assessment of alcohol-involved offenders douglas b. marlowe, j.d., ph.d. national association of...
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Assessment of Assessment of Alcohol-Involved Alcohol-Involved
OffendersOffendersDouglas B. Marlowe, J.D., Ph.D.Douglas B. Marlowe, J.D., Ph.D.
National Association of Drug Court ProfessionalsNational Association of Drug Court Professionals
Treatment Research Institute at the Treatment Research Institute at the University of PennsylvaniaUniversity of Pennsylvania
Levels of AssessmentLevels of Assessment
CharginChargingg& &
ReleaseRelease
Legal ScreeningLegal Screening
Clinical EvaluationClinical Evaluation
PerformancePerformanceMonitoringMonitoring • Behavioral ChangeBehavioral Change
• Attitudinal ChangeAttitudinal Change
Clinical Screening (PSI)Clinical Screening (PSI) Sentencing Sentencing & &
dispositiondisposition
• Level of CareLevel of Care
• Service Service MatchingMatching
• Criminal historyCriminal history• Flight riskFlight risk• Risk of dangerousnessRisk of dangerousness
• Risk of dangerousnessRisk of dangerousness• Prognostic risksPrognostic risks• Criminogenic needsCriminogenic needs
• ASAM placementASAM placement• BiopsychosocialBiopsychosocial
• Urine screensUrine screens• MotivationMotivation• Self efficacySelf efficacy• HostilityHostility• Satisfaction . . .Satisfaction . . .
(Prosecution) (Prosecution)
(Probation / Pre-trial) (Probation / Pre-trial)
(Treatment) (Treatment)
(??) (??)
In the Real World . . .In the Real World . . .• Legal screening drives dispositions & pleasLegal screening drives dispositions & pleas
• Clinical assessment performed after dispositionClinical assessment performed after disposition
• Duplication and fragmentation of effortDuplication and fragmentation of effort
• Risks and needs assessed separatelyRisks and needs assessed separately
• Risk equated with dangerousnessRisk equated with dangerousness
• Wrong factors evaluatedWrong factors evaluated
• Wrong tools usedWrong tools used
• Tools not normed or validated for Tools not normed or validated for alcohol offendersalcohol offenders
In an Ideal World . . .In an Ideal World . . .
Arrest On dispositionArraignment;bail hearing
Trial Sentencing
Medical crisis(e.g., acute withdrawal, DTs)
Stability; daily living skills; violence potential
Intoxication defenses
• Risk of dangerousness (in or out decision)• Prognostic risks• Criminogenic needs
Performance measures
In an Ideal World . . .In an Ideal World . . .
Arrest On dispositionArraignment;bail hearing
Trial SentencingSentencing
Medical crisis(e.g., acute withdrawal, DTs)
Stability; daily living skills; violence potential
Intoxication defenses
• Risk of dangerousnessRisk of dangerousness (in or out decision)(in or out decision)• Prognostic risksPrognostic risks• Criminogenic needsCriminogenic needs
Performance measures
Dispositions for Alcohol Dispositions for Alcohol OffendersOffenders
Diversion (ARD) Incarceration
Probation w/o verdict
DWI / Drug Courts
Intermediatesanctions
Psychosocial Psychosocial FunctioningFunctioning
$$$$$$ Costs $$$$$$$$
$$$$$$ Costs $$$$$$$$
$$Public Safety
Public Safety RisksRisks
Risk of DangerousnessRisk of Dangerousness
• History of violence or dangerousness (incl. DWI)History of violence or dangerousness (incl. DWI)
• PsychopathyPsychopathy
• Substance abuse & psychosis or dementiaSubstance abuse & psychosis or dementia
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
• Antisocial Personality DisorderAntisocial Personality Disorder
• Familial history of crime or addictionFamilial history of crime or addiction
• Criminal associationsCriminal associations
Criminogenic NeedsCriminogenic Needs
Substance Dependence or AddictionSubstance Dependence or Addiction
Criminogenic NeedsCriminogenic Needs
Substance Dependence or AddictionSubstance Dependence or Addiction1.1. Binge patternBinge pattern2.2. Cravings or compulsionsCravings or compulsions3.3. Withdrawal symptomsWithdrawal symptoms
Criminogenic NeedsCriminogenic Needs
Substance Dependence or AddictionSubstance Dependence or Addiction1.1. Binge patternBinge pattern2.2. Cravings or compulsionsCravings or compulsions3.3. Withdrawal symptomsWithdrawal symptoms
} Abstinence is a distal goal
Criminogenic NeedsCriminogenic Needs
Substance Dependence or AddictionSubstance Dependence or Addiction1.1. Binge patternBinge pattern2.2. Cravings or compulsionsCravings or compulsions3.3. Withdrawal symptomsWithdrawal symptoms
Substance Abuse Substance Abuse
} Abstinence is a distal goal
Criminogenic NeedsCriminogenic Needs
Substance Dependence or AddictionSubstance Dependence or Addiction1.1. Binge patternBinge pattern2.2. Cravings or compulsionsCravings or compulsions3.3. Withdrawal symptomsWithdrawal symptoms
Substance Abuse Substance Abuse
} Abstinence is a distal goal
Abstinence is a proximal goal}
Criminogenic NeedsCriminogenic Needs
Substance Dependence or AddictionSubstance Dependence or Addiction1.1. Binge patternBinge pattern2.2. Cravings or compulsionsCravings or compulsions3.3. Withdrawal symptomsWithdrawal symptoms
Substance Abuse Substance Abuse
Mental illnessMental illness
Functional impairmentsFunctional impairments
} Abstinence is a distal goal
Abstinence is a proximal goal}
Criminogenic NeedsCriminogenic Needs
Substance Dependence or AddictionSubstance Dependence or Addiction1.1. Binge patternBinge pattern2.2. Cravings or compulsionsCravings or compulsions3.3. Withdrawal symptomsWithdrawal symptoms
Substance Abuse Substance Abuse
Mental illnessMental illness
Functional impairmentsFunctional impairments
} Abstinence is a distal goal
Abstinence is a proximal goal}
} Regimen compliance is a proximal goal
Risk & Needs MatrixRisk & Needs Matrix
High RiskHigh Risk Low RiskLow Risk
High High NeedsNeeds
Low Low NeedsNeeds
AccountabilityAccountability&&
TreatmentTreatment
TreatmentTreatment
PreventionPrevention
AccountabilityAccountability
Practice ImplicationsPractice Implications
High RiskHigh Risk Low RiskLow Risk
High High NeedsNeeds
Low Low NeedsNeeds
Status hearingsStatus hearings Intensive treatmentIntensive treatment ComplianceCompliance is proximal is proximal Restrictive consequencesRestrictive consequences Positive reinforcementPositive reinforcement
Noncompliance hearingsNoncompliance hearings Intensive treatment Intensive treatment TreatmentTreatment is proximal is proximal
Positive reinforcementPositive reinforcement
v.o.p. / status calendarv.o.p. / status calendar AbstinenceAbstinence is proximal is proximal Psychosocial rehab.Psychosocial rehab. Restrictive consequencesRestrictive consequences NoNo AA or MET AA or MET
Secondary prevention Secondary prevention AbstinenceAbstinence is proximal is proximal NoNo AA or MET AA or MET Individual counselingIndividual counseling oror stratified groups stratified groups
Dispositions for Alcohol Dispositions for Alcohol OffendersOffenders
Diversion (ARD) Incarceration
Probation w/o verdict
DWI / Drug Courts
Intermediatesanctions
Low riskLow riskLow Low needsneeds
Low riskLow riskHigh High needsneeds
High riskHigh riskHigh High needsneeds High riskHigh risk
Low Low needsneeds
Risk ofRisk ofDangerousnesDangerousnesss
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