title: Impact of jail sanctions during drug court participation upon substance abuse treatment completion.
abstract: OBJECTIVE
  This study of participants in a US drug treatment court describes the relationship between the imposition of short-term jail sanctions and substance abuse treatment dropout, and examines offender characteristics moderating or modifying the impact of jail sanctions on treatment dropout.
  
  
  METHODS
  Data were derived from administrative information collected by the Dane County Wisconsin Drug Treatment Court from 1996-2004 on all 573 participants achieving a final disposition of treatment completion or failure during those program years. Iterative Cox proportional hazards models of time to treatment failure were created; jail sanctions during drug court participation were framed as time-dependent covariates. A theoretical framework and specific statistical criteria guided construction of a final parsimonious model of time to treatment drop-out.
  
  
  RESULTS
  Treatment failure was associated with unemployment [hazard ratio (HR) in unemployed versus employed = 1.41, P-value 0.0079], lower educational attainment (HR in high school non-graduate versus graduate = 1.41, P = 0.02) and application of the first jail sanction (HR 2.71, P < 0.001). The association between treatment failure and a first sanction was considerably stronger for sanctions administered earlier in participation (HR for sanction 1 at <30 days 11.34, P-value 0.0002). Conclusions  An initial jail sanction for non-adherence may be more likely to foster treatment compliance in less refractory individuals (i.e. those not already acclimated or socialized to incarceration or other corrections interventions). More stringent supervisory conditions and individualized services may be required to reintegrate such offenders and promote longer-term public safety.
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Department of Family Medicine, Madison, WI, USA. randy.brown@fammed.wisc.edu
authors.forename: Randall T
authors.initials: RT
authors.lastname: Brown
authors.forename: Paul A
authors.initials: PA
authors.lastname: Allison
authors.forename: F Javier
authors.initials: FJ
authors.lastname: Nieto
mesh_terms: D015986:Confounding Factors, Epidemiologic; D057237:Criminals / Q000523:psychology / Q000706:statistics & numerical data; D055030:Drug Users / Q000523:psychology / Q000706:statistics & numerical data; D004522:Educational Status; D005260:Female; D006801:Humans; D035846:Law Enforcement; D008297:Male; D037141:Mandatory Programs; D008962:Models, Theoretical; D010349:Patient Compliance; D010352:Patient Dropouts / Q000523:psychology / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D019966:Substance-Related Disorders / Q000523:psychology / Q000534:rehabilitation*; D013997:Time Factors; D017211:Treatment Failure; D014478:Unemployment / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology