The Role of Legal Coercion in the Treatment of Offenders with Alcohol and Heroin Problems*
| DOI | 10.1177/000486589703000201 |
| Date | 01 August 1997 |
| Author | Wayne Hall |
| Published date | 01 August 1997 |
| Subject Matter | Articles |
The Role of Legal Coercion in the
Treatment of Offenders with Alcohol
and Heroin Problems'
Wayne Hal/f
This article discusses the ethical justification
for,
and
reviews the American
evidence on the effectiveness of, treatment for alcohol
and
heroin
dependence that is provided under legal coercion to offenders whose
alcohol
and
drug dependence has contributed to the commission
of
the
offence with which they have been charged or convicted. Thearticle focuses
on legally coerced treatment for drink-driving offenders
and
heroin-dependentproperty offenders. It outlines the variousarguments that
have been made for providing such treatmentunder legal coercion} namely:
the over-representation
of
alcohol
and
drug dependent persons in prison
populations; the contributory causal role
of
alcohol and other drug problems
in the offences that lead to their imprisonment,· the high rates of relapse to
drug use
and
criminal involvement after incarceration; the desirability
of
keeping injecting heroin users out
of
prisons as a way
of
reducing the
transmission
of
infectious diseases such as HIV and hepatitis; and the
putatively greater cost-effectiveness
of
treatment compared with
incarceration. The ethical objections to legally coerced drug treatment are
briefly discussed before the evidence on theeffectiveness
of
legally coerced
treatment for alcohol and other drug dependenceis reviewed. The evidence}
which is primarily from the
USA}
gives qualified support for some forms
of
legally coerced drug treatment, provided that these programs are well
resourcecl, carefully implementecl, and their performance is monitored to
ensure that they provide a humane
and
effective alternative to
imprisonment. Expectations about what these programs can achieve also
need to be realistic.
Legally coerced drug and alcohol treatment is treatment entered into by
persons charged with or convicted of an offence to which their alcohol or drug
dependence has contributed. It is most often provided as an alternative to
imprisonment, and usually under the threat of imprisonment if the person fails
to comply with the requirements of treatment. The use
of
legal coercion to
encourage alcohol and drug dependent offenders to undergo treatment for their
alcohol and drug problems has been apopular alternative to imprisonment
over the past 60 years in the US (Leukefeld &Tims 1988) and for the past 20
or so years in Australia (eg Carney 1987; Schlosser &Bush 1983). Treatment
under coercion has become a
common
way
of
dealing with drink driving
offenders; it has also been increasingly used as an alternative to imprisonment
for drug and property offenders who are dependent on heroin and other illicit
drugs.
The
expansion
of
such programs was most recently recommended by
*Received: 16 February 1996; accepted in revised form: 31 January 1997. An earlier version
of this paper was presented to the Second Annual Symposium of NSW Corrections Health
Service on 'Drug Related Crime', Sydney,
21-22
September 1995.
tPhD, Professor and Director, National Drug and Alcohol Research Centre, University of
New South Wales, Sydney 2052.
103
104 (1997) 30 The Australian and New Zealand Journal of Criminology
the Pennington Committee in Victoria as a way of preventing the correctional
system from being overwhelmed by drug offenders (Premier's Drug Advisory
Council 1996).
The case for treatment under coercion
One
of
the major justifications for drug treatment under coercion is that the
alcohol and drug dependence of some offenders contributes to the commission
of
the offence with which they have been charged or convicted, and that
treatment under coercion is an effective way
of
treating their drug dependence
and thereby reducing the likelihood
of
their re-offending (Inciardi &
McBride 1991). The causal connection between drug dependence and criminal
offences is least contentious in the case
of
drink driving offences where
driving with a blood alcohol level above the prescribed limit is defined for
very good public health reasons as an offence (Homel 1990).
The connection between dependent heroin use and property crime is more
contentious. There is no doubt that offenders who are dependent on heroin are
over-represented in the Australian prison population (Pedic 1990;
Stathis 1991; Stathis, Bertram &Eyland 1991). Estimates derived from
surveys
of
drug use among new receptions in Australia suggest aprevalence
of
injecting drug use (usually heroin)
of
18% to 23% of men (Gaughwin,
Douglas &. Wodak 1991; Potter &Connolly 1990; Stathis et al 1991).
Prevalence estimates derived from cross-sectional surveys are higher still:
36% to 42% for men (Gaughwin et al 1991) and 70% among women (Gorta
&Miner 1986). These estimates compare with estimates
of
the prevalence
of
heroin dependence in the Australian population of 0.4% to 0.7%
of
adults
(Hall 1996).
The relationship between heroin dependence and property crime is more
controversial. Heroin dependence is not a simple and direct cause
of
crime
(Hammersley, Forsyth, Morrison &Davies 1989) since most Australian heroin
users commit criminal offences before they begin to use heroin (Dobinson &
Ward 1985, 1987; Hall, Bell &Carless 1993). The evidence is nonetheless
reasonably persuasive that the development of heroin dependence intensifies
criminal involvement (Ball, Shaffer &Nurco 1983; Dobinson &Ward 1985,
1987; McGlothlin, Anglin &Wilson 1978). Moreover, there is reasonable
Australian evidence that methadone maintenance treatment reduces illicit
heroin use and criminal activity while users remain in treatment (Bell, Hall &
Bythe 1992; Ward, Mattick & Hall 1992). There is also evidence from the
USA that other forms of drug treatment similarly reduce heroin use and crime
(Gerstein &Harwood 1990; Hubbard, Collins, Rachal &Cavanaugh 1988).
The case for treating heroin dependent offenders under coercion is
reinforced by evidence they are very likely to relapse to drug use on their
release, and hence to re-offend and return to prison (Gerstein &
Harwood 1990; Thompson 1995). If the community wishes to reduce relapse
to heroin use and criminal recidivism, and since treatment reduces relapse to
heroin use, then coerced treatment provides an alternative to imprisonment
that may reduce recidivism.
The advent
of
HIV/AIDS has provided an additional argument for treating
rather than imprisoning heroin dependent offenders. Prisoners who have
injected heroin are at higher risk of having contracted HIV and hepatitis by
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