Effective Programs for Drug Offenders Douglas B. Marlowe, J. D. , Ph. D. Treatment Research Institute at the University of Pennsylvania TRI science addiction
Programs for Drug Offenders Diversion Incarceration Drug Courts Probation w/o verdict (Prop 36) Intermediate sanctions TRI science addiction
Programs for Drug Offenders $ $$$ $$ st s o $C $ $$$ $ Diversion Incarceration Drug Courts Probation w/o verdict (Prop 36) Intermediate sanctions TRI science addiction
Programs for Drug Offenders Pub lic S a fe t y R i sk s Diversion Incarceration Drug Courts Probation w/o verdict (Prop 36) Intermediate sanctions TRI science addiction
Programs for Drug Offenders Psychosocial Functioning Diversion Incarceration Drug Courts Probation w/o verdict (Prop 36) Intermediate sanctions TRI science addiction
Programs for Drug Offenders $ $$$ Psychosocial Functioning $$$ $$ st s Pub o lic S $C $ a fe t y $$$ Ri$k s s Diversion Incarceration Drug Courts Probation w/o verdict (Prop 36) Intermediate sanctions TRI science addiction
Programs for Drug Offenders Diversion Incarceration Drug Courts Probation w/o verdict (Prop 36) Intermediate sanctions TRI science addiction
Programs for Drug Offenders Over-reliance Diversion Incarceration Drug Courts Probation w/o verdict (Prop 36) Intermediate sanctions TRI science addiction
Prison Criminal Recidivism in 3 Years • 68% re-arrested • 47% convicted • 50% re-incarcerated Relapse to Drug Abuse in 3 Years • 95% relapse TRI science addiction
Programs for Drug Offenders Diversion Incarceration Drug Courts Probation w/o verdict (Prop 36) Intermediate sanctions TRI science addiction
Programs for Drug Offenders Over-reliance Diversion Incarceration Drug Courts Probation w/o verdict (Prop 36) Intermediate sanctions TRI science addiction
Intermediate Sanctions No effect • Boot camp • House arrest “Worse” effect • Anklet monitoring • Scared Straight • Intensive Supervised Probation (ISP) Slight improvement • Restitution TRI science addiction
Programs for Drug Offenders Diversion Incarceration Drug Courts Probation w/o verdict (Prop 36) Intermediate sanctions TRI science addiction
Programs for Drug Offenders Over-reliance Diversion Incarceration Drug Courts Probation w/o verdict (Prop 36) Intermediate sanctions TRI science addiction
Diversion to Treatment Attrition • • 50% - 67% don’t show for intake 40% - 80% drop out in 3 months 90% drop out in 12 months 70% of probationers and parolees drop out within 2 - 6 months TRI science addiction
Programs for Drug Offenders Diversion Incarceration Drug Courts Probation w/o verdict (Prop 36) Intermediate sanctions TRI science addiction
Programs for Drug Offenders Over-reliance Diversion Incarceration Drug Courts Probation w/o verdict (Prop 36) Intermediate sanctions TRI science addiction
Effects of Proposition 36 • 30% never showed for treatment • 40% attended 90 days of treatment • 24% completed treatment • 20% probation revocations • 60% parole revocations • Increased recidivism • Decreased costs TRI science addiction
Programs for Drug Offenders Diversion Incarceration Drug Courts Probation w/o verdict (Prop 36) Intermediate sanctions TRI science addiction
Programs for Drug Offenders Reliance Diversion Incarceration Drug Courts Probation w/o verdict (Prop 36) Intermediate sanctions TRI science addiction
Effects of Drug Courts • 60% complete > 12 months of treatment • 50% graduate • Reduced recidivism and drug use • Serves ~ 5% of eligible population TRI science addiction
Programs for Drug Offenders Diversion Incarceration Drug Courts Probation w/o verdict (Prop 36) Intermediate sanctions TRI science addiction
Programs for Drug Offenders Ø 50% success rate Ø 5% eligible pop. Diversion Incarceration Drug Courts Probation w/o verdict (Prop 36) Intermediate sanctions TRI science addiction
Programs for Drug Offenders Ø 50% success rate Ø 5% eligible pop. Ø 25% success rate ØCost savings Diversion Incarceration Drug Courts Probation w/o verdict (Prop 36) Intermediate sanctions TRI science addiction
Programs for Drug Offenders Ø 10% success rate ØMost cost savings Ø 50% success rate Ø 5% eligible pop. Ø 25% success rate ØCost savings Diversion Incarceration Drug Courts Probation w/o verdict (Prop 36) Intermediate sanctions TRI science addiction
Programs for Drug Offenders Ø 10% success rate ØMost cost savings Ø 50% success rate Ø 5% eligible pop. ØLow success rate ØPublic safety Ø 25% success rate ØCost savings Diversion Incarceration Drug Courts Probation w/o verdict (Prop 36) Intermediate sanctions TRI science addiction
Criminogenic Risks • Age during rehabilitation < 25 years • Criminal onset < 16 years • Prior rehabilitation failures • History of violence • Antisocial Personality Disorder • Psychopathy • Familial history of crime • Criminal associations TRI science addiction
Criminogenic Needs Drug Dependence or Addiction TRI science addiction
Criminogenic Needs Drug Dependence or Addiction 1. Binge pattern 2. Cravings or compulsions 3. Withdrawal symptoms TRI science addiction
Criminogenic Needs Drug Dependence or Addiction 1. Binge pattern 2. Cravings or compulsions 3. Withdrawal symptoms } Abstinence is a distal goal TRI science addiction
Criminogenic Needs Drug Dependence or Addiction 1. Binge pattern 2. Cravings or compulsions 3. Withdrawal symptoms } Abstinence is a distal goal Drug Abuse or Misuse TRI science addiction
Criminogenic Needs Drug Dependence or Addiction 1. Binge pattern 2. Cravings or compulsions 3. Withdrawal symptoms } Drug Abuse or Misuse } Abstinence is a distal goal Abstinence is a proximal goal TRI science addiction
Criminogenic Needs Drug Dependence or Addiction 1. Binge pattern 2. Cravings or compulsions 3. Withdrawal symptoms } Drug Abuse or Misuse } Abstinence is a distal goal Abstinence is a proximal goal Collateral needs – – – Dual diagnosis Chronic medical condition (e. g. , HIV+, HCV, diabetes) Homelessness, chronic unemployment TRI science addiction
Criminogenic Needs Drug Dependence or Addiction 1. Binge pattern 2. Cravings or compulsions 3. Withdrawal symptoms } Drug Abuse or Misuse Collateral needs – – – } } Abstinence is a distal goal Abstinence is a proximal goal Regimen compliance is proximal Dual diagnosis Chronic medical condition (e. g. , HIV+, HCV, diabetes) Homelessness, chronic unemployment TRI science addiction
Risk & Needs Matrix High Risk Low Risk High Needs Low Needs TRI science addiction
Risk & Needs Matrix High Risk High Needs Low Risk Accountability & Treatment Low Needs TRI science addiction
Risk & Needs Matrix High Risk High Needs Accountability & Treatment Low Risk Treatment Low Needs TRI science addiction
Risk & Needs Matrix High Risk High Needs Accountability & Treatment Low Needs Low Risk Accountability Treatment TRI science addiction
Risk & Needs Matrix High Risk High Needs Accountability & Treatment Low Needs Accountability Low Risk Treatment Prevention TRI science addiction
Practice Implications High Risk High Needs Low Risk ü Noncompliance hearings ü Status hearings ü Intensive treatment ü Compliance is proximal ü Treatment is proximal ü Restrictive consequences ü Positive reinforcement ü v. o. p. / status calendar ü Secondary prevention ü Abstinence is proximal ü Restrictive consequences ü No AA or MET ü Individual counseling or stratified groups TRI science addiction
Programs for Drug Offenders Diversion Incarceration Drug Courts Probation w/o verdict (Prop 36) Intermediate sanctions TRI science addiction
Programs for Drug Offenders Low risk Low needs Diversion Incarceration Drug Courts Probation w/o verdict (Prop 36) Intermediate sanctions TRI science addiction
Programs for Drug Offenders Low risk Low needs Low risk High needs Diversion Incarceration Drug Courts Probation w/o verdict (Prop 36) Intermediate sanctions TRI science addiction
Programs for Drug Offenders High risk High needs Low risk Low needs Low risk High needs Diversion Incarceration Drug Courts Probation w/o verdict (Prop 36) Intermediate sanctions TRI science addiction
Programs for Drug Offenders High risk High needs Low risk Low needs Low risk High needs Diversion High risk Low needs Incarceration Drug Courts Probation w/o verdict (Prop 36) Intermediate sanctions TRI science addiction
Ok, Mr. Big Shot. . . PROVE IT!!!!
“Key Components” • Judicial status hearings • Graduated sanctions & rewards • Urine drug screens • Drug abuse treatment • Case management • Nolle prosse or conditions-served • Expunged record (diversion) (NADCP, 1997) TRI science addiction
“Key Components” üJudicial status hearings • Graduated sanctions & rewards • Urine drug screens • Drug abuse treatment • Case management • Nolle prosse or conditions-served • Expunged record (diversion) (NADCP, 1997) TRI science addiction
Research Site 1 st Study: New Castle Co. (misdemeanor) TRI science addiction
Matching Design High Risk Bi-Weekly As Needed (n = 42) Matched Low Risk (n = 95) Unmatched As Usual (monthly) (n = 50) (n = 92) TRI science addiction
% Drug-free Urines by Group % drug-free urine samples 80 matched low-risk a matched a high-risk nonmatched high-risk b nonmatched low-risk a 70 60 50 40 30 20 10 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 p <. 001 Week in Drug Court TRI science addiction
% Drug-free Urines by Group % drug-free urine samples 80 matched low-risk a matched a high-risk nonmatched high-risk b nonmatched low-risk a 70 60 50 40 30 20 10 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 p <. 001 Week in Drug Court TRI science addiction
% Drug-free Urines by Group % drug-free urine samples 80 matched low-risk a matched a high-risk nonmatched high-risk b nonmatched low-risk a 70 60 50 40 30 20 10 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 p <. 001 Week in Drug Court TRI science addiction
% Drug-free Urines by Group % drug-free urine samples 80 matched low-risk a matched a high-risk nonmatched high-risk b nonmatched low-risk a 70 60 50 40 30 20 10 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 p <. 001 Week in Drug Court TRI science addiction
Drug-Positive Urines: 6 Mos. * * * p <. 05 TRI science addiction
Graduation Rates: 12 mos. * * p <. 05 TRI science addiction
“Key Components” üJudicial status hearings • Graduated sanctions & rewards • Urinalyses • Drug abuse treatment • Case management • Nolle prosse or time served • Expunged record (diversion) (NADCP, 1997) TRI science addiction
“Key Components” üJudicial status hearings üGraduated sanctions & rewards • Urinalyses • Drug abuse treatment • Case management • Nolle prosse or time served • Expunged record (diversion) (NADCP, 1997) TRI science addiction
Rewards 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 10 Reduced status hearings 11 Reduced homework assignments 12 Total TRI science addiction
Rewards Months of compliance STANDARD REWARDS ENHANCED ESCALATING REWARDS 1 $5. 00 gift certificate 2 $10. 00 gift certificate 3 Hat or Candle $15. 00 gift certificate 4 $20. 00 gift certificate 5 $25. 00 gift certificate 6 Reduced community service $30. 00 gift certificate 7 Reduced 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 Total $60. 00 gift certificate $390. 00 TRI science addiction
Rewards 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 $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 3 Hat or Candle 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 $45. 00 gift certificate $75. 00 gift certificate 9 10 Reduced 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 $60. 00 gift certificate $125. 00 gift certificate 12 Total $390. 00 TRI science addiction
# Drug-Free Urines (13 mos. ) n = 61 n = 60 p = n. s. TRI science addiction
Mean % Sessions Attended n = 61 n = 60 p = n. s. TRI science addiction
Mean % Drug-Free Urines n = 34 n = 26 n = 24 n = 34 n = 29 *p <. 05 TRI science addiction
Summary • One size does not fit all! • Drug courts are best suited for high risk and high needs offenders • When possible, separate court calendars and treatment tracks should be held for high risk vs. low risk clients • You may need to be nicest to the clients you might like the least TRI science addiction
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