1. Annals of Research and Knowledge (ARK)
4/1/2014
Targeting Interventions by Risk, Need & Responsivity
Douglas B. Marlowe, J.D., Ph.D., FCPP

2. Risk Principle Not necessarily a risk for violence or dangerousness
Difficult prognosis or lesser amenability to treatment
The higher the risk level, the more intensive the supervision and accountability should be, and vice versa
Mixing risk levels is contraindicated

3. 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

4. Annals of Research and Knowledge (ARK)
4/1/2014
Need Principle
Clinical syndromes or impairments (diagnosis)
The higher the need level, the more intensive the treatment or rehabilitation services should be, and vice versa
Mixing need levels is contraindicated

5. Treatment Courts (e.g., Drug Courts) Deflection; Banked probation
Risk & Needs Matrix
High Risk
Low Risk
Supervision
Treatment
Pro-social habilitation
Adaptive habilitation
Treatment
• (Pro-social rehabilitation)
• Adaptive rehabilitation
Treatment Courts (e.g., Drug Courts)
Treatment Diversion
High
Needs
Supervision
Pro-social habilitation
(Adaptive habilitation)
Secondary prevention
Diversion
Intensive
Probation (ISP, HOPE)
Deflection; Banked probation
Low
Needs

6. Annals of Research and Knowledge (ARK)
4/1/2014
Specific Responsivity
Order and timing of intervention is crucial:
Responsivity needs — interfere with rehabilitation
Criminogenic needs — cause or exacerbate crime
Maintenance needs — degrade rehabilitation gains
Humanitarian needs — cause distress
Restorative needs — e.g., restitution, community svc.
Continuing-care plan to address unmet needs
Each phase advancement increases the odds of subsequent phase advancements

7. Annals of Research and Knowledge (ARK)
4/1/2014
Case Planning
Type 1 Case (Dual Diagnosis)
5 phases
Stabilization:
- Housing assistance
- Stabilize cravings, withdrawal,
anhedonia
- Mental health tx
yes
Criminogenic:
- Addiction treatment
- Delinquent peer affiliations
- Pro-social regimen; structure
- Family crisis mgmt.
yes
Responsivity
Needs?
Criminogenic
Needs? no no
Pro-Social Habilitation:
- Criminal thinking
- Adaptive problem-solving
18 – 24 mos.
≥ 300 hrs.
Maintenance:
- Vocational / educational counseling
- Life skills training
- Therapy / recovery svcs
* Restitution; community svc; fees
** HIV/STD prevention
** Overdose prevention & reversal
yes
Maintenance
Needs?
Continuing
Care no
*Restorative justice interventions
**Humanitarian Needs

8. Annals of Research and Knowledge (ARK)
4/1/2014
Case Planning
Type 2 Case (Addiction)
4 phases
Stabilization:
- Housing assistance
- Stabilize cravings, withdrawal,
anhedonia
- Mental health tx
yes
Criminogenic:
- Addiction treatment
- Delinquent peer affiliations
- Pro-social regimen; structure
- Family crisis mgmt.
yes
Responsivity
Needs?
Criminogenic
Needs? no no
Pro-Social Habilitation:
- Criminal thinking
- Adaptive problem-solving
12 – 18 mos.
≥ 200 hrs.
Maintenance:
- Vocational / educational counseling
- Life skills training
- Therapy / recovery svcs
* Restitution; community svc; fees
** HIV/STD prevention
** Overdose prevention & reversal
yes
Maintenance
Needs?
Continuing
Care no
*Restorative justice interventions
**Humanitarian Needs

9. Annals of Research and Knowledge (ARK)
4/1/2014
Case Planning
Stabilization:
- Housing assistance
- Stabilize cravings, withdrawal,
anhedonia
- Mental health tx
yes
Criminogenic:
- Addiction treatment
- Delinquent peer affiliations
- Pro-social regimen; structure
- Family crisis mgmt.
yes
Responsivity
Needs?
Criminogenic
Needs? no
Type 3 (Socialized)
3 phases no
Pro-Social Habilitation:
- Criminal thinking
- Adaptive problem-solving
~ 12 mos.
~ 150 hrs.
Maintenance:
- Vocational / educational counseling
- Life skills training
- Therapy / recovery svcs
* Restitution; community svc; fees
** HIV/STD prevention
** Overdose prevention & reversal
yes
Maintenance
Needs?
Continuing
Care no
*Restorative justice interventions
**Humanitarian Needs

10. Annals of Research and Knowledge (ARK)
4/1/2014
Case Planning
Stabilization:
- Housing assistance
- Stabilize cravings, withdrawal,
anhedonia
- Mental health tx
yes
Criminogenic:
- Addiction treatment
- Delinquent peer affiliations
- Pro-social regimen; structure
- Family crisis mgmt.
yes
Responsivity
Needs?
Criminogenic
Needs? no no
Pro-Social Habilitation:
- Criminal thinking
- Adaptive problem-solving
~ 6 – 12 mos.
< 100 hrs.
Type 4 Case:
(Situational)
2 phases
Maintenance:
- Vocational / educational counseling
- Life skills training
- Therapy / recovery svcs
* Restitution; community svc; fees
** HIV/STD prevention
** Overdose prevention & reversal
yes
Maintenance
Needs?
Continuing
Care no
*Restorative justice interventions
**Humanitarian Needs

11. Annals of Research and Knowledge (ARK)
4/1/2014
Case Planning
Stabilization:
- Housing assistance
- Stabilize cravings, withdrawal,
anhedonia
- Mental health tx
yes
Criminogenic:
- Addiction treatment
- Delinquent peer affiliations
- Pro-social regimen; structure
- Family crisis mgmt.
yes
Responsivity
Needs?
Criminogenic
Needs? no no
Pro-Social Habilitation:
- Criminal thinking
- Adaptive problem-solving
Type 5 Case: (Deflection)
1 phase
~ 3 mos.
~ hrs.
Maintenance:
- Vocational / educational counseling
- Life skills training
- Therapy / recovery svcs
* Restitution; community svc; fees
** HIV/STD prevention
** Overdose prevention & reversal
yes
Maintenance
Needs?
Continuing
Care no
*Restorative justice interventions
**Humanitarian Needs

12. Shaping Behavior Don’t expect too much Don’t expect too little
Learned helplessness, ratio burden, ceiling effects
Don’t expect too little
Habituation, complacency
Proximal vs. distal goals
Phase specificity
What was once distal becomes proximal

13. Treat or Punish?
Substance Dependence or Addiction

14. Treat or Punish? Substance Dependence or Addiction
Triggered binge pattern
Cravings or compulsions
Withdrawal symptoms

15. Abstinence is a distal goal
Treat or Punish?
Substance Dependence or Addiction
Triggered binge pattern
Cravings or compulsions
Withdrawal symptoms
Abstinence is a distal goal }

16. Abstinence is a distal goal
Treat or Punish?
Substance Dependence or Addiction
Triggered binge pattern
Cravings or compulsions
Withdrawal symptoms
Substance Abuse
Abstinence is a distal goal }

17. } } Treat or Punish? Substance Dependence or Addiction Substance Abuse
Triggered binge pattern
Cravings or compulsions
Withdrawal symptoms
Substance Abuse
Abstinence is a distal goal
Abstinence is a proximal goal } }

18. } } Treat or Punish? Collateral needs
Substance Dependence or Addiction
Triggered 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 } }

19. } } } Treat or Punish? Collateral needs
Substance Dependence or Addiction
Triggered 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 } }

20. Pre-Disposition Assessment
Require assessment of risk and need before disposition
E.g., as part of a pre-sentence investigation (PSI)
Use immunity especially at pre-adjudication stage
Valid, reliable, & culturally unbiased instruments
Substance abuse vs. dependence diagnosis guides treatment conditions and response to technical violations involving new drug use
Automate the if then decisions