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Assessment of Alcohol-Involved Offenders

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Assessment of Alcohol-Involved Offenders Douglas B. Marlowe, J.D., Ph.D. National Association of Drug Court Professionals Treatment Research Institute at the – PowerPoint PPT presentation

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Title: Assessment of Alcohol-Involved Offenders


1
Assessment of Alcohol-Involved Offenders
Douglas B. Marlowe, J.D., Ph.D.
National Association of Drug Court
Professionals Treatment Research Institute at the
University of Pennsylvania
2
Levels of Assessment
Legal Screening
  • Criminal history
  • Flight risk
  • Risk of dangerousness

(Prosecution)
Charging Release
Clinical Screening (PSI)
  • Risk of dangerousness
  • Prognostic risks
  • Criminogenic needs

(Probation / Pre-trial)
Sentencing disposition
Clinical Evaluation
  • ASAM placement
  • Biopsychosocial
  • Level of Care
  • Service Matching

(Treatment)
Performance Monitoring
  • Behavioral Change
  • Attitudinal Change
  • Urine screens
  • Motivation
  • Self efficacy
  • Hostility
  • Satisfaction . . .

(??)
3
In the Real World . . .
  • Legal screening drives dispositions pleas
  • Clinical assessment performed after disposition
  • Duplication and fragmentation of effort
  • Risks and needs assessed separately
  • Risk equated with dangerousness
  • Wrong factors evaluated
  • Wrong tools used
  • Tools not normed or validated for
  • alcohol offenders

4
In an Ideal World . . .
  • Risk of dangerousness
  • (in or out decision)
  • Prognostic risks
  • Criminogenic needs

Stability daily living skills violence
potential
Medical crisis (e.g., acute withdrawal, DTs)
Performance measures
Intoxication defenses
Arrest
On disposition
Arraignment bail hearing
Trial
Sentencing
5
In an Ideal World . . .
  • Risk of dangerousness
  • (in or out decision)
  • Prognostic risks
  • Criminogenic needs

Stability daily living skills violence
potential
Medical crisis (e.g., acute withdrawal, DTs)
Performance measures
Intoxication defenses
Arrest
On disposition
Arraignment bail hearing
Trial
Sentencing
6
Dispositions for Alcohol Offenders
Psychosocial Functioning

Costs
Public Safety Risks
Diversion (ARD)
Incarceration
DWI / Drug Courts
Probation w/o verdict
Intermediate sanctions
7
Risk of Dangerousness
  • History of violence or dangerousness (incl. DWI)
  • Psychopathy
  • Substance abuse psychosis or dementia

8
Prognostic Risks
  • Current age lt 25 years
  • Delinquent onset lt 16 years
  • Substance abuse onset lt 14 years
  • Prior rehabilitation failures
  • Antisocial Personality Disorder
  • Familial history of crime or addiction
  • Criminal associations

9
Criminogenic Needs
  • Substance Dependence or Addiction

10
Criminogenic Needs
  • Substance Dependence or Addiction
  • Binge pattern
  • Cravings or compulsions
  • Withdrawal symptoms

11
Criminogenic Needs
Abstinence is a distal goal
  • Substance Dependence or Addiction
  • Binge pattern
  • Cravings or compulsions
  • Withdrawal symptoms

12
Criminogenic Needs
Abstinence is a distal goal
  • Substance Dependence or Addiction
  • Binge pattern
  • Cravings or compulsions
  • Withdrawal symptoms
  • Substance Abuse

13
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

14
Criminogenic Needs
Abstinence is a distal goal
  • Substance Dependence or Addiction
  • Binge pattern
  • Cravings or compulsions
  • Withdrawal symptoms
  • Substance Abuse
  • Mental illness
  • Functional impairments
  • Abstinence is a proximal goal

15
Criminogenic Needs
Abstinence is a distal goal
  • Substance Dependence or Addiction
  • Binge pattern
  • Cravings or compulsions
  • Withdrawal symptoms
  • Substance Abuse
  • Mental illness
  • Functional impairments
  • Abstinence is a proximal goal

Regimen compliance is a proximal goal

16
Risk Needs Matrix
High Risk
Low Risk
Treatment
Accountability Treatment
High Needs
Prevention
Accountability
Low Needs
17
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
  • Psychosocial rehab.
  • Restrictive consequences
  • No AA or MET

Low Needs
18
Dispositions for Alcohol Offenders

Risk of Dangerousness
High risk High needs
Low risk Low needs
High risk Low needs
Low risk High needs
Diversion (ARD)
Incarceration
DWI / Drug Courts
Probation w/o verdict
Intermediate sanctions
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