Transcript Document

Targeting Participants
for Adult Drug Courts
Douglas B. Marlowe, J.D., Ph.D.
National Association of Drug Court
Professionals
Avg. Crime Reduction
Citation
Institution(s)
No. Drug Courts Crime Reduced
Mitchell et al. (2012)
U.S.F., G.M.U.
& Penn. State
92
12%
Rempel et al. (2012)
Urban Institute,
CCI & RTI
23
13%
Wilson et al. (2006)
Campbell
Collaborative
55
14%
Latimer et al. (2006)
Canada Dept. of
Justice
66
9%
Shaffer (2010)
University of
Nevada
76
9%
Lowenkamp et al.
(2005)
University of
Cincinnati
22
8%
Aos et al. (2006)
Washington State Inst.
for Public Policy
57
8%
Variable Effects
(Carey et al., 2012; Downey & Roman, 2010; GAO, 2011; Mitchell et al., 2012; Shaffer, 2010)
Variable Effects
Some are harmful
Some don’t work
6%-9%
Let’s do the math:
2,559 drug courts (as of 12/31/10)
x .06
8% - 16%
= 154 harmful drug courts
Decrease crime
No effect on crime
Increase crime
72% - 88%
another
205
ineffective drug courts
Most +drug
courts
work
(Carey et al., 2012; Downey & Roman, 2010; GAO, 2011; Mitchell et al., 2012; Shaffer, 2010)
Variable Cost Benefits
14% cost beneficial
14%
~ 15%
Positive cost benefit
Negative cost benefit
~71%
(Downey & Roman, 2010)
Equal cost benefit
“[M]ost of the crimes prevented are insignificant in
nature. Collectively, theft, drug offenses, trespassing,
and traffic offenses make up over 60% of the
comparison group’s arrests. These crimes are nearly
costless to society, and so in terms of reduced
victimization, preventing these crimes contributes
little.” (pp. 30-31)
Effect Size by Risk Level
Percent reduction in rearrests
20
15
10%*
10
}
8%
Twice the reduction
in rearrests
5%
5
0
All subjects
“Moderator analysis”
No crim. hx
Crim. hx
*p <.05
Lowenkamp et al., 2005
Percent reductions in recidivism
Drug Courts That Accepted Participants With NonDrug Charges Had Nearly Twice the Reduction in
Recidivism
50%
41%
40%
21%
30%
20%
10%
0%
Drug court accepts nondrug charges
N=42
Drug court does NOT
accept non-drug
charges
N=24
*p <.05
Non-drug charges included property, theft, prostitution and forgery offenses
Carey et al. (2012)
Percent reductions in recidivism
Drug Courts That Accepted Participants With Prior
Violence Had Equivalent Reductions in Recidivism
50%
36%
38%
40%
30%
20%
10%
0%
Drug Court accepts
participants with prior
violence
N=14
Drug Court does NOT accept
participants with prior
violence
N=39
p = n.s.
Carey et al. (2012)
Drug Courts That Excluded Participants with Serious
Mental Health Problems Had Over 50% Less Cost
Savings
37%
50%
40%
30%
21%
20%
10%
0%
Program excludes offenders Program does NOT exclude
with serious MH issues
offenders with serious MH
N=32
issues
N=18
*p <.05
Carey et al. (2012)
Avg. Benefit Per $1 invested
5
Benefit /cost dollar ratio
$4.13
{
~ 90% greater
4
$3.36
cost benefits
3
$2.21
$2.15
}
~ 50% greater
cost benefits
2
1
0
current pop.
prior violence
“Synthetic analysis”
drug dependence
all risk levels
Bhati et al. (2008)
Risk Principle
• Not necessarily a risk for violence or
dangerousness
• Risk essentially means a complicated
prognosis or lesser amenability to treatment
• The higher the risk level, the more intensive
the supervision and accountability should be;
and vice versa
• Mixing risk levels is contraindicated
(Andrews & Bonta, 2010)
Prevalent Risk Factors
• Current age < 25 years
• Delinquency onset < 16 years
• Substance abuse onset < 14 years
• Prior convictions
• Prior rehabilitation failures
• History of violence
• Antisocial personality disorder or psychopathy
• Familial history of crime or addiction
• Criminal or substance abuse associations
Need Principle
• Target criminogenic needs, not all needs
– Responsivity: Treat disorders or functional
impairments that may be lesser predictors of
recidivism, but complicate risk reduction
• The higher the need level, the more intensive the
treatment or rehabilitation services should be;
and vice versa
• Mixing need levels is contraindicated
(Andrews & Bonta, 2010)
Criminogenic Needs
Substance Dependence or Addiction
Criminogenic Needs
Substance Dependence or Addiction
1.
2.
3.
Triggered binge response
Cravings or compulsions
Withdrawal symptoms
Criminogenic Needs
Substance Dependence or Addiction
1.
2.
3.
}
Triggered binge response
Cravings or compulsions
Withdrawal symptoms
Abstinence is a distal goal
Criminogenic Needs
Substance Dependence or Addiction
1.
2.
3.
}
Triggered binge response
Cravings or compulsions
Withdrawal symptoms
Substance Abuse
Abstinence is a distal goal
Criminogenic Needs
Substance Dependence or Addiction
1.
2.
3.
}
Triggered binge response
Cravings or compulsions
Withdrawal symptoms
Substance Abuse
}
Abstinence is a distal goal
Abstinence is a proximal goal
Criminogenic Needs
Substance Dependence or Addiction
1.
2.
3.
}
Triggered binge response
Cravings or compulsions
Withdrawal symptoms
Substance Abuse
}
Abstinence is a distal goal
Abstinence is a proximal goal
Collateral needs
–
–
Dual diagnosis
Serious functional impairments
Criminogenic Needs
Substance Dependence or Addiction
1.
2.
3.
}
Triggered binge response
Cravings or compulsions
Withdrawal symptoms
Substance Abuse
Collateral needs
–
–
Abstinence is a distal goal
}
}
Abstinence is a proximal goal
Regimen compliance is proximal
Dual diagnosis
Serious functional impairments
Risk & Needs Matrix
High Risk
Low Risk
High
Needs
(dependent)
Accountability,
Treatment &
Habilitation
Treatment
&
Habilitation
Low
Needs
(abuse)
Accountability
&
Habilitation
Diversion &
Secondary Prevention
Practice Implications
High Risk
High
Needs
(dependent)
Low
Needs
(abuse)
Low Risk
 Status calendar
 Noncompliance calendar
 Treatment (~200 hrs.)
 Prosocial & adaptive habilit.
 Graduated consequences
for substance use
 Positive reinforcement
 Self-help/alumni groups
 Treatment (separate milieu)
 Adaptive habilitation
 Graduated consequences
for substance use
 Positive reinforcement
Self-help/alumni groups
 Status calendar
 Noncompliance calendar
 Psycho-education
 Prosocial habilitation
 Substantial consequences
for substance use
 Negative reinforcement
 “Zero tolerance” for
substance use
 Individual/stratified groups
 Shorter supervision period
Assessment is Key
• Structured assessments are far
superior to professional judgment
– No suitability determinations
• Tools are validated and culturally unbiased
• Administered prior to entry of conditions
• Many risk tools are adequate
• Most clinical tools are not adequate for identifying
the target population for Drug Courts
– structured DSM-congruent diagnostic interview
– assessors trained on criteria and item intent
– check records and interview collaterals
Summary
• Drug courts reduce re-arrest rates
approximately twice as much for high-risk
participants than for low-risk participants
• Drug courts are approximately 50% more costeffective for high-risk participants than for lowrisk participants
• Removing eligibility restrictions helps to reach
the target population
Recommendations
1. Remove unwarranted eligibility restrictions
based on criminal history and clinical severity
2. Target high-risk and high-need participants
using standardized and validated assessments
3. Cease suitability determinations based on
motivation, attitude, or readiness for change
4. Do not mix risk or need levels in your milieu
5. If necessary, develop alternate tracks based on
risk and/or need