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

Programs for Drug Offenders TRI science addiction DiversionIncarceration Probation w/o verdict (Prop 36) Drug Courts Intermediate sanctions

Programs for Drug Offenders TRI science addiction DiversionIncarceration Probation w/o verdict (Prop 36) Drug Courts $$$$$$ Costs $$$$$$$$$ Intermediate sanctions

Programs for Drug Offenders TRI science addiction DiversionIncarceration Probation w/o verdict (Prop 36) Drug Courts Public Safety Risks Intermediate sanctions

Programs for Drug Offenders TRI science addiction DiversionIncarceration Probation w/o verdict (Prop 36) Drug Courts Psychosocial Functioning Intermediate sanctions

Programs for Drug Offenders TRI science addiction DiversionIncarceration Probation w/o verdict (Prop 36) Drug Courts Psychosocial Functioning $$$$$$ Costs $$$$$$$$$ Public Safety Risks Intermediate sanctions

Programs for Drug Offenders TRI science addiction DiversionIncarceration Probation w/o verdict (Prop 36) Drug Courts Intermediate sanctions

Programs for Drug Offenders TRI science addiction DiversionIncarceration Probation w/o verdict (Prop 36) Drug Courts Intermediate sanctions Over-reliance

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

Programs for Drug Offenders TRI science addiction DiversionIncarceration Probation w/o verdict (Prop 36) Drug Courts Intermediate sanctions

Programs for Drug Offenders TRI science addiction DiversionIncarceration Probation w/o verdict (Prop 36) Drug Courts Intermediate sanctions Over-reliance

Intermediate Sanctions No effect Boot camp House arrest “Worse” effect Anklet monitoring Scared Straight Intensive Supervised Probation (ISP) Slight improvement Restitution TRI science addiction

Programs for Drug Offenders TRI science addiction DiversionIncarceration Probation w/o verdict (Prop 36) Drug Courts Intermediate sanctions

Programs for Drug Offenders TRI science addiction DiversionIncarceration Probation w/o verdict (Prop 36) Drug Courts Intermediate sanctions Over-reliance

Diversion 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

Programs for Drug Offenders TRI science addiction DiversionIncarceration Probation w/o verdict (Prop 36) Drug Courts Intermediate sanctions

Programs for Drug Offenders TRI science addiction DiversionIncarceration Probation w/o verdict (Prop 36) Drug Courts Intermediate sanctions Over-reliance

Effects of Proposition 36 TRI science addiction 30% never showed for treatment 40% attended 90 days of treatment 24% completed treatment 20% probation revocations 60% parole revocations Increased recidivism Decreased costs

Programs for Drug Offenders TRI science addiction DiversionIncarceration Probation w/o verdict (Prop 36) Drug Courts Intermediate sanctions

Programs for Drug Offenders TRI science addiction DiversionIncarceration Probation w/o verdict (Prop 36) Drug Courts Intermediate sanctions Reliance

60% complete > 12 months of treatment 50% graduate Reduced recidivism and drug use Serves ~ 5% of eligible population TRI science addiction Effects of Drug Courts

Programs for Drug Offenders TRI science addiction DiversionIncarceration Probation w/o verdict (Prop 36) Drug Courts Intermediate sanctions

Programs for Drug Offenders TRI science addiction DiversionIncarceration Probation w/o verdict (Prop 36) Drug Courts Intermediate sanctions  50% success rate  5% eligible pop.

Programs for Drug Offenders TRI science addiction DiversionIncarceration Probation w/o verdict (Prop 36) Drug Courts Intermediate sanctions  50% success rate  5% eligible pop.  25% success rate  Cost savings

Programs for Drug Offenders TRI science addiction DiversionIncarceration Probation w/o verdict (Prop 36) Drug Courts Intermediate sanctions  50% success rate  5% eligible pop.  25% success rate  Cost savings  10% success rate  Most cost savings

Programs for Drug Offenders TRI science addiction DiversionIncarceration Probation w/o verdict (Prop 36) Drug Courts Intermediate sanctions  50% success rate  5% eligible pop.  25% success rate  Cost savings  10% success rate  Most cost savings  Low success rate  Public safety

Criminogenic Risks TRI science addiction Age during rehabilitation < 25 yearsAge during rehabilitation < 25 years Criminal onset < 16 yearsCriminal onset < 16 years Prior rehabilitation failuresPrior rehabilitation failures History of violenceHistory of violence Antisocial Personality DisorderAntisocial Personality Disorder PsychopathyPsychopathy Familial history of crimeFamilial history of crime Criminal associationsCriminal associations

Criminogenic Needs Drug Dependence or Addiction Drug Dependence or Addiction TRI science addiction

Criminogenic Needs Drug Dependence or Addiction Drug Dependence or Addiction 1.Binge pattern 2.Cravings or compulsions 3.Withdrawal symptoms TRI science addiction

Criminogenic Needs Drug Dependence or Addiction Drug Dependence or Addiction 1.Binge pattern 2.Cravings or compulsions 3.Withdrawal symptoms TRI science addiction } Abstinence is a distal goal

Criminogenic Needs Drug Dependence or Addiction Drug Dependence or Addiction 1.Binge pattern 2.Cravings or compulsions 3.Withdrawal symptoms Drug Abuse or Misuse TRI science addiction } Abstinence is a distal goal

Criminogenic Needs Drug Dependence or Addiction Drug Dependence or Addiction 1.Binge pattern 2.Cravings or compulsions 3.Withdrawal symptoms Drug Abuse or Misuse TRI science addiction } Abstinence is a distal goal Abstinence is a proximal goal }

Criminogenic Needs Drug Dependence or Addiction Drug Dependence or Addiction 1.Binge pattern 2.Cravings or compulsions 3.Withdrawal symptoms Drug Abuse or Misuse Collateral needs Collateral needs –Dual diagnosis –Chronic medical condition (e.g., HIV+, HCV, diabetes) –Homelessness, chronic unemployment TRI science addiction } Abstinence is a distal goal Abstinence is a proximal goal }

Criminogenic Needs Drug Dependence or Addiction Drug Dependence or Addiction 1.Binge pattern 2.Cravings or compulsions 3.Withdrawal symptoms Drug Abuse or Misuse Collateral needs Collateral needs –Dual diagnosis –Chronic medical condition (e.g., HIV+, HCV, diabetes) –Homelessness, chronic unemployment TRI science addiction } Abstinence is a distal goal Abstinence is a proximal goal } } Regimen compliance is proximal

TRI science addiction High Risk Low Risk HighNeeds LowNeeds Risk & Needs Matrix

TRI science addiction High Risk Low Risk HighNeeds LowNeeds Accountability &Treatment

Risk & Needs Matrix TRI science addiction High Risk Low Risk HighNeeds LowNeeds Accountability &Treatment Treatment

Risk & Needs Matrix TRI science addiction High Risk Low Risk HighNeeds LowNeeds Accountability &Treatment Treatment Accountability

Risk & Needs Matrix TRI science addiction High Risk Low Risk HighNeeds LowNeeds Accountability &Treatment Treatment Prevention Accountability

Practice Implications TRI science addiction High Risk Low Risk HighNeeds LowNeeds Status hearings Status hearings Intensive treatment Intensive treatment Compliance is proximal Compliance is proximal Restrictive consequences Restrictive consequences Positive reinforcement Positive reinforcement Noncompliance hearings Noncompliance hearings Intensive treatment Intensive treatment Treatment is proximal Treatment is proximal Positive reinforcement Positive reinforcement v.o.p. / status calendar v.o.p. / status calendar Abstinence is proximal Abstinence is proximal Restrictive consequences Restrictive consequences Secondary prevention Secondary prevention Abstinence is proximal Abstinence is proximal No AA or MET No AA or MET Individual counseling Individual counseling or stratified groups or stratified groups

Programs for Drug Offenders TRI science addiction DiversionIncarceration Probation w/o verdict (Prop 36) Drug Courts Intermediate sanctions

Programs for Drug Offenders TRI science addiction DiversionIncarceration Probation w/o verdict (Prop 36) Drug Courts Intermediate sanctions Low risk Low needs

Programs for Drug Offenders TRI science addiction DiversionIncarceration Probation w/o verdict (Prop 36) Drug Courts Intermediate sanctions Low risk High needs Low risk Low needs

Programs for Drug Offenders TRI science addiction DiversionIncarceration Probation w/o verdict (Prop 36) Drug Courts Intermediate sanctions Low risk High needs High risk High needs Low risk Low needs

Programs for Drug Offenders TRI science addiction DiversionIncarceration Probation w/o verdict (Prop 36) Drug Courts Intermediate sanctions Low risk High needs High risk High needs High risk Low needs Low risk Low needs

Ok, Mr. Big Shot... PROVE IT!!!!

“Key Components” Judicial status hearings Graduated sanctions & rewards Urine drug screens Drug abuse treatment Case management Nolle prosse or conditions-served Expunged record (diversion) TRI science addiction (NADCP, 1997)

“Key Components” Judicial status hearings Graduated sanctions & rewards Urine drug screens Drug abuse treatment Case management Nolle prosse or conditions-served Expunged record (diversion) TRI science addiction (NADCP, 1997)

Research Site TRI science addiction 1st Study: New Castle Co. (misdemeanor)

Matching Design TRI science addiction High RiskLow Risk Matched Unmatched Bi-Weekly (n = 42) As Needed (n = 95) As Usual (monthly) (n = 50)(n = 92)

% Drug-free Urines by Group TRI science addiction p <.001

% Drug-free Urines by Group TRI science addiction p <.001

% Drug-free Urines by Group TRI science addiction p <.001

% Drug-free Urines by Group TRI science addiction p <.001

Drug-Positive Urines: 6 Mos. TRI science addiction * * p <.05 * *

Graduation Rates: 12 mos. TRI science addiction * * p <.05 *

“Key Components” Judicial status hearings Graduated sanctions & rewards Urinalyses Drug abuse treatment Case management Nolle prosse or time served Expunged record (diversion) TRI science addiction (NADCP, 1997)

“Key Components” Judicial status hearings Graduated sanctions & rewards Urinalyses Drug abuse treatment Case management Nolle prosse or time served Expunged record (diversion) TRI science addiction (NADCP, 1997)

Months of compliance STANDARD REWARDS Hat or Candle Reduced community service 7 Reduced drug testing 8 Reduced treatment requirements 9 10Reduced status hearings 11 Reduced homework assignments 12 Total Rewards TRI science addiction

Months of compliance STANDARD REWARDS ENHANCED ESCALATING REWARDS 1$5.00 gift certificate 2$10.00 gift certificate 3Hat or Candle$15.00 gift certificate 4$20.00 gift certificate 5$25.00 gift certificate 6 Reduced community service $30.00 gift certificate 7Reduced drug testing$35.00 gift certificate 8 Reduced treatment requirements $40.00 gift certificate 9$45.00 gift certificate 10 Reduced status hearings $50.00 gift certificate 11 Reduced homework assignments $55.00 gift certificate 12$60.00 gift certificate Total $ TRI science addiction Rewards

Months of compliance STANDARD REWARDS ENHANCED ESCALATING REWARDS ENHANCED THINNING REWARDS 1 $5.00 gift certificate $30.00 gift certificate 2$10.00 gift certificate $30.00 gift certificate 3 Hat or Candle$15.00 gift certificate $30.00 gift certificate 4$20.00 gift certificate Eligible for $50.00 gift certificate if compliant one additional month 5 $25.00 gift certificate $50.00 gift certificate 6 Reduced community service $30.00 gift certificate Eligible for $50.00 gift certificate if compliant one additional month 7 Reduced drug testing$35.00 gift certificate $50.00 gift certificate 8 Reduced treatment requirements $40.00 gift certificate Eligible for $75.00 gift certificate if compliant one additional month 9 $45.00 gift certificate $75.00 gift certificate 10Reduced status hearings$50.00 gift certificate Eligible for $ gift certificate if compliant two additional months 11 Reduced homework assignments $55.00 gift certificate Eligible for $ gift certificate if compliant one additional month 12 $60.00 gift certificate $ gift certificate Total $ TRI science addiction Rewards

# Drug-Free Urines (13 mos.) TRI science addiction n=61n=60n=60 p = n.s.

Mean % Sessions Attended TRI science addiction n=61n=60n=60 p = n.s.

Mean % Drug-Free Urines TRI science addiction *p <.05 n=34 n=29 n=34 n=29 n=26 n=24

Summary One size does not fit all!One size does not fit all! Drug courts are best suited for high risk and high needs offendersDrug courts are best suited for high risk and high needs offenders When possible, separate court calendars and treatment tracks should be held for high risk vs. low risk clientsWhen possible, separate court calendars and treatment tracks should be held for high risk vs. low risk clients You may need to be nicest to the clients you might like the leastYou may need to be nicest to the clients you might like the least TRI science addiction