Therapeutic communities with aftercare in secure settings may reduced drug misuse and criminal activity.

Perry A, Coulton S, Glanville J, Godfrey C, Lunn J, McDougall C, Neale Z

Published Online:

July 16, 2008

A number of policy directives are aimed at enabling people with drug problems to live healthy, crime free lives. Drug-using offenders naturally represent a socially excluded group who may experience problems in relation to their drug use. A number of studies and previous systematic reviews have considered the effectiveness of drug treatment interventions for drug misusers in the general population, mixed populations of offenders and non-offenders, drug treatment in a specific setting or country with limited outcome measures. This review focuses on drug treatment for offenders across a number of different settings. A number of studies have been conducted displaying a wide range of outcome measures with varying methodological quality. Little information is provided on the costs and cost-effectiveness of such interventions. Promising results are shown for therapeutic communities with aftercare.

Abstract (click to read)

Background:

Drug strategies internationally recognize link between drug use and crime. This review consider interventions for drug-using offenders under the care of the criminal justice system.

Objectives:

To assess the effectiveness of interventions for drug-using offenders in reducing criminal activity and drug use in the courts, secure establishments and community-based settings.

Search strategy:

Twenty two electronic databases were searched (1980 to 2004). Internet sites and experts in the field were contacted for further information.

Selection criteria:

Randomised Controlled Trials designed to reduce, eliminate or prevent relapse in drug using offenders

Data collection and analysis:

Two authors independently assessed trials for inclusion. Data were extracted by one author and double checked.

Main results:

Twenty four studies, 8936 participants, met the inclusion criteria. Results show that comparing a court-based community pre-trial release with drugs testing and sanctions versus routine pre-trial, for arrest at 90 days results favoured the comparison group OR 1.33 (95% CI 1.04 to 1.70). Comparing therapeutic community with aftercare with a mental health programme with a waiting list control, considering incarceration at 12 months OR 0.37 (95% CI 0.16 to 0.87), results in favour of the treatment Comparing intensive supervision with routine parole/probation, for recidivism OR 1.98 (95% CI 1.01 to 3.87) results in favour of comparison group, no statistically significant difference between the groups for arrest OR 1.49 (95% CI 0.88 to 2.51), drug arrest OR 1.10 (95% CI 0.50 to 2.39), conviction OR 0.93 (95% CI 0.55 to 1.58 ) and incarceration at one year OR 0.88 (95% CI 0.50, 1.54). Comparing intensive supervision and increased surveillance with intensive supervision alone, no statistically significant difference between the groups for recidivism OR 2.09 (95% CI, 0.86 to 5.07), arrest OR 1.22 (95% CI 0.51 to 2.88]), drug arrest, OR 1.29 (95% CI 0.35 to 4.85), conviction OR0.1.14 (95% CI, 0.22, to 5.91) and incarceration OR 1.30 (95% CI 0.39, to 4.30]) at one year.

Authors' conclusions:

Limited conclusions can be drawn about the effectiveness of drug treatment programmes for drug-using offenders in the courts or the community. This is partly due to the broad range of studies and the heterogeneity of the different outcome measures presented. Therapeutic communities with aftercare show promising results for the reduction of drug use and criminal activity in drug using offenders. Standardisation of outcome measures and costing methodology would help improve the quality of research conducted in the area.

This record should be cited as:

Perry A, Coulton S, Glanville J, Godfrey C, Lunn J, McDougall C, Neale Z. Interventions for drug-using offenders in the courts, secure establishments and the community.. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD005193. DOI: 10.1002/14651858.CD005193.pub2

Assessed as up to date:

May 19, 2006

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Primary Review Group:

Drugs and Alcohol Group

Health topics:

Tobacco, drugs, & alcohol dependence > Polydrug use

Cochrane group topics:

Drugs and Alcohol > Polydrug > Pharmacological and/or psychosocial interventions

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Therapeutic communities with aftercare in secure settings may reduced drug misuse and criminal activity.

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