“Drug Offender Treatment
Lessons Learned: New
Challenges from
Institution to Community”
2013 FADAA/FCCMH Annual Conference
Robert L. Neri, LMHC, CAP
Senior Vice President /Chief Clinical
Officer
WestCare Foundation, Inc.
Lessons Learned in Corrections
• Learning from the Past
• Lessons of the Present
• Looking to the Future
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Lessons Learned in Corrections
Training Objectives:
Participants will be able to list examples of the many
dynamic changes in the field of drug offender treatment
Participants will be able to assess their programs’
readiness for future anticipated changes
Participants will be exposed to the significance of the
treatment environment and culture as it relates to
outcomes
Participants will leave with several ideas to process and
plan with their program staff
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Lessons Learned in Corrections
Do you know that 90% of your
brain works without using any
words at all?
Just so you know that means
there’s only a 10% chance of
me making any sense at all
once I start talking
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Lessons Learned in Corrections
“I kept trying to be what you
wanted, he said- but at a
certain point you needed to
stop adding to the list”
Ex Offender
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Lessons Learned in Corrections
TREATMENT/CORRECTIONS CONTINUUM
TREATMENT
CORRECTIONS
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Lessons Learned in Corrections
Treatment Is Dynamic &
Changing
Separated vs. Integrated
Relapse (Shame-based) vs. Relapse Analysis
Medication (Shunned) vs. Medication Valued
Harsh Confrontation vs. Motivational Continuum
Recovering Staff vs. Multi-Disciplinary
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Lessons Learned in Corrections
Treatment Is Dynamic &
Changing Continued
Instinct-Based vs. Research- Based
One Size Fits All vs. Individualized
Supervision vs. Supervision
Intermittent
Planned
Must Hit Bottom vs. Coercion Works
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Lessons Learned in Corrections
CLIENT
RECOVERY
IS
RELATIONAL
JUDGE
COUNSELOR
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Lessons Learned in Corrections
Client Motivation is
Dependent Upon Internal as
well as External Pressures
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Lessons Learned in Corrections
Motivational Changes in
Treatment
Treatment Dosage
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Lessons Learned in Corrections
Developmental Model Principles
• “It’s a process not an event”
• “Treatment is cumulative”
• Developmental Psychology
means:
“Psychology of Maturation”
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Lessons Learned in Corrections
COMPETENCY BASED
APPROACH TO LEARNING
Competency Mastery Requires:
• Information knowledge
• Implementation knowledge
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Lessons Learned in Corrections
Establish a therapeutic
alliance:
build and facilitate trust
transfer
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Lessons Learned in Corrections
HIGH PAIN
HHIGH HOPE
LOW PAIN
LOW HOPE
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Lessons Learned in Corrections
Ratio of Rewards to Sanctions and the
Probability of Success
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Lessons Learned in Corrections
Incentives & Sanctions
Maximize benefit by timing
of rewards and
consequences
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Lessons Learned in Corrections
Finding a New Vocabulary for
Affirmation and Validation
• Pulling Up the Positive to Avoid the Punitive
• Affirm the Small Steps and Progress
• Educate- Which Means “Lead Forth”
• Learn to Articulate Affirmations
• Develop Emotional Literacy….Name it,
Claim it, Own it, Change it!
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Lessons Learned in Corrections
{Assess / Deprivation Needs}
• Trauma History
• Resiliency Factors
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Lessons Learned in Corrections
Programs are:
Expectations based-
Emphasize relationships
Rules based-
Emphasize compliance
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Lessons Learned in Corrections
Compliance is adaptation
Not
Treatment
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Lessons Learned in Corrections
Institutionalization requires
treatment
Emotional Incarceration
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Lessons Learned in Corrections
Gender Specific Challenges for Men
Masculinity
Demands
Treatment
Demands
Being Self-Reliant
Seeking Help
Vs.
Being Stoic
Expressing Feelings
Taking Action
Becoming
Introspective
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Lessons Learned in Corrections
Gender Specific Challenges for Men
Masculinity
Demands
Treatment
Demands
Showing Strength
Showing Weakness
Vs.
Experiencing Pride
Experiencing Guilt
& Shame
Acting Invincible
Acting Vulnerable
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Lessons Learned in Corrections
Facilitate movement from
compliance to
internalization through
gradual reduction of
structure and insight work
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Lessons Learned in Corrections
Create a treatment culture
that promotes “Mistakes as
wonderful opportunities to
learn”.
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Lessons Learned in Corrections
Teach social network
mapping and assist clients
with building a social
support network
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Lessons Learned in Corrections
How Can Programs Improve Care
• Ask and integrate trauma related
questions / practices
• Deliver more experiential based
learning
• Improve cognitive health approach
(teach memory / thinking skills)
• Use incentives 4:1 to sanctions
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Lessons Learned in Corrections
How Can Programs Improve Care
Continued
• Insure program cultures are expectations
based vs. rules based
• Aftercare can be more of a system rather
than a loose aggregate of diverse
providers
• Develop a youthful offender track of
services
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Lessons Learned in Corrections
Risk, Need, Responsivity
The Big 8
NEED
Anti-social cognitions
GOAL
Reduce anti-social cognition,
recognize risky thinking and
feelings, adopt alternatives
Anti-social companions
Reduce association with criminals,
enhance contact with pro-social
friends
Anti-social personalities
Build problem-solving, selfimaging, anger awareness, and
coping skills
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Lessons Learned in Corrections
Risk, Need, Responsivity
The Big 8
NEED
GOAL
Family and marital relationships
Reduce conflict, build positive
relationships and communication
Substance abuse
Reduce usage, reduce the support
for abusive behavior, enhance
awareness
Employment
Provide employment-seeking-and –
keeping skills and enhance
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performance?
Lessons Learned in Corrections
Risk, Need, Responsivity
The Big 8
NEED
GOAL
Education
Increase performance rewards and
satisfaction
Leisure and recreation
Enhance pro social activities
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Lessons Learned in Corrections

Expectations

Reality
Not easy, but worth it
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Lessons Learned in Corrections
Questions?
Thank you
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