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Major Studies of Drugs and Drug Policy | ||||
Legislative Options for Cannabis - Australian Government |
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CHAPTER 5: DIVERSION AND COMPULSORY TREATMENTTASC PROGRAMS IN THE USMore recently in the US, coordinated programs have been developed in a number of States to refer 'drug-abusing offenders to community-based treatment in lieu of prosecution or probation revocation', e.g. the Treatment Alternatives to Street Crime (TASC) program ([63]Anglin & Hser 1990, p428), begun in 1972 and by 1988 operating in 18 States (Cook et al. 1988 in Anglin & Hser 1990, p428). This provides community-based treatment for drug-dependent offenders who 'otherwise might become progressively more involved with the criminal justice system' (p428). Diversionary dispositions such as deferred prosecution, creative community sentencing, and pretrial intervention are used to motivate offenders to enter and remain in treatment. Evaluation Such limited evaluation as has taken place (through the Treatment Outcomes Prospective Study) indicates that criminal justice referred clients, because they were monitored, tended to stay in treatment longer than voluntary clients, which is usually associated with more successful treatment outcomes ([64]Anglin & Hser 1990, p429). Although evaluations of treatment are positive, it remains a question as to whether improvements would have occurred over time anyway due to maturation or other outside influences. In terms of client characteristics and treatment effectiveness, it was found that 'addicts who have a more stable family background, an intact marriage, a job, a history of minimal criminality, less evidence of alcohol or polydrug abuse, and less severe psychiatric disorders are more likely to achieve a better outcome in most programs' (Anglin & Hser 1990, p429). Many studies have shown that, while older clients, mostly opiate users, tend to stay in treatment longer and therefore benefit most (possibly due to the 'maturing out' effect noted by Winick (1962 in Anglin & Hser 1990, p435), those under 25 tend to leave treatment prematurely, thus limiting their prospects for effective results. In terms of program factors which appeared to be most beneficial, the significant ones were: psychotherapy, urine testing, and legal coercion. 'Clients referred from the criminal justice system have been shown to stay in treatment longer than other clients' (Collins et al., cited in [65]Leukefeld & Timms 1988, p57) and longer retention suggests better treatment outcomes than with other clients (but see above). Some argue that treatment cannot be effective if the client is coerced, and the findings are not consistent on this issue. However, the best-designed studies 'generally support the proposition that a collaborative relationship between the criminal justice system and community-treatment delivery systems produces, at an aggregate level, enhanced treatment outcomes' ([66]Anglin & Hser 1990, p439). While length of retention in treatment is an important predictor of success it appears that 'for many drug abusers, repeated exposure to treatment is more effective than one episode' (McLellan & Druley 1977 in Anglin & Hser 1990, p441). Total time in treatment may be more important, when accrued across treatment episodes, than retention in a single program (p441). In a number of other countries, any illegal drug use including that of cannabis is sufficient grounds for recommending or ordering treatment, implying that some other countries regard cannabis use more seriously than Australia does, and deserving of treatment. The mode of treatment depends on the profile of the individual user and on such factors as are mentioned elsewhere in this report, e.g. whether the person is a polydrug user, length of time of use, degree of psychopathology and so forth. Outpatient non-methadone programs which involve clients with all types of drug use who tend not to have serious criminal histories, are the most obvious option for treatment of cannabis dependence. Therapeutic communities are not necessarily specific to any class of drug and could also therefore potentially be of benefit to certain cannabis-dependent persons. Since the numbers of cannabis users who have problems is still small and very few are likely to be seriously enough dependent to be referred by the court, it is unlikely that treatment facilities could not incorporate them. Summary of findingsA summary of findings from Australian and international literature concerned with diversion and treatment for drug offenders suggests the following conclusions with relation to cannabis users:
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