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

TRI science addiction Effective Use of Rewards & Sanctions Treatment Research Institute at the University of Pennsylvania Douglas B. Marlowe, J.D., Ph.D. © Dr. Douglas Marlowe, March 8, 2011 The following presentation may not be copied in whole or in part without the written permission of the author or the National Drug Court Institute. Written permission will generally be given without cost, upon request.

TRI science addiction Basic Terminology SANCTION REWARD Punishment Positive Reinforcement GIVE Negative Reinforcement Response Cost TAKE

TRI science addiction Certainty • FR-1 schedule for initiation • Reliable detection • Second chances

TRI science addiction Celerity

TRI science addiction Celerity • Effects degrade exponentially • Interference from new behaviors • Status hearings

TRI science addiction MINIMAL MODERATE Magnitude Effective Zone Habituation Effects Ceiling Effects EFFECTIVENESS SEVERE MAGNITUDE OF SANCTION

TRI science addiction Escalation • Rehearsal • Intermediate responses • Ratchet up or down

TRI science addiction Fairness • Proportionality • Like people in like circumstances • Procedural justice • Advance notice • Punish the act, not the individual

TRI science addiction Quitting & Defiance • Unfairness • Learned Helplessness • Predictability • Controllability • Ratio Burden

TRI science addiction Target Behaviors • Proximal vs. distal (shaping) • Phase-specific • Capture the behavior • Clearly defined

TRI science addiction Proximal vs. Distal Goals Drug Dependence or Addiction

TRI science addiction Proximal vs. Distal Goals Drug Dependence or Addiction • Binge pattern • Cravings or compulsions • Withdrawal symptoms

TRI science addiction Proximal vs. Distal Goals Abstinence is a distal goal Drug Dependence or Addiction • Binge pattern • Cravings or compulsions • Withdrawal symptoms }

TRI science addiction Proximal vs. Distal Goals Abstinence is a distal goal Drug Dependence or Addiction • Binge pattern • Cravings or compulsions • Withdrawal symptoms Drug Abuse or Misuse }

TRI science addiction Proximal vs. Distal Goals 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 } }

TRI science addiction Proximal vs. Distal Goals 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 } }

TRI science addiction Proximal vs. Distal Goals 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 } }

TRI science addiction Pitfalls of Sanctions • Escape or avoidance • Overgeneralization • Superstition • Doesn’t teach what to do • FR forever (no thinning)

TRI science addiction Pitfalls of the Carrot • Coddling • Complacency • Entitlement • May reduce intrinsic motivation

TRI science addiction Certainty and celerity Beware individualism The Works of BF Skinner Higher magnitude for proximal behaviors Lower magnitude for distal behaviors Behavior Modification 101 Predictable and attainable goals Reward desired behaviors Expect more over time

TRI science addiction 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.

This project was supported by Grant No. 2009-DD-BX-K003 awarded by the Bureau of Justice Assistance. The Bureau of Justice Assistance is a component of the Office of Justice Programs, which also includes the Bureau of Justice Statistics, the National Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention, and the Office for Victims of Crime. Points of view or opinions in this document are those of the author and do not represent the official position or policies of the United States Department of Justice.

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