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Targeting Participants for Drug Courts. National Association of Drug Court Professionals. Douglas B. Marlowe, J.D., Ph.D. Effect Size by Risk Level. Percent reduction in rearrests. Twice the reduction in rearrests. 10%*. 8%. }. 5%. Lowenkamp et al., 2005. * p
Citation preview
Targeting Targeting Participants for Drug Participants for Drug
CourtsCourtsDouglas B. Marlowe, J.D., Ph.D.Douglas B. Marlowe, J.D., Ph.D.
National Association of Drug CourtNational Association of Drug Court ProfessionalsProfessionals
Effect Size by Risk Effect Size by Risk LevelLevel
0
5
10
15
20
All subjects No crim. hx Crim. hx
Pe
rce
nt
red
uc
tio
n in
rea
rre
sts
5%
10%*
Lowenkamp et al., Lowenkamp et al., 20052005
Twice the reductionTwice the reduction in rearrestsin rearrests}}
8%
*p <.05
“Moderator analysis”
Drug Courts That Accepted Participants With Non-Drug Charges Had Nearly Twice the
Reduction in Recidivism
*p <.05
Non-drug charges included property, theft, prostitution and forgery offenses Carey et al. Carey et al.
(2012)(2012)
Drug Courts That Accepted Participants With Prior Violence Had Equivalent Reductions in
Recidivism
p = n.s.
Carey et al. Carey et al. (2012)(2012)
Drug Courts That Excluded Participants with Serious Mental Health Problems Had Over 50%
Less Cost Savings
*p <.05
Carey et al. Carey et al. (2012)(2012)
Avg. Benefit Per $1 Avg. Benefit Per $1 invested invested
0
1
2
3
4
5
current pop. prior violence drug dependence all risk levels
Be
nef
it /c
os
t d
olla
r ra
tio
$2.21 $2.15
$4.13
$3.36
~~ 50% greater 50% greater cost benefitscost benefits}}
Bhati et al. Bhati et al. (2008)(2008)
“Synthetic analysis”
{~~ 90% greater 90% greater
cost benefitscost benefits
Risk PrincipleRisk Principle• NotNot necessarily a risk for violence or necessarily a risk for violence or
dangerousnessdangerousness
• Risk essentially means a difficult prognosis or Risk essentially means a difficult prognosis or lesser amenability to treatmentlesser amenability to treatment
• The higher the risk level, the more intensive The higher the risk level, the more intensive the supervision and accountability should be; the supervision and accountability should be; and vice versaand vice versa
• Mixing risk levels is contraindicatedMixing risk levels is contraindicated
(Andrews & Bonta, (Andrews & Bonta, 2010)2010)
Prognostic RisksPrognostic Risks• 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
Need PrincipleNeed Principle• Clinical disorders or functional impairments Clinical disorders or functional impairments
(diagnosis)(diagnosis)
• Target criminogenic & responsivity needs firstTarget criminogenic & responsivity needs first
• The higher the need level, the more intensive The higher the need level, the more intensive the treatment or rehabilitation services should the treatment or rehabilitation services should be; be; and vice versaand vice versa
• Mixing need levels is contraindicatedMixing need levels is contraindicated
(Andrews & Bonta, (Andrews & Bonta, 2010)2010)
Substance Dependence or AddictionSubstance Dependence or Addiction
Criminogenic NeedsCriminogenic Needs
Criminogenic NeedsCriminogenic Needs
Substance Dependence or AddictionSubstance Dependence or Addiction1.1. Triggered binge responseTriggered binge response2.2. Cravings or compulsionsCravings or compulsions3.3. Withdrawal symptomsWithdrawal symptoms
Substance Dependence or AddictionSubstance Dependence or Addiction1.1. Triggered binge responseTriggered binge response2.2. Cravings or compulsionsCravings or compulsions3.3. Withdrawal symptomsWithdrawal symptoms
} Abstinence is a distal goal
Criminogenic NeedsCriminogenic Needs
Substance Dependence or AddictionSubstance Dependence or Addiction1.1. Triggered binge responseTriggered binge response2.2. Cravings or compulsionsCravings or compulsions3.3. Withdrawal symptomsWithdrawal symptoms
Substance AbuseSubstance Abuse
} Abstinence is a distal goal
Criminogenic NeedsCriminogenic Needs
Substance Dependence or AddictionSubstance Dependence or Addiction1.1. Triggered binge responseTriggered binge response2.2. Cravings or compulsionsCravings or compulsions3.3. Withdrawal symptomsWithdrawal symptoms
Substance AbuseSubstance Abuse
} Abstinence is a distal goal
Abstinence is a proximal goal}
Criminogenic NeedsCriminogenic Needs
Substance Dependence or AddictionSubstance Dependence or Addiction1.1. Triggered binge responseTriggered binge response2.2. Cravings or compulsionsCravings or compulsions3.3. Withdrawal symptomsWithdrawal symptoms
Substance AbuseSubstance Abuse
Responsivity needsResponsivity needs– Dual diagnosisDual diagnosis– Serious functional impairmentsSerious functional impairments
} Abstinence is a distal goal
Abstinence is a proximal goal}
Criminogenic NeedsCriminogenic Needs
Substance Dependence or AddictionSubstance Dependence or Addiction1.1. Triggered binge responseTriggered binge response2.2. Cravings or compulsionsCravings or compulsions3.3. Withdrawal symptomsWithdrawal symptoms
Substance AbuseSubstance Abuse
Responsivity needsResponsivity needs– Dual diagnosisDual diagnosis– Serious functional impairmentsSerious functional impairments
} Abstinence is a distal goal
Abstinence is a proximal goal}
} Regimen compliance is proximal
Criminogenic NeedsCriminogenic Needs
Risk & Need QuadrantsRisk & Need QuadrantsHigh RiskHigh Risk Low RiskLow Risk
High High NeedsNeeds
(dependent)(dependent)
Low Low NeedsNeeds
(abuse)(abuse)
• SupervisionSupervision
• Treatment Treatment
• Pro-social habilitationPro-social habilitation
• Adaptive habilitationAdaptive habilitation
• Treatment Treatment
• (Pro-social rehabilitation)(Pro-social rehabilitation)
• Adaptive habilitationAdaptive habilitation
• SupervisionSupervision
• Pro-social habilitationPro-social habilitation
• (Adaptive habilitation)(Adaptive habilitation)
• Secondary preventionSecondary prevention
• DiversionDiversion
Practice ImplicationsPractice ImplicationsHigh RiskHigh Risk Low RiskLow Risk
High High NeedsNeeds
(dependent)(dependent)
Low Low NeedsNeeds
(abuse)(abuse)
Status calendarStatus calendar TreatmentTreatment Prosocial & adaptive habilit.Prosocial & adaptive habilit. Abstinence is distalAbstinence is distal Positive reinforcementPositive reinforcement Self-help/alumni groupsSelf-help/alumni groups ~ 18-24 mos. (~200 hrs.)~ 18-24 mos. (~200 hrs.)
Noncompliance calendarNoncompliance calendar Treatment (separate milieu)Treatment (separate milieu) Adaptive habilitationAdaptive habilitation Abstinence is distalAbstinence is distal Positive reinforcement Positive reinforcement Self-help/alumni groupsSelf-help/alumni groups ~ 12-18 mos. (~150 hrs.)~ 12-18 mos. (~150 hrs.)
Status calendarStatus calendar
Prosocial habilitationProsocial habilitation Abstinence is proximalAbstinence is proximalNegative reinforcementNegative reinforcement~ 12-18 mos. (~100 hrs.)~ 12-18 mos. (~100 hrs.)
Noncompliance calendarNoncompliance calendar Psycho-education Psycho-education
Abstinence is proximalAbstinence is proximal IndividualIndividual//stratified groupsstratified groups ~ 3-6 mos.~ 3-6 mos. (~ 12-26 hrs.)(~ 12-26 hrs.)