Douglas B. Marlowe, J.D., Ph.D. Treatment Research Institute at the University of Pennsylvania TRI science addiction Targeting Dispositions by Risks &

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

Treatment Research Institute at the

University of Pennsylvania

TRIscience

addiction

Targeting Targeting Dispositions by Risks Dispositions by Risks

& Needs & Needs

Dispositions for Drug Dispositions for Drug OffendersOffenders

Diversion (ARD) Incarceration

Probation w/o verdict

Drug / DWI Courts

Intermediatesanctions

Psychosocial Psychosocial FunctioningFunctioning

$$$$$$ Costs $$$$$$$$

$$$$$$ Costs $$$$$$$$

$$Public Safety

Public Safety RisksRisks

Prognostic RisksPrognostic Risks

TRIscience

addiction

• 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

Criminogenic NeedsCriminogenic Needs

Substance Dependence or AddictionSubstance Dependence or Addiction

TRIscience

addiction

Criminogenic NeedsCriminogenic Needs

Substance Dependence or AddictionSubstance Dependence or Addiction1.1. Binge patternBinge pattern2.2. Cravings or compulsionsCravings or compulsions3.3. Withdrawal symptomsWithdrawal symptoms

TRIscience

addiction

Criminogenic NeedsCriminogenic Needs

Substance Dependence or AddictionSubstance Dependence or Addiction1.1. Binge patternBinge pattern2.2. Cravings or compulsionsCravings or compulsions3.3. Withdrawal symptomsWithdrawal symptoms

TRIscience

addiction

} Abstinence is a distal goal

Criminogenic NeedsCriminogenic Needs

Substance Dependence or AddictionSubstance Dependence or Addiction1.1. Binge patternBinge pattern2.2. Cravings or compulsionsCravings or compulsions3.3. Withdrawal symptomsWithdrawal symptoms

Substance AbuseSubstance Abuse

TRIscience

addiction

} Abstinence is a distal goal

Criminogenic NeedsCriminogenic Needs

Substance Dependence or AddictionSubstance Dependence or Addiction1.1. Binge patternBinge pattern2.2. Cravings or compulsionsCravings or compulsions3.3. Withdrawal symptomsWithdrawal symptoms

Substance AbuseSubstance Abuse

TRIscience

addiction

} Abstinence is a distal goal

Abstinence is a proximal goal}

Criminogenic NeedsCriminogenic Needs

Substance Dependence or AddictionSubstance Dependence or Addiction1.1. Binge patternBinge pattern2.2. Cravings or compulsionsCravings or compulsions3.3. Withdrawal symptomsWithdrawal symptoms

Substance AbuseSubstance Abuse

Collateral needsCollateral needs– Dual diagnosisDual diagnosis– Chronic medical condition (e.g., HIV+, HCV, diabetes)Chronic medical condition (e.g., HIV+, HCV, diabetes)– Homelessness, chronic unemployment Homelessness, chronic unemployment

TRIscience

addiction

} Abstinence is a distal goal

Abstinence is a proximal goal}

Criminogenic NeedsCriminogenic Needs

Substance Dependence or AddictionSubstance Dependence or Addiction1.1. Binge patternBinge pattern2.2. Cravings or compulsionsCravings or compulsions3.3. Withdrawal symptomsWithdrawal symptoms

Substance AbuseSubstance Abuse

Collateral needsCollateral needs– Dual diagnosisDual diagnosis– Chronic medical condition (e.g., HIV+, HCV, diabetes)Chronic medical condition (e.g., HIV+, HCV, diabetes)– Homelessness, chronic unemployment Homelessness, chronic unemployment

TRIscience

addiction

} Abstinence is a distal goal

Abstinence is a proximal goal}

} Regimen compliance is proximal

TRIscience

addiction

High RiskHigh Risk Low RiskLow Risk

High High NeedsNeeds

Low Low NeedsNeeds

Risk & Needs MatrixRisk & Needs Matrix

Risk & Needs MatrixRisk & Needs Matrix

TRIscience

addiction

High RiskHigh Risk Low RiskLow Risk

High High NeedsNeeds

Low Low NeedsNeeds

Accountability,Accountability,Treatment &Treatment &HabilitationHabilitation

Risk & Needs MatrixRisk & Needs Matrix

TRIscience

addiction

High RiskHigh Risk Low RiskLow Risk

High High NeedsNeeds

Low Low NeedsNeeds

TreatmentTreatment&&

HabilitationHabilitation

Accountability,Accountability,Treatment &Treatment &HabilitationHabilitation

Risk & Needs MatrixRisk & Needs Matrix

TRIscience

addiction

High RiskHigh Risk Low RiskLow Risk

High High NeedsNeeds

Low Low NeedsNeeds

AccountabilityAccountability&&

HabilitationHabilitation

TreatmentTreatment&&

HabilitationHabilitation

Accountability,Accountability,Treatment &Treatment &HabilitationHabilitation

Risk & Needs MatrixRisk & Needs Matrix

TRIscience

addiction

High RiskHigh Risk Low RiskLow Risk

High High NeedsNeeds

Low Low NeedsNeeds

PreventionPrevention AccountabilityAccountability

&&HabilitationHabilitation

TreatmentTreatment&&

HabilitationHabilitation

Accountability,Accountability,Treatment &Treatment &HabilitationHabilitation

Practice ImplicationsPractice Implications

TRIscience

addiction

High RiskHigh Risk Low RiskLow Risk

High High NeedsNeeds

Low Low NeedsNeeds

Status hearingsStatus hearings Treatment & habilitationTreatment & habilitation ComplianceCompliance is proximal is proximal Restrictive consequencesRestrictive consequences Positive reinforcementPositive reinforcement Agonist medicationAgonist medication

Noncompliance hearingsNoncompliance hearings Treatment & habilitationTreatment & habilitation TreatmentTreatment is proximal is proximal

Positive reinforcementPositive reinforcement Agonist medicationAgonist medication

v.o.p. / status calendarv.o.p. / status calendar AbstinenceAbstinence is proximal is proximal Psychosocial habilitationPsychosocial habilitation Restrictive consequencesRestrictive consequences NoNo AA or MET AA or MET Antagonist medicationAntagonist medication

Secondary prevention Secondary prevention AbstinenceAbstinence is proximal is proximal NoNo AA or MET AA or MET Individual counselingIndividual counseling oror stratified groups stratified groups

Dispositions for Drug Dispositions for Drug OffendersOffenders

Diversion (ARD) Incarceration

Probation w/o verdict

Drug / DWI Courts

Intermediatesanctions

Low riskLow riskLow Low needsneeds

Low riskLow riskHigh High needsneeds

High riskHigh riskHigh High needsneeds High riskHigh risk

Low Low needsneeds

Risk ofRisk ofDangerousnesDangerousnesss

Ok, Mr. Big Shot . . .Ok, Mr. Big Shot . . .

PROVE IT!PROVE IT!

““Key Components”Key Components”

• Judicial status hearings

• Graduated sanctions & rewards

• Urine drug screens

• Drug abuse treatment

• Case management

• Nolle prosse or conditions-served

• Expunged record (diversion)

TRIscience

addiction

(NADCP, 1997)(NADCP, 1997)

““Key Components”Key Components”

Judicial status hearings

• Graduated sanctions & rewards

• Urine drug screens

• Drug abuse treatment

• Case management

• Nolle prosse or conditions-served

• Expunged record (diversion)

TRIscience

addiction

(NADCP, 1997)(NADCP, 1997)

Matching DesignMatching Design

TRIscience

addiction

High Risk Low Risk

Matched

Unmatched

Bi-Weekly(n = 42)

As Needed(n = 95)

As Usual(monthly)

(n = 50)

(n = 92)

0

10

20

30

40

50

60

70

80

1 2 3 4 5 6 7 8 9 10 11 12 13 14

Week in Drug Court

% d

rug

-fre

e u

rin

e sa

mp

les

matchedlow-riskmatchedhigh-risknonmatchedhigh-risknonmatchedlow-risk

a

a

a

b

% Drug-free Urines by % Drug-free Urines by GroupGroup

TRIscience

addiction

p p < .001< .001

0

10

20

30

40

50

60

70

80

1 2 3 4 5 6 7 8 9 10 11 12 13 14

Week in Drug Court

% d

rug

-fre

e u

rin

e sa

mp

les

matchedlow-riskmatchedhigh-risknonmatchedhigh-risknonmatchedlow-risk

a

a

a

b

% Drug-free Urines by % Drug-free Urines by GroupGroup

TRIscience

addiction

p p < .001< .001

0

10

20

30

40

50

60

70

80

1 2 3 4 5 6 7 8 9 10 11 12 13 14

Week in Drug Court

% d

rug

-fre

e u

rin

e sa

mp

les

matchedlow-riskmatchedhigh-risknonmatchedhigh-risknonmatchedlow-risk

a

a

a

b

% Drug-free Urines by % Drug-free Urines by GroupGroup

TRIscience

addiction

p p < .001< .001

0

10

20

30

40

50

60

70

80

1 2 3 4 5 6 7 8 9 10 11 12 13 14

Week in Drug Court

% d

rug

-fre

e u

rin

e sa

mp

les

matchedlow-riskmatchedhigh-risknonmatchedhigh-risknonmatchedlow-risk

a

a

a

b

% Drug-free Urines by % Drug-free Urines by GroupGroup

TRIscience

addiction

p p < .001< .001

Drug-Positive Urines: 6 Drug-Positive Urines: 6 Mos.Mos.

TRIscience

addiction

50%

8%

44%

64%

0%

20%

40%

60%

80%

100%

UA

Dru

g P

osit

ive

Matched Unmatched

Low riskHigh risk

* * p < .05

**

**

Graduation Rates: 12 Graduation Rates: 12 mos.mos.

TRIscience

addiction

72% 75% 75%

56%

0%

20%

40%

60%

80%

100%

Gra

du

ati

on

Rate

Matched Unmatched

Low riskHigh risk

* * p < .05

**

““Key Components”Key Components”

Judicial status hearings

• Graduated sanctions & rewards

• Urinalyses

• Drug abuse treatment

• Case management

• Nolle prosse or time served

• Expunged record (diversion)

TRIscience

addiction

(NADCP, 1997)(NADCP, 1997)

““Key Components”Key Components”

Judicial status hearings

Graduated sanctions & rewards

• Urinalyses

• Drug abuse treatment

• Case management

• Nolle prosse or time served

• Expunged record (diversion)

TRIscience

addiction

(NADCP, 1997)(NADCP, 1997)

Months of compliance

STANDARDREWARDS

1 Applause; hat / candle;

framed certificate; travel

2

3

4Applause; keychain;

certificate; ↓↓hearings & UA

5

6

7

8Applause; certificate; travel; ↓↓ hearings & UA

9

10

11

12 Grad ceremony; framed plaque; dismissal

Total

RewardsRewards

Months of compliance

STANDARDREWARDS

ESCALATING REWARDS

1 Applause; hat / candle;

framed certificate; travel$5.00 gift certificate

2 $10.00 gift certificate

3 $15.00 gift certificate

4Applause; keychain;

certificate; ↓↓hearings & UA

$20.00 gift certificate

5 $25.00 gift certificate

6 $30.00 gift certificate

7 $35.00 gift certificate

8Applause; certificate; travel; ↓↓ hearings & UA

$40.00 gift certificate

9 $45.00 gift certificate

10 $50.00 gift certificate

11 $55.00 gift certificate

12 Grad ceremony; framed plaque; dismissal

$60.00 gift certificate

Total $390.00

RewardsRewards

Months of compliance

STANDARDREWARDS

ESCALATING REWARDS

THINNING REWARDS

1 Applause; hat / candle;

framed certificate; travel$5.00 gift certificate

$30.00 gift certificate

2 $10.00 gift certificate $30.00 gift certificate

3 $15.00 gift certificate $30.00 gift certificate

4Applause; keychain;

certificate; ↓↓hearings & UA

$20.00 gift certificateEligible for $50.00 gift certificate if compliant one additional month

5 $25.00 gift certificate $50.00 gift certificate

6 $30.00 gift certificateEligible for $50.00 gift certificate if compliant one additional month

7 $35.00 gift certificate $50.00 gift certificate

8Applause; certificate; travel; ↓↓ hearings & UA

$40.00 gift certificateEligible for $75.00 gift certificate if compliant one additional month

9 $45.00 gift certificate $75.00 gift certificate

10 $50.00 gift certificateEligible for $125.00 gift certificate if compliant two additional months

11 $55.00 gift certificateEligible for $125.00 gift certificate if compliant one additional month

12 Grad ceremony; framed plaque; dismissal

$60.00 gift certificate$125.00 gift certificate

Total $390.00 $390.00

RewardsRewards

# Drug-Free Urines (13 mos.)# Drug-Free Urines (13 mos.)

TRIscience

addiction

33.5 34.837.6

0

10

20

30

40

50

60

To

tal D

rug

-Fre

e U

rin

es

As Usual Escalating Thinningn=61n=61 n=60n=60 n=60n=60

p = n.s.

Mean % Sessions AttendedMean % Sessions Attended

TRIscience

addiction

87%82%

88%

0%

25%

50%

75%

100%

As Usual Escalating Thinningn=61n=61 n=60n=60 n=60n=60

p = n.s.

Mean % Drug-Free UrinesMean % Drug-Free Urines

TRIscience

addiction

77%

82%84% 84%

90%

80%

60%

70%

80%

90%

As Usual Escalating Thinning

High risk

Low risk

*p < .05n=3n=344

n=2n=299

n=3n=344

n=2n=299

n=2n=266

n=2n=244

Remaining ConcernsRemaining Concerns• Measurement errorMeasurement error

• DissimulationDissimulation

• Treatment needs vs. supervision needs Treatment needs vs. supervision needs

• Changing circumstancesChanging circumstances

• Non-compliance vs. non-responsivenessNon-compliance vs. non-responsiveness

• Individualized vs. standard responsesIndividualized vs. standard responses

ADAPTIVE INTERVENTION

ADAPTIVE INTERVENTION

Baseline Risk Assessment

ADAPTIVE INTERVENTION

Baseline Risk Assessment

BI-WEEKLY COURT HEARINGS

High RiskHigh Risk

ADAPTIVE INTERVENTION

AS-NEEDED COURT HEARINGS

Baseline Risk Assessment

BI-WEEKLY COURT HEARINGS

High RiskHigh Risk Low RiskLow Risk

ADAPTIVE INTERVENTION

Monthly Progress

Assessments

AS-NEEDED COURT HEARINGS

Baseline Risk Assessment

BI-WEEKLY COURT HEARINGS

High RiskHigh Risk Low RiskLow Risk

ADAPTIVE INTERVENTION

Monthly Progress

Assessments

AS-NEEDED COURT HEARINGS

Baseline Risk Assessment

BI-WEEKLY COURT HEARINGS

High RiskHigh Risk Low RiskLow Risk

NON-COMPLIANTNON-COMPLIANT ≥ 2 missed counseling sessions

and/or ≥ 2 missed urine specimens

If As-Needed:

BI-WEEKLY COURT

HEARINGS

ADAPTIVE INTERVENTION

Monthly Progress

Assessments

AS-NEEDED COURT HEARINGS

Baseline Risk Assessment

BI-WEEKLY COURT HEARINGS

High RiskHigh Risk Low RiskLow Risk

NON-COMPLIANTNON-COMPLIANT ≥ 2 missed counseling sessions

and/or ≥ 2 missed urine specimens

If As-Needed:

BI-WEEKLY COURT

HEARINGS

ADAPTIVE INTERVENTION

If Bi-Weekly:

JEOPARDY CONTRACT

Monthly Progress

Assessments

AS-NEEDED COURT HEARINGS

Baseline Risk Assessment

BI-WEEKLY COURT HEARINGS

High RiskHigh Risk Low RiskLow Risk

NON-COMPLIANTNON-COMPLIANT ≥ 2 missed counseling sessions

and/or ≥ 2 missed urine specimens

If As-Needed:

BI-WEEKLY COURT

HEARINGS

ADAPTIVE INTERVENTION

If Bi-Weekly:

JEOPARDY CONTRACT

Monthly Progress

Assessments

AS-NEEDED COURT HEARINGS

Baseline Risk Assessment

BI-WEEKLY COURT HEARINGS

High RiskHigh Risk Low RiskLow Risk

NON-COMPLIANTNON-COMPLIANT ≥ 2 missed counseling sessions

and/or ≥ 2 missed urine specimens

NON-RESPONSIVENON-RESPONSIVE

≥ 2 drug-positive urines

If As-Needed:

BI-WEEKLY COURT

HEARINGS

ADAPTIVE INTERVENTION

INTENSIVE CLINICAL CASE MANAGEMENT

If Bi-Weekly:

JEOPARDY CONTRACT

Monthly Progress

Assessments

AS-NEEDED COURT HEARINGS

Baseline Risk Assessment

BI-WEEKLY COURT HEARINGS

High RiskHigh Risk Low RiskLow Risk

NON-COMPLIANTNON-COMPLIANT ≥ 2 missed counseling sessions

and/or ≥ 2 missed urine specimens

NON-RESPONSIVENON-RESPONSIVE

≥ 2 drug-positive urines

If As-Needed:

BI-WEEKLY COURT

HEARINGS

ADAPTIVE INTERVENTION

INTENSIVE CLINICAL CASE MANAGEMENT

If Bi-Weekly:

JEOPARDY CONTRACT

Monthly Progress

Assessments

AS-NEEDED COURT HEARINGS

Baseline Risk Assessment

BI-WEEKLY COURT HEARINGS

High RiskHigh Risk Low RiskLow Risk

NON-COMPLIANTNON-COMPLIANT ≥ 2 missed counseling sessions

and/or ≥ 2 missed urine specimens

NON-RESPONSIVENON-RESPONSIVE

≥ 2 drug-positive urines

RESPONSIVE & RESPONSIVE & COMPLIANTCOMPLIANT

If As-Needed:

BI-WEEKLY COURT

HEARINGS

ADAPTIVE INTERVENTION

INTENSIVE CLINICAL CASE MANAGEMENT

If Bi-Weekly:

JEOPARDY CONTRACT

CONTINUE AS PREVIOUSLY

ASSIGNED

Monthly Progress

Assessments

AS-NEEDED COURT HEARINGS

Baseline Risk Assessment

BI-WEEKLY COURT HEARINGS

High RiskHigh Risk Low RiskLow Risk

NON-COMPLIANTNON-COMPLIANT ≥ 2 missed counseling sessions

and/or ≥ 2 missed urine specimens

NON-RESPONSIVENON-RESPONSIVE

≥ 2 drug-positive urines

RESPONSIVE & RESPONSIVE & COMPLIANTCOMPLIANT

If As-Needed:

BI-WEEKLY COURT

HEARINGS

ADAPTIVE INTERVENTION

INTENSIVE CLINICAL CASE MANAGEMENT

RESPONSIVE & RESPONSIVE & COMPLIANTCOMPLIANT

NON-RESPONSIVENON-RESPONSIVE

≥ 2 drug-positive urines

If Bi-Weekly:

JEOPARDY CONTRACT

CONTINUE AS PREVIOUSLY

ASSIGNED

Monthly Progress

Assessments

AS-NEEDED COURT HEARINGS

Baseline Risk Assessment Low RiskLow RiskHigh RiskHigh Risk

BI-WEEKLY COURT HEARINGS

NON-COMPLIANTNON-COMPLIANT ≥ 2 missed counseling sessions

and/or ≥ 2 missed urine specimens

Graduated: 20 WeeksGraduated: 20 Weeks

33%

0%

60%

38%

50%

21%

0%

20%

40%

60%

80%

High Risk Low Risk Total

Adaptive

As-Usual

p = .14ES = 0.6 (moderate)

n=6n=6 n=6n=6 n=10n=10 n=16n=16n=8n=8 n=14n=14

On Warrant StatusOn Warrant Status

17%

50%

10% 13% 13%

29%

0%

20%

40%

60%

80%

High Risk Low Risk Total

Adaptive

As-Usual

p = .27ES = 0.4 (moderate)

n=6n=6 n=6n=6 n=10n=10 n=16n=16n=8n=8 n=14n=14

% Drug-Free Urines% Drug-Free Urines

48%

40%

74%

54%

64%

48%

0%

20%

40%

60%

80%

High Risk Low Risk Total

Adaptive

As-Usual

p = .28ES = 0.4 (moderate)

n=6n=6 n=6n=6 n=10n=10 n=16n=16n=8n=8 n=14n=14

Ultimately GraduatedUltimately Graduated

79%88%

0%

20%

40%

60%

80%

100%

Adaptive As-Usual p = .43ES = 0.12 (small)

Days to GraduationDays to Graduation

0

40

80

120

160

200

240

280

Adaptive As-Usual

161.79

(73.75)

277.91277.91(168.9(168.9

3)3)

p = .03ES = 0.92 (large)

Days to Case ResolutionDays to Case Resolution

0

40

80

120

160

200

240

280

320

Adaptive As-Usual

171.50

(74.74)

307.64307.64(194.1(194.1

8)8)

p = .01ES = 0.96 (large)

Response OrderedResponse Ordered

31%

88%

0%

20%

40%

60%

80%

100%

Adaptive As-Usual

Days to a ResponseDays to a Response

89.67 (79.61)

16.25 (24.66)

0

20

40

60

80

100

Adaptive As-Usual

Cost ImplicationsCost Implications

• Avg. annual cost per participant Avg. annual cost per participant **– administration =administration = $ 4,000.00 $ 4,000.00 – outpatient treatment =outpatient treatment = + + $ 7,000.00$ 7,000.00

$11,000.00$11,000.00• Resolution in 4 fewer mos. Resolution in 4 fewer mos. ÷ ÷ 1/3 yr. 1/3 yr. • Potential costs savings = Potential costs savings = $ 3,700.00$ 3,700.00

* * Urban Institute, Urban Institute, 20082008

Cost ImplicationsCost Implications

• Avg. annual cost per participant Avg. annual cost per participant **– administration =administration = $ 4,000.00 $ 4,000.00 – outpatient treatment =outpatient treatment = + + $ 7,000.00$ 7,000.00

$11,000.00$11,000.00• Resolution in 4 fewer mos. Resolution in 4 fewer mos. ÷ ÷ 1/3 yr. 1/3 yr. • Potential costs savings = Potential costs savings = $ 3,700.00$ 3,700.00

Per participant per Per participant per year!year!

* * Urban Institute, Urban Institute, 20082008

SummarySummary

• One size does One size does notnot fit all fit all

• Drug courts are best suited for high risk Drug courts are best suited for high risk and high needs offendersand high needs offenders

• When possible, separate court calendars When possible, separate court calendars and treatment tracks should be held for and treatment tracks should be held for high risk vs. low risk clientshigh risk vs. low risk clients

• You may need to be nicest to the clients You may need to be nicest to the clients you might like the leastyou might like the least

TRIscience

addiction

Summary (cont.)Summary (cont.)

• Adaptive algorithms consistently Adaptive algorithms consistently outperform individualized professional outperform individualized professional judgmentjudgment

• Better outcomes in less timeBetter outcomes in less time

• Time = $$$$!Time = $$$$!

References References

TRIscience

addiction

Marlowe, DB et al. (2008). Adaptive interventions in drug court: A pilot Marlowe, DB et al. (2008). Adaptive interventions in drug court: A pilot experiment. experiment. Criminal Justice Review, 33Criminal Justice Review, 33, 343-360., 343-360.

Marlowe, DB et al. (in press). Adaptive interventions may optimize Marlowe, DB et al. (in press). Adaptive interventions may optimize outcomes in drug courts: A pilot study. outcomes in drug courts: A pilot study. Current Psychiatry ReportsCurrent Psychiatry Reports..

Marlowe, DB et al. (2007). Adapting judicial supervision to the risk level Marlowe, DB et al. (2007). Adapting judicial supervision to the risk level of drug offenders: Discharge and six-month outcomes from a of drug offenders: Discharge and six-month outcomes from a prospective matching study. prospective matching study. Drug & Alcohol Dependence, 88SDrug & Alcohol Dependence, 88S, 4-13., 4-13.

Marlowe, DB et al. (2006). Matching judicial supervision to clients’ risk Marlowe, DB et al. (2006). Matching judicial supervision to clients’ risk status in drug court. status in drug court. Crime & Delinquency, 52Crime & Delinquency, 52, 52-76. , 52-76.

AcknowledgmentAcknowledgment

National Institute on Drug AbuseNational Institute on Drug Abuse

Grant #R01-DA-13096