Assessment of Alcohol-Involved Offenders Douglas B. Marlowe, J.D., Ph.D. National Association of Drug Court Professionals Treatment Research Institute at the University of Pennsylvania

Levels of Assessment Charging & Release Legal Screening Clinical Evaluation Performance PerformanceMonitoring Behavioral Change Behavioral Change Attitudinal Change Attitudinal Change Clinical Screening (PSI) Sentencing & disposition Level of Care Level of Care Service Matching Service Matching Criminal history Criminal history Flight risk Flight risk Risk of dangerousness Risk of dangerousness Prognostic risks Prognostic risks Criminogenic needs Criminogenic needs ASAM placement ASAM placement Biopsychosocial Biopsychosocial Urine screens Urine screens Motivation Motivation Self efficacy Self efficacy Hostility Hostility Satisfaction... Satisfaction... (Prosecution) (Probation / Pre-trial) (Treatment) (??)

In the Real World... Legal screening drives dispositions & pleasLegal screening drives dispositions & pleas Clinical assessment performed after dispositionClinical assessment performed after disposition Duplication and fragmentation of effortDuplication and fragmentation of effort Risks and needs assessed separatelyRisks and needs assessed separately Risk equated with dangerousnessRisk equated with dangerousness Wrong factors evaluatedWrong factors evaluated Wrong tools usedWrong tools used Tools not normed or validated forTools not normed or validated for alcohol offenders alcohol offenders

In an Ideal World... ArrestOn dispositionArraignment; bail hearing TrialSentencing Medical crisis (e.g., acute withdrawal, DTs) Stability; daily living skills; violence potential Intoxication defenses Risk of dangerousness (in or out decision) Prognostic risks Criminogenic needs Performance measures

In an Ideal World... ArrestOn dispositionArraignment; bail hearing Trial Sentencing Medical crisis (e.g., acute withdrawal, DTs) Stability; daily living skills; violence potential Intoxication defenses Risk of dangerousness Risk of dangerousness (in or out decision) (in or out decision) Prognostic risks Prognostic risks Criminogenic needs Criminogenic needs Performance measures

Dispositions for Alcohol Offenders Diversion (ARD)Incarceration Probation w/o verdict DWI / Drug Courts Intermediate sanctions Psychosocial Functioning $$$$$$ Costs $$$$$$$$$ Public Safety Risks

Risk of Dangerousness History of violence or dangerousness (incl. DWI)History of violence or dangerousness (incl. DWI) PsychopathyPsychopathy Substance abuse & psychosis or dementiaSubstance abuse & psychosis or dementia

Prognostic 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 Antisocial Personality DisorderAntisocial Personality Disorder Familial history of crime or addictionFamilial history of crime or addiction Criminal associationsCriminal associations

Criminogenic Needs Substance Dependence or Addiction Substance Dependence or Addiction

Criminogenic Needs Substance Dependence or Addiction Substance Dependence or Addiction 1.Binge pattern 2.Cravings or compulsions 3.Withdrawal symptoms

Criminogenic Needs Substance Dependence or Addiction Substance Dependence or Addiction 1.Binge pattern 2.Cravings or compulsions 3.Withdrawal symptoms } Abstinence is a distal goal

Criminogenic Needs Substance Dependence or Addiction Substance Dependence or Addiction 1.Binge pattern 2.Cravings or compulsions 3.Withdrawal symptoms Substance Abuse } Abstinence is a distal goal

Criminogenic Needs Substance Dependence or Addiction Substance Dependence or Addiction 1.Binge pattern 2.Cravings or compulsions 3.Withdrawal symptoms Substance Abuse } Abstinence is a distal goal Abstinence is a proximal goal }

Criminogenic Needs Substance Dependence or Addiction Substance Dependence or Addiction 1.Binge pattern 2.Cravings or compulsions 3.Withdrawal symptoms Substance Abuse Mental illness Mental illness Functional impairments Functional impairments } Abstinence is a distal goal Abstinence is a proximal goal }

Criminogenic Needs Substance Dependence or Addiction Substance Dependence or Addiction 1.Binge pattern 2.Cravings or compulsions 3.Withdrawal symptoms Substance Abuse Mental illness Mental illness Functional impairments Functional impairments } Abstinence is a distal goal Abstinence is a proximal goal } } Regimen compliance isa proximal goal

Risk & Needs Matrix High Risk Low Risk HighNeeds LowNeeds Accountability &Treatment Treatment Prevention Accountability

Practice Implications High Risk Low Risk HighNeeds LowNeeds Status hearings Status hearings Intensive treatment Intensive treatment Compliance is proximal Compliance is proximal Restrictive consequences Restrictive consequences Positive reinforcement Positive reinforcement Noncompliance hearings Noncompliance hearings Intensive treatment Intensive treatment Treatment is proximal Treatment is proximal Positive reinforcement Positive reinforcement v.o.p. / status calendar v.o.p. / status calendar Abstinence is proximal Abstinence is proximal Psychosocial rehab. Psychosocial rehab. Restrictive consequences Restrictive consequences No AA or MET No AA or MET Secondary prevention Secondary prevention Abstinence is proximal Abstinence is proximal No AA or MET No AA or MET Individual counseling Individual counseling or stratified groups or stratified groups

Dispositions for Alcohol Offenders Diversion (ARD)Incarceration Probation w/o verdict DWI / Drug Courts Intermediate sanctions Low risk Low needs Low risk High needs High risk High needs High risk Low needs Risk of Dangerousness