Targeting Participants Targeting Participants for Adult Drug Courtsfor Adult Drug Courts
Douglas B. Marlowe, J.D., Ph.D.Douglas B. Marlowe, J.D., Ph.D.
National Association of Drug Court National Association of Drug Court ProfessionalsProfessionals
CitatioCitationn
Institution(sInstitution(s))
No. Drug No. Drug CourtsCourts
Crime Crime ReducedReduced
Wilson et al. Wilson et al. (2006)(2006)
Campbell Campbell CollaboratiCollaborativeve
5555
1414%%
Latimer et al. Latimer et al. (2006)(2006)
Canada Dept. Canada Dept. ofofJusticeJustice
6666
99%%
Shaffer Shaffer (2010)(2010)
University University of of NevadaNevada
7766
9%9%
Lowenkamp et al.Lowenkamp et al.(2005)(2005)
University University of of CincinnatiCincinnati
2222
8%8%
8%8%
Aos et al. Aos et al. (2006)(2006)
Washington State Washington State Inst.Inst. for Public Policyfor Public Policy
5577
Mitchell et al. Mitchell et al. (2012)(2012)
U.S.F., U.S.F., G.M.U.G.M.U.& Penn. & Penn. State State
9922
1212%%
AvgAvg. Crime Reduction. Crime Reduction
Rempel et al. Rempel et al. (2012)(2012)
Urban Urban Institute, Institute, CCI & RTICCI & RTI
2233
1313%%
Variable EffectsVariable Effects
(Carey et al., 2012; Downey & Roman, 2010; GAO, 2011; Mitchell et al., 2012; Shaffer, 2010)(Carey et al., 2012; Downey & Roman, 2010; GAO, 2011; Mitchell et al., 2012; Shaffer, 2010)
Decrease crime
No effect on crime
Increase crime
72% - 72% - 88%88%
6%-6%-9%9%
8% - 8% - 16%16%
Most drug courts workMost drug courts work
Variable EffectsVariable Effects
(Carey et al., 2012; Downey & Roman, 2010; GAO, 2011; Mitchell et al., 2012; Shaffer, 2010)(Carey et al., 2012; Downey & Roman, 2010; GAO, 2011; Mitchell et al., 2012; Shaffer, 2010)
Some don’t workSome don’t workSome are harmfulSome are harmful Let’s do the math:Let’s do the math:
2,559 drug courts 2,559 drug courts (as of 12/31/10)(as of 12/31/10)
x .06 x .06
= 154 harmful drug courts= 154 harmful drug courts
+ another 205 ineffective drug courts+ another 205 ineffective drug courts
Variable Cost BenefitsVariable Cost Benefits
(Downey & Roman, 2010)(Downey & Roman, 2010)
Positive cost benefit
Negative cost benefit
Equal cost benefit~71~71%%
~ ~ 15%15%
1414%%
14% cost beneficial14% cost beneficial
““[M]ost of the crimes prevented are insignificant in [M]ost of the crimes prevented are insignificant in nature. Collectively, theft, drug offenses, trespassing, nature. Collectively, theft, drug offenses, trespassing, and traffic offenses make up over 60% of the and traffic offenses make up over 60% of the comparison group’s arrests. These crimes are nearly comparison group’s arrests. These crimes are nearly costless to society, and so in terms of reduced costless to society, and so in terms of reduced victimization, preventing these crimes contributes victimization, preventing these crimes contributes little.” little.” (pp. 30-31)
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%5%
10%*10%*
Lowenkamp et al., Lowenkamp et al., 20052005
Twice the reduction Twice the reduction in rearrestsin rearrests}}
8%8%
**p p <.05<.05
““Moderator analysis”Moderator analysis”
Drug Courts That Accepted Participants With Non-Drug Courts That Accepted Participants With Non-Drug Charges Had Nearly Drug Charges Had Nearly TwiceTwice the Reduction in the Reduction in
RecidivismRecidivism
**p p <.05<.05
Non-drug charges included property, theft, prostitution and forgery Non-drug charges included property, theft, prostitution and forgery offensesoffenses Carey et al. Carey et al.
(2012)(2012)
Drug Courts That Accepted Participants With Prior Drug Courts That Accepted Participants With Prior Violence Had Equivalent Reductions in Recidivism Violence Had Equivalent Reductions in Recidivism
pp = n.s. = n.s.
Carey et al. Carey et al. (2012)(2012)
Drug Courts That Excluded Participants with Serious Drug Courts That Excluded Participants with Serious Mental Health Problems Had Over 50% Less Cost Mental Health Problems Had Over 50% Less Cost
SavingsSavings
**p p <.05<.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”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 complicated Risk essentially means a complicated prognosis or lesser amenability to treatmentprognosis or lesser 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)
Prevalent Risk FactorsPrevalent Risk Factors• Current age < 25 yearsCurrent age < 25 years
• Delinquency onset < 16 yearsDelinquency onset < 16 years
• Substance abuse onset < 14 yearsSubstance abuse onset < 14 years
• Prior convictionsPrior convictions
• Prior rehabilitation failuresPrior rehabilitation failures
• History of violenceHistory of violence
• Antisocial personality disorder or psychopathyAntisocial personality disorder or psychopathy
• Familial history of crime or addictionFamilial history of crime or addiction
• Criminal or substance abuse associationsCriminal or substance abuse associations
Need PrincipleNeed Principle• Target criminogenic needs, not all needsTarget criminogenic needs, not all needs
– ResponsivityResponsivity: Treat disorders or functional : Treat disorders or functional impairments that may be lesser predictors of impairments that may be lesser predictors of recidivism, but complicate risk reductionrecidivism, but complicate risk reduction
• 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
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
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 Abstinence is a distaldistal goalgoal
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
Substance AbuseSubstance Abuse
}} Abstinence is a Abstinence is a distaldistal goalgoal
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
Substance AbuseSubstance Abuse
}} Abstinence is a Abstinence is a distaldistal goalgoal
Abstinence is a Abstinence is a proximalproximal goalgoal}}
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
Substance AbuseSubstance Abuse
Collateral needsCollateral needs– Dual diagnosisDual diagnosis– Serious functional impairmentsSerious functional impairments
}} Abstinence is a Abstinence is a distaldistal goalgoal
Abstinence is a Abstinence is a proximalproximal goalgoal}}
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
Substance AbuseSubstance Abuse
Collateral needsCollateral needs– Dual diagnosisDual diagnosis– Serious functional impairmentsSerious functional impairments
}} Abstinence is a Abstinence is a distaldistal goalgoal
Abstinence is a Abstinence is a proximalproximal goalgoal}}
}} Regimen compliance is Regimen compliance is proximalproximal
Criminogenic NeedsCriminogenic Needs
Risk & Needs MatrixRisk & Needs Matrix
High RiskHigh Risk Low RiskLow Risk
High High NeedsNeeds
(dependent)(dependent)
Low Low NeedsNeeds(abuse)(abuse)
Accountability,Accountability,Treatment &Treatment &HabilitationHabilitation
TreatmentTreatment&&
HabilitationHabilitation
AccountabilityAccountability&&
HabilitationHabilitation
Diversion &Diversion &
Secondary PreventionSecondary Prevention
Practice ImplicationsPractice ImplicationsHigh RiskHigh Risk Low RiskLow Risk
High High NeedsNeeds
(dependent)(dependent)
Low Low NeedsNeeds(abuse)(abuse)
Status calendarStatus calendar Treatment (~200 hrs.)Treatment (~200 hrs.) Prosocial & adaptive habilit.Prosocial & adaptive habilit. Graduated consequencesGraduated consequences
for substance usefor substance use Positive reinforcementPositive reinforcement Self-help/alumni groupsSelf-help/alumni groups
Noncompliance calendarNoncompliance calendar Treatment (separate milieu)Treatment (separate milieu) Adaptive habilitationAdaptive habilitation Graduated consequencesGraduated consequences
for substance usefor substance use Positive reinforcement Positive reinforcement Self-help/alumni groupsSelf-help/alumni groups
Status calendarStatus calendar
Prosocial habilitationProsocial habilitation Substantial consequencesSubstantial consequences
for substance usefor substance useNegative reinforcementNegative reinforcement
Noncompliance calendarNoncompliance calendar Psycho-education Psycho-education
“ “Zero tolerance” for Zero tolerance” for
substance usesubstance use IndividualIndividual//stratified groupsstratified groups Shorter supervision periodShorter supervision period
Assessment is KeyAssessment is Key• Structured assessments are far Structured assessments are far superior superior
to professional judgmentto professional judgment– No suitability determinationsNo suitability determinations
• Tools are validated and culturally unbiasedTools are validated and culturally unbiased
• Administered prior to entry of conditionsAdministered prior to entry of conditions
• Many risk tools are adequateMany risk tools are adequate
• Most clinical tools are Most clinical tools are notnot adequate for identifying adequate for identifying the target population for Drug Courtsthe target population for Drug Courts– structured DSM-congruent diagnostic interviewstructured DSM-congruent diagnostic interview
– assessors trained on criteria and item intentassessors trained on criteria and item intent
– check records and interview collateralscheck records and interview collaterals
SummarySummary• Drug courts reduce re-arrest rates Drug courts reduce re-arrest rates
approximately twice as much for high-risk approximately twice as much for high-risk participants than for low-risk participantsparticipants than for low-risk participants
• Drug courts are approximately 50% more cost-Drug courts are approximately 50% more cost-effective for high-risk participants than for low-effective for high-risk participants than for low-risk participants risk participants
• Removing eligibility restrictions helps to reach Removing eligibility restrictions helps to reach the target population the target population
RecommendationsRecommendations1.1. Remove unwarranted eligibility restrictions Remove unwarranted eligibility restrictions
based on criminal history and clinical severitybased on criminal history and clinical severity
2.2. Target high-risk and high-need participants Target high-risk and high-need participants using standardized and validated assessmentsusing standardized and validated assessments
3.3. Cease suitability determinations based on Cease suitability determinations based on motivation, attitude, or readiness for changemotivation, attitude, or readiness for change
4.4. Do not mix risk or need levels in your milieuDo not mix risk or need levels in your milieu
5.5. If necessary, develop alternate tracks based on If necessary, develop alternate tracks based on risk and/or need risk and/or need