Douglas B. Marlowe, J.D., Ph.D. Treatment Research Institute at the University of Pennsylvania TRI science addiction Effective Strategies for Drug-Abusing Offenders

Drugs and Crime TRI science addiction 80% of U.S. jail and prison inmates – –Drug or alcohol-related offense – –Intoxicated at time of offense – –Furtherance of drug habit – –Regular drug use – –History of drug or alcohol treatment 67%-75% state 33% federal

Drugs and Crime 67% of probationers 80% of parolees 60% of adult arrestees 20% - 40% of juvenile arrestees TRI science addiction

Drugs and Crime 50% of violent crimes 50% of domestic violence 80% of child abuse and neglect 50% - 75% of theft and property crimes 75% - 99% drug dealing/manufacturing TRI science addiction

Shifts in Drug Policy Public Safety (Punishment) Public Health (Treatment) TRI science addiction

Public Safety Strategies TRI science addiction

What if we put them in prison? Criminal Recidivism in 3 Years 68% re-arrested 47% convicted 50% re-incarcerated Relapse to Drug Abuse in 3 Years 95% relapse TRI science addiction

What if we treat them in prison? Criminal Recidivism Small effect (10 percentage points) Relapse to Drug Use Generally no effect But... Reduced disciplinary infractions Reduced absenteeism by C.O.s  Increased compliance with aftercare  TRI science addiction

What about intermediate sanctions? No effect Boot camp House arrest “Worse” effect Anklet monitoring Scared Straight Intensive Supervised Probation (ISP) Slight improvement Restitution TRI science addiction

Public Health Strategies TRI science addiction

What about Referral to Treatment? 50% - 67% don’t show for intake 40% - 80% drop out in 3 months 90% drop out in 12 months 70% of probationers and parolees drop out within months Attrition TRI science addiction Outcomes 15 percentage-point decrease in drug use 6 percentage-point decrease in crime

What about CJS case management? Assess, refer, monitor and report Create service linkages Effective at assessment and referral Longer length of stay in treatment Mixed results Small effect for high-risk clients TASC Programs TRI science addiction

Summary thus far... Prison doesn’t work Treatment in prison doesn’t last Intermediate sanctions don’t work Treatment referrals don’t take Treatment referrals with CJS case management sometimes work a little bit TRI science addiction

Integrated Public Health/Public Safety Strategies TRI science addiction

Drug Courts Nonviolent drug offenders Nolle prosse or probation Plead guilty or stipulate to arrest report On-going judicial status hearings Treatment & case management Frequent urine monitoring Graduated sanctions and rewards TRI science addiction (NADCP, 1997 )

60% complete > 12 months of treatment 50% graduate Reduced recidivism and drug use – 30 pct pts during tx – 20 pct pts post-tx TRI science addiction Effects of Drug Court

What about prisoner re-entry? Residential and segregated Peer-run with staff oversight Treat the “whole person” Confrontation, encounter groups, community mtgs., mentoring, volunteerism Strict enforcement of Code of Conduct Correctional Therapeutic Communities (TC’s) TRI science addiction

Effects of Therapeutic Communities TRI science addiction In-prison TC No effect Work release TC percentage point decrease in recidivism and drug use In-prison TC + Work release TC  percentage point decrease in recidivism and drug use 

Elements of Success TRI science addiction What distinguishes successful approaches from unsuccessful approaches?

Common Denominators TRI science addiction 1.Treatment in the community 2.Avoid criminal record or incarceration 3.Close criminal justice supervision –Progress reports by treatment personnel –Urine screens –On-going status hearings

Common Denominators (cont.) TRI science addiction 4.Immediate and certain consequences –Reduced emphasis on adversarial proceedings –Pro forma disposition following termination –Stipulated sanctions and rewards

Proposition 36 TRI science addiction Nonviolent drug possession offenders Mandatory probation & drug treatment Expunge record or avoid prison No judicial status hearings Multiple v.o.p. hearings ? monies for urinalysis testing No graduated sanctions or rewards Quarterly progress reports

Proposition 36 Proposition 200 CJS locus of intervention? Pro forma disposition if terminated? Urinalyses? Therapist progress reports? Status hearings? Stipulated sanctions & rewards? Avoid record or incarceration? Case management? Treatment? Immediate consequences? Graduated rewards & sanctions? Guilty plea? TRI science addiction

Effects of Proposition 36 TRI science addiction 30% never show for treatment 40% attend 90 days of treatment 24% complete treatment 20% probation revocations 60% parole revocations Increased recidivism rates

“Doug” Policy TRI science addiction Continuing court jurisdiction Tracks according to risk status Non-compliance hearings Show-cause hearings –No new v.o.p proceedings –Burden of proof on defendant Stipulated sanctions & rewards Expunged record or probation

Acknowledgments National Institute on Drug Abuse Center for Substance Abuse Treatment National Institute of Justice Office of National Drug Control Policy TRI science addiction