- Email: [email protected]
Drug court treatment for methamphetamine dependence: Treatment response and posttreatment outcomes
Journal of Substance Abuse Treatment 34 (2008) 242 – 248
Regular article
Drug court treatment for methamphetamine dependence: Treatment response and posttreatment outcomes Patricia Marinelli-Casey, (Ph.D.)a,4, Rachel Gonzales, (M.P.H.)a, Maureen Hillhouse, (Ph.D.)a, Alfonso Ang, (Ph.D.)b, Joan Zweben, (Ph.D.)c, Judith Cohen, (Ph.D., M.P.H.)c, Peggy Fulton Hora, (J.D.)d, Richard A. Rawson, (Ph.D.)a, Methamphetamine Treatment Project Corporate Authors1 a
Integrated Substance Abuse Programs, University of California, Los Angeles, CA 90025, USA b David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA c East Bay Community Recovery Project, Hayward, CA, USA d Superior Court of California, Hayward, CA, USA Received 3 November 2006; received in revised form 7 March 2007; accepted 5 April 2007
Abstract Relatively little is known about the impact of drug court treatment programs for methamphetamine (MA) dependence. This article examines treatment performance among a subsample of 287 MA-dependent adults who participated in the Methamphetamine Treatment Project from 1999 to 2001. To gain a preliminary indication of MA users’ response to drug court intervention, we compared a group of 57 MA-dependent participants treated in outpatient treatment within the context of a drug court to a group of comparable MA-dependent individuals treated in outpatient treatment but not supervised by a drug court (n = 230). Analyses reveal that drug court participation was associated with better rates of engagement, retention, completion, and abstinence, compared to outpatient treatment without drug court supervision. Six- and 12-month outcome analyses indicated that participants who were enrolled in drug court intervention used MA significantly less frequently. These findings suggest that drug court supervision coupled with treatment may improve the outcomes of MAdependent offenders beyond that seen from treatment alone. D 2008 Published by Elsevier Inc. Keywords: Drug court treatment; Methamphetamine; Treatment response and outcomes; Matrix Model
1. Introduction Methamphetamine (MA) dependence is a growing problem in many parts of the United States, overwhelming the resources and infrastructures of substance abuse treatment and criminal justice systems. According to national treatment trend data, more than three fourths of western The contents are solely the responsibility of the authors and do not necessarily represent the official views of the agency. 4 Corresponding author. 1640 South Sepulveda Boulevard, Suite 200, Los Angeles, CA 90025, USA. Tel.: +1 310 445 0874x310; fax: +1 310 312 0538. E-mail address: [email protected] (P. Marinelli-Casey). 1 Acknowledgments detail Corporate list. 0740-5472/08/$ – see front matter D 2008 Published by Elsevier Inc. doi:10.1016/j.jsat.2007.04.005
states have higher rates of MA/amphetamine-related treatment admissions than cocaine- or heroin-related admissions (Rawson et al., 1995; Substance Abuse and Mental Health Data Archive, 1992). There have also been increased numbers of incarcerations and other problems within the criminal justice system among MA-dependent individuals, which corresponds to the linkage between MA dependence and illegal behaviors (Farabee, Prendergast, & Cartier, 2002). In fact, since 2002, the criminal justice system has been the number one referral source for MA treatment (Center for Substance Abuse Research, 2006). Current challenges associated with MA have stimulated much attention about understanding treatment effectiveness for MA dependence.
P. Marinelli-Casey et al. / Journal of Substance Abuse Treatment 34 (2008) 242–248
There has been a growing body of treatment outcome studies specific to assessing the effectiveness of treatment for MA. Together, findings from a diverse group of studies provide considerable evidence that treatment works for MA users, as these treatment participants consistently respond positively to treatment (e.g., Brecht, Greenwell, & Anglin, 2005; Cretzmeyer, Sarrazin, Huber, Block, & Hall, 2003; Gunter, Black, Zwick, & Arndt, 2004; Hser, Evans, & YuChuang, 2005; Hser, Yu-Chuang, Chou, & Anglin, 2003; Maglione, Chao, & Anglin, 2000a, 2000b; Rawson et al., 2002; Roll et al., 2006). Roll et al. (2006), for example, have recently demonstrated that the addition of a contingency management (CM) protocol significantly reduces MA use during the application of CM procedures, with participants concurrently receiving outpatient drug counseling. Rawson et al. (2006) have similarly found that the application of a CM protocol, as compared to cognitive–behavioral therapy treatment, can substantially reduce psychostimulant use (cocaine and MA) during treatment. In the largest randomized clinical trial conducted to date examining treatment for MA at eight outpatient sites, the Methamphetamine Treatment Project (MTP) funded by the Center for Substance Abuse Treatment found that the multielement Matrix Model produced superior retention and MA use reductions during the treatment period (as measured by urinalysis) when compared to treatment as usual (TAU) (Rawson et al., 2004). In this study, participant performance among those treated with the Matrix Model was statistically superior to the TAU condition in six of the eight sites. In one of the two sites in which there was no difference in treatment response between the two conditions, all participants were enrolled in a drug court program. This was the only site where participants were in treatment as a result of a drug court mandate, as all other sites recruited individuals who voluntarily enrolled in treatment or were referred to treatment as a condition of probation. It has been suggested that drug courts may be an effective tool for promoting successful treatment outcomes with MA-dependent adults (Huddleston, 2005). Drug courts are governed by a number of principles known as key components (National Association of Drug Court Professionals, 1997; Turner et al., 2002). Among these components are: integration of treatment with criminal case processing; early identification and prompt placement of eligible individuals into the program; provision of a continuum of services; alcohol and other drug testings; and ongoing judicial interaction. Each court has its own admission criteria and graduation regime. Currently, there are no data available on the treatment response of MA-dependent individuals within a drug court setting. To address this gap, we felt that because the Center for Substance Abuse Treatment MTP study provided one site in which MA-dependent individuals were treated with a drug court intervention, it would be possible to gain preliminary information on the treatment performance of MA users
243
within a drug court treatment program. The purpose of this article is to examine the treatment response of MA-dependent individuals who were enrolled in an MTP drug court intervention in California (n = 57). To provide a frame of reference, we compare participants from the drug court treatment site with a subsample of other MA-dependent MTP participants from four California treatment sites (n = 230), all of whom received Matrix Model treatment. Examined are differences in baseline sociodemographic factors, drug use severity, treatment response (i.e., immediate treatment dropout, retention, in-treatment drug use, and completion), and psychosocial and drug use outcomes at follow-up points. This article was not designed as a controlled evaluation of drug court intervention for MA dependence; rather, it is a detailed examination of the treatment response of MA-dependent adults within the conditions of one drug court program. We hope that this article provides a preliminary perspective on the treatment outcomes of MA-dependent adults who are treated within the context of a drug court intervention.
2. Methods 2.1. Participants and sites The present study, conducted between 1999 and 2001, uses a nonrandomized comparison group design that utilizes a subset of data from the MTP. To reduce heterogeneity in treatment content across participants, the subsample selected consists of those participants who received the Matrix Model of treatment only and excludes those who were assigned to the TAU condition. In addition, because we are particularly interested in examining treatment response among drug court participants, we created two groups: (1) MA-dependent participants receiving Matrix Model treatment (n = 57) at the sole MTP drug court site in California, and (2) a comparison group of MA-dependent participants who received treatment with the Matrix Model (n = 230) under nondrug court conditions at four other California sites. The comparison group (nondrug court) was created from four treatment sites and included participants with patient characteristics and drug use patterns similar to those of the drug court group. All four of these sites were located in California. The three sites that were excluded from the analysis had a predominately female population, had a higher percentage of intravenous drug users, and were located in other states. The decision to use a subsample of MTP sites allows an appropriate comparison between similar sample groups to illuminate potential differences between drug court participants and nondrug court participants. 2.2. Procedures As part of the multisite MTP trial, individuals were eligible for study participation if they met Diagnostic and
244
P. Marinelli-Casey et al. / Journal of Substance Abuse Treatment 34 (2008) 242–248
Statistical Manual of Mental Disorders, Fourth Edition criteria for MA dependence; used MA in the month before treatment entry; were proficient in the English language; were z18 years old; and resided in the same geographical location as the treatment facility, as defined by a reasonable driving distance not exceeding a 45-minute commute. All study participants received intensive outpatient treatment for MA dependence using the Matrix Model. Data were collected at baseline (the week before treatment entry), weekly during treatment, at discharge, and at 6 and 12 months following treatment admission. Scheduled data collection was completed at an acceptable rate, as 80.9% of participants completed the discharge interview, 84.8% completed the 6-month follow-up interview, and 84.5% completed the 12-month interview. The study was conducted under the review and approval of the Institutional Review Board (IRB) of the University of California, Los Angeles, as well as the local IRB for each participating treatment site. 2.2.1. Matrix Model The 16-week multicomponent treatment approach has been organized into a manualized protocol that includes cognitive–behavioral group counseling delivered thrice a week, 12 sessions of family education groups, 4 sessions of social support groups, and 4 sessions of individual counseling. These sessions are combined with weekly urine screening for illicit drugs, including cocaine, MA, opiates, cannabis, and benzodiazepines (Obert, McCann, Brethen, Marinelli-Casey, & Rawson, 2000). 2.2.2. Drug court condition Matrix Model treatment was offered in the context of a drug court program at one site. At the time of the study, it was an established drug court with an experienced drug court judge and other court personnel. Persons charged with misdemeanor or felony nonviolent drug offenses were eligible if they had not participated in a drug diversion program for at least 5 years and had previously completed any grant of probation. All participants who wanted an attorney had legal counsel present during status hearings in court. Participants were required to attend regular court sessions presided over by the same drug court judge who reviewed drug test results, as well as treatment and court contract compliance. 2.2.3. Nondrug court condition In the four nondrug court sites, the same Matrix Model counseling protocol was delivered. The services that were delivered as part of the drug court’s intervention techniques (i.e., incentives, sanctions, etc.) were not delivered to individuals in this condition. Although some participants in this condition had current involvement within the legal system (i.e., on probation), none of these participants’ treatment was under the supervision and monitoring of legal system personnel.
2.3. Measures All participants completed a standard battery of psychosocial assessments at each study time point (Huber et al., 1997). Data used for the current investigation were limited to self-reports collected from the bThe Fifth Edition of the Addiction Severity IndexQ (McLellan et al., 1992) and urine test results collected during the study. ASI assessment includes information on the nature, number, and severity of seven life domains: drug, alcohol, employment, family/ social, legal, medical, and psychiatric. 2.3.1. Operationalization of study variables Treatment site (defined as drug court vs. nondrug court) served as the primary independent variable in all analyses. Measures included sociodemographic characteristics (gender, age, race, educational attainment, employment status, and marital status); drug use severity factors (frequency for both MA and polydrug use at baseline, lifetime MA use, previous drug treatment episodes, and route of administration); in-treatment response factors (immediate treatment dropout, retention, in-treatment MA use, and completion); and treatment outcomes (MA use and psychosocial functioning, as measured by the seven ASI domains). 2.3.1.1. Immediate treatment dropout. Immediate dropout was used as a proxy measure for treatment engagement and was defined by bdropout within the first 30 days of admission into treatment.Q Although the first 2 weeks of treatment had been cited as being a critical window for engaging drug users in treatment (Huber et al., 1997), numerous clinical impressions (Simpson & Joe, 2004) suggest that the initial month (30 days) of entering treatment may be important. 2.3.1.2. Retention. Treatment retention was measured by the average length of stay in outpatient treatment (16 weeks possible). For purposes of analysis, this was defined by the mean number of weeks in treatment from the date of the first session attended to the date of the last session attended. 2.3.1.3. In-treatment MA use. MA use during treatment was measured by a variable that assessed the extent to which participants attained levels of abstinence during the 16-week treatment regimen. This variable was defined as follows: the mean number of MA-free urinalysis tests collected during treatment (one per week, 16 possible). 2.3.1.4. Completion. Treatment completion was measured as a dichotomous variable, defined as those who completed the 16-week Matrix Model with no more than two consecutive missed weeks of treatment versus those who did not complete treatment. 2.4. Statistical analysis Chi-square analyses (v 2) were conducted to examine group differences for categorical variables by treatment site.
P. Marinelli-Casey et al. / Journal of Substance Abuse Treatment 34 (2008) 242–248
Analysis of variance ( F) tests were used to examine associations between treatment site and continuous outcome variables of interest. Repeated measures regression was used to analyze posttreatment MA use outcomes by treatment site. Statistical Package for Social Sciences version 14.0 (Chicago, IL) was used for all analyses. The a level was set to p b .05 to denote statistical significance.
3. Results 3.1. Participant characteristics Table 1 provides a description of the characteristics of drug court participants and nondrug court participants. There were no statistically significant sociodemographic differences between the two groups, with the exception of ethnicity. There were more Latino participants in the drug court than in comparison sites ( p b .05). 3.2. Drug use characteristics Table 2 shows that at treatment entry, drug court participants used MA for significantly fewer days in the month prior to entry (8.7 F 7.9) than did nondrug court participants (12.6 F 5.9; F = 7.29, p b .01). In addition, drug court participants were less likely to have had previous drug abuse treatment episodes (33.3% vs. 52.2%; v 2 = 6.49, p b .01) and less likely to be injection users (7.4% vs. 22.2%; v 2 = 15.79, p b .001) than nondrug court participants. 3.3. Treatment response Table 3 provides a description of treatment response characteristics among drug court participants and nondrug court participants.
Table 1 Characteristics of drug court participants versus nondrug court participants Characteristics
Drug court treatment (n = 57)
Comparison (n = 230)
% Male Mean age in years (range, 18–57) % Caucasian % Latino % Asian % Less than high school education % High school graduate % Full-time employment % Unemployed % Retired/disabled % Single % Married % Divorced/separated/widowed
66.7 32 47.4 36.8 14.0 17.5 61.4 66.7 33.3 – 57.9 19.3 22.8
58.7 33 66.1 16.1444 14.3 20.9 44.3 76.4 21.0 2.6 48.3 19.6 32.2
444 p b .001.
245
Table 2 Drug use characteristics of drug court participants versus nondrug court participants Drug court treatment (n = 57)
Characteristics Mean days of polydrug use in the past month (range, 0–30) Mean days of MA use in the past month (range, 0–30) Mean years of lifetime MA use % Previous drug abuse treatment % Smoking MA % Snorting MA % Injecting MA
Nondrug court (n = 230)
3.1 F 6.2
5.0 F 7.4
8.7 F 7.9
12.6 F 5.944
8.4 F 8.2 33.3 59.3 33.3 7.4
7.6 F 9.8 52.244 64.8 13.0 22.2444
44 p b .01. 444 p b .001.
3.3.1. Immediate dropout, retention, and completion As described in Table 3, drug court participants remained in treatment longer than 30 days after initial admission (79% vs. 57%; v 2 = 9.65, p b .01) and were retained in treatment (mean number of weeks) at a much higher rate (11.2 F 6.2 vs. 8 F 6.5 weeks; F = 12.33, p N .001) than nondrug court participants. Additionally, treatment completion rates were highest among drug court participants, as compared to nondrug court participants (56.1% vs. 31.7%, respectively; v 2 = 11.72, p b .001). Treatment completion was defined as not missing more than two consecutive weeks of treatment. Logistic regression was performed to assess the extent to which being enrolled in a drug court affected treatment completion. Controlling for the potential effects of baseline participant and drug use factors, we found that being enrolled in drug court intervention was the most significant predictor of treatment completion (B = 0.784, p b .01, r 2 = 4.8%). No significant interactions between the variables were observed in these analyses. 3.3.2. In-treatment MA use Abstinence during treatment was measured by the mean number of MA-free urine specimens provided
Table 3 Treatment response of drug court participants versus nondrug court participants Response % Engagement (remained in treatment for N 30 days) Retention (mean weeks in treatment) In-treatment abstinence (mean MA-free urine tests) % Completed treatment 444 p b .001.
Drug court treatment (n = 57)
Nondrug court (n = 230)
79.9
56.5444
11.2 F 6.2
7.8 F 6.5444
8.51 F 6.3
5.98 F 5.7444
56.1
31.7444
246
P. Marinelli-Casey et al. / Journal of Substance Abuse Treatment 34 (2008) 242–248
during the entire treatment period. Results show that drug court participants were significantly more likely than comparison participants to provide a higher proportion of clean urine samples for MA (97.3% vs. 90.5%, respectively; F = 8.63, p b .001). Because these differences may be confounded by baseline factors, we controlled for these potential effects in a multiple linear regression. Results showed that drug court participants were more likely than comparison participants (B = 4.93, p b .001) to remain abstinent (MA-free) during treatment. A significant interaction (B = 0.28, p b .01) between baseline MA use and treatment site (drug court vs. nondrug court) was observed, indicating that participants who were both using MA less frequently in the month prior to treatment admission and were enrolled at the drug court site were more likely to remain MA-free during their respective treatment regimens than nondrug court participants. 3.4. MA use outcomes MA use was measured by both self-report and urinalysis, collected at three follow-up periods: discharge, 6 months after treatment, and 12 months after treatment. As Fig. 1 shows, there were substantial reductions in MA use over time for drug court participants compared to nondrug court comparison participants at discharge (M = 2.73 F 6.2 vs. 5.52 F 8.8; F = 14.031, p b .001), 6 months (M = 3.18 F 7.6 vs. 5.09 F 8.9; F = 6.913, p b .01), and 12 months (M = 2.91 F 7.4 vs. 3.96 F 7.9; F = 8.364, p b. 05). Controlling for other baseline factors, repeated measures analyses showed that MA use outcomes were also associated with MA use at baseline, as well as MA use during treatment. Specifically, participants who reported a greater frequency of MA use at baseline had increased MA use at follow-ups (B = 0.22, p b .001), whereas participants who had a higher percentage of MA-free urine samples during treatment had decreased MA use at follow-up points (B = 0.38, p b .001).
Fig. 1. Change in MA use overtime among drug court participants versus nondrug court participants.
3.5. Psychosocial outcomes: Changes in posttreatment ASI domains Of the seven ASI psychosocial domains (legal, employment, medical, psychological, family, drug, and alcohol), significant improvements in all composite measures across time were documented for both groups of participants. The drug court participants and nondrug court participants only differed with respect to the drug use domain. Specifically, at both 6 and 12 months after treatment, significantly greater reductions in the drug use composite were observed for drug court participants compared to nondrug court participants ( F = 20.252, p b .001; F = 5.119, p b .05, respectively).
4. Discussion Gauging the impact of a drug court intervention for reducing MA use is an important public health and policy issue. To date, few studies have examined the impact of drug courts on MA dependence. The current investigation gives support for the effectiveness of a drug court intervention for MA dependence. Compared to the participants who did not receive drug court treatment, drug court participants did better while in treatment, as shown by higher rates of retention, abstinence, and completion, as well as by lower rates of immediate treatment dropout. These findings are consistent with previous studies that demonstrated the effectiveness of drug court in terms of increasing treatment retention and completion, as well as reducing drug use during treatment (Belenko, 1998, 1999, 2001; Cooper, 1997). Some reports have shown that in-treatment performance is associated with improved outcomes (Brecht et al., 2005; Simpson, 2004). We found this to be true at follow-up assessments such that drug court participants had more successful treatment outcomes than nondrug court participants in terms of reduced MA use as measured by both self-reports and urinalyses. Although both drug court participants and comparison participants showed significant improvements in psychosocial measures of the ASI, drug court participants reported a greater reduction in the drug use domain. The drug court setting, in combination with the Matrix Model of treatment in this study, produced significantly improved in-treatment response and posttreatment outcomes for MA-dependent individuals. However, future research is needed to explore the importance of specific elements of drug courts and their interactions with substance abuse treatment models. The current body of drug court research does not provide details regarding which drug court processes or substance abuse treatment elements contribute to positive treatment outcomes. In this study, it is possible that some unique aspects of the drug court contributed to the positive treatment response and outcomes. Some study evaluations suggest that bjudge exposureQ in the drug court setting may play an important
P. Marinelli-Casey et al. / Journal of Substance Abuse Treatment 34 (2008) 242–248
247
role in shaping outcomes (National Association of Drug Court Professionals, 1997), as the personal attention given to drug court participants during treatment is an influential aspect of the drug court experience. Although positive outcomes may be attributed to the combination of drug court and the Matrix Model, findings from an earlier article (Rawson et al., 2004) suggest that regardless of the treatment model received, participation in drug court appears to be associated with better in-treatment response. More studies are needed to systematically evaluate the specific elements of drug courts and their interaction with substance abuse treatment models.
M.P.H.; Norman Rodrigues, Jr.; Janice Stalcup, M.S.N., Dr.P.H.; S. Alex Stalcup, M.D.; Ewa S. Stamper, Ph.D.; Janice Stimson, Psy.D.; Sarah Turcotte Manser, M.A.; Denna Vandersloot, M.Ed.; Ahndrea Weiner, M.S., M.F.T.; Kathryn Woodward, B.A.; Joan Zweben, Ph.D. The research presented in this article was supported by grants TI 11410, TI 11411, TI 11425, TI 11427, TI 11440, TI 11441, TI 11443, and TI 11484 from the Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services Center for Substance Abuse Treatment (5600 Fishers Lane, Rockwall II Suite 740, Rockville, MD 20857).
5. Limitations
References
This study was not designed to be a definitive assessment of the effectiveness of drug court intervention for MA dependence. There was no random assignment into treatment conditions. The nondrug court condition is presented to provide a frame of reference regarding treatment response to MA treatment. Furthermore, the study condition (drug court vs. nondrug court) may also be confounded by possible differences linked to geographic location because the drug court sample consisted of individuals attending a single program in a single geographical location. Although we attempted to control for this issue in the analysis design by selecting nondrug court sites that were similar to the drug court site in terms of participant characteristics, there was only one drug court judge. Therefore, it was not possible to tell whether these findings will replicate in other drug court settings, as there are well-known differences among judges in their decisions and actions on the same clinical situations. In spite of these limitations, this study adds information to the literature on MA treatment within a drug court setting. The data from the study provide a preliminary indication that MA users do respond positively to treatment within a drug court setting. Future research is needed to systematically evaluate the effect of drug courts on MA users with random assignment and appropriate control conditions.
Belenko, S. (1998). Research on drug courts: A critical review. The National Centre on Addiction and Substance Abuse, Columbia University. Belenko, S. (1999). Diverting drug offenders to treatment courts: The Portland experience. In C. Terry (Ed.), In the early drug courts: Case studies in judicial innovation (pp. 1 – 18). Newbury Park, CA7 Sage Publications. Belenko, S. (2001). Research on drug courts: A critical review 2001 update. The National Centre on Addiction and Substance Abuse, Columbia University. Brecht, M. L., Greenwell, L., & Anglin, M. D. (2005). Methamphetamine treatment: Trends and predictors of retention and completion in a large state treatment system (1992–2002). Journal of Substance Abuse Treatment, 29, 295 – 306. Center for Substance Abuse Research. (2006, June). Dramatic increase in national treatment admissions for methamphetamine coincides with increase in criminal justice referrals. CESAR FAX, Vol. 15, Issue 22. College Park, MD7 University of Maryland. Cooper, C. S. (1997). 1997 Drug court survey report: Executive summary. Washington, DC7 Drug Court Clearinghouse and Technical Assistance Project, American University and Justice Programs Office. Cretzmeyer, M., Sarrazin, M. V., Huber, D. L., Block, R. I., & Hall, J. A. (2003). Treatment of methamphetamine abuse: Research findings and clinical directions. Journal of Substance Abuse Treatment, 24, 267 – 277. Farabee, D., Prendergast, M., & Cartier, L. (2002). Methamphetamine use and HIV risk among substance-abusing offenders in California. Journal of Psychoactive Drugs, 34, 295 – 300. Gunter, T. D., Black, D. W., Zwick, J., & Arndt, S. (2004). Drug and alcohol treatment services effective for methamphetamine abuse. Annuals of Clinical Psychiatry, 16, 195 – 200. Hser, Y. -I., Evans, E., & Yu-Chuang, H. (2005). Treatment outcomes among women and men methamphetamine abusers in California. Journal of Substance Abuse Treatment, 28, 77 – 85. Hser, Y. -I., Yu-Chuang, H., Chou, C. -P., & Anglin, M. D. (2003). Longitudinal patterns of treatment utilization and outcomes among methamphetamine abusers: A growth curve modeling approach. Journal of Drug Issues, 33, 921 – 938. Huber, A., Ling, W., Shoptaw, S., Gulati, V., Brethren, P., & Rawson, R. A. (1997). Integrating treatment for methamphetamine abuse: A psychosocial perspective. Journal of Addictive Diseases, 16, 41 – 50. Huddleston, C. W. (2005). Drug courts: An effective strategy for communities facing methamphetamine. Bureau of Justice assistance bulletin (pp. 1 – 15). Office of Justice Programs, U.S. Department of Justice. Maglione, M., Chao, B., & Anglin, D. (2000a). Correlates of outpatient drug treatment drop-out among methamphetamine users. Journal of Psychoactive Drugs, 32, 221 – 228.
Acknowledgments M. Douglas Anglin, Ph.D.; Richard A. Rawson, Ph.D.; Patricia Marinelli-Casey, Ph.D.; Joseph Balabis, B.A.; Richard Bradway; Alison Hamilton Brown, Ph.D.; Cynthia Burke, Ph.D.; Darrell Christian, Ph.D.; Judith Cohen, Ph.D., M.P.H.; Florentina Cosmineanu, M.S.; Alice Dickow, B.A.; Melissa Donaldson; Yvonne Frazier; Thomas E. Freese, Ph.D.; Cheryl Gallagher, M.A.; Gantt P. Galloway, Pharm.D.; Vikas Gulati, B.S.; James Herrell, Ph.D., M.P.H.; Kathryn Horner, B.A.; Alice Huber, Ph.D.; Martin Y. Iguchi, Ph.D.; Russell H. Lord, Ed.D.; Michael J. McCann, M.A.; Sam Minsky, M.F.T.; Pat Morrisey, M.A., M.F.T.; Jeanne Obert, M.F.T., M.S.M.; Susan Pennell, M.A.; Chris Reiber, Ph.D.,
248
P. Marinelli-Casey et al. / Journal of Substance Abuse Treatment 34 (2008) 242–248
Maglione, M., Chao, B., & Anglin, D. (2000b). Residential treatment of methamphetamine users: Correlates of drop-out from the California Alcohol and Drug Data System (CADDS), 1994–1997. Addiction Research, 8, 65 – 79. McLellan, A. T., Kushner, H., Metzger, D., Peters, R., Smith, I., Grissom, G., et al. (1992). The fifth edition of the Addiction Severity Index. Journal of Substance Abuse Treatment, 9, 199 – 213. National Association of Drug Court Professionals. (1997). Defining drug courts: The key components. Washington, DC7 Office of Justice Programs, U.S. Department of Justice. Obert, J. L., McCann, M. J., Brethen, P., Marinelli-Casey, P., & Rawson, R. A. (2000). The Matrix Model of outpatient substance abuse treatment: History and description. Journal of Psychoactive Drugs, 32, 157 – 165. Rawson, R., Shoptaw, S., Obert, J. L., McCann, M., Hasson, A., MarinelliCasey, P., et al. (1995). An intensive outpatient approach for cocaine abuse: The Matrix Model. Journal of Substance Abuse Treatment, 12, 117 – 127. Rawson, R. A., Huber, A., Brethen, P., Obert, J., Gulati, V., Shoptaw, S., et al. (2002). Status of methamphetamine users 2–5 years after outpatient treatment. Journal of Addictive Diseases, 21, 107 – 119.
Rawson, R. A., Marinelli-Casey, P., Anglin, D., Dickow, A., Frazier, Y., Gallagher, C., et al. (2004). A multi-site comparison of psychosocial approaches for the treatment of MA dependence. Addiction, 99, 708 – 717. Rawson, R. A., McCann, M. J., Flammino, F., Shoptaw, S., Miotto, K., Reiber, C., et al. (2006). A comparison of contingency management and cognitive–behavioral approaches for stimulant-dependent individuals. Addiction, 101, 267 – 274. Roll, J. M., Huber, A., Sodano, R., Chudzynski, J., Moynier, E., & Shoptaw, S. (2006). A comparison of five reinforcement schedules for use in contingency management-based treatment of methamphetamine abuse. Psychological Record, 56, 67 – 81. Simpson, D. D. (2004). A conceptual framework for drug treatment process and outcomes. Journal of Substance Abuse Treatment, 27, 99 – 121. Simpson, D. D., & Joe, G. W. (2004). A longitudinal evaluation of treatment engagement and recovery stages. Journal of Substance Abuse Treatment, 27, 89 – 97. Substance Abuse and Mental Health Data Archive, online analysis of the concatenated 1992–2002 TEDS data set accessed 6/2/2006; available online at: http://www.icpsr.umich.edu/SAMHDA. Turner, S., Longshore, D., Wenzel, S., Deschenes, E., Greenwood, P., Fain, T., et al. (2002). A decade of drug treatment court research. Substance Use and Misuse, 37, 1489 – 1527.
Regular article
Drug court treatment for methamphetamine dependence: Treatment response and posttreatment outcomes Patricia Marinelli-Casey, (Ph.D.)a,4, Rachel Gonzales, (M.P.H.)a, Maureen Hillhouse, (Ph.D.)a, Alfonso Ang, (Ph.D.)b, Joan Zweben, (Ph.D.)c, Judith Cohen, (Ph.D., M.P.H.)c, Peggy Fulton Hora, (J.D.)d, Richard A. Rawson, (Ph.D.)a, Methamphetamine Treatment Project Corporate Authors1 a
Integrated Substance Abuse Programs, University of California, Los Angeles, CA 90025, USA b David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA c East Bay Community Recovery Project, Hayward, CA, USA d Superior Court of California, Hayward, CA, USA Received 3 November 2006; received in revised form 7 March 2007; accepted 5 April 2007
Abstract Relatively little is known about the impact of drug court treatment programs for methamphetamine (MA) dependence. This article examines treatment performance among a subsample of 287 MA-dependent adults who participated in the Methamphetamine Treatment Project from 1999 to 2001. To gain a preliminary indication of MA users’ response to drug court intervention, we compared a group of 57 MA-dependent participants treated in outpatient treatment within the context of a drug court to a group of comparable MA-dependent individuals treated in outpatient treatment but not supervised by a drug court (n = 230). Analyses reveal that drug court participation was associated with better rates of engagement, retention, completion, and abstinence, compared to outpatient treatment without drug court supervision. Six- and 12-month outcome analyses indicated that participants who were enrolled in drug court intervention used MA significantly less frequently. These findings suggest that drug court supervision coupled with treatment may improve the outcomes of MAdependent offenders beyond that seen from treatment alone. D 2008 Published by Elsevier Inc. Keywords: Drug court treatment; Methamphetamine; Treatment response and outcomes; Matrix Model
1. Introduction Methamphetamine (MA) dependence is a growing problem in many parts of the United States, overwhelming the resources and infrastructures of substance abuse treatment and criminal justice systems. According to national treatment trend data, more than three fourths of western The contents are solely the responsibility of the authors and do not necessarily represent the official views of the agency. 4 Corresponding author. 1640 South Sepulveda Boulevard, Suite 200, Los Angeles, CA 90025, USA. Tel.: +1 310 445 0874x310; fax: +1 310 312 0538. E-mail address: [email protected] (P. Marinelli-Casey). 1 Acknowledgments detail Corporate list. 0740-5472/08/$ – see front matter D 2008 Published by Elsevier Inc. doi:10.1016/j.jsat.2007.04.005
states have higher rates of MA/amphetamine-related treatment admissions than cocaine- or heroin-related admissions (Rawson et al., 1995; Substance Abuse and Mental Health Data Archive, 1992). There have also been increased numbers of incarcerations and other problems within the criminal justice system among MA-dependent individuals, which corresponds to the linkage between MA dependence and illegal behaviors (Farabee, Prendergast, & Cartier, 2002). In fact, since 2002, the criminal justice system has been the number one referral source for MA treatment (Center for Substance Abuse Research, 2006). Current challenges associated with MA have stimulated much attention about understanding treatment effectiveness for MA dependence.
P. Marinelli-Casey et al. / Journal of Substance Abuse Treatment 34 (2008) 242–248
There has been a growing body of treatment outcome studies specific to assessing the effectiveness of treatment for MA. Together, findings from a diverse group of studies provide considerable evidence that treatment works for MA users, as these treatment participants consistently respond positively to treatment (e.g., Brecht, Greenwell, & Anglin, 2005; Cretzmeyer, Sarrazin, Huber, Block, & Hall, 2003; Gunter, Black, Zwick, & Arndt, 2004; Hser, Evans, & YuChuang, 2005; Hser, Yu-Chuang, Chou, & Anglin, 2003; Maglione, Chao, & Anglin, 2000a, 2000b; Rawson et al., 2002; Roll et al., 2006). Roll et al. (2006), for example, have recently demonstrated that the addition of a contingency management (CM) protocol significantly reduces MA use during the application of CM procedures, with participants concurrently receiving outpatient drug counseling. Rawson et al. (2006) have similarly found that the application of a CM protocol, as compared to cognitive–behavioral therapy treatment, can substantially reduce psychostimulant use (cocaine and MA) during treatment. In the largest randomized clinical trial conducted to date examining treatment for MA at eight outpatient sites, the Methamphetamine Treatment Project (MTP) funded by the Center for Substance Abuse Treatment found that the multielement Matrix Model produced superior retention and MA use reductions during the treatment period (as measured by urinalysis) when compared to treatment as usual (TAU) (Rawson et al., 2004). In this study, participant performance among those treated with the Matrix Model was statistically superior to the TAU condition in six of the eight sites. In one of the two sites in which there was no difference in treatment response between the two conditions, all participants were enrolled in a drug court program. This was the only site where participants were in treatment as a result of a drug court mandate, as all other sites recruited individuals who voluntarily enrolled in treatment or were referred to treatment as a condition of probation. It has been suggested that drug courts may be an effective tool for promoting successful treatment outcomes with MA-dependent adults (Huddleston, 2005). Drug courts are governed by a number of principles known as key components (National Association of Drug Court Professionals, 1997; Turner et al., 2002). Among these components are: integration of treatment with criminal case processing; early identification and prompt placement of eligible individuals into the program; provision of a continuum of services; alcohol and other drug testings; and ongoing judicial interaction. Each court has its own admission criteria and graduation regime. Currently, there are no data available on the treatment response of MA-dependent individuals within a drug court setting. To address this gap, we felt that because the Center for Substance Abuse Treatment MTP study provided one site in which MA-dependent individuals were treated with a drug court intervention, it would be possible to gain preliminary information on the treatment performance of MA users
243
within a drug court treatment program. The purpose of this article is to examine the treatment response of MA-dependent individuals who were enrolled in an MTP drug court intervention in California (n = 57). To provide a frame of reference, we compare participants from the drug court treatment site with a subsample of other MA-dependent MTP participants from four California treatment sites (n = 230), all of whom received Matrix Model treatment. Examined are differences in baseline sociodemographic factors, drug use severity, treatment response (i.e., immediate treatment dropout, retention, in-treatment drug use, and completion), and psychosocial and drug use outcomes at follow-up points. This article was not designed as a controlled evaluation of drug court intervention for MA dependence; rather, it is a detailed examination of the treatment response of MA-dependent adults within the conditions of one drug court program. We hope that this article provides a preliminary perspective on the treatment outcomes of MA-dependent adults who are treated within the context of a drug court intervention.
2. Methods 2.1. Participants and sites The present study, conducted between 1999 and 2001, uses a nonrandomized comparison group design that utilizes a subset of data from the MTP. To reduce heterogeneity in treatment content across participants, the subsample selected consists of those participants who received the Matrix Model of treatment only and excludes those who were assigned to the TAU condition. In addition, because we are particularly interested in examining treatment response among drug court participants, we created two groups: (1) MA-dependent participants receiving Matrix Model treatment (n = 57) at the sole MTP drug court site in California, and (2) a comparison group of MA-dependent participants who received treatment with the Matrix Model (n = 230) under nondrug court conditions at four other California sites. The comparison group (nondrug court) was created from four treatment sites and included participants with patient characteristics and drug use patterns similar to those of the drug court group. All four of these sites were located in California. The three sites that were excluded from the analysis had a predominately female population, had a higher percentage of intravenous drug users, and were located in other states. The decision to use a subsample of MTP sites allows an appropriate comparison between similar sample groups to illuminate potential differences between drug court participants and nondrug court participants. 2.2. Procedures As part of the multisite MTP trial, individuals were eligible for study participation if they met Diagnostic and
244
P. Marinelli-Casey et al. / Journal of Substance Abuse Treatment 34 (2008) 242–248
Statistical Manual of Mental Disorders, Fourth Edition criteria for MA dependence; used MA in the month before treatment entry; were proficient in the English language; were z18 years old; and resided in the same geographical location as the treatment facility, as defined by a reasonable driving distance not exceeding a 45-minute commute. All study participants received intensive outpatient treatment for MA dependence using the Matrix Model. Data were collected at baseline (the week before treatment entry), weekly during treatment, at discharge, and at 6 and 12 months following treatment admission. Scheduled data collection was completed at an acceptable rate, as 80.9% of participants completed the discharge interview, 84.8% completed the 6-month follow-up interview, and 84.5% completed the 12-month interview. The study was conducted under the review and approval of the Institutional Review Board (IRB) of the University of California, Los Angeles, as well as the local IRB for each participating treatment site. 2.2.1. Matrix Model The 16-week multicomponent treatment approach has been organized into a manualized protocol that includes cognitive–behavioral group counseling delivered thrice a week, 12 sessions of family education groups, 4 sessions of social support groups, and 4 sessions of individual counseling. These sessions are combined with weekly urine screening for illicit drugs, including cocaine, MA, opiates, cannabis, and benzodiazepines (Obert, McCann, Brethen, Marinelli-Casey, & Rawson, 2000). 2.2.2. Drug court condition Matrix Model treatment was offered in the context of a drug court program at one site. At the time of the study, it was an established drug court with an experienced drug court judge and other court personnel. Persons charged with misdemeanor or felony nonviolent drug offenses were eligible if they had not participated in a drug diversion program for at least 5 years and had previously completed any grant of probation. All participants who wanted an attorney had legal counsel present during status hearings in court. Participants were required to attend regular court sessions presided over by the same drug court judge who reviewed drug test results, as well as treatment and court contract compliance. 2.2.3. Nondrug court condition In the four nondrug court sites, the same Matrix Model counseling protocol was delivered. The services that were delivered as part of the drug court’s intervention techniques (i.e., incentives, sanctions, etc.) were not delivered to individuals in this condition. Although some participants in this condition had current involvement within the legal system (i.e., on probation), none of these participants’ treatment was under the supervision and monitoring of legal system personnel.
2.3. Measures All participants completed a standard battery of psychosocial assessments at each study time point (Huber et al., 1997). Data used for the current investigation were limited to self-reports collected from the bThe Fifth Edition of the Addiction Severity IndexQ (McLellan et al., 1992) and urine test results collected during the study. ASI assessment includes information on the nature, number, and severity of seven life domains: drug, alcohol, employment, family/ social, legal, medical, and psychiatric. 2.3.1. Operationalization of study variables Treatment site (defined as drug court vs. nondrug court) served as the primary independent variable in all analyses. Measures included sociodemographic characteristics (gender, age, race, educational attainment, employment status, and marital status); drug use severity factors (frequency for both MA and polydrug use at baseline, lifetime MA use, previous drug treatment episodes, and route of administration); in-treatment response factors (immediate treatment dropout, retention, in-treatment MA use, and completion); and treatment outcomes (MA use and psychosocial functioning, as measured by the seven ASI domains). 2.3.1.1. Immediate treatment dropout. Immediate dropout was used as a proxy measure for treatment engagement and was defined by bdropout within the first 30 days of admission into treatment.Q Although the first 2 weeks of treatment had been cited as being a critical window for engaging drug users in treatment (Huber et al., 1997), numerous clinical impressions (Simpson & Joe, 2004) suggest that the initial month (30 days) of entering treatment may be important. 2.3.1.2. Retention. Treatment retention was measured by the average length of stay in outpatient treatment (16 weeks possible). For purposes of analysis, this was defined by the mean number of weeks in treatment from the date of the first session attended to the date of the last session attended. 2.3.1.3. In-treatment MA use. MA use during treatment was measured by a variable that assessed the extent to which participants attained levels of abstinence during the 16-week treatment regimen. This variable was defined as follows: the mean number of MA-free urinalysis tests collected during treatment (one per week, 16 possible). 2.3.1.4. Completion. Treatment completion was measured as a dichotomous variable, defined as those who completed the 16-week Matrix Model with no more than two consecutive missed weeks of treatment versus those who did not complete treatment. 2.4. Statistical analysis Chi-square analyses (v 2) were conducted to examine group differences for categorical variables by treatment site.
P. Marinelli-Casey et al. / Journal of Substance Abuse Treatment 34 (2008) 242–248
Analysis of variance ( F) tests were used to examine associations between treatment site and continuous outcome variables of interest. Repeated measures regression was used to analyze posttreatment MA use outcomes by treatment site. Statistical Package for Social Sciences version 14.0 (Chicago, IL) was used for all analyses. The a level was set to p b .05 to denote statistical significance.
3. Results 3.1. Participant characteristics Table 1 provides a description of the characteristics of drug court participants and nondrug court participants. There were no statistically significant sociodemographic differences between the two groups, with the exception of ethnicity. There were more Latino participants in the drug court than in comparison sites ( p b .05). 3.2. Drug use characteristics Table 2 shows that at treatment entry, drug court participants used MA for significantly fewer days in the month prior to entry (8.7 F 7.9) than did nondrug court participants (12.6 F 5.9; F = 7.29, p b .01). In addition, drug court participants were less likely to have had previous drug abuse treatment episodes (33.3% vs. 52.2%; v 2 = 6.49, p b .01) and less likely to be injection users (7.4% vs. 22.2%; v 2 = 15.79, p b .001) than nondrug court participants. 3.3. Treatment response Table 3 provides a description of treatment response characteristics among drug court participants and nondrug court participants.
Table 1 Characteristics of drug court participants versus nondrug court participants Characteristics
Drug court treatment (n = 57)
Comparison (n = 230)
% Male Mean age in years (range, 18–57) % Caucasian % Latino % Asian % Less than high school education % High school graduate % Full-time employment % Unemployed % Retired/disabled % Single % Married % Divorced/separated/widowed
66.7 32 47.4 36.8 14.0 17.5 61.4 66.7 33.3 – 57.9 19.3 22.8
58.7 33 66.1 16.1444 14.3 20.9 44.3 76.4 21.0 2.6 48.3 19.6 32.2
444 p b .001.
245
Table 2 Drug use characteristics of drug court participants versus nondrug court participants Drug court treatment (n = 57)
Characteristics Mean days of polydrug use in the past month (range, 0–30) Mean days of MA use in the past month (range, 0–30) Mean years of lifetime MA use % Previous drug abuse treatment % Smoking MA % Snorting MA % Injecting MA
Nondrug court (n = 230)
3.1 F 6.2
5.0 F 7.4
8.7 F 7.9
12.6 F 5.944
8.4 F 8.2 33.3 59.3 33.3 7.4
7.6 F 9.8 52.244 64.8 13.0 22.2444
44 p b .01. 444 p b .001.
3.3.1. Immediate dropout, retention, and completion As described in Table 3, drug court participants remained in treatment longer than 30 days after initial admission (79% vs. 57%; v 2 = 9.65, p b .01) and were retained in treatment (mean number of weeks) at a much higher rate (11.2 F 6.2 vs. 8 F 6.5 weeks; F = 12.33, p N .001) than nondrug court participants. Additionally, treatment completion rates were highest among drug court participants, as compared to nondrug court participants (56.1% vs. 31.7%, respectively; v 2 = 11.72, p b .001). Treatment completion was defined as not missing more than two consecutive weeks of treatment. Logistic regression was performed to assess the extent to which being enrolled in a drug court affected treatment completion. Controlling for the potential effects of baseline participant and drug use factors, we found that being enrolled in drug court intervention was the most significant predictor of treatment completion (B = 0.784, p b .01, r 2 = 4.8%). No significant interactions between the variables were observed in these analyses. 3.3.2. In-treatment MA use Abstinence during treatment was measured by the mean number of MA-free urine specimens provided
Table 3 Treatment response of drug court participants versus nondrug court participants Response % Engagement (remained in treatment for N 30 days) Retention (mean weeks in treatment) In-treatment abstinence (mean MA-free urine tests) % Completed treatment 444 p b .001.
Drug court treatment (n = 57)
Nondrug court (n = 230)
79.9
56.5444
11.2 F 6.2
7.8 F 6.5444
8.51 F 6.3
5.98 F 5.7444
56.1
31.7444
246
P. Marinelli-Casey et al. / Journal of Substance Abuse Treatment 34 (2008) 242–248
during the entire treatment period. Results show that drug court participants were significantly more likely than comparison participants to provide a higher proportion of clean urine samples for MA (97.3% vs. 90.5%, respectively; F = 8.63, p b .001). Because these differences may be confounded by baseline factors, we controlled for these potential effects in a multiple linear regression. Results showed that drug court participants were more likely than comparison participants (B = 4.93, p b .001) to remain abstinent (MA-free) during treatment. A significant interaction (B = 0.28, p b .01) between baseline MA use and treatment site (drug court vs. nondrug court) was observed, indicating that participants who were both using MA less frequently in the month prior to treatment admission and were enrolled at the drug court site were more likely to remain MA-free during their respective treatment regimens than nondrug court participants. 3.4. MA use outcomes MA use was measured by both self-report and urinalysis, collected at three follow-up periods: discharge, 6 months after treatment, and 12 months after treatment. As Fig. 1 shows, there were substantial reductions in MA use over time for drug court participants compared to nondrug court comparison participants at discharge (M = 2.73 F 6.2 vs. 5.52 F 8.8; F = 14.031, p b .001), 6 months (M = 3.18 F 7.6 vs. 5.09 F 8.9; F = 6.913, p b .01), and 12 months (M = 2.91 F 7.4 vs. 3.96 F 7.9; F = 8.364, p b. 05). Controlling for other baseline factors, repeated measures analyses showed that MA use outcomes were also associated with MA use at baseline, as well as MA use during treatment. Specifically, participants who reported a greater frequency of MA use at baseline had increased MA use at follow-ups (B = 0.22, p b .001), whereas participants who had a higher percentage of MA-free urine samples during treatment had decreased MA use at follow-up points (B = 0.38, p b .001).
Fig. 1. Change in MA use overtime among drug court participants versus nondrug court participants.
3.5. Psychosocial outcomes: Changes in posttreatment ASI domains Of the seven ASI psychosocial domains (legal, employment, medical, psychological, family, drug, and alcohol), significant improvements in all composite measures across time were documented for both groups of participants. The drug court participants and nondrug court participants only differed with respect to the drug use domain. Specifically, at both 6 and 12 months after treatment, significantly greater reductions in the drug use composite were observed for drug court participants compared to nondrug court participants ( F = 20.252, p b .001; F = 5.119, p b .05, respectively).
4. Discussion Gauging the impact of a drug court intervention for reducing MA use is an important public health and policy issue. To date, few studies have examined the impact of drug courts on MA dependence. The current investigation gives support for the effectiveness of a drug court intervention for MA dependence. Compared to the participants who did not receive drug court treatment, drug court participants did better while in treatment, as shown by higher rates of retention, abstinence, and completion, as well as by lower rates of immediate treatment dropout. These findings are consistent with previous studies that demonstrated the effectiveness of drug court in terms of increasing treatment retention and completion, as well as reducing drug use during treatment (Belenko, 1998, 1999, 2001; Cooper, 1997). Some reports have shown that in-treatment performance is associated with improved outcomes (Brecht et al., 2005; Simpson, 2004). We found this to be true at follow-up assessments such that drug court participants had more successful treatment outcomes than nondrug court participants in terms of reduced MA use as measured by both self-reports and urinalyses. Although both drug court participants and comparison participants showed significant improvements in psychosocial measures of the ASI, drug court participants reported a greater reduction in the drug use domain. The drug court setting, in combination with the Matrix Model of treatment in this study, produced significantly improved in-treatment response and posttreatment outcomes for MA-dependent individuals. However, future research is needed to explore the importance of specific elements of drug courts and their interactions with substance abuse treatment models. The current body of drug court research does not provide details regarding which drug court processes or substance abuse treatment elements contribute to positive treatment outcomes. In this study, it is possible that some unique aspects of the drug court contributed to the positive treatment response and outcomes. Some study evaluations suggest that bjudge exposureQ in the drug court setting may play an important
P. Marinelli-Casey et al. / Journal of Substance Abuse Treatment 34 (2008) 242–248
247
role in shaping outcomes (National Association of Drug Court Professionals, 1997), as the personal attention given to drug court participants during treatment is an influential aspect of the drug court experience. Although positive outcomes may be attributed to the combination of drug court and the Matrix Model, findings from an earlier article (Rawson et al., 2004) suggest that regardless of the treatment model received, participation in drug court appears to be associated with better in-treatment response. More studies are needed to systematically evaluate the specific elements of drug courts and their interaction with substance abuse treatment models.
M.P.H.; Norman Rodrigues, Jr.; Janice Stalcup, M.S.N., Dr.P.H.; S. Alex Stalcup, M.D.; Ewa S. Stamper, Ph.D.; Janice Stimson, Psy.D.; Sarah Turcotte Manser, M.A.; Denna Vandersloot, M.Ed.; Ahndrea Weiner, M.S., M.F.T.; Kathryn Woodward, B.A.; Joan Zweben, Ph.D. The research presented in this article was supported by grants TI 11410, TI 11411, TI 11425, TI 11427, TI 11440, TI 11441, TI 11443, and TI 11484 from the Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services Center for Substance Abuse Treatment (5600 Fishers Lane, Rockwall II Suite 740, Rockville, MD 20857).
5. Limitations
References
This study was not designed to be a definitive assessment of the effectiveness of drug court intervention for MA dependence. There was no random assignment into treatment conditions. The nondrug court condition is presented to provide a frame of reference regarding treatment response to MA treatment. Furthermore, the study condition (drug court vs. nondrug court) may also be confounded by possible differences linked to geographic location because the drug court sample consisted of individuals attending a single program in a single geographical location. Although we attempted to control for this issue in the analysis design by selecting nondrug court sites that were similar to the drug court site in terms of participant characteristics, there was only one drug court judge. Therefore, it was not possible to tell whether these findings will replicate in other drug court settings, as there are well-known differences among judges in their decisions and actions on the same clinical situations. In spite of these limitations, this study adds information to the literature on MA treatment within a drug court setting. The data from the study provide a preliminary indication that MA users do respond positively to treatment within a drug court setting. Future research is needed to systematically evaluate the effect of drug courts on MA users with random assignment and appropriate control conditions.
Belenko, S. (1998). Research on drug courts: A critical review. The National Centre on Addiction and Substance Abuse, Columbia University. Belenko, S. (1999). Diverting drug offenders to treatment courts: The Portland experience. In C. Terry (Ed.), In the early drug courts: Case studies in judicial innovation (pp. 1 – 18). Newbury Park, CA7 Sage Publications. Belenko, S. (2001). Research on drug courts: A critical review 2001 update. The National Centre on Addiction and Substance Abuse, Columbia University. Brecht, M. L., Greenwell, L., & Anglin, M. D. (2005). Methamphetamine treatment: Trends and predictors of retention and completion in a large state treatment system (1992–2002). Journal of Substance Abuse Treatment, 29, 295 – 306. Center for Substance Abuse Research. (2006, June). Dramatic increase in national treatment admissions for methamphetamine coincides with increase in criminal justice referrals. CESAR FAX, Vol. 15, Issue 22. College Park, MD7 University of Maryland. Cooper, C. S. (1997). 1997 Drug court survey report: Executive summary. Washington, DC7 Drug Court Clearinghouse and Technical Assistance Project, American University and Justice Programs Office. Cretzmeyer, M., Sarrazin, M. V., Huber, D. L., Block, R. I., & Hall, J. A. (2003). Treatment of methamphetamine abuse: Research findings and clinical directions. Journal of Substance Abuse Treatment, 24, 267 – 277. Farabee, D., Prendergast, M., & Cartier, L. (2002). Methamphetamine use and HIV risk among substance-abusing offenders in California. Journal of Psychoactive Drugs, 34, 295 – 300. Gunter, T. D., Black, D. W., Zwick, J., & Arndt, S. (2004). Drug and alcohol treatment services effective for methamphetamine abuse. Annuals of Clinical Psychiatry, 16, 195 – 200. Hser, Y. -I., Evans, E., & Yu-Chuang, H. (2005). Treatment outcomes among women and men methamphetamine abusers in California. Journal of Substance Abuse Treatment, 28, 77 – 85. Hser, Y. -I., Yu-Chuang, H., Chou, C. -P., & Anglin, M. D. (2003). Longitudinal patterns of treatment utilization and outcomes among methamphetamine abusers: A growth curve modeling approach. Journal of Drug Issues, 33, 921 – 938. Huber, A., Ling, W., Shoptaw, S., Gulati, V., Brethren, P., & Rawson, R. A. (1997). Integrating treatment for methamphetamine abuse: A psychosocial perspective. Journal of Addictive Diseases, 16, 41 – 50. Huddleston, C. W. (2005). Drug courts: An effective strategy for communities facing methamphetamine. Bureau of Justice assistance bulletin (pp. 1 – 15). Office of Justice Programs, U.S. Department of Justice. Maglione, M., Chao, B., & Anglin, D. (2000a). Correlates of outpatient drug treatment drop-out among methamphetamine users. Journal of Psychoactive Drugs, 32, 221 – 228.
Acknowledgments M. Douglas Anglin, Ph.D.; Richard A. Rawson, Ph.D.; Patricia Marinelli-Casey, Ph.D.; Joseph Balabis, B.A.; Richard Bradway; Alison Hamilton Brown, Ph.D.; Cynthia Burke, Ph.D.; Darrell Christian, Ph.D.; Judith Cohen, Ph.D., M.P.H.; Florentina Cosmineanu, M.S.; Alice Dickow, B.A.; Melissa Donaldson; Yvonne Frazier; Thomas E. Freese, Ph.D.; Cheryl Gallagher, M.A.; Gantt P. Galloway, Pharm.D.; Vikas Gulati, B.S.; James Herrell, Ph.D., M.P.H.; Kathryn Horner, B.A.; Alice Huber, Ph.D.; Martin Y. Iguchi, Ph.D.; Russell H. Lord, Ed.D.; Michael J. McCann, M.A.; Sam Minsky, M.F.T.; Pat Morrisey, M.A., M.F.T.; Jeanne Obert, M.F.T., M.S.M.; Susan Pennell, M.A.; Chris Reiber, Ph.D.,
248
P. Marinelli-Casey et al. / Journal of Substance Abuse Treatment 34 (2008) 242–248
Maglione, M., Chao, B., & Anglin, D. (2000b). Residential treatment of methamphetamine users: Correlates of drop-out from the California Alcohol and Drug Data System (CADDS), 1994–1997. Addiction Research, 8, 65 – 79. McLellan, A. T., Kushner, H., Metzger, D., Peters, R., Smith, I., Grissom, G., et al. (1992). The fifth edition of the Addiction Severity Index. Journal of Substance Abuse Treatment, 9, 199 – 213. National Association of Drug Court Professionals. (1997). Defining drug courts: The key components. Washington, DC7 Office of Justice Programs, U.S. Department of Justice. Obert, J. L., McCann, M. J., Brethen, P., Marinelli-Casey, P., & Rawson, R. A. (2000). The Matrix Model of outpatient substance abuse treatment: History and description. Journal of Psychoactive Drugs, 32, 157 – 165. Rawson, R., Shoptaw, S., Obert, J. L., McCann, M., Hasson, A., MarinelliCasey, P., et al. (1995). An intensive outpatient approach for cocaine abuse: The Matrix Model. Journal of Substance Abuse Treatment, 12, 117 – 127. Rawson, R. A., Huber, A., Brethen, P., Obert, J., Gulati, V., Shoptaw, S., et al. (2002). Status of methamphetamine users 2–5 years after outpatient treatment. Journal of Addictive Diseases, 21, 107 – 119.
Rawson, R. A., Marinelli-Casey, P., Anglin, D., Dickow, A., Frazier, Y., Gallagher, C., et al. (2004). A multi-site comparison of psychosocial approaches for the treatment of MA dependence. Addiction, 99, 708 – 717. Rawson, R. A., McCann, M. J., Flammino, F., Shoptaw, S., Miotto, K., Reiber, C., et al. (2006). A comparison of contingency management and cognitive–behavioral approaches for stimulant-dependent individuals. Addiction, 101, 267 – 274. Roll, J. M., Huber, A., Sodano, R., Chudzynski, J., Moynier, E., & Shoptaw, S. (2006). A comparison of five reinforcement schedules for use in contingency management-based treatment of methamphetamine abuse. Psychological Record, 56, 67 – 81. Simpson, D. D. (2004). A conceptual framework for drug treatment process and outcomes. Journal of Substance Abuse Treatment, 27, 99 – 121. Simpson, D. D., & Joe, G. W. (2004). A longitudinal evaluation of treatment engagement and recovery stages. Journal of Substance Abuse Treatment, 27, 89 – 97. Substance Abuse and Mental Health Data Archive, online analysis of the concatenated 1992–2002 TEDS data set accessed 6/2/2006; available online at: http://www.icpsr.umich.edu/SAMHDA. Turner, S., Longshore, D., Wenzel, S., Deschenes, E., Greenwood, P., Fain, T., et al. (2002). A decade of drug treatment court research. Substance Use and Misuse, 37, 1489 – 1527.