What treatment means in practice : an analysis of the delivery of evidence-based interventions in criminal justice drug treatment services in Birmingham, England

There is evidence that treatment for opiate addiction is effective in reducing drug use and offending (Prendergast et al. 2002; Gossop et al. 2003), based on effective combinations of substitution prescribing and evidenced psychosocial treatments (McLellan et al. 1993), yet concerns that few structured interventions are delivered in 'real life' settings. The current study assessed what keyworkers perceive as going on in drug working sessions in the criminal justice system. To assess what is actually delivered, cross-sectional case reviews were undertaken of 344 files of drug-using offenders in treatment, and interviews with the 35 keyworkers delivering case management and psychosocial interventions to the clients in these cases. This constituted all the active cases in the Drug Intervention Programme (DIP) in Birmingham, UK. Clients were typically seen for a mean of 44.3 min per session, in which time a range of tasks were undertaken, and workers estimating that evidenced interventions accounted for an average of 10 minutes per session. There was marked variability in session length and content, with some of this variability predicted by client characteristics, and by worker and team factors. The study provides little support for the delivery of evidence-based psychosocial interventions in mandated drug treatment services.