Incentives and Sanctions: Practical

Application of the Science of

Behavior Change

Shannon M. Carey, Ph.D.

Based on Need to Know Fact Sheet by NDCI

Purpose

What is the purpose of Sanctions?

What is the purpose of Incentives?

What other court responses are there?

Overview

• Brief review of the science of behavior

change

• Research on application in drug courts

• Sample incentives, sanctions and

treatment responses (guidelines)

• Implementing incentives and sanctions

(Review and discuss videos)

Certainty

1:1 Schedule for

initiation

Reliable detection

“Trust but verify”

Reliable detection

• Urine drug testing at least twice per week*

• Do not decrease frequency of testing until last

phase

• Do tests with short detection windows in field

• Random testing all 7 days

• Extend supervision into natural social

environment (work, home, school, street, cell

phones)

• Include law enforcement on the team

*Or use continuous detection methods

Reliable detection

Cell Phone Transcript from Phone during

Court Session - 1

• SF B Chic Nov 18 3:29pm R u getting anything in la?

•

• SF B Chic Nov 18 3:35pm Can we go in on the deal. If I

got 4 would u get 2 so we could do the 540

•

• SF B Chich Nov 18 3:45pm Toats

Reliable detection

Cell Phone Transcript from Phone during

Court Session - 2 • ?? Nov 18 6:47pm If you need a source for tina Hit up

714-647-0410 Tell them dan sent ya..Good stuff…

• AM Nov 18 6:48pm How lomng doles xaanax stay in system

• ?? Nov 18 6:48pm 72hrs to a week

• AM Nov 18 6:49pm anyway to clear em out

• ?? Nov 18 6:49pm Do you ever get swabbed!!!???????

• AM Nov 18 6:50pm Occasionally ans I no it doesn’t test for

that

• ?? Nov 18 6:50pm Well if ur dirty dirty.. Always check urself

into the ER for a panic attack or something.. do that day of

probation..Walk outta there with a hospital/dr ltr

Reliable detection

Participant in his outpatient substance abuse group

• AM Nov 18 6:22pm Plzbring tibaasement pLII

• AM Nov 18 6:23pm Theyre randomly testing me tnite

• AM Nov 18 6:25pm IM in grop

• AM Nov 18 6:27pm Plese bring to basement bathroom

• AM Nov 18 6:27pm Plzzzzzzzzzzzzz

• S Nov 18 6:29pm Ok

• AM Nov 18 6:29pmHit me up when ur down there ill walk out

• AM Nov 18 6:30pm How long bro

• S Nov 18 6:30pm Like 20

• AM Nov 18 6:34pm Im in the bathroom in the basement plz hurry im

trippin out

• S Nov 18 6:35pm Leavin hollies rite now

• AM Nov 18 6:36pm Shit whats ur eta from there

Reliable detection

Participant in his outpatient substance abuse group (cont)

• S Nov 18 6:37pm 15

• S Nov 18 6:38pm Shuld I wait in basement bathroom

• AM Nov 18 6:38pm Plz tell me u gotta vial to pissi in

• S Nov 18 6:38pm Ya

• AM Nov 18 6:42pm Put the vial of piss in bathrroom trashcan

• AM Nov 18 6:42pm I gotta go bak to geoup9 hit me up when its dun

• S Nov 18 6:54pm Its in the trash

Timing is Everything

Timing is Everything

• Effects degrade exponentially

• New behaviors interfere

• Status hearings every two weeks the first few

months

• Bring non compliant participants in sooner

• Continue hearings monthly until participants have

engaged in continuing/after care plans

Keep Centered

Effective

Zone Ceiling

Effects

Habituation

Effects

MINIMAL MODERATE

EF

FE

CT

IVE

NE

SS

SEVERE

Keep Centered

NDCI Handout

http://ndcrc.org/content/list-incentives-and-sanctions

Do Due Process

• Allow participants to explain

• Explain judge/team decision

• Be respectful (and expect respect)

• Have written incentive/sanction

guidelines

• Allow reasonable discretion

• The brain and decisions about

punishment

Sanctions or Treatment

Responses?

• Abuse or dependence?

• Proximal or distal behaviors

• Dependent: Expectations change over

time (Phases) – treatment then

sanctions

• Abuser: Higher level sanctions sooner

• Separate status hearings

• Rely on clinical expertise

Targeting

Targeting

• Define behavior clearly (both bad and

good)

• Point direction (describe positive

behavior you are looking for)

• Target the behavior not the person (be

respectful)

Remember that

unaddressed co-occurring

disorders may impede the

client’s ability to achieve

abstinence

Incentive and Sanction

Highlights

• Verbal acknowledgement

• The A Team

• Fish bowl (having your name in the

bowl is a reward)

• Being chosen as a mentor

• Peer nominated participant of the

month

Decision

Dollars

$

$

Incentive and Sanction

Highlights

• Thought Paper or Recording

• Community Service (giving back

meaningfully)

• Jury Box

• Jail

Courts that use jail greater than 6 days have worse (higher) recidivism

Incentive and Sanction

Highlights

• For some, incarceration is NOT the worst

punishment – (for some it is trauma)

– The threat of jail works best on those who have

something to lose by incarceration.

– Positive reinforcement works on those who have

nothing to lose by incarceration.

• Treatment responses may be perceived as

punishments-communication is the key to

explaining the difference.

Incentive and Sanction

Highlights

FOCUS ON THE POSITIVE BEHAVIOR

• People need to know what positive behaviors

are - before they can perform them

• They know what not to do, they need to

know what to do instead

• Bring up the participants doing well first (the

A team), and ask them what they are doing

that helps them succeed. (This will have the

most positive impact on those watching).

Incentive and Sanction

Highlights

Video 1: Highlighting the positive

Video 2: The A Team

Videos 3a-3d: Positive UA with jail sanction

Video 4: Learning experience with thought

paper

Incentive and Sanction

Highlights

During video, think about whether the judge:

• Is Respectful

• Allows the participant to explain

• Provides a clear explanation of behavior

being sanctioned

• Provides a clear explanation of what to do

instead

• Provides a learning experience for other

participants

Sample Incentive and

Sanction Schedules

• http://ndcrc.org/content/list-incentives-

and-sanctions

• http://ndcrc.org/content/incentives-and-

sanctions-fact-sheet-0

Other good info on incentives and sanctions:

• www.drugcourtonline.org

Sample Incentive and

Sanction Schedules

• Washington D.C.

• Merced, CA

• Kansas

• NDCI

Sanction Exercise

Behavior

First 30 days

Question T2: John

Abuser

T1: Allen

Addict

Positive for

cocaine

Proximal or Distal?

Sanction low, middle

or high?

Missed

Treatment

Session

Proximal or Distal?

Sanction low, middle

or high?

Missed Court

Session

Proximal or Distal?

Sanction low, middle

or high?

P D

M/H L

P P

M M

P P

M M

Incentives Exercise

Behavior

After 180 days

Question T2: John

Abuser

T1: Allen

Addict

Negative drug

tests for last 30

days

Proximal or Distal?

Incentive low,

middle or high?

Made all

Treatment

Session on time

for last 60 days

Proximal or Distal?

Incentive low,

middle or high?

P P

H M

P P

M M

“All Behavior is followed

by a consequence, and

the nature of that

consequence modifies

the organisms tendency

to repeat the behavior in

the future”

• B.F. Skinner

Normal methamphetamine addict 15 months post

abstinence

Patience: we are in this for the long haul.