The impact of drug court participation on mortality: 15-year outcomes from a randomized controlled trial.

AIM: To test the effects of drug court participation on long-term mortality risk. METHODS: During 1997-98, 235 individuals charged with a non-violent offense were randomly assigned to Baltimore City Drug Treatment Court (BCDTC) or traditional adjudication. Heroin was the predominant substance of choice among the sample. Participant mortality was observed for 15 years following randomization. RESULTS: Over 20% of participants died during the study, at an average age of 46.6 years, and 64.4% of deaths were substance-use related. Survival analyses estimated that neither mortality from any cause nor from substance use-related causes significantly differed between BCDTC and traditional adjudication. CONCLUSIONS: Frequent and premature death among the sample indicates that this is a high-risk population in need of effective substance use treatment. Roughly half of drug treatment courts are now estimated to offer medication assisted treatment (MAT), which is currently the most effective treatment for opioid use disorders. In this study of BCDTC implemented over 15 years ago, only 7% of participants received MAT, which may explain the lack of program impact on mortality. Historical barriers to providing MAT in drug court settings include access, concerns about diversion, negative attitudes, blanket prohibitions, and stigma. Drug treatment courts should implement best practice standards for substance use treatment and overdose prevention, including increased access to MAT and naloxone, and training to reduce stigmatizing language and practice.

The impact of residential change and housing stability on recidivism: pilot results from the Maryland Opportunities through Vouchers Experiment (MOVE).

OBJECTIVES: This article provides a description and preliminary assessment of the Maryland Opportunities through Vouchers Experiment (MOVE), a randomized housing mobility program for former prisoners designed to test whether residential relocation far away from former neighborhoods, incentivized through the provision of a housing subsidy, can yield reductions in recidivism. METHODS: The MOVE program was implemented as a randomized controlled trial. Participants were recruited from four different Maryland prisons and randomly assigned to experimental groups. In the first iteration of the experiment, treatment group participants received 6 months of free housing away from their home jurisdiction and control group participants received free housing back in their home jurisdiction. In the second iteration of the experiment, the treatment group remained the same and the control condition was redesigned to represent the status quo and did not receive free housing. Analyses were conducted of one-year rearrest rates. RESULTS: With respect to reductions in recidivism, pilot results suggest that there is some benefit to moving and a benefit to receiving free housing. Rearrest was lower among the treatment group of movers than the non-movers, and was also lower for non-movers who received free housing versus non-movers who did not receive housing. CONCLUSIONS: To the extent that pilot results can be validated and replicated in a full-scale implementation of the MOVE program, policies that provide greater access to housing assistance for formerly incarcerated individuals may yield substantial public safety benefits, particularly housing opportunities located far away from former neighborhoods.

The Baltimore City Drug Treatment Court: 3-year self-report outcome study.

This study reports results from interviews with 157 research participants who were interviewed 3 years after randomization into treatment and control conditions in the evaluation of the Baltimore City Drug Treatment Court. The interviews asked about crime, substance use, welfare, employment, education, mental and physical health, and family and social relationships. Program participants reported less crime and substance use than did controls. Few differences between groups were observed on other outcomes, although treatment cases were less likely than controls to be on the welfare rolls at the time of the interview. Effects differed substantially according to the originating court.