Adaptive Interventions in Drug Court

Abstract

This pilot study (N = 30) experimentally examined the effects of an adaptive intervention in an adult misdemeanor drug court. The adaptive algorithm adjusted the frequency of judicial status hearings and clinical case-management sessions according to pre-specified criteria in response to participants' ongoing performance in the program. Results revealed the adaptive algorithm was acceptable to both clients and staff, feasible to implement with greater than 85% fidelity, and showed promise for eliciting clinically meaningful improvements in drug abstinence and graduation rates. Estimated effect sizes ranged from 0.40 to 0.60 across various dependent measures. Compared to drug court as-usual, participants in the adaptive condition were more likely to receive responses from the drug court team for inadequate performance in the program and received those responses after a substantially shorter period of time. This suggests the adaptive algorithm may have more readily focused the drug court team's attention on poorly-performing individuals, thus allowing the team to "nip problems in the bud" before they developed too fully. These preliminary data justify additional research evaluating the effects of the adaptive algorithm in a fully powered experimental trial.Adaptive interventions adjust the dose or type of services that are administered to clients in response to clients' clinical presentation or on-going performance in treatment (e.g., Collins, Murphy & Bierman, 2004;Murphy, 2005;Murphy, Lynch, McKay, Oslin & TenHave, 2007). Matching services to clients' pre-treatment 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 services is readjusted over time according to pre-specified 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 pre-specified number of counseling sessions-he or she might be re-assigned to a motivational enhancement intervention. The term matching is commonly used to describe strategies that tailor treatment to clients' baseline characteristics whereas the term adaptive is commonly used for strategies that re-adjust the Address correspondence to Douglas B. Marlowe, J.D., Ph.D., Treatment Research Institute, 600 Public Ledger Bldg., 150 South Independence Mall West, Philadelphia, PA 19106. (215) 399-0980. (215) 399-0987 (fax). dmarlowe@tresearch.org.. NIH Public Access Author ManuscriptCrim Justice Rev. Aut...

An experimental trial of adaptive programming in drug court: outcomes at 6, 12 and 18 months

“…However, consequences from the bench were scheduled to be imposed according to the adaptive algorithm depicted in Figure 2 unless the judge elected to override an indicated consequence. The adaptive algorithm was developed and pilot-tested through a collaborative and iterative process involving the drug court staff and research team (Marlowe et al, 2008). Interventions were selected that are commonly administered in drug courts and adaptive criteria were developed that are objective and readily measurable.…”

“…Providing immediate feedback increases the likelihood that clinicians will recognize achievements and infractions by participants and respond in a swift and efficient manner (Marlowe et al, 2008). …”

A robust MPC approach to the design of behavioural treatments

“…Consider the set W defined in (2), where α, γ and ς define the bounds on the ∞ norm, 1 and sparsity respectively. Let n nz = dim{w}/ς, Then…”

“…So, scientists in social or behavioral science have been working on finding effective ways to use portable devices such as smart phones to change health behavior or maintain healthy behavior. Consequently, adaptive intervention is a treatment sequence that adapts the individuals circumstances [1], [4] (in our jargon, feedback control) is being developed by social and behavioral scientists for different areas such as criminal justice [2], mental health [3], depression [5], hypertension [6], substance abuse [7] and Alzheimer's disease [8].…”

Sample size formulae for two-stage randomized trials with survival outcomes

“…Examples of adaptive treatment strategies abound. See McKay et al (2004), Murphy et al (2007) and Marlowe et al (2008), for examples in the treatment of alcohol dependence, in continuing care for drug abuse, and in criminology, respectively. The second author is currently collaborating with scientists on improving the following simple adaptive treatment strategy for 504 ZHIGUO LI AND SUSAN A. MURPHY attention deficit hyperactivity disorder in children: provide behavioural modification therapy initially, and beginning at month two and every month thereafter, assess the child's classroom behaviour; if the behaviour problems in the classroom exceed a prespecified criterion, then augment the behavioural therapy with methylphenidate.…”