Toward a Drugs and Crime Research Agenda for the 21St Century

The Drugs-Crime Wars: Past, Present, and Future Directions in Theory, Policy, and Program Interventions

Duane C. McBride, Curtis J. VanderWaal, and Yvonne M. Terry-McElrath

Introduction The existence of the The relationship between drug use and drugs-crime relationship criminal behavior has generated a substan- The purpose of this section is to briefly dis- tial body of literature in peer-reviewed cuss what is known about the drugs-crime journals, government publications, and the relationship. This discussion will focus on public press. The very extent of such the historical policy context; the empirical research—as well as the breadth of policy nature of the relationship overall; and spe- positions based on or ignoring such cific drugs, crimes, and populations. research—argues for the importance of a review that can summarize theory, policy, and programmatic approaches to the Which drugs and what crime? issue. In this paper, we do not attempt to Before proceeding further, we wish to provide a comprehensive review of the clarify what we mean by “drugs” and pro- issues or literature. Instead, we seek to vide a more complete picture of what is About the Authors provide a sufficient review of the most involved in “crime” related to drug use. pertinent knowledge about the drugs- Duane C. McBride is a These clarifications are made in the hope professor with and chair of crime relationship to stimulate further dis- that readers will recognize that the crime the Department of Behavioral cussion among researchers regarding the aspect of the drugs-crime relationship is Sciences and director of the most important research questions that multifaceted and that the current exclu- Institute for Prevention still need attention. This discussion holds sion of alcohol from most discussions of of Addictions at Andrews great promise for the development of new the drugs-crime relationship may be University; Curtis J. VanderWaal approaches to the drugs-crime relation- detrimental. is a professor with the ship. As Brownstein has argued, “those Department of Social Work who do the research are in the best posi- and associate director of tion to interpret their findings and offer Substance inclusion decisions the Institute for the Prevention advice based on their conclusions” (1991, of Addictions at Andrews The term “drugs” as used throughout this p. 132). This paper approaches the above University; Yvonne M. paper refers to currently illicit substances Terry-McElrath is a research task by focusing on the following issues: in the United States based on Federal associate with the Institute for (a) documenting the existence of the drug schedules. Alcohol, prescription Social Research at the drugs-crime relationship, (b) addressing drugs, and other substances are excluded. University of Michigan. the nature and complexity of that relation- Although it is beyond the scope of the ship, (c) summarizing philosophical and current project, it is important to at least theoretical contributions that may best mention the alcohol-crime relationship. address the relationship, (d) reviewing Greenfeld (1998) reminds us that an esti- both State- and Federal-level policy mated 36 percent of convicted offenders approaches to breaking the relationship, were drinking at the time they committed including integrated program approaches, their crimes and that a high correlation has and (e) proposing key areas for future been observed between public order research.

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crimes and alcohol use. Alcohol is also policy has moved to various points along strongly related to violent crime (Coker et this continuum, and it often resides at dif- al., 2000; Dawkins, 1997; Ernst et al., ferent points at the same time in different 1997; Parker and Auerhahn, 1998; Pihl and locations and for different substances. Peterson, 1995). Ironically, this relation- Each time policy shifts, the act of drug use ship often remains outside sentencing takes on a slightly different character in decisions and monitoring procedures relation to crime. Thus, it is important to because alcohol is legal and therefore not present a brief history of drug policy in the subject to the same arrest, seizure, and United States, together with current possi- prosecution laws as are illicit drugs. Drug ble positions in the drug policy discussion, treatment interventions, however, often as each position has a unique implication include both alcohol and other drugs. for fighting drug-related crime. Comprehensive efforts to address crime and substance use should include alcohol An understanding of American drug policy treatment in programmatic considerations. begins with three early American cultural traditions that still strongly affect drug policy discussions: (a) libertarianism, (b) the The history of drug policy and emergence of a relatively open legal the definition of crime market resulting from the libertarian per- Crimes associated with drug use range spective, and (c) Puritan moralism. Liber- from violent (such as murder and aggra- tarianism argues that government must vated assault) to acquisitive (burglary, for- have an extremely compelling motive for gery, fraud, and deception) to specific interfering in the personal lives of citizens. drug-law violations. In addition, crimes Such interference legitimately occurs only such as bribery and corruption are related if a citizen’s behavior is a significant, actual to drug use as a result of drug policy prohi- risk to others (Mill, 1979). Consistent with bitions. Traditionally, discussions of the this libertarian tradition, early America had drugs-crime relationship have focused pri- an open-market orientation that empha- marily on violent crime; however, it is sized limited government interference in important to recognize the complexity of the production and distribution of desired criminal acts associated with drug use. goods and services.1 Nineteenth-century When considering the drugs-crime rela- national drug policy was consistent with tionship, this paper recommends that both libertarianism and the open market. researchers and policymakers include both While the Federal Government regulated violent and nonviolent crimes as well as the importation of such drugs as opium drug law violations and corruption associ- and cocaine, few regulations governed the ated with drug policy to grasp more fully distribution of these and other drugs the resulting harms and societal costs (for through what came to be called the patent example, see French and Martin, 1996). medicine industry (Belenko, 2000; Inciardi, 2001; Musto, 1999). Patent medicines Efforts to address the drugs-crime rela- were extensively advertised and, through tionship must incorporate a realization of them, the use of drugs such as opium and how the development of policy and law cocaine became integrated into routine has contributed to the relationship itself. American cultural behavior patterns Policy approaches to drug use in the (Musto, 1999). United States have historically ranged between legal markets in the 19th century Conflicting with both libertarianism and to decriminalization, harm reduction, med- the market-driven approach is the Puritan icalization, and strict prohibition (as the moralist perspective: Individual behaviors dominant policy) in the 20th. Over time, with the potential to harm the community

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are seen as a community problem within governments to develop their own treat- the legitimate purview of community ment programs. In 1970, the Comprehen- action (Cherrington, 1920; Schmidt, 1995). sive Drug Abuse Prevention and Control Puritan and other religious and moral tradi- Act consolidated and replaced the patch- tions present in American history often work of previous Federal drug laws. The viewed behavior such as substance use as Act created the drug schedules in current undermining the moral fabric of society, use today and initiated the so-called “war potentially causing the withdrawal of on drugs”; it also moved some posses- God’s blessing from America. The Puritan sion or casual transfer offenses to misde- moralist perspective dominated the early meanors instead of felonies. This era may 1900s, an era of societal reform and in- be considered a time when drug use was creasing prohibition (and thus increasing primarily considered a medical/mental penalties for drug use). One of the first health problem to be addressed by treat- successes of the social reform movement ment, with lessened emphasis on criminal in the early 20th century was the passage penalties for possession and use. of the Pure Food and Drug Act of 1906, which required the patent medicine indus- With an apparent increase in drug use, as try to list product ingredients. The subse- evidenced by an increase in drug overdose quent passage of the Harrison Act of 1914 cases and drug treatment admissions, a and the Marihuana Tax Act of 1937 made more prohibitionist movement again illegal the manufacture, sale, and posses- swept the Nation. New York’s Rockefeller sion of a variety of drugs, including opiates Drug Laws were passed in 1973, estab- and cocaine, as well as the nonmedical lishing mandatory prison sentences of up use of marijuana. A strongly prohibitionist to 20 years for the sale of any amount of approach continued through the 1950s heroin or cocaine. The Anti-Drug Abuse with the Boggs Act of 1951 and the Nar- Acts of 1986 and 1988 continued to em- cotic Control Act of 1956, when mandato- phasize law enforcement (although the ry minimum sentences for Federal drug 1988 Act gave more attention to treat- trafficking law violations were strength- ment and prevention). In yet another poli- ened and arrests without a warrant for cy shift, treatment (including diversion into drug charges were enabled. treatment from the criminal justice system) and prevention received increasing The 1960s and 1970s represented a major attention in the 1990s. Further, some cultural shift in the United States. For a States developed policies that effectively variety of reasons, American society expe- decriminalized marijuana possession rienced a “drug revolution” during this (removing jail/prison penalties) and initiat- era. There appeared to be an increase in ed policies, such as needle exchange pro- the proportion of individuals using drugs grams, that would reduce the dangers of and in the variety of drugs used. The evi- injecting drugs. dence for this increase is seen in the number of drug-related arrests and the Although scholars often focus on the rela- increase in drug use in the general popu- tively rapid development of national drug lation (Musto, 1999). During this era, policy, it is important to remember that drug policy initially shifted to a stronger many States passed legislation prohibiting treatment- and less punishment-oriented patent medicine and/or alcohol sales, as stance. In 1966, the Narcotic Addict well as marijuana use, a decade or more Rehabilitation Act allowed the establish- before similar legislation was passed by ment of the civil commitment system Congress (Belenko, 2000). Because of instead of prosecution for Federal offend- how the United States is organized, States ers and encouraged State and local often have or exercise considerable

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The history of discretion regarding alcohol and drug poli- The statistical relationship cies (Musto, 1999). between drug use and criminal drug policy can behavior be broken down Essentially, the history of drug policy (and debates about where drug policy should The general conclusion of almost three into five main move in the future) can be broken down decades of research on the relationship approaches: into five main approaches: prohibition, risk between drug use and crime has been reduction, medicalization, legalization/ that there is a clearly significant statistical prohibition, risk regulation, and decriminalization (for an relationship between the two phenomena reduction, indepth discussion, see McBride et al., (Austin and Lettieri, 1976; Dorsey and 1999; see also Goode, 1997). Prohibition Zawitz, 1999; Gandossy et al., 1980; medicalization, emphasizes severe penalties for use, dis- McBride and McCoy, 1993). Research indi- legalization/ tribution, and production. Risk reduction cates extensive drug use among arrested uses a public health approach to reduce populations, a high level of criminal be- regulation, and the risks and harms associated with illicit havior among drug users, and a fairly high decriminalization. drug use and emphasizes education on correlation between drug use and delin- risks, safer use practices, prevention, and quency/crime in the general population. treatment. Medicalization calls for physi- Research also indicates significant differ- cian treatment of drug addicts, viewing ences in the relationship based on drug substance abuse primarily as a medical type and type of crime. Importantly, all issue. Legalization/regulation supports these differences are further complicated increased access to drugs through govern- by ethnic and gender issues. mental regulation of these substances, with possible distribution of specific sub- The drugs-crime relationship stances through governmentally controlled within various population distribution channels. Decriminalization groups calls for a complete end to the use of criminal law to address individual drug Drug use among arrested/incarcerated use. This may imply a relatively open- populations and crime among drug market approach to drug availability and users. From the early 1970s onward, bio- use, but that need not be the case. logical and self-report data have indicated a relatively high rate of drug use among Although there has been significant debate arrested and incarcerated populations over which policy approach or approaches (Arrestee Drug Abuse Monitoring Pro- might best address the drugs-crime cycle, gram, 2000; Austin and Lettieri, 1976; more research is needed that examines Dorsey and Zawitz, 1999; Gandossy et scientifically the effects of policy positions al., 1980; McBride and McCoy, 1993). In on both drug use and crime. For the most 1999, the Arrestee Drug Abuse Moni- part, current Federal drug law takes a pro- toring Program (ADAM) collected data hibitionist stance that includes a strong from more than 40,000 adults in more deterrence approach to reducing the sup- than 30 sites and more than 400 juveniles ply of drugs and high penalties for drug in 9 sites throughout the United States law violations. As a result, a significant (ADAM, 2000). In almost all cities where portion of the drugs-crime relationship is the ADAM project operates, about two- simply an artifact of law and policy itself: thirds of both adult male and female “most directly, it is a crime to use, pos- felony arrestees had an illegal drug in their sess, manufacture or distribute drugs clas- bodies at the time of arrest (with higher sified as having the potential for abuse” rates among females). Even among juve- (Craddock, Collins, and Timrots, 1994). niles, the majority of arrestees were found to have an illegal drug in their urine (with

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higher rates among males). The data also 1991). Youths who used “hard” drugs suggest that, although current drug use (about 5 percent of the sample) accounted rates among adult arrestees are higher for 40 percent of all delinquencies and 60 than those reported in the more isolated percent of index crimes. reports of the 1970s (Austin and Lettieri, 1976), these rates have remained steady The impact of drug type on the for the past 5 years (the same patterns are drugs-crime relationship found among juvenile arrestees). An argu- ment can be made that with about two- The first National Institute on Drug Abuse thirds of arrestees already using illegal (NIDA)-sponsored Crime and Drugs Report drugs in the 72 hours prior to their arrest, (Austin and Lettieri, 1976) noted that a there is not much room for an increase. complex relationship exists between type of drug use and type of crime. This rela- A recent report from the Bureau of Justice tionship is further complicated if multiple Statistics (BJS) suggests that drug use drug use exists. The 1999 ADAM report also is extensive among inmates in local shows that a fairly large proportion of jails (Wilson, 2000). This document reports arrestees tested positive for more than that the majority of inmates in State pris- one drug (up to 30 percent), and that ons and local jails used drugs in the month reported criminal behavior tended to prior to the offense that put them in prison/ include a wide variety of offenses. The jail. Interestingly, this same report also ADAM data show that while cocaine was notes that about 10 percent of jail inmates the most likely drug found among adult test positive for drugs while in jail. arrestees in large cities (and there is literature suggesting a significant relationship The extent of crime among drug users between cocaine and violence), for many also has been documented. From the urban ADAM sites, violent offenders were 1960s through the 1990s, surveys of drug- more likely to test positive for marijuana using populations both in and out of treat- than cocaine. In addition, property offend- ment have consistently shown that the ers were more likely to test positive for large majority of users have extensive his- cocaine than marijuana in most sites tories of criminal behavior and time served (ADAM, 2000). in prison (Defleur, Ball, and Snarr, 1969; Inciardi, Horowitz, and Pottieger, 1993). This pattern applies to juveniles as well: The impact of crime type on the Between 40 and 57 percent of adoles- drugs-crime relationship cents treated for substance disorders also Drug law violations. A significant propor- have committed delinquent acts (Winters, tion of drug user arrests involve violations 1998). of drug laws only. As noted previously, the United States experienced wide drug poli- Drug use and crime levels among the cy shifts in the 20th century. Each shift general population. A tradition of studies has uniquely affected crimes related to shows a correlation between drug use and drug use and distribution. In a study of delinquency in general youth populations 611 juvenile cocaine users by Inciardi and (Elliott and Huizinga, 1984; Elliott, Huizinga, colleagues in the early 1990s, analyses and Menard, 1989; Harrison and Gfroerer, showed that participants had committed 1992). Analysis from the National Youth more than 400,000 criminal acts in the Survey has provided data often used to 12 months prior to being interviewed. Of examine this relationship. These data these, 60 percent were for drug law viola- report a direct correlation between serious tions, mostly sales of small amounts drug use and delinquency (Johnson et al.,

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(Inciardi, Horowitz, and Pottieger, 1993). violence associated with drug use, ”docu- At the Federal level, a total of 581,000 menting” the criminal consequences of drug arrests in 1980 nearly tripled to a such activity (see Anslinger and Tompkins, record high of 1,584,000 in 1997. By 1997, 1953; Inciardi, 2001). Among the best 79 percent of drug arrests were for pos- known of these efforts were the films session and 21 percent were for sales. “The Man with the Golden Arm” (purport- Forty-four percent of drug arrests overall ing to depict the effects of heroin use/ were for marijuana offenses (Uniform injection) and “Reefer Madness” (show- Crime Reports, 1998). Drug defendants ing the supposed behavioral conse- comprised 42 percent of felony convic- quences of marijuana use). Although such tions (Bureau of Justice Statistics, 1999). media portrayals exaggerated the possible A recent BJS Special Report (Wilson, links between drugs and crime, some 2000) also substantiates the extensive research has connected drug use with vio- percentage of drug-related crimes that lence. Grogger and Willis (2000) conclude result from violation of drug laws, suggest- that without the introduction of crack ing that about a quarter of jail inmates cocaine into urban America, 1991 crime have a current charge or conviction for rates would have been about 10 percent drug law violations. Critics have argued lower. These researchers also examined that since such arrests likely include many the impact of crack on specific types of low-level users and dealers, criminal jus- violent crime and reported that the biggest tice processing and the stiff sentences impact was on aggravated assault. that often are handed down because of mandatory minimums may be inappropri- In 1985, Goldstein provided the perspec- ate to the offense level (McBride et al., tive that has been most commonly used 2001). to examine the relationship between drug use and violence. Essentially, he argued Changes in drug The violence connection. Changes in for a tripartite scheme, where “psycho- drug policy are usually driven by concerns pharmacological violence” could result policy are usually for public safety and the perception of a directly or indirectly from the biochemical driven by concerns direct relationship between drugs and vio- behavioral consequences of drug use; lence (Brownstein, 1996, 2000). For exam- “economic-compulsive violence” could for public safety ple, the drug policy reform movement of relate to behavior/crimes engaged in to and the perception the early 1900s (changing from legal obtain money for drugs; and “systemic markets to strict prohibition) was accom- violence” could emerge in the context of of a direct panied by horror stories focused on exag- drug distribution, control of markets, the relationship gerated claims of criminal behavior as a process of obtaining drugs, and/or the consequence of drug use. In this litera- social ecology of drug distribution/use between drugs ture, there was a particular emphasis on areas.2 Some researchers have concluded and violence. horrific violent crime (including rape), with that there is minimal evidence regarding minority group members often portrayed the psychopharmacological impact of as the drug users engaged in the violent drugs on violence (Resignato, 2000); how- behavior. Musto (1999; see also Belenko, ever, Pihl and Peterson (1995) reviewed a 2000; Hickman, 2000) documents the wide range of studies on the issue. They public concern of the time (perhaps obses- concluded that alcohol and drugs can be sion) with Chinese opiate use, African- psychopharmacologically related to violent American cocaine use, and the use of acts through the release of dopamine, marijuana by Mexicans. The creation of which reduces inhibitory anxiety about the the Narcotics Bureau led to a type of consequences of aggressive behavior and media distribution industry focused on increases the rewards associated with

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violence. In addition, they argue that the Institute of Justice (NIJ) Research in Brief psychopharmacological effects of drugs supports this research, stating “illegal interfere with the user’s cognitive process- drugs and violence are linked primarily ing of the consequences of potentially vio- through drug marketing” (Roth, 1994, p. 1). lent situations. It should be noted that these authors believe that the evidence The impact of ethnicity for psychopharmacological effects of alco- and gender hol use on violence are much higher than for other drugs. Much of the research that has been conducted on drugs and crime has not had a However, some indications point to the sufficient focus on gender and ethnic vari- environment as being a more powerful ance. This limitation has significant reper- explanation of the drugs-violence relation- cussions on applying findings to other ship than the psychopharmacological population groups. As Paniagua (1998) properties of drugs (Brownstein, 2000; notes, the multicultural nature of current Fishbein, 1998; Parker and Auerhahn, society must incorporate a recognition of 1998). In terms of economic compulsive the complex nature of ethnicity and gen- and systemic violence, Collins (1990) as der. Specifically, individuals who share a well as Fagan and Chin (1990) argue that similar ethnicity or gender will not all be crack selling is the main contributor to the the same (i.e., recognition of language, drugs-violence relationship. Specifically, acculturation, and socioeconomic differ- their research found that violence (mostly ences); however, it is important to recog- robbery) emerged from the need to obtain nize cultural commonalities that may money to purchase drugs (predominately significantly affect both the extent and crack). Fagan and Chin suggest that the nature of the drugs-crime relationship drugs-violence relationship also emerges across individuals. Research that has as a part of the subculture of violence. focused on ethnicity and gender indicates that these variables may significantly In a 1994 study, Roth argued that drug affect various aspects of the drugs-crime users commit more property crime than relationship, including: violent crime. A recent publication by De Li, Priu, and MacKenzie (2000) examined ■ Source of drugs and/or works (Taylor the relationship between drug use and et al., 1994). property and violent crime in a population of probationers in Virginia. Results indicat- ■ Predictors of violence (Ellickson and ed that drug use had a positive association McGuigan, 2000). with property crime, whereas drug dealing had an association with both violent and ■ Types of violence experienced and reac- property crime (though the relationship tions to such violence (Brownstein et al., was stronger for property crime). The 1994; Fine and Weis, 1998; Mazza and analysis also showed an interactive effect Dennerstein, 1996). between drug use, drug dealing, and vio- ■ Stress-coping factors (Vaccaro and Wills, lent and property crime. Among juveniles, 1998). Linnever and Shoemaker (1995) found that arrests for both possession and selling of ■ Biological effects of drugs (Brady and drugs were related to the rate of property Randall, 1999). crime arrests. However, juvenile robbery arrest rates were related to only drug ■ Epidemiology of substance-use disor- sales arrests (not possession). A National ders (Brady and Randall, 1999).

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■ Psychiatric comorbidity (Brady and development of drug policy at all lev- Randall, 1999). els of government.

■ Social stigma issues (Brady and Randall, 4. Hyperbole, demagoguery, demoniza- 1999). tion, and perhaps even naivete have historically characterized the drugs- ■ Medical consequences of drug use, crime debate (and may still). However, including heredity issues and course of there is a clear statistical relationship illness (Brady and Randall, 1999). between drug use and crime. The majority of drug users have extensive ■ Assessment and treatment issues, histories of involvement with crimes including possible prevention settings and the criminal justice system; most (Brady and Randall, 1999; Metsch et al., arrestees are current drug users; and 1999; Paniagua, 1998). there is a correlation between drug use and delinquency/crime in general ■ Differences in initiation of drug use populations. A large proportion of this (Doherty et al., 2000). criminal activity is a result of drug law violations. Summary: What we know of the past 5. Although there is some evidence that drug costs may be related to property The intended purpose of this section has crimes and robberies, and that distri- been twofold. The first goal has been to bution and subcultural elements sur- review the history of American drug policy rounding drug use may be related to (as well as possible drug policy positions) violence, there is debate about the within the framework of the relationship evidence for a strong and continuous among policy, drug use, and crime. The connection between drug use and vio- second purpose has been to summarize lence. This relationship is also compli- the statistical documentation of the drugs- cated by the type of drug use, the crime relationship. Hopefully, this review category of crime, and ethnicity and has served to remind readers of the fol- gender. lowing issues:

1. American drug policy originated in the antithetical cultural traditions of rela- The nature and complexity of tively open-market/libertarian values the drugs-crime relationship and Puritan moralist social reform. These traditions still affect current As White and Gorman (2000) note, three debates about the drugs-crime rela- main explanatory models exist for grap- tionship, as well as the various policy pling with the drugs-crime relationship: positions between these two end- ■ Drug use causes or leads to crime. points on the policy continuum. ■ Crime causes or leads to drug use. 2. States have a history of experimenting with drug policies in advance of, and ■ The relationship is purely coincidental or sometimes in opposition to, Federal is based in a common etiology. action on the same issues. Based on their evaluations of the research 3. Public safety concerns have been supporting and/or refuting each of the the underlying rationale for the three main models above, they conclude

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that “one single model cannot account for On the other hand, some researchers the drug-crime relationship. Rather, the argue that a level of general delinquency drug-using, crime-committing population often precedes drug use (Elliott, Huizinga, is heterogeneous, and there are multiple and Menard, 1989). The subcultural expla- paths that lead to drug use and crime” nation is used here as well: Involvement in (White and Gorman, 2000, p. 151). Ten criminal activity and/or subcultures pro- years earlier, Collins (1990) also rejected vides “the context, the reference group, simple explanatory models for the com- and the definitions of a situation that are plex relationship. The debates over both conducive to subsequent involvement the direction of a drugs-crime relationship with drugs” (White and Gorman, 2000, as well as the etiological variables that p. 174; see also White, 1990). Individuals may be involved in the common occur- with deviant lifestyles and/or personalities rence of both drugs and crime have signifi- may also use substances for the purposes cant implications for attempts to intervene of self-medication (Khantzian, 1985; White in the drugs-crime cycle. and Gorman, 2000) or to provide a “reason” for deviant acts (Collins, 1993; White The direction of the relationship: and Gorman, 2000). Although Apospori Searching for a cause and associates (1995) concluded that the relationship between early delinquency At the popular and sometimes at the gov- and subsequent drug use was relatively ernmental level, the drugs-crime relation- weak, Bui, Ellickson, and Bell (2000) found ship is often clearly causal: Drug use what they called a modest relationship causes crime. Models such as Goldstein’s between delinquency in grade 10 and tripartite scheme (1985) have been used greater drug use in grade 12. Importantly, to illustrate this approach, specifying they found no significant differences by psychopharmacological, economic- ethnicity for this relationship. Hser, Anglin, compulsive, and systemic causes of vio- and Powers (1993) found that addicts who lence. As noted previously, arguments ceased narcotic use were less likely to that focus on the psychopharmacological engage in criminal behavior over a 24-year properties of various drugs cite research followup period. that indicates that stimulants may increase aggressiveness and paranoia and that Although there is some evidence of direc- many drugs have a strong disinhibiting tionality in the drugs-crime relationship, effect that could seriously interfere with researchers who have attempted to ad- judgment (Pihl and Peterson, 1995). dress this issue generally have concluded Economic arguments posit that the cost of that the relationship is extremely complex drugs, coupled with high unemployment and defies attempts to sort out directional- among drug users, results in the commis- ity. Work by Nurco and colleagues on crim- sion of property crimes to support drug inal careers initially found that increases in use (16 percent of jail inmates committed narcotic drug use were often followed by their current offense to get money for increases in criminal activity; conversely, drugs; BJS, 1999). Those who argue for a periods with no drug use were associated systemic approach maintain that drug use with less criminal activity of all types simply has a subcultural relationship with (these results applied for white, African- criminal behavior: Because it is illegal, American and Hispanic narcotics addicts; drug use involves the user in criminal sub- Nurco, Cisin, and Balter, 1981; Hanlon et cultures that often lead to future deviance al., 1990). However, in a subsequent 1993 (Fagan and Chin, 1990). article, Nurco, Kinlock, and Balter found that narcotic drug users had very early

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involvement in what these researchers call development of street identity for survival “precocious criminal activity.” This activity (Collison, 1996), social isolation that pre- pattern occurred prior to the onset of vents access to the social and economic addiction, and therefore simply could not systems of society (Harrell and Peterson, be attributed to addiction itself. A recent 1992; Stephens, 1991), and lack of what is article by Maxwell and Maxwell (2000) now referred to as human and social capi- provides another example of the confus- tal (described later in this chapter). Dembo ing directionality, suggesting that drug use and his colleagues have studied the drugs- has a very complex relationship with types crime relationship among high-risk youths of deviant behavior for women. Their find- entering the juvenile justice system through- ings suggest that frequent use of crack, out the last decade. In an important 1994 combined with early onset of crack use, is article, Dembo and colleagues found that related to prostitution. Drug selling, how- both delinquency and drug use emerge ever, was found to relate to decreased within the context of family problems and prostitution as it provided another opportu- peer deviant behavior. These researchers nity for income to purchase drugs. On a found that for both males and females, as broader level, Curtis (1999) found that well as African-Americans and whites, drug use rates did not decrease in either family alcohol and drug use, emotional Any simple the general or at-risk populations during problems, arrest history, and peer deviant the 1990s; however, there was a wide- behavior were related to continuing drug attempt to only spread decrease in urban crime during the use. Based on these models, any simple deter drug use same time period. He argues that market attempt to only deter drug use through and cultural forces were behind the ob- severe punishment or treatment will not through severe served changes in substance use patterns result in less crime or substance use, as punishment or and consequences: street drug dealers such approaches do not address the com- exerted higher control on both the drug plex cause of both behaviors (Harrell and treatment will not use of those who worked for them as well Peterson, 1992). result in less crime as the violence often associated with street drug dealing. or substance Summary use, as such A common origin Research on understanding the nature of the drugs-crime relationship illustrates that approaches do not One of the traditions of research on the no simple causal model can explain the address the drugs-crime relationship has emphasized phenomena. Rather, the statistical relation- that drug use and crime may not have a ship between the two activities may be a complex cause of direct causal relationship (White and result of their common etiological origin. both behaviors. Gorman, 2000), but may emerge in the As the purpose of this paper is to present same contextual milieu and have the a background for discussion of possible same antecedent variables such as poor research agendas to expand and reform social support systems, difficulty in research on the drugs-crime relationship, school, and membership in a deviant peer it is important to ground such a system- group (Hamid, 1998; Inciardi, Horowitz, wide effort in theoretical frameworks and Pottieger, 1993; Lurigio and Swartz, that allow for the complex nature of the 2000). These variables have been suggest- relationship. Such frameworks can be ed to include such issues as neighborhood then used to help shape possible future context (McBride and McCoy, 1982), the research.

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Philosophical and behavior. The theory calls attention to inherent personal characteristics that theoretical contributions affect individual behavior, including com- to addressing the drugs- petence, self-esteem, and self-direction crime relationship (Germain and Gitterman, 1995). This section will provide a theoretical Definitive theories of behavior that have framework for reviewing current program- been used to explain crime and deviance matic approaches to breaking the drugs- have varied. Since the 1960s, the follow- crime cycle. The theoretical approaches ing theories have been predominant: to be presented include both overarching anomie, social disorganization, differential behavioral theories and philosophies spe- association, social control, deterrence, cific to justice system programming. labeling, and conflict (Liska, Krohn, and Messner, 1989). Recently, however, atten- Overarching theoretical tion has been directed to new approaches approaches with the hope that theoretical and research advances will better support pre- While recognizing the existence of a wide vention and treatment: “integrated theory, range of theories on human behavior, this general theory, lifecourse transitions, and paper uses ecosystems theory as an over- social capital appear to offer promise for all framework for examining the drugs- the future” (Bartollas, 2000, p. 564). We crime relationship. Within this framework, will focus specifically on social capital the concept of social capital has emerged since it is a relatively new theory with recently as a promising approach to break- the potential to explain many complex ing the drugs-crime cycle. relationships.

Ecosystems theory. Human behavior, Social capital. The social sciences have including participation in drug use or crimi- always had an interest in the relationship nal activities, takes place within the broad- among community organization, social er social environment: circumstances, interaction, and individual behavior. Today, social norms, cultural conditions, and inter- the concept of social capital increasingly is actions with others (Kirst-Ashman, 2000). used to understand the extent of commu- Ecosystems theory acts as an organizing nity interaction and its effects. Social capi- framework (as opposed to a definitive the- tal was originally defined by Coleman ory of behavior or development) that calls (1988) as the quality and depth of relation- for an active awareness that the interac- ships between people in a family and tion of biology; interpersonal relationships; community. Putnam (1993) developed the culture; and legal, economic, organization- concept to include “the networks, norms al, and political forces affects an individ- and trust that facilitate coordination and ual’s behavior (Beckett and Johnson, cooperation for mutual benefit” (p. 2). The 1995; Kirst-Ashman, 2000). It should be World Bank Group (2002) modified the noted that the relative influences of each definition to include “the institutions, rela- force are likely to change throughout the tionships, and norms that shape the quali- lifecourse of each person. Essentially, ty and quantity of a society’s interactions” ecosystems theory helps provide the per- (p. 1). Finally, Rose (2000) emphasized the spective needed to understand the utility of social capital by defining it as “the breadth of systems (micro, mezzo, and stock of networks [relationships between macro) involved in any discussion of individuals] that are used to produce human behavior, as well as specific theo- goods and services in society” (p. 1422). ries that might be useful in addressing Increasing evidence shows that social

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Increasing capital and the social cohesion and norma- capital (informal friendship and family re- tive environment enabling its development lationships versus formal institutional evidence shows are critical for community and individual arrangements) and the quantity versus that social capital quality of life. The productive utility of in- quality of the social networks involved. formal face-to-face associations and for- and the social mal organizational networks has been The concept of social capital can be cohesion and noted, for example, in the areas of eco- applied to breaking the drugs-crime rela- nomic development (World Bank Group, tionship in several ways. First, high levels normative 2000), political participation (Putnam, of social capital in communities may play environment 2000; Putnam and Campbell, 2000), health arole in preventing drug use and other promotion (Baum, 1997, 2000; Kawachi deviant behavior through the presence of enabling its et al., 1997; Kawachi, Kennedy, and Glass, stronger formal and informal social bonds development 1999; Veenstra, 2000), and general quality and networks. The presence of anti-drug- of life at the individual and community use norms within more informal structures are critical for levels (Billings, 2000; Caspi et al., 1998; (such as family networks, communities of community and Lerner, 2000; Parcel and Menaghan, 1993; faith, and neighborhoods) may contribute Popay, 2000). to lower drug use rates. Conversely, lower individual levels of community social capital may be quality of life. Recent studies based on social control associated with greater access to drugs and social bonding theories have devel- and more lenient social norms and low- oped highly innovative solutions to crime ered social controls regarding the use of prevention, linking the levels of collective drugs or association with drug users. efficacy (Sampson and Raudenbush, 1999; Second, drug users who have recently Sampson, Raudenbush, and Earls, 1997; entered the criminal justice system may Fagan, 1987), community cohesion and/or find that the presence of high levels of integration (Hirschfield and Bowers, 1997; social capital in a community result in a Jobes, 1999; Kawachi, Kennedy, and stronger network of diversion options. Wilkinson, 1999; Kennedy et al., 1998; This could be due, in part, to formal and Lee, 2000; Mullen and Donnermeyer, informal network interest in restorative 1985; Walklate, 1998), local informal net- justice (described later in this chapter) works (Bursik, 1999; Savelsberg, 1999), versus punishment approaches to crime and youth family dynamics (Brannigan, intervention. Third, once a drug offender 1997; Hagan, 1995, 1997; Macmillan, is incarcerated, high levels of social capital 1995; Sampson and Laub, 1990) to crime within the offender’s home community rates in a given neighborhood. might better preserve networks of support for reintegration upon the offender’s re- Despite the extent of recent studies apply- lease. Offenders might more easily obtain ing the concept of social capital, very little jobs, receive support for continued sobri- research has been conducted to measure ety, and receive reinforcement for socially the relationship between social capital and appropriate behaviors. Finally, communi- drug use. The only related (and very limit- ties with high levels of social capital might ed) evidence points to the role of social have strong formal (vertical) social net- capital in preventing youth behavior prob- works in the form of coalitions or collabo- lems (Parcel and Menaghan, 1993). Put- ratives working to reduce substance use. nam (2000) found that this was especially Such agency connections may help focus true for those at higher risk for parental the community on policy development abuse. As effective intervention programs related to drug prevention and treatment are developed, it is essential to differenti- systems in homes, schools, and busi- ate between the various forms of social nesses. Such strong, integrated social

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networks may offer a larger range of serv- to incorporate factors that best support ices and may develop more formal hori- the inherent personal characteristics that zontal relationships with other service affect individual behavior and they address providers, thereby improving the coordi- the broader context of the social environ- nated delivery of services and care to ment. These concepts have significant those with drug or alcohol problems. implications for how programmatic interventions may occur within the criminal jus- One example of the impact that social- tice system. capital-based concepts are currently having on the drugs-crime relationship in the Retributive justice. The traditional crimi- United States is the recent establishment nal justice perspective of retributive justice of the Office of Faith-Based and Commu- generally sees drug abuse as a willful nity Initiatives in the White House. This choice made by an offender capable of action has focused the Nation’s attention choosing between right and wrong and on the role of faith-based institutions in acting on that choice. The approach the provision of drug treatment, aftercare, emphasizes deterrence through strict and other services. Such interventions penalties, including increasing arrests, may be particularly important in poor and developing tougher sentencing laws, and minority communities with large numbers building new prisons to hold and punish of high-risk individuals, where there are offenders (McBride et al., 2001). Imple- few (if any) traditional drug treatment pro- mentation of this perspective does tem- grams. However, these same communi- porarily reduce the number of criminals on ties are often served by churches and the streets as well as interrupt an offend- other faith-based organizations that care er’s drug use. However, drug-using offend- deeply about the members of their com- ers do not appear to alter their behavior in munity and are well established in serv- the face of punishment alone (Goldkamp, ice provision. While concerns about 1994). Thus, it is highly likely that offend- church-state separation, attempts at ers will recidivate, and the cycle of drug proselytization, and teachings of bigotry use and crime will continue (Hora, Schma, and prejudice have prompted some to de- and Rosenthal, 1999). mand a clear ban on the use of public funds to support faith-based institutions, Therapeutic jurisprudence and restora- others have begun to carefully examine tive justice. Therapeutic jurisprudence the potential of these organizations to has been defined as “the use of social sci- improve the lives of their clients. At presence to study the extent to which a legal ent, there has not been sufficient research rule or practice promotes the psychologi- to determine the effectiveness of treat- cal and physical well-being of the people it ment in faith-based settings. affects” (Slobogin, 1995, p. 196). Within this framework, key players from the justice system (including judges, prosecu- Criminal justice philosophies tors, and defense attorneys) move from An examination of recent approaches to adversarial roles to problem solvers as part intervention in the drugs-crime cycle re- of a collaborative team while still perform- quires a brief review of major criminal jus- ing their traditional roles of guardians of tice philosophies and recent conceptual community protection, administrators of developments. Philosophies with the the law, and protectors of due process greatest promise for success acknowl- (Spangenberg and Beeman, 1998). Thera- edge the complex relationship between peutic jurisprudence specifically addresses drugs and crime. In addition, they attempt the needs and problems of drug offenders from a medical, therapeutic perspective.

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Drug addiction is viewed as a problem community reparative boards, family group with deeply rooted biological, psychologi- conferencing, and circle sentencing (see cal, and social influences, and substance Bazemore and Umbreit, 2001). The shared abusers are seen as having a condition features of these approaches include: that requires treatment. From this perspective, the criminal justice system ■ Promoting citizen and community own- offers the best opportunity some offenders ership of the criminal justice system. will ever have to confront and overcome ■ their drug use and its consequences. Pro- Providing an opportunity for the victim grammatic approaches that often employ and other community members to con- therapeutic justice principles include drug front the offender about his or her courts, restorative conferencing, cross- behavior. systems case management, coerced and ■ Providing opportunities for the offender voluntary drug treatment programs, day to learn about the impact of the crime reporting centers, and intensive monitor- and to take responsibility and be held ing approaches. Each of these approaches accountable for the offense. will be reviewed in greater detail later in this paper. ■ Creating meaningful consequences developed by the victim, the communi- Within the past decade, a justice philoso- ty, and sometimes by the offender and phy associated with the principles under- his or her support system. lying therapeutic jurisprudence has emerged: restorative justice. Used primarily for non- Although concerns and implementation violent adult and juvenile offenders, the issues exist regarding restorative justice restorative justice approach (also termed (such as some resistance by the victims’ restorative conferencing) attempts to bal- rights movement, the need for collabora- ance the needs of victims, the community, tive relations with the community at large, and offenders. Unlike retributive justice, and potential clashes with current sen- which is concerned primarily with punish- tencing and corrections law), the philo- ing the offender, restorative justice seeks sophical approach shows promise as a to repair the damage inflicted by the future direction in addressing drugs and crime. This approach makes the criminal crime (Smith, 2001). process less formal by involving the victim and community members in the planning and implementation of the sentencing. Summary Rather than asking what should be done Human behavior is an extremely complex to punish the offender, restorative justice phenomenon, and theories imply that pro- asks the following questions (Zehr, 1990): grams that acknowledge the multiple systems and factors that affect behavior will ■ What is the nature of the harm resulting have the greatest chance for realistically from the crime? assisting in behavior change—in this case, reducing both drug use and crime. ■ What needs to be done to repair the harm? Although programmatic interventions focusing on punishment and deterrence ■ Who is responsible for the repair? alone can temporarily reduce drug and crime rates, long-term solutions seem to Restorative justice has been implemented favor interventions based on principles in a number of programmatic methods, similar to those of therapeutic jurispru- including victim-offender mediation, dence as well as restorative justice.

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State- and Federal-level with cancer treatments and to increase appetite in patients with AIDS. Many policy approaches to State medical marijuana laws were allow- breaking the drugs-crime ed to expire or were repealed following relationship Marinol’s approval (Dogwill, 1998). As noted previously, American drug policy Current efforts at marijuana medicalization is undergoing continual modification. Thus, began in the mid-1990s as a result of the observed relationship between crime media pressure and general dissatisfaction levels associated with drug use and drug with Marinol and other antiemetic drugs policy is constantly changing. There are (Dogwill, 1998). As of the end of the 2000 currently a broad array of drug policy legislative year, 28 States had statutes movements that may directly affect the providing for the medicinal use of marijua- drugs-crime relationship. The most wide- na (Pacula et al., 2001). The type of laws spread and potentially influential of these enacted by States varies, and States may policy changes include marijuana medical- have more than one law type. The list ization and/or decriminalization, lessening below shows the number of States with of the powder and crack cocaine sentenc- currently operating laws and a brief ing disparity, current activity surrounding description of the laws and related pro- club drugs, revisiting the concept of tections (Pacula et al., 2001): mandatory minimum sentencing, treatment versus prison, and model State drug 1. Therapeutic research programs laws. Each of these movements will be (TRPs): 14 (only 6 of which are cur- briefly described below, with a focus on rently operational). TRPs are adminis- how the proposed policy changes may tered by State health departments or affect the drugs-crime relationship. pharmacy boards and must be approved by the Food and Drug Administra- tion and adhere to specific Federal Marijuana medicalization regulations. Protection is provided Movement toward the medicalization of only to approved and participating marijuana has been ongoing since the patients, physicians, and pharmacies, 1970s (see Belenko, 2000; Goode, 1997). and for specified ailments not respond- The two actions that preceded the move- ing to other available treatments. ment were the National Commission on Marihuana and Drug Abuse report in 1972 2. Physician prescription laws: 13. These that called for reduced penalties for pos- laws are of three types: One allows session, and the unpublished 1975 trial of physicians to discuss the medical ben- United States v. Randal, which allowed efits of marijuana with patients; the the use of a medical necessity defense second allows physicians to prescribe for marijuana possession when a glauco- marijuana for medical purposes; and ma patient was arrested for growing his the third provides an affirmative own plants (Belenko, 2000). By the end defense for physician discussion or of 1982, 31 States and the District of prescription of marijuana. These laws Columbia had enacted medical marijuana protect physicians only, not patients. provisions (Markoff, 1997). However, 3. Medical necessity laws: 10. These in 1986, the Food and Drug Administra- actions provide a defense from pros- tion approved the use of the brand- ecution to patients and/or caregivers name drug Marinol (dronabinol, delta-9- for possessing marijuana for medical tetrahydrocannabinol, or THC) to prevent purposes if obtained via physician the nausea and vomiting often occurring

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recommendation, certification, or jail/prison penalties for subsequent pos- authorization. session offenses. MacCoun and Reuter (1997) have suggested that a better term 4. Rescheduling laws: 3. These laws re- might be depenalization. While the exact schedule marijuana to categories that definition of decriminalization is debated, recognize an acceptable use for mari- complex, and inconsistently applied, a re- juana and/or claim a lower potential for view of State statutes shows significant abuse. variation regarding possible penalties for simple marijuana possession ranging from Of the four types of laws noted above, no monetary penalties and no incarcera- only TRPs are federally sanctioned. Al- tion to fines in the five figures and multiple though the other three types of laws have years in prison (ImpacTeen Illicit Drug been or are being challenged in court, no Team, 2002). In addition, anecdotal reports firm ruling has been given that would suggest that some local police depart- clearly identify the final outcome of med- ments simply do not enforce existing ical marijuana initiatives. Although the out- marijuana possession laws. All of this sug- come of the medical marijuana debate is gests that States (and communities) show unknown, the policies in question have significant variance in marijuana policy, several ramifications for the drugs-crime and the impact of this variance should be relationship (Pacula et al., 2001). These examined to determine the possible rami- include potential decreases in marijuana- fications for arrests, black-market prices, related arrests due to a supportable de- use rates, and associated harms. fense for medical use, significant changes in black-market marijuana prices between States with varying medicalization policies, Lessening of the powder and changes in the ability or willingness to crack cocaine sentencing prosecute recreational marijuana users, disparity changes in possession penalties, and dif- There has been considerable public and ferences in use rates for both adults and research focus on the current sentencing adolescents. differences between the possession or sale of powder versus crack cocaine. Marijuana decriminalization Sentencing disparities emerged in the 1980s in the context of large increases in The decriminalization of marijuana posses- crack cocaine use, together with the con- sion in law or in enforcement policy has clusion that crack cocaine caused signifi- been evolving for many years. In the cantly more harm than powder cocaine to early 1970s, the National Commission on the individual and the community through Marihuana and Drug Abuse called for the increased violence (McBride et al., 2001). decriminalization of simple marijuana pos- Congress eventually enacted legislation session. This would mean the removal of mandating 5-year prison terms for the all criminal penalties; possession would be possession or sale of 5 grams of crack neither a felony nor a misdemeanor. In cocaine. This same legislation mandated practice, the application of such a simple the same penalty (5 years) for the posses- definition is complex. Although 11 States sion of 500 grams of powder cocaine indicate that they have decriminalized mar- (Sentencing Project, 1998). Thus, the ijuana, an examination of those statutes Federal Government defined the mandato- indicates that, operationally, decriminaliza- ry minimum sentencing disparity of crack tion means the removal of incarceration to powder cocaine at 100:1. The ramifica- for first or second marijuana possession tions of this policy became apparent fairly offenses but may include fines and/or

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early in its application: There were signifi- department mentions of Ecstasy in 1994. cant increases in the prison population, in In 1999, the number had risen to 2,850 the number of drug users in prison, and (DAWN, 2000). Results of these increases specifically in the number of African- have been felt in both research and policy. Americans in prison (Beck and Mumola, Research focus on the psychopharmaco- 1999; Mumola, 1999). Currently, 86 per- logical effects of Ecstasy is growing (for cent of all Federal crack cocaine defen- example, see Boot, McGregor, and Hall, dants are African-American (Sentencing 2000), as are attempts to provide valid Project, 1998). In 1995, the U.S. Sentencing information about the effects and dangers Commission recommended the elimination of its use (Larkin, 2000). At the Federal of the sentencing disparity between crack policy level, the Ecstasy Anti-Proliferation and powder forms of cocaine, arguing that Act was enacted in October 2000. The Act the policy had not accomplished its goal of directs the U.S. Sentencing Commission reducing crack use but had resulted in sig- to increase penalties for Ecstasy traffick- nificant unintended consequences. The ing as part of an increased deterrence recommendation was not acted upon. In approach to use. State laws also are 1997, the same group recommended mov- changing, with substantial numbers of ing to a 5:1 sentencing ratio, the Clinton States moving to schedule Ecstasy and/or administration recommended a 10:1 ratio, to increase penalties for sales (ImpacTeen and an additional bill was introduced in the Illicit Drug Team, 2002). Senate specifying a 20:1 ratio. No action was ever taken, however, and the initial Reconsidering mandatory sentencing disparity remains at the original minimum sentencing Federal level of 100:1. It is important to note that at the State level, sentencing dis- Mandatory minimum sentencing plays a parity is not universally mandated (but may significant role in the drugs-crime relation- be specified in State sentencing guide- ship and has been a major component of lines). Some States, such as Michigan, the war on drugs. Initially, it was thought have begun to modify the disparity in their that high mandatory penalties for drug law laws (Sentencing Project, 1998). violations (such as serving at least 85 percent of an assigned sentence) would have The growing club drug reaction a deterrent effect on drug use, related criminal behavior, and associated costs The general term “club drugs” refers to a (see McBride et al., 2001). However, the “number of illicit drugs, primarily synthet- primary results of mandatory minimum ic, that are most commonly encountered sentencing likely have been to increase at nightclubs and ‘raves’” (Drug Enforce- dramatically the number of drug-related ment Administration Intelligence Division, arrests and the proportion of prisoners 2000, p. 1). Examples of club drugs in- who are drug users (Harlow, 1998; Mumola, clude Ecstasy, Ketamine, Rohypnol, and 1999). Mandatory minimums for drug GHB (gamma-hydroxybutyrate). Both use charges may play a significant role in the rates and emergency department men- shifting of power from judges to prosecu- tions for these substances (especially tors, prison overcrowding, and a break- Ecstasy) have recently increased. Johns- down in truth-in-sentencing laws because ton, O’Malley, and Bachman (2001) report of early release due to prison overcrowd- that use of Ecstasy in the past 12 months ing. In reality, prison overcrowding often among 12th graders increased from 6 per- makes mandatory minimum sentencing cent in 1999 to 8 percent in 2000. Accord- laws all but impossible to enforce (see ing to the Drug Abuse Warning Network McBride et al., 2001). (DAWN), there were only 25 emergency

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Those who question the appropriateness Farabee, Prendergast, and Anglin (1998) of mandatory minimum sentences have determined that findings generally sup- been supported by studies suggesting that ported the use of coercive measures to this approach to addressing the drugs- increase the likelihood that an offender crime relationship is not effective and is will enter and remain in treatment. Speci- more costly than treatment (for example, fically, they concluded that compulsory see Caulkins et al., 1998). Significant activi- substance abuse treatment is “an effec- ty at the State and Federal level is focusing tive source of treatment referral, as well on mandatory minimum sentencing revi- as a means for enhancing retention and sion. Along with seeking to reduce the compliance” (p. 7). Since researchers gen- crack/powder sentencing discrepancy, the erally agree that length of time in treat- U.S. Sentencing Commission has been ment is strongly related to treatment actively supporting efforts to reevaluate success, coercing offenders into treat- mandatory minimum sentencing (Sen- ment and then applying graduated sanc- tencing Project, 1998). New York (the State tions to motivate continued participation is that played a major role in the introduction a potentially successful strategy. It can of mandatory minimum sentencing for certainly be stated that coerced treatment drug offenders via the Rockefeller Drug plays a major role in treatment referrals. Laws) is seriously considering significant Recent studies indicate that the criminal modification of its policies. The proposed justice system is responsible for 40 to 50 New York modifications focus on an expan- percent of community-based treatment sion of treatment services, a reduction in program referrals (Farabee, Prendergast, the range of mandatory minimum sen- and Anglin, 1998). Rates of referral vary tences, and an expansion of judicial discre- widely by substance, with marijuana and tion (Sengupta, 2001). If and when these methamphetamine referrals occurring sig- changes take place (at the national level nificantly more often than referrals for and/or in specific States), it will be impor- other substances (Drug Abuse Warning tant to examine their impact on the drugs- Network, 2000). crime relationship. However, Taxman (2000) argues that merely mandating an offender to treat- Treatment versus prison ment does little to increase motivation Coerced treatment (also referred to as or success. Simpson and colleagues compulsory, mandated, or involuntary (Simpson et al., 1997; Simpson, Joe, and treatment) is a heavily debated issue. Brown, 1997) have found that failure to Some oppose the practice on philosophi- address motivation and readiness for treat- cal or constitutional grounds, while many ment reduces treatment effectiveness. In treatment clinicians maintain that treat- addition, Farabee et al. (1999) maintain ment can be successful only if a person that the application of mandated treatment is truly motivated to change. Other re- varies widely, ranging from simple referral searchers (Anglin and Maugh, 1992; to treatment to strict graduated sanctions Salmon and Salmon, 1983) and policymak- with heavy monitoring and clear penalties ers have argued that few chronic addicts for failure. More research is needed to will voluntarily agree to enter and remain determine which offender types may ex- in treatment without external coercion. perience the greatest benefits of coerced In a review of research examining the treatment, and with which levels of treat- relationship between various levels of ment structures and settings (e.g. residen- legal pressure and treatment outcomes, tial versus intensive outpatient with heavy monitoring).

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Reports on the promise of coerced offenders into 18-month residential treat- treatment have prompted some State ment programs in lieu of prison time legislatures to adopt various forms of (Gallagher, 2001). These plans resulted pri- corrections-initiated drug treatment for marily from the recommendations of an nonviolent drug-using offenders. The fol- independent commission charged to study lowing is a review of these State initia- the impact of drug cases on New York tives, as well as a Federal measure under State courts. The principal recommenda- current consideration. tion of this commission was to “launch a systematic, statewide approach to the California. State voters recently passed delivery of ‘coerced’ drug treatment to the Substance Abuse and Crime Preven- nonviolent addicts in every jurisdiction” tion Act of 2000, which targets $128 mil- (New York State Commission on Drugs lion per year to help counties develop the and the Courts, 2000, p. 7). capacity to provide drug treatment, literacy training, family counseling, and vocational Massachusetts. The Department of training services for an expected 36,000 Public Health’s Bureau of Substance new treatment clients per year (San Abuse Services recently reported that Francisco Examiner, 2000). integrating such services across the State resulted in significant improvements in a Arizona. The Arizona Drug Medicalization, number of categories, including reductions Prevention and Control Act of 1996 in crime involvement, psychological prob- requires mandatory treatment and pro- lems, and use of health services, as well hibits incarceration of first- and second- as improvements in employment levels time drug offenders. A 1998 Arizona and abstinence rates (Massachusetts De- Supreme Court report concluded that the partment of Public Health, 2000). Based in State saved $2.5 million in its first year by part on these successes, ballot initiative sending users into treatment rather than Proposition P was introduced in the 2000 prison (Arizona Supreme Court, 1999). general election to divert drug forfeiture Although critics claim it is too early to money from police and district attorneys argue for program effectiveness due to to treatment centers. The measure failed, selection bias and lack of long-term recidi- possibly due to claims that the initiative vism rates, the study found that 77 per- was a cover for efforts to decriminalize cent of offenders tested drug free at the dangerous drugs (Boston Globe, 2000). end of their outpatient treatment programs. In addition, probationers who National. The U.S. Senate is currently received treatment were twice as likely to considering the recently introduced Drug be employed (90 versus 41 percent), to Abuse Education, Prevention, and Treat- finish community service requirements ment Act of 2001 (S. 304, 2001). The (85 versus 40 percent), and to complete measure would, among other things, probation successfully (85 versus 22 per- authorize new funding grants to States for cent) when compared with those who did the purpose of providing drug treatment not complete treatment. services to inmates and residential treatment facilities. New York. Governor Pataki recently unveiled a plan to reform the State’s Rockefeller Drug Laws by cutting mini- Model State drug laws mum sentences from 15 to 8 1/3 years for In 1992, the President’s Commission on some offenses, giving judges increased Model State Drug Laws was charged with discretion in sentencing, and giving prose- the task of creating a compilation of model cutors the power to divert repeat drug State laws that would effectively address

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drug and alcohol use (President’s Com- and members (National Alliance for Model mission on Model State Drug Laws, State Drug Laws, 2001). Several States 1993). After a series of public hearings, have passed legislation using the model drug treatment program site visits, and laws as a framework for laws specifically meetings with various individuals, agen- tailored to their needs, including Arizona, cies and groups, a total of 44 model laws Arkansas, Georgia, Iowa, Kansas, Louisi- and policies were developed. In its report, ana, Mississippi, New Jersey, North the Commission noted that Carolina, Pennsylvania, and Utah (National Alliance for Model State Drug Laws, [T]he legislative remedies offered 2001). However, no known evaluations of within do not rely exclusively on pun- the impact of these laws currently exist. ishment and deterrence to “solve” Additional efforts by the Alliance to assist drug problems. Instead, the goal of with drug policy revision include providing this report is to establish a compre- national and Federal agencies with assis- hensive continuum of responses and tance on State and local laws and policies. services, encompassing prevention, education, detection, treatment, rehabilitation, and law enforcement Summary to allow individuals and communities Trends in State- and Federal-level policies to fully address alcohol and other aimed at the drugs-crime relationship can drug problems. Tough sanctions are (and indeed do) move in different direc- used to punish those individuals who tions for different substances. Although refuse to abide by the law. More there has been considerable movement to importantly, the recommended sanc- modify marijuana laws at the State level, tions are designed to be construc- no comparable action has been seen at tive, attempting to leverage alcohol the Federal level. The movement toward The President’s and other drug abusers into treat- reducing the sentencing disparity between Commission ment, rehabilitation, and ultimately, crack and powder cocaine (as well as re- recovery. (pp. 1–2) duce overall penalties) is co-occurring with on Model State State and Federal trends to increase the Drug Laws’ five The five main policy areas are as follows scheduling and penalties for club drugs (see appendix A for a listing of specific such as Ecstasy. A further concern raised main policy areas model laws and policies within these by this section is that although research are economic areas): economic remedies, community may indicate the legitimacy and wisdom mobilization, crimes code enforcement, of revising current policy (such as moving remedies, treatment, and drug-free families/schools/ to coerced treatment instead of incarcera- community workplaces (President’s Commission on tion), there is often significant resistance Model State Drug Laws, 1993). to such actions based on the fear of fur- mobilization, ther escalations of the drugs-crime con- Following the compilation of the model crimes code nection or negative voter reaction. The laws and policies, The National Alliance for nature of public policy is complex and re- enforcement, Model State Drug Laws (Alliance) was ciprocal: The public elects policymakers organized as a nonprofit group that would treatment, who support the majority view. This tends serve as an ongoing resource for States to make legislators cautious about sup- and drug-free considering implementation of legislation porting changes in drug policy. Therefore, based on the model laws. The Alliance families/schools/ the development of possible public policy has held several conferences across the that might contradict traditional viewpoints workplaces. United States to work with elected and can be highly problematic (Tonry, 1996). appointed officials, substance abuse pro- However, the breadth and scope of poten- fessionals, and other community leaders tial legislative actions is impressive. With

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an increasing number of States developing receive drug treatment services in a sig- innovative laws based on examples such nificantly restrictive prison-based thera- as the Model State Drug Laws, there is peutic community. Nonviolent drug-using need for researchers to examine the pos- offenders might receive sentencing and sible effects of such policy changes. ongoing supervision from a drug court and participate in minimally restrictive victim- This paper has reviewed a wide variety of offender mediation, along with mandated data describing the drugs-crime relation- attendance in intensive outpatient drug ship and its complex nature, conceptual treatment services. frameworks that may help interpret the relationship, and the implications of policy Many jurisdictions struggle to integrate for the relationship. An important part of substance abuse treatment into their crim- society’s reaction to the relationship has inal justice systems, which often view been to develop programs to intervene such efforts as adjunct services rather with or break the drugs-crime cycle. Al- than primary, integrated components. though such intervention attempts have Taxman (2000) notes six threats that im- occurred for more than a century, they pede the implementation of treatment have become increasingly sophisticated as services: policy makers and clinicians have come to further understand and apply research ■ Lack of clear crime control goals for findings and relevant conceptual models. treatment services. The next section of this paper examines ■ many of the intervention programs that Lack of clear assessment and eligibility have been used and assesses key pro- requirements. gram elements that have shown some ■ Insufficient treatment duration to effect success at intervening in the drugs-crime behavioral change. relationship. ■ Lack of supervision and sanctions/ rewards to reinforce treatment goals. Integrated programmatic approaches to breaking the ■ Lack of objective drug testing to monitor drugs-crime cycle treatment progress. ■ In developing programmatic interventions Insufficient case management services. designed to break the drugs-crime cycle Many researchers and practitioners have among offenders, it is essential to ensure argued that to address these threats, a that neither community safety nor offend- comprehensive and integrated approach er accountability be compromised in any should be used to maximize treatment way, particularly for violent and chronic success and minimize future harm to offenders. However, as noted previously, the community (Anglin and Hser, 1990; drug-related crimes exist along a continu- Inciardi et al., 1997; Taxman, 1998, um of severity ranging from index crimes— Farabee et al., 1999; Martin et al., 1999; such as murder and armed robbery—to Taxman, 1998). Taxman (2000) argues for more minor offenses such as nonviolent a systems approach in which “correctional drug possession. Interventions such as and treatment agencies build a delivery drug treatment should be provided along a system that cuts across and integrates the continuum as well. Drug-involved offend- systems, reduces duplication in efforts to ers who commit serious crimes might create and recreate processes for unique

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programs, and emphasizes empirically manner, are destined to produce faulty driven programmatic components” (pp. and inadequate recommendations and 5–6). decisions. Careful assessment mechanisms not only will help identify those The following review will discuss interven- services that are most needed by offend- tions designed to break the drugs-crime ers, but also will prevent system duplica- cycle among offenders using an integrated tion leading to inefficient and poorly approach that can be applied throughout coordinated service delivery. By properly the range of sentencing alternatives.3 This assessing and coordinating services at approach, which integrates restorative intake, the justice system can more effec- justice with an ecosystems framework, tively work towards preventing increasing includes the following components: imme- levels of future recidivism and drug use. diate and comprehensive assessment; judicial processing, including the use of Offender evaluation generally occurs in drug courts; supervision and monitor- two phases: initial screening, followed by ing, including graduated sanctions and more comprehensive assessment. The cross-systems case management; cross- primary purpose of initial screening is to systems collaboration; the drug treatment determine if the need for a more compre- service continuum; and aftercare. hensive assessment exists. Thus, it is Common inappropriate to use screening instruments to formulate a diagnosis or decide screening Comprehensive assessment and treatment planning treatment needs. Screening instruments instruments also filter out individuals with medical, Appropriate client selection, assessment, psychological, or legal problems that include the CAGE and placement have been identified as need to be addressed prior to placement. Questionnaire, critical components of the treatment con- Common screening instruments include tinuum (Simpson and Curry, 1997–98; the CAGE Questionnaire, the Michigan the Michigan Taxman, 1998; Farabee et al., 1999). Sub- Alcoholism Screening Test, and the Alcoholism stance abuse problems are usually en- Offender Profile Index (for more detailed meshed within a wide variety of other descriptions of these tools, see Inciardi, Screening Test, issues. Thus, comprehensive assessment 1994). and the Offender is necessary to successfully address alcohol and other drug problems. If the screening instrument indicates an Profile Index. alcohol or other drug problem, a more Assessment. Assessment usually occurs comprehensive assessment is needed. At at the point of intake into the criminal jus- minimum, a comprehensive assessment tice system (often at either centralized should include: intake centers or police stations). Intake recommendations can heavily affect judi- ■ An indepth examination of the severity cial decisions; it is imperative that intake and nature of the alcohol and other drug personnel be thoroughly trained in the use abuse identified by the screening of comprehensive assessment tools. Such process. training should include incorporation of culture and ethnicity issues in comprehen- ■ A more thorough assessment of addi- sive evaluations, as well as dealing with tional problems flagged during screening the complexities of clients with multiple and further inquiry into problems that diagnoses. A poorly conducted assess- may not have been identified up to that ment, using techniques and measurement point. instruments that do not consider the ■ A strong effort to use multiple methods offender’s entire life situation in a holistic and sources.

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Components of a comprehensive assess- among incarcerated drug-using popula- ment instrument include: tions. Since the early 1970s, researchers have called attention to the special needs ■ History and current patterns of alcohol of jail inmates with mental illness (Gibbens, and other drug use. 1979; Gold, 1973; Verma, 1979). Although indepth studies on the prevalence of ■ Past and current involvement in the mental illness in prisons are very limited, criminal justice system, including any researchers estimate that around 7 to 9 history of violent behavior and manifes- percent of jail inmates are mentally ill tations of antisocial personality and psy- (BJS, 1999, as cited in Lurigio and Swartz, chopathology. 2000, p. 67). Rates of mental illness among those who are alcohol or drug ■ Family and social support systems. dependent are believed to be much high- ■ Medical history and current health sta- er. Peters and colleagues (1992) found tus, including HIV/AIDS screening. that, of jail inmates who were receiving substance abuse treatment, more than ■ Mental health history and current status, half self-reported a history of depression, including screening for any history of 45 percent reported serious anxiety or abuse, anxiety, or depression. tension, and 19 percent had a history of suicidal thoughts. Among juveniles, the ■ Educational and vocational history and Northwestern Juvenile Project has esti- needs. mated that two-thirds of juvenile detainees have one or more alcohol, drug, or Two commonly used assessment instru- mental disorders (Teplin, 2001). Because ments are the Addiction Severity Index depression is also a consistent predictor (ASI) and the Wisconsin Uniform Sub- of therapeutic noncompliance, it is impor- stance Abuse Screening Battery (adapted tant to make sure that an alcohol or other from the well-known Minnesota Multiphasic drug-diagnosed arrestee is properly as- Personality Inventory). The Wisconsin sessed and treated for depression or other instrument is composed of four separate mental disorders (Markou, Kosten, and sub-instruments: the Alcohol Dependence Koob, 1998). Scale, the Offender Drug Use History, the Client Management Classification inter- The conditions and care received by the view, and the Megargee Offender Typ- detained mentally ill have been found to ology. Important supplemental tests to be grossly inadequate (Alemagno, 2001; these comprehensive assessment instru- Birmingham et al., 2000; Lurigio and ments include the AIDS Initial Assess- Lewis, 1987). Outcome studies suggest ment Jail/Prison Supplement and various that to serve this population better, the biological tests to determine recent drug most effective approach includes ade- or alcohol use, including urinalysis, breath- quately training jail and prison personnel alyzer tests, blood tests, hair analysis, and to meet emergency situations, perform sweat tests (for more detailed descrip- basic assessments, and make appropriate tions of all of these tools, see Inciardi, referrals to community-based mental 1994). health services where safety concerns can be adequately monitored. Such an Comorbidity issues. Researchers report approach would have the added benefit of high rates of depression in street drug- also avoiding community-based service using populations (McBride et al., 2000). duplication (Cox, Landsberg, and Paravati, Additionally, a wide variety of data suggest 1989; Lurigio, 2000). that there is a high rate of comorbidity

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Treatment planning. The treatment plan and often uses an intensive supervision should be based on the client’s needs, and treatment program based on graduat- problems, strengths, and resources as ed sanctions (described below). Drug identified in the assessment process, and courts are partnerships between justice it should seek to use assessment informa- system personnel (prosecutors, defense tion to match the client with the best attorneys, and judges); treatment special- treatment modality and level of risk ists; and other social service personnel (Inciardi, 1994; McLellan et al., 1997; see (National Association of Drug Court Pro- also Taxman, 2000). Although clients fessionals, 2000). Drug courts allow should participate in the planning process judges to take a more active role than was to improve buy-in and treatment compli- provided by such previous options as man- ance, they cannot dictate treatment goals. dated lengthy sentences and to partner Treatment planning goals and objectives with community resources and agencies. should be specific, measurable, and attain- Judges draw on a variety of professionals able. They should also be flexible enough in assessing needs and recommending to adapt to emerging client needs as they services. They are then actively involved move through the criminal justice and in the decisionmaking process regarding treatment systems. Goals must conform what services are to be received. Judges to the limitations imposed by the court, also monitor compliance and apply sanc- parole or probation department, or other tions when a lack of compliance is evi- criminal justice agency that has jurisdiction dent. Some of the most unique and over the client. Good treatment plans also essential principles of drug courts include are designed to address issues related to immediate and upfront intervention; coor- treatment attrition, noncompliance, and dinated, comprehensive supervision; inadequate progress (Inciardi, 1994). access to a wide variety of treatment services including long-term treatment and At the conclusion of intake and assess- aftercare; and graduated sanctions and ment, intake officers generally have the incentive programs (Tauber, 1994; for option of dismissing the case with no fur- more indepth information on suggested ther action, placing the offender in a diver- organizational factors, see Berman and sion program, or referral to further justice Anderson, 1999; Cooper, 1997; McBride system processing. et al., 1999; National Association of Drug Court Professionals, 2000; Peyton and Judicial processing Gossweiler, 2001). If a decision is made to formally refer an Evaluations of drug courts have been offender to court for further processing, mixed. Concern has been expressed over judges will generally use the assessment evaluation research methodology, wide and arrest report as well as other facts to variations in populations served, and lack determine disposition and, if necessary, of consistent standards for assessment sentencing. In most jurisdictions, fact- and referral (Inciardi, McBride, and Rivers, finding and adjudication take place in 1996; U.S. General Accounting Office, conventional court systems. However, in 1997). More recent reviews by Belenko an attempt to play a more active role in (1998) and Covington (2001) have conclud- breaking the linkage between substance ed that drug courts have not been subject- use and crime, the judicial system devel- ed to consistent or methodologically oped the drug court. strong evaluations that define terms clearly (from program elements to definitions Specifically, a drug court takes responsibili- of success), examine the long-term impact ty for less serious drug-using offenders,

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of drug courts using appropriate compari- Graduated sanctions. Judicial processing son groups, or identify what program ele- within systems such as drug courts often ments contribute to successful outcomes. relies on graduated sanctions for supervi- Peyton and Gossweiler (2001) suggest the sion purposes. This approach helps ensure need for more comprehensive policies and offender rights and deters noncompliance. protocols consistently applied in all drug Graduated sanctions are based on the the- courts. This would contribute significantly oretical foundation of procedural justice, to methodologically strong evaluations. which posits that compliance is enhanced by procedures that are perceived as fair With the above concerns noted, evidence (Taxman, Soule, and Gelb, 1999). Lack of still points to a positive impact for drug compliance is a significant problem across courts: high treatment retention, increased the justice system. Studies indicate that sobriety, and reductions in recidivism have as many as 61 percent of probationers fail been noted in many drug court locations; to comply with release conditions (Langan in addition, savings in jail costs can be and Cunniff, 1992), and that 30 to 80 per- substantial (Drug Strategies, 1997; cent of new prison intakes each year are Cooper, 1997; Harrell, Cavanagh, and probation and parole violators (Burke, Roman, 2000). A recent evaluation of a 1997; Rhine, 1993). Some critics have midwestern drug court by Spohn and col- expressed concerns that graduated sanc- leagues (2001), which used a comparison tions are a form of “net widening,” in group design and controlled for a variety which probationers are given technical vio- of social and behavioral characteristics, lations for positive urinalysis tests. Such concluded that drug court participants had positive tests have become the equivalent significantly lower rates of recidivism than of crimes, although they are described by those who received standard court pro- the drug treatment system as relapses. cessing. To be successful, drug courts require a long-term outlook, significant Taxman, Soule, and Gelb (1999) state that initial resource allocation, and available the efficacy of graduated sanctions results treatment slots (Platt, 2001). Additional from the use of structured, incremental research is needed to address the signifi- responses to noncompliant behavior and cant issues critics have raised regarding from an emphasis on swift response to the scientific support for drug court noncompliant acts through a series of spe- enthusiasm. cific sanctions that vary based on such factors as the nature and number of violations. The concept of graduated sanctions Supervision and monitoring applies to the following: As stated in the introduction to this sec- ■ The type of initial treatment intervention tion, interventions for drug-using offend- (outpatient, residential, or types of col- ers must ensure community safety as well laborative services). as offender accountability. Programmatic approaches designed to help accomplish ■ The service delivery sentencing context safety and accountability goals include (from community diversion to incarcera- supervision via a system of graduated tion with coerced drug treatment in a sanctions, use of drug monitoring and State training school). testing to substantiate accountability, and system oversight and coordination ■ Overall intervention/treatment program through cross-systems case management. outcome goals. ■ Progress within the program (McBride et al., 1999).

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Taxman, Soule, and Gelb (1999) state that critics regard as net widening. Regular to be effective, graduated sanctions must drug testing is often part of an overall include three specific elements: strategy in which both treatment and criminal justice systems use graduated sanc- ■ Inform offenders about infractional tions to monitor compliance. Advocates of behavior and the potential conse- such strategies recommend that testing quences for such behavior. must be conducted frequently and randomly. Researchers (Marlowe, 2001; ■ Ensure that all members of the graduat- Taxman, Soule, and Gelb, 1999) have rec- ed sanctions judicial team adhere to the ommended several compliance-gaining agreed-on sanctions model. strategies, including clarification of negative and positive behaviors as well as ■ Strive to uphold offender dignity. swift, certain, and progressive responses. Use of a behavioral contract informing the It is important to use a team approach in offender of the graduated sanctions menu which treatment providers and criminal should be developed at intake or at the justice personnel share information about time of court-ordered probation. Such a progress or relapse issues. It is also im- sanctions menu should reflect certainty, portant to ensure that offenders are tested consistency, parsimony, proportionality, as long as they are under criminal justice and progressiveness (Taxman, Soule, and system supervision. Gelb, 1999), and it should provide for A wide variety of testing methods exists equivalent responses that allow for tailor- for illicit drugs, with variation in reliability ing sanctions to specific cases. and validity among testing procedures. Research specifically evaluating graduated The most widely practiced technique is sanctions approaches is very limited. How- urinalysis. Urinalysis offers a number of ever, the use of this approach is quite advantages compared with other testing common within drug courts. In addition, methods, including ease in obtaining a initial studies indicate that offenders in a sample, ability for sample retest, and low pretrial intervention program that used cost (Jacobs, DuPont, and Gold, 2000). graduated sanctions had lower rearrest However, subjects can easily tamper with rates for both short- and long-term (1-year) samples, and testing only reflects drug followup (Harrell, 1998). In addition, the use within the last few days. The window cost-benefits of graduated sanctions indi- of detection is also small for blood sam- Although a cate promise (Greenwood and Turner, pling, although results are highly reliable. 1993; Rivers and Trotti, 1995). In contrast, hair analysis allows for detec- combination of tion of long-term use (within the last 90 modalities is likely Drug monitoring and testing. In recent days), but provides unreliable data for years, drug testing programs have be- studying variables other than simple drug to offer the most come increasingly widespread in criminal presence. The least invasive testing tech- accurate results, justice settings (Jacobs, DuPont, and niques include sweat patch, saliva testing, Gold, 2000). In 1998, 71 percent of jails and nail testing, but the wider utility of privacy and reported having a policy to test inmates these approaches remains to be studied. feasibility issues for drug use; however, only 8 percent Although a combination of modalities is imposed mandatory treatment in response likely to offer the most accurate results, usually determine to positive test results. Instead, the most privacy and feasibility issues usually deter- which methods are common responses to positive testing mine which methods are used in practice involved punitive sanctions ranging from (Jacobs, DuPont, and Gold, 2000). Com- used in practice. loss of privileges to adding time to the prehensive outcome studies are needed sentence (Wilson, 2000), a practice that to evaluate the linkages between drug

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testing and expected (negative) conse- services, and the workforce. In addition, quences for positive results. CMs may intervene in crisis situations or assist offenders with relapse prevention Cross-systems case management, strategies such as developing non-drug- including TASC. Case management pro- related leisure activities. Intensive case vides one way for criminal justice systems management services are most critical to coordinate the comprehensive needs during the vulnerable 2-month period fol- of offenders. Case management has lowing discharge from primary treatment. emerged as a strategy to connect clients They provide continuity of care while to needed resources throughout the serv- simultaneously working to move the client ice continuum, at intake, during treatment, toward independence. and after treatment. Case management results in more rapid service access (Bo- Although a CM can help an offender navi- kos et al., 1992), higher levels of goal gate through the interconnected array of attainment (Godley et al., 1994; Rapp, treatment services, it is also clear that 1997), longer lengths of stay in treatment such services must be provided in the (Rapp et al., 1998), reductions in drug use context of the justice system. Drug courts, (Rapp, 1997), improved employment func- probation offices, and other criminal jus- tioning (Siegal et al., 1996) and improved tice system components must work with connection to needed resources over time CMs to coordinate an offender’s move- (Dennis, Karuntzos, and Rachal, 1992; ment through the justice system via the Godley et al., 1994; Schlenger, Kroutil, and use of graduated sanctions. The graduated Roland, 1992) when compared with stan- sanctions process allows the judge or pro- dard treatment services. Research sug- bation officer to maintain an appropriate gests that case management may be balance between community protection effective as an adjunct to substance abuse and offender rehabilitation. However, treatment for two reasons: Retention in judges generally have neither the time nor treatment is generally associated with bet- the training to ensure that offenders re- ter outcomes, and one of case manage- ceive a continuum of services. According ment’s primary goals is to keep the client to a recent NIJ examination of case engaged in the treatment process (Kolden management within the criminal justice et al., 1997; Siegal et al., 1995, 1996, system (Healey, 1999), optimum case 1997); and treatment is more likely to suc- management models currently combine ceed when a client’s non-substance-abuse two broad approaches: strengths-based problems are also being addressed (e.g. case management—focusing on a client’s financial problems, family problems, etc.; self-identified strengths and talents when see Siegal, 1998). developing a service plan, and assuming a client’s ability to use these strengths to Case managers (CMs), who are often move toward “socially acceptable choic- mental health or social workers, support es” (Clark, 1997; Enos and Southern, and reinforce treatment goals throughout 1996; Rapp et al., 1998; Siegal et al., the treatment continuum by providing the 1997); and assertive case management— following three functions: assessment requiring active involvement of the CM in (Babor et al., 1991); treatment planning seeking out and delivering services to and goal setting, linking, monitoring and clients as opposed to passive service pro- advocating (Ballew and Mink, 1996), in- vision (Healey, 1999; Inciardi, McBride, cluding navigating the often-confusing and Rivers, 1996). Within the criminal jus- social service system (Spear and Skala, tice setting, CMs combine support and 1995); and assisting in offender reintegra- positive regard for a client’s strengths with tion with home or other placement, social clear disapproval of the behaviors that led

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the client to become involved with the processes and 10 critical elements justice system. (Bureau of Justice Assistance, 1995). The four processes are: Healey (1999) notes that criminal justice case management often involves a con- ■ Identification of appropriate drug- scious blurring of roles between CMs, involved offenders. mental health providers, substance abuse counselors, domestic violence program ■ Assessment of treatment needs. counselors, and other social service ■ providers. Taxman and Sherman (1998) Referral to appropriate services and have suggested that much of the role con- placement. fusion can be reduced through a systemic ■ Continuous case management at all approach to case management, including points along the criminal justice process- agreed-on role clarifications and resource ing continuum (Anglin, Longshore, and allocation. Significant cross-training is Turner, 1999). often necessary to allow such blurring to take place without confusion of appropri- The 10 critical elements involve: ate role responsibility or misunderstand- ings regarding philosophical differences ■ Broad-based support within both the (Healey, 1999). criminal justice and treatment systems with formal communication systems. Effective use of assessment data within a case management framework requires ■ Independence as a unit with designated a complex information system that can administrator. ensure the availability of relevant information to those involved in service provision ■ Appropriate staff training on TASC poli- (Taxman and Sherman, 1998). If services cies and procedures. are to be integrated effectively, it is crucial that intake, assessment, and progress ■ An established data collection system. information be shared and not be need- ■ lessly duplicated. Such information can Explicit and agreed-on eligibility criteria. play a major role in increased service deliv- ■ Documented assessment/referral ery efficiency and improve the outcome of screening procedures. provided services (for further discussion of this area, see Mahoney et al., 1998). ■ Documented policies and procedures for drug testing. Perhaps the best example of a programmatic approach incorporating cross-systems ■ Offender monitoring procedures, includ- case management is TASC: Treatment ing reporting procedures (Bureau of Alternatives for Safe Communities (also Justice Assistance, 1995). known as Treatment Alternatives to Street Programs can be Crime, or Treatment Accountability for The usual position of a TASC program is Safer Communities). TASC is recognized that of a neutral party. Most program sites perceived as using as an offender management model do not provide treatment services of their nonbiased referral (Anglin, Longshore, and Turner, 1999) that own, nor are they an official member of links criminal justice system legal sanc- the criminal justice system. Thus, the judgments and tions with drug treatment program thera- programs can be perceived as using non- case management peutic interventions (Sigmon et al., 1999; biased referral judgments and case man- see also Inciardi and McBride, 1991). agement decisions. decisions. The TASC approach consists of 4 distinct

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Evaluations of TASC programs have been Cross-systems collaboration mixed, based on whether the evaluation is examining operational/procedural issues or By definition, the drugs-crime relationship outcome issues. Operational/procedural crosses currently accepted jurisdictional evaluation results (see Anglin, Longshore, responsibilities and requires system part- and Turner, 1999) have been consistently nerships. The promising components positive, citing strong screening and iden- described so far in this paper demand the tification of drug-using offenders (Toborg successful integration of a wide variety of et al., 1976); effective linkages with the services and jurisdictions, including crimi- criminal justice system; increased ethnic nal justice, drug treatment, social services, diversity in treatment; and increased and public health. Effective use of immedi- treatment participation (Collins et al., ate and comprehensive assessment, drug 1982); improvements in treatment reten- courts, communication necessary for suc- tion (Hubbard et al., 1989; Inciardi and cessful use of graduated sanctions, cross- McBride, 1991), and considerable cost- systems case management in the form of benefit ratios when compared with any agencies such as TASC, and post-criminal- form of incarceration (System Sciences, justice transition services to reintegrate 1979). Outcome evaluations have been drug users back into the community—all mixed. Studies focusing on recidivism of these approaches are based on an inte- generally show that TASC clients either grated care system. Yet, as Sigmon et al. have higher recidivism rates or no signifi- (1999) note, the adjudication process is cant differences in recidivism compared historically an adversarial system, and cre- with control groups (Anglin, Longshore, ating successful partnerships that involve and Turner, 1999; Owens et al., 1997). a variety of individual agencies is often However, as TASC uses higher monitoring difficult. levels, results on recidivism may simply To build the infrastructure required to sup- indicate “net widening”; those who are port cross-systems interactions, collabora- watched more are caught more. This may tive efforts are becoming widespread. indicate a possibility of higher public safety Eisenburg and Fabelo (1996) argue that in TASC communities, rather than program failure to develop an integrated infrastruc- failure. Anglin, Longshore, and Turner’s ture not only negatively affects the out- (1999) review of five TASC programs cho- comes of individual programs, but also sen to reflect similar programmatic and hastens treatment decay. Such infrastruc- population characteristics (including adher- tures have a variety of names but one ence to the 10 critical elements) indicated essential goal: to have representatives favorable outcomes for service delivery, from key agencies and services join drug-use days, drug crimes, and sexual together to identify the problems their activity while high on drugs. However, community is seeking to target, develop these results were either modest or were effective goals and strategies to address confined to high-risk offenders. Anglin, those problems, and then oversee the Longshore, and Turner conclude that more implementation of those goals and strate- problematic offenders may receive the gies (Sigmon et al., 1999). The types of highest benefit from program participation. problems such collaborative efforts ad- Covington (2001) reminds program address should not be narrowly construed. ministrators and researchers that TASC Sigmon and colleagues (1999) refer to programs have generally not received con- adjudication partnerships as an “umbrella sistent methodologically strong long-term concept under which many interagency outcome evaluations. Future research efforts can be classified” (p. 2). should focus on these issues.

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While collaborative formation usually coddled (Lipton, 1998). However, research results from grassroots efforts of local involving numerous large-scale studies leaders (Sigmon et al., 1999), the recent consistently demonstrates that treatment emergence of State- and county-level has beneficial outcomes. These federally managed-care models often require funded and independently evaluated stud- provider subcontracts and collaboration ies—including the Drug Abuse Treatment (McBride et al., 1999). Key agency mem- Outcome Study (DATOS), the National bers for collaboratives addressing drugs Treatment Improvement Evaluation Study and crime would include justice system (NTIES), the Treatment Outcome Prospec- agencies (offices of the prosecution, the tive Study (TOPS), and the Drug Abuse defense, and the court), as well as other Reporting Program (DARP)—have all con- groups such as law enforcement, welfare, firmed drug abuse treatment efficacy State and local corrections, managed through 1-year followup. These findings behavioral health care, community treat- remained valid when controlling for type ment, the health department, and State of service received (residential long-term, and local managed-care initiatives (Mull, outpatient drug-free, or outpatient metha- 1998; Sigmon et al., 1999). Such a mem- done maintenance) as well as drug and bership list would allow two essential client type (U.S. General Accounting types of individuals: “1) those who under- Office, 1998). However, the National stand and have an interest in the broad Research Council (2001) has questioned and specific problems of community wel- the strength of these studies’ conclusions, fare, justice, alcohol and other drug abuse, arguing that because the studies lacked and health and social services, and 2) randomized assignment, researchers community leaders who can ensure that “could not provide rigorous evidence productive change occurs” (McPhail and on the relative effectiveness or efficacy Wiest, 1995, p. 28). of particular drug-by-treatment combina- tions, or estimate the absolute effect size, Although each collaborative will be uniquely cost-effectiveness, or benefit-cost ratio of tailored to the community it serves, re- treatment” (p. 230). views of collaborative efforts have identified several critical elements for success Cost savings for treatment relative to (Sigmon et al., 1999, pp. 2–4; see also incarceration, interdiction, and health care Bureau of Justice Assistance, 1995; Mc- expenditures have been estimated by two Bride et al., 1999). These include leadership recent studies. The first, the California designation, membership integration, goal Drug and Alcohol Treatment Assessment setting, development of a team approach, (CALDATA), examined the effectiveness, emphasis on a long-term view, research costs, and benefits of providing alcohol and evaluation, efforts to develop broad- and drug treatment in California (Gerstein based community support, and sustainable et al., 1997). Economic savings to the funding (see appendix B for a more thor- California taxpayer both during and after ough discussion of these elements). treatment were estimated to be worth $10,000 per client, yielding a 1:7 cost- Continuum of drug treatment benefit ratio (the greatest share of the services benefits was found in crime reductions, with smaller savings in health care and Many policymakers, particularly legislators, welfare costs). The study also reported a oppose funding for drug treatment in cor- 68-percent reduction in drug selling and a rectional facilities, believing that the public 60-percent reduction in arrests resulting wants offenders punished rather than from drug treatment. In the second study,

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RAND researchers developed an econom- In a critique of the original 1994 RAND ic model to estimate the relative cost- model, the Office of National Drug Control effectiveness of four cocaine-control Policy (ONDCP)-funded National Research programs: three “supply control” pro- Council reviewers argued that RAND’s grams (source-country control, interdic- conclusions were “based on problematic tion, and domestic enforcement) and a estimates of treatment effectiveness “demand control” program treating heavy drawn from uncontrolled observational users (Rydell and Everingham, 1994). studies” (National Research Council, Results indicated that for every dollar 2001, p. 225), and that the assumptions spent on drug treatment, $7 would have and economic modeling procedures used to be spent on incarceration and $25 on by RAND researchers were flawed in interdiction to achieve the same degree of other ways and therefore not useful for reduction in cocaine use (cost savings policymaking (Manski, Pepper, and would vary depending on factors such as Thomas, 1999). Caulkins, Chiesa, and treatment setting, length of time in treat- Everingham (2000) offered an extensive ment, and degree of treatment structure). response to the latter set of criticisms, Further, they argued that even when only showing that modifying the model to in- looking at modest in-treatment effects corporate the reviewers’ suggested (assuming 0-percent post-treatment effec- changes did not in fact materially alter tiveness through abstinence), cost savings the conclusions. As for the concern that for treatment exceeded those that would RAND’s characterization of treatment was be achieved through incarceration and overly optimistic, the evidence is ambigu- interdiction. This study was later updated ous. Indeed, some have criticized their to distinguish among a variety of types of model for being overly pessimistic (Caul- Although billions domestic enforcement and used a more kins, Chiesa, and Everingham, 2000). optimistic assumption concerning how Clearly, future research in this area is of dollars are responsive consumption is to enforcement- needed to clarify and tighten assumptions, spent each year induced price increases. Caulkins and his improve methodologies, and incorporate colleagues (Caulkins et al., 1997) conclud- more carefully controlled data from drug to support drug ed that treatment outcome studies (for more com- abuse treatment, prehensive information on the economics treatment is more cost-effective than of drug treatment services, see Cart- the large majority either enforcement approach [con- wright, 2001). of offenders do ventional or federal] at reducing both cocaine consumption and cocaine Inmate participation in treatment. Al- not receive drug spending. Treatment is solidly but not though billions of dollars are spent each treatment services exceptionally more cost-effective year to support drug abuse treatment, the than the federal-level enforcement large majority of offenders do not receive of any kind. programs at reducing consumption; drug treatment services of any kind. it has a 1.6:1 edge over conventional ONDCP spent approximately 20 percent enforcement and close to a 3:1 ad- of its $18.4 billion budget on drug treat- vantage over mandatory minimums. ment in fiscal year 2000 (ONDCP, 2000). (p. 51) More than half of such Federal funding was allocated to support State block They also found treatment to be “enor- grants. In addition to these amounts, mously more cost-effective (on the order State, county, and local governments (as of 70 times more cost-effective) at reduc- well as private funding sources) con- ing spending on cocaine” (p. 51) than tributed significant funds to drug treat- enforcement strategies that shrink con- ment efforts (U.S. General Accounting sumption primarily by driving up prices.

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Office, 1998). However, it is unclear what that drug treatment for offenders is proportion of the total available funds have effective. been targeted toward treatment of drug- using offenders. Regarding offender treat- Effectiveness of drug treatment for ment services, 83 percent of State and 73 offenders. Drug treatment for offenders percent of Federal prisoners reported past is being taken seriously by even the drug use in 1997, with 57 percent of State strongest advocates of incarceration for and 45 percent of Federal prisoners re- drug possession and use. Flooded court porting use in the month prior to their dockets, overcrowded prisons, and high offense (Mumola, 1999). However, report- recidivism rates of drug-using offenders ed participation in drug treatment in have convinced even those most skeptical Federal and State prisons is minimal in of treatment that it is impossible to incar- most cases. The 1997 Survey of Inmates cerate all the illegal drug users in the in State and Federal Correctional Facilities Nation. Scientific research on the brain is (Mumola, 1999) reported decreases in the offering clues into the nature of drug percentage of both State and Federal independence, leading most to agree with mates undergoing drug treatment. It is the conclusions of NIDA: “Prolonged use important to note that these trends are dif- of these drugs eventually changes the ficult to interpret without knowing more brain in fundamental and long-lasting about the increases in actual drug treat- ways, explaining why people cannot just ment capacity within State and Federal quit on their own, why treatment is essen- systems relative to inmate population tial” (Leshner, 2001). This view has also increases. been adopted by ONDCP, which states that “chronic, hardcore drug use is a dis- Local jails have fared about the same as ease, and anyone suffering from a disease Federal and State facilities. According to needs treatment” (ONDCP, 2001, p. 1). BJS’s 1998 Annual Survey of Jails (Wilson, Recognizing both the public safety bene- 2000), 66 percent of jail inmates were fits from breaking the cycle of drug use actively involved with drugs prior to their and crime as well as the potential safety current incarceration, and 74 percent re- risks of allowing drug-addicted criminals ported past drug involvement. Almost on the streets (Taxman, 2000), ONDCP’s three-quarters of local jails (90 percent in National Drug Control Strategy advocates larger jurisdictions) state that they provide a two-pronged approach to the problem: substance abuse treatment or programs punish criminals for their behaviors while for their inmates. However, 64 percent of mandating sanctions-based drug treat- that total are self-help programs; only 12 ment. However, questions remain as to percent of jail jurisdictions (mostly large which treatment programs are effective, jurisdictions) provided detoxification, coun- and for which drug users. seling, and education in addition to self- help programs. There is a substantial Three major cautions must be noted when difference between what jails say they reviewing the mostly quasi-experimental provide and what inmates report. The per- drug treatment outcome studies. First, centage of inmates who actually reported many studies rely on client self-reports, that they participated in substance abuse which are least valid for higher penalty treatment or programs since their admis- drugs, recent use, and those involved with sion to jail was estimated at 10 percent the criminal justice system (for further lim- (19 percent for those who had used drugs itations on the validity of self-report drug at the time of the offense). Despite these use, see Hser, 1997). A second and relat- low rates of participation in treatment, a ed problem is selection bias. Both the broad range of studies continues to show selection of those who elect to enter

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treatment (and are thus perhaps viewed conformity such as employment or mar- as being more motivated to remain in riage (i.e., if an individual is employed, he treatment) and program terminations may or she has a greater incentive to adhere to leave only those participants who are treatment in order to not get fired; or, if most ready and capable of succeeding married, an individual may have a greater when released into the community. Such incentive to do well to prevent a spouse “weeding out” of participants who may from leaving); use of credible outcome be more likely to fail than succeed could measures; identifying appropriate followup lead researchers to incorrectly conclude periods; linking retention to outcomes; greater treatment effects than would be and identifying treatment components seen through more careful attention to that promote recovery. treatment design with randomized assignment to treatment groups (U.S. General Treatment settings. Overall, the size and Overall, the size Accounting Office, 1998; Pelissier et al., consistency of treatment effects across 2000). Third, making a generalization many reasonably good studies tend to and consistency of based on the issues just noted, a recent lend credibility to consistent claims of treatment effects National Research Council report (2001) treatment effectiveness. The following notes that very few randomized controlled section reviews a sample of recent out- across many research studies have been conducted come evaluations for offenders in a variety reasonably good on drug treatment outcomes, thereby of treatment settings, moving from more casting some doubt on the cause of some restrictive to less restrictive settings. Out- studies tend to outcomes. come measures that are typically used to lend credibility to gauge drug treatment effectiveness in Despite these challenges, however, some such studies include reduced frequency consistent claims researchers are paying more attention to or amount of drug used; relapse time or of treatment improving the scientific rigor of these eval- length of abstinence period; crime, arrest, uations to achieve the greatest accuracy and conviction rates; and maintenance of effectiveness. possible. The National Research Council parole or probation status. report summarized five recent treatment evaluation studies that were, in the com- Prison-based therapeutic communities. mittee’s view, “the methodological state Therapeutic communities (TCs) are gener- of the art in drug treatment research” ally intensive, long-term, self-help-based, (2001, p. 227). The studies, none of which highly structured residential treatment included drug-using offenders, were noted programs for chronic, hardcore drug for their random treatment assignment, users. Although still rooted in a self-help treatment fidelity, measurement reliability approach, prison-based TCs are more and validity, and continuous rather than likely than community-based TCs to have dichotomous outcome measurements. professionally trained staff, with inmates The committee also discussed in some being given a reasonable level of power detail the ways in which drug treatment and rewards without too much program outcome studies could be strengthened control (Wexler, 1995; see also ONDCP, through improved methodological and sta- 1996). Three TC approaches will be re- tistical rigor. In a separate review (in the viewed below. same volume) of drug treatment in the criminal justice system, Covington (2001) Wexler and colleagues have reported on suggested guidelines for evaluating crimi- the effectiveness of the Stay ‘N Out TC nal justice system-based drug treatment. program used by the Department of These guidelines included controlling for Corrections in New York State (Wexler, self-selection bias; controlling for stake in Falkin, and Lipton, 1990; Wexler et al., 1992). TC inmates were compared with

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inmates assigned to milieu therapy, coun- 29-percent reincarceration rate compared seling, or a no-treatment group (composed with 74 percent for program dropouts. of those who volunteered for TC treat- Similarly, although 54 percent of program ment but were placed on a waiting list). graduates were not convicted of any Comparing male post-treatment arrest crime (including minor offenses), only 25 rates, the groups receiving counseling and percent of the comparison group and 15 no treatment were equally likely to be percent of program dropouts were not arrested (40 and 41 percent, respectively), convicted of a crime. Again, these findings while those receiving milieu therapy had should be viewed with some caution an arrest rate of 35 percent, and those given that participants who remained in receiving TC group treatment had an treatment were acknowledged to have arrest rate of 27 percent. One significant been more highly motivated to succeed flaw in this finding is the researchers’ fail- than program dropouts. It is also impossi- ure to account for other background vari- ble to separate out the effects of the 6 ables, causing some to question the months of community followup treatment strength of the treatment effect (Pelissier (Pelissier et al., 2000). The second study et al., 2000). However, time-in-treatment (Field, 1989) found that approximately 75 effects were also noted that showed a percent of program completers were not strong positive relationship between the reincarcerated, compared with 37 percent number of months in the TC program in the comparison group. In contrast, only and the percentage of inmates who were 15 percent of participants who dropped successfully discharged from parole. out of treatment after less than 2 months Specifically, the percentage of male TC in the program were not reincarcerated inmates who had successful parole dis- during the 3-year followup. charges grew from 49 percent for those in treatment for less than 3 months to 58 A major concern of this and similar studies percent for those in treatment for 3 to 6 is the high dropout rates from voluntary months. Positive rates further increased to drug treatment programs. For example, 62 percent when inmates participated in a Field (1992) highlighted that, of 220 volun- TC from 6 to 9 months and to 77 percent teer inmates who had been admitted to for those in a TC from 9 to 12 months. Cornerstone over a 2-year period, 65 with- Those who eventually failed on parole drew after spending 1 to 2 days in the were still able to stay drug and crime free program, 58 withdrew after spending for significantly longer periods than the between 2 to 6 months in the program, comparison groups. 43 withdrew after spending at least 6 months in the program, and 43 graduated. Field (1985, 1989) conducted two evalua- Simpson and colleagues (1997) have esti- tions of the Cornerstone Program, a TC for mated that, on average, only 50 percent of alcohol- and drug-dependent inmates in all addicts who voluntarily enter treatment Oregon’s correctional system that also actually complete the recommended treat- required at least 6 months of followup ment course. High dropout rates tend to treatment in the community. Participants confuse conclusions about treatment out- had to be granted minimum security sta- comes because those who remain in tus by the prison superintendent. Treat- treatment could be arguably more motivat- ment clients had, on average, about 12 ed to remain drug and crime free than prior arrests, 6 prior convictions, and 6 those who drop out. As has been noted years of adult incarceration. In the first earlier, however, offenders who are given 3-year followup study (1985), program graduated sanctions as a form of coerced graduates were found to have had a treatment generally stay in treatment

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longer, complete treatment programs, and the comparison group. However, those report less drug use while in treatment who completed Crest did much better, programs than those in voluntary treat- and those who completed Crest plus ment (Simpson et al., 1997; Hubbard et aftercare were the least likely to have a al., 1989). new arrest. Specifically, less than one-third of clients with aftercare had a new arrest, The Key-Crest program is a corrections- compared with more than two-thirds of based, three-stage treatment model pro- the comparison group (Martin et al., 1999). gram that operates within Delaware’s correctional system. The first stage, the Long-term residential treatment. Prison- Key, is modeled on the Stay ‘N Out pro- based long-term residential treatment is gram and includes a 12-month intensive generally considered to last between 6 to residential TC that is based in the institu- 12 months. Participants often live together tion but segregated from the rest of the in units separated from the regular inmate Prison-based inmates. The second stage, the Crest population. These units are specifically residential Outreach Center, is a transitional TC in designed to focus on drug treatment. The which inmates work during the day and degree of structure can vary, but generally treatment is return to a community-based, more tradi- a professional drug treatment staff coordi- generally more tional TC environment during their non- nates all programs and services. Com- working hours. In the third or aftercare pared with TCs, prison-based residential likely than stage, clients have completed work re- treatment is generally more likely to therapeutic lease and are now on parole or other include professional therapeutic interven- supervision. Intervention at this stage usu- tions using standard treatment approach- communities to ally involves group or individual counseling es. For example, the Bureau of Prisons include as well as the opportunity to return to the includes programming on criminal life- work-release TC for booster sessions. style confrontation, cognitive and interper- professional While earlier studies (Martin, Butzin, and sonal skill building, and relapse prevention therapeutic Inciardi, 1995; Inciardi et al., 1997) demon- (Pelissier et al., 2000). Inmate-led self-help strated short-term (1-year) benefits of this approaches are not present in such facili- interventions TC treatment continuum, many of the pos- ties. The following discussion will present using standard itive improvements between the second an evaluation of long-term residential treat- and third stage clients appeared to disap- ment, as well as one specific evaluation treatment pear in 3-year followup studies (Martin project. approaches. et al., 1999). However, when less conser- vative analytical models were applied (the From 1990 to 1993, the National Institute new analysis examined Crest dropouts, on Drug Abuse funded the Drug Abuse Crest completers, and Crest completers Treatment Outcome Study (DATOS), with aftercare), significant findings which included 96 programs in 11 cities. emerged. When compared with the com- Positive outcomes were reported in multi- parison group, Crest dropouts were more ple treatment modalities, including long- than three times as likely to be drug free term residential treatment (Simpson et al., (as measured by initial self-reports and 1997). DATOS found that individuals in subsequent urinalysis); Crest completers long-term residential treatment reduced were more than five times as likely to be weekly or more frequent use of cocaine drug free; and Crest completers with after- from 66 percent in the year prior to treat- care were seven times more likely to be ment to 22 percent in the year following drug free. Rearrests on a new charge treatment (see exhibit 1). This same group showed a similar pattern, with Crest drop- reported a 26-percent drop (from 41 per- outs having the same rate of rearrests as cent down to 16 percent) in predatory illegal activity during that same time period

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(Fletcher, Tims, and Brown, 1997). Similar- phase, inmates were required to partici- ly dramatic reductions in self-reported pate in community transitional services in cocaine use were also found for short- which they received individual, group, term residential treatment. and/or family counseling from community- based drug treatment providers. Three- Using one of the most methodologically year followup findings indicated that men rigorous research designs to date, the and women who were motivated to Federal Bureau of Prisons (BOP) recently change were more likely to enter and conducted a 3-year, 20-site evaluation of complete treatment. Findings on both its residential drug treatment programs recidivism and post-treatment drug use (Pelissier et al., 2000). During the three- were significant for men but not for phase Treating Inmates’ Addiction to women.4 Specifically, men who entered Drugs (TRIAD) Drug Treatment Evaluation and completed in-prison residential treat- Project, more than 1,000 inmates first ment were 16 percent less likely to recidi- voluntarily participated in a 9- or 12-month vate when compared with untreated residential treatment program. Treatment inmates at 3-year postrelease followup. group results were compared with a true In addition, participants who entered and comparison group as well as a control completed treatment were 15 percent group, neither of whom received any drug less likely to use drugs than untreated treatment services. A second phase re- inmates within 3 years after release. quired inmates to continue drug abuse These findings are particularly significant booster sessions (including relapse pre- because the selection process actually vention and review of treatment tech- attracted riskier offenders into the treat- niques) for 1 year following their return to ment programs. In addition, this study the general community. During the final carefully addressed the issue of selection bias by comparing results using two different bias correction methods. Exhibit 1. Self-reported cocaine use among addicts participating in treatment Day reporting centers. As noted previously, many offenders are serving time be- Before treatment cause of nonviolent drug convictions. 1 year after treatment To deal with prison overcrowding and Percentage of DATOS sample the prohibitive costs associated with incarceration-based treatment programs, 80 some correctional facilities have devel- 66 67 oped day reporting centers (DRCs). DRCs 60 are a form of intermediate sanction in which offenders attend highly structured, 42 42 40 nonresidential programs where a variety of services and supervision are provided. 22 21 22 First introduced in the United States in 20 18 1986, DRCs can be operated by a wide range of public, government, and private 0 agencies, such as residential community Long-term Short-term Outpatient Outpatient resident resident methadone drug free corrections centers, work release pro- treatment grams, jails, TASCs, and treatment pro- Type of treatment grams (Parent, 1990; McBride and VanderWaal, 1997). Services such as drug Source: Chart reproduced from Taxman (1998). treatment and education, GED courses, English as a Second Language and life

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skills are often supervised by both correc- settings, services, eligibility criteria, moni- tions and case management personnel. toring procedures, levels of supervision, A DRC has three primary goals: enhanced and termination policies (Diggs and Pieper, supervision and decreased liberty for 1994). While some studies have shown offenders, treatment of offender prob- initial evidence of cost savings (Craddock, lems, and reduced crowding of incarcera- 2000) and lower rearrest rates (Diggs and tion facilities (Parent, 1990). The concept Pieper, 1994; McBride and VanderWaal, has been adapted in a number of ways, 1997), evidence of program effectiveness including: was not as great in programs that lasted 12 months or longer5 (Marciniak, 1999). ■ Providing enhanced treatment and Marciniak (2000) found high rates of pro- supervision to probationers or sen- gram termination for drug violations and tenced offenders not on probation. rearrests. Several authors (Blomberg and Lucken, 1994; Marciniak, 1999; Tonry, ■ Monitoring inmates on early release 1990, 1997) have also expressed concerns from jail or prison. of “net widening” since many offenders who would otherwise be sentenced to ■ Monitoring arrested persons prior to probation are placed in DRCs where they trial. are watched more closely and are there- ■ As a halfway-out step for inmates who fore more likely to be rearrested. Given have shown progress in community- the relatively recent emergence of this based corrections or work release form of intermediate sanctioning, future centers. studies should focus on success indicators such as program completion, drug ■ As a halfway-in step for offenders who use, rearrests, and cost-effectiveness, par- have violated their probation or parole ticularly in longer term programs. Program (Curtin, 1990, as cited in Diggs and success indicators should be based on Pieper, 1994). comparisons with offenders who would have been incarcerated as opposed to These programs are probably most appro- those traditionally found in probation to priate for nonviolent offenders whose be- avoid a net-widening bias (Diggs and haviors have not been improved through Pieper, 1994). probation and/or who need greater structure and treatment services than could be Outpatient and intensive outpatient treat- provided in a less restrictive setting. While ment. Taxman (1998) notes that the loca- attending the center, participants are often tion of drug treatment does not always required to submit to random drug testing relate to the intensity of services provided and participate in counseling, education, to the client. Instead, the number of serv- and vocational placement assistance. ice hours is often a better indicator. As Graduated sanctions are applied when par- such, community-based outpatient and ticipants are found to have violated the intensive outpatient treatment services terms of their sentence. are often used as a transition from TCs and other more intensive corrections- Relatively few studies have been conduct- based services. Such services are pared to assess predictors of program com- ticularly important to drug courts, who pletion or termination in DRCs. Studies primarily use treatment alternatives within which have been conducted are difficult the community. The setting is generally to compare due to the wide variability of less important than the quality and quantity of services provided to clients, although

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the organization providing the services Based on a comprehensive review of clini- must be supportive of delivering interven- cal and health services research on drug tions to correctional populations (Pogrebin, abuse, ONDCP (1996) made the following 1978). The DATOS study introduced in the recommendations regarding critical ele- previous section (regarding long-term resi- ments for successful treatment in any set- dential treatment) also included positive ting (e.g. prison based, residential, or outcomes for outpatient drug-free treat- outpatient): ment: self-reported cocaine use dropped from 42 percent before treatment to 18 ■ Complete and ongoing assessment of percent at 1-year followup (see exhibit 1). the client.

Treatment intervention approaches. ■ A comprehensive range of services, The previous section reviewed outcome including pharmacological treatment (if studies on a variety of drug treatment set- necessary), counseling (either individual tings, based on a range of restrictiveness. or group, in either structured or unstruc- Each of these settings often includes such tured settings), and HIV-risk reduction intervention approaches as life-skills train- education. ing, group and individual counseling, re- ■ lapse prevention training, and educational A continuum of treatment interventions. and vocational skills training. In addition, a ■ Case management and monitoring to variety of theoretical models influence the engage clients in services of appropriate content and approach to such interven- intensity. tions. It is beyond the scope of this paper to review these approaches and theories. ■ Provision and integration of continuing As mentioned earlier, however, NIDA has social supports. conducted a number of large-scale research evaluations on a variety of inter- NIDA came to many similar conclusions ventions (e.g. DARP, TOPS, DATOS), and in their research-based guide, Principles readers are referred to those studies to of Drug Addiction Treatment (NIDA, review intervention effectiveness. In addi- 1999). This guide also reviews scientifical- tion, NIDA is currently conducting con- ly based approaches to drug treatment trolled, multisite tests of emerging and makes recommendations. A full listing science-based drug abuse treatments of the NIDA recommendations is found in such as the use of buprenorphine/nalox- appendix C. one treatments for detoxifying opiate- It is important dependent patients and incorporating In addition to the recommendations and motivational enhancement therapy into principles listed by ONDCP and NIDA, it is to recognize standard treatments (Mathias, 2001). important to recognize the importance of the importance Motivational enhancements offer absti- matching the drug-using offender with nent clients a chance to win small prizes the appropriate treatment. This simple of matching the such as candy bars, Walkmans, or gift concept is, at times, especially difficult to drug-using certificates to local restaurants by testing employ in jurisdictions that may lack ade- negative for various illicit drugs. As the quate resources to provide a full continu- offender with number of abstinent weeks increases, um of services. Essentially, treatment the appropriate so do the number and value of the incen- matching recognizes that no single treat- tives. It is anticipated that such evalua- ment is universally applicable. Levels of treatment. tions will provide preliminary evidence of restriction and supervision, treatment effectiveness and efficacy so that knowl- modalities, and psychopharmacological edge about treatment effectiveness can treatment options (such as methadone) be improved. must be assessed on a case-by-case

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basis. The ramifications of this issue Aftercare include the need for training system personnel on treatment continuum issues, Aftercare (or continuing care) is defined realistic expectations by both treatment as “a set of supportive and therapeutic and criminal justice systems regarding the activities designed to prevent relapse and potential impacts of available services, and maintain behavioral changes achieved in the potential need to educate the commu- previous treatment stages” (Fortney et al., nity on what can be expected from avail- 1998, as cited in Inciardi et al., 2001). The able resources. aftercare phase of the treatment continuum is often neglected for drug-using Gender differences in treatment. offenders. As noted previously, most drug- Pelissier and her colleagues (2000) com- using offenders have high relapse rates pleted a comprehensive review of litera- and therefore require extended periods of ture on gender differences among treatment exposure and ongoing support substance abusers (for supporting litera- to achieve and maintain sobriety. In addi- ture documentation of this summary para- tion, most treatment graduates are ill graph, see Pelissier et al., 2000). Although equipped to integrate back into their old much of the current increase in the num- neighborhoods (Berman and Anderson, ber of incarcerated women is linked to 1999). For these reasons, providing after- substance abuse (Kassebaum, 1999), care as a followup to more restrictive few studies have examined gender differ- treatment may improve treatment effec- ences among substance-abusing inmates. tiveness. Cross-systems case manage- Studies primarily on nonoffending sub- ment and collaboration are critical at this stance abusers show that women general- phase in the treatment process to main- ly have different social, psychological, and tain an integrated continuum of care for economic circumstances; different initia- clients as they transition back into the tion and drug use patterns; and different community. criminal histories than men. Most discussions of treatment approaches for women Martin et al. (1999) recommend that treat- include a strong focus on ancillary services ment interventions at this stage include such as health care, child care, and female continued monitoring by previously in- treatment staff. Therapeutic recommen- volved treatment counselors (such as TC dations include a focus on relationship counselors). Interventions at this stage issues, support, skill building, and identifi- could include regular outpatient counsel- cation of strengths as opposed to the con- ing, support groups such as Alcoholics frontation strategies that are common for Anonymous, group therapy, and family men (for a summary of treatment effec- therapy sessions. In addition, Tauber tiveness studies for men and women, see (1994) calls for educational opportunities, Landry, 1997). Despite these differences, job training and placement, and health and however, few treatment programs focus housing assistance. heavily on women’s issues, particularly in Several studies (Lash, 1998; McKay et al., correctional facilities. Not surprisingly, few 1998; Rychtarik et al., 1992) with noncor- studies have looked at outcomes of treat- rectional populations have suggested that ment programs designed specifically for improved treatment outcomes can result women (Landry, 1997), in part due to the from aftercare (most of these studies are relatively small numbers of female drug correlational in nature). In such settings, it treatment participants (Moras, 1998). is possible that selection bias is present,

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since motivated clients may make better control of self-selection bias, and careful use of aftercare services (Inciardi et al., analysis of other intervening variables. 2001). However, recent studies with corrections-based treatment followed by Summary aftercare have also shown preliminary indications of success (DeLeon et al., 2000; Current research suggests that successful Wexler et al., 1999). Offenders in the programmatic efforts to intervene in the California-based Amity Right Turn Project drugs-crime relationship are based on a received voluntary TC treatment followed continuum of integrated services stretch- by community-based aftercare program- ing from assessment through aftercare. ming. No-treatment control groups were Although research has evaluated the compared with TC dropouts, TC gradu- various components that might be most ates, and aftercare completers after 12, beneficial for inclusion in a successfully in- 24, and 36 months. Although recidivism tegrated system, we know of no studies rates increased for all groups as time that have attempted to measure the suc- increased, those who completed both the cess or lack of impact of such integrated treatment and aftercare phases had the approaches. lowest rearrest rates. Inciardi and colleagues (2001; see also Martin et al., 1999) conducted a similar aftercare study Suggestions for future with Key-Crest participants. Voluntary research clients were randomly assigned and pur- posively sampled across four groups: a In any field of scientific inquiry, one of the no-treatment comparison group, treat- easiest things to do is to call for more ment dropouts, treatment graduates, and research. Not surprisingly, that is exactly treatment graduates with aftercare. Re- the most appropriate thing to do with searchers conducted followup interviews regard to the drugs-crime relationship. at 18 and 42 months and collected infor- New conceptual and mathematical models mation on drug use (interview and urine have emerged recently in the social sci- screen) and rearrest rates (interview ences that will allow a fresh perspective compared with official prison records). on many of the questions that have been Eighteen-month followups indicated that addressed in the past and provide a new treatment dropouts and graduates were baseline for the 21st century. Human cul- twice as likely than the comparison group tures change, some fairly rapidly, and even to be drug free, and treatment graduates a brief review of the past 25 years in the with aftercare were three times more like- United States with regard to drugs and ly to be drug free. Preliminary data from crime would indicate that ours has changed the 42-month followup were even more dramatically. In the area of the drugs-crime impressive. Although only 25 percent of relationship, one illustration of this change the comparison group were arrest free, is the apparent reduction in the violence more than half of the graduates with after- associated with cocaine/crack distribution. care remained arrest free. Similarly, 25 Such changes require fresh examinations percent of comparison cases remained of previously collected data and more rig- drug free, compared with 36 percent of orous evaluations of current programs and the treatment-with-aftercare group. Such policies. Although there are certainly many studies could be further strengthened areas of potential further inquiry, the fol- with larger sample sizes, evaluating suit- lowing areas are suggested: ability of clients for treatment, more careful

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Using secondary data analyses could obtain parallel geocoding data for to provide a new empirical the ADAM dataset, the number of ques- baseline for understanding the tions that could be addressed about the drugs-crime relationship drugs-crime relationship would expand geometrically. We need to integrate The Federal Government, other agencies, advances in analytical models with ad- and universities have collected enormous vances in neurobiology, personality, family amounts of data that are directly relevant systems, and peer influence studies as to many key drugs-crime questions. These well as include broader contextual vari- data include the National Household Sur- ables (including ecosystems theory, social vey on Drug Abuse (NHSDA), the Monitor- capital, economic opportunity, drug prices ing the Future (MTF) study, the Arrestee and market variables, drug laws/policy, Drug Abuse Monitoring Program, and and geographical data). the Treatment Episode Data Set (TEDS). These data could be used to provide a new baseline of knowledge about certain Consider using computer simu- statistical elements of the drugs-crime lation modeling to examine relationship across the lifespan and in key research questions many different segments of the popula- Some of the etiological ideas that re- tion. In addition, these data could be used searchers are examining may be applica- to demythologize many policy and popular ble to computer modeling in the future. conclusions about the drugs-crime rela- For example, it might be useful, in a simu- tionship. For example, data from some of lated model, to manipulate reductions in these systems call into question some supply, increases in price, changes in beliefs about the cocaine-violence connec- policy (such as treatment on demand and/ tion as well as suggest that the criminal or marijuana decriminalization/medicaliza- justice system may primarily direct mari- tion) to examine how such issues would juana users to the treatment system to affect drug use, crime, and their interrela- the exclusion of other drug users. tionship. Although the data entered in a simulation would be based on the types Further studying the nature and of research previously noted, and the pit- complexity of the drugs-crime falls and complexities of undertaking this relationship using the latest approach have not been thought out, it interdisciplinary conceptual may be time for the drugs-crime field to and analytical models begin considering the use of computer simulation technology to address the criti- Many of the interventions that have been cal issues facing many communities. applied to breaking the drugs-crime cycle have involved a fairly narrow focus on drug treatment and have not sufficiently Evaluating State changes in recognized the complex origins of both drug policy to examine different behaviors. Further, there is increasing attempts to address the drugs- evidence of a need to include multilevel crime relationship at a macro variables in order to understand how but yet subnational level crime and drugs are connected. This was Throughout this document, it has been not possible previously due to the statisti- noted that while there has been relatively cal precision needed. In addition, the 2000 little modification of drug law and policies Census and geocoding provide an oppor- at the national level, there has been con- tunity to add another data dimension to siderable legislative action in many States drugs-crime analyses. For example, if we

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and communities. Model State drug laws criteria and options. It is critical that we have been proposed. Many States are evaluate such changes early so that les- moving towards allowing medical marijua- sons learned from them may be used na, and many States have decriminalized strategically to change later interventions. marijuana possession (or at least removed incarceration penalties for the first marijua- Considering the need to na possession conviction). Other States establish research field stations are changing club-drug laws to increase in high-risk communities scheduling and penalties. In addition, there are significant differences between One idea that has been discussed episo- States (and communities) regarding treat- dically in the drug field for the past two ment availability and budgets. For many decades involves the use of a research years, there have been calls for interna- field station approach. Although there tional research comparing the impact of have been some attempts to undertake different national drug policies. However, such an endeavor, these efforts generally given significant differences between have been limited in time and/or place. national cultures, these comparisons are Existing data (combined with geocoding) difficult. Variance in State law and policy could be used to identify communities provides a more readily available opportu- with high rates of drug use and crime. nity to examine variance between entities Theoretically based multivariate research (the 50 States) with differing laws and poli- projects could then be conducted in these cies. These changes suggest a number of targeted communities from a qualitative, possible research areas. For example, on-the-ground perspective. Such an comparing differences in marijuana use approach might permit researchers to (or drug use in general), perceptions of understand some of the changes in risk, and peer disapproval in States that violence associated with crack distribu- have medical marijuana and/or marijuana tion that seem to have occurred in decriminalization with States with high- recent years. deterrence prohibition policies could provide an excellent foundation for evaluating Examining the relationship changing drugs-crime policies. between particular enforcement strategies and drug markets Evaluating attempted inter- Recent modifications to the ADAM study ventions in the drugs-crime (including asking subjects about access to cycle for net widening drugs and conditions that they perceive as As noted, the increasing availability of affecting access) provide the possibility of drug courts and other mandatory treat- empirically modeling the effects of specif- ment programs may encourage law ic enforcement strategies on specific drug enforcement to intervene earlier and more markets (cocaine, crack, and heroin) and formally in the lives of individual drug drug prices. In particular, researchers may users. This change in strategy and tactics be able to evaluate a particular enforce- could begin a formal criminal justice label- ment strategy’s impact on drug market ing process that may exacerbate, rather location (moving it indoors or to more than ameliorate, the relationship between urban settings), the number of dealers typ- drug use and crime. It may also result in ically used, the amount of time searching changing definitions of law violation and for drugs, or the price of that drug (from increase the number of those arrested STRIDE [System to Retrieve Information and incarcerated due to new placement from Drug Evidence] or other sources) and

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more. This could provide researchers with and feasibility? How does drug moni- very important information about how drug toring alone compare with more com- markets operate in local areas in response prehensive systems and treatment to enforcement strategies. interventions in terms of outcomes such as drug use and recidivism?

Comprehensively evaluating ■ What assessment protocols can most current programs designed accurately be used to place offenders in to intervene in the drugs- the safest, least restrictive, and most crime cycle effective treatment settings? Many programs exist that attempt to intervene in the drugs-crime cycle from the ■ What level and intensity of drug treat- juvenile to adult level. Although there have ment services are most appropriate for been significant attempts to evaluate which offender types and settings? these programs, most of these efforts ■ What forms and mixtures of the have been descriptive or have used fairly reviewed programmatic interventions simple analytical designs (often quasi- (e.g. graduated sanctions, supervision/ experimental). What is needed are large- monitoring, various drug treatment scale, carefully controlled studies that services and settings, aftercare, etc.) focus on long-term program outcomes predict program completion or termina- using multiple indicators of success and tion (or other specific outcomes) with that identify program elements related to which populations and under which outcomes. These evaluations should focus conditions? on what the literature might call best-case program models that generally involve comprehensive assessment, needed serv- Using interdisciplinary teams ice provision based on that assessment, to conduct research on the case management, graduated sanctions, drugs-crime relationship and aftercare. Most outcome studies A review of the literature shows that indi- examine such factors as rearrest rates or viduals from a variety of disciplines have drug relapses. Additional successful out- examined the drugs-crime relationship. come measures might include such non- Each discipline has approached the rela- crime-related outcomes as payment of tionship from its particular perspective, child support, family formation and stabili- and each discipline likely has an important ty, employment stability, and residential and unique perspective on understanding stability. In addition, it is important to the relationship. Some of the critical re- examine how these programs vary in their views of conceptualization, methodology, impact by gender, ethnicity, and age as and conclusions in drugs-crime research well as provision context (prison to com- are often based on particular disciplinary munity). Finally, it is crucial to examine perspectives. To broaden the perspectives program costs relative to the cost of incar- of these disciplines, the types of research ceration and the cost of no intervention. issues/questions that have been proposed Although specific recommendations for require the efforts of an interdisciplinary further research were included at the end team. If there is to be clear definition, of each program intervention section in development, and operationalization of this chapter, the following research ques- treatment program elements, treatment tions are of high priority: providers must provide input. Researchers ■ Which drug testing methods offer the trained in experimental or quasi-experimental best combination of accuracy, privacy, design are crucial in developing and carry- ing out the needed scientific designs.

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Social scientists (survey researchers, no significant differences between the coefficient geographers, and ethnographers) are for men and women. This lack of significance for needed if issues of gender, ethnicity, and women is likely a reflection of the smaller sample size for this population (Pelissier, 2001; personal other sociocultural and spatial characteris- communication). tics are to be included in the design and data interpretation. Given today’s strong 5. The issue of length of time in treatment as indica- social concern relative to cost-benefit out- tive of stronger gains in treatment was raised previ- comes, it is crucial to include economists ously in this paper. This issue is debated in the field. Marciniak (1999) argues that longer may be better on research teams. Drugs-crime research only up through 9 to 12 months; treatment deteriora- has clearly reached the stage where inter- tion may then begin. Other researchers argue that disciplinary research teams are required. this outcome needs more study.

Establishing interagency cooperation in funding research References An examination of the various governmen- Arrestee Drug Abuse Monitoring Program tal reports and our conversations with col- (2000). 1999 annual report on drug use leagues about this project suggest that among adult and juvenile arrestees (NCJ many different agencies focus on and 181426) [Online]. Available: www.adam- issue reports about the drugs-crime rela- nij.net/files/INTO.pdf. tionship. It appears that the authors of Alemagno, S.A. (2001). Women in jail: Is many of these reports are not aware of substance abuse treatment enough? the excellent research funded by other American Journal of Public Health, 91(5), agencies. Given the limited resources in 798–800. any given funding agency and the different research traditions in various agencies, Anglin, M., and Hser, Y. (1990). The integrated research will require significant treatment of drug abuse. In M. Tonry and interagency cooperation. Such cooperation J.Q. Wilson (eds.), Drugs and crime (pp. could make sufficient resources available 393–460). Chicago: University of Chicago to address the types of complex research Press. needed in drugs-crime analysis. Anglin, M., Longshore, D., and Turner, S. (1999). Treatment alternatives to street Notes crime: An evaluation of five programs. Criminal Justice & Behavior, 26(2), 1. For economists, the term “open market” has a very precise meaning. In this paper, however, we use 168–195. the term in a general sense to indicate low levels of government regulation. Anglin, M., and Maugh, T. (1992). Over- turning myths about coerced drug treat- 2. The companion papers to this work discuss the ment. California Psychologist, 19–22. psychopharmacological and economic components of the drugs-crime relationship. Anslinger, H., and Tompkins, W. (1953). 3. The focus will be primarily on adult intervention The traffic in narcotics. New York: Funk & strategies since other recent reports have completed Wagnalls. a comprehensive literature review and offered program guidelines focusing specifically on juveniles Apospori, E., Vega, W., Zimmerman, R., (McBride et al., 1999). Warheit, G., and Andres, G. (1995). A longitudinal study of the conditional effects of 4. Although Pelissier and her colleagues did not find a significant treatment effect on postrelease drug deviant behavior on drug use among three use and crime for women, further analyses indicated racial/ethnic groups of adolescents. In

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Salmon, R., and Salmon, R. (1983). The Sengupta, S. (2001, March 13). A new role of coercion in rehabilitation of drug plan to roll back drug terms. New York abusers. The International Journal of Times. Addictions, 18(1), 9–21. Sentencing Project (1998). Proposed Sampson, R.J., and Laub, J.H. (1990). changes in crack/cocaine sentencing laws Crime and deviance over the life course: would increase number of minorities in The salience of adult social bonds. Ameri- prison, have little impact on drug abuse can Sociological Review, 55(5), 609–627. [Online]. Available: www.sentencing project. org/brief/pub1057.htm. Sampson, R.J., and Raudenbush, S.W. (1999). Systematic social observation of Siegal, H.A. (1998). Comprehensive case public spaces: A new look at disorder in management for substance abuse treat- urban neighborhoods. American Journal ment (Treatment Improvement Protocol of Sociology, 105(3), 603–651. [TIP] Series, DHHS Publication No. SMA 98–3222). Rockville, MD: U.S. Department Sampson, R.J., Raudenbush, S.W., and of Health and Human Services, Center for Earls, F. (1997, August 15). Neighborhoods Substance Abuse Treatment. and violent crime: A multilevel study of collective efficacy. Science, 277, 918–924. Siegal, H.A., Fisher, J.H., Rapp, R.C., Kelliher, C.W., Wagner, J.H., O’Brien, W.F., San Francisco Examiner. (2000, November and Cole, P.A. (1996). Enhancing sub- 9). San Francisco plans to expand drug stance abuse treatment with case treatment. management: Its impact on employment. Journal of Substance Abuse Treatment, Savelsberg, J.J. (1999). Controlling vio- 13(2), 93–98. lence: Criminal justice, society, and les- sons from the US. Crime, Law & Social Siegal, H.A., Rapp, R.C., Kelliher, C.W., Change, 30(2), 185–203. Fisher, J.H., Wagner, J.H., and Cole, P.A. (1995). The strengths perspective of case Schlenger, W., Kroutil, L., and Roland, E. management: A promising inpatient sub- (1992). Case management as a mecha- stance abuse treatment enhancement. nism for linking drug abuse treatment and Journal of Psychoactive Drugs, 27(1), primary care: Preliminary evidence from 67–72. the ADAMHA/HRSA linkage demonstra- tion. In R.S. Ashery (ed.), Progress and Siegal, H.A., Rapp, R.C., Li, L., Saha, P., issues in case management (NIDA Re- and Kirk, K. (1997). The role of case man- search Monograph 127, DHHS Publica- agement in retaining clients in substance tion No. ADM 92–1946, pp. 316–330). abuse treatment: An explanatory analysis. Rockville, MD: U.S. Department of Health Journal of Drug Issues, 27(4), 821–831. and Human Services, National Institute on Drug Abuse. Sigmon, J., Nugent, M., Goerdt, J., and Wallace, S. (1999). Key elements of suc- Schmidt, L. (1995). “A battle no man’s but cessful adjudication partnerships (BJA God’s”: Origins of the American temper- Bulletin, NCJ 173949) [Online]. Available: ance crusade in the struggle for religious www.ncjrs.org/pdffiles1/bja/173949.pdf. authority. Journal of Studies on Alcohol, 56(1), 110–121. Simpson, D.C., and Curry, S., eds. (1997–98). DATOS first-wave findings released. Institute of Behavioral Research at Texas Christian University: Research

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Simpson, D., Joe, G., Broome, K., Hiller, Stephens, R. (1991). The street addict M., Knight, K., and Rowan-Szal, G. (1997). role: A theory of heroin addiction. Albany: Program diversity and treatment retention State University of New York Press. rates in the Drug Abuse Treatment Out- come Study (DATOS). Psychology of Substance Abuse and Mental Health Addictive Behaviors, 11(4), 279–293. Services Administration (2000). Treatment Episode Data Set (TEDS): 1993–1998. Simpson, D., Joe, G., and Brown, B. [Online]. Available: www.samhsa.gov/ (1997). Treatment retention and follow-up statistics/statistics.html. outcomes in the Drug Abuse Treatment Outcome Study (DATOS). Psychology of System Sciences (1979). Evaluation of Addictive Behaviors, 11(4), 294–307. treatment alternatives to street crime: National evaluation programs, phase II Slobogin, C. (1995). Therapeutic jurispru- reports (NCJ 51931). Washington, DC: dence: Five dilemmas to ponder. Psych- U.S. Department of Justice, National ology, Public Policy, and Law, 1(1), Institute of Law Enforcement and Criminal 193–219. Justice.

Smith, M.E. (2001). What future for “pub- Tauber, J. (1994). Treating drug-using lic safety” and “restorative justice” in offenders through sanctions, incentives. community corrections? (NIJ Research in Corrections Today, 56(1), 28–33. Brief, NCJ 187773) [Online]. Available: www.ncjrs.org/pdffiles1/nij/187773.pdf. Taxman, F. (1998). Reducing recidivism through a seamless system of care: Spangenberg, R., and Beeman, M. (1998). Components of effective treatment, Improving State and local criminal justice supervision, and transition services in the systems: A report on how public defend- community (NCJ 171836). Washington, ers, prosecutors, and other criminal justice DC: Office of National Drug Control Policy. system practitioners are collaborating across the country (BJA Monograph, NCJ Taxman, F. (2000). Effective practices for 173391) [Online]. Available: www.ncjrs. protecting public safety through substance org/pdffiles/173391.pdf. abuse treatment. Unpublished report com- missioned by the National Institute on Spear, F., and Skala, S.Y. (1995). Post- Drug Abuse. treatment services for chemically dependent adolescents. In E. Rahdert and D. Taxman, F., and Sherman, S. (1998). Czechowicz (eds.), Adolescent drug Seamless systems of care: Using automa- abuse: Clinical assessment and therapeu- tion to improve outcomes. In L.J. Moriarty tic interventions (NIDA Research Mono- and D.L. Carter (eds.), Criminal justice graph 156, NIH Publication No. 95–3908, technology in the 21st century. Spring- pp. 341–363) [Online]. Available: www.nida. field, IL: Charles C. Thomas. nih.gov/pdf/monographs/ 156.pdf. Taxman, F., Soule, D., and Gelb, A. (1999). Spohn, C., Piper, R.K., Martin, T., and Graduated sanctions: Stepping into Frenzel, E.D. (2001). Drug courts and accountable systems and offenders. recidivism: The results of an evaluation Prison Journal, 79(2), 182–204. using two comparison groups and multiple

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Taylor, D.L., Chitwood, D.D., McElrath, K., United States Sentencing Commission and Belgrave, L.L. (1994). Ethnicity, social (1997). Special report to the Congress: support, and injection drug use. Journal of Cocaine and Federal sentencing policy Black Psychology, 20(1), 36–46. [Online]. Available: www.ussc.gov/ legist.htm. Teplin, L.A. (2001). Assessing alcohol, drug, and mental disorders in juvenile Vaccaro, D., and Wills, T.A. (1998). Stress- detainees (NCJ 186367) [Online]. coping factors in adolescent substance Available: www.ncjrs.org/pdffiles1/ojjdp/ use: Test of ethnic and gender differences fs200102.pdf. in samples of urban adolescents. Journal of Drug Education, 28(3), 257–282. Toborg, M., Levin, D., Milkman, R., and Center, L. (1976). Treatment alternatives Veenstra, G. (2000). Social capital, SES to street crime (TASC) projects: National and health: An individual-level analysis. evaluation program, phase I summary Social Science and Medicine, 50(5), report (NCJ 34057). Washington, DC: U.S. 619–629. Department of Justice, National Institute of Law Enforcement and Criminal Justice. Verma, S.K. (1979). Criminality as a mental health problem—a point of view. Social Tonry, M. (1990). Stated and latent func- Defense, 15(57), 28–34. tions of ISP. Crime & Delinquency, 36(1), 174–191. Walklate, S. (1998). Crime and community: Fear or trust? British Journal of Sociology, Tonry, M. (1996). Sentencing matters. 49(4), 550–569. New York: Oxford University Press. Wexler, H. (1995). The success of thera- Tonry, M. (1997). Intermediate sanctions peutic communities for substance abusers in sentencing guidelines (NIJ Issues and in American prisons. Journal of Psycho- Practices, NCJ 165043) [Online]. Available: active Drugs, 27, 56–66. www.ncjrs.org/pdffiles/165043.pdf. Wexler, H., Falkin, G., and Lipton, D. U.S. General Accounting Office (1997). (1990). Outcome evaluation of a prison Drug courts: Overview of growth, charac- therapeutic community for substance teristics, and results (GAO/GGD–97–106) abuse treatment. Criminal Justice and [Online]. Available: www.ncjrs.org/pdffiles/ Behavior, 17(1), 71–92. dcourts.pdf. Wexler, H., Lipton, D., Falkin, G., and U.S. General Accounting Office (1998). Rosenbaum, A. (1992). Outcome evalua- Drug abuse: Research shows treatment is tion of a prison therapeutic community effective, but benefits may be overstated for substance abuse treatment. In C.G. (GAO/HEHS–98–72) [Online]. Available: Leukefeld and F.M. Tims (eds.), Drug www.druglibrary.org/schaffer/govpubs/ abuse treatment in prisons and jails (pp. gao/gao74.htm. 156–175). Washington, DC: U.S. Govern- ment Printing Office. Uniform Crime Reports (1998). Crime in the United States [Online]. Available: Wexler, H., Melnick, G., Lowe, L., and www.fbi.gov/ucr/Cius_98/98crime/ Peters, J. (1999). Three-year reincarnation 98cius01.pdf. outcomes for amity in-prison therapeutic community and aftercare in California. Prison Journal, 79(3), 321–336.

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White, H. (1990). The drug use-delinquency Authors’ note connection in adolescence. In R. Weisheit (ed.), Drugs, crime, and criminal justice. The authors would like to thank Helo Cincinnati: Anderson Publishing Company. Oidjarv and Shannon Bond for both their writing contributions and their assistance White, H., and Gorman, D. (2000). Dyna- with literature review, and Rachael Del Rio mics of the drug-crime relationship. In G. for her work in preparing the manuscript. LaFree (ed.), Criminal Justice 2000: In addition, the authors would like to Volume 1: The nature of crime: Continuity acknowledge the contributions of Frank and change (NCJ 182408, pp. 151–218) Chaloupka, Dick Clayton, Paul Goldstein, [Online]. Available: www.ncjrs.org/criminal_ Jamie Chriqui, and Rosalie Pacula, who justice2000/vol_1/02d.pdf. reviewed various concepts presented in the paper. Finally, in addition to the sup- Wilson, D.J. (2000). Drug use, testing, and port provided by the National Institute of treatment in jails (BJS Special Report, NCJ Justice, the authors would like to acknowl- 179999) [Online]. Available: www.ojp.usdoj. edge the ImpacTeen Project: a Policy gov/bjs/pub/pdf/duttj.pdf. Research Partnership to Reduce Youth Substance Use supported by the Robert Winters, K.C. (1998). Kids and drugs. Wood Johnson Foundation and adminis- Corrections Today, 60(6), 118–121. tered by the University of Illinois at World Bank Group. (2002). What is social Chicago. The views expressed are those capital? [Online]. Available: www.worldbank. of the authors and do not necessarily org/poverty/scapital/ whatsc.htm. reflect the views of the Robert Wood Johnson Foundation. Zehr, H. (1990). Changing lenses: A new focus for crime and justice. Scottsdale, Correspondence concerning this paper PA: Herald Press. should be addressed to Duane C. McBride, Department of Behavioral Sciences, Nethery Hall 203, Andrews University, Berrien Springs, MI 49104– 0030; e-mail [email protected].

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Appendix A. Model State early and periodic screening; diagnosis and treatment services; health profession- drug laws and policies als training; criminal justice treatment; The President’s Commission on Model caregiver’s assistance. State Drug Laws’ (1993) model legislation specified five main policy areas. Following Drug-free families/schools/ is a more complete list of the laws and workplaces policies within each general policy area. For drug-free families, underage alcohol consumption reduction; preventive coun- Economic remedies seling services for children of alcoholics Forfeiture reform; money laundering; and addicts; sensible advertising and fami- financial transaction reporting; money ly education; tobacco vending machine transmitter licensing and regulation; on- restriction; revocation of professional or going criminal conduct. business licenses for alcohol and other drugs.

Community mobilization For drug-free schools, drug-free school Expedited eviction of drug traffickers; drug zones; ban on tobacco use in schools; nuisance abatement; crimes code provi- intervention for students with substance sions to protect tenants and neighbors; abuse problems; State safe schools; antidrug volunteer protection; community alcohol- and drug-free colleges and univer- mobilization funding; alcohol/other drug sities; truancy, expulsion, and children out abuse policy and planning coordination. of school. For drug-free workplaces, drug-free Crimes code enforcement private-sector workplaces; drug-free workplace workers’ compensation premium Prescription accountability; State chemical reduction; employee assistance programs control; Uniform Controlled Substances and professionals; drug-free public work Act controlled substance analogs; contin- force; drug-free workplace; employee ued access by law enforcement to wire addiction recovery. and electronic communications; wiretap- ping and electronic surveillance control; driving while under the influence of alcohol and other drugs. Reference President’s Commission on Model State Treatment Drug Laws (1993), President’s Commis- sion on Model State Drug Laws: Executive Addiction cost reduction; Medicaid addic- summary, Washington, DC: President’s tion cost reduction; managed care con- Commission on Model State Drug Laws. sumer protection; family preservation;

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Appendix B. Critical Membership elements for collaborative As noted previously, membership should success be broad based, representing key agencies in the justice, law enforcement, and As noted in the main body of this paper, treatment systems, and a broad range of reviews of collaborative efforts have iden- other community agencies. tified several critical elements for suc- 1 cess. These elements are specified and Goals discussed below. Collaboratives should design specific goals Leadership that are clear, useful in the minds of participants, and achievable within specified There is a need for one or more key agen- timeframes, including both short- and long- cies to start the collaborative process, term goals, and with specified priorities. preferably bringing experienced leadership Successful collaborative groups have and/or supervision to the table. This body reported the existence of a strategic plan, must be willing to take the responsibility including specific goals, an outline of pro- to identify problems and help other mem- grams related to achieving those goals, bers to envision solutions, maintain the evaluation methods, and regular public support and involvement of other mem- progress updates. A description of goal bers, and work toward helping build an and program review and change was relat- atmosphere of equality. Because in many ed to successful formation and structure.2 communities the relationship between the Performance measures can be especially treatment and criminal justice systems is useful for evaluation and thus the possibili- often strained, there is a need to recog- ty of obtaining continued funding. nize differing primary responsibilities. Within the context of the courts, the jus- Team approach tice system has the primary role in monitoring offenders along the graduated Collaborative efforts should seek a team sanctions continuum; treatment systems approach for both decision planning and have the primary role in providing appropri- making. Leader agencies and/or organiza- ate and effective treatment services. tions should seek to maintain civility at Some evidence indicates that the opti- meetings and encourage flexibility. mum structure might place in the position Decisionmaking should strive to use of managing partner a “neutral” group consensus-building methods. Efforts that does not provide direct services (such toward developing a team approach can as TASC) to ensure unbiased service be assisted by making sure that each col- organization referrals, case management, laborative member has a clearly defined and collaborative organization. No matter role and responsibilities; this can be aided who holds the leadership role, this individual/ by early cross-training for collaborative agency/group must seek consciously to members in the activities and responsibili- actively involve all stakeholders from the ties of the systems involved. beginning of design and implementation of the proposed program(s) or initiative(s).

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Long-term view Funding Members should recognize the complexity Long-term funding sources are crucial for of collaborative goals and strategies, that the viability of any coalition. External fund- neither substance abuse nor crime has a ing sources may assist in providing incen- single solution. Realistic timelines for all tives for development of successful efforts should be set. partnerships3 such as through block grants or private foundations; in addition, com- Research and evaluation munities may have the possibility of pool- ing funds from various agencies. However, Communities considering collaborative efforts should be made to gain line-item work should use available information on legislative support for sustainability. best practices from the literature to guide collaborative and program development. In addition, methods should be developed to Notes systematically collect objective data for monitoring and evaluating collaborative 1. Sigmon, J., Nugent, M., Goerdt, J., and Wallace, S. (1999), Key elements of successful adjudication projects. partnerships (BJA Bulletin, NCJ 173949) pp. 2–4 [Online], available: http://www.ncjrs.org/pdffiles1/bja/ Broad support 173949.pdf; see also McBride, D.C., VanderWaal, C.J., Terry, Y.M., and VanBuren, H. (1999), Breaking The need to gain the support of the com- the cycle of drug use among juvenile offenders: Final munity at large is essential for sustainabili- technical report (NCJ 179273) [Online], available: http://www.ojp.usdoj.gov/nij/drugdocs.htm. ty; active efforts to seek community input can gain support, and regular communica- 2. Join Together (1999). Results of the fourth national tion about the goals and accomplishments survey on community efforts to reduce substance of the partnership can help maintain that abuse and gun violence [Online]. Available: www. support. jointogether.org/ sa/files/pdf/survey98.pdf. 3. Kraft, M., and Dickinson, J. (1997). Partnerships for improved service delivery: The Newark Target Cities Project. Health & Social Work, 22(2), 143–148.

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Appendix C. Principles of 8. Addicted or drug-abusing individuals * with coexisting mental disorders drug addiction treatment should have both disorders treated in NIDA (1999) developed a list of scientifi- an integrated way. cally based recommendations for drug 9. Medical detoxification is only the first treatment applicable for use across the stage of addiction treatment and by entire system of service delivery. These itself does little to change long-term principles are listed below: drug use. 1. No single treatment is appropriate for 10. Treatment does not need to be volun- all individuals. tary to be effective. 2. Treatment needs to be readily avail- 11. Possible drug use during treatment able. must be monitored continuously. 3. Effective treatment attends to multi- 12. Treatment programs should provide ple needs of the individual, not just his assessment for HIV/AIDS, Hepatitis B or her drug use. and C, tuberculosis, and other infec- 4. An individual’s treatment and services tious diseases; and counseling to help plan must be assessed continually and patients modify or change behaviors modified as necessary to ensure that that place themselves or others at risk the plan meets the person’s changing of infection. needs. 13. Recovery from drug addiction can be 5. Remaining in treatment for an ade- along-term process and frequently re- quate period of time is critical for quires multiple episodes of treatment. treatment effectiveness. 6. Counseling (individual and/or group) Reference and other behavioral therapies are critical components of effective treat- *National Institute on Drug Abuse (1999), ment for addiction. Principles of drug addiction treatment: A research-based guide (DHHS Publication 7. Medications are an important element No 00–4180), pp. 1–3 [Online], available: of treatment for many patients, espe- http://165.112.78.61/PODAT/PODATindex. cially when combined with counseling html. and other behavioral therapies.

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