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
(Prosecution)
Clinical Screening (PSI)
(Probation / Pre-trial)
Clinical Evaluation
(Treatment)
Performance
Monitoring
(??)
Charging
& Release
Sentencing
& disposition
• Criminal history
• Flight risk
• Risk of dangerousness
• Risk of dangerousness
• Prognostic risks
• Criminogenic needs
• Level of Care
• Service Matching
• Behavioral Change
• Attitudinal Change
• ASAM placement
• Biopsychosocial
• 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 . . .
Stability; daily living
skills; violence potential
Medical crisis
(e.g., acute
withdrawal, DTs)
Arrest
Arraignment;
bail hearing
• Risk of dangerousness
(in or out decision)
• Prognostic risks
• Criminogenic needs
Performance
measures
Intoxication
defenses
Trial
Sentencing
On disposition
In an Ideal World . . .
Stability; daily living
skills; violence potential
Medical crisis
(e.g., acute
withdrawal, DTs)
Arrest
Arraignment;
bail hearing
• Risk of dangerousness
(in or out decision)
• Prognostic risks
• Criminogenic needs
Performance
measures
Intoxication
defenses
Trial
Sentencing
On disposition
Dispositions for Alcohol Offenders
Psychosocial Functioning
Diversion (ARD)
DWI / Drug Courts
Probation w/o verdict
Intermediate
sanctions
Incarceration
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
1.
2.
3.
Binge pattern
Cravings or compulsions
Withdrawal symptoms
Criminogenic Needs
Substance Dependence or Addiction
1.
2.
3.
Binge pattern
Cravings or compulsions
Withdrawal symptoms
}
Abstinence is a distal goal
Criminogenic Needs
Substance Dependence or Addiction
1.
2.
3.
Binge pattern
Cravings or compulsions
Withdrawal symptoms
Substance Abuse
}
Abstinence is a distal goal
Criminogenic Needs
Substance Dependence or Addiction
1.
2.
3.
Binge pattern
Cravings or compulsions
Withdrawal symptoms
Substance Abuse
}
}
Abstinence is a distal goal
Abstinence is a proximal goal
Criminogenic Needs
Substance Dependence or Addiction
1.
2.
3.
Binge pattern
Cravings or compulsions
Withdrawal symptoms
Substance Abuse
}
}
Mental illness
Functional impairments
Abstinence is a distal goal
Abstinence is a proximal goal
Criminogenic Needs
Substance Dependence or Addiction
1.
2.
3.
Binge pattern
Cravings or compulsions
Withdrawal symptoms
Substance Abuse
}
}
Mental illness
Functional impairments
Abstinence is a distal goal
Abstinence is a proximal goal
}
Regimen compliance is
a proximal goal
Risk & Needs Matrix
High Risk
High
Needs
Accountability
&
Treatment
Low
Needs
Accountability
Low Risk
Treatment
Prevention
Practice Implications
High Risk
High
Needs
Low
Needs
Low Risk
 Noncompliance hearings
 Status hearings
 Intensive treatment
 Intensive treatment
 Compliance is proximal  Treatment is proximal
 Restrictive consequences
 Positive reinforcement
 Positive reinforcement
 v.o.p. / status calendar
 Abstinence is proximal
 Secondary prevention
 Psychosocial rehab.
 Abstinence is proximal
 Restrictive consequences  No AA or MET
 No AA or MET
 Individual counseling
or stratified groups
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
Probation w/o verdict
Intermediate
sanctions
Incarceration