treatment Court. 10

11 Eligibility for these courts is limited to those who have been charged with B, C, or D felony drug offenses. * The minimum length of treatment for felony drug courts is 12 months, although the average length of treatment is around 20 months. Felony drug courts offer the same treatment modalities as misdemeanor drug courts, although they only have three phases of treatment. The goals of the felony drug courts are very similar to those of the misdemeanor courts. The sanctions, however, are much more severe. Any positive drug test in the second phase of treatment results in the loss of thirty days of clean time, and positive drug tests in the third phase result in the loss of three months of clean time. Considering that at least four months of abstinence in a row is needed to advance to the next phase, the loss of clean time is significant. Like the misdemeanor drug courts, infractions are divided into several classes based on their severity, and the sanctions become harsher with each successive infraction. The table below describes the sanctions for felony drug courts. * This section is based on the document: Manhattan Treatment Court. New York City Drug Courts Initiative. New York City Drug Court Initiative, Web. 13 Dec

12 Infraction Court Imposed Sanction Possible Consequences Abscond or termination from program with involuntary return to court 1 st Sanction: 1-14 Days Jail Change in Treatment Modality 2 nd Sanction: Days Jail 3 rd Sanction: Failure: Jail Sentence At every Sanction: Full Treatment Level Review Return to Earliest Phase of Treatment Increase in Jail Alternative Termination from MTC Abscond or termination from program with voluntary return to court Substituted or tampered urine Submitting fraudulent documents Positive or missed urine Missed appts. Rule breaking 2 late arrivals 1 st Sanction: Lunch remand, 2 days penalty box, essay writing, detox/rehab, phase change 2 nd Sanction: 1-7 Days Jail; Program Change 3 rd Sanction: 8-14 Days Jail; Program Change 4 th Sanction: Days Jail 5 th Sanction: Failure: Jail Sentence 1 st Sanction: 1 day bench, essay writing, detox/rehab, phase change 2 nd Sanction: Lunch Remand, detox/ rehab, phase change 3 rd Sanction: 1-7 Days Jail; detox/rehab/ program change 4 th Sanction: 8-14 days jail; program change 5 th Sanction: days jail 6 th Sanction: Failure: Jail Sentence Same as above At Every Sanction: Increased case management visits and urine tests Detox/rehab Journal writing Loss of program privileges Loss of compliance time, amount depending on current phase level Figure 4. Sanctions schedule for Manhattan Felony Court participants. The infractions are divided into three categories of increasing severity. The sanctions depend on the type and frequency of infractions. As participants commit more infractions, the sanctions become more severe, until the participant is terminated from the program. This table is modified from: Manhattan Treatment Court. New York City Drug Courts Initiative. New York City Drug Court Initiative, Web. 13 Dec Upon graduation from the felony drug courts, the participant will be dismissed of his or her charges, although the charges will still remain on his or her permanent record. Part II: Drug Court Outcomes To discuss the success of drug court participants in drug court programs, the New York City Drug Court Initiative reports the one-year retention rates of participants in all of the drug courts. The retention rate refers to the proportion of participants, one year after enrollment, that is either still participating in the program or has graduated. The retention rates for the drug court 12

13 programs in 2011 ranged from 46 to 79 percent. The overall graduation rates for the six NYC Drug Courts have ranged from 25 percent (Manhattan Misdemeanor Treatment Court) to 66 percent (Screening and Treatment Enhancement Program). The table below displays the outcomes for the six NYC drug courts in STEP MBTC MTC MMTC QMTC SITC Referrals 1,265 2, Pleas Retention Rate (%) Graduation Rate (Since Opening) (%) Failure Rate (since opening) (%) Involuntary Failure Rate (since opening) (%) Average Graduation Time (months) to Figure 5. Pleas refers to the number of people in each drug court who decided to plead guilty and enroll in the drug court after referral. The retention rate is a measure of the percentage of participants who either graduated from the program or still continue to participate in the drug court. Failure rate refers to the overall percentage of participants since enrollment that failed out of the drug court program, while involuntary failure rate refers to the percentage of failures that were dismissed from the program due to incurring too many sanctions. This figure is modified from: Kamins, Barry, Barry, Justin, Lindsay, Lisa. Drug Court Initiative Annual Report New York: Criminal Court of the City of New York, Web. The New York State Drug Court Evaluation determines the efficacy of the NY Drug Courts by evaluating recidivism rates and sentencing outcomes for drug court and comparison samples, where recidivism rate is defined as the percentage of defendants who were reconvicted or re-arrested during a particular time frame. * Additionally, the evaluation determines the * This section is based on the text: Cissner, Amanda.B., Rempel, Michael, Walker Franklin, Allyson, Roman, John K., Bieler, Samuel, Cohen, Robyn, and Cadoret, Carolyn R. A Statewide Evaluation of New York s Adult Drug Courts. New York, New York: Center for Court Innovation, Web. 13

14 differential effects that drug court treatment may have based on the demographics of the target population, the drug court policies and procedures, and the severity of the crime committed. The study was conducted by the Center for Court Innovation, a partnership between the New York State Unified Court System and the Fund for the City of New York. The drug court sample evaluated in the study included participants enrolled in the drug courts in 2005 or The comparison sample included members of the criminal justice population that were convicted of crimes that would have been eligible for drug court participation, but were not screened for drug court eligibility in either 2005 or The comparison sample therefore consisted of defendants that could have been eligible for drug court participation, but were instead processed through the conventional court system. Since studies on drug court outcomes are not conducive to randomized design, the researchers conducted a propensity score matching analysis to minimize the differences in baseline characteristics between the two groups. Propensity score analysis assigns a number between zero and one that quantifies the probability an individual will fall into either the treatment or the control group. Based on this, weights are applied to the data, allowing the treatment and control groups to be balanced on all observable attributes (Rossman et al 268). This procedure was able to eliminate all but one of the differences in a set of 61 baseline characteristics between the drug court and comparison samples. Importantly, data on the substance abuse, mental health, educational, and employment histories were not able to be included in this procedure. It is therefore possible that the comparison group had significantly different substance abuse histories than the drug court group, which could potentially bias the results of the evaluation. The New York State Evaluation followed the progress of drug court (n=7,535) and comparison sample (n=7,535) participants over a span of three years after enrollment in the program or initial court disposition, respectively. The evaluation found that the overall re-arrest 14

15 rate for drug court participants was statistically significantly lower than the re-arrest rate for the comparison group sample (22 percent vs. 25 percent, p<0.05) after one year. After three years, the re-arrest rates were lower for the drug court sample, although the difference between the two samples was not as statistically significant (40 percent vs. 42 percent, p<.10). Similarly, the re-arrest rates for drug related charges were statistically significantly lower for the drug court sample than for the comparison sample at the one year follow up mark (8 percent vs. 11 percent, p<0.01). However, after three years, there was no difference between the drug related re-arrest rates for the drug court and comparison samples (17 percent vs. 19 percent). The effects of the drug courts were the most pronounced among felony drug court participants. Three years after initial disposition or enrollment, the re-arrest rate for felony drug court participants was statistically significantly lower than for felony criminals in the comparison sample (21 percent vs. 25 percent, p<0.01). Conversely, the re-arrest rates between misdemeanor drug court participants and comparison sample members was not statistically significantly different, as shown by the evaluation s modeling of the relative effect sizes of all of the drug courts. The authors of the evaluation argue that drug courts with more legal leverage over the program participants perform better. Drug court participants with felony level charges face more severe punishments if they drop out of the program; therefore, the authors of the evaluation argue that the incentives for felony drug court participants to successfully complete the drug court program are higher than for misdemeanor drug court participants. The evaluation also shows a differential impact of drug courts based on the risk level of the participant. High-risk participants are defined as defendants with between a 63 and 77 percent chance of being re-arrested, while low risk participants are defendants with a 1 to 33 percent change of being re-arrested. Higher risk participants are the most affected by drug court 15

16 participation, with a difference of 9 percent between the re-arrest rates of the drug court and comparison samples at the three-year follow up mark (p<0.001). By comparison, there was no significant difference between the re-arrest rates of the drug court and comparison sample participants who were classified as low-risk. Although drug court participants spent significantly less time incarcerated over the span of three years (144 vs. 168 days, p<0.05), the evaluation did not take into account days spent in jail due to sanctions during the treatment program. The evaluation shows that drug courts that always sentence program failures with the predetermined jail or prison alternative produced lower recidivism rates than conventional courts (47 percent vs. 51 percent, p<0.001). However, there were no significant differences in the rates of recidivism between the drug court and comparison samples based on the certainty of the sanctions imposed by the drug courts. That is, knowing the sanction schedule beforehand did not determine the recidivism of drug court participants. These results were not gathered through randomization; the difference in recidivism rates between the drug court and comparison samples was compared for drug courts that implemented certain sanctions and those that did not. This means that it might be difficult to isolate the effects of the sanctions on drug court participants. Finally, the evaluation assessed the effects of drug court participation for drug court graduates and dropouts. At the three-year follow up mark, 36 percent of drug court graduates had been re-arrested, compared to 64 percent of drug court dropouts. Importantly, 44 percent of comparison group members had been re-arrested, indicating that drug court dropouts fared worse than defendants who went through traditional court processes. It is important to note that this study does not include any information on the effects of drug courts on the specific drug use patterns of program participants. While the study discusses the effects of drug courts on recidivism rates, it does not explain whether the prevalence of drug 16

17 addiction and drug abuse decreased as a result of the court monitored treatment programs. The study also neglected to discuss the merits of the sanctioning methods, especially incarceration. Although it showed the effects of the certainty of sanctions on recidivism rates, the evaluation did not explore the efficacy of using incarceration, or more generally, the effects of using sanctions to punish deviant behavior. These results were discussed in the Multistate Adult Drug Court Evaluation (MADCE), conducted in 2011 by the Urban Institute. * This study determined drug use and recidivism outcomes for drug courts across the nation. The evaluation studied the policies and outcomes of 23 drug courts across the country, including eight drug courts in New York State. Although their outcomes do not apply directly to the New York City drug courts, the results of the analysis can be generalized to understand the merits and problems within the drug court system. MADCE can be differentiated from the majority of drug court analyses in two ways: first, it determines the effects of drug court participation on drug use, as opposed to simply re-arrest rates; second, it analyzes the differences in outcomes between drug court graduates and dropouts. The study examined the relationship between drug court policies and outcomes in 23 drug courts nationwide. It also compared the drug use and criminal behavior outcomes of the drug courts to six comparison sites, which represent jurisdictions throughout the country that do not implement drug courts, but include alternative treatment for drug involved offenders. Like the New York State Evaluation, the MADCE study incorporated propensity score matching analysis to control for baseline differences between the drug court and comparison samples. The study controlled * This section is based on the text: Rossman, Sheila B., Rempel, Michael, Roman, John K., Zweig, Janine M., Lindquist, Christine H., Green, Mia., Downey, Mitchell, Yahner, Jennifer, Bhati, Avilash S., and Farole, Donald J. The Multisite Adult Drug Court Evaluation: The Impact of Drug Courts, Volume Four. Washington, DC: Urban Institute, Web. 17

18 for differences in demographics, social ties, drug use history, criminal history, mental/physical health, and differences resulting from attrition bias. The study was not able to control for differences in participants motivations to change, although the authors assert that this difference might have been minimized by controlling for other variables, such as drug use history, that are related to measures of motivation to change. The MADCE study determined drug use frequency, severity, and criminal behavior incidence six months and eighteen months after drug court and comparison group defendants entered their respective programs. Drug court participants (N=951) were found to have used drugs significantly less often than offenders in the comparison group (N=523) both six months and eighteen months post-baseline. Specifically, the study reported that 56 percent of drug court participants tested positive for drug use at eighteen months post-baseline, compared to 76 percent of comparison group members (p<0.01). Drug court participants were also found to have used drugs for fewer days in the month prior to testing (2.1 vs 4.8, p<0.001). The study differentiated the effects of drug court participation by primary drug of choice, and found that while drug court participants were significantly less likely to report the use of alcohol, heroin, and prescription pain medication, they were equally as likely as comparison group members to have used cocaine, heroine, amphetamines and hallucinogens. Like the New York State Evaluation, the MADCE study found that drug court participation predicted lower re-arrest rates. The difference in re-arrest rates between the drug court and comparison samples was no longer significant, however, 24 months post baseline. These results are very similar to those of the NYS evaluation, which found that the significance of the difference in recidivism rates between the drug court and comparison samples diminished with time. 18

19 It is crucial to note that the MADCE study found differential effects in both drug use and criminal behavior outcomes based on the initial drug histories and mental health characteristics of the defendants. Specifically, a higher frequency of drug use at baseline significantly predicted greater frequency of use at eighteen months for both drug court and comparison offenders. Likewise, defendants who used drugs more frequently at baseline or had mental health issues were more likely to be re-arrested. These results are extremely important. First, they show that the severity of substance use and mental health disorders can predict the success of drug court participants. Second, they highlight the fact that differences in baseline characteristics must be taken into account in drug court analyses in order to fully understand the differential impacts that drug court treatment programs can have on participants. The MADCE study also determined the differences in outcomes between drug court graduates and failures. Like the New York State Evaluation, which found that drug court failures had significantly higher re-arrest rates than drug court graduates, the MADCE study found that 32 percent of drug court participants that were retained * at eighteen months reported criminal behavior in the past year, compared to 66 percent of participants that were not retained in the drug court program. Similarly, 50 percent of retained participants reported drug use within the past year, compared to 78 percent of participants who were not retained. Finally, drug court graduates were incarcerated for an average of 11.8 days, compared to days for drug court failures. These results therefore indicate that the benefits of drug courts are only extended to program graduates, and that program failures are likely to do as badly, if not worse, than comparison group defendants. From the MADCE study and NYS evaluation, we can conclude that: * In this case, retained participants are defendants that had either graduated or were participating in the program at the given time point. 19

20 a) Lower drug use rates result in lower re-incarceration rates. b) Defendants with more severe substance use and mental health disorders are more likely to relapse and to be re-arrested. c) Most of the successes of drug court programs can be attributed to drug court graduates, while drug court failures are likely to experience outcomes worse than defendants who went through the conventional court system. The possibility that drug court graduates are more likely at baseline to have milder drug addictions and to suffer from fewer mental health problems must therefore be considered. It is also plausible that if defendants with more severe substance use disorders are more likely to relapse, they are more likely to be sanctioned. The ability of drug court treatment programs to truly serve as an alternative to incarceration for all substance using defendants, especially severely addicted defendants, depends on the capacity of drug courts to offer continuous and functional treatment. It is therefore important that the treatment programs, as well as the philosophies underlying the treatment modalities offered, are designed to maximize the success of more severely addicted defendants. Finally, both of the evaluations only focus on the effects of drug court programs relative to the conventional criminal justice system. They did not consider the efficacy of court monitored treatment programs relative to non-punitive, community based treatment programs. The implicit assumption, therefore, is that drug courts are the best alternative to incarceration for drug-addicted members of the criminal justice population. Despite the classification of drug addiction as a disease, drug addicted offenders must still be processed through the criminal justice system. The implications of this assumption on the development of drug policy in the criminal justice system will be discussed further in this paper. Part III: Analysis of Drug Court Procedures and Policies 20

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