MENTAL HEALTH, GENDER, AND DRUG COURT COMPLETIONT ALISON R. GRAY, B.S. University of De~aware

CHRISTINE A. SAUM, Ph.D. University of De~aware ABSTRACT: Drug-blvolved offenders report high rates o f mental health problems that can negatively impact criminal justice outcomes. Yet, relatively little attention has been given to the mental health issues o f drug court offenders. Therefore, this study examined 449 participants in a Delaware drug court and investigated relationships between mental health, gender, and program completion. Bivariate results indicated that gender was related to both mental health status and completion status. Multivariate findings revealed that two indicators o f mental health, depression and being prescribed drugs for a psychological or emotional problem, were significant predictors o f drug court completion. Policy implications include assessing the mental health status o f all drug court participants at program entry so that services can be provided which aim to improve offender health and increase the likelihood o f successful program outcomes. Drug courts must better meet the needs o f participants with co-occurring disorders if they are to remain an effective and viable criminal justice intervention.

INTRODUCTION Evidence continues to develop in support of the overall success of the drug court movement (Belenko, 2001; Gottfredson, Kearley, Najaka, & Rocha, 2005). Researchers, practitioners, and policy makers are now looking beyond whether drugs courts "work" by examining ways in which drug courts can be most effective. We know that drug courts can produce positive results including high retention rates for participants and significant post-program reductions in relapse and recidivism (Bavon, 2001; Butzin, Saum, & Scarpitti, 2002). Yet, these findings are not consistent across the increasingly diverse population of drug court offenders. Prior research has found drug court outcomes vary according to gender (Johnson-Listwan, Koetzle Shaffer, Latessa, t This research was supported by grant RO1 DA12424 "Drug Court Offenders in Outpatient Treatment," by the National Institute on Drug Abuse. ~? Direct all correspondence to Alison R. Gray, University o f Delaware, Center for Drug & Alcohol Studies, Newark, D E 19716. Email: arb@udeLedu. AMERICAN JOURNAL OF CRIMINAL JUSTICE, Vol. 30 No. 1, 2005 9 2005 Southern Criminal Justice Association

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MENTAL HEALTH. GENDER, AND D R U G COURT

2000; Peters & Murrin, 2000; Taxman, 1999), race (Sechrest & Shicor, 2001), age (Peters & Murrin, 2000) employment (Mateyoke-Scrivner, Webster, Staton, & Leukefeld, 2004) and criminal history (Saum, Scarpitti, & Robbins, 2001). Drug-involved offenders report high rates of mental health problems (Compton, Cottler, Jacobs, Ben-Abdallah, & Spitznagel, 2003; Jainchill, DeLeon, & Pinkham, 1986), and these mental health problems can negatively impact criminal justice outcomes (Gossweiller & Martin, 1996). However, relatively little attention has been given to the mental health issues of drug court offenders. Mental health has been addressed in the drug court literature only peripherally, often in reference to substance-abusing offenders who are assessed to have mental health needs (i.e. have co-occurring disorders) and require treatment beyond that available in typical drug courts (Belenko, 2001; Cooper, 1997; Hagedorn & Willenbring, 2003). Most of the drug court literature that discusses mental health has focused solely on women participants (D'Angelo & Wolf, 2002; Dannerbeck, Sundet & Lloyd, 2002; Harrell, Roman & Sack, 2001). This is largely due to the assessed need for mental health services for women. For example, national prevalence rates for certain mental health disorders are higher for women, and women overall are more likely to report and seek treatment for mental health problems (Langan & Pelissier, 2001; SAMHSA, 2002). In addition, it has been demonstrated that women in drug court programs have a higher rate of reported mental health problems than men do (D'Angelo & Wolf, 2002; Dannerback, Sundet, & Lloyd, 2002). Yet, because men are much more likely to be under the control of the criminal justice system than women are, there are proportionally more male offenders available to participate in drug courts. Thus, there is a relatively large population of men in drug court programs who may be affected by mental illness. As such, there is a need for a more in depth understanding of how mental health may impact drug court outcomes for both men and women, or for the drug court population as a whole. This study focuses on the mental health status of male and female drug court participants and the role of mental health problems in predicting drug court completion. More specifically, this study addresses the following questions: 1. What is the mental health status of drug court offenders in this sample? 2. Do mental health status and drug court completion vary according to gender? 3. Do mental health problems at admission predict drug court completion?

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LITERATURE REVIEW According to some authors, using a conceptual framework to evaluate drug courts should include an examination of population severity (Goldkamp, White & Robinson, 2001). Such an evaluation entails looking at drug use and crime while also giving consideration to other client characteristics and behaviors that contribute to the overall severity level of the population. Prevalence of mental illness among a drug court population is one client characteristic proven to be valuable in assessing the severity of a drug court population (Longshore et al., 2001). Offenders who use drugs often have other serious mental and physical health problems that can negatively impact treatment program success. Consequently, failure to address mental health issues can have a damaging affect on outcomes for drug court participants (Belenko, 1999).

Mental Health Problems among Drug Court Offenders Researchers have documented high rates of mental health problems among general offender populations and specifically within populations of drug court offenders. The Drug Court Survey Report (Cooper, 1997) indicated that 60% of the drug court programs surveyed had participants who were suffering from depression, bipolar disorders, anxiety disorders, or psychosis. Belenko (2001) completed a synopsis of the mental health problems reported in the drug court research he evaluated. Overall, he found high rates of mental health problems among drug court participants as demonstrated in the following findings: For example, 40% of Mendocino County (CA) and 20% of the Syracuse (NY) clients reported a need for mental health services at the time of admission to drug court. Based on the Addiction Severity Index (ASI), 57% of Salt Lake County (UT) clients had an indication of a psychological problem, and 46% needed treatment for this problem. Nearly one-third (30%) of Butler County (OH) clients had received past psychiatric care, as did about 40% of Santa Barbara (CA) and 48% of Salt Lake County (UT) participants (p. 19). In a study examining psychiatric illness among drug court participants (n=60), Hagedorn and Willenbring (2003) found that over 40% of the sample reported moderate to severe depression and 35% reported being moderately to severely anxious. The study also found that many offenders had been previously diagnosed with depression (31.7%), had received treatment for psychiatric problems, (41.7%), had taken psychi-

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atric medications (35%) or antidepressants (30%), and had received inpatient (20%) or outpatient (35%) psychiatric care. Though research is limited, studies have found that female drug court participants have a higher rate of reported mental health problems than men do. According to D'Angelo and Wolf's (2002) research on the Brooklyn Treatment Court indicated that mental health problems were more prevalent in the female population than the male population. In fact, while 19% of men reported they had attempted suicide, been institutionalized or received counseling, 30% of the women reported the same. In their study of Missouri drug courts, Dannerbeck, Sundet, and Lloyd (2002) reported that female drug court program participants were statistically more likely to be dually diagnosed than male participants (23% versus 12% respectively). Moreover, these researchers indicated that the women and men differed in many ways and that these differences have important implications for treatment strategies.

Mental Health Services in Drug Courts On a national level, the Drug Courts Program Office codified the need for drug court programs to make mental health services available as a critical element to the drug court model. The fourth key component in Defining Drug Courts states that effective treatment delivery must provide access to a continuum of alcohol, drug, and other related treatment services (Drug Courts Program Office, 1997). The component further specifies that if treatment for alcohol and other drug problems is to be effective, it must call on mental health care resources. Thus, adherence to this key component of drug courts promotes comprehensive treatment of co-occurring problems among participants. Many state and local drug court programs also operate under the principle that substance abuse occurs simultaneously with other considerable problems that, if not addressed by the drug court, could inhibit an individual's recovery (Fielding, Tye, Ogawa, Imam, & Long, 2002). Although there is awareness that drug court programs should be comprehensive in addressing participants' needs, the incorporation of mental health services into programs has been slow and sporadic. Johnson-Listwan, Koetzle-Shaffer, and Latessa (2002) reported that while there was a need to target common problem areas such as mental health problems, treatment services for mental health needs of any kind are not provided in the majority of drug court programs surveyed. Indeed, although Cooper (1997) found high rates of mental health problems in the drug courts she evaluated, she reported that only 58% of the surveyed drug courts had specialized mental health treatment

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services available to drug court participants in need. Moreover, this report also indicated that drug court programs are generally ill-equipped to take on offenders who are dually diagnosed and few programs are capable of referring drug court offenders into inpatient treatment for longer than thirty days. The Brooklyn Treatment Court (BTC) was able to implement a mental health program for women drug court participants through a grant from the federal Center for Substance Abuse Treatment. The BTC worked to detect mental health problems in female participants at intake and to get them into treatment more swiftly (D'Angelo & Wolf, 2002; Harrell, Roman, & Sack, 2001). The BTC staff included an onsite mental health nurse practitioner whose job was to monitor offenders with mental illness and train drug court staff to address the mental health needs of their participants. Overall, however, an evaluation of this program indicated that one year after entering the drug court, there were no significant improvements in the psychiatric status of program participants (Harrell, Roman, & Sack, 2001). Based on the reported higher rates of mental illness found among female drug court offenders compared with their male counterparts, the needs of women in drug court who indicate mental health problems have been given greater attention than those of men. Yet, the extant literature has shown that a significant number of men also have mental health treatment needs. Furthermore, it is likely that both men and women with mental health problems will benefit from mental health treatment services delivered within the context of a drug court program. For example, the Brooklyn Treatment Court acknowledged that mental health problems are not solely a problem for women, but that drug court officials felt that improvements upon the mental health services would especially benefit women (D'Angelo & Wolf, 2002). Further investigation into the mental health problems of drug court offenders is needed so that more informed decisions can be made regarding the need and importance of mental health treatment services for this population. The current study addresses this gap in the literature by examining any differences in drug court completion for offender participants with and without co-occurring disorders of substance abuse and mental health. Specifically, it is hypothesized that drug court participants who report mental health problems (depression, anxiety, and/or being prescribed medication for a psychological or emotional problem in the thirty days prior to drug court) will be less likely to successfully complete drug court.

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DATA AND METHODS Data for this study come from a longitudinal study funded by the National Institute on Drug Abuse (NIDA) examining the influence of drug courts on treatment retention and post drug court outcomes. Over a period of four years, (2000-2003), the project recruited and interviewed 586 outpatient participants. The majority of participants (n=474) had been ordered to treatment by the Delaware Superior Court's drug court. The rest of the participants (n=112) served as a comparison group. They attended the same treatment programs as the drug court offenders, but were not ordered to do so by the drug court. Study participants were assigned to one of two drug court tracks-a diversion program for offenders arrested for their first drug offense not carrying a mandatory sentence, or a post-plea program for offenders on probation who are arrested for a new offense. Participants in each program attended treatment at one of four state-contracted providers located in New Castle County, Delaware. Treatment for most clients included psycho-educational programming (consisting primarily of substance abuse education), urine monitoring, group therapy, and individual counseling if required. All participants attend bi-weekly or monthly status hearings with their regular drug court judge. Graduation from the drug court program is contingent upon successful completion of all program requirements and the approval of the drug court judge. For a more complete description of the Delaware Superior Court drug court programs please see Butzin, Saum, and Scarpitti (2002). Respondents in the sample were recruited by treatment program staff upon entry into the drug court program. At this time, those who were interested in participating in the project signed a consent form so that, upon discharge, project staff can gather data from their treatment files. Field data that was collected includes the Addiction Severity Index (ASI), admission and discharge reports, program details (including urinalysis results, treatment session attendance) and locating information. At the end of their program participation, all study clients (both those who completed drug court and those who did not) were contacted to take part in a Client Satisfaction Survey (CSS) interview for which they were paid $20. In addition, program participants were contacted for post program follow-up interviews 12 and 24 months after drug court discharge. All interviews were voluntary and were conducted by trained interviewers. Study respondents' privacy was protected by a Certificate of Confidentiality from NIDA. The subjects of focus for the current study were 449 drug court offenders who had completed the CSS interview and for whom data was

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collected from treatment center files. Comparison group participants were excluded from the present analysis due to the focus on mental health problems of drug court offenders.

Methods The variable gender refers to the sex of the respondents and was collected from admission reports in the treatment program files. Gender was coded 0 for male and 1 for female. Age refers to the age of the respondent at time of entry into the drug court program and was collected from admission reports in the treatment program files. Age is measured as a ratio level variable. The variable race refers to the racial identity that was recorded from treatment program admission reports. For purposes of analyses, race was grouped into two categories: White and non-White. Almost all respondents identified with a White or Black race, therefore, the few respondents who identified themselves as something other than Black or White were grouped with Black respondents into the non-White category. A dummy variable was created: 0 for Non-white and 1 for white. The variable education refers to the total number of years of education ever received by the respondent and was collected from admission reports. Substance abuse severity refers to the number of days a respondent used his or her primary drug of choice in the 30 days prior to entering the drug court program. This measure of drug use is self reported and is collected from the admission reports in the treatment program files. Substance abuse severity is measured as a ratio level variable with the possible values ranging from 0 to 30. Criminal history refers to the total number of times a respondent has been arrested prior to entering the drug court program. The measure of criminal history is self reported and is collected at intake from the Addiction Severity Index (described briefly below). All of the measures of mental health were collected from the Addiction Severity Index (ASI). The ASI is a tool which assesses seven different domains of psycho-social functioning. Three questions from the ASI section on psychiatric status are used in these analyses. The use of individual items from the ASI has been tested for reliability and validity (Treatment Research Institute, 1990). Any depression in the past 30 days refers to self-reported feelings of depression within the 30 days prior to entering the drug court program. This measure of depression was dummy coded 0 for no reported depression and 1 for presence of depression. Any anxiety in the past 30 days refers to self-reported feelings of anxiety within the 30 days prior to entering the drug court program. The measure of anxiety was dummy coded 0 for no reported

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anxiety and 1 for presence of anxiety. Any medication for psychological problems or emotional problems in the past 30 days refers to self-reported prescribed medication for psychological or emotional problems 30 days prior to entering treatment. The measure was dummy coded 0 for no reported prescription and 1 for having medication prescribed. Completion status refers to the outcome of a particpants' stay in the drug court program. Completion status is collected from discharge reports in the treatment program files. For purposes of this study, completion status is defined as 0 for unsuccessful (including official terminations and program absconders) or 1 for successful (i.e. graduation). Participants who were neutrally discharged due to medical problems were excluded from the analysis.

ANALYSIS Bivariate comparisons (between client characteristics and drug court completion and mental health variables and gender) were performed using chi-square analysis for categorical variables and t-tests for continuous variables. Logistic regression analysis was utilized to allow for the simultaneous examination of the independent variables as predictors of completion status.

RESULTS Women comprised approximately one-quarter of the total sample. About 44% of the sample identified themselves as White, with nonWhites accounting for the other 56%. The mean age of the sample was 28.9 with a standard deviation of 9.9. The sample completed a mean of 11.6 years of education, with a standard deviation of 1.6. Respondents reported drug use in the thirty days prior to entering the drug court program at a mean of 3.2 days with a standard deviation of 7.2. With regard to criminal history, the sample reported a mean number of 1.8 arrests in their lifetime with a standard deviation of 3.0. Approximately, 18% of the offenders in this sample reported feelings of depression in the thirty days prior to starting the drug court program. A similar percentage of respondents (19%) reported feelings of anxiety in the thirty days before entering drug court. Fewer drug court participants indicated that they had been prescribed medication for psychological or emotional problems in the thirty days prior to starting drug court (8.3%). Altogether, just under one-third (30.3%) of the offenders reported at least one of the three mental health problems. Finally, 67% of the sample successfully completed the drug court treatment program.

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Analyses were performed to determine if any of the independent variables were statistically associated with the dependent variable, drug court completion status, and results are reported in Table 1. Findings indicated that completion was significantly related to gender, race, education, drug use severity, criminal history, depression, and having been prescribed medication. Age and anxiety were not significant predictors of completion status.

TABLE 1 Drug Court Completion by Client Characteristics (N=449) Client Characteristics Gender* Males Females Race*** White Non-white Depression* Anxiety Prescription*** Age (mean years) Education (mean years)*** Drug Use Severity (mean days)*** Criminal History (mean arrests)***

Completers

Non-Completers

64.9% 35.1

76.2 23.8

76.0% 24.0% 15.3% 20.1% 11.6% 28.9 11.8 2.3 1.32

60.5 39.5 23.9% 17.4% 1.5% 28.8 11.3 5.1 2.7

* p<.05, *** p<.001 Both women drug court clients and white drug court clients were more likely to complete the drug court program. Drug court participants with more education were also more likely to complete the program. Drug use severity was related to completion status in that those who did not complete treatment used twice as many days in the 30 days prior to entering the program. Additionally, noncompleters had double the number of prior arrests. Two mental health variables were significant predictors of completion-depression and prescribed medication. Drug court participants who reported feeling depressed at the time of entry into the program were less likely to complete the program. In all, 57% of those who reported feeling depressed completed the program, compared with nearly 70% of those who did not report feeling depressed (/)<.05). Interestingly, those who reported having been prescribed medication for mental health problems were more likely to complete the program. Approximately 94% of those prescribed a medication completed drug

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court, while only 65 % of those who did not report having a prescription completed the program (p<.001). The bivariate relationships between gender and the mental health variables were also examined (See Table 2). The analyses revealed that depression, anxiety, and having been prescribed medication for psychological or emotional problems were significantly related to gender. With regard to depression, female respondents were much more likely to report feelings of depression. Approximately 40% of the women reported feeling depressed compared to only about 18% of the men (p<.001). A similar gender breakdown was found for anxiety--37% percent of the women reported feelings of anxiety in the 30 days prior to entering the drug court, while 18.8% of the men reported the same (p<.001). A large gender difference was also apparent for the prescription drug variable. Nearly 24% of the females in the sample reported having been given a prescription in the 30 days prior to treatment, while only 6.1% of the males in the sample reported the same (p<.001).

TABLE 2 Mental Health Variables by Gender (N=449) Mental Health Variable Depression*** Anxiety*** Prescription *** *** p<.00l

Males (%)

Females (%)

17.9 18.8 6.1

39.1 37.1 23.5

A logistic model was tested which included the sociodemographic, drug use and crime variables, and the mental health indicators. The results for the logistic model that regressed completion on gender, age, education, race, drug use severity, criminal history, depression, anxiety, and having a prescription are presented in Table 3. A -2 Log Likelihood of 446.171 indicates that the model is a good fit for the data. With a chi-square of 8.43 and a p value of .393, the Hosmer and Lemeshow Test indicates that the logistic regression is a useful statistical tool in explaining the relationship between treatment completion and the independent variables included in this model. Race, drug use severity, criminal history, and two of the mental health indices were statistically significant predictors of completion. For race, Whites were much more likely to successfully complete drug court. The odds of completing drug court successfully for White participants were 118.3% higher than for non-Whites while controlling for the other independent variables. With regard to drug severity, the odds of completing drug court decreased by 6% for each day of drug use in the

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TABLE 3 Logistic Regression Model: Client Characteristics and Mental Health Variables Influencing the Likelihood of Drug Court Completion. Variable B Gender -0.521 Age -0.011 Education 0.149 Race** 0.781 Drug Use Severity*** -0.062 Criminal History*** -0.194 Depression* -0.802 Anxiety 0.511 Prescription* 1.935 X2.** * p<.05, ** p<.01, *** p<.001

SE .301 .012 .081 .248 .016 .044 .352 .368 .797 73.658

Wald 2.998 0.940 3.381 9.883 14.318 19.214 5.201 1.933 5.894

Exp (B) 0.594 0.989 1.160 2.183 0.940 0.823 0.448 1.667 6.922

thirty days prior to entering the program. In terms of criminal history, for every additional arrest, the odds of drug court completion decreased by 17.7%. The model also indicated that two of the three mental health indices included were significant predictors of drug court completion. For drug court participants who reported feeling depressed in the thirty days prior to entering the program, the odds of completing treatment were 55.2% lower than for participants who did not report feelings of depression. For drug court participants who reported having been given a prescription medication for psychological or emotional problems in the thirty days prior to entering drug court, completion was about 700% more likely compared with those who did not report having a prescription.

DISCUSSION This research on offender participants in a Delaware drug court program accomplished the stated goals of (a) establishing the mental health status of this sample, (b) determining whether there was variation in mental health status and/or drug court outcome according to gender, and (c) examining if differences in drug court completion could be predicted by three indicators of mental health at program entry. A fairly substantial percentage of the sample (about 30%) reported to have had at least one mental health problem in the 30 days prior to drug court entry. Specifically, 18% reported depression, 19% reported anxiety and 8% reported having been prescribed medication

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for a psychological or emotional problem. There were gender differences that were similar to findings in previous research--the women drug court participants reported having experienced mental health problems two to four times more often than the men participants did. At the bivariate level, drug court completion varied by gender, as women overall were more likely to complete the program than were men. However, this relationship was not maintained at the level of statistical significance in the multivariate analysis. The logistic model revealed that other factors were potentially more important in terms of understanding what types of participants complete drug court. The multivariate results revealed that some pre-program measures of mental health status were statistically significant predictors of program completion. As anticipated, depression was related to negative completion. Those who reported depression were statistically less likely to successfully complete the drug court program than those who did not. However, contrary to what was expected, those participants who reported being prescribed medication were actually more likely to successfully complete drug court than those who did not report being prescribed medication. No relationship was found between reported feelings of anxiety and drug court outcome. The research presented here moves the literature forward by demonstrating a relationship between two mental health indicators and drug court completion. The finding that offenders who report feeling depressed in the thirty days prior to entering treatment are less likely to complete drug court has considerable implications. Knowing this information at treatment program entry would allow interventions and the provisions of services that aim to improve the client's health. Thus, if a client's depression was hindering his or her ability to make progress in treatment, addressing this condition may result in a greater likelihood of completing drug court and increase the likelihood of post drug ceurt success. Indeed, recent meta-analysis of 44 methodologically rigorous research studies provides strong evidence for the effectiveness of integrating the treatment of depression and substance abuse treatment (Nunes & Levin, 2004). The finding that drug court participants who were prescribed drugs for psychological or emotional problems were more likely to complete the program is of further significance. Having a recent prescription indicates that a client has been under care for a mental health problem and that the client may have continued contact with a medical professional It is probable that individuals who are treated for their mental health issues are at an advantage over untreated drug court participants with mental health concerns because they are already addressing a

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problem that may have been related to their illicit drug use and/or their placement into drug court. A potential limitation of this study was the limited measure of mental health status. The three self-reported indicators of mental health that were utilized may not have captured the extent or severity of the offenders' mental health problems. For example, it is impossible to know which participants were prescribed medications for more severe conditions such as schizophrenia or bipolar disorder and which participants were treated for more common, potentially less severe emotional problems such as general depression or anxiety. Moreover, as with social science research that asks participants to reveal personal and often sensitive information, a client may be unwilling to acknowledge the presence of mental health issues and underreporting may occur.

Based on the findings, it is critical that drug court programs provide mental health screenings and services or linkages with mental health providers so that drug courts can better meet the needs of both its female and male participants and those of the increasingly diverse offender participants entering drug courts across the nation. Indeed, drug court programs must move beyond the mere notion that offenders will do better if their needs (beyond substance abuse treatment) are addressed and begin to implement these changes. Although this is a complicated task in terms of funding, planning and coordinating of services, drug courts, much more so than traditional criminal justice programs, have the ability to realize these goals. Moreover, new federal legislation including the Mentally Ill Offender Treatment and Crime Reduction Act of 2004, which aims to support collaborative efforts between criminal justice and mental health agencies at the state and local levels, can support such efforts. This study has raised further questions and suggested new avenues for investigation. Future research should include multiple (and if possible, clinical) indices of mental health, examine variations for offenders being treated for psychological or emotional problems through a variety of modalities (as opposed to medication only), and should further investigate the influence of gender on the ability of mental health problems to predict drug court completion and other drug court outcomes.

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Belenko. S. (2001). Research on drug Courts: A critical review. New York: Columbia University. Butzin, C. A., Saum, C. A., & Scarpitti, F. R. (2002). Factors associated with completion of a drug court diversion program. Substance Use and Misuse, 37, 1615-1633. Compton, W. M., Cottler, L. B., Jacobs, J. L., Ben-Abdallah, A., & Spitznagel. E. L. (2003). The role of psychiatric disorders in predicting drug dependence treatment outcomes. American Journal of Psychiatry, 160. 890-895. Cooper, C. S. (1997). 1997 Drug court survey report. Washington, D.C.: United States Department of Justice. D'Angelo, L. & Wolf, R. V. (2002). Women and addiction: Challenges for drug court practitioners. The Justice System Journal, 23, 385-400. Dannerbeck, A., Sundet P., & Lloyd K. (2002). Drug courts: Gender differences and their implications for treatment strategies. Corrections Compendium, 27(12), 1-10. Drug Courts Program Office. (1997). Defining drug courts: The key components. Washington, D.C.: U.S. Department of Justice. Fielding, J. E., Tye G., Ogawa P. L., Imam I. J. & Long, A. M. (2002). Los Angeles County drug court programs: Initial results. Journal of Substance Abuse Treatment, 23, 217-224. Goldkamp, J. S., White M. D., & Robinson J. B. (2001). Do drug courts work? Getting inside the drug court black box. Journal of Drug Issues, 31, 27-72. Gossweiller, R. S., & Martin, S. S. (1996). The role of personality in treatment outcome for drug involved offenders. International Journal of Sociology and Social Policy, 16(5/6), 131-155. Gottfredson, D. C., Kearley, B. W., Najaka, S. S., & Rocha, C. M. (2005). The Baltimore city drug treatment court: 3-year self-report outcome study. Evaluation Review, 29, 42-64. Hagedorn, H., & Willenbring, M. (2003). Psychiatric illness among drug court probationers. American Journal of Drug and Alcohol Abuse, 29, 775-788. Harrell, A., Roman, J. & Sack, E. (2001). Drug court services for female offenders, 19961999: Evaluation of the Brooklyn treatment court. Justice Policy Center, Urban Institute. Jainchill, N., De Leon, G., & Pinkham, L. (1986). Psychiatric diagnosis among substance abusers in therapeutic community treatment. Journal of Psychoactive Drugs, 18, 209-213. Johnson-Listwan, S., Koetzle-Shaffer, D., & Latessa, E. J. (2002). The drug court movement: Recommendations for improvements. Corrections Today, 64(5), 52-57. Langan, N.P., & Pelissier, B.M. (2001). Gender differences among prisoners in drug treatment. Journal of Substance Abuse Treatment, 13, 291-301. Longshore, D., Turner, S., Wenzel, S., Morral A., Harrell A., McBride, D., Deschenes, E., & Iguchi, M. (2001). Drug courts: A conceptual framework. Journal of Drug Issues, 31, 7-26. Mateyoke-Scrivner, A., Webster, J. M., Staton, M., & Leukefeld C. (2004). Treatment retention predictors of drug court participants in a rural state. American Journal of Drug and Alcohol Abuse, 30, 605-626. Nunes, E. V., & Levin, F. R. (2004). Treatment of depression in patients with alcohol or other drug dependence: A meta-analysis. Journal of the American Medical Association, 291, 1887-1896.

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Peters, R. H., & Murrin, M. R. (2000). Effectiveness of treatment-based drug courts in reducing criminal recidivism. Criminal Justice and Behavior, 27, 72-96. Saum, C. A., Scarpitti, F. R., & Robbins, C. A. (2001). Violent offenders in drug court. Journal of Drug Issues, 31, 107-128. Sechrest, D. K., & Shicor, D. (2001). Determinants of graduation from a day treatment drug court in California: A preliminary study. Journal of Drug Issues, 31, 129-148. Substance Abuse and Mental Health Services Administration. (2002). Report to Congress

on the prevention and treatment of co-occurring substance abuse disorders and mental disorders. U.S. Department of Health and Human Services. Taxman, F. S. (1999). Unraveling 'what works' for offenders in substance abuse treatment services. National Drug Court Institute Review, 2, 93-134. Treatment Research Institute. (1990). Addiction severity index manual and question by question guide. The University of Pennsylvania/Veterans Administration Center for Studies of Addiction.