targeting participants for adult drug courts douglas b. marlowe, j.d., ph.d. national association of...

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


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



Substance AbuseSubstance Abuse






Abstinence is a Abstinence is a proximalproximal goalgoal}}




Collateral needsCollateral needs– Dual diagnosisDual diagnosis– Serious functional impairmentsSerious functional impairments






Collateral needsCollateral needs– Dual diagnosisDual diagnosis– Serious functional impairmentsSerious functional impairments



}} Regimen compliance is Regimen compliance is proximalproximal


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

targeting participants for adult drug courts douglas b. marlowe, j.d., ph.d. national association of...

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