Prompted to Treatment by the Criminal Justice System: Relationships with Treatment Retention & Outcome among Cocaine Users

BACKGROUND AND OBJECTIVES:

A substantial portion of individuals entering treatment for substance use have been referred by the criminal justice system, yet there are conflicting reports regarding treatment engagement and outcome differences compared to those not referred. This study examined baseline characteristic and treatment outcome differences among cocaine-dependent individuals participating in cocaine treatment randomized trials.

METHODS:

This secondary analysis pooled samples across five completed randomized controlled trials, resulting in 434 participants. Of these, 67 (15%) were prompted to treatment by the criminal justice system.

RESULTS:

This subsample of criminal justice prompted (CJP) individuals did not differ from those not prompted by the criminal justice system in terms of gender, race/ethnicity, marital status, or age. However, the CJP group reported more years of regular cocaine use, more severe employment and legal problems, as well as less readiness to change prior to treatment. Treatment outcomes did not differ significantly from those without a criminal justice prompt, and on some measures the outcomes for CJP group were better (e.g., percentage of days cocaine abstinent, number of therapy sessions attended).

DISCUSSION AND CONCLUSIONS:

These findings suggest that being prompted to treatment by the criminal justice system may not lead to poorer treatment engagement or substance use outcomes for individuals participating in randomized controlled treatment trials.

SCIENTIFIC SIGNIFICANCE:

Despite some baseline indicators of poorer treatment prognosis, individuals who have been prompted to treatment by the criminal justice system have similar treatment outcomes as those presenting to treatment voluntarily.

Within treatment outcomes according to criminal justice prompt

	Prompted by Criminal Justice System (CJP) N = 67	Not Prompted by Criminal Justice System (non-CJP) N = 367	Total N = 434
	Mean (SD)	Mean (SD)	Mean (SD)	X2 or F
Days retained in treatment protocol	55.4 (29.3)	53.4 (33.1)	53.7 (32.5)	0.22
Completed treatment period, n (%)	36 (53.7)	186 (51.0)	222 (51.4)	0.68
Percentage of cocaine positive urine specimens	55 (37)	62 (37)	61 (37)	1.43
Percentage of days abstinent from cocaine	83 (19)	74 (26)	76 (25)	6.27*
Maximum consecutive days abstinent	24 (20.6)	22.3 (24.9)	22.6 (24.2)	0.25
Maximum days of continuous abstinence during last two weeks of treatment	10 (4.0)	8.3 (4.7)	8.6 (4.6)	4.65*
3+ weeks of continuous abstinence, n (%)	31 (46.3)	149 (40.8)	180 (41.7)	0.69
‘Good Functioning’ = zero cocaine use, employment, or psychological problems last 28 days of treatment, n (%)a	4 (7.5)	48 (14.5)	52 (13.5)	1.89

*p<.05

**p<.01

***p<.001

asample size reduced due to missing data

Full article at:   http://goo.gl/DiHFbZ

By:  Kiluk BD1, Serafini K, Malin-Mayor B, Babuscio TA, Nich C, Carroll KM.

• 1Yale University School of Medicine, New Haven, Connecticut. 
• Am J Addict. 2015 Apr;24(3):225-32. doi: 10.1111/ajad.12208. Epub 2015 Mar 24.

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