Diversion Programs for Individuals Who Use Substances: A Review of the Literature

• Author: Leah Dean,Peter Mallow,Robin Lindquist-Grantz,Jennifer Chubinski,Michelle Lydenberg
• DOI: 10.1177/00220426211000330
• Published date: 01 July 2021
• Date: 01 July 2021
• Subject Matter: Articles

https://doi.org/10.1177/00220426211000330

Journal of Drug Issues

2021, Vol. 51(3) 483 –503

© The Author(s) 2021

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DOI: 10.1177/00220426211000330

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Article

Diversion Programs for Individuals

Who Use Substances: A Review

of the Literature

Robin Lindquist-Grantz1, Peter Mallow2, Leah Dean3,

Michelle Lydenberg4, and Jennifer Chubinski2

Abstract

Diversion programs connect individuals to treatment instead of criminal sanctions and are used

more frequently to address substance use. This systematic scoping review included 31 published

empirical studies to examine evaluations of diversion programs that address substance use and

misuse. We assessed the program characteristics and implementation settings, as well as the

outcomes measured and study methods used. We identified five prevalent study outcomes

categories: (a) Service utilization (program retention and completion), (b) Recidivism/criminality,

(c) Substance use, (d) Psychosocial functioning, and (e) Other outcomes (e.g., trauma, quality

of life, and housing). Findings demonstrated limited but promising evidence for improvements

in recidivism, substance use, and psychosocial outcomes. The limited evidence may be partly

due to heterogeneity in diversion program implementation, study designs used, and differences

among subpopulations. Most studies examined postbooking diversion programs; therefore,

further examination of alternative approaches such as prebooking diversion programs is needed

to fully understand diversion program impacts.

Keywords

diversion programs, substance use, substance abuse, drugs and alcohol, criminal justice

Drug and alcohol use contribute substantially to global disease burden (Degenhardt et al.,

2018). In the United States, estimates from the 2018 National Survey on Drug Use and Health

indicated that 19.5% of people aged 12 years and older used illicit drugs in the past year and

7.4% of people aged 12 years and older met the criteria for a substance use disorder (SUD;

Substance Abuse and Mental Health Services Administration, 2019). In 2018, the most used

illicit substance was marijuana, with 15.9% of people aged 12 years and older using it; however,

opioid misuse was the second most reported (3.7% of people aged 12 years and older). The vast

majority of opioid users were misusing prescription pain relievers (97.1%), compared with 8%

using heroin. The surging opioid epidemic in the past decade has resulted in an increase in

opioid-related deaths (Rudd et al., 2016). It has also negatively affected children and families

1University of Cincinnati, OH, USA

2Xavier University, Cincinnati, OH, USA

3RTI International, Research Triangle Park, NC, USA

4Interact for Health, Cincinnati, OH, USA

Corresponding Author:

Robin Lindquist-Grantz, Institute for Policy Research, University of Cincinnati, 225 Calhoun Street, Suite 260,

PO Box 210132, Cincinnati, OH 45221-0132, USA.

Email: lindqurn@uc.edu

1000330JODXXX10.1177/00220426211000330Journal of Drug IssuesLindquist-Grantz et al.

research-article2021

484 Journal of Drug Issues 51(3)

(Brundage & Levine, 2019) and has strained community health and social systems (Crowley et

al., 2019; Florence et al., 2016; Guy et al., 2018; Hagemeier, 2018). As families and communities

battle the devastation produced by this public health crisis, the National Institute on Drug Abuse

(NIDA) has called for improving access to treatment and recovery services (2020).

Criminal justice is among the important social systems impacted by the opioid epidemic

(Zajac et al., 2019). Alternative strategies to divert low-level drug offenders—including opioid

misuse—from long-term incarceration to reduce economic, health, and social burdens have

expanded in recent years (Caulkins et al., 2020). Among these alternative strategies are diversion

programs that redirect people who use illicit drugs toward treatment rather than jail or other

criminal sanctions (Albert et al., 2011). Substance use diversion programs stem from those that

were first used to redirect individuals with mental illness toward an alternative intervention in

place of criminal sanctions (Compton et al., 2017; Hartford et al., 2006). Studies have shown that

mental health diversion programs can help to lessen pressure on the criminal justice system by

reducing the overall number of arrests and have the potential to decrease jail costs and officer

engagement expenditures (Shapiro et al., 2015). In some of those programs, police officers were

integrated to help prevent and manage drug overdose challenges among persons with mental

health disorders (Compton et al., 2008; Fisher et al., 2006; Pinals, 2017).

Diversion programs generally fall into two categories: (a) postbooking programs that take

place after an arrest has occurred, and (b) prebooking programs such as those that occur at pre-

arrest or post-overdose (Case et al., 2009; Lattimore et al., 2003). Postbooking programs have

been used longer and vary based on the stage in which they are administered in the criminal

justice process and by whom they are operated (e.g., jail-based vs. court-based; Broner et al.,

2002). Drug courts are not the only type of postbooking programs that have been developed;

however, they are prominently featured and cited as a distinct postbooking effort aimed at divert-

ing low-level drug-involved offenders from incarceration, so that the disease of addiction can be

treated in a community-based setting rather than placement in the criminal justice system

(Caulkins et al., 2020).

Prebooking programs are also on the rise as a means to help individuals who have substance

use and behavioral health needs to obtain treatment and prevent future entry into the criminal

justice system. A number of terms have been applied to prebooking prevention and intervention

programs, such as pre-arrest diversion and deflection (Charlier, 2019). Whereas these terms have

previously been used interchangeably, definitions and distinctions are being advanced in the

field. For example, Charlier and Reichert (2020) have proposed a five-pathway typology for

deflection for people with SUDs, mental health disorders, or co-occurring disorders based on

how contact with the individual is initiated. Conversely, Kopak and Gleicher (2020) distinguished

between the two terms with deflection referring to citizen-initiated contacts and pre-arrest diver-

sion referring to police-led contacts. Regardless of the approach taken, the goal of prebooking

programs is to connect individuals to treatment, reduce crime, improve public safety, and improve

police–community relations (Charlier, 2017). More notably, research on deflection and pre-arrest

diversion is still in the early stages (Kopak & Gleicher, 2020).

Involvement in the criminal justice system increases with the intensity of opioid use

(Winkelman et al., 2018). With recent increases in legislation and funding support, it is clear that

new innovations in providing treatment and overdose prevention services are needed and evalu-

ation of these new practices and programs are warranted (Caulkins et al., 2020). Although there

are a number of literature reviews that focus on the evidence associated with mental health diver-

sion programs (Hartford et al., 2006; Loveland & Boyle, 2007; Shapiro et al., 2015; Sirotich,

2009), very few have focused on substance use diversion programs. In one of the most compre-

hensive reviews, Harvey and colleagues (2007) examined studies of diversion and aftercare pro-

grams of adult drug-involved offenders. Other reviews have focused on the effectiveness of

opioid maintenance treatment in prison settings (Hedrich et al., 2012), community-based opioid

overdose prevention and naloxone distribution programs (Clark et al., 2014), peer recovery