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Drug Treatment

Substance abuse is a major societal concern, most notably because of its frequent co-occurrence with crime. Estimates from the National Center on Addiction and Substance Abuse indicated that 80% of the 1.7 million individuals incarcerated in 1996 were also engaged in drug and/or alcohol abuse (Sanford & Arrigo, 2005). The number of individuals with drug charges sentenced to state prisons each year has increased dramatically from 9,000 in 1980 to 107,000 in 1998 (Hora, 2002). In 1996, individuals incarcerated for drug use accounted for 60% of the federal prison population, 23% of the state prison population, and 22% of the county jail population (Hora, 2002). In 1998, an estimated 417,000 jail inmates had committed a drug offense or used drugs regularly compared with 261,000 in 1989 (Wilson, 2000). Additionally, about 138,000 convicted jail inmates were under the influence of drugs at the time of their offense (Wilson, 2000). In 1990, the Federal Bureau of Prisons treated 441 people in the Residential Drug Abuse Program; by 2008, 17,523 offenders were receiving residential substance abuse treatment each year (Federal Bureau of Prisons, 2009). According to a report by The National Center on Addiction and Substance Abuse at Columbia University (2009), the federal government spent $238.2 billion on substance abuse and addiction, or 9.6% of the total federal budget. State governments spent $135.8 billion, while local governments spent a conservative $93.8 billion on services related to substance abuse and addiction.

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Incarceration and other nontreatment based management tactics (community-control, etc.) have done little to curb the drug abuse cycle. The Drug Court model, developed in 1989, was first implemented in Miami, Florida, to address the growing number of drug arrests resulting from the “war on drugs” (Sanford & Arrigo, 2005). Soon thereafter, Drug Courts began gaining traction as criminal justice officials realized that incarceration alone did not curb an offender's drug problem. Separate court dockets were adapted to allow treatment, supervision, regular court appearances, and random urine screenings (Sanford & Arrigo, 2005).

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Investigations of demographic characteristics associated with the successful drug treatment completion have yielded varying, often contradictory results. Success in urban Drug Courts was associated with being single, having full-time employment, having spent less time abusing drugs, and having fewer prior legal incidents, whereas, rural Drug Court completion was correlated with being older and having fewer juvenile incarcerations (Mateyoke-Scrivner, Webster, Staton, & Leukefeld, 2004). Hartley and Phillips (2001) found that being older, having more education, and maintaining employment during the Drug Court program were the only correlates associated with treatment completion; they observed no correlation between successful completion and gender, race, marital status, number of children, or drug of choice. Butzin et al. (2002) found treatment success to be correlated with higher levels of education, being Caucasian, maintaining employment, and less frequent substance use; however, the authors noted that past studies often found no significant differences in these variables. These results suggest that whereas the overall success of the Drug Court model is well documented, the degree of success can vary widely as a factor of individual characteristics and circumstances.

Compared with demographic variables, little is known about the psychological factors related to Drug Court completion. However, research has indicated a number of psychological and personality traits associated with completion (or failure) in other treatment programs or settings (Lang & Belenko, 2000). One of the most frequently researched constructs associated with failure to complete treatment is antisocial personality disorder (APD) and its related features such as acting-out, sensation seeking, risk taking, and impulsivity. Although an association between APD and failure to complete might be expected in light of the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, the empirical literature has been mixed. Lang and Belenko (2000) reported that residential drug treatment participants who engaged in antisocial behaviors, including lower levels of social conformity and connectedness, were more likely to drop out of treatment. Additionally, individuals who dropped out of treatment had an earlier onset of substance abuse, more felony convictions, higher levels of risk-taking, and the increased difficulty controlling violent behaviors (Lang & Belenko, 2000). APD has also been shown to be associated with poorer outcomes in community-based treatment facilities (Marlowe et al., 1997). Specifically, in a multiple regression, individuals diagnosed with APD completed fewer sessions in treatment (β = –.44, p = .005). More generally, personality traits commonly associated with APD, including impulsivity, affective lability, egocentricity, and externalizing proclivity, were the indicative of fewer total weeks of treatment enrollment and the total number of clean urine samples (Marlowe et al., 1997). However, in other studies (McKay, Alterman, Cacciola, Mulvaney, & O'Brien, 2000; McKay, Alterman, McLellan, & Snider, 1994), investigators have not found an association between APD and substance abuse treatment completion.

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Gilmore, Lash, Foster, and Blosser (2001) examined the Addiction Acknowledgement Scale (AAS) and Negative Treatment Indicators (TRT) scales in predicting completion of a 28-day residential drug treatment program. The researchers found the AAS had no predictive value in regards to treatment; however, the TRT scale showed a significant negative correlation with treatment completion. Higher TRT scale scores were associated with a reduced likelihood of returning to treatment after original screening having fewer days in treatment, poorer participation and motivation, and less retention of program material (Gilmore et al., 2001).

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