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

National Association of Drug Court National Association of Drug Court

ProfessionalsProfessionals

Effective Use of Effective Use of Rewards & SanctionsRewards & Sanctions

Basic TerminologyBasic Terminology

Positive Reinforcement

Negative Reinforcement

Punishment

Response Cost

REWARDSANCTION

TAKE

GIVE

Carrot Carrot andand Stick Stick

• Reduce undesirable behaviors Reduce undesirable behaviors andand

increase desirable behaviorsincrease desirable behaviors

• Positive vs. negative Positive vs. negative

reinforcementreinforcement

CertaintyCertainty• Reliable detection is most influentialReliable detection is most influential

• Random drug testing twice per week, Random drug testing twice per week, including weekends & holidaysincluding weekends & holidays

• Sufficient detection windows & panelsSufficient detection windows & panels

• Community supervisionCommunity supervision

• Last supervisory burdensLast supervisory burdens to be liftedto be lifted

• Second chancesSecond chances

CelerityCelerity• Timing is second most influentialTiming is second most influential

• Interference from new behaviorsInterference from new behaviors

• Status hearings every 2 weeks until Status hearings every 2 weeks until the case has stabilizedthe case has stabilized

• Noncompliance hearings Noncompliance hearings where indicatedwhere indicated

MagnitudeMagnitude

MAGNITUDE OF SANCTIONMAGNITUDE OF SANCTION

Effective Effective

ZoneZoneCeilingCeiling

EffectsEffects

HabituationHabituation

EffectsEffects

MINIMALMINIMAL MODERATEMODERATE SEVERSEVEREE

EF

FE

CT

IVE

NE

SE

FF

EC

TIV

EN

ES

SS

Procedural FairnessProcedural Fairness

• Clearly communicated policiesClearly communicated policies

and proceduresand procedures

• Presumptive consequencesPresumptive consequences

with flexible applicationwith flexible application

• Opportunity to be heardOpportunity to be heard

• Respect and dignityRespect and dignity

Target BehaviorsTarget Behaviors

• Don’t expect too muchDon’t expect too much– Learned helplessness and ratio burdenLearned helplessness and ratio burden

• Don’t expect too littleDon’t expect too little– HabituationHabituation

• Proximal Proximal vsvs. distal goals . distal goals

• Phase specificityPhase specificity– What was once distal becomesWhat was once distal becomes proximalproximal

Treat or Punish?Treat or Punish?

Substance Dependence or AddictionSubstance Dependence or Addiction

Substance Dependence or AddictionSubstance Dependence or Addiction1.1. Triggered binge patternTriggered binge pattern2.2. Cravings or compulsionsCravings or compulsions3.3. Withdrawal symptomsWithdrawal symptoms

Treat or Punish?Treat or Punish?

Substance Dependence or AddictionSubstance Dependence or Addiction1.1. Triggered binge patternTriggered binge pattern2.2. Cravings or compulsionsCravings or compulsions3.3. Withdrawal symptomsWithdrawal symptoms

} Abstinence is a distal goal

Treat or Punish?Treat or Punish?

Substance Dependence or AddictionSubstance Dependence or Addiction1.1. Triggered binge patternTriggered binge pattern2.2. Cravings or compulsionsCravings or compulsions3.3. Withdrawal symptomsWithdrawal symptoms

Substance AbuseSubstance Abuse

} Abstinence is a distal goal

Treat or Punish?Treat or Punish?

Substance Dependence or AddictionSubstance Dependence or Addiction1.1. Triggered binge patternTriggered binge pattern2.2. Cravings or compulsionsCravings or compulsions3.3. Withdrawal symptomsWithdrawal symptoms

Substance AbuseSubstance Abuse

} Abstinence is a distal goal

Abstinence is a proximal goal}

Treat or Punish?Treat or Punish?

Substance Dependence or AddictionSubstance Dependence or Addiction1.1. Triggered binge patternTriggered binge pattern2.2. Cravings or compulsionsCravings or compulsions3.3. Withdrawal symptomsWithdrawal symptoms

Substance AbuseSubstance Abuse

Collateral needsCollateral needs– Dual diagnosisDual diagnosis– Chronic medical condition (e.g., HIV+, HCV, diabetes)Chronic medical condition (e.g., HIV+, HCV, diabetes)– Homelessness, chronic unemployment Homelessness, chronic unemployment

} Abstinence is a distal goal

Abstinence is a proximal goal}

Treat or Punish?Treat or Punish?

Substance Dependence or AddictionSubstance Dependence or Addiction1.1. Triggered binge patternTriggered binge pattern2.2. Cravings or compulsionsCravings or compulsions3.3. Withdrawal symptomsWithdrawal symptoms

Substance AbuseSubstance Abuse

Collateral needsCollateral needs– Dual diagnosisDual diagnosis– Chronic medical condition (e.g., HIV+, HCV, diabetes)Chronic medical condition (e.g., HIV+, HCV, diabetes)– Homelessness, chronic unemployment Homelessness, chronic unemployment

} Abstinence is a distal goal

Abstinence is a proximal goal}

} Regimen compliance is proximal

Treat or Punish?Treat or Punish?

Tangible RewardsTangible Rewards

• Most important for reinforcement-Most important for reinforcement-starved participantsstarved participants

• Fishbowl procedure or point Fishbowl procedure or point systemssystems

• Symbolic rewardsSymbolic rewards

Phase RegressionPhase Regression

• An example of response costAn example of response cost

• Often a sign that services were Often a sign that services were withdrawn prematurelywithdrawn prematurely

• Temporary regression and remedial Temporary regression and remedial plan (accelerated redemption)plan (accelerated redemption)

• Avoid the Abstinence Violation Effect Avoid the Abstinence Violation Effect (A.V.E.)(A.V.E.)

Readings Readings Burdon WM et al (2001). Drug courts and contingency management. Burdon WM et al (2001). Drug courts and contingency management. Journal of Drug Journal of Drug

Issues, 31,Issues, 31, 73-90. 73-90.

Harrell A & Roman J (2001). Reducing drug use and crime among offenders: The impact Harrell A & Roman J (2001). Reducing drug use and crime among offenders: The impact of graduated sanctions. of graduated sanctions. Journal of Drug Issues, 31, Journal of Drug Issues, 31, 207-232. 207-232.

Marlowe DB (2007). Strategies for administering rewards and sanctions. In JE Marlowe DB (2007). Strategies for administering rewards and sanctions. In JE Lessenger & GF Roper (Eds.), Lessenger & GF Roper (Eds.), Drug courts: A new approach to treatment and Drug courts: A new approach to treatment and rehabilitation rehabilitation (pp. 317-336). New York: Springer. (pp. 317-336). New York: Springer.

Marlowe DB (2008). Application of sanctions. In Marlowe DB (2008). Application of sanctions. In Drug Court Quality Improvement Drug Court Quality Improvement MonographMonograph. Alexandria, VA: NDCI.. Alexandria, VA: NDCI.

Marlowe DB & Wong CJ (2008). Contingency management in adult criminal drug courts Marlowe DB & Wong CJ (2008). Contingency management in adult criminal drug courts (pp. 334-354). In ST Higgins, K Silverman & SH Heil (Eds.), (pp. 334-354). In ST Higgins, K Silverman & SH Heil (Eds.), Contingency management Contingency management in substance abuse treatmentin substance abuse treatment. New York: Guilford. . New York: Guilford.

Marlowe DB (2011). Applying incentives and sanctions. In Marlowe DB (2011). Applying incentives and sanctions. In The drug court judicial The drug court judicial benchbookbenchbook (pp.139-157). Alexandria, VA: NDCI. (pp.139-157). Alexandria, VA: NDCI.