1. What Makes Drug Courts Effective? Douglas B. Marlowe, J.D., Ph.D. Treatment Research Institute at the University of Pennsylvania TRI science addiction

2. “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)

3. “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)

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

5. 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

6. During Treatment Findings TRI science addiction

7. Counseling Attendance: 14 Weeks p = n.s. Mean sessions attended (n=99) (n=82) TRI science addiction

8. % Drug-Free Urines by Week Time Effect: p <.001Grp. x Time: p = n.s. TRI science addiction

9. Program Completion Status p = n.s. TRI science addiction

10. Post-Treatment Findings TRI science addiction

11. ASI Composite Scores: Baseline to 12 Months * Time: p<.01 * Time: p<.01 * * * TRI science addiction

12. 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

13. 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

14. - Interaction Effect - Antisocial Personality Disorder *p <.05 Clean Urines: 14 wks TRI science addiction n=30n=69n=30n=52 As needed Bi-weekly

15. - Interaction Effect - Prior Drug Treatment *p <.05 TRI science addiction Clean Urines: 14 wks n=25n=74n=25n=56 As needed Bi-weekly

16. Replication Sites 1st Study: New Castle Co. (misdemeanor) Replications: Kent Co. (felony and misdemeanor) Sussex Co. (felony and misdemeanor) TRI science addiction

17. - Replication of Interaction - Prior Drug Treatment TRI science addiction * *p =.055 Clean Urines: 14 wks n=6n=26n=6n=19 As needed Bi-weekly

18. Matching Study TRI science addiction High RiskLow Risk Matched Unmatched Bi-Weekly As Needed As Usual (monthly)

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

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

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

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

23. “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)

24. “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)

25. Graduated Sanctions TRI science addiction (Harrell et al., 1998)

26. TRI science addiction Standard Track (Harrell et al., 1998) Graduated Sanctions

27. TRI science addiction Standard TrackTreatment Track (Harrell et al., 1998) Graduated Sanctions

28. TRI science addiction Standard Track *Sanctions Track Treatment Track (Harrell et al., 1998) * included 3-day and 7-day jail stays Graduated Sanctions

29. 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

30. 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

31. 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

32. 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

33. 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

34. % Graduated on Time (13 mos.) TRI science addiction n=61n=60n=60 *p <.05

35. Drug-Free Urines by Risk Level TRI science addiction *p <.05 n=34 n=29 n=34 n=29 n=26 n=24

36. 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

37. 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

38. Five-Cluster Solution TRI science addiction

39. Urinalysis Results * * p <.01 * N=44N=82N=58N=11N=29 TRI science addiction

40. Graduation Rates * * p <.05 * N=44N=82N=58N=11N=29 TRI science addiction

41. 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