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Evidence-Based Dispositions
for Drug Offenders
Douglas B. Marlowe, J.D., Ph.D.
Treatment Research Institute at the
University of Pennsylvania
Dispositions for Drug Offenders
Psychosocial Functioning
Pre-plea diversion
(ARD)
Drug Courts
Disposition before
judgment (Prop. 36)
Incarceration
Intermediate
sanctions
Prognostic Risks
• Current age < 25 years
• Delinquent onset < 16 years
• Substance abuse onset < 14 years
• Prior rehabilitation failures
• History of violence
• Antisocial Personality Disorder
• Psychopathy
• Familial history of crime or addiction
• Criminal or substance abuse associations
Criminogenic Needs
Substance Dependence or Addiction
Criminogenic Needs
Substance Dependence or Addiction
1.
2.
3.
Binge pattern
Cravings or compulsions
Withdrawal symptoms
Criminogenic Needs
Substance Dependence or Addiction
1.
2.
3.
Binge pattern
Cravings or compulsions
Withdrawal symptoms
}
Abstinence is a distal goal
Criminogenic Needs
Substance Dependence or Addiction
1.
2.
3.
Binge pattern
Cravings or compulsions
Withdrawal symptoms
Substance Abuse
}
Abstinence is a distal goal
Criminogenic Needs
Substance Dependence or Addiction
1.
2.
3.
Binge pattern
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.
Binge pattern
Cravings or compulsions
Withdrawal symptoms
Substance Abuse
}
}
Abstinence is a distal goal
Abstinence is a proximal goal
Collateral needs
–
–
–
Dual diagnosis
Chronic medical condition (e.g., HIV+, HCV, diabetes)
Homelessness, chronic unemployment
Criminogenic Needs
Substance Dependence or Addiction
1.
2.
3.
Binge pattern
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
Chronic medical condition (e.g., HIV+, HCV, diabetes)
Homelessness, chronic unemployment
Risk & Needs Matrix
High Risk
High
Needs
Low
Needs
Low Risk
Risk & Needs Matrix
High Risk
High
Needs
Low
Needs
Accountability,
Treatment &
Habilitation
Low Risk
Risk & Needs Matrix
High
Needs
Low
Needs
High Risk
Low Risk
Accountability,
Treatment &
Habilitation
Treatment
&
Habilitation
Risk & Needs Matrix
High Risk
Low Risk
High
Needs
Accountability,
Treatment &
Habilitation
Treatment
&
Habilitation
Low
Needs
Accountability
&
Habilitation
Risk & Needs Matrix
High Risk
Low Risk
High
Needs
Accountability,
Treatment &
Habilitation
Treatment
&
Habilitation
Low
Needs
Accountability
&
Habilitation
Prevention
Practice Implications
High Risk
High
Needs
Low
Needs
Low Risk
 Noncompliance hearings
 Status hearings
 Treatment & habilitation  Treatment & habilitation
 Compliance is proximal  Treatment is proximal
 Restrictive consequences
 Positive reinforcement
 Positive reinforcement
 Agonist medication
 Agonist medication
 v.o.p. / status calendar
 Abstinence is proximal
 Secondary prevention
 Psychosocial habilitation  Abstinence is proximal
 Restrictive consequences  No AA or MET
 No AA or MET
 Individual counseling
or stratified groups
 Antagonist medication
Dispositions for Drug Offenders
Risk of
Dangerousness
High risk
High needs
Low risk
Low needs
Low risk
High needs
Pre-plea diversion
(ARD)
High risk
Low needs
Drug Courts
Disposition before
judgment (Prop. 36)
Incarceration
Intermediate
sanctions