1. Based on a Need to Know Fact Sheet by Doug Marlowe, J.D. Ph.D./NDCI
Incentives and Sanctions: Practical Application of the Science of Behavior Change
Shannon M. Carey, Ph.D.
Based on a Need to Know Fact Sheet by Doug Marlowe, J.D. Ph.D./NDCI

2. Purpose What is the purpose of Sanctions?
What is the purpose of Incentives?
What other court responses are there?

3. Overview Brief review of the science of behavior change
Research on application in drug courts
Sample incentives, sanctions and treatment responses (guidelines)
Implementing incentives and sanctions (Review and discuss videos)

4. Certainty
1:1 Schedule for initiation Reliable detection “Trust but verify”

5. *Or use continuous detection methods
Reliable detection
Urine drug testing at least twice per week*
Do not decrease frequency of testing until last phase
Do tests with short detection windows in field
Random testing all 7 days
Extend supervision into natural social environment (work, home, school, street, cell phones)
Include law enforcement on the team
*Or use continuous detection methods

6. Reliable detection
Cell Phone Transcript from Phone during Court Session - 1
SF B Chic Nov 18 3:29pm R u getting anything in la?
SF B Chic Nov 18 3:35pm Can we go in on the deal. If I got 4 would u get 2 so we could do the 540
SF B Chich Nov 18 3:45pm Toats

7. Reliable detection
Cell Phone Transcript from Phone during Court Session - 2
?? Nov 18 6:47pm If you need a source for tina Hit up Tell them dan sent ya..Good stuff…
 AM Nov 18 6:48pm How lomng doles xaanax stay in system
 ?? Nov 18 6:48pm 72hrs to a week 
 AM Nov 18 6:49pm anyway to clear em out
 ?? Nov 18 6:49pm Do you ever get swabbed!!!???????
 AM Nov 18 6:50pm Occasionally ans I no it doesn’t test for that
 ?? Nov 18 6:50pm Well if ur dirty dirty.. Always check urself into the ER for a panic attack or something.. do that day of probation..Walk outta there with a hospital/dr ltr

8. Reliable detection Participant in his outpatient substance abuse group
 AM Nov 18 6:22pm Plzbring tibaasement pLII
 AM Nov 18 6:23pm Theyre randomly testing me tnite
 AM Nov 18 6:25pm IM in grop
 AM Nov 18 6:27pm Plese bring to basement bathroom
 AM Nov 18 6:27pm Plzzzzzzzzzzzzz
 S Nov 18 6:29pm Ok
 AM Nov 18 6:29pmHit me up when ur down there ill walk out
 AM Nov 18 6:30pm How long bro
 S Nov 18 6:30pm Like 20 
AM Nov 18 6:34pm Im in the bathroom in the basement plz hurry im trippin out
 S Nov 18 6:35pm Leavin hollies rite now
 AM Nov 18 6:36pm Shit whats ur eta from there

9. Reliable detection
Participant in his outpatient substance abuse group (cont)
 S Nov 18 6:37pm 15
 S Nov 18 6:38pm Shuld I wait in basement bathroom
 AM Nov 18 6:38pm Plz tell me u gotta vial to pissi in
S Nov 18 6:38pm Ya
 AM Nov 18 6:42pm Put the vial of piss in bathrroom trashcan
 AM Nov 18 6:42pm I gotta go bak to geoup9 hit me up when its dun
 S Nov 18 6:54pm Its in the trash

10. Timing is Everything

11. Timing is Everything Effects degrade exponentially
New behaviors interfere
Status hearings every two weeks the first few months
Bring non compliant participants in sooner
Catch them doing something right, provide incentive sooner
Continue hearings monthly until participants have engaged in continuing/after care plans

12. Keep Centered EFFECTIVENESS Habituation Effects Effective Zone Ceiling
SEVERE
MINIMAL
MODERATE

13. Keep Centered NDCI Handout

14. (Procedural Fairness)
Do Due Process
(Procedural Fairness)
Allow participants to explain
Explain judge/team decision
Be respectful (and expect respect)
Have written incentive/sanction guidelines
Allow reasonable discretion
The brain and decisions about punishment

15. Sanctions or Treatment Responses?
Abuse or dependence (mild, moderate or severe substance use disorder)?
Proximal or distal behaviors

16. Abstinence is a distal goal
Needs
Substance Dependence or Addiction
Binge pattern
Cravings or compulsions
Withdrawal symptoms
Abstinence is a distal goal }

17. Abstinence is a distal goal
Needs
Substance Dependence or Addiction
Binge pattern
Cravings or compulsions
Withdrawal symptoms
Substance Abuse
Abstinence is a distal goal }

18. Abstinence is a distal goal Abstinence is a proximal goal
Needs
Substance Dependence or Addiction
Binge pattern
Cravings or compulsions
Withdrawal symptoms
Substance Abuse
1. Still enjoyable
2. No Cravings or compulsions
3. No withdrawal symptoms
Abstinence is a distal goal
Abstinence is a proximal goal } }

19. Abstinence is a distal goal Abstinence is a proximal goal
Needs
Substance Dependence or Addiction
Binge pattern
Cravings or compulsions
Withdrawal symptoms
Substance Abuse
Collateral needs
Dual diagnosis
Chronic medical condition (e.g., HIV+, HCV, diabetes)
Homelessness, chronic unemployment
Abstinence is a distal goal
Abstinence is a proximal goal } }

20. } } } Needs Collateral needs Substance Dependence or Addiction
Binge pattern
Cravings or compulsions
Withdrawal symptoms
Substance Abuse
Collateral needs
Dual diagnosis
Chronic medical condition (e.g., HIV+, HCV, diabetes)
Homelessness, chronic unemployment
Abstinence is a distal goal
Abstinence is a proximal goal }
Regimen compliance is proximal } }

21. Sanctions or Treatment Responses?
Abuse or dependence (mild, moderate or severe substance use disorder)?
Proximal or distal behaviors
Dependent: Expectations change over time (Phases)
Abuser: Higher level sanctions sooner
Separate status hearings
Rely on clinical expertise

22. Targeting

23. Targeting Define behavior clearly (both bad and good)
Point direction (describe positive behavior you are looking for)
Target the behavior not the person (be respectful)

24. Targeting Don’t expect too much Don’t expect too little
Learned helplessness and ratio burden
Don’t expect too little
Habituation
Proximal vs. distal goals
Phase specificity
What was once distal becomes
proximal

25. Phase Regression An example of response cost
Often a sign that services were withdrawn prematurely
Temporary regression and remedial plan (accelerated redemption)
Avoid the Abstinence Violation Effect (A.V.E.)

26. Remember that unaddressed co-occurring disorders may impede the client’s ability to achieve abstinence

27. Incentive and Sanction Highlights
Verbal acknowledgement
The A Team (being called early/being on the A team)
Fish bowl (having your name in the bowl is a reward)
Being chosen as a mentor

28. Incentive and Sanction Highlights
A Team Video

29. Decision Dollars $ $

30. Incentive and Sanction Highlights
Thought Paper or Recording
Community Service (giving back meaningfully)
Curfew
Jury Box
Jail

31. Courts that use jail greater than 6 days have worse (higher) recidivism

32. Incentive and Sanction Highlights
For some, incarceration is NOT the worst punishment – (for some it is trauma)
The threat of jail works best on those who have something to lose by incarceration.
Positive reinforcement works on those who have nothing to lose by incarceration.
Treatment responses may be perceived as punishments-communication is the key to explaining the difference.

33. Incentive and Sanction Highlights
FOCUS ON THE POSITIVE BEHAVIOR
People need to know what positive behaviors are - before they can perform them
They know what not to do, they need to know what to do instead
Bring up the participants doing well first (the A team), and ask them what they are doing that helps them succeed. (This will have the most positive impact on those watching).

34. Incentive and Sanction Highlights
Video 1: Highlighting the positive
Video 2: The A Team
Videos 3a-3d: Positive UA with jail sanction
Video 4: Learning experience with thought paper

35. Incentive and Sanction Highlights
During video, think about whether the judge:
Is Respectful
Allows the participant to explain
Provides a clear explanation of behavior being sanctioned
Provides a clear explanation of what to do instead
Provides a learning experience for other participants

36. Sample Incentive and Sanction Schedules
Other good info on incentives and sanctions:

37. Sample Incentive and Sanction Schedules
Washington D.C.
Merced, CA
Kansas
NDCI

38. Sanction Exercise Behavior First 30 days Question T2: John Abuser
T1: Allen Addict
Positive for cocaine
Proximal or Distal?
Sanction low, middle or high?
Missed Treatment Session
Missed Court Session P D
M/H L P P M M P P M M

39. Incentives Exercise Behavior After 180 days Question T2: John Abuser
T1: Allen Addict
Negative drug tests for last 30 days
Proximal or Distal?
Incentive low, middle or high?
Made all Treatment Session on time for last 60 days P P M H P P M M

40. “All Behavior is followed by a consequence, and the nature of that consequence modifies the organisms tendency to repeat the behavior in the future”
B.F. Skinner

41. Patience: we are in this for the long haul. 15 months post abstinence
Normal
methamphetamine
addict
15 months post abstinence

42. Readings
Burdon WM et al (2001). Drug courts and contingency management. Journal of Drug Issues, 31,
Harrell A & Roman J (2001). Reducing drug use and crime among offenders: The impact of graduated sanctions. Journal of Drug Issues, 31,
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 ). 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 ). In ST Higgins, K Silverman & SH Heil (Eds.), Contingency management in substance abuse treatment. New York: Guilford.
Marlowe DB (2011). Applying incentives and sanctions. In The drug court judicial benchbook (pp ). Alexandria, VA: NDCI.