Drug Treatment Court Completion: Impact of Drug Involvement, Mental Health, and Sexual Abuse Victimization

Developed in 1989 in response to the explosion of drug related arrests, drug treatment courts (DTC) have proliferated across the United States and now number nearly 2,500. Considerable research into the effectiveness of drug treatment courts has indicated overall favorable outcomes such as lowering rates of recidivism.  Drug court participants are a vulnerable, high risk population.  They have increased risk for psychiatric diagnoses and exposure to adverse life events such as trauma and physical and sexual abuse.  Individual factors associated with drug treatment court program completion have rarely been studied.  Yet, it is clear that these vulnerabilities may adversely affect drug treatment (the main DTC intervention), and ultimately, DTC program completion.  As part of an ongoing program evaluation effort, this presentation examines the impact of criminal background, mental health problems, and sexual abuse history on drug court program completion among 241 participants in the Milwaukee County Drug Treatment Court who entered the program between 2009 and 2012.  Just over a third of the participants (n=90 or 37%), successfully completed the program; 63% (n=151) failed to complete the program. Demographically, 53% (n=127) were non-Hispanic white and 33% (n=80) were women.  Based on information provided in the Addiction Severity Index, 49% (n=118) had a history of inpatient or outpatient treatment for a mental health condition; 20% (n=48) reported a history of sexual abuse.  Using logistic regression controlling for age, race/ethnicity, gender, and education, key predictors of program completion were examined.  Specifically, our analyses investigated the impact of type of arrest charge at entry, history of mental health treatment, and history of sexual abuse on program completion.  Those who were admitted to the program with only drug-related charges had 2.61 times the odds of program completion compared to others (95% CI: 1.48, 4.60).  Regression analyses suggested that the main effects of mental health treatment history and sexual abuse history both adversely impacted completion. Those with a history of mental health treatment had .40 times the odds of program completion (95% CI: 0.22, 0.72) compared to others. Those with a history of sexual abuse also had .40 times the odds of program completion (95% CI: 0.17, 0.93) compared to others.   Moreover, we also found that a significant interaction between these two variables adversely affected outcomes.  Those with a mental health treatment history and a history of sexual abuse had a 97% reduction in the odds of program completion compared to others (OR: .03; 95% CI: 0.01, 0.20).  Overall, the combined impact of mental health treatment history and sexual abuse on DTC completion was striking.  Of the 33 participants with combined risks, only 2 (6%) completed the program, compared to 88 (42%) of the rest of the sample.  For participants with addiction, mental health diagnoses, and sexual abuse victimization history, our findings suggest that DTCs need to expand the scope of intervention beyond drug treatment.  Accordingly, we discuss the implications of these findings for the future design and enhancement of drug treatment court programming in ways that can facilitate the success of highly vulnerable participants.