Bipartisan consensus and collaboration in the current US political environment is almost unheard of. There is, however, one area where many have agreed to take action. From the President on down and across the political aisle, there has been bipartisan agreement to focus on criminal justice reform. The United States:
Fortunately, there is increasing agreement that the high economic and societal costs of incarceration could be reduced if we focus on treatment for those among the incarcerated population who are suffering from the disease of addiction.
In many cases these offenses are a manifestation of the disease of addiction rather than a criminal proclivity, so providing addiction treatment is effective in preventing legal recidivism.
I am a Senior Fellow in the Justice Programs Office (JPO) of the School of Public Affairs (SPA) at American University, Washington, DC. In this capacity, I have had an opportunity to open up an important conversation. In February I presented the first in an interactive webinar series on Critical Treatment Issues: “What to expect from state-of-the-art addiction treatment for criminal justice populations in applying the new American Society of Addiction Medicine (ASAM) Criteria.” This is a part of the Bureau of Justice Assistance (BJA), US Department of Justice, Drug Court Technical Assistance Project at American University.
* If you’d like to review the recorded sessions and/or register for upcoming webinars, read SHARING SOLUTIONS below.
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Addiction treatment is assessment and outcomes-driven, not program and compliance-focused.
Note these definitions of Compliance and Adherence -Webster’s Dictionary defines “comply” as follows: to act in accordance with another’s wishes, or with rules and regulations.
It defines “adhere“: to cling, cleave (to be steadfast, hold fast), stick fast.
The criminal justice system correctly focuses on Compliance, Consequences and Control. If laws of the land are to Control public safety, then everyone has to Comply. If people do not Comply, there have to be Consequences.
Look back at the November, 2007 edition of Tips & Topics. There I wrote more on the contrast between the mission of criminal justice versus the focus of addiction treatment.
This is the cycle of Individualized, assessment and outcomes-driven services:
* ASAM Criteria Multidimensional Assessment
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Structure the phases in drug and other specialty courts based on functional milestones, not on time and compliance.
Usually the “phases” are structured in terms of time frames and tasks rather than achievement of functional milestones. Such phases, without functional milestones, too easily promote compliance ,”Doing Time” vs. adherence “Doing Treatment and Change.”
Compare and contrast these sets of Phase language:
A. Compliance style phase language
Orientation Phase, Length of Phase – Minimum of two (2) months.
A. Functional change style phase language
Orientation Phase, Length of Phase – Minimum of two (2) months; or earlier, in collaboration with treatment provider, if functional change achieved.
B. Compliance style phase language
Attendance at NA/AA meetings (if required to attend by the court). Identify a home group, attend frequently, and begin to identify with a sponsor.
B. Functional change style phase language
Identification of support group; attend 12-Step or other support group in collaboration with treatment provider who assesses what is the most effective support group as part of the individualized treatment plan (Assess participant’s Dimension 6, Recovery Environment).
C. Compliance style phase language
Advancement to next phase – Participant must be compliant with all court appearances and treatment recommendations, be actively participating in substance abuse treatment, participating in 12 step Fellowship meetings (if required to attend), complying with ancillary services if referred or recommended by Court and/or treatment provider), have completed any sanctions imposed and provided negative urinalysis for minimum of two consecutive months.
C. Functional change style phase language
Advancement to next phase – Consistent attendance, demonstrating functional improvement in problems that threaten public safety or increase legal recidivism and crime. (Review all six ASAM Criteria dimensions e.g, Dimension 2, chronic pain; Dimension 3 co-occurring disorders or impulsivity; Dimension 4 stage of change; Dimension 5 coping skills to not use; Dimension 6 friends, family, work, finances etc.)
References
1. Pew Center on the States (2008). One in 100: behind bars in America 2008. (http://www.pewcenteronthestates.org/uploadedFiles/8015PCTS_Prison08_FINAL_2-1-1_FORWEB.pdf.) 2. Mumola CJ & Karberg JC. Drug Use and Dependence, State and Federal Prisoners, 2004. Bureau of Justice Statistics, October 2006, NCJ 213530. 3. CASA Columbia, 2010. Behind Bars II. http://www.casacolumbia.org/addiction-research/reports/substance-abuse-prison-system-2010. 4. Mumola CJ. Substance Abuse and Treatment of Adults on Probation, 1995. Bureau of Justice Statistics. March 1998, NCJ 166611. 5. Bruce RD, Smith-Rohrburg D, Altice FL. (2007) Pharmacological treatment of substance abuse in correctional facilities; prospects and barriers to expanding access to evidence-based therapy. In R Greifenger (Ed) Public Health Behind Bars; from prisons to communities. (pp 385-411) Springer.
It is challenging to make the shift from compliance-driven programs to individualized, outcomes-driven services. Such a change holds everyone accountable for achieving real functional change- both the participant and the treatment provider. It requires collaboration between the court team and the treatment provider.
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Give the judge and the court team robust information. Report on whether the participant is improving in function that increases public safety.
Many treatment providers report just on the participant’s compliance with court orders:
1. Attend and participate in treatment and 12-Step support groups.
2. Provide negative drug screens.
3. Abstain from using substances and avoid negative peer influences.
In such reports the attention is all on compliance to court orders. Instead, the focus should be on the more critical level of improvement in function which truly affects the goal of lasting change.
Here are some elements of a robust report to the court:
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Rethink sanctions and incentives to focus on engagement, improved function and recovery.
1. Sanction for lack of good faith adherence to treatment, not for signs and symptoms of the disease of addiction:
2. Create incentives that are person-centered and assessment-based, not generic rewards.
In the September 2014 edition of Tips & Topics, I suggested some perspectives on sanctions and incentives.
This Easter while we were away for the weekend, a would-be robber threw a brick through the window next to the front door. They reached in and unlocked the door ready to steal anything that could be turned into quick cash. Things to be grateful for:
We read statistics about home invasions and crime, and it is all so theoretical and such a pity for those “other” people whose homes were robbed. It is all SO different when it becomes personal.
When you do a clinical assessment with a client, and note down his or her arrest record and previous crimes, it is so matter-of-fact and routine. But that client was like my would-be robber who threw the brick through my window invading our space and property.
Of course we’ll never know who it was. What urgent need compelled him/her to commit such a crime? How illuminating it would be to actually talk to and assess that person. What would I say? How would I feel? How would I negotiate restorative justice with this person? (Google “restorative justice” if that system is new to you.)
How was your Easter weekend?
Past webinars to view
1. “What to expect from state-of-the-art addiction treatment for criminal justice populations in applying the new ASAM Criteria”
– This webinar reviews how addiction is a brain disease with biopsychosocial-spiritual manifestations, causes and treatment needs; and how the ASAM (American Society of Addiction Medicine) criteria is applied to criminal justice clients. It explains what to expect from treatment providers: a comprehensive multidimensional assessment; person-centered, outcomes-driven services and treatment planning. There is discussion about communication issues between treatment providers and court personnel; what to expect of court personnel and the treatment provider.
The recordings can be accessed from the Justice Programs Office’s YouTube page:
Session 1: https://www.youtube.com/watch?v=AuUEP52z1Xk
Follow-up Q&A: https://www.youtube.com/watch?v=rj6FabxX5lk
They are also available on the American University website at: http://www.american.edu/spa/jpo/videos/webinars.cfm
2. “Doing Time or Doing Treatment: Moving beyond Program Phases to Real Lasting Change”
– This webinar addresses the differences in the culture and mission between criminal justice and treatment of addiction. It emphasizes the path to achieving outcomes of increased public safety, decreased legal recidivism and crime, safety for children and families by expecting accountable, real change to reach public safety goals. It contrasts passive, compliant participation in treatment programs phases where clients too often just “do time” in treatment; and discusses the use of incentives and sanctions that promote treatment engagement and sustainable change. There is also discussion about punishing for rule breaking and positive drug tests; and abstinence-oriented versus abstinence-mandated approaches.
The recordings can be accessed from the Justice Programs Office’s YouTube page:
Session 2: https://www.youtube.com/watch?v=KtLi1IPtv6k
Follow-up Q&A: https://www.youtube.com/watch?v=fPWSdoN7wR8
They are also available on the American University website at: http://www.american.edu/spa/jpo/videos/webinars.cfm
Upcoming webinars April 4 and 5, 2016
1. Upcoming session in the webinar series on Critical Treatment Issues:Monday, April 4, 2016 from 1:00 to 2:00 p.m. EDT, with a follow-up interactive web meeting on Tuesday, April 5 from 1:00 to 2:00 pm EDT to address questions participants have that could not be answered during the session.
“Engaging Participants in a Self-Change Process” – Stages of change and “discovery, dropout prevention” plans versus “recovery, relapse prevention” plans; holding participants accountable to an individualized treatment plan based on stage of change versus compliance with program phases and rules; evidence-based practices EBPs), therapeutic alliance and examples of EBPs that engage participants in a self-change process e.g., Motivational Interviewing, CBT, stages of change work, Interactive Journaling.————————————————————————————————————————
To register for the webinar(s):————————————————————————————————————————
1. Go to: https://bja-au.webex.com/bja-au/onstage/g.php?PRID=a6642d1af8e20bd689ac7433ee634daf
2. Choose the webinar event(s) you would like to register for and click Register.
3. On the registration form, enter your information and then click Submit.
4. This will generate an automatic email confirming your registration and providing you with the information to attend the event (the email will be from “messenger”).——————————————————-
Please contact Monica Fuhrmann (fuhrmann@american.edu) if you have any questions on the webinar or the registration process.