CHAPTER 5: DIVERSION AND COMPULSORY TREATMENT

TASC PROGRAMS IN THE US

More 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 findings

A 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:

• While the vast majority of cannabis users do not report any problems, there are increasing reports of individuals both in Australia and in other countries (e.g. the United States and New Zealand) who are seeking treatment for cannabis dependence.
• It is generally accepted that a prison sentence is unsatisfactory for offenders with drug problems, and diversion with the purpose of treatment is a widely used alternative, welcomed by judges and magistrates. Usually the illegal drug involved is heroin but occasionally cannabis is the offender's primary drug.
• Criminal justice involvement is seen as providing an opportunity to intervene in drug users' lives in order to confront the users with their drug problems and to bring them into contact with treatment agencies, often for the first time.
• The earlier the intervention in the users' lives the better, and the longer (or more frequent) the periods of treatment, the more successful the treatment outcome.
• In some cases merely attending for assessment is sufficient to bring about a change in attitude since the users are often confronted with their drug problem for the first time.
• While some dispute the value of coercion in getting drug users into treatment, it is often the only way, and there is more evidence to indicate successful treatment results for involuntary than for voluntary clients. This is primarily due to the length of time spent in treatment. Frequently the attitude of an unwilling client will change quite quickly once treatment has begun.
• The success of diversion to treatment programs depends on the skill and experience of the drug counsellor, the availability of sufficient places in suitable treatment facilities, and close cooperation between health and criminal justice agencies.
• It would be more cost effective to provide additional funds for the training of counsellors and the provision of suitable facilities than to continue to send repeat drug offenders to prison.
• Conclusions regarding treatment for cannabis offenders, particularly repeat offenders, are as follows:
• There are reports from most diversion programs/treatment agencies of individuals being referred for other drug use who also have serious problems in reducing or ceasing their cannabis use. Some of these may also be alcohol-dependent. There appears then to be some demand for cannabis treatment in this country.
• Interpreting treatment in its broadest and most ideal sense (i.e. as a program personally selected by the client in consultation with a counsellor, tailored to the needs and characteristics of the particular individual), for a repeat offender facing a prison sentence, treatment is a preferable alternative. Treatment appears to have the potential to help offenders restructure their lives in such a way as to avoid breaches of the law which bring them continually into contact with the criminal justice system. In the sense that treatment may be 'compulsory' (i.e. court mandated), while the client must be assessed as suitable for treatment (genuinely motivated to participate, although there may be some initial resistance), the advantage of the compulsory nature of the treatment is that it provides the 'crisis' generally acknowledged as necessary to get most drug users into treatment and to keep them there long enough for a successful outcome. In the case of cannabis use, the earlier the intervention the better, since there is likely to be less criminal involvement and therefore more likelihood of a successful outcome for the client. Young users, particularly juveniles, should receive more attention than they appear to be getting at present in Australia from, for instance, juvenile 'panels' (such as those in South Australia) for whom this is not a major focus.
• A final consideration regarding the treatment option for cannabis users is the availability of treatment programs and facilities and counsellors of sufficient quality and in sufficient numbers to accommodate those referred from the court system, since this is vital for successful treatment outcomes.