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Douglas B. Marlowe, J.D., Ph.D. Treatment Research Institute at the University of Pennsylvania Evidence-Based Dispositions for Drug Offenders.

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Presentation on theme: "Douglas B. Marlowe, J.D., Ph.D. Treatment Research Institute at the University of Pennsylvania Evidence-Based Dispositions for Drug Offenders."— Presentation transcript:

1 Douglas B. Marlowe, J.D., Ph.D. Treatment Research Institute at the University of Pennsylvania Evidence-Based Dispositions for Drug Offenders

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

3 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

4 Criminogenic Needs Substance Dependence or Addiction Substance Dependence or Addiction

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

6 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

7 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

8 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 }

9 Criminogenic Needs Substance Dependence or Addiction Substance Dependence or Addiction 1.Binge pattern 2.Cravings or compulsions 3.Withdrawal symptoms Substance Abuse Collateral needs 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 Substance Dependence or Addiction Substance Dependence or Addiction 1.Binge pattern 2.Cravings or compulsions 3.Withdrawal symptoms Substance Abuse Collateral needs 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 High Risk Low Risk HighNeeds LowNeeds Risk & Needs Matrix

12 High Risk Low Risk HighNeeds LowNeeds Accountability, Treatment & Habilitation

13 Risk & Needs Matrix High Risk Low Risk HighNeeds LowNeeds Treatment&Habilitation Accountability, Treatment & Habilitation

14 Risk & Needs Matrix High Risk Low Risk HighNeeds LowNeeds Accountability &Habilitation Treatment&Habilitation Accountability, Treatment & Habilitation

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

16 Practice Implications High Risk Low Risk HighNeeds LowNeeds Status hearings Treatment & habilitation Treatment & habilitation Compliance is proximal Compliance is proximal Restrictive consequences Restrictive consequences Positive reinforcement Positive reinforcement Agonist medication Agonist medication Noncompliance hearings Treatment & habilitation Treatment & habilitation Treatment is proximal Treatment is proximal Positive reinforcement Positive reinforcement Agonist medication Agonist medication v.o.p. / status calendar v.o.p. / status calendar Abstinence is proximal Abstinence is proximal Psychosocial habilitation Psychosocial habilitation Restrictive consequences Restrictive consequences No AA or MET No AA or MET Antagonist medication Antagonist medication 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

17 Dispositions for Drug Offenders Incarceration Drug Courts Intermediate sanctions Low risk Low needs Low risk High needs High risk High needs High risk Low needs Risk of Dangerousness Pre-plea diversion (ARD) Disposition before judgment (Prop. 36)

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