Criminal Justice Policy Review

http://cjp.sagepub.com Recidivism Among Drug Offenders Following Exposure to Treatment

John R. Hepburn Criminal Justice Policy Review 2005; 16; 237 DOI: 10.1177/0887403404270604 The online version of this article can be found at: http://cjp.sagepub.com/cgi/content/abstract/16/2/237

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Department of Criminology at Indiana University of Pennsylvania

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Hepburn 10.1177/0887403404270604 / RECIDIVISM AMONG CRIMINAL DRUGJUSTICE OFFENDERS POLICY REVIEW / June 2005

Recidivism Among Drug Offenders Following Exposure to Treatment

John R. Hepburn
Arizona State University

The contemporary debate about punishment versus treatment for drug-using criminal offenders often revolves around the pragmatic issue of the extent to which treatment is more effective than punishment at reducing the probability of subsequent criminal behavior. Although there is growing evidence that treatment works, it is equally apparent that the effects of exposure to treatment vary by offender characteristics, offense characteristics, and the degree of program involvement. Using data on 3,328 drug-using offenders eligible for diversion from prosecution to a community treatment program, multivariate survival models indicate significant differences in the time of rearrest during a 5-year follow-up period, suggesting that the act of entering treatment is a signal of the offenders readiness for treatment and that the time to rearrest is affected by exposure to treatment. The findings are discussed in terms of current efforts to use the threat of legal sanction to motivate criminal offenders into drug treatment. Keywords: drug offenders; treatment; recidivism

Two broad strategies characterize recent efforts to use legal sanctions to reduce recidivism among drug offenders. One strategy is simply to impose a legal sanction as a means of deterring the offender from future offenses. In its simplest form, the doctrine of specific deterrence assumes that a rational person, having already been punished for past criminal behavior and wanting to avoid future pains of punishment, will choose not to commit future criminal behaviors. There is, however, little empirical support in the literaAUTHORS NOTE: This research was supported by a grant from the U.S. Department of Justice, National Institute of Justice, 94-IJ-CX-0028. Important contributions have been made by Scott Rodgers (Maricopa County Attorneys Office) and Wayne Johnston (University of Texas, Permian Basin), both of whom provided assistance in the automation of data, and by Celesta Albonetti (University of Iowa), who assisted with the analysis and interpretation of the data. The observations and interpretations reported herein are those of the author and do not necessarily represent those of the U.S. Department of Justice.
Criminal Justice Policy Review, Volume 16, Number 2, June 2005 237-259 DOI: 10.1177/0887403404270604 2005 Sage Publications

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ture to suggest that legal sanctions (in the absence of treatment) affect recidivism, especially among drug-using offenders (Caulkins, Rydell, Schwabe, & Chiesa, 1997; Speckart, Anglin, & Deschenes, 1989). The second strategy is to use the threat of legal sanction as a means to coerce drug-using offenders into drug treatment programs (Belenko, 1990; Belenko, Fagan, & Dumanovsky, 1994; Skolnick, 1997). Pretrial prosecutorial diversion programs, drug courts, and other alternatives-to-sanctions programs that have emerged in the past 20 years rely on the threat of legal sanctions to motivate offenders to enter and complete drug treatment programs. In such cases, legal sanction is a threat used to coerce compliance with treatment, with the expectation that exposure to treatment will lessen the likelihood of recidivism. This analysis of a prosecutorial diversion program examines the effectiveness of exposure to treatment on recidivism. It begins by noting the ability of the threat of prosecution to motivate persons charged with a felony drug offense to enter and complete a community-based outpatient drug treatment program, and then, it uses survival models to answer the following question: Does this exposure to treatment affect the likelihood of rearrest?

COMMUNITY-BASED DRUG TREATMENT

Community-based treatment programs can be effective. Significant treatment effects have been observed in such encompassing studies as the Treatment Outcome Prospective Study (TOPS), which looked at the 5-year outcomes for more than 11,000 persons admitted to 1 of 41 treatment programs located in 10 cities (Harwood, Collins, Hubbard, Marsden, & Rachal, 1988; Hubbard et al., 1989); the Drug Abuse Reporting Program (DARP), which examined outcomes among more than 44,000 persons 3 to 12 years after they were admitted to 1 of 53 federally funded treatment programs from 1969 to 1973 (Simpson, 1993; Simpson & Sells, 1982); and the Drug Abuse Treatment Outcome Study, which included nearly 10,000 persons treated in 1991 through 1993 at 1 of 99 programs located in 11 cities (Hubbard, Craddock, Flynn, Anderson, & Etheridge, 1997; Leshner, 1997; Simpson, Joe, & Brown, 1997). In these and other analyses (Benedict, Huff-Corzine, & Corzine, 1998; Inciardi & Martin, 1993; Lipton, 1995; Prendergast, Podus, & McCormack, 1998), exposure to treatment appears to significantly reduce subsequent drug use and criminal behavior. According to the Institute of Medicine (1996), community-based treatment programs are both effective and cost-effective in reducing not only

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drug consumption but also the associated health and social consequences (p. 192). D. Anglin and Hser (1990b) suggest that the benefits of successful treatment can be grouped into three categories: (a) reduced costs to the drug user (e.g., medical expenses and lost earnings), (b) reduced costs to third parties (e.g., to the usersfamilies and to victims of property crimes), and (c) reduced costs to taxpayers (e.g., welfare payments to families and the costs of court processing and correctional supervision). Among the findings of the TOPS, for example, is the conclusion that treatment resulted in a 30% decline in costs to victims of drug-related crimes and a nearly 25% decrease in costs to the criminal justice system (Harwood et al., 1988). Similarly, Tabbush (1986) calculated that for every $1 spent on publicly funded programs in California, more than $11 was saved in the costs of arrest and prosecutions, losses resulting from property crimes, and medical expenses for drug addiction. Gerstein et al. (1994) conclude from their analysis of California drug and alcohol treatment programs that each dollar spent on treatment saved $7 in crime and health care costs. More recently, French et al. (2000) report that each dollar spent on outpatient treatment in the state of Washington produced, on average, $9.80 in net benefits to the community. Successful outcomes, however, are predicated on the clients retention in the program (D. Anglin & Hser, 1990a; Gerstein & Harwood, 1990; Gerstein et al., 1994; Inciardi & Martin, 1993). Many of those who enter treatment voluntarily, such as those who are self-referrals or who enter treatment at the encouragement of the family or employers, fail to complete treatment (Prendergast et al., 1998). In fact, Boyum and Kleiman (2002) report that nearly half of all persons who enter community treatment programs drop out prior to completion. Program entry and retention are so problematic among drug users that recent efforts have tried to identify the factors that predict entry (Boyle, Polinsky, & Hser, 2000; Carroll & Rousaville, 1992; Hser, Maglione, Polinsky, & Anglin, 1998) and longterm retention (M. Anglin, Brecht, & Maddahian, 1989; Shearer, Myers, & Ogan, 2001). In addition to select sociodemographic characteristics and drug use histories, attention focuses on the clients readiness for treatment (DeLeon & Jainchill, 1986; Sia, Dansereau, & Czuchry, 2000) as a key factor in predicting program entry and retention.

Legal Coercion To Treatment

For drug-using criminal offenders, the threat of legal sanction often is used to motivate participation in drug treatment programs. By some accounts, criminal justice referrals account for at least half of all persons

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participating in publicly funded community-based drug treatment programs (D. Anglin, Prendergast, & Farabee, 1998). In their analysis, for instance, Hiller, Knight, Broome, and Simpson (1998) report that nearly two thirds of a national sample of clients admitted to community-based treatment programs were under some form of legal coercion to receive treatment. Furthermore, it is apparent that many offenders who enter treatment programs are motivated by the threat of legal sanction rather than by a belief that they want and need treatment. Compared to voluntary admissions, those legally coerced into treatment are less likely to believe they need treatment, have less desire for treatment, have a lower readiness for treatment, and are less willing to actively participate in their treatment (Farabee, Nelson, & Spence, 1994; Sia et al., 2000). These and other differences support the belief that many offenders would not otherwise receive treatment were it not coerced by the threat of legal sanction (Boyle et al., 2000; Czuchry & Dansereau, 2000; Farabee, Prendergast, & Anglin, 1998; Hser et al., 1998). Legal coercion may be a strong motivation to treatment, but it is not enough to assure success. In the absence of a willingness to seek treatment, many of those legally coerced to treatment fail to enter treatment, fail to complete treatment, and relapse during treatment (D. Anglin, Longshore, & Turner, 1999; Maxwell, 2000; Prendergast, Anglin, & Wellisch, 1995; Prendergast et al., 1998). But then, success is elusive among self-referrals too. Because the goal of legal coercion is to provide a level of motivation where none exists, proponents suggest that legal coercion is successful if it can provide a level of motivation that places offenders on an even plane with self-referrals (Lurigio, 2000). In their review of the 44,000 drug abusers in the DARP, for example, Simpson and Friend (1988) report no difference in treatment retention between voluntary admissions and legal referrals. Hiller et al. (1998; Knight, Hiller, Broome, & Simpson, 2000) report that among a national sample of admissions, clients under the threat of legal sanction stayed in treatment longer than those without high legal pressure to participate. A similar result is reported by D. Anglin et al. (1998), whose review of 11 studies concluded that coerced drug-using offenders began treatment sooner and remained in treatment longer than those who entered voluntarily.

Legal Coercion, Exposure to Treatment, and Successful Outcomes

Although it seems clear that the threat of legal sanction can affect the offenders program entry and retention, the impact of treatment on coerced

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offenders is less evident. Because retention in treatment has been found consistently to predict successful outcomes (D. Anglin & Hser, 1990a; DeLeon, 1988; Gerstein & Harwood, 1990; Inciardi & Martin, 1993), it follows that exposure to treatment, whether coerced or voluntary, can achieve successful outcomes among most offender populations (Banks & Gottfredson, 2003; Miller & Flaherty, 2000). Moreover, although it is evident that drug users do not need to complete the entire program of treatment to achieve some measure of successful outcomes, it appears that there is a as-yet-unspecified minimum length of time in treatment that is essential to achieve any program effects (Satel, 1999; Simpson et al., 1997). If so, then the value of the legal threat of sanctions rests on its ability to coerce offenders to stay in treatment long enough to receive some of the treatment benefits (D. Anglin, 1988; DeLeon & Jainchill, 1986; Inciardi & Martin, 1993). Although few in number, recent studies report that coerced treatment produces desired attitudinal and behavioral changes. Schmidt and Weisner (1993) report an improved psychosocial status and a reduction in recidivism among offenders coerced into alcohol treatment, and Brecht, Anglin, and Wang (1993) report no difference in recidivism between those offenders coerced into treatment and those offenders who voluntarily entered treatment. After surveying the research to date, Miller and Flaherty (2000) conclude that coerced treatment can increase employment and decrease recidivism among offenders. Although there is growing evidence that treatment works, it is equally apparent that the effects of coerced exposure to treatment vary by offender characteristics and offense characteristics. Age, ethnicity, gender, education, employment status, type of drug use, prior record of arrests or convictions, and prior history of treatment have been found to be associated with both program completion and postprogram recidivism (Benedict et al., 1998; Boyle et al., 2000; Hepburn & Albonetti, 1994; Visher & Linster, 1990). Among offenders coerced into treatment, the period of retention in treatment is shorter among those who are younger, non-White, and male; those with a prior record of arrests or treatments; and those with a longer and more serious history of drug use. Among those who complete drug treatment programs, successful outcomes are less likely among those who, not coincidentally, also are younger, non-White, and male; those with a prior record of arrests or treatments; and those with a longer and more serious history of drug use. In summary, although the threat of legal sanction is expected to motivate criminal offenders into treatment, not all offenders enter and complete the prescribed treatment program. This creates the possibility of three groups

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of offenders who have been referred to treatment under the threat of legal sanction: (a) those who fail to enter the treatment program, (b) those who enter the program but fail to complete the treatment program, and (c) those who enter and successfully complete the treatment program. The presence of these three groupings creates differences in exposure to treatment, permitting us to ask the question, When relevant sociodemographic characteristics of the offenders are controlled, does differential exposure to treatment affect the likelihood and the time of rearrest? If so, then we would expect to find different levels of recidivism among similarly situated offenders based on the degree of their exposure to treatment.

METHOD
The Office of the County Attorney in Maricopa County (Phoenix), Arizona, permits those persons charged with drug offenses who meet the criteria of eligibility to be diverted from prosecution to a community-based outpatient treatment program. Qualifications for diversion vary somewhat by the nature of the drug possessed, but the intent is to offer diversion to only casual users with no prior criminal history. In general, eligibility for diversion is limited to those offenders who (a) have no prior felony conviction for any drug offense, (b) have no prior misdemeanor conviction for any drug offense within the past year, (c) have no other felony charges pending, and (d) have not previously been diverted to treatment. Although the diverted offender must pay a fee and the costs of treatment, ability to pay is not a criterion of eligibility. Those charged with drug offenses who are ineligible for diversion and virtually all the eligible offenders who do not enter the treatment program or who fail to complete the treatment program are prosecuted. The treatment program is designed to reduce subsequent drug use. Its four drug-specific programs vary in duration, objectives, and methods on the basis of the type and severity of the offenders drug use, but each program involves some combination of random drug testing and an educational seminar. All except the program for marijuana possession involve some combination of individual or group counseling. Program participants must attend all required seminars, lectures, and counseling sessions and pay the assessed costs associated with their participation in treatment.

Observation Period and the Sample

Data were collected on 4,479 drug use offenders who were arrested during the 24-month period between March 1989 and March 1991.1 Of these,

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1,151 (or 25.7%) were declared ineligible for diversion and were criminally prosecuted. The focus of this analysis is on the 3,328 offenders determined to be eligible for diversion to treatment, of whom 1,558 did not enter treatment and were prosecuted; 493 entered treatment, dropped out before successful completion of the treatment program, and were prosecuted; and 1,277 entered and successfully completed treatment, thereby averting prosecution. Recidivism is defined in terms of a subsequent arrest for any charge other than a moving violation traffic charge, as determined by a search of county and state law enforcement records. Arrest is the most commonly used measure in recidivism studies because official arrest information is easier to obtain than any self-reported measures of criminal activity and because arrest data are widely viewed as a more valid measure of criminal activity than conviction or incarceration data. The length of observation during which the offenders were at risk varies from 53 to 77 months (depending on when they entered the program). On average, the observation period is more than 5 years. Offenders were not detained during prosecution, and convicted offenders received fines or short jail sentences (less than 60 days) rather than lengthy confinement. As such, these offenders remained in the risk pool from the time of initial arrest.

Characteristics of the Sample

Table 1 summarizes the variables included in the analysis, their coding, and the distribution of all 4,479 offenders. Males compose 82% of the sample, and the mean age of the offenders is 28 years (SD = 7). Most of the offenders are White, 11% are African American, and 16% are Hispanic. Two thirds of the offenders have no record of a prior arrest. Most of the offenders face only one charge, and most were arrested for possession or use of marijuana; 20% were charged with possession or use of cocaine (or crack). Finally, it is apparent in Table 1 that 43% of the offenders were rearrested during the follow-up observation period.

Statistical Analysis
The analysis begins by estimating life tables of survival rates for a rearrest during the observation period. The life table analysis is extended to include testing equality across the following: (a) the four offender groups, including those not eligible for treatment; (b) the offender group that

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CRIMINAL JUSTICE POLICY REVIEW / June 2005 Descriptive Statistics and Coding for Variables in the Model of Time to Rearrest (N = 4,479) Coding 1 = male 0 = female 1 = African American 0 = not African American 1 = Hispanic 0 = not Hispanic Age at arrest 1 = prior arrest 0 = no prior arrest 1 = more than one 0 = one 1 = cocaine offense 0 = other drug offense 1 = marijuana offense 0 = other drug offense 1 = paraphernalia offense 0 = other drug offense 1 = offender entered and completed treatment program 0 = other 1 = offender entered but failed to complete treatment program 0 = other 1 = offender eligible for treatment but did not enter program 0 = other 1 = yes 0 = no Percentage 82 18 11 89 16 84 33 67 34 66 20 80 61 39 4 96 29 71 11 89 35 65 43 57 100 M SD

Table 1: Variable

Offender related Gender African American Hispanic Age Prior arrest Offense related Number of charges Cocaine offense Marijuana offense Paraphernalia offense Offender groupa Diversion eligible, complete program Diversion eligible, fail program Diversion eligible, no program exposure Rearrest

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a. The reference category consists of all other diversion-eligible offenders and that group of offenders who were judged ineligible for diversion to the treatment program and who were prosecuted.

entered treatment versus the offender group that although eligible, did not enter treatment; (c) the offender group that did not enter treatment versus the offender group that entered treatment but did not complete treatment; and (d) the offender group that entered but failed to complete treatment compared to the offender group that successfully completed treatment. The

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effect of exposure to treatment on recidivism is further analyzed by regression equations that are estimated using survival analysis procedures that allow an estimation of net effects of variables included in the model on the dependent variable with right censoring.2

FINDINGS
As already noted, nearly half (46.8%) of all offenders eligible for diversion to treatment did not enter the treatment program and were prosecuted. Of those who did enter the program, however, nearly three fourths (72.2%) did complete the treatment program. Among the 3,328 eligible offenders referred to treatment under the threat of legal sanction, only 1,277 offenders, or 38.4% of the total, completed the treatment program. Recidivism outcomes vary substantially among the three treatment-eligible groups: 52% of those drug users who did not enter the treatment program were rearrested during the follow-up period, compared to 43% of those who entered but failed to complete the program and 22% of those who entered and completed the treatment program. These bivariate findings suggest that recidivism rates are affected by exposure to treatment.

Survival Curves Across Offender Groups

Figure 1 provides the survival curves for the four offender groups, illustrating that offenders who completed the treatment program experienced a longer time to rearrest than offenders in any of the other three groups. The log-rank value of 375.34 (df = 4, p = .0001) and the Wilcoxon statistic of 383.36 (df = 3, p = .0001) indicate a rejection of the null hypothesis of no difference across the four groups. Compared to the offender group that successfully completed the treatment program, offenders who failed to complete treatment, offenders who were eligible for treatment but did not enter treatment, and offenders who were determined to be ineligible for treatment experienced an early and sudden drop in survival rates, followed by a less abrupt but continuous decline in survival through the observation period. To further explore the effects of treatment exposure, comparisons are created by separate estimates of the survival functions for the group exposed to treatment, regardless of whether they completed treatment, and for the group of eligible offenders who did not enter treatment. Figure 2 indicates that those exposed to treatment, regardless of retention in the program, performed better than the group of eligible offenders who did not enter treatment. Those who were not diverted to treatment had a higher rate

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Figure 1: Survival Curves for Time to Rearrest for Four Offender Groups

of failure earlier in the time period and continued to experience a lower survival rate during the entire period of observation. The effect of treatment exposure is further illuminated in Figures 3 and 4. In Figure 3, there is a significant difference in the survival curves of those diversion-eligible offenders who did not enter the treatment program and those who entered but failed to complete the program: Those who entered treatment had a lower rate of failure throughout the period. In Figure 4, it is apparent that those offenders who successfully completed treatment experienced a significantly longer survival time to rearrest than those offenders who entered treatment but failed to complete the program.

Regression Models of Survival Time

The regression analysis begins by estimating a model that includes only information on offender and offense characteristics. Model 1 in Table 2 provides the coefficient estimates and standard errors for this model for all 4,479 offenders (both treatment eligible and treatment ineligible). Of the offender characteristics included in the analysis, a record of prior arrest exerts the strongest net effect (b = 1.16, p .01) on the time to a rearrest. Offenders

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Figure 2: Survival Curves for Time to Rearrest for Diversion Eligible, Enter Program Offenders and Diversion Eligible, Not Enter Program Offenders

Figure 3: Survival Curves for Time to Rearrest for Diversion Eligible, Not Enter Program, Charges Filed Offenders and Diversion Eligible, Enter Program, Fail Program Offenders

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Figure 4: Survival Curves for Time to Rearrest for Diversion Eligible, Fail Program Offenders and Diversion Eligible, Complete Program Offenders

with a prior arrest experience a significantly shorter time to rearrest. Compared to White offenders, African American offenders (b = .81, p .01) and Hispanic offenders (b = .33, p .01) have a significant decrease in time to rearrest. Of the two minority group contrasts with White offenders, African American offenders experience the stronger reduction in survival time. In addition, male offenders experience a significant reduction in survival time (b = .36, p .01) compared to female offenders, and there is a positive relationship (b = .04, p .01) between offenders age and time to rearrest. Finally, Model 1 indicates that only two of the offense characteristics produce a statistically significant effect on time to rearrest. Offenders arrested for more than one charge experience a significant reduction (b = .35, p .01) in time to rearrest, and offenders charged with an offense involving the use or possession of marijuana increased (b = .64, p .05) time to rearrest. The question of concern is whether exposure to treatment affects time to rearrest when these offender and offense characteristics are included in the model. Model 2 in Table 2 begins this analysis by ascertaining the effect of participation in treatment, regardless of treatment completion, compared to those who also were diversion eligible but who did not enter treatment. Of the 3,328 offenders who compose these two groups, those with some

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Table 2: Model 1 Estimate 0.36** 0.81** 0.33** 0.04** 1.16** 0.35** 0.64* 0.16 0.39 1.09** 7.52** 0.20 5,739.16 0.09 0.08 0.11 0.13 0.22 0.27** 0.44** 0.25 0.47 0.09 0.13 0.15 0.29 0.22* 0.39** 0.15 0.72* 0.33** 0.11 0.14 0.17 0.33 0.13 7.12** 0.28 2,822.03 0.10 0.12 0.10 0.01 0.08 0.46** 0.62** 0.07 0.04** 0.95** 0.11 0.14 0.12 0.01 0.10 0.33** 0.45** 0.16 0.03** 0.76** 0.13 0.15 0.13 0.01 0.11 SE Estimate SE Estimate SE Estimate 0.65** 0.86** 0.25 0.03** 0.90** 0.34** 0.26 0.61** 0.01 Model 2 Model 3 Model 4 SE 0.19 0.26 0.19 0.01 0.16 0.14 0.20 0.26 0.44

Regression Estimates and Standard Errors for Variables Included in Four Models of Time to Rearrest Following Exposure to Treatment

Variable

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Offender characteristics Gender African American Hispanic Age Prior arrest Offense related Number of charges Marijuana offense Cocaine offense Paraphernalia offense Group Diversion eligible, enter program (N = 1,770)a Diversion eligible, not enter program (N = 1,558)b Diversion eligible, complete program (N = 1,277)c Intercept Log likelihood 7.16** 0.23 3,859.75

1.13** 0.14 7.95** 0.37 1,618.30

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a. Number of noncensored values = 1,286; number of right censored values = 2,042. Reference category is diversion eligible, not enter program (N = 1,558). b. Number of noncensored values = 1,016; number of right censored values = 1,035. Reference category is diversion eligible, enter program, fail program (N = 493). c. Number of noncensored values = 479; number of right censored values = 1,291. Reference category is diversion eligible, enter program, fail program (N = 493). *p .05. **p .01.

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exposure to treatment, compared to those who failed to enter the treatment program, experienced a statistically significant increase (b = 1.09, p .01) in time to rearrest. The magnitude of the effect translates to a net 197% increase in the mean time to rearrest for offenders who entered treatment. Model 3 in Table 2 contrasts the effects of not entering treatment to those of entering treatment but failing to complete treatment. Of the 2,051 offenders included in this stage of the analysis, 50% were rearrested during the observation period. Compared to those who entered and failed treatment, those who did not enter treatment experienced a significant reduction (b = .33, p .01) in time to rearrest. Net of the covariates in the model, this effect yields a 30% reduction in the mean time to rearrest for offenders who were eligible for diversion but did not enter (compared to those who did enter but then failed to complete the program). Last, Model 4 in Table 2 examines the effects of program completion among the 1,773 who entered treatment. Offenders who successfully completed the treatment program, compared to those who failed the program, had a substantial increase (b = 1.13, p .01) in time to rearrest. The estimated effect represents a 210% longer mean time to rearrest for offenders who completed the treatment program compared to offenders who entered but did not complete treatment. In each of the four models reported in Table 2, offender and offense characteristics are significant predictors of time to rearrest. Controlling for offender treatment group, which varies across Models 2, 3 and 4, offenders gender and prior arrest record have a significant effect on the time to rearrest; age also has a significant effect, but its effect is much smaller. The effect of African American ethnicity remains significant in all four models, but the effect of Hispanic ethnicity is no longer significant once offender group is controlled. That is, the mean time to rearrest is significantly less for African American offenders than for White offenders, regardless of exposure to treatment, but there is no difference in time to rearrest between Hispanic and White offenders once the level of treatment exposure is controlled. Finally, it is noted that the number of charges filed and the nature of the drug also continue to have a significant effect on time to rearrest, regardless of exposure to treatment. In summary, the results reported in Table 2 affirm those observed in the bivariate survival curves presented in Figures 1, 2, 3, and 4. Time to rearrest is significantly affected by exposure to treatment, and the most significant positive effect occurs when treatment has been successfully completed. Although offender and offense characteristics are significant predictors of

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time to rearrest, exposure to treatment is a significant predictor when the effects of these characteristics are controlled. Indeed, exposure to treatment is a stronger predictor of time to rearrest than any of the offender or offense characteristics in Models 2 and 4. It also is apparent, however, that entry without completion of treatment is not as important as treatment completion.

CONCLUSION
Confronted by the limited success that legal sanctions have as a specific deterrent for drug users (Gaes, Flanagan, Motiuk, & Stewart, 1999; Gerstein & Harwood, 1990; Speckart et al., 1989), there has been a greater receptivity recently to treatment as an alternative to prosecution and incarceration. Community-based treatment has been shown to be cost-effective (Caulkins et al., 1997; French et al., 2000; Institute of Medicine, 1996) and to significantly reduce the likelihood of recidivism (Benedict et al., 1998; Lipton, 1995; Smith & Akers, 1993). Diversion to treatment has been widely advocated by academics (Belenko, 1990; Skolnick, 1997) and has received a measure of public support, as evidenced by the passage of Proposition 200 in Arizona in 1996 and Proposition 36 in California in 2000, each mandating treatment rather than punishment for less serious drug offenders. These efforts rely on the threat of legal sanction to motivate offenders to enter and complete drug treatment programs, with the expectation that exposure to treatment will reduce recidivism.

Summary
This study of a prosecutorial diversion program examines the effects of exposure to treatment on criminal recidivism among a group of offenders motivated to treatment by the threat of prosecution and a felony conviction. The analysis focuses on estimating the effects on the time to rearrest of participation in the treatment program, controlling for select offender characteristics and offense type. The use of survival rates permits an examination of the temporal patterns (rates) of recidivism during the 5-year follow-up period. In light of the extended observation period, the findings are an important addition to our knowledge of treatment effectiveness, and they contribute to our base of knowledge about recidivism more generally. The nonparametric analysis reveals that significant differences exist among the survival curves for the four offender groups. Two observations

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are of particular interest. First, it is noteworthy that among those offenders eligible for treatment, the rate and level of failure was greater for those who failed to enter the program than for those who entered the program and failed to complete the program. This suggests that one or two factors may be operating among those who enter the program. One is the receptivity factor, by which the act of entering or not entering the program indicates the extent to which the offender is interested in avoiding further criminal sanctions and gaining treatment; this receptivity to treatment signals a decreased likelihood of future criminal behavior. The other is the treatment factor, by which the offenders presence at some level of treatment, even if the full regimen of treatment is not completed satisfactorily, provides some benefit that aids in delaying the time to future criminal activity. The second observation worthy of comment is the finding that those offenders who enter and complete the treatment program performed substantially better during the observation period than those offenders who enter and fail to complete the treatment program. This finding provides further support for the impact of treatment on those eligible offenders who are receptive enough to enter the treatment program. Two substantively important findings emerge from the multivariate regression analysis. First, the results continue to support the conclusions derived from the survival curves: that offenders who entered and completed treatment fared significantly better than those who entered and failed treatment, and both groups performed better than those eligible for diversion who failed to enter treatment. The regression analysis permitted an analysis of the effects of these treatment conditions when controlling for possible differences among the offender groupings in such characteristics as age, ethnicity, gender, prior arrest record, and offense type. Even with these factors controlled, however, the difference in recidivism between the offender groups remains significant and strong. Finally, offenders ethnicity, gender, and prior arrest record significantly decrease the time to a rearrest. The effect for ethnicity and prior arrest record is reduced substantially when variables measuring the effect of exposure to treatment and the successful completion of the treatment program are included in the analysis. These findings suggest that the diversion program was instrumental in reducing the time to failure for the offenders included in this analysis and that future research should consider whether the effect of program intervention on recidivism is mediated by offender characteristics.

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Discussion
The link between drugs and crime has been widely documented (Hser, Longshore, & Anglin, 1994; Menard, Mihalic, & Huizinga, 2001; White & Gorman, 2000). More than half of the sample of 10,000 adults (both men and women) arrested in 34 urban sites in 2000 tested positive for drugs at the time of arrest (U.S. Department of Justice, 2003), more than one third of jail inmates reported in 1996 that they were under the influence of drugs at the time of their offense (Harlow, 1998), and more than half of a small sample of Massachusettss prison inmates reported that drug use was a significant contributor to the offense for which they were incarcerated (Kouri, Pope, Powell, Oliva, & Campbell, 1997). In light of this pervasive association between drug use and crime, drug treatment has been widely adopted as an intervention that will reduce future criminal behavior. The effectiveness of treatment, however, is severely undermined by high rates of attrition. Even though participation is coerced by the threat of legal sanction, most programs experience a dropout rate of 50% or more. The net effect of the prosecutorial diversion program studied is that only 53% of those eligible for treatment even entered treatment and that 27% of those who began treatment dropped out prior to its completion. Critics argue that it is hard to discern program effects when, in this case, only 38% of all eligible offenders enter and complete the treatment. Boyum and Kleiman (2002), Prendergast et al. (1995), and others point to these high rates of attrition to support their conclusion that any official mandate to treatment is illusionary. These are programs in name only; higher retention and completion rates are necessary, they argue, if such programs are to be viable responses to drug-using offenders. Critics also point to the fact that it is difficult to separate the receptivity effect from the treatment effect in determining successful outcomes (Banks & Gottfredson, 2003). Boyum and Kleiman (2002) note that none of the studies to date has relied on a double blind experimental research design to
tell how much of the well-documented correlation between entering and staying in treatment on the one hand and reducing drug use on the other ought to be regarded as an effect of the treatment itself, as opposed to the motivation that leads someone to seek treatment and continue with it. (p. 371)

This study has not helped to clarify these differences, and the differential effects of receptivity and treatment continue to be important questions for

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researchers. However, criminal justice practitioners and policy makers are less concerned with partitioning the explained variance between receptivity effects and treatment effects than with the major finding (from this research and elsewhere) that an offenders entry to treatment signals the likelihood of a more successful outcome than an offenders failure to enter treatment. Similarly, practitioners and policy makers take interest in the finding that retention in treatment through completion improves the likelihood of successful outcomes, regardless of whether that effect reflects increased levels of receptivity to treatment or increased dosages of the treatment. Two final points are relevant to the discussion of treatment and its effects on recidivism. First, it is important to note that few studies to date attempt to differentiate the deterrent effects of the encounter with the criminal justice system from the rehabilitation effects of the drug treatment that was a part of that encounter (Norland, Sowell, & DiChiara, 2003; Speckart et al., 1989). Instead, most studies assume that any subsequent behaviors, especially criminal justice or drug-using behaviors, are a measure of the rehabilitative effect of the drug treatment program. Yet the entire experience of arrest and the threat of legal sanction, combined with a period of enforced compliance with a treatment protocol, may also be viewed by an offender as a penalty incurred as a result of the original behavior and, as a perceived penalty, may then serve as a specific deterrent to subsequent behaviors. Once again, the extent to which the successful outcomes are the result of deterrence or rehabilitation tends to be more of a concern to the researcher than to the practitioner, to whom it is important only to note that exposure to treatment decreases the likelihood of posttreatment recidivism. Second, the discussion of drug treatment and its effects must retain the distinction between the suppression effects while in treatment and the rehabilitation effects following the completion of treatment. Most studies have examined the latter, but there is evidence that program participation suppresses recidivism during the time of involvement (Harwood et al., 1988; Hubbard et al., 1989; Speckart et al., 1989). That is, whether it is a receptivity effect or a treatment effect, it is relevant to note that exposure to treatment reduces the level of criminal activity during the period of time when offenders are in treatment. If this reduction during treatment is simply a suppression effect, then one policy implication is the possibility that the effect observed with more expensive treatment counselors may be achieved with the use of less expensive staff. Irrespective of whether this reduction in crime during treatment is the result of a suppression effect or a treatment effect, however, this more immediate benefit of placing offenders in drug

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treatment further supports the efforts by criminal justice policy makers to coerce offenders into treatment. In conclusion, drug-using offenders increasingly are being referred to treatment, most often by using the threat of legal sanctions as a so-called hammer to coerce program entry and completion. Although the rates of entry and completion are low, there are observable benefits to those who are exposed to treatment. It may be because of self-selection, or it may be because of the effects of treatment, and it is unclear whether the results are owing to specific deterrence or rehabilitation, but much research in the past two decades has consistently reported that increased exposure to treatment predicts lower rates of recidivism, both during the time when the offender is exposed to the treatment and for several years following treatment exposure. Researchers need to continue their efforts to identify those offender and offense characteristics that will identify those persons for whom diversion to treatment will be most beneficial, as well as to unravel the complexities of treatment effects versus receptivity effects on outcomes, but the growing weight of accumulated studies provides strong evidence to support the continued use of diversion from punishment to treatment as an effective means to reduce future criminal behavior.

NOTES
1. During this time, the prosecutors office rejected another 1,449 cases that had been submitted by police, largely because of insufficient evidence for prosecution. An additional 999 cases were dropped from this analysis because the defendants absconded immediately after the initial arrest and received neither prosecution nor treatment. 2. Following Chung, Schmidt, and Witte (1991; Elandt-Johnson & Johnson, 1980; Kalbfleisch & Prentice, 1980; Lee, 1980; Maltz, 1984), survival time T is assumed to be a random variable with some distribution characterized by a cumulative distribution function F(t, q ), where q is a set of parameters to be estimated and F(t, q ) = P(T ) = the probability of failure at or before time t, for any t 0. The fact that F(t, q ) is a cumulative distribution function implies that F(t, q ) approaches one as t approaches infinity. The survival function is defined as

S(t, q ) = 1 F(t, q ) = P(T > t)

In the analysis, this formula provides the probability of survival, that is, the probability of success until time t.

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John R. Hepburn is a professor in the School of Justice & Social Inquiry at Arizona State University. His most recent research has examined important issues in the offenders reentry to the community and the factors that predict successful outcomes in the community. Currently, he is the principal investigator of a federally funded study of the impact of short-term residential treatment on the community adjustment of drug-using offenders following release from jail.

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