Assessment of Alcohol-Involved Offenders

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

Levels of Assessment • Legal Screening • Criminal history • Flight risk • Risk of dangerousness • (Prosecution) • Charging • & Release • Clinical Screening (PSI) • Risk of dangerousness • Prognostic risks • Criminogenic needs • (Probation / Pre-trial) • Sentencing • & disposition • Clinical Evaluation • ASAM placement • Biopsychosocial • Level of Care • Service Matching • (Treatment) • Performance • Monitoring • Behavioral Change • Attitudinal Change • Urine screens • Motivation • Self efficacy • Hostility • Satisfaction . . . • (??)

In the Real World . . . • Legal screening drives dispositions & pleas • Clinical assessment performed after disposition • Duplication and fragmentation of effort • Risks and needs assessed separately • Risk equated with dangerousness • Wrong factors evaluated • Wrong tools used • Tools not normed or validated for alcohol offenders

In an Ideal World . . . • Risk of dangerousness • (in or out decision) • Prognostic risks • Criminogenic needs Stability; daily living skills; violence potential Medical crisis (e.g., acute withdrawal, DTs) Performance measures Intoxication defenses Arrest Arraignment; bail hearing Trial Sentencing On disposition

Dispositions for Alcohol Offenders Psychosocial Functioning $$$$$$ Costs $$$$$$$$$ Public Safety Risks Diversion (ARD) DWI / Drug Courts Incarceration Probation w/o verdict Intermediate sanctions

Risk of Dangerousness • History of violence or dangerousness (incl. DWI) • Psychopathy • Substance abuse & psychosis or dementia

Prognostic Risks • Current age < 25 years • Delinquent onset < 16 years • Substance abuse onset < 14 years • Prior rehabilitation failures • Antisocial Personality Disorder • Familial history of crime or addiction • Criminal associations

Criminogenic Needs Substance Dependence or Addiction

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

Criminogenic Needs Abstinence is a distal goal Substance Dependence or Addiction • Binge pattern • Cravings or compulsions • Withdrawal symptoms }

Criminogenic Needs Abstinence is a distal goal Substance Dependence or Addiction • Binge pattern • Cravings or compulsions • Withdrawal symptoms Substance Abuse }

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 } }

Criminogenic Needs Abstinence is a distal goal Substance Dependence or Addiction • Binge pattern • Cravings or compulsions • Withdrawal symptoms Substance Abuse Mental illness Functional impairments Abstinence is a proximal goal } }

Criminogenic Needs Abstinence is a distal goal Substance Dependence or Addiction • Binge pattern • Cravings or compulsions • Withdrawal symptoms Substance Abuse Mental illness Functional impairments Abstinence is a proximal goal } Regimen compliance is a proximal goal } }

Risk & Needs Matrix High Risk Low Risk Treatment Accountability & Treatment High Needs Accountability Prevention Low Needs

Practice Implications High Risk Low Risk • Noncompliance hearings • Intensive treatment • Treatment is proximal • Positive reinforcement • Status hearings • Intensive treatment • Compliance is proximal • Restrictive consequences • Positive reinforcement 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 rehab. • Restrictive consequences • No AA or MET Low Needs

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

Assessment of Alcohol-Involved Offenders