Annex H
THE EFFECTIVENESS OF DRUG TREATMENT PROGRAMMES
INTRODUCTION
1. For prisoners and probationers, as in
the community (outside the CJS), drug treatment can be very effective
both healthwise and in terms of reducing offending. Treatment
is not a panacea—as many drop out as complete courses of
treatment, and not all of those who complete do so successfully.
However, treatment is still highly cost-effective. A conclusion
from NTORS, the National Treatment Outcomes Research Study of
programmes in the community, is that for every extra £1 spent,
£3 is saved in terms of victimisation/crime and (to a much
lesser degree) the CJS.
DRUG TREATMENT
FOR PRISONERS
2. In the last few years, some 60 drug treatment
programmes have been established for prisoners in England and
Wales. There are now over 4,300 prisoner entrants to therapeutic
communities and rehabilitation programmes. With around 100,000
sentenced prisoners arriving/departing every year, this is still
a comparatively modest level of provision, given reasonable assumptions
about levels of need. Approximately three-quarters of prisoners
have used illicit drugs in the previous year before going to prison.
Of these, two-thirds (ie half of all prisoners) have used heroin,
cocaine or crack—the most costly and damaging drugs. Roughly
the same proportion considered themselves to have a drug problem
(Liriano & Ramsay, 2003, analysing the Criminality Survey
2000). However, while many prisoners reporting a drug problem
were interested in treatment, which is an important pre-requisite,
at least as many were not interested.
3. So, in conclusion, estimates for the
proportion of all newly-arrived prisoners who can usefully or
theoretically be targeted for treatment range from roughly 40%
(considering themselves to have a drug problem) to close to three-quarters
(recent drug users, but not necessarily using drugs on a regular
basis). This latter option is a less sensible one.
RESEARCH RESULTS
AND METHODOLOGIES
(DRUGS AND
OFFENDING BEHAVIOUR
PROGRAMMES)
4. Current models of evaluation typically
take the form of retrospective reconviction studies. These are
usually single-focus evaluations of individual programmes examined
in isolation. They do not explain why programmes work or fail
to work for different participants. There is a basic difficulty
in that prisoners generally have a multiplicity of needs, which
are best addressed holistically. In other words, both interventions
and their evaluations should ideally be multi-modal. It is also
fair to say that interventions do not necessarily work mechanistically—in
particular, they need to be followed up by further support or
after-care or additional treatment.
5. There is one drugs-evaluation for which
various published evaluations exist: the RAPt[10]
programme. Those studies are presented in Chapter 6 of Home Office
Research Study 267 (Prisoners' Drug Use and Treatment: Seven
Research Studies, 2003). Those evaluations show that RAPT
graduates achieved significant reductions in their drug use and
offending on their release, compared variously with their own
expected outcomes, or with other groups of broadly comparable
prisoners, or with those starting but not completing treatment.
These positive results are important in that RAPt is the longest-accredited
drug treatment programme for prisoners. They may partly reflect
the fact that RAPt places a strong emphasis on after-care, both
in prison and on release.
6. However, it is important to bear in mind
that such studies are not able to take account of "selection
bias", the fact that those electing for treatment may be
so strongly motivated that they are almost bound to perform better
than expected for offenders with their criminal careers. There
is another bias, in the opposite direction, that is also hard
to take account of: that when comparisons are made with groups
of broadly comparable offenders, these are not necessarily drug-using
offenders, yet given that drug-users have a worse prognosis on
release, this means that a relatively severe test is being imposed,
in this kind of evaluation.
7. The obvious alternative is random allocation
to (or not to) treatment as a precursor to any evaluation. However,
this faces ethical and practical difficulties that have proved
difficult in prisons (Farrington et al, 2002). More fundamentally,
random-controlled trials (RCTs) are typically conceived of as
single-issue evaluations—and the point has already been
made that there are limits to the value of any one intervention
or programme in isolation from other responses.
8. While there will always be a need to
do single-issue evaluations, which can be relatively cost-effective,
the North American research literature suggests that these should
ideally be complemented by at least a very occasional multi-modal
evaluation, carried out prospectively rather than retrospectively.
The value of such multi-modal studies, which are not cheap because
they involve repeated surveys of people both in custody and on
release as well as analysis of reconviction data, is that they
can take account of prisoners' different levels of motivation
and other relevant factors. There is even a sense in which some
of the value of RCTs can be embodied in multi-modal approaches:
prisoners with comparable motivation may not all get the same
opportunities to receive treatment.
THE BROADER
PICTURE: THE
VALUE OF
DRUG TREATMENT
IN THE
COMMUNITY
9. The value of a prospective, longitudinal
research study is helpfully illustrated by NTORS (National Treatment
Outcome Research Study), the first and only UK study of treatment
outcomes for problem drug users. Over 1,000 drug users were followed
for five years, during and after different types of treatment.
Substantial decreases in drug use were observed, as were important
reductions in acquisitive crime—particularly for heroin
users. As noted above, treatment was shown to be highly cost-effective.
10. The value of drug treatment in addressing
both drug use and offending is also confirmed by evaluations of
DTTOs (Drug Treatment and Testing Orders). The latest report (by
Hough et al, 2003) shows that, while only a third of those
probationers receiving this type of community punishment completed
their orders, their two-year reconviction rate (53%) was substantially
lower than the rate for those whose order was revoked (91%). The
authors concluded that, with DTTOs, the key to success lies in
retaining people on their orders.
10 Rehabilitation for Addicted Prisoners trust-a "12-Step"
drug treatment programme. Back
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