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Urban Institute National Drug Court Evaluation 2011

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Chapter	4	


JUNE 2011

Shelli B. Rossman, The Urban Institute
John K. Roman, The Urban Institute
Janine M. Zweig, The Urban Institute
Michael Rempel, Center for Court Innovation
Christine H. Lindquist, RTI International


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The Urban Institute
Janeen Buck Willison
P. Mitchell Downey
Jennifer Yahner
Center for Court Innovation
Dana Kralstein
Mia Green
Kelli Henry
RTI International
Kristine Fahrney
With Avinash S. Bhati, Donald J. Farole Jr., Erica Lagerson, Joshua
Markman, and Courtney Schafer


Justice Policy Center

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Justice Policy Center

The views expressed are those of the authors and should
not be attributed to the Urban Institute, its trustees, or its


© 2011 Urban Institute
This project was supported by Award No. 2003-DC-BX-1001, awarded by the National Institute
of Justice, Office of Justice Programs, U.S. Department of Justice. The opinions, findings, and
conclusions or recommendations expressed in this publication are those of the author(s) and do
not necessarily reflect those of the Department of Justice.

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The National Institute of Justice’s (NIJ) Multi-Site Adult Drug Court Evaluation (MADCE)
entailed multi-site, multi-year process, impact, and cost-benefit data collection, analysis, and
reporting that required the collaboration of numerous individuals and organizations to whom we
extend our appreciation for their contributions to the successful completion of this study.
In particular, we thank the Office of Justice Programs for its support through the Drug Court
Discretionary Grant Program, and for other support from the Bureau of Justice Assistance. We
also are deeply indebted to the judges, drug court coordinators, and staff of drug courts, as well
as the administrators and staff of the comparison jurisdictions, whose efforts form the foundation
without which this research would not have been possible:
Osceola County Drug Court⎯Kissimmee, FL
Volusia County Adult Drug Court Program⎯Deland, FL
Fulton County Drug Court⎯Atlanta, Georgia
Hall County Drug Court⎯Gainesville, GA
Cook County Drug Court Rehabilitation Alternative Program (R.A.P.)⎯Chicago, IL
Kane County Rehabilitation Court⎯St. Charles, IL
New York
Auburn Drug and Alcohol Treatment Court⎯Auburn, NY
Batavia City Drug Treatment Court⎯Batavia, NY
City of Niagara Falls Drug Treatment Court⎯Niagara Falls, NY
Finger Lakes Drug Court (Canandaigua City)⎯Canandaigua, NY
Finger Lakes Drug Court, Felony Division (Ontario County)⎯Canandaigua, NY
Lackawanna City Drug Court⎯Lackawanna, NY
Syracuse Community Treatment Court⎯Syracuse, NY
Wayne County Drug Treatment Court⎯Lyons, NY
Chester County Drug Court⎯West Chester, PA
Philadelphia Treatment Court⎯Philadelphia, PA
South Carolina
York County Drug Treatment Court⎯York, SC



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CHART Court (Snohomish County)⎯Everett, WA
King County Drug Diversion Court⎯Seattle, WA
Kitsap County Adult Drug Court⎯Port Orchard, WA
Pierce County Felony Drug Court⎯Tacoma, WA
Thurston County Drug Court Program⎯Olympia, WA
Comparison Sites
Human Services Associates, Inc.⎯Orlando, FL
Stewart-Marchman Center for Chemical Independence⎯Daytona Beach, FL
Illinois TASC⎯Chicago, IL
Judicial Division 3, North Carolina Probation⎯NC
Judicial Division 4, North Carolina Probation⎯NC
Pierce County Drug Offender Sentencing Alternative and Breaking the Cycle⎯Tacoma, WA
We further acknowledge the contributions and assistance of the National Crime Information
Center at the Federal Bureau of Investigation for providing data from the Interstate Identification
Index (III) System. Similarly, we thank the Florida Department of Law Enforcement (FDLE),
Georgia Bureau of Investigation, Illinois Criminal Justice Information Authority (ILCJIA), New
York State Division of Criminal Justice Services (DCJS), North Carolina Department of Justice,
North Carolina Department of Correction, Pennsylvania Commission on Crime and Delinquency
(PCCD), Pennsylvania Department of Corrections, South Carolina Office of Research and
Statistics (SCORS), Washington Department of Corrections, and the State of Washington
Administrative Office of the Courts for the provision of state-level official records data. We are
also grateful to the county jails and state departments of corrections and their staffs that
facilitated our ability to perform follow-up survey data collection with respondents who were
incarcerated at the time their interviews were scheduled. The authors are solely responsible for
any errors in the use of these data.
During the course of this study, we had the good fortune to be guided by Janice Munsterman, our
initial NIJ technical monitor and subsequently Director of the State Justice Institute; Christopher
Innes, former Chief of the Justice Systems Research Division at NIJ and currently Chief of
Research and Evaluation at the National Institute of Corrections; and Linda Truitt, who ably
served as our NIJ technical monitor throughout most years of MADCE. We convened three
working group meetings with public and private substantive and technical experts in April 2004,
February 2006, and May 2009. We greatly appreciate the assistance and support we received

Jennifer Columbel, formerly with the Bureau of Justice Assistance and currently at the
National Association of Drug Court Professionals
Donald J. Farole, Jr., Bureau of Justice Statistics
Michael Finigan, NPC Research
Gerald Gaes, Florida State University


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Adele Harrell, former director of the Justice Policy Center at The Urban Institute
Pamela Lattimore, RTI International
Akiva Liberman, formerly with NIJ and currently at The Urban Institute
Douglas Marlowe, Treatment Research Institute at the University of Pennsylvania
Antonio-Morgan Lopez, RTI International
Ruby Qazilbash, Bureau of Justice Assistance
David B. Wilson, Criminology, Law, and Society at George Mason University
Philip Wirtz, School of Business and Public Management at The George Washington
Douglas Wissoker, The Urban Institute

Aside from the authors, many staff of UI, RTI, and CCI supported this effort. We thank Nancy
LaVigne, Director of the UI Justice Policy Center, and Terry Dunworth, former center director,
for supporting this project from initiation through completion of the final report. We thank
Ritahdi Chakravarti, Aaron Chalfin, Dionne Davis, Douglas Gilchrist-Scott, Rayanne Hawkins,
Shalyn Johnson, Michael Kane, Carly Knight, Aaron Morrissey, Kevin Roland, and David
D’Orio for their respective contributions in providing data collection, analytic, and
administrative assistance to this effort. Lastly, we extend our thanks to the field coordinators and
field supervisors, whose dedication to conducting baseline and follow-up interviews was critical
to the research effort.



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The	Multi‐Site	Adult	Drug	Court	Evaluation:	Executive	Summary
Drug courts emerged spontaneously during the late 1980s and early 1990s in response to
burgeoning drug offender arrests and prosecutions that overwhelmed the capacity of numerous
courts to expeditiously process such cases. In 2002, the National Institute of Justice (NIJ)
commissioned the first adult drug court evaluation that would select multiple sites from across
the country. In 2003, researchers from the Urban Institute’s Justice Policy Center (UI-JPC), RTI
International (RTI), and the Center for Court Innovation (CCI) teamed to conduct NIJ’s MultiSite Adult Drug Court Evaluation. The main objectives were as follows:

Test whether drug courts reduce drug use, crime, and multiple other problems associated
with drug abuse, in comparison with similar offenders not exposed to drug courts.


Address how drug courts work and for whom by isolating key individual and program
factors that make drug courts more or less effective in achieving their desired outcomes.


Explain how offender attitudes and behaviors change when they are exposed to drug
courts and how these changes help explain the effectiveness of drug court programs.


Examine whether drug courts generate cost savings.

This report provides an overview of the research design and key findings from the impact and
cost-benefit evaluations, and identifies implications for policy and practice.

The	MADCE	Research	Design	
Despite the centrality of reducing drug use, most prior drug court evaluations relied on
recidivism as the sole measure of impact. The MADCE, however, was planned to measure
multiple outcomes (crime, drug use, socioeconomic outcomes, family functioning, and mental
health) and to capture the intervening role of court policies and practices, offender perceptions,
and interim compliance with program requirements (see Figure ES-1).
The MADCE used a quasi-experimental design for which we conducted an extensive site
selection process to identify drug court and comparison sites that met basic evaluability criteria
and collectively reflected substantial variation in key drug court policies and practices.

MADCE Executive Summary


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Figure ES-1. MADCE Conceptual Framework
Drug Court Context

Target Population

Drug Court Practices

Community Setting

Drug Use

Use of Legal Pressure


-Addiction severity

-Severity of consequences for failure


-Drugs of abuse

-Drug arrest rate

-Drug use history

-Poverty / economics

Drug Laws
-Mandatory sentences
-Drug law severity

Court Characteristics
-Court size

-Felony /
misdemeanor charge
-Recidivism risk —
prior arrests /
-Opportunity to offend
(street days)

-Court resources

Other Risk Factors
-Health problems
-Mental health problems
-Employment problems
-Housing instability
-Family conflict
-Family support
-Close ties to drug users
-Close ties to

Individual Court Experiences
-Drug Court participation

-Age, gender, race
-Marital status, children
-Education, income

In-Program Behavior

Post-Program Outcomes

Perceived Legal

Compliance with
Drug Intervention

Reduced Drug Use

-Severity and
likelihood of
termination and
alternative sentence

-Likelihood of entry
-# and type of drug
test violations

-Drug testing requirements,


-% treatment days

-Sanctions rules, practices

-Readiness to change

-Treatment duration &

-Supervision requirements/practices
-Prosecution involvement
-Interactions with judge and
supervising officers

Understanding of

-Court appearances

-Received expected
sanctions & rewards

Drug Court Practices

-Understood expected

-Program intensity

graduation &

-Reduction in health and
mental health problems

-Admission requirements

-Certainty/severity of
-Certainty & value of

-Drug Court

-Treatment requirements

-Procedural justice

-Support services by type – offered
and used

-Distributive justice
-Personal involvement
of judge & supervising

-Any, type, and number of
arrests / convictions post

-Case management
FTAs – % of
-Violations of

Perceptions of
Court Fairness

-Any, type, and frequency
of self-reported offending

Improved Functioning

- General deterrence

-Days of treatment by type

Reduced Recidivism

-Court FTAs – % of

-Timeliness of intervention

Drug Treatment

-Results of saliva test

-Decrease in postintervention incarceration

-Rehabilitation focus

-Completion requirements

-Any, type, and frequency
of self-reported use postprogram

Compliance with

Perceived Risk of
Sanctions & Rewards


-Treatment history


Offender Perceptions

-Increase in likelihood and
days of employment
-Gains in economic
-Reductions in family

Use of Services
-Type and amount of drug
-Type and amount of other
support services

Between February and June 2004, we administered a web-based survey to every active adult
drug court in operation for at least one year at that time (593), of which 380 courts (64 percent)
responded (see Final Report, Volume 2). We used the survey data to choose 23 drug courts and 6
“comparison” sites from the same geographic areas in 8 states. Rather than including strict “no
treatment” conditions, we sought comparison sites that reflect the diverse array of activities that
are employed to assist drug-involved offenders in jurisdictions without drug courts. These sites
included several Treatment Alternatives for Safer Communities (TASC) programs, a Breaking
the Cycle program, and standard probation supervision with referral to treatment. Figure ES-2
presents the locations of the 29 total sites.
The research comprises three major components: process and impact evaluations, and a costbenefit analysis. The process evaluation describes how the 23 drug court sites vary in program
eligibility, supervision, treatment, team collaboration, and other key policies and practices (see
Final Report, Volume 3). The impact evaluation examines whether drug courts produce better
outcomes than comparison sites and tests which court policies and offender attitudes might
explain those effects (see Volume 4). The cost-benefit analysis (Final Report, Volume 4)
evaluates drug court costs and benefits.

MADCE Executive Summary


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Figure ES-2. MADCE Drug Court Clusters and Comparison Sites

The MADCE research used a variety of data sources, including:

Field Visits. We conducted multiple site visits to all 29 drug court and comparison
locations to document program characteristics and operations. These visits included
interviews with key stakeholders and structured observations of courtroom proceedings.


Self-Report Surveys. A sample of 1,781 offenders (1,156 drug court participants and 625
comparison group members) were interviewed at three intervals: (1) baseline, (2) 6
months after baseline, and (3) 18 months after baseline. The interviews lasted between
1.5 and 2 hours and covered a wealth of domains spanning background characteristics,
offender perceptions, in-program experiences and compliance, and outcomes.


Oral Fluids Test. A Buccal swab oral fluids drug test was administered during the 18month interview for respondents who were not incarcerated or in residential treatment at
that time. Ninety-five percent of eligible respondents consented to the oral fluids test.

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Administrative Records. Official criminal history and recidivism data were obtained from
state administrative data sources and the National Crime Information Center (NCIC) of
the Federal Bureau of Investigation (FBI) at 24 months after study enrollment.


Costs and Benefits. The self-report surveys and official recidivism records were used to
estimate the amount of each program activity in which each offender participated
(quantities), which were then multiplied by the price of each activity (prices). The prices
were developed from a combination of stakeholder interviews, review of official budget
and other administrative records, and national estimates of prices.

The	Rationale	for	the	MADCE	Design	
The design described above has several advantages. First, it drew upon a conceptual framework
spelling out the linkages between policies, practices, perceptions, and behavior change (see
Figure ES-1). Second, although the study does not involve a random sample of drug courts
nationwide, it does include multiple sites from across the country, making the results more
generalizable than prior single-site studies or statewide evaluations that focus on multiple sites
within a single state court system. Third, the large size of the pooled sample and collection of
extensive offender attitudinal and process data allowed us to open the “black box” of effective
drug court practices far beyond most prior studies. Fourth, we were able to include many smallto medium-sized courts among our sites; the resulting diverse range of community contexts is
likely to yield more generalizable results than if we had only used courts in the largest urban
centers, as has been the case in most prior drug court evaluations. Finally, we included many
more drug courts—23 in total—than was originally planned given our ability to geographically
cluster sites and pool data across them. Many of these advantages could not have been obtained
had we instead conducted a randomized experiment in a small number of sites.
Given the use of a quasi-experimental design, the impact study had to address three important
threats to validity: (1) selection bias, (2) attrition bias, and (3) clustering of outcomes within
sites. The first two problems—selection and attrition—were handled simultaneously with
propensity score modeling and a strategy that we refer to as super weighting (adjusting
simultaneously for baseline differences between drug court and comparison group members and
between those who were retained and not retained at follow-up). We note there was relatively
little attrition as 86 percent of the baseline sample was interviewed at the 6-month follow-up, and
83 percent was interviewed at the 18-month follow-up. We handled the third problem—site-level
clustering—with hierarchical modeling (which adjusts statistically for differences in outcomes
from community-specific contexts in our 23 drug court and 6 comparison sites).

MADCE Executive Summary


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Overview	of	the	Impact	and	Cost‐Benefit	Findings	
Do	Drug	Courts	Reduce	Substance	Use,	Crime,	and	Other	Problems?	

Substance Use: Drug courts produce significant reductions in drug relapse. In the year
prior to the 18-month interview, drug court participants were significantly less likely than
the comparison group to report using all drugs (56 vs. 76 percent) and also less likely to
report using “serious” drugs (41 vs. 58 percent), which omit marijuana and “light”
alcohol use (fewer than four drinks per day for women or less than five drinks per day for
men). On the 18-month oral fluids drug test, significantly fewer drug court participants
tested positive for illegal drugs (29 vs. 46 percent). Further, among those who tested
positive or self-reported using drugs, drug court participants used drugs less frequently
than the comparison group.


Crime: Drug courts produce significant reductions in criminal behavior. In the year prior
to the 18-month interview, drug court participants were significantly less likely than the
comparison group to report committing crimes (40 vs. 53 percent), and of those who
committed any crime, drug court participants committed fewer. Thus, although both
samples averaged large numbers of criminal acts at 18-month follow-up, drug courts
reduced that number by half (43.0 vs. 88.2 criminal acts in the prior year). Among
specific offenses, drug court participation reduced drug possession, drug sales offenses,
driving while intoxicated, and property-related crime. Finally, drug courts reduced the
probability of an official re-arrest over 24 months (52 vs. 62 percent), but this last effect
was not statistically significant.


Other Psychosocial Outcomes: Drug court participants experience select benefits in
other areas of their lives besides drug use and criminal behavior. At 18 months, drug
court participants were significantly less likely than comparison offenders to report a
need for employment, educational, and financial services, suggesting that drug court
participation addressed those needs. Further, drug court participants reported significantly
less family conflict than comparison offenders. However, there were only modest, nonsignificant differences in 18-month employment rates, income, and family emotional
support; and the samples did not differ in reported symptoms of depression or in
experiencing homelessness.


Durability of the Drug Court Impact: With respect to substance use and crime, improved
outcomes at the 6-month interviews were nearly identical to improvements reported at the
18-month interviews, which includes at least some post-program time for 72 percent of
the drug court sample. For instance, drug court participants were significantly less likely
to report drug use in the prior six months (41 percent) than the comparison group (62
percent), a gap that was then largely sustained in the six months prior to the subsequent
18-month interview (46 vs. 68 percent).

MADCE Executive Summary


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For	Whom	Do	Drug	Courts	Have	Their	Greatest	Effects?	
Since we found that drug courts produce substantial reductions in substance use and crime, we
next tested whether these effects are especially pronounced among some, but not other categories
of offenders, defined by demographics, social ties, prior drug use, criminality, or mental health.

Few Subgroup Differences: Across multiple categories of offenders, we found extremely
few differences in the magnitude of the drug court impact. Our findings indicate that
nearly all categories of offenders benefit comparably from the drug court intervention,
suggesting that widespread drug court policies to restrict eligibility to a narrow
subpopulation may be counterproductive. Specifically, there were not any subgroupbased differences in the rate of positive drug tests, and only 3 of 17 subgroups selfreported less drug use at 18 months. Drug courts also impacted criminal behavior
similarly across most subgroups.


Exceptions: A small number of subgroups experienced differential effect. Relative to
similar offenders in the comparison group, those reporting more frequent drug use at
baseline showed a particularly large reduction in drug use at the 18-month follow-up.
Concerning criminal behavior, offenders with violent histories showed a greater
reduction in crime than others at follow-up. We also found that those showing symptoms
of mental health problems (narcissism and depression, but not antisocial personality
disorder) evidenced a smaller reduction in drug use and crime than those without these

What	Are	the	Mechanisms	Through	Which	Drug	Courts	Work?	
We used multiple methods to determine which drug court policies and practices, and which
offender attitudes, explain the drug court impact on drug use and crime. Major findings include:

Role of the Judge: The primary mechanism by which drug courts reduce substance use
and crime is through the judge. Drug court offenders believe that their judge treated them
more fairly than the comparison group, including demonstrating greater respect and
interest in them as individuals and greater opportunities to express their own voice during
the proceedings. Furthermore, when offenders have more positive attitudes toward the
judge, they have better outcomes. This was true across all offender subgroups when
examining demographics, drug use history, criminality, and mental health. A separate
analysis drawing upon the results of structured courtroom observations found, similarly,
that drug courts whose judge was rated by members of the research team as exhibiting a
more positive judicial demeanor (e.g., respectful, fair, attentive, enthusiastic,
consistent/predictable, caring, and knowledgeable) produced better outcomes than other
drug courts. Both analyses reaffirmed the central role of the judge.


Role of Other Offender Attitudes: Greater perceptions of legal leverage produced a
reduction in substance use and crime, whereas perceptions related to sanctions did not
have an effect. Among drug court offenders, those who perceived the consequences of

MADCE Executive Summary


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failing the program as more undesirable (“extremely bad”) engaged in fewer in-program
infractions and demonstrated less substance use and crime at the 18-month follow-up.
However, perceptions related to the certainty, severity, or undesirability of intermediate
sanctions were not generally associated with outcomes across several analyses. Offender
scores on several instruments designed to measure motivation to change also did not
predict subsequent outcomes, suggesting that the construct of “motivation” may not
necessarily be a good predictor of who will ultimately succeed in drug court.

Role of Court Policies and Practices: Practices that appear most related to reductions in
crime and substance use are judicial status hearings, judicial praise, drug testing,
substance abuse treatment, and greater leverage. Across multiple methods, among the
most consistent findings were that offenders who received higher levels of judicial
supervision and drug testing, and who attended more than a month of substance abuse
treatment, reported fewer crimes and fewer days of drug use. Regarding leverage,
individuals who rated the alternative sentence for drug court failure as more severe were
more likely to have reduced days of drug use at 18 months. Also, courts rated by the
research team as having high leverage over clients reduced crime at 18 months. As
previously noted, where the judge exhibits a more positive judicial demeanor, outcomes
are improved.

Do	Drug	Courts	Generate	Cost	Savings?	

Program Investments: Drug courts invest more money than the comparison sites in
community-based services and in court supervision. Drug courts costs are higher than
business-as-usual case processing due to larger program investments, including
significantly more drug tests, judicial status hearings, time with case managers, and
substance abuse treatment.


Outcomes: Drug courts save money through improved outcomes. Drug courts save
money through improved outcomes, primarily savings to victims from significantly fewer
crimes, re-arrests, and days incarcerated (whereas a slight increase in participant wages
relative to the comparison group was not statistically significant).


Net Impact: Drug courts save an average of $5,680 per participant, returning a net
benefit of $2 for every $1 of cost, but these findings are not statistically significant. The
net cost-benefit findings are comparable to previous multi-site studies, including
statewide evaluations in California and Washington. However, in this study, the findings
were driven by a reduction in the most serious offending by relatively few individuals,
not by a widespread reduction of serious offending. Drug courts prevent a great deal of
crime, but the majority of crimes have small costs to society. An important implication is
that drug courts are especially likely to save money if they enroll serious offenders (who,
in the absence of drug court, are particularly likely to engage in serious future offending).

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The MADCE has shown that drug courts prevent crime and substance use, work equally well for
most subgroups of participant populations, are effective through the role of the judge, and can
increase effectiveness if they implement program practices in particular ways (e.g., with high
leverage; medium predictability of sanctions based on flexibility in applying sanctioning
schedules known to participants; and enrolling participants either pre-plea or post-plea, but not
mixing individuals drawn from both entry points in the same drug court population). Below is a
brief summary of the most salient implications that have further explanation in Volume 4,
Chapter 10 of the Final Report.

Implications	for	Policy	and	Practice	
The Role of the Judge 

Hold frequent judicial status hearings; in light of previous research on this topic,
consider increasing the frequency of status hearings for “high risk” participants in


If the jurisdiction allows it, choose drug court judges carefully. Drug courts will be best
served if administrators intentionally assign judges to the drug court who are committed
to the model and interested in serving in this role.


Monitor “client satisfaction” with the judge.


Train judges on best practices regarding judicial demeanor and regarding how to
communicate effectively with program participants.

Drug Court Eligibility Requirements 

Consider broadening drug court eligibility requirements, since there is little evidence
that drug courts work particularly well with one or another narrowly defined category of


Consider including violent offenders with substance use issues.


Increase participants’ perceptions of the court’s leverage (i.e., authority to impose
undesirable consequences in the event of program failure).

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Drug Testing 

Provide drug tests frequently, more than once per week during the initial phase of the

Federal and State Policy 

Drug courts work, so ensure that provisions are made to fund their existence.


In keeping with the emphasis on evidence-based practices, develop standards to guide
drug court practice.


Encourage programs to include more serious offenders to achieve greater returns on
drug court investments.


Encourage programs to serve greater numbers of participants, so that positive impacts
are not limited to small numbers of offenders.

MADCE Executive Summary