Drug Treatment and Testing Orders: Evaluation of the Scottish Pilots
EXECUTIVE SUMMARY
Background
Drug Treatment and Testing Orders (DTTOs) - which are 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 - have been introduced in the UK through provisions in the Crime and Disorder Act 1998. Under the relevant legislation, courts can require an offender to undergo treatment for his or her drug misuse, subject to the offender's consent to such an order being made. DTTOs - which can be for a minimum of six months and a maximum of three years - can be made as a 'stand alone' option or in conjunction with another community-based disposal such as a probation order. They differ from existing provisions insofar as the role of the supervising officer is limited, mandatory drug-testing is an integral component of the order and the courts have powers to review orders on a regular basis.
DTTOs were first introduced in the UK in three pilot schemes in Croydon, Liverpool and Gloucestershire. The first Scottish scheme was established in Glasgow in October 1999 when orders became available to the Glasgow Sheriff, Stipendiary Magistrate and (subsequently) High Courts. Initial implementation and uptake was slower than expected, with the first order being made in February 2000. The second pilot area began in Fife in July 2000 when DTTOs were made available to Cupar, Dunfermline and Kirkcaldy Sheriff Courts. The first order in Fife was made in August 2000 at Kirkcaldy Sheriff Court. The DTTO scheme in Glasgow consisted of criminal justice social workers and addiction workers, with treatment services provided by the Glasgow Drug Problem Service (GDPS) and Phoenix House. In Fife, the social workers, addiction workers and drugs workers were based together in two teams, with additional services provided by a consultant psychiatrist.
The Department of Applied Social Science at the University of Stirling was commissioned by the Scottish Executive to undertake an evaluation of the pilot schemes. The aim of the research was to evaluate the effectiveness of the pilot DTTOs in reducing drug misuse and associated offending and to assess the costs of DTTOs and alternative disposals.
Methods
A range of research methods was employed in the evaluation of the DTTO pilots. These included: 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; observation of court reviews; and a costing of DTTOs and their alternatives. The amount and type of information available to the researchers was limited by the absence of planned monitoring databases in the two pilot sites by the conclusion of the fieldwork period. This also prevented some direct comparisons between the study sites since aggregate information provided was not always in a comparable format. It should also be recognised that the evaluation focused upon an early stage in the operation of the pilots and practice is therefore likely subsequently to have evolved.
Selecting offenders for DTTOs
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. DTTO staff preferred to conduct assessments for DTTOs in the community though some sentencers were reluctant to grant bail for this purpose. Drug testing (which was not a feature of the English pilots) was undertaken at the assessment stage to obtain information about the types of substances used. It was thought by managers to help bring home to offenders how seriously their behaviour was being taken by the courts and to provide a clear indication of the degree of intrusiveness that would be associated with a DTTO.
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.
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. Motivation was a key factor in the assessment of offenders' suitability, albeit one that was difficult to assess. DTTO staff believed that DTTOs were most appropriate for offenders who were at least in their twenties, with a well-established pattern of drug use and a willingness to change their lifestyle. Young offenders (that is, those aged 16 and 17 years) and those with an absence of stability in their lives were considered less likely to complete a DTTO.
DTTOs were perceived by professionals as differing in a number of respects from probation orders with drug treatment requirements. The preference in the Scottish pilots was for DTTOs to be made as a stand-alone option, in contrast with the English pilots where in two schemes DTTOs were usually made alongside a probation order. DTTOs were believed by managers to be particularly appropriate for female offenders though, in practice, only 17 per cent of orders were made in respect of women.
Offenders given DTTOs
During the research fieldwork period (July 2000 to mid-April 2001 in Fife and between February 2000 and February 2001 in Glasgow) 96 DTTOs were made (47 in Glasgow and 49 in Fife). The conversion rate of DTTO recommendations to orders was very high in both pilot sites (92% in Glasgow and 94% in Fife). In Glasgow, the majority of referrals and orders emanated from the Sheriff Court. 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). The majority of DTTOs imposed were for 12 or 18 months. In Glasgow, there was a tendency for women more often than men to be given a DTTO in addition to a probation order.
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. Offenders in Fife were more likely than those in Glasgow to have a history of convictions for housebreaking and to have received their DTTO for this type of offence.
All of the offenders given DTTOs were using heroin, either alone or in combination with other substances. Most had used heroin within the previous 30 days (usually through intravenous injection) and pre-sentence expenditure was reported as being between 10 and 200 per day, with an average of 490 per person per week. None of the offenders was employed when given a DTTO and most were identified in their social enquiry reports as experiencing drug-related health problems.
Most offenders given a DTTO had tried to come off heroin in the past by accessing a range of services. Most offenders believed that they would have received a custodial sentence if they had not been given a DTTO and a few acknowledged that they had agreed to a DTTO primarily to avoid a prison sentence. However, most offenders had viewed the DTTO principally as an opportunity to get help to come off drugs and indicated that they would still have agreed to an order even if it had not been an alternative to imprisonment. Most offenders also believed that the length of order they had received was both proportionate to their offence and appropriate for the realisation of treatment goals.
Use of DTTOs by the courts
The use of DTTOs by the courts was initially lower than anticipated in Glasgow and higher than expected in Fife. The high usage in Fife from the outset was attributed partly to the fact that sentencers and others had been able to draw upon the experience of DTTOs in Glasgow and partly because they were keen to embrace a new disposal that promised to address an identified need. This was particularly important given the absence hitherto of treatment-focused options for dealing with offenders involved in substance misuse in Fife. Managers believed that the use of DTTOs might be adversely affected by the high unit cost of orders, the resource implications of reviewing orders, the low conversion rate of assessment requests to positive DTTO recommendations and concern about the validity of the order from a human rights perspective. However, it appeared that the use of DTTOs was steadily increasing in Glasgow as sentencers gained more confidence in them. Sentencers were unable to identify features of DTTOs that would discourage them from continuing to make orders.
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.
Treatment providers felt sufficiently well informed about DTTOs, though those in Glasgow suggested that they were not given enough information about offenders at the assessment stage. Much of the communication between treatment providers and DTTO staff occurred informally and was generally believed to be effective, though treatment providers in Glasgow suggested that the timing and content of written communication could be improved and DTTO staff reported occasional tension arising with respect to communication from treatment providers. The co-location of the treatment providers and DTTO staff in Fife appeared to have circumvented the problems that sometimes arose in Glasgow. It also appeared to have prevented the blurring of established professional boundaries between the DTTO social workers and addiction workers.
Social work managers were broadly content with the range of treatment services available to offenders on DTTOs, though services were not uniformly available in different parts of Fife and some treatment providers in Glasgow had been reluctant to accept offenders as part of a DTTO. However, some gaps in services were identified. These included provision for women (in Fife); groupwork for offenders on methadone treatment (in Glasgow); short-term residential detox facilities; and facilities for drug users with a dual diagnosis.
Around one half of the offenders interviewed had accessed drug treatment in the past with varying degrees of success. Methadone prescription and associated counselling, which was the most common treatment offered in the pilots, was viewed by most offenders as a necessary first step to becoming drug free. Offenders did not feel coerced into treatments or activities though opportunities for choice were, in practice, limited. However most offenders reported being happy with the treatment they had received, with some stressing the importance of having access to a range of activities to occupy their time.
Drug testing
Drug testing is an integral part of DTTOs. Glasgow used laboratory testing (which meant that delays of up to two weeks for the receipt of results sometimes occurred) while a combination of laboratory and dipstick testing was employed in Fife. 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. Testing was thought by managers to reinforce the authority of the order and to provide a more accurate indicator of offenders' drug use. However, treatment providers expressed concern that the frequency of testing, especially in the early stages of an order, might serve to decrease offenders' motivation to become drug free. Testing, moreover, could tell if a drug was being used, but could not show how often it was being used or in what quantities.
Offenders were generally sanguine about the frequency of testing to which they were subjected and most believed that testing would help them to reduce their use of drugs. Offenders viewed testing both as a deterrent to continued drug use and as an incentive to becoming and remaining drug free.
Reviews and enforcement
DTTOs must be reviewed by the court not less than monthly, either through a review hearing or a paper review. The dialogue between the offender and the sentencer is a distinctive feature of the DTTO and sentencers expressed a clear preference for hearings, which entailed face-to-face reviews. 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 withhearings with the offender in chambers, though the number of people present tended to undermine the informality of the process. Sentencers were divided in their views as to whether defence agents should be present at all review hearings. When they were present, the dialogue between the sentencer and the offender was usually restricted.
Professional respondents regarded reviews as an important mechanism for motivating offenders to complete their orders and in the majority of cases there was continuity of sentencer across reviews. The majority of reviews that were observed by the researchers were encouraging on the part of the sentencer and responsive on the part of the offender. Offenders were generally content with the frequency of reviews, believing that it kept them 'on their toes'. Reviews, like testing, were perceived by offenders both as a 'carrot' and as a 'stick'.
Sentencers had rarely made amendments to DTTOs at reviews and few orders had been revoked or breached. Sentencers stressed that they would be reluctant to revoke a DTTO without first giving the offender another opportunity to comply with the order. The DTTO was perceived by sentencers and by other professionals as a high tariff option and the former indicated that the likely outcome of revocation of a DTTO would be the imposition of a custodial sentence.
The breach rate in the Scottish pilots was low in comparison with the relatively high breach rates observed in the English pilot schemes, with only two offenders each having been breached in Glasgow and Fife. The low breach rate might reflect the quality of initial assessments and/or the approach to enforcement. The enforcement procedures were somewhat unclear and while most sentencers were satisfied with the flexibility afforded, some sentencers, treatment providers and offenders were concerned that too much leeway was given to offenders who failed to comply. Managers, on the other hand, believed that the flexible response to offenders on DTTOs was a strength of the scheme, avoiding the rigidity of enforcement evidenced in the pilots in England and Wales. Other features of the new orders that were thought to facilitate completion included stability in offenders' circumstances, a consistent approach by the different professionals involved in the DTTO and features of the order itself. Addiction workers stressed the importance of support networks to assist offenders in the longer term.
Effects of DTTOs on drug use and offending
Professional respondents considered a successful DTTO to have brought about a reduction in drug use and associated offending, though some sentencers believed that at the end of the order total abstinence should have been achieved. Factors that tended to undermine the success of the order included living in an area where drug use was rife. Professional respondents were optimistic (albeit cautiously so) that DTTOs could help bring about reductions in drug use and, as a consequence, drug-related offending. They were also optimistic that DTTOs, with their emphasis upon enhancing offenders' social inclusion, could also have a positive impact on other aspects of their lives. Staff attributed 'failures' on DTTOs - which they said were more likely among young offenders - to inadequate assessments or to DTTOs being made by the court against the advice of the scheme.
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 high levels of motivation among offenders to reduce their drug use and offending. Most offenders were said to have shown a positive or mixed response to treatment, most treatment objectives had been at least partially achieved and most offenders were said to have demonstrated reductions in their drug use, offending and other problems.
Offenders reported marked reductions in drug use and drug-related offending since being placed on a DTTO, with an average weekly expenditure of 57 on drugs six months into a DTTO, compared with a weekly expenditure of 490 before being given an order. Offenders identified abstinence as an ultimate goal of a DTTO along with the ability to lead a 'normal' life. Offenders were optimistic that they could become and remain drug free, though several had experienced a relapse around five months into their orders. Offenders also considered further offending to be unlikely, though some would not rule out the possibility of being convicted of other offences that were not related to drug misuse.
Overall, offenders were positively disposed towards the DTTO primarily because it offered them access to treatments and services to help get them and keep them off drugs. Family members were also reported to be positive about DTTOs, with some offenders reporting improvements in family relationships since being placed on an order.
The sample of offenders attending the Fast Track Programme in Forth Valley had been made subject to probation orders for similar offences to the offenders on DTTOs. The offenders attending Fast Track were equally positive about the experience and believed that it had reduced their likelihood of continuing to use drugs, though some were concerned that their orders would have ended before they had become completely drug free. Offenders were also critical of the lengthy assessment period, which resulted in an excessive delay between being placed on probation and accessing treatment.
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 (7,293) in established schemes. By comparison, a six-month prison sentence was estimated to cost 7,029 in 1999/00.
Conclusions
DTTOs had become well established in the pilot areas as an additional option for the courts in dealing effectively with drug-related offending. DTTOs were viewed as differing in purpose from existing disposals with respect to their direct emphasis upon the treatment of drug misuse as a means of reducing re-offending. Despite a slow start in Glasgow, a steady flow of referrals was being achieved in both study sites and the high conversion rate of positive recommendations for a DTTO to actual orders would appear to indicate sentencer confidence in the new measure. Drug testing at the assessment stage appeared to facilitate the subsequent retention of offenders in treatment and supervision. The available data also pointed to DTTOs having had a positive and dramatic impact on drug use and offending which was sustained for at least six months into the orders. The treatment that was provided to offenders given DTTOs - in most cases methadone prescription and counselling - appeared to have been the most important single factor in helping them reduce their use of illegal drugs, but the system of testing and reviews also appeared to have made some contribution in this respect.
A number of issues were identified that will need to be addressed by future DTTO schemes. These included: the limited range of treatment services available to the DTTO pilots and the likelihood that treatment was determined more by the treatment services available than by the treatment needs of offenders made subject to DTTOs; the resource-intensive nature of DTTOs and the resource implications of court delays; the limitations of drugs tests and resource implications of alternative testing methods; the balancing of an appropriately stringent and consistent approach to enforcement with a recognition of drug misuse as a relapsing condition; and the importance of ensuring that computerised systems are in place for monitoring gate-keeping and providing information about the progress and outcomes of orders.
Multi-agency working was, perhaps, the biggest challenge faced by the DTTO schemes. DTTOs required not only that different professionals worked together in a co-ordinated way; 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. For example, developing effective inter-agency protocols for the operation of DTTO schemes is essential and the energy invested in this at the developmental stage will pay dividends in the longer with respect to the operation and management of orders.