Targeting Participants for Drug Courts Douglas B. Marlowe, J.D., Ph.D. National Association of Drug Court Professionals

Targeting Targeting Participants for Drug Participants for Drug

CourtsCourtsDouglas B. Marlowe, J.D., Ph.D.Douglas B. Marlowe, J.D., Ph.D.

National Association of Drug CourtNational 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%%

Rempel et al. Rempel et al. (2012)(2012)

Urban Urban Institute, Institute, CCI & RTICCI & RTI

2233

1313%%

Criminal RecidivismCriminal Recidivism

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:

~2,700 drug courts ~2,700 drug courts (as of 12/31/12)(as of 12/31/12)

x .06 x .06

= 162 harmful drug courts= 162 harmful drug courts

+ another 216 ineffective drug courts+ another 216 ineffective drug courts

Variable Cost BenefitsVariable Cost Benefits

Positive cost benefit

Negative costbenefitEqual cost benefit

~71~71%%

~ ~ 15%15%

1414%%

14% cost beneficial14% cost beneficial

(Downey & Roman, 2010)(Downey & Roman, 2010)

Variable Cost BenefitsVariable Cost Benefits

Positive cost benefit

Negative costbenefitEqual cost benefit

~71~71%%

~ ~ 15%15%

1414%%

14% cost beneficial14% cost beneficial

(Downey & Roman, 2010)(Downey & Roman, 2010)

Most are cost neutralMost are cost neutral

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%

10%*

Lowenkamp et al., Lowenkamp et al., 20052005

Twice the reductionTwice the reduction in rearrestsin rearrests}}

8%

*p <.05

“Moderator analysis”

Drug Courts That Accepted Participants With Non-Drug Charges Had Nearly Twice the

Reduction in Recidivism

*p <.05

Non-drug charges included property, theft, prostitution and forgery offenses Carey et al. Carey et al.

(2012)(2012)

Drug Courts That Accepted Participants With Prior Violence Had Equivalent Reductions in

Recidivism

p = n.s.

Carey et al. Carey et al. (2012)(2012)

Drug Courts That Excluded Participants with Serious Mental Health Problems Had Over 50%

Less Cost Savings

*p <.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”

{~~ 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 difficult prognosis or Risk essentially means a difficult prognosis or lesser amenability to treatmentlesser 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)

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

Need PrincipleNeed Principle• Clinical disorders or functional impairmentsClinical disorders or functional impairments

• Target criminogenic needs firstTarget criminogenic needs first

• 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 contraindicated Mixing need levels is contraindicated (don’t do it!)(don’t do it!)

(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 distal goal



Substance AbuseSubstance Abuse






Abstinence is a proximal goal}




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 proximal


Alternative TracksAlternative TracksHigh RiskHigh Risk Low RiskLow Risk

High High NeedsNeeds

(dependent)(dependent)

Low Low NeedsNeeds

(abuse)(abuse)

Standard Track

Accountability,Accountability,Treatment &Treatment &HabilitationHabilitation

Treatment Track TreatmentTreatment

&&HabilitationHabilitation

Supervision Track AccountabilityAccountability

&&HabilitationHabilitation

Diversion Track Secondary PreventionSecondary Prevention

Documents

Targeting Participants for Drug Courts Douglas B. Marlowe, J.D., Ph.D. National Association of Drug Court Professionals