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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