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

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

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

3. 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

4. Criminogenic Needs Substance Dependence or Addiction

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

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

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

8. 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 } }

9. 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 } }

10. 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 } }

11. Risk & Needs Matrix High Risk Low Risk High Needs Low Needs

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

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

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

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

16. 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

17. 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