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The research on the effectiveness of legally requiring or coercing AOD treatment has been contradictory due to the many different types of individuals in the programs, the different type of programs, problems with the implementation of the programs, and methodological problems in evaluating the programs. (13) However, there are some encouraging facts that suggest the benefits of court ordered treatment.

Generally, the recent research on the impact of drug courts shows that:

1) participants get into treatment earlier in their substance abusing careers and remain in the treatment at a rate almost double the rate for most community-based programs (about 50% to 70% remain in treatment after one year);
2) program costs are generally lower than standard criminal justice system processing;
3) drug courts provide closer and more frequent supervision than under the standard probation, parole, or pretrial supervision of these offenders;
4) drug use and criminal behavior are comparatively reduced while drug-court participants are under program supervision (but few studies have tracked recidivism longer than one year); and
5) some programs show increased employment and education. (1)(5)(16)(39)

Employers have traditionally used Employee Assistance Programs (EAP) to identify and refer their employees to AOD treatment based upon the potential benefits of AOD treatment in terms of reduced psychological, medical, social, and legal consequences and increased productivity in the workplace.

Studies show that workplace urine surveillance has been successful in detecting employees with significant AOD problems. Also of interest is that studies show - compared to non-coerced employees who were in treatment - coerced employees did not have as severe AOD problems. This finding shows that EAP can be very significant in the early identification and referral of employees who have AOD problems before more severe consequences develop.

A recent study showed that EAP coerced employees complied with AOD treatment at rates superior to employees who sought treatment voluntarily or on their own. The coerced group had significant AOD and other life problems at the start of treatment that were generally less severe or chronic than those from the self-referred group.

Moreover, coerced participants were significantly more likely to remain in inpatient or outpatient treatment than the self-referred participants. Post-treatment follow-up of coerced patients indicated marked improvements in AOD use, employment, medical, family, and psychiatric problems. These levels of improvement were comparable to those shown by the self-referred patients.

Therefore, the literature on required treatment for employee populations generally shows reduced psychiatric, medical, and legal consequences, and increased productivity in the workplace comparable to volunteer referrals.

In fact, much of the literature on the effectiveness of therapy and treatment in general, concludes that client motivation for intervention, including how a person gets into treatment, is not associated with differential outcomes. A better predictor of outcome is what some call “motivational congruence,” that is, the therapist assessing the client’s motivation for change and working with it. (21)

This issue of motivational congruence will lead us into our next two sections, where we will study one of the key issues of DOA treatment, both voluntary and involuntary. In these chapters, we will look at ways to influence the motivation for change.

Review Questions Section VII

What is the difference in success rate between DOA patients referred via drug courts and the average DOA patient in community based programs?

Are coerced patients more likely or less likely to succeed in treatment?

What is motivational congruence and why is it important?