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SURJ Issues Briefs offer an array of brief facts in support of general criminal
justice reform Substance Abuse Treatment (March 2004)
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SURJ
SUBSTANCE ABUSE: TREATMENT EFFECTIVENESS AND COST- EFFECTIVENESS
Prepared by Tom Eichler, Apryl Walker
October 1, 2003 Revised October 28, 2003
Concerns about criminal justice reform must include the fact that most incarcerated offenders have a substance abuse problem, whether alcohol, drugs or both. Much is known about reduction of substance abusing behavior, but full utilization of treatment options is inhibited by lingering questions in the minds of policy makers and the public:
-does treatment work?
-does treatment work for those with extensive criminal backgrounds?
-does treatment work in a coercive (court directed) environment?
-are cost-effective treatment options available?
Introduction
Substance abuse treatment continues to be viewed with skepticism by policy makers and funders. This is evidenced by the fact that health care plans, whether public or private, continue to reflect greater limits to care for drug and alcohol treatment in the forms of higher co-pays, fewer allowable treatment contacts, and lifetime limits than are imposed for other chronic diseases such as diabetes, asthma, or hypertension. Enthusiasm for paying for substance abuse treatment, whether in the civil environment or in the criminal justice system, is mitigated by inevitable anecdotal examples of the person who has relapsed.
The following research brief was developed by the SURJ Treatment Working Group to aid the group’s understanding of the effectiveness and cost-effectiveness of treatment for substance use disorders. It is believed that a clearer understanding of the issues surrounding substance use treatment effectiveness and cost-effectiveness is needed to for the development of public policy to provide treatment for more Delaware citizens affected by substance use disorders, mental health disorders and co-occurring mental health and substance use disorders.
Why It Matters
In a survey of the problem nationally, Lana D. Harrison, Associate Director, Center for Drug and Alcohol Studies, University of Delaware has reported:
Arrests for drug abuse violations increased 57.5% between 1989 and 1996, rising from 654,000 in 1989 to more than 1 million in 1996;
Drug offenders comprised a third of all persons convicted of a felony in state court in 1996;
More than 80% of state and 70% of federal prisoners reported past drug use;
Half (52%) of state prison inmates and a third (34%) of federal prison inmates indicated they were under the influence of alcohol or drugs while committing the offense leading to their imprisonment;
One in five (19%) state prisoners reported committing their offense to purchase drugs.1
What Constitutes Success?
Drug and alcohol treatment are often subject to an unrealistic public expectation for a "cure" to demonstrate success. In an article exploring treatment myths (O’Brien and McClelland, 1996) drug addiction is compared to other chronic diseases such as asthma, diabetes, and hypertension in which relapse may occur despite considerable improvement. They contend that treatment should be considered successful if considerable improvement occurs, even though complete remission or cure is not achieved.2
In spite of this insight, research studies continue to use the very conservative standard in which a single incident of drug use is recorded as a permanent failure, for example one positive drug screen in an 18-month period. Even with this very strict standard for what must be seen as a chronic disease, studies are showing significant treatment results.
Writing in the Journal of the American Medical Association, prominent addiction researchers Tom McLellan, Ph.D., David Lewis, M.D., Charles O'Brien, M.D., Ph.D., and Herbert Kleber, M.D., conclude drug dependence has much in common with chronic illnesses such as diabetes, hypertension and asthma, and should be insured, treated and evaluated in a like manner. Additionally, the article states that while many physicians believe there are no effective interventions for addiction, the research says otherwise, especially when outcomes are compared with type 2 diabetes, hypertension and asthma, diseases "well studied and are widely believed to have effective treatments, although they are not yet curable." (JAMA, October 4, 2000)
-Office of National Drug Control Policy 3
Treatment In The Community – Deflecting Entry From The Criminal Justice System
Treatment in the community can deflect potential offenders before they become entrained in the criminal justice system. It is also vital to those reentering the community after release from incarceration. Reports of the effectiveness of treatment in the community include:
Privately Supported Treatment
According to the Aetna Federal Employee Health Benefit Plan, the health care costs of alcoholics increased from $140 to $1,370 per month prior to treatment and dropped to $190 per month three years after treatment.
Blue Cross/Blue Shield found that families' health care costs decreased by 87% after treatment, a reduction from $100 per month to $13.34 per month in the 5th year of treatment.
A study conducted on the "cost offsets of drug abuse treatment provided in the private sector," people with drug use disorders who participate in treatment enjoy a 40 percent reduction in health care costs two years after treatment.6
According to Alcohol Health & Research World, within one year 50% of the costs of treatment for drug use disorders are offset due to reductions in medical costs by the affected family, along with the primary patient.7
During treatment for drug use disorders, 4% of participants became HIV-positive. In comparison, 16% of people with drug use disorders that are not in treatment become infected with the HIV virus. The lifetime costs to provide treatment for a single AIDS patient is approximately $85,000.8
Pregnancies and deliveries complicated by substance use disorders cost $43,000 to $145,000 per patient. After one year of treatment in a CSAT-funded program, 95 percent of women reported uncomplicated, drug-free births.9
Publicly Supported Community Treatment
According to the Center for Substance Abuse Treatment, the average benefits of substance abuse treatment exceeds the costs by 3 to 1.10
The Center for Substance Abuse Treatment found that substance abuse treatment resulted in a cost-savings of nearly $1.7 billion nationally in 1994.11
A study that evaluated the cost-effectiveness of publicly supported treatment programs in California concluded that approximately $7 in future savings costs are being gained for every dollar being sent on treatment programs in that state.12
According to a review of treatment studies done at the Center for Drug and Alcohol Studies, University of Delaware (Harrison, L.D., Crime & Delinquency, July 2001) : 13
A national study of treatment effectiveness, the Treatment Outcome Prospective Study (TOPS) documented the progress of 11,750 clients entering treatment for drug abuse between 1979 and 1981 in 41 programs throughout the United States. A large percentage of the clients were also involved with the criminal justice system. The average illegal income in the year following treatment was reduced by nearly two thirds. The study concluded treatment is economically effective, because the cost of treatment was more than recovered by the savings in crime reduction.
The Drug Abuse Treatment Outcome study (DATOS) conducted a longitudinal study involved about 4,500 clients admitted to drug treatment between 1991 and 1993 in 12 cities for inpatient long-term residential, therapeutic community, methadone maintenance, and outpatient drug free programs. The 1 year follow-up showed the percentage of outpatient clients who reported using cocaine and alcohol was reduced by half, and less than 1 in 10 clients reported weekly or more frequent marijuana use.
Diversion From The Criminal Justice System – Drug Courts and Proposition 36
Delaware is the first state to have a drug court system operating statewide. The drug courts, both part of the Superior Court and Court of Common Pleas, allow defendants to seek treatment as an alternative to the normal process of trial and, upon conviction, sentencing. Expungement of misdemeanor or felony charges, the opportunity to avoid sentencing that can include incarceration, and the opportunity to avoid mandatory loss of driving license upon conviction of a drug charge are powerful incentives for offenders to take the drug court track. Failure to successfully complete the drug court course of treatment places the offender back into the normal court process, a powerful incentive for compliance.
According to the National Association of Drug Court Professionals,
A drug court is a special court given the responsibility to handle cases involving drug-using offenders through comprehensive supervision, drug testing, treatment services and immediate sanctions and incentives. Drug court programs bring the full weight of all interveners (judges, prosecutors, defense counsel, substance abuse treatment specialists, probation officers, law enforcement and correctional personnel, educational and vocational experts, community leaders and others) to bear, forcing the offender to deal with his or her substance abuse problem.14
Arizona’s Coconino County DUI/Drug Court targets individuals who were arrested for offenses that are drug or alcohol related and who have committed no prior or current violent offenses. Mississippi Drug Courts target defendants convicted of drug possession. In Delaware, the Superior Court’s Drug Court program targets individuals (including probation violators) who commit non-violent drug offenses that do not carry minimum mandatory sentences.
Coconino County, Arizona DUI/Drug Court 15:
·
The cost 16 incurred by Coconino County is $6,408.00 when one offender goes through the average cycle of the DUI/Drug Court program·
The cost 17 incurred by Coconino County is $22,740.00 when one offender goes through the average cycle of the traditional court system·
The difference in cost is $16,332.00 between Coconino County’s DUI/Drug Court and traditional court system·
The traditional court system is 3.5 times more expensive than the DUI/Drug CourtMississippi Drug Court 18:
·
The cost is $16,757.00 per year to incarcerate a drug offender through the Mississippi Department of Corrections·
The cost is $5,000.00 per year to treat a drug offender through the Mississippi Drug Court programIf 500 drug offenders participate in the Mississippi Drug Court program, as opposed to being incarcerated, the state will save from $5.3 million to $5.4 million a year.
California Proposition 36 passed by the voters in 2000 requires low level, non-violent drug offenders to enter treatment as an alternative to incarceration19. Based on a July 2003 UCLA first annual study on Proposition 36, the Drug Policy Alliance estimates that the diversion from incarceration to treatment saved at least $275 million in the first year. Some 37,495 people were diverted to treatment in the first year at an average cost savings from avoided incarceration of $10,640 per offender, for a total cost avoidance of $398 million. Deducting $120 million for treatment costs for the 37,495 offenders provided a net savings of more than $275 million.
Delaware Drug Court 20:
Baseline evaluation shows that:
§
Track I§
Of those who graduated from Drug Court:·
2% were arrested during the program period·
39.4% were arrested following graduation from the program§
Of those who did not complete Drug Court:·
51.5% were arrested during the program period·
46.9% were arrested after leaving the program§
Track II§
Of those who graduated from Drug Court:·
8% were arrested during the program period·
19% were arrested following graduation from the program§
Of those who did not complete Drug Court:·
41% were arrested during program period·
55% were arrested after leaving the programAccording to Superior Court of Delaware Web Page 21:
§
Statistics show that Drug Court has successfully reduced the number of drug-addicted babies born to mothers who graduated from Drug Court and were previously addicted§
As of Dec 31, 1999, over 1,700 offenders were served by Drug Court. Of these, 1,700, over 63% have either successfully completed or are still active in treatment 22Drug courts are demonstrating nationwide that treatment can be an effective alternative to incarceration. Presently, the effectiveness of the Delaware Superior Court drug court system in New Castle County is being evaluated by the University of Delaware’s Center for Drug and Alcohol Studies at the University of Delaware.
Treatment While Under Correction Supervision – Rehabilitation
|
Because the criminal justice system deals with a large proportion of chronic drug abusers, the criminal justice system is an ideal place to organize and provide needed drug treatment services. The criminal justice system has become the largest source of mandated, or coerced, drug treatment in the United States. p.464 Prisoners have numerous barriers to reintegration, sans drug use, into the community. Perhaps one of the greatest insights of drug treatment is that drug abuse is a disorder of the whole person, so the whole person must be treated. Drug abuse is often regarded as a symptom of underlying problems, and those underlying problems must be treated for the individual to stop abusing drugs. This is particularly true in the case of drug-abusing offenders, who present a litany of problems. p.472-473 -Lana D. Harrison, Associate Director, Center for Drug and Alcohol Studies, University of Delaware. |
According to the Bureau of Justice Statistics, 75% of offenders in state and federal prisoners are drug involved. Many states have responded to this issue through providing in-prison substance use treatment to offenders.
Statistical Analysis Center Evaluation of Boot Camp 23
The Delaware Department of Correction operates a boot camp program, which serves as a diversion option for those headed for a drug offense minimum mandatory sentence of two years or longer. The Boot Camp, which opened in April 1997, provides a six-month program with intense, military type discipline through a highly disciplined regime that includes 360 hours of substance abuse treatment. Delaware’s boot camp is serving many with serious criminal histories, with the average boot camper having 13.4 arrests including 4.3 prior felony arrests. An evaluation of the boot camp program by the Delaware Statistical Analysis Center indicates that:
Probably the most important result shows that where 98 percent of Boot Camp graduates have a prior history of felony arrests, they only have a 25 percent felony rearrest rate 18 months after graduation…a 73-percentage point decrease in felony arrests at 18 months at risk is very significant. (Delaware’s Adult Boot Camp, O’Connell, Huenke, Knox, p. 3, May 2001)
Sentencing Accountability Commission (SENTAC) Evaluation of DOC TC Programs
Delaware has been a leader in prison-based drug treatment. Its KEY therapeutic community treatment program for inmates in secure care has received national and international recognition. The CREST therapeutic community treatment program at work release, and subsequently aftercare services for released inmates have added to the continuum of care.
These Delaware inmate treatment programs have benefited from extensive independent evaluations through federally funded grants to the University of Delaware’s Center for Drug and Alcohol Studies. They have also been closely examined by the State’s Sentencing Accountability Commission (SENTAC) whose findings were published in its report Sentencing Trends and Correctional Treatment in Delaware, April 2002,www.state.de.us/cjc/finalreport . 24
In making its report SENTAC reviewed research on correctional treatment, particularly treatment communities (TC), in several states and made these findings:
Research on the Amity prison TC in California found that only 27 percent of inmates who completed both the TC and aftercare returned to prison within three years of release, compared to 75 percent of similar inmates who had no such treatment
. 25A study of Delaware’s Key/Crest continuum found that offenders who completed the Key TC only were marginally less likely to be arrested than the control group. Offenders who completed Key and Crest work release had rearrest rates of 57 percent compared to a 70 percent rearrest rate for the comparison group. Those who completed Key, Crest and aftercare were significantly less likely to be rearrested (31%) compared to the comparison group who received no treatment services (70%).
26 Although this study, conducted by the University of Delaware Center on Drug and Alcohol Studies, relied on self-reports of rearrest, the Delaware Statistical Analysis Center (SAC) verified overall research trends using criminal justice databases.Studies of the Kyle New Vision TC in Texas found that the three-year reincarceration rate for inmates who completed all phases of treatment was 26 percent, compared with 52 percent of inmates who had no treatment. This study also found that the most significant impact of treatment was on The most severely addicted inmates.
27In addition to changes in criminal recidivism, a number of important byproducts were observed in these studies. The implementation of TCs in institutional settings has produced documented reductions in drug use within the institutions, dramatic reductions in levels of institutional violence and disciplinary incidents, improved working conditions and reduced tress on staff, and improved morale of both staff and inmates.
28Other research finding in the SENTAC report support the efficacy of treatment for offenders. Key findings include:
Length of time in treatment is consistently the most important variable related to treatment outcome. For TC clients, research has shown that a minimum of 9-12 months is needed to produce good outcomes.29
Successful outcomes may require more than one treatment experience. Many addicted individuals have multiple episodes of treatment, often with a cumulative impact.
30A comprehensive continuum of treatment services, including aftercare, supports treatment effectiveness.
31Treatment does not need to be voluntary to be effective.
32
These results compare very favorably with general population recidivism, which shows higher rates of commitment to prison terms of 1+ years.
The SENTAC report’s bottom line on prison-based treatment in Delaware:
Because of different measurement standards, there is no way to make direct comparisons with other states’ programs. However, we do know that in Delaware, an average of 39.2 percent of offenders released from prison from 1981 through 1994 were returned to prison within 18 to 24 months
53. Although this study used a more stringent measure of recidivism, felony rearrest, we can see that all program graduates do better than the general population. (p. 52)Center for Drug and Alcohol Studies (University of Delaware) Evaluations of DOC TCs
The on-going evaluations of Delaware’s prison-based treatment programs by the University of Delaware’s Center for Drug and Alcohol Studies, likewise, find very positive beneficial results of the KEY, CREST, and aftercare treatment initiatives:
§
Martin, Butzin, Saum & Inciardi Study 33o
Three years after release from prison, 69% of those who completed both Crest and Aftercare were arrest freeo
Three years after release from prison, 55% of those who completed Crest but did not complete Aftercare were arrest freeo
Three years after release from prison, 29% of the comparison group 34 were arrest freeCrest, Aftercare and Relapse 35
§
Three years after release from prison, 35% of those who completed both Crest and Aftercare were drug freeThree years after release from prison, 27% of those who completed Crest but did not complete Aftercare were drug free
Three years after release from prison, 5% of the comparison group was drug free. 36
Treatment and Employment Rates 37
Those who completed the Crest program have a 76% employment rate
Those who entered but did not complete the Crest program (terminated) have a 54% employment rate
Those who completed a traditional work release program have a 61% employment rate
Treatment, Employment Status and their Affect on Relapse 38
Of those that completed a traditional work release program and are unemployed, 72% relapse
Of those that completed a traditional work release program and are employed, 55% relapse
Of those that terminated the Crest program and are unemployed, 55% relapse
Of those that terminated the Crest program and are employed, 56% relapse
Of those who completed the Crest program and are unemployed, 44% relapse
Of those who completed the Crest Program and are employed, 44% relapse
A more recent study by the Center for Drug and Alcohol Studies,39 currently in press, continues the evaluation of the CREST treatment program out to 42 and 60 months from release. Findings include:
Long-term effects are most apparent where residential treatment is followed by aftercare;
There was a 70% reduction in the odds for new arrest for those assigned to treatment compared to the non-treatment control group after 42 months;
At 60 months the odds are still 60% less for new arrest of those in treatment compared with no treatment;
At 60 months, 52% of those who were in the CREST program followed by aftercare were rearrested, compared with 77% of those with no treatment;
Those in the treated groups are 15 to 20 times more likely to be drug-free compared to the group with no treatment.
Another study also in press from the Center,40 examines the cost-effectiveness of the CREST program, revealing that nearly 90% of the cost of the CREST program is recaptured in the first 12 months after release in lower recidivism alone. Reincarceration of released offenders during the 18 month study period indicates average days reincarcerated as:
Untreated comparison group – 104.20 average days reincarcerated;
CREST work release only - 91.96 days;
CREST plus Aftercare - 42.60 days;
Average of all CREST participants – 74.39 days.
This finding does not take into account further down stream savings nor does it include associated savings in reduced police, court, crime victim savings.
National Center on Addiction and Substance Abuse (CASA) Evaluation of Drug treatment Alternative-to-Prison (DTAP) Program 41
The National Center on Addiction and Substance Abuse (CASA) at Columbia University recently completed an evaluation of a treatment alternative program I Brooklyn, New York. The DTAP program provides access to therapeutic community treatment as an alternative to incarceration to offenders facing a mandatory prison sentence. Participants are "mainstreamed" into treatment at a select group of private, residential drug treatment programs where they receive 15 to 24 moths of drug treatment. Program candidates are addicts who have repeatedly sold drugs, have not been convicted of a violent crime, are willing to engage in treatment and communal living, do not have a history of violence or severe mental disorder, and are facing a mandatory prison sentence (4.5 years or longer).
CASA’S evaluation indicates that DTAP graduates are:
33 percent less likely to be rearrested (39 percent vs. 58 percent);
reconviction rate 45 percent lower (26 percent vs. 47 percent);
87 percent less likely to return to prison (2 percent vs. 15 percent);
three and one-half times likelier to be employed than they were before arrest (26 percent before arrest vs. 92 after DTAP).
The evaluation finds the DTAP program achieves its results at about half the average cost of incarceration ($32, 975 for DTAP vs. $64,338 for prison).
Rand Institute Evaluation of Treatment Versus Incarceration Options
In a policy analysis by the RAND Drug Policy Research Center the authors pose the question if $1 million was available to reduce illicit drug use and its consequences, what expenditure option would produce the greatest results: 42
longer sentences (enforcement with mandatory minimum length sentences)?
conventional enforcement (enforcement using "conventional" length sentences)? or
treatment of heavy drug users?
The researchers analyzed the three options in terms of kilograms of cocaine consumption averted by the options. Their findings indicate that longer, mandatory sentences are the least cost/effective way to use the $1 million to reduce cocaine consumption. Conventional enforcement has more impact, but treatment of heavy drug users has by far the greatest result:
Incarceration of drug dealers does little to reduce cocaine consumption, meantime the cost of long sentences consumes a much larger part of the $1 million. Treatment is found to be most cost/effective because for the relatively modest cost of treatment, actual consumption is reduced, even using modest expectations on the effectiveness of the treatment itself.
The report found even greater support for treatment in reducing crime, as most drug related crimes are committed to get money to support drug use:
"In terms of reducing the dollar value of the cocaine market, mandatory minimums and conventional enforcement are about equally effective, but that effect is small – about 13.5 cents per dollar spent. Treatment is estimated to be over 70 times as effective as either enforcement approach…The only way the enforcement programs reduce spending on cocaine is by incapacitating dealers who are also users and, thereby, reducing demand for cocaine. Not surprisingly, that is a very expensive way to reduce cocaine spending." P.51
| "…mandatory sentences should seem most appealing to people with very short time horizons…mandatory minimums are analogous to financing purchases with a credit card, conventional enforcement to paying cash, and treatment to investing." Mandatory Minimum Drug Sentences: Throwing Away The Key Or The Taxpayers’ Money? P. 78 |
Conclusions
In reviewing the growing body of research literature on substance abuse treatment we conclude that:
Treatment does work, it can be an alternative to persons becoming entrained in the criminal justice system;
Substance abuse is a complex problem of the "whole person" and treatment approaches must take this into account to be successful;
Persons with extensive criminal backgrounds are being successfully treated;
Care needs to be given to the definition of "success" for those with substance abuse needs; the model of a "chronic" disease where "improvement" rather than "cure" is the most realistic standard;
The coercive environment of the court and incarceration can provide important, perhaps essential, motivation for those with extensive substance abuse histories;
Cost-effective treatment has been documented although much more needs to be known about matching the particular form of treatment to the individual.
| Coerced substance abuse
treatment is just as effective as voluntary treatment. Source: Miller NS, Flahety JA. Effectiveness of coerced addiction treatment (alternative consequences): a review of clinical research. Journal of Substance abuse Treatment 2000; 18:9-16. |
REFERENCES:
1
Harrison, L. D., The Revolving Prison Door for Drug-Involved Offenders: Challenges and Opportunities, Crime and Delinquency, July 2001.2
O’Brien, C.P., & McClelland, T.A. (1996), Myths about the treatment of addiction. Lancet, 347, 237-240.3
Office of National Drug Control Policy. (2002). The costs of parity for substance abuse treatment. Retrieved on August 22, 2003 from http://www.whitehousedrugpolicy.gov/prevent/workplace/health.html4
Office of National Drug Control Policy. (2002). The costs of parity for substance abuse treatment. Retrieved on August 22, 2003 from http://www.whitehousedrugpolicy.gov/prevent/workplace/health..html5 Holder, H.D., & Hallan, J.B. (1986). Impact of alcoholism treatment on total health care costs: A six year study. Advances in Alcoholism and Substance Abuse, 6, 1-15
6
Lennox, R. (1993). Cost offsets of drug abuse treatment provided in the private sector.. Washington, D.C.: Presented at annual meeting of the Association for Health Services Research7
Luckey, J. (1987). Justifying alcohol treatment on the basis of cost savings: The offset literature.. AlcoholHealth & Research World. Rockville, MD: National Institute of Alcoholism and Alcohol Abuse, Fall, 8-15.
8
Metzger, D., Woody, G., & DePhillips, D. (1991). Risk for AIDS behaviors in opiate addicts in and out of methadone treatment.. Manuscript submitted; Center on Addiction and Substance Abuse at Columbia University.. (1993). The cost of substance abuse to America's health care system, report 1: Medicaid hospital costs9
Health Insurance Association of America. (1994). Cost of maternity care, physicians' fees, and hospital charges, by census region, based on Consumer Price Index. The Sourcebook of Health Insurance Data. Washington, D.C.: Health Insurance Association of America; Center for Substance Abuse Treatment. (1995). Study of grantees administered by the Women and Children's Branch.10
Center for Substance Abuse Treatment. (2000). Benefits of substance abuse treatment vary by modality. CSAT by Fax, 5 (6). Retrieved on August 29, 2003 from http://www.cesar.umd.edu/cesar/csatfax/vol5/csat5-5.PDF11
Missouri Institute of Public Health. (2002). MIMH policy brief. Retrieved on August 29, 2003 fromhttp://www.mimh.edu/mimhweb/pie/reports/Policy%20Brief%20April%202002.pdf
12
California Department of Alcohol and Drug Programs. (1994) Evaluating recovery services: The California drug and alcohol treatment assessment (CALDATA). Sacramento, CA: State of California Department of Alcohol and Drug Programs.13
Harrison, L. D., The Revolving Prison Door for Drug-Involved Offenders: Challenges and Opportunities, Crime and Delinquency, July 2001.14
National Association of Drug Court Professionals.. (n.d.) What is a drug court? Retrieved on August 21, 2003, from http://www.nadcp..org/whatis/15
Solop, F., Wonders, N., Hagen K., & McCarrier, K. (2003) Coconino County DUI/Drug Court evaluation. Flagstaff, AZ: Northern Arizona University.16
Cost includes courtroom visits, treatment days, probation contacts, jail days, prison days, and drug tests17
Cost includes courtroom visits, treatment days, probation contacts, jail days, prison days, and drug tests18
Gates, J. (2003). Officials call for drug courts statewide. The Clarion Ledger. Retrieved June 25, 2003 from http://www.clarionledger..com/news/0301/28/m07.html; Bryant, P. (2003) Review of the feasibility of extending drug courts statewide in Mississippi. Retrieved June 25, 2003 from the State of Mississippi Office of State Auditor website: www.osa.state.ms.us.19
Drug Policy Alliance, Prop. 36 Exceeds Expectations with Huge Savings, July 17, 2003, www.prop36.org/pr071703.html.20
Whillhite, S., & O’Connell, J. (1998). The Delaware Drug Court: A baseline evaluation; Superior Court of Delaware. (n.d.). Delaware Drug Court.. Retrieved on July 1, 2003 from http://courts.state.de.us/superior/drug_de.htm21
Track II "targets defendants who are arrested for drug offenses who have no or minimal prior felony convictions and who are charged with offenses other than trafficking or delivery (which carry minimum mandatory sentences)"; see Superior Court of Delaware. (n.d.). Delaware Drug Court. Retrieved on July 1, 2003 from http://courts.state.de.us/superior/drug_de.htm22
Superior Court of Delaware. (n.d.). Delaware Drug Court.. Retrieved on July 1, 2003 from http://courts.state.de.us/superior/drug_de.htm23
Delaware’s Adult Boot Camp, O’Connell, Huenke, Knox, p. 3, May 200124
Sentencing Trends and Correctional Treatment in Delaware, Delaware Sentencing Accountability Commission, (prepared by O’Connel, J, Peyton, E., & Rockholz, P.) April 2002.25
Wexler, Harry K.; Melnick, Gerald; Lowe, Louis and Peter, Jean. 1999. "Three year re-incarceration outcomes for Amity in-prison therapeutic community and aftercare in California." The Prison Journal,79(3) 32 1-336.
26
Martin, Steven S.; Butzin, Clifford A.; Saum, Christine A. and Inciardi, James A. 1999. "Three yearoutcomes of therapeutic community treatment for drug-involved offenders in Delaware: from prison to
work release to aftercare." The Prison Journal, 79(23), 294-320.
27
Knight, Kevin; Simpson, D. Dwayne, and Hiller, Matthew L. 1999. "Three year reincarceration outcomesfor in-prison therapeutic community treatment in Texas." The Prison Journal, 79(3), 337-351.
28
Deitch, David; Koutsenok, M.; McGrath, P.; Ratelle, John; and Carleton, R. 1998. Outcome FindingsRegarding In-custody Adverse Behavior Between Therapeutic Community Treatment and Non-treatment
Populations and Its Impact on Custody Personnel Quality of Life. San Diego, CA: University of California
–San Diego, Department of Psychiatry, Addiction Technology Transfer Center.
29
Wexler, H.K.; Falkin, G.P.; and Lipton, D.S. 1988. A model prison rehabilitation program: An evaluationof the Stay’n Out therapeutic community. Final report to the National Institute on Drug Abuse.
30
Principles of Drug Addiction Treatment: A Research-Based Guide. National Institute on Drug Abuse,1999. NIH Publication No. 99-4180.
31
Center for Substance Abuse Treatment. Continuity of Offender Treatment for Substance Use DisordersFrom Institution to Community. Treatment Improvement Protocol (TIP) Series, Number 30. Washington,
DC: U.S. Government Printing Office, 1998.
32
Leukefeld, C.G., and Tims, F.M., eds. Compulsory Treatment of Drug Abuse: Research and ClinicalPractice. National Institute on Drug Abuse Research Monograph, Number 86. Rockville, MD: National
Institute on Drug Abuse, 1988.
33
Martin, S., Clifford, B., Christine, S., & Inciardi J. (1999). Three-year outcomes of therapeutic community treatment for drug-involved offenders in Delaware: From prison to work release to aftercare. The Prison Journal, 79 (3).34
The comparison group includes ex-offenders who were released from prison 3 years earlier but did not enter the Crest or Aftercare programs35
Martin, S., Clifford, B., Christine, S., & Inciardi J. (1999). Three-year outcomes of therapeutic community treatment for drug-involved offenders in Delaware: From prison to work release to aftercare. The Prison Journal, 79 (3).36
The comparison group includes ex-offenders who were released from prison 3 years earlier but did not enter the Crest or Aftercare programs37
Butzin, C., et al. (1999). Measuring the impact of drug treatment: Beyond relapse and recidivism. Corrections Management Quarterly, 3 (4), 1-7.38
Ibid.39
Inciardi, J. A., Martin, S. S., Butzin, C. A., Five-Year Outcomes of Therapeutic Community Treatment of Drug-Involved Offenders After Release From Prison, in press Crime and Deliquency.McCollister, K. E., French, M. T., Inciardi, J. A., Butzin, C. A., Martin, S. S., Hooper, R. M., Post-Release
40
Substance Abuse Treatment for Criminal Offenders: A Cost-Effectiveness Analysis, in press Journal of Quantitative Criminology.41
Crossing the Bridge: An Evaluation of the Drug Treatment Alternative-to-Prison (DTAP) program, The National Center on Addiction and Substance Abuse at Columbia University, March 2003.42
Mandatory Minimum Drug Sentences: Throwing Away The Key Or The Taxpayers’ Money? Jonathan P. Caulkins, C. Peter Rydell, William L. Schwabe, James Chiesa, Drug Policy Research Center RAND, 1997