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

Effective Use of Rewards & Sanctions National Association of Drug Court Professionals Douglas B. Marlowe, J.D., Ph.D.

Basic Terminology SANCTION REWARD Punishment Positive Reinforcement GIVE Negative Reinforcement Response Cost TAKE

Carrot and Stick • Reduce undesirable behaviors and increase desirable behaviors • Positive vs. negative reinforcement

Certainty • Reliable detection is most influential • Random drug testing twice per week, including weekends & holidays • Sufficient detection windows & panels • Community supervision • Last supervisory burdens to be lifted • Second chances

Celerity • Timing is second most influential • Interference from new behaviors • Status hearings every 2 weeks until the case has stabilized • Noncompliance hearings where indicated

MINIMAL MODERATE Magnitude Effective Zone Habituation Effects Ceiling Effects EFFECTIVENESS SEVERE MAGNITUDE OF SANCTION

Incentive & Sanction Lists http://ndcrc.org/content/list-incentives-and-sanctions

Procedural Fairness • Clearly communicated policies and procedures • Presumptive consequences with flexible application • Opportunity to be heard • Respect and dignity

Target Behaviors • Don’t expect too much • Learned helplessness and ratio burden • Don’t expect too little • Habituation • Proximal vs. distal goals • Phase specificity • What was once distal becomes proximal

Treat or Punish? Substance Dependence or Addiction

Treat or Punish? Substance Dependence or Addiction • Triggered binge pattern • Cravings or compulsions • Withdrawal symptoms

Treat or Punish? Abstinence is a distal goal Substance Dependence or Addiction • Triggered binge pattern • Cravings or compulsions • Withdrawal symptoms }

Treat or Punish? Abstinence is a distal goal Substance Dependence or Addiction • Triggered binge pattern • Cravings or compulsions • Withdrawal symptoms Substance Abuse }

Treat or Punish? Abstinence is a distal goal Substance Dependence or Addiction • Triggered binge pattern • Cravings or compulsions • Withdrawal symptoms Substance Abuse Abstinence is a proximal goal } }

Treat or Punish? Abstinence is a distal goal Substance Dependence or Addiction • Triggered 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 } }

Treat or Punish? Abstinence is a distal goal Substance Dependence or Addiction • Triggered 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 } }

Tangible Rewards • Most important for reinforcement-starved participants • Fishbowl procedure or point systems • Symbolic rewards

Phase Regression • An example of response cost • Often a sign that services were withdrawn prematurely • Temporary regression and remedial plan (accelerated redemption) • Avoid the Abstinence Violation Effect (A.V.E.)

Readings Burdon WM et al (2001). Drug courts and contingency management. Journal of Drug Issues, 31, 73-90. Harrell A & Roman J (2001). Reducing drug use and crime among offenders: The impact of graduated sanctions. Journal of Drug Issues, 31, 207-232. Marlowe DB (2007). Strategies for administering rewards and sanctions. In JE Lessenger & GF Roper (Eds.), Drug courts: A new approach to treatment and rehabilitation (pp. 317-336). New York: Springer. Marlowe DB (2008). Application of sanctions. In Drug Court Quality Improvement Monograph. Alexandria, VA: NDCI. Marlowe DB & Wong CJ (2008). Contingency management in adult criminal drug courts (pp. 334-354). In ST Higgins, K Silverman & SH Heil (Eds.), Contingency management in substance abuse treatment. New York: Guilford. Marlowe DB (2011). Applying incentives and sanctions. In The drug court judicial benchbook (pp.139-157). Alexandria, VA: NDCI.

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