Criminal justice referral and incentives in outpatient substance abuse treatment.

A substantial number of substance abusers entering outpatient psychosocial counseling treatment are referred from the criminal justice (CJ) system. This secondary analysis of previously published findings from National Drug Abuse Treatment Clinical Trials Network (CTN) protocol CTN-0006 (Motivational Incentives for Enhanced Drug Abuse Recovery: Drug Free Clinics), a large, multi-site trial of a prize-based abstinence incentive intervention, examined the influence of CJ referral on usual care outcomes and response to the incentive procedure. CJ referrals (n=138) were more likely than those not CJ referred (n=277) to provide stimulant negative urine samples whether missing samples were counted as positive or as missing. A significant interaction term was found only for percentage of treatment completers (p=0.27). On that retention variable, and three additional drug use measures, significant incentive effects were confined to participants who entered treatment without referral from the criminal justice system. Nevertheless, there were trends toward better retention and less drug use in CJ referrals who received abstinence incentives as well.

Conclusions: This study suggests that abstinence incentives should be offered as a first priority to stimulant users entering treatment without criminal justice referral. However, incentives can also be considered for use with criminal justice-referred stimulant users, based on the observation that best outcomes were obtained in CJ referrals who also received the abstinence incentive program.

Related protocols: CTN-0006