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

1. Targeting Participants for Drug Courts National Association of Drug CourtProfessionals Douglas B. Marlowe, J.D., Ph.D.

2. Effect Size by Risk Level Percent reduction in rearrests Twice the reduction in rearrests 10%* 8% } 5% Lowenkamp et al., 2005 *p <.05 “Moderator analysis”

3. Drug Courts That Accepted Participants With Non-Drug Charges Had Nearly Twice the Reduction in Recidivism *p <.05 Carey et al. (2012) Non-drug charges included property, theft, prostitution and forgery offenses

4. Drug Courts That Accepted Participants With Prior Violence Had Equivalent Reductions in Recidivism Carey et al. (2012) p = n.s.

5. Drug Courts That Excluded Participants with Serious Mental Health Problems Had Over 50% Less Cost Savings Carey et al. (2012) *p <.05

6. Avg. Benefit Per $1 invested ~90% greater cost benefits $4.13 Benefit /cost dollar ratio { ~50% greater cost benefits $3.36 $2.21 $2.15 } Bhati et al. (2008) “Synthetic analysis”

7. Risk Principle • Not necessarily a risk for violence or dangerousness • Risk essentially means a difficult prognosis or lesser amenability to treatment • The higher the risk level, the more intensive the supervision and accountability should be; and vice versa • Mixing risk levels is contraindicated (Andrews & Bonta, 2010)

8. 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

9. Need Principle • Clinical disorders or functional impairments (diagnosis) • Target criminogenic & responsivity needs first • The higher the need level, the more intensive the treatment or rehabilitation services should be; and vice versa • Mixing need levels is contraindicated (Andrews & Bonta, 2010)

10. Criminogenic Needs Substance Dependence or Addiction

11. Criminogenic Needs Substance Dependence or Addiction • Triggered binge response • Cravings or compulsions • Withdrawal symptoms

12. Criminogenic Needs Abstinence is a distal goal Substance Dependence or Addiction • Triggered binge response • Cravings or compulsions • Withdrawal symptoms }

13. Criminogenic Needs Abstinence is a distal goal Substance Dependence or Addiction • Triggered binge response • Cravings or compulsions • Withdrawal symptoms Substance Abuse }

14. Criminogenic Needs Abstinence is a distal goal Substance Dependence or Addiction • Triggered binge response • Cravings or compulsions • Withdrawal symptoms Substance Abuse Abstinence is a proximal goal } }

15. Criminogenic Needs Abstinence is a distal goal Substance Dependence or Addiction • Triggered binge response • Cravings or compulsions • Withdrawal symptoms Substance Abuse Responsivity needs • Dual diagnosis • Serious functional impairments Abstinence is a proximal goal } }

16. Criminogenic Needs Abstinence is a distal goal Substance Dependence or Addiction • Triggered binge response • Cravings or compulsions • Withdrawal symptoms Substance Abuse Responsivity needs • Dual diagnosis • Serious functional impairments Abstinence is a proximal goal } Regimen compliance is proximal } }

17. Risk & Need Quadrants High Risk Low Risk • Supervision • Treatment • Pro-social habilitation • Adaptive habilitation • Treatment • (Pro-social rehabilitation) • Adaptive habilitation High Needs (dependent) • Supervision • Pro-social habilitation • (Adaptive habilitation) • Secondary prevention • Diversion Low Needs (abuse)

18. Practice Implications High Risk Low Risk • Noncompliance calendar • Treatment (separate milieu) • Adaptive habilitation • Abstinence is distal • Positive reinforcement • Self-help/alumni groups • ~ 12-18 mos. (~150 hrs.) • Status calendar • Treatment • Prosocial & adaptive habilit. • Abstinence is distal • Positive reinforcement • Self-help/alumni groups • ~ 18-24 mos. (~200 hrs.) High Needs (dependent) • Noncompliance calendar • Psycho-education • Abstinence is proximal • Individual/stratified groups • ~ 3-6 mos.(~ 12-26 hrs.) • Status calendar • Prosocial habilitation • Abstinence is proximal • Negative reinforcement • ~ 12-18 mos. (~100 hrs.) Low Needs (abuse)