Douglas%20B.%20Marlowe,%20J.D.,%20Ph.D.

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Effective Programs for Drug Offenders

• Douglas B. Marlowe, J.D., Ph.D.

Treatment Research Institute at the University of
Pennsylvania
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Programs for Drug Offenders

Diversion
Incarceration
Drug Courts
Probation w/o verdict (Prop 36)
Intermediate sanctions
3
Programs for Drug Offenders
Costs

Diversion
Incarceration
Drug Courts
Probation w/o verdict (Prop 36)
Intermediate sanctions
4
Programs for Drug Offenders

Public Safety Risks
Diversion
Incarceration
Drug Courts
Probation w/o verdict (Prop 36)
Intermediate sanctions
5
Programs for Drug Offenders
Psychosocial Functioning

Diversion
Incarceration
Drug Courts
Probation w/o verdict (Prop 36)
Intermediate sanctions
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Programs for Drug Offenders
Psychosocial Functioning
Costs

Public Safety Risks
Diversion
Incarceration
Drug Courts
Probation w/o verdict (Prop 36)
Intermediate sanctions
7
Programs for Drug Offenders

Diversion
Incarceration
Drug Courts
Probation w/o verdict (Prop 36)
Intermediate sanctions
8
Programs for Drug Offenders

Over-reliance
Diversion
Incarceration
Drug Courts
Probation w/o verdict (Prop 36)
Intermediate sanctions
9
Prison

• Criminal Recidivism in 3 Years
• 68 re-arrested
• 47 convicted
• 50 re-incarcerated
• Relapse to Drug Abuse in 3 Years
• 95 relapse

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Programs for Drug Offenders

Diversion
Incarceration
Drug Courts
Probation w/o verdict (Prop 36)
Intermediate sanctions
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Programs for Drug Offenders

Over-reliance
Diversion
Incarceration
Drug Courts
Probation w/o verdict (Prop 36)
Intermediate sanctions
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Intermediate Sanctions

• No effect
• Boot camp

• House arrest
• Worse effect
• Anklet monitoring

• Scared Straight
• Intensive Supervised Probation (ISP)
• Slight improvement
• Restitution

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Programs for Drug Offenders

Diversion
Incarceration
Drug Courts
Probation w/o verdict (Prop 36)
Intermediate sanctions
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Programs for Drug Offenders

Over-reliance
Diversion
Incarceration
Drug Courts
Probation w/o verdict (Prop 36)
Intermediate sanctions
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Diversion to Treatment
Attrition

• 50 - 67 dont show for intake
• 40 - 80 drop out in 3 months
• 90 drop out in 12 months
• 70 of probationers and parolees drop out
  within 2 - 6 months

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Programs for Drug Offenders

Diversion
Incarceration
Drug Courts
Probation w/o verdict (Prop 36)
Intermediate sanctions
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Programs for Drug Offenders

Over-reliance
Diversion
Incarceration
Drug Courts
Probation w/o verdict (Prop 36)
Intermediate sanctions
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Effects of Proposition 36

• 30 never showed for treatment
• 40 attended 90 days of treatment
• 24 completed treatment
• 20 probation revocations
• 60 parole revocations
• Increased recidivism
• Decreased costs

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Programs for Drug Offenders

Diversion
Incarceration
Drug Courts
Probation w/o verdict (Prop 36)
Intermediate sanctions
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Programs for Drug Offenders

Reliance
Diversion
Incarceration
Drug Courts
Probation w/o verdict (Prop 36)
Intermediate sanctions
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• 60 complete gt 12 months of treatment
• 50 graduate
• Reduced recidivism and drug use
• Serves 5 of eligible population

Effects of Drug Courts
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Programs for Drug Offenders

Diversion
Incarceration
Drug Courts
Probation w/o verdict (Prop 36)
Intermediate sanctions
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Programs for Drug Offenders

• 50 success rate
• 5 eligible pop.

Diversion
Incarceration
Drug Courts
Probation w/o verdict (Prop 36)
Intermediate sanctions
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Programs for Drug Offenders

• 50 success rate
• 5 eligible pop.

• 25 success rate
• Cost savings

Diversion
Incarceration
Drug Courts
Probation w/o verdict (Prop 36)
Intermediate sanctions
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Programs for Drug Offenders

• 10 success rate
• Most cost savings

• 50 success rate
• 5 eligible pop.

• 25 success rate
• Cost savings

Diversion
Incarceration
Drug Courts
Probation w/o verdict (Prop 36)
Intermediate sanctions
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Programs for Drug Offenders

• 10 success rate
• Most cost savings

• 50 success rate
• 5 eligible pop.

• Low success rate
• Public safety

• 25 success rate
• Cost savings

Diversion
Incarceration
Drug Courts
Probation w/o verdict (Prop 36)
Intermediate sanctions
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Criminogenic Risks

• Age during rehabilitation lt 25 years
• Criminal onset lt 16 years
• Prior rehabilitation failures
• History of violence
• Antisocial Personality Disorder
• Psychopathy
• Familial history of crime
• Criminal associations

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Criminogenic Needs

• Drug Dependence or Addiction

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Criminogenic Needs

• Drug Dependence or Addiction
• Binge pattern
• Cravings or compulsions
• Withdrawal symptoms

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Criminogenic Needs
Abstinence is a distal goal

• Drug Dependence or Addiction
• Binge pattern
• Cravings or compulsions
• Withdrawal symptoms

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Criminogenic Needs
Abstinence is a distal goal

• Drug Dependence or Addiction
• Binge pattern
• Cravings or compulsions
• Withdrawal symptoms
• Drug Abuse or Misuse

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Criminogenic Needs
Abstinence is a distal goal

• Drug Dependence or Addiction
• Binge pattern
• Cravings or compulsions
• Withdrawal symptoms
• Drug Abuse or Misuse

• Abstinence is a proximal goal

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Criminogenic Needs
Abstinence is a distal goal

• Drug Dependence or Addiction
• Binge pattern
• Cravings or compulsions
• Withdrawal symptoms
• Drug Abuse or Misuse
• Collateral needs
• Dual diagnosis
• Chronic medical condition (e.g., HIV, HCV,
  diabetes)
• Homelessness, chronic unemployment

• Abstinence is a proximal goal

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Criminogenic Needs
Abstinence is a distal goal

• Drug Dependence or Addiction
• Binge pattern
• Cravings or compulsions
• Withdrawal symptoms
• Drug Abuse or Misuse
• Collateral needs
• Dual diagnosis
• Chronic medical condition (e.g., HIV, HCV,
  diabetes)
• Homelessness, chronic unemployment

• Abstinence is a proximal goal

Regimen compliance is proximal

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Risk Needs Matrix
High Risk
Low Risk
High Needs
Low Needs
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Risk Needs Matrix
High Risk
Low Risk
Accountability Treatment
High Needs
Low Needs
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Risk Needs Matrix
High Risk
Low Risk
Treatment
Accountability Treatment
High Needs
Low Needs
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Risk Needs Matrix
High Risk
Low Risk
Treatment
Accountability Treatment
High Needs
Accountability
Low Needs
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Risk Needs Matrix
High Risk
Low Risk
Treatment
Accountability Treatment
High Needs
Prevention
Accountability
Low Needs
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Practice Implications
High Risk
Low Risk

• Noncompliance hearings
• Intensive treatment
• Treatment is proximal
• Positive reinforcement

• Status hearings
• Intensive treatment
• Compliance is proximal
• Restrictive consequences
• Positive reinforcement

High Needs

• Secondary prevention
• Abstinence is proximal
• No AA or MET
• Individual counseling
• or stratified groups

• v.o.p. / status calendar
• Abstinence is proximal
• Restrictive consequences

Low Needs
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Programs for Drug Offenders

Diversion
Incarceration
Drug Courts
Probation w/o verdict (Prop 36)
Intermediate sanctions
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Programs for Drug Offenders

Low risk Low needs
Diversion
Incarceration
Drug Courts
Probation w/o verdict (Prop 36)
Intermediate sanctions
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Programs for Drug Offenders

Low risk Low needs
Low risk High needs
Diversion
Incarceration
Drug Courts
Probation w/o verdict (Prop 36)
Intermediate sanctions
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Programs for Drug Offenders

High risk High needs
Low risk Low needs
Low risk High needs
Diversion
Incarceration
Drug Courts
Probation w/o verdict (Prop 36)
Intermediate sanctions
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Programs for Drug Offenders

High risk High needs
Low risk Low needs
High risk Low needs
Low risk High needs
Diversion
Incarceration
Drug Courts
Probation w/o verdict (Prop 36)
Intermediate sanctions
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Ok, Mr. Big Shot . . .

• PROVE IT!!!!

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Key Components

• Judicial status hearings
• Graduated sanctions rewards
• Urine drug screens
• Drug abuse treatment
• Case management
• Nolle prosse or conditions-served
• Expunged record (diversion)

(NADCP, 1997)
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Key Components

• Judicial status hearings
• Graduated sanctions rewards
• Urine drug screens
• Drug abuse treatment
• Case management
• Nolle prosse or conditions-served
• Expunged record (diversion)

(NADCP, 1997)
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Research Site
1st Study New Castle Co. (misdemeanor)
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Matching Design
High Risk
Low Risk
Matched
Bi-Weekly (n 42)
As Needed (n 95)
As Usual (monthly)
Unmatched
(n 50)
(n 92)
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Drug-free Urines by Group
p lt .001
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Drug-free Urines by Group
p lt .001
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Drug-free Urines by Group
p lt .001
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Drug-free Urines by Group
p lt .001
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Drug-Positive Urines 6 Mos.


p lt .05
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Graduation Rates 12 mos.

p lt .05
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Key Components

• Judicial status hearings
• Graduated sanctions rewards
• Urinalyses
• Drug abuse treatment
• Case management
• Nolle prosse or time served
• Expunged record (diversion)

(NADCP, 1997)
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Key Components

• Judicial status hearings
• Graduated sanctions rewards
• Urinalyses
• Drug abuse treatment
• Case management
• Nolle prosse or time served
• Expunged record (diversion)

(NADCP, 1997)
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Rewards
Months of compliance STANDARD REWARDS
1
2
3 Hat or Candle
4
5
6 Reduced community service
7 Reduced drug testing
8 Reduced treatment requirements
9
10 Reduced status hearings
11 Reduced homework assignments
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Total
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Rewards
Months of compliance STANDARD REWARDS ENHANCED ESCALATING REWARDS
1 5.00 gift certificate
2 10.00 gift certificate
3 Hat or Candle 15.00 gift certificate
4 20.00 gift certificate
5 25.00 gift certificate
6 Reduced community service 30.00 gift certificate
7 Reduced drug testing 35.00 gift certificate
8 Reduced treatment requirements 40.00 gift certificate
9 45.00 gift certificate
10 Reduced status hearings 50.00 gift certificate
11 Reduced homework assignments 55.00 gift certificate
12 60.00 gift certificate
Total 390.00
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Rewards
Months of compliance STANDARD REWARDS ENHANCED ESCALATING REWARDS ENHANCED THINNING REWARDS
1 5.00 gift certificate 30.00 gift certificate
2 10.00 gift certificate 30.00 gift certificate
3 Hat or Candle 15.00 gift certificate 30.00 gift certificate
4 20.00 gift certificate Eligible for 50.00 gift certificate if compliant one additional month
5 25.00 gift certificate 50.00 gift certificate
6 Reduced community service 30.00 gift certificate Eligible for 50.00 gift certificate if compliant one additional month
7 Reduced drug testing 35.00 gift certificate 50.00 gift certificate
8 Reduced treatment requirements 40.00 gift certificate Eligible for 75.00 gift certificate if compliant one additional month
9 45.00 gift certificate 75.00 gift certificate
10 Reduced status hearings 50.00 gift certificate Eligible for 125.00 gift certificate if compliant two additional months
11 Reduced homework assignments 55.00 gift certificate Eligible for 125.00 gift certificate if compliant one additional month
12 60.00 gift certificate 125.00 gift certificate
Total 390.00 390.00
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Drug-Free Urines (13 mos.)
p n.s.
n61
n60
n60
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Mean Sessions Attended
n61
n60
n60
p n.s.
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Mean Drug-Free Urines
n34
n26
n24
n34
n29
n29
p lt .05
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Summary

• One size does not fit all!
• Drug courts are best suited for high risk and
  high needs offenders
• When possible, separate court calendars and
  treatment tracks should be held for high risk vs.
  low risk clients
• You may need to be nicest to the clients you
  might like the least