Presented by: Cary Heck, Ph.D. University of Wyoming Targeting the Right Participants for Adult Drug Courts (High Risk, High Needs) Presented by: Cary Heck, Ph.D. University of Wyoming National Association of Drug Court Professionals Developed by Douglas Marlowe, J.D., Ph.D Presented By Cary Heck Ph.D. © Douglas Marlowe, May 10, 2011 The following presentation may not be copied in whole or in part without the written permission of the author or the National Drug Court Institute. Written permission will generally be given without cost, upon request.

Dispositions for Drug Offenders Psychosocial Functioning $$$$$$ Costs $$$$$$$$$ Public Safety Risks Drug Courts Incarceration Pre-plea diversion (ARD) Disposition before judgment (Prop. 36) Intermediate sanctions

Prognostic Risks Current age < 25 years Delinquent onset < 16 years Substance abuse onset < 14 years Prior rehabilitation failures History of violence Antisocial Personality Disorder Psychopathy Familial history of crime or addiction Criminal or substance abuse associations

Criminogenic Needs Substance Dependence or Addiction

Criminogenic Needs Substance Dependence or Addiction Binge pattern Cravings or compulsions Withdrawal symptoms

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

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

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

Abstinence is a distal goal Abstinence is a proximal goal Criminogenic 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 } }

} } } Criminogenic 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 } }

Risk & Needs Matrix High Risk Low Risk High Needs Low Needs

Risk & Needs Matrix High Risk Low Risk High Needs Low Needs Accountability, Treatment & Habilitation High Needs Low Needs

Risk & Needs Matrix High Risk Low Risk High Needs Low Needs Treatment Habilitation Accountability, Treatment & Habilitation High Needs Low Needs

Risk & Needs Matrix High Risk Low Risk High Needs Low Needs Treatment Habilitation Accountability, Treatment & Habilitation High Needs Accountability & Habilitation Low Needs

Risk & Needs Matrix High Risk Low Risk High Needs Low Needs Treatment Habilitation Accountability, Treatment & Habilitation High Needs Accountability & Habilitation Prevention Low Needs

Practice Implications High Risk Low Risk Status calendar Treatment & habilitation Compliance is proximal Restrictive consequences Positive reinforcement Prescribed medication Self-help groups Noncompliance calendar Treatment & habilitation Treatment is proximal Positive reinforcement Prescribed medication Self-help groups High Needs Noncompliance calendar Secondary prevention Abstinence is proximal Shorter total duration Individual counseling or stratified groups v.o.p. / status calendar Psychosocial habilitation Abstinence & supervision are proximal Restrictive consequences No AA/NA Low Needs

Dispositions for Drug Offenders Risk of Dangerousness High risk High needs Low risk Low needs High risk Low needs Low risk High needs Drug Courts Incarceration Pre-plea diversion (ARD) Disposition before judgment (Prop. 36) Intermediate sanctions

Sponsor’s Note This project was supported by Grant No. 2012-DC-BX-K004 awarded by the Bureau of Justice Assistance. The Bureau of Justice Assistance is a component of the Office of Justice Programs, which also includes the Bureau of Justice Statistics, the National Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention, the SMART Office, and the Office for Victims of Crime. Points of view or opinions in this document are those of the author and do not represent the official position or policies of the United States Department of Justice.