Douglas B. Marlowe, J.D., Ph.D. Chief of Science, Law & Policy. National Association of Drug Court Professionals

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1 Alternative Tracks in Adult Drug Courts Douglas B. Marlowe, J.D., Ph.D. Chief of Science, Law & Policy National Association of Drug Court Professionals

2 Previous Webinar Drug courts reduce crime approximately twice as much for high-risk participants

3 Effect Size by Risk Level 20 Percent reduction in rearrests %* 8% 5% All subjects No crim. hx Crim. hx Twice the reduction }in rearrests *p <.05 Moderator analysis Lowenkamp et al., 2005

4 Drug Courts That Accepted Participants With Non- Drug Charges Had Nearly Twice the Reduction in Recidivism Percent reductions in recidivism 50% 40% 30% 20% 10% 0% 41% Drug court accepts nondrug charges N=42 21% 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)

5 Previous Webinar Drug courts reduce crime approximately twice as much for high-risk participants Drug courts are approximately 50% more costeffective for high-need participants

6 Drug Courts That Excluded Participants with Serious Mental Health Problems Had Over 50% Less Cost Savings 50% 37% 40% 30% 21% 20% 10% 0% Program excludes offenders with serious MH issues N=32 Program does NOT exclude offenders with serious MH issues N=18 *p <.05 Carey et al. (2012)

7 Previous Webinar Drug courts reduce crime approximately twice as much for high-risk participants Drug courts are approximately 50% more costeffective for high-need participants Drug courts are at least as effective and costeffective for offenders with violence histories

8 Drug Courts That Accepted Participants With Prior Violence Had Equivalent Reductions in Recidivism Percent reductions in recidivism 50% 40% 30% 20% 10% 0% Drug Court accepts participants with prior violence N=14 36% 38% Drug Court does NOT accept participants with prior violence N=39 p = n.s. Carey et al. (2012)

Drug Courts That Accepted Participants with Prior Violence Charges Had Equivalent Cost Savings Percent reductions in recidivism 50% 40% 30% 20% 10% 0% Drug

9 Drug Courts That Accepted Participants with Prior Violence Charges Had Equivalent Cost Savings Percent reductions in recidivism 50% 40% 30% 20% 10% 0% Drug Court accepts participants with violence charges N=09 27% 29% Drug Court does NOT accept participants with violence charges N=44 p = n.s. Carey et al. (2012)

10 Previous Webinar Drug courts reduce crime approximately twice as much for high-risk participants Drug courts are approximately 50% more costeffective for high-need participants Drug courts are at least as effective and costeffective for offenders with violence histories Removing eligibility restrictions helps to reach the target population

11 Avg. Benefit Per $1 invested 5 $4.13 Benefit /cost dollar ratio $2.21 $2.15 $3.36 } cost ~ 50% greater benefits 0 current pop. prior violence drug dependence no restrictions Synthetic analysis Bhati et al. (2008)

12 Previous Webinar Drug courts reduce crime approximately twice as much for high-risk participants Drug courts are approximately 50% more costeffective for high-risk participants Drug courts are at least as effective and costeffective for offenders with histories of violence, Removing eligibility restrictions helps to reach the target population Suitability determinations do not improve outcomes

13 Risk Principle Not necessarily a risk for violence or dangerousness Risk essentially means a complicated or difficult prognosis 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

14 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

15 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)

16 Prevalent Needs Substance dependence or addiction ( abuse) Triggered binge response Cravings or compulsions Withdrawal symptoms Co-occurring major Axis I disorder Deficient daily living or employment skills Executive dysfunction (acute or chronic) Impulsivity, emotional reactivity, impaired executive control, poor decision-making ability

Supervision Track Accountability & Habilitation Low Risk

17 Risk & Needs Matrix High Needs (dependent) Low Needs (abuse) High Risk Standard Track Accountability, Treatment & Habilitation Supervision Track Accountability & Habilitation Low Risk Treatment Track Treatment & Habilitation Diversion Track Secondary Prevention

Highlighted Differences High Needs (dependent) Low Needs (abuse) High Risk Status calendar Treatment Pro-social & adaptive habilitation Graduated consequences for substance use Self-help/alumni

18 Highlighted Differences High Needs (dependent) Low Needs (abuse) High Risk Status calendar Treatment Pro-social & adaptive habilitation Graduated consequences for substance use Self-help/alumni groups Status calendar Secondary prevention Pro-social habilitation Substantial consequences for substance use Low Risk Noncompliance calendar Treatment (separate milieu) Adaptive habilitation Graduated consequences for substance use Self-help/alumni groups Noncompliance calendar Psycho-education Zero tolerance for substance use Individual or stratified groups Shorter length of supervision

19 Adjusting Tracks Measurement error is unavoidable Continuous surveillance (at least days) Adaptive algorithms with a-priori decision rules for making adjustments Faster detection of infractions More consistent and reliable consequences Significantly better outcomes in a shorter period of time

Targeting Interventions by Risk, Need, Responsivity DOUGLAS B. MARLOWE, JD, PHD

Targeting Interventions by Risk, Need, Responsivity DOUGLAS B. MARLOWE, JD, PHD Risk Principle Not necessarily a risk for violence or dangerousness Complicated progsis or lesser amenability to treatment