Summry Effect evlution of the Rehbilittion of Drug-Addicted Offenders Act (SOV) The Rehbilittion of Drug-Addicted Offenders Act (SOV) ws lunched on April first 2001. This lw permitted the compulsory plcement of criminl ddicts for up to two yers in government-designted secure nd semi-secure fcilities. To meet severl objections rised pertining to proportionlity nd subsidirity of the lw, SOV ws lunched s n experiment which should be evluted within six yers. After this period the SOV would only be continued in cse of fvourble outcome of the evlution. In 2001, the Reserch nd Documenttion Centre of the Netherlnds Ministry of Justice (WODC) commissioned the Trimbos Institute nd the Amsterdm Institute for Addiction Reserch (AIAR) to evlute the functioning of SOV. Trimbos crried out the process evlution nd AIAR the effectiveness study. This report presents the outcome of the effectiveness study. Qusi compulsory (diversion) nd compulsory tretment of criminl ddicts In the Netherlnds qusi compulsory tretment is seen s n importnt wy to reduce public nuisnce. Specificlly criminl nuisnce cused by ddicted offenders. In this pproch the criminl ddict is offered choice between tretment nd detention. This legl pressure is considered importnt becuse this group of criminl ddicts is not believed to enter tretment on purely voluntry bsis. Mrlow s behviourl model, however, shows tht severl other sources of pressure my ct upon the criminl ddict in ddition to legl pressure. This rises questions bout the voluntry chrcter of voluntry tretment control groups in effect evlutions. Since qusi compulsory tretment tkes plce t the boundry between criminl lw institutions nd ddiction tretment, its ims re both reduction of criminl offences nd improvement of the mentl, physicl nd socil sitution of the offender. The ltter by chnging or stbilizing his drug tking behviour. To ccomplish these gols it is required tht the criminl ddict enters tretment, prticiptes in the tretment in such wy tht the tretment gols my be ccomplished nd does not drop out of tretment premturely. An evlution of the Dutch qusi compulsory tretment progrmmes on these chrcteristics showed tht only smll prt of the trget group ctully entered tretment, the effect of legl pressure on tretment retention ws mrginl nd n effect of qusi compulsory tretment on psychosocil problems, ddictive behviour nd criminl offences ws difficult to prove. The level of legl pressure in the qusi compulsory tretment setting in the Netherlnds, however, is low compred to other countries. This ws considered n importnt cuse for these findings.
146 Effectevlutie vn de Strfrechtelijke Opvng Verslfden (SOV) Until the SOV ct ws lunched, compulsory plcement in tretment progrmme ws only possible in cse of dnger, either to oneself or to others. Compulsory tretment or plcement in tretment progrmme ws not llowed in the context of reducing criminl nuisnce. Compulsion could be used in cse of dnger, qusi compulsion could be used in cse of criminl nuisnce. The SOV chnged this sitution. Although officilly dnger (to persons or goods) is still requirement for compulsory plcement in tretment setting, the SOV ct mde it esier to pply compulsion in strictly criminl nuisnce cses. This compulsory plcement ws seen s probble solution to the low level of coverge nd the limited effect on tretment retention of the qusi compulsory lterntives. It is importnt to relise, however, tht SOV is not compulsory tretment but merely compulsory plcement in tretment setting. Reserch design nd reserch questions The evlution focuses on the min ims of SOV: 1) reduction of criminl recidivism, 2) reduction of ddiction problems nd 3) improvement of socil functioning. The Dutch Minister of Justice stted the following effect criterion: Comprble outcome to intensive qusi compulsory tretment, significntly better outcomes thn regulr detention nd reduction in criminl recidivism of 15 to 20%. Bsed on this criterion the following reserch questions were formulted: 1 Among hrd core criminl ddicts, does SOV result in t lest comprble reduction in criminl recidivism compred to intensive qusi compulsory interventions nd lrger reduction in criminl recidivism compred to regulr detention? 2 Among hrd core criminl ddicts, does SOV result in t lest comprble reduction in ddiction (relted) problems compred to intensive qusi compulsory interventions nd lrger reduction in ddiction (relted) problems compred to regulr detention? 3 Does SOV, compred to intensive qusi compulsory interventions, result in t lest comprble outcomes on socil functioning? 4 Is SOV successful in terms of composite criteri bsed on criminlity, ddiction nd socil functioning? 5 To wht extend did respondents chnge during their sty in SOV? 6 Wht re the expecttions, experiences nd stisfction of respondents with respect to SOV nd the qusi compulsory tretments? 7 Wht intervention nd respondent chrcteristics re relted to successful outcome within the SOV popultion? To nswer these questions we used qusi experimentl design with three comprison groups two qusi compulsory tretment groups nd third group of detined criminl ddicts. The former 2 control groups
Summry 147 comprised 1) clients of the forensic ddiction clinic (FVK), nd 2) clients of Triple-Ex. FVK clients re criminl ddicts who re considered tretble but for whom, given their ddiction, the severity of the offence, their personlity structure nd their tretment history, dmittnce in regulr ddiction tretment centre seems not fruitful option. Triple-Ex (ex ddict, ex criminl ex unemployed) is qusi compulsory tretment setting nd is prt of the Prnssi psycho-medicl centre in The Hgue. This chpter ends with the opertionliztion of success. First for ech im (criminlity, ddiction nd socil functioning) success criterion ws developed. Reduction in criminlity ws opertionlized in two wys: 1) decrese in the percentge of respondents committing crimes (criminlity prevention) nd 2) reduction in the number of crimes committed (criminlity reduction). With respect to ddiction we restricted ourselves to use of illegl opite nd stimulnt use nd hevy lcohol use (defined s more thn five glsses dy). Socil functioning comprises three domins (housing, work nd finnces) combined to one criterion. The prtil criteri were combined into so clled composite criteri. Becuse informtion on socil functioning ws not vilble for the regulr detinees, composite success criteri for comprisons with this control group were only bsed on combintion of the success criteri for criminlity nd ddiction. Bseline chrcteristics of the experimentl nd control groups All study groups (SOV, FVK en Triple-Ex) reched prt of their trget group: hevy criminl chronic hrd drug users. The detined criminl ddicts control group ws comprble to SOV in terms of ddictive behviour nd severity of ddiction. The overll mjority in ll study groups were lredy ddicted to opites, stimulnts or both for mny yers. Most respondents reported contcts erlier in their lives with ddiction tretment. About three qurter of the SOV respondents did enter clinicl tretment t some point in their life. It is not known whether they did ctully complete this erlier tretment(s). We do know, however, tht these tretments did not solve their criminl behviour neither their ddictive behviour. All respondents hd n impressive criminl history, spent lrge prt of their lives in prison nd hd lrge number of erlier convictions. All study groups cn lso be considered problemtic in terms of work experience nd eductionl level. The ltter ws low nd respondents hd more experience with being unemployed thn with hving job. Despite the similrities the study groups did show substntil differences in primry substnce of buse (SOV nd regulr detinees more often opites, FVK nd Triple-Ex more often stimulnts), tretment history (SOV respondents more often strted tretment t some point in their
148 Effectevlutie vn de Strfrechtelijke Opvng Verslfden (SOV) life), criminl history (SOV hd more convictions nd spent more months in detention, SOV nd regulr detinees reported more often property crimes, FVK nd Triple-Ex more often violent crimes), work experiences (SOV nd regulr detinees less fvourble), nd mentl helth cre history (lifetime, SOV respondents hd comprble mentl helth problems but received less often mentl helth tretment). The effect evlution sttisticlly controls for these initil differences by including the following covrites in the nlyses: ge, work sttus, primry substnce of buse, yers hrd drug use, former ddiction tretment, number of months detined lifetime, former mentl helth tretment, nd suicide thoughts t some point in their life. Chnges during their sty in SOV (reserch question 5) Soon fter the strt of SOV, respondents reported substntil improvement of perceived physicl nd mentl helth nd self esteem. This improvement sustined when SOV ended. Reported chnges in self efficcy nd mstery were less pronounced nd pertined minly to the perceived bility to withstnd environmentl pressure to use substnces. The effectiveness of SOV (reserch questions 1 to 4) In ll comprisons both SOV respondents nd respondents from qusi compulsory settings showed higher observed success rte thn regulr detined criminl ddicts. Both in terms of observed (rw) success rtes nd in terms of (for initil differences) djusted odds rtios. Bsed on djusted odds rtio s SOV ws somewht effective in terms of criminlity prevention compred to FVK nd Triple-Ex, comprble in terms of criminlity reduction to FVK nd better thn Triple-Ex, comprble to FVK nd better thn Triple-Ex in terms of ddiction (when the entire follow-up period is tken into ccount, else comprble to both FVK nd Triple-Ex), nd comprble to FVK nd better thn Triple-Ex in terms of socil functioning. See tble s1 for the success rtes. Tble s1 Observed success rtes (% succes) Criteri nd domins SOV FVK Triple-Ex Reg. det. Criminlity prevention 23 18 24 7 Criminlity reduction 43 33 31 9 Addiction (30 dys) 49 42 48 Addiction (follow-up period) 45 32 30 10 Socil functioning 43 41 30 Work 25 13 16 Finnce 47 57 48 Housing 58 55 46 No dt vilble.
Summry 149 The nswer to reserch question 1 (reduction of criminl recidivism) depends on whether one tkes criminlity prevention or criminlity reduction perspective (see tbles s2-s5). From criminlity prevention perspective SOV is somewht less successful thn both qusi compulsory tretments but substntilly better thn regulr detention. From criminlity reduction perspective SOV did somewht better thn both qusi compulsory tretment groups nd substntilly better thn regulr detention. The nswer to reserch question 2 depends on the time frme (30 dys prior to the interview or the entire follow-up period). In the first cse SOV hd comprble outcomes to FVK nd Triple-Ex but does substntilly better thn regulr detention. In the ltter cse SOV did better thn FVK nd Triple-Ex nd did substntilly better thn regulr detention. In terms of socil functioning (reserch question 3) SOV hd comprble outcomes to FVK nd better outcomes thn Triple-Ex. Tble s2 Observed success rtes (%), composite criteri strtified to study group (criminlity prevention perspective) Success in terms of SOV FVK Triple-Ex Reg. det. p (n=154) (n=87) (n=50) (n=72) Criminlity nd ddiction 18 12 20 4 0.004 Criminlity 23 18 24 7 0.002 Criminlity or ddiction 51 39 34 13 <0.001 Tble s3 Observed success rtes (%), composite criteri strtified to study group (criminlity prevention perspective) Success in terms of SOV FVK Triple-Ex p 2 (n=154) (n=87) (n=50) Criminlity nd ddiction nd socil functioning 12 10 16 0.231 Criminlity nd ddiction 16 15 22 0.171 Criminlity 22 17 22 0.448 Addiction nd socil functioning 28 23 26 0.981 Devitions with previous tbles cused by prerequisite tht sitution on socil functioning is not deteriorted nd the fct tht the success criterion for ddiction is different.
150 Effectevlutie vn de Strfrechtelijke Opvng Verslfden (SOV) Tble s4 Observed success rtes (%), composite criteri strtified to study group (criminlity reduction perspective) Success in terms of SOV FVK Triple-Ex Reg. det. p (n=151) (n=80) (n=48) (n=71) Criminlity nd ddiction 28 20 19 4 0.002 Criminlity 43 33 31 9 <0.001 Criminlity or ddiction 58 43 38 11 <0.001 Tble s5 Observed success rtes (%), composite criteri strtified to study group (criminlity reduction perspective) Success in terms of SOV FVK Triple-Ex p (n=151) (n=80) (n=48) Criminlity nd ddiction nd socil functioning 21 18 17 0.861 Criminlity nd ddiction 28 26 27 0.762 Criminlity 40 30 30 0.918 Addiction nd socil functioning 28 24 21 0.779 Devitions with previous tbles cused by prerequisite tht sitution on socil functioning is not deteriorted nd the fct tht the success criterion for ddiction is different. To tke into ccount tht SOV hs gols in term of criminlity, ddiction nd socil functioning, outcomes on these three res re combined into composite outcome mesures, SOV s well s the two qusi compulsory tretment groups did substntilly better thn regulr detention on these composite outcomes (both in terms of observed success rtes nd djusted odds rtio s). Using the most strict composite criterion (success both in terms of criminlity nd ddiction) bsolute success rtes were reltively low (between 12% nd 28%), despite the fct tht both SOV nd qusi compulsory tretment did much better job thn regulr detention. In reltive terms the success rte of SOV ws bout 4.5 to 7 times higher thn the success rte for regulr detention. When compring SOV with both qusi compulsory tretments SOV did somewht better from criminlity reduction perspective nd the qusi compulsory control groups did somewht better from criminlity prevention perspective. The bsolute success probbility, however, seemed to decrese over time. Predictors for success (reserch question 7) To wht extend is the probbility of success relted to 1) perceived coercion, 2) primry substnce of buse, 3) cognitive level nd 4) time in tretment? The nswer to this question my offer informtion for tretment mtching. In our study perceived legl coercion ws neither relted to ctul legl coercion neither to success rte. The smll (non significnt) reltion found suggests decrese in success rtes with n increse in
Summry 151 perceived legl pressure. Primry drug of buse ws lso not sttisticlly significnt relted to success rte. Respondents reporting stimulnts or combintion of stimulnts nd opites s their primry substnce of buse, hd somewht higher (non significnt) success rte compred to respondents with opites s primry substnce of buse. Success rte ws not relted to level of cognitive cpcities. We did find, however, strong positive reltion between tretment durtion nd success rte. Tht is, composite criteri success rte incresed with n increse in tretment durtion. To sttisticlly djust for this potentilly confounding effect tretment durtion ws included s covrite in ll nlyses. The respondent opinion (reserch question 6) There ws much consensus mong SOV, FVK nd Triple-Ex respondents bout res of life in which they were in need of help. Most help ws needed for housing, work, finnce, drug use, ctivities of dily living nd socilizing. Help ws considered reltively less importnt by respondents for physicl nd mentl helth problems, socil contcts nd surprisingly, criminl behviour. The proportion of respondents expecting the tretment fcilities to be ble to ctully supply help on specific res of life ws lower thn the proportion of respondents in need of help on these res of life. Only minority of the respondents reported during follow-up to hve received considerbly or lot of help on specific res of life. Ares of life which were most frequently mentioned s res for which considerbly or lot of help ws received were housing, drug use nd physicl helth. There ws no re of life, however, for which more thn 50% of the respondents received considerbly or lot of help. Compred to the qusi compulsory tretment fcilities, SOV did specificlly well in terms of housing. Less thn one third of the SOV respondents received considerbly or lot of help with respect to criminl behviour. FVK nd SOV did better on this subject but even here, less thn hlf received considerbly or lot of help for their criminl behviour. In ll three tretment groups less thn one third received help for work nd finnce. Only mjority ws stisfied with the help they received on specific res of life nd less thn hlf of SOV nd FVK respondents thought the help received dequte for their problems. Among Triple-Ex respondents this ws slightly more thn hlf (54%). Conclusion Bsed on the reserch findings, SOV hs significntly better outcomes with respect to ddictive behviour nd socil functioning thn regulr detention nd comprble outcomes to two intensive qusi compulsory tretment progrms: the forensic ddiction clinic nd Triple-Ex. Consequently, our finl conclusion is tht SOV fulfils the required criteri. Success rtes re however reltively low nd decrese over time.
152 Effectevlutie vn de Strfrechtelijke Opvng Verslfden (SOV) Given the limited mount of tretment plces nd its long durtion, the impct of SOV on ntionl crime figures, perceived criminl nuisnce nd the burden of criminl ddicts on legl institutions will probbly be limited. This lso pplies, however, to qusi compulsory interventions. Some qulifying remrks hve to be mde on the study design. Firstly, in the Netherlnds both judges nd public prosecutors will never gree to rndom lloction of suspects to the different experimentl conditions (jil, qusi compulsory tretment or compulsory plcement in tretment progrm). This ruled out the possibility of n experimentl design with rndom lloction. Consequently we hd to select the best lterntive: qusi experimentl design with three control conditions: two qusi compulsory tretment groups nd regulr detention group. The former (FVK nd Triple-Ex) hve criminl ddicts s their trget group. Compred to SOV, FVK ims t slightly more problemtic ptient group in terms of psychitric problems. Triple-Ex ims t comprble group of criminl ddicts s SOV. The ltter control group consists of detined criminl ddicts. Dt of this group were bout three yers older thn dt of the other three groups. As consequence, it cnnot be ruled out tht we re prtly looking t period or cohort effect. The qusi experimentl design hs consequences for the finl conclusion. The most importnt being tht cusl sttements like SOV cused more improvement thn the control conditions re formlly not llowed. However, the internl vlidity of the findings cn be considerbly enhnced by sttisticlly correcting for initil differences between study groups. Allowing for tenttive effect sttements. This is wht we did in this evlution. Only minority of the respondents ws stisfied with the help they received. With the exception of housing SOV did less well thn both qusi compulsory control groups, specificlly with respect to drug use. On verge respondents rted SOV on scle from 1 to 10, 4.7 (phse 1), 5.1 (phse 2) nd 5.2 (phse 3), Triple-Ex 5.7 nd FVK 6.5. People were more stisfied bout received informtion, sy nd counselling thn bout the effect of the tretment. Less thn hlf of the SOV nd Triple-Ex respondents nd slightly over one hlf (54%) of the respondents of FVK thought the tretment they received dequte for their problems.