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Source publication
Drug courts have been used in the criminal justice system to treat substance use disorders since 1989. This study evaluates a drug court in Indiana, focusing specifically on the most predictive variables for being terminated from the program and comparing recidivism patterns of drug court and probation participants. Participants were most likely to...
Contexts in source publication
Context 1
... statistics were not in the problematic area; therefore, all independent vari- ables were included in the logistic regression analysis. The findings from the logistic regression analysis are noted in Table 1. ...
Context 2
... noted in Table 1, 6 of the 11 independent variables reached statistical significance. First, participants that did not have a high school diploma or equivalent at admission were 2.2 times more likely to be terminated than participants that did have a high school diploma or equivalent at admission. ...
Citations
... Research has shown that, as compared to incarceration, recovery courts reduce recidivism (e.g., subsequent drugrelated arrests) (Jewell et al., 2017). However, program attrition (or "drop out") rates remain high, with some findings suggesting that up to three-quarters of participants fail to graduate from recovery courts (Gallagher et al., 2015). Education and employment serve as protective factors and decrease the likelihood of attrition, with attrition also varying by demographic characteristics, such as age, sex, and race (Abarno et al., 2022;Gallagher et al., 2015;Gray & Saum, 2005;Hickert et al., 2009). ...
... However, program attrition (or "drop out") rates remain high, with some findings suggesting that up to three-quarters of participants fail to graduate from recovery courts (Gallagher et al., 2015). Education and employment serve as protective factors and decrease the likelihood of attrition, with attrition also varying by demographic characteristics, such as age, sex, and race (Abarno et al., 2022;Gallagher et al., 2015;Gray & Saum, 2005;Hickert et al., 2009). Other factors that influencing attrition include selfidentified readiness for change (Cosden et al., 2010) and severity of co-occurring psychiatric conditions (Evans et al., 2009). ...
Background
Recovery courts offer an empirically supported alternative to incarceration for legally involved individuals struggling with addiction. While studies suggest that graduation from recovery courts leads to a lower likelihood of recidivism as compared to incarceration, attrition rates among recovery court participants are high. Relatively little is known about how court participants’ social and family interactions affect progression through recovery court programs – information that could facilitate development of interventions to decrease court program attrition.
Methods
We used in-depth, semi-structured qualitative interviews with recovery court participants (N = 68) across nine recovery courts in one northeastern state to explore the role of social relationships on recovery court program progress.
Results
We found the following relationships can serve as barriers or facilitators through the recovery court program: relationship with one’s self, minor children, other family, twelve-step peer support group members, court program peers, sober living home residents, and court staff. Participants described how recovery courts favored increased focus on one’s self, which was not practical for those with family roles, and study participants felt recovery courts hindered relationships with minor children. Although other family relationships could be motivational, participants also faced misunderstanding and stigma from family members. Furthermore, overreliance on family members and friends for logistical needs (e.g., housing, transportation) could stress fragile relationships and lead to missed court requirements. Court programming facilitated supportive relationships with peers in recovery through required twelve-step peer support group involvement and interaction with court peers. However, ongoing substance use among these peer groups could be distressing for participants, especially in residential facilities. Recovery court staff were further sources of new relationships that were validating of participant progress.
Conclusion
Our findings indicate that the impact of social relationships on recovery court participants is complex and could influence court program progress. We suggest that recovery courts serving legally involved populations consider borrowing approaches from the family treatment court model to strengthen pre-existing relationships and support navigation of parenting roles. Connection to wrap-around services could further alleviate stress on family dynamics. Additional incorporation of previous program graduates or those with substance use histories into recovery court programming could also be explored.
... There is a wealth of information on the effectiveness of treatment courts, and as a whole, they successfully treat substance use and mental health disorders and criminality which results in reductions in criminal recidivism rates (Gallagher et al., 2015). Meta-analyses completed over a decade ago demonstrated this fact (Mitchell et al., 2012;Shaffer, 2011); accordingly, treatment court research has shifted from focusing on if they work to modern topics such as eliminating racial disparities that exist in some programs. ...
... Drug courts were created to address high levels of drug offenses, decrease incarceration, and provide a more cost-effective alternative for handling drug offenders (Goldkamp, 1994;Marlowe et al., 2016). Prior research that has assessed drug courts has typically found more positive outcomes than other forms of traditional court intervention (e.g., probation, incarceration) including reduced drug use and lower rates of recidivism (Gallagher et al., 2015a;Gottfredson & Exum, 2002;Kaeble et al., 2015;Krebs et al., 2007;Marlowe et al., 2016;Mitchell et al., 2012;Rempel et al., 2012;Shaffer, 2011;Spohn et al., 2001;Wilson et al., 2006). While these results are promising, most of the research that has examined the effectiveness of drug courts has been quantitative, with fewer qualitative studies being conducted (Burns & Peyrot, 2003;Fulkerson et al., 2013;Podkopacz et al., 2004;Wolfer & Roberts, 2008), and there are even fewer studies that have compared differences between those who have successfully graduated versus those who were unsuccessful (Fulkerson et al., 2013). ...
... Furthermore, one study's noteworthy strength is the size of the sample. As other researchers have noted, small sample sizes are a common problem in studies [23], [24] with forensic psychiatric patients. ...
Drug abuse has been a significant problem in Pakistan for an abundance
of decades, as evidenced by research. However, it is not certain if forensic psychiatric patients' medication discontinuations have made the
matter worse. There is an important investigation vacuum because this isthe first study of its kind from Pakistan. This study aimed to investigate the discontinuation of pharmaceutical treatment discontinuation upon
discharge in Pakistani forensic psychiatric cases. Specifically, we
investigated the prevalence and correlation of discontinuation of
pharmaceutical treatment. The cross-sectional study was conducted from
July 1, 2023, to December 20, 2023, in the pharmacology and forensic
medicine departments at Ayub Medical College in Abbottabad, KPK,
Pakistan. Each patient's covariate medication type was first subjected to
bivariate Cox regression analysis. All covariates that showed a strong
correlation with cessation were included in a Cox regression model
using forward conditional covariate selection. Of the 118 patients
receiving pharmaceutical treatment at discharge, 72 (61%) discontinued
it within six months. The concurrent presence of psychosis and
personality disorder was the most significant association, while variables
linked to a higher probability of treatment termination differed amongst
different types of psychotropic medicines. A lower rate of drug
discontinuation was linked to older age at discharge, longer hospital
stays, and the presence of a trustee or limited guardian. This covered
antipsychotics, antidepressants, anti-epileptics, and all other
psychotropic medications; psychostimulants and medications used to
treat addiction problems were not. Pharmaceutical discontinuation in
drug abusers has been associated with specific situations for a large
number of former forensic psychiatric patients. This information is important for both individuals working with the group of former patients after being discharged and for those participating in pre-discharge management in a forensic psychiatry.
... Gallagher (2014) reported, for example, that DTC graduates were 11 times less likely to recidivate than DTC participants who did not complete the program. Thus, while DTC participation appears to matter, DTC program graduation may matter even more in reducing recidivism (Gallagher et al., 2015). Effective DTCs, therefore, must pay attention to graduation rates and make efforts to retain participants in DTC programming until they achieve completion (Gallagher et al., 2015). ...
... Thus, while DTC participation appears to matter, DTC program graduation may matter even more in reducing recidivism (Gallagher et al., 2015). Effective DTCs, therefore, must pay attention to graduation rates and make efforts to retain participants in DTC programming until they achieve completion (Gallagher et al., 2015). Conversely, DTCs with low program retention numbers and graduation rates raise questions about implementation fidelity and how effective those programs will be at reducing recidivism (Hiller et al., 2010;Marlowe et al., 2003). ...
... When studies do include measures of program components, those measures are generally limited in scope and do not represent the full range of programmatic components that may impact the likelihood of graduation (Festinger et al., 2002;Jones, 2013;Jones & Kemp, 2011). Another challenge that researchers encounter is that the total amount of time a participant spends in the program has implications for program components (i.e., how many total sessions attended), which must be accounted for when researchers make decisions about how to measure program components (Gallagher et al., 2015;McRee & Drapela, 2012;Randall-Kosich et al., 2022). ...
Drug court programs were introduced in 1989 to reduce incarceration of people with drug-related offenses by integrating substance use treatment into court settings. Previous research has demonstrated drug court programs reduce recidivism, particularly among individuals who successfully complete the program. While much of the existing research is dedicated to examining characteristics of program participants related to graduation and recidivism, little is known about program characteristics associated with effective drug courts. This study identifies characteristics of effective drug courts by examining the effect of various program characteristics (e.g., type and length of treatment, supervision, drug screening results, and punishment) on program completion, net of individual characteristics, legally relevant factors, and mental health history. Administrative data of 357 participants admitted to an adult drug court program in a small city between 2008 and 2018 were utilized. Policy implications are put forth as are directions for future research.
... There is a growing literature examining predictors of successful SUD diversion program completion and recidivism. This literature commonly concentrates on demographic factors including gender (Gray and Saum, 2005;Zettler, 2019;Gallagher et al., 2020), race (Hartley and Phillips, 2001;Gray and Saum, 2005;Ho et al., 2018;Zettler, 2019), and age (Ho et al., 2018;Shannon et al., 2018;Zettler, 2019); and socioeconomic factors such as educational attainment (Hartley and Phillips, 2001;Butzin et al., 2002;Dannerbeck et al., 2006;Ho et al., 2018), employment (Hartley and Phillips, 2001;Butzin et al., 2002;Dannerbeck et al., 2006;Gallagher et al., 2015;Gill, 2016;Ho et al., 2018;Shannon et al., 2018;Zettler, 2019;Gallagher et al., 2020), marital status and social relationships (Dannerbeck et al., 2006;DeVall and Lanier, 2012;Ho et al., 2018), and criminal history (DeVall and Lanier, 2012;Ho et al., 2018;Shannon et al., 2018;Gallagher et al., 2020). These studies suggest that a younger age at time of matriculation, greater extent of criminal history, minority status, less than high school education, and unemployment, may relate to lower likelihood of SUD diversion program completion. ...
... Evidence for relationships between other comorbid conditions (e.g., anxiety, posttraumatic stress disorder, psychosis) is less clear, but generally supports increased dropout for individuals with dual diagnoses (Levin et al., 2004;Gray and Saum, 2005;Lejuez et al., 2008;Evans et al., 2009;Szafranski et al., 2017;Zettler, 2018). However, it is important to note that some studies suggest comorbid mental illness is not associated with termination from diversion or treatment programs Gallagher et al., 2015) or may increase retention (Amaro et al., 2007;Hesse, 2009;López-Goñi et al., 2021), which also may be due to variations in study populations and treatment programs. For full systematic reviews highlighting some of these inconsistencies see Brorson et al. (2013) and Lappan et al. (2020). ...
Introduction
In the US, women are one of the fastest-growing segments of the prison population and more than a quarter of women in state prison are incarcerated for drug offenses. Substance use criminal diversion programs can be effective. It may be beneficial to identify individuals who are most likely to complete the program versus terminate early as this can provide information regarding who may need additional or unique programming to improve the likelihood of successful program completion. Prior research investigating prediction of success in these programs has primarily focused on demographic factors in male samples.
Methods
The current study used machine learning (ML) to examine other non-demographic factors related to the likelihood of completing a substance use criminal diversion program for women. A total of 179 women who were enrolled in a criminal diversion program consented and completed neuropsychological, self-report symptom measures, criminal history and demographic surveys at baseline. Model one entered 145 variables into a machine learning (ML) ensemble model, using repeated, nested cross-validation, predicting subsequent graduation versus termination from the program. An identical ML analysis was conducted for model two, in which 34 variables were entered, including the Women’s Risk/Needs Assessment (WRNA).
Results
ML models were unable to predict graduation at an individual level better than chance (AUC = 0.59 [SE = 0.08] and 0.54 [SE = 0.13]). Post-hoc analyses indicated measures of impulsivity, trauma history, interoceptive awareness, employment/financial risk, housing safety, antisocial friends, anger/hostility, and WRNA total score and risk scores exhibited medium to large effect sizes in predicting treatment completion (p < 0.05; ds = 0.29 to 0.81).
Discussion
Results point towards the complexity involved in attempting to predict treatment completion at the individual level but also provide potential targets to inform future research aiming to reduce recidivism.
... Evidence has consistently shown that the treatment court model is more effective than traditional approaches, like incarceration or probation, at reducing criminal recidivism rates (Gallagher et al., 2015;Mitchell et al., 2012;Shaffer, 2011). Therefore, it is not surprising that adult treatment court models continue to become more prevalent throughout the United States. ...
... In no way do the findings from the research questions suggest that the treatment court model is less effective than alternative approaches, such as traditional probation or incarceration. As discussed previously, treatment courts have years of evidence that they are more effective than alternative approaches at reducing criminal recidivism rates (Gallagher et al., 2015;Mitchell et al., 2012;Shaffer, 2011). The findings, however, do suggest that the majority of treatment courts are not following best practice standards when it comes to evaluation and in creating an equitable and inclusive environment. ...
Disparities in treatment court outcomes, and how the majority of treatment courts are struggling to monitor and react to important indicators of racial disparities in their programs
... The current study contributes to the drug court literature in several ways. First, while there are studies that have examined differences between drug court participants and a comparison group (Deschenes et al., 2001;Gallagher et al., 2015;Gottfredson & Exum, 2002;Krebs et al., 2007;Mitchell et al., 2012;Rempel et al., 2012;Shaffer, 2011;Spohn et al., 2001;Wilson et al., 2006), a greater portion of the literature have either failed to include a comparison group (Carey et al., 2012;Kaeble et al., 2015;Lowenkamp et al., 2005;Marlowe et al., 2016;Roman et al., 2003;Shaffer, 2006;U.S. Government Accountability Office, 2011) or, have lacked statistically appropriate methods to analyze differences between the groups. ...
... Prior literature has often found that adult drug court participants experience lower rates of recidivism than individuals who engage in more traditional forms of court interventions, such as probation or incarceration (Deschenes et al., 2001;Gallagher et al., 2015;Gottfredson & Exum, 2002;Krebs et al., 2007;Mitchell et al., 2012;Rempel et al., 2012;Shaffer, 2011;Spohn et al., 2001;Wilson et al., 2006). Meta-analyses on drug courts have indicated that rearrest rates for graduates two years post-program were reduced by an average of eight to 14%, with the most effective adult drug courts reducing recidivism by 35 to 80%, compared to traditional court interventions (Carey et al., 2012;Lowenkamp et al., 2005;Marlowe et al., 2016;Roman et al., 2003;Shaffer, 2006). ...
... imprisonment, job loss, and social ostracization, and limit access to treatments through oppressive policies and stigma (Carroll et al., 2021;de Vogel et al., 2021;Gallagher et al., 2015;Henderson & Dressler, 2020;Nieweglowski et al., 2019). Recent estimates suggest that only 11-12% of individuals with a SUD seek treatment, highlighting the consequences of these deterrents (Han et al., 2017;Substance Abuse & Mental Health Services Administration, 2022). ...
Stigma facilitates negative outcomes for those with substance use disorders (SUDs), such as restricted healthcare access, job loss, and social ostracization. Many professionals advocate for reducing stigmatizing language in their conduct. However, there remains a notable degree of stigmatizing language in self-report measures. Thus, I aimed to examine psychometric changes from replacing stigmatizing language in self-report measures and test if these changes affect the respondents’ stigmatizing beliefs. I conducted a randomly assigned double-masked experiment with undergraduates (n = 125; Mage = 19.18, SD = 1.05; 62% female; 58% White), Reddit users (n = 224; Mage = 31.28, SD = 9.21; 58% male; 82% White), and Buddhist Recovery Network members (n = 136; Mage = 50.48, SD = 11.50; 61% male; 94% White). The participants completed either the original version of the Addictions Belief Inventory consisting of stigmatizing terms (e.g., drug abuser) or a modified version consisting of non-stigmatizing terms (e.g., those with SUDs). I found no changes to the psychometric properties when I compared the factor structures, distributions, and construct validities. There was a minor reduction in one subscale’s internal consistency and a large change in the mean scores, which varied by sample type. Removing stigmatizing language did not change the measure’s psychometric properties notably. However, I found that removing stigmatizing language reduces stigmatizing beliefs and that this reduction was substantial, especially for those who have no history of SUDs, such as some undergraduates or Reddit users. These findings support an ongoing effort to reduce stigmatizing language among professionals and academics.
... Approximately one half to three quarters of adult drug court and mental health court participants have sparse work histories or low educational achievement (Cissner et al., 2013;Deschenes et al., 2009;Green & Rempel, 2012;Hickert et al, 2009;Leukefeld et al., 2007;Linhorst et al., 2015). Being unemployed or having less than a high school diploma or general educational development (GED) certificate predicts poorer outcomes in drug courts and mental health courts (DeVall & Lanier, 2012;Gallagher, 2013;Gallagher et al., 2015;Mateyoke-Scrivener et al., 2004;Peters et al., 1999;Reich et al., 2015;Roll et al., 2005;Shannon et al., 2015), DWI programs (Green, 2023), child welfare programs (Donohue et al., 2016), and traditional substance use treatment programs (Keefer, 2013;SAMHSA, 2014). At least two studies in adult drug courts have reported improved outcomes when participants received prevocational training that prepared them for how to find employment and perform effectively on the job (Deschenes et al., 2009;Leukefeld et al., 2007). ...
Participants receive desired evidence-based services from qualified treatment, public health, social service, or rehabilitation professionals that safeguard their health and welfare, help them to achieve their chosen life goals, sustain indefinite recovery, and enhance their quality of life. Trained evaluators assess participants' skills, resources, and other recovery capital, and work collaboratively with them in deciding what complementary services are needed to help them remain safe and healthy, reach their achievable goals, and optimize their long-term adaptive functioning. A. Health-Risk Prevention B. Housing Assistance C. Family and Significant Other Counseling D. Vocational, Educational, and Life Skills Counseling E. Medical and Dental Care F. Community, Cultural, and Spiritual Activities A. HEALTH-RISK PREVENTION Participants receive education, training, and resources on statutorily authorized or permissible health-risk prevention measures that are proven to reduce the risk of drug overdose or overdose-related mortality, transmission of communicable diseases, and other serious health threats. Examples may include training on and distribution of naloxone overdose reversal kits, fentanyl and xylazine test strips, and condoms and other safer-sex products and practices. Participants are not sanctioned or discharged unsuccessfully from treatment court for availing themselves of lawfully authorized health-risk prevention measures that have been recommended by a qualified treatment or public health professional , and they are not required to discontinue such measures after they have initiated abstinence or are clinically stable, because a recurrence of symptoms or emerging stressors could reawaken their disorder and associated health threats. Participants may also be called upon to save the life of another family member, friend, or acquaintance and are prepared to respond effectively in such crises. All team members and other professionals affiliated with the treatment court receive training on evidence based health-risk prevention measures and are prepared to respond quickly and effectively in the event of a drug overdose or other medical emergency.
