# Presentation: 660835

## 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

## 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

## 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.

## 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.

## 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.

## 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.

## 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.”

## 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!

## 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

## 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.
- 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 the Prison Mindset Activates Addictive Thinking:Survival and Money

- 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

- 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 Relationships

- 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.

## 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!

## 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?

## 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.

## 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.