Effectiveness Evaluation of the "Expanded Addiction Treatment Program" Must Be Conducted Immediately

Drug offenses and driving under the influence (DUI) have consistently ranked as the top two crime types in Taiwan over the past 20 years. Combined, they frequently account for roughly 40% of annual convictions and newly imprisoned individuals, and over 20% of the prison population. Consequently, the state and society inevitably pour massive resources into handling them. It is no surprise that these have been the most frequently adjusted criminal policies over the past two decades and became a focal issue at this year's National Judicial Reform Conference.

During the "National Judicial Reform Conference Review Symposium" on December 24, Executive Yuan Political Deputy Minister Lo Ping-cheng (羅秉成) and Department of Overall Planning Director-General Lin Li-ying (林麗瑩) of the Ministry of Justice pointed out that the Executive Yuan is currently planning to expand the scope of addiction treatment for drug offenders and intends to apply this system to DUI offenders as well. Political Deputy Minister Lo is coordinating cross-ministerial resources (especially medical resources from the Ministry of Health and Welfare) and expects to clarify how many cases can be handled per unit of time by the end of January, after which the allocation of limited resources will be planned accordingly.

What deserves first-of-all support is this: compared to the traditional mindset of combating crime with harsh punishments, prioritizing treatment is the correct direction, given that solid evidence already supports the physiological, psychological, and social causes of drug addiction. Unfortunately, however, neither the Ministry of Justice's report at the National Judicial Reform Conference nor the explanations provided by Political Deputy Minister Lo and Director-General Lin at the symposium highlighted a key point: reducing the recidivism rates for drug use and DUI is expected to significantly help lower the overall crime rate and recidivism rate.

According to research data compiled by the author in recent years, Taiwan's overall recidivism rate since 1985 has likely increased (contrary to general expectations) along with policies heavily penalizing drug offenders, while simultaneously decreasing as treatment-oriented dispositions—such as correctional education, drug rehabilitation, and addiction treatment—were increasingly utilized. Particularly since the legalization of addiction treatment in 2008, the overall recidivism rate has declined noticeably, with a similar downward trend in the crime rate. Therefore, it can be inferred that expanding addiction treatment for drug offenders and incorporating DUI offenders into addiction treatment could further reduce recidivism and crime rates.

The aforementioned research is a macro-statistical study, making it rather difficult to directly infer a causal relationship between policies and changes in recidivism or crime rates. To accurately evaluate the effectiveness of addiction treatment, individual-level follow-up studies are most appropriate and necessary. At the symposium, the author raised a question regarding whether an effectiveness evaluation was simultaneously planned for the new policy of expanding addiction treatment; Director-General Lin pointed out that this policy was derived precisely from prior effectiveness evaluation studies.

Due to time constraints, further discussion on this matter was not possible during the symposium. The following analysis examines the inadequacies of the current policy briefing and the "prior effectiveness evaluation studies," and subsequent articles will offer concrete recommendations for "future effectiveness evaluation studies" in the hope of assisting with policy planning.

Insufficient Arguments in the Policy Briefing

When the Second Meeting of the Fifth Division of the National Judicial Reform Conference discussed addiction treatment on April 20, the Ministry of Justice cited in its report, Improvement of Diverse Treatment Models for Drug Abusers, that: "According to Hsu Chun-chin et al. (2013), conditional suspension of prosecution with mandated addiction treatment is more effective than imprisonment." However, Professor Hsu and his colleagues conducted an "expert opinion survey" targeting psychiatrists and medical social workers who participated in addiction treatment—that is, reporting what the experts "felt." While views formed by experts through direct contact with cases are undoubtedly an important foundation for inspiring subsequent research, they do not constitute studies tracking and comparing relapse rates (or recidivism rates) across different treatment conditions.

Two other effectiveness evaluations concerning addiction treatment can be found on the "Judicial Statistics Information Network," both of which observed "revocation of dispositions of suspension of prosecution" as the observation item (Chang Wen-ling, 2014, Statistical Analysis of Drug Addiction Treatment; General Analysis of Addiction Treatment Profiles for Drug Users, included in: Digest of Judicial Statistics, April 2017). The 2014 paper did not distinguish whether the reason for revoking the suspension of prosecution was re-offending in drug use. While the 2017 paper did make this distinction and concluded that from October 2008 to February 2017, there were 23,508 drug offenders subject to suspension of prosecution conditional on completing addiction treatment, among whom approximately 17.2% had their suspension of prosecution revoked due to recidivism in drug offenses, the article also provided corresponding annual figures.

However, these figures present at least three problems:

1. There is no follow-up period information, making it impossible to know how long after completing treatment the offenders re-offended (relapsed) (within 6 months, 1 year, 2 years...). "Follow-up period" is a critical concept in recidivism research and medical relapse research, based on a simple logic: the longer the time elapsed, the greater the opportunity to re-offend. For example, comparing the recidivism rates of groups (A and B) tracked for 3 years and 1 month respectively after addiction treatment is clearly an unequal comparison of opportunities; even if group B's recidivism rate is found to be much lower, it is meaningless. The correct approach is to compare the recidivism rates of groups A and B tracked over the exact same duration.

2. The report lumped groups with different follow-up periods together in its calculations, thereby yielding figures of ambiguous temporal significance.

3. There was no comparison of the effects of addiction treatment versus other dispositions (such as drug abstention, correctional education, or imprisonment).

In other words, relying solely on the research cited in the Ministry of Justice's briefing and the public information on the "Judicial Statistics Information Network" is insufficient to support the inference that "addiction treatment is more effective."

More and Larger-Scale Research Is Needed

The author has currently found two local empirical studies conducted in an appropriate manner, whose preliminary evidence supports the effectiveness of addiction treatment in preventing drug recidivism and alcohol abstinence (Ch'en Ch'üan-hsi et al., 2012, Recidivism Rate Tracking of 18 Months of Methadone Maintenance Therapy for Released Drug Offenders in Taiwan, Taiwanese Journal of Public Health, 31(5), 485–497; Ko Huei-chen et al., 2001, A Discussion on Addiction Treatment Models for Alcoholism, Department of Health Science and Technology Research and Development Project). However, for the planning of criminal policy, these two studies still fall short in several respects:

1. Sample sizes are too small: Only a little over 100 samples in each study completed treatment and were tracked until the end of the research. Therefore, more samples are needed to re-verify the conclusions and identify the key factors influencing efficacy.
2. Ko Huei-chen et al. (2001) is a medical study; its samples were not DUI offenders, and the tracked outcome variable was relapse into alcoholism rather than DUI recidivism.

Other domestic studies on addiction treatment for drug offenders mostly consist of interviews with offenders or experts, lacking tracking of recidivism behavior. The few tracking studies available unfortunately suffer from the aforementioned "errors in calculating follow-up periods," leading to analyses utilizing underestimated or temporally ambiguous recidivism rates. Consequently, their conclusions become distorted or meaningless (e.g., Wang Hsueh-fang, 2015, A Discussion on the Benefits of Drug Suspension of Prosecution Addiction Treatment in Taiwan) and fail to provide the information required for policy planning.

In summary, available research in our country regarding the effectiveness of addiction treatment in reducing recidivism remains too scarce and too small in scale. If policy planners do not reserve resources for more and larger-scale studies, it will be difficult in the future to prove that "expanding addiction treatment" actually achieves the effects anticipated at the time of policymaking.