Adaptive Interventions in Drug Court

• Author: Jason R. Croft,Karen L. Dugosh,Douglas B. Marlowe,Patricia L. Arabia,David S. Festinger,Kathleen M. Benasutti,James R. McKay
• DOI: 10.1177/0734016808320325
• Published date: 01 September 2008
• Date: 01 September 2008
• Subject Matter: Articles

Adaptive Interventions in Drug Court

A Pilot Experiment

Douglas B. Marlowe

Treatment Research Institute, Philadelphia

University of Pennsylvania, Philadelphia

National Association of Drug Court Professionals, Alexandria, Virginia

David S. Festinger

Patricia L. Arabia

Karen L. Dugosh

Kathleen M. Benasutti

Jason R. Croft

Treatment Research Institute, Philadelphia

James R. McKay

Treatment Research Institute, Philadelphia

University of Pennsylvania, Philadelphia

This pilot study (N=30) experimentally examines the effects of an adaptive intervention in a

misdemeanor drug court. The adaptive algorithm adjusted the frequency of court hearings and

case management sessions according to prespecified criteria in response to participants’ perfor-

mance. Results reveal that the adaptive algorithm was acceptable to clients and staff, was feasi-

ble to implement with greater than 85% fidelity, and showed promise for eliciting substantial

improvements in drug abstinence and graduation rates. Compared to drug court as usual, partic-

ipants in the adaptive condition were more likely to receive responses from the drug court team

for inadequate performance and received those responses after a shorter period. This suggests the

adaptive algorithm more readily focused the team’s attention on poorly performing individuals,

allowing them to address problems before they developed too fully. These preliminary data jus-

tify further research evaluating the adaptive algorithm in a fully powered experimental trial.

Keywords: drug court; adaptive treatment; criminal justice; antisocial personality disorder

Adaptive interventions adjust the dose or type of services that are administered to clients

in response to clients’ clinical presentation or ongoing performance in treatment

343

Criminal Justice Review

Volume 33 Number 3

September 2008 343-360

© 2008 Georgia State University

Research Foundation, Inc.

10.1177/0734016808320325

http://cjr.sagepub.com

hosted at

http://online.sagepub.com

Authors’ Note: This research was supported by Grant R01-DA-13096 from the National Institute on Drug

Abuse (NIDA). The views expressed are those of the authors and do not necessarily reflect the views of NIDA.

The authors gratefully acknowledge the continuing collaboration of the New Castle County Court of Common

Pleas, Delaware State Attorney General’s Office, Delaware Office of the Public Defender, Delaware Association

of Criminal Defense Lawyers, Delaware State Division of Substance Abuse and Mental Health, Treatment

Access Center, and Brandywine Counseling, Inc. Correspondence concerning this article should be addressed

to Douglas B. Marlowe, Treatment Research Institute, 600 Public Ledger Bldg., 150 South Independence Mall

W., Philadelphia, PA 19106; phone: 215-399-0980; fax: 215-399-0987; e-mail: dmarlowe@tresearch.org.

(e.g., Collins, Murphy, & Bierman, 2004; Murphy, 2005; Murphy, Lynch, McKay, Oslin,

& TenHave, 2007). Matching services to clients’ pretreatment characteristics is perhaps the

simplest form of adapting treatment to the needs of the individual. For example, tailoring

services to the needs of youths or racial minorities is one common approach to adapting

treatment for the individual. Similarly, a history of negative outcomes in prior treatment

episodes might lead a program to offer a higher dosage or greater variety of services for a

new client than would ordinarily be provided to new admissions. This, too, is a simple form

of adapting treatment to the needs of the individual.

At a more sophisticated level of adaptive programming, the nature or intensity of ser-

vices is readjusted over time according to prespecified criteria as a consequence of clients’

performance in treatment. For example, if a client falls below an effective threshold for

engagement in treatment—by, for example, missing a prespecified number of counseling

sessions—he or she might be reassigned to a motivational enhancement intervention. The

term matching is commonly used to describe strategies that tailor treatment to clients’base-

line characteristics, whereas the term adaptive is commonly used for strategies that read-

just the interventions over the course of treatment (e.g., Marlowe, Festinger, Dugosh, Lee,

& Benasutti, 2007).

Adaptive interventions have been shown to be effective in treating a wide range of sub-

stance abuse disorders, including tobacco dependence (Reid et al., 2003), opiate depen-

dence (Brooner et al., 2004; Brooner, Kidorf, Stoller, Neufeld, & Kolodner, 2007; Kidorf,

Neufeld, & Brooner, 2004; King et al., 2002), cannabis abuse (Kidorf, Neufeld, King,

Clark, & Brooner, 2007), and alcoholism (O’Malley et al., 2003) and in continuing-care

interventions for drug dependence (McKay, Lynch, Shepard, Morgenstern, et al., 2005;

McKay, Lynch, Shepard, & Pettinati, 2005). The specific content and structure of the adap-

tive interventions vary depending on the nature of the disorder being treated; however, the

findings from these studies suggest that employing standardized criteria for determining

when and how to respond to clients’ progress or lack thereof in treatment can yield signif-

icant improvements beyond that obtained when professionals exercise individualized judg-

ment in specific cases. This is consistent with a longstanding body of evidence from

correctional studies indicating that standardized assessments and interventions reliably out-

perform individualized professional judgment (e.g., Andrews & Bonta, 1998; Wormith &

Goldstone, 1984).

Beginning in 1999, our research team initiated a planned sequence of experiments aimed

at matching the intensity of judicial supervision in drug court programs to the risk level of

participants. According to the criminological paradigm of the risk principle, intensive court

monitoring would be expected to exert the greatest effects for high-risk offenders who have

more severe antisocial propensities or treatment-refractory drug use histories but may be

unnecessary or contraindicated for low-risk offenders (e.g., Andrews & Bonta, 1998;

Taxman & Marlowe, 2006). Low-risk offenders are less likely to be on a fixed antisocial

trajectory and are apt to “adjust course” readily following a run-in with the law; therefore,

because of a statistical ceiling effect, intensive court supervision may offer little incremen-

tal benefits for these individuals at a substantial cost (DeMatteo, Marlowe, & Festinger,

2006). On the other hand, high-risk offenders often require intensive and sustained inter-

ventions to dislodge their entrenched, negative behavioral patterns.

344 Criminal Justice Review