Prompted to treatment by the criminal justice system: Relationships with treatment retention and outcome among cocaine users

Abstract

Background and Objectives A substantial portion of individuals entering treatment for substance use have been referred by the criminal justice system, yet there are conflicting reports regarding treatment engagement and outcome differences compared to those not referred. This study examined baseline characteristic and treatment outcome differences among cocaine-dependent individuals participating in cocaine treatment randomized trials. Methods This secondary analysis pooled samples across five completed randomized controlled trials, resulting in 434 participants. Of these, 67 (15%) were prompted to treatment by the criminal justice system. Results This subsample of criminal justice prompted (CJP) individuals did not differ from those not prompted by the criminal justice system in terms of gender, race/ethnicity, marital status, or age. However, the CJP group reported more years of regular cocaine use, more severe employment and legal problems, as well as less readiness to change prior to treatment. Treatment outcomes did not differ significantly from those without a criminal justice prompt, and on some measures the outcomes for CJP group were better (e.g., percentage of days cocaine abstinent, number of therapy sessions attended). Discussion and Conclusions These findings suggest that being prompted to treatment by the criminal justice system may not lead to poorer treatment engagement or substance use outcomes for individuals participating in randomized controlled treatment trials. Scientific Significance Despite some baseline indicators of poorer treatment prognosis, individuals who have been prompted to treatment by the criminal justice system have similar treatment outcomes as those presenting to treatment voluntarily.

The Criminal Justice System and More Lenient Drug Policy: Three Case Studies on California's Changes to How Its Criminal Justice System Addresses Drug Use

“…Probation plays a type of system navigator role through the referrals it provides, while also wielding the power to coerce clients to take-up necessary services. Most research evaluating the policy lever of coercion to induce treatment has ignored the role of probation departments, simply asking whether one was under probation supervision (J. F. Kelly et al, 2005; S. M. Kelly, O'Grady, Jaffe, Gandhi, & Schwartz, 2013; Kiluk et al, 2015;Marshall & Hser, 2002;Wild, Yuan, Rush, & Urbanoski). Other research has treated justice-related coercion as a unitary policy, ignoring the heterogeneity in how it is used (Farabee, Prendergast, & Anglin, 1998).…”

“…M. Kelly et al, 2013;Kiluk et al, 2015;Perron & Bright, 2008). Some studies have been able to extend the time horizon beyond the index episode, typically measuring longer-term outcomes such as drug use or recidivism (J. F. Kelly et al, 2005;Kiluk et al, 2015). But because these studies start with a sample already in treatment and do not have information on the timing of the CS spell, they do not attempt to analyze the role of CS in inducing treatment.…”

“…Most studies examining the role of legal pressure and SUD treatment utilize a prospective sample of SUD treatment participants that have selfidentified as being referred by the justice system, allowing these studies to only measure retention and other outcomes associated to that episode (Coviello et al, 2013;S. M. Kelly et al, 2013;Kiluk et al, 2015;Wild et al, 2016). This single-episode process, though, does not reflect the recovery trajectory, or "treatment career," experienced by many people afflicted by addiction, who frequently drop out of treatment and relapse Dennis, Scott, Funk, & Foss, 2005).…”

“…Thus, most studies have tested the effect of coercion on treatment retention for the index episode (Coviello et al, 2013;Hiller, Knight, Broome, & Simpson, 1998;S. M. Kelly et al, 2013;Kiluk et al, 2015;Perron & Bright, 2008). Some studies have been able to extend the time horizon beyond the index episode, typically measuring longer-term outcomes such as drug use or recidivism (J. F. Kelly et al, 2005;Kiluk et al, 2015).…”

Motivation and substance use outcomes among adolescents in a school-based intervention

“…For instance, Kiluk and colleagues (2015) found that adults referred to treatment by the criminal justice system (external motivation) had similar substance use treatment outcomes as those who were not. Our results suggest that the low problem recognition characterizing the Coerced Action group may be reflective of less drug involvement and their coerced action may be an appropriate response to substance use.…”