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Douglas B. Marlowe, J.D., Ph.D.
Treatment Research Institute at the
University of Pennsylvania
Evidence-Based Dispositions for Drug
Offenders
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Dispositions for Drug Offenders
Pre-plea diversion
(ARD)
IncarcerationDrug Courts
Intermediatesanctions
Psychosocial Functioning
$$$$$$ Costs $$$$$$$$$
Public Safety Risks
Disposition beforejudgment (Prop. 36)
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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
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Criminogenic Needs
Substance Dependence or Addiction
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Criminogenic Needs
Substance Dependence or Addiction1. Binge pattern2. Cravings or compulsions3. Withdrawal symptoms
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Criminogenic Needs
Substance Dependence or Addiction1. Binge pattern2. Cravings or compulsions3. Withdrawal symptoms
} Abstinence is a distal goal
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Criminogenic Needs
Substance Dependence or Addiction1. Binge pattern2. Cravings or compulsions3. Withdrawal symptoms
Substance Abuse
} Abstinence is a distal goal
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Criminogenic Needs
Substance Dependence or Addiction1. Binge pattern2. Cravings or compulsions3. Withdrawal symptoms
Substance Abuse
} Abstinence is a distal goal
Abstinence is a proximal goal}
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Criminogenic Needs
Substance Dependence or Addiction1. Binge pattern2. Cravings or compulsions3. Withdrawal symptoms
Substance Abuse
Collateral needs– Dual diagnosis– Chronic medical condition (e.g., HIV+, HCV, diabetes)– Homelessness, chronic unemployment
} Abstinence is a distal goal
Abstinence is a proximal goal}
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Criminogenic Needs
Substance Dependence or Addiction1. Binge pattern2. Cravings or compulsions3. Withdrawal symptoms
Substance Abuse
Collateral needs– Dual diagnosis– Chronic medical condition (e.g., HIV+, HCV, diabetes)– Homelessness, chronic unemployment
} Abstinence is a distal goal
Abstinence is a proximal goal}
} Regimen compliance is proximal
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High Risk Low Risk
High Needs
Low Needs
Risk & Needs Matrix
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Risk & Needs Matrix
High Risk Low Risk
High Needs
Low Needs
Accountability,Treatment &Habilitation
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Risk & Needs Matrix
High Risk Low Risk
High Needs
Low Needs
Treatment&
Habilitation
Accountability,Treatment &Habilitation
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Risk & Needs Matrix
High Risk Low Risk
High Needs
Low Needs
Accountability&
Habilitation
Treatment&
Habilitation
Accountability,Treatment &Habilitation
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Risk & Needs Matrix
High Risk Low Risk
High Needs
Low Needs
Prevention Accountability
&Habilitation
Treatment&
Habilitation
Accountability,Treatment &Habilitation
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Practice Implications
High Risk Low Risk
High Needs
Low Needs
Status hearings Treatment & habilitation Compliance is proximal Restrictive consequences Positive reinforcement Agonist medication
Noncompliance hearings Treatment & habilitation Treatment is proximal
Positive reinforcement Agonist medication
v.o.p. / status calendar Abstinence is proximal Psychosocial habilitation Restrictive consequences No AA or MET Antagonist medication
Secondary prevention Abstinence is proximal No AA or MET Individual counseling or stratified groups
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Dispositions for Drug Offenders
IncarcerationDrug Courts
Intermediatesanctions
Low riskLow needs
Low riskHigh needs
High riskHigh needs High risk
Low needs
Risk ofDangerousness
Pre-plea diversion
(ARD)Disposition before
judgment (Prop. 36)