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

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Targeting Dispositions by Risks Needs

• Douglas B. Marlowe, J.D., Ph.D.

Treatment Research Institute at the University of
Pennsylvania
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Dispositions for Drug Offenders
Psychosocial Functioning

Costs
Public Safety Risks
Diversion (ARD)
Incarceration
Drug / DWI Courts
Probation w/o verdict
Intermediate sanctions
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Prognostic Risks

• Current age lt 25 years
• Delinquent onset lt 16 years
• Substance abuse onset lt 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 Addiction
• Binge pattern
• Cravings or compulsions
• Withdrawal symptoms

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Criminogenic Needs
Abstinence is a distal goal

• Substance Dependence or Addiction
• Binge pattern
• Cravings or compulsions
• Withdrawal symptoms

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Criminogenic Needs
Abstinence is a distal goal

• Substance Dependence or Addiction
• Binge pattern
• Cravings or compulsions
• Withdrawal symptoms
• Substance Abuse

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Criminogenic Needs
Abstinence is a distal goal

• Substance Dependence or Addiction
• Binge pattern
• Cravings or compulsions
• Withdrawal symptoms
• Substance Abuse

• Abstinence is a proximal goal

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Criminogenic Needs
Abstinence is a distal goal

• Substance Dependence or Addiction
• Binge pattern
• Cravings or compulsions
• Withdrawal symptoms
• Substance Abuse
• Collateral needs
• Dual diagnosis
• Chronic medical condition (e.g., HIV, HCV,
  diabetes)
• Homelessness, chronic unemployment

• Abstinence is a proximal goal

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Criminogenic Needs
Abstinence is a distal goal

• Substance Dependence or Addiction
• Binge pattern
• Cravings or compulsions
• Withdrawal symptoms
• Substance Abuse
• Collateral needs
• Dual diagnosis
• Chronic medical condition (e.g., HIV, HCV,
  diabetes)
• Homelessness, chronic unemployment

• Abstinence is a proximal goal

Regimen compliance is proximal

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Risk Needs Matrix
High Risk
Low Risk
High Needs
Low Needs
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Risk Needs Matrix
High Risk
Low Risk
Accountability, Treatment Habilitation
High Needs
Low Needs
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Risk Needs Matrix
High Risk
Low Risk
Treatment Habilitation
Accountability, Treatment Habilitation
High Needs
Low Needs
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Risk Needs Matrix
High Risk
Low Risk
Treatment Habilitation
Accountability, Treatment Habilitation
High Needs
Accountability Habilitation
Low Needs
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Risk Needs Matrix
High Risk
Low Risk
Treatment Habilitation
Accountability, Treatment Habilitation
High Needs
Prevention
Accountability Habilitation
Low Needs
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Practice Implications
High Risk
Low Risk

• Noncompliance hearings
• Treatment habilitation
• Treatment is proximal
• Positive reinforcement
• Agonist medication

• Status hearings
• Treatment habilitation
• Compliance is proximal
• Restrictive consequences
• Positive reinforcement
• Agonist medication

High Needs

• Secondary prevention
• Abstinence is proximal
• No AA or MET
• Individual counseling
• or stratified groups

• v.o.p. / status calendar
• Abstinence is proximal
• Psychosocial habilitation
• Restrictive consequences
• No AA or MET
• Antagonist medication

Low Needs
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Dispositions for Drug Offenders

Risk of Dangerousness
High risk High needs
Low risk Low needs
High risk Low needs
Low risk High needs
Diversion (ARD)
Incarceration
Drug / DWI Courts
Probation w/o verdict
Intermediate sanctions