The Multi-site Adult Drug Court Evaluation (MADCE) was a 6-year national evaluation funded by the National Institute of Justice that looked at the impact of adult drug courts.
Adult drug courts are specialized and problem-solving courts for drug-involved offenders that provide a combination of substance abuse treatment services and intensive judicial supervision of the treatment process. By addressing offenders’ drug abuse problems, adult drug courts aim to reduce drug relapse and prevent future offending.
The MADCE project had four primary goals: 1) test whether drug courts work for participants by reducing their drug use, crime, and multiple other problems associated with drug abuse, 2) examine for whom drug courts work best, 3) explain how drug courts work, and 4) examine whether drug courts generate cost savings.
The therapeutic jurisprudence model and deterrence theory make up the theoretical foundation of drug courts. Under therapeutic jurisprudence, it is argued that legal rules and procedures can be used to improve the mental and physical well-being of clients (that is, drug-involved offenders) within the court system. The emphasis under this model is on the selection of a therapeutic option that promotes health but does not conflict with the normative values of the justice system, such as due process (Rottman and Casey 1999). Drug courts offer a therapeutic option through the provision of treatment and services that can address underlying drug abuse issues but do so through intensive court-based supervision, where drug-involved offenders are held accountable for their actions.
Drug courts also work under the framework of deterrence theory. Deterrence theory holds that the receipt or threat of punishment for committing an offense reduces the likelihood that the offense is committed. Three aspects of punishment (perceived certainty, severity, and celerity) are hypothesized to affect the decision-making process of would-be offenders (Urban Institute 2011b). As a way to deter future offending, drug courts usually employ graduated sanctions, in which responses to violations committed by participants become incrementally harsher.
Drug court programs generally include a multidisciplinary team. Drug court team members consist of judges, prosecutors, defense counsel, social workers, treatment providers, and the offenders.
The MADCE included 23 drug courts located in several different geographic areas across the United States. There were eight MADCE drugs courts in New York state, six in Washington state, two in Florida, two in Georgia, two in Illinois, two in Pennsylvania, and one in South Carolina. Most of the courts operated in urban or suburban areas, with only about one-fourth operating in rural areas.
Although adult drug courts vary in practice and implementation, some basic components of the programs are quite similar. Drug courts generally:
- Provide participants with intensive treatment and other services to achieve and maintain sobriety, and to address any drug-related issues
- Require participants to adhere to regular and random drug tests
- Require frequent court appearances before the judge, to review progress in treatment and address any violations of program requirements
- Adhere to a schedule of graduated sanctions, where responses to violations committed by participants become incrementally harsher
The MADCE provides an example of how drug courts across the country can adhere to similar underlying principles but differ in many other factors, such as participant eligibility, program intensity, the type of substance abuse treatment used by participants, the number of courtroom hearings, the swiftness of sanctions, and the use of risk assessments. As part of the MADCE, a Web-based survey was administered in 2004 to every active adult drug court in operation for at least 1 year (Urban Institute 2011c). The survey results provide descriptive information about program characteristics and operations for the 380 adult drug courts that responded. Among the findings:
- Most adult drug court programs are small. Forty-six percent had fewer than 50 active participants in the program, while about 13 percent reported 200 or more active participants.
- More than one-third of drug courts reported serving only those who are diagnosed as addicted to or dependent on drugs, while one third of the courts serve regular users of drug or alcohol and just under one third serve anyone who uses.
- On average, adult drug court programs required 13 months in programming before participants could graduate, with most requiring between 12 and 18 months.
- Almost all of the courts reported providing the following types of treatment services: residential, intensive outpatient, outpatient individual counseling, outpatient group counseling, drug education, self-help, and relapse.
- Almost all of the courts reported using urine tests to collect drug test samples. A small number of drug courts reported also using a patch, saliva, and hair samples to test for drug use. The vast majority of the courts reported testing for marijuana, crack/cocaine, heroin/opiates, methamphetamine, alcohol, and benzodiazepines. A smaller number of courts reported also testing for stimulants, PCP, LSD, and other drugs.
For the full results of the survey, please see the Urban Institute’s 2011 report titled The Multi-site Adult Drug Court Evaluation: What’s Happening With Drug Courts? A Portrait of Adult Drug Courts in 2004 (please see Additional References for a link to the report).
18 to 100
Overall, the outcome results of the Multi-site Adult Drug Court Evaluation (MADCE) conducted by Urban Institute (2011e) showed that drug court participants did better than comparison offenders on most measures of drug use, criminal behavior, and incarceration. However, there are a few significant differences between the groups on measures of other psychosocial benefits, including socioeconomic status, mental and physical health, family support, and homelessness.
At the 6-month follow-up, 40 percent of drug court participants compared with 55 percent of comparison offenders self-reported that they had used at least one of eight measured substances—a significant difference. However, there was no significant difference in the percentage of drug court and comparison offenders self-reporting serious drug use (32 percent versus 40 percent). Drug court participants did average significantly fewer days of drug use per month (1.5 days versus 3.7) and fewer days of serious use per month (1.0 day versus 2.2 days).
By the 18-month follow-up, drug court participants reported significantly fewer occurrences of any drug use (56 percent versus 76 percent), serious drug use (41 percent versus 58 percent), days of use per month (2.1 days versus 4.8) and days of serious use per month (1.1 days versus 2.3).
The oral swab tests administered at the 18-month interview showed that drug court participants had a significantly lower rate of testing positive than the comparison offenders (29 percent versus 46 percent). However, when examining specific drugs that were tested, there were no significant differences between the groups in the rates of positive drug tests for marijuana, cocaine, opiates, or amphetamines.
At the 6-month follow-up, drug court participants were significantly less likely than comparison offenders to self-report engaging in any criminal behavior (28 percent versus 40 percent). Drug court participants also averaged significantly fewer instances of criminal acts (12.8 versus 34.1). During the following year (the 1-year period before the 18-month survey), drug court participants were still significantly less likely to engage in any criminal behavior (40 percent versus 53 percent). They also averaged fewer than half as many criminal acts (43.0 versus 88.2) and drug-related crimes (30.6 versus 83.1) as the comparison group.
When totaling responses across the two follow-up periods to create a complete set of 18-month criminal behavior measures, nearly half of the drug court group (49 percent) reported at least one criminal act, compared with 64 percent of the comparison group, a statistically significant difference. When counting the total number of criminal acts, drug court participants again averaged fewer than half as many criminal acts as the comparison group (52.5 versus 110.1).
However, when looking at criminal acts that were officially detected, there were no significant differences in the rearrest rate. Slightly more than half (52 percent) of the drug court group was rearrested during the 24-month follow-up period, compared with 62 percent of the comparison group. Drug court participants averaged fewer total rearrests (1.25 versus 1.66), but again the difference was not statistically significant.
Almost the same percentage of drug court participants and comparison offenders self-reported that they experienced at least some incarceration during the 18-month follow-up period (57 percent versus 58 percent, a nonsignificant difference). Drug court participants spent fewer days incarcerated (62.7 days versus 95.3); however, this difference also was not statistically significant.
The official data also showed that there were no significant differences in the percentage of drug court participants and comparison offenders who were sentenced to jail or prison during the 24-month follow-up period (19 percent versus 26 percent). However, drug court participants averaged significantly fewer days sentenced to jail or prison (32.1 days versus 59.4).
There were few significant differences between drug court participants and comparison offenders on measures of socioeconomic status (SES). At 6 months, significantly more drug court participants were enrolled in school (16 percent versus 8 percent), but that difference disappeared by 18 months. At the 18-month follow-up, significantly fewer drug court participants reported needing or wanting educational services or financial assistance. But on all other measures of SES, there were no significant differences.
Mental and Physical Health
There also were few significant differences on measures of mental and physical health. At 6 months, drug court participants rated their current emotional or mental health status significantly higher than comparison offenders, but the difference did not persist to 18 months. At both follow-up periods, drug court participants were significantly more likely to have been set up with public insurance (Medicare or Medicaid). But there were no other significant differences on any other measures.
There were also only a few significant differences on measures of family support and family conflict. At 6 months, drug court participants reported significantly fewer conflicts (0.70 versus 0.98), but again that difference disappeared by 18 months. At 18 months, drug court participants averaged significantly less family conflict, based on a three-item index of conflict. However, there were no other significant differences on any other measures of family support.
There were no significant differences in the rates of homeless and in the average level of interest to receive housing services.