Boosting Drug Treatment Attendance Through Police-Sent Text Message Nudges: A Randomised Controlled Trial with Drug-Positive Arrestees

By Metropolitan Police Service T/Superintendent Paul Dwyer, MSt (Cantab), BSc (Hons), CMgr MCMI 

I was born and bred in London and many of my loved ones are Londoners. As such I care deeply about this city and the safety of all its inhabitants. Having spent most of my career in frontline roles I have seen the effect of what illicit drugs can do to a person and the devastating impact drug misuse can have on many others in society.

In 2021 I had the privilege of becoming the Drugs Lead Responsible Officer for the Metropolitan Police with responsibility for addressing drug related crime. The situation I faced was a surge in drug-related deaths, a high recidivism rate of adult drug offenders with approximately 50% of murders and acquisitive crime in the capital drug-related. Adult drug re-offending was particularly problematic with Government, the Mayor’s Office and I feeling this area to be in urgent need of reform. High attrition from drug treatment programmes was a concern to me. I identified there was a knowledge gap in effective strategies to assist people with an addiction in arriving at an initial intake meeting with treatment centres.

My objective was to innovatively address poor attendance of criminal justice referrals to drug treatment leading to recidivism, moving from a reactive police-led approach supporting colleagues to proactively manage offender behaviours promptly, developing knowledge of ‘What Works’ providing an evidence-base to policing through working with broader partners taking a more holistic public health approach.

I looked outside of policing to develop solutions identifying an opportunity from the health sector using nudge theory where in short health practitioners such as doctors and dentists improved their patient attendance rates by sending reminders to their patients prior to their appointments. I recognised the benefits for a drugs context particularly in identifying intransigent offenders causing the most harm to society.

I led a study testing a new approach through global pioneering research in collaboration with the University of Cambridge with the aim to investigate whether text message reminders sent by the police to individuals they arrested who tested positive for Class A drugs and were referred to drug treatment facilities increased their attendance rates relative to those who did not receive these messages. I also observed whether the messages caused a reduction in criminal activity relative to those who did not receive a message. I utilised my organisations Drugs Intervention Programme to conduct a randomised control trial involving 813 drug-positive arrestees taken into custodies across London between 21st April 2022 and 15th August 2022.

The outcomes showed that the overall attendance rate at drug treatment centres across London was higher in the group who received a reminder message compared to the group who did not. The difference represented a 20% change in attendance as a result of receiving the nudge. Recidivism was marginally lower in the group who received a reminder message compared to the group who did not.

The findings suggest that police text reminders positively impacted the behaviour of drug-positive arrestees. Those who received a text message reminder had significantly lower no-show rates compared to those who did not receive a message. Given the low cost of the intervention, it may be beneficial for more police Forces to adopt text message nudges as a standard policy for drug-positive arrestees required to attend drug treatment assessments.

This study bridges a critical academic and criminological research gap, showing that nudges can help individuals, who could be viewed as having bounded or limited rationality by virtue of likely Class A drug addiction, who are required by the police to attend medical appointments make it through the rehabilitation door and ultimately contribute to public safety by reducing the cycle of addiction and crime.

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