Shifting the focus from simple comparisons of
voluntary and coerced clients, this study examined the relationship
between legal pressure and drug treatment retention by assessing
perceptions of legal pressure held by two groups of legally-mandated
treatment clients: (1) participants of the Drug Treatment Alternative
to Prison (DTAP) program and (2) a matched group of probationers,
parolees, Treatment Alternatives to Street Crime (TASC) participants,
and other court-mandated clients attending the same community-based
treatment programs used by DTAP. DTAP was developed and operated by
the Office of the Kings County (Brooklyn) District Attorney in New
York City. It was selected for study because of the program's
uniquely coercive program components, such as the threat of a
legally-mandatory prison term for noncompliance and an apprehension
unit specifically assigned to the program. It also had an exceptional
record of participant retention and completion (two to four times
greater than the retention rates reported for other long-term
residential programs). In lieu of a prison sentence, Brooklyn DTAP
provided the option of long-term treatment (generally 15-24 months)
in a residential therapeutic community to repeat, nonviolent felony
defendants. The charges were dropped if the person completed the
program, while those who failed in treatment faced prison terms under
New York's mandatory sentencing statutes. The goals of this project
were (1) to test whether DTAP participants would show significantly
higher retention rates when compared to a matched sample of other
legally-mandated treatment clients, and (2) to assess the role of
perceived legal pressure in predicting retention for both of these
groups.
Data were collected from interviews with program
participants that were conducted at admission to treatment and
follow-up interviews conducted about eight weeks later. Intake
interviews were conducted, on average, one week after the client's
admission to treatment. The one-to-one interviews, which lasted up to
two hours, were conducted by trained researchers in a private
location at the treatment site. The intake interview battery included
a mixture of standardized measures and those developed by the Vera
Institute. Part 1 consists of extensive history and status
information gathered from the Addiction Severity Index (ASI), a
widely-used, standardized measure that assessed individuals' family
and social backgrounds, employment and education, substance abuse,
criminal/legal, medical, and psychiatric status and histories. Part 2
contains supplemental questions to the ASI covering employment
history and self-reported criminal behavior. Also included are
treatment entry date, number of days in treatment, and termination date,
which were used to calculate the study's central outcome measure:
retention in treatment. Subjects were tracked for at least six months
after admission. Those entering the research early in the data
collection period were tracked for about 20 months. Part 3 consists
of criminal history data obtained from official records kept by the
New York State Division of Criminal Justice Services. Part 4 includes
additional substance abuse history data gathered using the Chemical
Use, Abuse, and Dependence (CUAD) scale, which employed
quantity/frequency measures and probed drug-related life
problems. Psychiatric data were collected with two standardized
measures often used in research on substance abusers: the Symptom
Checklist-90-Revised (Part 5) and the Beck Depression Inventory (Part
6). Intake measures of the client's motivation for treatment included
the Circumstances, Motivation, Readiness, and Suitability (CMRS)
scale (Part 7) and the Stages of Change Readiness and Treatment
Eagerness (SOCRATES) scale (Part 8). Additionally, the Vera Institute
created a 14-item measure called the Motivational/Program Supplement
(M/PS) questionnaire (Part 9), which addressed other motivational and
background factors that prior research suggested may influence
retention. The final data collection from the intake interview is
Part 10, which contains data from the Perception of Legal Pressure
(PLP) questionnaire developed by Vera researchers. A follow-up
interview focusing on program factors was conducted with all
available subjects about eight weeks after admission. The follow-up
sample consisted of 131 individuals, including 75 DTAP participants
and 56 comparison participants. Two standardized measures were
administered in the interview. The Community-Oriented Programs
Environment Scale (COPES) (Part 11) included three subscales focusing
on staff-client relationships, therapeutic interactions, and program
maintenance dimensions such as order, clarity, and control. The
Treatment Services Review (Part 12) was a brief instrument designed
by the creators of the ASI that yielded quantitative indicators of
the number and type of services received by treatment clients.
Matched sampling.
Participants in four drug treatment programs in Kings
County, New York, between 1994 and 1995.
Individuals.
personal interviews, and official records from the New
York State Division of Criminal Justice Services
Data in Part 1 were collected with the Addiction
Severity Index and include age, sex, race, religion, and
education. Additional variables cover medical problems, employment
history, detailed substance abuse and treatment history, number of
times arrested for various crimes, history of incarceration, family's
substance abuse and criminal histories, relationships with family and
friends, psychological problems such as depression, anxiety, and
suicide, current living arrangements, and sources of income. Part 2,
Supplemental Background and Retention Data, contains treatment entry
date, number of days in treatment, age at treatment entry,
termination date, treatment condition, arrest date, detention at
arrest, date released on probation/parole, violation of
probation/parole arrest date and location, problem drug, prior drug
treatment, as well as age, gender, race, education, and marital
status. Part 3, Division of Criminal Justice Services Data, includes
data on the number of arrests before and after program entry, and
number of total misdemeanor and felony arrests, convictions, and
sentences. Part 4, Chemical Use, Abuse, and Dependence Data, contains
information on type of substance abuse, intoxication or withdrawal at
work, school, or home, effects of abuse on social, occupational, or
recreational activities, and effects of abuse on relationships,
health, emotions, and employment. Parts 5 and 6 contain psychiatric
data gathered from the Symptom Checklist-90-Revised and Beck's
Depression Inventory, respectively. Part 7 variables from the
Circumstances, Motivation, Readiness, and Suitability scale include
family's attitude toward treatment, subject's need for treatment,
subject's desire to change life, and legal consequences if subject
did not participate in treatment. Part 8, Stages of Change Readiness
and Treatment Eagerness scale, contains data on how the subject
viewed the drug problem, desire to change, and history of dealing
with substance abuse. Part 9, Motivational/Program Supplement Data,
includes variables on the subject's need for treatment, attitudes
toward treatment sessions, the family's reaction to treatment, and a
likelihood of completion rating. Part 10, Perceived Legal Coercion
Data, gathered information on who referred the subject to the
treatment program, who was keeping track of attendance, whether
someone explained the rules of participation in the program and the
consequences if the subject failed the program, whether the rules and
consequences were put in writing, who monitored program participants,
the likelihood of using drugs while in treatment, the likelihood of
leaving the program before completion, whether the subject understood
the legal consequences of failing the program, the type and frequency
of reports and contacts with the criminal justice system, and the
subject's reaction to various penalties for not completing the
program. Part 11 contains data from the Community Oriented Programs
Environment Scale (COPES). Part 12, Treatment Services Review Data,
includes data on the number of times the subject received medical
attention, days in school, days employed, days intoxicated, days in
substance abuse treatment, days tested for drugs, number of contacts
with the criminal justice system, days treated for psychological
problems, and time spent at recreational activities. Additional
variables include the number of individual and group treatment
sessions spent discussing medical problems, education and employment,
substance abuse, legal problems, and psychological and emotional
problems.
Not applicable.
The following scales were used in this data collection:
Addiction Severity Index (Parts 1 and 2), Chemical Use, Abuse, and
Dependence scale (Part 4), Symptom Checklist-90-Revised (Part 5),
Beck's Depression Inventory (Part 6), Circumstances, Motivation,
Readiness, and Suitability scale (Part 7), Stages of Change Readiness
and Treatment Eagerness scale (Parts 8 and 9), Community Oriented
Programs Environment scale (Part 11), and Treatment Services Review
scale (Part 12). In addition to the above common scales, the
principal investigator also created a scale for Part 10 to
specifically measure Perceived Legal Coercion among legally-mandated
treatment clients.