A Meta-Analytic Examination of Drug Treatment Courts: Do They Reduce Recidivism?

1. Introduction

Drug treatment courts (DTCs) aim to reduce crime committed as a result of illicit drug dependency through court-monitored treatment and community service support for offenders with substance abuse problems. Participants are generally referred to DTC programs through a number of sources, such as the courts or Crown prosecutors, and must meet a set of eligibility requirements (e.g., serious drug use, non-violent offences). As part of their treatment, DTC participants typically attend counselling sessions through a structured out-patient program (although some may attend in-patient programs) and are typically subject to random drug tests during the program. Participants must also appear regularly in court, where a judge reviews their progress and often imposes sanctions for negative behaviour (e.g., verbal reprimands, incarceration, expulsion from the program) or provides rewards for positive behaviour (e.g., verbal commendations, reductions in the frequency of court contact). DTC staff in many programs also work with community partners to address participants’ other needs, such as safe housing, stable employment and vocational skills training. Once a participant gains stability and demonstrates control over the substance abuse problems, criminal charges may be stayed or, in some cases, the offender may receive a non-custodial sentence. If unsuccessful, an offender will usually be sentenced as part of the regular court process.

The first formal DTC in Canada was established in Toronto in 1998, followed by a second court in Vancouver in 2001. As part of its commitment under Canada’s Drug Strategy to expand drug treatment courts in Canada, the federal government announced in 2005 that additional funding would be provided to establish four additional courts in Edmonton, Regina, Winnipeg and Ottawa. In the United States, there are a substantial number of DTCs operating within many states.

Despite the popularity and intuitive appeal of DTCs, it is crucial to fully evaluate the effectiveness of such an approach, particularly as the cost of using the courts as a social control mechanism is relatively high. The main goal of DTCs is to reduce substance use and subsequently reduce criminal behaviour which is committed as a result of the substance abuse. There have been numerous evaluations of individual DTCs, and the results have varied considerably. Fielding, Tye, Ogawa, Imam and Long (2002), for example, reported that participation in a drug treatment court was associated with significant reductions in recidivism compared to participation in the traditional court process, while Meither, Lu and Reese (2000) reported that DTC participation was associated with an increase in recidivism.

Given that there are a relatively high number of drug treatment court evaluations and that the results are difficult to interpret individually, this body of empirical knowledge would need to be aggregated. Summarizing this research through standard narrative approaches (e.g., literature review, annotated bibliography), however, would perhaps not analyze the available data objectively and might lead to inappropriate conclusions. In order to objectively summarize this body of research, a meta-analysis was selected as the most appropriate method.

A meta-analysis can be understood as a statistical analysis of a collection of studies that aggregates the magnitude of a relationship between two or more variables (Glass, McGaw & Smith, 1981). Meta-analytic statistics can describe the typical strength of the effect under investigation (i.e., change in recidivism as a result of DTC participation), the degree of statistical significance, and the variability, and can provide an opportunity to explore and identify potential moderating variables. The outcome of a meta-analysis is an effect size estimate (ESE), which can be interpreted as the estimated effect of the independent variable on the dependent variable. For example, an average effect size estimate of +0.10 translates into the independent variable accounting for a 10% change in the dependent variable (Rosenthal, 1991).

Meta-analytic reviews are generally regarded as a superior method of research synthesis compared to traditional narrative reviews as the former are "more systematic, more explicit, more exhaustive, and more quantitative" (Rosenthal 1991, p. 17). Critics argue, however, that one of the major limitations of meta-analytic techniques is that the sampling procedures are biased in favour of including predominantly published studies. It is surmised that, since the probability of publishing a study is increased by the statistical significance of the results, published studies are not actually representative of the entire body of research that has been conducted in a given area. Consequently, a calculated effect size, based exclusively on published studies, may be overestimating the relationship. Coined the "file drawer problem" (Rosenthal, 1991, p. 103), this suggests that if unpublished studies were included in the meta-analysis, the effect size estimate would be smaller. In order to counter this issue, unpublished articles, governmental and non-governmental reports, and student papers were sought in the present meta-analysis.