TargetingDispByRisksNeeds_02-09

8/13/2019 TargetingDispByRisksNeeds_02-09

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Douglas B. Marlowe, J.D., Ph.D.Treatment Research Ins t i tu te at the

Universi ty of Pennsy lvania

TRI scienceaddict ion

Targeting Dispositionsby Risks Needs


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Dispositions for Drug Offenders

Diversion (ARD) Incarceration

Probation w/o verdict

Drug / DWI Courts

Intermediatesanctions

Psychosocial Functioning


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Prognostic Risks


Current age < 25 years Delinquent onset < 16 years

Substance abuse onset < 14 years

Prior rehabilitation failures

History of violence

Antisocial Personality Disorder

Psychopathy

Familial history of crime or addiction

Criminal or substance abuse associations


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Criminogenic NeedsSubstance Dependence or Addiction



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1. Binge pattern

2. Cravings or compulsions

3. Withdrawal symptoms



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1. Binge pattern




} Abstinence is a distal goal


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1. Binge pattern



Substance Abuse




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1. Binge pattern



Substance Abuse



Abstinence is a proximal goal}


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1. Binge pattern



Substance Abuse

Collateral needs

Dual diagnosis

Chronic medical condition (e.g., HIV+, HCV, diabetes)

Homelessness, chronic unemployment



Abstinence is a proximal goal}


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High Risk Low Risk

High

Needs

LowNeeds

Risk Needs Matrix


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Risk Needs Matrix


High Risk Low Risk

High

Needs

LowNeeds

Accountability,

Treatment &Habilitation


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Risk Needs Matrix


High Risk Low Risk

High

Needs

LowNeeds

Treatment

&Habilitation

Accountability,



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Risk Needs Matrix


High Risk Low Risk

High

Needs

LowNeeds

Accountability

&

Habilitation

Treatment

&Habilitation

Accountability,



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Risk Needs Matrix


High Risk Low Risk

High

Needs

LowNeeds

PreventionAccountability

&

Habilitation

Treatment

&Habilitation

Accountability,



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Practice Implications


High Risk Low Risk

High

Needs

LowNeeds

Status hearingsTreatment & habilitation

Compliance is proximal

Restrictive consequences

Positive reinforcement

Agonist medication

Noncompliance hearings

Treatment & habilitation

Treatment is proximal

Positive reinforcement

Agonist medication

v.o.p. / status calendar

Abstinence is proximalPsychosocial habilitation

Restrictive consequences

No AA or MET

Antagonist medication

Secondary prevention

Abstinence is proximal

No AA or MET

Individual counselingorstratified groups


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Dispositions for Drug Offenders

Diversion (ARD) Incarceration

Probation w/o verdict

Drug / DWI Courts

Intermediate

sanctions

Low riskLow needs

Low risk

High needs

High risk

High needs High risk

Low needs

Risk of

Dangerousness

TargetingDispByRisksNeeds_02-09

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