Douglas B. Marlowe, J.D., Ph.D. Effective Use of Rewards & Sanctions Douglas B. Marlowe, J.D., Ph.D. National Association of Drug Court Professionals

Basic Terminology Punishment Positive Reinforcement Negative SANCTION REWARD Punishment Positive Reinforcement GIVE Negative Reinforcement Response Cost TAKE

Carrot and Stick Reduce undesirable behaviors and increase desirable behaviors Positive vs. negative reinforcement

Certainty Reliable detection is most influential Random drug testing twice per week, including weekends & holidays Sufficient detection windows & panels Community supervision Last supervisory burdens to be lifted Second chances

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

Magnitude EFFECTIVENESS MAGNITUDE OF SANCTION Habituation Effects Zone Ceiling Effects EFFECTIVENESS SEVERE MINIMAL MODERATE MAGNITUDE OF SANCTION

Incentive & Sanction Lists http://ndcrc.org/content/list-incentives-and-sanctions

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

Target Behaviors Don’t expect too much Don’t expect too little Learned helplessness and ratio burden Don’t expect too little Habituation Proximal vs. distal goals Phase specificity What was once distal becomes proximal

Treat or Punish? Substance Dependence or Addiction

Treat or Punish? Substance Dependence or Addiction Triggered binge pattern Cravings or compulsions Withdrawal symptoms

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

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

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

Abstinence is a distal goal Abstinence is a proximal goal Treat or Punish? Substance Dependence or Addiction Triggered binge pattern Cravings or compulsions Withdrawal symptoms Substance Abuse 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? Collateral needs Substance Dependence or Addiction Triggered binge pattern Cravings or compulsions Withdrawal symptoms Substance Abuse 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 } }

Tangible Rewards Most important for reinforcement- starved participants Fishbowl procedure or point systems Symbolic rewards

Phase Regression An example of response cost Often a sign that services were withdrawn prematurely Temporary regression and remedial plan (accelerated redemption) Avoid the Abstinence Violation Effect (A.V.E.)

Readings Burdon WM et al (2001). Drug courts and contingency management. Journal of Drug Issues, 31, 73-90. Harrell A & Roman J (2001). Reducing drug use and crime among offenders: The impact of graduated sanctions. Journal of Drug Issues, 31, 207-232. 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. 317-336). 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. 334-354). 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.139-157). Alexandria, VA: NDCI.