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Effective Interventions Unit: Reducing the impact of local drug markets: A research review

Chapter 4 Demand Reduction

This chapter presents evidence from studies that have examined how police approaches to tackling low-level drug markets can encompass demand reduction.

The aim of demand reduction is ultimately to reduce the number of drug users / buyers in a drug market. Approaches which might contribute to this include coordinating police enforcement action against a market with targeted treatment provision. This chapter concentrates on different approaches to linking enforcement activity with treatment. Clearly, such an approach assumes sufficient treatment resources to cope with demand.

The enforcement contribution to demand reduction

Researchers have highlighted the potential for law enforcement to impact positively on the lives of drug users and user-dealers. Some have proposed that street enforcement should aim to arrest users and divert them into treatment programmes. This challenges the perception that drug users will generally seek treatment on a voluntary basis. It is argued that there are ways in which law enforcement activity can persuade drug users to take 'early retirement' from their drug careers ²⁹.

This argument relies on the provision of community-based programmes for drug users, provided within a multi-agency framework (involving the police, courts, criminal justice social work & medical profession), in which law enforcement measures may offer an effective way of encouraging drug users to seek and accept help ³⁰.

An attempt to capitalise on the disruptive effects of policing on drug markets is currently being carried out as part of a project in Derbyshire. It brings together supply reduction, demand and harm reduction activities together in one approach. The project includes a wide range of agencies as part of a problem solving approach to the targeted drug markets. The project is currently being evaluated and is summarised below.

The effects of 'supply reduction' policing upon demand

One evaluation of a police crackdown ³¹ showed an increase in local demand for drug treatment during the period of the intervention ³². However, it is not clear whether this increase in demand for treatment translated into a decrease in the demand for drugs, or whether the initial demand for treatment led to a sustained impact on drug use and, by extension, on the drug market.

There are a number of studies that have examined whether or not police enforcement in itself encourages entry into treatment. One of the best-designed studies tested the hypothesis that drug law enforcement encourages entry into methadone maintenance therapy (MMT) by surveying heroin users with and without experience of MMT ³³. Those who were currently in MMT were asked about the most important reasons for them entering treatment. Although not the most frequently cited reason, the majority of respondents cited 'avoiding more trouble with the
police / courts' as 'important' or 'very important' in their decision to enter treatment. This seemed broadly consistent with the behaviour of heroin users in the sample; those who had been imprisoned or had a friend or family member imprisoned were more likely to have tried MMT ³⁴.

It should be noted that this particular study did not examine the effects of a police crackdown. Weatherburn and Lind (2001: 586) caution that:

"…even if the results… are read as indicating that street-level drug law enforcement encourages entry into treatment, it does not follow that dramatically increasing the level or intensity of street-level drug enforcement will further hasten the rate of entry into treatment. The present study… examined the effects of ongoing drug law enforcement activity on heroin users drawn from a range of locations and over a long period of time."

Overall, existing evidence seems to suggest that the existence of enforcement may be a factor in any user coming to a decision, at some point, to try and quit. It does not confirm a causal relationship between enforcement interventions and moves to treatment.

The effectiveness of such a role assumes that treatment will ultimately reduce users' demand for drugs and the criminality associated with this demand. There is a strong body of evidence for the effectiveness of treatment in both of these respects ³⁵.

NTORS found strong evidence for the effectiveness of different treatment modalities in reducing drug use, even 4-5 years after entering treatment. It also looked at rates of drug-selling among drug users. It found that one year after entering treatment, dealing offences were reduced to less than a fifth of the levels on entry. The rate of involvement in crime was also reduced, to less than two-thirds of entry levels ³⁶. This marked reduction continued to be evident after 4 - 5 years ³⁷.

There are a number of ways in which the police can play a role in diverting persistent offenders to treatment. More can be done than simply hoping that disruption of drug markets will eventually cause drug users to address their problems. One example of a proactive approach that diverts offenders with drug problems into treatment is the Tower Project in Blackpool:

Diversion to treatment: Arrest referral

Arrest referral offers another way for the police to take a more proactive role in encouraging users into treatment. This section describes the ways in which arrest referral schemes are designed and some of the evidence for their effectiveness.

Arrest referral schemes offer an opportunity to drug users who have been arrested to engage with drug treatment and / or other appropriate services with a view to reducing their offending behaviour. Arrest referral is a gateway into services from police setting but has no formal link with the due process of law. It is entirely voluntary on the part of the offender.

The EIU guide to Arrest Referral identifies 3 broad approaches to arrest referral:

• Information- giving schemes involve the provision of information to arrestees about local drug and other relevant services by the police. There is no advice, counselling or follow-up. Take-up rates have been found to be low.

• Proactive schemes involve arrest referral workers working in close co-operation with the police, often with direct access to prisoners in custody suites. Police may screen or target arrestees for the arrest referral worker. Agreement to talk to the worker is voluntary.

• Coercive / incentive schemes are linked to diversion from prosecution, or other disposal. Essentially, the incentive model uses the coercive nature of the criminal justice system to encourage drug users to seek assistance in tackling their drug problems. To operate legally, they have to avoid offering the possibility of dropping charges as an inducement to seek treatment ³⁸.

The majority of DAT areas in Scotland either have, or are planning, an arrest referral scheme. The EIU guide identified little if any current support for the coercive model in Scotland.

Evidence on arrest referral schemes in England and Wales suggests that arrest referral can assist the transition from chaotic lifestyles to treatment by providing a pathway into services from a criminal justice setting. Findings from the national monitoring & evaluation of arrest referral in England and Wales looked at effectiveness measures such as:

• Schemes' success in ensuring entry into specialist drug treatment services: evidence showed that over half of all problem drug-using offenders who were screened by an arrest referral worker were voluntarily referred to a specialist drug treatment service. Of those referred, a quarter made a demand for treatment.

• Whether engagement with specialist drug treatment facilitates reductions in the levels of crime: evidence did show significant reductions in offending and re-arrest.

However drug-using offenders referred by an arrest referral scheme were significantly more likely to drop out of treatment once engaged compared to self or GP referred drug users ³⁹.

Findings from more detailed evaluations of 3 arrest referral schemes in England ⁴⁰ assessed the schemes' impact by conducting follow-up interviews with samples of people who had passed through each scheme. The schemes evaluated were all 'proactive' schemes. Self-reported drug use and drug expenditure fell steeply among the respondents who had contact with a scheme and avoided a prison sentence. There were also reductions in crime rates among the study population. However the researchers observe that there may have been a bias towards success caused by the design of the study.

There is no comparable evidence in a Scottish context, although a national evaluation of arrest referral schemes is due to take place in 2004-5.

There are other diversionary measures in operation at different stages of the criminal justice system, e.g. Drug Treatment and Testing Orders, which have not been considered as part of this review. In this report we have restricted consideration to those that operate prior to or at the point of arrest by the police.

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