Substance use disorder treatment in the community is a superior alternative to incarceration for offenders with a substance misuse background, according to a recent study evaluating the effectiveness of the contract treatment sanction in Sweden.

Contract treatment refers to a criminal penalty in which the offender voluntarily consents to treatment in accordance with a specific implementation plan.

"Contract treatment is an alternative to incarceration. It is mainly used when the offence is deemed to have occurred as a result of substance misuse or some other condition requiring treatment," says Suvi Virtanen, a University Lecturer in Psychology at the University of Eastern Finland.

A rehabilitation period is always planned based on individual needs. In addition to psychosocial treatment, it may include opioid substitution therapy.

In addition to Sweden, a sanction similar to contract treatment is in use in, e.g., Norway and many EU countries; however, not in Finland. The United States, in turn, has adopted a model of specialised drug courts.

Contract treatment carries a smaller risk of recidivism

Although contract treatment has been in use in Sweden since the late 1980s, its effectiveness has not been studied until now. The present study combined data from the Swedish Prison and Probation Service's client register with other national registries, including data on visits to specialised health care. The study cohort included 11,893 individuals who were serving a contract treatment sanction between 1999 and 2012, and they were followed up for at least two years.

"With the introduction of contract treatment, criminal behaviour and substance-related adverse health events, such as overdoses and hospitalizations due to psychiatric and somatic reasons, decreased significantly compared to the period before contract treatment," Virtanen says.

A significant proportion of those sentenced to contract treatment had also served community sanctions and prison sentences. In the within-individual research design, an individual's risk of recidivism and adverse health events during contract treatment was examined compared to periods when the individual was serving a community sanction or was on parole after a prison sentence.

"The risk of recidivism and adverse health events was lower during contract treatment than during a community sanction or probation," Virtanen notes.

Providing treatment yields better results than punishment

Substance misuse problems and criminality often go hand in hand. The most effective way to prevent recidivism is to address its root causes, which often are, in one way or another, linked to the use of substances.

"Substance use disorders are increasingly understood as a health issue that should primarily be addressed by means of health care. Usually, prison is not the best place for an individual who needs appropriate treatment and support for recovery," Virtanen says.

The results of the study provide support for the notion that, from the viewpoint of societal security and public health, providing treatment can lead to better outcomes than penalties that emphasise punishment.

In the future, the researchers intend to study the effectiveness of contract treatment in more recent data.