DiscoverCounselor Toolbox PodcastSubstance Abuse Treatment for Adults in the Criminal Justice System TIP 44
Substance Abuse Treatment for Adults in the Criminal Justice System TIP 44

Substance Abuse Treatment for Adults in the Criminal Justice System TIP 44

Update: 2020-08-29
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TIP 44: Substance Abuse Treatment for Adults in the Criminal Justice System

Dawn-Elise Snipes PhD, LMHC, LPC-MHSP


CEUs available at: allceus.com/member/cart/index/product/id/117/c/


Objectives

– Identify purpose, sources of information and areas of concern for screening

– Explore the pitfalls of diagnosis in the CJ system

– Identify preferred screening and assessment instruments and what they measure

– Examine placement strategies based on criminality, mental health and addiction issues

– Discuss general treatment issues in CJ


 


Screening

– Purpose

– Screen out

– Assess needs

– Gather information

– Eligibility and suitability


 


– Information sources

– Booking records

– Interview

– Instruments

– Correctional records / pre-sentence investigations

– Past treatment records

– Police reports

– Drug tests

Screening Areas of Concern

• Accuracy

• Continuity and system-wide sharing

• Re-screening and re-assessing

• Timing

• Drug testing

• Detoxification needs

• Readiness for treatment

• History of trauma

• Psychopathy

• Risk for violence

• Recidivism

Diagnosis Pitfalls

• Stigma

• Inaccuracy due to withdrawal

• SA diagnosis obscuring MH diagnosis

• SA diagnosis limiting offenders’ access

Reasons for Diagnosis

• Reimbursement

• Support pharmacological interventions

• When psychiatric concerns emerge

• Clarification of co-occurring disorders

• Research/evaluation

De-stigmatizing Diagnosis

• Short hand

• Presenting issues and differential diagnosis

• Normalize diagnoses

• Google “Famous people with…”

• “All About Me” worksheet

Screening Instruments

• Reliability and validity

• Reproduced

• Addiction Severity Index

• Alcohol use subscale

• ASI–Drug use subscale (ASI-Drug)

• Drug Abuse Screening Test (DAST-20)

• Michigan Alcoholism Screening Test (MAST)

• Simple Screening Instrument for Substance Abuse (SSI-SA)

Assessment Instruments: ASI

• Addictions Severity Index

• Reproduced

• Structured interview format

• Examines functioning

• Drug/alcohol use

• Relationships

• Employment

• Legal involvement

• Physical health

• Mental health

Assessment Areas

• SA

• History

• Motivation

• Severity and frequency

• Detoxification needs

• Treatment history


• Criminal Involvement

• Criminal thinking

• Offense(s)

• Probation

• Diversionary programs

• Diagnosis of any personality disorder

Assessment Areas cont…

– Health

– Intoxication

– Infectious disease

– Pregnancy

– General health

– Acute conditions


– MH

– Suicidality

– MH diagnosis and treatment history

– Acute symptoms

– Current medications

Assessment Areas cont…

– Special Considerations

– Educational level

– Reading level/literacy

– Language/cultural barriers

– Physical disability

– Developmental disability

– Learning/cognitive disability

– Housing

– Dependants/family issues

– History of abuse (victim or perp)

Triage and Placement

– Continuum ACC of services

– Pretreatment (Detoxification)

– Outpatient

– Inpatient

Triage and Placement cont.

> Key staff preparations

• Treatment resource database

• Eligibility and suitability

• Document referral process

• MOU

• Information to be shared

• Supervision and treatment responsibilities

• Ongoing effectiveness


Placement Strategies

– Target offenders

• Moderate to high risk of recidivism

• Criminal history

• Poor employment history

• Poor support environment

• Homelessness

• Antisocial traits

• impulsivity, lack empathy, anger issues, entitlement

Placement Strategies cont…

• Moderate to severe substance abuse problems

• Substance dependence

• SA related arrests

• History of SA

• with or without treatment

• Positive drug tests


Placement Strategies cont…

• Moderate to severe mental health issues

• Suicidal or violent behaviors

• Acute symptoms

• Cognitive impairment

• concentration, problem solving

• Social impairment

• interpersonal skills, frustration tolerance


Offender Characteristics

• Perceived severity of problems

• Readiness for change

• Motivation

• SOCRATES*, TIP 35

• Prior evidence of attempts to improve

• Perceived importance of treatment


 


*Stages of Change, Readiness, and Treatment Eagerness Scale

Implementing Treatment

– Involvement in treatment planning

– Motivational interviewing

– Coordination with “team”

– Updates at status changes

– Community-based linkages at re-entry


Implementing Treatment cont…

• Outreach and low-intensity interventions

• Provided to all offenders

• Entrance

• Daily activities

• Exit / Re-entry

• Skills

• Communication and social skills

• Self-regulation/self-soothing

• Problem solving and goal setting


General CJ Treatment Issues

• Components of criminality

• Criminal thinking

• Criminal code

• Inmate value system

• Manipulation

• Criminal thinking

• Learned behavior

• Recognize thinking errors and impact on behavior

• CBT and staff / peer confrontation

General CJ Treatment Issues cont…

• Criminal code

• Refusal to cooperate with authority

• Refusal to confront negative behavior

• Participation in treatment viewed as weakness

• “Snitch syndrome”

• Manipulation

• Throwing focus

• Team splitting

• Demeaning others

General CJ Treatment Issues cont…

• Excuse making

• Blaming

• Justifying

• Throwing focus

• “I think, therefore it is.”

• Lying: commission / omission

• Making fools of / Pulling the wool

• Build-up / Bring down

General CJ Treatment Issues cont…

• Assuming

• I'm unique / It doesn’t apply to me

• Ingratiating / Phony manipulation

• Fragmented personality behaviors inconsistent

• Minimizing / Exaggerating

• Vagueness / Non-committal

• Anger

• Power Plays


General CJ Treatment Issues cont…

• Victim Playing

• Closed Channel / Unreceptive

• Ownership / Unawareness of other’s boundaries

Addressing Anger and Hostility

• Identifying the feeling(s)

• Understanding where feeling is coming from

• Identifying goals the anger is serving

• Identifying goals the anger is undermining

• Working toward taking the longer view

• Positive / pro-social thought process

Barriers to Effective Treatment

• Assessment: Inaccurate placements

• Poor staff training

• Staff transition

• Overreliance on institutional sanctions vs. peer pressure

• Aftercare availability and compliance

• Coercion

• Treatment vs. other facility opportunities

Drug Courts

• 10 Components

• Integrate treatment services with justice system

• Non-adversarial approach

• Promote public safety while protecting participants’ due process

• Identify early and promptly place

• Access to treatment of co-occurring disorders

• Abstinence is monitored by drug testing

Drug Courts cont…

• Coordinated strategy governing responses to compliance

• Ongoing judicial interaction with participant

• Monitoring and evaluating goal achievement

• Continuing interdisciplinary education

• Forging partnerships for local support and program effectiveness

Drug courts, public agencies, community-based organizations

Treatment Accountability for Safer Communities (TASC)

• TASC programs bridge treatment providers and CJ system

• Range of services

• Screening and assessment

• Referral to community-based services

• Monitoring of treatment

• Case management

• Court liaison

Interventions

• Brief (TIP 34)

• Motivational (TIP 35)

• Behavior contacts

• Phased treatment

• Substance abuse education

• Detoxification

• Day reporting

• Drug testing

Interventions cont…

• Criminal thinking assessment and treatment

• Coping skills training

• Relapse prevention tools

• Strengths building

• Communication skills enhancement

Wrap Around Services

• Vocational

• Job readiness assessment and preparation

• Liaison with employer

• Literacy assessment and referral

• Anger management training

• HIV education / testing / counseling

• Assistance in accessing public assistance

• Self-help programs

Treatment Issues in Jails

• Most treatment is involuntary

• Lack of affiliation with prosocial peers

• Lack of modeling from peers/staff

• Scheduling constraints

• Gang affiliation

• Confidentiality

• Trauma

• Hopelessness

Special Issues: Community Supervision

• Therapeutic community

• Intensive outpatient

• Half-way houses

• Day reporting

Special Issues: Women

• Mental health issues

• Abuse history

• HIV positive

• Poorer employment histories

• Child custody issues

• Lower educational level


Special Population: Elderly

• In and out of “the system”

• Prison rules are the norm

• Developmental milestones are absent

• Disculturation

• Engage by having them help others

• Special issues

• Increased health problems

• Slow response to directions

• Physical issues presenting as MH

• Lack of assertiveness

• Slip through the cracks

Summary

• Unique set of learned behaviors

• Drawbacks and benefits to giving up criminality

• Work with the client

• Clear boundaries and rules

• Identify biopsychosocial issues

• Influence on treatment and recovery

• Seamless transition into the community

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Substance Abuse Treatment for Adults in the Criminal Justice System TIP 44

Substance Abuse Treatment for Adults in the Criminal Justice System TIP 44

Charles Snipes