Treatment and Therapeutic Communities [Western Prisons studio session]

Transcript: Treatment & Therapeutic Communities

A recent study shows that over 50% of the prisoners released in 1994 were back in prison within 3 years. Our panelists talk about the role that therapeutic communities can play in treating inmates for, especially, drug addiction and keeping them from re-offending once they're released.

These are selections from the whole transcript. Some comments will also occur on other themed pages because they cover more than one topic.

Jim Peck: Elliott Weiss, bring us up to date on how Ed's doing.
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Elliott Weiss: Ed right now is in a still a semi-safe environment he's in a work center. He's been working in a, in a factory in fact he didn't have a good start he left, the day after he left he came down with a fever and spent five days in bed with the flu and that was his introduction to the work center. But he got a job at a local factory near the work center and its in the county adjacent to the county he's going to reside in and he's already got permission from his parole officer to keep that job. So on that, on that end its very good, it looks positive for him. He's, I spoke to Ed last week and he's been in contact with the members of his support group already and they told him what to expect, they're looking forward to having him become a member of the support group.
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Jim Peck: I know one of the things that we didn't touch on in the piece that we showed, there's a large aftercare component of this program.
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Elliott Weiss: Correct.
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Jim Peck: Why is that critical?
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Elliott Weiss: When we started this program and we got the funds, we started a number of years ago we didn't have any funds for aftercare and the staff got together and we had talked, and we knew this was going to be a big problem. So we went to the local district which was Boise, Idaho, District Four in our state and got permission to form an aftercare group in that particular district and we got a parole officer to run it. And what we did is teach in the last phase of our program, the reentry phase we taught them how to run their own support group. And it works. I mean it the picture we drew when we asked for funding was its like a doctor they can repair a leg beautifully, but if they don't give the patient a crutch to walk on all their work is going to be for naught.
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Jim Peck: And now part of that crutch is that these inmates when they get out get back together with other inmates and that's unusual in this system.
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Elliott Weiss: That was a big sell we had, when we said that the policy at the time was if you're an offender and you go out on parole you do not contact other offenders and we had to fight for this because in the therapeutic community we teach them to be otherscented so to speak. A drug addict or a convict doing time, an inmate does it on their own, leave me alone, I am going to leave you alone. We teach them in the community they're responsible to each other and when they go out they call each other on their behavior in the same way they do inside. So the support group, which we call the winner's circle does work like that. And what was interesting is the first few years Boise University tracked our graduates and they came back and they gave us our success rate which was good and the politicians loved it. And the staff said there's something wrong here, why don't you go back and check district by district and they did find out the district that we had the support group in, that we started the aftercare program was really carrying the rest of the state in percentage wise and the Governor responded. The politicians listened to us and the Governor responded and gave us transitional people in each districts and now we have a transitional program in the seven districts that the state's divided into.
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Dorothy Nash Holmes: Drug treatments one of the programs that's been found very effective to actually reduce recidivism. You can help an inmate fix a lot of things about himself, but he or she's got to make the commitment to change when it comes to drugs and there are certain ways that have proven to be effective to doing that. But if you can't get it started while they're in prison, if you just keep them still and keep them from the public, yeah they go into a, they go into a remission, its an institutional remission, they can't get the drug so well, so they're not using them. As soon as they get out like he said within weeks they're back doing the same thing. This is the one opportunity we really have to do something that works. The problem we have is the funds are endangered, now all the prisons may have to stop that pretty soon.
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Sheila Leslie: I think in the west we have a very libertarian attitude towards addiction and we think just stop you know just stop you know its not that hard and in Nevada especially where we have 24 hour access legally to alcohol and drugs are also readily available in that kind of tourist transient community we see a lot of people that get into trouble. They end up in prison. 80% of them were high when they committed their crime so obviously there's a connection there and yet we have a major newspaper in our state that says the best and only drug prevention program we need in Nevada is prison. Just stop. So I think we really need to reeducate the public, the policy makers about addiction and what it means and as Dorothy said what a therapeutic community can do in a prison and the fact that treatment works, recovery is possible.
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Jim Peck: And we're not talking I know this program isn't just like AA or a regular 12-step program. This is, this has a lot of enhancements that are unique and custom built for this population.
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Elliott Weiss: They call each other the members of the community its 100 bed facility and they call, they call themselves and family.. Now for most of them in there this is the first, the first community or positive family that they've had in their lifetime. It's the first time they had to be accountable to the people around them. So it's a unique situation it is. Unfortunately and I can say this without any hesitation that's the best treatment program in this state of Idaho and it has to be behind bars. We need programs like this outside before they get in and the taxpayer has to be educated that this is going to be a big bang for their dollar. I mean it's a lot cheaper to do treatment outside prison than it is inside.
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Dorothy Nash Holmes: And I think its real counterproductive to focus on how they got there and why they're that way. Our prison therapeutic communities, and we have two of them in Nevada, they are biocyclesocial okay. They touch on all the bases that may have gotten the person that way. The issue is face that you're there, become accountable and help yourself get out of that. They are very in your face, they're very confrontational to each other, they hold each, they're tough, they're a tougher family than I have at home. They hold each other accountable for their misdeeds and there are punishments and there are rewards and they sympathize with one another. But if you don't do that the inmate's left with the family that he has outside. You heard on the clip he got bad news, about two weeks ago in Nevada we had one of our women, not the ones in the film, but in that camp who learned that her daughter was dumped on the steps of a hospital, dead, DUI, from drugs and that single fact probably affected that 130 women in that camp more than anything else that had happened. They felt like her family and they had to help that woman who lost her daughter to drugs while she's in prison for drugs. We've got to have programs like this that can break those generations of cycles like that.
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Jim Peck: Well at certainly Ed's story is poignant, but I don't get the feeling from any of you that you think it's unusual with him, with his daughter, with any of that.
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All: No.
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Dr. Ed Latessa: That's common. I think that clip demonstrates a number of issues. One is of course with Ed's daughter which is very common with as he said he hasn't been there, his wife hasn't been there and we know that children of people incarcerated are much more likely to get into trouble and use drugs so that illustrated it. I think it also illustrates how limited we are, if that's 100 bed program and what does Idaho have 5,000 inmates and you know that's not an uncommon story where we have thousands of people incarcerated that can use a program and yet we can only provide it for a small number. It also shows I think Ed illustrated when he said you know now I have to practice what I learned and that's one of the difficulties of treatment programs in institutional settings. It's easy in a controlled setting to make sure that no drugs are available and that everybody's supportive and reinforcing each other. Its when they come out and that's why aftercare is so critical because that's when the rubber meets the road, that's' when we decide are we going to go to work, are we going to go drink with our friends, are we going to do things. And so that, that need for reentry and transition's critical it increases effectiveness of programs dramatically. Yet because of money often we can only do what we can in the institution without doing anything coming out.
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Dorothy Nash Holmes: That's why we need the partnership, prison can't do it alone, transitional homes like Step Two can't do it alone, we need the drug court. That is a continual reminder and a continual monitor. We need the parole officers. We need all the different players in the system on the same page each accepting we know that it works. We've all finally reached a point in America where we understand what works and but everyone has a role in it, its no one person's job, but we all have to be at the table.
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Sheila Leslie: I think that's a very important point that she just made. We know what works, treatment works as long as you can get it. Too often we give, in Nevada we give a prisoner $20 gate money and say see ya later, good luck, hope we don't see you back here again and of course we do end up seeing most of them back again. So if we know what works why aren't we doing it? And I think that's a question as a society we have to ask. I personally would like to see more reentry programs where people do go through a drug court where there's a judge monitoring their behavior during that time period when and I think it's the first six months when a lot of them end up having a relapse. So it can be done. The drug war, we're so used to just say no doesn't work, we're loosing the drug war on the you know the interdiction side, the only way to reduce demand is to work with people, we know how to do it, we just have to develop the political will to do it.
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Robert Lampert: I think there needs to be a seamless continuum of services and treatment all the way from arrest all the way through that the assessment instrument needs to remain consistent from when we first assess all the way to release to see that progress. We need to be able to target the resources that we do have towards the population that are best served. We need to be able to use research and measurable objectives to know what population is best benefited by that type of services. Residential treatment services are best geared towards the highest risk population, it wastes resources and actually makes offenders worse if we put a low risk population in that type of environment. So we need to be able to know who it is that we're targeting and why and then provide the services for them.
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Jackie Crawford: You know I don't want to underestimate at this time the community because number one substance abuse drugs, they do not discriminate and we're finding, I'm seeing more and more as middle class person coming into our prison and their parents coming who are absolutely ashamed, embarrassed and they want to see something done and I think you're going to see a change in the attitude and change in the direction because they want to know what their tax dollars are going for. They want to see some help for their sibling or their son or their daughter or grandson. But you know, drugs do not discriminate and at that point there's a lot of people who are coming in and even your entertainers you're seeing more and more of the relapse and what's happening with them and even some of your favorite radio talk show individuals. Across the board drugs are an issue and a problem and I think you may see a change because those are the individuals who are getting the treatment. They're coming back saying this is what's needed, not incarceration. I believe that's where we in corrections begin to tap into that mainstream community.
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Jim Peck: And when we're talking to corrections we're sort of its easy to think of this as sort of the end of the process you know the folks have ended up here and now what do we do? It occurs to me as watching these three pieces that we're seeing how this hits every different part of growth of life of family and that kind of thing. I know that folks are going to be going in front of their legislatures, Director Beauclair I know you're going to be there going through that and again to talk about money a little bit and allocation resources many times it comes down to well folks when its on the floor do you want to put money into schools, do you want it to go into corrections.
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Tom Beauclair: I'd like to respond to that you know there's not enough money for anybody and there never will be enough money. I really think that we have to stop, somebody had mentioned earlier the funding streams, we tend to fund things in a silo and we don't cross over into those other paths. I think we have to look at this a little differently in that this is not a corrections problem, it's a social problem, it's a society problem and until our communities get involved the true test is going to be in the communities, not in prison. Like Dr. Latessa said, its not going to be in prison, its pretty easy to get sober in prison particularly in a real safe environment, but the true test is in the community and without strong community involvement and support there will never be enough money.
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Jim Peck: Well and what happened, you know Dr. Latessa maybe you can answer this I remember when I was growing up seeing things like Scared Straight and seeing a lot of this stuff that I mean I felt as if I was bombarded by information as a teenager about don't do this, don't let this happen to you. Is that still out there? Are people paying as much attention or are we just okay with warehousing people?
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Dr. Ed Latessa: Well many of those type of programs aren't very effective, they don't work and I think we've learned that "Just Say No" and try to scare somebody out of use, you know interesting when you hear some of the stories, some of the clips, many of the people have all been incarcerated before. So clearly prison hasn't been the answer for them they've been in programs in some cases before as well so I think in recent years we've begun to focus a lot more on maximizing, programming, what we call evidence based practices for example. In Oregon now the legislature just passed a statute that requires that a certain percentage of the programs that are offered all be evidence based and I think that's a trend we're going to see in other states because we're you know legislators and others don't want to spend money on things that aren't very effective. Are we still bombarded with it I think it's a little tougher today. Certainly we're inundated in the media with, with drug use and lifestyles that we wouldn't have seen when we were growing up, things that kids see on TV today and, and so and I think that does have an affect on them, but the fact is in terms of corrections and correctional programming we do know what works and we know that we can have some effect on behavior. I agree with Director Beauclair that not everyone can be treated, we know that there are extremely high risk psychopathic type of offenders that we really don't have any interventions for at this point, but I think the majority of people that come through the criminal justice system can be rehabilitated or certainly we can reduce recidivism a significant amount for those people.
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Jim Peck: Do the programs that we have in place are they working? I mean do we, or do we need to go back and come up with a new system of programs? We seen that a little bit with the clip that we just saw about the injustments to sort of a basic 12 step kind of program. A lot of people, I think some people would say its easier to fund programs that are already there and get them going, but do we need to rethink that, do we need a new grassroots push to do that?
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Marianne Johnstone: Drug Court definitely is cost-effective. It's of my understanding it's about $2,000 a year for a drug court person to go in that program and complete it and certainly if he spent a year or so in prison $2,000 wouldn't even come close. So and what is it California I think does not put first time drug offenders or, or drug offenders in prison they put them in treatment because its more cost effective.
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Terry Kolkey: One of the things about that program the good side about it and what people are talking about is having faith in the community. That the drug court program or its called Prop 36 I believe, was passed by the voters because the political process didn't have the willpower to produce those sort of results it took the people to do it.
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Dr. Theresa Martinez: We do have programs that work I mean event this program that we saw at the beginning is obviously a program that works, but most people are fighting over just a couple you know couple hundred beds for thousands of people and most of the people in there are involved in drugs and alcohol.
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Marianne Johnstone: 80%.
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Dr. Theresa Martinez: So how in the world I mean it's ironic to scary to think that we've got thousands and thousands of inmates across the country who have drug and alcohol programs, who've got programs that work, but we don't have the money for enough beds for them to be. And by the way that's also a racial issue across the country because when there are a black inmates in the systems or Latino inmates in the system they don't even though they have the highest rates of arrest for drugs in federal prisons and in state prisons they're not going into the programs as much as the European Americans as the whites, I mean so it's a racial issue. Why aren't we putting the money into more beds for those?
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Elliott Weiss: First of all as the program you just saw on TV there Ed was, Ed is . . . just graduated cost the state of Idaho an additional $3,800 per inmate. It doesn't take long when you're out working paying that back and paying taxes, right now they're not producing anything as far as taxes, they're using taxes. $3,800 is a pretty good investment to a taxpayer, especially when you consider the cost of keeping an inmate and bringing them back through the system, just court costs and arrest costs are close, far exceed that as a matter of fact.
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Jim Peck: Well and again I'll point out about this program in Idaho this is a voluntary program its not looked upon favorably from folks in the general population and yet you can't even.
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Elliott Weiss: I'd have to disagree with you on that, when we started the general population looked at them and said oh you guys are the, you're the other ones, you know we know how to do time. It's completely changes, the general population now we're getting more volunteers than ever before, we just don't have enough beds and they see change in people who have gone through the system four or five times and now are out and not coming back.
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Jim Peck: Well and sometimes the people that are coming back in that program are coming back as success stories and they're coming back and working with the people who are there now.
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Terry Kolkey: One of the things in terms of, you were asking do programs, do the programs work, you know addictions a very long-term process and just because somebody relapses I don't look at that as a failure. I mean you might have somebody who spent five years as a drug addict and then they get clean and then maybe they spend three or four years clean, if they have a relapse that's a success that they've had three or four years clean. I mean you have people that may go on and off, on and off, but the process gets better and better over time and you can't just be impatient and say because they had a couple relapses it's a failure, actually it's a success.
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Tom Bolan: And I wanted to clarify something that was said earlier and that was regarding 12-step programs because one thing I don't want people to leave with the impression of is that programs like this don't integrate with 12-step programs. It is that addiction thinking, addictive thinking defies logic, it defies intentions. You know we work with mothers who said they wouldn't do, never do anything to harm their child and they've meant that with the deepest part of their heart, yet they had the child in the baby seat while they were scoring drugs on the street, because they thought they could get away with it this time. For a non addicted person to hear that, they can't understand the logic behind that because there isn't logic behind that. Intensive treatment programs like this teach people about their own addictive thinking and that they need community and fellowship to be able to combat that. The program in the clip we saw provides that fellowship, but the gentlemen also spoke too that everyday he needs to go to meetings and I believe that he meant meetings of narcotics anonymous and alcoholics anonymous. So an intensive treatment program is like a discovery process on the path to recovery. And the 12-step programs which also have people that have been in the systems that's helping people that are new in recovery are very much an important part of the landscape.
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Jim Peck: But you know it has to truly be a lifestyle change, this isn't, like a diet as opposed to a way of changing your habits.
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Tom Bolan: Absolutely.
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Elliott Weiss: You know and the 12-step programs didn't work for offenders at first because the 12-step programs for someone who knows how to live in society. You have to change their value system first. The 12-step program was written by two gentlemen, two men, designed for men who know how to live in a community. I think we have to take offenders through a therapeutic community and change their sense of values first. People that we see go out now that are in 12-step programs, graduates of ours didn't feel comfortable in 12-step programs prior to going through the experience of a therapeutic community and changing their belief system and their value system to being pro-social. Before they felt like outcasts going into an AA group or any 12-step group, narcotics anonymous, now they go in and embrace it because their value system was given an opportunity to change first and indeed it did change.
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Robert Lampert: I think part of that is a shift in accountability from forced accountability from the prison officials and prison professionals down to the level of peers and ultimately to the level of the individual and their cohorts and positive role models if you will in society helping them maintain that self control.
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Dorothy Nash Holmes: And rehabilitation isn't an event, it's a process. You have to change their criminal thinking, their cognitive makeup first. You have to stop them and slow them down and get them out of the environment, that's prison. You have to change their thinking that's next. You have to change their acting that's next. It's a full process no it won't work if any one of those pieces are missing so we've got to have the protection of the public, we've got to have the incarceration in some cases, we've got to have the treatment. It doesn't do any good to put them in prison and not treat 'em there and say they'll get the treatment on the outside it has to be part of the package.
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Sheila Leslie: Getting treatment on the outside isn't necessarily an easy thing either. In Nevada we have long waiting lists for all of our treatment programs. So we need better access in the community to avoid people committing crimes and then I agree with the Professor within the prison structure we can't just have one program and say oh that takes care of it and that's how legislatures tend to think oh we already have a substance abuse program and yet we're serving 100 people and we need to be serving 5,000 people. So we need to expand the treatment opportunity and instead we have congress taking the treatment money away so we have a real disconnect in our country about what we're funding and why.
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