Effective Use of Rewards & Sanctions
National TASC Conference 2003
Raleigh, North Carolina
Effective Use of
Rewards & Sanctions
Douglas B. Marlowe, J.D., Ph.D.
Treatment Research Institute at the
University of Pennsylvania
Basic Terminology
SANCTION
GIVE
TAKE
Douglas B. Marlowe, J.D., Ph.D.
[email protected]
www.tresearch.org
REWARD
Punishment
Positive
Reinforcement
Negative
Reinforcement
Response Cost
TRI
science
addiction
Effective Use of Rewards & Sanctions
National TASC Conference 2003
Raleigh, North Carolina
Carrot and Stick
• Reduce undesirable behaviors and
i
increase
desirable
d i bl behaviors
b h i
• Positive vs. negative
reinforcement
Certainty
• Reliable detection is most influential
• Random drug testing twice per week
week,
including weekends & holidays
• Sufficient detection windows & panels
• Community supervision
• Last supervisory burdens
to be lifted
• Second chances
Douglas B. Marlowe, J.D., Ph.D.
[email protected]
www.tresearch.org
TRI
science
addiction
Effective Use of Rewards & Sanctions
National TASC Conference 2003
Raleigh, North Carolina
Celerity
• Timing is second most influential
• Interference from new behaviors
• Status hearings every 2 weeks until
the case has stabilized
• Noncompliance hearings
where indicated
Magnitude
EF
FFECTIVENESS
Habituation
Effective
Zone
Effects
MINIMAL
Ceiling
Effects
MODERATE
SEVERE
MAGNITUDE OF SANCTION
Douglas B. Marlowe, J.D., Ph.D.
[email protected]
www.tresearch.org
TRI
science
addiction
Effective Use of Rewards & Sanctions
National TASC Conference 2003
Raleigh, North Carolina
Procedural Fairness
• Clearly communicated policies
and
d procedures
d
• Presumptive consequences
with flexible application
• Opportunity
O
t it to
t be
b heard
h d
• Respect and dignity
Target Behaviors
• Don’t expect too much
– Learned
L
d helplessness
h l l
and
d ratio
ti burden
b d
• Don’t expect too little
– Habituation
• Proximal vs
vs.. distal goals
• Phase specificity
Douglas B. Marlowe, J.D., Ph.D.
[email protected]
www.tresearch.org
TRI
science
addiction
Effective Use of Rewards & Sanctions
National TASC Conference 2003
Raleigh, North Carolina
Treat or Punish?
Substance Dependence or Addiction
Treat or Punish?
Substance Dependence or Addiction
1
1.
2.
3.
Triggered binge pattern
Cravings or compulsions
Withdrawal symptoms
Douglas B. Marlowe, J.D., Ph.D.
[email protected]
www.tresearch.org
TRI
science
addiction
Effective Use of Rewards & Sanctions
National TASC Conference 2003
Raleigh, North Carolina
Treat or Punish?
Substance Dependence or Addiction
1
1.
2.
3.
Triggered binge pattern
Cravings or compulsions
Withdrawal symptoms
}
Abstinence is a distal goal
Treat or Punish?
Substance Dependence or Addiction
1
1.
2.
3.
Triggered binge pattern
Cravings or compulsions
Withdrawal symptoms
}
Abstinence is a distal goal
Substance Abuse
Douglas B. Marlowe, J.D., Ph.D.
[email protected]
www.tresearch.org
TRI
science
addiction
Effective Use of Rewards & Sanctions
National TASC Conference 2003
Raleigh, North Carolina
Treat or Punish?
Substance Dependence or Addiction
1
1.
2.
3.
Triggered binge pattern
Cravings or compulsions
Withdrawal symptoms
Substance Abuse
}
}
Abstinence is a distal goal
Abstinence is a proximal goal
Treat or Punish?
Substance Dependence or Addiction
1
1.
2.
3.
Triggered binge pattern
Cravings or compulsions
Withdrawal symptoms
Substance Abuse
}
}
Abstinence is a distal goal
Abstinence is a proximal goal
Collateral needs
–
–
–
Dual diagnosis
Chronic medical condition (e.g., HIV+, HCV, diabetes)
Homelessness, chronic unemployment
Douglas B. Marlowe, J.D., Ph.D.
[email protected]
www.tresearch.org
TRI
science
addiction
Effective Use of Rewards & Sanctions
National TASC Conference 2003
Raleigh, North Carolina
Treat or Punish?
Substance Dependence or Addiction
1
1.
2.
3.
Triggered binge pattern
Cravings or compulsions
Withdrawal symptoms
Substance Abuse
Collateral needs
–
–
–
}
}
Abstinence is a distal goal
Abstinence is a proximal goal
}
Regimen compliance is proximal
Dual diagnosis
Chronic medical condition (e.g., HIV+, HCV, diabetes)
Homelessness, chronic unemployment
Tangible Rewards
• Most important for reinforcementreinforcementstarved
t
d participants
ti i
t
• Fishbowl procedure or point
systems
• Symbolic rewards
Douglas B. Marlowe, J.D., Ph.D.
[email protected]
www.tresearch.org
TRI
science
addiction
Effective Use of Rewards & Sanctions
National TASC Conference 2003
Raleigh, North Carolina
Readings
Burdon WM et al (2001
2001)). Drug courts and contingency management.
management. Journal
of Drug Issues, 31
31,, 73
73--90.
90.
Harrell A & Roman J (2001
2001)). Reducing drug use and crime among offenders:
offenders:
The impact of graduated sanctions
sanctions.. Journal of Drug Issues, 31
31,, 207
207--232.
232.
Marlowe DB (2007)
2007). Strategies for administering rewards and sanctions
sanctions.. In JE
Lessenger & GF Roper (Eds.
(Eds.), Drug courts
courts:: A new approach to treatment and
rehabilitation (pp
(pp.. 317317-336)
336). New York:
York: Springer
Springer..
Marlowe DB (2008
2008)). Application of sanctions
sanctions.. In Drug Court Quality
Improvement Monograph
Monograph.. Alexandria, VA
VA:: NDCI
NDCI..
Marlowe DB & Wong CJ (2008)
2008). Contingency management in adult criminal
drug courts (pp.
(pp. 334
334--354
354)). In ST Higgins, K Silverman & SH Heil (Eds.
(Eds.),
Contingency management in substance abuse treatment
treatment.. New York:
York: Guilford
Guilford..
Marlowe DB (2011
2011)). Applying incentives and sanctions
sanctions.. In The drug court
judicial benchbook (pp
(pp..139139-157)
157). Alexandria, VA:
VA: NDCI
NDCI..
Douglas B. Marlowe, J.D., Ph.D.
[email protected]
www.tresearch.org
TRI
science
addiction