New research suggests that using contract care instead of prison could be a more effective way to address substance-related crimes like drunk driving.
By Per Jørgen Ystehede
When courts sanction care
In 2021, the Swedish Prison and Probation Services reported that 60% of those serving prison or probation sentences had substance abuse problems. However, most studies on substance abuse treatment in the justice system come from penal contexts that are markedly different from the Nordic context, according to Anna Kahlmeter.
Kahlmeter is a researcher at the Department of Criminology at Stockholm University. Her new study, funded by NSfK, addresses this knowledge gap by exploring court-imposed care orders, often referred to as “contract care”, for aggravated drink-driving and drug offences in Sweden.
— So what is contract care?
Contract care (or “kontraktsvård” as it is called in Swedish) is an alternative to imprisonment in cases where a prison sentence would have been imposed but the crime in question can be related mainly to substance abuse, tells Kahlmeter.
Probation services propose court-imposed care in their pre-sentencing report to the district court, and a treatment plan is established as a contract that the defendant must agree to before the trial, which is why it is generally referred to as contract care. Contract care typically begins with institutional care and then transitions to outpatient treatment. As of yet, social services must also accept payment responsibility for part of the treatment period. It has, however, been suggested that the responsibility is moved entirely to the prison and probation services.
A decline in the use of contract care
Research on contract care and its potential to prevent reconvictions is scarce. Previous studies have focused mainly on custodial sanctions and used noncustodial sanctions (i.e., alternatives to serving time in prison, such as community service) as a basis for comparison while often overlooking the specific features of such sanctions.
Kahlmeter’s study examined the development of contract care sentencing in relation to prison sentences and other alternative sanctions from its introduction in the late 1980s until the present day. Kahlmeter has utilised Swedish register data to investigate court-imposed care in Sweden from 1988 to 2020 and assesses its potential to prevent reconvictions among individuals convicted of drug offences and aggravated drink-driving.
— The discussion in Sweden has been about the underuse and reduced use of contract care and the reasons for this, says Kahlmeter. It is not known why; some argue that it is because social services do not want to take on the cost responsibility, but it is a rather complicated sanction with many factors that need to be in place for it to happen. For example, short processing times at probation and social services, where a well-thought-out treatment plan has to be developed, and consent has to be given by individuals who often have complex life situations.
Kahlmeter’s findings demonstrate that, while court-imposed care has declined, this decline is mainly driven by a reduction in drink-driving cases, resulting in a contract care sentence. Though Kahlmeter has not argued that the data “prove” a causal link, this decline may also likely be due to reactive adjustments (for example longer sentences) and new sanctions, such as the introduction of a conditional sentence with the condition of community service and the implementation of electronic monitoring.
Court imposed care as an alternative to imprisonment.
While the use of contract care has decreased, other alternative sanctions, often including rehabilitative elements, have increased. This indicates a shift towards alternative sanctions that do not require a pre-specified treatment contract rather than a move towards more prison sentences.
However, a substantial proportion of drug- and drink-driving offenders (45 per cent, on average, over the period) were still sentenced to prison. This is concerning, thinks Kahlmeter, as alternative sanctions, and not just contract care, appear to be at least as viable a response to substance-related crimes as imprisonment. This is particularly relevant as the Swedish Prison and Probation Service´s forecasts show that Swedish prisons are at risk of overcrowding, which may limit access to treatment for individuals in prison.
You can read more about Kahlmeter’s research in this policy brief (PDF), as well in Nordic Journal of Criminology.
See also
Anna Kahlmeter – Stockholm University (su.se)
Research grants – Nordic Research Council for Criminology (nsfk.org)
On methods
Kahlmeter’s study used national Swedish register data: The conviction register, Statistics Sweden’s Longitudinal Integration Database for Health Insurance and Labour Market Studies (LISA) and data from the National Board of Health and Welfare’s registers for in-patient and out-patient care, data from the prison and probation services, and immigration registers. The study population was individuals over 20 years old who had been convicted of aggravated drink-driving or drug offences (excluding severe and minor drug offences) and sentenced to either prison (≤ 2 years) or alternative sanctions. The reason for selecting these two types of offences is that they represent the two most typical contract care cases, and the nature of the offence itself indicates problematic substance use.