Are Non-Pharmacological Interventions Effective in Reducing Drug Use and Criminality? A Systematic and Meta-Analytical Review with an Economic Appraisal of These Interventions.
Background:The numbers of incarcerated people suffering from drug dependence has steadily risen since the 1980s and only a small proportion of these receive appropriate treatment. A systematic review to evaluate the effectiveness and economic evidence of non-pharmacological interventions for drug using offenders was conducted.Methods:Cochrane Collaboration criteria were used to identify trials across 14 databases between 2004 and 2014. A series of meta-analyses and an economic appraisal were conducted.Results: 43 trials were identified showing to have limited effect in reducing re-arrests RR 0.97 (95% CI 0.89-1.07) and drug use RR 0.90 (95% CI 0.80-1.00) but were found to significantly reduce re-incarceration RR 0.70 (95% CI 0.57-0.85). Therapeutic community programs were found to significantly reduce the number of re-arrests RR 0.70 (95% CI 0.56-0.87). 10 papers contained economic information. One paper presented a cost-benefit analysis and two reported on the cost and cost effectiveness of the intervention.Conclusions:We suggest that therapeutic community interventions have some benefit in reducing subsequent re-arrest. We recommend that economic evaluations should form part of standard trial protocols.
Department of Health Sciences, Mental Health and Addictions Research Group, ARRC Building, 2nd Floor, University of York, Heslington, York YO10 5DD, UK. amanda.perry@york.ac.uk.
Amanda E
AE
Perry
Department of Health Sciences, Mental Health and Addictions Research Group, ARRC Building, 2nd Floor, University of York, Heslington, York YO10 5DD, UK. Rebecca.woodhouse@york.ac.uk.
Rebecca
R
Woodhouse
Department of Health Sciences, Mental Health and Addictions Research Group, ARRC Building, 2nd Floor, University of York, Heslington, York YO10 5DD, UK. mjneilson@gmail.com.
Matthew
M
Neilson
Health Economics and Decision Science, School for Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK. m.martyn-stjames@sheffield.ac.uk.
Marrissa
M
Martyn St James
York Health Economics Consortium Ltd., Enterprise House, Innovation Way, University of York, York YO10 5NQ, UK. Julie.glanville@york.ac.uk.
Julie
J
Glanville
York Trials Unit and NIHR RDS YH, Department of Health Sciences, Faculty of Science, ARRC Building, University of York, Heslington, York YO10 5DD, UK. catherine.hewitt@york.ac.uk.
Catherine
C
Hewitt
Department of Health Sciences, Mental Health and Addictions Research Group, ARRC Building, 2nd Floor, University of York, Heslington, York YO10 5DD, UK. dominic.trepel@york.ac.uk.
Dominic
D
Trépel
drug treatment; economic appraisal; offenders; systematic review
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