Beyond the Gate But Still Behind the Fence: Addictive Thinking Styles of ExOffenders

Jonathan M. Hartiens, Ph.D. Michael D. McCarty, Ph.D. Center for Addiction Treatment VAMC Martinsburg WV
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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
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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 reentry.
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Objectives (cont’d)

Describe how addictive thinking in exoffenders, 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.
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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 02/11/08 5 Disorder3.

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.
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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 7 02/11/08

Living in prison conditions a mindset in which:
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Prison Mindset: Defining Features

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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!
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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 02/11/08 problems

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How Prison Mindset Activates Addictive Thinking: Survival and Work
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.

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.

I can’t be bored on the job.

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How the Prison Mindset Activates Addictive Thinking: Survival and Money
Thoughts:  The more money I make, the better my chances at surviving. Behaviors:  Turn down jobs that are “beneath” them. Work overtime, second jobs, or do under-the-table work.

Its my money to spend how I want now that I’m not drinking or using.

Binge spending, giving $ to someone else, gambling - finding ways to get rid of it.
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How the Prison Mindset Activates Addictive Thinking: Survival and Money
Thoughts:

Behaviors:
Flash cash, Showboating

I need money to be somebody. I need money to give to my partner or children.

Give away savings, rent or grocery money to children or spouse.

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How the Prison Mindset Activates Addictive Thinking: Survival and Relationships
Thoughts:

Behaviors:

I can’t make it on my own. I need someone to take care of me. I need to be needed.

Moves in with a partner who already has a house and structured lifestyle. Selects a needy caretaking partner who enables addictive behavior.
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Conditioned from living in prison and based on:
 

Prison Mindset: Defining Features

  

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!
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Roundtable Exercise
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Identify someone as a reporter/scribe With your peers at your table, identify:

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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?
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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 02/11/08 16 recidivism and tailor specific interventions to address

Suggestions for Further Thought when the offender The Prison Mindset doesn’t leave

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.
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