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Drug Treatment and Testing Orders: Evaluation of the Scottish Pilots

CHAPTER SIX: EFFECT OF DTTOS ON DRUG USE AND OFFENDING

INTRODUCTION

6.1 This chapter focuses on the effectiveness of DTTOs in reducing drug use and associated offending behaviour and in helping to effect other positive changes in offenders' lives. In doing so it draws primarily upon interviews with different professionals involved in the DTTO pilots, on questionnaires completed by DTTO workers and treatment providers in respect of individual offenders made subject to orders and on interviews with offenders at the beginning of and six months into a DTTO.

WHAT CONSTITUTES A SUCCESSFUL DTTO?

6.2 Social work managers considered DTTOs to be successful if they managed to achieve the desired changes in offenders' drug use and to impact positively upon their offending, though as one manager observed, "there has to be a degree of realism". Managers also expressed the hope that offenders on DTTOs might benefit in other ways through improved health, improved relationships and improved social circumstances.

6.3 For sentencers, a DTTO would be defined as having been a success if it had impacted positively upon offenders' drug use and related offending behaviour. However sentencers varied with respect to whether they hoped for total abstinence or a significant reduction in the use of illegal drugs. Among the former group, one sheriff explained:

"A successful DTTO is one which demonstrates and proves and enforces the total withdrawal from drugs by an offender. That is probably asking too much…To my mind reducing programmes have value but the end result always has to be total withdrawal and unless there is a reasonable swift and steady reduction then you get the suspicion that they are not really wanting to come off."

6.4 A slightly different perspective was expressed by another sheriff who in recognition of the relapsing nature of drug misuse noted:

"Well, that he continues to keep out of trouble and that he continues to reduce, if not stop his drug misuse. I mean, I don't feel that they should always be expected never to return to drugs. I mean there's bound to be the odd blip but if they can address that and get back off again then that's a success story."

6.5 Two sheriffs also suggested that the success of a DTTO might be assessed in terms of other improvements having been brought about in offenders' lives, such as finding a job and staying away from their former peers.

6.6 DTTO staff believed that completing a DTTO rather than a custodial sentence would be an incentive to offenders to maintain a low offending and drug using profile. Achieving that stability in offenders' lives, to the point that they were enabled to "lead normal lives" was the main criterion of a successful DTTO:

"A successful DTTO to me is somebody that makes positive lifestyle changes, stops offending, looks, starts looking after theirself, maybe re-establishes relationships with family members…leading a normal life."

"In the long term, if they manage to resolve whatever is going in their lives, obviously it is going to improve things for them in the longer term. They might be able to…establish a long term relationship or stay in a long term relationship, which can lead to a permanent employment, housing situation and moving, moving gradually away from offending behaviour and developing more pro-social activities and returning to a normal lifestyle as a society would expect one to do or enter into."

6.7 Elimination of anti-social behaviour and reduced expenditure on drug use were also reported by DTTO social workers to be markers of success of a DTTO. Some DTTO staff suggested that abstinence from drugs was not necessarily a marker of a successful DTTO and that in some cases a significant reduction in drug use would be considered a success.

"…if they are chaotic drugs users, for example, using drugs 200 a day, even if they are at the end of the DTTO, they're still using 10 a day and they're funding it through their benefits or whatever or their legitimate means … then that is a success and that will play a major role…in crime reduction on a long term basis."

"We can't expect them a year down the line to be totally drug free, totally out of that culture and everything because it won't happen, and everything you do, you're setting people up to fail, so you can give them goals that they can reach…that's better."

6.8 The impact on the community in terms of public safety was also mentioned by the addiction workers and social workers, who felt that the reduction in criminality and health issues that could be brought about by a DTTO would benefit many people living in the offenders' locales. One worker described this longer term and wider benefit of DTTO as being "like investing your one pound now and multiplying it by 10 next year, you know…whatever you invest now, it will have long term impact in the society". To achieve this, however, the social consequences of being a drug-using offender - such as stigma, marginalisation, lack of training, education or employment record - were all reported by DTTO staff as needing attention during and on completion of an order.

6.9 When asked what constituted a successful DTTO, treatment providers, like social work managers and DTTO staff, made a distinction between the ideal and the achievable. A successful DTTO would be defined by someone:

"…maintained on a prescription only showing, when you do analysis, only showing positive for methadone, no evidence of drug use, no evidence of injectional sites, improved health gains and just completing their order."

"… who completed their order, who was completely drug free, who had moved on in their life… had raised their standard of living and was not committing crime any more… [realistically] if they can at least reduce their drug use to recreational and non-destructive in their life."

6.10 The supportive nature of the order was viewed as highly beneficial by treatment providers, who also singled out specific features of it such as group work, challenging attitudes towards drugs, and social and leisure activities as being helpful. However, the motivation of the individual and the stage they were at in the "cycle of addiction" was thought to be the fundamental factor in enabling a DTTO to succeed.

6.11 Treatment providers believed that housing had a major influence on offenders' ability to complete DTTOs. As one explained:

"The only concern that we have is for those individuals that are homeless and living within the hostel accommodation… at the end of the day when all services have shut down, or whatever, and they have got to go back to the hostel population… there are large numbers of people who are using drugs there. I think it is a very difficult situation for somebody to maintain a drug free existence whilst still staying there."

6.12 Treatment providers believed that a range of social factors - such as living in an area where drug use was prevalent, having friends who used drugs and having drug-using partners - made it more difficult for offenders successfully to complete a DTTO. As one treatment provider remarked, "they're still living in the same environment… they're still surrounded by the same socio-economic problems".

PERSPECTIVES ON THE EFFECTIVENESS OF DTTOS

Social work managers

6.13 Social work managers believed that DTTOs could be effective in helping offenders to reduce their use of drugs and in some cases to become drug-free. They recognised that offenders were more likely to change their patterns of drug use and the types of substances used than to become completely drug-free. However this was regarded as a positive outcome so long as offenders were no longer offending to support their use of drugs. Some managers believed that DTTOs were better placed than other disposals to effect positive changes in drug use because of the accountability they demanded of offenders. Factors they thought made DTTOs effective in this regard included: the early and rapid engagement with treatment; the access to a range of treatment options that can be tailored to the individual's needs; the clear framework of accountability associated with a DTTO; and the active involvement of both the offender and the sentencer in the review process. One manager, on the other hand, stressed that the effectiveness of DTTOs was very much dependent upon the offender's own motivation to change:

"I think that people who are responding the best are people who are probably at a stage in their lives where they would like to change anyway, however maybe they're just needing that final step to help them across the bridge."

6.14 Managers also identified a number of factors that limited the effectiveness of DTTOs with respect to facilitating improvements in offenders' use of drugs. First, they pointed out that DTTOs were appropriate only for a rather narrow band of drug-misusing offenders with distinct profiles. Second, DTTOs, although relatively intrusive, were still nonetheless peripheral to offenders' lives and to other external influences upon their drug use and associated behaviour.

6.15 Social work managers also believed that DTTOs could have a positive impact upon drug-related offending, though offenders sometimes continued to offend to pay off debts that had accrued while they were taking drugs. Managers believed that factors that accounted for the success of the DTTO in addressing drug misuse were also relevant to understanding how and why the orders might impact upon offending, given that the latter was a direct consequence of the former.

6.16 Social work managers were generally optimistic that DTTOs could make a wider impact on offender's lives through assisting them to access accommodation, employment, health and other services and through improving their social functioning, their relationships and their personal coping mechanisms. In this respect DTTOs were perceived as fulfilling a similar function to probation, though with DTTOs drug misuse featured as the most dominant problem in the individual's life.

DTTO staff

6.17 Staff in the two pilot areas believed that the unique emphasis of the DTTO on drug use and associated offending and the approach adopted towards offenders on orders were key to their success. As an addiction worker explained:

"We preserve the dignity, the respect…which is something drug-users have never even had or don't get a lot you know, they're treated extremely badly. So they get respect, they get dignity.. and we're able to divert a lot o' resources and time…to devote to people."

6.18 DTTO staff expressed a confidence that the 'lifestyle' of being on a DTTO would be maintained after completion of the order. In the addiction workers' view, longer term abstinence from drugs could not be guaranteed and relapse was a likely outcome, but there was optimism about longer term rehabilitation of drug using offenders who have had a DTTO.

"A lot of people get back positive relationships either be it family or pals they used to know before they ditched them and things like that so…it's giving somebody all the aspects of their lifestyle back…and they're even looking at things like employment, college, which is something that was not available, wisnae an option for them before."

Treatment providers

6.19 The treatment providers spoke very positively about the reduction seen in drug use among offenders on DTTOs and reported having seen improvements in the physical health of offenders given DTTOs. They also observed that when relapses did occur, the amount of drugs used was greatly reduced compared to usage prior to the DTTO. The fact that the treatment was part of a court order was also seen as a "safety net" in the event of relapse, preventing people being lost to treatment services as usually occurs. Treatment providers also commented that prison sentences would not have been effective with people given DTTOs but that orders could be an effective form of intervention at the end of a drug-using career. However they qualified this by noting that the effectiveness of treatment "depends very much on the individuals themselves and how their life is at the time".

6.20 Treatment providers did not feel well placed to comment on whether DTTOs could help bring about reductions in offending, though their perception was that they were effective in this respect, not least because through being kept fully occupied offenders had little free time in which to commit crimes. Treatment providers also speculated that if their drug use had reduced, offenders could fund their use of drugs through legal avenues rather than through offending. Only one treatment provider pointed out that every time those on a DTTO used an illicit drug they were committing an offence.

Sentencers

6.21 Sentencers were, on the whole, optimistic that DTTOs had the potential to bring about reductions in offenders' drug use, though some also suggested that it was too early to reach a definitive conclusion in this respect. Several sentencers made reference to cases in which the offender's drug use had ceased, reduced or changed (for example from heroin to diazepam) while they were subject to an order, while one stressed that the effectiveness of DTTOs was dependent upon offenders who were sufficiently motivated to change being made subject to orders.

6.22 Most sentencers were cautiously optimistic that the experience of a DTTO could lead to a reduction in or cessation of drug use in the longer term. The frequency of testing, intensity of contact, explicit focus upon drug misuse and rapid access to treatment services were thought by some sheriffs to indicate that a DTTO was more likely to impact positively upon drug misuse than a probation order with a drug treatment requirement.

6.23 The majority of sentencers were similarly optimistic that DTTOs were having a positive effect on drug-related crime at the individual level at least in the short term (that is, while offenders were subject to orders) and were hopeful that these benefits would be sustained in the longer term. Some sheriffs also pointed out, however, that in view of the modest scale of the DTTO pilot scheme, it was inappropriate to expect it to have a perceptible effect on levels of offending and drug use more generally.

6.24 Sentencers identified a range of factors that they viewed as contributing to the effectiveness of DTTOs in reducing drug misuse and, by inference, drug-related crime. These included: the intensity of contact demanded by the order; the drug testing element; the involvement of the court in reviewing orders and adopting a stance clearly oriented towards rehabilitation; and the availability of professional support and treatment. Sentencers also suggested that the threat of a custodial sentence hanging over the offender and the motivation of the offender were significant factors in this respect. As one sheriff explained, 'If they have the motivation, they then are in the age group that is likely to stop offending'. The addictive nature of illegal drugs and the prevalence of drug misuse and associated social problems, on the other hand, were regarded by some sentencers as detracting from the ability of DTTOs to bring about sustained changes in drug use among offenders given orders. Similarly, two sheriffs suggested that continued association with offending peers was likely to undermine offenders' attempts to desist from further criminal activity in the longer term.

6.25 Other potential benefits of DTTOs that were identified by sentencers included: improved family relationships as a result of the offender coming off drugs; enhanced ability to look after their children; help with housing and access to employment, accommodation, education and other relevant resources; improvements in general health; increased structure in offenders' lives; and improved social functioning.

FAILURES ON DTTO

6.26 DTTO workers were also able to comment on instances in which DTTOs had not been a success. For example, addiction workers suggested that in some cases offenders had effectively been set up to fail, either because they had not been properly assessed, because the recommendation in the SER was vague or open-ended or because the sentencer had decided to impose an order in the face of a clear recommendation for an alternative disposal.

6.27 Younger offenders (for instance those in their teens), while suitable in many respects for a DTTO, were also perceived by staff as being more likely to have difficulties complying with the requirements of an order. They also attributed some offenders' failures to comply to the intensity and intrusiveness of the order - as one worker explained "it's not an easy road for them" - and suggested that offenders who refused to be assessed for a DTTO frequently cited the perceived intensity of commitment required.

DTTO WORKERS' AND TREATMENT PROVIDERS' PERSPECTIVES ON THE EFFECTIVENESS OF DTTOS IN INDIVIDUAL CASES

6.28 Treatment providers and DTTO social workers in the two pilot areas were asked to complete questionnaires relating to individual offenders at three stages in their orders: shortly after the offender had begun a DTTO; six months into the order; and on completion. Treatment providers completed 45 initial questionnaires (35 in Glasgow and 10 in Fife) and 18 six-month questionnaires (all in Glasgow). DTTO social workers completed 47 initial questionnaires (23 in Glasgow and 24 in Fife) and 33 six-month questionnaires (17 in Glasgow and 16 in Fife). In addition, three completion questionnaires (relating to two individuals) were completed. However, in view of the small number of completed cases for which data were available, the subsequent discussion will focus only upon the questionnaires completed initially and after six months.

Offenders' motivation to change

6.29 The majority of offenders were viewed by DTTO staff and treatment providers as being very motivated or fairly motivated to reduce their drug use, offending and other problems at the start of their orders (Tables 6.1 and 6.2). In comparison with treatment providers, DTTO workers were more likely to indicate that offenders were highly motivated to address their drug use at the outset of their orders, though why this was so is difficult to explain. It is possible that offenders presented a more optimistic picture to DTTO workers because the latter had a direct role in reporting progress to the court. Alternatively, treatment providers may have been slightly more cynical about the potential for success in the context of 'coerced' treatment or on the basis of prior experience of treating people who misused drugs.

Table 6.1 Treatment providers' views of offenders' motivation at start of DTTO

Table 6.2: DTTO workers' views of offenders' motivation at start of DTTO

6.30 Six months into their orders, treatment providers still believed that the majority of offenders were motivated to change (Table 6.3). Offenders' levels of motivation to change were also thought by DTTO workers to be high, though a higher proportion of offenders were thought not to be motivated to change after being on a DTTO for six months (Table 6.4). To facilitate comparison between these Tables we have included percentages, though it should be recognised that these are based upon very small numbers. They seem to suggest that at this stage, treatment providers were slightly more optimistic than DTTO workers with respect to offenders' potential to reduce their use of drugs while DTTO workers were more optimistic with respect to their potential to reduce their involvement in drug-related offending. These differences may reflect the varying emphases placed by treatment providers and DTTO workers on the reduction of drug use and offending behaviour.

Table 6.3: Treatment providers' views of offenders' motivation after six months

Table 6.4: DTTO workers' views of offenders' motivation after six months

Offenders' responses to treatment and to the DTTO

6.31 Treatment providers' and DTTO workers expectations of how well offenders would respond to a DTTO and to the treatment provided are shown in Tables 6.5 and 6.6. Treatment providers were more likely than DTTO workers to anticipate a mixed response in both respects while DTTO workers were more likely than treatment providers to indicate that offenders would respond very positively to treatment and to a DTTO.

Table 6.5: Treatment providers' views of how offenders are likely to respond (at start of order)

Table 6.6: DTTO workers' views of how offenders are likely to respond (at start of order)

6.32 After the first six months on a DTTO, treatment providers and DTTO workers believed that up to half the offenders given orders had shown a positive response to treatment (Table 6.7). DTTO workers also believed that one half of the offenders had responded positively (16) to their DTTO, while seven had shown a mixed response and in nine cases the offender's response had been poor.

Table 6.7: Perceived response of offenders to treatment ¹⁹

Achievement of objectives

6.33 Treatment providers and DTTO workers were also invited in the questionnaire to indicated what they considered to be the main objectives of treatment (in the case of treatment providers) or intervention (in the case of DTTO workers) in each case and to indicate the extent to which they had been achieved after the offender had been on an order for six months. The resultant responses are summarised in Tables 6.8 and 6.9. The small number of cases associated with individual objectives makes it difficult to draw conclusions from these data. However it appears that, overall, offenders were mostly considered to have made some progress towards reducing their drug use, stopping offending and addressing other problems.

Table 6.8: Treatment providers' views of the extent to which objectives have been achieved (after six months)

Table 6.9: DTTO workers' views of the extent to which objectives have been achieved (after six months)

Effectiveness of treatment and other services

6.34 Questionnaire respondents were also asked to indicate how effective they considered treatment and other services to have been (Tables 6.10 and 6.11). As with the data relating to objectives, conclusions are necessarily tentative. However it does appear that most interventions were thought in most cases to have met with some measure of success. DTTO workers, however, identified a wider range of treatments as being ineffective in one or more cases. This may be because their involvement with offenders was more 'holistic' and they were therefore better placed to assess the impact of various services and supports.

Table 6.10: Treatment providers' views as to how effective treatment and other services have been (after six months)

Table 6.11: DTTO workers' views as to how effective treatment and other services have been (after six months)

Changes in drug use, offending and other problems

6.35 The questionnaires sought treatment providers' and DTTO workers' estimates, at the start of a DTTO, of how much being on a DTTO was likely to affect offenders' drug use, offending and other problems. Treatment providers believed that in 19 cases (42%) the offender's drug use would improve significantly, in 24 cases (53%) it would improve slightly and in two cases (4%) there would be no change. DTTO workers believed that in 24 cases (52%) drug use would improve significantly, in 17 cases (37%) it would change slightly and in five cases (11%) there would be no change.

6.36 Questionnaires completed at the six-month stage revealed that most offenders on DTTOs were thought by treatment providers and by DTTO workers to have shown an improvement in their drug use (Table 6.12), with drug use reportedly having reduced considerably in around one third of cases.

Table 6.12: Perceptions of change in drug use as a result of DTTO (after six months)

6.37 Treatment providers and DTTO workers were also optimistic that being on a DTTO would help reduce offending. Twenty-two offenders (49%) were thought by treatment providers to be likely to show a significant improvement in their offending, a similar number were thought likely to show a slight improvement in this respect and only one (2%) was considered unlikely to change. DTTO workers thought that in 25 cases (56%) offending would improve significantly, in 14 cases (31%) it would improve slightly and in six cases (13%) it would remain unchanged.

6.38 Six months into their orders the majority of offenders were considered by both treatment providers and by DTTO workers to have shown a significant improvement in their offending (Table 6.13). In only one case did a DTTO worker consider an offender's offending to have got slightly worse since being placed on a DTTO.

Table 6.13: Perceptions of change in drug related offending as a result of DTTO (after six months)

6.39 Treatment providers and DTTO workers were more cautious in their expectations that offenders' other problems would change significantly as a result of being on a DTTO. Treatment providers believed that other problems would improve significantly in 15 cases (33%) and slightly in 26 cases (58%) while in four cases (9%) they would remain unchanged. DTTO workers anticipated significant improvement in offenders' other problems in 16 cases (35%), a slight improvement in 20 cases (44%), no change in eight cases (17%) and a slight worsening of problems in two cases (4%).

6.40 At the six-month stage of the DTTO, offenders' problems were thought both by treatment providers and by DTTO staff to have shown some improvement in most cases (Table 6.14). However improvements in offenders' other problems were not as marked as perceived improvements in their drug use and offending since being made subject to a DTTO.

Table 6.14: Perceptions of change in other problems as a result of DTTO (after six months)

Likelihood of continued drug use and offending

6.41 Treatment providers and DTTO workers were asked to indicate how likely they thought it was that offenders would resort to their former patterns of drug use and offending. At the start of the order treatment providers believed that four offenders (9%) were very likely to resort to former patterns of drug use and 28 (65%) were fairly likely to do so while in 11 cases (26%) this outcome was not likely at all. Similarly, DTTO workers believed that resorting to previous patterns of drug use was very likely in four cases (9%), fairly likely in 27 cases (59%) and not likely in 15 cases (33%).

6.42 After offenders had been on DTTOs for six months, a higher proportion of offenders were considered by both treatment providers and DTTO workers as being very likely to re-sort to their previous patterns of drug use (Table 6.15). At this stage, however, resorting to further drug use was still considered unlikely among around one third of offenders on orders.

Table 6.15: Perceived likelihood of returning to previous pattern of drug use (after six months)

6.43 At the start of their orders treatment providers believed that six offenders (15%) were very likely to resort to their former patterns of offending, 22 (54%) were fairly likely to do so and in 13 cases (32%) this outcome was unlikely. DTTO workers believed that 4 offenders (9%) were very likely to return to their former pattern of offending and 21 (47%) were fairly likely to do so while in 20 cases (44%) such a resumption of offending was unlikely.

6.44 Some offenders in respect of whom questionnaires were completed at the six-month stage in their order were thought by treatment providers and DTTO workers to be very likely to return to former patterns of offending. However in a relatively high proportion of cases treatment providers (3/8) and DTTO workers (14/31) believed that this outcome was unlikely (Table 6.16).

Table 6.16: Perceived likelihood of returning to previous pattern of offending (after six months)

OFFENDERS' PERSPECTIVES ON DRUG USE AND OFFENDING AT THE EARLY STAGES OF THE ORDER

6.45 With the exception of four offenders who indicated that they had stopped using heroin before they were sentenced, all of those who took part in initial interviews indicated that their drug use had decreased - in most cases markedly - since they started their DTTO. Offenders used terms such as "50 times better" and "a drastic cut" to describe how their drug use had changed since they received a DTTO. As one respondent explained:

"It's night and day, basically, from then to now. It's only, what, once or twice a month. Before it was every day. So I'd say it's a lot better now."

6.46 Twelve offenders admitted that they were still occasionally using drugs (including heroin), though in each case they reported much lower levels of use than before they received their orders. Others indicated that they were now only using methadone.

6.47 Only two offenders - both of whom were still using heroin occasionally - indicated that they had committed any offences in the previous month. In both cases they suggested that their level of offending was lower than prior to receiving a DTTO. The remainder said that they had not re-offended since being placed on a DTTO, attributing this to the fact that with their drug use decreased or stabilised, there was no need for them to offend:

"My offending now's non-existent. I don't have to offend now because I've got no reason to."

"I've stopped offending altogether because I don't need to get money to buy drugs because I'm on the methadone script."

6.48 Throughout the interviews offenders emphasised the direct link between their drug use and offending. As another offender observed:

"If you take the drug addiction away then I would be, maybe not the best citizen in the world but, you know, somebody you could trust."

DRUG USE AND OFFENDING AFTER SIX MONTHS ON A DTTO

6.49 Six months into their DTTOs, nine of the ten offenders who were interviewed indicated that they had used heroin in the previous two months. Six described having relapsed - though four had subsequently managed to stabilise their drug use again - while three others had continued to use heroin occasionally since receiving their order. The remaining respondent indicated that he no longer used heroin but continued to use cannabis. Each of the offenders had spent money on drugs in the previous month, ranging from 20 to 200 per week. On average this group of offenders reported having spent 57 per week on drugs, compared with the average of 490 per week offenders at initial interview reported having spent before they were made subject to a DTTO. Four offenders indicated that they had offended in the previous month to obtain money for drugs, one of whom had been imprisoned as a result.

RISK OF FURTHER DRUG USE

6.50 In the initial (post-sentence) interviews offenders were asked what they hoped to achieve as a result of being on a DTTO. Their responses are summarised in Table 6.16.

Table 6.16: What offenders hoped to achieve through being on a DTTO

6.51 Most offenders identified abstinence - initially from heroin and eventually from methadone - as an ultimate goal. For many, this was coupled with a desire to make a fresh start and achieve a 'normal' life. As one offender explained, "I hope to achieve a normal way of life. Stay straight basically". A similar sentiment was echoed by another offender who responded:

"I cannae go back to the way it was before, it was just starting to get too much…It was always that same routine and that was getting me down - just seeing everybody else walking about and I was thinking 'how can I not be just like a normal person?'..Even when I took the drugs I wasnae happy. I was only taking them as a habit."

6.52 Once their drug use was stabilised many offenders hoped to find employment or pursue education or training and five hoped to get a house of their own and "settle down". Other priorities included mending or establishing relationships and avoiding further offending or its consequences. One offender viewed his DTTO as his last chance to forestall what he regarded as the almost inevitable consequence of continued heroin use:

"If I don't make this project work I don't see that there is much of a life left, is there?. … I'm going to die through heroin abuse…if I don't get my act together."

6.53 Early on in their orders, offenders were unanimous in the view that they did not want to start using heroin again. Some were optimistic that with the help of the DTTO they would be able to remain drug free. Others, however, were more guarded in their responses, recognising that relapse was a possibility and that they had failed in attempts to come off drugs in the past. Some indicated that methadone had taken away the urge to use heroin, while a few acknowledged that they still experienced cravings and had continued to use heroin, albeit occasionally, since being given their order.

6.54 Offenders identified aspects of DTTOs that they believed could help them reduce or cease their use of drugs. These included testing, reviews and the treatment and other services provided. Methadone was viewed as helpful in assisting offenders to stabilise their drug use, while some offenders cited counselling and groupwork as having helped them to gain insight into their use of drugs:

"Hopefully through being here for 18 months I'll have enough information in my head …[so that] when things go wrong for me, instead of running out the door and using, I'll be able to deal with my problems better."

6.55 A few offenders singled out the combination of services as having been beneficial while others stressed the structure that was provided by a DTTO as being helpful in this regard. In the longer term, some offenders believed that finding employment would help them to remain drug free. Ultimately, however, several offenders stressed the importance of willpower and personal motivation to change.

6.56 None of the offenders thought, at the six-month stage in their orders, that it was likely that their drug use would increase and all expressed a continuing desire to become or to remain drug free. Three offenders considered it very unlikely that they would start using heroin again because they did not wish to put themselves through the experience again. As one respondent commented:

"It is the only time in my life that I can ever remember not liking drugs, not wanting drugs, you know."

6.57 Others, while hopeful, were somewhat less optimistic in their outlook, in some cases because they had already experienced a relapse since starting their DTTO:

"It's a sort of social thing at the moment…I'd like to be abstinent but it's not working out like that at the moment…I didn't really know what to expect…this is the first kinda proper treatment that I've had for my drug use…I wouldn't say treatment's difficult, the only thing that's difficult is staying clean, you know. For somebody that's been using drugs for the last 10 years, 15 years, to stop - that's kinda hard, you know."

6.58 Offenders still believed that being on a DTTO would help them reduce their use of drugs or achieve abstinence through the services provided and the monitoring aspect of the order. One offender, who had continued to have positive tests throughout his order, believed that once he obtained a clean sample, maintaining it would be something to aspire to:

"I suppose it's like a gold star that you want to keep, an' so it would help me."

RISK OF FURTHER OFFENDING

6.59 Not surprisingly, given the link between their offending and their drug use, at initial interview offenders were generally optimistic that if they could remain drug free they would not re-offend, as the following comments illustrate:

"When I'm clean and I'm no' using drugs I don't commit crime - it's just not in me."

"If I wis on drugs I'd probably offend but hopefully I'll be aff the drugs and I'll no' need tae."

"I'll never offend again...This order's done me wonders."

6.60 Some offenders, however, acknowledged that further offending was a possibility because they could not rule out completely the risk that they might eventually resort to using drugs. A few others believed that further offending may be possible, either because they had a pattern of opportunistic offending that pre-dated their drug use (and which, in one case, was perceived almost as an addiction in itself) or because they might find themselves in situations (a "different scenario") in which offending (such as fighting or committing a breach of the peace) was the result.

6.61 Most offenders who were interviewed after being on an order for six months considered it unlikely that they would re-offend, especially if they managed to stay off drugs. However, two thought it possible that they might become involved in other types of offending that were not related to drugs.

OFFENDERS' OVERALL VIEWS OF DTTOS

6.62 At the stage of the initial interviews offenders were, on the whole, positively disposed towards the DTTO. Indeed, many viewed aspects of it that might be considered by an outsider to be particularly intrusive or restrictive as positive features of this new order. One offender described the DTTO staff and treatment providers as "a lot more helpful than anybody else has been the 10 years I have been using" while another suggested that:

"The DTTO covers everything that probation couldn't cover…I think this is one of the best things that the government has actually brought out. For people that are willing to take the chance, it's the best thing that they've brought out."

6.63 Several offenders volunteered the observation that a DTTO had been the "best thing that had happened" to them. Through being on an order, their drug use had stabilised, they were receiving additional support through counselling and groupwork and they had received help with other practical matters such as housing. For example, two offenders from Glasgow who had been homeless had found temporary accommodation with the help of DTTO staff. Six months into their orders, the offenders who were interviewed were still, on the whole, positive about their experience of a DTTO.

6.64 It is worth noting that several offenders had experienced a relapse in their drug use between 4-6 months into their order, though they had also, in most instances, succeeded in subsequently re-stabilising their use of drugs. These findings suggest that this may be a critical period for offenders who are attempting to remain drug free and they may have implications for the nature and range of services and supports available at this stage in the order. It also corresponds with the findings from the evaluation of the pilots in England and Wales that the majority of orders were revoked in the first four months.

FAMILIES' VIEWS OF DTTOS

6.65 The offenders who were on DTTOs had been using heroin for several years when they received their orders and relationships with families and partners had suffered as a result. Most reported that their families and partners were pleased that they had been made subject to a DTTO, variously describing the latter as "happy", "delighted", "chuffed" and "over the moon" that they were being given an opportunity to come off drugs. Two offenders said that family members had already begun to notice an improvement in their physical appearance since they started their DTTO. In a few cases family members were said by offenders to be sceptical about the likely success of the DTTO because they had failed in the past to keep promises to stop using heroin.

6.66 Most offenders reported that their relationships with their families had begun to improve since they began their DTTO, with family members beginning to regain trust that had been eroded as a direct consequence of the offender's drug use. Several offenders said that the fact they were receiving treatment and support for their drug problem meant that their families now had less need to worry about the harm they might cause themselves. In a few cases offenders noted that their families were now financially better off because they were no longer using drugs.

COMPARISON GROUP INTERVIEWS

6.67 Interviews were conducted with ten offenders who had been given probation orders with drug treatment requirements as part of the Forth Valley Fast Track Programme. Most of the respondents received their probation order for shoplifting, however one had various other charges alongside the shoplifting charge including charges for possession of heroin and cannabis and two were charged with non-payment of fines. Five respondents reported committing their offences whilst under the influence of drugs and all reported having committed offences in order to obtain money to buy drugs. At the point where the probation order was made, the amount of money being spent on drugs ranged from 30 to 200 per day, with most of this money coming from offending. Expenditure on drugs was, therefore, similar to that reported among the offenders given DTTOs, which was shown to vary from 10 to 200 per day (Para. 3.60).

6.68 The respondents interviewed were at differing stages in their orders with three having completed more than one year. All ten respondents reported using heroin with some reporting the use of benzodiazepines, cannabis and amphetamine sulphate occasionally as secondary substances. All also indicated that they were offending minimally since being placed on probation and markedly less than prior to when they received their order. The three respondents who had completed more than a year on their orders all claimed that they were not offending at all.

6.69 Each of the respondents stated that they had agreed to the order because they were ready to address their heroin addiction and recognised that they needed support and help in order to do so. Each had received a probation order of two years and estimated that they would have received a custodial sentence of between six months and 2 years if they had not been made subject to probation though - like the offenders on DTTOs - they indicated that they would have consented to being placed on probation even without the threat of custody. As one probationer observed:

"You're basically not just saying yes because you're not wanting the jail, know what I mean."

6.70 Eight respondents reported having previously been on probation without a drug treatment requirement and had mixed views about the extent to which their current order differed from that earlier experience. However, all respondent were optimistic that their current order would help them to stop their drug use and related offending and would facilitate their re-integration into the community in the longer term. As one explained, he saw the purpose of his order being:

"[to] take me from being, you know, an offending drug user to just becoming a normal person, a normal person in society really."

6.71 Respondents believed that they had been given their order on account of the long-standing nature of their offending and drug-use and the fact that they had appeared on many occasions in front of the sentencing sheriff:

"Because he knows my background I think, because he knows all my offending is because of drugs, it's not as if I was a criminal before I started taking heroin."

6.72 Most respondents were receiving a small (35 - 40 ml) daily prescription of methadone. One respondent was expecting to be given such a prescription in the near future, "if I keep me nose clean, like".

6.73 Of those respondents who had completed six months or more of their orders, all but one had been referred to more than one treatment provider. Two were attending a community day programme (not drug-specific) which they felt helped to fill the day. One was regularly attending a community centre for similar reasons.

6.74 Amongst those respondents at the start of their orders, expectations of treatment that would be offered ranged from receiving a methadone prescription only to other interventions, including anger management. Most wanted to be provided with a methadone prescription although there was a general awareness that the dosage was routinely low. There were conflicting views regarding how useful groupwork would prove to be. Thus while one probationer suggested that groupwork might be helpful, another questioned whether this would be the case:

"You're not really wanting to sit in a group of people and talk about all your woes and that, know what I mean? It's hard enough to tell a stranger."

6.75 All were content to be subject to drug testing as part of their order. As one offender explained, "it's an insurance policy really. Helps you to be a bit stronger". They understood that testing was important because of the obvious dangers of using opiates on top of prescribed methadone and the need for workers to establish the true nature and extent of their drug use. Two respondents reported having been drug tested during previous treatment episodes, however, they still felt that testing, in combination with methadone, would make it more likely that they would reduce their use of drugs. One respondent noted that he had had trouble complying with the prescribing regime:

"Although my intentions were good to come off it and that, it took me a wee while to get to grips with what I was going to have to do and that I'd have to stop using and all the buzz and that, you know."

6.76 One respondent noted that he had had his prescription suspended for non-compliance. He had no quarrel with the decision in itself but felt that a more flexible response might have helped:

"I mean they were right to stop it. Served me right really. But two months was too long. That was really hard. I thought it would have been better if they'd said that I'd be off it for a couple of weeks and then put on twenty mls if I behaved meself and then back on the full thing a while after that. Something like that, ken? That would have given me something to aim for."

6.77 Respondents were asked how they would feel about attending monthly court reviews such as those included in DTTOs. One respondent felt that monthly reviews would be too frequent though he would be happy to attend court every three months. Others felt that reviews would be pointless, though one qualified this by suggesting that they might be useful if the same sheriff saw him on each occasion. Amongst those who had completed six months or more of their orders however, there was more recognition of the potential value of the review system. Three respondents noted the value of building up a relationship with a particular judge over the course of the order:

"You'll maybe get the odd judge that you don't know but the judge that I usually deal with, Judge X - or if its in Stirling it'll be Y or Z... if you're making an improvement then he'll say, 'Well, we'll maybe give him another few months to see how he keeps on going'. So it does help a wee bit aye."

6.78 All the respondents had accessed treatment services in the past with varying degrees of success. However, each believed that they would have more success on this occasion as a result of the support offered by Fast Track. Achieving a normal life was seen to be the most important outcome of the probation order.

"To get some normality back in my life and be able to wake up and have my breakfast in the morning because I'm hungry and not go out and try to score smack and that first."

6.79 Each of the probationers was optimistic that they could avoid further drug use and offending once they had become stabilised on a methadone prescription. Most indicated that their long-term aim was to stop using all drugs. Three pointed out that they had some concerns that the order would be completed before they attempted this final recovery stage:

"In that way the order couldn't be too long could it. I might need this sort of support for years, know what I mean?"

6.80 While all respondents had a positive attitude toward their probation order and towards the Fast Track programme, there was dissatisfaction expressed in many cases regarding the lengthy assessment period. Four respondents complained that there was an unrealistic expectation of abstinence at the commencement of the order. However, all four stated that it would not be appropriate for methadone to be routinely dispensed without some sort of assessment:

"I mean, they have to test you like. See if you're motivated. My point is that it's just too long. Just makes it a wee bit too easy to get into bother."

6.81 Thus, whilst appreciating the reasons for an assessment period, there was a general feeling that the delay between being placed on probation and beginning treatment was excessive:

"It would be a shame to get on the programme, go to court, get the probation, get the Fast Track and what have you, but then I've still got to go out the next day and offend to score my drugs. So, if I was basically put on a prescription once I got on the Fast Track order, then I wouldn't have any excuse to offend or take drugs or anything. I would fear it was an awful waste getting caught now for shoplifting or something and then losing it all, you know, which is actually a big worry of mine at the moment."

6.82 Two respondents reported having waited for a period of two months with no substitute prescribing being provided. Both admitted that they had continued to offend to pay for drugs during the assessment period and were worried about being caught and removed from the programme before they had been given a chance of succeeding.

6.83 Overall, however, all the respondents were enthusiastic about the programme and remarkably optimistic about their chances of success. Most respondents - and particularly those who had completed six months or more of their orders - recognised that the services offered were providing an important support system. As one offender explained, "if you took away the services I'd be totally in shit, you know what I mean".

SUMMARY

6.84 Professional respondents considered a successful DTTO to have brought about a reduction in drug use and associated offending, though some sentencers believed that at the end of the order total abstinence should have been achieved. Factors that tended to undermine the success of the order included living in an area where drug use was rife. Professional respondents were optimistic (albeit cautiously so) that DTTOs could help bring about reductions in drug use and, as a consequence, drug-related offending. They were also optimistic that DTTOs, with their emphasis upon enhancing offenders' social inclusion, could also have a positive impact on other aspects of their lives. Staff attributed 'failures' on DTTOs - which they thought were more likely among young offenders - to inadequate assessments or to DTTOs being made by the court against the advice of the scheme.

6.85 Questionnaires completed by DTTO staff and treatment providers at the start of a DTTO and after the offender had been on an order for six months indicated high levels of motivation among offenders to reduce their drug use and offending. Most offenders were said to have shown a positive or mixed response to treatment, most treatment objectives had been at least partially achieved and most offenders were said to have demonstrated reductions in their drug use, offending and other problems.

6.86 Offenders reported marked reductions in drug use and drug-related offending since being placed on a DTTO, with an average weekly expenditure of 57 on drugs six months into a DTTO, compared with a weekly expenditure of 490 before being given an order. Offenders identified abstinence as an ultimate goal of a DTTO along with the ability to lead a 'normal' life. Offenders were optimistic that they could become and remain drug free, though several had experienced a relapse around five months into their orders. Offenders also considered further offending to be unlikely, though some would not rule out the possibility of being convicted of other offences that were not related to drug misuse.

6.87 Overall, offenders were positively disposed towards the DTTO, primarily because it offered them access to treatments and services to help get them and keep them off drugs. Family members were also reported to be positive about DTTOs, with some offenders reporting improvements in family relationships since being placed on an order.

6.88 The sample of offenders attending the Fast Track Programme in Forth Valley had been made subject to probation orders for similar offences to the offenders on DTTOs. The offenders attending Fast Track were equally positive about the experience and believed that it had reduced their likelihood of continuing to use drugs, though some were concerned that their orders would have ended before they had become completely drug free. Offenders were also critical of the length of the assessment period, which they suggested resulted in an excessive delay between being placed on probation and accessing treatment.

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