1. Douglas B. Marlowe, J.D., Ph.D. Treatment Research Institute at the University of Pennsylvania TRI science addiction Effective Use of Rewards & Sanctions © Dr. Douglas Marlowe, March 8, 2011 The following presentation may not be copied in whole or in part without the written permission of the author or the National Drug Court Institute. Written permission will generally be given without cost, upon request.

2. Basic Terminology Positive Reinforcement Negative Reinforcement Punishment Response Cost REWARDSANCTION TAKE GIVE TRI science addiction

3. Certainty TRI science addiction FR-1 schedule for initiationFR-1 schedule for initiation Reliable detectionReliable detection Second chancesSecond chances

4. Celerity TRI science addiction

5. Celerity TRI science addiction

6. Celerity TRI science addiction Effects degrade exponentiallyEffects degrade exponentially Interference from new behaviorsInterference from new behaviors Status hearingsStatus hearings

7. Magnitude TRI science addiction MAGNITUDE OF SANCTION EffectiveZone CeilingEffectsHabituationEffectsMINIMALMODERATESEVERE EFFECTIVENESS

8. Escalation TRI science addiction RehearsalRehearsal Intermediate responsesIntermediate responses Ratchet up or downRatchet up or down

9. Fairness TRI science addiction ProportionalityProportionality Like people in like circumstancesLike people in like circumstances Procedural justiceProcedural justice Advance noticeAdvance notice Punish the act, not the individualPunish the act, not the individual

10. Quitting & Defiance TRI science addiction UnfairnessUnfairness Learned HelplessnessLearned Helplessness –Predictability –Controllability Ratio BurdenRatio Burden

11. Target Behaviors TRI science addiction Proximal vs. distal (shaping)Proximal vs. distal (shaping) Phase-specificPhase-specific Capture the behaviorCapture the behavior Clearly definedClearly defined

12. Proximal vs. Distal Goals Drug Dependence or Addiction Drug Dependence or Addiction TRI science addiction

13. Drug Dependence or Addiction Drug Dependence or Addiction 1.Binge pattern 2.Cravings or compulsions 3.Withdrawal symptoms TRI science addiction Proximal vs. Distal Goals

14. 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 Proximal vs. Distal Goals

15. 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 Proximal vs. Distal Goals

16. 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 } Proximal vs. Distal Goals

17. 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 } Proximal vs. Distal Goals

18. 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 Proximal vs. Distal Goals

19. Pitfalls of Sanctions TRI science addiction Escape or avoidanceEscape or avoidance OvergeneralizationOvergeneralization SuperstitionSuperstition Doesn’t teach what to doDoesn’t teach what to do FR forever (no thinning)FR forever (no thinning)

20. Pitfalls of the Carrot TRI science addiction CoddlingCoddling ComplacencyComplacency EntitlementEntitlement May reduce intrinsic motivationMay reduce intrinsic motivation

21. Behavior Modification 101 The Works of BF Skinner TRI science addiction Certainty and celerity Beware individualism Higher magnitude for proximal behaviors Lower magnitude for distal behaviors Predictable and attainable goals Reward desired behaviors Expect more over time over time

22. Readings TRI science addiction 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.

23. This project was supported by Grant No. 2009- DD-BX-K003 awarded by the Bureau of Justice Assistance. The Bureau of Justice Assistance is a component of the Office of Justice Programs, which also includes the Bureau of Justice Statistics, the National Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention, and the Office for Victims of Crime. Points of view or opinions in this document are those of the author and do not represent the official position or policies of the United States Department of Justice.