Article

Addiction Severity Index Scores and Urine Drug Screens at Baseline as Predictors of Graduation From Drug Court

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Abstract

Graduation rates from drug courts are impressive and are often attributed to the delivered treatments. However, it is unclear whether graduation rates are bolstered by low severity of drug use problems upon entry into drug court. To address this question, this study examined the relationship between baseline substance use severity and graduation rates among 251 drug court clients. Results revealed that participants with subthreshold drug composite scores on the Addiction Severity Index (ASI) were significantly more likely to graduate than those scoring in the mild-to-moderate or severe range. Furthermore, results revealed that participants who provided a drug-negative baseline urine were significantly more likely to graduate than those who provided a drug-positive baseline urine. A binary logistic regression analysis revealed that ASI drug composite score, urine screen, race, and years educated were statistically significant predictors of drug court graduation.

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... Previous research suggests that severity of need is related to graduation rates. Ample research suggests that graduation is more likely among clients who are older (Hickert et al., 2009;Mateyoke-Scrivner et al., 2004;Stageberg et al., 2001;Wolf et al., 2003;DeVall & Lanier, 2012), female (Gallagher et al., 2020;Gray & Saum, 2005;Hartman et al., 2007;Stageberg et al., 2001), White vs. non-White (Brewster, 2001;Butzin et al., 2002;Fulkerson et al., 2012;Gray & Saum, 2005;Hartley & Phillips, 2001;Ho et al., 2018;Mateyoke-Scrivner et al., 2004;Shah et al., 2013;Shannon et al., 2016;Stageberg et al., 2001), employed (Butzin et al., 2002;Gallagher et al., 2020;Hartley & Phillips, 2001;Listwan et al., 2009;Mateyoke-Scrivner et al., 2004;Roll et al., 2005;Stageberg et al., 2001;Wu et al., 2012), and more educated (Gill, 2016;Gray & Saum, 2005;Listwan et al., 2009;Mateyoke-Scrivner et al., 2004;Shah et al., 2013;Shannon et al., 2016;Stageberg et al., 2001). Multiple studies also suggest that individuals with more serious criminal histories (Gallagher et al., 2020;Gray & Saum, 2005;Mateyoke-Scrivner et al., 2004;Miller & Shutt, 2001;Peters et al., 1999;Rempel & DeStefano, 2001;Shannon et al., 2016;Wolf et al., 2003) and those who use harder drugs (e.g., cocaine, opioids) are less likely to graduate (Brown, 2010a;Hartley & Phillips, 2001;Hickert et al., 2009;Mateyoke-Scrivner et al., 2004;Wolf et al., 2003). ...
... Previous research suggests that severity of need is related to graduation rates. Ample research suggests that graduation is more likely among clients who are older (Hickert et al., 2009;Mateyoke-Scrivner et al., 2004;Stageberg et al., 2001;Wolf et al., 2003;DeVall & Lanier, 2012), female (Gallagher et al., 2020;Gray & Saum, 2005;Hartman et al., 2007;Stageberg et al., 2001), White vs. non-White (Brewster, 2001;Butzin et al., 2002;Fulkerson et al., 2012;Gray & Saum, 2005;Hartley & Phillips, 2001;Ho et al., 2018;Mateyoke-Scrivner et al., 2004;Shah et al., 2013;Shannon et al., 2016;Stageberg et al., 2001), employed (Butzin et al., 2002;Gallagher et al., 2020;Hartley & Phillips, 2001;Listwan et al., 2009;Mateyoke-Scrivner et al., 2004;Roll et al., 2005;Stageberg et al., 2001;Wu et al., 2012), and more educated (Gill, 2016;Gray & Saum, 2005;Listwan et al., 2009;Mateyoke-Scrivner et al., 2004;Shah et al., 2013;Shannon et al., 2016;Stageberg et al., 2001). Multiple studies also suggest that individuals with more serious criminal histories (Gallagher et al., 2020;Gray & Saum, 2005;Mateyoke-Scrivner et al., 2004;Miller & Shutt, 2001;Peters et al., 1999;Rempel & DeStefano, 2001;Shannon et al., 2016;Wolf et al., 2003) and those who use harder drugs (e.g., cocaine, opioids) are less likely to graduate (Brown, 2010a;Hartley & Phillips, 2001;Hickert et al., 2009;Mateyoke-Scrivner et al., 2004;Wolf et al., 2003). ...
... Multiple studies also suggest that individuals with more serious criminal histories (Gallagher et al., 2020;Gray & Saum, 2005;Mateyoke-Scrivner et al., 2004;Miller & Shutt, 2001;Peters et al., 1999;Rempel & DeStefano, 2001;Shannon et al., 2016;Wolf et al., 2003) and those who use harder drugs (e.g., cocaine, opioids) are less likely to graduate (Brown, 2010a;Hartley & Phillips, 2001;Hickert et al., 2009;Mateyoke-Scrivner et al., 2004;Wolf et al., 2003). A few studies also found that co-occurring mental health problems (Mendoza et al., 2013;Shannon et al., 2016) and SUD severity (Butzin et al., 2002;Gray & Saum, 2005;Shah et al., 2013) were associated with lower drug court graduation rates. ...
Article
Introduction Although existing research suggests drug courts reduce recidivism and substance use, a large portion of drug court participants do not graduate. According to a conceptual framework, severity of need and program intensity may help to explain variation in drug court effectiveness. Understanding variation in drug court graduation can help to identify high risk participants and effective programmatic elements. Methods Our sample included 247 drug court participants from an adult felony-level drug court located in a large metropolitan area of the southeastern United States that either graduated (n = 113) or were terminated (n = 134) from the program. We used participant and program characteristics from drug court program records to predict drug court graduation. Results In bivariate analyses, several participant and program characteristics were significantly associated with drug court graduation. In the final multivariate model, only one participant-level characteristic was significantly related to graduation: emotional/personal risk and needs (aOR: 0.56, 95% CI: 0.33, 0.93). Alternatively, three program characteristics remained statistically significant predictors of drug court graduation in the final multivariate model. Receiving more individual counseling sessions was positively associated with drug court graduation (aOR: 1.27, 95% CI: 1.14, 1.41), while jail and monetary fine sanctions were negatively associated with drug court graduation (aOR jail: 0.45, 95% CI: 0.30, 0.68; aOR fine: 0.28, 95% CI: 0.10, 0.78). Conclusions Our findings suggest that drug court programs may benefit by tailoring services for individuals with high emotional/personal risk and participants who receive certain types of sanctions. More rigorous research should explore the causal relationship between individual counseling and drug court graduation to determine if wide-scale programmatic changes are warranted.
... Given that substance abuse treatment is a critical part of drug court, there may be some similarities and differences in factors associated with substance abuse treatment completion and drug court program completion. Findings from previous studies suggest numerous social and demographic factors are associated with drug court completion including: older age at intake (DeVall & Lanier, 2012;Fulkerson, Keena, & O'Brien, 2012;Hickert, Boyle, & Tollefson, 2009), being a parent (Wu, Altshuler, Short, & Roll, 2012), being female (Dannerbeck, Sundet, & Lloyd, 2002), having a higher level of education (Brown, 2010;DeVall & Lanier, 2012;Fulkerson et al., 2012;Hartley & Phillips, 2001;Howard, 2016;Shah et al., 2013), being employed at or after intake (DeVall & Lanier, 2012;Hartley & Phillips, 2001;Howard, 2016;Roll, Prendergast, Richardson, Burdon, & Ramirez, 2005;Shannon, Jackson, Perkins, & Neal, 2014;Wu et al., 2012), and reporting White as one's race (Hartley & Phillips, 2001;McKean & Warren-Gordon, 2011;Shah et al., 2013). More specifically, in regards to race, McKean and Warren-Gordon (2011) suggest that race, specifically being African American, may interact with other factors such as psychological well-being to reduce the likelihood of drug court completion. ...
... Given that substance abuse treatment is a critical part of drug court, there may be some similarities and differences in factors associated with substance abuse treatment completion and drug court program completion. Findings from previous studies suggest numerous social and demographic factors are associated with drug court completion including: older age at intake (DeVall & Lanier, 2012;Fulkerson, Keena, & O'Brien, 2012;Hickert, Boyle, & Tollefson, 2009), being a parent (Wu, Altshuler, Short, & Roll, 2012), being female (Dannerbeck, Sundet, & Lloyd, 2002), having a higher level of education (Brown, 2010;DeVall & Lanier, 2012;Fulkerson et al., 2012;Hartley & Phillips, 2001;Howard, 2016;Shah et al., 2013), being employed at or after intake (DeVall & Lanier, 2012;Hartley & Phillips, 2001;Howard, 2016;Roll, Prendergast, Richardson, Burdon, & Ramirez, 2005;Shannon, Jackson, Perkins, & Neal, 2014;Wu et al., 2012), and reporting White as one's race (Hartley & Phillips, 2001;McKean & Warren-Gordon, 2011;Shah et al., 2013). More specifically, in regards to race, McKean and Warren-Gordon (2011) suggest that race, specifically being African American, may interact with other factors such as psychological well-being to reduce the likelihood of drug court completion. ...
... More specifically, the absence of a cocaine-use disorder (Brown, 2010;Mateyoke-Scrivner, Webster, Staton, & Leukefeld, 2004) and fewer symptoms of depression have been associated with more positive drug court program completion outcomes (Mendoza, Trinidad, Nochajski, & Farrell, 2013). In regards to substance use, Shah et al. (2013) noted lower Addiction Severity Index composite scores and a negative urine screen at baseline were associated with drug court program completion. Further, Roll et al. (2005) showed that individuals with a history of intravenous drug use were less likely to complete drug court. ...
Article
This study examined individual factors and during-program data to understand drug court program completion. A total of 534 Kentucky Drug Court (KDC) participants were randomly selected from the larger KDC population (N = 4,881). Logistic regression showed that older age and receiving outpatient referrals were associated with completion. Factors associated with reduced odds of completion were: Non-White race, being married, lower educational level, increasing number of psychological/emotional treatment episodes, increasing number of positive drug tests, receiving incarceration and warrant sanctions, and prior criminal justice involvement. Understanding drug court completion is important to make modifications to better meet participants’ needs.
... This study used composite scores calculated from the integrated ASI-5 questionnaire ranging from 0 (not an issue) to 1 (severe issue: McLellan et al. 1992). A composite score ≤ 0.04 is considered mild issues, scores > 0.04 but ≤ 0.24 are moderate issues, and scores > 0.24 are severe issues (Shah et al. 2013). The ASI-5 alcohol, drug, and psychiatric composite scores showed adequate concurrent and discriminant validity (Calsyn et al. 2004;Shah et al. 2013). ...
... A composite score ≤ 0.04 is considered mild issues, scores > 0.04 but ≤ 0.24 are moderate issues, and scores > 0.24 are severe issues (Shah et al. 2013). The ASI-5 alcohol, drug, and psychiatric composite scores showed adequate concurrent and discriminant validity (Calsyn et al. 2004;Shah et al. 2013). This study focused on how much consumers' alcohol use composite score (M = .18, ...
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This study examined the influence of gender, post-treatment issue severities, and treatment participation rate on the post-treatment employment status of consumers with substance use disorders. The study analyzed the archival data of 100 unemployed and underemployed participants from a substance abuse intensive outpatient program. We found significant differences in the characteristics of gender, severity of alcohol use, drug use, psychiatric issues, and treatment participation rate. Female gender and low treatment participation rates negatively predicted employment. This study increased understanding about the interplay of alcohol, drug, and psychiatric influences on post-treatment employment status.
... A recent national survey of treatment courts also found racial and ethnic disparities in 2019 graduation rates, with African Americans and Hispanics completing programs less often than white participants (DeVall et al., 2023). Previous research has consistently found racial and ethnic disparities in graduation rates (Marlowe, 2013;Shah et al., 2015;Shannon et al., 2016) and, unfortunately, the trend dates back over 20 years (Brewster, 2001). Additionally, this disparity is not limited to African Americans and Hispanics, as evidenced by American Indians and those who identify as biracial also graduating treatment courts at lower rates than their white counterparts (Gallagher et al., 2023). ...
Article
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
... However, there are conflicting views regarding the reliability of the ASI as a meaningful predictor of treatment dropout. 24,25 Data Analysis Data were analyzed using SPSS version 17.0. Besides the descriptive statistics (mean ± standard deviation, range) for all, the participants were grouped as relapsed (n=18) or non-relapsed (n=42). ...
Article
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Introduction Substance abuse is a complex issue requiring multi-disciplinary management. Protracted abstinence syndrome leads to persistent discomfort even after detoxification lasting months, resulting in poor sleep duration and quality. Despite being a major contributor to relapse and sleep disturbances, no objective assessment procedures to monitor sleep after the detoxification have been reported. The study aims to assess sleep structure after detoxification via polysomnography and psychometrically assess sleep over the next 6 months in abstinent and relapsing patients. Methods Sixty successfully detoxified males (35.8 ± 7.3 years) with a history of heroin abuse (DSM-V) (mean composite scores (ASI): 1.3 ± 0.06, 3.48 ± 0.38, 5.45 ± 0.63, 1.2 ± 0.19, 3.93 ± 0.9, and 2.61 ± 0.8 for medical status, employment/support status, alcohol/drugs status, legal status, family/social relationships, and psychiatric status, respectively) were recruited immediately following their detoxification, without giving additional psychoactive substances or medications. Polysomnography was done in the second week following detoxification to allow washout of medications, followed by a monthly sleep assessment through sleep diary and daytime sleepiness using a visual analog scale. Relapse was proved by a urine test. Polysomnographic parameters and ASI subscales for relapsing and non-relapsing participants were compared using a 2-tailed Student’s t-test (p<0.05). Results Eighteen participants relapsed by 6 months (12 by 3 months). Only the ASI legal problems score was significantly different for the two groups (p=0.001). The differences were significant for NREM stages I (p=0.001) and II (p=0.002), bilateral limb movement (p=0.009), and arousal indices (p=0.001). Conclusion Measuring polysomnographic parameters (percentage of NREM I and II, arousal index, and limb movement index) for sleep disturbance in detoxified heroin-abuse patients can be potential predictors for relapse in a 6-month follow-up.
... This finding is consistent with past literature suggesting the importance of education for drug court completion. Based on the existing literature, having a higher level of education (Brown, 2010;DeVall & Lanier, 2012;Fulkerson et al., 2012;Hartley & Phillips, 2001;Howard, 2016;Shah et al., 2013) has been associated with better drug court program outcomes. Specifically, Shah and colleagues (2013) showed for each additional year of education, the participant was 1.4 times more likely to graduate. ...
Article
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The study purpose was to compare individuals participating in rural and urban drug courts to examine factors associated with program completion. Secondary data (participant assessment; drug court Management Information System) as well as conviction information from a statewide database were examined for a sample of drug court participants ( N = 534). Based on multivariate analysis, for rural participants, two variables were significantly associated with increased program completion: age and outpatient treatment. Conversely, for rural participants, the number of felony/misdemeanor convictions before drug court and receiving an incarceration sanction during drug court were associated with program non-completion. For urban participants, gender and age were associated with increased odds of completion, whereas marital status, education, and past 30-day cocaine use were associated with program non-completion. Findings suggest contextual differences in participant characteristics and during-program occurrences, which ultimately influenced program completion. Understanding contextual factors has important implications for program planning and implementation.
... Drug court is supported by more than 25 years of empirical research suggesting there are multiple factors that might be different between those who do and do not complete the program. Examinations of both men and women drug court participants have identified multiple characteristics including age (DeVall & Lanier, 2012), education (DeVall & Lanier, 2012, marital status (Mateyoke-Scrivner, Webster, Staton, & Leukefeld, 2004), employment (DeVall & Lanier, 2012, race (Shah et al., 2013), substance use (Brown, 2010), mental health (Mendoza, Trinidad, Nochajski, & Farrell, 2013), and criminal history Wolf, Sowards, & Wolf, 2003) that could affect program completion. Drug court participants experience issues related to physical health, family and interpersonal relationships, victimization (e.g., domestic violence), and housing (e.g., unstable living conditions) that could also affect their programmatic success (Wolf & Colyer, 2001). ...
Article
The study purpose was to examine factors affecting women in completing drug court. Participants were 212 women drug court participants selected via stratified random sampling (by county) from the larger Kentucky Drug Court participant population. Various secondary data sources were used (e.g., participant assessment, Management Information System), and multivariate logistic regression examining 17 independent variables showed 4 variables were significantly associated with program completion for women: employment at program assessment, intravenous opiate use, number of times hospitalized for psychological or emotional problems, and conviction of a misdemeanor-eligible violent crime before drug court. Study findings can be used by social workers and other practitioners to better understand women’s drug court participation and to identify ways to tailor program services for women’s unique needs.
... Findings have shown that parolees undergoing treatment, for instance, were less likely to be rearrested for drug abuse violations if they presented less serious (i.e. less harmful drugs such as marijuana) forms of drug use (Friedmann et al., 2012). Similar results were found with drug court clients, such that those with lower substance use severity scores were more likely to achieve favorable outcomes following substance use treatment program completion (Shah et al., 2013). ...
Article
Purpose – Effective substance use treatment is a viable way to reduce criminal justice contact among drug-involved offenders, but there is still a lot to learn about which indicators have the greatest impact on treatment outcomes. The purpose of this paper is to determine which clinical indicators influenced the likelihood of rearrest among male drug-involved offenders. Design/methodology/approach – This prospective longitudinal study examined indicators of 12-month post-treatment rearrest for male criminal justice-involved substance use treatment patients. Multinomial logistic regression results drawn from a sample of 1,531 adult male patients who were mandated to substance use treatment indicated that there were different factors related to the likelihood of one as well as multiple post-treatment arrests. Findings – Demographic risk factors, such as age and unemployment, were associated with significant increases in the probability of experiencing an arrest within 12-months of treatment discharge. Substance use relapse was also a significant indicator of the likelihood of rearrest and contributed to an increase in the odds of one post-treatment rearrest as well as multiple rearrests. A drug dependence diagnosis, relative to a diagnosis for alcohol dependence, was associated with an increased likelihood of rearrest. Participation in outpatient treatment was associated with a lower likelihood of rearrest. Practical implications – These findings emphasize the need for treatment providers to concentrate heavily on demographic risk reduction to minimize the chance that male patients are rearrested after treatment. Relapse prevention, on the other hand, is critical in the effort to minimize the number of post-treatment rearrests in this population. Originality/value – The results from this study provide evidence to empirically support the refinement of substance treatment programs for male patients involved in the criminal justice system.
... Consistent with existing literature (Ahmadi et al., 2009), individuals with a negative urine sample at treatment initiation remain in treatment longer and achieve more abstinence than those who enter treatment with a positive sample. Negative urine screens at baseline are indicative of a good prognosis in treatment overall (Shah et al., 2013;Sofuoglu, Gonzalez, Poling, & Kosten, 2003) and in predominately African American samples as well Tzilos, Rhodes, Ledgerwood, & Greenwald, 2009). However, the current study found differential outcomes in baseline urine results and treatment outcomes by treatment type and race. ...
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We sought to understand the individual level predictors of intermediate outcomes in a diversion drug court. Outcomes included acceptance to drug court, sanction(s), incentives(s), drug test results, and graduation. Because much of the prior literature on individual level predictors of these outcomes is mixed, drug courts can benefit from analysis of their own data to understand what factors are important, or not, for their population. We analyzed administrative data and found significant predictors varied by outcome. Results showed that the court adhered to best practices (Florida Adult Drug Court Best Practice Standards, 2017), because there were no race or sex differences between those accepted to drug court or not, those sanctioned when in drug court, and those graduated successfully versus unsuccessfully discharged. The court team can use these findings to better understand their population, their program, and ensure compliance with best practices. Results also contribute to the broader drug court literature.
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Drug courts are slowly beginning to expand their admission criteria to include more chronic and serious offenders since traditional probation and incarceration have failed to prevent drug use and crime. Drug courts have moved from providing diversion programs for first-time offenders charged with drug possession to developing tracks for more complex clients. Many of these new drug court participants have extensive criminal histories, including histories of violent crime. Drug court decision-makers thus confront the difficulty of balancing the needs of treatment versus corrections by attempting to target offenders whose criminal histories suggest that their candidacy in a drug court would not pose a risk to public safety. To date, little is known about whether drug courts are appropriate for offenders with lengthy criminal histories that often include violence. The research presented here explores correlates of drug court graduation for seriously crime-involved offenders, most of whom have a history of violence.
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This study examined program outcomes for 133 graduates (46.2%) and 155 terminated clients (53.8%) of an adult felony drug court in Salt Lake City, Utah, in an effort to identify factors that predict program completion and drop out. Logistic regression analyses identified three factors related to drop out: depression, cocaine/stimulants as most troubling substance, and additional charges prior to drug court intake. Two factors were found to be related to completion: spending free time with family rather than with friends or alone and older age at intake. The model correctly predicted 65% of graduates and 73% of dropouts. These findings are discussed with respect to their implications for policy, practice, and future research.
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This article argues that evaluation of drug courts will benefit not only from an organizing typology that focuses research on the critical structural elements of the drug court model but also from an understanding of how drug courts are thought to deliver their impact. In developing a causal model of drug court impact, the analysis separates assessment of impact into two investigations: whether drug courts "Work" and how they work. Data from the ongoing National Inst of Justice supported evaluation of the Portland and Las Vegas drug courts are analyzed to answer the comparative question of whether there is an impact (and of what sort) and then to move consideration of the internal elements of the drug court (the black box of drug court treatment) through the development of successive theoretical models. The illustrative analyses guided by these models consider the relative contributions of instrumental drug court treatment functions and defendant risk attributes, which contribute importantly to drug court outcomes. The exploratory findings differ by site, but show some support for the importance of treatment, sanctions and appearances before the drug court judge--and their interaction--in lowering the prospects for subsequent rearrest and increasing likelihood of graduation. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Analyses were performed to construct and confirm the validity of new conjoint intake and 6-month follow-up scales for the Addiction Severity Index (A. T. McLellan, L. Luborsky, G. E. Woody, & C. P. O'Brien, 1980) applied to a diverse sample of substance dependence patients ( N = 1,008). A multistage scaling strategy identified 5 psychometrically integral addiction problem scales. Exploratory item and factor analyses, confirmatory oblique item clustering, and variance partitioning verified that the scales comprised relatively little common variance and that each retained a substantial amount of unique and reliable variance. Resulting scales (Psychiatric, Drug, Alcohol, Family, and Legal Problems, respectively) were highly internally consistent and structurally stable overall, at intake and follow-up and across gender, age, ethnicity, and substance abuse categories. Concurrent and predictive validity over 2 years were supported for clinical subsamples based on comorbid psychopathology and mood, HIV risk behaviors, personality indices, urine toxicology, and criminal records. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Drug courts combine punishment and treatment to provide an intermediate sanction for offenders. This paper contains an analysis of drug court case files for 196 participants in one mid-Atlantic jurisdiction. Logistic regression reveals that employment status before and during the program, race, education, and referral time are significant predictors of successful completion. Policy implications and suggestions about participant screening and program administration are offered.
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This pilot study (N = 30) experimentally examined the effects of an adaptive intervention in an adult misdemeanor drug court. The adaptive algorithm adjusted the frequency of judicial status hearings and clinical case-management sessions according to pre-specified criteria in response to participants' ongoing performance in the program. Results revealed the adaptive algorithm was acceptable to both clients and staff, feasible to implement with greater than 85% fidelity, and showed promise for eliciting clinically meaningful improvements in drug abstinence and graduation rates. Estimated effect sizes ranged from 0.40 to 0.60 across various dependent measures. Compared to drug court as-usual, participants in the adaptive condition were more likely to receive responses from the drug court team for inadequate performance in the program and received those responses after a substantially shorter period of time. This suggests the adaptive algorithm may have more readily focused the drug court team's attention on poorly-performing individuals, thus allowing the team to "nip problems in the bud" before they developed too fully. These preliminary data justify additional research evaluating the effects of the adaptive algorithm in a fully powered experimental trial.
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High performance liquid chromatography has been applied to the separation of the globin chains of 16 non-human species which include common mammalian and avian species. The procedure uses a large-pore C4 column which has been effectively employed for the separation of human globin chains. In many cases, the gradient for human chains with trifluoroacetic acid-water-acetonitrile was satisfactory or required only moderate modification. The separations were excellent for all except dog hemoglobin. Many results substantiate prior published information about heterogeneity, amino acid composition, etc. of the individual hemoglobins. Additional data on some of these hemoglobins have also been obtained, and some previously unstudied hemoglobins have been examined.
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Factors related to successful completion of a first offender diversion program were examined from initial data of a longitudinal study of drug treatment court outcomes in Delaware. The strongest predictors of success were factors associated with social stakeholder values, especially those involving employment. Other factors associated with program completion included race, education, and frequency of drug use. While the overall success of drug treatment courts continues to be documented, these data suggest success varies with individual characteristics. The continuing study will explore whether these characteristics are also related to subsequent outcomes, especially drug use relapse and criminal recidivism, over a 24-month post-treatment period.
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This article reports outcomes from a program of experimental research evaluating the risk principle in drug courts. Prior studies revealed that participants who were high risk and had (a) antisocial personality disorder or (b) a prior history of drug abuse treatment performed better in drug court when scheduled to attend biweekly judicial status hearings in court. In contrast, participants who were low risk performed equivalently regardless of the court hearings schedule. This study prospectively matches drug court clients to the optimal schedule of court hearings based on an assessment of their risk status and compares outcomes to clients randomly assigned to the standard hearings schedule. Results confirmed that participants who were high risk and matched to biweekly hearings had better during-treatment outcomes than participants assigned to status hearings as usual. These findings provide confirmation of the risk principle in drug courts and yield practical information for enhancing the efficacy and cost-efficiency of drug courts.
Article
This study sought to identify patterns of substance use among 1,019 participants of the New South Wales Drug Court program (Sydney, Australia) between 2003 and 2009. Group-based trajectory modeling identified five groups of participants: compliant participants (24.4%), who had a near-zero probability of returning a positive urine test at each occasion; responding participants (25.3%), for whom the probability of returning a positive test decreased; relapsing participants (14.1%), for whom the probability of returning a positive test increased; mid-level chronic participants (26.0%), who had a one in two chance of returning a positive test at each episode; and a high-level chronic group (10.2%), who had a very high probability of returning a positive test at each episode. Group membership probability was found to be a good predictor of treatment and criminal justice outcomes. The challenge for future research is to identify the characteristics that explain these early-phase substance use trajectories.
Article
PurposeThe objective of this research was to systematically review quasi-experimental and experimental evaluations of the effectiveness of drug courts in reducing offending.Methods Our search identified 154 independent evaluations: 92 evaluations of adult drug courts, 34 of juvenile drug courts, and 28 of DWI drug courts. The findings of these studies were synthesized using meta-analysis.ResultsThe vast majority of adult drug court evaluations, even the most rigorous evaluations, find that participants have lower recidivism than non-participants. The average effect of participation is analogous to a drop in recidivism from 50% to 38%; and, these effects last up to three years. Evaluations of DWI drug courts find effects similar in magnitude to those of adult drug courts, but the most rigorous evaluations do not uniformly find reductions in recidivism. Juvenile drug courts have substantially smaller effects on recidivism. Larger reductions in recidivism were found in adult drug courts that had high graduation rates, and those that accepted only non-violent offenders.Conclusions These findings support the effectiveness of adult drug courts in reducing recidivism. The evidence assessing DWI courts' effectiveness is very promising but more experimental evaluations are needed. Juvenile drug courts typically produce small reductions in recidivism.
Article
This research examines outcomes among first-year participants in the dedicated drug treatment court in Broward County, Florida, from July 1, 1991, through June 30, 1992. Participant data are used to predict the likelihood of successful program graduation. This research is designed to help understand the differences between participants who fail to graduate versus those who successfully complete the drug court treatment program. Independent variables are derived from interview questionnaires soliciting personal demographic, behavioral, and drug use history information. Logistic regression analysis is used to identify significant predictors. The research finds that demographic characteristics, such as race and education, as well as crack use, are the most useful defendant characteristics for predicting program graduation. The implications of these findings for public policy decision makers are discussed.
Article
This paper focuses on an evaluation of the Riverside County (California) Drug Court Program, a post conviction program that operates much like most drug courts in the country. Riverside County has a large population of drug abusers. A recent study (Sechrest and Josi, 1996) showed that about 40% of the prison commitments from this county were for drug offenses (this figure did not include commitments for other crimes with drug involvement). The “Inland Empire,” comprising Riverside County and San Bernardino counties, is known as one of the highest, if not the highest, producers of methamphetamine in the nation.
Article
The purpose of this article is to describe results of a process evaluation for a drug court program. In all, 69 different individuals representing 10 different agency perspectives provided information about the drug court program for this study. Results indicated that although this drug court program was relatively new, it was a highly regarded program both nationally and locally. The program has been implemented successfully, fits well into the local community, has served many eligible persons in the community, and has successfully met its goals. The feedback from each of the agencies and perspectives surveyed was overwhelmingly positive. In addition, results of the intake data provided information about characteristics of clients who terminated from the program compared to clients who graduated. The process evaluation approach provided in-depth information from a variety of perspectives on multiple dimensions of the program.
Article
This study evaluates the impact of enhanced drug court services in a large county in Southern California. These enhanced services, including specialty counseling groups, educational/employment resources, and increased Residential Treatment (RT) beds, were designed to increase program retention and successful completion (graduation) of drug court. This study examines outcomes for 477 male and 273 female drug court participants between January 2004 and March 2005 in Orange County, California. Data were gathered from various sources including the Drug Court management information system (MIS) and probation records. The results suggest that several enhancements individually increase participation retention (as opposed to termination) in drug court, particularly education, employment, RT, and two specialty counseling groups (Alcohol Recovery and Mask of Addiction). Similarly, participant graduation rates were improved with the individual effects of education, employment, and the same two specialty counseling groups. The combination of RT, specialty counseling groups, and employment achievement increased graduation rates for drug court participants. This research suggests further examination of these variables in alternate settings to determine the extent to which these strong but preliminary results are generalizable.
Article
A substantial body of research supports the effectiveness of drug courts in terms of reducing drug use and criminal recidivism among drug-involved offenders. However, it is unclear whether drug courts are appropriate for all clients, most notably the sizeable portion of clients who do not have a diagnosable or clinically significant substance use disorder. For these clients, drug court treatment may be ineffective or even contraindicated. Instead, best practice standards suggest that these clients would benefit from a prevention intervention designed to interrupt the acquisition of addictive behaviors. Unfortunately, such interventions have not been tested with adult offenders in drug courts. In this article, we describe a platform of cognitive and behavioral techniques that can potentially be used with nondrug-dependent drug court clients.
Article
In this study, the authors describe and evaluate the impact of increased access to residential treatment added to traditional drug court services in Orange County, California, with a goal of increasing program retention, successful completion, and graduation rates for a high-risk drug offender population participating in drug court between January 2004 and March 2005. Data were gathered from various sources, including the drug court management information system (MIS) and probation records, and the health care agency that provided case management services to drug court participants. The results suggest that increasing the drug court's capacity to adapt treatment for participants in need of a higher level of care was related to positive outcomes. Limitations of this study include the design that is susceptible to uncontrolled influences of extraneous variables such as changes in policy. This research encourages further examination of these variables in alternate settings to determine the extent to which these strong but preliminary results are generalizable.
Article
Drug courts have been proposed as a solution to the increasing numbers of drug involved offenders entering our criminal justice system, and they have become widespread since their introduction in 1989. Evaluations of these programs have led to mixed results. Using meta-analytic methods, we systematically reviewed the extant evidence on the effectiveness of drug courts in reducing future criminal offending. Fifty studies representing 55 evaluations were identified, including both experimental and quasi-experimental comparison group designs. The overall findings tentatively suggest that drug offenders participating in a drug court are less likely to reoffend than similar offenders sentenced to traditional correctional options. The equivocation of this conclusion stems from the generally weak methodological nature of the research in this area, although higher quality studies also observed positive results. Furthermore, the evidence tentatively suggests that drug courts using a single model (pre- or post-plea) may be more effective than those not employing these methods. These courts have a clear incentive for completion of the drug court program.
Article
Graduation rates in drug courts average 50% to 70%, but it is unclear what proportion of graduates responded to the drug court services and what proportion might not have had serious drug problems upon entry. This study cluster-analyzed urine drug screen results during the first 14 weeks of treatment on 284 participants from three misdemeanor drug courts. A four-cluster solution (R(2) > .75) produced distinct subgroups characterized by (1) consistently drug-negative urine specimens (34% of the sample), (2) consistently drug-positive specimens (21%), (3) consistently missed urine specimens (26%), and (4) urine specimens that began as drug-positive but became progressively drug-negative over time (19%). These data suggest that approximately one-third of the participants might not have had serious drug problems upon entry. Approximately one-fifth appeared to respond to drug court services, and nearly one-half continued to exhibit problems after 14 weeks. Implications for adaptive programming in drug courts are discussed.
Article
This study of participants in a US drug treatment court describes the relationship between the imposition of short-term jail sanctions and substance abuse treatment dropout, and examines offender characteristics moderating or modifying the impact of jail sanctions on treatment dropout. Data were derived from administrative information collected by the Dane County Wisconsin Drug Treatment Court from 1996-2004 on all 573 participants achieving a final disposition of treatment completion or failure during those program years. Iterative Cox proportional hazards models of time to treatment failure were created; jail sanctions during drug court participation were framed as time-dependent covariates. A theoretical framework and specific statistical criteria guided construction of a final parsimonious model of time to treatment drop-out. Treatment failure was associated with unemployment [hazard ratio (HR) in unemployed versus employed = 1.41, P-value 0.0079], lower educational attainment (HR in high school non-graduate versus graduate = 1.41, P = 0.02) and application of the first jail sanction (HR 2.71, P < 0.001). The association between treatment failure and a first sanction was considerably stronger for sanctions administered earlier in participation (HR for sanction 1 at <30 days 11.34, P-value 0.0002). Conclusions  An initial jail sanction for non-adherence may be more likely to foster treatment compliance in less refractory individuals (i.e. those not already acclimated or socialized to incarceration or other corrections interventions). More stringent supervisory conditions and individualized services may be required to reintegrate such offenders and promote longer-term public safety.
Article
Subjects in the study included all participants (N = 573) in drug treatment court in amid-sized U.S. city from 1996 through 2004. Administrative data from the drug court included measures of demographics and socioeconomics, substance use, and criminal justice history. Stepwise multivariate logistic regression yielded a final model of failure to complete drug treatment. Unemployment, lower educational attainment, and cocaine use disorders were associated with failure to complete treatment. The limitations of administrative data should be considered in the interpretation of results.
Article
The Addiction Severity Index (ASI) is 12 years old and has been revised to include a new section on family history of alcohol, drug, and psychiatric problems. New items were added in existing sections to assess route of drug administration; additional illegal activities; emotional, physical, and sexual abuse; quality of the recovery environment; and history of close personal relationships. No changes were made in the composite scoring to maintain comparability with previous editions. This article discusses the clinical and research uses of the ASI over the past 12 years, emphasizing some special circumstances that affect its administration. The article then describes the rationale for and description of the changes made in the ASI. The final section provides "normative data" on the composite scores and severity ratings for samples of opiate, alcohol, and cocaine abusers as well as drug abusing inmates, pregnant women, homeless men, and psychiatrically ill substance abusers.
Article
The Addiction Severity Index (ASI) is a clinical/research instrument which has been in wide use during the past 6 years to assess the treatment problems found in alcohol- and drug-abusing patients. In a study of male veterans, a preliminary evaluation of the ASI has indicated reliability and validity. The present report presents an expanded examination of these issues; 181 subjects from three treatment centers were studied. Results of concurrent reliability studies indicate that trained technicians can estimate the severity of patients' treatment problems with an average concordance of .89. Test-retest studies show that the information obtained from the ASI is consistent over a 3-day interval, even with different interviewers. Comparisons of the ASI severity ratings and composite measures with a battery of previously validated tests indicate evidence of concurrent and discriminant validity. The reliability and validity results were consistent across subgroups of patients categorized by age, race, sex, primary drug problem, and treatment center. The authors discuss the strengths and limitations of the instrument based upon 5 years of use. The overall conclusion is that the ASI is a reliable and valid instrument that has a wide range of clinical and research applications, and that it may offer advantages in the examination of important issues such as the prediction of treatment outcome, the comparison of different forms of treatment, and the "matching" of patients to treatments.
Article
The Addiction Severity Index (ASI) is a structured clinical interview developed to fill the need for a reliable, valid, and standardized diagnostic and evaluative instrument in the field of alcohol and drug abuse. The ASI may be administered by a technician in 20 to 30 minutes producing 10-point problem severity ratings in each of six areas commonly affected by addiction. Analyses of these problem severity ratings on 524 male veteran alcoholics and drug addicts showed them to be highly reliable and valid. Correlational analyses using the severity ratings indicated considerable independence between the problem areas, suggesting that the treatment problems of patients are not necessarily related to the severity of their chemical abuse. Cluster analyses using these ratings revealed the presence of six subgroups having distinctly different patterns of treatment problems. The authors suggest the use of the ASI to match patients with treatments and to promote greater comparability of research findings.
Article
The authors compared the efficacy of a multicomponent behavioral treatment and drug abuse counseling for cocaine-dependent individuals. The 38 patients were enrolled in outpatient treatment and were randomly assigned to the two treatments. Counseling in the behavioral treatment was based on the community reinforcement approach, while the drug abuse counseling was based on the disease model of dependence and recovery. Patients in the behavioral, but not the drug counseling, treatment also received incentives contingent on submitting cocaine-free urine specimens. Of the 19 patients who received behavioral treatment, 58% completed 24 weeks of treatment, versus 11% of the patients who received counseling. In the behavioral treatment group 68% and 42% of the patients achieved at least 8 and 16 weeks of documented continuous cocaine abstinence, respectively, versus 11% and 5% in the drug abuse counseling group. This multicomponent behavioral treatment appears to be an effective intervention for retaining outpatients in treatment and establishing cocaine abstinence.
Article
This study attempted to identify predictors of completion of a 27 h/week 4-week day hospital program for cocaine dependence. The research subjects were 95 lower socioeconomic, primarily African American male veterans. Of a wide range of predictor variables available at baseline, including sociodemographic and historical information, Addiction Severity Index data, psychiatric diagnoses, SCL-90 measures, and measures of craving and familial alcoholism, only the cocaine urine toxicology result and self report of days of cocaine use in the past 30 days (log transformed) were significant predictors. The urine toxicology result was the more powerful predictor with 73 percent with a negative urine completing treatment, as contrasted with 36 percent with a positive urine. Three additional measures obtained at the end of treatment week 1 further increased ability to predict treatment completion/attrition. Two of these measures were based on counsellor ratings and one was based on the patient's report of psychiatric treatment services received during the first treatment week. Thus, patients at high risk for dropout can be identified fairly early. Whether treatments can be adapted to retain such patients is an important question for the field.
Article
The primary study objective was to ascertain whether a prior finding that the baseline cocaine urine toxicology predicted treatment dropout for cocaine dependent outpatients could be extended to three additional cocaine dependent outpatient treatment samples and whether the urine toxicology also predicted attainment of initial abstinence for the four samples. A secondary objective was to ascertain the extent to which other baseline variables accounted for additional outcome variance over and above that afforded by urine toxicology. To evaluate the first objective, the relationships between the baseline cocaine urine and each of two measures of within treatment response--the completion of treatment or the attainment of initial abstinence--were determined for each of the treatment samples. The second objective was evaluated by a stepwise, hierarchical logistic regression analysis, with the urine toxicology entered in the first step, baseline Addiction Severity Index (ASI) variables in the second step, and achievement of initial abstinence as the outcome. In all four samples, patients with a urine indicative of recent cocaine use were less than half as likely to complete treatment or achieve initial abstinence. Individual ASI baseline variables did not contribute statistically significant variance over and above that predicted by the cocaine urine toxicology. The findings confirm the utility of the initial cocaine urine as a predictor of unfavorable outpatient treatment response.
Article
Sixty-one cocaine dependent outpatients submitted a single urine sample at least 1 week prior to entry into a 4-week treatment study. Participants were then expected to provide three urine samples per week during the month of treatment. The 61 patients studied here all completed treatment and provided an average of more than 11 of 12 scheduled urine samples. Participants who submitted a cocaine-positive sample prior to treatment provided more positive urine samples during the 4-week trial, were less likely to be completely abstinent during the month, and took longer to reach an initial abstinence criterion of three consecutive cocaine-free urines. Thus, a single pretreatment urine test represents a powerful predictor of subsequent cocaine use. The results suggest that future randomized trials stratify group assignment based on the results of a baseline urine test.
Article
We examined the effects of increasing the number of times misdemeanor drug court clients appeared before a judge for judicial status hearings. Our previous findings showed no main effect of increased hearings during the first 14 weeks of the program. The present study examined participants' discharge status in the program, and also explored potential interactions between client characteristics and the frequency of judicial status hearings on outcomes. Results revealed no main effects for hearing frequency on graduation status. Drug offenders who satisfied DSM-IV criteria for antisocial personality disorder (APD) achieved more weeks of urinalysis-confirmed drug abstinence when assigned to more frequent judicial status hearings, whereas subjects without APD achieved more abstinence and were more likely to graduate successfully from the program when assigned to less frequent hearings. Additionally, clients with a history of substance abuse treatment achieved more weeks of abstinence when assigned to more frequent hearings. These findings lend useful guidance to drug courts. Status hearings are expensive and time consuming and should be targeted to clients who would benefit most from them.
Article
Drug courts are popular for dealing with drug-abusing offenders. However, relatively little is known about participant characteristics that reliably predict either success or failure in these treatment settings. In this article, we report on 99 individuals who were enrolled in a drug court program (approximately one-half of whom successfully completed the program). Using, logistic regression techniques we identified 2 significant predictors of outcome. First, individuals who were employed at the time of their enrollment into the drug court program were more likely to successfully complete the treatment program. Second, individuals with a history of illicit intravenous drug use were less likely to complete the program.
Article
This article reports recent findings from a program of experimental research examining the effects of adapting judicial supervision to the risk level of drug-abusing offenders. Prior studies revealed that high-risk participants with (1) antisocial personality disorder or (2) a history of drug abuse treatment performed significantly better in drug court when they were scheduled to attend frequent, bi-weekly judicial status hearings in court. Low-risk participants performed equivalently regardless of the schedule of court hearings. The current study prospectively matched misdemeanor drug court clients to the optimal schedule of court hearings based upon an assessment of their risk status, and compared outcomes to those of clients randomly assigned to the standard schedule of court hearings. Results confirmed that high-risk participants graduated at a higher rate, provided more drug-negative urine specimens at 6 months post-admission, and reported significantly less drug use and alcohol intoxication at 6 months post-admission when they were matched to bi-weekly hearings as compared to the usual schedule of hearings. These findings yield practical information for enhancing the efficacy and cost-efficiency of drug court services. Directions for future research on adaptive programming for drug offenders are discussed.
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