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