Presented by:

Cary Heck, Ph.D.

University of WyomingNational Association of Drug Court National Association of Drug Court

ProfessionalsProfessionalsDeveloped by Douglas Marlowe, J.D., Ph.DDeveloped by Douglas Marlowe, J.D., Ph.D

Presented By Cary Heck Ph.D.Presented By Cary Heck Ph.D.

Targeting the Right Targeting the Right Participants for Adult Drug Participants for Adult Drug

Courts (High Risk, High Courts (High Risk, High Needs)Needs)

© Douglas Marlowe, May 10, 2011The 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.

Dispositions for Drug Dispositions for Drug OffendersOffenders

Pre-plea diversion

(ARD)

IncarcerationDrug Courts

Intermediatesanctions

Psychosocial Psychosocial FunctioningFunctioning

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

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

$$Public Safety

Public Safety RisksRisks

Disposition beforejudgment (Prop. 36)

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

• History of violenceHistory of violence

• Antisocial Personality DisorderAntisocial Personality Disorder

• PsychopathyPsychopathy

• Familial history of crime or addictionFamilial history of crime or addiction

• Criminal or substance abuse associationsCriminal or substance abuse 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 AbuseSubstance 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 AbuseSubstance 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 AbuseSubstance Abuse

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

} 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 AbuseSubstance Abuse

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

} Abstinence is a distal goal

Abstinence is a proximal goal}

} Regimen compliance is proximal

High RiskHigh Risk Low RiskLow Risk

High High NeedsNeeds

Low Low NeedsNeeds

Risk & Needs MatrixRisk & Needs Matrix

Risk & Needs MatrixRisk & Needs Matrix

High RiskHigh Risk Low RiskLow Risk

High High NeedsNeeds

Low Low NeedsNeeds

Accountability,Accountability,Treatment &Treatment &HabilitationHabilitation

Risk & Needs MatrixRisk & Needs Matrix

High RiskHigh Risk Low RiskLow Risk

High High NeedsNeeds

Low Low NeedsNeeds

TreatmentTreatment&&

HabilitationHabilitation

Accountability,Accountability,Treatment &Treatment &HabilitationHabilitation

Risk & Needs MatrixRisk & Needs Matrix

High RiskHigh Risk Low RiskLow Risk

High High NeedsNeeds

Low Low NeedsNeeds

AccountabilityAccountability&&

HabilitationHabilitation

TreatmentTreatment&&

HabilitationHabilitation

Accountability,Accountability,Treatment &Treatment &HabilitationHabilitation

Risk & Needs MatrixRisk & Needs Matrix

High RiskHigh Risk Low RiskLow Risk

High High NeedsNeeds

Low Low NeedsNeeds

PreventionPrevention AccountabilityAccountability

&&HabilitationHabilitation

TreatmentTreatment&&

HabilitationHabilitation

Accountability,Accountability,Treatment &Treatment &HabilitationHabilitation

Practice ImplicationsPractice Implications

High RiskHigh Risk Low RiskLow Risk

High High NeedsNeeds

Low Low NeedsNeeds

Status calendarStatus calendar Treatment & habilitationTreatment & habilitation Compliance is proximal Compliance is proximal Restrictive consequencesRestrictive consequences Positive reinforcementPositive reinforcement Prescribed medicationPrescribed medication Self-help groupsSelf-help groups

Noncompliance calendarNoncompliance calendar Treatment & habilitationTreatment & habilitation Treatment is proximal Treatment is proximal

Positive reinforcementPositive reinforcement Prescribed medicationPrescribed medication Self-help groupsSelf-help groups

v.o.p. / status calendarv.o.p. / status calendar Psychosocial habilitationPsychosocial habilitationAbstinence & supervisionAbstinence & supervision

are proximal are proximal Restrictive consequencesRestrictive consequences NoNo AA/NA AA/NA

Noncompliance calendarNoncompliance calendar Secondary prevention Secondary prevention Abstinence is proximal Abstinence is proximal Shorter total durationShorter total duration Individual counselingIndividual counseling oror stratified groups stratified groups

Dispositions for Drug Dispositions for Drug OffendersOffenders

IncarcerationDrug 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

Pre-plea diversion

(ARD)Disposition before

judgment (Prop. 36)

Sponsor’s Note

• This project was supported by Grant No. 2012-DC-BX-K004 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, the SMART Office, 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.