GAO-05-219, Adult Drug Courts: Evidence Indicates Recidivism Reductions and Mixed Results for Other Outcomes


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Report to Congressional Committees:

United States Government Accountability Office:

GAO:

February 2005:

Adult Drug Courts:

Evidence Indicates Recidivism Reductions and Mixed Results for Other 
Outcomes:

GAO-05-219:

GAO Highlights:

Highlights of GAO-05-219, a report to congressional committees

Why GAO Did This Study:

Drug court programs, which were established in the late 1980s as a 
local response to increasing numbers of drug-related cases and 
expanding jail and prison populations, have become popular nationwide 
in the criminal justice system. These programs are designed to reduce 
defendants’ repeated crime (that is, recidivism), and substance abuse 
behavior by engaging them in a judicially monitored substance abuse 
treatment. However, determining whether drug court programs are 
effective at reducing recidivism and substance use has been challenging 
because of a large amount of weak empirical evidence.

The 21st Century Department of Justice Appropriations Authorization Act 
requires that GAO assess drug court program effectiveness. To meet this 
mandate, GAO conducted a systematic review of drug court program 
research, from which it selected 27 evaluations of 39 adult drug court 
programs that met its criteria for, among other things, methodological 
soundness. This report describes the results of that review of 
published evaluations of adult drug court programs, particularly 
relating to (1) recidivism outcomes, (2) substance use relapse, (3) 
program completion, and (4) the costs and benefits of drug court 
programs.

DOJ reviewed a draft of this report and had no comments. Office of 
National Drug Control Policy reviewed a draft of this report and 
generally agreed with the findings.

What GAO Found:

Most of the adult drug court programs assessed in the evaluations GAO 
reviewed led to recidivism reductions during periods of time that 
generally corresponded to the length of the drug court program. GAO’s 
analysis of evaluations reporting these data for 23 programs showed the 
following:
* Lower percentages of drug court program participants than comparison 
group members were rearrested or reconvicted.
* Program participants had fewer recidivism events than comparison 
group members. 
* Recidivism reductions occurred for participants who had committed 
different types of offenses.
* There was inconclusive evidence that specific drug court components, 
such as the behavior of the judge or the amount of treatment received, 
affected participants’ recidivism while in the program.
Recidivism reductions also occurred for some period of time after 
participants completed the drug court program in most of the programs 
reporting these data.

Evidence about the effectiveness of adult drug court programs in 
reducing participants’ substance use relapse is limited to data 
available from eight drug court programs. Evaluations of these eight 
drug court programs reported mixed results on substance use relapse. 
For example, drug test results generally showed significant reductions 
in use during participation in the program, while self-reported results 
generally showed no significant reductions in use.

Completion rates, which refer to the percentage of individuals who 
successfully completed a program, in selected adult drug court programs 
ranged from 27 to 66 percent. Other than participants’ compliance with 
drug court program procedures, no other program factor (such as the 
severity of the sanction that would be invoked if participants failed 
to complete the program) consistently predicted participants’ program 
completion.

A limited number of evaluations—four evaluations of seven adult drug 
court programs—provided sufficient cost and benefit data to estimate 
their net benefits. Although the cost of six of these programs was 
greater than the costs to provide criminal justice services to the 
comparison group, all seven programs yielded positive net benefits, 
primarily from reductions in recidivism affecting judicial system costs 
and avoided costs to potential victims. Financial cost savings for the 
criminal justice system (taking into account recidivism reductions) 
were found in two of the seven programs.

Figure 1: Overview of GAO Analysis of Drug Court Program Effectiveness: 

[See PDF for image]

[End of figure]

www.gao.gov/cgi-bin/getrpt?GAO-05-219.

To view the full product, including the scope and methodology, click on 
the link above. For more information, contact Laurie E. Ekstrand at 
(202) 512-8777 or ekstrandl@gao.gov.

[End of section]

Contents:

Letter:

Background:

Results:

Concluding Observations:

Agency Comments and Our Evaluation:

Appendix I: Objectives, Scope, and Methodology:

Appendix II: Evaluations Used Multiple Approaches to Assess Selection 
Bias:

Comparison Groups Can Introduce the Problem of Selection Bias:

Evaluations Addressed Selection Bias through Design:

Evaluations Used a Variety of Statistical Methods to Minimize the 
Possible Effects of Selection Bias:

Appendix III: GAO Criteria for Assessing Evaluations of Drug Court 
Programs' Cost-Benefit Analyses:

The Evaluations We Reviewed and the Net Benefit Measure:

Criteria for Assessing a Drug Court Program's Cost-Benefit Analysis:

How the Drug Court Evaluations We Reviewed Used the Identified Cost- 
Benefit Principles:

Appendix IV: Overview of Drug Court Program Characteristics and 
Participants:

Drug Court Program Components:

Drug Court Program Participants:

Appendix V: Drug Court Programs Are Associated with Recidivism 
Reductions:

Drug Court Programs Led to Within-Program Recidivism Reductions:

Limited Evidence Indicates That Recidivism Reductions Endure:

Appendix VI: Limited and Mixed Evidence on Drug Court Programs' Impacts 
on Substance Use Relapse:

Limited Evidence on Drug Court Programs' Impact on Substance Use 
Relapse:

Evidence on Drug Court Programs' Impact on Substance Use Relapse Is 
Mixed:

Appendix VII: Evidence Is Mixed about the Factors That Predict Program 
Completion:

Program Completion Rates Vary:

Program Completion Is Associated with Compliance with Program 
Procedures:

Effects of Drug Court Programs' Components on Program Completion Are 
Mixed:

Participants Who Were Older and Had Less Criminal History than Other 
Participants Were Most Likely to Complete Programs:

Appendix VIII: Evidence from Four Evaluations Indicates Drug Court 
Programs' Positive Net Benefits:

Most Evaluations Found Drug Court Programs More Expensive than 
Conventional Case Processing:

Drug Court Programs' Net Benefits Derived from Reductions in 
Recidivism: 

All Seven Drug Court Programs Reported Positive Net Benefits:

Net Benefits May Underestimate the Programs' True Benefits:

Appendix IX: GAO Contacts and Staff Acknowledgments:

GAO Contacts:

Acknowledgments:

Bibliography:

Tables:

Table 1: Summary Information about Adult Drug Court Programs Included 
in GAO's Review:

Table 2: The Eight Drug Court Program Evaluations in Our Cost-Benefit 
Review:

Table 3: Research Designs, Comparison Groups, and Methods to Address 
Selection Bias for Evaluations GAO Used in Recidivism Analysis:

Table 4: The Eight Drug Court Program Evaluations in Our Cost-Benefit 
Review:

Table 5: Five Criteria for Assessing a Cost-Benefit Analysis of a Drug 
Court Program:

Table 6: Summary of Criteria Applied in Eight Drug Court Program 
Evaluation Assessments:

Table 7: Differences in Overall Rearrest Rates between Drug Court 
Program Participants and Comparison Group Members:

Table 8: Differences in Reconviction Rates between Drug Court Program 
Participants and Comparison Group Members:

Table 9: Differences in Rearrest and Reconviction Rates, over Longer 
Time Periods, between Drug Court Program Participants and Comparison 
Group Members:

Table 10: Post-Program Differences in Recidivism in Six New York State 
Drug Court Programs:

Table 11: Substance Use Relapse Results, by Different Measures of Use, 
for Programs GAO Reviewed:

Table 12: Completion Rates for Selected Drug Court Programs Included in 
GAO's Review:

Table 13: Reported Costs per Drug Court Program Participant in Four 
Evaluations:

Table 14: Net Benefits per Participant in Seven Drug Court Programs:

Abbreviations:

APD: antisocial personality disorder: 
GAO: Government Accountability Office: 
ONDCP: Office of National Drug Control Policy:

United States Government Accountability Office:

Washington, DC 20548:

February 28, 2005:

The Honorable Arlen Specter: 
Chairman:
The Honorable Patrick J. Leahy: 
Ranking Minority Member:
Committee on the Judiciary: 
United States Senate:

The Honorable F. James Sensenbrenner, Jr.: 
Chairman: 
The Honorable John Conyers, Jr.: 
Ranking Minority Member: 
Committee on the Judiciary: 
House of Representatives:

Drug court programs were established in the late 1980s as a local 
response to increasing numbers of drug-related cases and expanding jail 
and prison populations. These programs are designed to use a court's 
authority to reduce crime by changing defendants' substance abuse 
behavior. Under this concept, in exchange for the possibility of 
dismissed charges or reduced sentences, defendants are diverted to drug 
court programs in which they agree to participate in judicially 
monitored substance abuse treatment. Title II of the 21st Century 
Department of Justice Appropriations Authorization Act reauthorizes the 
award of federal grants for drug court programs that include court- 
supervised drug treatment.[Footnote 1] The award of federal grants to 
drug court programs was first authorized under Title V of the Violent 
Crime Control and Law Enforcement Act of 1994.[Footnote 2]

Drug court programs have become popular nationwide in the criminal 
justice system. As of September 2004, there were over 1,200 drug court 
programs operating in addition to about 500 being planned. With such 
expansion, it is important for policy and operational decision makers 
to have definitive information about drug court programs' effectiveness 
in reducing recidivism and substance use relapse.[Footnote 3] In this 
respect, the 21st Century Department of Justice Appropriations 
Authorization Act requires that we study drug court program 
effectiveness.[Footnote 4] In response, this report describes the 
results of published empirical evaluations of adult drug court 
programs, particularly relating to (1) recidivism outcomes of 
participants and other comparable offenders, (2) substance use relapse 
of participants and other comparable offenders, (3) program completion 
of participants, and (4) costs and benefits of drug court programs.

To address our objectives, we conducted a systematic review of drug 
court program literature. We identified 117 evaluations of adult drug 
court programs in the United States that were published between May 
1997 and January 2004 and reported recidivism, substance use relapse, 
or program completion outcomes. Of these 117, we selected 27 
evaluations that met additional criteria for methodological soundness. 
Most of the evaluations we selected used designs in which all drug 
court program participants were compared with an appropriate group of 
similar offenders who did not participate in the drug court program. In 
order to ensure that the groups are similar in virtually all respects 
aside from the intervention, we selected evaluations in which the 
comparison group was matched to the program group as closely as 
possible on a number of characteristics or that used statistical models 
to adjust, or control for, preexisting differences between the program 
and comparison groups. Five of the 27 evaluations were experiments in 
which participants were randomly assigned to groups. Random assignment 
works to ensure that the groups are comparable.

The 27 evaluations we selected for our review reported information on 
39 unique adult drug court programs. We systematically collected 
information from these evaluations about the methodological 
characteristics of the evaluations, the participants and components of 
the drug court programs, the outcomes, and, where available, the costs 
of the drug court programs. To assess the methodological strength of 
the evaluations, we used generally accepted social science principles. 
Additionally, we used standard cost-benefit criteria to screen and 
assess the eight evaluations that reported cost and benefit 
information. Four of these contained sufficient data on costs and 
benefits to allow us to assess net benefits. We selected the 
evaluations in our review according to the strength of their 
methodologies; therefore, our results cannot be generalized to all drug 
court programs or their evaluations. Finally, we interviewed drug court 
researchers and officials at the Department of Justice, the National 
Institute on Drug Abuse, and the Office of National Drug Control Policy 
(ONDCP). We conducted our work from October 2003 through February 2005 
in accordance with generally accepted government auditing standards. 
Appendix I presents more details about our scope and methodology, 
including a list of the evaluations we reviewed. Appendix II describes 
the research designs and methods used in assessing recidivism in the 
evaluations we reviewed, and appendix III presents our criteria for 
assessing evaluations of drug court programs' cost-benefit analyses.

Background:

Of the 1,700 drug court programs operating or planned as of September 
2004, about 1,040--nearly 770 operating and about 270 being planned-- 
were adult drug court programs, according to data collected by the 
Office of Justice Programs' Drug Court Clearinghouse and Technical 
Assistance Project.[Footnote 5] The primary purpose of these programs 
is to use a court's authority to reduce crime by changing defendants' 
substance abuse behavior. In exchange for the possibility of dismissed 
charges or reduced sentences, eligible defendants who agree to 
participate are diverted to drug court programs in various ways and at 
various stages in the judicial process. These programs are typically 
offered to defendants as an alternative to probation or short-term 
incarceration.

Drug court programs share several general characteristics but vary in 
their specific policies and procedures because of, among other things, 
differences in local jurisdictions and criminal justice system 
practices. In general, judges preside over drug court proceedings, 
which are called status hearings; monitor defendants' progress with 
mandatory drug testing; and prescribe sanctions and rewards as 
appropriate in collaboration with prosecutors, defense attorneys, 
treatment providers, and others. Drug court programs also vary in terms 
of the substance abuse treatment required. However, most programs offer 
a range of treatment options and generally require a minimum of about 1 
year of participation before a defendant completes the program.

In order to determine defendants' eligibility for participation, drug 
court programs typically screen defendants based on their legal status 
and substance use. The screening process and eligibility criteria can 
vary across drug court programs.[Footnote 6] According to the 
literature, eligible drug court program participants ranged from 
nonviolent offenders charged with drug-related offenses who have 
substance addictions to relatively medium-risk defendants with fairly 
extensive criminal histories and failed prior substance abuse treatment 
experiences. Participants were also described as predominantly male 
with poor employment and educational achievements. Appendix IV presents 
additional information about the general characteristics of drug court 
programs and participants in the evaluations we reviewed.

Research on drug court programs has generally focused on program 
descriptions and process measures, such as program completion rates, 
and presented limited empirical evidence about the effectiveness of 
drug court programs in reducing recidivism and substance use. In 1997, 
we reported on 12 evaluations that met minimum research standards and 
concluded that the evaluations showed some positive results but did not 
firmly establish whether drug court programs were successful in 
reducing offender recidivism and substance use relapse.[Footnote 7] 
More recently, two syntheses of multiple drug court program evaluations 
have drawn positive conclusions about the impact of drug court 
programs. One synthesis concluded that criminal activity and substance 
use are reduced relative to other comparable offenders while 
participants are engaged in the drug court program, and that program 
completion rates ranged from 36 to 60 percent.[Footnote 8] Further, the 
other synthesis reported that drug offenders participating in a drug 
court program are less likely to re-offend than similar offenders 
sentenced to traditional correctional options, such as 
probation.[Footnote 9]

Some of the evaluations included in these two syntheses had 
methodological limitations such as, the lack of strong comparison 
groups and the lack of appropriate statistical controls. Some did not 
use designs that compared all drug court program participants-- 
including graduates, those still active, and dropouts--with similar 
nonparticipants. For example, they compared the outcomes of 
participants who completed the program with the outcomes of those who 
did not (that is, dropouts). These evaluations, upon finding that 
program graduates had better outcomes than dropouts, have concluded 
that drug court programs are effective. This is a likely overestimation 
of the positive effects of the intervention because the evaluation is 
comparing successes to failures, rather than all participants to 
nonparticipants. Additionally, other evaluations did not use 
appropriate statistical methods to adjust for preexisting differences 
between the program and comparison groups. Without these adjustments, 
variations in measured outcomes for each group may be a function of the 
preexisting differences between the groups, rather than the drug court 
program.

Results:

In most of the evaluations we reviewed, adult drug court programs led 
to recidivism reductions during periods of time that generally 
corresponded to the length of the drug court program--that is, within- 
program.[Footnote 10] Our analysis of evaluations reporting recidivism 
data for 23 programs showed that lower percentages of drug court 
program participants than comparison group members were rearrested or 
reconvicted. Program participants also had fewer incidents of rearrests 
or reconvictions and a longer time until rearrest or reconviction than 
comparison group members. These recidivism reductions were observed for 
any felony offense and for drug offenses, whether they were felonies or 
misdemeanors. However, we were unable to find conclusive evidence that 
specific drug court program components, such as the behavior of the 
judge, the amount of treatment received, the level of supervision 
provided, and the sanctions for not complying with program 
requirements, affect participants' within-program recidivism. Post- 
program recidivism reductions were measured for up to 1 year after 
participants completed the drug court program in several evaluations, 
and in these the evidence suggests that the recidivism differences 
observed during the program endured. A more detailed description of the 
recidivism reduction results is included in appendix V.

Evidence about the effectiveness of drug court programs in reducing 
participants' substance use relapse is limited and mixed. The evidence 
included in our review on substance use relapse outcomes is limited to 
data available from eight drug court programs. The data include drug 
test results and self-reported drug use; both measures were reported 
for some programs. Drug test results generally showed significant 
reductions in use during participation in the program, while self- 
reported results generally showed no significant reductions in use. 
Appendix VI presents additional information about the evaluations we 
reviewed that reported on substance use relapse outcomes.

Completion rates, which refer to the number of individuals who 
successfully completed a drug court program as a percentage of the 
total number admitted, in the programs we reviewed that assessed 
completion ranged from 27 to 66 percent. As might be expected, program 
completion was associated with participants' compliance with program 
requirements. Specifically, evaluations of 16 adult drug court programs 
that assessed completion found that participants' compliance with 
procedures was consistently associated with completion. These program 
procedures include attending treatment sessions, engaging in treatment 
early in the program, and appearing at status hearings. No other 
program factor, such as the severity of the sanction that would be 
invoked if participants failed to complete the program and the manner 
in which judges conducted status hearings, predicted participants' 
program completion. Several characteristics of the drug court program 
participants themselves were also associated with an increased 
likelihood of program completion. These characteristics include lower 
levels of prior involvement in the criminal justice system and age, as 
older participants were more likely to complete drug court programs 
than younger ones. Appendix VII presents additional information about 
the evaluations we reviewed that reported on program completion.

A limited number of evaluations in our review discussed the costs and 
benefits of adult drug court programs. Four evaluations of seven drug 
court programs provided sufficient cost and benefit data to estimate 
their net benefits (that is, the benefits minus costs). The cost per 
drug court program participant was greater than the cost per comparison 
group member in six of these drug court programs. However, all seven 
programs yielded positive net benefits, primarily from reductions in 
recidivism affecting both judicial system costs and avoided costs to 
potential victims. Net benefits ranged from about $1,000 per 
participant to about $15,000 in the seven programs. These benefits may 
underestimate drug court programs' true benefits because the 
evaluations did not include indirect benefits (such as reduced medical 
costs of treated participants). Financial cost savings for the criminal 
justice system (taking into account recidivism reductions) were found 
in two of the seven programs. We provide additional information about 
the reported costs and benefits of drug court programs we reviewed in 
appendix VIII.

Concluding Observations:

Overall, positive findings from relatively rigorous evaluations in 
relation to recidivism, coupled with positive net benefit results, 
albeit from fewer studies, indicate that drug court programs can be an 
effective means to deal with some offenders. These programs appear to 
provide an opportunity for some individuals to take advantage of a 
structured program to help them reduce their criminal involvement and 
their substance abuse problems, as well as potentially provide a 
benefit to society in general.

Although not representative of all drug court programs, our review of 
27 relatively rigorous evaluations provides evidence that drug court 
programs can reduce recidivism compared to criminal justice 
alternatives, such as probation. These results are consistent with 
those of past reviews of drug court evaluations. Positive results 
concerning recidivism are closely associated with program completion. 
Specifically, while drug court participation is generally associated 
with lower recidivism, the recidivism of program completers is lower 
than for participants in comparison or control groups. Thus, practices 
that encourage program completion may enhance the success of drug court 
programs in relation to recidivism.

While our review sheds little light on the specific aspects of these 
programs that are linked to positive recidivism outcomes, both 
participant compliance with drug court procedures and some participant 
characteristics seem to be related to success. To the extent that 
research can help to discern best practices for drug courts, the models 
for effective programs can be enhanced. Specifically, to the extent 
that drug court program managers can learn more about methods to retain 
participants for the duration of the program, they may be able to 
further enhance the positive impacts of drug court programs.

Agency Comments and Our Evaluation:

We requested comments on a draft of this report from the Attorney 
General and the Director of ONDCP. Department of Justice officials 
informed us that the agency had no comments on the report. ONDCP 
officials informed us that the agency generally concurred with our 
findings.

We are sending copies of this report to other interested congressional 
committees, the Attorney General, and the Director of the Office of 
National Drug Control Policy. We will also make copies available to 
others upon request. In addition, the report will be available at no 
charge on GAO's Web site at http://www.gao.gov.

If you or your staff have any questions concerning this report, please 
contact me at (202) 512-8777 or by e-mail at EkstrandL@gao.gov or 
William J. Sabol, Assistant Director, at (202) 512-3464, or 
SabolW@gao.gov. Key contributors to this report are listed in appendix 
IX.

Signed by: 

Laurie E. Ekstrand, Director: 
Homeland Security and Justice Issues:

[End of section]

Appendix I: Objectives, Scope, and Methodology:

The 21st Century Department of Justice Appropriations Authorization Act 
requires that we assess drug court program effectiveness.[Footnote 11] 
Our objectives were to assess the results of methodologically sound, 
published empirical evaluations of adult drug court programs, 
particularly relating to (1) recidivism outcomes of participants and 
other comparable offenders, (2) substance use relapse of participants 
and other comparable offenders, (3) program completion of participants, 
and (4) costs and benefits of drug court programs.

To identify the universe of evaluations to include in our review, we 
used a three-stage process. First, we (1) conducted key-word searches 
of criminal justice and social science research databases;[Footnote 12] 
(2) searched drug court program-related Web sites, such as those of the 
National Drug Court Institute and the National Association of Drug 
Court Professionals; (3) reviewed bibliographies, published summaries, 
meta-analyses, and prior GAO reports on drug court programs;[Footnote 
13] and (4) asked drug court researchers and officials in agencies that 
fund drug court research to identify evaluations. Our literary search 
identified over 230 documents, which consisted of published and 
unpublished outcome evaluations, process evaluations that described 
program objectives and operations, manuals and guides related to drug 
court program operations, commentary from drug court practitioners, and 
summaries of multiple program evaluations. Next, we reviewed these 
documents and identified 117 evaluations of adult drug court programs 
in the United States that (1) were published between May 1997 and 
January 2004[Footnote 14] and (2) reported recidivism, substance use 
relapse, or program completion outcomes.

Finally, to select the evaluations we used in our in-depth review, we 
screened them to determine whether they met additional criteria for 
methodological soundness. Specifically, to assess recidivism and 
substance use relapse, we selected evaluations that used either an 
experimental design in which (1) eligible offenders were randomly 
assigned to different programs or conditions and (2) there was an 
acceptable level of attrition[Footnote 15] or a quasi-experimental 
design in which (1) all drug court program participants were compared 
with an appropriate group of comparable offenders who did not 
participate in the drug court program, and (2) appropriate statistical 
methods were used to adjust, or control, for group differences. If 
random assignment was not used, in an attempt to ensure that the groups 
were similar, aside from program participation (the intervention), the 
comparison group(s) should have been as alike as possible on a range of 
important characteristics. Statistical analyses can be used to further 
minimize differences between the program and comparison groups. 
Typically, statistical analyses to control for differences such as 
these are not necessary when study participants are randomly assigned 
to groups.

To assess program completion, we also selected evaluations that 
compared the outcomes of participants (such as program graduates and 
those who dropped out) within a drug court program in order to 
determine what factors, if any, are associated with program completion. 
We selected those evaluations that used appropriate statistical methods 
to control for differences between the participant groups. Of the 117 
evaluations we screened, we selected 27 evaluations for our in-depth 
review.

The 27 evaluations we selected for our review reported information on 
39 unique adult drug court programs that were implemented between 1991 
and 1999. Table 1 lists the drug court program evaluated, researchers, 
and outcomes we used in our assessment of drug court program 
effectiveness. All of the evaluations we reviewed, as well as others 
consulted, is included in the bibliography.

Table 1: Summary Information about Adult Drug Court Programs Included 
in GAO's Review:

Drug court program evaluated (researcher): Bakersfield (Calif.) 
Municipal Drug Court (Anspach and Ferguson, 2003); 
Outcomes used in our assessment: Program completion: Yes.

Drug court program evaluated (researcher): Baltimore City (Md.) Drug 
Treatment Court (Banks and Gottfredson, 2003); 
Outcomes used in our assessment: Recidivism: Yes. 


Drug court program evaluated (researcher): Baltimore City (Md.) Drug 
Treatment Court (Gottfredson and Exum, 2002; Gottfredson, Najaka, and 
Kearley, 2003); 
Outcomes used in our assessment: Recidivism: Yes. 

Drug court program evaluated (researcher): Breaking the Cycle 
Program,[A] Birmingham, Ala. (Harrell and others, 2003); 
Outcomes used in our assessment: Recidivism: Yes; 
Outcomes used in our assessment: Drug use: Yes. 

Drug court program evaluated (researcher): Breaking the Cycle 
Program,[A] Jacksonville, Fla. (Harrell and others, 2003); 
Outcomes used in our assessment: Recidivism: Yes; 
Outcomes used in our assessment: Drug use: Yes. 

Drug court program evaluated (researcher): Breaking the Cycle 
Program,[A] Tacoma, Wash (Harrell and others, 2003); 
Outcomes used in our assessment: Recidivism: Yes; 
Outcomes used in our assessment: Drug use: Yes. 

Drug court program evaluated (researcher): Bronx (N.Y.) Treatment Court 
(Rempel and others, 2003); 
Outcomes used in our assessment: Recidivism: Yes; 
Outcomes used in our assessment: Program completion: Yes.

Drug court program evaluated (researcher): Brooklyn (N.Y.) Treatment 
Court (Rempel and DeStefano, 2001); 
Outcomes used in our assessment: Program completion: Yes.

Drug court program evaluated (researcher): Brooklyn (N.Y.) Treatment 
Court (Rempel and others, 2003); 
Outcomes used in our assessment: Recidivism: Yes; 
Outcomes used in our assessment: Program completion: Yes.

Drug court program evaluated (researcher): Broward County (Fla.) Drug 
Court (Schiff and Terry, 1997); 
Outcomes used in our assessment: Program completion: Yes.

Drug court program evaluated (researcher): Broward County (Fla.) Drug 
Court (Senjo and Leip, 2001); 
Outcomes used in our assessment: Program completion: Yes.

Drug court program evaluated (researcher): Chester County (Penn.) Drug 
Court Program (Brewster, 2001); 
Outcomes used in our assessment: Recidivism: Yes; 
Outcomes used in our assessment: Drug use: Yes. 

Drug court program evaluated (researcher): Clark County Drug Court (Las 
Vegas, Nev.) (Goldkamp, White, and Robinson, 2001); 
Outcomes used in our assessment: Program completion: Yes.

Drug court program evaluated (researcher): Clark County Drug Court (Las 
Vegas, Nev.) (Miethe, Lu, and Reese, 2000); 
Outcomes used in our assessment: Recidivism: Yes. 

Drug court program evaluated (researcher): Creek County (Okla.) Drug 
Court (Anspach and Ferguson, 2003); 
Outcomes used in our assessment: Program completion: Yes.

Drug court program evaluated (researcher): D.C. Superior Court Drug 
Intervention Program (Harrell, Cavanagh, and Roman, 1998); 
Outcomes used in our assessment: Recidivism: Yes; 
Outcomes used in our assessment: Drug use: Yes. 

Drug court program evaluated (researcher): Douglas County (Neb.) Drug 
Court (Spohn and others, 2001; 
Martin, Spohn, Piper, and Frenzel-Davis, 2001); 
Outcomes used in our assessment: Recidivism: Yes. 

Drug court program evaluated (researcher): Escambia County (Fla.) Drug 
Court (Peters and Murrin, 2000); 
Outcomes used in our assessment: Program completion: Yes.

Drug court program evaluated (researcher): Escambia County (Fla.) Drug 
Court (Peters, Haas, and Murrin, 1999); 
Outcomes used in our assessment: Program completion: Yes.

Drug court program evaluated (researcher): Escambia County (Fla.) Drug 
Court (Truitt and others, 2002); 
Outcomes used in our assessment: Recidivism: Yes; 
Outcomes used in our assessment: Program completion: Yes.

Drug court program evaluated (researcher): Hamilton County Drug Court 
(Cincinnati, Ohio) (Listwan and others, 2003); 
Outcomes used in our assessment: Recidivism: Yes[B]. 

Drug court program evaluated (researcher): Jackson County (Mo.) Drug 
Court (Anspach and Ferguson, 2003); 
Outcomes used in our assessment: Program completion: Yes.

Drug court program evaluated (researcher): Jackson County (Mo.) Drug 
Court (Truitt and others, 2002); 
Outcomes used in our assessment: Recidivism: Yes; 
Outcomes used in our assessment: Program completion: Yes.

Drug court program evaluated (researcher): Kentucky Drug Court 
Programs[C] (LOGAN, HOYT, AND LEUKEFELD, 2001); 
Outcomes used in our assessment: Recidivism: Yes. 

Drug court program evaluated (researcher): Las Cruces (N. Mex.) 
Municipal DWI Drug Court (Breckenridge and others, 2000); 
Outcomes used in our assessment: Recidivism: Yes[D]. 

Drug court program evaluated (researcher): Los Angeles County (Calif.) 
Drug Court Program (Deschenes and others, 1999; 
Fielding and others, 2002); 
Outcomes used in our assessment: Recidivism: Yes. 

Drug court program evaluated (researcher): Maricopa County (Ariz.) 
First Time Drug Offender Program (Deschenes, and others, 1996; 
Turner and others, 1999); 
Outcomes used in our assessment: Recidivism: Yes; 
Outcomes used in our assessment: Drug use: Yes. 

Drug court program evaluated (researcher): Multnomah County (Ore.) 
Sanctions, Treatment, Opportunity, and Progress (STOP) Drug Diversion 
Program (Finigan, 1998); 
Outcomes used in our assessment: Recidivism: Yes. 

Drug court program evaluated (researcher): Multnomah County (Ore.) 
Sanctions, Treatment, Opportunity, and Progress (STOP) Drug Diversion 
Program (Goldkamp, White, and Robinson, 2001); 
Outcomes used in our assessment: Program completion: Yes.

Drug court program evaluated (researcher): New Castle County (Del.) 
Drug Court (Marlowe and others, 2004; 
Festinger and others, 2002); 
Outcomes used in our assessment: Drug use: Yes; 
Outcomes used in our assessment: Program completion: Yes.

Drug court program evaluated (researcher): North Carolina Drug 
Treatment Court (Craddock, 2002); 
Outcomes used in our assessment: Recidivism: Yes. 

Drug court program evaluated (researcher): Okaloosa County (Fla.) Drug 
Court (Peters and Murrin, 2000); 
Outcomes used in our assessment: Program completion: Yes.

Drug court program evaluated (researcher): Orange County (Calif.) Drug 
Court Program (Deschenes and others, 2001); 
Outcomes used in our assessment: Recidivism: Yes; 
Outcomes used in our assessment: Program completion: Yes.

Drug court program evaluated (researcher): Queens (N.Y.) Treatment 
Court (Rempel and others, 2003); 
Outcomes used in our assessment: Recidivism: Yes; 
Outcomes used in our assessment: Program completion: Yes.

Drug court program evaluated (researcher): Rochester (N.Y.) Drug 
Treatment Court (Rempel and others, 2003); 
Outcomes used in our assessment: Recidivism: Yes. 

Drug court program evaluated (researcher): So. San Mateo County 
(Calif.) Drug Court (Wolfe, Guydish, and Termondt, 2002); 
Outcomes used in our assessment: Recidivism: Yes. 

Drug court program evaluated (researcher): St. Mary Parish (La.) Drug 
Court (Anspach and Ferguson, 2003); 
Outcomes used in our assessment: Program completion: Yes.

Drug court program evaluated (researcher): Suffolk County (N.Y.) Drug 
Treatment Court (Rempel and others, 2003); 
Outcomes used in our assessment: Recidivism: Yes; 
Outcomes used in our assessment: Program completion: Yes.

Drug court program evaluated (researcher): Syracuse (N.Y.) Community 
Treatment Court (Rempel and others, 2003); 
Outcomes used in our assessment: Recidivism: Yes; 
Outcomes used in our assessment: Program completion: Yes.

Drug court program evaluated (researcher): Washington State Drug Court 
Program[E] (Barnoski and Aos, 2003); 
Outcomes used in our assessment: Recidivism: Yes. 

Source: GAO analysis of drug court program evaluations.

[A] According to the principal researcher of the evaluation, the 
Breaking the Cycle program is technically not considered to be a drug 
court program. However, we included the program in our review because 
it incorporates several of the basic drug court program components, 
such as drug testing and access to treatment services.

[B] Recidivism results for the Hamilton County evaluation were not 
included in our review because upon our further review, we found that 
the nonequivalent control group design did not sufficiently control for 
group differences that could have explained the reported (favorable) 
recidivism differences.

[C] The evaluation of the Kentucky Drug Court Program included three 
programs: (1) Fayette Drug Court program, (2) Jefferson County Drug 
Court program, and (3) Warren Drug Court program. The data for these 
three programs were combined in the analyses conducted. However, 
information about the program components and participants was reported 
separately for each program.

[D] We included the evaluation of the Las Cruces Municipal DWI Drug 
Court because it was an experiment that assessed recidivism. However, 
we did not include its results in our final review of recidivism 
outcomes because it is a specialty court that handles only misdemeanor 
driving while intoxicated (DWI) defendants.

[E] The evaluation of Washington State Drug Court Program included six 
programs: those in (1) King, (2) Kitsap, (3) Pierce, (4) Skagit, (5) 
Spokane, and (6) Thurston counties. Limited information about the 
program components and participants were reported for each of the six 
programs. However, some of the recidivism analyses combined data from 
multiple counties.

[End of table]

To obtain information on our outcomes of interest--that is, recidivism, 
substance use relapse, and program completion--we used a data 
collection instrument to systematically collect information about the 
methodological characteristics of the evaluations, the participants and 
components of the drug court programs, and the outcomes of the 
participants and other comparable groups.

To assess the methodological strength of the 27 evaluations, we used 
generally accepted social science principles.[Footnote 16] For example, 
we assessed elements such as whether data were collected during or 
after program completion and the appropriateness of outcome measures, 
statistical analyses, and any reported results. Each evaluation was 
read and coded by a senior social scientist with training and 
experience in evaluation research methods. A second senior social 
scientist and other members of our evaluation team then reviewed each 
completed data collection instrument to verify the accuracy of the 
information included. Part of our assessment also focused on the 
quality of the data used in the evaluations as reported by the 
researchers and our observations of any problems with missing data, any 
limitations of data sources for the purposes for which they were used, 
and inconsistencies in reporting data; 
we incorporated any data problems noted into our appraisals.

To assess the cost-benefit analyses of drug court program evaluations, 
we reviewed all of the evaluations selected for our structured review 
that reported cost or benefit information. Of the 27 evaluations 
included in our in-depth review, 8 reported information about program 
costs and 4 about benefits. The 8 evaluations we included in our cost 
review are shown in table 2.

Table 2: The Eight Drug Court Program Evaluations in Our Cost-Benefit 
Review:

Included in cost-benefit analysis: 

Drug court program evaluation: Breaking the Cycle Program (Harrell and 
others, 2003); 
Reported data on benefits: Yes; 
Reported data on costs: Yes.

Drug court program evaluation: D.C. Superior Court Drug Intervention 
Program Harrell, Cavanagh, and Roman, 1998); 
Reported data on benefits: Yes; 
Reported data on costs: Yes.

Drug court program evaluation: Multnomah County (Ore.) STOP Drug 
Diversion Program (Carey and Finigan, 2003); 
Reported data on benefits: Yes; 
Reported data on costs: Yes.

Drug court program evaluation: Washington State Drug Court Program 
(Barnoski and Aos, 2003); 
Reported data on benefits: Yes; 
Reported data on costs: Yes.

Not included in cost-benefit analysis: 

Drug court program evaluation: Douglas County (Neb.) Drug Court 
(Martin, Spohn, Piper, and Frenzel-Davis, 2001); 
Reported data on benefits: No; 
Reported data on costs: Yes.

Drug court program evaluation: Kentucky Drug Court Programs (Logan, 
Hoyt, and Leukefeld, 2001); 
Reported data on benefits: No; 
Reported data on costs: Yes.

Drug court program evaluation: Los Angeles County (Calif.) Drug Court 
Program (Deschenes and others, 1999); 
Reported data on benefits: No; 
Reported data on costs: Yes.

Drug court program evaluation: Maricopa County (Ariz.) First Time Drug 
Offender Program (Deschenes and others, 1996); 
Reported data on benefits: No; 
Reported data on costs: Yes.

Source: GAO analysis of drug court program evaluations.

[End of table]

Four of the 8 evaluations reported sufficient data on both benefits and 
costs, which allowed us to assess the reported net benefits of the drug 
court programs. Specifically, we were able to determine whether the 
reduction of recidivism--the benefit--would outweigh the additional 
costs of a program. We used standard cost-benefit criteria to screen 
and assess these evaluations that reported cost and benefit 
information. Additionally, we reviewed methodologies describing 
approaches for conducting cost analyses of drug court programs.

We selected the evaluations in our review based on their methodological 
strength; therefore, our results cannot be generalized to all drug 
court programs or their evaluations. Although the findings of the 
evaluations we reviewed are not representative of the findings of all 
evaluations of drug court programs, the evaluations consist of those 
published evaluations we could identify that used the strongest designs 
to assess drug court program effectiveness.

Finally, we interviewed drug court program researchers and officials at 
the Department of Justice, the National Institute on Drug Abuse, and 
the Office of National Drug Control Policy. We conducted our work from 
October 2003 through February 2005 in accordance with generally 
accepted government auditing standards.

[End of section]

Appendix II: Evaluations Used Multiple Approaches to Assess Selection 
Bias:

Most of the evaluations included in our review used quasi-experimental 
comparison groups.[Footnote 17] The use of quasi-experimental 
comparison groups can result in comparisons between drug court 
participants and comparison group members that differ on key variables 
related to recidivism. Systematic difference between comparison groups 
and treatment groups, called selection bias, threatens the validity of 
evaluation findings. Though design and analysis strategies differed, 
each of the quasi-experimental evaluations in our review used some 
combination of design and statistical methods to address the issue of 
selection bias. Approaches to address selection bias in design 
generally included attempts to choose comparison groups that share key 
commonalities with treatment groups (usually including likelihood of 
eligibility to participate in a drug court were it available) and 
therefore were less likely to differ on observed and unobserved 
characteristics related to recidivism. The evaluations in our review 
also included attempts to minimize the effects of selection bias 
through the application of various statistical methods.

Comparison Groups Can Introduce the Problem of Selection Bias:

The observed differences in recidivism that we discuss in this report 
could arise from measured and unmeasured sources of variation between 
drug court participants and comparison group members. If comparison 
group members differed systematically from drug court participants on 
variables or factors that are also associated with recidivism and these 
variables were not accounted for by the design or analysis used in the 
evaluation, then the observed differences in recidivism could be due to 
these sources of variation rather than participation in the drug court 
program. For example, if successful drug court participants differed 
systematically in their substance abuse addiction problems from the 
members of the group against which they are compared, and if the 
differences in substance abuse addiction are not explicitly assessed in 
the evaluation, these differences, and not necessarily participation in 
the drug court program, could explain any observed recidivism 
differences. Similarly, if participants differed from comparison group 
members in their motivation to complete the drug court, recidivism 
differences could arise from these. Evaluations generally do not have 
measures of variables, such as motivation, that can be explicitly 
included in the analysis of drug court outcomes.

One way to address issues of selection bias is in the design of the 
comparison groups. Generally, random assignment of eligible 
participants to treatment and control groups addresses selection bias 
by randomly distributing individual differences between the treatment 
and control group. Another way to address selection bias is 
statistically--by forming comparison groups that consist of individuals 
that are as similar as possible to drug court participants and by using 
statistical techniques to control for observed differences, including 
sophisticated two-step procedures that attempt to address differences 
in selection into the drug court program. For the recidivism outcomes 
we reported, the evaluations in our review used design and statistical 
methods to address selection bias.

Evaluations Addressed Selection Bias through Design:

Evaluations in our review were either experiments or quasi-experiments. 
The experiments randomly assigned eligible defendants to a drug court 
program or a control group of defendants who received conventional case 
processing.[Footnote 18] The quasi-experiments used one of two types of 
comparison groups:

* historical comparison group--formed from individuals who received 
conventional case processing during a period of time shortly before the 
drug court program was implemented and:

* contemporaneous comparison group--formed from defendants (1) who were 
eligible for drug court but received conventional case processing 
during the same time period as the drug court program participants, (2) 
who were from a district within a court's jurisdiction from which 
arrestees were not eligible to participate in the drug court program, 
or (3) who had similar charges and were matched on characteristics.

If implemented as designed, experiments can provide strong evidence for 
the effectiveness (or lack thereof) of a drug court intervention. A key 
presumption of random assignment is that any individual factor that 
could be associated with the outcome of interest (recidivism) is 
randomly distributed between the experimental and control groups. 
Hence, if none of these factors are correlated systematically with 
assignment into groups, then the threat of selection bias is reduced. 
Presuming that the randomization is complete and that the experiment 
was carried out without high levels of attrition of subjects from 
either group, the observed differences in recidivism between the two 
groups would likely arise from the intervention, rather than observed 
or unobserved individual factors.

Several of the evaluations used quasi-experimental designs in which the 
comparison group members were chosen from defendants who appeared 
before the court during a period of time shortly before the drug court 
program was introduced and, based on certain observable 
characteristics, were deemed to be eligible to participate in the drug 
court program. Theoretically, if there were no significant changes in 
processes that led to defendants appearing in a court during the pre- 
and drug court periods, and if their eligibility for drug court 
participation could be determined, a historical comparison group would 
consist of individuals that share characteristics with drug court 
defendants. Alternatively, if there were a significant difference in 
processing between the pre-drug court and drug court periods (for 
example, such as a shift in prosecution priorities toward particular 
types of offenses or a change in the nature of a community's drug 
problem), then the historical comparison group could consist of 
defendants that differed systematically from the drug court participant 
group.

The historical comparison group in the evaluations we reviewed 
generally consisted of defendants who were arrested and arraigned in 
the court that offered the drug court program in a period immediately 
prior to the implementation of the drug court. In one case, the 
comparison group members were chosen from defendants on probation in 
the period prior to the drug court. To minimize possible bias that 
could arise from changes in court practices or the composition of 
defendants entering a court in the period prior to the implementation 
of a drug court, in the evaluations we reviewed, the prior periods 
generally ended within 4 months to 1 year before the implementation of 
the drug court program.

Another subset of the evaluations we included in our review used quasi- 
experiments with contemporaneous comparison groups. One comparison 
group consisted of defendants who met the drug court program's 
eligibility requirements but who were arrested in areas within a 
court's jurisdiction that did not enroll individuals in the drug court. 
Another comparison group was formed by selecting members from other, 
comparable jurisdictions. A third consisted of individuals who, while 
otherwise eligible to enroll in the drug court, were unable to 
participate because of logistical reasons. Others consisted of 
defendants charged with similar offenses as drug court participants and 
who were then matched on key variables.

Evaluations Used a Variety of Statistical Methods to Minimize the 
Possible Effects of Selection Bias:

All of the quasi-experiments that we reviewed, whether they used 
historical or contemporaneous comparison groups, used various 
statistical methods to control for individual differences between drug 
court participants and comparison group members on observable 
variables. Several evaluations used sophisticated statistical methods 
that not only adjusted results for individual level differences but 
also attempted to correct for selection bias by modeling unobserved 
differences between drug court and comparison group members.[Footnote 
19] These methods reduce but do not completely eliminate potential bias 
from unobserved confounding factors. The extent to which they reduce 
bias depends upon the richness and quality of the control variables 
that are used to estimate the models.

These methods essentially use statistical models to predict individual 
probabilities of participation in the drug court program (regardless of 
actual participation). The models predict the probability, sometimes 
called a propensity score, based on variation in individual level 
characteristics (for example, criminal histories and demographic 
attributes) that offenders in a given group would participate. Some of 
the evaluations that we reviewed incorporated this technique as the 
first stage of a two-stage model that estimated recidivism differences. 
Others used it to identify the individuals to include in a comparison 
group.

Other studies matched comparison group members to drug court 
participants on a more limited set of demographic and criminal justice 
variables (such as type of charge and prior criminal history) and then, 
post-matching, used various methods to control for differences on 
unmatched variables. A presumption behind these matching methods is 
that by selecting for inclusion in the comparison group only those 
defendants who matched drug court participants on these observed 
characteristics, the evaluation would create a comparison group that 
was similar in composition to the drug court participants. A limited 
set of matching variables that is based largely upon demographic 
variables may be unlikely to capture all of the individual-level 
sources of variation in recidivism that could account for differences 
between the drug court participants and comparison group members. 
Therefore, these evaluations attempted to control for differences in 
key, nonmatch variables (such as criminal justice risk-level 
differences) in their analysis.

Some of the evaluations attempted to control for individual-level 
differences between the drug court participants and the comparison 
group members using various linear and nonlinear (e.g., logistic) 
regression methods. This approach relies on the assumption that the 
observed characteristics included in the regression are the key 
variables that predict recidivism. The regression models adjust the 
results for differences between the two samples on these 
characteristics and allow the researcher to avoid making incorrect 
inferences about recidivism differences because one group (either 
treatment or comparison) differs systematically from the other in the 
presence of the key variables that are associated with recidivism. 
Evaluations that used regression methods generally made efforts to 
control for variables that are known to be related to recidivism, such 
as criminal history, type and number of charges, and age. Table 3 
describes the comparison groups used in the evaluations we reviewed and 
the methods used by these evaluations to address selection bias.

Table 3: Research Designs, Comparison Groups, and Methods to Address 
Selection Bias for Evaluations GAO Used in Recidivism Analysis:

Experimental design: 

Drug court program and design: Baltimore City Drug Treatment Court; 
Comparison group used in evaluation: Randomly assigned from the initial 
pool of willing, eligible defendants to a control group that received 
"treatment as usual," which included less intensive drug testing, 
probation, judicial monitoring, and treatment; 
Methods to address selection bias: Random assignment to control prior 
to appearance before a drug court judge, who made final determinations 
for drug court entry.

Drug court program and design: D.C. Superior Court Drug Intervention 
Program; 
Comparison group used in evaluation: Randomly assigned from the initial 
pool of eligible drug court participants to a standard (control) 
docket. Participants received services such as supervision, drug tests 
(twice weekly), judicial monitoring, and were encouraged to seek 
community treatment; 
Methods to address selection bias: Random assignment and various 
regression methods to control for individual differences between drug 
court participants and control group members, such as age, gender, 
prior criminal history, severity of drug use, and employment status.

Drug court program and design: Maricopa County First Time Drug Offender 
Program; 
Comparison group used in evaluation: All individuals identified as 
eligible for the drug court program were randomly assigned to one of 
three study groups at the time of their initial probation assignment. 
The three study groups were: 
1. probation with no testing;
2. probation with low-rate (monthly) drug testing; and; 
3. probation with high-rate (biweekly) drug testing; 
Methods to address selection bias: Random assignment.

Quasi-experimental, historical comparison group: 

Drug court program and design: Breaking the Cycle Program, Birmingham; 
Comparison group used in evaluation: Historical arrestees: sample drawn 
from arrestees in a drug use forecasting project in the Birmingham jail 
over a 2-month period in the year prior to the start of the treatment 
court. Arrestees were chosen using the same criteria to select 
treatment court participants: age, county, felony charges, and 
involvement with illegal drugs; 
Methods to address selection bias: Regression methods that control for 
individual differences and a two- stage estimation procedure to account 
for unmeasured sample differences.

Drug court program and design: Breaking the Cycle Program, 
Jacksonville; 
Comparison group used in evaluation: Historical arrestees: sample drawn 
from arrestees in the Duval County jail over a 4-month period that 
ended 5 months prior to the start of the treatment court. Arrestees 
were chosen using the same criteria to select treatment court 
participants: age, county of residence (Duval), felony charges, and 
involvement with illegal drugs; 
Methods to address selection bias: Regression methods that control for 
individual differences and a two-stage estimation procedure to account 
for unmeasured sample differences.

Drug court program and design: Breaking the Cycle Program, Tacoma; 
Comparison group used in evaluation: Historical arrestees: sample drawn 
from arrestees in the Pierce County jail over a 4-month period that 
ended 5 months prior to the start of the treatment court. Arrestees 
were chosen using the same criteria to select treatment court 
participants: age, county of residence (Pierce), felony charges, and 
involvement with illegal drugs; 
Methods to address selection bias: Regression methods that control for 
individual differences and a two- stage estimation procedure to account 
for unmeasured sample differences.

Drug court program and design: Bronx Treatment Court; 
Comparison group used in evaluation: Historical arrestees: defendants 
arrested in the Bronx in the 4 months prior to the opening of the drug 
court on selected felony charges of criminal sale of a controlled 
substance; 
Methods to address selection bias: Propensity score matching 
methodology (to identify comparison group members having similar 
predicted probabilities of participating in the drug court as drug 
court participants); match model based on age, race, specific charges, 
and various criminal history measures. Comparison group members matched 
to the drug court participant having the nearest propensity score.

Drug court program and design: Chester County Drug Court Program; 
Comparison group used in evaluation: Historical probationers: 
defendants placed on probation during the 10-month period prior to the 
inception of the drug court program who would have been eligible had 
the drug court program existed (i.e., charged with nonmandatory drug 
offenses, had no prior violent offenses, and were not on probation or 
parole); 
Methods to address selection bias: Comparison group was similar to the 
drug court sample in demographic characteristics (age, race, and 
gender), prior record, and prior drug treatment characteristics. Author 
and county officials were unaware of historical events that would have 
caused threats to validity of comparison.

Drug court program and design: Escambia County Drug Court; 
Comparison group used in evaluation: Historical arrestees: defendants 
arrested and arraigned in Escambia County over a 27-month period that 
ended in the month prior to the beginning of the drug court. Selected 
on the same type of charges as drug court participants; 
Methods to address selection bias: Instrumental variable approach that 
controls for the probability of participation in the drug court program 
and models unobserved motivational differences between participants and 
nonparticipants.

Drug court program and design: Jackson County Drug Court; 
Comparison group used in evaluation: Historical arrestees: defendants 
arrested in Jackson County over a 3-year period that ended in the 15 
months prior to the beginning of the drug court. Selected on the same 
type of charges as drug court participants; 
Methods to address selection bias: Instrumental variable approach that 
controls for the probability of participation in the drug court program 
and models unobserved motivational differences between participants and 
nonparticipants.

Drug court program and design: Queens Treatment Court; 
Comparison group used in evaluation: Historical arrestees: defendants 
arrested in Queens in the year prior to the opening of the drug court 
on a most serious charge of criminal sale or possession of drugs (that 
met charge eligibility for drug court). Excluded defendants who did not 
meet the drug court's paper eligibility criteria, i.e., current and 
prior violence and those cases in which the arrest did not lead to a 
conviction; 
Methods to address selection bias: Propensity score matching 
methodology (to identify comparison group members having similar 
predicted probabilities of participating in the drug court as drug 
court participants); match model based on age, race, specific charges, 
and various criminal history measures. Comparison group members matched 
to the drug court participant having the nearest propensity score.

Drug court program and design: So. San Mateo County Drug Court; 
Comparison group used in evaluation: Historical arrestees: defendants 
arrested and processed before the start of the drug court but who would 
have been eligible for the drug court; 
Methods to address selection bias: Regression methods to control for 
individual differences on key variables, such as ethnicity, prior 
convictions, primary language, and severity of charges.

Drug court program and design: Suffolk County Drug Treatment Court; 
Comparison group used in evaluation: Historical arrestees: defendants 
arrested in Suffolk County in the year prior to the opening of the drug 
court on a most serious charge of felony or misdemeanor criminal 
possession of a controlled substance (that met eligibility for drug 
court). Excluded defendants with current violent charges or prior 
violent convictions and those cases in which the arrest did not lead to 
a conviction; 
Methods to address selection bias: Propensity score matching 
methodology (to identify comparison group members having similar 
predicted probabilities of participating in the drug court as drug 
court participants); match model based on age, race, specific charges, 
and various criminal history measures. Comparison group members matched 
to the drug court participant having the nearest propensity score.

Drug court program and design: Syracuse Community Treatment Court; 
Comparison group used in evaluation: Historical arrestees: defendants 
arrested in Syracuse City in the year prior to the opening of the drug 
court on a most serious charge of felony or misdemeanor criminal 
possession of a controlled substance (that met drug court charge 
eligibility). Excluded defendants with prior violent convictions or 
pending violent charges and those cases in which the arrest did not 
lead to a conviction; 
Methods to address selection bias: Propensity score matching 
methodology (to identify comparison group members having similar 
predicted probabilities of participating in the drug court as drug 
court participants); match model based on age, race, specific charges, 
and various criminal history measures. Comparison group members matched 
to the drug court participant having the nearest propensity score.

Quasi-experimental, contemporaneous comparison group: 

Drug court program and design: Brooklyn Treatment Court; 
Comparison group used in evaluation: Contemporaneous: drug felony 
defendants arrested in Brooklyn but not screened in the drug court, 
primarily because they were arrested within one of the two geographic 
zones that were ineligible to send defendants to the drug court. 
Defendants met the same paper eligibility criteria as drug court 
participants. Excluded defendants with prior violent felony or 
misdemeanor convictions, with current violent offense charges, and 
those cases in which the arrest did not lead to a conviction; 
Methods to address selection bias: Propensity score matching 
methodology (to identify comparison group members having similar 
predicted probabilities of participating in the drug court as drug 
court participants); match model based on age, race, specific charges, 
and various criminal history measures. Comparison group members matched 
to the drug court participant having the nearest propensity score.

Drug court program and design: Clark County Drug Court; 
Comparison group used in evaluation: Contemporaneous arrestees: sample 
drawn from criminal defendants who had charges filed in the Clark 
County District Courts but did not enter the drug court. Sample 
stratified on drug type and type of charge; 
Methods to address selection bias: Regression methods to control for 
individual differences in gender, race/ethnicity, age, prior 
convictions, number of charges and types of charges (e.g., drug 
possession or sales and economic crimes), prior controlled substances 
types, and recidivism in the year after sentencing.

Drug court program and design: Douglas County Drug Court; 
Comparison group used in evaluation: Contemporaneous: felony drug 
arrestees who had charges filed in court and traditionally 
adjudicated.[A] Most had no more than one prior felony conviction, and 
few had been convicted of a prior violent felony. Slightly less than 
half were characterized as medium-or high-risk offenders; 
Methods to address selection bias: Matched to drug court participants 
on most serious offense, gender, race and ethnicity, and age. Risk-
level data were not available for this group. Regression methods to 
control for prior criminal history.

Drug court program and design: Kentucky Drug Court Programs; 
Comparison group used in evaluation: Contemporaneous: assessed 
offenders, combined felony and misdemeanor charge or conviction; 
Methods to address selection bias: Regression methods to control for 
individual differences in age, gender, race, location of court, year of 
participation, and criminal justice involvement.

Drug court program and design: Los Angeles County Drug Court Program; 
Comparison group used in evaluation: Contemporaneous: felony offenders 
charged with drug possession but sentenced at trial to probation. Drawn 
from the same pool of offenders screened for participation in the drug 
court; 
Methods to address selection bias: Matched with the sample of drug 
court defendants of a risk scale score (a composite scale based on 
criminal justice and social factors and used to determine release 
risk), time of hearing, gender, and age. Separate analyses done between 
drug court and both comparison group members having various levels of 
risk.

Drug court program and design: Multnomah County STOP Drug Diversion 
Program; 
Comparison group used in evaluation: Contemporaneous arrestees who were 
eligible for the STOP program but did not receive it. Arrested for 
possession of controlled substance and considered to be eligible for 
STOP but did not receive it; 
Methods to address selection bias: Matched sample approach to select a 
group of eligible clients who were representative of program 
participants on age, gender, race/ethnicity, and prior criminal history.

Drug court program and design: North Carolina Drug Treatment Court; 
Comparison group used in evaluation: Contemporaneous probationers who 
would have been eligible for the drug court but were not admitted. 
Comparison group was screened for chemical dependence and sample 
selected based on drug addiction (from screening) and eligibility for 
drug court; 
Methods to address selection bias: Regression methods to control for 
individual differences in age, gender, ethnicity, type of offense (for 
example, property or drug), offense seriousness, and graduation status.

Drug court program and design: Orange County Drug Court Program; 
Comparison group used in evaluation: Contemporaneous defendants who had 
similar charges as the drug court participants and were sentenced to 
probation. Drawn from the same pool of offenders screened for 
participation in the drug court; 
Methods to address selection bias: Matched to drug court participants 
on gender, race and ethnicity, and age.

Drug court program and design: Rochester Drug Treatment Court; 
Comparison group used in evaluation: Contemporaneous arrestees: 
defendants arrested in Rochester during the same period of time as the 
drug court was in operation but who were not arraigned before judges 
supportive of the drug court program. Excluded defendants that did not 
meet the drug court's paper eligibility criteria (i.e., current and 
prior violence) and those cases in which the arrest did not lead to a 
conviction; 
Methods to address selection bias: Propensity score matching 
methodology (to identify comparison group members having similar 
predicted probabilities of participating in the drug court as drug 
court participants); match model based on age, race, specific charges, 
and various criminal history measures. Comparison group members matched 
to the drug court participant having the nearest propensity score.

Quasi-experimental, both historical and contemporaneous comparison 
groups: 

Drug court program and design: Washington State Court Program; 
Comparison group used in evaluation: Historical and contemporaneous 
defendants: 
Historical group: defendants with cases filed in the 2 years prior to 
the start of the drug court in each of the county drug court programs 
included in the evaluation; 
Contemporaneous group: defendants with similar cases who were processed 
in counties without drug courts that were comparable to the counties 
that did have drug courts; 
Methods to address selection bias: Various statistical methods 
including regressions to control for individual differences in age, 
gender, ethnicity, prior youth and adult convictions, current charges; 
propensity score matching to identify comparison group members with 
similar predicted probabilities of entering the drug court.

Source: GAO analysis of drug court program evaluations.

[A] While these defendants consisted primarily of those arrested during 
the time the drug court program was in operation (a contemporaneous 
comparison), some individuals who were arrested in the 3 months prior 
to the start of the drug court program were included.

[End of table]

[End of section]

Appendix III: GAO Criteria for Assessing Evaluations of Drug Court 
Programs' Cost-Benefit Analyses:

In this appendix, we outline the criteria we used in assessing the cost-
benefit analyses of drug court program evaluations, and we discuss how 
the evaluations we reviewed followed these criteria in their analyses.

The Evaluations We Reviewed and the Net Benefit Measure:

Cost-benefit analysis determines the costs associated with implementing 
or operating a program and weighs that cost against any benefits 
expected from the program. The results of a cost-benefit analysis can 
be represented as either a net benefit--calculated as total benefits 
minus total costs--or a benefit-to-cost ratio--calculated as total 
benefits divided by total costs.

We used the net benefit--benefit minus cost--measure to represent the 
cost-benefit analyses of the drug court programs we reviewed. Net 
benefit can be used to evaluate the cost savings--that is, the 
benefits--for each participant in a drug court program relative to the 
cost savings for each offender processed by conventional case 
processing in the same jurisdiction.

To assess the cost-benefit analyses of drug court program evaluations, 
we reviewed all of the evaluations selected for our structured review 
that reported cost or benefit information. Of the 27 evaluations 
included in the structured review, 8 reported information about program 
costs and 4 about benefits. The 8 evaluations we included in our cost- 
benefit review are shown in table 4.

Table 4: The Eight Drug Court Program Evaluations in Our Cost-Benefit 
Review:

Included in cost-benefit analysis: 

Drug court program evaluation: Breaking the Cycle Program (Harrell and 
others, 2003); 
Reported data on benefits: Yes; 
Reported data on costs: Yes.

Drug court program evaluation: D.C. Superior Court Drug Intervention 
Program (Harrell, Cavanagh, and Roman, 1998); 
Reported data on benefits: Yes; 
Reported data on costs: Yes.

Drug court program evaluation: Multnomah County (Ore.) STOP Drug 
Diversion Program (Carey and Finigan, 2003); 
Reported data on benefits: Yes; 
Reported data on costs: Yes.

Drug court program evaluation: Washington State Drug Court Program 
(Barnoski and Aos, 2003); 
Reported data on benefits: Yes; 
Reported data on costs: Yes.

Not included in cost-benefit analysis: 

Drug court program evaluation: Douglas County (Neb.) Drug Court 
(Martin, Spohn, Piper, and Frenzel-Davis, 2001); 
Reported data on benefits: No; 
Reported data on costs: Yes.

Drug court program evaluation: Kentucky Drug Court Programs (Logan, 
Hoyt, and Leukefeld, 2001); 
Reported data on benefits: No; 
Reported data on costs: Yes.

Drug court program evaluation: Los Angeles County (Calif.) Drug Court 
Program (Deschenes and others, 1999); 
Reported data on benefits: No; 
Reported data on costs: Yes.

Drug court program evaluation: Maricopa County First Time Drug Offender 
Program (Deschenes and others, 1996); 
Reported data on benefits: No; 
Reported data on costs: Yes.

Source: GAO analysis of drug court program evaluations.

[End of table]

Four of the 8 evaluations reported sufficient data on both costs and 
benefits, which allowed us to assess the reported net benefits of the 
drug court programs. Specifically, we were able to determine whether 
the reduction of recidivism--the benefit--would outweigh the additional 
costs of a program.

Criteria for Assessing a Drug Court Program's Cost-Benefit Analysis:

Conducting a cost-benefit analysis is theoretically straightforward-- 
determine the monetary value of a program's benefits and compare that 
value with the monetary value of the program's costs. However, the 
analysis is more complicated in practice because of decisions that have 
to be made about who to include as recipients of the benefits and how 
to measure costs and benefits.[Footnote 20] On the basis of the general 
principles of cost-benefit analysis, we identified five criteria that 
we used in assessing the cost-benefit analyses of the drug court 
programs we reviewed. Table 5 describes these criteria; 
where further explanation is needed, we discuss them in the text that 
follows.

Table 5: Five Criteria for Assessing a Cost-Benefit Analysis of a Drug 
Court Program:

Criterion: 1. States the program's purpose; 
Description: In general, the purpose of a drug court program is to 
reduce repeated criminal behavior--to reduce recidivism--by reducing 
offenders' substance-using behavior.

Criterion: 2. Identifies the baseline; 
Description: The baseline, or alternative, is what would happen to an 
offender if the drug court program did not exist.

Criterion: 3. Assesses all relevant costs; 
Description: The costs involved in a drug court program are those 
associated with the program's operation and those associated with the 
baseline.

Criterion: 4. Assesses all relevant benefits; 
Description: Benefits usually attributed to drug court programs are 
costs avoided because of reduced recidivism; 
they accrue to the criminal justice system and potential victims of 
crime. Other benefits an analysis could consider include reduced 
medical costs and successful program participants' increased 
productivity.

Criterion: 5. Assesses uncertainty in cost and benefit estimates; 
Description: Most cost and benefit estimates entail uncertainty from 
imprecision in the data underlying the analysis and the assumptions 
built into the analysis. Assessing uncertainty enhances confidence in 
the estimates used in evaluation.

Source: GAO analysis.

[End of table]

Identifies the Baseline:

A cost-benefit analysis should identify what the baseline program is. 
In the case of drug court programs, the analysis should state what 
would happen to an offender if the drug court program did not exist. 
The costs and benefits of this alternative program or case processing, 
called the baseline, are the standard by which the drug court program 
costs and benefits are judged. There is no single baseline against 
which all drug court programs are compared. For example, one 
jurisdiction may offer drug court program participation to defendants 
as an alternative for jail, another as an alternative for probation.

Assesses All Relevant Costs:

A cost-benefit analysis should enumerate and assess all relevant costs. 
A cost-benefit analysis of a drug court program should consider two 
sets of costs--those associated with the program's operation and those 
associated with the baseline. For both sets of costs, the analysis 
should determine which costs are relevant and then measure them.

Determining Relevant Costs:

Drug court programs often require additional expenses from criminal 
justice system agencies, although these may differ from program to 
program. The true cost of a drug court program consists of these 
expenses--the resources that would have been used in their next best 
alternative use--if not used for the program. Drug court programs have 
several basic elements, one of which is ongoing monitoring of the 
participants by a judge or other personnel in the criminal justice 
system.[Footnote 21] Others are regular status hearings and drug 
testing, substance abuse treatment, and the prescription of sanctions 
for noncompliance with program requirements. While an analysis should 
consider all of these costs, it should not consider costs that were 
incurred before the program began (that is, sunk costs) since they are 
not relevant to the current decision to fund or continue funding the 
program.

In addition to the program's costs, the analysis should include the 
costs of the baseline. These depend on the types of offenders who are 
eligible for the drug court program in each jurisdiction and the 
alternative program or processing available for them. The baseline 
costs may include the cost of traditional adjudication (including a 
judge's time during the early phases of judicial processing), the costs 
of jail time served, or costs of probation (such as the salaries of 
probation officers or any required monitoring).

Measuring Drug Court Program and Baseline Program Costs:

The various methods of measuring or estimating costs require varying 
amounts of time, data, and analysis. The most straightforward way of 
measuring the costs of both a drug court program and the baseline is to 
use budget or expenditure figures from the agencies involved to 
calculate average costs.[Footnote 22] While this method has the 
advantage of simplicity, average cost may be a misleading measure of 
resource costs if it does not accurately portray the resources 
defendants actually used.

For example, a few very high cost program participants could skew the 
average cost to such an extent that actual cost appears to be larger 
than it is. This is especially important in assessing average costs 
associated with the baseline program. The average baseline defendant in 
a jurisdiction may be very different from participants in a drug court 
program. Therefore, comparing costs associated with the average 
defendant with those of the average drug court participant may not be 
valid.

A less simple approach, requiring a more intensive use of time and 
data, is to conceptualize the cost of drug court program participation 
as a series of transactions within the criminal justice system 
agencies.[Footnote 23] Since a defendant interacts with a number of 
these agencies, this method requires obtaining data about each 
defendant from each agency. These data can be aggregated for individual 
defendants to determine the total amount of resources used per 
participant, and these resources can then be multiplied by their price. 
This approach has the advantage of allowing a better determination of 
the true cost of drug court participation, relative to participation in 
an alternative program. However, since it is more labor intensive, 
jurisdictions may not have records organized in a way that allows for 
tracking individuals across agencies.

Assesses and Measures All Relevant Benefits:

As with costs, all relevant benefits of the drug court program should 
be assessed relative to the baseline.[Footnote 24] The typical benefit 
attributed to drug court programs is avoided costs from reductions in 
recidivism. Other benefits that could be considered in the analysis 
include reduced medical costs and increased worker productivity 
stemming from reduced drug dependency.

Reductions in recidivism can lead to benefits, or cost savings, for 
criminal justice agencies and for potential victims of crime. A 
reduction in the number of arrests would result in a reduction in 
expenditures for the agencies, including police, prosecutors, courts, 
corrections departments, and probation agencies.

Potential victims benefit from reduced recidivism. Benefits accrued 
because of reduced victimization include direct monetary costs, such as 
the value of stolen property and medical expenses, and quality-of-life 
costs related to pain and suffering. Not including pain and suffering 
costs would underestimate the true cost of crime, but some researchers 
exclude these intangibles because it is difficult to assign appropriate 
dollar values to them. This results in a more conservative estimate of 
the benefit of the drug court program.

In addition, the analysis should, to the extent possible, assess 
benefits to society from a reduction in substance abuse. These benefits 
may include avoided medical care costs, such as medical services a 
treated drug addict did not require. Additionally, if drug court 
programs are effective, the labor market outcomes of the participants 
may improve. For example, successful participants may be unemployed 
less often or may earn higher wages because of increased productivity. 
To the extent that they may therefore pay higher taxes, such taxes are 
benefits to taxpayers in general.[Footnote 25]

Challenges in Measuring Drug Court Program Benefits:

The simplest approach to measuring the benefits of reduced recidivism 
is using arrest data. This approach has the appeal that an arrest is 
usually the beginning of expenditures by a criminal justice agency. 
Then, the value of this benefit per arrest can be estimated in the same 
way that costs are estimated--by using agency budgets to calculate the 
average savings from each avoided arrest.

It is possible to measure criminal victimization by using arrest data 
as well. However, this approach requires the assumption that each 
criminal act results in an arrest. To the extent that this is not true, 
the estimation of victimization may be underestimated by a significant 
margin. Another approach to measuring victimization would be to use 
self-reported criminal behavior by the drug court program and 
comparison group participants. However, this approach relies on the 
forthrightness of the defendants, which is not ideal. Since both of 
these methods have drawbacks, any measurement of criminal victimization 
is much more uncertain than measures of expenditures by the agencies.

Measuring the cost of crime may also be problematic. Estimates of the 
costs of crimes at the national level are available in the 
literature.[Footnote 26] For example, these can provide an estimate of 
the cost of a burglary, and a researcher can apply the cost to the 
number of burglaries by the participant. Ideally, an analysis would 
also include the costs of crimes specific to the drug court program's 
jurisdiction to account for regional differences. For example, the 
average value of a car stolen in Miami might be different from the 
average value of a car stolen in Tallahassee.

Assesses Uncertainty in Cost and Benefit Estimates:

The uncertainty in most cost and benefit estimates is the result of 
imprecision in the underlying data used in the analysis and the 
assumptions on which the analysis is built. Assessing uncertainty can 
enhance the confidence in the estimates in the evaluation. Useful 
information for an analysis to report includes the estimates of costs 
and benefits and the sensitivity of the cost and benefit estimates to 
assumptions made in the analysis.

Estimates of costs and benefits should take into account how likely it 
is that a particular outcome (for example, arrest for a crime that will 
warrant participation in the drug court program) will occur, in 
addition to the value (for example, the cost to victims, the criminal 
justice expenditures) of that outcome. Taking account of the likelihood 
of occurrence allows the researcher to provide a better assessment of 
how reliable the data--the costs and benefits--are.

Uncertainty also derives from assumptions made in an analysis. In an 
assessment of an analysis, it is helpful to know which assumptions can 
be changed without altering the conclusion of the analysis. Sensitivity 
analysis, or systematically varying the assumptions to see what effect 
variations have on estimated outcomes, can be applied to several 
components of a drug court program's cost analysis.[Footnote 27] For 
example, one assumption in the criminal justice area is the numerical 
relationship between the commission of a crime and the arrest rate. Not 
every crime results in an arrest, but a cost-benefit analysis may have 
been able to examine only arrest data, given the lack of other data 
available. Using arrest data assumes, in effect, that every crime does 
result in an arrest--an assumption that is likely to underestimate the 
change in crime that the public experiences. A sensitivity analysis 
could examine this possible understatement by increasing the study's 
assumed rate of crime per arrest (for example, the Washington State 
study assumes that 20 percent of robberies result in an arrest) to 
better approximate the actual crime rate.

How the Drug Court Evaluations We Reviewed Used the Identified Cost- 
Benefit Principles:

We reviewed eight evaluations of 10 drug court programs for their use 
of the criteria. At least five of these evaluations made a concerted 
effort to assess all relevant costs as well as benefits. Only two 
evaluations assessed uncertainty. However, the two evaluations that 
conducted sensitivity analyses were two of the three that did not 
present costs and benefits separately so as to allow for an assessment 
of net benefits. Table 6 summarizes the evaluations we reviewed and 
their application of the five criteria in their assessments.

Table 6: Summary of Criteria Applied in Eight Drug Court Program 
Evaluation Assessments:

BTC Program (Harrell and others, 2003); 
Drug court program evaluation: Birmingham, Ala; 
Stated purpose: Yes; 
Identified baseline: Yes; 
Assessed costs: Drug court: Yes; 
Assessed costs: Baseline: Yes; 
Assessed benefits: Recidivism: Yes; 
Assessed benefits: Other: No; 
Assessed uncertainty: No.

Drug court program evaluation: Jacksonville, Fla; 
Stated purpose: Yes; 
Identified baseline: Yes; 
Assessed costs: Drug court: Yes; 
Assessed costs: Baseline: Yes; 
Assessed benefits: Recidivism: Yes; 
Assessed benefits: Other: No; 
Assessed uncertainty: No.

Drug court program evaluation: Tacoma, Wash; 
Stated purpose: Yes; 
Identified baseline: Yes; 
Assessed costs: Drug court: Yes; 
Assessed costs: Baseline: Yes; 
Assessed benefits: Recidivism: Yes; 
Assessed benefits: Other: No; 
Assessed uncertainty: No.

Drug court program evaluation: D.C. Superior Court Drug Intervention 
Program (Harrell, Cavanagh, and Roman, 1998); 
Stated purpose: Yes; 
Identified baseline: Yes; 
Assessed costs: Drug court: Yes; 
Assessed costs: Baseline: Yes; 
Assessed benefits: Recidivism: Yes; 
Assessed benefits: Other: No; 
Assessed uncertainty: No.

Drug court program evaluation: Douglas County (Neb.) Drug Court 
(Martin, Spohn, Piper, and Frenzel-Davis, 2001); 
Stated purpose: Yes; 
Identified baseline: Yes; 
Assessed costs: Drug court: Yes; 
Assessed costs: Baseline: Yes; 
Assessed benefits: Recidivism: No; 
Assessed benefits: Other: No; 
Assessed uncertainty: No.

Drug court program evaluation: Kentucky Drug Court Programs (Logan, 
Hoyt, and Leukefeld, 2001); 
Stated purpose: Yes; 
Identified baseline: No; 
Assessed costs: Drug court: Yes; 
Assessed costs: Baseline: No; 
Assessed benefits: Recidivism: No[A]; 
Assessed benefits: Other: No; 
Assessed uncertainty: Yes.

Drug court program evaluation: Los Angeles County (Calif.) Drug Court 
Program (Deschenes and others, 1999); 
Stated purpose: Yes; 
Identified baseline: No; 
Assessed costs: Drug court: Yes; 
Assessed costs: Baseline: Yes; 
Assessed benefits: Recidivism: No; 
Assessed benefits: Other: No; 
Assessed uncertainty: Yes.

Drug court program evaluation: Maricopa County First Time Drug Offender 
Program (Deschenes and others, 1996); 
Stated purpose: Yes; 
Identified baseline: Yes; 
Assessed costs: Drug court: Yes; 
Assessed costs: Baseline: Yes; 
Assessed benefits: Recidivism: No; 
Assessed benefits: Other: No; 
Assessed uncertainty: No.

Drug court program evaluation: Multnomah County (Ore.) STOP Drug 
Diversion Program (Carey and Finigan, 2003); 
Stated purpose: Yes; 
Identified baseline: Yes; 
Assessed costs: Drug court: Yes; 
Assessed costs: Baseline: Yes; 
Assessed benefits: Recidivism: Yes; 
Assessed benefits: Other: No; 
Assessed uncertainty: No.

Drug court program evaluation: Washington State Drug Court Program 
(Barnoski and Aos, 2003); 
Stated purpose: Yes; 
Identified baseline: Yes; 
Assessed costs: Drug court: Yes; 
Assessed costs: Baseline: Yes; 
Assessed benefits: Recidivism: Yes; 
Assessed benefits: Other: No; 
Assessed uncertainty: No.

Source: GAO analysis of drug court program evaluations.

[A] The Kentucky study does include estimates of benefits from reduced 
recidivism, but does not appear to include victimization costs.

[End of table]

All Evaluations Stated the Program's Purpose:

All eight evaluations provided a statement of the purpose of the drug 
court program, although the purpose of the programs varied somewhat one 
from another. Evaluations of some of the programs--for example, those 
in Kentucky, Washington, D.C., and Multnomah County--explicitly stated 
that the purpose was to address the source of criminal behavior--drug 
addiction, dependency, and the like--in order to reduce recidivism. 
None of the evaluations, however, included reduced drug dependency in 
their calculation of net benefits.

All Evaluations Identified a Baseline:

Of the eight evaluations we reviewed, five compared drug court program 
participants with the baseline of conventional case processing in the 
criminal courts in their jurisdictions. The evaluation of the D.C. 
Superior Court Drug Intervention Program used a different baseline for 
comparison. This program was an experiment that randomly assigned drug 
felony defendants to one of three court dockets. The standard docket 
offered defendants weekly drug testing, judicial monitoring, and 
encouragement to seek treatment in the community. The sanctions docket 
offered a program of graduated sanctions with weekly drug testing, 
judicial monitoring of drug use, and referral to community-based 
treatment. The treatment docket offered weekly drug testing and an 
intensive daily treatment program based in D.C. Superior Court. The 
evaluation studied the sanctions and treatment docket participants 
against the outcomes of the standard docket participants.

The Evaluations Varied in Assessing Costs:

The eight evaluations varied in the types of costs reported. All eight 
included only costs directly attributable to drug court programs. None 
attempted to allocate any shared costs incurred jointly by a drug court 
program and another activity not directly related to the program (such 
as policing). Further, no evaluation included sunk costs. All eight 
evaluations included direct program costs such as urine analysis. 
However, they varied in reporting costs for adjudication and sanctions. 
Six of the eight evaluations included costs of adjudication or 
sanctions.[Footnote 28]

Including Baseline Costs:

All of the evaluations, except for the Kentucky state evaluation, 
attempted to include the cost of the baseline in the analysis. 
Consequently, this evaluation did not report a net benefit value.

Estimating Costs:

The evaluations varied in how they estimated costs. The most common 
method was to compute average costs. The Multnomah County evaluation 
differed in that it determined the cost to the agencies directly from 
the administrative records on the drug court program participants and 
the comparison group. In addition, the researchers on this evaluation 
followed a smaller sample of drug court program and control group 
participants through the system, tracking the use of resources in the 
various transactions associated with them. For example, the researchers 
used a stopwatch at arraignments to determine how much time the judge 
and other drug court staff spent in this process.

The Evaluations Varied in Assessing Benefits:

In their estimation of benefits attributable to the drug court 
programs, five of the evaluations included estimates of drug court 
program and criminal justice system costs and avoided victimization 
costs (Breaking the Cycle, the D.C. Superior Court Drug Intervention 
Program dockets, Kentucky, Multnomah County, and Washington State). The 
D.C. Superior Court and Breaking the Cycle evaluations differed 
substantially from the others in both the method of measuring 
victimization and the victim costs. Rather than using arrest as the 
indicator of crimes committed, the evaluations used self-reported 
criminal activity. In addition, the studies did not use "quality of 
life" costs in their measure of cost of crime.

One evaluation estimated just drug court program costs avoided (Douglas 
County, Nebraska). One evaluation (Los Angeles County) included only 
criminal justice system costs avoided during the treatment period, but 
it did not cover recidivism. The Maricopa County evaluation only 
reported average costs.

The Evaluations' Assessment of Uncertainty Was Limited or Nonexistent:

No evaluation we reviewed presented the likelihood of estimated costs 
and benefits, and only two evaluations conducted sensitivity analysis. 
In the Los Angeles County Drug Court evaluation, participants were 
partitioned into low-risk, medium-risk, and high-risk groups, on the 
basis of criminal history and other risk factors. The Kentucky Drug 
Court Program evaluation placed its estimates of the benefit-to-cost 
ratio within ranges that depended on whether accounting or economic 
costs were included, and it included earnings improvements.

[End of section]

Appendix IV: Overview of Drug Court Program Characteristics and 
Participants:

This appendix provides a general description of drug court program 
components and describes program participants in the evaluations we 
reviewed. Drug court programs rely on a combination of judicial 
supervision and substance abuse treatment to motivate defendants' 
recovery. Judges preside over drug court proceedings, which are called 
status hearings; 
monitor defendants' progress with mandatory drug testing; 
and prescribe sanctions and rewards, as appropriate in collaboration 
with prosecutors, defense attorneys, treatment providers, and others. 
Drug court programs can vary in terms of the substance abuse treatment 
required. However, most programs offer a range of treatment options and 
generally require a minimum of about 1 year of participation before a 
defendant completes the program. Drug court program participants can 
vary across programs according to differences in eligibility 
requirements and jurisdictions. The participants in the drug court 
programs we reviewed were predominantly male, generally unemployed at 
the time of program entry, and had prior involvement in the criminal 
justice system.

Drug Court Program Components:

This section describes typical drug court program approaches, screening 
processes and participant eligibility requirements, completion 
requirements, treatment components, and sanctions.

Drug Court Program Approaches:

Drug court programs generally have taken two approaches to processing 
cases: (1) deferred prosecution (diversion) and (2) post-adjudication. 
In the diversion model, the courts defer prosecution dependent on the 
offender's agreement to participate in the drug court program. Deferred 
adjudication models do not require the defendant to plead guilty. 
Instead the defendant enters the drug court before pleading to a 
charge. Defendants who complete the treatment program are not 
prosecuted further or their charges are dismissed. Failure to complete 
the program results in prosecution for the original offense. This 
approach is intended to capitalize on the trauma of arrest and offers 
defendants the opportunity to obtain treatment and avoid the 
possibility of a felony conviction.

In contrast, offenders participating in a post-adjudication (post-plea) 
drug court program plead guilty to the charge(s) and their sentences 
are suspended or deferred. Upon successful completion of the program, 
sentences are waived and in many cases records are expunged. This 
approach provides an incentive for the defendant to rehabilitate 
because progress toward rehabilitation is factored into the sentencing 
determination. Both of these approaches provide the offender with a 
powerful incentive to complete the requirements of the drug court 
program.

Some drug court programs use both deferred prosecution and post- 
adjudication approaches and assign defendants to an approach depending 
on the severity of the charge. Additionally, drug court programs may 
also combine aspects of these models into a hybrid, or combined, 
approach.

Screening Process and Participant Eligibility Criteria:

Defendants reach the drug court program from different sources and at 
varying points in case processing. Screening defendants to determine 
eligibility for a drug court program generally includes screening them 
for legal and clinical eligibility. Initially, defendants are screened 
for legal eligibility, based on criminal history and current case 
information. Depending on the program, an assistant district or 
prosecuting attorney, court clerk, or drug court coordinator typically 
conducts the review. Criteria for legal eligibility typically include 
charging offense, prior convictions, pending cases, and supervision 
status. Drug courts generally accept defendants charged with drug 
possession or other nonviolent offenses such as property crimes. Some 
drug court programs allow defendants who have prior convictions to 
participate, and others do not. Federal grants administered under Title 
II of the 21st Century Department of Justice Appropriations 
Authorization Act are not supposed to be awarded to any drug court 
program that allows either current or past violent offenders to 
participate in its program.[Footnote 29]

After defendants are determined to be legally eligible for the program, 
treatment providers or case managers will typically determine 
defendants' clinical eligibility. This can be determined through 
structured assessment tests, interviews, or even preliminary drug test 
results. While drug courts generally only accept defendants with 
substance abuse problems, they vary in the level of addiction or type 
of drug to which defendants are addicted. For example, some programs do 
not accept defendants who only have addictions to marijuana or alcohol, 
while others do.

Clinical eligibility can also include factors such as medical or mental 
health barriers and motivation or treatment readiness. In several drug 
court programs in our review, the drug court judge's satisfaction with 
or assessment of an offender's motivation and ability to complete the 
program was a factor used to screen defendants.

Program Completion Requirements:

Drug court programs typically require defendants to complete a 1-year 
treatment program in order to graduate from or complete the program. 
Some programs impose other conditions that participants must meet in 
addition to treatment. These conditions could include remaining drug- 
free for a minimum amount of time, not being arrested for a specified 
period of time, maintaining employment or obtaining an educational 
degree or certification, or performing community service.

Judicial Supervision and Status Hearings:

The central element of all drug court programs is attendance at the 
regularly scheduled status hearings at which the drug court judge 
monitors the progress of participants. Monitoring is based on treatment 
provider reports on such matters as drug testing and attendance at 
counseling sessions. The judge is to reinforce progress and address 
noncompliance with program requirements. The primary objectives of the 
status hearing are to keep the defendant in treatment and to provide 
continuing court supervision. More broadly, judicial supervision 
includes regular court appearances and direct in-court interaction with 
the judge, as well as scheduled case manager visits.

Drug Testing Requirements:

Monitoring participants' substance use through mandatory and frequent 
testing is a core component of drug court programs. Programs vary in 
the specific policies and procedures regarding the nature and frequency 
of testing. For example, in some programs in our review participants 
were required to call to find out whether they are required to be 
tested in a given period or on a randomly selected day of the week. The 
frequency of testing generally varied depending on the stage or phase 
of the program that participants were in.

Treatment Components:

In most drug court programs, treatment is designed to last at least 1 
year and is generally administered on an outpatient basis with limited 
inpatient treatment, as needed, to address special detoxification or 
relapse situations. Many of the programs operate with the philosophy 
that because drug addiction is a disease, relapses can occur and that 
the court must respond with progressive sanctions or enhanced 
treatment, rather than immediate termination.

Treatment services are generally divided into three phases. 
Detoxification, stabilization, counseling, drug education, and therapy 
are commonly provided during phases I and II, and in some instances, 
throughout the program. Other services relating to personal and 
educational development, job skills, and employment services are 
provided during phases II and III, after participants have responded to 
initial detoxification and stabilization. Housing, family, and medical 
services are frequently available throughout the program. In some 
instances, a fourth phase consisting primarily of aftercare-related 
services is provided. The objectives of drug court program treatment 
are generally to (1) eliminate the program participants' physical 
dependence on drugs through detoxification; (2) treat the defendant's 
craving for drugs through stabilization (referred to as rehabilitation 
stage) during which frequent group or individual counseling sessions 
are generally employed; and (3) focus on helping the defendant obtain 
education or job training, find a job, and remain drug free.

Drug court programs can also either directly provide or refer 
participants to a variety of other services and support, and they may 
include medical or health care, mentoring, and educational or 
vocational programs. The use of community-based treatment self-help 
groups, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), 
and aftercare programs also varies across drug court programs.

Sanctions for Noncompliance:

Judges generally prescribe sanctions and rewards as appropriate in 
collaboration with prosecutors, defense attorneys, treatment providers, 
and others. Typical sanctions for program noncompliance include oral 
warnings from the judge; transfer to an earlier stage of the program; 
attendance at more frequent status hearings, treatment sessions, or 
drug tests; and serving jail time for several days or weeks. The 
approach or philosophy for how a drug court judge prescribes sanctions 
can vary. For example, some judges use a graduated sanctions approach, 
where sanctions are applied in increasing severity. Other judges may 
use discretion in prescribing sanctions, assessing participants' 
noncompliance on a case-by-case basis.

Termination Criteria:

Drug court programs typically use various criteria for ending a 
defendant's participation in the program before completion. These 
criteria may include a new felony offense, multiple failures to comply 
with program requirements such as not attending status hearings or 
treatment sessions, and a pattern of positive drug tests.

Before terminating a defendant for continuing to use drugs, drug court 
programs generally will use an array of treatment services and 
available sanctions. There are no uniform standards among all programs 
on the number of failed drug tests and failures to attend treatment 
sessions that lead to a participant's termination. Drug court program 
judges generally make decisions to terminate a program participant on a 
case-by-case basis, taking into account the recommendations of others, 
including the treatment provider, prosecutor, and defense counsel. 
Relapses are expected, and the extent to which noncompliance results in 
terminations varies from program to program. Once a defendant is 
terminated, he or she is usually referred for adjudication or 
sentencing.

Drug Court Program Participants:

All of the evaluations we reviewed reported some basic substance use or 
demographic data about the drug court program participants. However, 
not every evaluation reported the same types of information or provided 
equivalent levels of detail.

Participants' Substance Use Characteristics:

The types of drugs participants reported using varied. Cocaine (crack 
or powder) was selected by the highest percentage of participants as 
the primary drug of choice in most of the programs reporting these 
data.[Footnote 30] However, in Baltimore, 77 percent reported heroin 
was primary drug of choice, whereas 43 percent of participants in the 
Tacoma, Washington, Breaking the Cycle program reported using 
methamphetamine, suggesting regional differences in drugs of choice. 
Participants in evaluations we reviewed did not always report "hard" 
drugs as their primary substances of choice. In several evaluations we 
reviewed, participants reported that alcohol or marijuana was their 
primary drug of choice. For example, in Chester County, 47 percent of 
participants reported marijuana, and 84 percent of participants in 
Maricopa County reported alcohol as primary drugs of choice.

Selected Demographic and Socioeconomic Characteristics:

The participants in the drug court programs we reviewed were generally 
in their early 30s, predominantly male, and generally unemployed at the 
time of program entry. Participants' average age at program entry 
ranged from 24 years (in a misdemeanor-only drug court program in New 
Castle County, Delaware) to 36 years (in the Baltimore City Drug 
Treatment Court).[Footnote 31] In the majority of these evaluations, 
participants were, on average, between 30 and 35.

Participants were also predominantly male. The percentage of male 
defendants participating in drug court programs we reviewed ranged from 
46 percent in Bakersfield, California, to 88 percent in the 
Jacksonville, Florida, Breaking the Cycle program. Generally, however, 
about 60 to 80 percent of participants in these programs were male, 
which corresponds to other reviews estimating that across multiple drug 
court programs about 70 percent of participants are male.

In about half of the evaluations we reviewed that reported data about 
participants' race or ethnicity, the majority (50 percent or more) of 
the participants were white. However, in some programs, most 
participants (that is, over 75 percent of the sample) were 
predominantly of one racial or ethnic background. For example, in five 
of the six Washington state drug court programs, between 79 and 92 
percent of participants were white; and in the Baltimore and 
Washington, D.C., drug court programs, between 89 and 99 percent of 
participants were black. Some other programs reported that the 
participants were not predominantly of one racial or ethnic background. 
For example, in Los Angeles County, 23 percent of participants were 
white, 30 percent black, and 43 percent Hispanic or other.

Drug court participants in the evaluations we reviewed that reported 
data on employment and educational status were generally unemployed 
with less than a high school education at program entry. Between 16 to 
82 percent of participants were employed at the time of entry into the 
program.[Footnote 32] However, in about two-thirds of the programs 
reporting these data, less than half of the participants were employed 
at the time of entry into the drug court program. Similarly, in 
evaluations that reported information about participants' educational 
status, 24 to 75 percent of participants reported that they had less 
than a high school education at the time of entry into the program. 
Generally, about 30 to 60 percent had less than a high school education 
at the time of entry into the program. For example, in the New York 
State evaluation, across the programs, the median percentage of 
participants who have received a general equivalency diploma (GED) or 
high school diploma is 45 percent; similarly, the median percentage 
employed or in school is 34 percent.

Criminal Justice Histories:

Participants' prior involvement in the criminal justice system, as 
reported in evaluations we reviewed, was generally 
considerable.[Footnote 33] Most participants were not first-time 
offenders. However the types and severity of involvement varied. In the 
evaluations that reported these data, the average number of prior 
arrests (of any kind) ranged from about 1 to about 13 per participant 
over different time periods, ranging from 1 to 5 years before entry 
into the drug court program. Additionally, in the six New York State 
drug court programs, the percent of participants with prior convictions 
ranged from 19 percent in Queens, which says it does not accept 
participants with prior felony convictions, to 69 percent in Syracuse. 
However, the researchers note that less than one-third of prior 
convictions in all courts were drug-related, which indicates that 
participants are involved in a wider range of criminal activity. This 
description of drug court participants' criminal justice system 
involvement in the evaluations we reviewed was similar to descriptions 
reported by other sources. For example, the Drug Court Clearinghouse 
and Technical Assistance Project's 2001 survey of responding adult drug 
court programs reported that 9 percent of participants had no prior 
felony convictions and 56 percent had been previously incarcerated.

[End of section]

Appendix V: Drug Court Programs Are Associated with Recidivism 
Reductions:

In most of the evaluations we reviewed, adult drug court programs led 
to statistically significant recidivism reductions during periods of 
time that generally corresponded to the length of the drug court 
program--that is, within-program.[Footnote 34] For the remaining 
programs, evaluations showed no significant differences in recidivism. 
Our analysis of the evaluations showed lower percentages of drug court 
program participants than comparison group members were rearrested or 
reconvicted. Program participants also had fewer recidivism events-- 
that is, incidents of rearrests or reconvictions--and a longer time 
until rearrest or reconviction than comparison group participants. 
Recidivism reductions were observed for any felony offense and for drug 
offenses, whether they were felonies or misdemeanors. However, the 
evaluations did not provide conclusive evidence that specific drug 
court program components, such as the judge's characteristics or 
behavior, the amount of treatment received, the level of supervision 
provided, and the sanctions for noncompliance with program 
requirements, affect participants' within-program recidivism. In most 
of the programs that reported post-program data, recidivism reductions 
occurred for some period of time after participants completed the drug 
court program.

Drug Court Programs Led to Within-Program Recidivism Reductions:

The 27 evaluations we reviewed provided within-program recidivism 
comparisons between drug court program participants and an appropriate 
control or comparison group of non-drug court defendants in 23 
different drug court programs. Regardless of the type of comparison 
group used, within-program recidivism reductions occurred for various 
measures of recidivism, such as rearrests and reconvictions, and 
prevailed across different types of offenses.[Footnote 35] Less clear, 
however, was the effect that certain drug court program components, 
such as treatment options or sanctions, had on participants' recidivism 
outcomes.

Drug Court Programs Were Associated with Lower Rearrest Rates for 
Program Participants:

Drug court programs included in our review were associated with 
reductions in overall rearrest rates--that is, the percentage of a 
group arrested for any new offense (felony or misdemeanor) in a given 
period of time. Thirteen drug court programs reported overall rearrest 
data.[Footnote 36] Ten of these found statistically significant 
reductions in overall rearrest rates for drug court program 
participants.[Footnote 37] Across studies showing rearrest reductions, 
rates of drug court program participants generally ranged from about 10 
to 30 percentage points below those of the comparison group. Table 7 
shows these differences in rearrest rates by the length of the time 
frame covered.

Table 7: Differences in Overall Rearrest Rates between Drug Court 
Program Participants and Comparison Group Members:

Significant reported reductions: 

Drug court program: Baltimore City Drug Treatment Court; 
Comparison group used in program evaluation: Significant reported 
reductions: Randomly assigned similar defendants; 
Percentage point difference, time frame covered: Up to 1 year after 
entry: Significant reported reductions: -16%[A]; 
Percentage point difference, time frame covered: Up to 2 years after 
entry: Significant reported reductions: - 15%[A].

Drug court program: Breaking the Cycle Program, Birmingham[B]; 
Comparison group used in program evaluation: Significant reported 
reductions: Historical--arrestees; 
Percentage point difference, time frame covered: Up to 1 year after 
entry: Significant reported reductions: -35[A].

Drug court program: Breaking the Cycle Program, Tacoma[B]; 
Comparison group used in program evaluation: Significant reported 
reductions: Historical--arrestees; 
Percentage point difference, time frame covered: Up to 1 year after 
entry: Significant reported reductions: -15[A].

Drug court program: D.C. Superior Court Drug Intervention Program, 
sanctions docket; 
Comparison group used in program evaluation: Significant reported 
reductions: Randomly assigned similar defendants; 
Percentage point difference, time frame covered: Up to 1 year after 
entry: Significant reported reductions: -8[A].

Drug court program: Douglas County Drug Court; 
Comparison group used in program evaluation: Significant reported 
reductions: Contemporaneous-- traditionally adjudicated offenders[C]; 
Percentage point difference, time frame covered: Up to 1 year after 
entry: Significant reported reductions: -19[A].

Drug court program: Jackson County Drug Court; 
Comparison group used in program evaluation: Significant reported 
reductions: Historical-- arrestees; 
Percentage point difference, time frame covered: Up to 1 year after 
entry: Significant reported reductions: [Empty]; 
Percentage point difference, time frame covered: Up to 2 years after 
entry: Significant reported reductions: -20[A].

Drug court program: Kentucky Drug Court Programs; 
Comparison group used in program evaluation: Significant reported 
reductions: Contemporaneous--assessed offenders, combined felony and 
misdemeanor charge or conviction; 
Percentage point difference, time frame covered: Up to 1 year after 
entry: Significant reported reductions: - 17[A]; 
Percentage point difference, time frame covered: Up to 2 years after 
entry: Significant reported reductions: -4[A].

Drug court program: Los Angeles County Drug Court Program; 
Comparison group used in program evaluation: Significant reported 
reductions: Contemporaneous--probationers; 
Percentage point difference, time frame covered: Up to 1 year after 
entry: Significant reported reductions: -27[A].

Drug court program: Maricopa County First Time Drug Offender Program; 
Comparison group used in program evaluation: Significant reported 
reductions: Randomly assigned similar probationers--results for 
combined groups; 
Percentage point difference, time frame covered: Up to 1 year after 
entry: Significant reported reductions: -1; 
Percentage point difference, time frame covered: Up to 2 years after 
entry: Significant reported reductions: -11[A] (3 yrs).

Drug court program: Orange County Drug Court Program; 
Comparison group used in program evaluation: Significant reported 
reductions: Contemporaneous--probationers; 
Percentage point difference, time frame covered: Up to 1 year after 
entry: Significant reported reductions: -10[A].

Nonsignificant reported differences: 

Drug court program: Breaking the Cycle Program, Jacksonville[B]; 
Comparison group used in program evaluation: Significant reported 
reductions: Historical--arrestees; 
Percentage point difference, time frame covered: Up to 1 year after 
entry: Significant reported reductions: 7.

Drug court program: D.C. Superior Court Drug Intervention Program, 
treatment docket; 
Comparison group used in program evaluation: Significant reported 
reductions: Randomly assigned similar defendants; 
Percentage point difference, time frame covered: Up to 1 year after 
entry: Significant reported reductions: -1.

Drug court program: Escambia County Drug Court; 
Comparison group used in program evaluation: Significant reported 
reductions: Historical-- arrestees; 
Percentage point difference, time frame covered: Up to 2 years after 
entry: Significant reported reductions: -10.

Source: GAO analysis of drug court program evaluations.

Note: When the difference is negative, that indicates that a drug court 
program reduced rearrests; when it is positive, that indicates that 
drug court program participants had higher rearrest rates than their 
comparison group. Nonsignificant differences may be positive or 
negative, but the absence of a statistical difference is interpreted to 
mean that there is no difference in recidivism between the drug court 
program and comparison group.

[A] The difference was reported to be statistically significant.

[B] According to the principal researcher of the evaluation, the 
Breaking the Cycle program is technically not considered to be a drug 
court program. However, we included the program in our review because 
it incorporates several of the basic drug court program components, 
such as drug testing and access to treatment services.

[C] While these defendants consisted primarily of those arrested during 
the time the drug court program was in operation (a contemporaneous 
comparison), some individuals who were arrested in the 3 months prior 
to the start of the drug court program were included.

[End of table]

Not All Drug Court Programs Reduced Recidivism for All Offenses:

In two drug court programs (Breaking the Cycle program in Jacksonville 
and the D.C. Superior Court treatment docket), the program did not lead 
to significant differences in overall within-program recidivism. The 
absence of a significant difference suggests that these drug court 
programs did not necessarily lead to recidivism reductions. In one of 
these programs (the D.C. Superior Court), two types of drug court 
program interventions were examined--(1) a treatment docket, consisting 
of an intensive treatment-only intervention and (2) a sanctions docket, 
consisting of an intervention that combined referrals to treatment with 
graduated sanctions. The evaluation showed statistically significant 
reduction in rearrests for the sanctions docket. However, results for 
the treatment docket (treatment alone) were not statistically 
significant. A third drug court program in Escambia County showed mixed 
results. The drug court program showed no differences for overall 
rearrest rates (both felonies and misdemeanors) but showed a 
significant reduction in felony rearrest rates.

Drug Court Programs Were Associated with Lower Reconviction Rates for 
Program Participants:

The evaluations we reviewed showed lower reconviction rates--the 
percentage of a group convicted for a new offense in a given period of 
time--for drug court program participants than for comparison group 
members.[Footnote 38] Almost all of the programs (10 of 12) with these 
data reported a statistically significant reduction in reconviction 
rates for drug court program participants in one of the time frames 
covered. The two programs that did not show statistically significant 
reductions in reported results in a direction of reconviction 
reduction, but not at a statistically significant level. Table 8 
displays the differences in reconviction rates between drug court 
participants and comparison group members after up to 1 year and after 
2 to 3 years of entry into their respective programs.

Table 8: Differences in Reconviction Rates between Drug Court Program 
Participants and Comparison Group Members:

Significant reported reductions: 

Drug court program: Bronx Treatment Court[A]; 
Comparison group used in program evaluation: Significant reported 
reductions: Historical-- eligible arrestees; 
Percentage point difference, time frame covered: Up to 1 year after 
entry: Significant reported reductions: - 9%[B]; 
Percentage point difference, time frame covered: 2 to 3 years after 
entry: Significant reported reductions: -15%[B] (3 yrs).

Drug court program: Brooklyn Treatment Court[A]; 
Comparison group used in program evaluation: Significant reported 
reductions: Contemporaneous--eligible arrestees; 
Percentage point difference, time frame covered: Up to 1 year after 
entry: Significant reported reductions: -10[B]; 
Percentage point difference, time frame covered: 2 to 3 years after 
entry: Significant reported reductions: - 14[B] (3 yrs).

Drug court program: Douglas County Drug Court; 
Comparison group used in program evaluation: Significant reported 
reductions: Contemporaneous-- traditionally adjudicated offenders[C]; 
Percentage point difference, time frame covered: Up to 1 year after 
entry: Significant reported reductions: -8[B]; 
Percentage point difference, time frame covered: 2 to 3 years after 
entry: Significant reported reductions: [Empty].

Drug court program: Kentucky Drug Court Programs; 
Comparison group used in program evaluation: Significant reported 
reductions: Contemporaneous--assessed offenders, combined felony and 
misdemeanor charge or conviction; 
Percentage point difference, time frame covered: Up to 1 year after 
entry: Significant reported reductions: - 15[B]; 
Percentage point difference, time frame covered: 2 to 3 years after 
entry: Significant reported reductions: -5[B].

Drug court program: Maricopa County First Time Drug Offender Program; 
Comparison group used in program evaluation: Significant reported 
reductions: Randomly assigned similar probationers--results for 
combined groups; 
Percentage point difference, time frame covered: Up to 1 year after 
entry: Significant reported reductions: -3; 
Percentage point difference, time frame covered: 2 to 3 years after 
entry: Significant reported reductions: -6[B].

Drug court program: Queens Treatment Court[A]; 
Comparison group used in program evaluation: Significant reported 
reductions: Historical-- eligible arrestees; 
Percentage point difference, time frame covered: Up to 1 year after 
entry: Significant reported reductions: - 21[B]; 
Percentage point difference, time frame covered: 2 to 3 years after 
entry: Significant reported reductions: -13[B] (3 yrs).

Drug court program: Rochester Drug Treatment Court[A]; 
Comparison group used in program evaluation: Significant reported 
reductions: Contemporaneous--eligible arrestees who were not arraigned 
before a judge supportive of the program; 
Percentage point difference, time frame covered: Up to 1 year after 
entry: Significant reported reductions: -10[B]; 
Percentage point difference, time frame covered: 2 to 3 years after 
entry: Significant reported reductions: -10[B] (3 yrs).

Drug court program: Suffolk County Drug Treatment Court[A]; 
Comparison group used in program evaluation: Significant reported 
reductions: Historical--eligible arrestees; 
Percentage point difference, time frame covered: Up to 1 year after 
entry: Significant reported reductions: -21[B]; 
Percentage point difference, time frame covered: 2 to 3 years after 
entry: Significant reported reductions: -25[B] (3 yrs).

Drug court program: Syracuse Community Treatment Court[A]; 
Comparison group used in program evaluation: Significant reported 
reductions: Historical--eligible arrestees; 
Percentage point difference, time frame covered: Up to 1 year after 
entry: Significant reported reductions: -16[B]; 
Percentage point difference, time frame covered: 2 to 3 years after 
entry: Significant reported reductions: -14[B] (2 yrs).

Drug court program: Washington State Drug Court Program, five counties 
combined; 
Comparison group used in program evaluation: Significant reported 
reductions: Historical--arrestees; 
Percentage point difference, time frame covered: 2 to 3 years after 
entry: Significant reported reductions: - 6[B].

Drug court program: Nonsignificant reported reductions.

Drug court program: Baltimore City Drug Treatment Court; 
Comparison group used in program evaluation: Significant reported 
reductions: Randomly assigned similar defendants; 
Percentage point difference, time frame covered: Up to 1 year after 
entry: Significant reported reductions: -5; 
Percentage point difference, time frame covered: 2 to 3 years after 
entry: Significant reported reductions: [Empty].

Drug court program: Washington State Drug Court Program, King County; 
Comparison group used in program evaluation: Significant reported 
reductions: Historical--arrestees; 
Percentage point difference, time frame covered: 2 to 3 years after 
entry: Significant reported reductions: -2.

Source: GAO analysis of drug court program evaluations.

Note: When the difference is negative, that indicates that a drug court 
program reduced reconvictions; when it is positive, that indicates that 
drug court program participants had higher reconviction rates than the 
comparison group members. Nonsignificant differences may be positive or 
negative, but the absence of a statistical difference is interpreted to 
mean that there is no difference in recidivism between the drug court 
program and comparison group.

[A] The data for these six drug court programs were provided from one 
multisite evaluation of New York state drug court programs.

[B] The difference was reported to be statistically significant.

[C] While these defendants consisted primarily of those arrested during 
the time the drug court program was in operation (a contemporaneous 
comparison), some individuals who were arrested in the 3 months prior 
to the start of the drug court program were included.

[End of table]

The significant differences in reconviction rates between drug court 
participants and comparison group members ranged from 8 to 21 
percentage points within 1 year of entry into the drug court program. 
For the eight drug court programs in which follow-up data were provided 
for more than 1 year, statistically significant differences in 
reconviction rates ranged from between 5 and 25 percentage points. In 
five of these drug court programs, the differences in reconvictions 
generally increased or remained about the same as the length of the 
follow-up period increased.

Drug Court Participants Had Fewer Recidivism Events and Longer Times to 
First Recidivism Event than Comparison Group Members Did:

Consistent with reducing the percentage of participants rearrested or 
reconvicted within a given period, drug court program effects may occur 
by reducing the number of recidivism events--the number of arrests or 
convictions within a particular period--that participants commit and by 
increasing the time until participants commit an offense leading to an 
arrest or reconviction. In 8 of 12 programs, drug court participants 
had fewer rearrests and in 7 of 9 programs they had fewer reconvictions 
than comparison group members. Per 100 drug court program and 
comparison group participants, drug court program participants had 
between 9 and 90 fewer arrests during the program, or between 18 and 89 
fewer convictions during the program, depending on the recidivism 
measure reported.

Drug court program participants also generally had longer times to 
first arrest or conviction than comparison group members. In 11 of 16 
programs in which the time to first event was reported, drug court 
program participants had longer times to the first recidivism event.

Recidivism Reductions Were Observed for Different Offense Types:

Evidence showed recidivism reductions for different types of offenses, 
specifically for felonies and drug offenses, which may indicate 
decreased involvement in substance abuse. In almost all (9 of 12) of 
the programs that reported data on felony offense recidivism rates 
(either rearrest or reconviction), drug court participants had lower 
felony recidivism rates or fewer recidivism events. Similarly, in 11 of 
14 of the programs that reported data on drug offense recidivism, drug 
court participants were either rearrested or reconvicted for drug 
offenses at lower rates.

One drug court program that found no significant reduction in rearrests 
did find a reduction in specific offense types. Specifically, the 
evaluation of the drug court program in Escambia County found that 
there were no significant differences in overall rearrests between drug 
court participants and comparison group members within 2 years. 
However, the evaluation found significant reductions in felony 
rearrests that amounted to a 28-percentage point reduction in felony 
rearrest rates for drug court program participants. Because of 
relatively low participation rates, the researchers cautioned against 
interpreting such a large reduction in felony rearrests as indicative 
of the amount of a reduction that could be expected from the drug court 
program were it to be implemented for a larger numbers of defendants.

Drug Court Program Components Were Infrequently Evaluated and Results 
Were Inconclusive:

A limited number of evaluations reported information about whether 
specific drug court program components affect participants' recidivism, 
and their results were mixed. Drug court program judges, the treatment 
programs prescribed for participants, and the sanctions used to enforce 
compliance with drug court program procedures are three of the basic 
components of drug court programs. Two evaluations that we reviewed 
provided data on the effects of treatment and supervision on drug court 
program participants' within-program recidivism outcomes.

Effects of the Role of the Judge:

None of the evaluations we reviewed explicitly studied the effect of 
the judge--considered to be a critical component of a drug court 
program--on participants' within-program recidivism.

Effects of Substance Abuse Treatment and Sanctions Imposed:

In evaluations of two drug court programs, the effects of two basic 
components of drug courts--substance abuse treatment and sanctions-- 
were assessed, and their results varied. The specific types of 
substance abuse treatment provided to participants differ among 
programs. In general, treatment, depending on the needs of the 
participant, can include detoxification, individual and group 
counseling on an outpatient basis, substance use prevention education, 
as well as other health, educational, vocational, or medical services. 
Similarly, the types and severity of sanctions that judges use to 
enforce compliance with program requirements vary. These sanctions can 
include writing an essay, observing drug court proceedings for several 
days from the jury box, community service, or short jail stays. Drug 
court programs may use a graduated sanctions approach, where successive 
infractions are met with increasingly severe sanctions. In other 
programs, judges may have discretion to apply sanctions, as needed, 
according to the specifics of the case.

To assess the effect of treatment, two evaluations examined recidivism 
differences between drug court program participants who attended more 
treatment sessions than other participants. In one of the two 
evaluations that provided the strongest designs for measuring treatment 
effects--the evaluation of the Baltimore City Drug Treatment Court-- 
treatment contributed to reductions in recidivism. However, in the 
other--the evaluation of the D.C. Superior Court treatment docket-- 
there were no differences between the treatment docket and the control 
group, who were assigned to a standard docket, consisting of some level 
of supervision, monitoring, and access to services.[Footnote 39] In 
both of these evaluations, drug court program participants and control 
group members participated in treatment, but the drug court program 
participants received more treatment and were engaged in a more 
structured treatment regime than were control group members.

Findings from these two evaluations also indicate that treatment 
requirements combined with supervision and sanctioning contribute the 
most to recidivism reductions. While the evaluation of the Baltimore 
City Drug Treatment Court measured a distinct difference between those 
who participated more heavily in treatment, it also found that those 
who received treatment combined with supervision had the lowest 
recidivism rates. The D.C. Superior Court sanctions docket, which also 
combined judicial supervision with treatment, specifically engaged 
participants in a program in which judges applied an established set of 
graduated sanctions for failing to comply with drug court program 
requirements. The sanctions docket led to fewer rearrests for 
participants as compared with the control group assigned to the 
standard docket. The Baltimore City and D.C. Superior Court sanctions 
docket results support the contention that treatment requirements that 
are combined with supervision and sanctioning contribute the most to 
recidivism reductions.

Limited Evidence Indicates That Recidivism Reductions Endure:

While fewer evaluations reported post-program, rather than within- 
program, recidivism results, those that did indicate that recidivism 
reductions endure beyond the time that participants are engaged in the 
program.[Footnote 40] Evaluations we reviewed reported post-program 
recidivism for longer periods for 17 drug court programs. In 13 of 
these 17 programs, drug court program participants had lower rearrest 
or reconviction rates than comparison group members. One evaluation of 
6 programs defined explicit post-program periods of about 1 year, and 
drug court program participants had lower recidivism than comparison 
group members of 5 of the 6 programs. Among drug court program 
participants, graduates had lower post-program recidivism than dropouts.

Lower Rearrest and Reconviction Rates:

Significantly lower rearrest and reconviction rates were reported for 
participants in 13 of the 17 drug court programs that reported these 
data. As shown in table 9, for 6 drug court programs reporting 
significant reductions, the differences in rearrest rates between drug 
court program participants and comparison group members ranged between 
4 to 20 percentage points. The evaluation of the Multnomah County drug 
court program reported only the mean number of arrests (recidivism 
events), but it also showed post-program reduction in recidivism using 
this measure. For the 9 drug court programs reporting significant 
reductions, the differences in reconviction rates between drug court 
participants and comparison group members ranged from 5 to 25 
percentage points.

Table 9: Differences in Rearrest and Reconviction Rates, over Longer 
Time Periods, between Drug Court Program Participants and Comparison 
Group Members:

Significant reported reductions: 

Drug court program: Baltimore City Drug Treatment Court; 
Recidivism measure, percentage point difference: Rearrested: -15[A]; 
Recidivism measure, percentage point difference: Time frame covered 
after entry: 2 years.

Drug court program: Bronx Treatment Court[B]; 
Recidivism measure, percentage point difference: Reconvicted: -15[A]; 
Recidivism measure, percentage point difference: Time frame covered 
after entry: Up to 4 years.

Drug court program: Brooklyn Treatment Court[B]; 
Recidivism measure, percentage point difference: Reconvicted: -14[A]; 
Recidivism measure, percentage point difference: Time frame covered 
after entry: Up to 4 years.

Drug court program: Jackson County Drug Court; 
Recidivism measure, percentage point difference: Rearrested: -20[A]; 
Recidivism measure, percentage point difference: Time frame covered 
after entry: 2 years.

Drug court program: Kentucky Drug Court Programs; 
Recidivism measure, percentage point difference: Rearrested: -4[A]; 
Recidivism measure, percentage point difference: Time frame covered 
after entry: 1 year post-program; 
Recidivism measure, percentage point difference: Reconvicted: -5[A]; 
Recidivism measure, percentage point difference: Time frame covered 
after entry: 1 year post-program.

Drug court program: Maricopa County First Time Drug Offender Program; 
Recidivism measure, percentage point difference: Rearrested: -11[A]; 
Recidivism measure, percentage point difference: Time frame covered 
after entry: 3 years; 
Recidivism measure, percentage point difference: Reconvicted: -6[A]; 
Recidivism measure, percentage point difference: Time frame covered 
after entry: 3 years.

Drug court program: Multnomah County STOP Drug Diversion Program[C]; 
Recidivism measure, percentage point difference: Rearrested: -0.94[A]; 
Recidivism measure, percentage point difference: Time frame covered 
after entry: 2 years.

Drug court program: North Carolina Drug Treatment Court; 
Recidivism measure, percentage point difference: Rearrested: -10[A]; 
Recidivism measure, percentage point difference: Time frame covered 
after entry: 1 year post program.

Drug court program: Queens Treatment Court[B]; 
Recidivism measure, percentage point difference: Reconvicted: -13[A]; 
Recidivism measure, percentage point difference: Time frame covered 
after entry: Up to 4 years.

Drug court program: Rochester Drug Treatment Court[B]; 
Recidivism measure, percentage point difference: Reconvicted: 
-10[A]; 
Recidivism measure, percentage point difference: Time frame covered 
after entry: Up to 4 years.

Drug court program: Suffolk County Drug Treatment Court[B]; 
Recidivism measure, percentage point difference: Reconvicted: 
-25[A]; 
Recidivism measure, percentage point difference: Time frame covered 
after entry: Up to 4 years.

Drug court program: Syracuse Community Treatment Court[B]; 
Recidivism measure, percentage point difference: Reconvicted: 
-14[A]; 
Recidivism measure, percentage point difference: Time frame covered 
after entry: Up to 4 years.

Drug court program: Washington State Drug Court Program, five counties 
combined; 
Recidivism measure, percentage point difference: Reconvicted: -6[A]; 
Recidivism measure, percentage point difference: Time frame covered 
after entry: 3 years.

Nonsignificant reported differences or significant increase: 

Drug court program: Clark County Drug Court; 
Recidivism measure, percentage point difference: Reconvicted: 10[A]; 
Recidivism measure, percentage point difference: Time frame covered 
after entry: 2 years post program.

Drug court program: Escambia County Drug Court[D]; 
Recidivism measure, percentage point difference: Rearrested: -10; 
Recidivism measure, percentage point difference: Time frame covered 
after entry: 2 years.

Drug court program: Southern San Mateo County Drug Court; 
Recidivism measure, percentage point difference: Rearrested: 2; 
Recidivism measure, percentage point difference: Time frame covered 
after entry: 2 years.

Drug court program: Washington State Drug Court Program, King County; 
Recidivism measure, percentage point difference: Reconvicted: -2; 
Recidivism measure, percentage point difference: Time frame covered 
after entry: 3 years.

Source: GAO analysis of drug court program evaluations.

Note: When the difference is negative, that indicates that a drug court 
program reduced recidivism; when it is positive, that indicates that 
drug court program participants had higher recidivism rates than 
members of their comparison group.

[A] The difference was reported to be statistically significant.

[B] The data for these six drug court programs were provided from one 
multisite evaluation of New York state drug court programs.

[C] The Multnomah County results show differences in the average number 
of arrests only.

[D] Escambia County drug court showed a significant reduction in felony 
rearrest rates but showed no significant difference for overall 
rearrest rates (both felonies and misdemeanors).

[End of table]

Evidence that a gap in post-program recidivism can increase over time 
comes from the evaluation of the Maricopa County drug court program. In 
Maricopa County, there were no reported differences in recidivism 
(specifically rearrest rates) during the 1-year within-program time 
frame. However, a 3-year follow-up evaluation found a significant (11 
percentage point) difference in rearrest rates between the drug court 
program participants and control group members. The difference arose 
largely from an increase in the percentage of control group members 
that had been rearrested by the end of the 3-year follow-up; 32 percent 
of the control group were rearrested by 1 year, but by 3 years, 44 
percent were rearrested. For the drug court participants, 31 percent 
had been rearrested at the end of 1 year, but only an additional 2 
percent of the sample were rearrested within 3 years.

Recidivism Reductions in Explicit Post-Program Periods:

For the six programs with explicit post-program periods, participants 
had significantly lower recidivism than comparison group members in all 
but one program, as shown in table 10.

Table 10: Post-Program Differences in Recidivism in Six New York State 
Drug Court Programs:

Significant reported reductions: 

New York state drug court program: Bronx Treatment Court; 
Comparison group used in evaluation: Historical arrestees: eligible 
defendants arrested in the Bronx prior to the start of the drug court 
program; 
Percentage point difference in recidivism, 1-year post-program: - 
13%[A].

New York state drug court program: Brooklyn Treatment Court; 
Comparison group used in evaluation: Contemporaneous: eligible drug 
felony defendants arrested in Brooklyn but not screened in the drug 
court, primarily because they were arrested within one of the two 
geographic zones that were ineligible to send defendants to the drug 
court program; 
Percentage point difference in recidivism, 1-year post- program: -6[B].

New York state drug court program: Queens Treatment Court; 
Comparison group used in evaluation: Historical arrestees: eligible 
defendants arrested in Queens in the year prior to the drug court 
program's implementation; 
Percentage point difference in recidivism, 1-year post-program: -13[A].

New York state drug court program: Rochester Drug Treatment Court; 
Comparison group used in evaluation: Contemporaneous arrestees: 
eligible defendants arrested in Rochester during the same period of 
time as the drug court was in operation but who were not arraigned 
before a judge supportive of the program; 
Percentage point difference in recidivism, 1-year post-program: -7[B].

New York state drug court program: Suffolk County Drug Treatment Court; 
Comparison group used in evaluation: Historical arrestees: eligible 
defendants arrested in Suffolk County in the year prior to the start of 
the drug court program; 
Percentage point difference in recidivism, 1- year post-program: -9[B].

Nonsignificant reported reduction: 

New York state drug court program: Syracuse Community Treatment Court; 
Comparison group used in evaluation: Historical arrestees: eligible 
defendants arrested in Syracuse City in the year prior to the start of 
the drug court program; 
Percentage point difference in recidivism, 1- year post-program: -7.

Source: GAO analysis of drug court program evaluations.

[A] Significant at at least the 1 percent level.

[B] Significant at the 5 percent level.

[End of table]

In five of the six New York state drug court programs, drug court 
participants had significantly lower post-program recidivism rates than 
did their comparison group members. The differences in recidivism, 
measured by the percentage with a new arrest leading to a conviction 
for 1 year after drug court participants left the program, ranged from 
6 to 13 percentage points, as shown in table 10. These findings 
indicate that for some programs at least, drug court programs can be 
effective at reducing criminal behavior while participants are engaged 
in the program and after they leave the program. The evaluation of 
these drug court programs reports that there is evidence that the 
effects of drug court programs on recidivism do not diminish over time, 
but because the post-program period was only 1 year, that improved 
understanding of the longer-run effects of drug courts on recidivism 
would benefit from additional research that extends the post-program 
follow-up time frames.

Graduates Had Lower Post-Program Recidivism than Dropouts:

Several evaluations compared post-program recidivism outcomes for drug 
court program graduates with those of dropouts--those participants who 
were terminated from the program either by their withdrawal or by 
sanctioning. These evaluations show that the post-program recidivism 
differences observed between all drug court program and comparison 
group participants arise primarily from the large recidivism 
differences between drug court program graduates and dropouts. 
Evaluations that reported these comparisons showed large differences in 
the recidivism rates of drug court program graduates compared with both 
dropouts and comparison group members. For example, in three New York 
state drug court programs, dropouts were four to seven times more 
likely to be reconvicted than graduates. Specifically, in the Bronx 
Treatment Court, 29 percent of dropouts were reconvicted during the 
first year after the program as compared with only 4 percent of 
graduates. In addition, the post-program recidivism rates of dropouts 
were generally no different from (or in some cases greater than) the 
recidivism rates of comparison group members.

[End of section]

Appendix VI: Limited and Mixed Evidence on Drug Court Programs' Impacts 
on Substance Use Relapse:

Evidence about the effectiveness of drug court programs in reducing 
participants' substance use relapse is limited and mixed. The evidence 
on substance use relapse outcomes is limited to data available from 
eight drug court programs included in our review. The data include drug 
test results and self-reported drug use; both measures were reported 
for some programs. Drug test results generally showed significant 
reductions in use during participation in the program, while self- 
reported results generally showed no significant reductions in use.

Limited Evidence on Drug Court Programs' Impact on Substance Use 
Relapse:

The evidence on substance use relapse outcomes is limited to data 
available from eight drug court programs.[Footnote 41] Evaluations in 
these eight drug court programs used two different measures of 
substance use--drug test results and self-reported use--to compare 
relapse between participants and comparison group members. Three of 
these programs used both measures to assess relapse. Table 11 shows the 
comparison group used in the programs' evaluation and the results for 
the eight drug court programs that presented substance use relapse 
data, grouped by the type of drug use measure used.

Table 11: Substance Use Relapse Results, by Different Measures of Use, 
for Programs GAO Reviewed:

Drug tests: 

Drug court program: Chester County Drug Court; 
Comparison group used in evaluation of program: Historical--
probationers; 
Results of substance use relapse: Reduction within-program: There were 
significantly lower rates of positive drug test results for drug court 
program participants.

Drug court program: Maricopa County First Time Drug Offender Program; 
Comparison group used in evaluation of program: All individuals 
identified as eligible for the drug court program were randomly 
assigned to one of three study groups at the time of their initial 
probation assignment. The three study groups were: 
(1) probation with no testing; 
(2) probation with low-rate (monthly) drug testing; 
and; 
(3) probation with high-rate (biweekly) drug testing; 
Results of substance use relapse: No reduction within-program: Among 
all drug court and probation control group members, there were no 
significant differences in the percent that tested positive for any 
drug. However, significantly lower percentages of drug court 
participants tested positive for cocaine. Significantly higher 
percentages of drug court participants tested positive for marijuana, 
valium, and alcohol.

Self-reported drug use: 

Drug court program: Breaking the Cycle Program, Birmingham; 
Comparison group used in evaluation of program: Historical--arrestees; 
Results of substance use relapse: Reduction within-program: 
Participants reported lower use of any drug during the past 30 days and 
significantly lower use of stronger drugs (such as cocaine and heroin).

Drug court program: Breaking the Cycle Program, Jacksonville; 
Comparison group used in evaluation of program: Historical--arrestees; 
Results of substance use relapse: Reduction within-program: 
Participants reported significantly lower use during the past 30 days 
of any drug, lower heavy drug use (defined as 16 or more days of 
illegal drug use), and lower marijuana use. They reported no 
differences in use of stronger drugs (such as cocaine).

Drug court program: Breaking the Cycle Program, Tacoma; 
Comparison group used in evaluation of program: Historical--arrestees; 
Results of substance use relapse: No reduction within-program: There 
was no difference in self-reported drug use on rates or types of drugs.

Both drug tests and self-reported use: 

Drug court program: D.C. Superior Court Drug Intervention Program, 
sanctions docket; 
Comparison group used in evaluation of program: Randomly assigned 
eligible defendants; 
Results of substance use relapse: Reduction within-program: Drug tests 
were taken during the final month of the program--that is, within-
program. Twenty-seven percent of drug court participants tested drug-
free in all drug tests compared with 11 percent of the control group. 
Fifty-three percent of drug court participants had a "bad test outcome" 
(negative result, missed test, or tampered result) as compared with 71 
percent of the control group; 
No reduction post-program: There were no differences in self-reported 
drug use that occurred during the year after sentencing.

Drug court program: D.C. Superior Court Drug Intervention Program, 
treatment docket; 
Comparison group used in evaluation of program: Randomly assigned 
eligible defendants; 
Results of substance use relapse: Reduction within-program: Drug tests 
were taken during the final month of the program. Twenty-two percent of 
drug court participants tested drug-free in all drug tests as compared 
with 11 percent of the control group. Also, 64 percent of the drug 
court participants had "bad test outcome" (negative result, missed 
test, or tampered result) as compared with 71 percent of the control 
group; 
No reduction post-program: There were no differences in self-reported 
drug use that occurred during the year after sentencing.

Drug court program: New Castle County Drug Court Program; 
Comparison group used in evaluation of program: Drug court program 
participants who were randomly assigned to biweekly versus "as needed" 
judicial status hearings; 
Results of substance use relapse: Reduction within- program for 
subgroups: There were significant reductions in positive drug test 
results for participants with mental health problems and prior 
treatment who were assigned to the biweekly condition compared with 
those assigned to the "as-needed" condition. There were significant 
reductions in positive test results for those without mental health 
problems assigned to the "as-needed" condition, but not to the biweekly 
condition. However, there were no overall differences either in drug 
tests or self-reported drug use between groups assigned to biweekly or 
"as-needed" hearings.

Source: GAO analysis of drug court program evaluations.

[End of table]

All of the drug test results on substance use relapse were limited to 
those obtained when participants were still engaged in the drug court 
program. After drug court program participants exit the control of the 
criminal justice system, researchers must obtain participants' 
voluntary consent to obtain substance use relapse data, regardless of 
whether the data are self-reported or based upon urinalysis or other 
testing methods.[Footnote 42]

Evidence on Drug Court Programs' Impact on Substance Use Relapse Is 
Mixed:

The results on substance use relapse are mixed. Four of the five drug 
court programs that used drug test results reported reductions in use. 
However, self-reported data on substance use relapse show contradictory 
results.

In both of the D.C. Superior Court dockets, prior to sentencing, drug 
court program participants had better drug test results than did 
defendants who had been randomly assigned to the control group. 
Similarly, in the Chester County Drug Court, within-program drug 
relapse was observed using drug test results. Drug court program 
participants had fewer positive urinalysis results than did a 
comparison group of eligible offenders who had been placed on probation 
in the 10 months prior to the implementation of the drug court program. 
These results indicate decreased relapse among participants despite the 
fact that drug court program participants were tested more frequently 
than were the members of the comparison group. However, in Maricopa 
County, there were no significant differences in the percentage of drug 
court participants and the combined control groups that tested positive.

One evaluation we reviewed provided limited evidence that judicial 
status hearings reduce within-program substance use for certain types 
of drug court program participants. This evaluation, an experiment in a 
drug court program in New Castle County, randomly assigned eligible 
drug court program defendants to one of two forms of judicial status 
hearing conditions: (1) biweekly, regularly scheduled status hearings 
or (2) status hearings scheduled on an as-needed basis. During the 14- 
week drug court program, participants with antisocial personality 
disorder (APD) and those who had prior drug treatment episodes had 
significantly lower levels of substance use--as measured by drug test 
results--when they were assigned to regularly scheduled biweekly 
judicial status hearings as compared with when they were assigned to 
status hearings on an as-needed basis.[Footnote 43]

Four of the six programs with self-reported drug use results reported 
no significant reductions in use. For example, after sentencing, 
neither of the D.C. Superior Court dockets' participants reported lower 
rates of substance use. Alternatively, in two of the three Breaking the 
Cycle programs, participants reported lower rates of substance use than 
did comparison group members. These differences in self-reported 
substance use persisted even after the researchers controlled for 
sample differences and selection. The use of self-reported data 
presents challenges related to underreporting that we have discussed in 
a prior report.[Footnote 44]

[End of section]

Appendix VII: Evidence Is Mixed about the Factors That Predict Program 
Completion:

As discussed in appendix V, participants who completed the drug court 
program (that is, graduates) had much lower recidivism rates than those 
who dropped out. Further, the recidivism rates for drug court program 
dropouts are comparable to the rates of comparison group members. 
Completion rates--an indicator of the extent to which participants 
successfully complete their drug court program requirements--for 
participants in selected programs we reviewed ranged from about 30 
percent to about 70 percent.[Footnote 45]

In evaluations of 16 drug court programs in which completion was 
assessed, one factor--drug court program participants' compliance with 
program procedures--was consistently associated with program 
completion. These program procedures include attending treatment 
sessions, producing drug-free urinalysis test results, and appearing at 
status hearings. No other program factor, such as the severity of the 
sanction that would be imposed if participants failed to complete the 
program or the manner in which judges conducted status hearings, 
predicted participants' program completion. Several characteristics of 
the drug court program participants themselves were also associated 
with an increased likelihood of program completion. These 
characteristics, while not assessed in all of the programs, include 
lower levels of prior involvement in the criminal justice system, and 
age, as older participants were more likely to complete drug court 
programs than younger ones.

Program Completion Rates Vary:

Completion rates ranged from 27 percent to 66 percent for 16 drug court 
programs included in evaluations that assessed program completion. 
These rates, while consistent with rates reported in other reviews of 
multiple drug court programs, are not directly comparable because drug 
court programs have different program completion requirements, the 
rates were measured over varying time periods, and study designs can 
affect the completion measures. Participants are not only required to 
attend treatment, but also to appear in court on a regular basis and 
follow other rules that are specific to the drug court program. These 
rules can involve, but are not limited to, policies on drug testing, 
case manager or probation officer visits, school or job attendance, 
support groups, and graduation requirements. Table 12 shows completion 
rates for the drug court programs whose evaluations assessed program 
completion.

Table 12: Completion Rates for Selected Drug Court Programs Included in 
GAO's Review:

Drug court program: Bakersfield Municipal Drug Court; 
Completion rate: 36%.

Drug court program: Bronx Treatment Court; 
Completion rate: 44.

Drug court program: Brooklyn Treatment Court; 
(Rempel and others, 2003); 
Completion rate: 44.
(Rempel and DeStefano, 2001); 
Completion rate: 58.

Drug court program: Broward County Drug Court; 
(Schiff and Terry, 1997); 
Completion rate: 39.
(Senjo and Leip, 2001); 
Completion rate: 29.

Drug court program: Clark County Drug Court; 
Completion rate: 52[A].

Drug court program: Creek County Drug Court; 
Completion rate: 48.

Drug court program: Escambia County Drug Court Program; 
(Peters and Murrin, 2000); 
Completion rate: 48.
(Peters, Haas, and Murrin, 1999); 
Completion rate: 45.

Drug court program: (Truitt and others, 2002); 
Completion rate: 49.

Drug court program: Jackson County Drug Court Program; 
(Anspach and Ferguson, 2003); 
Completion rate: 29.
(Truitt and others, 2002); 
Completion rate: 27.

Drug court program: Multnomah County STOP Drug Diversion Program; 
Completion rate: 51[A].

Drug court program: New Castle County Drug Court; 
As-needed hearings; 
Completion rate: 58.
Biweekly hearings; 
Completion rate: 49.

Drug court program: Okaloosa County Drug Court; 
Completion rate: 53.

Drug court program: Orange County Drug Court Program; 
Completion rate: 43.

Drug court program: Queens Treatment Court; 
Completion rate: 66.

Drug court program: St. Mary Parish Drug Court; 
Completion rate: 32.

Drug court program: Suffolk County Drug Treatment Court; 
Completion rate: 62.

Drug court program: Syracuse Community Treatment Court; 
Completion rate: 41.

Source: GAO analysis of drug court program evaluations.

[A] Evaluation reports "favorable" status, which includes defendants 
active in treatment plus those who graduated.

[End of table]

As noted earlier, drug court programs vary in their specific program 
completion requirements. Similarly, programs may terminate defendants' 
program participation for a variety of reasons. Drug court program 
participants can be terminated from the program if they are arrested 
for a new offense, especially for felony offenses; 
if they regularly fail to appear at status hearings or treatment 
sessions; or if they repeatedly do not comply with program procedures. 
Consecutive positive drug test results do not always lead to program 
termination; in some programs, this could lead to a change in the 
treatment services provided or sanctions.

Program Completion Is Associated with Compliance with Program 
Procedures:

Drug court participants' compliance with drug court procedures, such as 
appearing at treatment sessions and remaining drug-free during the 
program, was generally a strong predictor of program completion. The 
level of program compliance is typically indicated by the degree to 
which participants follow rules and procedures determined by the drug 
court program, attend required meetings and treatment sessions, and 
generally progress toward recovery. Given that program completion is 
related to compliance with drug court procedures, we sought to assess 
whether the evaluations included in our review provided conclusive 
evidence about specific aspects of compliance that were associated with 
program completion. For example, in some drug court programs greater 
levels of participation were associated with greater likelihood of 
completing the drug court program. Similarly, participants having more 
within-program arrests, more instances of warrants for failure to 
appear, and more positive drug tests were generally less likely to 
complete the program than those having fewer of these.

However, for some of the specific aspects of compliance, the findings 
were not consistent across drug court programs and in some cases they 
were even contradictory. For example, one evaluation of four drug court 
programs (Bakersfield, Creek County, Jackson County, and St. Mary's 
Parish) found an inconsistent relationship between drug test results 
and program completion across the four drug court programs. This cross- 
site evaluation assessed how various aspects of compliance predicted 
completion in each program using the same measures of compliance in 
each drug court program. In relation to the association between drug 
test results and completion, the evaluation found that in one program 
(Creek County) drug test results did not have a significant effect on 
completion. In another drug court program (St. Mary's Parish), drug 
court program participants that had no positive drug test results were 
more likely to complete the program than were participants who had 
comparatively "low" or "moderate" numbers of positive test results, 
whereas there were no differences in program completion between those 
participants who had comparatively "high" numbers of positive test 
results and those who had no positive test results.[Footnote 46] In the 
two remaining programs (Bakersfield and Jackson County), participants 
with positive test results in the low range actually had a higher 
likelihood of completing the program than participants with no positive 
test results, while in Jackson County, participants with positive test 
results in the high range were less likely than those with no positive 
test results to complete the program. This evaluation suggests that 
there may not be consistency across every drug court program in the 
relationship between drug test results and program completion.

Initial Engagement of Drug Court Participants:

Some research studies indicate that drug court participants' first few 
weeks in treatment are predictive of success. Early engagement in the 
drug court program has been measured by whether participants attended 
treatment during the first few weeks after program entry and whether 
participants have fewer indications of noncompliance (such as failure 
to appear or warrants) during the first month of program participation.

One evaluation of five drug court programs in New York State assessed 
the role of participants' early engagement in the drug court program on 
their chances of completing the program.[Footnote 47] It found, 
consistently among the drug court programs, that early engagement by 
participants, measured by whether the participant absconded from 
program contact within 30 days of program entry significantly predicted 
program completion. Across the five New York drug court programs, 
participants that received warrants within 30 days of program entry 
were from about three to eight times more likely to fail to complete 
the drug court program than were participants who did not receive a 
warrant within 30 days of program entry.[Footnote 48]

Further, in the Brooklyn Treatment Court, participants' compliance with 
drug court program procedures early in the program also contributed to 
participants' completing 90 days of drug treatment. Those participants 
who disappeared from contact, prompting the issuance of a police 
warrant, had lower chances of completing 90 days of treatment than 
those participants who did not. Additionally, those participants who 
attended at least 1 day of treatment within 30 days of entering the 
program also had greater chances of completing 90 days of treatment 
than those who did not attend at least 1 day of treatment within the 
first 30 days of entering the program.

Other aspects of compliance, such as treatment attendance during the 
entire program, appearance at status hearings, within-program arrests, 
and failure to appear, were generally but not consistently associated 
with completion. For example, the percentage of expected treatment 
sessions attended increased the likelihood of completion in five of 
seven drug court programs.[Footnote 49] On the other hand, in two of 
the four drug court programs in which they were measured, within- 
program arrests and failure to appear decreased the likelihood of 
completion but had no effect in the other two drug court 
programs.[Footnote 50] Alternatively, in both drug court programs 
(Multnomah and Clark Counties) in which the effects of within-program 
sanctions were assessed, an increase in the number of sanctions ordered 
led to a decrease in the likelihood of completion.

Effects of Drug Court Programs' Components on Program Completion Are 
Mixed:

In several drug court programs, the effects of various drug court 
program components were examined to determine the factors that predict 
program completion. Among the components that were examined were 
various consequences of program failure and the role of the judge and 
judicial status hearings. In a few drug court programs, efforts were 
made to examine the role of individual motivation to participate in 
drug court programs. In addition, evaluations of a few drug court 
programs examined the role of social factors in predicting program 
completion. Specifically, these evaluations assessed variables that 
measured individual's attachments to other individuals and social 
institutions.

Legal Consequences of Program Failure:

Several drug court program evaluations in our review assessed the 
effects of different sanctions, or legal consequences of failure, on 
program completion. For example, if a drug court program participant 
fails to complete the program, he or she may be sentenced to a 
predetermined incarceration alternative. The results of these 
evaluations were mixed and not directly comparable.[Footnote 51] For 
example, in the Brooklyn Treatment Court, participants with a more 
serious treatment mandate--that is, those participants that faced 
longer jail or incarceration terms if they failed to comply with 
program requirements--were more likely to complete the drug court 
program than those with a less serious treatment mandate. The 
predetermined jail sentences for Brooklyn participants who failed to 
complete the program ranged from 6 months to 4½ years, depending on the 
severity of the charge (felony or misdemeanor) and prior criminal 
history (whether it was a first felony offense or not).

Alternatively, in the drug court program in Suffolk County, the length 
of the incarceration sentence faced by those who failed to complete the 
drug court program did not contribute to program completion. The 
predetermined sentence (minimum length of the most common prison 
alternative) in Suffolk County ranged from 6 months to 1 year. The 
researchers who conducted the evaluation did not provide an explanation 
for these differing effects.[Footnote 52]

Drug Court Judge:

The judge has been described in the research as a key component of a 
drug court program. The presence of consistent judicial monitoring of 
participants is also described as a distinguishing component of drug 
court programs, compared with other court-based treatment programs, 
such as probation. Several evaluations in our review examined the 
effect of drug court judges on program completion. Each demonstrated 
that judges can play an important role in contributing to participants' 
program completion. However, the effect of the judge on program 
completion is difficult to distinguish from the requirement to attend 
judicial status hearings. For example, one evaluation of drug court 
program completion in Broward County attempted to assess the types of 
comments that judges made and the effect of these comments on program 
completion. Court monitoring comments made by judges that the 
researchers classified as supportive were found to contribute to 
program completion.[Footnote 53] On the other hand, in one evaluation 
of two drug court programs (Clark and Multnomah Counties), the number 
of appearances before the drug court judge was found to increase the 
likelihood of program completion.

A third evaluation (in New Castle County, Delaware) assessed the 
regularity of judicial status hearings on program completion. 
Participants were randomly assigned to one of two different forms of 
judicial status hearings: (1) biweekly hearings and (2) hearings on an 
as-needed basis, as determined by court officials. There were two main 
findings from this evaluation (that were also supported by the two 
replications of the experiment). First, there was no "direct" effect of 
the different status hearing schedules on program completion rates. 
Second, there was an interaction between client characteristics and 
program completion. Drug court program participants that either had 
prior treatment experiences or were diagnosed as having APD were more 
likely to complete the program when they were assigned to the regular 
biweekly status hearings as compared with when they were assigned to 
status hearings on an as-needed basis. Conversely participants who were 
not diagnosed as having APD or who had no prior treatment experiences 
were more likely to complete the program when they were assigned to 
status hearings on an as-needed basis, as compared with the biweekly 
condition.

The results from the New Castle County experiment show that the 
regularity of the schedule of status hearings can contribute to program 
completion for distinct subpopulations of drug court program 
participants and that there may not be a "one size fits all" approach 
to scheduling court appearances for all participants.

Participants Who Were Older and Had Less Criminal History than Other 
Participants Were Most Likely to Complete Programs:

The evaluations of several drug court programs examined some of the 
attributes of drug court participants and how those factors were 
related to program completion. Attributes such as prior substance abuse 
treatment, prior criminal history, type of drug used, demographic 
characteristics, and employment and education were assessed. Prior 
criminal history, whether measured by the number of arrests or 
convictions prior to program entry, and age, as older were generally 
likely to complete their drug court programs than were younger 
participants to complete the program, were related to program 
completion.

The other attributes were generally found not to be significant 
predictors of completion, although among various minorities of drug 
court programs in which they were assessed, they were significant 
predictors of completion. For example, prior substance abuse treatment 
was a significant predictor of completion in three of seven drug court 
programs, but it was not significant in the other four drug court 
programs. Similarly, other attributes such as type of drug use, race or 
ethnicity, gender, or employment or education level were not observed 
to consistently predict completion.

The evaluations that assessed participants' attributes were 
correlational--that is, they that examined the associations among these 
factors and the probability of program completion. Although not all of 
the evaluations included all of the same factors in their analyses, 
some general patterns about the correlates of program completion 
emerged. Attributes of drug court program participants that were 
associated with an increased likelihood of program completion include 
the following: (1) lower levels of prior criminal history; (2) 
substance use other than cocaine or heroin; (3) employment or school 
attendance at the time of program intake, along with higher levels of 
education; and (4) age, as older participants were more likely to 
complete the programs.[Footnote 54] One evaluation attempted to measure 
the effect of motivation and readiness for treatment on program 
completion. It found that those participants who were better able to 
recognize their problems, recognize external problems, and were ready 
for treatment, were more likely to complete the drug court program.

[End of section]

Appendix VIII: Evidence from Four Evaluations Indicates Drug Court 
Programs' Positive Net Benefits:

Four evaluations in our review included sufficient information about 
seven drug court programs' costs and benefits to estimate their net 
benefits--that is, benefits less costs.[Footnote 55] All but one of the 
evaluations found that drug court programs were more expensive than 
conventional case processing. The costs to operate drug court programs 
above the costs of providing conventional case processing services 
ranged from about $750 to about $8,500 per participant. However, taking 
into account the drug court programs' benefits, especially the reduced 
costs of crime associated with reductions in recidivism, all four 
evaluations we reviewed reported net benefits ranging from about $1,000 
per participant to about $15,000, mostly because of reduced 
victimization. Additionally, these benefits may underestimate drug 
court programs' true benefits because the evaluations did not include 
indirect benefits (such as reduced medical costs of treated 
participants).

Most Evaluations Found Drug Court Programs More Expensive than 
Conventional Case Processing:

All but one of the evaluations we reviewed found drug court programs 
more expensive than conventional case processing. A combination of 
judicial supervision, monitoring, and treatment services that drug 
court programs typically provide to their participants--services in 
addition to those provided to offenders who are processed with 
conventional procedures receive--result in additional expense to 
criminal justice agencies. Table 13 shows the net costs of drug court 
programs--costs above normal court costs--including supervision, 
monitoring, and treatment, ranging from somewhat less than $800 to 
about $8,700 per participant.

Table 13: Reported Costs per Drug Court Program Participant in Four 
Evaluations:

Drug court program: D.C. Superior Court Drug Intervention Program; 
Treatment docket; 
Costs above normal costs: $8,708.
Sanctions docket; 
Costs above normal costs: $3,248.

Drug court program: Washington State Drug Court Program; 
Costs above normal costs: $3,892.

Drug court program: Breaking the Cycle Program[A]; 
Tacoma, Wash; 
Costs above normal costs: $1,461.
Jacksonville, Fla; 
Costs above normal costs: $1,133.
Birmingham, Ala; 
Costs above normal costs: $767.

Drug court program: Multnomah County (Ore.) STOP Program; 
Costs above normal costs: ($1,442).

Source: Drug court program evaluations.

[A] According to the principal researcher of the evaluation, the 
Breaking the Cycle program is technically not considered to be a drug 
court program. However, we included the program in our review because 
it incorporates several of the basic drug court program components, 
such as drug testing and access to treatment services.

[End of table]

The Multnomah County drug court program cost about $1,400 less than 
normal court procedures. Rather than relying on administrative records 
and budgets, the program's evaluation used a methodology that closely 
followed participants through treatment and court adjudication. It 
calculated the amount of time that each drug court participant and 
comparison group participant spent in different activities, such as 
treatment and court hearings. The evaluation found that the judge spent 
less time with offenders in the drug court program than in normal court 
processing and that this led to the estimated decreased costs.

Drug Court Programs' Net Benefits Derived from Reductions in Recidivism:

The monetary benefits of reduced recidivism can be placed in two 
categories: (1) reduced future expenditure by criminal justice agencies 
and (2) reduced future victimization. Any arrest is a cost to a number 
of criminal justice agencies, including police, prosecutors, courts, 
corrections departments, and probation agencies. Reducing arrests by 
reducing recidivism would benefit these agencies.[Footnote 56] The 
justice system's benefits in the seven drug court programs we reviewed 
ranged from none to about $3,800 per participant. Some of the range is 
due to methodological differences among the evaluations, but some may 
be due to differences among the communities served by the courts. A 
reduction in recidivism also benefits people who might otherwise be 
victimized. The costs to potential victims of crime that are thus 
avoided include direct monetary costs, such as the value of property 
that is not stolen and expenses for health care that are not incurred, 
and quality-of-life costs, such as costs for pain and suffering that 
are not experienced. Benefits to potential victims reported in the 
evaluations we reviewed ranged from about $500 to $24,000 per 
participant.

The evaluations we reviewed monetized the benefits from averted crime 
inconsistently, but the differences in method do not explain the range 
of benefits. For example, excluding the cost of pain and suffering from 
victimizations that do not occur underestimates the true cost of crime. 
However, the two evaluations that did not include these costs--D.C. 
Superior Court and Breaking the Cycle--found the highest and lowest per 
participant dollar values of reduced recidivism, at $24,000 and $500, 
respectively.

All Seven Drug Court Programs Reported Positive Net Benefits:

Although six of the seven drug court programs were more costly than 
conventional case processing, the monetary value of the benefits from 
reduced recidivism--to the justice system and potential victims--was 
greater than the costs, producing positive net benefits in all seven 
programs. The net benefits of the seven drug court programs we reviewed 
ranged from about $1,000 to about $15,000 per participant. Table 14 
presents benefits to the justice system and to potential victims, the 
net costs of the programs (costs of the drug programs above 
conventional case processing), and net benefits, or benefits minus net 
costs.

Table 14: Net Benefits per Participant in Seven Drug Court Programs:

Drug court program: D.C. Superior Court Drug Intervention Program.
Treatment docket[A]; 
Benefits: Avoided potential victim: $24,030[B]; 
Costs (net drug court program costs): $8,708; 
Net benefits (benefits less costs): Justice system plus avoided 
potential victims: $15,322.

Drug court program: D.C. Superior Court Drug Intervention Program.
Sanctions docket; 
Benefits: Justice system: $19[C]; 
Benefits: Avoided potential victim: $6,203[B]; 
Costs (net drug court program costs): $3,248; 
Net benefits (benefits less costs): Justice system: ($3,230); 
Net benefits (benefits less costs): Justice system plus avoided 
potential victims: $2,973.

Drug court program: Breaking the Cycle Program.
Tacoma, Wash; 
Benefits: Justice system: $394[C]; 
Benefits: Avoided potential victim: $7,324[B]; 
Costs (net drug court program costs): $1,461; 
Net benefits (benefits less costs): Justice system: ($1,067); 
Net benefits (benefits less costs): Justice system plus avoided 
potential victims: $6,257.
Jacksonville, Fla; 
Benefits: Justice system: 0[C]; 
Benefits: Avoided potential victim: $2,900[B]; 
Costs (net drug court program costs): $1,133; 
Net benefits (benefits less costs): Justice system: ($1,133); 
Net benefits (benefits less costs): Justice system plus avoided 
potential victims: $1,767.
Birmingham, Ala; 
Benefits: Justice system: $1,320[C]; 
Benefits: Avoided potential victim: $479[B]; 
Costs (net drug court program costs): $767; 
Net benefits (benefits less costs): Justice system: $553; 
Net benefits (benefits less costs): Justice system plus avoided 
potential victims: $1,032.

Drug court program: Multnomah County (Ore.) STOP Program; 
Benefits: Justice system: $2,329; 
Benefits: Avoided potential victim: $1,301; 
Costs (net drug court program costs): ($1,442); 
Net benefits (benefits less costs): Justice system: $3,771; 
Net benefits (benefits less costs): Justice system plus avoided 
potential victims: $5,072.

Drug court program: Washington State Drug Court Program; 
Benefits: Justice system: $3,759; 
Benefits: Avoided potential victim: $3,020; 
Costs (net drug court program costs): $3,891; 
Net benefits (benefits less costs): Justice system: ($132); 
Net benefits (benefits less costs): Justice system plus avoided 
potential victims: $2,888.

Source: GAO analysis of drug court program evaluations' reported costs 
and benefits.

[A] The D.C. Superior Court Drug Intervention Program evaluation did 
not draw conclusions about the net benefits of the treatment docket 
because of inconsistencies between self-reported crime and official 
arrest records.

[B] Benefits to potential victims were derived from survey data and do 
not include the cost of pain and suffering.

[C] Benefits to the justice system were determined by official records 
of arrest.

[End of table]

However, as shown in the last two columns of table 14, the financial 
cost savings due to reductions in recidivism for the criminal justice 
agencies were not always positive. Positive financial cost savings for 
the criminal justice agencies were indicated for only two programs-- 
Breaking the Cycle Program in Birmingham and the drug court program in 
Multnomah County.

Net Benefits May Underestimate the Programs' True Benefits:

None of the evaluations included indirect, or secondary, benefits to 
society derived from a reduction in participants' substance abuse. 
Indirect benefits might include costs avoided because treated drug 
addicts did not use medical services that would otherwise have been 
required. After successful drug treatment, such individuals might have 
fewer periods of unemployment and might be more productive, earning 
higher wages. To the extent that they pay higher taxes as a result, 
these are benefits to taxpaying members of society. While these 
benefits are difficult to quantify in assessing a drug court program, 
their absence suggests that reported net benefits are understated.

[End of section]

Appendix IX: GAO Contacts and Staff Acknowledgments:

GAO Contacts:

Laurie E. Ekstrand, (202) 512-8777; 
William J. Sabol, (202) 512-3464:

Acknowledgments:

In addition to those named above, Mary Catherine Hult, David P. 
Alexander, Michele C. Fejfar, Benjamin A. Bolitzer, Harold J. Brumm, 
Jr., Wayne A. Ekblad, Ann H. Finley, Ronald La Due Lake, Jean L. 
McSween, Albert Schmidt, Barry J. Seltser, Douglas M. Sloane, Shana B. 
Wallace, and Kathryn G. Young made key contributions to this report.

[End of section]

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FOOTNOTES

[1] Pub. L. No. 107-273, 116 Stat. 1758, 1795 (2002).

[2] Pub. L. No. 103-322. 

[3] We use the term recidivism to refer generally to the act of 
committing new criminal offenses after having been arrested or 
convicted of a crime.

[4] Pub. L. No. 107-273, 116 Stat. 1758, 1799 (2002).

[5] The totals of adult drug court programs include tribal drug court 
programs, but exclude family drug court programs.

[6] Criteria for legal eligibility can include the current offense, 
criminal justice histories, or supervision status (that is, whether the 
defendant is currently on probation). Criteria related to substance use 
can include frequency and type of current substance use, prior 
treatment experiences, or motivation to seek substance abuse treatment.

[7] GAO, Drug Courts: Overview of Growth, Characteristics, and Results, 
GAO/GGD-97-106 (Washington, D.C.: July 31, 1997).

[8] Belenko, S. Research on Drug Courts: A Critical Review 2001 Update. 
The National Center on Addiction and Substance Abuse at Columbia 
University, June 2001, p. 1. In his review, Belenko states that the 
reported program completion rates are consistent with findings in other 
studies.

[9] Wilson, D.B., O. Mitchell, and D.L. MacKenzie, A Systematic Review 
of Drug Court Effects on Recidivism, (forthcoming), p. 20.

[10] We use within-program to refer to the period of time that all 
individuals who are enrolled are expected to be participating in the 
drug court program.

[11] Pub. L. No. 107-273, 116 Stat. 1758, 1799 (2002). 

[12] We searched the ERIC, Biosis Previews, Social Scisearch, National 
Criminal Justice Reference Service, Dissertation Abstracts Online, Gale 
Group Magazine Database, Wilson Social Science Abstracts, Gale Group 
Trade & Industry Database, Gale Group Health & Wellness Database, Gale 
Group Legal Resources Index, and Periodicals Abstracts PlusText. 

[13] GAO, Drug Courts: Information on a New Approach to Address Drug- 
Related Crime, GAO/GGD-95-159BR (Washington, D.C.: May 22, 1995); 
GAO, Drug Courts: Overview of Growth, Characteristics, and Results, 
GAO/GGD-97-106 (Washington, D.C.: July 31, 1997); 
and GAO, Drug Courts: Better DOJ Data Collection and Evaluation Efforts 
Needed to Measure Impact of Drug Court Programs, GAO-02-434 
(Washington, D.C.: April 18, 2002).

[14] In our last report that assessed the published research, GAO/GGD-
97-106, we completed our review in May 1997.

[15] Over time, participants in an evaluation can drop out for various 
reasons. Acceptable levels of attrition can vary depending on other 
characteristics of the evaluation design, such as the sample size, the 
time frames covered, and statistical methods used.

[16] Social science research standards are discussed in the scientific 
literature. For example, see Campbell, Donald T., and Julian Stanley, 
Experimental and Quasi-Experimental Designs for Research (Chicago: Rand 
McNally, 1963); 
Cook, Thomas D., and Donald T. Campbell, Quasi- experimentation: Design 
and Analysis Issues for Field Settings (Boston: Houghton Mifflin, 
1990); 
and GAO, Designing Evaluations, GAO/PEMD- 10.1.4 (Washington, D.C.: May 
1991).

[17] In contrast to experimental control groups, where participants are 
deliberately randomly assigned to either treatment or control groups 
for purposes of comparison, the comparison groups in quasi-experimental 
groups are constructed from relatively comparable existing groups not 
receiving treatment. Quasi-experimental methods are often used to 
assess effects in the natural setting, where a true experiment may not 
be feasible.

[18] We use conventional case processing in this report to refer to the 
general set of criminal justice procedures that comparison group 
members receive.

[19] See, for example, Heckman, James, Hidehiko Ichimura, and Petra 
Todd (1997). "Matching as an Econometric Evaluation Estimator: Evidence 
from a Job Training Programme," Review of Economic Studies, Vol. 64, 
No. 4, pp. 605-654.

[20] Generally, a cost is the value of resources used to achieve a 
benefit. Economic costs consider the opportunity cost, which is the 
value of the resources in their best alternative use. The costs to and 
the benefits that accrue to all members of society, rather than just to 
its taxpaying members, should be included in the analysis. For example, 
benefits from a decrease in crime, such as reduced victimization, 
accrue to all members of society, regardless of whether they are 
taxpayers, and should be included.

[21] In an assessment of the costs associated with the salaries of 
criminal justice personnel, costs that are directly attributable to the 
drug court program (such as the salary of a full-time drug court judge) 
should be included. Costs that are incurred jointly by the program and 
other activities (such as costs for probation officers with shared 
caseloads) should be allocated among the program and the activities, 
according to some generally accepted accounting principles or 
standards. Finally, costs that would be incurred in the absence of the 
program (such as costs for nondedicated police personnel) should be 
excluded from the analysis.

[22] Average costs are calculated by dividing the budget totals by the 
number of drug court program cases in a given year and by the number of 
baseline, or nondrug, cases in the same year.

[23] This is called the transaction cost approach. For more information 
about this methodology, see Carey, S. M., and M. W. Finigan, A Detailed 
Cost Analysis in a Mature Drug Court Setting: A Cost-Benefit Evaluation 
of the Multnomah County Drug Court, (Portland, Ore.: NPC Research, July 
2003).

[24] The present value of estimated costs and benefits should be 
calculated. Researchers should identify the follow-up period in which 
the benefits would accrue. The value of future benefits should be 
discounted by an appropriate interest rate, to account for the fact 
that these benefits are deferred.

[25] These benefits may be difficult to quantify, but earnings and 
employment data could be estimated through surveys of participants or 
could be obtained from state unemployment insurance agencies.

[26] A commonly cited reference is Miller, T. R., M. A. Cohen, and B. 
Wiersema, Victim Costs and Consequences: A New Look (Washington, D.C.: 
National Institute of Justice, Office of Justice Programs, Department 
of Justice, January 1996).

[27] A sensitivity analysis does not, however, provide information 
about the range and distribution of the possible values of a given 
outcome. Additional analysis can allow a researcher to determine the 
likely range of an estimated outcome. In essence, additional analysis 
can provide an upper and a lower bound of an estimate, giving an 
indication of how much uncertainty there is in the outcome. For 
example, researchers may estimate how much time a judge spends on a 
drug court program participant's case, and the estimate may be high or 
low. The range of possible values of time spent by a judge can be 
defined, which can help in assessing how reliable the costs associated 
with a judge's time are in an analysis.

[28] Breaking the Cycle, D.C. Superior Court, Multnomah County, and 
Washington State evaluations considered adjudication and sanctions 
cost. Douglas County did not include sanctions costs, while Maricopa 
County did include confinement and supervision costs. The Los Angeles 
and Kentucky drug court program evaluations did not include 
adjudication or sanction costs.

[29] Section 2953 of Title II defines "violent offender" to mean a 
person who "(1) is charged with or convicted of an offense, during the 
course of which offense or conduct (A) the person carried, possessed, 
or used a firearm or dangerous weapon; 
(B) there occurred the death of or serious bodily injury to any person; 
or (C) there occurred the use of force against the person of another, 
without regard to whether any of the circumstances described in 
subparagraph (A) or (B) is an element of the offense or conduct of 
which or for which the person is charged or convicted; 
or (2) has one or more prior convictions for a felony crime of violence 
involving the use or attempted use of force against a person with the 
intent to cause death or serious bodily harm."

[30] The evaluations used different measures to report drug use, such 
as "primary drug of choice," "used in the past 30 days," or "used in 
the 90 days before program entry." Participants may indicate using more 
than one substance. 

[31] Most evaluations we reviewed reported average age. However, some 
reported median age, which ranged from 23 to 34 years.

[32] The 82 percent employed occurred in the Las Cruces Municipal DWI 
Court, the only DWI court included in our review.

[33] Most evaluations reported some information on criminal justice 
system involvement. However, the measures and types of information 
reported varied. For example, some evaluations reported arrests, others 
convictions; 
some reported the average number of prior events--either arrest or 
conviction--while others reported the percent of participants with at 
least one event.

[34] We use within-program to refer to the period of time that all 
individuals who are enrolled are expected to be participating in the 
drug court program.

[35] Appendix II presents details on the research designs and 
comparison groups used in the evaluations we reviewed.

[36] The evaluations we reviewed provided comparative arrest data for 
drug court program participants and comparison group members for 13 
drug court programs. In 1 drug court program--the D.C. Superior Court-
-data were available for two dockets, or types of drug court program 
interventions, to which defendants were assigned.

[37] Rearrests, as well as reconvictions, do not measure all re- 
offending, as every offense or violation does not lead to an arrest.

[38] The evaluations we reviewed measured reconviction rates during 
periods of up to 3 years after entry into either the drug court program 
or the comparison group.

[39] The evaluation notes that recidivism analysis does not test the 
effect of a strong treatment program because the treatment docket 
experienced substantial operational problems, including closure because 
of building structural problems and financial problems that precluded 
certain types of services from being delivered.

[40] We generally use the term post-program to refer to some period of 
time after drug court participants and comparison group members 
completed their respective programs. However, for some drug court 
programs, the evaluations measured recidivism for a period after 
participants left the program. These represent explicit post-program 
periods. Post-program recidivism outcomes were generally observed for 
no longer than 1 year. Hence, it is not possible to determine whether 
the differences in recidivism observed between drug court program 
participants and comparison groups would persist.

[41] Some other evaluations we reviewed provided descriptive data on 
drug court program participants' substance use while they were engaged 
in the drug court program, but these evaluations did not assess 
substance use relapse as an outcome by comparing the outcomes of 
participants against those of a comparison group.

[42] According to researchers, collecting these data can be expensive. 
Also, given likely differences between those who might volunteer and 
those who would decline, the collected data might have limited value.

[43] Preliminary data from replication experiments confirmed the 
results of the original experiment, in that the researchers found 
evidence of the interaction between the mental health status of 
participants and biweekly status hearings. 

[44] For more information, please see GAO, Drug Use Measurement: 
Strengths, Limitations, and Recommendations for Improvement, GAO/PEMD- 
93-18 (Washington, D.C.: June 25, 1993).

[45] Completion rates represent the individuals who completed or were 
favorably discharged from a drug court program as a percentage of the 
total number admitted and not still enrolled.

[46] The evaluation classified the percent of positive drug test 
results into four categories: (1) zero positive test results; (2) 
"low," where the percentage of test results that were positive ranged 
from 1 to 8 percent of drug tests; (3) "moderate," where the percentage 
of test results that were positive ranged from 9 to 28 percent of drug 
tests; and (4) "high," where the percentage of test results that were 
positive ranged from 29 to 100 percent.

[47] The drug court programs were in the Bronx, Brooklyn, Queens, 
Suffolk County, and Syracuse.

[48] As defined in the evaluation of these drug court programs, a judge 
issues a bench warrant when a defendant fails to make a scheduled court 
appearance. Bench warrants can also be issued if defendants fail to 
appear for scheduled appointments with case managers or treatment 
representatives.

[49] The five in which treatment attendance increased the chances of 
completion were (1) Bakersfield, (2) Clark County, (3) Creek County, 
(4) St. Mary's Parish, and (5) Multnomah, while the two in which it did 
not affect completion were Jackson County and Broward County.

[50] In the Bakersfield and Jackson County drug court programs, these 
effects were observed, but in the Creek County and St. Mary's Parish 
drug court programs, the effects were not observed.

[51] A number of variables are used to indicate the amount of legal 
coercion facing participants. These include the type and severity of 
charge leading participants to enter the drug court program, the length 
of the incarceration time participants face if they fail the drug court 
program (only in Suffolk), jail or prison alternatives (not used in 
Bronx, Suffolk, and Syracuse), the "treatment mandate," which is used 
in one program (Brooklyn) as a proxy for jail or prison alternative 
because there is a fairly uniform sentencing approach based on the 
treatment mandate.

[52] Rempel, M., and others, The New York State Adult Drug Court 
Evaluation: Policies, Participants, and Impacts. New York: Center for 
Court Innovation, 2003, p. 100.

[53] Senjo, S. R., and L. A. Leip. "Testing and Developing Theory in 
Drug Court: A Four-Part Logit Model to Predict Program Completion," 
Criminal Justice Policy Review, vol. 12, no. 1, 2001, p. 82.

[54] However, not all of these factors consistently predicted program 
completion in all drug court programs in which they were examined. 

[55] Appendix III provides more information about our review of drug 
court program evaluations that presented cost data and the criteria we 
used to assess them.

[56] A reduction in arrests would result in a benefit to the taxpaying 
members of society, since taxpayers fund the criminal justice agencies.

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