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

Targeting Targeting Participants for Drug Participants for Drug

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

National Association of Drug CourtNational Association of Drug Court ProfessionalsProfessionals

Effect Size by Risk Effect Size by Risk LevelLevel

0

5

10

15

20

All subjects No crim. hx Crim. hx

Pe

rce

nt

red

uc

tio

n in

rea

rre

sts

5%

10%*

Lowenkamp et al., Lowenkamp et al., 20052005

Twice the reductionTwice the reduction in rearrestsin rearrests}}

8%

*p <.05

“Moderator analysis”

Drug Courts That Accepted Participants With Non-Drug Charges Had Nearly Twice the

Reduction in Recidivism

*p <.05

Non-drug charges included property, theft, prostitution and forgery offenses Carey et al. Carey et al.

(2012)(2012)

Drug Courts That Accepted Participants With Prior Violence Had Equivalent Reductions in

Recidivism

p = n.s.

Carey et al. Carey et al. (2012)(2012)

Drug Courts That Excluded Participants with Serious Mental Health Problems Had Over 50%

Less Cost Savings

*p <.05

Carey et al. Carey et al. (2012)(2012)

Avg. Benefit Per $1 Avg. Benefit Per $1 invested invested

0

1

2

3

4

5

current pop. prior violence drug dependence all risk levels

Be

nef

it /c

os

t d

olla

r ra

tio

$2.21 $2.15

$4.13

$3.36

~~ 50% greater 50% greater cost benefitscost benefits}}

Bhati et al. Bhati et al. (2008)(2008)

“Synthetic analysis”

{~~ 90% greater 90% greater

cost benefitscost benefits

Risk PrincipleRisk Principle• NotNot necessarily a risk for violence or necessarily a risk for violence or

dangerousnessdangerousness

• Risk essentially means a difficult prognosis or Risk essentially means a difficult prognosis or lesser amenability to treatmentlesser amenability to treatment

• The higher the risk level, the more intensive The higher the risk level, the more intensive the supervision and accountability should be; the supervision and accountability should be; and vice versaand vice versa

• Mixing risk levels is contraindicatedMixing risk levels is contraindicated

(Andrews & Bonta, (Andrews & Bonta, 2010)2010)

Prognostic RisksPrognostic Risks• Current age < 25 yearsCurrent age < 25 years

• Delinquent onset < 16 yearsDelinquent onset < 16 years

• Substance abuse onset < 14 yearsSubstance abuse onset < 14 years

• Prior rehabilitation failuresPrior rehabilitation failures

• History of violenceHistory of violence

• Antisocial Personality DisorderAntisocial Personality Disorder

• PsychopathyPsychopathy

• Familial history of crime or addictionFamilial history of crime or addiction

• Criminal or substance abuse associationsCriminal or substance abuse associations

Need PrincipleNeed Principle• Clinical disorders or functional impairments Clinical disorders or functional impairments

(diagnosis)(diagnosis)

• Target criminogenic & responsivity needs firstTarget criminogenic & responsivity needs first

• The higher the need level, the more intensive The higher the need level, the more intensive the treatment or rehabilitation services should the treatment or rehabilitation services should be; be; and vice versaand vice versa

• Mixing need levels is contraindicatedMixing need levels is contraindicated

(Andrews & Bonta, (Andrews & Bonta, 2010)2010)

Substance Dependence or AddictionSubstance Dependence or Addiction

Criminogenic NeedsCriminogenic Needs


Substance Dependence or AddictionSubstance Dependence or Addiction1.1. Triggered binge responseTriggered binge response2.2. Cravings or compulsionsCravings or compulsions3.3. Withdrawal symptomsWithdrawal symptoms


} Abstinence is a distal goal



Substance AbuseSubstance Abuse






Abstinence is a proximal goal}




Responsivity needsResponsivity needs– Dual diagnosisDual diagnosis– Serious functional impairmentsSerious functional impairments






Responsivity needsResponsivity needs– Dual diagnosisDual diagnosis– Serious functional impairmentsSerious functional impairments



} Regimen compliance is proximal


Risk & Need QuadrantsRisk & Need QuadrantsHigh RiskHigh Risk Low RiskLow Risk

High High NeedsNeeds

(dependent)(dependent)

Low Low NeedsNeeds

(abuse)(abuse)

• SupervisionSupervision

• Treatment Treatment

• Pro-social habilitationPro-social habilitation

• Adaptive habilitationAdaptive habilitation

• Treatment Treatment

• (Pro-social rehabilitation)(Pro-social rehabilitation)

• Adaptive habilitationAdaptive habilitation

• SupervisionSupervision

• Pro-social habilitationPro-social habilitation

• (Adaptive habilitation)(Adaptive habilitation)

• Secondary preventionSecondary prevention

• DiversionDiversion

Practice ImplicationsPractice ImplicationsHigh RiskHigh Risk Low RiskLow Risk

High High NeedsNeeds

(dependent)(dependent)

Low Low NeedsNeeds

(abuse)(abuse)

Status calendarStatus calendar TreatmentTreatment Prosocial & adaptive habilit.Prosocial & adaptive habilit. Abstinence is distalAbstinence is distal Positive reinforcementPositive reinforcement Self-help/alumni groupsSelf-help/alumni groups ~ 18-24 mos. (~200 hrs.)~ 18-24 mos. (~200 hrs.)

Noncompliance calendarNoncompliance calendar Treatment (separate milieu)Treatment (separate milieu) Adaptive habilitationAdaptive habilitation Abstinence is distalAbstinence is distal Positive reinforcement Positive reinforcement Self-help/alumni groupsSelf-help/alumni groups ~ 12-18 mos. (~150 hrs.)~ 12-18 mos. (~150 hrs.)

Status calendarStatus calendar

Prosocial habilitationProsocial habilitation Abstinence is proximalAbstinence is proximalNegative reinforcementNegative reinforcement~ 12-18 mos. (~100 hrs.)~ 12-18 mos. (~100 hrs.)

Noncompliance calendarNoncompliance calendar Psycho-education Psycho-education

Abstinence is proximalAbstinence is proximal IndividualIndividual//stratified groupsstratified groups ~ 3-6 mos.~ 3-6 mos. (~ 12-26 hrs.)(~ 12-26 hrs.)

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

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