In Reply: We thank Dr. Zonana for calling attention to our incomplete representation of his statement that "from the public viewpoint, only a relapse rate of zero is acceptable." As we inferred, such a view might lead to the conclusion that the only solution for sex offenders would be indefinite confinement, with or without treatment. Zonana makes no such recommendation. Rather, he acknowledges the growing evidence of treatability for some sex offenders. He develops several lines of argument against the civil commitment statutes, one of which involves his representation of the public viewpoint. Since our review of the treatment research literature yielded evidence that treatment makes a difference, we meant to point out that treatment would be expected to have some beneficial impact whether it is prison based or in the context of civil commitment.
This evidence of some beneficial impact leaves unanswered important questions of differential responsiveness of subpopulations of sex offenders and of where treatment should be provided (prisons, mental hospitals, "hybrid" institutions, or outpatient settings). We noted evidence that treatment in institutional settings and an extensive criminal record are in general associated with poorer outcome. We also mentioned several concerns of mental health professionals and public administrators, including risks associated with mixing populations and the drain on mental health services resources. Reid (1) has pointed out that questions of treatability, where such patients are housed, and what resources are available for their care are conceptually separable.
We believe the main policy implication of our article is that, given the prospect of effective treatments and the major uncertainties surrounding verification of just how effective these treatments may be, new treatment programs cannot be responsibly developed without clinical research components.