Beyond the Gate But Still Behind the Fence: Addictive Thinking Styles of Ex-Offenders

1. Beyond the Gate But Still Behind the Fence: Addictive Thinking Styles of Ex-Offenders Jonathan M. Hartiens, Ph.D. Michael D. McCarty, Ph.D. Center for Addiction Treatment VAMC Martinsburg WV

2. How We Got Here • Center For Addiction (CAT-5) is a VA residential drug and alcohol program; has been working with formerly incarcerated veterans (IV) for 15 years • Noticed clinical difference between regular substance abuse patients and veterans who had been incarcerated • Began prison group six years ago to learn what these differences were related to; patients taught us how they looked at the world • Applied for and received a three year grant (2005) to study and develop programming to help formerly incarcerated veterans transition into the community. • Identifying clinical tools and methods that are replicable and useable in other settings

3. Objectives • Discuss how addiction is a pervasive and often overlooked problem among the incarcerated • Discuss how recidivism is related to addictive thinking patterns that are often overlooked. • Define “Prison Mindset” and how it activates addictive thinking during community re-entry.

4. Objectives (cont’d) • Describe how addictive thinking in ex-offenders, once activated, tends to be expressed in three areas of daily living – work, money, and relationships. • Examine how addictive behaviors that are a progression towards recidivism and relapse are often misinterpreted as healthy behaviors.

5. Pervasiveness of Substance Abuse Among The Incarcerated • Substance Abuse is the most common occurring psychiatric disorder among the incarcerated population. It occurs at a much higher rate than the general population1. • 75% of inmates reported substance abuse problems on self report measures2. • When given a structured diagnostic interview, 95% of inmates met criteria for a Substance Use Disorder3.

6. Offender Characteristics (Cont’d) • Of those incarcerated, 64%4 to 70%5 were acutely intoxicated with one or more substances or withdrawing from them at time of arrest. • Of first time offenders, 41% had a history of regular drug use. This percentage increased to 81% for those with 5 or more convictions6.

7. What do these statistics mean? • Substance Abuse is a significant problem among the incarcerated and tends to be minimized. • In a majority of cases, Substance Abuse precedes or accompanies criminal behavior. • The more often a person is incarcerated, the more likely substance abuse is part of his/her lifestyle. • The fact that recidivism and substance abuse are so interconnected suggests a common underlying mechanism exists that activates both problems- a “Prison Mindset.”

8. Prison Mindset: Defining Features Living in prison conditions a mindset in which: • Routines are structured by someone else. • Choices are made by others. Offenders lose the ability to make decisions. • Basic needs are met without any effort. • Have to constantly prove and protect oneself. • Respect and safety is generated by inflicting fear in others. • Appearance of weakness or fear invites aggression from others. • The goal is simple – SURVIVAL!

9. How Prison Mindset Impacts The Reentry Process • Person needs structure, cannot provide it for self • Making choices are terrifying and overwhelming • Difficult to ask for help, to do so is a sign of weakness • Does not know how to meet basic needs • Compulsion to prove oneself • Uses fear and intimidation to solve problems

10. Thoughts I’ve got to have a job that pays me the most money. I’ve got to make up for lost time. I need to prove myself. I can’t be bored on the job. Behaviors Take whatever job is available regardless of its impact on recovery. Work excessive hours. Complicate simple instructions; don’t ask for help; do other people’s work. Work in a way that mimics their drug of choice. How Prison Mindset Activates Addictive Thinking:Survival and Work

11. Thoughts: The more money I make, the better my chances at surviving. Its my money to spend how I want now that I’m not drinking or using. Behaviors: Turn down jobs that are “beneath” them. Work overtime, second jobs, or do under-the-table work. Binge spending, giving $ to someone else, gambling - finding ways to get rid of it. How the Prison Mindset Activates Addictive Thinking:Survival and Money

12. Thoughts: I need money to be somebody. I need money to give to my partner or children. Behaviors: Flash cash, Showboating Give away savings, rent or grocery money to children or spouse. How the Prison Mindset Activates Addictive Thinking:Survival and Money

13. Thoughts: I can’t make it on my own. I need someone to take care of me. I need to be needed. Behaviors: Moves in with a partner who already has a house and structured lifestyle. Selects a needy caretaking partner who enables addictive behavior. How the Prison Mindset Activates Addictive Thinking:Survival and Relationships

14. Prison Mindset: Defining Features Conditioned from living in prison and based on: • Routines are structured by someone else. • Choices are made by the partner. Ex-offenders lack the ability to make decisions in the relationship. • Basic needs are met without any effort. • Have to constantly prove oneself in the relationship. • Respect and safety is generated by inflicting fear in the relationship. • Hears feedback as an attack which triggers aggression towards the partner. • The goal is simple – SURVIVAL!

15. Roundtable Exercise • Identify someone as a reporter/scribe • With your peers at your table, identify: • What are the common barriers (attitudes, feelings, behaviors) you have to help your clients deal with when they are in job search? • What job retention barriers do you have to often address with your clients to help them stay employed? • What are the reasons your clients give as to why they quit or lost their job? (can’t use substance use). • What do you think are the real reasons your clients quit or lose their jobs? (can’t use substance use • Count the number of people at your table that ask about money and relationships as a routine part of your case management?

16. Suggestions for Further Thought • The Prison Mindset doesn’t leave when the offender leaves prison - it just changes locations. • The Prison Mindset activates addictive thinking and behaviors in ex-offenders. • Addictive behaviors are intricately related to recidivism. • Recidivism is reduced when one addresses the prison mindset and the addictive behaviors which become activated in work, money, and relationship settings. • Recidivism would be better understood as a process, not an event. Each ex-offender has a specific and unique pattern that follows a predictable course of events prior to ending in re-arrest. By collecting information on one’s addictive behaviors, case managers could identify various patterns of recidivism and tailor specific interventions to address them.

17. References 1 Timmerman, I.G. & Emmelkamp, P.M. (2001). The prevalence and comorbidity of axis I and II pathology in a group of forensic patients. International Journal of Offender Therapy and Comparative Criminology, 45 (2), 198-213. 2 Ibid 3 Kouri, E.M., Pope Jr., G.H., Powell, K.F., Oliva, P.S., & Campbell, C. (1997). Drug use and history of criminal behavior among 133 incarcerated men. American Journal of Drug and Alcohol Abuse, 23 (3), 413-419 4 Ibid 5 National Institute of Justice. (1989). NJR Reports, 215, Washington DC. 6 National Institute on Addiction and Substance Abuse, (1998). Behind Bars: Substance Abuse and America’s Prison Population. New York: Columbia.