Magazine article Addiction Professional

Mandated Clients Finding Their Way

Magazine article Addiction Professional

Mandated Clients Finding Their Way

Article excerpt

Evidence indicates promising results for clients court-ordered to treatment

Research, and the experience of justice and treatment professionals nationwide, is calling into question the notion that an individual with an addiction has to want help to benefit from it. Analyses of clients who are mandated into treatment through the order of a court or other justice official are demonstrating that some people can be prodded on the path to change and see good results.

One particularly telling study looked at 2,095 men undergoing treatment for substance use disorders at one of 15 inpatient programs operated by the Department of Veterans Affairs (VA). The majority of the study sample consisted of individuals who had entered treatment voluntarily and had no prior criminal justice involvement. But 7% of the subjects were on probation or parole and were mandated to participate in treatment, while 11% were justice-involved but still participating in treatment voluntarily. A group of researchers found that the mandated group did as well as the others during treatment, and at one-year follow-up actually reported better rates of abstinence and avoidance of substance-related consequences in their lives.

"One of the National Institute on Drug Abuse's principles of effective treatment is that treatment doesn't have to be voluntary to be effective," lead researcher John F. Kelly, PhD, associate director of addiction research at Massachusetts General Hospital, said in an interview with Addiction Professional. "These outcomes are very promising. The arrest rates for mandated clients went and stayed down after treatment, and employment was up."

Severity doesn't explain outcomes

The research group, encompassing Kelly, John W Finney, PhD, and Rudolf Moos, PhD, found that successful results for the mandated group held up even after controlling for other factors that could have explained the change this group experienced. The researchers controlled for a less severe clinical profile for the mandated group at treatment intake, as those individuals reported the lowest level of negative consequences from alcohol and drug consumption and the fewest symptoms of depression and anxiety.

"The mandated group was a little better off, so we might have anticipated a better prognosis," Kelly says. "We wondered whether the outcomes could be explained by a better profile, but when we controlled for those variables, we still found that they responded as well to treatment. …

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