Scottish Government

Crime and Criminal Justice Research Programme
Research Findings No.62/2002

Evaluation of the Scottish Pilots
Drug Treatment and Testing Orders

Susan Eley, Kathryn Gallop, Gill McIvor, Kerry Morgan and Rowdy Yates
University of Stirling

This document is also available in pdf format (111k)

Main findings

• A DTTO was considered to be a high tariff disposal that was appropriate for drug users who offended rather than for offenders who used drugs.
• 47 DTTOs had been imposed in Glasgow and 49 in Fife. In both schemes almost all of the recommendations for DTTOs resulted in the making of an order. Orders were imposed on offenders who were likely otherwise to receive a custodial sentence.
• In both pilot schemes the majority of offenders received a methadone prescription. Although drug services were considered to be generally adequate, it is possible that treatment was determined by availability rather than being needs-led.
• The proportion of positive drug tests for opiates decreased over time. Offenders regarded drug testing both as a deterrent to continued drug use and as an incentive to becoming and remaining drug free.
• Most reviews involved direct contact between the offender and sentencer and in most cases the same sentencer was involved in conducting successive reviews. Offenders regarded reviews, like drug testing, as both a 'carrot' and a 'stick'.
• Professionals were optimistic that DTTOs could impact positively on drug use, offending and other aspects of offenders' lives. Offenders reported marked reductions in drug use and drug-related offending that appeared to be sustained for at least six months. For example, weekly reported expenditure on drugs decreased from 490 before the DTTO to 57 after six months on an order.
• The predicted average cost of a DTTO in established schemes (7,293) compared not unfavourably with the published cost of a 6 month prison sentence (7,029) in 1999/2000.

Introduction

Drug Treatment and Testing Orders (DTTOs) - aimed at providing courts with a further community-based option to deal more effectively with some serious drug misusers who commit crimes to fund their habit - were introduced in the UK through provisions in the Crime and Disorder Act 1998. Under the relevant legislation courts can require offenders to undergo treatment for their drug misuse, subject to their consenting to such an order being made.

DTTOs of between six months and three years can be made as a 'stand alone' option or in conjunction with another community-based disposal such as probation. They differ from existing provisions insofar as 1) the role of the supervising officer is limited 2) mandatory drug-testing is an integral component of the order and 3) the courts have powers to review orders on a regular basis.

Pilot DTTO schemes were introduced in Glasgow (in October 1999) and Fife (in July 2000). This research was commissioned to study the operation of the pilots and to evaluate their effectiveness in reducing drug misuse and related offending.

Methods

A range of research methods was employed in the evaluation of the DTTO pilots including: the analysis of information collected from social enquiry reports and DTTO records; the completion of questionnaires by DTTO staff and treatment providers; interviews with social work managers, DTTO staff, treatment providers and sentencers; interviews with offenders given DTTOs and with a small sample of offenders who participated in the Fast Track Scheme in Forth Valley; and observation of court reviews.

Assessing offenders for a DTTO

There was general agreement among professionals involved in the pilot that the primary purpose of the DTTO was to help bring about reductions in drug use and related offending among offenders given orders. There was a shared view among sentencers that the DTTO was a high tariff disposal to be used, in the main, when other options had been exhausted. DTTO staff emphasised that orders were appropriate for drug users who offended but less so for offenders who used drugs, since the latter were likely to continue offending even if they received treatment for their drug use.

The assessment process was believed by staff to operate smoothly in most respects, though they acknowledged the two-week timescale to be tight, especially in Glasgow where offenders were separately assessed by a DTTO social worker, addiction worker and treatment provider. Sentencers were unanimously positive about the quality of DTTO assessment reports, which they compared favourably with assessments for other types of social work disposals.

Offenders given DTTOs

Ninety-six DTTOs were made (47 in Glasgow and 49 in Fife). The use of DTTOs by the courts was initially lower than anticipated in Glasgow and higher than expected in Fife. The high usage from the outset in Fife may have reflected the absence of other treatment options for offenders who misused drugs.

The conversion rate of DTTO recommendations to orders was very high in both pilot sites (92% in Glasgow and 94% in Fife). The majority of DTTOs imposed were for 12 or 18 months. Offenders who were assessed for a DTTO but who received an alternative disposal were most often imprisoned or given probation orders (with or without additional requirements).

Most offenders given DTTOs were in their twenties or early thirties, with those in Glasgow older, on average, than those in Fife. More than two-thirds had ten or more previous convictions and a similar proportion had served at least one previous custodial sentence. Offenders received their DTTOs mostly for acquisitive property offences (such as shoplifting, theft from cars and housebreaking) and drug offences.

All of the offenders given DTTOs had been using heroin, either alone or in combination with other substances. Pre-sentence expenditure was reported as being between 10 and 200 per day, with an average of 490 per person per week. Most offenders given a DTTO had tried to come off heroin in the past by accessing a range of services.

Treatment provision

Treatment provision in Glasgow was mostly provided by GDPS, Phoenix House and the DTTO addiction workers. DTTO provision in Fife was in-house, with prescribing provided by the offender's GP or a consultant psychiatrist. In both sites, the treatment providers undertook urine testing and provided a range of individual counselling, groupwork and other services.

Some tensions occasionally arose regarding communication between DTTO staff and treatment providers in Glasgow. The co-location of the treatment providers and DTTO staff in Fife appeared to have prevented similar problems from arising.

Methadone prescription and counselling was the most common treatment offered in the pilots and was viewed by most offenders as a necessary first step to becoming drug free. Offenders did not feel coerced into treatments or activities though choice was, in practice, limited and it appeared that treatment may have been determined by availability rather than being needs-led.

Drug testing

The percentage of positive tests for opiates decreased over time, especially in Glasgow. Around two-thirds of drug testing appointments were attended, with higher rates of attendance in Glasgow, where the testing and the issuing of methadone took place at the same location.

Despite its limitations, testing was believed to reinforce the authority of the order and to provide a more accurate indicator of offenders' drug use. Offenders were generally sanguine about the frequency of testing to which they were subjected and viewed drug testing both as a deterrent to continued drug use and as an incentive to becoming and remaining drug free.

Reviews

DTTOs must be reviewed by the court not less than monthly. In Glasgow, the majority of review hearings were conducted in open court, with the court being cleared if issues of a sensitive nature were likely to be discussed. In Fife, sheriffs conducted the majority of review hearings in chambers. Sentencers were divided in their views as to whether defence agents should be present at all reviews. When they were present, the dialogue between the sentencer and the offender was usually restricted.

Reviews were believed to help motivate offenders to complete their orders, especially if there was a continuity of sentencer across reviews, which occurred in most cases. The majority of observed review hearings were encouraging on the part of the sentencer and responsive on the part of the offender. Offenders were generally content with the arrangements for reviews, which they viewed both as a 'carrot' and as a 'stick'.

Enforcement

Sentencers had rarely made amendments to DTTOs at reviews and few orders had been revoked or breached. The breach rate in the Scottish pilots was low in comparison with the relatively high breach rates observed in the English pilot schemes, though some respondents were concerned that this was because too much leeway was given to offenders who failed to comply.

The effect of DTTOs on drug use and offending

Professional respondents were optimistic that DTTOs could help bring about reductions in drug use and drug-related offending. They were also optimistic that DTTOs could have a positive impact on other aspects of offenders' lives. Questionnaires completed by DTTO staff and treatment providers at the start of a DTTO and after the offender had been on an order for six months indicated that most offenders had shown a positive or mixed response to treatment, most treatment objectives had been at least partially achieved and most offenders had demonstrated reductions in their drug use, offending and other problems.

Offenders reported marked reductions in drug use and drug-related offending as a result of being placed on a DTTO. Average reported weekly expenditure on drugs was 57 after six months on a DTTO compared with 490 before being given an order. Offenders identified abstinence as an ultimate goal of a DTTO and were optimistic that they could become and remain drug free, though several had experienced a relapse around five months into their orders. Offenders also reported dramatic reductions in offending since being given a DTTO.

The costs of DTTOs

The costs per month of DTTOs were very similar in the two pilot sites, at 503 in Glasgow and 487 in Fife. With indirect costs associated with review hearings added, the cost of an average-length DTTO was estimated to be 9,129. However it was also estimated that the unit cost of a DTTO might reduce to just under 7,300 in established schemes. By comparison, the published cost of a six month prison sentence (i.e. three months in prison) was 7,029 in 1999/2000.

Conclusions

DTTOs had become well established as an additional option for the courts in dealing effectively with drug-related offending. Issues that will need to be addressed in the proposed phased rollout of DTTOs include: how to ensure that treatment is needs-led rather than determined by availability; how to minimise court and other delays; how to balance accuracy and efficiency in drug testing; and how to balance a consistent and appropriately stringent approach to enforcement with a recognition of drug misuse as a relapsing condition.

Multi-agency working was arguably the biggest challenge faced by the DTTO schemes, requiring not only that different professionals worked together in a co-ordinated way but that there was also some blurring of established roles and responsibilities. Careful planning with realistic timescales will therefore be required prior to the introduction of new DTTO schemes. Work in this preparatory phase should include the development of effective inter-agency protocols and the establishment of effective systems for monitoring the effectiveness of gate-keeping and the process and outcomes of orders.