Associations With Substance Abuse Treatment Completion Among Drug Court Participants

Abstract

Subjects in the study included all participants (N = 573) in drug treatment court in a mid-sized U.S. city from 1996 through 2004. Administrative data from the drug court

1 The term drug court, which has become tradition-driven and bound, is misleading and can more accurately be considered to be a drug user treatment facilitating court. Inaccurate nosologies, whatever their underpinnings and stakeholders, do not increase the necessary quality and effectiveness of appropriate substance use intervention planning, implementation, or assessment. Editor's note.

included measures of demographics and socioeconomics, substance use, and criminal justice history. Stepwise multivariate logistic regression yielded a final model of failure to complete drug treatment.

2 The term drug treatment, also tradition-bound, which is not pharmacotherapy or chemotherapy, is also misleading. Treatment can be briefly and usefully defined as a planned, goal directed, temporally structured change process, of necessary quality, appropriateness, and conditions (endogenous and exogenous), which is bounded (culture, place, time, etc.) and can be categorized into professional-based, tradition-based, mutual-help based (AA, NA, etc.) and self-help (“natural recovery”) models. There are no unique models or techniques used with substance users—of whatever types and heterogeneities—which are not also used with non-substance users. In the West, with the relatively new ideology of “harm reduction” and the even newer quality of life (QoL) treatment-driven model, there are now a new set of goals in addition to those derived from/associated with the older tradition of abstinence-driven models. Editor's note.

Unemployment, lower educational attainment, and cocaine use disorders were associated with failure to complete treatment. The limitations of administrative data should be considered in the interpretation of results.

RÉSUMÉ

Accomplir d’ traitement d’ un tribunal de drogue

Les sujets étaient tous les participants d’un tribunal de drogue illicité dans une cite moyenne aux Etas Unis dans 1996 à 2004. Les donnés administratifs du tribunal ont inclus les mesures de démographiques et socio-économiques, l’histoire de l’activité de drogue et l’histoire criminelle. La régression logistique multivariable par étapes a rapporté un modèle final de manqué d’accomplir le traitement. L’échec de traitement etait associé avec le chômage, le bas attainement éducatif, l’utilisation de cocaine. On doit consideré les limites du donnés administratifs dans l’interpretation des résultats. Le financement etait fourni pour National Institutes of Health, National Institute on Drug Abuse (1 K23 DA017283-01).

RESUMEN

Asociaciones con terminación del tratamiento del abuso de drogas en un tribunal de drogas. Los sujetos en este estudio fueron todos los participantes en un tribunal de drogas (n = 573) en una ciudad de mediano tamaño de los Estados Unidos entre los años 1996 y 2004. Datos administrativos del tribunal incluían información demográfica, historia del uso de drogas, historia criminal, y estatus socioeconómico. Un análisis de regresión logística paso-a-paso con múltiples covariables reveló que el desempleo, el bajo nivel de educacion, y el uso de cocaina estaban asociados con la falta de completar el tratamiento. En la interpretación de estos resultados se deben tener en cuenta las limitaciones relacionadas con el uso de datos administrativos. Este estudio estuvo financiado por el Instituto Nacional del Abuso de los Drogas.

Keywords :

• Drug court
• criminal justice
• drug abuse
• unemployment
• cocaine
• treatment adherence
• addiction severity
• treatment failure
• case management

THE AUTHOR

Randall Brown, M.D., is an Assistant Professor in the Department of Family Medicine and a Ph.D. candidate in the Department of Population Health Sciences at the University of Wisconsin, School of Medicine and Public Health. He continues active practice in Madison, Wisconsin, as a family physician at the Wingra Family Medical Center and as an addictionologist as the Co-Director of the AODA Consultation Service at the University of Wisconsin Hospital and Clinics, and as a staff physician with the NewStart Addiction Medicine Consultation Service at Meriter Hospital. His ongoing research, funded by the National Institute on Drug Abuse and intramural funding through the University of Wisconsin, focuses upon services to substance-dependent individuals in the criminal justice system.

Notes

1 The term drug court, which has become tradition-driven and bound, is misleading and can more accurately be considered to be a drug user treatment facilitating court. Inaccurate nosologies, whatever their underpinnings and stakeholders, do not increase the necessary quality and effectiveness of appropriate substance use intervention planning, implementation, or assessment. Editor's note.

2 The term drug treatment, also tradition-bound, which is not pharmacotherapy or chemotherapy, is also misleading. Treatment can be briefly and usefully defined as a planned, goal directed, temporally structured change process, of necessary quality, appropriateness, and conditions (endogenous and exogenous), which is bounded (culture, place, time, etc.) and can be categorized into professional-based, tradition-based, mutual-help based (AA, NA, etc.) and self-help (“natural recovery”) models. There are no unique models or techniques used with substance users—of whatever types and heterogeneities—which are not also used with non-substance users. In the West, with the relatively new ideology of “harm reduction” and the even newer quality of life (QoL) treatment-driven model, there are now a new set of goals in addition to those derived from/associated with the older tradition of abstinence-driven models. Editor's note.

3 The reader is asked to consider that the terms drug court and drug treatment courts, which have become tradition-driven and bound, are misleading and can more accurately be considered to be drug user treatment facilitating courts. These courts represent a range of specialized courts in which drug users, who represent a heterogeneous and not a homogeneous population, and not drugs, are given the opportunity for treatment under certain conditions and are diverted from the criminal justice system. Inaccurate nosologies, whatever their underpinnings and stakeholders, do not increase the necessary quality and effectiveness of appropriate substance use intervention planning, implementation, or assessment. Editor's note.

4 See footnote 2.

5 The journal's style utilizes the category substance abuse as a diagnostic category. Substances are used or misused; living organisms are and can be abused. Editor's note.