Presented by: Cary Heck, Ph.D. University of Wyoming

Targeting the Right Participants for Adult Drug Courts (High Risk, High Needs) National Association of Drug Court Professionals Developed by Douglas Marlowe, J.D., Ph.D Presented By Cary Heck Ph.D. Presented by: Cary Heck, Ph.D. University of Wyoming © 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.

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

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

Criminogenic Needs Substance Dependence or Addiction

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

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

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

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 } }

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 } }

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 } }

Risk & Needs Matrix High Risk Low Risk High Needs Low Needs

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

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

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

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

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

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

Sponsor’s Note • This project was supported by Grant No. 2012-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.

Presented by: Cary Heck, Ph.D. University of Wyoming