The influence of legal coercion on dropout from substance abuse treatment: Results from a national survey

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Abstract

Legal coercion is frequently used to leverage substance abuse treatment upon persons who would otherwise not seek it voluntarily. Various methodological and conceptual problems of the existing research have prevented a clear understanding of its effectiveness. The influence of legal coercion on retention in substance abuse treatment was examined using a national survey of programs in the public sector of care and three different treatment modalities including short-term residential (N=756), long-term residential (N=757), and outpatient treatment (N=1181). Legal coercion was found to reduce the risk of dropout across all three treatment modalities. The greatest effect was among persons in short-term residential treatment. The smallest effect was observed in outpatient treatment. This study shows that legal coercion significantly reduces the risk of dropout in substance abuse treatment. However, the differential effects across treatment conditions must be carefully considered when using coercion to involve individuals in treatment.

Section snippets

Background

Legal coercion is a common method for leveraging substance abuse treatment among people who would otherwise not participate voluntarily. It involves legally compelling an individual to participate in treatment as an alternative to another type of sanction, such as incarceration Hough, 2002, Miller and Flaherty, 2000. The practice of coercion reflects a desire on the part of the criminal justice system to provide treatment to substance users, with the idea that this approach can reduce

Sample

The NTIES was conducted by the National Opinion Research Center (NORC) in collaboration with the Research Triangle Institute. The NTIES was based on a universe of 698 service delivery units (SDUs) which are defined as one treatment modality provided at a single site (Gerstein et al., 1997). Hereafter, SDUs are referred to as “treatment programs”. The NTIES treatment modalities included methadone, outpatient non-methadone, short-term residential, long-term residential, and corrections.

The NTIES

Sample characteristics

Table 1 summarizes the sample characteristics by treatment modality. In general, the clients in these data were unmarried males, approximately 30 years of age with slightly less than a high-school education. Most subjects had a history of substance abuse treatment, and either alcohol or cocaine was the primary drug for their current treatment episode. Subjects had a high overall number of service needs (means between 4.5 and 5.5 services needed), and approximately one-third of the service needs

Discussion

This study contributes to the existing literature on the effects of legal coercion on treatment retention. It utilized one of the most comprehensive data sources on publicly funded substance abuse treatment services. The results of this study generalize to substance abuse treatment programs in the publicly funded community programs. This study does not generalize to clients in private tier programs.

The results indicate that legal coercion is associated with a reduced risk of treatment dropout

Disclosure statement

Funding for this study was provided by NIDA Grant (F31 DA 022801-01) awarded to the first author. The NIDA had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication. The first author led the design of the study and undertook the statistical analysis. The second author also contributed to the study design and managed the literature searches and summaries of previous related

Conflict of interest

None.

Acknowledgements

The authors would like to thank two anonymous reviewers of this journal who provided very thoughtful suggestions and comments to improve the manuscript.

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