Practice Profile: Adult Drug Courts

Drug courts are specialized courts that combine drug treatment with the legal and moral authority of the court in an effort to break the cycle of drug use and drug related crime.

Practice Goals

Drug courts aim to reduce recidivism and substance abuse among eligible people who have been convicted of nonviolent drug offenses. Drug courts require participants to abstain from drug and alcohol use, be accountable for their behavior, and fulfill the legal responsibilities of the offenses they committed. Ultimately, drug court programs are designed to rehabilitate people convicted of drug offenses and teach accountability. Often used as an alternative to incarceration (post-adjudication models), drug courts provide them an opportunity to receive treatment and education services designed to help them live crime-free lives, while still being closely monitored. Drugs courts may also operate as diversion programs (pre-adjudication models) where they are offered entry into the drug court with an agreement that the charges against them will be reduced or dismissed upon successful program completion.

Target Population

Adult drug court programs target adults age 18 and older. Demographically, the population is diverse. Eligibility criteria for entering a drug court program are determined by certain characteristics including offense type, criminal history, and substance abuse history. Typically, drug court programs do not allow violent individuals to participate.

Practice Components

In 1997, the National Association of Drug Court Professionals (NADCP) established six key components of drug courts: (1) collaborative, non-adversarial, outcome driven court processing; (2) early identification of eligible persons; (3) drug treatment integrated into criminal justice case processing; (4) urine testing; (5) judicial monitoring; and (6) the use of graduated sanctions/rewards (NADCP, 2012). Adult drug court treatment objectives are based on the six components that NADCP proposes.

The main components of drug court programs include screening participants for drugs and alcohol, ensuring participants comply with treatment, and making sure participants attend status hearings in order for judicial staff to monitor individual progress in court. Judicial staff collaborate with drug court staff to determine individual sanctions or rewards in response to a participant’s positive or negative behavior. Various rewards such as praise, tokens of achievement, or advancement to the next program phase are used to motivate progress. Sanctions may include increased treatment attendance, community service, or brief jail stays. It is up to each court’s discretion to determine which sanctions and awards are suitable for the situation.

If participants are compliant with program requirements, then advancement through three or more less intense stages occurs. Judicial and drug court staff members must decide if a participant has met the requirements of the phase necessary to progress.

If participants comply with program structure and complete mandated requirements, then successful completion is possible. The incentive to complete the program successfully is typically a reduced or dismissed charge.

Practice Theory

According to Shaffer (2011) drug court programs are based on the theoretical perspective of Therapeutic Jurisprudence (TJ). In a practical application of drug courts, this means that interactions between judicial staff and defendants, the structure and organization of the court proceedings, and legal rules and policies are all dealt with in a manner that encourages health and positive growth. TJ is applicable to drug court programs because the aim is to improve the lives of drug users. However, Shaffer cautions that while TJ is relevant to drug court programs, it does not prescribe what types of treatment should be provided to them outside of the courtroom setting.

For information on components that may impact the effectiveness of adult drug court programs, please see “Other Information.”

Crime & Delinquency | Multiple crime/offense types

Crime & Delinquency | Multiple crime/offense types
Overall, the meta-analyses examining the effect of adult drug courts found that program participants were less likely to recidivate compared to those who did not participate. Synthesizing results across 26 studies, Aos and colleagues (2001) found a small negative mean effect size (d=-0.08), meaning that recidivism rates were, on average, lower for participants in drug court programs compared to individuals who did not enter into a drug court. Similarly, Drake (2012) analyzed 55 studies and also found a small negative effect (d=-0.25) showing a decrease in recidivism for program participants. Other studies have estimated the effect of drug courts using different methodologies. For instance, Shaffer (2010) used a phi coefficient to estimate the size of the program effect. The researchers calculated a small mean effect size (f=0.09) across 60 studies revealing a significant decrease in the recidivism of drug court participants compared to non-participants. Here a positive effect size suggests that, similar to the Aos and Drake findings, drug courts reduce recidivism rates compared to traditional criminal justice responses. Latimer and colleagues (2006), also using the phi coefficient, found a comparable small positive mean effect (f=0.16) in their review of 54 drug court studies. However, the findings were not significant. Analyzing results across 92 studies, Mitchell and colleagues (2012) used odds ratios to calculate the size of the program effect. In this study, the authors found a small to medium mean positive effect (OR=1.66) suggesting that compared to nonparticipants, recidivism rates among drug court participants were significantly lower. Finally, Sevigny, Fuleihan, and Ferdik (2013) found a significant moderate effect (logs odds ratio=-0.77) on recidivism (measured as reincarceration) favoring the treatment group. This means that relative to an assumed 50 percent incarceration rate for the comparison group, drug court participants had a 31.6 percent overall incarceration rate, or fewer than 184 incarcerations per 1,000 drug court participants.

Crime & Delinquency | Drug and alcohol offenses

Crime & Delinquency | Drug and alcohol offenses
Mitchell and colleagues (2012) reviewed 42 studies that examined the effect of participating in a drug court program on drug-related offenses. The authors found a significant odds ratio of 1.7. This means that relative to a 50 percent recidivism rate in the comparison group (a typical value), the odds ratio translates into a recidivism rate of approximately 37 percent for drug court participants, meaning on average, drug court participants have a recidivism rate about 13 percentage points lower than nonparticipants.

Drugs & Substance Abuse | Multiple substances

Drugs & Substance Abuse | Multiple substances
Mitchell and colleagues (2012) reviewed four studies that examined the effect of participating in a drug court program on drug use and found an odds ratio of 1.45, which indicates reduced drug use for drug court participants compared to nonparticipants. However, because of the small number of studies, the effect size was not significant.

Meta-Analysis Snapshot
	Literature Coverage Dates	Number of Studies	Number of Study Participants
Meta Analysis 1	1993-2000	26	14691
Meta Analysis 2	1993-2005	66	17214
Meta Analysis 3	1993-2011	154	0
Meta Analysis 4	1994-2006	60	20830
Meta Analysis 5	1990-2012	51	0
Meta Analysis 6	1995-2012	11	5973

Meta Analysis 1

Aos and colleagues (2001) set out to evaluate the costs and benefits of certain juvenile and adult criminal justice policies, violence prevention programs, and other efforts to decrease certain at-risk behaviors of juveniles and adults. They used meta-analytic techniques to estimate the degree to which a program or policy can be expected to influence the outcome of interest (i.e., criminality).

The review focused on evaluations that measured a program’s effect on criminal behavior. Program evaluations were gathered from a wide variety of sources, including studies that were published in peer-reviewed journals, as well as other studies not published in journals (such as government or private agency sources). Once evaluations that met the criteria of inclusion were located, four types of information on the program’s effectiveness in reducing crime were recorded: (1) Did the program affect the percent of the population that offended or reoffend? (2) Of those that offended or reoffended, did the program change the average number of offenses? (3) Did the program affect the types of offenses of those that offended or reoffended? (4) Of those that offended or reoffended, did the program change the timing of offenses? Of the four effects, almost all of the evaluations provided information on the first effect. Far fewer evaluations reported information on the second effect, and even fewer reported information on the third effect. Almost none of the evaluations reported information on the fourth effect.

The search resulted in the inclusion of 26 studies of drug court programs. The 26 studies included approximately 14,691 adult participants. Three of the studies by Goldkamp (2000) were excluded due to repeated review of cohorts. The group of 26 studies included published and unpublished evaluations that spanned from 1993 to 2000. No information was provided on the age, gender, or racial/ethnic breakdown of the studies’ samples, or on the location of the programs.

The mean difference effect size was calculated for each program. Adjustments were made to the effect sizes for small sample sizes, evaluations of “non-real world” programs, and for the quality of the research design (the quality of each study was rated using the University of Maryland’s five-point scale; only studies that received a rating of ‘3’ or higher on the scale were included in the analysis). Once effect sizes were calculated for each program effect, the individual measures were added together to produce a weighted average effect size for a program or practice area. The inverse variance weight was calculated for each program effect and those weights were used to compute the average. The fixed effects model was used for the analysis.

Meta Analysis 2

Latimer, Morton-Bourgon, and Chrétein (2006) located 54 individual studies between 1993 and 2005 to determine if drug treatment courts for youth and adults reduce recidivism compared to traditional justice system responses. Similar to Aos and colleagues (2001), to be included in this meta-analysis, studies needed to have (1) examined the effectiveness of a drug treatment court, (2) used a control group that did not experience the drug treatment court, (3) searched for sufficient statistical information to establish an effect size, and (4) measured the impact of the drug treatment court on recidivism rates (Latimer et al., 2006). Age, length of the program, follow-up period, and methodological versus random assignment were identified as variables in the analysis.

Because studies often contained information on more than one program, data from 66 individual drug treatment court programs were aggregated and analyzed. The 66 studies included 17,214 individuals who had successfully completed a drug treatment court program. The comparison group comprised of 14,505 who had not received the intervention. The meta-analysis evaluated mean participant characteristics. Average program size consisted of 260 participants who were 28.4 years old. No information was provided on the gender or racial/ethnic breakdown of the studies’ samples, or on the location of the programs.

The phi coefficient (Pearson’s r product moment correlation applied to dichotomous data) was used as the effect size estimate. Once the effect size estimate from each study was calculated for recidivism, the overall mean effect size estimate, along with the corresponding confidence intervals, and a weight effect size estimate were calculated.

Meta Analysis 3

Mitchell and colleagues (2012) conducted an extensive search process for studies that (1) evaluated a drug court program (defined as specialized courts for handling drug-involved cases that are processed in a non-adversarial manner, refer them to appropriate treatment programs, regularly test for drug use, and have a judge who actively monitors progress and provides sanctions for misbehavior), (2) included a comparison group in the evaluation that was treated in a traditional fashion by the court system, (3) measured criminal behavior (such as arrest or conviction), and (4) provided enough information to compute an odds ratio.

The search process resulted in the inclusion of 154 independent evaluations of drug courts. Of those, 92 assessed adult drug courts, 34 examined juvenile drug courts, and 28 investigated driving while intoxicated (DWI) drug courts. The outcomes reported here are for the 92 evaluations that assessed adult drug courts. The first data set preference was given to effect sizes that were general, based on arrest, dichotomous, and followed sample members for 12 months. For each evaluation contrast, an odds ratio was calculated. Effect sizes were calculated for three outcomes: (1) general recidivism; (2) drug related recidivism); and (3) drug use. The study utilized the effect size. In addition, a standardized mean different effect size was used and transformed to odds ratios. A random-effects model was used.

To control for the rigor of study design, the 154 studies were placed into four possible categories: (1) weak quasi-experiments, (2) standard quasi-experiments, (3) rigorous quasi-experiments, and (4) randomized experiments. Measures were also coded into three dimensions pulled from a study by Longshore and colleagues (2001). They included leverage, population severity, and program intensity.

Meta Analysis 4

Shaffer (2010) sought to identify characteristics of effective drug courts. The author used meta-analytic techniques to investigate the relationship between six structural and five process dimensions of drug court effectiveness. The six structural dimensions included target population, leverage, service delivery, staff, funding, and quality assurance. The five process dimensions included assessment, philosophy, treatment, predictability, and intensity. The objective was to merge survey data with existing study data to determine the relative influence of each dimension listed above.

Studies of drug court programs using an experimental or quasi-experimental design were searched for in various locations, including databases and government reports (i.e., Academic Press, Criminal Justice Abstracts, and Government Publications Monthly). This search included a comparison group and at least one measure of criminal behavior with a six month follow-up period.

A total of 115 studies were found, but only 60 studies evaluated separate drug courts and were eligible for inclusion. From the 60 outcome evaluations, there were 76 individual samples of drug courts and 6 multi-site evaluations where the results could not be disaggregated. From the eligible studies, there were 61 samples of adult drug courts that contributed to the overall effect size. This included 20,830 individuals contributing to the overall effect size.

Meta Analysis 5

Drake (2012) conducted a meta-analysis to review the effectiveness of various types of chemical dependency treatment in the adult and juvenile justice systems to determine whether the programs reduce crime and substance abuse. For adults, the different types of treatments included drug treatment during incarceration, drug treatment delivered in the community, case management for individuals with substance use disorders, therapeutic communities for those with co-occurring disorders, and drug courts. There were four primary methods used to locate studies: (1) bibliographies of systematic and narrative reviews in various topic areas were consulted; (2) citations from the individual studies were examined; (3) independent searches of research databases were conducted; and (4) authors of primary research were contacted. Studies were included if they had a comparison group (random or non-random assignment), contained enough information to calculate an effect size, and had a standardized measure of the primary outcome of interest (crime). A total of 51 evaluation studies of adult drug courts were included in the analysis.

The search process resulted in the inclusion of 51 evaluation studies of adult drug courts. However, some studies represented multiple sites under evaluation. The 51 individual studies represented 67 effect sizes. The standardized mean difference effect size was calculated for each program effect. Once the effect sizes are calculated, the individual measures are summed to produce a weight average effect size for the program area (in this instance, adult drug courts). Adjustments were made to the effect sizes to account for small sample sizes, evaluations of “non-real world” programs, and research design quality (the quality of each study was rated using the University of Maryland’s five-point scale; only studies that received a rating of ‘1’ or higher on the scale were included in the analysis). A random effects model was used to calculate the weighted average effect size.

Meta Analysis 6

Sevigny, Fuleihan, and Ferdik (2013) conducted a meta-analysis to determine the impact of adult drug courts on overall incarceration. A comprehensive search of the literature was conducted to identify eligible studies. To be eligible for review, studies were required to 1) be experimental or quasi-experimental evaluations of U.S. adult drug court programs, 2) use a comparison group that is subject to routine criminal justice processing such as probation, 3) report incarceration outcomes, and 4) be published in English. All studies also had to be published after 1989, the date the first drug court was established.

The search process resulted in 229 potentially eligible publications, of which 201 were available for further review. However, a large majority of these studies did not report incarceration outcomes, leaving only 19 studies that contributed at least one independent effect size related to incarceration outcomes, and only 11 that focused on the overall use of incarceration. Approximately 11.1 percent of the included studies were categorized as randomized experimental, 50 percent as strong quasi-experimental, and 38.9 percent as weak quasi-experimental. The majority of studies were evaluated between 1995–1999 (72.2 percent), with 5.6 percent evaluated between 1990–1994. Approximately 22.2 percent were evaluated in 2000 or later. A logs odds ratio was calculated to examine the impact of drug courts on overall incarceration.

Several meta-analyses included additional tests—called moderator analyses--to see if any factors strengthened the likelihood that adult drug courts improved outcomes. Three moderator analyses assessed the impact of four factors on program effectiveness: program duration, leverage, program intensity, and population severity.

Program duration: Two analyses found that the duration of drug court programs had an impact on their effectiveness. Latimer and colleagues (2006) found that drug court programs that provided services for 1 year to 18 months demonstrated a significant reduction in recidivism compared with shorter or longer programs. Similarly, Shaffer (2006) found that drug courts designed to last between 8 and 16 months were significantly more effective than those designed to last less than 8 months or longer than 16 months.

Leverage (rewards and sanctions): Two analyses indicated that pre-adjudication models and post-adjudication models work equally for reducing recidivism. Both Mitchell and colleagues (2011) and Shaffer (2006) found that there were no significant differences between drug court programs that used a pre-adjudication model compared to those programs that use a post-adjudication model.

Program intensity: The findings on the impact of program intensity are mixed. Mitchell and colleagues found that drug court programs that had more than 2 status hearings a month had a significantly larger effect on drug-related recidivism than other courts (but no significant effect on general recidivism). Shaffer found overall mixed results. While some program requirements (restitution, education, and “other” requirements) were associated with reduced recidivism, other program requirements (community service, fines, and employment) were not.

Population severity: Two analyses found that program effects are bigger when programs serve populations with less severe problems. Mitchell and colleagues found that drug court programs that included only non-violent individuals had statistically larger effect sizes on general recidivism measures than programs that included violent individuals (the effect was not significant on drug-related recidivism). Shaffer also found that drug court programs that excluded violent individuals were significantly associated with reductions in recidivism.