"I Really Didn't Need Treatment, It Was Just a Way for Me Not to Go to Jail": Court-Mandated Drug Treatment Experiences among Racially Minoritized Individuals in Three US States.

Over the past three decades, court-mandated drug treatment has emerged as a popular strategy to manage drug-related crime and substance use disorder (SUD). These programs offer dismissal or reduction of criminal charges upon satisfactory completion of drug treatment and additional conditions such as negative urine screenings, as determined by the criminal-legal system. Treatment modalities utilized via mandated treatment programs vary substantially across jurisdictions in the intensity and format of treatment. This variation can be explained in part by differences in state-level sentencing policies and the landscape of drug treatment and social services. We analyzed 27 qualitative individuals with Black and Hispanic individuals recruited from metropolitan areas in 3 US states who had received court-mandated treatment. Interviews were analyzed using a hybrid deductive-inductive approach to examine common challenges and diverging experiences of mandated treatment. Our analysis highlights intrinsic motivation, perceived agency, and perceived quality of care as key determinants of the effectiveness of mandated treatment on long-lasting behavioral change. Findings suggest there is a need to increase the emphasis on service quality within mandated treatment, including the utilization of evidence-based practices. This will require reframing success within mandated treatment programs from quantitative metrics, such as treatment attendance, to include qualitative metrics, such as level of therapeutic engagement.