An overview of diversion strategies for Australian drug-related offenders

Exploring Reasons for Non-Engagement From a Peer-Led Diversionary Intervention for Veterans in Police Custody

UK veterans with complex needs arrested in police custody can access support through pre-charge diversion into treatment and ancillary services. We consider why veterans in police custody disengaged from a peer-led criminal justice diversionary support service in one UK region that adopted a continuous case management approach. Seven hundred and fifty-seven veterans were assessed to have high levels of comorbid health needs and socio-economic harms, with one-quarter (26.7%, n = 202) subsequently disengaging from the service. A logistic regression model using Multivariate Imputation by Chained Equations identified that veterans of a younger age, no-fixed-abode, a history of incarceration, and those from a Royal Navy background were likelier to disengage from the intervention. We conclude that this peer-based diversionary model has some efficacy in maintaining the engagement of a highly complex, comorbid segment of criminally-justice-exposed UK military veterans. The perceived benefits of an integrated peer-based model predicated on continuous case-management techniques are discussed.

Criminal reactions to drug-using offenders: A systematic review of the effect of treatment and/or punishment on reduction of drug use and/or criminal recidivism

The association between substance use and crime is very common, but complex. Several countries have found strategies to face drug abuse and criminality that may exist associated to it, seeking to reduce overcrowded prisons and to promote the reductions of criminal recidivism and/or substance use. Through the guidelines of PRISMA, a systematic review was conducted with the aim to explore the different criminal reactions to individuals who use substances and are involved in the criminal justice system, namely the role of treatment and/or punishment in the reduction of crime recidivism and/or drug (ab)use. After gathering the following criteria of inclusion (individuals who use substances and are involved in the criminal justice system, between 18 and 65 years old, regardless of gender; consumers of licit/illicit psychoactive substances; without psychopathology not related with use/abuse of drugs; treatment programs; judicial interventions) the database found 155 articles between 1971 and 2022 from which 110 were selected for analysis (57 are from Academic Search Complete, 28 from PsycInfo, 10 from Academic Search Ultimate, seven from Sociology Source Ultimate, four from Business Source Complete, two from Criminal Justice Abstracts, and two from PsycArticles); additional records were included trough manual search. From these studies, 23 articles were included, as they answered the research question, and therefore, constitute the final sample of this revision. The results indicate treatment as an effective response of the criminal justice system in the reduction of criminal recidivism and/or drug use, addressing the criminogenic effect of reclusion/imprisonment. Therefore, interventions that privilege treatment should be chosen, although there are still gaps in terms of evaluation, monitoring and scientific publications regarding the effectiveness of treatment in this population.

Pre-Arrest/Booking Drug Control Strategies: Diversion to Treatment, Harm Reduction and Police Involvement

Elements of a “pluralized” drug policy have been emerging in the United States that attempt to augment punishment with an emphasis on enhanced public health and therapeutic measures. While much of this reform involves compulsory treatment diversion, a “middle ground” to reform has involved the use of pre-arrest/booking strategies in support of harm reduction policies and noncompulsory treatment diversion. In this examination of the cities of Baltimore and San Francisco, we argue that such strategies have proven problematic because of the contradictions inherent in pluralized drug control models that attempt to reconcile abstinence and prohibitions against drug use with tolerance and outreach. We identify two primary factors contributing to these contradictions. The first is an emphasis on compulsory treatment diversion mechanisms in the United States, and in the obverse, disagreements over the wisdom of harm reduction in drug policy reform. The second are limitations on the policing role in social outreach, or what we call here “reintegrative” community policing, involving both organizational factors on the part of law enforcement and resistance from community activists and public health agencies.

Ethical Implications in Vaccine Pharmacotherapy for Treatment and Prevention of Drug of Abuse Dependence

Different immunotherapeutic approaches are in the pipeline for the treatment of drug dependence. "Drug vaccines" aim to induce the immune system to produce antibodies that bind to drugs and prevent them from inducing rewarding effects in the brain. Drugs of abuse currently being tested using these new approaches are opioids, nicotine, cocaine, and methamphetamine. In human clinical trials, "cocaine and nicotine vaccines" have been shown to induce sufficient antibody levels while producing few side effects. Studies in humans, determining how these vaccines interact in combination with their target drug, are underway. However, although vaccines can become a reasonable treatment option for drugs of abuse, there are several disadvantages that must be considered. These include i) great individual variability in the formation of antibodies, ii) the lack of protection against a structurally dissimilar drug that produces the same effects as the drug of choice, and iii) the lack of an effect on the drug desire that may predispose an addict to relapse. In addition, a comprehensive overview of several crucial ethical issues has not yet been widely discussed in order to have not only a biological approach to immunotherapy of addiction. Overall, immunotherapy offers a range of possible treatment options: the pharmacological treatment of addiction, the treatment of overdoses, the prevention of toxicity to the brain or the heart, and the protection of the fetus during pregnancy. So far, the results obtained from a small-scale experiment using vaccines against cocaine and nicotine suggest that a number of important technical challenges still need to be overcome before such vaccines can be approved for clinical use.

The Magistrates Early Referral Into Treatment (MERIT) Pilot Program: Court Outcomes and Recidivism

Diversion programs for drug offenders have proliferated in the last decade in the belief that treatment of underlying drug use will decrease an individual's criminal activity. The NSW Magistrates Early Referral Into Treatment (MERIT) program diverts adult offenders with significant drug problems, on bail, from the court to a 3-month intensive drug treatment program. This article reports on the criminal justice outcomes of the Lismore MERIT Pilot Program. Findings indicate that participants who completed the program were significantly less likely to reoffend, took longer to reoffend and received less severe sentences than those who did not complete the program. The reduction in reoffending is significantly associated with program completion even when other factors associated with recidivism are controlled for, including previous incarceration. Overall these findings contribute to the growing literature indicating that providing treatment for offenders with illicit drug problems can be an effective crime reduction strategy.

Vaccines against drug abuse

The currently available medications for the treatment of drug abuse have had only limited success. Anti-addiction vaccines, aimed at eliciting antibodies that block the pharmacological effects of drugs, have great potential for treating drug abuse. We review the status of two vaccines that are undergoing clinical trials (for cocaine and nicotine addiction) and two that are still in preclinical development (for methamphetamine and heroin addiction). We also outline the challenges and ethical concerns associated with the development of anti-addiction vaccines and their use as future therapeutics.

Ethical and policy issues in using vaccines to treat and prevent cocaine and nicotine dependence

PURPOSE OF REVIEW

To describe the rationale of vaccines against cocaine and nicotine, to review progress in developing and trialing vaccines to treat dependence on these drugs and to discuss some of the ethical issues that may arise from their use in legally coerced addiction treatment or for prevention of addiction in adolescents.

RECENT FINDINGS

Several randomized controlled trials of cocaine and nicotine vaccines for relapse prevention have produced mixed results. The studies demonstrate that it is possible to raise antibodies to cocaine and nicotine in humans. In abstinent patients who show high levels of drug antibodies, the rewarding effects of these drugs are attenuated. Phase 2 trials have not found nicotine vaccines to be superior to placebo because only a third of those vaccinated develop sufficient levels of antibody to block the effects of nicotine.

SUMMARY

Vaccines are a novel approach to relapse prevention that need to more reliably induce immunity in a larger proportion of vaccinated patients if they are to protect against relapse after achieving abstinence. Vaccines are unlikely to prevent addiction in adolescents. Their use under legal coercion should only be considered after considerable experience with their use in voluntary patients.

The efficacy of diversion and aftercare strategies for adult drug-involved offenders: a summary and methodological review of the outcome literature

Diversion strategies aim to redirect drug-involved offenders away from the criminal justice system and into treatment. Despite the interest in diversionary practices, the emergence of an empirical evaluation literature has been slow. A methodological review of published outcome studies was conducted to investigate the current strength of evidence for the efficacy of diversion and aftercare practices for criminal offenders. Twenty outcome studies were identified for review: 19 on diversion and one on aftercare. The vast majority of studies were non-randomised evaluations, reflecting the paucity of rigorous evaluation work in this area. Although most studies were prospective, very few reported on long-term outcomes following treatment. Detail was lacking with regard to basic study characteristics, such as eligibility criteria and outcomes. Despite these methodological shortcomings, results provide some tentative evidence that diversion and aftercare programmes could be effective. Best practice elements of diversion and aftercare programmes are identified and feasible strategies to improve the methodological quality of future evaluations are considered.

Evidence-based policy or policy-based evidence? The role of evidence in the development and implementation of the Illicit Drug Diversion Initiative

ISSUES

Evidence-based policy is promoted as the ideal in drug policy, yet public policy theorists suggest that policy-based evidence may be a more fitting analogy, where evidence is used selectively to support a predetermined policy direction. The following paper assesses the resonance of this notion to the development of the Illicit Drug Diversion Initiative (IDDI), an apparently pragmatic reform adopted in Australia in 1999 through the Federal Coalition 'Tough on Drugs' strategy. It utilises interviews with key informants from the Australian drug policy arena conducted in 2005 to assess the role of evidence in the design and implementation of the IDDI.

KEY FINDINGS

The current paper shows that while policy-makers were generally supportive of the IDDI and viewed drug diversion as a more pragmatic response to drug users, they contend that implementation has suffered through a selective and variable emphasis upon evidence. Most notably, the IDDI is not premised upon best-practice objectives of reducing harm from drug use, but instead on 'Tough on Drugs' objectives of reducing drug use and crime.

IMPLICATIONS

This paper contends that policy-based evidence may facilitate the adoption of pragmatic reforms, but reduce the capacity for effective reform. It therefore has both functional and dysfunctional elements. The paper concludes that greater attention is needed to understanding how to mesh political and pragmatic objectives, and hence to maximise the benefits from policy-based evidence.

The Magistrates Early Referral Into Treatment (MERIT) Pilot Program: a descriptive analysis of a court diversion program in rural Australia

There has been a rapid expansion of drugs courts and diversion programs in Western countries, with the aim of diverting drug offenders into treatment. This study presents data from a rural pre-plea court-based diversion into treatment program for adult defendants appearing at a Local (Magistrate's) Court who have significant illicit drug problems. Unusual features include the intended duration of treatment (three months), and the emphasis on specialised caseworkers, who provide case management services, intensive individual counseling and group therapy sessions, and attend court, providing detailed legal reports. In the first two years, 238 participants were recruited to 266 program episodes. The participants were mostly recidivist offenders, with 61% having been previously imprisoned, and 85% having at least one prior conviction. Half the participants completed the program. Characteristics significantly associated with program completion were principal drug of concern (heroin/amphetamines vs. cannabis/other, OR = 0.4 [95% CI: 0.2, 0.7]), Aboriginality (Aboriginal vs. not, OR = 0.4 [95% CI: 0.2, 0.9]) and accommodation (privately owned vs. other, OR = 2.5 [95% CI: 1.3, 4.7]). Participants identified the caseworker support as the most important element of the program. We conclude that the program was successfully implemented, and that adequately supported skilled caseworkers were critical to its success.

Social control and coercion in addiction treatment: towards evidence-based policy and practice

BACKGROUND

Social pressures are often an integral part of the process of seeking addiction treatment. However, scientists have not developed conclusive evidence on the processes, benefits and limitations of using legal, formal and informal social control tactics to inform policy makers, service providers and the public. This paper characterizes barriers to a robust interdisciplinary analysis of social control and coercion in addiction treatment and provides directions for future research.

APPROACH

Conceptual analysis and review of key studies and trends in the area are used to describe eight implicit assumptions underlying policy, practice and scholarship on this topic.

FINDINGS

Many policies, programmes and researchers are guided by a simplistic behaviourist and health-service perspective on social controls that (a) overemphasizes the use of criminal justice systems to compel individuals into treatment and (b) fails to take into account provider, patient and public views.

CONCLUSIONS

Policies and programmes that expand addiction treatment options deserve support. However, drawing a firm distinction between social controls (objective use of social pressure) and coercion (client perceptions and decision-making processes) supports a parallel position that rejects treatment policies, programmes, and associated practices that create client perceptions of coercion.

Quasi-compulsory treatment of drug dependent offenders: an international literature review

This paper reports on a review of the literature on the quasi-compulsory treatment (QCT) of drug dependent offenders in five languages; English, German, French, Italian and Dutch. The findings of this review on previous reviews and on the availability, process, and outcomes of QCT are summarized. The review found that previous, anglophone reviews have tended to present positive outcomes from QCT, but that there are some problems with this research. QCT is increasingly available internationally, but may be applied at different stages of the criminal justice process, and to different types of offender. Research on the process of QCT is comparatively rare. The available research does suggest problems of system integration between criminal justice and treatment agencies in implementing QCT. The research in languages other than English shows a wider range of outcomes (including negative effects) for QCT than was found in the English literature. We conclude that the international literature shows that QCT does not inevitably produce worse outcome than voluntary treatment, but that we need more multimethod, multisite studies of QCT in order to inform policy and practice, which is currently being made in the absence of reliable evidence in many countries.

Neuroscience research on the addictions: a prospectus for future ethical and policy analysis

The increasing evidence that many addictive phenomena have a genetic and neurobiological basis promises improvements in societal responses to addiction that raise important ethical and social policy issues. One of the major potential benefits of such research is improved treatment of drug addiction, but in order to do the research required to realize this promise, it will be necessary to address ethical doubts raised about the capacity of addicted persons to give free and informed consent to participate in studies that involve the administration of drugs of dependence. Neuroscience research on addiction promises to transform the long running debate between moral and medical models of addiction by providing a detailed causal explanation of addiction in terms of brain processes. We must avoid causal models of addiction being misinterpreted as supporting simple-minded social policies, e.g., that we identify the minority of the community that is genetically and biologically vulnerable to addiction and hence can neglect social policy options for reducing addiction, including drug control policies. Causal accounts of addiction supplied by neuroscience and genetic research may also be seen to warrant the use of pharmacotherapies and drug vaccines under legal coercion. Neuroscientists also need to anticipate the ethical issues that may arise if the knowledge that they produce delivers interventions that enhance human cognitive and other capacities. Advances in neuroimaging that enable us to identify "addicts" or predict future risk of addiction will raise concerns about invasion of privacy, third-party use of neuroimaging data, the powers of courts to coerce defendants to undergo such tests, and consumer protection against the overinterpretation of test results. Given the strong public and media interest in the results of their research, neuroscientists and geneticists have a moral obligation, and a professional interest, to minimize popular misunderstandings of their work in the media that may rebound to its detriment.

Magistrates' Early Referral into Treatment (MERIT): preliminary findings of a 12-month court diversion trial for drug offenders

The purpose of this paper is to present a description and preliminary findings of a 12-month trial of a Local Court diversion programme, called MERIT for Magistrates' Early Referral into Treatment. The aim of MERIT is to divert eligible drug offenders to treatment and rehabilitation services. A total of 172 offenders were assessed and 131 entered the programme. The sources of referral were court (58%), police (17%) and self (10%). Main problem drugs were heroin (57%), cannabis (21%) and amphetamines (11%). The majority (85%) had previous convictions and 50% had been in jail. At the end of the trial period one-third (33%) completed the programme and one-third (33%) remained in treatment. Main treatment interventions were case management and out-patient counselling, detoxification, residential rehabilitation and methadone maintenance. Police records showed that of the original 43 (33%) graduates only six had come to police notice, mainly for relatively minor offences. Early acceptance and preliminary results has led to an expansion of the MERIT programme across New South Wales. With the rapid expansion of drug courts and diversion programmes across Australia, descriptive studies are useful to provide beneficial data to assist policy makers and service providers to develop programmes.