Program Goals/Target Population
In a large urban county within a Midwestern state, there had been an increase of self-reported substance abuse among individuals sentenced to prison and among probation and parole violators returning to prison. The Department of Corrections (DOC) in this county was interested in finding programs and procedures that could help in the management of parolees with substance abuse issues. One method that is commonly used to supervise and manage the risk of parolees with substance abuse histories is drug testing. The DOC agreed to test three different models: 1) random drug testing with immediate results and immediate sanctions, 2) random drug testing with delayed results and delayed sanctions, and 3) routine (non-random) drug-testing procedures with delayed results and delayed sanctions. The goal of the experiment was to determine the efficacy of alternative methods of instant drug testing, and determine how the different methods affected rates of relapse and recidivism of parolees with substance abuse issues (Grommon, et al. 2013).
Program Theory
The theoretical basis for instant, randomized drug testing resides in learning and deterrence theories. Learning theory suggests that the association of negative outcomes with an undesired behavior should lead to a reduction in that negative behavior. Deterrence theory focuses on the swiftness, certainty, and severity of consequences to deter undesirable behavior (O’Connell et al. 2011). Within this model, certainty and immediacy of consequences are critical to desistance from substance abuse and criminal behavior.
One particular example of an intervention that was developed based on deterrence and learning theories is the Hawaii Opportunity Probation and Enforcement (HOPE) program, which targeted individuals on probation with substance abuse histories and used incentives and sanctions to reinforce good behavior and punish poor behavior. HOPE included random drug testing with swift and certain sanctions imposed for positive or missed drug tests and a graduated referral process. A prior evaluation of HOPE showed that participants were 72 percent less likely to have a positive urine test, 55 percent less likely to be arrested for a new crime, and 55 percent less likely to have their probation revoked compared with the control group members (Hawken and Kleiman 2009).
Program Activities
The experiment involved three different methods of instant drug testing. The parolees were randomly placed into one of three groups: an experimental group, or one of two control groups.
The treatment group received frequent, random drug testing with instant results, immediate sanctions, and referrals for substance abuse treatment upon a positive screen. Individuals in the treatment group were required to call a toll-free number each day that indicated whether they were selected for a drug test. If selected, the individual was to report to the jail and submit a urine sample that same day. The protocol ensured that individuals would be tested at least an average of 2 times per week. A four-panel handheld test was used for instant results (testing for alcohol, cocaine, opiates/heroin, and THC). The urine samples were then forwarded to the lab for confirmation, where they were tested for eight substances. Instant drug tests results were used as the primary indicator of drug use, regardless of the subsequent lab analysis. Individuals who either tested positive or failed to report for a drug test were incarcerated for 3 days. Three missed tests in a row led to an arrest warrant. Those incarcerated were assessed by drug counselors and were offered drug treatment from a local nonprofit treatment vendor. If necessary, the participant was referred to outpatient counseling, intensive outpatient counseling or day treatment, residential treatment, or self-help meetings. Referrals were an offer of treatment but not a condition of supervision.
The first control group received frequent, random drug testing and treatment referral, but did not receive immediate test results or immediate sanctions. Individuals in the group were also required to call a toll-free number each day that determined whether they were selected for a drug test. If selected, the individual was to report to the jail and submit a urine sample that same day. Once the urine sample was submitted, individuals were allowed to leave the county jail to await contact from the community supervision agents who reviewed the laboratory results. Urine samples were sent to the laboratory for screening, and providers received results within 3–4 days. Protocol ensured that individuals would be tested an average of 2 times per week. Standard, graduated sanctions were used with individuals who either tested positive or failed to report for a drug test. The first testing violation resulted in mandatory assessment via a referral to an outpatient treatment provider. If the provider advised an intake, the outpatient treatment became mandated. The second violation resulted in referral to an inpatient treatment provider; treatment was mandated if the provider advised an intake. The third resulted in a case review to determine possible revocation of community supervision.
The second control group received standard “parole as usual,” and was not randomly tested nor did they receive immediate sanctions. Procedures for the second control group mirrored those for standard parole, in regard to testing frequency, feedback, sanctions, and treatment referrals. Individuals in the group were tested for illegal drugs when they reported to their community supervision agent, approximately once per month. The drug tests were sent to the laboratory and results were processed within 3–4 days. For positive drug tests or failure to appear, standard graduated sanctioning procedures were used (the same procedures that were used for the first control group). They were referred to treatment when appropriate.
Key Personnel
Key personnel included the DOC’s institutional field office, and program unit staff. Stakeholders from various organizations were also involved in the program, including the local sheriff’s office, substance abuse treatment service agencies, and the research team.
