1. 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.

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

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. Criminogenic Needs
Substance Dependence or Addiction

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

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

7. 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 }

8. 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 } }

9. 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 } }

10. } } } 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 } }

11. Risk & Needs Matrix
High Risk
Low Risk
High
Needs
Low
Needs

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

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

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

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

16. 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

17. 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

18. Sponsor’s Note
This project was supported by Grant No 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.