Thursday, November 10, 2005

Incarceration/ Pain/ Motivation...continued

Another bullet-point of my workshop at IAODAPCA talked about "amenability to treatment".

According to Marlowe, et al (Federal Probation, 00149128, Sep2003, Vol. 67, Issue 2), diverting someone to treatment in lieu of incarceration is often based on several criteria which may be more influenced by public tolerance and fears than by clinical outcomes. Some common reasons to consider someone un-amenable to treatment include having two or more convictions, having previous failures in treatment, committing rule violations in treatment, as well as certain 'exclusionary offenses' which automatically make the individual ineligible for treatment. So if any of these are present, state law may dictate that this individual is not appropriate for treatment in lieu of prison (depending on the state in question). The problem is, this is all normal behavior for someone who has developed the skills needed to commit street crimes.

Now, let's add another piece to this puzzle. According to a report by SAMHSA in 2001, 75-80% of substance abuse treatment is 12 step, abstinence-based, outpatient, group treatment. All this information taken together, I start to wonder, not if the criminal offender is amenable to treatment, but if treatment is amenable to recovery for the criminal offender. Another way to come to the same conclusion is to say that the only criminal offenders eligable for treatment are those who aren't really criminal offenders. I think we're selling them, and ourselves, short.

This is where I think a sociological understanding of the meaning of the drug-life can merge with cognitive-based intervention models to help us transform traditional drug treatment into something more effective for the criminal substance abuser. At their core, these three views (social, cognitive, and traditional drug treatment) remain philosphically opposed in their understanding of the relationship between crime and substance abuse. However, I think they can greatly enlighten and enhance one another.

Someone in the workshop asked exactly what the sociological model of treatment was. I don't know that there is one. I think the value of the sociological perspective is one of understanding the nature of the individual's behavior. It's the perspective that suggests that turning up the pain, whether in treatment or in prison, is not nearly as effective toward behavioral change as turning up the hope.
The value of the cognitive approach, on the other hand, is that it suggests that traditional drug treatment is not enough, we must challenge the "skills" of criminality and offer alternative pro-social skills.

So more questions:

How do you think we should change treatment based on this discussion?

As you think about these things, and as you look at how you've provided treatment over the years, are there things you would like to change about your counseling style or your treatment content?

What are some creative ways to instill hope for this individual, deemed by many as un-amenable to treatment?

2 Comments:

Blogger Dr. Deborah Serani said...

Great questions you are posing here.

7:57 AM  
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