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Drug Diversion Should Be Evidence Based

A recent story finding a controversial private rehabilitation facility tied to NSW Courts has raised questions regarding drug diversion programs.

Most experts are in agreement that if a person is charged with drug use or their offending relates to problematic alcohol and other drug use, treatment is a preferable intervention to standard criminal justice processes.

However, it is crucial that drug diversion programs follow best-practice, particularly when it comes to identifying and diverting offenders into evidence-based treatment.

What is Drug Diversion?

There are two main forms of drug diversion in Australia:

  • Police diversion: where police do not to charge an offender (usually giving a ‘caution’) on the condition that they complete an alcohol and other drug education or treatment program.
  • Court diversion: where a charged offender is diverted from the court to undertake an alcohol and other drug education or treatment program, usually to avoid a conviction.

Referrals can also be made via conditions on bail, parole or as a result of a treatment order via specialist therapeutic courts such as Drug Courts.

There are many different forms of drug diversion programs operating throughout Australia.

Generally the aim of these programs is to, in the case of recreational users,  provide an opportunity to deter and educate about the risks of prolonged drug use and, for dependent users, to offer a therapeutic responses to address the causes of drug use and crime.

Specialist drug diversion staff assess appropriateness for entering into diversion programs and select treatment providers accordingly. However, the processes involved for diversion programs differ greatly across Australia.

Although there has always been a strong economic case for drug diversion over traditional justice processes, diversion programs may not be following evidence-based practice.

‘What Works’ In Drug Diversion?

Alcohol and other drug treatment for forensic clients should follow the ‘risk-need-responsivity model‘ to ensure interventions achieve their aim of reducing crime.

This requires considering the following at diversion:

  • An assessment of risk of reoffending;
  • An assessment of the factors that are associated with criminal behaviour (‘criminogenic needs’); and
  • Treatment being matched accordingly resulting in the best positive outcomes (‘responsivity’).

If there is no link between an offender’s alcohol and other drug use and their offending they should not participate in the drug diversion program.

It has been noted that therapeutic programs, if poorly implemented, run the risk of ‘net-widening’ and unnecessarily prolonging time spent by offenders within the criminal justice system.

Non-compliance with diversion programs often results in offenders coming back before the court. As such policy-makers should look at decriminalisation or depenalisation as a solution for low risk drug offending, not increasing the number of people on diversion programs.

Best practice drug diversion programs ensure:

  • A broad-range of interventions are available;
  • Equitable access to programs regardless of age, gender, ethnicity or substance of use;
  • Clear eligibility criteria; and
  • Explicit aims and procedures for the program.

If an offender is referred to alcohol and other drug treatment providers, it should be clear they are following evidence-based treatment. A stepped-care approach should be taken to utilising the least intensive but most effective treatment options available given an offender’s needs.

Evidence-based Treatment

It’s important that police, lawyers, court staff and the judiciary are aware of evidence-based alcohol and other drug treatment.

This is particularly important in relation to referrals to private alcohol and other drug treatment providers, which are largely unregulated.

Unlike private providers, publicly-funded services need to maintain health accreditation standards and are externally assessed regularly. However, the public treatment sector is chronically underfunded, leading to private providers filling the gap.

Generally, treatment interventions which focus on Cognitive Behaviour Therapy (CBT) or Motivational Interviewing (MI) are the most effective for alcohol and other drug issues.

CBT helps to strengthen skills to manage cravings and difficult situations or emotions that might trigger a relapse. MI helps to develop and strengthen the motivation to change, is also effective.

Treatment programs can involve residential rehabilitation, day rehabilitation or outpatient treatment, the latter of which is the least intensive.

Residential rehabilitation

Residential rehab involves people staying in a facility designed around a therapeutic community. It requires a high level of commitment as it can go from a few weeks to over a year. Much of the time spent in residential rehabilitation involves either group or individual therapy, or working in the centre.

Some people may be ready for treatment but not for the level of intensity that requires them to live and negotiate interpersonal relationships with people they don’t know; and to be without the day-to-day support of family or friends.

Residential rehab can be a good option for people who don’t have a stable home situation, or who need a complete break from their environment, or as a step up when less intensive treatments have not been effective.

An average of about three months of residential treatment seems to be effective. The optimal treatment time seems to be similar in non-residential treatment, suggesting a combination of residential and non-residential treatment might be effective over that time. But completing the treatment program and actively participating seem to be more important than treatment setting or length.

Programs that are one-size-fits-all or have overly punitive rules are less likely to be successful.

Day rehabilitation

Day rehab is where a person lives at home but attends treatment typically three to five days a week, for around six to eight weeks. The program is usually similar to residential rehabilitation, except you go home in the afternoon.

This can be a good option when someone doesn’t need or want the intensity of residential rehabilitation, has commitments that make it difficult to be away from home for long periods (such as kids), or as a step down when residential rehabilitation has finished.

Outpatient treatment

The most common outpatient treatment is counselling (group or individual talking therapy, typically occurring once a week for an hour at a time, for six to 12 weeks). It may also include case management (help with accessing other services such as housing, medical or mental health services) or pharmacotherapy (prescribed medicine, such as methadone for opiate dependence).

Outpatient treatment can be a good option for people who don’t want or need intensive treatment, have daytime commitments (such as work), or as a step down when day or residential rehabilitation has finished.

People with quite severe and complex problems can still do well in outpatient counselling, especially when they have good professional, community or family support. Severity of dependence isn’t a consistent predictor of treatment outcome.

The exact nature of these treatment types may differ between providers, whether they are in the public or private sector.

It’s crucial that drug diversion programs follow the evidence to maximise outcomes for diverted offenders and to ensure their work has an impact on overall crime.

Jarryd Bartle is our specialist consultant on the intersection of alcohol and other drug problems and the criminal law.

Need help? 360Edge can assist in evaluating and improving drug diversion programs, as well as providing tailored training to justice professionals.