Program Profile: Adult Treatment Drug Courts (Multi-site)

This is a program that focuses on drug-involved individuals and aims to provide specialized substance abuse treatment services. The program is rated Promising. Participants in the treatment group were statistically significantly less likely to report drug use and criminal activity than participants in the comparison group. However, there was no statistically significant effect on incarceration, socioeconomic status, mental health, family support, or homelessness.

A Promising rating implies that implementing the program may result in the intended outcome(s).

This program's rating is based on evidence that includes either 1) one study conducted in multiple sites; or 2) two or three studies, each conducted at a different site. Learn about how we make the multisite determination.

A Promising rating implies that implementing the program may result in the intended outcome(s).

This program's rating is based on evidence that includes either 1) one study conducted in multiple sites; or 2) two or three studies, each conducted at a different site. Learn about how we make the multisite determination.

Program Goals

The Multi-site Adult Drug Court Evaluation (MADCE) was a 6-year national evaluation funded by the National Institute of Justice that looked at the impact of adult drug courts.

Adult treatment drug courts are specialized and problem-solving courts for drug-involved individuals that provide a combination of substance abuse treatment services and intensive judicial supervision of the treatment process. By addressing their drug abuse problems, adult treatment drug courts aim to reduce drug relapse and prevent future offending.

The MADCE project had four primary goals: 1) test whether drug courts work for participants by reducing their drug use, crime, and multiple other problems associated with drug abuse, 2) examine for whom drug courts work best, 3) explain how drug courts work, and 4) examine whether drug courts generate cost savings.

Program Theory

The therapeutic jurisprudence model and deterrence theory make up the theoretical foundation of drug courts. Under therapeutic jurisprudence, it is argued that legal rules and procedures can be used to improve the mental and physical well-being of clients (that is, drug-involved persons) within the court system. The emphasis under this model is on the selection of a therapeutic option that promotes health but does not conflict with the normative values of the justice system, such as due process (Rottman and Casey 1999). Drug courts offer a therapeutic option through the provision of treatment and services that can address underlying drug abuse issues but do so through intensive court-based supervision, where drug-involved person are held accountable for their actions.

Drug courts also work under the framework of deterrence theory. Deterrence theory holds that the receipt or threat of punishment for committing an offense reduces the likelihood that the offense is committed. Three aspects of punishment (perceived certainty, severity, and celerity) are hypothesized to affect the decision-making process of would-be offenders (Rossman et al. 2011b). As a way to deter future offending, drug courts usually employ graduated sanctions, in which responses to violations committed by participants become incrementally harsher.

Key Personnel

Drug court programs generally include a multidisciplinary team. Drug court team members consist of judges, prosecutors, defense counsel, social workers, treatment providers, and the convicted person.

Target Sites

The MADCE included 23 drug courts located in several different geographic areas across the United States. There were eight MADCE drugs courts in New York state, six in Washington state, two in Florida, two in Georgia, two in Illinois, two in Pennsylvania, and one in South Carolina. Most of the courts operated in urban or suburban areas, with only about one-fourth operating in rural areas.

Program Components

Although adult drug treatment courts vary in practice and implementation, some basic components of the programs are quite similar. Drug courts generally:

• Provide participants with intensive treatment and other services to achieve and maintain sobriety, and to address any drug-related issues
• Require participants to adhere to regular and random drug tests
• Require frequent court appearances before the judge, to review progress in treatment and address any violations of program requirements
• Adhere to a schedule of graduated sanctions, where responses to violations committed by participants become incrementally harsher

The MADCE provides an example of how drug courts across the country can adhere to similar underlying principles but differ in many other factors, such as participant eligibility, program intensity, the type of substance abuse treatment used by participants, the number of courtroom hearings, the swiftness of sanctions, and the use of risk assessments. As part of the MADCE, a Web-based survey was administered in 2004 to every active adult drug court in operation for at least 1 year (Zweig et al. 2011). The survey results provide descriptive information about program characteristics and operations for the 380 adult drug courts that responded. Among the findings:

• Most adult drug court programs are small. Forty-six percent had fewer than 50 active participants in the program, while about 13 percent reported 200 or more active participants.
• More than one-third of drug courts reported serving only those who are diagnosed as addicted to or dependent on drugs, while one third of the courts serve regular users of drug or alcohol and just under one third serve anyone who uses.
• On average, adult drug court programs required 13 months in programming before participants could graduate, with most requiring between 12 and 18 months.
• Almost all of the courts reported providing the following types of treatment services: residential, intensive outpatient, outpatient individual counseling, outpatient group counseling, drug education, self-help, and relapse.
• Almost all of the courts reported using urine tests to collect drug test samples. A small number of drug courts reported also using a patch, saliva, and hair samples to test for drug use. The vast majority of the courts reported testing for marijuana, crack/cocaine, heroin/opiates, methamphetamine, alcohol, and benzodiazepines. A smaller number of courts reported also testing for stimulants, PCP, LSD, and other drugs.

For the full results of the survey, please see the Urban Institute’s 2011 report titled The Multi-site Adult Drug Court Evaluation: What’s Happening With Drug Courts? A Portrait of Adult Drug Courts in 2004 (please see Additional References for a link to the report).

Study

The Multi-site Adult Drug Court Evaluation (MADCE) conducted by Rossman and colleagues (2011d) used a quasi-experimental design to assess the impact of adult drug courts located in various sites across the United States. The first component of the MADCE consisted of a Web-based survey administered in 2004 to every active adult drug court in operation for at least 1 year at that time. Of the 593 adult drug courts eligible for the survey, 380 courts (64 percent) responded. From the survey data, 23 drug courts and 6 comparison sites from the same geographic areas in eight states were selected for inclusion in the process and impact evaluations and cost–benefit analysis.

The site selection procedure concentrated on three main components of drug courts: 1) provision of substance abuse treatment; 2) leverage the court has in monitoring clients; and 3) predictability of sanctioning policies of the court. Using a combination of hotspot mapping techniques and subjective criteria about how geographically close courts were, 16 potential geographic clusters of drug courts were identified for consideration. From this cluster, the 23 drug courts came from the following states: eight courts in New York state, six in Washington state, two in Florida, two in Georgia, two in Illinois, two in Pennsylvania, and one in South Carolina. The sites were chosen to ensure variation in eligibility criteria, program requirements, community settings, and treatment and testing practices of the drug courts.

Comparison jurisdictions were selected if a) the site did not operate a drug court; b) the site operated a drug court but had a greater number of drug-involved individuals than could be enrolled, who could therefore serve as a comparison group; or c) the site had a group of drug-involved persons who did not meet the criteria for the local drug court but met the criteria of drug courts in other areas of the country. The comparison sites offered alternative treatment for drug-involved persons through programs other than drug courts, such as Breaking the Cycle or Treatment Alternatives for Safe Communities. The six comparison sites came from the following states: two sites in Florida, two in North Carolina, one in Illinois, and one in Washington state.

The adult drug court treatment group (n = 1,156) was 68 percent male, 32 percent female, 57 percent white, 29 percent African American, 7 percent Hispanic/Latino, and 7 percent other (including multiracial)—with an average age of 33. The comparison group (n = 625) was 72 percent male, 38 percent female, 50 percent white, 41 percent African American, 5 percent Hispanic/Latino, and 5 percent other—with an average age of 35. A propensity score weighting procedure was used to eliminate significant differences between groups at baseline.

In this multisite evaluation, each observation (that is, each person) was nested within a particular site. Examination of the data showed that persons from different sites systematically varied on key drug use, criminal behavior, and other psychosocial outcomes. Hierarchical linear modeling (HLM) techniques were employed for impact analyses to adjust for the site-specific variances in outcomes and to correct the assumed degrees of freedom based on the much smaller number of sites (29) than offending persons (1,781).

Data was collected from a variety of sources: field visits, self-report surveys, oral fluid tests, and administrative records. Self-report surveys were administered at baseline, 6 months postbaseline, and 18 months postbaseline. In addition, oral swab tests were conducted in conjunction with the 18-month interviews for nonincarcerated respondents. The chosen test was a six-panel oral fluid screen for amphetamines, cannabinoids, cocaine, methamphetamines, opiates, and phencyclidine. Finally, study participants’ official records were collected from the National Crime Information Center at the Federal Bureau of Investigation and from state-level criminal justice agencies. Collection of administrative data concentrated on three categories of variables: arrests, convictions, and incarcerations. Administrative data was collected for a 24-month follow-up period.

Outcomes were organized into the following key domains:

• Drug use: whether the person used drugs, days of drug use per month, and results of the oral fluids drug test
• Criminal activity: incidence and prevalence of official rearrest and of self-reported criminal behavior
• Incarceration: number of days incarcerated
• Socioeconomic status: employment status, school status, and annual income
• Mental health: classified as “depressed” (based on multi-item instrument) and self-reported assessment of mental health (excellent, very good, good, fair, and poor)
• Family support and conflict: the extent of family conflict, family emotional support, and family instrumental support
• Homelessness: whether the person was homeless since the previous survey point

Ordinary least squares regression analyses were conducted for normally distributed outcomes to determine differences between groups, and logistic regression was used for dichotomous outcomes. No subgroup analysis was conducted.

As part of the Multisite Adult Drug Court Evaluation (MADCE), Rossman and colleagues (2011d) conducted a cost–benefit analysis. During the 18-month period of the study, the analysis showed that each drug court participant cost society (on average) $13,102, while each comparison offender who did not receive drug court cost society $19,310. The difference (the net benefits) totals $6,208, but it is not significant. The total benefit-to-cost ration is 1.92:1, meaning that for every $1 invested in drug courts $1.92 in costs is saved; however, this result also was not significant. When examining the average costs of crime, arrest, and incarceration, drug courts were shown to prevent $11,566 per participant compared with not receiving drug court, a result that was significant. However, the authors noted that when a small number of outliers were removed from the analysis (whose costs are mainly from the commission of serious crimes) most of the benefits of drug court disappear. This was interpreted as meaning that most of the crime reduction is from reductions in low-level offending, with only a few serious crimes being prevented.

These sources were used in the development of the program profile:

These sources were used in the development of the program profile:

National Association of Drug Court Professional. 1997. Defining Drug Courts: The Key Components. Washington, D.C.: U.S. Department of Justice, Office of Justice Programs, Drug Court Programs Office.

https://www.ncjrs.gov/pdffiles1/bja/205621.pdf

(NIJ) National Institute of Justice. 2012a. Drug Courts. Washington, D.C.: Office of Justice Programs, NIJ, Bureau of Justice Assistance, and the Office of Juvenile Justice and Delinquency Prevention.

https://www.ncjrs.gov/pdffiles1/nij/238527.pdf

(NIJ) National Institute of Justice. 2012b. “NIJ’s Multisite Adult Drug Court Evaluation.”

http://www.nij.gov/topics/courts/drug-courts/madce.htm

Rottman, David, and Pamela Casey. 1999. "Therapeutic Jurisprudence and the Emergence of Problem-Solving Courts." National Institute of Justice Journal 240:12–19.

http://www.ncjrs.gov/pdffiles1/jr000240.pdf

Rossman, Shelli Balter, John K. Roman, Janine M. Zweig, Michael Rempel, and Christine H. Lindquist. 2011a. The Multi-site Adult Drug Court Evaluation: Executive Summary. Final Report: Executive Summary. Washington, D.C.: Urban Institute.

https://www.ncjrs.gov/pdffiles1/nij/grants/237108.pdf

Rossman, Shelli Balter, John K. Roman, Janine M. Zweig, Christine H. Lindquist, Michael Rempel, Janeen Buck Willison, P. Mitchell Downey, and Kristine Fahrney. 2011b. The Multi-site Adult Drug Court Evaluation: Study Design and Overview. Final Report: Vol. 1. Washington, D.C.: Urban Institute.

https://www.ncjrs.gov/pdffiles1/nij/grants/237109.pdf

Rossman, Shelli Balter, Janine M. Zweig, Dana Kralstein, Kelli Henry, P. Mitchell Downey, and Christine H. Lindquist. 2011c. The Multisite Adult Drug Court Evaluation: The Drug Court Experience. Final Report: Vol. 3. Washington, D.C.: Urban Institute.

https://www.ncjrs.gov/pdffiles1/nij/grants/237111.pdf

Zweig, Janine M., Shelli Balter Rossman, John K. Roman, Joshua A. Markman, Erica Lagerson, and Courtney Shafer. 2011. The Multi-site Adult Drug Court Evaluation: What’s Happening with Drug Courts? A Portrait of Adult Drug Courts in 2004. Final Report: Vol. 2. Washington, D.C.: Urban Institute.

https://www.ncjrs.gov/pdffiles1/nij/grants/237110.pdf

Following are CrimeSolutions-rated programs that are related to this practice:

Rehabilitation Programs for Adults Convicted of a Crime

This practice includes programs that are designed to reduce recidivism among adults by improving their behaviors, skills, mental health, social functioning, and access to education and employment. They may become participants in rehabilitation programs during multiple points in their involvement with the criminal justice system. This practice is rated Promising for reducing recidivism among adults who have been convicted of an offense.

Evidence Ratings for Outcomes

Crime & Delinquency - Multiple crime/offense types

Why might a practice's outcome ratings differ from the ratings of specific programs encompassed by that practice?