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Evidence-Based Dispositions for Drug Offenders. Treatment Research Institute at the University of Pennsylvania. Douglas B. Marlowe, J.D., Ph.D. Dispositions for Drug Offenders. Psychosocial Functioning. $$$$$$ Costs $$$$$$$$$. Public Safety Risks. Drug Courts. Incarceration.

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douglas b marlowe j d ph d

Evidence-Based Dispositions for Drug Offenders

Treatment Research Institute at the University of Pennsylvania

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

slide2

Dispositions for Drug Offenders

Psychosocial Functioning

$$$$$$ Costs $$$$$$$$$

Public Safety Risks

Drug Courts

Incarceration

Pre-plea diversion

(ARD)

Disposition before

judgment (Prop. 36)

Intermediate

sanctions

slide3

Prognostic Risks

  • Current age < 25 years
  • Delinquent onset < 16 years
  • Substance abuse onset < 14 years
  • Prior rehabilitation failures
  • History of violence
  • Antisocial Personality Disorder
  • Psychopathy
  • Familial history of crime or addiction
  • Criminal or substance abuse associations
slide4

Criminogenic Needs

Substance Dependence or Addiction

slide5

Criminogenic Needs

Substance Dependence or Addiction

  • Binge pattern
  • Cravings or compulsions
  • Withdrawal symptoms
slide6

Criminogenic Needs

Abstinence is a distal goal

Substance Dependence or Addiction

  • Binge pattern
  • Cravings or compulsions
  • Withdrawal symptoms

}

slide7

Criminogenic Needs

Abstinence is a distal goal

Substance Dependence or Addiction

  • Binge pattern
  • Cravings or compulsions
  • Withdrawal symptoms

Substance Abuse

}

slide8

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

}

}

slide9

Criminogenic Needs

Abstinence is a distal goal

Substance Dependence or Addiction

  • Binge pattern
  • Cravings or compulsions
  • Withdrawal symptoms

Substance Abuse

Collateral needs

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

Abstinence is a proximal goal

}

}

slide10

Criminogenic Needs

Abstinence is a distal goal

Substance Dependence or Addiction

  • Binge pattern
  • Cravings or compulsions
  • Withdrawal symptoms

Substance Abuse

Collateral needs

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

Abstinence is a proximal goal

}

Regimen compliance is proximal

}

}

slide11

Risk & Needs Matrix

High Risk

Low Risk

High

Needs

Low

Needs

slide12

Risk & Needs Matrix

High Risk

Low Risk

Accountability,

Treatment &

Habilitation

High

Needs

Low

Needs

slide13

Risk & Needs Matrix

High Risk

Low Risk

Treatment

&

Habilitation

Accountability,

Treatment &

Habilitation

High

Needs

Low

Needs

slide14

Risk & Needs Matrix

High Risk

Low Risk

Treatment

&

Habilitation

Accountability,

Treatment &

Habilitation

High

Needs

Accountability

&

Habilitation

Low

Needs

slide15

Risk & Needs Matrix

High Risk

Low Risk

Treatment

&

Habilitation

Accountability,

Treatment &

Habilitation

High

Needs

Accountability

&

Habilitation

Prevention

Low

Needs

slide16

Practice Implications

High Risk

Low Risk

  • Noncompliance hearings
  • Treatment & habilitation
  • Treatment is proximal
  • Positive reinforcement
  • Agonist medication
  • Status hearings
  • Treatment & habilitation
  • Compliance is proximal
  • Restrictive consequences
  • Positive reinforcement
  • Agonist medication

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 habilitation
  • Restrictive consequences
  • No AA or MET
  • Antagonist medication

Low

Needs

slide17

Dispositions for Drug Offenders

Risk of

Dangerousness

High risk

High needs

Low risk

Low needs

High risk

Low needs

Low risk

High needs

Drug Courts

Incarceration

Pre-plea diversion

(ARD)

Disposition before

judgment (Prop. 36)

Intermediate

sanctions