Substance Abuse Treatment with Correctional Clients

Practical Implications for Institutional and Community Settings

Letitia C Pallone, Barbara Sims

• Publisher: Routledge
• Year: 2012
• eBook ISBN: 9781136413513
• Topic: Medizin
• Subtopic: Gesundheitsversorgung

Explore the possibilities for successfully treating incarcerated or community-based substance abusers

Substance Abuse Treatment with Correctional Clients: Practical Implications for Institutional and Community Settings provides key research findings and policy implications for treating alcohol- and drug-addicted correctional clients. This book addresses a range of critical issues associated with delivering treatment in institutional and community settings. The critical thinking questions, tables, extensive bibliographies, and name and subject index will help academics and practitioners in criminal justice, sociology, counseling/psychology, and public policy.

Substance Abuse Treatment with Correctional Clients shares the practical knowledge of researchers and practitioners in the fields of drug and alcohol addictions, substance abuse counseling, and criminal justice. The first section provides a review of the theoretical explanations for substance abuse, best practice treatment programs for substance abusers, and the use of coerced/mandated treatment. The second section addresses the substance-addicted offender in the institutional setting, the third includes works that describe community-based treatment programs and the problems associated with them, and the fourth looks at special treatment populations, including juveniles and adolescent females.

In Substance Abuse Treatment with Correctional Clients, you will find:

• reviews of various types of treatment programs being used to treat substance-addicted individuals
  
• a study of the predictors of success and/or failure in corrections-based substance abuse programminghow to identify and use the predictors to prevent relapse
  
• arguments for and against coerced treatment in the correctional environment, and the concept of motivation
  
• a thorough investigation of the therapeutic community (TC) program for institutional-based substance abusers
  
• descriptions of treatment programming designed specifically for substance abusing community corrections clientsdrug courts and Pennsylvania's Restrictive Intermediate Punishment treatment program

Substance Abuse Treatment with Correctional Clients guides you through the major policy issues faced by those who provide substance abuse treatment under what can only be described as coercive circumstances. In this important resource, you will discover major treatment modules as well as advice for working with adult, juvenile, and male or female offenders. This book provides you with the techniques that treatment communities need for helping offenders stay clean after they re-enter the community environment.

PART I: THE NATURE OF THE PROBLEM

Myriad explanations exist for why people abuse substances. Among theorists and practitioners from major disciplines of study, a consensus has been reached about the multicausal nature of abuse. That is to say, the abuse of substances probably has many causes, not just one. Through an examination of studies that seek to cull out the major predictors of substance abuse, Chapter 1 by Sims lays the foundation for the chapters that follow. She does so by first discussing the major theoretical explanations for substance abuse, which she then follows up with a review of the major types of programs currently being used to treat the substance-addicted individual. She concludes Chapter 1 with a brief description of critical issues faced by correctional managers who attempt to implement “free-world” substance abuse programming in the prison and community-based correctional setting.

Chapter 2 by Golden and Sims examines further some of the issues of corrections-based substance abuse programming. This chapter deals specifically with those factors that have been found to be predictors of success and/or failure in these types of programs. They suggest, as do many of the authors in subsequent chapters, that unless these predictors are addressed, complete with the realization that clients will more than likely present with co-occurring problems, that treatment failures will be greater in number than treatment successes.

In Chapter 3, Shearer tackles the controversial issue of coerced treatment. He does so by laying out the arguments for and against coerced treatment in the correctional environment, using the concept of “motivation” and its many derivatives. It is, as Shearer argues, individual motivation for breaking the cycle of substance abuse that is the key turning point for this type of programming.

Chapter 1

Treating the Substance-Addicted Offender: Theory and Practice

Barbara Sims

The purpose of this chapter is to provide a foundation for the subsequent chapters. It does so through a look at well-known theoretical explanations for alcohol and drug abuse, followed by a review of the literature on treatment programs.

THEORETICAL EXPLANATIONS FOR ALCOHOL AND DRUG ABUSE

The theoretical explanations for alcohol and drug abuse are varied, and it is clear that one theory does not fit all individuals. Some use is connected to pleasure-seeking behavior, and the opportunity for the feelings associated with use seems worth the risks of encountering negative consequences (Jung, 2001). As Jung (2001) points out, some individuals become addicted as they increasingly come to rely on drugs or alcohol in their daily living. The major theories associated with the crossover of drug use to drug addiction include biological theory, psychological theory, developmental theory, and problem behavior theory. These theories are not to be viewed as holding adversarial positions; rather, they complement one another and produce a more complete picture of drug addiction when the overlap between them is taken into account.

Biological Theory

According to research by Tarter, Alterman, and Edwards (1985), biological characteristics may predispose individuals to problems with drug/alcohol use. Primarily, Tarter et al. (1985) found this to be the case in a study of adult males. Certain temperamental characteristics appeared to account for a higher risk of abusing alcohol, especially in males who began using alcohol at an early age. The researchers propose that alcohol may actually be more reinforcing in some individuals with a certain level of inherent sensitivity toward alcohol such that continued use, and eventual abuse, is the outcome (Tarter et al., 1985).

Sher’s (1991) vulnerability model proposes a similar scenario as that of Tarter et al. (1985). In this model, innate dispositions of greater sensitivity to drugs seem to produce a greater reliance on drugs and alcohol as a method of relieving stress. This was particularly true of individuals who had not developed adequate coping skills (Sher, 1991). Similarly, the negative effect model suggests that drugs and alcohol are often used as a form of self-medication in individuals suffering from depression or recovering from some catastrophic life event (Jung, 2001).

When it comes to distinguishing one type of drug user from another, that is to say, in trying to determine which drugs are more likely to be involved in addiction and in what type of individual, much of the research suggests that types of individuals do not vary by much. Tarter, Moss, Arria, Mezzich, and Vanyukov (1992) argue that although the properties associated with the effects of drugs on individual neurology may differ and may determine the rate at which addiction occurs, drug-/alcohol-dependent individuals do not differ that much one from the other. At least, they do not differ in any neurophysiological sense. Rather, explanations for drug choice are more likely to be found in cultural or social norms, or related to the current laws associated with drug and alcohol use (Jung, 2001).

This is consistent with findings in the literature that associate addiction with lower levels of certain brain chemistries (dopamine, serotonin, etc.). According to Blum et al. (1995), most psychoactive drugs affect the levels of these chemicals in the brain by way of a series of neurotransmitters. In their study, for example, the administering of amino acid precursors to a group of alcohol-dependent individuals produced higher levels of dopamine and serotonin, which, in turn, reduced the craving for alcohol.

Psychological Theory

Much of individual knowledge about the use of drugs or alcohol takes place in the social setting. Social learning theory suggests that we learn drug use just as we learn any other type of behavior, through observing use by others (Bandura, 1977). This knowledge of what types of drugs are used, which are more socially accepted than others, and the effects of different types of drugs on individuals is easily acquired in a culture whose social norms tolerate certain levels of usage. As Jung (2001:167) says, “We acquire much knowledge about the effects of alcohol and other drugs before we actually use a specific drug.”

Social learning theory also predicts drug abuse through individual self-efficacy, the degree to which self-esteem and self-confidence allow individuals to believe in their ability to cope with tasks and control outcomes (Jung, 2001). Individuals with a low sense of self-efficacy may turn to drugs and alcohol, as mentioned previously, to assist with stress reduction or to alleviate the discomfort associated with the introduction of noxious stimuli into one’s life. This can be viewed as the “I give up” syndrome in individuals who are not confident in their ability to approach problems in a manner such that a positive outcome can be achieved.

An unfortunate outcome for people with low levels of self-efficacy, and thus a poorly developed set of coping skills, is that they will eventually alienate themselves from individuals who are not similarly situated. Learning theory predicts that the result of this alienation, the “hanging out with” other people who are themselves using and abusing drugs and alcohol, only reinforces this type of escapist behavior. This “reciprocal influence exists among members of this group” (Jung, 2001:168).

The Developmental Perspective

A great deal of overlap can be seen between social learning theory and many of the models for drug addiction found in the developmental perspective. This perspective argues from the standpoint that what we learn about drug and alcohol use as we develop provides the foundation for the more proximate precursors of use in adolescence and into adulthood (Jung, 2001).

In addition to this learning process or the modeling of behavior we see in others, Hawkins and Weis (1985) suggest that weak bonds to the key institutions of society, e.g., families and schools, can contribute to drug or alcohol dependency. So too could the lack of conventional role models in a young person’s life. A chaotic home life with consistent parental arguing, for example, where arguing escalates to physical confrontations in front of the child can result in several negative outcomes for the child. Academic failure is one, and the other is the inability to develop the sort of interpersonal skills that individuals need in order to cope with life stressors, those skills important to the self-efficacy model discussed earlier (Jung, 2001).

This family interaction model is of major concern to Brook, Brook, Gordon, Whiteman, and Cohen (1990) who propose that adolescents with secure ties to affectionate parents and who have learned within the family more conventional values are less likely to experiment with drugs or alcohol and to hang out with kids who do. For example, the positive effects of maternal interest in the child cannot be overemphasized, according to Brook et al. (1990), when it comes to any deviant activity, including drug or alcohol use.

Problem Behavior Theory

In this final category of theoretical explanations for addiction (which by no means exhausts the literature surrounding this extremely complicated phenomenon) there is again a fair amount of overlap with those theories previously discussed. This area of thought covers

1. excuse theory;

2. self-handicapping theory;

3. self-awareness reduction theory;

4. tension reduction theory; and

5. stress response dampening theory.

Excuse theory, simply put, allows individuals to place blame for certain behavior on their drug or alcohol use. According to MacAndrew and Edgerton (1969), being under the influence of some substance is, in some circles, a socially accepted excuse for inappropriate behavior. “I was drinking” is often the lamentation of perpetrators of domestic violence, promising to stop drinking and thus the abusing behavior. Unfortunately, many victims of domestic violence also often blame their abuse on the drinking or drug-using behaviors of their perpetrators. Both parties engage in excusing such conduct because of the influence of drugs or alcohol.

In a similar vein, self-handicapping theory suggests that an overindulgence in drugs or alcohol often occurs prior to certain situations in which one believes that he or she is likely to fail (Jung, 2001). Lack of adequate social skills and the social learning theory again come into play. Learned expectations of “I am likely to fail because I have before in this type of situation” set individuals up for failure. Or, a past success can put pressure on individuals to keep performing at a certain level. Self-handicapping occurs when individuals believe that the past success must have been an anomaly given the past history of the individual. Indulging in drugs and/or alcohol prior to the upcoming event allows the individual to excuse the expected failure because of being under the influence.

J. Hull (1987) proposed that drugs and alcohol actually impair thinking processes, which can bring about a reduction in self-awareness, primarily the reality of the immediate moment. This, again, gives people under the influence of drugs or alcohol yet another excuse for having engaged in inappropriate or offensive behavior. “I wasn’t aware of what I was doing, so I am not to blame” is often the expression used in these types of situations.

Both tension reduction theory and stress response dampening theory have been alluded to previously, and C. Hull’s (1943) early research supports both. According to Hull (1943), any response that reduces discomfort will be sought out again when people are confronted with similar situations that produced the discomfort and the subsequent behavior that reduced it. Unfortunately, drug and alcohol use reduce tension or stress only temporarily. The pleasure of escaping some unpleasant situation is short-lived. Excessive use of drugs or alcohol actually increases tension and stress. The individual will, sooner or later, have to face up to the consequences, and in many cases to family members and friends. In other cases, individuals may be faced with criminal sanctions. For individuals who use substances as a means of relieving stress, the unlearning of this response is critical. Treatment approaches should include the introduction, or the learning of, alternative means of reducing or dealing with stress (Jung, 2001).

In short, the literature suggests that drug and alcohol abuse is multifaceted in nature and that there is no one single cause. Reasons for abusing drugs or alcohol vary from one individual to another depending on the biological disposition of that individual and a host of social, cultural, and psychological factors which most certainly vary from one person to another. If it is true that no one theory can explain substance abuse, it follows that there can be no “one size fits all” treatment program for this particular population.

TREATING SUBSTANCE ADDICTION

Just as the theoretical explanations for drug and/or alcohol abuse and dependence should be viewed together as a whole because of the overlap between and among them, so too should the programs that have been developed to combat abuse and dependence. Programs identified and discussed here are grounded in three basic categories: (1) pharmacological treatment programs, (2) psychotherapeutic programs, and (3) behavioral modification programs.

Pharmacological Treatment Programs

Administering drugs to alcohol- or drug-dependent individuals is usually a first step taken to alleviate the adverse effects of abstinence. During detoxification, some patients are, for example, administered such drugs as Librium or Valium to relieve the symptoms of anxiety and depression (Jung, 2001). Sometimes, however, drugs are administered to purposefully cause severe physical discomfort in the presence of other drugs. For alcoholics, disulfiram is often administered to block the elimination from the liver of toxins associated with drinking alcohol. Drinking while taking this drug causes extreme nausea and vomiting in the drinker (Brewer, 1993). Also, other drugs, such as naltrexone, have been found to block the effects of alcohol and thus reduce cravings and relapses (Volpicelli, Clay, Watson, & Volpicelli, 1995).

Other treatment programs, sometimes referred to as drug-replacement approaches, include a pharmacological approach as one component of treatment. Methadone maintenance programs are good examples of this approach.

Methadone Maintenance Treatment

Opiod addiction, in recent years, has become a major problem in the drug-treatment community. Data from the Office of National Drug Control Policy indicate there were almost 1 million heroin-dependent individuals in the United States and about 100,000 first-time users at the beginning of the twenty-first century (National Drug Court Institute [NDCI], 2002). In addition, data from the 1998 Monitoring the Future study reveal some use of heroin among the nation’s high school students (1.4 percent of tenth graders) (NDCI, 2002).

One of the most widely known and studied treatment programs for heroin addiction is methadone maintenance (NDCI, 2002). For over three decades, methadone has been used in conjunction with other services to the client, e.g., counseling and medical attention. In most treatment programs, daily doses are administered by a registered nurse, with fewer doses given as the person becomes stable. Doses vary, not unlike any other drug, from one patient to another depending on need. Methadone is taken orally and is quickly absorbed into body tissue and released into the bloodstream. In most treatment programs, patients are tested regularly for the presence of both methadone and illegal drugs (NDCI, 2002). According to research conducted by several agencies (National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism), methadone treatment programs are highly effective in reducing the craving for heroin (NDCI, 2002).

Criticism for methadone treatment programs can be separated into two major areas. Some critics insist that it is nothing more than a drug substitution program, and others suggest that because a drug is still being ingested by addicted individuals, it does not reflect a true recovery program (NDCI, 2002). According to research, however, and as reported by the NDCI (2002), both arguments fall short. First, methadone does not cause euphoric effects in the patient as does heroin; it is taken orally as opposed to being administered through injection, snorting, or smoking, and it is releas...

Table of contents

• Cover
• Halftitle
• Title
• Copyright
• Dedication
• Contents
• About the Editor
• Contributors
• Preface
• Introduction
• Part I: The Nature of the Problem
• Part II: Institutional-Based Treatment Programs
• Part III: Community-Based Treatment Programs
• Part IV: Special Treatment Populations
• Index