CrimeSolutions.gov

Additional Resources:

Program Profile: Adult Treatment Drug Courts (Multi-site)

Evidence Rating: Promising - One study Promising - One study

Date: This profile was posted on June 28, 2012

Program Summary

This was a 6-year national evaluation of the impacts made by adult drug courts (specialized and problem-solving courts for drug-involved offenders). The program is rated Promising. Participants did better than comparison offenders on measures of drug use, criminal behavior, and incarceration. However, there were few significant differences between the groups on measures of other benefits, including socioeconomic status, mental and physical health, family support and homelessness.

Program Description

Program Goals
The Multi-site Adult Drug Court Evaluation (MADCE) was a 6-year national evaluation funded by the National Institute of Justice that looked at the impact of adult drug courts.

Adult treatment drug courts are specialized and problem-solving courts for drug-involved offenders that provide a combination of substance abuse treatment services and intensive judicial supervision of the treatment process. By addressing offenders’ drug abuse problems, adult treatment drug courts aim to reduce drug relapse and prevent future offending.

The MADCE project had four primary goals: 1) test whether drug courts work for participants by reducing their drug use, crime, and multiple other problems associated with drug abuse, 2) examine for whom drug courts work best, 3) explain how drug courts work, and 4) examine whether drug courts generate cost savings.


Program Theory
The therapeutic jurisprudence model and deterrence theory make up the theoretical foundation of drug courts. Under therapeutic jurisprudence, it is argued that legal rules and procedures can be used to improve the mental and physical well-being of clients (that is, drug-involved offenders) within the court system. The emphasis under this model is on the selection of a therapeutic option that promotes health but does not conflict with the normative values of the justice system, such as due process (Rottman and Casey 1999). Drug courts offer a therapeutic option through the provision of treatment and services that can address underlying drug abuse issues but do so through intensive court-based supervision, where drug-involved offenders are held accountable for their actions.

Drug courts also work under the framework of deterrence theory. Deterrence theory holds that the receipt or threat of punishment for committing an offense reduces the likelihood that the offense is committed. Three aspects of punishment (perceived certainty, severity, and celerity) are hypothesized to affect the decision-making process of would-be offenders (Urban Institute 2011b). As a way to deter future offending, drug courts usually employ graduated sanctions, in which responses to violations committed by participants become incrementally harsher.


Key Personnel
Drug court programs generally include a multidisciplinary team. Drug court team members consist of judges, prosecutors, defense counsel, social workers, treatment providers, and the offenders.

Target Sites
The MADCE included 23 drug courts located in several different geographic areas across the United States. There were eight MADCE drugs courts in New York state, six in Washington state, two in Florida, two in Georgia, two in Illinois, two in Pennsylvania, and one in South Carolina. Most of the courts operated in urban or suburban areas, with only about one-fourth operating in rural areas.

Program Components
Although adult treatment drug courts vary in practice and implementation, some basic components of the programs are quite similar. Drug courts generally:

  • Provide participants with intensive treatment and other services to achieve and maintain sobriety, and to address any drug-related issues
  • Require participants to adhere to regular and random drug tests
  • Require frequent court appearances before the judge, to review progress in treatment and address any violations of program requirements
  • Adhere to a schedule of graduated sanctions, where responses to violations committed by participants become incrementally harsher
The MADCE provides an example of how drug courts across the country can adhere to similar underlying principles but differ in many other factors, such as participant eligibility, program intensity, the type of substance abuse treatment used by participants, the number of courtroom hearings, the swiftness of sanctions, and the use of risk assessments. As part of the MADCE, a Web-based survey was administered in 2004 to every active adult drug court in operation for at least 1 year (Urban Institute 2011c). The survey results provide descriptive information about program characteristics and operations for the 380 adult drug courts that responded. Among the findings:

  • Most adult drug court programs are small. Forty-six percent had fewer than 50 active participants in the program, while about 13 percent reported 200 or more active participants.
  • More than one-third of drug courts reported serving only those who are diagnosed as addicted to or dependent on drugs, while one third of the courts serve regular users of drug or alcohol and just under one third serve anyone who uses.
  • On average, adult drug court programs required 13 months in programming before participants could graduate, with most requiring between 12 and 18 months.
  • Almost all of the courts reported providing the following types of treatment services: residential, intensive outpatient, outpatient individual counseling, outpatient group counseling, drug education, self-help, and relapse.
  • Almost all of the courts reported using urine tests to collect drug test samples. A small number of drug courts reported also using a patch, saliva, and hair samples to test for drug use. The vast majority of the courts reported testing for marijuana, crack/cocaine, heroin/opiates, methamphetamine, alcohol, and benzodiazepines. A smaller number of courts reported also testing for stimulants, PCP, LSD, and other drugs.
For the full results of the survey, please see the Urban Institute’s 2011 report titled The Multi-site Adult Drug Court Evaluation: What’s Happening With Drug Courts? A Portrait of Adult Drug Courts in 2004 (please see Additional References for a link to the report).

Evaluation Outcomes

top border
Study 1
Overall, the outcome results of the Multi-site Adult Drug Court Evaluation (MADCE) conducted by Urban Institute (2011e) showed that drug court participants did better than comparison offenders on most measures of drug use, criminal behavior, and incarceration. However, there are a few significant differences between the groups on measures of other psychosocial benefits, including socioeconomic status, mental and physical health, family support, and homelessness.

Drug Use
At the 6-month follow-up, 40 percent of drug court participants compared with 55 percent of comparison offenders self-reported that they had used at least one of eight measured substances—a significant difference. However, there was no significant difference in the percentage of drug court and comparison offenders self-reporting serious drug use (32 percent versus 40 percent). Drug court participants did average significantly fewer days of drug use per month (1.5 days versus 3.7) and fewer days of serious use per month (1.0 day versus 2.2 days).

By the 18-month follow-up, drug court participants reported significantly fewer occurrences of any drug use (56 percent versus 76 percent), serious drug use (41 percent versus 58 percent), days of use per month (2.1 days versus 4.8) and days of serious use per month (1.1 days versus 2.3).

The oral swab tests administered at the 18-month interview showed that drug court participants had a significantly lower rate of testing positive than the comparison offenders (29 percent versus 46 percent). However, when examining specific drugs that were tested, there were no significant differences between the groups in the rates of positive drug tests for marijuana, cocaine, opiates, or amphetamines.


Criminal Behavior
At the 6-month follow-up, drug court participants were significantly less likely than comparison offenders to self-report engaging in any criminal behavior (28 percent versus 40 percent). Drug court participants also averaged significantly fewer instances of criminal acts (12.8 versus 34.1). During the following year (the 1-year period before the 18-month survey), drug court participants were still significantly less likely to engage in any criminal behavior (40 percent versus 53 percent). They also averaged fewer than half as many criminal acts (43.0 versus 88.2) and drug-related crimes (30.6 versus 83.1) as the comparison group.

When totaling responses across the two follow-up periods to create a complete set of 18-month criminal behavior measures, nearly half of the drug court group (49 percent) reported at least one criminal act, compared with 64 percent of the comparison group, a statistically significant difference. When counting the total number of criminal acts, drug court participants again averaged fewer than half as many criminal acts as the comparison group (52.5 versus 110.1).

However, when looking at criminal acts that were officially detected, there were no significant differences in the rearrest rate. Slightly more than half (52 percent) of the drug court group was rearrested during the 24-month follow-up period, compared with 62 percent of the comparison group. Drug court participants averaged fewer total rearrests (1.25 versus 1.66), but again the difference was not statistically significant.


Incarceration
Almost the same percentage of drug court participants and comparison offenders self-reported that they experienced at least some incarceration during the 18-month follow-up period (57 percent versus 58 percent, a nonsignificant difference). Drug court participants spent fewer days incarcerated (62.7 days versus 95.3); however, this difference also was not statistically significant.

The official data also showed that there were no significant differences in the percentage of drug court participants and comparison offenders who were sentenced to jail or prison during the 24-month follow-up period (19 percent versus 26 percent). However, drug court participants averaged significantly fewer days sentenced to jail or prison (32.1 days versus 59.4).


Socioeconomic Status
There were few significant differences between drug court participants and comparison offenders on measures of socioeconomic status (SES). At 6 months, significantly more drug court participants were enrolled in school (16 percent versus 8 percent), but that difference disappeared by 18 months. At the 18-month follow-up, significantly fewer drug court participants reported needing or wanting educational services or financial assistance. But on all other measures of SES, there were no significant differences.

Mental and Physical Health
There also were few significant differences on measures of mental and physical health. At 6 months, drug court participants rated their current emotional or mental health status significantly higher than comparison offenders, but the difference did not persist to 18 months. At both follow-up periods, drug court participants were significantly more likely to have been set up with public insurance (Medicare or Medicaid). But there were no other significant differences on any other measures.

Family Support
There were also only a few significant differences on measures of family support and family conflict. At 6 months, drug court participants reported significantly fewer conflicts (0.70 versus 0.98), but again that difference disappeared by 18 months. At 18 months, drug court participants averaged significantly less family conflict, based on a three-item index of conflict. However, there were no other significant differences on any other measures of family support.

Homelessness
There were no significant differences in the rates of homeless and in the average level of interest to receive housing services.
bottom border

Evaluation Methodology

top border
Study 1
The Multi-site Adult Drug Court Evaluation (MADCE) conducted by Urban Institute (2011e) used a quasi-experimental design to assess the impact of adult drug courts located in various sites across the United States. The first component of the MADCE consisted of a Web-based survey administered in 2004 to every active adult drug court in operation for at least 1 year at that time. Of the 593 adult drug courts eligible for the survey, 380 courts (64 percent) responded. From the survey data, 23 drug courts and 6 comparison sites from the same geographic areas in eight states were selected for inclusion in the process and impact evaluations and cost–benefit analysis.

The site selection procedure concentrated on three main components of drug courts: 1) provision of substance abuse treatment; 2) leverage the court has in monitoring clients; and 3) predictability of sanctioning policies of the court. Using a combination of hotspot mapping techniques and subjective criteria about how geographically close courts were, 16 potential geographic clusters of drug courts were identified for consideration. From this cluster, the 23 drug courts came from the following states: eight courts in New York state, six in Washington state, two in Florida, two in Georgia, two in Illinois, two in Pennsylvania, and one in South Carolina. The sites were chosen to ensure variation in eligibility criteria, program requirements, community settings, and treatment and testing practices of the drug courts.

Comparison jurisdictions were selected if a) the site did not operate a drug court; b) the site operated a drug court but had a greater number of drug-involved offenders than could be enrolled, who could therefore serve as a comparison group; or c) the site had a group of drug-involved offenders who did not meet the criteria for the local drug court but met the criteria of drug courts in other areas of the country. The comparison sites offered alternative treatment for drug-involved offenders through programs other than drug courts, such as Breaking the Cycle or Treatment Alternatives for Safe Communities. The six comparison sites came from the following states: two sites in Florida, two in North Carolina, one in Illinois, and one in Washington state.

The adult drug court group (n=1,156) was 68 percent male, 32 percent female, 57 percent white, 29 percent African American, 7 percent Hispanic/Latino, and 7 percent other (including multiracial)—with an average age of 33. The comparison group (n=625) was 72 percent male, 38 percent female, 50 percent white, 41 percent African American, 5 percent Hispanic/Latino, and 5 percent other—with an average age of 35. A propensity score weighting procedure was used to eliminate significant differences between groups at baseline.

In this multisite evaluation, each observation (that is, each offender) was nested within a particular site. Examination of the data showed that offenders from different sites systematically varied on key drug use, criminal behavior, and other psychosocial outcomes. Hierarchical linear modeling (HLM) techniques were employed for impact analyses to adjust for the site-specific variances in outcomes and to correct the assumed degrees of freedom based on the much smaller number of sites (29) than offenders (1,781).

Data was collected from a variety of sources: field visits, self-report surveys, oral fluid tests, and administrative records. Self-report surveys were administered at baseline, 6 months postbaseline, and 18 months postbaseline. In addition, oral swab tests were conducted in conjunction with the 18-month interviews for nonincarcerated respondents. The chosen test was a six-panel oral fluid screen for amphetamines, cannabinoids, cocaine, methamphetamines, opiates, and phencyclidine. Finally, study participants’ official records were collected from the National Crime Information Center at the Federal Bureau of Investigation and from state-level criminal justice agencies. Collection of administrative data concentrated on three categories of variables: arrests, convictions, and incarcerations. Administrative data was collected for a 24-month follow-up period.

Outcomes were organized into the following key domains:
  • Drug use: whether the offender used drugs, days of drug use per month, and results of the oral fluids drug test
  • Criminal activity: incidence and prevalence of official rearrest and of self-reported criminal behavior
  • Incarceration: number of days incarcerated
  • Socioeconomic status: employment status, school status, and annual income
  • Mental health: classified as “depressed” (based on multi-item instrument) and self-reported assessment of mental health (excellent, very good, good, fair, and poor)
  • Family support and conflict: the extent of family conflict, family emotional support, and family instrumental support
  • Homelessness: whether the offender was homeless since the previous survey point
bottom border

Cost

top border
As part of the Multi-site Adult Drug Court Evaluation (MADCE), the Urban Institute (2011e) conducted a cost–benefit analysis. During the 18-month period of the study, the analysis showed that each drug court participant cost society (on average) $13,102, while each comparison offender who did not receive drug court cost society $19,310. The difference (the net benefits) totals $6,208, but it is not significant. The total benefit-to-cost ration is 1.92:1, meaning that for every $1 invested in drug courts $1.92 in costs is saved; however, this result also was not significant. When examining the average costs of crime, arrest, and incarceration, drug courts were shown to prevent $11,566 per participant compared with those in the comparison group not receiving drug court, a result that was significant. However, the authors noted that when a small number of outliers were removed from the analysis (whose costs are mainly from the commission of serious crimes) most of the benefits of drug court disappear. This was interpreted as meaning that most of the crime reduction is from reductions in low-level offending, with only a few serious crimes being prevented.
bottom border

Implementation Information

top border
In 1997 the Drug Court Program Office, within the federal Office of Justice Programs, collaborated with the National Association of Drug Court Professionals to create a document promoting 10 key components of drug court operations: https://www.ncjrs.gov/pdffiles1/bja/205621.pdf.

The National Association of Drug Court Professionals (http://www.nadcp.org/nadcp-home/) and the National Drug Court Institute (http://www.ndci.org/ndci-home/) provide information on drug court programs, including research briefs, fact sheets, and opportunities to attend trainings on how to implement a drug court program.

In addition, the Adult Drug Court Research to Practice Initiative (R2P) provides timely dissemination of relevant information derived from the growing body of research on adult drug courts that is easily understandable and relevant to practitioners and policymakers: http://research2practice.org/.
bottom border

Other Information (Including Subgroup Findings)

top border
The Multi-site Adult Drug Court Evaluation (MADCE) was conducted by the Urban Institute in partnership with the Center for Court Innovation and RTI International.
bottom border

Evidence-Base (Studies Reviewed)

top border
These sources were used in the development of the program profile:

Study 1
(Urban Institute) Rossman, Shelli B., Michael Rempel, John K. Roman, Janine M. Zweig, Christine H. Lindquist, Mia Green, P. Mitchell Downey, Jennifer Yahner, Avinash Singh Bhati, and Donald J. Farole Jr. 2011e. The Multi-site Adult Drug Court Evaluation: The Impact of Drug Courts. Final Report: Vol. 4. Washington, D.C.: Urban Institute.
https://www.ncjrs.gov/pdffiles1/nij/grants/237112.pdf
bottom border

Additional References

top border
These sources were used in the development of the program profile:

National Association of Drug Court Professional. 1997. Defining Drug Courts: The Key Components. Washington, D.C.: U.S. Department of Justice, Office of Justice Programs, Drug Court Programs Office.
https://www.ncjrs.gov/pdffiles1/bja/205621.pdf

(NIJ) National Institute of Justice. 2012a. Drug Courts. Washington, D.C.: Office of Justice Programs, NIJ, Bureau of Justice Assistance, and the Office of Juvenile Justice and Delinquency Prevention.
https://www.ncjrs.gov/pdffiles1/nij/238527.pdf

(NIJ) National Institute of Justice. 2012b. “NIJ’s Multisite Adult Drug Court Evaluation.”
http://www.nij.gov/topics/courts/drug-courts/madce.htm

Rottman, David, and Pamela Casey. 1999. Therapeutic Jurisprudence and the Emergence of Problem-Solving Courts. National Institute of Justice Journal 240:12–19.
http://www.ncjrs.gov/pdffiles1/jr000240.pdf

(Urban Institute) Rossman, Shelli Balter, John K. Roman, Janine M. Zweig, Michael Rempel, and Christine H. Lindquist. 2011a. The Multi-site Adult Drug Court Evaluation: Executive Summary. Final Report: Executive Summary. Washington, D.C.: Urban Institute.
https://www.ncjrs.gov/pdffiles1/nij/grants/237108.pdf

(Urban Institute) Rossman, Shelli Balter, John K. Roman, Janine M. Zweig, Christine H. Lindquist, Michael Rempel, Janeen Buck Willison, P. Mitchell Downey, and Kristine Fahrney. 2011b. The Multi-site Adult Drug Court Evaluation: Study Design and Overview. Final Report: Vol. 1. Washington, D.C.: Urban Institute.
https://www.ncjrs.gov/pdffiles1/nij/grants/237109.pdf

(Urban Institute) Zweig, Janine M., Shelli Balter Rossman, John K. Roman, Joshua A. Markman, Erica Lagerson, and Courtney Shafer. 2011c. The Multi-site Adult Drug Court Evaluation: What’s Happening with Drug Courts? A Portrait of Adult Drug Courts in 2004. Final Report: Vol. 2. Washington, D.C.: Urban Institute.
https://www.ncjrs.gov/pdffiles1/nij/grants/237110.pdf

(Urban Institute) Rossman, Shelli Balter, Janine M. Zweig, Dana Kralstein, Kelli Henry, P. Mitchell Downey, and Christine H. Lindquist. 2011d. The Multi-site Adult Drug Court Evaluation: The Drug Court Experience. Final Report: Vol. 3. Washington, D.C.: Urban Institute.
https://www.ncjrs.gov/pdffiles1/nij/grants/237111.pdf
bottom border

Related Practices

top border
Following are CrimeSolutions.gov-rated practices that are related to this program:

Adult Drug Courts
Drug courts are specialized courts that combine drug treatment with the legal and moral authority of the court in an effort to break the cycle of drug use and drug related crime. The practice was rated Promising for reducing recidivism; Promising for reducing alcohol and drug-related offenses (with a 13 percent lower rate compared to nonparticipants); but No Effects for reducing multiple substance use.

Evidence Ratings for Outcomes:
Promising - More than one Meta-Analysis Crime & Delinquency - Multiple crime/offense types
Promising - One Meta-Analysis Crime & Delinquency - Drug and alcohol offenses
No Effects - One Meta-Analysis Drugs & Substance Abuse - Multiple substances
bottom border


Program Snapshot

Age: 18+

Gender: Both

Race/Ethnicity: Black, American Indians/Alaska Native, Asian/Pacific Islander, Hispanic, White, Other

Geography: Rural, Suburban, Urban

Setting (Delivery): Other Community Setting, Courts

Program Type: Alcohol and Drug Therapy/Treatment, Alternatives to Incarceration, Diversion, Drug Court, General deterrence

Targeted Population: Alcohol and Other Drug (AOD) Offenders

Current Program Status: Not Active

Researcher:
Michael Rempel
Research Director
Center for Court Innovation
520 8th Avenue, 18th Floor
New York NY 10018
Phone: 646.386.5910
Fax: 212.397.0985
Website
Email

Training and TA Provider:
Valerie Raine
Director, Drug Court Programs
Center for Court Innovation
520 8th Avenue, 18th Floor
New York NY 10018
Phone: 646.386.4470
Fax: 212.397.0985
Website
Email