Douglas B. Marlowe, J.D., Ph.D. Treatment Research Institute at the University of Pennsylvania Effective Use of Rewards & Sanctions

Basic Terminology Positive Reinforcement Negative Reinforcement Punishment Response Cost REWARDSANCTION TAKE GIVE

Carrot and Stick Reduce undesirable behaviors andReduce undesirable behaviors and increase desirable behaviors increase desirable behaviors No thinning for punishmentNo thinning for punishment Positive vs. negativePositive vs. negative reinforcement reinforcement

Certainty Reliable detection is keyReliable detection is key Random drug testing twice per week, including weekends and holidaysRandom drug testing twice per week, including weekends and holidays Sufficient detection windows & panelsSufficient detection windows & panels Community supervisionCommunity supervision Last supervisory burdensLast supervisory burdens to be lifted to be lifted Second chancesSecond chances

Celerity Timing is second most influentialTiming is second most influential Interference from new behaviorsInterference from new behaviors Status hearings every 2 weeks untilStatus hearings every 2 weeks until the case has stabilized the case has stabilized Noncompliance hearingsNoncompliance hearings where indicated where indicated

Magnitude MAGNITUDE OF SANCTION EffectiveZone CeilingEffectsHabituationEffectsMINIMALMODERATESEVERE EFFECTIVENESS

Procedural Fairness Clearly communicated policiesClearly communicated policies and procedures and procedures Presumptive consequencesPresumptive consequences with flexible application with flexible application Opportunity to be heardOpportunity to be heard Respect and dignityRespect and dignity

Target Behaviors Don’t expect too muchDon’t expect too much –Learned helplessness and ratio burden Don’t expect too littleDon’t expect too little –Habituation Proximal vs. distal goalsProximal vs. distal goals Phase specificityPhase specificity

Treat or Punish? Substance Dependence or Addiction Substance Dependence or Addiction

1.Triggered binge pattern 2.Cravings or compulsions 3.Withdrawal symptoms Treat or Punish?

Substance Dependence or Addiction Substance Dependence or Addiction 1.Triggered binge pattern 2.Cravings or compulsions 3.Withdrawal symptoms } Abstinence is a distal goal Treat or Punish?

Substance Dependence or Addiction Substance Dependence or Addiction 1.Triggered binge pattern 2.Cravings or compulsions 3.Withdrawal symptoms Substance Abuse } Abstinence is a distal goal Treat or Punish?

Substance Dependence or Addiction Substance Dependence or Addiction 1.Triggered binge pattern 2.Cravings or compulsions 3.Withdrawal symptoms Substance Abuse } Abstinence is a distal goal Abstinence is a proximal goal } Treat or Punish?

Substance Dependence or Addiction Substance Dependence or Addiction 1.Triggered binge pattern 2.Cravings or compulsions 3.Withdrawal symptoms Substance Abuse Collateral needs Collateral needs –Dual diagnosis –Chronic medical condition (e.g., HIV+, HCV, diabetes) –Homelessness, chronic unemployment } Abstinence is a distal goal Abstinence is a proximal goal } Treat or Punish?

Substance Dependence or Addiction Substance Dependence or Addiction 1.Triggered binge pattern 2.Cravings or compulsions 3.Withdrawal symptoms Substance Abuse Collateral needs Collateral needs –Dual diagnosis –Chronic medical condition (e.g., HIV+, HCV, diabetes) –Homelessness, chronic unemployment } Abstinence is a distal goal Abstinence is a proximal goal } } Regimen compliance is proximal Treat or Punish?

Tangible Rewards Most important for reinforcement- starved participantsMost important for reinforcement- starved participants Fishbowl procedureFishbowl procedure Symbolic rewardsSymbolic rewards

Readings Burdon WM et al (2001). Drug courts and contingency management. Journal of Drug Issues, 31, Harrell A & Roman J (2001). Reducing drug use and crime among offenders: The impact of graduated sanctions. Journal of Drug Issues, 31, Marlowe DB (2007). Strategies for administering rewards and sanctions. In JE Lessenger & GF Roper (Eds.), Drug courts: A new approach to treatment and rehabilitation (pp ). New York: Springer. Marlowe DB (2008). Application of sanctions. In Drug Court Quality Improvement Monograph. Alexandria, VA: NDCI. Marlowe DB & Wong CJ (2008). Contingency management in adult criminal drug courts (pp ). In ST Higgins, K Silverman & SH Heil (Eds.), Contingency management in substance abuse treatment. New York: Guilford. Marlowe DB (2011). Applying incentives and sanctions. In The drug court judicial benchbook (pp ). Alexandria, VA: NDCI.