1. Incentives and Sanctions: the informed use of responses to motivate behavior change LADCP Drug Court Fall Training Session New Orleans, Louisiana 12/9-10/2015 Judge William Meyer (ret.) Senior Judicial Fellow National Drug Court Institute

2. Q1: The greater the magnitude of the sanction, the greater the deterrent effect. 1.True 2.False

3. Not Severity but Certainty Certainty does exert a deterrent effect on behavior. However, perceived severity, even if certainty is present, does not exert a deterrent effect on future behavior. Harrell, A., & Roman, J. (2001). “Reducing Drug Use and Crime Among Offenders: The Impact of Graduated Sanctions.” Journal of Drug Issues, 31 (1), 207-232.

4. Why are drug offenders in particular not motivated or deterred by severity punishment? Example: 1/2 day work crew vs. 2 days later-why not show?

5. Dr. Antoine Bechara* Substance Abusers choose Short Term Rewards Despite Mounting Losses Substance Abusers choose option of getting higher rewards although choice has greater punishment Substance Abusers had abnormally high physiological responses to obtain the chance of getting a reward Reported in NIDA NOTES, Vol. 18, #4 (Dec. 2003)

6. How sanctions can bring about the wrong response

7. Defiant Behavior Multi-disciplinary research demonstrates that defiant behavior results when sanctions: (a) are perceived as unfair; (b) punish the individual not the act; (c) are imposed on individuals poorly bonded to the community, (d) are imposed on individuals who fail to feel shame or contrition for their acts. Sherman, L. W. (1993). “Defiance, Deterrence, and Irrelevance: A Theory of the Criminal Justice Sanction.” Journal of Research in Crime and Delinquency, 30 (4), 445-473.

8. Procedural Due Process Standing-dignity and respect Neutrality Participation—invitation to speak

9. Principle #1: SANCTIONS SHOULD NOT BE PAINFUL, HUMILIATING OR INJURIOUS 1.Certainty Not Severity of Sanction 2.Importance of Perception of Fairness

10. Q2: Almost Without Exception, Offenders Prefer to Be Sentenced to Alternatives to Incarceration? 1.True 2.False

11. Contrary to expectations, incarceration is not necessarily viewed by the criminal offender as the harshest punishment Wood, P. B., & Grasmick, H. G. (1995). “Inmates Rank the Severity of Ten Alternative Sanctions Compared to Prison.” Oklahoma Department of Corrections

12. Incarceration Not Most Feared In a comparison of alternative sanctions to prison time, 6-24% of inmates surveyed preferred 12 months incarceration compared to sanctions ranging from a halfway house (6.7%), probation (12.4%) or day fines (24%). Wood, P. B., & Grasmick, H. G. (1995). “Inmates Rank the Severity of Ten Alternative Sanctions Compared to Prison.” Oklahoma Department of Corrections: www.doc.state.ok.us/DOCS/OCJRC/OCJRC95/950725j.htm See also Petersilla, J. and Deschanes, E., “What Punishes? Inmates Rank the Security of Prison v. Intermediate Sanctions?” Federal Probation, Vol. 58, No. 1 (March 1994). www.doc.state.ok.us/DOCS/OCJRC/OCJRC95/950725j.htm

13. Who is motivated by punishment? Those with a lot to loose—children, job, connection with community etc. What tends to happen with those with no connection to community? Use of positive and negative reinforcement See Higgins, S. T., & Silverman, K. (1999). Motivating Behavior Change Among Illicit-Drug Abusers. Washington, D.C.: American Psychological Association; particularly Chapter 17, Crowley, T., “Clinical Implications and Future Directions,” pp. 345-351.

14. Different Strokes for Different Folks 1. Similar sanctions have completely different effects depending upon the social situation and offender type. 2.Different treatment modalities can increase or decrease criminality depending on offenders’ risk/need profile and treatment modality. 3.Criminal sanctions may decrease criminality in employed offenders but increase it in unemployed offenders. 4.Threat of criminal sanctions deters future criminality in people who are lower risk. See Sherman, L. W. (1993). “Defiance, Deterrence, and Irrelevance: A Theory of the Criminal Justice Sanction.” Journal of Research in Crime and Delinquency, 30 (4), 445-473..

15. Juveniles? How many of you work with Juveniles? Research suggests that developmentally, 18-21 year olds are still adolescents. (Geidd, 2004) Juveniles are not small or young adults Responses must be individualized to take this into consideration. Thinking toward the future.

16. Motivating Juveniles Four cognitive variables related to change: 1.Reasons for drug use 2.Expectations 3.Readiness for Behavioral Change 4. Self-Esteem Monti, Colby & O’Leary, Adolescents, Alcohol and Substance Abuse (Gilford Press 2001)

17. Reasons for Drug Use Recreational (To have fun) Social conformity Mood Enhancement Cope with Stress Petraitis, Flay & Miller, Reviewing Theories of Adolescent Substance Abuse, Psychological Bulletin, 117, 67-68 (1995 )

18. Expectations Balancing Test: risk perception—perceived costs vs. benefits: negative physical effects negative psychological effects future health concerns positive and negative social effects

19. Readiness for Behavioral Change Scientists know very little about the determinants of motivational variables to promote positive change in juveniles and adolescents What the research does tell us: – Just say “know” – Confrontation vs. Motivational Interviewing – Enhance self-efficacy Monti, Colby & O’Leary, Adolescents, Alcohol and Substance Abuse (Gilford Press 2001)

20. Self-efficacy Promote confidence and self-worth for positive change Not just “do it” but “I can do it”

21. Strategy 15 Goal Oriented Incentives and Sanctions Respond to compliance and noncompliance with incentives and sanctions that are designed to reinforce or modify the behavior of youth and their families. – Immediate – Predictable – Consistent Juvenile Drug Courts: Strategies in Practice, BJA, March 2003

22. Bad Ideas Research tells us some things don’t work with juveniles: – Boot camps (OJJDP, 1996; NIJ, 2003) – DARE (Ennett, et al., 1994; Lynam, et al., 1999) – Scared Straight (Petrosino, et al., 2000)

23. What does work Avoiding Negative Peers How do you respond in terms of S & I? Proximal vs. Distal Positive Peer Culture How do you respond in terms of S & I? Proximal vs. Distal Parental Consistency How do you respond in terms of S & I?

24. What Works Multisystemic Therapy—for antisocial behavior Multisystemic Therapy (MST) is an intensive family- and community-based treatment that addresses the multiple determinants of serious antisocial behavior in juvenile offenders. Contingency Management—for substance abuse Patients are rewarded or punished for their behavior; generally, adherence to or failure to adhere to program rules and regulations or their treatment plan.

25. Resources Shaffer, C. et al “ Mechanisms of effectiveness in Juvenile Court: Altering Risk Processes Associated with Delinquency and Substance Abuse”, VII Drug Court Review 1 (Nov. 2010) Linden, P. et al. “Developing Accountability in the Lives of Youth: Defining the Operational Features of A Juvenile Drug Treatment Court.” VII Drug Court Review 1 (Nov. 2010)

26. Individualized Responses: Juvenile Drug Court Fairness and Equality are often synonymous for adolescents. (Key Principle #1 ) Judge/You as Probation officer must go to greater lengths to articulate why response is “fair”. Adolescents are less able to learn vicariously. Timelines for targeted behaviors must be short.

27. Incentives in Juvenile Drug Court Developmental issues: – Risk-taking behavior peaks in adolescence. – Egocentrism abounds (the “spotlight effect”) – Perceived invulnerability. – Magical or wishful thinking. Important to identify reinforcers through observation and inquiry. “Hollow Interventions” Promoting Responsible Adolescent Behavior in Juvenile Drug Court Participants Through Use of Incentives and Sanctions. NCJFCJ, 2004

28. Pitfalls in Sanctioning: Juveniles Admonishment in front of peers. Reaction, if embarrassed? Reaction, impress peers? Explanations that include some future benefit. It is all about now

29. Target Behaviors Initial Behaviors and Attitudes: Defiant Uncooperative Relapse-Positive Tests Denial pre-contemplative or contemplative Withdrawn/ non-communicative Suspicious Low self-esteem/confidence

30. Target Behaviors Behaviors and attitudes near end of program: Communicative Self-Aware Improved self-esteem Maintenance Stage of change Aim to Please Open

31. What are our Expectations? Abstain from drug and alcohol use Show up to Court Go to Treatment Take Random Urine Tests See Prob. and/or Case Mgr. Pay for some of the above Job Literacy—GED Good Attitude

32. Addicts vs. Abusers: Proximal and Distal Behaviors Should we emphasize certain target behaviors during different phases of the program? What Behaviors? Why? How do we respond to show that emphasis?

33. Who is High Risk? Age during treatment < 25 years Drug use onset < 14 years Criminal onset < 16 years Prior treatment/rehabilitation failures History of violence Anti-Social Personality Disorder (APD) Psychopathy (APD + NPD) Familial history of crime Criminal associations

34. 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 } Abstinence is a distal goal Abstinence is a proximal goal } } Regimen compliance is proximal Proximal vs. Distal Goals

35. Marlowe’s Risk Need Matrix High Risk/High NeedsLow Risk/High Needs High Risk/Low NeedsLow Risk/Low Needs HIGH LOW RISK High LOW NEEDS

36. Principle #2 RESPONSES ARE IN THE EYES OF THE BEHAVER.

37. Q3:Graduated Rewards, Are More Effective in Motivating Behavior than Fixed Rewards. 1.True 2.False

38. Research demonstrates that graduated sanctions work in the drug court context. Harrell, A., & Roman, J. (2001). “Reducing drug use and crime among offenders: The impact of graduated sanctions.” Journal of Drug Issues, 31 (1), 207-232

39. Research on graduated rewards reveals that participants receiving graduated reinforcements achieved greater mean levels of abstinence than participants receiving fixed reinforcements. Roll, J., Higgins, S. and Badger, G. “An Experimental Comparison of Three Different Schedules of Reinforcement of Drug Abstinence Using Cigarette Smoking as an Exemplar.” Journal of Applied Behavioral Analysis, Vol. 29, p. 495-504 No. 4 (Winter 1996).

40. Consequences Habituation and Satiation Moderate Consequences work best Rewards for intrinsic motivation

41. Principle #3: RESPONSES MUST BE OF SUFFICIENT INTENSITY

42. Q4: Putting a person on “Zero Tolerance” is an effective response to non-compliant behavior ? 1.True 2.False

43. What Happens When You Deliver Sanctions on an Intermittent Schedule? Sanctions Should Be Delivered for Every Infraction Those Offenders Who Received Sanctions on a Continuous Schedule Evidenced a Significantly Lower Arrest Rate Than Those Offenders Who Received Intermittent Sanctions. Brennan, P. And Mednick, S. “Learning Theory Approach to the Deterrence of Criminal Recidivism.” Vol. 103, Journal of Abnormal Psychology, Pp. 430-440 (1994).

44. The fishbowl study and prospect of potential rewards. Petry, N. M., Martin, B., Cooney, J. L., & Kranzler, H. R. (2000). “Give Them Prizes and They Will Come: Contingency Management for Treatment of Alcohol Dependence.” Journal of Consulting and Clinical Psychology, 68 (2), 250-257. Petry, N. M. (2001). “Contingent reinforcement for compliance with goal-related activities in HIV-positive substance abusers.” The Behavior Analyst Today, 2 (2), 78-85.

45. Principle #4: RESPONSES SHOULD BE DELIVERED FOR EVERY TARGET BEHAVIOR.

46. Q5: Behaviors Are Much More Likely to Be Changed When Responses Are Delivered Immediately. 1.True 2.False

47. Brain Research Neuroscientists conclude: “rewards and punishments received soon after an action are more important than rewards and punishments received later.” Dayan, P., & Abbott, L. F. (2001). Theoretical Neuroscience: Computational and Mathematical Modeling of Neural Systems. Cambridge, MA: MIT Press.

48. Principle #5: RESPONSES SHOULD BE DELIVERED IMMEDIATELY.

49. Q6: The primary purpose of a frequent and random drug testing program is to deter the offender from using. 1.True 2.False

50. Failure to reliably detect drug use in effect puts a person on an intermittent schedule of rewards and sanctions, which is ineffectual in changing behavior. Marlowe, D. B., & Kirby, K. C. (1999). “Effective use of sanctions in drug courts: Lessons from behavioral research.” National Drug Court Institute Review, II (1), 11-xxix.

51. Principle #6 (UN)DESIRABLE BEHAVIOR MUST BE RELIABLY DETECTED

52. Q7: Written guidelines that detail consequences to participant behavior should be given to each participant when they enter the program. 1.True 2.False

53. Learned Helplessness Failure to specify particular behaviors that are targeted and the consequences for non- compliance can result in a behavior syndrome known as “learned helplessness where a drug court participant can become aggressive, withdrawn and/or despondent.” Marlowe, D. B., & Kirby, K. C. (1999). “Effective Use of Sanctions in Drug Courts: Lessons From Behavioral Research.” National Drug Court Institute Review, II (1), 11-xxix.

54. How can we instill expectations in Drug Court participants? Participant Handbook Phase System Contingency Contracting Courtroom as Classroom

55. Participant Handbooks and Policy and Procedure Manuals C.A.S.E. http://www.ndcrc.org/

56. Principle #7: RESPONSES MUST BE PREDICTABLE AND CONTROLLABLE.

57. Q8: Frequency of contact between a judge/probation officer and participant can actually have a negative impact on program completion. 1.True 2.False

58. Frequency of Contact Who might have inverse relationship vis-à-vis program completion? Who might more frequent contact help? What does that tell us about our drug court programs?

59. Principle #8: RESPONSES MAY HAVE UNINTENTIONAL SIDE EFFECTS.

60. Q9: Punishment seems to be the best motivator of behavior change. A.True B.False

61. The Carrot Is Mightier Than the Stick Those in reinforcement contingency stayed longer in treatment than those in punishment Effects of punishment are transitory- change ends when punishment ends Punishment most effective when used with positive reinforcement Higgins, S. T., & Silverman, K. (1999). Motivating Behavior Change Among Illicit-Drug Abusers. Washington, D.C.: American Psychological Association, p. 330

62. Principle #9: BEHAVIOR DOES NOT CHANGE BY PUNISHMENT ALONE.

63. Q10: The effectiveness of a treatment course can be influenced by the initial description of the benefit. 1.True 2.False

64. The Messenger is Part of the Message Fairness and the Perception of Fairness How do you accomplish this? Motivational Interventions

66. Response Considerations and Elements 1. Who are they (Risk/ Need)? 2. Where are they (phase of the program)? 3. What are the behaviors we are responding to? (proximal and distal) 4. What is the response choice and magnitude and why? 5. Deliver and explain the response using the above elements

67. Motivational Interventions

68. Open-ended Questions Playbacks Affirmations

69. Principle #10: THE METHOD OF DELIVERY OF THE RESPONSE IS AS IMPORTANT AS THE RESPONSE ITSELF.

70. Basic Themes in the 10 Principles Fairness Certainty and Immediacy Reinforcement Trumps Punishment Importance of Response Delivery

71. The End “All Behavior is followed by a consequence, and the nature of that consequence modifies the organisms tendency to repeat the behavior in the future” B.F. Skinner