best practices treating the marijuana user guy a. wheeler, msw, cap, ccjap justice for life...
TRANSCRIPT
Best PracticesBest Practices Treating the Marijuana User Treating the Marijuana User
Guy A. Wheeler, MSW, CAP, CCJAP Guy A. Wheeler, MSW, CAP, CCJAP Justice For Life InstituteJustice For Life InstituteFort Lauderdale, FloridaFort Lauderdale, Florida
TreatingTreating the Marijuana the Marijuana UserUser
THE DESIGN
Judge
Probation
TREATMENT
PARTNERSHIP
15%(ONE TO THREE YEARS AFTER COMPLETION)
32% FOR THOSE WHO OPTED OUT THE PROGRAM
50% REDUCTION FOR NEW FELONIES
EMERGING ADULTHOODEMERGING ADULTHOOD18-2918-29
RISK FACTORSAGE (<29)EARLY ONSET OF SUBSTANCE USE(<14)EARLY ONSET CRIME(<16 YEARS)PRIOR TX FAILURESSUBSTANCE USE SEVERITYCRIMINAL HISTORYANTISOCIAL PERSONALITY DISORDER
““Habilitation vs. Habilitation vs. Rehabilitation"Rehabilitation"
Treatment providers increasingly note that many clients Treatment providers increasingly note that many clients require "habilitation," not simply "rehabilitation." In other require "habilitation," not simply "rehabilitation." In other words, some addicted persons have not lost functional words, some addicted persons have not lost functional capacities and skills as a result of their addiction but have, in capacities and skills as a result of their addiction but have, in fact, never acquired them. fact, never acquired them.
Many persons, for example, have not acquired the capacity to Many persons, for example, have not acquired the capacity to control impulses or to distinguish between emotional states. control impulses or to distinguish between emotional states. Some lack the skills to sustain day-to-day relationships with Some lack the skills to sustain day-to-day relationships with others, or suffer from Attention Deficit Disorder. The fact that others, or suffer from Attention Deficit Disorder. The fact that more and more clients suffer from a lack of basic capabilities more and more clients suffer from a lack of basic capabilities and skills makes the treatment of the underlying addiction and skills makes the treatment of the underlying addiction more difficult.more difficult. 1010
Did You Know…Did You Know…
““Very few addictions starts after Very few addictions starts after age 30age 30. . MostMost addiction starts between 18-29 addiction starts between 18-29”.”.
Dr. Mark Willenbring M.D.Dr. Mark Willenbring M.D.Director of Treatment & Recovery Research, Director of Treatment & Recovery Research,
National Institute of Alcohol Abuse & AlcoholismNational Institute of Alcohol Abuse & Alcoholism
STAGES OF DEVELOPMENTSTAGES OF DEVELOPMENT
Industry vs. Industry vs. InferiorityInferiority
Identity vs. Role Identity vs. Role ConfusionConfusion
Intimacy vs. Intimacy vs. IsolationIsolation
Competence
Fidelity
Love
Competence
Fidelity
Love
GALLUP POLL
STRESS, ANGER, AND WORRY OCCURS IN THE EARLY 20’S
FEAR, FAILURE, FRUSTRATION , AND FUTURE
OUR PERCEPTIONOUR PERCEPTION
Dress SloppyDress Sloppy
Resistant / lacking Resistant / lacking commitment, not ready to commitment, not ready to
changechange
Disrespectful, “Thug”
Distrustful, Arrogant, Problems with Authority
Angry, Hostile, Secretive, Not Honest, Unmotivated
Disrespectful, “Thug”
Distrustful, Arrogant, Problems with Authority
Angry, Hostile, Secretive, Not Honest, Unmotivated
BEHAVIORBEHAVIOR
Non-verbal; speaking only when spoken to
Non-verbal; speaking only when spoken to
PERCEPTIONS /LABELS
PERCEPTIONS /LABELS
Questioning Questioning
Refusal to look in the eyes
Refusal to look in the eyes
Tardy, incomplete tasks/assignments
Tardy, incomplete tasks/assignments
Refuses to develop rapport, doesn’t care, not buying
into treatment
Refuses to develop rapport, doesn’t care, not buying
into treatment
BEHAVIORBEHAVIOR
War Stories War Stories
PERCEPTIONS /LABELS
PERCEPTIONS /LABELS
Defeatist attitude, unwilling to Defeatist attitude, unwilling to changechange
Loud/Boisterous
Loud/Boisterous
Denial/Minimizing
Denial/Minimizing
Inappropriate, doesn’t careInappropriate, doesn’t care
Lacking motivationLacking motivation
THEIR PERCEPTIONTHEIR PERCEPTION
THEIR LENSTHEIR LENS(HOW DO THEY SEE US)(HOW DO THEY SEE US)
UNAWAREUNAWARE
INSENSITIVEINSENSITIVE
UNWILLING TO LISTENUNWILLING TO LISTEN
UNFAIRUNFAIR
AUTHORITY/THE LAWAUTHORITY/THE LAW
MISTRUSTMISTRUST
THEIR (“Street”) THINKINGTHEIR (“Street”) THINKING
I’m Smarter Than You / Manipulative
You Don’t Understand Where I Come From (Great Defense)
I’m Smarter Than You / Manipulative
You Don’t Understand Where I Come From (Great Defense)
THEIR “STREET” THINKINGTHEIR “STREET” THINKINGSuperopitimismSuperopitimism
Here & NowHere & Now
Physical Strength / Physical Strength / RespectRespect
SlickSlick
SystemSystem
Trusting To Their Trusting To Their EnvironmentEnvironment
Invisibility SyndromeInvisibility Syndrome
Disillusionment Disillusionment and confusionand confusion
Feeling trappedFeeling trapped
Conflicted success Conflicted success identityidentity
Internalized rageInternalized rage
DepressionDepression
Substance abuseSubstance abuse
Loss of hopeLoss of hope
Anderson J. Franklin, Ph.D.
I am an invisible man. I am a man of I am an invisible man. I am a man of substance, of flesh and bone, fiber substance, of flesh and bone, fiber and liquids - and I might even be said and liquids - and I might even be said to possess a mind. I am invisible, to possess a mind. I am invisible, understand, simply because people understand, simply because people refuse to see me.refuse to see me.
Invisible ManInvisible Man
Ralph Ellison
Locked MindLocked Mind
IdentityIdentity
““When When II discover discover
who who II am, am, I'llI'll
be be Free”Free”..Ralph Ellison
Where Do We Start?Where Do We Start?
REAL DEALREAL DEALThe Bottom Line – a significant number of young adults The Bottom Line – a significant number of young adults
are having real difficulties. It is more difficult for those are having real difficulties. It is more difficult for those with the least resources (economic, psychological & with the least resources (economic, psychological & intellectual).intellectual).
Moreover, efforts to change others’ behaviors without Moreover, efforts to change others’ behaviors without understanding individuals’ reasons for engaging in the understanding individuals’ reasons for engaging in the behavior are short-sighted and likely to be behavior are short-sighted and likely to be unsuccessful, especially in the emerging adult unsuccessful, especially in the emerging adult population.population.
SURVIVAL MODESURVIVAL MODEDue to the emotional, spiritual Due to the emotional, spiritual and cultural breakdown with and cultural breakdown with the family, combined with life the family, combined with life obstacles, faulty thinking, and obstacles, faulty thinking, and a overzealous ID, providesa overzealous ID, providesdifficultydifficultyreaching ourreaching ouryoung adults.young adults.
WHAT WORKSWHAT WORKS
BEST PRACTICESBEST PRACTICES
LOWHIGH
PROGNOSTIC RISK
Standard Drug Court Track(10 Key Components)
•Status Calendar• Substance Abuse Treatment•Pro -Social Habilitation• Adaptive Habilitation•Focus Consequences on Treatment & Supervision•Prescribed Medication
CR
IMIN
OG
ENIC
NEE
DH
IGH
(Sub
stan
ce D
epen
denc
e)LO
W(S
ubst
ance
Abu
se)
Alternate Track(Treatment Emphasis)
•Non-Compliance Calendar
• Substance Abuse Treatment
•Adaptive Habilitation
•Focus Consequences on Treatment
•Prescribed Medication
Alternate Track(Diversion Emphasis)
•Non-Compliance Calendar
• Prevention Services
•Focus Consequences on Abstinence
Alternate Track(Accountability Emphasis)
•Status Calendar
• Prevention Services
•Pro-Social Habilitation
•Focus Consequences on Abstinence & Supervision
REPECT SCALEREPECT SCALE
African American Adolescent Respect Scale African American Adolescent Respect Scale (AAARS). Dr. Joy Leary (AAARS). Dr. Joy Leary a. 20 Questions – Arrested Development – a. 20 Questions – Arrested Development –
Prefrontal CortexPrefrontal Cortex
b. Access Youth Attitudes Toward Respectb. Access Youth Attitudes Toward Respect
c. The instrument was developed using four groups of items c. The instrument was developed using four groups of items that dealt with “prosocial” attitudes toward respect. The four that dealt with “prosocial” attitudes toward respect. The four areas included:areas included:
FamilyFamily Peer GroupPeer Group Society (part 1) InstitutionsSociety (part 1) Institutions Society (part 2) CultureSociety (part 2) Culture
Question???Question???
What is the strongest predictor of What is the strongest predictor of
Change?Change?
The Answer…The Answer…
A A
THERAPUETIC THERAPUETIC
RELATIONSHIPRELATIONSHIP
CHANGE PERCEPTIONCHANGE PERCEPTION Strength Model (soldiers/servants)Strength Model (soldiers/servants)Study Them/and Their CultureStudy Them/and Their CultureTeach Them To Survive In Their Own Teach Them To Survive In Their Own
Environment/JungleEnvironment/JungleLISTENLISTENTRAUMATRAUMA
ObservationsObservations
Stress/AnxietyStress/Anxiety Depressed MoodsDepressed Moods
Quarter-like CrisisQuarter-like Crisis
Not in ControlNot in Control
Unprepared from Unprepared from Crossover from Crossover from Education to Work Education to Work CrisisCrisis
Adjustment IssuesAdjustment Issues ADHDADHD
DistressDistress
CrimeCrime
Divorce/Family Divorce/Family Disruption/JobDisruption/Job
Reality /Affect Reality /Affect DistortionsDistortions
Brook JS, Rosen Z, Brook DW. The effect of early marijuana use on later Brook JS, Rosen Z, Brook DW. The effect of early marijuana use on later anxiety and depressive symptoms. NYS Psychologist 35–39, January anxiety and depressive symptoms. NYS Psychologist 35–39, January 2001.2001.
Spoken WordSpoken Word
If the word has the potency to revive If the word has the potency to revive and make us free, it has also the and make us free, it has also the
power to blind, imprison, and power to blind, imprison, and destroy. destroy.
Ralph Ellison
TECHNIQUES/SKILLSTECHNIQUES/SKILLS
RESPECT RESPECT ENTHUSIASM ENTHUSIASM STRUCTURE EDUCATESTRUCTURE EDUCATE
TIMETIME HARMONYHARMONY
ADDRESS THEMADDRESS THEM Point Out ConflictPoint Out Conflict
Intrinsic Before ExtrinsicIntrinsic Before Extrinsic
Cognitive RestructuringCognitive Restructuring
Genuine Concern/Accurate EmpathyGenuine Concern/Accurate Empathy
TECHNIQUES/SKILLS TECHNIQUES/SKILLS CONTINUECONTINUE
Give them a VOICEGive them a VOICE
UnderstandingUnderstanding
Unconditional Positive RegardsUnconditional Positive Regards
AttentionAttention
Allow ResistanceAllow Resistance
Encourage ThemEncourage Them
More SolutionsMore SolutionsCapture their StrengthsCapture their Strengths
Challenge their Beliefs SystemChallenge their Beliefs System
Teach them to Deal w/Frustration & AngerTeach them to Deal w/Frustration & Anger
Allow Appropriate AngerAllow Appropriate Anger
Make Suggestions & Provide GuidanceMake Suggestions & Provide Guidance
Give Assignments for Peer LearningGive Assignments for Peer Learning
Inform them about criminal justice systemInform them about criminal justice system
Instill HOPEInstill HOPE
VISIONVISION
AmbivalenceAmbivalence
Motivational InterviewingMotivational Interviewing
ESTABLISH RAPPORT (INTEREST)ESTABLISH RAPPORT (INTEREST)
USE APPROPRIATE OPEN-ENDED USE APPROPRIATE OPEN-ENDED QUESTIONSQUESTIONS
– CanCan you tell me where does your you tell me where does your marijuana fit into all this?marijuana fit into all this?
– MayMay I ask about your use of alcohol? I ask about your use of alcohol?
ESTABLISH RAPPORT (INTEREST)ESTABLISH RAPPORT (INTEREST)
USE APPROPRIATE OPEN-ENDED USE APPROPRIATE OPEN-ENDED QUESTIONSQUESTIONS
– CanCan you tell me where does your you tell me where does your marijuana fit into all this?marijuana fit into all this?
– MayMay I ask about your use of alcohol? I ask about your use of alcohol?
ASK ABOUT THE GOOD THINGS ASK ABOUT THE GOOD THINGS
Motivational InterviewingMotivational Interviewing
ASK ABOUT A TYPICAL DAY
ASK ABOUT LIFESTYLE AND STRESS
ASK ABOUT CONCERNS DIRECTLY
ASK ABOUT THE NEXT STEP
ASK ABOUT A TYPICAL DAY
ASK ABOUT LIFESTYLE AND STRESS
ASK ABOUT CONCERNS DIRECTLY
ASK ABOUT THE NEXT STEP
REINFORCEMENT TECHNIQUESREINFORCEMENT TECHNIQUES
USING CRT SKILLS, TAKE THE CLIENT USING CRT SKILLS, TAKE THE CLIENT THROUGH ANY SITUATION THAT THEY THROUGH ANY SITUATION THAT THEY MIGHT FACE: MIGHT FACE:
– Drug RefusalDrug Refusal
– AssertionAssertion
– Respond To The Name GameRespond To The Name Game
– Gang or Group Pressure Gang or Group Pressure
USING CRT SKILLS, TAKE THE CLIENT USING CRT SKILLS, TAKE THE CLIENT THROUGH ANY SITUATION THAT THEY THROUGH ANY SITUATION THAT THEY MIGHT FACE: MIGHT FACE:
– Drug RefusalDrug Refusal
– AssertionAssertion
– Respond To The Name GameRespond To The Name Game
– Gang or Group Pressure Gang or Group Pressure
LIFELIFE
““Life is to be lived, not controlled, Life is to be lived, not controlled, and humanity is won by continuing to and humanity is won by continuing to play in face of certain defeat”. play in face of certain defeat”. Ralph Ellison
H.E.A.T.H.E.A.T.
HHabilitationabilitation
EEmpowermentmpowerment
AAccountabilityccountability
TTherapyherapy
CopyrightCopyright © Guy A. Wheeler Group/Justice For Life Institute © Guy A. Wheeler Group/Justice For Life Institute
Lifestyle Educational Groups Lifestyle Educational Groups (LEG)(LEG)
The The Lifestyle Educational GroupLifestyle Educational Group provides a blended approach provides a blended approach addressing drug usage and addressing drug usage and dependency conducive to criminal dependency conducive to criminal behavior and social dysfunction.behavior and social dysfunction.
Dr. Staton Samenow’s philosophy Dr. Staton Samenow’s philosophy of criminal faulty thinking.of criminal faulty thinking.
Modality used for all groupsModality used for all groups
We focus on habilitation skills We focus on habilitation skills opposed to just rehabilitation. opposed to just rehabilitation. Rehabilitation assumes that the Rehabilitation assumes that the person was responsible, capable, person was responsible, capable,
and stable before trouble and stable before trouble happens. happens.
Whereas habilitation dictates the Whereas habilitation dictates the person needs to first gain the person needs to first gain the missed stability (in their lives) in missed stability (in their lives) in order to build a solid foundation order to build a solid foundation through coping strategies without through coping strategies without excuses. excuses.
Cultural proficiency concept Cultural proficiency concept utilizes a person-in-the utilizes a person-in-the environment approach that environment approach that promotes change.promotes change.Copyright © Guy A. Wheeler Group/Justice For Life Institute
Psycho-Educational Group (PEG)Psycho-Educational Group (PEG)• This judicial treatment alternative This judicial treatment alternative
provides psycho-educational and provides psycho-educational and counseling services that breaks the counseling services that breaks the cycle of addiction and reduces cycle of addiction and reduces recidivism while enhancing the public recidivism while enhancing the public safety of our community. safety of our community.
• 12-Week (twelve 12-Week (twelve week cycleweek cycle) ) educational component.educational component.
• Emphasize a curriculum on relapse Emphasize a curriculum on relapse prevention planning while addressing prevention planning while addressing other life issues such as denial, other life issues such as denial, critical thinking, family, relationships critical thinking, family, relationships and the addiction process.and the addiction process.
• Each group has 12 different relative Each group has 12 different relative life topics that unveil the triggers of life topics that unveil the triggers of drug abuse and viable strategies of drug abuse and viable strategies of resistance. resistance.
• Therapeutic change occurs when Therapeutic change occurs when treatment works in tandem with the treatment works in tandem with the criminal justice system. criminal justice system.
• Intensive, multi-dimensional, Intensive, multi-dimensional, systemic two phase approach.systemic two phase approach.
Copyright © Guy A. Wheeler Group/Justice For Life Institute
12
6
39
1
2
4
57
8
10
11
PSYCHOEDUCATIONAL GROUP (PEG)“ANYTHING CAN TAKE OVER YOUR LIFE”
Copyright © Guy A. Wheeler Group/Justice For Life Institute
QU
ES
TIO
NS
??
?Q
UE
ST
ION
S?
??
4848
The The endend
4949
Dr. James CoteDr. James Cote
Professor of Sociology at the University of Western Professor of Sociology at the University of Western Ontario and author of “Arrested Development”.Ontario and author of “Arrested Development”.
Different PerspectiveDifferent Perspective
Social & Economic FactorSocial & Economic Factor
Social DisorganizationSocial Disorganization
Baby Boomers – choices openBaby Boomers – choices open
Emerging Adults “The In-Between Age”Emerging Adults “The In-Between Age”
Age of Identity Exploration – Young people are Age of Identity Exploration – Young people are deciding who they are and what they want out of deciding who they are and what they want out of work, school and love.work, school and love.
Age of Instability - The post high school years are Age of Instability - The post high school years are marked by repeated residence changes, as young marked by repeated residence changes, as young people either go to college or live with friends or a people either go to college or live with friends or a romantic partner.romantic partner.
Age of Self-Focus - Freed of the parent and society-Age of Self-Focus - Freed of the parent and society-directed routine of school, young people try to directed routine of school, young people try to decide what they want to do, where they want to go decide what they want to do, where they want to go and who they want to be with (before those choices and who they want to be with (before those choices get limited by the constraints of marriage, children get limited by the constraints of marriage, children and a career).and a career).
Age of Feeling In-Between - Many say they are Age of Feeling In-Between - Many say they are taking responsibility for themselves, but still do no taking responsibility for themselves, but still do no completely feel like an adult.completely feel like an adult.
Age of Possibilities – Optimism reigns.Age of Possibilities – Optimism reigns.Dr. Jeffrey Arnett (Emerging Adulthood-2004)Dr. Jeffrey Arnett (Emerging Adulthood-2004)
Another Perspective