Mentoring shown to reduce future criminality

More than 100 people attended a Nov. 30 conference hosted by Co-Occurring Collaborative Serving Maine on how mentoring can reduce future criminality.

Diverting former inmates from crime to becoming responsible and contributing citizens is a worthy goal. Estimates of recidivism comparing those who access mentoring versus those who do not illustrate the effectiveness of the re-entry programs.

Preventing future crime is cost-effective and allows focus on needs that currently remain unaddressed. The total cost of a crime is not captured and generally we are unable to determine true expenditures. However, it is substantial.

Leadership to bring about sustainable system changes remains elusive. Considerable holes exist in the system. Funding is inadequate and seems about to get worse.

A discussion remains pending about victims, loss to families and society, the cost of crime and justice systems, public/private engagement needs, and the dysfunction of adequately dealing with crime and disorder. We hold tight to a reactionary model of crime control and an overreliance on punishment as the single prevention model.

For example, billions of dollars have been spent on the “War on Drugs” (1971 law), and in the intervening 42 years the problem actually appears to have worsened. Police make many arrests, but without community change efforts, the reduction goals cannot succeed.

Can we make use of successful programs such as mentoring for individuals returning to society to help them avoid re-criminalizing? And will it cost less than the current silo system? Absolutely.

If we accept the benefits of post-incarceration mentoring to reduce future crime by former inmates, we can replace the “what is” with “what can be,” thereby reducing recidivism.

Richard Lumb

Wilton

Reprinted (with minor edits) from Kennebec Journal

Changing Substance Abuse Relapse Policies

Dr. David Mee-Lee, a leading expert in co-occurring substance abuse and mental disorders, has recommended changing how substance abuse clinicians use the word “relapse.” He published the advice below in two issues of his newsletter, “Tips and Topics.”

“The general public still largely views addiction as a self-inflicted problem,” Mee-Lee said. “There is less tolerance for supporting treatment when compared with physical illness, and even for many mental disorders. What is even worse still is when addiction treatment also embraces policies which appear to view addiction relapse as wilful misconduct, needing consequences and possible discharge.”

Mee-Lee said people with substance abuse problems are often sent away from support groups or sent to crisis services if they have relapsed. In contrast, people with recurring depression, psychosis or diabetes are welcomed by health professionals.

There is no reason to refer people to a crisis service or turn them away from support groups and housing because they have used drugs once, Mee-Lee said. Professionals in the field are using the word “relapse” to reclassify their clients unnecessarily, based on moral judgment.

Mee-Lee quoted a 2012 interview with Bill Miller, the developer of motivational interviewing. ”When you’ve relapsed, it’s pretty clear you’ve done something bad and it’s your own fault,” Miller said. He said the word relapse “takes on very pejorative, shaming overtones.”

In 2009, Mee-Lee wrote in-depth guidelines for changing relapse policies. He recommended psychiatrists approach relapses as occasions to revisit clients’ treatment plans.

Excluding clients from services worsens their conditions. Clients can become homeless because of relapsing while living in treatment facilities. When they become homeless, their health generally becomes worse than it would have been otherwise. Giving them housing would improve their stability and reduce health care costs.

The fact that clients might trigger others in a group by being drunk or high is not a sufficient reason to leave them without services, Mee-Lee said. Clients with anxiety or trauma histories are not excluded from support groups because they might trigger others.

If a client is genuinely committed to getting help, but still brings drugs into the treatment setting occasionally, Mee-Lee believes clinicians should work with the client to improve treatment outcomes rather than putting him or her out on the street. However, if a client is just using a treatment center as a hotel and bringing drugs into the building, that is a different story.

For more information on changing relapse policies, please visit Mee-Lee’s website at http://changecompanies.net/tipsntopics/2009/06/june-2009/#more-807.

Helping Clients Withdraw from Psychiatric Medication

Are you a clinician who wants to help clients withdraw from medication successfully? Maybe you need to go through a withdrawal of your own – a withdrawal from the prescription-oriented mindset. That’s what David Cohen, Ph.D., LCSW, said at CCSME’s Innovative Solutions for Building Recovery with Alternatives to Psychotropic Medication conference last week.

Cohen brought a wealth of experience to the presentation, since he has been studying withdrawal from medications since 1982. He cited many studies showing that if medications are withdrawn gradually, clients experience outcomes that are at least as good – and sometimes better – than they would experience if they remained on medication.

This pattern is consistent across multiple conditions – depression, bipolar disorder and schizophrenia. One study of antipsychotic discontinuation showed that 56 percent of the patients got better while only 12 percent got worse.

“Coming off drugs is a natural outcome in the majority of treatment,” Cohen said. “Many people feel they awaken.” But he also added a caveat. “Drugs are one answer, an answer, and they’re here to stay. We’re a drug culture.”’

 

Pills in hand

Drug withdrawal effects can be challenging. Cohen quoted Joanna Moncrieff, one of the other speakers at the conference: “If withdrawal… could be efficiently managed, the success of drug discontinuation might be much greater than usually assumed and might outweigh the disadvantages of continued treatment.”

There is some reluctance in the psychiatric community to acknowledge withdrawal effects, Cohen said, but hundreds of case reports exist. The symptoms may be physical or psychological. The transitional effects persist until the brain reaches a new homeostasis. There are three types of effects that can occur: withdrawal effects, rebound effects, and relapses.

“The only thing that seemed to matter is the half-life,” Cohen said. He showed data demonstrating that drugs with longer half-lives transition out of one’s system gradually, making it easier for brain activity to stabilize.

Cohen said clinicians should try not to work with clients who want to stop taking medication until they have become comfortable with the concept. Otherwise, he said, “We sabotage the effort and use the result as confirmation that we were right all along.”

The Pitfalls of Psychotropics

Has mental illness become an epidemic in the United States? Robert Whitaker, a science journalist and author specializing in mental health, says the answer is “yes.” He will speak at CCSME’s upcoming conference, “Innovative Solutions for Building Recovery with Alternatives to Psychotropic Medication.”

Whitaker wrote a peer-reviewed article, “Anatomy of an Epidemic: Psychiatric Drugs and the Astonishing Rise of Mental Illness in America,” which outlines the story of this disaster. His research shows that mental illness has increased fourfold in the United States since 1955 – the year when Thorazine, the first modern psychiatric medication, was introduced. Although hospitalization rates have dropped, disability due to mental illness has skyrocketed.

By using three classes of drugs – neuroleptics, benzodiazepines and antidepressants – psychiatric professionals have traded short-term benefits for long-term disability and dependence on Social Security, Whitaker said.

Whitaker quoted a well-known researcher, David Healy, who said psychiatric treatments “have set up a revolving door.” Medications may increase the likelihood of future mental health symptoms.

Whitaker cited many studies showing people who have symptoms of schizophrenia in the United States become more likely to have relapses once they have been on neuroleptic medication. In contrast, people in developing nations who experience schizophrenic symptoms are less likely to be medicated. They also experience better long-term outcomes.

There has also been an upward trend in disability since the introduction of Prozac, Whitaker said. The effectiveness of antidepressants is questionable, Whitaker says, and their use leads to long-term mental health problems. Antidepressants tend to trigger mania and psychosis.

Benzodiazepines also cause long-term problems when they are used to treat panic attacks. The medications alter clients’ mental functioning to a point where they become likely to relapse later.

Whitaker has written multiple books on mental health – Anatomy of an Epidemic and Mad in America – and has also written a series of articles on mental health for the New York Times.