Effectiveness of substance use disorder treatment as an alternative to imprisonment
Abstract Introduction Drug courts are criminal justice programs to divert people with substance use disorders from incarceration into treatment. Drug courts have become increasingly popular in the US and other countries. However, their effectiveness in reducing important public health outcomes such...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-04-01
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| Series: | BMC Psychiatry |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12888-024-05734-y |
| _version_ | 1797209166648967168 |
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| author | Suvi Virtanen Mikko Aaltonen Antti Latvala Mats Forsman Paul Lichtenstein Zheng Chang |
| author_facet | Suvi Virtanen Mikko Aaltonen Antti Latvala Mats Forsman Paul Lichtenstein Zheng Chang |
| author_sort | Suvi Virtanen |
| collection | DOAJ |
| description | Abstract Introduction Drug courts are criminal justice programs to divert people with substance use disorders from incarceration into treatment. Drug courts have become increasingly popular in the US and other countries. However, their effectiveness in reducing important public health outcomes such as recidivism and substance-related health harms remains ambiguous and contested. We used nationwide register data from Sweden to evaluate the effectiveness of contract treatment sanction, the Swedish version of drug court, in reducing substance misuse, adverse somatic and mental health outcomes, and recidivism. Methods In this prospective cohort study, two quasi-experimental designs were used: difference-in-differences and the within-individual design. In the latter, we compared the risk of outcomes during time on contract treatment to, 1) parole after imprisonment and, 2) probation. Results The cohort included 11,893 individuals (13% women) who underwent contract treatment. Contract treatment was associated with a reduction of 7 percentage points (95% CI: -.088, -.055) in substance misuse, 5 percentage points (-.064, -.034) in adverse mental health events, 9 percentage points (-.113, -.076) in adverse somatic health events, and 3 fewer charges (-3.16, -2.85) for crime in difference-in-differences analyses. Within-individual associations suggested that the same individual had longer times-to-event for all outcomes during contract treatment than on parole or on probation. Conclusions Contract treatment is an effective intervention from both public health and criminal justice perspective. Our findings suggest that it is a superior alternative to incarceration in its target group. Further, we find that an implementation approach that is less punitive and more inclusive than what is typical in the US can be successful. |
| first_indexed | 2024-04-24T09:50:23Z |
| format | Article |
| id | doaj.art-e1dab7b5df394f16b16f5affa20287db |
| institution | Directory Open Access Journal |
| issn | 1471-244X |
| language | English |
| last_indexed | 2024-04-24T09:50:23Z |
| publishDate | 2024-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Psychiatry |
| spelling | doaj.art-e1dab7b5df394f16b16f5affa20287db2024-04-14T11:24:05ZengBMCBMC Psychiatry1471-244X2024-04-012411910.1186/s12888-024-05734-yEffectiveness of substance use disorder treatment as an alternative to imprisonmentSuvi Virtanen0Mikko Aaltonen1Antti Latvala2Mats Forsman3Paul Lichtenstein4Zheng Chang5Department of Medical Epidemiology and BiostatisticsUEF Law School, University of Eastern FinlandDepartment of Medical Epidemiology and BiostatisticsDepartment of Medical Epidemiology and BiostatisticsDepartment of Medical Epidemiology and BiostatisticsDepartment of Medical Epidemiology and BiostatisticsAbstract Introduction Drug courts are criminal justice programs to divert people with substance use disorders from incarceration into treatment. Drug courts have become increasingly popular in the US and other countries. However, their effectiveness in reducing important public health outcomes such as recidivism and substance-related health harms remains ambiguous and contested. We used nationwide register data from Sweden to evaluate the effectiveness of contract treatment sanction, the Swedish version of drug court, in reducing substance misuse, adverse somatic and mental health outcomes, and recidivism. Methods In this prospective cohort study, two quasi-experimental designs were used: difference-in-differences and the within-individual design. In the latter, we compared the risk of outcomes during time on contract treatment to, 1) parole after imprisonment and, 2) probation. Results The cohort included 11,893 individuals (13% women) who underwent contract treatment. Contract treatment was associated with a reduction of 7 percentage points (95% CI: -.088, -.055) in substance misuse, 5 percentage points (-.064, -.034) in adverse mental health events, 9 percentage points (-.113, -.076) in adverse somatic health events, and 3 fewer charges (-3.16, -2.85) for crime in difference-in-differences analyses. Within-individual associations suggested that the same individual had longer times-to-event for all outcomes during contract treatment than on parole or on probation. Conclusions Contract treatment is an effective intervention from both public health and criminal justice perspective. Our findings suggest that it is a superior alternative to incarceration in its target group. Further, we find that an implementation approach that is less punitive and more inclusive than what is typical in the US can be successful.https://doi.org/10.1186/s12888-024-05734-ySubstance use disorderTreatmentDrug courtHarm reductionCrimeIncarceration |
| spellingShingle | Suvi Virtanen Mikko Aaltonen Antti Latvala Mats Forsman Paul Lichtenstein Zheng Chang Effectiveness of substance use disorder treatment as an alternative to imprisonment BMC Psychiatry Substance use disorder Treatment Drug court Harm reduction Crime Incarceration |
| title | Effectiveness of substance use disorder treatment as an alternative to imprisonment |
| title_full | Effectiveness of substance use disorder treatment as an alternative to imprisonment |
| title_fullStr | Effectiveness of substance use disorder treatment as an alternative to imprisonment |
| title_full_unstemmed | Effectiveness of substance use disorder treatment as an alternative to imprisonment |
| title_short | Effectiveness of substance use disorder treatment as an alternative to imprisonment |
| title_sort | effectiveness of substance use disorder treatment as an alternative to imprisonment |
| topic | Substance use disorder Treatment Drug court Harm reduction Crime Incarceration |
| url | https://doi.org/10.1186/s12888-024-05734-y |
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