Elsevier

Drug and Alcohol Dependence

Volume 79, Issue 2, 1 August 2005, Pages 145-155
Drug and Alcohol Dependence

Are judicial status hearings a “key component” of drug court?: Six and twelve months outcomes

https://doi.org/10.1016/j.drugalcdep.2005.01.019Get rights and content

Abstract

Substantial evidence indicates that drug courts can be superior to traditional probation programs for enhancing treatment retention and reducing substance use and crime among drug offenders. Few studies have isolated the effects of the hypothesized “key components” of drug courts to determine their contributions to outcomes. This article presents outcomes at 6 and 12 months post-admission for misdemeanor drug court clients who were randomly assigned to different dosages of judicial status hearings. Although earlier work [Festinger, D.S., Marlowe, D.B., Lee, P.A., Kirby, K.C., Bovasso, G., McLellan, A.T., 2002. Status hearings in drug court: when more is less and less is more. Drug Alcohol Depend. 68, 151–157] revealed superior during-treatment effects for high-risk participants who were assigned to more frequent bi-weekly hearings, those effects did not extend post-treatment. The results did reveal significant pre-to-post improvements for participants, as a whole, in self-reported drug use, alcohol use, and criminal recidivism; however, lacking a no-drug court control condition, it is not possible to discern the magnitude of the effect of the drug court program. Approximately, half of the participants resumed drug or alcohol use within 12 months of admission to drug court, and approximately 10–15% resumed illegal activities. These findings lend credence to the potential effectiveness of drug courts; however, continuing-care strategies are required to extend the effects of drug courts beyond the initial active phases of the program.

Introduction

Drug courts are separate criminal court dockets that provide judicially supervised drug abuse treatment and case management services to nonviolent drug-abusing offenders in lieu of criminal prosecution or incarceration. According to the National Association of Drug Court Professionals (NADCP, 1997), the “key components” of a drug court in the United States include: (1) on-going status hearings before the judge in court; (2) mandatory completion of drug abuse treatment; (3) random urine drug screens; and (4) progressive negative sanctions for program infractions and positive rewards for achievements. In pre-plea or diversionary drug courts, participants who satisfactorily complete the program may have their criminal charges dropped, and may apply for record expungement after remaining arrest-free for an additional waiting period and meeting other obligations such as paying a filing fee. This permits these individuals to respond truthfully on an employment application or similar document that they have not been arrested for a drug-related offense. In post-adjudication drug courts, graduates may avoid incarceration, reduce their probationary obligations, or receive a sentence of time-served in the program.

The drug court model has been exported from the U.S. to several other countries, including Australia, Brazil, Canada, England, Ireland, and Scotland (e.g., La Prairie et al., 2002, Makkai, 2002, Bean, 2002). This has generated considerable controversy among international commentators about whether drug courts have proven sufficiently successful in the U.S. to justify their transfer to other nations (e.g., Anderson, 2001), and whether some aspects of the U.S. drug court model could be at odds with other systems of jurisprudence. In Great Britain, for example, there has been much resistance from the judiciary to relaxing procedural formalities in the courtroom, and thus risking negative effects on the decorum of the court (Nolan, 2002).

Reviews of dozens of program evaluations in the United States (Belenko, 1998, Belenko, 1999, Belenko, 2001) concluded that an average of 60% of drug court clients completed 1 year or more of drug treatment, and roughly one-half graduated from the program. This compares quite favorably to typical retention rates in community-based drug treatment programs, where over 70% of probationers and parolees drop out of treatment or attend irregularly within 3 months (Langan and Cunniff, 1992, Nurco et al., 1991, Taxman, 1999, Young et al., 1991) and over 90% drop out within 12 months (Satel, 1999). In the majority of outcome evaluations that included a comparison condition (15 of 21 published studies as of 2002), drug court clients achieved significantly greater reductions in drug use and criminal recidivism compared to individuals on standard or intensive probation (Belenko, 2002). Importantly, many of those studies employed nonrandomized comparison samples, such as offenders who refused or were ineligible for drug court (e.g., U.S. General Accounting Office [GAO] 2002); however, two experimental studies reported roughly a 15%-point reduction in criminal recidivism for adult drug court clients compared to probationers at 2 years post-admission in Baltimore (Gottfredson et al., 2003) and at 3 years post-admission in Arizona (Turner et al., 1999).

Little is known about how drug courts work because few studies have isolated the effects of the hypothesized “key components” of the intervention (e.g., Goldkamp, 2001, Longshore et al., 2001, Marlowe et al., 2003a). This lack of evidence extends to judicial status hearings, which are believed to be the defining element of drug court. According to the NADCP (1997), the judge is the leader of the drug court team and plays a critical role during status hearings by evaluating clients’ performance and imposing sanctions and rewards contingent upon that performance. Moreover, it is believed that “on-going judicial supervision communicates to participants – often for the first time – that someone in authority cares about them and is closely watching what they do” (NADCP, 1997, p. 27). In qualitative evaluations, drug court clients have, in fact, commonly credited their success in the program to their interactions with the judge (Cooper, 1997, Goldkamp et al., 2002, Harrell and Smith, 1997, Satel, 1998, Saum et al., 2002); however, prior to the current program of research, there was no controlled evidence to indicate whether the judge is, in fact, necessary or helpful to drug court outcomes.

This article reports 6 and 12 months outcomes from a controlled, experimental study of the effects of judicial status hearings on drug court outcomes. Consenting misdemeanor drug court participants were randomly assigned at intake either to attend judicial status hearings on a bi-weekly basis throughout their enrollment in the program (“bi-weekly” condition), or to be monitored by their treatment case managers who petitioned the drug court for status hearings only as needed in response to serious or repeated infractions (“as-needed” condition). These conditions reflect the extremes of drug court practice. The highest “dosage” of status hearings generally used by drug courts is bi-weekly, whereas the smallest “dosage” is on an as-needed basis, whenever there is a problem or need identified by the judge or by treatment personnel (NADCP, 1997).

In prior during-treatment analyses, we found that, for the participants as a whole, judicial status hearings had no impact on counseling attendance, urine drug-screen results, or self-reported substance use or criminal activity during their enrollment in drug court (Marlowe et al., 2003c), or in graduation rates from the program (Festinger et al., 2002). However, we found a significant interaction effect, in which certain “high-risk” drug court clients performed significantly better when they were assigned to bi-weekly status hearings, whereas “low-risk” clients performed equivalently or better when they were assigned to as-needed hearings. Specifically, participants who (1) met DSM-IV diagnostic criteria for antisocial personality disorder (APD), or (2) had a prior history of drug abuse treatment, provided more drug-negative urine specimens while they were in drug court and were more likely to graduate from the program when they were assigned to bi-weekly hearings; conversely, those without these risk factors performed equivalently or better when they were assigned to as-needed hearings (Festinger et al., 2002).

This article reports outcomes at 6 and 12 months post-admission for this same cohort of misdemeanor drug court participants. The misdemeanor drug court program was scheduled to be a minimum of 4 months in length, although most participants required 6–8 months to graduate; therefore, the current analyses reflect outcomes for most participants proximally to their discharge from the program, and at approximately 4–6 months post-discharge. We were interested in determining whether a main effect of judicial status hearings might emerge at a later point following participants’ enrollment in the program, and whether the during-treatment interaction effects we detected would extend to the post-treatment interval. Finally, this study evaluated a range of post-treatment outcomes that have rarely been reported in the drug court literature. The large majority of drug court evaluations have relied exclusively on criminal recidivism records for measuring post-treatment effects (Belenko, 2002, GAO, 2002, Marlowe et al., 2003a). This study extends that literature by reporting the results of post-treatment urine drug screens and structured interviews with participants about their functioning in multiple psychosocial domains.

Section snippets

Human subjects protections

This study was approved and monitored by the Institutional Review Boards of the Treatment Research Institute and the Delaware State Department of Health and Social Services. A NIH Confidentiality Certificate was obtained, which shielded the research data from a court order or subpoena. Monthly meetings were established for the study that were regularly attended by the drug court judge and by representatives of the attorney general's office, public defender's office, criminal defense bar,

Results

Table 1 presents ASI composite scores at baseline, 6-month follow-up, and 12-month follow-up. Results of repeated-measures mixed-effects ANOVAs revealed significant reductions in self-reported drug problems, alcohol problems, and legal problems for participants, as a whole, from baseline to the follow-ups. However, the only condition-by-time effect was in the medical domain, in which bi-weekly participants reported significantly greater improvements over time in medical problems than did the

Discussion

This article presents outcomes at 6 and 12 months post-admission for misdemeanor drug court clients who were prospectively assigned to different schedules of judicial status hearings. The results revealed no significant group effects or group-by-time effects for drug use, alcohol intoxication, criminal activities, criminal charges, employment problems, psychiatric problems, or social or familial problems. The only significant group-by-time effect was in the medical domain, and this appeared to

Acknowledgements

This research was supported by grant #R01-DA-13096 from the National Institute on Drug Abuse (NIDA) with supplemental funding from the Center for Substance Abuse Treatment (CSAT). The views expressed are those of the authors and do not reflect the views of NIDA or CSAT. Portions of these data were presented at the 64th Annual Scientific Meeting of the College on Problems of Drug Dependence, Quebec City, Canada, the 2004 Annual Conference of the American Psychology-Law Society, Scottsdale, AZ,

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