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What Makes Drug Courts Effective? Douglas B. Marlowe, J.D., Ph.D. Treatment Research Institute at the University of Pennsylvania TRI science addiction
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“Key Components” Judicial status hearings Graduated sanctions & rewards Urinalyses Drug abuse treatment Case management Nolle prosse or conditions-served Expunged record (diversion) TRI science addiction (NADCP, 1997)
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“Key Components” Judicial status hearings Graduated sanctions & rewards Urinalyses Drug abuse treatment Case management Nolle prosse or conditions-served Expunged record (diversion) TRI science addiction (NADCP, 1997)
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Research Site TRI science addiction 1st Study: New Castle Co. (misdemeanor)
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Research Design Randomly assigned to: – –Bi-weekly status hearings – –As-needed status hearings Equivalent drug treatment, case management, urine drug screens, and sanctions & rewards Assessments included: – – Baseline ………….. ASI; ASPD diagnostic interview – – Weekly ………….… Random UAs – – Monthly (x 3) …….. Perceived Deterrence Questionnaire – – 6 & 12 months …... ASI; UA – – 24 months ………... State criminal justice records TRI science addiction
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During Treatment Findings TRI science addiction
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Counseling Attendance: 14 Weeks p = n.s. Mean sessions attended (n=99) (n=82) TRI science addiction
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% Drug-Free Urines by Week Time Effect: p <.001Grp. x Time: p = n.s. TRI science addiction
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Program Completion Status p = n.s. TRI science addiction
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Post-Treatment Findings TRI science addiction
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ASI Composite Scores: Baseline to 12 Months * Time: p<.01 * Time: p<.01 * * * TRI science addiction
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Client Interaction Effects Age Race Gender Years of education Employment Status Marital Status Drug severity Prior drug treatment history ASPD diagnosis Legal severity TRI science addiction
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Age Race Gender Years of education Employment Status Marital Status Drug severity Prior drug treatment history ASPD diagnosis Legal severity Experimental Condition (Bi-weekly vs. As-Needed Status Hearings) TRI science addiction Client Interaction Effects
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- Interaction Effect - Antisocial Personality Disorder *p <.05 Clean Urines: 14 wks TRI science addiction n=30n=69n=30n=52 As needed Bi-weekly
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- Interaction Effect - Prior Drug Treatment *p <.05 TRI science addiction Clean Urines: 14 wks n=25n=74n=25n=56 As needed Bi-weekly
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Replication Sites 1st Study: New Castle Co. (misdemeanor) Replications: Kent Co. (felony and misdemeanor) Sussex Co. (felony and misdemeanor) TRI science addiction
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- Replication of Interaction - Prior Drug Treatment TRI science addiction * *p =.055 Clean Urines: 14 wks n=6n=26n=6n=19 As needed Bi-weekly
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Matching Study TRI science addiction High RiskLow Risk Matched Unmatched Bi-Weekly As Needed As Usual (monthly)
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% Drug-free Urines by Group TRI science addiction p <.001
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% Drug-free Urines by Group TRI science addiction p <.001
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% Drug-free Urines by Group TRI science addiction p <.001
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% Drug-free Urines by Group TRI science addiction p <.001
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“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)
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“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)
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Graduated Sanctions TRI science addiction (Harrell et al., 1998)
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TRI science addiction Standard Track (Harrell et al., 1998) Graduated Sanctions
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TRI science addiction Standard TrackTreatment Track (Harrell et al., 1998) Graduated Sanctions
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TRI science addiction Standard Track *Sanctions Track Treatment Track (Harrell et al., 1998) * included 3-day and 7-day jail stays Graduated Sanctions
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TRI science addiction Standard Track *Sanctions Track Treatment Track (Harrell et al., 1998) * included 3-day and 7-day jail stays 40% entered 19% completed drug use Graduated Sanctions
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TRI science addiction Standard Track *Sanctions Track Treatment Track (Harrell et al., 1998) 66% entered 30% completed drug use re-arrests (1 yr) * included 3-day and 7-day jail stays 40% entered 19% completed drug use Graduated Sanctions
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Months of compliance STANDARD REWARDS 1 2 3 Hat or Candle 4 5 6 Reduced community service 7 Reduced drug testing 8 Reduced treatment requirements 9 10Reduced status hearings 11 Reduced homework assignments 12 Total TRI science addiction Graduated Rewards
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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 $390.00 TRI science addiction Graduated Rewards
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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 $125.00 gift certificate if compliant two additional months 11 Reduced homework assignments $55.00 gift certificate Eligible for $125.00 gift certificate if compliant one additional month 12 $60.00 gift certificate $125.00 gift certificate Total $390.00 TRI science addiction Graduated Rewards
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% Graduated on Time (13 mos.) TRI science addiction n=61n=60n=60 *p <.05
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Drug-Free Urines by Risk Level TRI science addiction *p <.05 n=34 n=29 n=34 n=29 n=26 n=24
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Phase Advancement by Age* TRI science addiction p <.05 Phase 1 Phase 3 Phase 2 Graduation *Median split at 23 years n=25 n=36 n=33 n=33 n=27 n=27
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Deterrence Theory Clients weigh the costs and benefits of violating the law or using drugs Cost/benefit ratio is influenced by: –Perceived certainty of detection –Perceived certainty of sanctions or rewards –Perceived magnitude of sanctions or rewards TRI science addiction
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Five-Cluster Solution TRI science addiction
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Urinalysis Results * * p <.01 * N=44N=82N=58N=11N=29 TRI science addiction
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Graduation Rates * * p <.05 * N=44N=82N=58N=11N=29 TRI science addiction
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Acknowledgments National Institute on Drug Abuse National Institute on Drug Abuse grants #R01-DA-13096 and R01-DA-14566 Center for Substance Abuse Treatment TRI science addiction
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