Reductions In Criminal Activity Research Articles

Determinants of successful methadone maintenance treatments in two groups of patients: a first study

Background: drug abuse is a social and public health problem, with high costs to society. It is, therefore, important to develop effective treatments for this problem, and evaluate these by identifying determinants of successful outcomes in order to plan more efficient public health interventions.The methadone maintenance treatment (MMT), at an appropriate dosage, is recognized as the most effective therapy for opiate addiction, but it is very important to consider the motivation and stage of change of patients for reaching treatment success. These must also be considered when investigating the determinants of MMT success. The aim of this study is to identify the determinants of successful MMT given to “heroin-addicts" attending the drug addiction Services of the Local Health unit of the Italian autonomous Province of Trento in two groups of patients, as outlined below. Methods: a retrospective cohort study was conducted. 393 heroin addicted patients, admitted for the first time to a MMT program in the drug addiction Services of Trento Local Health unit between the years 2000-2008, were considered. Patients were divided into 2 groups on the basis of the objective of treatment suggested by the clinical team and negotiated with the patient: group a labelled high evolution, group B low evolution.High evolution corresponds to a clinical situation in which, by opinion of the operators, the patient has the ability to pursue goals of change. In these cases, the methadone treatment is aimed at reaching a drug free condition and the goal/outcome is opioid abstinence (negative urine results in 90%-100%). Low evolution is characterized by little or no compliance to the assessment and/or therapeutic proposal aimed at achieving change. In these cases, the methadone treatment is aimed at achieving two or more of the following objectives: retention in treatment regimens, improvement of health and/or psychological distress, reduction of criminal activity, of overdose risk, of risk behavior and increase of work.The probability of successful treatment was estimated by means of a multivariate logistic model. The odds ratios and 95% confidence intervals were calculated. Results: for group a, the absence of previous admissions into rehabilitation centres, and social therapy associated with MMT were associated to an overall successful treatment.For the group B, the determinants of successful MMT were: having started treatment after 35 years, having a low educational level, not having previous imprisonments and not assuming the substance more than once a week. Conclusions: the “program" related factors usually considered (like for instance: previous admissions into rehabilitation centres, social therapy) and “individual" ones (like for instance: having started treatment after 35 years, having a low educational level, not having previous imprisonments and not assuming the substance more than once a week ), influenced the effectiveness of MMT in a different way: if for patients in high evolution group the determinants of success were more associated to “program-related" factors, in the case of the low evolution group, the positive outcome seemed to be mostly related to “individual" factors....

Economic benefits of substance use disorder treatment: A systematic literature review of economic evaluation studies from 2003 to 2021

IntroductionThe economic burden of substance use disorder (SUD) is significant, comprising costs of health care and social services, criminal justice resources, loss of productivity, and premature mortality. This study assembles and synthesizes two decades of evidence describing the benefits of SUD treatment across five main outcome domains; 1) health care utilization; 2) self-reported criminal activity by offense type; 3) criminal justice involvement collected from administrative records or self-reported; 4) productivity assessed through working hours or wages earned; and 5) social services (e.g., a day spent in transitional housing). MethodsThis review included studies if they reported the monetary value of the intervention outcomes, most commonly through a cost-benefit or cost-effectiveness framework. The search included studies from 2003 to the present day as of this writing (up to October 15, 2021). Summary cost estimates were adjusted using the US Consumer Price Index (CPI) to reflect the 12-month benefits per client in USD 2021. We followed the PRISMA methodology for study selection and assessed quality using the Checklist for Health Economic Evaluation Reporting Standards (CHEERS). ResultsThe databases yielded 729 studies after removing duplicates, and we ultimately selected 12 for review. Studies varied widely regarding analytical approaches, time horizons, outcome domains, and other methodological factors. Among the ten studies that found positive economic benefits, reductions in criminal activity or criminal justice costs represented the largest or second largest component of these benefits (range $621 to $193,440 per client). ConclusionsConsistent with previous findings, a reduction in criminal activity costs is driven by the relatively high societal cost per criminal offense, notably for violent crimes, such as aggravated assault and rape/sexual assault. Accepting the economic rationale for increased investment in SUD interventions will require recognizing that more benefits accrue to individuals by avoiding being victims of a crime than to governments through budget offsets resulting from savings in non-SUD program expenses. Future studies should explore individually tailored interventions to optimize care management, which may yield unexpected economic benefits to services utilization, and criminal activity data to estimate economic benefits across a broad range of interventions.

Implementing Sports as a Rehabilitation Method for Inmates

The incarceration system in the United States has leaned towards becoming more punitive than rehabilitative. A direct consequence would be the issue of mass incarceration. In fact, the United States imprisons the most people in the world with over 2 million prisoners. Because of the mass influx of inmates in prisons, the conditions deteriorate, creating a harsh prison environment that may be detrimental to the psychological, physical, and social aspects of an inmate. In fact, 64 percent of prisoners have reported mental health concerns and experienced suicidal feelings. Rehabilitative programs and methods aimed at reducing criminal traits and recidivism do exist in prisons, but most have issues with funding and resources. The rehabilitative method of sports and recreational activities is proven to be effective and minimal for funding. Sports have profound effects on alleviating depression, stress, and anxiety. It has been shown to affect the prefrontal cortex, the hippocampus, and the amygdala; all three neurological components allow for control of behavior and a greater reduction in criminal activity. The rehabilitative method of sports has also decreased the risks of obesity and contributed to positive effects on the cardiovascular, immune, and digestive systems. Socially, sports have allowed for the formation of new relationships and an overall sense of freedom in a setting that is not shackled by chains. Implementing sports for inmates is both an effective and efficient method of rehabilitation.

The Effects of Parental and Sibling Incarceration: Evidence from Ohio

Every year, millions of Americans experience the incarceration of a family member. Using 30 years of administrative data from Ohio and exploiting differing incarceration propensities of randomly assigned judges, this paper provides the first quasi-experimental estimates of the effects of parental and sibling incarceration in the United States. Parental incarceration has beneficial effects on some important outcomes for children, reducing their likelihood of incarceration by 4.9 percentage points and improving their adult neighborhood quality. While estimates on academic performance and teen parenthood are imprecise, we reject large positive or negative effects. Sibling incarceration leads to similar reductions in criminal activity. (JEL H76, J13, K42)

INTERACTION OF STATE AGENCIES AND BUSINESS IN THE REPUBLIC OF KAZAKHSTAN DURING THE FINAL STAGE OF THE PRESIDENCY OF N.A. NAZARBAEV

The article examines the relationship between government officials and entrepreneurs with the emphasis on reducing administrative barriers, strengthening the rule of law in the economy, and increasing the activity of the business community. The article describes multi-circuit system of central and regional republican bodies responsible for regulating economic processes. Special attention is paid to the role of the non-state sector in establishing constructive cooperation between private firms and state-funded organizations. This work provides comprehensive analysis of strengths and weaknesses of the fight against corruption offenses and manifestations of unfair competition. The article describes measures to overcome discretionary decisions, streamline the implementation and control of tax audits. It also provides examples of the abuse of power by government officials when working with businessmen. The article evaluates the effectiveness of electronic portals that helped to resist such attempts. In addition, this work analyzes state’s efforts to streamline and simplify customs procedures. It talks about measures to simplify access of enterprises of various forms of ownership to participate in tenders for public procurement. This article provides comprehensive recommendations on the reduction of criminal activity among entrepreneurs and government officials.

Cash, crime, and cryptocurrencies

In The Curse of Cash, Kenneth Rogoff lists reductions in criminal activity and tax evasion among the primary benefits of eliminating cash. We maintain that, to the extent that individuals are interested in purchasing illicit goods and services or evading taxes, eliminating cash will encourage them to switch to close substitutes. Hence, governments intent on realizing the benefits cited by Rogoff would not merely need to eliminate cash. They would also need to ban alternatives. This is especially relevant given the proliferation of cryptocurrencies, which provide a fair degree of anonymity for users.

The Effects of Parental and Sibling Incarceration: Evidence from Ohio

Link to 2-page non-technical summary of paper and policy implications: https://bit.ly/3umF21l Every year, millions of Americans experience the incarceration of a family member. Using 30 years of administrative data from Ohio and exploiting differing incarceration propensities of randomly assigned judges, this paper provides the first quasi-experimental estimates of the effects of parental and sibling incarceration in the US. Contrary to conventional wisdom, parental incarceration has a net positive effect on some important outcomes for children, reducing their likelihood of incarceration by 4.9 percentage points and improving their adult neighborhood quality. We can also reject large positive or negative effects of parental incarceration on academic performance and teen parenthood. Sibling incarceration leads to similar reductions in criminal activity.

The Effect of Police on Crime: Evidence from the 2014 World Cup in São Paulo

I estimate the causal impact of police on crime, based on evidence from Brazil. To tackle reverse causality, I consider as a natural experiment the creation of a special police unit to intensify surveillance around a few tournament-related locations in SA£o Paulo during the 2014 FIFA World Cup. To better isolate the specific impact of policing, I account for different ways in which the tournament may affect crime, namely, via fan concentration and voluntary incapacitation. Difference-in-differences estimates reveal that increased police presence leads to significant reductions in criminal activity. My estimate of the crime-police elasticity (−0.37) is close to figures obtained in previous studies, suggesting that this effect is robust across settings and remains stable even in a high-crime, weak-institutions context, as in the case of Brazil.

Cash, Crime, and Cryptocurrencies

In The Curse of Cash, Kenneth Rogoff lists reductions in criminal activity and tax evasion among the primary benefits of eliminating cash. We maintain that, to the extent that individuals are interested in purchasing illicit goods and services or evading taxes, eliminating cash will encourage them to switch to close substitutes. Hence, governments intent on realizing the benefits cited by Rogoff would not merely need to eliminate cash. They would also need to ban alternatives. This is especially relevant given the proliferation of cryptocurrencies, which provide a fair degree of anonymity for users.

The Unintended Impact of Pretrial Detention on Case Outcomes: Evidence from New York City Arraignments

In the United States, over 400,000 individuals are in jail daily waiting for their criminal cases to be resolved. The majority of detainees are held because they cannot post bail. We estimate the impact of being detained pretrial on the likelihood of being convicted and sentence length using data on nearly a million criminal cases in New York City. Causal effects are identified using variation across arraignment judges in their propensities to detain defendants. We find that being detained increases the probability of conviction by 13 percentage points for felony defendants. Although pretrial detention lowers the probability of rearrest while cases are being adjudicated, this reduction in criminal activity is mostly offset by an increase in recidivism within 2 years after disposition. Higher pretrial detention rates among minority defendants explain 40 percent of the black-white gap in rates of being sentenced to prison and 28 percent of the Hispanic-white gap. Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted. (US Constitution, Eighth Amendment)

Criminal Charges Prior to and After Enrollment in Opioid Agonist Treatment: A Comparison of Methadone Maintenance and Office-based Buprenorphine

ABSTRACTBackground: Entry into methadone maintenance is associated with a reduction in criminal activity; less is known about the effects of office-based buprenorphine. Objective: To compare criminal charges before and after enrollment in methadone maintenance or office-based buprenorphine. Methods: Subjects were opioid-dependent adults who initiated either methadone maintenance (n = 252) or office-based buprenorphine (n = 252) between 2003 and 2007. Medical records were reviewed to gather demographic data and a state-maintained web-based database to collect data on criminal charges. Overall charges and drug charges in the 2 years prior to and after treatment enrollment were compared. Multivariable analysis was used to examine risk factors for charges after treatment enrollment. Results: In the 2 years after enrolling in treatment, subjects receiving methadone had a significant decline in the proportion of subjects with any charges (49.6% vs. 32.5%, p < .001) or drug charges (25.0% vs. 17.5%, p = .015), as well as the mean number of cases (0.97 vs. 0.63, p = .002) and drug cases (0.38 vs. 0.23, p = .008), while those who initiated buprenorphine did not have significant changes in any of these measures. On multivariable analysis, the strongest predictor of criminal charges in the 2 years after treatment enrollment was prior charges (adjusted odds ratio 3.35, 95% confidence interval, 2.24–5.01). Conclusions: Enrollment in office-based buprenorphine treatment did not appear to have the same beneficial effect on subsequent criminal charges as methadone maintenance. If this observation is replicated in other settings, it may have implications for matching individuals to these treatment options.

Interventions for drug-using offenders with co-occurring mental illness.

This is an updated version of an original Cochrane review published in Issue 3 2006 (Perry 2006). The review represents one from a family of four reviews focusing on interventions for drug-using offenders. This specific review considers interventions aimed at reducing drug use or criminal activity, or both for drug-using offenders with co-occurring mental illness. To assess the effectiveness of interventions for drug-using offenders with co-occurring mental illness in reducing criminal activity or drug use, or both. We searched 14 electronic bibliographic databases up to May 2014 and 5 Internet resources (searched between 2004 and 11 November 2009). We contacted experts in the field for further information. We included randomised controlled trials designed to reduce, eliminate, or prevent relapse of drug use and criminal activity, or both in drug-using offenders with co-occurring mental illness. We also reported data on the cost and cost-effectiveness of interventions. We used standard methodological procedures expected by The Cochrane Collaboration. Eight trials with 2058 participants met the inclusion criteria. The methodological quality of the trials was generally difficult to rate due to a lack of clear reporting. On most 'Risk of bias' items, we rated the majority of studies as unclear. Overall, we could not statistically combine the results due to the heterogenous nature of the different study interventions and comparison groups. A narrative summary of the findings identified that the interventions reported limited success with reducing self report drug use, but did have some impact on re-incarceration rates, but not re-arrest. In the single comparisons, we found moderate-quality evidence that therapeutic communities determine a reduction in re-incarceration but reported less success for outcomes of re-arrest, moderate quality of evidence and self report drug use. Three single studies evaluating case management via a mental health drug court (very low quality of evidence), motivational interviewing and cognitive skills (low and very low quality of evidence) and interpersonal psychotherapy (very low quality of evidence) did not report significant reductions in criminal activity and self report drug use respectively. Quality of evidence for these three types of interventions was low to very low. The trials reported some cost information, but it was not sufficient to be able to evaluate the cost-effectiveness of the interventions. Two of the five trials showed some promising results for the use of therapeutic communities and aftercare, but only in relation to reducing subsequent re-incarceration. Overall, the studies showed a high degree of variation, warranting a degree of caution in the interpretation of the magnitude of effect and direction of benefit for treatment outcomes. More evaluations are required to assess the effectiveness of interventions for drug-using offenders with co-occurring mental health problems.

P2-354 Effectiveness of opioid substitution therapy among prisoners with drug dependence: a meta analysis

BackgroundIllicit drug use is widespread in penal institutions worldwide. Despite this, the use of opioid substitution therapy (OST) in prisons is low. This study evaluates the effectiveness of OST in...

The licensing of behavior analysts: Protecting the profession and the public.

HISTORICAL CONTEXT AND CURRENT CONCERNS The need for states to regulate the practice of behavior analysis and for behavior analysis in turn to become a recognized applied discipline is a growing issue (see Cautilli & Dziewolska, 2008). While behavior analysis is an independent academic discipline having its own training programs, offering degrees at the master's and doctoral levels, these programs are often not tailored to prepare the graduate for licensure in existing mental and behavioral health professions, such as counseling, marriage and family therapy, or clinical psychology. There are manifold reasons for this. One of the major historical reasons is that the behavioral model of human development originated outside of the field of psychology at the University of Kansas in the Family Life Department located in the department of home economics (Baer, 1993), which placed it outside of psychology and opened its training programs to greater focus on behavioral intervention, while focusing less on other aspects of psychological knowledge. Another historical factor that remains powerfully influential is that behaviorism was and still is viewed as a dead area by many in both academic and clinical psychology. The cognitive revolution in academia (1) (see Robinson-Riegler & Robinson-Riegler, 2003) and the prevalence of psychoanalytic and humanistic models--as well as the incorporation of some New Age ideas--in the clinical realm can be viewed as contributing factors (see Dawes, 1994; Lilienfeld, Lynn, & Lohr, 2003). Indeed, some academic institutions effectively expelled behaviorists from psychology departments (for one battle see Wyatt, 1991). In spite of psychology's relative neglect of behavior analysis, the field of behavior analysis has made significant contributions to many areas of human treatment, including neurological rehabilitation (Wood, 1987), developmental disorders such as autism (Mental Health: A Report of the Surgeon General, 1999), and behavioral elements of psychiatric disorders (Salzinger, 1998). A burgeoning area of interest in which applied behavior analysis has shown success is crime reduction, which places behavior analysis as a sought after service in the now growing field of community re-entry. Overall, behavioral programs based on the operant and respondent conditioning procedures of behavior analysis have been shown to lead to a 13-20% reduction in criminal recidivism (Redondo-Illescas, Sanchez-Meca, & Garrido-Genoves, 2001). While this is modest by intervention standards in other areas, these numbers taken across the entire prison population represent a substantial reduction in criminal activity and a substantial reduction in the pain brought by crime to victims and their family members, as well as the family members of offenders. Studies have shown that behavior modification/analysis procedures can reduce criminal activity of those with ADHD by as much as 50% (see Satterfield & Schell, 1997; Satterfield, Satterfield, & Schell, 1987). In addition, parenting models based on operant conditioning procedures have been shown consistently to reduce conduct disorders in children and adolescents, prevent delinquency, and have sustained long term effects (Cautilli & Tillman, 2004; McMahon & Wells, 1998). With sex offenders, behavioral programs are a promising practice for reducing socially inappropriate sexual desires and behavior (Marshall, Jones, Ward, Johnston, & Barbaree, 1991). It is our belief that in a free market society the public should have access to choose this type of professional--yet current insurance laws block such access. These laws suggest that only licensed professionals can receive reimbursement in essence locking behavior analysts out of this market. Since behavior analysis is not yet a licensed profession, ready access to these effective interventions may be limited. Given the historical context mentioned above, most programs in clinical psychology or counseling do not provide more than a cursory glance at the theory, techniques, or clinical evidence that undergird applied behaviorism (Dorsey & Mikolsky, in preparation). …

Effectiveness of crime prevention through environmental design in reducing criminal activity in liquor stores: a pilot study.

Liquor store employees experience disproportionately higher rates of workplace injury death than employees in any other retail setting. However, efforts to introduce workplace violence prevention programs into liquor stores have been minimal. This study examines the effectiveness of a Crime Prevention Through Environmental Design intervention in reducing criminal activity in Santa Monica, California liquor stores. Nine stores enrolling in the study received an individualized intervention safety plan; the remaining 13 served as a comparison group. Mixed-effects Poisson regression was used to examine intervention effectiveness. The largest reductions in criminal activity occurred for robbery and shoplifting outcomes. We conclude that the Crime Prevention Through Environmental Design program reduced crime and injury in liquor stores and educated small businesses about the risks associated with retail violence and the countermeasures that can be taken.

Multisystemic Treatment of Criminality and Violence in Adolescents

To discuss the emergent success of multisystemic therapy (MST), a family-based therapeutic approach that has been viewed as a promising treatment for violence and other serious antisocial behaviors in adolescents. The empirical underpinnings, theoretical foundation, and clinical features of MST are described, followed by a brief review of studies of MST effectiveness with serious juvenile offenders. The theoretical foundation and clinical features of MST draw upon empirical findings regarding the multidetermined nature of serious antisocial behavior as well as upon social-ecological models of behavior in which the youth and family's school, work, peers, and neighborhood are viewed as interconnected systems with dynamic and reciprocal influences on the behavior of family members. In controlled studies with serious juvenile offenders, MST has demonstrated long-term reductions in criminal activity, violent offenses, drug-related arrests, and incarceration. The success of MST can be attributed primarily to (1) the match between MST intervention foci and empirically identified correlates/causes of criminality and violence in adolescents (e.g., parental discipline, family affective relations, peer associations, school performance) and (2) the flexible use of well-validated intervention strategies in the natural environment.

Multisystemic treatment of substance-abusing and dependent delinquents: outcomes, treatment fidelity, and transportability.

The effectiveness and transportability of multisystemic therapy (MST) were examined in a study that included 118 juvenile offenders meeting DSM-III-R criteria for substance abuse or dependence and their families. Participants were randomly assigned to receive MST versus usual community services. Outcome measures assessed drug use, criminal activity, and days in out-of-home placement at posttreatment (T2) and at a 6-month posttreatment follow-up (T3); also treatment adherence was examined from multiple perspectives (i.e., caregiver, youth, and therapist). MST reduced alcohol, marijuana, and other drug use at T2 and total days in out-of-home placement by 50% at T3. Reductions in criminal activity, however, were not as large as have been obtained previously for MST. Examination of treatment adherence measures suggests that the modest results of MST were due, at least in part, to difficulty in transporting this complex treatment model from the direct control of its developers. Increased emphasis on quality assurance mechanisms to enhance treatment fidelity may help overcome barriers to transportability.

Group Work with High-Risk Urban Youths on Probation

In recent years, rehabilitation has been out of favor in the criminal justice community, although both recidivism and incarceration have increased. Expanding numbers of violent young offenders have placed a burden on the courts, jails, and prisons in many large urban centers. As a result, young first-offense felons can plea bargain and receive probation sentences instead of going to prison. Along with the systemic pressures to use community corrections for first offenders, recent criminal justice research has found that rehabilitation approaches are more effective than punitive measures in reducing rearrest (Andrews, 1989; Boone, 1994; Gendreau, 1993; Matthews, Boone, & Fogg, 1994; O'Leary & Clear, 1984). Whereas punishing smarter programs such as shock incarceration or boot camp actually increase rates of recidivism, offender rehabilitation programs with specific characteristics can result in the reduction of criminal activity (Fabiano, 1991a, 1991b; Gendreau, 1993; Petersilla, 1990). Interventions that have proved the most effective are intensive, behavioral, and focused on the highest risk offenders (Andrews, 1989). When they follow principles of effective rehabilitation interventions, sentences of probation have the potential to reduce recidivism. Community corrections programs can be more efficient and effective than incarceration. This article describes an innovative group work project designed for a large urban probation department. The project targets 16- to 20-year-old African American and Latino young men on probation who are at high risk of rearrest. The purpose is to teach young probationers how to protect their physical safety and avoid rearrest by adopting prosocial thinking and actions. The department adopted this approach to test the potential of cognitive-behavioral group work to reduce re-arrest rates among young men on probation. The project design translates the criminal justice literature into specific interventions that rely heavily on cognitive restructuring. Recent theoretical models for social cognitive approaches (Gilcrist, Schinke, Bolbo, & Snow, 1986; Nurius, 1989, 1994; Shilling, El-Bassel, Hadden, & Gilbert, 1995), particularly in working with involuntary clients (Brown & Caddick, 1993; Ivanoff, Blythe, & Tripodi, 1994), provided the rationale for collaboration between the probation department and social work faculty. Description of Project and Participants The group work project was customized to reflect the issues that commonly confront urban youths of color. Many of these young men are routinely exposed to criminal activity and violence associated with drug use, random shootings, easy access to handguns, and intrafamily violence. Loss permeates their lives. They quickly develop a sense of nihilism and alienation that gives ready justification for violent acts. The cognitive-behavioral group intervention described in this article is called SAFE-T; it provides a rehabilitation modality for use in probation supervision. The acronym SAFE-T stands for self, awareness, feelings, education, and tasks; it links the ideas of thinking and action. Participants Group members are 16- to 20-year-old African American and Latino youths who are serving probation terms of five years for crimes such as drug dealing, robbery, and assault. Twelve to 15 members are assigned to each group, and probationers' commitments to school, training, substance abuse treatment, or employment are accommodated. Group Leaders Group sessions are led by probation officers who receive intensive training in group work methods. In addition, the officers learn about the ever-changing and colorful language of the young men. In preparation for their groups, officers listen to the latest rap music and watch movies and television programs marketed for urban youths. Group Sessions The 32 sessions of the SAFE-T groups are divided into four modules of eight 105-minute meetings, each including a 15-minute break. …

Multisystemic therapy: an effective violence prevention approach for serious juvenile offenders

This article provides an overview of a treatment approach, Multisystemic Therapy (MST), that has demonstrated long-term reductions in criminal activity and violence among youth at high-risk for perpetrating violence. Importantly, central aspects of MST are consistent with the recent public health agenda of violence prevention in the United States. Moreover, as demonstrated from the findings of controlled clinical trials evaluating MST with serious juvenile offenders, the viability of the public health approach is supported.

A 40 month follow‐up of pregnant drug using women treated at Westmead Hospital

A 40 month follow-up of 84 women admitted to a study of the outpatient management of pregnant heroin users is reported. Fifty-eight of the patients were on methadone at the time of their delivery while a further 26 remained on heroin at delivery. The whereabouts of 61 patients were identified at the time of follow-up but only 46 consented to interview. Twenty-three could not be traced even utilising the services of the Departments of Corrective Services and Community Services. The general health of mothers and babies was reported as good to excellent and only one child was in the care of the State. Many patients on methadone at delivery had exited the programme whereas those on heroin at delivery were likely to be on methadone programmes at follow-up. A majority of all patients had had no new legal charges laid in the 12 months preceding the interview and if any charges had been laid they were likely to be traffic offences. Drug use, on the other hand, continued to be a problem even in those on methadone programmes. Up to 75% of patients in one group reported intermittent use of heroin and other drugs and these self reports were confirmed by urine testing. The data suggest that methadone does lead to a reduction in criminal activity and in daily drug usage but it does not completely abolish drug seeking behaviour. Overall, the results suggest that the use of methadone is safe for mother and baby and it has positive benefit in the management of pregnant drug users.