Douglas B. Marlowe, J.D., Ph.D. Treatment Research Institute at the University of Pennsylvania TRI science addiction Targeting Dispositions by Risks & Needs

Dispositions for Drug Offenders Diversion (ARD)Incarceration Probation w/o verdict Drug / DWI Courts Intermediate sanctions Psychosocial Functioning $$$$$$ Costs $$$$$$$$$ Public Safety Risks

Prognostic Risks TRI science addiction Current age < 25 yearsCurrent age < 25 years Delinquent onset < 16 yearsDelinquent onset < 16 years Substance abuse onset < 14 yearsSubstance abuse onset < 14 years Prior rehabilitation failuresPrior rehabilitation failures History of violenceHistory of violence Antisocial Personality DisorderAntisocial Personality Disorder PsychopathyPsychopathy Familial history of crime or addictionFamilial history of crime or addiction Criminal or substance abuse associationsCriminal or substance abuse associations

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

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

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

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

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

Criminogenic Needs Substance Dependence or Addiction Substance Dependence or Addiction 1.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 TRI science addiction } Abstinence is a distal goal Abstinence is a proximal goal }

Criminogenic Needs Substance Dependence or Addiction Substance Dependence or Addiction 1.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 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 & Habilitation

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

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

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

Practice Implications TRI science addiction High Risk Low Risk HighNeeds LowNeeds Status hearings Status hearings Treatment & habilitation Treatment & habilitation Compliance is proximal Compliance is proximal Restrictive consequences Restrictive consequences Positive reinforcement Positive reinforcement Agonist medication Agonist medication Noncompliance hearings Noncompliance hearings Treatment & habilitation Treatment & habilitation Treatment is proximal Treatment is proximal Positive reinforcement Positive reinforcement Agonist medication Agonist medication v.o.p. / status calendar v.o.p. / status calendar Abstinence is proximal Abstinence is proximal Psychosocial habilitation Psychosocial habilitation Restrictive consequences Restrictive consequences No AA or MET No AA or MET Antagonist medication Antagonist medication 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

Dispositions for Drug Offenders Diversion (ARD)Incarceration Probation w/o verdict Drug / DWI Courts Intermediate sanctions Low risk Low needs Low risk High needs High risk High needs High risk Low needs Risk of Dangerousness