Douglas B. Marlowe, J.D., Ph.D.

TRI science addiction Targeting Dispositions by Risks & Needs Treatment Research Institute at the University of Pennsylvania Douglas B. Marlowe, J.D., Ph.D.

Dispositions for Drug Offenders Psychosocial Functioning $$$$$$ Costs $$$$$$$$$ Public Safety Risks Diversion (ARD) Drug / DWI Courts Incarceration Probation w/o verdict Intermediate sanctions

TRI science addiction 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

TRI science addiction Criminogenic Needs Substance Dependence or Addiction

TRI science addiction Criminogenic Needs Substance Dependence or Addiction • Binge pattern • Cravings or compulsions • Withdrawal symptoms

TRI science addiction Criminogenic Needs Abstinence is a distal goal Substance Dependence or Addiction • Binge pattern • Cravings or compulsions • Withdrawal symptoms }

TRI science addiction Criminogenic Needs Abstinence is a distal goal Substance Dependence or Addiction • Binge pattern • Cravings or compulsions • Withdrawal symptoms Substance Abuse }

TRI science addiction Criminogenic Needs Abstinence is a distal goal Substance Dependence or Addiction • Binge pattern • Cravings or compulsions • Withdrawal symptoms Substance Abuse Abstinence is a proximal goal } }

TRI science addiction Criminogenic Needs Abstinence is a distal goal 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 proximal goal } }

TRI science addiction Criminogenic Needs Abstinence is a distal goal 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 proximal goal } Regimen compliance is proximal } }

TRI science addiction Risk & Needs Matrix High Risk Low Risk High Needs Low Needs

TRI science addiction Risk & Needs Matrix High Risk Low Risk Accountability, Treatment & Habilitation High Needs Low Needs

TRI science addiction Risk & Needs Matrix High Risk Low Risk Treatment & Habilitation Accountability, Treatment & Habilitation High Needs Low Needs

TRI science addiction Risk & Needs Matrix High Risk Low Risk Treatment & Habilitation Accountability, Treatment & Habilitation High Needs Accountability & Habilitation Low Needs

TRI science addiction Risk & Needs Matrix High Risk Low Risk Treatment & Habilitation Accountability, Treatment & Habilitation High Needs Accountability & Habilitation Prevention Low Needs

TRI science addiction Practice Implications High Risk Low Risk • Noncompliance hearings • Treatment & habilitation • Treatment is proximal • Positive reinforcement • Agonist medication • Status hearings • Treatment & habilitation • Compliance is proximal • Restrictive consequences • Positive reinforcement • Agonist medication High Needs • Secondary prevention • Abstinence is proximal • No AA or MET • Individual counseling or stratified groups • v.o.p. / status calendar • Abstinence is proximal • Psychosocial habilitation • Restrictive consequences • No AA or MET • Antagonist medication Low Needs

Dispositions for Drug Offenders Risk of Dangerousness High risk High needs Low risk Low needs High risk Low needs Low risk High needs Diversion (ARD) Drug / DWI Courts Incarceration Probation w/o verdict Intermediate sanctions

Douglas B. Marlowe, J.D., Ph.D.