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

Effect Size by Risk Level Percent reduction in rearrests 5% 10%* Lowenkamp et al., 2005 Twice the reduction in rearrests 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 difficult prognosis or lesser amenability to treatmentRisk essentially means a difficult 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)

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 History of violenceHistory of violence Antisocial Personality DisorderAntisocial Personality Disorder PsychopathyPsychopathy Familial history of crime or addictionFamilial history of crime or addiction Criminal or substance abuse associationsCriminal or substance abuse associations

Need Principle Clinical disorders or functional impairments (diagnosis)Clinical disorders or functional impairments (diagnosis) Target criminogenic & responsivity needs firstTarget criminogenic & responsivity needs first 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 Responsivity needs Responsivity 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 Responsivity needs Responsivity needs –Dual diagnosis –Serious functional impairments } Abstinence is a distal goal Abstinence is a proximal goal } } Regimen compliance is proximal Criminogenic Needs

Risk & Need Quadrants High Risk Low Risk HighNeeds(dependent) LowNeeds(abuse) Supervision Supervision Treatment Treatment Pro-social habilitation Pro-social habilitation Adaptive habilitation Adaptive habilitation Treatment Treatment (Pro-social rehabilitation) (Pro-social rehabilitation) Adaptive habilitation Adaptive habilitation Supervision Supervision Pro-social habilitation Pro-social habilitation (Adaptive habilitation) (Adaptive habilitation) Secondary prevention Secondary prevention Diversion Diversion

Practice Implications High Risk Low Risk HighNeeds(dependent) LowNeeds(abuse) Status calendar Treatment Treatment Prosocial & adaptive habilit. Prosocial & adaptive habilit. Abstinence is distal Abstinence is distal Positive reinforcement Positive reinforcement Self-help/alumni groups Self-help/alumni groups ~ mos. (~200 hrs.) ~ mos. (~200 hrs.) Noncompliance calendar Treatment (separate milieu) Treatment (separate milieu) Adaptive habilitation Adaptive habilitation Abstinence is distal Abstinence is distal Positive reinforcement Positive reinforcement Self-help/alumni groups Self-help/alumni groups ~ mos. (~150 hrs.) ~ mos. (~150 hrs.) Status calendar Status calendar Prosocial habilitation Prosocial habilitation Abstinence is proximal Abstinence is proximal Negative reinforcement Negative reinforcement ~ mos. (~100 hrs.) ~ mos. (~100 hrs.) Noncompliance calendar Noncompliance calendar Psycho-education Psycho-education Abstinence is proximal Abstinence is proximal Individual/stratified groups Individual/stratified groups ~ 3-6 mos. (~ hrs.) ~ 3-6 mos. (~ hrs.)