The effectiveness of compulsory drug treatment: A systematic review

doi:10.1016/j.drugpo.2015.12.005

International Journal of Drug Policy

Volume 28, February 2016, Pages 1-9

https://doi.org/10.1016/j.drugpo.2015.12.005 Get rights and content

Abstract

Background

Despite widespread implementation of compulsory treatment modalities for drug dependence, there has been no systematic evaluation of the scientific evidence on the effectiveness of compulsory drug treatment.

Methods

We conducted a systematic review of studies assessing the outcomes of compulsory treatment. We conducted a search in duplicate of all relevant peer-reviewed scientific literature evaluating compulsory treatment modalities. The following academic databases were searched: PubMed, PAIS International, Proquest, PsycINFO, Web of Science, Soc Abstracts, JSTOR, EBSCO/Academic Search Complete, REDALYC, SciELO Brazil. We also searched the Internet, and article reference lists, from database inception to July 15th, 2015. Eligibility criteria are as follows: peer-reviewed scientific studies presenting original data. Primary outcome of interest was post-treatment drug use. Secondary outcome of interest was post-treatment criminal recidivism.

Results

Of an initial 430 potential studies identified, nine quantitative studies met the inclusion criteria. Studies evaluated compulsory treatment options including drug detention facilities, short (i.e., 21-day) and long-term (i.e., 6 months) inpatient treatment, community-based treatment, group-based outpatient treatment, and prison-based treatment. Three studies (33%) reported no significant impacts of compulsory treatment compared with control interventions. Two studies (22%) found equivocal results but did not compare against a control condition. Two studies (22%) observed negative impacts of compulsory treatment on criminal recidivism. Two studies (22%) observed positive impacts of compulsory inpatient treatment on criminal recidivism and drug use.

Conclusion

There is limited scientific literature evaluating compulsory drug treatment. Evidence does not, on the whole, suggest improved outcomes related to compulsory treatment approaches, with some studies suggesting potential harms. Given the potential for human rights abuses within compulsory treatment settings, non-compulsory treatment modalities should be prioritized by policymakers seeking to reduce drug-related harms.

Section snippets

Background

Globally, dependence to illicit and off-label drugs remains a key source of morbidity and mortality, and is implicated in criminal recidivism. For instance, 1.7 million of the world's estimated 13 million people who inject drugs (PWID) are believed to be HIV-positive while more than 60% of PWID globally are estimated to be hepatitis C (HCV) positive (UNODC, 2015). Illicit drug dependence is also estimated to have contribute to 20.0 million disability-adjusted life years in 2010 (Degenhardt,

Methods

We employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for the development of systematic reviews (Moher, Liberati, Tetzlaff, & Altman, 2009). A full review protocol is available by request to the corresponding author.

Study selection and characteristics

Overall, as seen in Fig. 1, 430 studies were initially identified, of which 378 were excluded because they did not present primary and/or specific data on compulsory treatment. Of the remaining 52 studies, 17 were excluded because they constituted reviews or editorials, 18 were excluded because they did not focus on illicit drug use (i.e., they focused on alcohol treatment), and 8 studies were excluded because they evaluated quasi-compulsory treatment rather than compulsory treatment

Summary of evidence

While a limited literature exists, the majority of studies (78%) evaluating compulsory treatment failed to detect any significant positive impacts on drug use or criminal recidivism over other approaches, with two studies (22%) detecting negative impacts of compulsory treatment on criminal recidivism compared with control arms. Further, only two studies (22%) observed a significant impact of long-term compulsory inpatient treatment on criminal recidivism: one reported a small effect size on

Funding

Dan Werb is supported by a US National Institute on Drug Abuse Avenir Award (DP2 DA040256-01) and the Canadian Institutes of Health Research (MOP 79297). Further support was provided by the Open Society Foundations through an operating grant for the International Centre for Science in Drug Policy. This study was also supported by the Canadian Institutes of Health Research through the Canadian Research Initiative in Substance Misuse (SMN–139148 and SMN-139150). Benedikt Fischer acknowledges

Acknowledgments

DW had full access to all the data in the study and had final responsibility for the decision to submit for publication. MM and CR conducted the systematic search, with assistance from DW. DW drafted the manuscript. EW provided guidance on the systematic review and meta-analysis methodology. BF, AK, SS, and EW revised the manuscript substantially. All authors have seen and approved the final version.

Conflict of interest: All authors declare that they have no conflicts of interest.

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Editors' ChoiceThe effectiveness of compulsory drug treatment: A systematic review

Abstract

Background

Methods

Results

Conclusion

Section snippets

Background

Methods

Study selection and characteristics

Summary of evidence

Funding

Acknowledgments

The Lancet

Lancet

Lancet

Drug and Alcohol Dependence

International Journal of Law and Psychiatry

Journal of Substance Abuse Treatment

International Journal of Drug Policy

Journal of Substance Abuse Treatment

International Journal of Drug Policy

Lancet

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International Journal of Drug Policy

Social Science & Medicine

International Journal of Drug Policy

International Journal of Drug Policy

World drug report 2015

Effectiveness of interventions to address HIV in prisons

Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence

Cochrane Database of Systematic Reviews

Methadone at tapered doses for the management of opioid withdrawal

Cochrane Database of Systematic Reviews

Buprenorphine for the management of opioid withdrawal

Cochrane Database of Systematic Reviews

Long-term suboxone treatment and its benefit on long-term remission for opiate dependence

Journal of Psychiatry

Pharmaceutical heroin for heroin maintenance in chronic heroin dependents

Cochrane Database of Systematic Reviews

Efficacy of psychostimulant drugs for cocaine dependence

Cochrane Database of Systematic Reviews

Effectiveness of secondary prevention and treatment interventions for crack-cocaine abuse: A comprehensive narrative overview of English-language studies

International Journal of Drug Policy

Pilot randomized double blind placebo-controlled study of dexamphetamine for cocaine dependence

Addiction

Dextroamphetamine for cocaine-dependence treatment: A double-blind randomized clinical trial

Journal of Clinical Psychopharmacology

The efficacy of cognitive behavioral therapy: A review of meta-analyses

Cognitive Therapy and Research

A meta-analytic review of psychosocial interventions for substance use disorders

American Journal of Psychiatry

Contingency management for treatment of substance use disorders: A meta-analysis

Addiction

Compulsory commitment to care of substance misusers: International trends during 25 years

European Addiction Research

Compulsory substance-user treatment and harm reduction: A critical analysis

Substance Use & Misuse

Compulsory community-based substance abuse treatment and the mentally ill criminal offender

The Prison Journal

Assessment of compulsory treatment of people who use drugs in Cambodia, China, Malaysia and Viet Nam: Application of selected human rights principles

Editors' Choice
The effectiveness of compulsory drug treatment: A systematic review