4.4. The Importance of Tailoring Treatment to Individual Offenders
Public health advocates claim that clients are disadvantaged by criminal justice involvement, in that it can increase antisocial behavior and cause distrust of treatment providers, not to mention its high financial burden. However, public safety advocates argue that drug-involved offenders are characteristically impulsive and irresponsible, and they need close monitoring and supervision to foster a sense of accountability and help them stay on the right path. Research suggests that both arguments may be accurate, but that they describe different types of clients. The risk principle provides that intensive supervision and criminal justice involvement are useful for high-risk offenders with a strong inclination to engage in drug abuse or criminal activity, but such severe monitoring tends to be impractical for low-risk offenders. Risk factors such as age, start of criminal activity/drug use, and antisocial personality disorder (APD) can influence which method is best for dealing with these individuals, making the consideration of individual circumstances and characteristics imperative.
Harrell, Cavanagh, and Roman (1998) examined the impact of differing court dockets on offender drug use and criminal activity in their study of the Washington, D.C., Superior Court Drug Intervention Program (SCDIP). Offenders were randomly assigned to one of three dockets. The sanctions-driven docket offered drug-involved defendants a program of graduated sanctions with weekly drug testing, referrals to community-based treatment, and judicial monitoring of drug use, while the treatment docket offered drug offenders weekly drug testing and an intensive, court-based day treatment program. The remaining participants were placed in a standard docket, which offered drug offenders weekly drug testing, judicial monitoring, and encouragement to seek community-based treatment programs.
Records obtained from the Pretrial Services Agency provided data on defendant characteristics to determine intervention eligibility including criminal history, case processing, and drug test results. Semistructured interviews were also conducted annually on each docket to gather information on those who were offered treatment or programs. Focus group interviews were conducted to gather insight on the defendants’ views on drug court procedures and programs. The evaluation assessed the extent to which SCDIP sanctions and programs reduced drug use and criminal activity, increased voluntary participation in drug treatment services, and improved socioeconomic functioning of participants in the year following the program.
Many of the defendants participating in the standard docket voluntarily participated in community-based treatment programs during pretrial release. One third reported detox services and one quarter reported outpatient treatment. Approximately two thirds (65%) were sentenced to probation: 88% of those who consistently tested drug free in the month before sentencing and 63% of those who tested positive for drugs or skipped tests. Graduated sanctions program participants were more willing to receive detox during the program, while 60% of participants reported attending drug treatment services such as Alcoholics Anonymous (AA) as did 63% of those on the standard docket. Overall, 19% of the 140 participants graduated from the treatment program, whereas 9% left the program in good standing. Two thirds of the participants, including all graduates from this program, received probation.
The entire target group of drug-using defendants on both sanctions and treatment dockets were more likely to test drug free in the month before sentencing. There was a lower likelihood of arrest with sanction program participants who had more days on the street prior to their first arrest after sentencing than with the standard docket group. Treatment participants were not significantly less likely to be arrested in the same year as sentencing or to have more street days before first arrest during the year. Treatment participants were significantly less likely to be arrested for a drug offense than those of the standard docket.
DeMatteo, Marlowe, and Festinger (2006) analyzed the benefits of utilizing secondary prevention services for low-risk drug court clients. Most substance abuse treatment programs are tailored to be beneficial to high-risk clients with serious substance abuse programs, but these programs may be unnecessary or even harmful to those without serious problems. Secondary prevention strategies are designed to interrupt the acquisition of addictive behaviors, rather than trying to treat addiction directly, and are intended for those who have been exposed to risk factors related to certain behaviors but have not yet displayed said behaviors.
Standard drug court procedures incorporate several programs that are ill-suited to the needs of low-risk clients. For example, group counseling sessions often combine high-risk and low-risk offenders and can lead to learned deviance in the low-risk clients. Twelve-step programs are not considered appropriate for individuals who are not addicted to drugs or alcohol and can actually weaken their resistance to such addictions. Motivational interviewing, which is designed to help drug abusers realize the extent to which drug use has negatively affected their lives, may lack effect for those on whom drug use has yet to have a major detrimental effect. It is recommended, then, that interventions for low-risk clients should focus more on interfering with the reinforcing properties of drugs, rather than treating what may be emerging problems as full-fledged addictions.
Marlowe and colleagues (Marlowe, Festinger, Lee, & Patapis, 2005) examined whether perceived deterrence theory helps explain the success of drug courts in dealing with drug-involved offenders. Perceived deterrence theory reasons that the likelihood of an offender engaging in drug use or criminal activity is affected by the perceived likelihood of being detected and the certainty of being punished or rewarded based on behavior. This research used data from three experimental studies on the effect of judicial status hearings on drug court outcomes, in which participants were randomly assigned to either Group 1 (biweekly hearing schedule) or Group 2 (hearings only as needed).
In addition to testing for program success, ASI, and APD, participants were subject to a “perceived deterrence questionnaire,” which was a 6-item Likert scale assessing participants’ perceptions of the likelihood that they would be detected/sanctioned for infractions and recognized/ rewarded for achievements, and the likelihood that sanctions/ rewards would be meaningful for them. This questionnaire was administered 3 times monthly over the course of the study.
Based on data from the questionnaires, participants were classified into one of five clusters: believers (34%), average (27%), skeptics (11%), disillusioned (14%), and learners (14%). Believers had high perceived deterrence over the whole course of the program, while skeptics had the opposite. Average had consistently moderate scores. Disillusioned had initially high perceived deterrence, but scores diminished over time, while learners experienced the opposite effect. Believers tended to be older and female, while skeptics were younger and less frequently female. Participants with prior treatment history tended to be disillusioned. Males (who tended to not be believers) had lower graduation rates. Cluster groupings were not significantly linked with ASI scores, alcohol problems, or legal problems.