A BRIEF OVERVIEW OF DRUG INTERVENTIONS IN THE CRIMINALJUSTICE SYSTEM (ENGLAND AND WALES) WITH A FOCUS ON SPECIFIC
INTERVENTIONS PROVIDED AT ARREST - ARREST REFERRAL AND AS A
COMMUNITY SENTENCE - DRUG TREATMENT AND TESTING ORDERS

Shireen Sadiq*
I. INTRODUCTION
The overarching aim of the UK Government’s drug policy is to reduce the harm that drugs cause tosociety - communities, individuals and their families. The key to delivering this aim is to reduce the numberof people caught up in the chaotic lives of addiction and crime (problematic drug users) and to stop young
people from entering their ranks. Tackling the enormous challenge of drug misuse is not a matter for
Government or its agencies alone.
The updated Drug Strategy, published in December 2002, sets out plans to break the link between drugs
and crime through joining up drug interventions delivered in the criminal justice system more effectively anddeveloping an ‘end to end’ approach from arrest through to sentence and beyond.
Evidence from early pilots and more extensive evaluation has highlighted that drug interventions in thecriminal justice system offer an effective means of putting drug misusing offenders in touch with appropriate
services locally where they can receive help to reduce their drug use.
To help provide an overview of the potential benefits and implications for implementation of these typesof interventions, particularly at arrest and at the community sentence stage, this paper will outline a briefsummary of evidence from early pilots and programmes relating to Arrest Referral and Drug Treatment andTesting Orders. It will include references to the models of delivery as the evidence base as well as practicalimplementation issues which may need to be considered for effective delivery.
A. Terminology
To facilitate an understanding of assumptions which may be made in the paper, this section will seek to
describe some of the terms used which have been adapted from definitions adopted by the Health Advisory
Service (HAS) and the Advisory Council on the Misuse of Drugs (ACMD) National Treatment Agency andthe Audit Commission.
• Drug Use: illegal and illicit drug taking that does not cause any perceived immediate harm- eventhough it may carry some risk of harm e.g. health problems.
• Drug Misuse: illegal and illicit drug taking which leads a person to experience social, psychological,
physical or legal problems related to intoxication and/or regular excessive consumption and/or
dependence.
• Treatment: describes a range of interventions which are intended to address an identified drug related
problem or condition relating to a person’s physical, psychological or social (including legal) wellbeing. Structured treatment (evidence based) follows assessment and is delivered according to a careplan with clear goals regularly reviewed with the client. It may comprise a number of concurrent or* Criminal Justice Policy Lead,
Criminal Justice Interventions Programme,
Drug Strategy Directorate,
Home Office,U.K

The views expressed in this paper are those of the author, not necessarily those of the Home Office (nor do theyreflect Government policy).

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sequential treatment interventions. Drug treatment can encompass a wide range of interventions /treatment modalities (types).
• Problematic Drug User: describes those drug misusers who experience social, psychological or legal
problems related to their drug misuse rather than those who use drugs casually or recreationally.
• Polydrug user: describes the pattern of drug misuse where the same person will use opiates
particularly heroin as well as crack, cocaine, other stimulants and drugs such as benzodiazepines.
B. The Legal Framework and the Roles of Criminal Justice Agencies
In order to understand how drug interventions are delivered within the context of the criminal justicesystem in England and Wales there is a need to have some understanding of the legal framework andagencies involved, for the purposes of this paper this is very briefly covered in Appendix A of my first paper.
II. EVIDENCE BASE – DRUGS AND CRIME
The relationship between drugs and crime is complex, though not all drug users commit crime. Research
has helped to quantify the potential demand for Arrest Referral and other programmes and provides a‘profile’ of those offenders who would most benefit.
The New English and Welsh Drug Abuse Monitoring programme (NEW ADAM), aims to provide basic
intelligence on: drug misuse at the point of entry into the criminal justice system and links between drugs
and crime. The programme involved adult offenders who had been arrested and subsequently interviewed
and drug tested (using urine samples) to check for drug presence, in 8 police custody suites. The study found
the following:• 65% of arrestees test positive for at least one illegal drug
• 30 % tested positive for two or more such substances• 29% tested positive for heroin/cocaine• users of both heroin/cocaine/crack commit between 5-10 as many offences as arrestees who do notuse drugs• 78% saw a connection between drug use and acquisitive crime• users of heroin and crack cocaine were also responsible for more than half, by value, of acquisitive
crime
Most of the arrestee group described above were not in treatment. Strategies aimed at reducing thedemand for illicit drugs by breaking the link between drugs and crime have been an integral part of the UK
Government’s anti-drug strategies since the mid-1990’s. There is strong evidence that for many problem
drugs using offenders treatment can be a cost effective way of reducing their offending. The importance of
this connection can be demonstrated through the recent estimations of the economic and social costs of ClassA drug use by York University (Godfrey et al 2002).The study found that the total (including victim) socialand economic cost of Class A drug use in England and Wales, was estimated to be between £10 billion and£18 billion per annum. Problem drug users account for almost all economic and social costs (99%) and drug
related crime accounts for around 88% of total economic and social costs.
A. Evidence Base- Treatment and Estimating ‘Demand’We know that treatment works. Appropriate treatment, can reduce both drug misuse and related
offending. Evidence highlights that problem drug using offenders referred through the criminal justicesystem to treatment, and then retained in treatment, report significant reductions in drug related crime,
spending on drugs and use of drugs (NTORS, Gossop 2001).
Findings from early pilots of arrest referral to engage drug misusing offenders in the criminal justicesystem highlighted that drug using offenders do take up and engage in programmes of help, more findings
from these pilots will be outlined later in the paper (Edmunds et al 1998).
Evidence suggests that there are strong links between users of certain drugs and crime particularly
acquisitive. It is therefore not surprising to find that problem drug users frequently turn up in the Criminal

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Justice System. It is estimated that 180,000 problematic drug users enter the criminal justice system throughpolice custody suites each year, of these only a minority are already in treatment (NEW ADAM). It is also
estimated that there are around 250,000 problem Class A drug users in England and Wales (Godfrey et al), ofwhom 100,000 (NDTMS) may be in specialist treatment.
The brief information provided in this section demonstrates the potential size of the population ofproblematic drug users in and out of treatment and the criminal justice system as well as the importance andcost effectiveness of treatment.
III. DRUG INTERVENTIONS IN THE CRIMINAL JUSTICE SYSTEM
Drug interventions in the criminal justice system offer an effective means of putting offenders who areusing illegal drugs in touch with appropriate services locally where they can receive help to reduce their druguse.
Since 1998 a range of criminal justice based drug interventions have been introduced or piloted inEngland and Wales, which were designed to either facilitate the referral of offenders into drug treatment, ordeliver treatment within the context of a community or custodial sentence.
These interventions have been implemented to provide access and engagement at key points in thecriminal justice system; these are listed, in brief, below:
In police custody suites – Proactive arrest referral schemes now cover all 43 police forces in England andWales. Drug Testing Pilot Programme - Drug testing after charge under the provisions of the Criminal Justice
and Court Services Act 2000 operate in one custody suite in nine police force areas and in additional custody
suites covered by four police forces within the street crime areas.
Courts – All courts in the drug testing pilot programme /street crime areas have access to the results(positive/negative) of drug tests in police custody to inform bail/sentencing decisions: and power to orderpre-sentence drug tests in the pilot areas. Arrest referral workers have a presence in some Magistrates
Courts.
Probation – Drug Treatment and Testing Orders were introduced to courts in all probation areas inEngland and Wales from October 2000. Drug Abstinence Orders/Requirements are being piloted in 9
probation areas (part of the Drug Testing pilot programme).
Prison – Healthcare teams provide clinical services and detoxification for prisoners received into
custody. Counselling, assessment, referral, advice and throughcare (CARAT) teams have operated in all
prisons from September 1999. There are a range of structured drug treatment programmes and therapeuticcommunities available in selected prisons. Mandatory drug testing has been available since 1997 asignificant number of prisons have chosen to give prisoners access to voluntary testing units.
Post-release – currently there is no comprehensive aftercare provision for drug misusers returning to thecommunity from custody. Initiatives have developed in an ad hoc manner and prisoners serving less than 12
months are not currently subject to statutory supervision and therefore particularly vulnerable following
release. Drug testing as a licence condition is being piloted in the 9 drug testing pilot areas.
A. Drug Treatment Services
Interventions delivered in the criminal justice system will only be effective when associated withappropriate treatment interventions. Treatment and support needs to be accessible to those who need it
regardless of origin, gender, sexual orientation or source of referral. Although waiting times to accessspecialist drug treatment is reducing there are still problems in some parts of the country (NTORS 2001).
The availability and effectiveness of drug treatment (delivered by a range of NGOs providers) is variable
across England and Wales. The Department of Health and Home Office jointly funded the National
Treatment Agency (NTA), created in 2001 as a special Health Authority. The NTA’s remit covers Englandand its current priorities are to ensure equality in drug treatment; increase the capacity and competence of the26

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drug treatment workforce; increase quality and accountability at all levels of the drug treatment system;
improve the availability and accessibility of drug treatment in all areas of the country; and increase theeffectiveness of drug treatment. The National Treatment Agency (NTA) is currently taking forward a
programme of work to improve accessibility and availability to treatment services, generally and is working
with Drug Action Teams (DATs) to ensure that drug misusers in all areas (England) have access to the fullrange of treatment.
The Department of Health commissioned the NTA to enhance planning commissioning and provision of
drug treatment services. This resulted in the development of Models of Care, a national framework (seeAppendix A). The range of interventions outlined in the framework are grouped into four broad bands ortiers, which range from the least specialist and intensive in Tier 1 to the most specialist and intensive in Tier
4. Local areas covered by Drug Action Teams (strategic local partnerships) will be expected to ensure thatthey provide the right balance of local drug treatment services to fit the needs of their local population andcan provide access to the types of services outlined in the four tiers.
Models of Care is based on current evidence, quality standards and good practice in England andadvocates a systems approach to meeting the multiple needs of drug misusers. It recognises the need for
effective assessment which should be needs-led and seen as an on going process. The three levels ofassessment which should be available locally to provide access between the four tiers are:• Level 1 Screening and referral assessment• Level 2 Drug and alcohol misuse triage assessment• Level 3 Comprehensive drug and alcohol misuse assessment
The following section on Arrest Referral will briefly describe the term and models, outline the evidencebase and links with drugs and crime, from early pilots and programmes and briefly refer to the processes
adopted, practical and implementation issues for ‘effective delivery.
B. What is Arrest Referral?
Arrest referral schemes are partnership initiatives between the police, local drug services (delivered by
Non Government Organisations NGOs and Statutory Services) and Drug Action Teams (DAT)/Drug andAlcohol Action Teams (DAAT) that use the point of arrest within custody suites as an opportunity forindependent drug workers to, to make contact with arrestees with drug problems while they are in police
detention and refer them to appropriate treatment to address their drug use. The pro-active arrest referral
initiative is one of a series of criminal justice interventions that seeks to identify problem drug-using
offenders in the criminal justice system and refer them to treatment.
Arrest Referral Schemes are not alternatives to prosecution or due process but provide a direct routefrom the custody suite to drug treatment or other programmes of help.
Evidence has suggested that the proactive approach is (Edmunds et al 1998) most effective. This iswhere a dedicated drugs worker, independent of the police, based in or on call to a police custody suite,
makes contact with problem drug-using arrestees and refers them to appropriate treatment: with the aim of
reducing their drug use and drug-related offending. The evidence provided to date supports therecommendation that all those arrested regardless of alleged offence should be introduced and/or informed of
the scheme i.e. ‘blanket coverage’.
Involvement with arrest referral is voluntary and is not an alternative to prosecution or due process.
Focused on the point of entry to the criminal justice system, this initiative aims to identify and help problem
drug-using offenders break their cycle of drug use and crime as early as possible.
Arrest referral schemes have been in operation in various forms since the 1980s. Three main models ofdelivery have been identified in earlier research: (Edmunds et al 1998, 1999).
• Information model. This approach involves the provision of basic information (such as leaflets)
about local drug treatment services that can be delivered by police custody staff. Problem drug-using
offenders will be expected to contact treatment services through their own volition.

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RESOURCE MATERIAL SERIES No. 64• Proactive model. In this model, a dedicated and independent drug worker based in the custody suiteor on-call, assesses problem drug-using offenders and refers them to an appropriate treatment
service.
• Incentive or coercive model. This model can provide incentives to seek help. ‘Caution Plus’ schemes
involve cautioning a problem drug-using offender arrested for possession of illicit drugs with thespecific requirement to seek advice from a drugs worker. ‘Deferred Caution’ schemes delay thedecision to issue a caution following attendance at a drug service within, for example, 30 days. If a
positive report is recorded no further action will be taken.
1. Evidence Base - Arrest Referral
The evidence base for developing arrest referral initiatives consist of three strands of research which
demonstrate:• strong links between drug use and offending behaviour;• high numbers of potentially problematic drug users entering the criminal justice system; and• the (cost) effectiveness of treatment in achieving sustained reductions in drug use and related
offending.
Evidence already exists which demonstrates the potential of arrest referral schemes to deliver reductions
in drug use and offending behaviour. Three demonstration arrest referral schemes in Southwark, Derby andBrighton, were evaluated (Edmunds et al 1998) each adopting the ‘proactive’ model. Findings showed thesepilots addressed an unmet need; whilst offenders had on average 21 previous convictions, previous arrest had
not deterred them from drugs/crime; they were poly drug users, injectors with lengthy drug using careerswhich started when they were young. Only a quarter seen at arrest were in touch with drug services and athird had never been in contact.
At the six month follow up, large reductions were noted in self-reported drug use, rates of injecting werealso reduced, average expenditure (median) on drugs fell from £400 per week to £70 per week (six months).
The total number of criminal offences committed per month was also reduced from 10,800 in the month
before contact with a scheme to 2,200.
The research concluded that the proactive model could be successful by identifying and targeting
criminally active drug users who may benefit from treatment, referring this group to specialist drug treatment
services and helping to ensure that referrals enter treatment programmes.
2. Expansion of Arrest Referral Schemes through the Joint Funding Initiative
The Home Office Crime Reduction Programme (CRP) was a three-year, evidence-based initiative
costing £420 million, aimed at achieving a sustained reduction in crime, improving and mainstreaming
knowledge of best practice and implementing cost-effective crime reduction activity. The programme
included burglary reduction, targeted policing, violence against women, use of Close Circuit Television(CCTV), sentencing and treatment of offenders, early interventions, youth inclusion and arrest referral.
Encouraged by the evidence from early pilots for arrest referral, the Home Office agreed in summer 1999
to contribute £20 million over three years, from the Crime Reduction Programme (CRP). It is important tonote that at the time a Key Performance Target for all Police Forces in England & Wales had been set out inthe 10 year U.K Drug Strategy (1998),- to double by 1999 the number of ‘proactive schemes in their force,and have full coverage by March 2002.
The Joint Funding Initiative (JFI) was established to help accelerate the development of arrest referral
schemes across England and Wales and to learn more about how to maximise the effectiveness of thisinitiative. Funding was made available from December 1999 until March 2002. Following an invitation to all
Police Forces in England and Wales, 41 out of 43 police forces applied for funding under the arrangements
set out in the Home Office Circular 41/1999. Forces working in partnership with the DAT and local agencies
were asked to identify the number of workers, and associated funding, with a view that police forces would
continue funding schemes after 2003. The JFI provided funding for arrest referral workers which had to be‘matched’ locally by the relevant police force, DAT or other partnership arrangement (based on prior

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research a unit cost of £40,000 per worker was used including ‘on costs’) the JFI would contribute a
maximum of up to £20,000 per worker.
An additional year’s central funding (up to Spring 2003) was subsequently provided by the Home Office.
This initial investment from central government funded the establishment of schemes and arrest referral
workers as well as contributing to the funding of local drug treatment services.
The majority of arrest referral schemes became operational from April 1st 2000. By the end of April
2002, all Police Forces in England and Wales were operating pro-active schemes (either funded by the Home
Office or by police force funding schemes locally), employing approximately 400 workers. Central funding
is now available to sustain delivery of drugs work in custody suites and court cells (as appropriate) over the
next three years,
3. Monitoring and Evaluation of the Joint Funding Initiative
A key objective of the CRP and JFI was to obtain evidence of ‘what works’ with regard to crime
reduction initiatives. To build on the existing evidence base from the previous DPI research (Edmunds et al,1998), research was commissioned to assess how effective arrest referral schemes were by determining
whether:• arrest referral schemes are successful in targeting the key group of problem drug-using arrestees andensuring their entry into specialist drug treatment services and;• whether engagement with specialist drug treatment facilitates reductions in levels of crime (throughself-reported offending and in police arrest figures).
A three-year programme of monitoring and evaluation was commissioned comprising two mainelements:• a national monitoring system to collect basic epidemiological information in the number,characteristics and referral outcomes of problem drug-using offenders screened by arrest referral
workers (this is ongoing); and• a programme of area-based research and evaluation studies to provide an assessment of the
behavioural outcomes of arrest referral and how these can be maximised (this completes in summer
2003).
We know that arrest referral and treatment are inextricably linked. This programme would build on thework of the earlier pilot programmes and improve both knowledge and understanding of evidence based
practice, to do the right things, right.
The Evaluation programme seeks to explore and demonstrate the combination and type of relationships
needed to achieve the desired reductions in drug use and crime and improvements in health and social
outcomes. This will be undertaken through a range of approaches including:• Validation of monitoring• In-depth, qualitative process and non-engagement studies• Outcome assessments• Re-arrest and reconviction studies• Testing veracity of self-reported data
• Economic cost benefit analyses• Examination of the efficacy of different treatment modalities
4. The National Monitoring System
The National Arrest Referral Monitoring System (NARMS) collates information on all arrestees
screened, assessed and referred by the worker, this data is then linked to the National Drug Treatment
Monitoring System (NDTMS) to identify uptake into specialist drug treatment. A generic monitoring form
used across England & Wales (NARMS). See Appendix B.

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Data is collected locally by the National Drug Treatment Monitoring System (NDTMS) and allows theanonymous follow-up of arrestees into treatment. One-year follow-up of those in treatment (client review).
C. How Does Arrest Referral Work?
The arrest referral process can simply be broken down into a number of key stages:• ‘booking in’ to police custody and initial offer of referral by the police• subsequent contact with arrest referral worker to provide more information on the scheme andencourage participation.
In Appendix A of my first paper, the final section on the Police Service, briefly outlines the process
undertaken known as ‘booking in’ of the detainee by the arresting officer and custody sergeant, irrespectiveof whether the detainee is seeing an arrest referral worker.
• All those at the ‘booking in’ stage are informed by the police that a scheme operates at the police
station as the Custody Officer brings arrest referral to the attention of detainees as part of thebooking-in procedure• However the introduction by the police must comply with PACE
• The introduction must be restricted to a statement of factual information
The following statement is the one which is usually read out to the detainee‘A drug referral scheme operates at this police station.
If you are interested, I can arrange for you to see an
Independent drugs worker in due course.
Are you interested’?
• Those who wish to know more are offered an opportunity to see an Arrest Referral Worker who
explains how the scheme works, contact is made with the worker according to the arrangements
drawn up between the police and the provider agency of arrest referral , it could be the cell or someother venue (see working protocols).
• Workers (according to local agreements may also be permitted by the Custody Officer to ‘cold call’,that is talk to the detainee directly in the cell. Evidence suggests not all detainees agree to see aworker at the initial stage of booking in, however on reflection in the cells and/or meeting a worker
in the cells their perspective may change.
• If the detainee agrees, a screening interview and assessment is undertaken to identify a programme ofhelp.
• The arrest referral worker arranges for client ‘entry’ or referral into treatment or arranges further
follow-up.
• The client then attends the first appointment for treatment or is provided with the opportunity ofcarrying on seeing the arrest referral worker until a treatment place becomes available.
There are a range of practical considerations to be aware of in terms of implementing such a scheme thefollowing lists briefly a few key issues for further consideration:
1. Starting from ‘Scratch’ in the Community
Need the right people at the ‘right level’ to be part of a strategic working group of players including
Police, Health, NGO’s and DAT.
• Identify treatment availability capacity and appropriateness• Custody suites – how many, throughput of arrestees, other initiatives at arrest• Agree model and service specification (based on local picture including coverage of custody suites)• Draw up and monitor Service Level Agreements with providers of arrest referral services• Agree recruitment, Job Descriptions and CRO (crime) checks• Agree local monitoring and evaluation• Manage external and internal promotion - community• Ensure development of working protocols

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2. Starting from Scratch in the Community - Working Protocols• Need agreed terminology and definitions• Operation - how it works, who does what, do’s and dont’s for ‘workers’• Confidentiality and rules of disclosure• Agreed hours of cover for workers• Identification and passes in the custody suites• Health and safety in the custody environment• Monitoring responsibilities• Where to see arrestees:- The custody area
- Client’s own cell, Solicitors Consultation room, Doctors’ consultation room, Police interview
room, designated AR office, unoccupied areas of the custody suite.
- venues outside the police custody area
Group 4 custody area (private company), locations within magistrate’s courts, Probation office,drugs agency.
3. Establishing Arrest Referral - A Typical Service Provider may Include the Following• Non government organisation (NGO) or state health provider providing community based drop in,practical advice information, advice and counselling and support• Provide access to prescribing treatment based on philosophy of harm reduction through GP liaison• Will cover e.g. 6 custody suites at the times when they are ‘busy’ and review with police to ensure
this is appropriate• Employ trained drug workers, supervised by a manager• Provide training (focus work in criminal justice system)• Participate in the local ‘steering group’• Agree risk assessment/referral protocols/information sharing/confidentiality agreements withsteering group/police and other stakeholders• Ensure national and local monitoring arrangements implemented and that forms/data are fullycompleted where possible and returned appropriately (include analysis).
4. Role of the Arrest Referral Drug Worker
Recommendations are raised later in the emerging findings, but basic responsibilities would include:• Promoting/explaining scheme to detainees• Undertaking screening interview and comprehensive assessment to inform referral• Refer onto other services• Monitoring client progress• Development work with police and service deliverers• Training/inducting police and service deliverers• Liaison and work with colleagues involved at other points of contact with criminal justice system• Record-keeping to inform police and agency key performance indicators
D. National Implementation -Findings from the National Monitoring and Evaluation Programme
1. The National Monitoring System
Published evidence from the NARMS shows that between October 2000 and September 2001, 48,810
arrestees were screened and interviewed, over half interviewed (58%) were referred to specialist drug
treatment, over half (51%) were not currently engaged in treatment. Of those referred 22% made a demand
for treatment, but there was variation in treatment take up across England & Wales. The findings from themonitoring system are explored more fully in the analysis of the emerging findings published in July 2002.
2. The National Evaluation Programme- Emerging Findings
In July 2002, a summary of the emerging findings, from the research programmes at 18 months (Sondhi
et al, 2002), was published July 2002.
The main findings are listed below; many are being taken forward from 2003/04:

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RESOURCE MATERIAL SERIES No. 64• Proactive arrest referral schemes provide an effective way of reaching problem drug-using prolificoffenders and referring them to drug treatment and other appropriate services. (48,810 individuals
were screened between October 2000 and September 2001 in England and Wales, of whom over half
were voluntarily referred to a specialist drug treatment service).
• Workers had some success in getting problem drug-using offenders into treatment. Of those referred,a quarter made a demand for treatment (or 5,520 individuals), however some were significantly more
likely to drop-out of treatment once engaged compared to self or GP referred drug users to the same
service. Further evidence provided more information about this group who had difficulties engaging
in treatment.
• Black and Asian drug users; older poly-drug users with negative previous experiences of treatment;
young crack-using street robbers and female crack-using sex workers were all less likely to engage
with treatment than other groups.
• Contact with an arrest referral worker lead to a reduction in re-arrest rates, self-reported drug use andoffending. The level of police re-arrest rates significantly declined six months after contact with anarrest referral worker compared to the six months before contact. Two thirds (67 per cent) werearrested less often following referral than before.
• Preliminary analyses suggests that arrest referral schemes can provide significant economic andsocial benefits analyses suggest that the economic and social benefits of the arrest referral initiative
are around £4.4 billion over an eight year period.
• Significant reductions were also reported in secondary indicators such as physical and psychologicalhealth.
• Treatment retention has been identified as an important predictor of a successful outcome. It is likelythat there is a combined effect of initial contact with an arrest referral worker, impact of community
or custodial sentencing and treatment engagement that contributes towards a successful outcome.
• Self-reported drug use was validated by biological assay screening (saliva sampling) and theconcordance was high, suggesting that problem drug-using offenders provide accurate informationon their drug-using habits.
• The evaluation report also described the process and delivery of arrest referral schemes andpresented some recommendations as to how the full potential of such schemes could be maximised.
For example, schemes should:- remain independent from the police- offer harm reduction advice where appropriate- provide low threshold treatment interventions through a case managed approach to retention andengagement into treatment- develop integrated care pathways consistent with the Models of Care approach (NTA 2002)- be extended to juveniles, alcohol users and detainees in Magistrates’ courts as appropriate.
3. Involvement at a Strategic Level and Partnership Working
Partnerships are key and need ongoing development at both strategic and operational levels.
Strategically- the DAT should work with the police and other stakeholders to ensure that there is a clear
strategic direction with shared aims and objectives for this work which integrates with other criminal justiceinterventions. Arrest referral should be considered as part of the overall delivery of local drug service
provision. In England it should be considered as an integral part of the Models of Care framework for thecommissioning and provision of specialist drug treatment services. (From July 2002, Models of Care had thesame status as a national service framework for drug treatment.)
Arrest referral workers need to have knowledge of all available local treatment options including waitingtimes and be able to contribute to the planning and delivery of drug treatment services. Workers should be

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represented on DAT/DAAT treatment planning forums and have information which can contribute to thedevelopment and planning of treatment services.
4. Throughcare and Aftercare
Some problem drug-using offenders fail to engage with community-based treatment because they areretained in the criminal justice system. A number of arrest referral workers have used this knowledge todevelop appropriate links – for example, with probation services when a Drug Treatment and Testing Order(DTTO is considered) and also with providers of treatment services in prisons. Integrated links are needed toensure that the substance misuse needs identified at arrest continue to be addressed elsewhere in the criminal
justice system, DATs/DAATs should continue to engage with relevant stakeholders to identify how thisshould be progressed.
5. Accredited Training
The development of accredited training was a key recommendation and will contribute towards
recruitment and retention of workers. Work is being taken forward to ensure that arrest referral workers areincluded within the development of a national workforce and training strategy being taken forward in
England by the NTA. The implementation of the National Occupational Standards for Drugs and Alcohol(DANOS) will be an ideal opportunity to develop practitioner competency. This will include standards
working with a more diverse range of problem drug-using offenders (including crack users and black andother ethnic minorities).
Police custody staff should also be provided with routine training on drug awareness issues (including
key harm reduction messages).
6. Next Steps Enhanced Arrest Referral and Integration
The recent emerging findings from the national evaluation and monitoring programme (DPAS Paper 18)
published in July 2002 identified a number of recommendations, including operational enhancements which
would maximise effectiveness of delivery at arrest and minimise non-engagement of drug misusing
offenders particularly when referred to specialist treatment interventions.
The evidence base supported by feedback from workers, police, and treatment providers and service
users over the last year have contributed to informing the interventions which contribute to the delivery ofenhanced arrest referral. It was recognised that many schemes and workers had moved beyond assessment
and referral in order to retain and engage drug misusing offenders until structured treatment became
available.
Using the sustainable resources and evidence now available those involved in planning and deliveringdrugs work in custody suites can build on and further extend the role and interventions currently provided bydrug workers in a custody suite/magistrates court. Moving beyond assessment and referral, the additional
resources and evidence seeks to now enhance delivery to include interventions such as harm reduction
advice, caseload management, care planning and delivery of low threshold treatment interventions. Thesetypes of services reflect the level of delivery of a Tier 2 type service.
This focus seeks to apply the recommendations and align the work delivered in criminal justice settings
more closely with the Models of Care approach but also recognises the expertise of delivery of drug workwithin a criminal justice setting.
It is recognised that drug workers working within a criminal justice setting such as a police custody suiteor magistrates court should be appropriately supported, supervised and skilled to deliver Tier 2 typeinterventions (at a minimum level). This includes drug advice, information, harm reduction information(including managing overdose), screening and specialist drug assessment, referral, care planning and casemanagement and delivery of low threshold treatment interventions such as motivational engagement.
E. Requirements of Enhanced Arrest Referral
Using the existing knowledge gained through local commissioning and delivery of arrest referral,commissioners, Police and other stakeholders within the DAT should seek to apply the recent evidence base

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and recommendations when commissioning criminal justice related drug interventions in police custody
suites/magistrates courts in order that workers:• can deliver drug-and alcohol-related advice, and identify how the offender may access information
and referral services (and their families)• know where and how to access services which reduce risks caused by injecting drug misuse,including needle exchange facilities (in drug treatment services and pharmacy-based schemes)• deliver and also know where to access services that minimise the spread of blood-borne diseases todrug misusers• deliver advice and know where to access services that minimise the risk of overdose and other drugand alcohol-related harm
• as part of local arrangements (i.e. agreed with police, DATs) target high-risk and local priority groups• undertake specialist drug and alcohol screening and assessment within a criminal context (Triage
assessment - level 2)• initiate care planning and case management in line with Models of Care and which reflects local
DAT treatment arrangements• deliver motivational and cognitive based interventions (drugs)• access as appropriate community-based, low-threshold prescribing services to sustain engagement ofoffenders whilst waiting for Tier 3 services
All of these enhancements build on work already being delivered across many of the police forces inEngland and Wales. Previous Home Office reports have shown, there is much variety between schemes, abasic core set of skills and competences is being developed to inform training and support delivery.
F. Partnership between Agencies
The DAT/DAATs and Police should ensure with other key stakeholders that there are planning andmonitoring arrangements which address both strategic and operational issues. Best practice has highlighted
the value of a local steering group, which takes on operational responsibility and ensures the development
and delivery of local procedures, protocols and day to day working arrangements. Recognition that
information and feedback from workers could inform current delivery of treatment interventions and futurecommissioning of services. Strategically DATs need to ensure that there are appropriate mechanisms to havefeedback from workers such as those working in Criminal Justice settings to inform current and futuredelivery of interventions.
The following section will now focus on Drug Treatment and Testing Orders briefly describing outcomesfrom the early pilots, the purpose and methods of delivery.
IV. Drug Treatment and Testing Orders
A. What is the Drug Treatment and Testing Order?
Drug Treatment and Testing Orders, usually referred to as DTTOs, are a sentence of the court andimplicitly a punishment for a crime. They were introduced under the Crime and Disorder Act 1998 in thepilot areas and rolled out to courts in England and Wales from October 2000.
B. Background
The DTTO was introduced as a response to the growing evidence of links between problem drug use andpersistent acquisitive offending; it was a government manifesto, to break this link. , Drug Treatment andTesting Orders (DTTOs) replaced the power to add a requirement for drug treatment to a probation order.
There had been low use of earlier legislation and it replaced the provision in the 1991 Criminal Justice Act
for offenders to undergo treatment as a condition of a probation order (contained in paragraph 6 of Schedule
1A of the Act.). Lessons learnt and the experiences from USA drugs courts particularly relating to the close
involvement of Sentencers in sentence review and management and lastly the ongoing evidence thattreatment works and can reduce crime (NTORS), and that coercion could also be as effective (Hearnden et al2000).
The purpose of the Drug Treatment and Testing Order is to break the link between drug use and crime. It
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124TH INTERNATIONAL TRAINING COURSE
VISITING EXPERTS’ PAPERS• a sentence of the court• a punishment for crime• in place to prevent future crime• an integral part of the UK Drug Strategy• a key component of the crime reduction strategy
It can be imposed on any offender over 16 who has a dependency on or propensity to misuse drugs andfor whom treatment may be helpful. The order is available in both the Crown and Magistrates’ Courts, sothat it has the broadest possible application, within its established targeting criteria.
It obliges the offender to:• undergo treatment as specified for a set period of between six months and three years• be tested regularly for drug use• attend regular court review hearings at which progress under the Order will be reviewed.
Uniquely, in English and Welsh Law, courts have a vital role to play throughout the currency of the orderand through the regular court reviews an offender's motivation and progress on the order can be monitored.
The conditions of the Order may also be amended if required at the review hearing.
Regular drug testing provides an important reality check. Drug testing is mandatory and courts regularly
review the offender’s progress. The aim of testing is to help in monitoring the offender's compliance andprogress with treatment. If testing requirements are not met and/or attendance at mandatory treatment is notadhered to, the court can ‘revoke’ a DTTO and re-sentence the offender. DTTOs cannot be imposed without
the consent of the offender.
DTTOs aim to bring persistent and dependent drug-misusing offenders into a closely supervised
programme of treatment in order to effectively break the links between their drug misuse and their offending.
DTTOs were implemented nationally in October 2000 following pilot schemes in Croydon, Gloucesterand Liverpool. The pilot sites were independently evaluated by the Criminal Policy Research Unit at SouthBank University. The pilot sites demonstrated the following areas of impact (through self-report interviews
with offenders):• reductions in drug use and offending at the start of the order• fall in average weekly amount spent on drugs• reduction in levels of polydrug use• six-monthly interviews with offenders demonstrated that these reductions were sustained over time
Evidence suggested that drug dependent offenders can be successfully coerced into treatment as they
pass through the criminal process (Turnbull et al. 2000).
C. Key Elements of the DTTO are:
• Assessment• Treatment• Testing• Enforcement• Court Review
D. Assessment
Home Office National Standards expects suitability for a DTTO to be assessed according to four main
criteria:• type and seriousness of offence• seriousness of drug problem and susceptibility to treatment• motivation to change• volume of drug-related offending.

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One key area of learning from the early pilots was the importance of getting the referral and assessment
procedures right. With experience now broadening in the supervision of DTTOs what is being found is that
an offender’s capacity to manage being on a DTTO is a critical factor in assessment.
An initial assessment or screening may also occur in a variety of settings, for example an arrest referral
scheme, the probation service or a drug service. The purpose of the initial assessment is to explore thepossibility of a DTTO with the offender and to make a decision about whether to proceed to a full
assessment. The screener will need to consider the pattern of the offender's drug misuse and nature andvolume of their offending, as well as their motivation to undertake drug treatment. The court may receive
information about drug related offending from an arrest referral worker, drugs worker in an approved hostel
or a probation officer.
However an initial screening assessment will not be sufficient basis for a DTTO recommendation to thecourt. A full assessment as part of the pre-sentence report (PSR) should always be undertaken. This mayeither be carried out by the probation area themselves or by a drug treatment service purchased to provide thetreatment aspect of the DTTO. The decision to impose a DTTO, whilst ultimately being made by the court,
will nevertheless involve all of the stakeholders, the court, the probation service, the drug service, and theoffender.
A Specific Sentence Report may provide information that leads to a request for assessment. Once thedecision to adjourn for this special assessment is made the court will adjourn to a court date which fits bestwith the 15 day adjournment.
A question raised early on by some Sentencers was how were they supposed to know who will succeed
under this Order - they are not experts?
The answer would be, they are not expected to be. Sentencing is, and will remain, a matter for the court.
But the initial assessment of the offender by the probation service and treatment providers will be crucial in
identifying and targeting the new Order at those who are causing a disproportionate level of disruption totheir community and are most susceptible to treatment. Sentencers should be able to work with and consider
the advice of the experts in order to make an appropriate sentencing decision on the basis of all the facts,
including the advice of the probation service about what community interventions are available and might beappropriate.
1. Assessment and Pre-Sentence Report
The assessment is usually provided within a pre-sentence report but is undertaken jointly by probationand treatment staff. It should include the following:• a statement that the offender has been assessed by probation and treatment staff, is dependent upon or
having a propensity to misuse drugs and as being susceptible to the kind of treatment being proposed• a treatment plan, including the name and address of the treatment provider, and whether thetreatment will be residential or non-residential• confirmation that arrangements for this treatment are in place• the suggested length of the order• a signed statement from the offender that the requirements of the order and the consequences of a
failure to comply have been fully explained by the responsible officer and confirming that theoffender is willing to comply with the order• a proposal for the minimum frequency of drug testing and of court review hearings to be specified in
the order• where there is a need for a residence requirement (other than for residential treatment) a proposal thata probation order be made alongside the DTTO and an explanation of the reasons why this residence
requirement is deemed necessary.
E. Treatment and Enforcement through DTTO National Standards
Home Office guidance (PC43/2000) says that individual treatment programmes should be developed at a
local level on the basis of the range of treatment available locally and the individual’s need.

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VISITING EXPERTS’ PAPERS
Subsequently Home Office National Standards determined that the contract requirement was:Commencement of treatment within 2 working days andContact of 20 (now reduced to 15hrs) over 5 days for the first 13 weeks
then 12 hrs per week for 3 days if progress is being made.
The range of treatment should include:
1. Treatment Related• In patient detoxification• Community detoxification• Structured programmes• Health Assessment/Education• Relapse Prevention• Residential rehabilitation• Hepatitis test & vaccination• Counseling
2. Offence Focused Work• Supervision plan & reviews• Accredited programmes 1:1 or group• Victim awareness• Relapse prevention
3. Lifestyles Packages• Social skills• Training• Pre-employment work
• Basic literacy skills• Use of leisure• Housing• Family support• The first appointment with the probation service to take place within one working day of the order
being made and contact with the treatment provider shall be arranged to take place within two
working days of the order.
• Contact, including treatment, across all the requirements of the order to be on five days per week, fora total of 20 hours a week, for the first 13 weeks of the order. There is discretion for this to be
reduced to a minimum of three days a week and 12 hours a week thereafter, if the offender is
responding well. The minimum for the first 13 weeks of the order shall be 15 hours a week and nine
hours a week thereafter.
• Contact with the offender to include provision for treatment, offence focused work and lifestyleprogrammes.
• It is anticipated that the offender will not usually be employed at the commencement of the order. If
the offender obtains employment the probation service and treatment provider shall consider if thetreatment and contact requirements shall be reduced to facilitate this and an early review hearing
arranged for this to be considered by the court. Nevertheless, the minimum treatment and contact
requirements shall be met in all cases.
• Treatment provided under the order must comply with co-existing national standards, such as thosethat will be introduced through the DH Models of Care.
F. Testing
The purpose of regular testing is to provide supervising officers, treatment providers and the courts withan objective measure of the offender’s progress towards becoming drug free. The supervising officer must
put these results into the context of the offender’s overall progress on the order when reporting to thesentencing court for each review hearing.

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RESOURCE MATERIAL SERIES No. 64
Offenders should be tested at least twice a week for the first 13 weeks of the order with discretion for thisto be reduced to a minimum of once a week thereafter depending upon progress.
G. Court Reviews
1. What is the Purpose of the Court Reviews?
The purpose of the Court Review is to enable the Court to monitor the offenders progress in treatment
and to decide whether any changes to the conditions including treatment need to be made. Preferably held by
the same sentencer or specialist bench. Courts can already ask for progress reports on offenders but now thereview process is ‘designed-in’. The court receives a written report from the probation officer including drug
test results. The review hearing provides an opportunity to encourage and support progress, if the court is not
happy with the offenders’ progress, the offender can be required to explain themselves. If the order is really
not working, the court may also amend the Order. Normally the offender attends with a member of the
DTTO staff team. Courts have the option of waiving the requirement for an offender to attend the court inperson if they are making satisfactory progress as long as this is confirmed by the written reports from theProbation Officer/Treatment Provider. The style of the review hearing may be less formal. The outcomes of
the court review hearing could include: amendments to the Order, progress expected before next review andwhether breach proceedings are justified.
V. SUMMARY
Evidence from early pilots and more extensive evaluation has highlighted that drug interventions in thecriminal justice system offer an effective means of putting drug misusing offenders in touch with appropriate
services locally where they can receive help to reduce their drug use.
Interventions particularly at arrest and at the community sentence stage provide opportunities to engage
but need to be part of a wider package of interventions across the criminal justice system.
Why deliver drug interventions in the Criminal Justice System?
Because they have the potential:• to reduce drug related crime• to reduce drug misuse• to improve health of drug misusers and• to assist social reintegration of drug misusers.

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124TH INTERNATIONAL TRAINING COURSE
VISITING EXPERTS’ PAPERS
APPENDIX A
MODELS OF CARE - FOUR TIER FRAMEWORKTable 1. Drug Misuse Treatment Tiers and Commissioning Levels
Service Modality

Commissioning
Level

Tier No.

Tier Title

1

Non-substance misuse
specific services

For example:
Personal/general medical services (primary care)
Non-DM specific social services including children andfamily services; non-DM specific assessment and caremanagement
Housing and homelessness services
Non-SM specific probation services
Vaccination / communicable diseases
Sexual health / health promotion
Accident and emergency services
General psychiatric services
Vocational services

Local DAT*/ PCT/
PCG

2Open access drug
misuse services

Drug-related advice and information
Open access or drop-in services
Motivational interviewing/ brief interventions
Needle exchange (pharmacy/service/outreach)
Outreach services (detached/domiciliary/peripatetic)
Low-threshold prescribing
Liaison with drug misuse services for acute medical andpsychiatric sector
DM specific assessment and care management

Local DAT/ PCT/PCG

3

Structured communitybased specialist drug
misuse services

Drug specialist care planning and co-ordination
Structured care planned counselling and therapy options
Structured day programmes (urban and semi-urban)
Community-based detoxification services
Community-based prescribing stabilisation and maintenanceprescribing
Community-based drug treatment for offenders on DTTOs
Other structured community-based drug treatment services
targeting specific groups
Structured aftercare programmes
Liaison with drug treatment services

Local DAT*/ MultiDAT

4a

Residential substancemisuse specific services

Inpatient drug detoxification and stabilisation services
Drug and alcohol residential rehabilitation services
Residential drug and alcohol crisis centres
Residential co-morbidity services
Specialist drug and alcohol residential units targeting specificgroups, e.g. mother and child units services

Multi-DAT/ Regional/
National

4b

Highly specialist nonsubstance misuse
specific services

For example:
Specialist liver disease units
Forensic services
Specialist psychiatric units including: personality disorderunits; eating disorders units
Terminal care services
Young people’s hospital and residential services providing
drug and alcohol treatment services (16 to 21 years)
HIV specialist units

Regional/ National

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RESOURCE MATERIAL SERIES No. 64
APPENDIX B
TELEPHONE ENQUIRIES:
020 7273 4045
1. CONTACT DETAILS:ARREST REFERRAL MONITORING FORM

PLEASE SEND THIS COPY TO YOURLOCAL NDTMS

Date of contact (4 digit year):

Where was contact made ( one)
Police////Police station:

Court

Drug Action Team area:

Other

Drug worker’s code/name:2. DETAILS OF CLIENT: Full name, address and postcode are NOT required
First initial

Date of birth (4 digit year):

Surname initial

Local authority/ council of residence

Gender M/F( ) if NFA

Ethnic group: Which of the following groups do you belong to?

(

one)

WHITE:White British

White Irish

White OtherMIXED:White/Black Caribbean.

White/Black African

White/Asian

BLACK:

Caribbean

AfricanBlack OtherASIAN:

IndianPakistani

OTHER:

Chinese

Other

Offence: What alleged offence have you been arrested for?

(

one)

Bangladeshi

Mixed Other
Asian Other

Please specify:

If more than one offence tick the most serious

Shoplifting

Street robbery

Burglary

Fraud

Other theft

Wounding/assault

Auto-crime

Soliciting

Selling/possession of drugs

Handling stolen goods

Other
Please specify

3. TREATMENT HISTORY:
Have you ever received treatment for a drug problem?

Y/N

If yes, are you still receiving treatment for your drug problem?

Y/N

4. DRUG AND ALCOHOL PROFILE: Drugs used in the last month? (Include alcohol as main drug if appropriate)
Main problem drug

Injected Y/NDrugs used in the last month

Injected Y/NInjected Y/NAlcohol units

Injected Y/N

Per week

Injected Y/N

On average (to the nearest £), how much do you spend on illicit drugs per week?

£

5. INCOME AND OFFENDING BEHAVIOUR:
What are your three main sources of income? (please

three options that apply)

Legitimate paid work

Selling drugs

Burglary

Benefits

Street robbery

Sex work

Shoplifting

Auto-crime

Fraud

Handling stolen goods

Begging
Other

Do you have any previous convictions?

Specify
Y/N

6. SUMMARY: Initial assessment recommendation
Initial assessment recommendation: Complete after discussing and agreeing the recommendation with the client (please
No further intervention required

Referral refused (by client)

Referral to specialist drug treatment
Continue in treatment
Referral to specialist drug agencyĺĺ

Agency name
Agency nameCaseload/case management
Scheduled for further appointment
Other referrals
Alcohol service

Referral to mental health service

GP/GP liaison or Primary Care

Referral to CARATs or Prison Healthcare

DTTO teams

Referral to housing agency

Other

40

ĺ

specify:

all that apply)

124TH INTERNATIONAL TRAINING COURSE
VISITING EXPERTS’ PAPERSGUIDANCE NOTES:The National Arrest Referral Monitoring System collects routine information on the number and characteristics of problem drug-using
offenders who report a demand for treatment. The data collected forms a module with the National Drug Treatment Monitoring (NDTMS).
All the information collected is anonymous and confidential (initials, date of birth and gender are used to calculate the number ofindividuals). See Informed Consent sheet for more details. DETACH THE CARBON COPY AND RETURN TO YOUR LOCAL NDTMS.

PLEASE COMPLETE THIS FORM:

x On all arrestees with whom you have a face-to-face contact. This may lead to a further detailed assessment of clinical or othertreatment needs that may lead to a referral to a drugs service.

x For all face-to-face contacts, regardless of whether you have seen the arrestee before.
x Do not complete this form for all contacts such as brief personal interactions, letter or telephone contacts.
1.

CONTACT DETAILSx Contact Tick Police if seen in a custody suite; Tick Other for gateway agencies.
x Drug worker’s code/name: This is used to allow local feedback. Include a code if it has been agreed locally with your NDTMS
manager.

2.

DETAILS OF CLIENTx Initials, date of birth and gender No names and addresses are required.
x Local authority of residence This is the client’s Unitary or County of residencex NFA If the client has No Fixed Abode tick this box. This may include living in a hostel, B&B etc.
x Ethnic group Please use the client’s own definition and select from the list providedx Offence Please tick one option only. If the client has committed several offences then please enter the most serious. If a client has
been arrested on a WARRANT then please tick the original offence.

3.

TREATMENT HISTORYx Ever treated Include if client has ever accessed treatment for a drug problem, including GPs and generic services.
x Current treatment Include if client is currently accessing treatment, including GP services.
4.

DRUG AND ALCOHOL PROFILEx Main problem drug Write in the drug that is the main problem for the client. Include alcohol here if appropriate.
x Drugs used in the last month Please WRITE in all illicit and licit drugs used in the last month.
x Alcohol units per week The number of units of alcohol the client is estimated to use per week.
x Illicit drugs spend Include estimates of client’s spend per week. If drugs are not directly purchased, enter “0”.
5.

INCOME AND OFFENDING BEHAVIOUR

x Sources of income Please include client’s three main sources of income from list.
6.

SUMMARY Initial Assessment Recommendationx Complete any assessment recommendations (tick all that apply).
x If the client refuses a referral following an assessment, please tick REFERRAL REFUSED (BY CLIENT)x Caseload/case management Tick this box if, after assessment, you arrange to meet the client again at another venue.

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