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62 Fed. Probation 3 (1998)
The Effectiveness of Coerced Treatment for Drug-Abusing Offenders

handle is hein.journals/fedpro62 and id is 5 raw text is: The Effectiveness of Coerced Treatment for Drug-Abusing Offenders By DAVID FARABEE, MICHAEL PRENDERGAST, AND M. DOUGLAS ANGLIN* Background RIMINAL JUSTICE referrals constitute a sub- stantial proportion of the publicly funded drug treatment population m the United States. Ac cording to recent data, the criminal justice system is re- sponsible for 40 to 50 percent of referrals to community- based treatment programs (Maxwell, 1996; Price & D'Aunno, 1992; Spiegelman, 1984; Weisner, 1987). Given our nation's high proportion of criminal justice treatment clients, a major policy and program issue in drug treatment is the effectiveness and appropriate- ness of coercing offenders to enter and remain in treat ment. This article provides an overview of studies re- garding the effectiveness of various levels of coerced treatment and concludes with a number of treatment and policy implications. Some researchers (Hartjen, Mitchell, & Washburne, 1981, Platt, Buhnnger, Kaplan, Brown, & Taube, 1988; Rosenthal, 1988) have argued that little benefit can be derived when a drug user is forced into treatment by the criminal justice system. Some oppose coerced treat ment on philosophical or constitutional grounds. Oth- ers argue against coerced treatment on clinical grounds, maintaining that treatment can be effective only if the person is truly motivated to change; a varia- tion of this position is that addicts must hit bottom before they are able to benefit from treatment, a cir cumstance that is not true of most coerced clients. Ac cording to this view, it is a poor investment to devote re- sources to individuals who are unlikely to change because they have little or no motivation to change. Furthermore, in situations where treatment slots are limited, it may also violate notions of distributive jus- tice to provide treatment to addicts who don't really want it--even if they might benefit from it-ahead of (or instead of) those who do desire treatment. Other researchers (Anglin & Maugh, 1992; Salmon & Salmon, 1983) have argued that few chronic addicts *The authors all are with the UCLA Drug Abuse Research Center. Dr. Farabee is an assistant research psychologist, Dr. Prendergast is an associate research historian, and Dr. An- glin is the director. A version of this article was presented and distributed at the Office of National Drug Control Policy's Conference of Scholars and Policy Makers, Washington, DC, March 23-25, 1998. The authors wish to acknowledge Dana Baldwin, Ph.D., for her valuable contributions in preparing the manuscript. will enter and remain in treatment without some ex ternal motivation and that legal coercion is as justifi- able as any other motivation for treatment entry. It also has been argued that because controlling drug abuse and addiction benefits society as a whole, the criminal justice system should bring drug-abusing offenders into treatment to safeguard and promote the interests and well-being of the community (Anglin, 1988; Anglin & Hser, 1991). But consideration of legal and ethical questions surrounding coerced treatment do not arise unless it can be demonstrated that coerced treatment is effective and that resources spent on coerced clients do produce desirable results. Answering the question regarding the effectiveness of coerced treatment is by no means straightforward. A number of conceptual issues need to be addressed in order to design meaningful empirical studies or to in- terpret existing studies appropriately. Two issues of particular importance are the definition of coerced treatment and the interaction of coercion (external pressure) and motivation (internal pressure). The terminology used to discuss coerced treatment is far from consistent: coerced, compulsory, man- dated, involuntary, legal pressure, and criminal justice referral are all used in the literature; some- times the terms are used interchangeably within the same article. This would not be a problem if these terms were synonyms. But coercion is not a single well-defined entity- it in fact represents a range of op- tions of varying degrees of seventy across the various stages of criminal justice processing. Coercion can be used to refer to such actions as a probation officer's rec- ommendation to enter treatment, a drug court judge's offer of a choice between treatment or jail, a judge's re- quirement that the offender enter treatment as a con- dition of probation, or a correctional policy of sending inmates involuntarily to a prison treatment program in order to fill the beds. In other cases, a treatment client's merely being involved with the criminal justice sys- tem is sufficient for him to be brought under the um- brella of coercion. Coercive treatment approaches for drug addiction have been applied consistently throughout the twenti- eth century, beginning with the morphine maintenance clinics in some communities during the 1920s. The 1930s marked the establishment of the federal nar cotics treatment facilities in Fort Worth, Texas, and Vol. 62, No. I

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