Best PracticesBest Practices Treating the Marijuana User Treating the Marijuana User

Guy A. Wheeler, MSW, CAP, CCJAP Guy A. Wheeler, MSW, CAP, CCJAP Justice For Life InstituteJustice For Life InstituteFort Lauderdale, FloridaFort Lauderdale, Florida

guyawheelergroup@aol.com

TreatingTreating the Marijuana the Marijuana UserUser

THE DESIGN

Judge

Probation

TREATMENT

PARTNERSHIP

15%(ONE TO THREE YEARS AFTER COMPLETION)

32% FOR THOSE WHO OPTED OUT THE PROGRAM

50% REDUCTION FOR NEW FELONIES

EMERGING ADULTHOODEMERGING ADULTHOOD18-2918-29

RISK FACTORSAGE (<29)EARLY ONSET OF SUBSTANCE USE(<14)EARLY ONSET CRIME(<16 YEARS)PRIOR TX FAILURESSUBSTANCE USE SEVERITYCRIMINAL HISTORYANTISOCIAL PERSONALITY DISORDER

““Habilitation vs. Habilitation vs. Rehabilitation"Rehabilitation"

Treatment providers increasingly note that many clients Treatment providers increasingly note that many clients require "habilitation," not simply "rehabilitation." In other require "habilitation," not simply "rehabilitation." In other words, some addicted persons have not lost functional words, some addicted persons have not lost functional capacities and skills as a result of their addiction but have, in capacities and skills as a result of their addiction but have, in fact, never acquired them. fact, never acquired them.

Many persons, for example, have not acquired the capacity to Many persons, for example, have not acquired the capacity to control impulses or to distinguish between emotional states. control impulses or to distinguish between emotional states. Some lack the skills to sustain day-to-day relationships with Some lack the skills to sustain day-to-day relationships with others, or suffer from Attention Deficit Disorder. The fact that others, or suffer from Attention Deficit Disorder. The fact that more and more clients suffer from a lack of basic capabilities more and more clients suffer from a lack of basic capabilities and skills makes the treatment of the underlying addiction and skills makes the treatment of the underlying addiction more difficult.more difficult. 1010

Did You Know…Did You Know…

““Very few addictions starts after Very few addictions starts after age 30age 30. . MostMost addiction starts between 18-29 addiction starts between 18-29”.”.

Dr. Mark Willenbring M.D.Dr. Mark Willenbring M.D.Director of Treatment & Recovery Research, Director of Treatment & Recovery Research,

National Institute of Alcohol Abuse & AlcoholismNational Institute of Alcohol Abuse & Alcoholism

STAGES OF DEVELOPMENTSTAGES OF DEVELOPMENT

Industry vs. Industry vs. InferiorityInferiority

Identity vs. Role Identity vs. Role ConfusionConfusion

Intimacy vs. Intimacy vs. IsolationIsolation

Competence

Fidelity

Love

Competence

Fidelity

Love

GALLUP POLL

STRESS, ANGER, AND WORRY OCCURS IN THE EARLY 20’S

FEAR, FAILURE, FRUSTRATION , AND FUTURE

OUR PERCEPTIONOUR PERCEPTION

Dress SloppyDress Sloppy

Resistant / lacking Resistant / lacking commitment, not ready to commitment, not ready to

changechange

Disrespectful, “Thug”

Distrustful, Arrogant, Problems with Authority

Angry, Hostile, Secretive, Not Honest, Unmotivated

Disrespectful, “Thug”

Distrustful, Arrogant, Problems with Authority

Angry, Hostile, Secretive, Not Honest, Unmotivated

BEHAVIORBEHAVIOR

Non-verbal; speaking only when spoken to

Non-verbal; speaking only when spoken to

PERCEPTIONS /LABELS

PERCEPTIONS /LABELS

Questioning Questioning

Refusal to look in the eyes

Refusal to look in the eyes

Tardy, incomplete tasks/assignments

Tardy, incomplete tasks/assignments

Refuses to develop rapport, doesn’t care, not buying

into treatment

Refuses to develop rapport, doesn’t care, not buying

into treatment

BEHAVIORBEHAVIOR

War Stories War Stories

PERCEPTIONS /LABELS

PERCEPTIONS /LABELS

Defeatist attitude, unwilling to Defeatist attitude, unwilling to changechange

Loud/Boisterous

Loud/Boisterous

Denial/Minimizing

Denial/Minimizing

Inappropriate, doesn’t careInappropriate, doesn’t care

Lacking motivationLacking motivation

THEIR PERCEPTIONTHEIR PERCEPTION

THEIR LENSTHEIR LENS(HOW DO THEY SEE US)(HOW DO THEY SEE US)

UNAWAREUNAWARE

INSENSITIVEINSENSITIVE

UNWILLING TO LISTENUNWILLING TO LISTEN

UNFAIRUNFAIR

AUTHORITY/THE LAWAUTHORITY/THE LAW

MISTRUSTMISTRUST

THEIR (“Street”) THINKINGTHEIR (“Street”) THINKING

I’m Smarter Than You / Manipulative

You Don’t Understand Where I Come From (Great Defense)

I’m Smarter Than You / Manipulative

You Don’t Understand Where I Come From (Great Defense)

THEIR “STREET” THINKINGTHEIR “STREET” THINKINGSuperopitimismSuperopitimism

Here & NowHere & Now

Physical Strength / Physical Strength / RespectRespect

SlickSlick

SystemSystem

Trusting To Their Trusting To Their EnvironmentEnvironment

Invisibility SyndromeInvisibility Syndrome

Disillusionment Disillusionment and confusionand confusion

Feeling trappedFeeling trapped

Conflicted success Conflicted success identityidentity

Internalized rageInternalized rage

DepressionDepression

Substance abuseSubstance abuse

Loss of hopeLoss of hope

Anderson J. Franklin, Ph.D.

I am an invisible man. I am a man of I am an invisible man. I am a man of substance, of flesh and bone, fiber substance, of flesh and bone, fiber and liquids - and I might even be said and liquids - and I might even be said to possess a mind. I am invisible, to possess a mind. I am invisible, understand, simply because people understand, simply because people refuse to see me.refuse to see me.

Invisible ManInvisible Man

Ralph Ellison

Locked MindLocked Mind

IdentityIdentity

““When When II discover discover

who who II am, am, I'llI'll

be be Free”Free”..Ralph Ellison

Where Do We Start?Where Do We Start?

REAL DEALREAL DEALThe Bottom Line – a significant number of young adults The Bottom Line – a significant number of young adults

are having real difficulties. It is more difficult for those are having real difficulties. It is more difficult for those with the least resources (economic, psychological & with the least resources (economic, psychological & intellectual).intellectual).

Moreover, efforts to change others’ behaviors without Moreover, efforts to change others’ behaviors without understanding individuals’ reasons for engaging in the understanding individuals’ reasons for engaging in the behavior are short-sighted and likely to be behavior are short-sighted and likely to be unsuccessful, especially in the emerging adult unsuccessful, especially in the emerging adult population.population.

SURVIVAL MODESURVIVAL MODEDue to the emotional, spiritual Due to the emotional, spiritual and cultural breakdown with and cultural breakdown with the family, combined with life the family, combined with life obstacles, faulty thinking, and obstacles, faulty thinking, and a overzealous ID, providesa overzealous ID, providesdifficultydifficultyreaching ourreaching ouryoung adults.young adults.

WHAT WORKSWHAT WORKS

BEST PRACTICESBEST PRACTICES

LOWHIGH

PROGNOSTIC RISK

Standard Drug Court Track(10 Key Components)

•Status Calendar• Substance Abuse Treatment•Pro -Social Habilitation• Adaptive Habilitation•Focus Consequences on Treatment & Supervision•Prescribed Medication

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Alternate Track(Treatment Emphasis)

•Non-Compliance Calendar

• Substance Abuse Treatment

•Adaptive Habilitation

•Focus Consequences on Treatment

•Prescribed Medication

Alternate Track(Diversion Emphasis)

•Non-Compliance Calendar

• Prevention Services

•Focus Consequences on Abstinence

Alternate Track(Accountability Emphasis)

•Status Calendar

• Prevention Services

•Pro-Social Habilitation

•Focus Consequences on Abstinence & Supervision

REPECT SCALEREPECT SCALE

African American Adolescent Respect Scale African American Adolescent Respect Scale (AAARS). Dr. Joy Leary (AAARS). Dr. Joy Leary a. 20 Questions – Arrested Development – a. 20 Questions – Arrested Development –

Prefrontal CortexPrefrontal Cortex

b. Access Youth Attitudes Toward Respectb. Access Youth Attitudes Toward Respect

c. The instrument was developed using four groups of items c. The instrument was developed using four groups of items that dealt with “prosocial” attitudes toward respect. The four that dealt with “prosocial” attitudes toward respect. The four areas included:areas included:

FamilyFamily Peer GroupPeer Group Society (part 1) InstitutionsSociety (part 1) Institutions Society (part 2) CultureSociety (part 2) Culture

Question???Question???

What is the strongest predictor of What is the strongest predictor of

Change?Change?

The Answer…The Answer…

A A

THERAPUETIC THERAPUETIC

RELATIONSHIPRELATIONSHIP

CHANGE PERCEPTIONCHANGE PERCEPTION Strength Model (soldiers/servants)Strength Model (soldiers/servants)Study Them/and Their CultureStudy Them/and Their CultureTeach Them To Survive In Their Own Teach Them To Survive In Their Own

Environment/JungleEnvironment/JungleLISTENLISTENTRAUMATRAUMA

ObservationsObservations

Stress/AnxietyStress/Anxiety Depressed MoodsDepressed Moods

Quarter-like CrisisQuarter-like Crisis

Not in ControlNot in Control

Unprepared from Unprepared from Crossover from Crossover from Education to Work Education to Work CrisisCrisis

Adjustment IssuesAdjustment Issues ADHDADHD

DistressDistress

CrimeCrime

Divorce/Family Divorce/Family Disruption/JobDisruption/Job

Reality /Affect Reality /Affect DistortionsDistortions

Brook JS, Rosen Z, Brook DW. The effect of early marijuana use on later Brook JS, Rosen Z, Brook DW. The effect of early marijuana use on later anxiety and depressive symptoms. NYS Psychologist 35–39, January anxiety and depressive symptoms. NYS Psychologist 35–39, January 2001.2001.

Spoken WordSpoken Word

If the word has the potency to revive If the word has the potency to revive and make us free, it has also the and make us free, it has also the

power to blind, imprison, and power to blind, imprison, and destroy. destroy.

Ralph Ellison

TECHNIQUES/SKILLSTECHNIQUES/SKILLS

RESPECT RESPECT ENTHUSIASM ENTHUSIASM STRUCTURE EDUCATESTRUCTURE EDUCATE

TIMETIME HARMONYHARMONY

ADDRESS THEMADDRESS THEM Point Out ConflictPoint Out Conflict

Intrinsic Before ExtrinsicIntrinsic Before Extrinsic

Cognitive RestructuringCognitive Restructuring

Genuine Concern/Accurate EmpathyGenuine Concern/Accurate Empathy

TECHNIQUES/SKILLS TECHNIQUES/SKILLS CONTINUECONTINUE

Give them a VOICEGive them a VOICE

UnderstandingUnderstanding

Unconditional Positive RegardsUnconditional Positive Regards

AttentionAttention

Allow ResistanceAllow Resistance

Encourage ThemEncourage Them

More SolutionsMore SolutionsCapture their StrengthsCapture their Strengths

Challenge their Beliefs SystemChallenge their Beliefs System

Teach them to Deal w/Frustration & AngerTeach them to Deal w/Frustration & Anger

Allow Appropriate AngerAllow Appropriate Anger

Make Suggestions & Provide GuidanceMake Suggestions & Provide Guidance

Give Assignments for Peer LearningGive Assignments for Peer Learning

Inform them about criminal justice systemInform them about criminal justice system

Instill HOPEInstill HOPE

VISIONVISION

AmbivalenceAmbivalence

Motivational InterviewingMotivational Interviewing

ESTABLISH RAPPORT (INTEREST)ESTABLISH RAPPORT (INTEREST)

USE APPROPRIATE OPEN-ENDED USE APPROPRIATE OPEN-ENDED QUESTIONSQUESTIONS

– CanCan you tell me where does your you tell me where does your marijuana fit into all this?marijuana fit into all this?

– MayMay I ask about your use of alcohol? I ask about your use of alcohol?

ESTABLISH RAPPORT (INTEREST)ESTABLISH RAPPORT (INTEREST)

USE APPROPRIATE OPEN-ENDED USE APPROPRIATE OPEN-ENDED QUESTIONSQUESTIONS

– CanCan you tell me where does your you tell me where does your marijuana fit into all this?marijuana fit into all this?

– MayMay I ask about your use of alcohol? I ask about your use of alcohol?

ASK ABOUT THE GOOD THINGS ASK ABOUT THE GOOD THINGS

Motivational InterviewingMotivational Interviewing

ASK ABOUT A TYPICAL DAY

ASK ABOUT LIFESTYLE AND STRESS

ASK ABOUT CONCERNS DIRECTLY

ASK ABOUT THE NEXT STEP

ASK ABOUT A TYPICAL DAY

ASK ABOUT LIFESTYLE AND STRESS

ASK ABOUT CONCERNS DIRECTLY

ASK ABOUT THE NEXT STEP

REINFORCEMENT TECHNIQUESREINFORCEMENT TECHNIQUES

USING CRT SKILLS, TAKE THE CLIENT USING CRT SKILLS, TAKE THE CLIENT THROUGH ANY SITUATION THAT THEY THROUGH ANY SITUATION THAT THEY MIGHT FACE: MIGHT FACE:

– Drug RefusalDrug Refusal

– AssertionAssertion

– Respond To The Name GameRespond To The Name Game

– Gang or Group Pressure Gang or Group Pressure

USING CRT SKILLS, TAKE THE CLIENT USING CRT SKILLS, TAKE THE CLIENT THROUGH ANY SITUATION THAT THEY THROUGH ANY SITUATION THAT THEY MIGHT FACE: MIGHT FACE:

– Drug RefusalDrug Refusal

– AssertionAssertion

– Respond To The Name GameRespond To The Name Game

– Gang or Group Pressure Gang or Group Pressure

LIFELIFE

““Life is to be lived, not controlled, Life is to be lived, not controlled, and humanity is won by continuing to and humanity is won by continuing to play in face of certain defeat”. play in face of certain defeat”. Ralph Ellison

H.E.A.T.H.E.A.T.

HHabilitationabilitation

EEmpowermentmpowerment

AAccountabilityccountability

TTherapyherapy

CopyrightCopyright © Guy A. Wheeler Group/Justice For Life Institute © Guy A. Wheeler Group/Justice For Life Institute

Lifestyle Educational Groups Lifestyle Educational Groups (LEG)(LEG)

The The Lifestyle Educational GroupLifestyle Educational Group provides a blended approach provides a blended approach addressing drug usage and addressing drug usage and dependency conducive to criminal dependency conducive to criminal behavior and social dysfunction.behavior and social dysfunction.

Dr. Staton Samenow’s philosophy Dr. Staton Samenow’s philosophy of criminal faulty thinking.of criminal faulty thinking.

Modality used for all groupsModality used for all groups

We focus on habilitation skills We focus on habilitation skills opposed to just rehabilitation. opposed to just rehabilitation. Rehabilitation assumes that the Rehabilitation assumes that the person was responsible, capable, person was responsible, capable,

and stable before trouble and stable before trouble happens. happens.

Whereas habilitation dictates the Whereas habilitation dictates the person needs to first gain the person needs to first gain the missed stability (in their lives) in missed stability (in their lives) in order to build a solid foundation order to build a solid foundation through coping strategies without through coping strategies without excuses. excuses.

Cultural proficiency concept Cultural proficiency concept utilizes a person-in-the utilizes a person-in-the environment approach that environment approach that promotes change.promotes change.Copyright © Guy A. Wheeler Group/Justice For Life Institute

Psycho-Educational Group (PEG)Psycho-Educational Group (PEG)• This judicial treatment alternative This judicial treatment alternative

provides psycho-educational and provides psycho-educational and counseling services that breaks the counseling services that breaks the cycle of addiction and reduces cycle of addiction and reduces recidivism while enhancing the public recidivism while enhancing the public safety of our community. safety of our community.

• 12-Week (twelve 12-Week (twelve week cycleweek cycle) ) educational component.educational component.

• Emphasize a curriculum on relapse Emphasize a curriculum on relapse prevention planning while addressing prevention planning while addressing other life issues such as denial, other life issues such as denial, critical thinking, family, relationships critical thinking, family, relationships and the addiction process.and the addiction process.

• Each group has 12 different relative Each group has 12 different relative life topics that unveil the triggers of life topics that unveil the triggers of drug abuse and viable strategies of drug abuse and viable strategies of resistance. resistance.

• Therapeutic change occurs when Therapeutic change occurs when treatment works in tandem with the treatment works in tandem with the criminal justice system. criminal justice system.

• Intensive, multi-dimensional, Intensive, multi-dimensional, systemic two phase approach.systemic two phase approach.

Copyright © Guy A. Wheeler Group/Justice For Life Institute

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PSYCHOEDUCATIONAL GROUP (PEG)“ANYTHING CAN TAKE OVER YOUR LIFE”

Copyright © Guy A. Wheeler Group/Justice For Life Institute

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Dr. James CoteDr. James Cote

Professor of Sociology at the University of Western Professor of Sociology at the University of Western Ontario and author of “Arrested Development”.Ontario and author of “Arrested Development”.

Different PerspectiveDifferent Perspective

Social & Economic FactorSocial & Economic Factor

Social DisorganizationSocial Disorganization

Baby Boomers – choices openBaby Boomers – choices open

Emerging Adults “The In-Between Age”Emerging Adults “The In-Between Age”

Age of Identity Exploration – Young people are Age of Identity Exploration – Young people are deciding who they are and what they want out of deciding who they are and what they want out of work, school and love.work, school and love.

Age of Instability - The post high school years are Age of Instability - The post high school years are marked by repeated residence changes, as young marked by repeated residence changes, as young people either go to college or live with friends or a people either go to college or live with friends or a romantic partner.romantic partner.

Age of Self-Focus - Freed of the parent and society-Age of Self-Focus - Freed of the parent and society-directed routine of school, young people try to directed routine of school, young people try to decide what they want to do, where they want to go decide what they want to do, where they want to go and who they want to be with (before those choices and who they want to be with (before those choices get limited by the constraints of marriage, children get limited by the constraints of marriage, children and a career).and a career).

Age of Feeling In-Between - Many say they are Age of Feeling In-Between - Many say they are taking responsibility for themselves, but still do no taking responsibility for themselves, but still do no completely feel like an adult.completely feel like an adult.

Age of Possibilities – Optimism reigns.Age of Possibilities – Optimism reigns.Dr. Jeffrey Arnett (Emerging Adulthood-2004)Dr. Jeffrey Arnett (Emerging Adulthood-2004)

Another Perspective