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

02/11/08 1
 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
02/11/08 2
 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.
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 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.
02/11/08 4
 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
02/11/08Disorder3. 5
 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.
02/11/08 6
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
 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!
02/11/08 8
 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
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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.
 I can’t be bored on the job.
02/11/08
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.
10
 How the Prison Mindset Activates
Addictive Thinking:
Survival and Money
Thoughts: Behaviors:
 The more money I  Turn down jobs that are

make, the better my “beneath” them. Work

chances at surviving. overtime, second jobs, or
do under-the-table work.

 Its my money to spend  Binge spending, giving $

how I want now that to someone else,
I’m not drinking or gambling - finding ways
using. to get rid of it.

02/11/08 11
 How the Prison Mindset Activates
Addictive Thinking:
Survival and Money
Thoughts: Behaviors:

 I need money to be Flash cash, Showboating

somebody.

 I need money to give Give away savings, rent

to my partner or or grocery money to
children. children or spouse.

02/11/08 12
 How the Prison Mindset Activates
Addictive Thinking:
Survival and Relationships
Thoughts: Behaviors:

 I can’t make it on my  Moves in with a

own. I need someone partner who already
to take care of me. has a house and
structured lifestyle.

 I need to be needed.
 Selects a needy
caretaking partner
who enables addictive
behavior.

02/11/08 13
 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!
02/11/08 14
 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?

02/11/08 15
 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
02/11/08 16
recidivism and tailor specific interventions to address
 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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