Criminal justice referral and incentives in outpatient substance abuse treatment

Abstract

A substantial number of substance abusers entering outpatient psychosocial counseling treatment are referred from the criminal justice (CJ) system. This secondary analysis of previously published findings from a large (N=415) multi-site trial of a prize-based abstinence incentive intervention (Petry et al., 2005) examined the influence of CJ referral on usual care outcomes and response to the incentive procedure. CJ referrals (n=138) were more likely than those not CJ referred (n=277) to provide stimulant negative urine samples whether missing samples were counted as positive (50 versus 41%, p=.016) or as missing (96 versus 91%, p<.001). A significant interaction term was found only for percentage of treatment completers (p=.027). However, on that retention variable, and three additional drug use measures, significant incentive effects were confined to participants who entered treatment without referral from the criminal justice system. The study suggests that abstinence incentives should be offered as a first priority to stimulant users entering treatment without criminal justice referral. However, incentives can be considered for use with CJ-referred stimulant users based on the observation that best outcomes were obtained in CJ referrals who also received the abstinence incentive program.

Fig. 1

Percent of participants retained in the study. Each line represents one of the four study subgroups. Retention is shown as a function of urine samples collected twice weekly during the 12-week intervention.

Fig. 2

Percentage of stimulant negative urines submitted during twice weekly urine collections as a function of usual care versus abstinence incentive treatment group. Data are shown separately for CJ referred (top panel) and CJ not referred (bottom panel) participants. Missing samples were treated as positive in this figure.