Incentives and Sanctions: Practical Application of the Science of Behavior Change

1. Incentives and Sanctions: Practical Application of the Science of Behavior Change Shannon M. Carey, Ph.D. Based on a Need to Know Fact Sheet by Doug Marlowe, J.D. Ph.D./NDCI

2. Purpose What is the purpose of Sanctions? What is the purpose of Incentives? What other court responses are there?

3. Overview • Brief review of the science of behavior change • Research on application in drug courts • Sample incentives, sanctions and treatment responses (guidelines) • Implementing incentives and sanctions (Review and discuss videos)

4. Certainty 1:1 Schedule for initiation Reliable detection “Trust but verify”

5. Reliable detection • Urine drug testing at least twice per week* • Do not decrease frequency of testing until last phase • Do tests with short detection windows in field • Random testing all 7 days • Extend supervision into natural social environment (work, home, school, street, cell phones) • Include law enforcement on the team *Or use continuous detection methods

6. Reliable detection Cell Phone Transcript from Phone during Court Session - 1 • SF B Chic Nov 18 3:29pm R u getting anything in la? • SF B Chic Nov 18 3:35pm Can we go in on the deal. If I got 4 would u get 2 so we could do the 540 • SF B Chich Nov 18 3:45pm Toats

7. Reliable detection Cell Phone Transcript from Phone during Court Session - 2 • ?? Nov 18 6:47pm If you need a source for tina Hit up 714-647-0410 Tell them dan sent ya..Good stuff… •  AM Nov 18 6:48pm How lomng doles xaanax stay in system •  ?? Nov 18 6:48pm 72hrs to a week  •  AM Nov 18 6:49pm anyway to clear em out •  ?? Nov 18 6:49pm Do you ever get swabbed!!!??????? •  AM Nov 18 6:50pm Occasionally ans I no it doesn’t test for that •  ?? Nov 18 6:50pm Well if ur dirty dirty.. Always check urself into the ER for a panic attack or something.. do that day of probation..Walk outta there with a hospital/drltr

8. Reliable detection Participant in his outpatient substance abuse group •  AM Nov 18 6:22pm PlzbringtibaasementpLII •  AM Nov 18 6:23pm Theyre randomly testing me tnite •  AM Nov 18 6:25pm IM in grop •  AM Nov 18 6:27pm Plese bring to basement bathroom •  AM Nov 18 6:27pm Plzzzzzzzzzzzzz •  S Nov 18 6:29pm Ok •  AM Nov 18 6:29pmHit me up when ur down there ill walk out •  AM Nov 18 6:30pm How long bro •  S Nov 18 6:30pm Like 20  • AM Nov 18 6:34pm Im in the bathroom in the basement plz hurry imtrippin out •  S Nov 18 6:35pm Leavin hollies rite now •  AM Nov 18 6:36pm Shit whatsur eta from there

9. Reliable detection Participant in his outpatient substance abuse group (cont) •  S Nov 18 6:37pm 15 •  S Nov 18 6:38pm Shuld I wait in basement bathroom •  AM Nov 18 6:38pm Plz tell me u gotta vial to pissi in • S Nov 18 6:38pm Ya •  AM Nov 18 6:42pm Put the vial of piss in bathrroom trashcan •  AM Nov 18 6:42pm I gotta go bak to geoup9 hit me up when its dun •  S Nov 18 6:54pm Its in the trash

10. Timing is Everything

11. Timing is Everything • Effects degrade exponentially • New behaviors interfere • Status hearings every two weeks the first few months • Bring non compliant participants in sooner • Catch them doing something right, provide incentive sooner • Continue hearings monthly until participants have engaged in continuing/after care plans

12. MINIMAL MODERATE Keep Centered Effective Zone Habituation Effects Ceiling Effects EFFECTIVENESS SEVERE

13. Keep Centered NDCI Handout http://ndcrc.org/content/list-incentives-and-sanctions

14. Do Due Process (Procedural Fairness) • Allow participants to explain • Explain judge/team decision • Be respectful (and expect respect) • Have written incentive/sanction guidelines • Allow reasonable discretion • The brain and decisions about punishment

15. Sanctions or Treatment Responses? • Abuse or dependence (mild, moderate or severe substance use disorder)? • Proximal or distal behaviors

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

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

18. Needs Abstinence is a distal goal Substance Dependence or Addiction • Binge pattern • Cravings or compulsions • Withdrawal symptoms Substance Abuse 1. Still enjoyable 2. No Cravings or compulsions 3. No withdrawal symptoms Abstinence is a proximal goal } }

19. 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 } }

20. 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 } }

21. Sanctions or Treatment Responses? • Abuse or dependence (mild, moderate or severe substance use disorder)? • Proximal or distal behaviors • Dependent: Expectations change over time (Phases) • Abuser: Higher level sanctions sooner • Separate status hearings • Rely on clinical expertise

22. Targeting

23. Targeting • Define behavior clearly (both bad and good) • Point direction (describe positive behavior you are looking for) • Target the behavior not the person (be respectful)

24. Targeting • Don’t expect too much • Learned helplessness and ratio burden • Don’t expect too little • Habituation • Proximal vs. distal goals • Phase specificity • What was once distal becomes proximal

25. Phase Regression • An example of response cost • Often a sign that services were withdrawn prematurely • Temporary regression and remedial plan (accelerated redemption) • Avoid the Abstinence Violation Effect (A.V.E.)

26. Remember that unaddressed co-occurring disorders may impede the client’s ability to achieve abstinence

27. Incentive and Sanction Highlights • Verbal acknowledgement • The A Team (being called early/being on the A team) • Fish bowl (having your name in the bowl is a reward) • Being chosen as a mentor

28. Incentive and Sanction Highlights A Team Video

29. Decision Dollars $ $

30. Incentive and Sanction Highlights • Thought Paper or Recording • Community Service (giving back meaningfully) • Curfew • Jury Box • Jail

31. Courts that use jail greater than 6 days have worse(higher) recidivism

32. Incentive and Sanction Highlights • For some, incarceration is NOT the worst punishment – (for some it is trauma) • The threat of jail works best on those who have something to lose by incarceration. • Positive reinforcement works on those who have nothing to lose by incarceration. • Treatment responses may be perceived as punishments-communication is the key to explaining the difference.

33. Incentive and Sanction Highlights • FOCUS ON THE POSITIVE BEHAVIOR • People need to know what positive behaviors are - before they can perform them • They know what not to do, they need to know what to do instead • Bring up the participants doing well first (the A team), and ask them what they are doing that helps them succeed. (This will have the most positive impact on those watching).

34. Incentive and Sanction Highlights • Video 1: Highlighting the positive • Video 2: The A Team • Videos 3a-3d: Positive UA with jail sanction • Video 4: Learning experience with thought paper

35. Incentive and Sanction Highlights • During video, think about whether the judge: • Is Respectful • Allows the participant to explain • Provides a clear explanation of behavior being sanctioned • Provides a clear explanation of what to do instead • Provides a learning experience for other participants

36. Sample Incentive and Sanction Schedules • http://ndcrc.org/content/list-incentives-and-sanctions • http://ndcrc.org/content/incentives-and-sanctions-fact-sheet-0 Other good info on incentives and sanctions: • www.drugcourtonline.org

37. Sample Incentive and Sanction Schedules • Washington D.C. • Merced, CA • Kansas • NDCI

38. Sanction Exercise P D M/H L P P M M P P M M

39. Incentives Exercise P P H M P P M M

40. “All Behavior is followed by a consequence, and the nature of that consequence modifies the organisms tendency to repeat the behavior in the future” • B.F. Skinner

41. Patience: we are in this for the long haul. 15 months post abstinence Normal methamphetamine addict

42. Readings Burdon WM et al (2001). Drug courts and contingency management. Journal of Drug Issues, 31, 73-90. Harrell A & Roman J (2001). Reducing drug use and crime among offenders: The impact of graduated sanctions. Journal of Drug Issues, 31, 207-232. Marlowe DB (2007). Strategies for administering rewards and sanctions. In JE Lessenger & GF Roper (Eds.), Drug courts: A new approach to treatment and rehabilitation (pp. 317-336). New York: Springer. Marlowe DB (2008). Application of sanctions. In Drug Court Quality Improvement Monograph. Alexandria, VA: NDCI. Marlowe DB & Wong CJ (2008). Contingency management in adult criminal drug courts (pp. 334-354). In ST Higgins, K Silverman & SH Heil (Eds.), Contingency management in substance abuse treatment. New York: Guilford. Marlowe DB (2011). Applying incentives and sanctions. In The drug court judicial benchbook (pp.139-157). Alexandria, VA: NDCI.