Targeting Participants for Adult Drug Courts Douglas B. Marlowe, J.D., Ph.D. National Association of Drug Court Professionals

CitationInstitution(s) No. Drug Courts Crime Reduced Wilson et al. (2006) CampbellCollaborative 55 14% Latimer et al. (2006) Canada Dept. of Justice 66 9% 9% Shaffer (2010) University of Nevada 76 9% 9% Lowenkamp et al. (2005) University of Cincinnati 22 8% 8% Aos et al. (2006) Washington State Inst. for Public Policy for Public Policy 57 Mitchell et al. (2012) U.S.F., G.M.U. & Penn. State 92 12% Avg. Crime Reduction Rempel et al. (2012) Urban Institute, CCI & RTI 23 13%

Variable Effects (Carey et al., 2012; Downey & Roman, 2010; GAO, 2011; Mitchell et al., 2012; Shaffer, 2010)

72% - 88% 6%-9% 8% - 16% Most drug courts work Variable Effects (Carey et al., 2012; Downey & Roman, 2010; GAO, 2011; Mitchell et al., 2012; Shaffer, 2010) Some don’t work Some are harmful Let’s do the math: 2,559 drug courts (as of 12/31/10) 2,559 drug courts (as of 12/31/10) x.06 = 154 harmful drug courts + another 205 ineffective drug courts + another 205 ineffective drug courts

Variable Cost Benefits (Downey & Roman, 2010) ~71% ~ 15% 14% 14% cost beneficial “[M]ost of the crimes prevented are insignificant in nature. Collectively, theft, drug offenses, trespassing, and traffic offenses make up over 60% of the comparison group’s arrests. These crimes are nearly costless to society, and so in terms of reduced victimization, preventing these crimes contributes little.” “[M]ost of the crimes prevented are insignificant in nature. Collectively, theft, drug offenses, trespassing, and traffic offenses make up over 60% of the comparison group’s arrests. These crimes are nearly costless to society, and so in terms of reduced victimization, preventing these crimes contributes little.” (pp )

Effect Size by Risk Level Percent reduction in rearrests 5% 10%* Lowenkamp et al., 2005 Twice the reduction in 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. (2012)

Drug Courts That Accepted Participants With Prior Violence Had Equivalent Reductions in Recidivism p = n.s. Carey et al. (2012)

Drug Courts That Excluded Participants with Serious Mental Health Problems Had Over 50% Less Cost Savings *p <.05 Carey et al. (2012)

Avg. Benefit Per $1 invested Benefit /cost dollar ratio $2.21 $2.15 $4.13 $3.36 ~ 50% greater cost benefits } Bhati et al. (2008) “Synthetic analysis” { ~ 90% greater cost benefits

Risk Principle Not necessarily a risk for violence or dangerousnessNot necessarily a risk for violence or dangerousness Risk essentially means a complicated prognosis or lesser amenability to treatmentRisk essentially means a complicated prognosis or lesser amenability to treatment The higher the risk level, the more intensive the supervision and accountability should be; and vice versaThe higher the risk level, the more intensive the supervision and accountability should be; and vice versa Mixing risk levels is contraindicatedMixing risk levels is contraindicated (Andrews & Bonta, 2010)

Prevalent Risk Factors Current age < 25 yearsCurrent age < 25 years Delinquency onset < 16 yearsDelinquency onset < 16 years Substance abuse onset < 14 yearsSubstance abuse onset < 14 years Prior convictionsPrior convictions Prior rehabilitation failuresPrior rehabilitation failures History of violenceHistory of violence Antisocial personality disorder or psychopathyAntisocial personality disorder or psychopathy Familial history of crime or addictionFamilial history of crime or addiction Criminal or substance abuse associationsCriminal or substance abuse associations

Need Principle Target criminogenic needs, not all needsTarget criminogenic needs, not all needs –Responsivity: Treat disorders or functional impairments that may be lesser predictors of recidivism, but complicate risk reduction The higher the need level, the more intensive the treatment or rehabilitation services should be; and vice versaThe higher the need level, the more intensive the treatment or rehabilitation services should be; and vice versa Mixing need levels is contraindicatedMixing need levels is contraindicated (Andrews & Bonta, 2010)

Substance Dependence or Addiction Substance Dependence or Addiction Criminogenic Needs

Substance Dependence or Addiction Substance Dependence or Addiction 1.Triggered binge response 2.Cravings or compulsions 3.Withdrawal symptoms

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

Substance Dependence or Addiction Substance Dependence or Addiction 1.Triggered binge response 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.Triggered binge response 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.Triggered binge response 2.Cravings or compulsions 3.Withdrawal symptoms Substance Abuse Collateral needs Collateral needs –Dual diagnosis –Serious functional impairments } Abstinence is a distal goal Abstinence is a proximal goal } Criminogenic Needs

Substance Dependence or Addiction Substance Dependence or Addiction 1.Triggered binge response 2.Cravings or compulsions 3.Withdrawal symptoms Substance Abuse Collateral needs Collateral needs –Dual diagnosis –Serious functional impairments } Abstinence is a distal goal Abstinence is a proximal goal } } Regimen compliance is proximal Criminogenic Needs

Risk & Needs Matrix High Risk Low Risk HighNeeds(dependent) LowNeeds(abuse) Accountability, Treatment & Habilitation Treatment&Habilitation Accountability&Habilitation Diversion & Secondary Prevention

Practice Implications High Risk Low Risk HighNeeds(dependent) LowNeeds(abuse) Status calendar Status calendar Treatment (~200 hrs.) Treatment (~200 hrs.) Prosocial & adaptive habilit. Prosocial & adaptive habilit. Graduated consequences Graduated consequences for substance use for substance use Positive reinforcement Positive reinforcement Self-help/alumni groups Self-help/alumni groups Noncompliance calendar Noncompliance calendar Treatment (separate milieu) Treatment (separate milieu) Adaptive habilitation Adaptive habilitation Graduated consequences Graduated consequences for substance use for substance use Positive reinforcement Positive reinforcement Self-help/alumni groups Self-help/alumni groups Status calendar Status calendar Prosocial habilitation Prosocial habilitation Substantial consequences Substantial consequences for substance use for substance use Negative reinforcement Negative reinforcement Noncompliance calendar Noncompliance calendar Psycho-education Psycho-education “Zero tolerance” for “Zero tolerance” for substance use substance use Individual/stratified groups Individual/stratified groups Shorter supervision period Shorter supervision period

Assessment is Key Structured assessments are far superior to professional judgmentStructured assessments are far superior to professional judgment –No suitability determinations Tools are validated and culturally unbiasedTools are validated and culturally unbiased Administered prior to entry of conditionsAdministered prior to entry of conditions Many risk tools are adequateMany risk tools are adequate Most clinical tools are not adequate for identifying the target population for Drug CourtsMost clinical tools are not adequate for identifying the target population for Drug Courts –structured DSM-congruent diagnostic interview –assessors trained on criteria and item intent –check records and interview collaterals

Summary Drug courts reduce re-arrest rates approximately twice as much for high-risk participants than for low-risk participantsDrug courts reduce re-arrest rates approximately twice as much for high-risk participants than for low-risk participants Drug courts are approximately 50% more cost- effective for high-risk participants than for low- risk participantsDrug courts are approximately 50% more cost- effective for high-risk participants than for low- risk participants Removing eligibility restrictions helps to reach the target populationRemoving eligibility restrictions helps to reach the target population

Recommendations 1.Remove unwarranted eligibility restrictions based on criminal history and clinical severity 2.Target high-risk and high-need participants using standardized and validated assessments 3.Cease suitability determinations based on motivation, attitude, or readiness for change 4.Do not mix risk or need levels in your milieu 5.If necessary, develop alternate tracks based on risk and/or need