Incentives and Sanctions: Practical Application of the Science of

Behavior Change

Shannon M. Carey, Ph.D.

Based on a Need to Know Fact Sheet by Doug Marlowe, J.D. Ph.D./NDCI

Purpose

What is the purpose of Sanctions?

What is the purpose of Incentives?

What other court responses are there?

Overview

• Brief review of the science of behavior change

• Research on application in drug courts

• Sample incentives, sanctions and treatment responses (guidelines)

• Implementing incentives and sanctions (Review and discuss videos)

Certainty

1:1 Schedule for initiation

Reliable detection

“Trust but verify”

Reliable detection

• Urine drug testing at least twice per week*

• Do not decrease frequency of testing until last phase

• Do tests with short detection windows in field

• Random testing all 7 days

• Extend supervision into natural social environment (work, home, school, street, cell phones)

• Include law enforcement on the team

*Or use continuous detection methods

Reliable detection

Cell Phone Transcript from Phone during Court Session - 1

• SF B Chic Nov 18 3:29pm R u getting anything in la?

•  

• SF B Chic Nov 18 3:35pm Can we go in on the deal. If I got 4 would u get 2 so we could do the 540

•  

• SF B Chich Nov 18 3:45pm Toats

Reliable detection

Cell Phone Transcript from Phone during Court Session - 2• ?? Nov 18 6:47pm If you need a source for tina Hit up

714-647-0410 Tell them dan sent ya..Good stuff…•  AM Nov 18 6:48pm How lomng doles xaanax stay in system•  ?? Nov 18 6:48pm 72hrs to a week •  AM Nov 18 6:49pm anyway to clear em out•  ?? Nov 18 6:49pm Do you ever get swabbed!!!???????•  AM Nov 18 6:50pm Occasionally ans I no it doesn’t test for

that•  ?? Nov 18 6:50pm Well if ur dirty dirty.. Always check urself

into the ER for a panic attack or something.. do that day of

probation..Walk outta there with a hospital/dr ltr

 

Reliable detection

Participant in his outpatient substance abuse group•  AM Nov 18 6:22pm Plzbring tibaasement pLII•  AM Nov 18 6:23pm Theyre randomly testing me tnite•  AM Nov 18 6:25pm IM in grop•  AM Nov 18 6:27pm Plese bring to basement bathroom•  AM Nov 18 6:27pm Plzzzzzzzzzzzzz•  S Nov 18 6:29pm Ok•  AM Nov 18 6:29pmHit me up when ur down there ill walk out•  AM Nov 18 6:30pm How long bro•  S Nov 18 6:30pm Like 20 • AM Nov 18 6:34pm Im in the bathroom in the basement plz hurry im

trippin out•  S Nov 18 6:35pm Leavin hollies rite now •  AM Nov 18 6:36pm Shit whats ur eta from there

Reliable detection

Participant in his outpatient substance abuse group (cont)•  S Nov 18 6:37pm 15•  S Nov 18 6:38pm Shuld I wait in basement bathroom•  AM Nov 18 6:38pm Plz tell me u gotta vial to pissi in• S Nov 18 6:38pm Ya•  AM Nov 18 6:42pm Put the vial of piss in bathrroom trashcan•  AM Nov 18 6:42pm I gotta go bak to geoup9 hit me up when its dun•  S Nov 18 6:54pm Its in the trash

Timing is Everything

Timing is Everything

• Effects degrade exponentially

• New behaviors interfere

• Status hearings every two weeks the first few months

• Bring non compliant participants in sooner

• Catch them doing something right, provide incentive sooner

• Continue hearings monthly until participants have engaged in continuing/after care plans

Keep Centered

Effective Zone

Ceiling

Effects

Habituation

Effects

MINIMAL MODERATE

EF

FE

CT

IVE

NE

SS

SEVERE

Keep Centered

NDCI Handout

http://ndcrc.org/content/list-incentives-and-sanctions

Do Due Process

• Allow participants to explain

• Explain judge/team decision

• Be respectful (and expect respect)

• Have written incentive/sanction

guidelines

• Allow reasonable discretion• The brain and decisions about

punishment

(Procedural Fairness)

Sanctions or Treatment Responses?

• Abuse or dependence (mild, moderate

or severe substance use disorder)?

• Proximal or distal behaviors

Needs

Substance Dependence or Addiction1. Binge pattern2. Cravings or compulsions3. Withdrawal symptoms

} Abstinence is a distal goal

Needs

Substance Dependence or Addiction1. Binge pattern2. Cravings or compulsions3. Withdrawal symptoms

Substance Abuse

} Abstinence is a distal goal

Needs

Substance Dependence or Addiction1. Binge pattern2. Cravings or compulsions3. Withdrawal symptoms

Substance Abuse1. Still enjoyable2. No Cravings or compulsions3. No withdrawal symptoms

} Abstinence is a distal goal

Abstinence is a proximal goal}

Needs

Substance Dependence or Addiction1. Binge pattern2. Cravings or compulsions3. Withdrawal symptoms

Substance Abuse

Collateral needs– Dual diagnosis– Chronic medical condition (e.g., HIV+, HCV, diabetes)– Homelessness, chronic unemployment

} Abstinence is a distal goal

Abstinence is a proximal goal}

Needs

Substance Dependence or Addiction1. Binge pattern2. Cravings or compulsions3. Withdrawal symptoms

Substance Abuse

Collateral needs– Dual diagnosis– Chronic medical condition (e.g., HIV+, HCV, diabetes)– Homelessness, chronic unemployment

} Abstinence is a distal goal

Abstinence is a proximal goal}

} Regimen compliance is proximal

Sanctions or Treatment Responses?

• Abuse or dependence (mild, moderate

or severe substance use disorder)?

• Proximal or distal behaviors

• Dependent: Expectations change over

time (Phases)

• Abuser: Higher level sanctions sooner

• Separate status hearings• Rely on clinical expertise

Targeting

Targeting

• Define behavior clearly (both

bad and good)

• Point direction (describe positive

behavior you are looking for)

• Target the behavior not the

person (be respectful)

Targeting• Don’t expect too much

– Learned helplessness and ratio burden

• Don’t expect too little– Habituation

• Proximal vs. distal goals

• Phase specificity– What was once distal becomes proximal

Phase Regression

• An example of response cost

• Often a sign that services were withdrawn prematurely

• Temporary regression and remedial plan (accelerated redemption)

• Avoid the Abstinence Violation Effect (A.V.E.)

Remember that unaddressed co-

occurring disorders may impede the client’s ability to

achieve abstinence

Incentive and Sanction Highlights

• Verbal acknowledgement

• The A Team (being called

early/being on the A team)

• Fish bowl (having your name in

the bowl is a reward)

• Being chosen as a mentor

Incentive and Sanction Highlights

A Team Video

Decision Dollars

$

$

Incentive and Sanction Highlights

• Thought Paper or Recording

• Community Service (giving back

meaningfully)

• Curfew

• Jury Box

• Jail

Courts that use jail greater than 6 days have worse (higher) recidivism

Incentive and Sanction Highlights

• For some, incarceration is NOT the worst punishment – (for some it is trauma)– The threat of jail works best on those who have

something to lose by incarceration.– Positive reinforcement works on those who have

nothing to lose by incarceration.

• Treatment responses may be perceived as punishments-communication is the key to explaining the difference.

Incentive and Sanction Highlights

FOCUS ON THE POSITIVE BEHAVIOR

• People need to know what positive behaviors are - before they can perform them

• They know what not to do, they need to know what to do instead

• Bring up the participants doing well first (the A team), and ask them what they are doing that helps them succeed. (This will have the most positive impact on those watching).

Incentive and Sanction Highlights

Video 1: Highlighting the positive

Video 2: The A Team

Videos 3a-3d: Positive UA with jail sanction

Video 4: Learning experience with thought paper

Incentive and Sanction Highlights

During video, think about whether the judge:

• Is Respectful

• Allows the participant to explain

• Provides a clear explanation of behavior being sanctioned

• Provides a clear explanation of what to do instead

• Provides a learning experience for other participants

Sample Incentive and Sanction Schedules

• http://ndcrc.org/content/list-incentives-and-sanctions

• http://ndcrc.org/content/incentives-and-sanctions-fact-sheet-0

Other good info on incentives and

sanctions:

• www.drugcourtonline.org

Sample Incentive and Sanction Schedules

• Washington D.C.

• Merced, CA

• Kansas

• NDCI

Sanction Exercise

BehaviorFirst 30 days

Question T2: John Abuser

T1: Allen Addict

Positive for cocaine

Proximal or Distal?

Sanction low, middle or high?

Missed Treatment Session

Proximal or Distal?

Sanction low, middle or high?

Missed Court Session

Proximal or Distal?

Sanction low, middle or high?

P D

M/H L

P P

M M

P P

M M

Incentives Exercise

BehaviorAfter 180 days

Question T2: John Abuser

T1: Allen Addict

Negative drug tests for last 30 days

Proximal or Distal?

Incentive low, middle or high?

Made all Treatment Session on time for last 60 days

Proximal or Distal?

Incentive low, middle or high?

P P

HM

P P

M M

“All Behavior is followed by a consequence, and the nature of that consequence modifies the organisms tendency to repeat the behavior in the future”

• B.F. Skinner

Normal methamphetamine addict 15 months post abstinence

Patience: we are in this for the long haul.

Readings Burdon WM et al (2001). Drug courts and contingency management. Journal

of Drug Issues, 31, 73-90.

Harrell A & Roman J (2001). Reducing drug use and crime among offenders: The impact of graduated sanctions. Journal of Drug Issues, 31, 207-232.

Marlowe DB (2007). Strategies for administering rewards and sanctions. In JE Lessenger & GF Roper (Eds.), Drug courts: A new approach to treatment and rehabilitation (pp. 317-336). New York: Springer.

Marlowe DB (2008). Application of sanctions. In Drug Court Quality Improvement Monograph. Alexandria, VA: NDCI.

Marlowe DB & Wong CJ (2008). Contingency management in adult criminal drug courts (pp. 334-354). In ST Higgins, K Silverman & SH Heil (Eds.), Contingency management in substance abuse treatment. New York: Guilford.

Marlowe DB (2011). Applying incentives and sanctions. In The drug court judicial benchbook (pp.139-157). Alexandria, VA: NDCI.