Recovery Management With Offender Populations

S. Doug Lemon, Psy.D.Licensed Clinical Psychologist

Chief PsychologistUnited States Penitentiary, McCreary

The views expressed in written conference materials or by this speaker do not necessarily reflect the official policies of the Federal Bureau of Prisons; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Offender StatisticsUnited States

▪In 2013, 2.3 million prisoners held in Federal or State prisons or local jails.

▪Nearly 7 million people under some form of correctional supervision (2013).

▪57% of those are probationers. 25% of probationers were female (2013).

▪In 2002, 66% of jail inmates reported they were regular drug users.

▪Almost a third of these said they were using drugs at the time of their arrest.

Source: Bureau of Justice Statistics, Prison Statistics.

Prison Programs

• 74% state/federal facilities have substance abuse programs

• 58% have mental health programs

Source: Bureau of Justice Statistics, Prison Statistics 2005

Offender StatisticsFlorida

▪Approximately 100,000 inmates housed in the Florida DOC.▪11,000 inmates participated in substance abuse treatment.▪38,000 participated in community-based substance abuse

programs.

Source: Florida Department of Corrections, 2013 Annual Report.

Barriers to TreatmentEducation

▪Nationally, 41% of inmates have less than a high school diploma, compared to 18% of the general population.

Source: Bureau of Justice Statistics Special Report: Education and Correctional Populations, January, 2003.

Barriers to TreatmentCulture

▪Antisocial individuals often subscribe to a counter-culture world view

▪Macho attitudes are very common among male offenders▪Offenders are often more resistant to treatment than

individuals in the general population▪Short-sighted thinking is the norm▪Egocentrism abounds

Barriers to TreatmentLifestyle

▪Criminal thinking▪Blinders▪Living for the moment▪Extremely materialistic▪See hard-working, law-abiding citizens as weak or square

Barriers to TreatmentEnvironmental Factors

▪Peer pressure to avoid mental health/substance abuse treatment

▪Correctional facilities are very negative environments▪Family support is often lacking or non-existent

Barriers to TreatmentSentence Length

▪“I don’t have enough time”▪“I’ll start programming when I get short”

Barriers to TreatmentProviders are viewed as “police”

▪Be up front about limits of confidentiality▪Be consistent!▪Show your concern, don’t talk about it

Barriers to TreatmentAftercare

▪Little to no coordination between providers in prison and those in the community

▪There is evidence this is beginning to change

Treatment OptionsPsycho-educational Groups

▪Drug Abuse Education ▸Often mandatory. ▸Typically 12-16 hours▸May spark interest in additional programs▸Helps weed out inmates not appropriate for more in-depth

programs

Treatment Options Psycho-educational Groups

▪ Breaking Barriers (Instar Performance)▸ Voluntary▸ Cognitive Re-structuring techniques▸ Introduces the Reality Model

*Results take time to measure

*Will it meet my needs over time?

Treatment Options12-Step Programs

▪Voluntary▪May be more acceptable in the prison culture than traditional

drug treatment▪Sponsorship is more difficult▪Work best if assisted by community volunteers▪There are security concerns with this, though

Treatment OptionsInside Out

▪Has its roots in SMART Recovery▪Members must be selected▪6-month program ▪Inmate co-facilitator▪Role plays

Treatment Options

• Non-residential treatment (4-6 months)• Intensive outpatient treatment (FL)

Treatment OptionsResidential Drug Abuse Program

Challenge Program▪Intensive▪Therapeutic community model▪Longer-term treatment (9-12 months)▪Some eligible for early release after completion▪Should involve halfway house component▪Similar to Residential Therapeutic Community (FL)▪Some offer dual diagnosis programs

Criminal Thinking/Beliefs5 Most Common Beliefs

▪INMATE: “You can’t help me unless you have experienced what I have. You’ve never sold drugs or used them. How can you help?”

COUNSELOR: “Have you heard of a male obstetrician?”▪INMATE: “If you grew up where I grew up, you’d be doing the

same thing.”

COUNSELOR: “Some day you’ve got to let that go, or you’ll never be successful.”

▪INMATE: “Why get treatment in prison? I’ve got to do it on parole.”

Criminal Thinking/Beliefs5 Most Common Beliefs, continued

COUNSELOR: “Sobriety/recovery takes practice.”▪INMATE: “I haven’t thought about or used drugs since I

came to prison, so I know I’m not going to when I am released.”

COUNSELOR: “You don’t have the same stressors and easy access to your drug of choice now.”

▪INMATE: “If I can’t get the time off, I’m not going to the residential drug program.”

COUNSELOR: “If you don’t get treatment, you will end up spending a whole lot more time in jail, or end up dead.”

Therapeutic TechniquesWhat works?

▪Use a culturally-sensitive approach▪Reality model is very useful▪Talk in terms of being successful rather than moralizing▪Encourage greater self-awareness▪Use groups when possible▪Teach cognitive re-structuring▪Know when to hold ‘em and when to fold ‘em

Therapeutic Techniques

What works for you?