Assessment of Alcohol-Involved Offenders Douglas B. Marlowe, J.D., Ph.D. National Association of Drug Court Professionals Treatment Research Institute.

Assessment of Assessment of Alcohol-Involved Alcohol-Involved

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

National Association of Drug Court ProfessionalsNational Association of Drug Court Professionals

Treatment Research Institute at the Treatment Research Institute at the University of PennsylvaniaUniversity of Pennsylvania

Levels of AssessmentLevels of Assessment

CharginChargingg& &

ReleaseRelease

Legal ScreeningLegal Screening

Clinical EvaluationClinical Evaluation

PerformancePerformanceMonitoringMonitoring • Behavioral ChangeBehavioral Change

• Attitudinal ChangeAttitudinal Change

Clinical Screening (PSI)Clinical Screening (PSI) Sentencing Sentencing & &

dispositiondisposition

• Level of CareLevel of Care

• Service Service MatchingMatching

• Criminal historyCriminal history• Flight riskFlight risk• Risk of dangerousnessRisk of dangerousness

• Risk of dangerousnessRisk of dangerousness• Prognostic risksPrognostic risks• Criminogenic needsCriminogenic needs

• ASAM placementASAM placement• BiopsychosocialBiopsychosocial

• Urine screensUrine screens• MotivationMotivation• Self efficacySelf efficacy• HostilityHostility• Satisfaction . . .Satisfaction . . .

(Prosecution) (Prosecution)

(Probation / Pre-trial) (Probation / Pre-trial)

(Treatment) (Treatment)

(??) (??)

In the Real World . . .In the Real World . . .• Legal screening drives dispositions & pleasLegal screening drives dispositions & pleas

• Clinical assessment performed after dispositionClinical assessment performed after disposition

• Duplication and fragmentation of effortDuplication and fragmentation of effort

• Risks and needs assessed separatelyRisks and needs assessed separately

• Risk equated with dangerousnessRisk equated with dangerousness

• Wrong factors evaluatedWrong factors evaluated

• Wrong tools usedWrong tools used

• Tools not normed or validated for Tools not normed or validated for alcohol offendersalcohol offenders

In an Ideal World . . .In an Ideal World . . .

Arrest On dispositionArraignment;bail hearing

Trial Sentencing

Medical crisis(e.g., acute withdrawal, DTs)

Stability; daily living skills; violence potential

Intoxication defenses

• Risk of dangerousness (in or out decision)• Prognostic risks• Criminogenic needs

Performance measures

In an Ideal World . . .In an Ideal World . . .

Arrest On dispositionArraignment;bail hearing

Trial SentencingSentencing

Medical crisis(e.g., acute withdrawal, DTs)

Stability; daily living skills; violence potential

Intoxication defenses

• Risk of dangerousnessRisk of dangerousness (in or out decision)(in or out decision)• Prognostic risksPrognostic risks• Criminogenic needsCriminogenic needs

Performance measures

Dispositions for Alcohol Dispositions for Alcohol OffendersOffenders

Diversion (ARD) Incarceration

Probation w/o verdict

DWI / Drug Courts

Intermediatesanctions

Psychosocial Psychosocial FunctioningFunctioning

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

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

$$Public Safety

Public Safety RisksRisks

Risk of DangerousnessRisk of Dangerousness

• History of violence or dangerousness (incl. DWI)History of violence or dangerousness (incl. DWI)

• PsychopathyPsychopathy

• Substance abuse & psychosis or dementiaSubstance abuse & psychosis or dementia

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

• Antisocial Personality DisorderAntisocial Personality Disorder

• Familial history of crime or addictionFamilial history of crime or addiction

• Criminal associationsCriminal associations

Criminogenic NeedsCriminogenic Needs

Substance Dependence or AddictionSubstance Dependence or 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

Criminogenic NeedsCriminogenic Needs

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

} 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 Abuse Substance Abuse

} 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 Abuse Substance Abuse

} 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 Abuse Substance Abuse

Mental illnessMental illness

Functional impairmentsFunctional impairments

} 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 Abuse Substance Abuse

Mental illnessMental illness

Functional impairmentsFunctional impairments

} Abstinence is a distal goal

Abstinence is a proximal goal}

} Regimen compliance is a proximal goal

Risk & Needs MatrixRisk & Needs Matrix

High RiskHigh Risk Low RiskLow Risk

High High NeedsNeeds

Low Low NeedsNeeds

AccountabilityAccountability&&

TreatmentTreatment

TreatmentTreatment

PreventionPrevention

AccountabilityAccountability

Practice ImplicationsPractice Implications

High RiskHigh Risk Low RiskLow Risk

High High NeedsNeeds

Low Low NeedsNeeds

Status hearingsStatus hearings Intensive treatmentIntensive treatment ComplianceCompliance is proximal is proximal Restrictive consequencesRestrictive consequences Positive reinforcementPositive reinforcement

Noncompliance hearingsNoncompliance hearings Intensive treatment Intensive treatment TreatmentTreatment is proximal is proximal

Positive reinforcementPositive reinforcement

v.o.p. / status calendarv.o.p. / status calendar AbstinenceAbstinence is proximal is proximal Psychosocial rehab.Psychosocial rehab. Restrictive consequencesRestrictive consequences NoNo AA or MET AA or MET

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 Alcohol Dispositions for Alcohol OffendersOffenders

Diversion (ARD) Incarceration

Probation w/o verdict

DWI / Drug 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