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

TRI. science. addiction. What Makes Drug Courts Effective?. Treatment Research Institute at the University of Pennsylvania. Douglas B. Marlowe, J.D., Ph.D. TRI. science. addiction. “Key Components”. Judicial status hearings Graduated sanctions & rewards Urinalyses

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

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  1. TRI science addiction What Makes Drug Courts Effective? Treatment Research Institute at the University of Pennsylvania Douglas B. Marlowe, J.D., Ph.D.

  2. TRI science addiction “Key Components” • Judicial status hearings • Graduated sanctions & rewards • Urinalyses • Drug abuse treatment • Case management • Nolle prosse or conditions-served • Expunged record (diversion) (NADCP, 1997)

  3. TRI science addiction “Key Components” • Judicial status hearings • Graduated sanctions & rewards • Urinalyses • Drug abuse treatment • Case management • Nolle prosse or conditions-served • Expunged record (diversion) (NADCP, 1997)

  4. TRI science addiction Research Site 1st Study: New Castle Co. (misdemeanor)

  5. TRI science addiction Research Design • Randomly assigned to: • Bi-weekly status hearings • As-needed status hearings • Equivalent drug treatment, case management, urine drug screens, and sanctions & rewards • Assessments included: • Baseline …………..ASI; ASPD diagnostic interview • Weekly ………….… Random UAs • Monthly (x 3) ……..Perceived Deterrence Questionnaire • 6 & 12 months …... ASI; UA • 24 months ………... State criminal justice records

  6. TRI science addiction During Treatment Findings

  7. TRI science addiction Counseling Attendance: 14 Weeks Mean sessions attended p = n.s. (n=82) (n=99)

  8. TRI science addiction % Drug-Free Urines by Week Time Effect: p < .001 Grp. x Time: p = n.s.

  9. TRI science addiction Program Completion Status p = n.s.

  10. TRI science addiction Post-Treatment Findings

  11. ASI Composite Scores: Baseline to 12 Months TRI science addiction * *Time: p<.01 * *

  12. TRI science addiction Client Interaction Effects • Age • Race • Gender • Years of education • Employment Status • Marital Status • Drug severity • Prior drug treatment history • ASPD diagnosis • Legal severity

  13. Experimental Condition (Bi-weekly vs. As-Needed Status Hearings) TRI science addiction Client Interaction Effects • Age • Race • Gender • Years of education • Employment Status • Marital Status • Drug severity • Prior drug treatment history • ASPD diagnosis • Legal severity

  14. TRI science addiction - Interaction Effect - Antisocial Personality Disorder Clean Urines: 14 wks *p < .05 n=30 n=69 n=30 n=52 As needed Bi-weekly

  15. TRI science addiction - Interaction Effect - Prior Drug Treatment Clean Urines: 14 wks *p < .05 n=25 n=74 n=25 n=56 As needed Bi-weekly

  16. Replications: Kent Co. (felony and misdemeanor) Sussex Co. (felony and misdemeanor) TRI science addiction Replication Sites 1st Study: New Castle Co. (misdemeanor)

  17. TRI science addiction - Replication of Interaction - Prior Drug Treatment * Clean Urines: 14 wks *p = .055 n=6 n=26 n=6 n=19 As needed Bi-weekly

  18. TRI science addiction Matching Study High Risk Low Risk As Needed Matched Bi-Weekly Unmatched As Usual (monthly)

  19. 80 matched a low-risk 70 matched a high-risk nonmatched 60 b high-risk nonmatched a 50 low-risk % drug-free urine samples 40 30 20 10 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Week in Drug Court TRI science addiction % Drug-free Urines by Group p < .001

  20. 80 matched a low-risk 70 matched a high-risk nonmatched 60 b high-risk nonmatched a 50 low-risk % drug-free urine samples 40 30 20 10 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Week in Drug Court TRI science addiction % Drug-free Urines by Group p < .001

  21. 80 matched a low-risk 70 matched a high-risk nonmatched 60 b high-risk nonmatched a 50 low-risk % drug-free urine samples 40 30 20 10 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Week in Drug Court TRI science addiction % Drug-free Urines by Group p < .001

  22. 80 matched a low-risk 70 matched a high-risk nonmatched 60 b high-risk nonmatched a 50 low-risk % drug-free urine samples 40 30 20 10 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Week in Drug Court TRI science addiction % Drug-free Urines by Group p < .001

  23. TRI science addiction “Key Components” • Judicial status hearings • Graduated sanctions & rewards • Urinalyses • Drug abuse treatment • Case management • Nolle prosse or time served • Expunged record (diversion) (NADCP, 1997)

  24. TRI science addiction “Key Components” • Judicial status hearings • Graduated sanctions & rewards • Urinalyses • Drug abuse treatment • Case management • Nolle prosse or time served • Expunged record (diversion) (NADCP, 1997)

  25. TRI science addiction Graduated Sanctions (Harrell et al., 1998)

  26. TRI science addiction Graduated Sanctions (Harrell et al., 1998) Standard Track

  27. TRI science addiction Graduated Sanctions (Harrell et al., 1998) Standard Track Treatment Track

  28. TRI science addiction Graduated Sanctions (Harrell et al., 1998) Standard Track Treatment Track *Sanctions Track * included 3-day and 7-day jail stays

  29. TRI science addiction Graduated Sanctions (Harrell et al., 1998) • 40% entered • 19% completed •  drug use Standard Track Treatment Track *Sanctions Track * included 3-day and 7-day jail stays

  30. TRI science addiction Graduated Sanctions (Harrell et al., 1998) • 40% entered • 19% completed •  drug use Standard Track Treatment Track *Sanctions Track * included 3-day and 7-day jail stays • 66% entered • 30% completed •  drug use •  re-arrests (1 yr)

  31. TRI science addiction Graduated Rewards

  32. TRI science addiction Graduated Rewards

  33. TRI science addiction Graduated Rewards

  34. TRI science addiction % Graduated on Time (13 mos.) n=61 n=60 n=60 *p < .05

  35. TRI science addiction Drug-Free Urines by Risk Level n=26 n=34 n=24 n=34 n=29 n=29 *p < .05

  36. *Median split at 23 years TRI science addiction Phase Advancement by Age* Graduation Phase 3 Phase 2 Phase 1 n=25 n=36 n=27 n=33 n=27 n=33 p < .05

  37. TRI science addiction Deterrence Theory • Clients weigh the costs and benefits of violating the law or using drugs • Cost/benefit ratio is influenced by: • Perceived certainty of detection • Perceived certainty of sanctions or rewards • Perceived magnitude of sanctions or rewards

  38. TRI science addiction Five-Cluster Solution

  39. TRI science addiction Urinalysis Results * * *p < .01 N=44 N=82 N=58 N=11 N=29

  40. * * *p < .05 N=44 N=82 N=58 N=11 N=29 TRI science addiction Graduation Rates

  41. TRI science addiction Acknowledgments National Institute on Drug Abusegrants #R01-DA-13096 and R01-DA-14566 Center for Substance Abuse Treatment

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