Effectiveness of legally mandated non-custodial drug and alcohol treatment orders for improved health, well-being, global functioning and quality of life: a systematic review and meta-analysis

Abstract

Abstract Background Adults in the criminal justice system are disproportionately more likely to use alcohol and drugs compared to the general population. Legally mandated alcohol and drug treatment orders have been proposed as an alternative to prison. However, little is known about how treatment orders affect the health and well-being of this population. Methods A systematic review and meta-analysis. We searched 14 electronic databases (last searched November 2023) for studies comparing adults in legally mandated non-custodial drug and alcohol treatment orders to those receiving mandatory treatment orders or usual care. Global functioning, quality of life, drug or alcohol use measures, dependence severity, depression/anxiety outcomes, family member/significant other outcomes, and adverse events were selected based on a minimum core outcome set. We performed a meta-analysis using mean differences and risk ratios with 95% confidence intervals. We assessed the certainty of the evidence using GRADE. Equity-related factors were mapped to the PROGRESS-plus framework. People with lived experience provided input throughout the review process. Results From 6917 records, 11 studies involving 4643 individuals (70% men; seven randomised controlled trials (RCTs)) met the eligibility criteria. All studies were conducted in high-income countries and involved drug and alcohol 0courts. The main outcomes of global functioning and quality of life were not reported. Poor reporting limited the meta-analysis. There were no differences between the groups receiving the intervention and those in the control group regarding number of positive drug screenings (MD -0.80, 95% CI -3.60 to 2.00, 10 participants, p = 0.58); depression (RR 0.93, 95% CI 0.78 to 1.10, 1533 participants, p = 0.38); or serious adverse events (RR 0.33, 95% CI 0.02 to 6.65, 10