Drug Courts’ Effects On Criminal Offending Research Paper

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Drug courts are problem-solving courts that divert generally low-level drug-involved offenders from conventional prosecution. These courts use their legal and moral authority to monitor offenders’ abstinence from drugs and compliance with individualized treatment programs. This is done through regular status hearings before the court and routine drug testing. All drug court participants are expected to be engaged in some form of drug treatment. Successful complete of a drug treatment program is celebrated with a graduation ceremony and generally reward with dismissal of charges or expunging the initiating conviction.

This research paper summarizes the findings from a recent systematic review and meta-analysis conducted by Mitchell et al. (2011) of the numerous studies that have examined the effectiveness of this criminal justice innovation. The systematic search identified 154 independent, eligible evaluations, 92 evaluations of adult drug courts, 34 of juvenile drug courts, and 28 of drunk-driving (DWI) drug courts. The findings most strongly support the effectiveness of adult drug courts, as rigorous evaluations find reductions in recidivism and these effects generally persist for at least 3 years. The evidence also cautiously suggests that DWI drug courts are effective in reducing recidivism, although few rigorous experimental evaluations have been conducted of DWI courts and the findings of these more rigorous evaluations are inconsistent. For juvenile drug courts, they found considerably smaller effects on recidivism than for adult drug courts but the evidence is suggestive of positive effects.

Background Description

Since they emerged in the late 1980s, drug courts have proliferated across the United States and more recently are being adopted elsewhere. Recent data indicate that there are over 2,400 drug courts in operation in the United States (Huddleson and Marlowe 2011). Other countries that have adopted drug courts include Canada, the United Kingdom, New Zealand, Australia, South Africa, Bermuda, and Jamaica (Berman and Feinblatt 2005).

Initially started entirely for nonviolent druginvolved adult offenders, the drug court model has grown to include specialized juvenile drug courts and DWI (driving while intoxicated) courts. The drug court model helped spawn a broader movement of therapeutic jurisprudence that includes a range of problem-solving courts, including mental health courts, prostitution courts, domestic violence, and others.

According to the National Association of Drug Court Professionals (1997, see also Hora 2002), there are several key components of a drug court: (1) early identification of eligible offenders; (2) a collaborative, non-adversarial, court processing; (3) regular judicial monitoring in the form of status hearings for drug court clients before the judge; (4) required drug treatment, (5) urine testing; (6) and the use of graduated sanctions for failure to comply with the court requirement and rewards for successful progress toward program completion. The specific treatment requirements are individualized to the needs of each client, and there is variability in how different drug courts implement these key components.

Eligible drug court clients are identified by prosecutors and diverted from traditional prosecution. The drug court client must, however, agree to the diversion to the drug court and the terms of drug court participation. The typical drug court client is a nonviolent drug individual charged with a drug or property offense, although some drug courts do accept individuals charged with or previously convicted of a violent offense. Most drug courts do not accept individuals with drug trafficking offenses. Thus, the ideal is that drug court clients are those individuals for whom drug use is presumed to play an important role in their criminal behavior.

As a non-adversarial judicial process, drug court clients must agree in some form to their guilt. One model is a pre-plea arrangement where no formal plea or other findings of guilt are formally entered but the client does stipulate that the facts of the case are correct, ensuring a successful prosecution if they are unsuccessful in the program. The case is dismissed if the participant completes the drug court. A postplea/predisposition model requires a formal plea from the participant but delays sentencing. The case is dismissed for program graduates but sentence is imposed for those that fail. For more serious offenders, a post-plea/post-disposition model may be used. Under this approach, drug court participation is essentially a condition of probation and successful program completion is rewarded with a suspected sentence of incarceration, that is, he or she avoids a jail or prison sentence.

All drug court clients are required to participate in some form of drug treatment. A drug court may refer clients to a broad range of treatment services available throughout their community or may have a working relationship with a single treatment provider. The intensity of treatment varies and, ideally, is tailored to the needs of the client.

Drug court clients appear regularly before the judge for status hearings. These status hearings are crucial as it is here that the drug court judge and clients converse directly, and it is in these hearings where judges in collaboration with other court actors most clearly use the authority of the court to motivate treatment compliance. The court uses various rewards (e.g., praise, tokens of achievement, movement to the next phase of the program) and sanctions (e.g., increased treatment attendance or urine testing, short jail stays) to compel compliance to program requirements. Clients advance through three or more progressively less intense stages before completing the drug court, which typically takes about 12to 18-months. Successful completion of the drug court is acknowledged with a formal graduation ceremony.

An early review of the evidence on drug courts conducted by the US General Accounting Office (GAO 1997) was unable to arrive at a firm conclusion, either for or against, regarding their effectiveness in reducing crime and drug use. In contrast, a 2001 review by Belenko drew a cautious but positive conclusion regarding the effectiveness of drug courts based on 37 evaluations. Both of these reviews, however, comment on the lack of evidence on outcomes measured post program. That is, most of the studies examined drug use and criminal behavior during the period of the drug court. Thus, it was not clear whether the reductions in drug use and criminal behavior would continue after graduation from a drug court.

Recent reviews have been more favorable. The GAO updated its review and concluded that drug courts were effective, at last during the program period, at reducing criminal behavior (U.S. General Accountability Office 2005). Furthermore, cost-benefit evaluations examined in this report also showed that drug courts yield a net benefit to society. The metaanalysis by Wilson et al. (2006) of 55 drug court effectiveness studies tentatively concluded that drug court participants have lower rates of recidivism than similar offenders who did not participate in drug courts. These findings held for evaluations that measured recidivism during and after program participation. Like the earlier reviews, these findings were tempered by the generally weak methodological rigor of the evaluations.

Evidence Of Effectiveness Of Drug Courts

This research paper summarizes the findings of a recent meta-analysis and systematic review on the effectiveness of drug courts by Mitchell et al. (2011) published by the Campbell Collaboration (www.campbellcollaboration.org). This metaanalysis is an update of an earlier meta-analysis by the same authors (Wilson et al. 2006). This review examined the evidence of the traditional adult drug court and two newer adaptations of this model: juvenile drug courts and DWI drug courts.

Summary Of Methods

The focus of the meta-analysis by Mitchell and colleagues (2011) was to synthesize all evaluations of the effectiveness of drug courts that used an experimental or quasi-experimental design and examined drug use or criminal behavior as an outcome. The evaluations must have compared a drug court (adult, juvenile, or DWI) to a comparison condition, such as probation. Studies that simply compared program graduates with program failures were excluded.

Mitchell and colleagues implemented a search strategy designed to find all published and unpublished evaluations that satisfied the above criteria. Their approach included keyword searching on numerous bibliographic databases and culling the reference list of prior reviews and eligible studies. In addition, websites of several organizations involved in promoting drug courts or organizations that conduct evaluations of drug courts were searched. The search was updated through August of 2011. This process yielded 181 studies that reported the results of 154 independent evaluations of drug court programs. See Mitchell and colleagues (2011) for a complete list of these references.

Drug Courts’ Effects on Criminal Offending, Table 1Drug Courts’ Effects on Criminal Offending, Table 1 Mean odds ratio by type of recidivism measure

Results across studies were converted to odds ratios and these served as the basis for the meta-analysis. The odds ratio reflects the odds of success (or failure) in one group compared to another. In this case, the odds of success in the drug court versus the comparison. These were coded such that odds ratios greater than one reflected less criminal behavior or drug use among the drug court participants relative to the comparison condition and odds ratios less than one more criminal behavior. That is, values greater than one favor the drug court whereas values less than one favor the comparison.

Odds ratios were averaged across studies using the inverse variance weight method assuming a random effects model. This model gives greater weight to larger studies and assumes that the odds ratios vary both as a result of study level sampling error and true study level differences.

Summary Of Results

Of the 154 evaluations included in the Mitchell and colleagues meta-analysis, 92 were evaluations of adult drug courts, 34 were of juvenile drug courts, and 28 evaluated DWI courts. Only 8 of these 154 evaluations were of drug courts outside of the United States (the other countries represented in the review included Australia, Canada, Guam, and New Zealand). The vast majority of these evaluations were relatively recent and have been conducted since 1999.

Mitchell and colleagues examined three different outcomes across the 154 studies: (1) general recidivism (typically measured as rearrest for any offense), (2) drug-related recidivism (typically measured as rearrest for a drug offense), and (3) drug use (usually measured as self-reported drug use or via urinalysis), for each type of court. Table 1 reports the mean odds ratio for each of these outcome types by each court type. All of these mean odds ratios favor the drug court over the treatment group, although the effect for the outcome of drug recidivism for juvenile drug courts is near a no different value. The pattern of evidence clearly favors the drug courts with most studies observing positive effects. For the general measure of recidivism, the percentage of studies observing positive effects was 88 % for adult drug courts, 70 % for juvenile drug courts, and 85 % for DWI courts.

These effects are easier to interpret if they are translating into simple percentages. For example, the mean odds ratio of 1.66 for general recidivism for the adult drug courts translates into a reduction in recidivism from 50 % (a common rate in the comparison conditions) to 38 % for the drug court participants. This is a small to moderate effect by most standards but arguably one of practical and policy significance. The comparable percent success rates for general recidivism for juvenile courts and DWI courts are 42 % and 38 %, respectively. All three of the mean odds ratios for the most general recidivism measure reported by each study are statistically significant.

An effect of drug courts on future criminal behavior is presumed to be mediated by reductions in drug use and drug dependence. That is, the core logic of drug courts is a presumed connection between drug use and more general criminal behavior. Thus, it is surprising that roughly half of the evaluations of drug courts did not report results specific to drug use. For both adult drug and DWI courts, the results for drug-specific measures of recidivism (rearrest for drug-related offenses) are quite similar to those for general measures of recidivism. The more direct measures of drug use, such as self-report or urinalysis, also produce roughly similar results for these two court types. The latter effects were not statistically significant; however, given the small number of studies contributing to the mean (and correspondingly large confidence interval), this result is not surprising.

In contrast, the pattern of mean odds ratios for juvenile drug courts across the three outcome types is counter-intuitive. The mean odds ratios are positive and statistically significant for general recidivism and more direct measures of drug use but essentially a value of no difference for drug-related measures of recidivism. There is not clear explanation for this pattern other than the smaller number of studies evaluating drug use outcomes.

Prior reviews of the drug court literature were critical of the high percentage of evaluations that only examined effects during the period of program enrollment. To address this concern, Mitchell and colleagues examined effects separately for different follow-up periods and clearly differentiated effects that overlapped either partially or completely with the period of program enrollment.

More specifically, they first compared results measured during the first, second, third, and fourth years post entry into the program using all available studies at each time period. Next they examined only those studies reporting results at 12 and 24-months post program entry and also those studies reporting results at 12-, 24-, and 36-months post program. This was only done for adult drug courts as there was insufficient data for these analyses for the juvenile and DWI courts. The analyses showed that the effects of adult drug courts on recidivism are not limited to the short term. Rather, the research suggests that drug court participants have reduced recidivism during and after drug court treatment, and these effects appear to last at least 3 years post-drug court entry.

Although the overall findings are encouraging and suggest that drug courts are generally effective, the findings were highly heterogeneous across studies. That is, there was great variability in the size of the effects across the different studies. This variability may be due to the numerous methodological differences across the studies or due to actual difference in the structure and design of the drug court.

Mitchell and colleagues examined the influence of numerous methodological features on study outcomes. Of greatest concern was whether selection bias might account for the overall positive findings. Because the vast majority of the studies included in this meta-analyses were quasi-experimental (i.e., did not randomly assign participants to the drug court and comparison conditions), it is plausible that naturally occurring differences between the groups might upwardly (or downwardly) bias the effectiveness estimates. For example, a selection mechanism resulting in the drug court program having more highly motivated individuals would result in a positive odds ratio even if the treatment was not effective. The evaluations included in this meta-analysis included studies with a low likelihood of selection bias, that is, experimental studies with random assignment to conditions, and studies with a high likelihood of selection bias, that is, studies with included drug court eligible offenders who elected not to participate.

Studies were grouped into four categories. The most rigorous category was randomized experiments. The second was high quality quasiexperimental designs. These rigorous quasiexperiment studies typically used subject-level matching on key variables or propensity score matching to ensure comparability of clients in each condition. The third category was standard quasi-experimental designs. These typically used either a historical comparison group that met drug court eligibility criteria constructed from archival data or a group of offenders who were eligible but not referred to the drug court program. The critical feature here is that the participants did not self-select into the drug court or comparison condition. The fourth and weakest category of studies was quasi-experimental designs that involved comparing drug court clients to drug offenders who were eligible for the drug court but declined participation (drug court refusers).

The evidence suggests that the overall mean results are at least somewhat positively biased. The weakest quality studies did, on average, produce the largest results across the three types of courts. Thus, it is important to focus more closely on the findings from the higher quality studies.

For adult drug courts, Mitchell and colleagues concluded that the more rigorous studies still provided evidence of general effectiveness. This finding was complicated by the inconsistent results across the three randomized experimental studies of adult drug courts. They concluded, however, that all three experimental evaluations of adult drug courts provide evidence of these courts’ effectiveness in reducing recidivism. Two of the three evaluations find recidivism reductions in the first year after program entry, and the remaining evaluation finds a recidivism reduction at 3 years post-program entry. Furthermore, the vast majority of the rigorous quasi-experimental evaluations of drug courts find moderate reductions in general recidivism.

For juvenile drug courts, the picture is more complicated. The average effects for the 11 rigorous quasi-experimental studies and for the single experimental study were positive. Unfortunately, these effects were small overall (ranging from a mean odds ratio of 1.22 to 1.39 for general and drug-specific measures of recidivism) but not statistically significant. Thus, the most rigorous evidence suggests that juvenile drug courts have small effects but clearly additional research is needed to firm-up this conclusion.

For DWI drug courts, the rigorous quasiexperimental studies had a large and statistically significant mean odds ratio for both general recidivism and drug-specific recidivism (1.99 and 1.78, respectively). Unfortunately, the mean odds ratio for the four randomized studies was very small and statistically nonsignificant. However, Mitchell and colleagues noted that three of these four evaluations reported positive effects but that a single influential negative finding seriously attenuated the overall mean odds ratio. Thus, Mitchell and colleagues concluded the evidence of effectiveness for DWI courts was encouraging but that clearly additional high quality studies are needed.

As already discussed, drug courts vary substantially in how they implement the various key elements. Mitchell and colleagues explored numerous differences in the structure of the drug courts across studies and whether these differences were related to the observed effects. These analyses were guided by a framework proposed by Longshore et al. (2001). This framework has five dimensions and predicts that the most effective drug courts (1) will use the court’s leverage (rewards and sanctions) to motivate offender change, (2) will serve populations with less severe problems, (3) will have high program intensity, (4) will apply rewards and sanctions predictably, and (5) will emphasize offender rehabilitation as opposed to other court goals like speedy case processing and punitive sanctioning.

Unfortunately, it was not possible to categorize the studies on all of these dimensions. Mitchell and colleagues were able to code variables that related to the first three dimensions but not the last two. Furthermore, the categorizations were often rather crude and were unable to cleanly differentiate the studies on each dimension.

The first dimension is the use of sanctions and rewards or what Longshore and colleagues refer to as leverage. To examine leverage, Mitchell and colleagues coded studies by the method of case disposition (pre-plea, post-plea, or mixed) and what happens to the charges/ sentences upon graduation (dismissed/expunged or not dismissed/expunged). Mitchell and colleagues found mixed support for the leverage hypothesis. Consistent with the hypothesis, drug courts that dismiss/expunge charges upon graduation had higher mean odds ratios on both measures of recidivism. This difference is statistically significant for the drug recidivism measure, but is nonsignificant for the general recidivism measure. Counter to their hypothesis, however, drug courts that predominantly used post-plea case processing did not have greater reductions in recidivism than other courts. Post-plea courts are presumed to have greater leverage because offenders have been convicted and face immediate sentencing upon failure in drug court whereas the in the pre-plea model, the case must still be processed.

In practice, what may matter most are not these structural differences but the certainty and swiftness of sanctions and rewards. Mitchell and colleagues were not able to categorize courts on this dimension based on the information provided in the evaluation reports. Evidence supporting the importance of the certainty and swiftness of sanctions is emerging from studies of Project HOPE, a variant on the drug court model. The key feature of Project HOPE is the certainty and swiftness of sanctions, typically a night in jail, for failure to remain drug free (i.e., a dirty urinalysis) or adhere to a simplified set of terms and conditions of probation.

The second dimension of Longshore and colleagues framework is the intensity of the program. Mitchell and colleagues categorized the studies on several variables designed to address this dimension. These included the length of the program, frequency of drug testing, frequency of status hearings, and number of phases through which the clients progressed.

The analyses did not generally support the hypothesis that more intense programs are associated with greater reductions in recidivism. The one exception was for analyses involving the number of status hearings. For the adult drug courts, courts with more than two status hearings in first treatment phase had larger effects of drug-related recidivism than other courts. The number of status hearings was also positively related to improved outcomes for juvenile drug courts. Other than the number of status hearings, these findings suggest that drug courts with greater program intensity are no more effective in reducing recidivism than other courts. Once again, however, these analyses do not fully capture the differences in the intensity of the drug treatment provided by the various drug courts, nor do they capture the differences in the quality of drug treatment services.

The third dimension of Longshore and colleagues’ framework posits that drug court programs that serve less severe populations will be most effective. This hypothesis is in conflict with a core element of Andrews and colleagues’ (1990) principle that more effective programs serve more severe populations. This “risk principle” has found empirical support (see Andrews and Bonta 1992). Mitchell and colleagues examined this issue by categorizing studies by whether individuals with violent criminal histories or with extensive prior convictions were eligible for the program.

Analyses of the general recidivism effect sizes support Longshore and colleagues’ prediction. Specifically, samples that included only nonviolent offenders had statistically larger mean odds ratios on the general recidivism measure than samples that included violent offenders. Similarly, samples with minor criminal history had larger mean odds ratios than evaluations based on samples with more criminal history; however, this difference was not statistically significant. These findings were not replicated in the analysis of the drug-related recidivism outcome measure. Here there were no differences in the mean effects odds ratios on either of the measures of population severity. For the juvenile and DWI courts, there were no meaningful patterns across these categorizations. Thus, these findings are more supportive of Longshore and colleagues’ hypothesis than Andrews and colleagues’ risk principle although the finding is clearly weak and inconsistent across the different types of drug courts.

Key Issues And Controversies

The rapid expansion of drug courts has been based on a presumption that they are effective and on the local problems that they solve, such as jail overcrowding. The approach also resonated with the get-tough approach to crime that has dominated crime policy during that past quarter century. Drug courts also help address the problem of increasing prison and jail populations by diverting a portion of drug-involved offenders toward community sanctions and treatment. Thus, the drug court model satisfied both get-touch and rehabilitation ideologies, allowing for a broad base of support that facilitated adoption of the approach.

This general belief in the value of drug courts is not without detractors. For example, a recent report by the Justice Policy Institute (Walsh 2011) questioned our “addiction” to drug courts. The report does not question the basic effectiveness of drug courts but argues that there are unintended consequences to our use of them as a solution to what is essentially a public health problem: drug addiction. First, the report argues that drug courts have expanded the involvement of the criminal justice system into the lives of low-level offenders, or what is often called, net widening. Many of the individuals who enter a drug court program would have had their cases dismissed or been diverted to a community treatment program prior to the development of drug courts. Second, the report argues that criminal sanctions for individuals who fail in the drug court are often greater than what they would have received through conventional processing. Third, the report argues that a criminal conviction should not be a criterion for low-income and other disadvantages groups to gain access to needed drug treatment. And finally, the report argues that these negative consequences often affect minority groups more severely, both because they are less likely to be eligible given higher rates of offense histories that preclude eligibility and through higher failures rates for those admitted. The report argues for strengthening community-based treatment services for drug-involved individuals that do not require a criminal conviction and diverting many of the existing drug court clients to these community programs.

These criticisms of drug courts are specific to drug courts within the United States and reflect the broader ecosystem within which they operate. Addressing these criticisms would require larger changes within this ecosystem, primarily a major policy shift from a criminal justice approach to drug addiction to a public health approach. In the absence of such a shift, these courts are likely to continue to serve as an important means of facilitating access to drug treatment and improving treatment compliance through judicial sanctions.


The meta-analysis by Mitchell and colleagues draws generally positive conclusions regarding the effectiveness of drug courts for reducing criminal behavior and drug use. The vast majority of the programs that evaluate the effectiveness of these programs find that participants have lower rates of recidivism than nonparticipants. The analysis suggests that the typical effect is roughly a reduction from 50 % to approximately 38 % for adult drug courts. For juvenile drug courts, the effects appear to be smaller, roughly a reduction from 50 % to 43.5 %. The findings for DWI courts are promising but not unambiguous, given the mixed findings and limited number of studies.

The findings are not without caveats. The number of randomized controlled trials (true experiments) is limited. These high quality studies do indicate, however, that drug courts can work. The high variability in effects across studies suggests differential effectiveness across variations in drug courts. That is, some courts may be highly effective whereas others may be ineffective. The meta-analysis by Mitchell and colleagues explored several hypotheses regarding differential effectiveness and found limited support for differential effects based on the leverage of the court. Additionally, there was weak support that drug courts will be more effective with less severe populations.

Despite the rather large number of studies examining the effectiveness of drug courts, this body of literature provides limited insight into the critical components of effectiveness. It is likely that the quality of the drug treatment services provided to drug court clients and the degree to which these treatments are evidence based are related to program’s success. Furthermore, the findings from deterrence research in criminology and from behavioral psychology would imply the importance of certainty and swiftness in the application of judicial sanctions and rewards. The collection of studies reviewed by Mitchell and colleagues provides limited information on the role of these important features of the drug court model. Clearly, future research on the relationship between drug court elements and effectiveness is needed.


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