Substance-abuse treatment: changing the correctional culture.

Author:Simpson, Mark

Substance-abuse treatment programs in correctional settings face many obstacles, some of which are external, that challenge their integrity. While reentry initiatives have received unprecedented visibility within corrections in recent years, the reality of public-sector funding requires administrators to make hard decisions in allocating the limited resources given to them. Most correctional systems have accepted the reality that the "lock them up and throw away the key" mentality is both self-defeating and fiscally ruinous; however, the critical need to focus on security to ensure the safety of offenders, staff and society leads administrators and other stakeholders to place substance-abuse treatment at a lower priority than they might otherwise prefer. As a result, such programs must always justify their existence and face the constant threat of reduced funding.

Other obstacles for substance-abuse treatment programs in correctional settings are internal. One such obstacle is the potential for conflict between staff tasked with the delivery of treatment and security personnel whose jobs are to maintain the safety and security of the institution in which the program is embedded. While little formal study has been published regarding this potential conflict in the area of substance-abuse treatment, numerous authors have documented potential conflict between security personnel and staff who deliver programs for offenders with severe mental illness. Appelbaum et al., for example, note that security and mental health staff have distinct professional cultures and missions that can clash if not managed appropriately. (1) The primary mission of the security staff is to serve society by confining inmates, whereas mental health providers serve the individual patient primarily by providing treatment. As these authors observe, the correctional culture emphasizes regimentation, consistency in the application of rules, implicit authority of security staff and the imposition of punitive sanctions for violations of institution rules. The culture of the mental health staff, on the other hand, is characterized by individualized treatment, informed consent and negotiated compliance.

This clash of cultures is potentially even more problematic with regard to substance-abuse treatment. Correctional staff may be uncomfortable with the task of supervising offenders who exhibit behaviors associated with severe mental illness, but they can usually accept that the offenders are "sick" and are in need of behavioral and/or psychotropic interventions delivered by specially trained providers to help manage their behaviors. This is less often the case with offenders with substance-abuse disorders, whose behaviors are viewed as volitional and therefore under their control. In this regard, correctional staff may view an offender's substance abuse as a character flaw that is best met with sanctions rather than as a disorder that can be impacted through treatment.

Potential conflict between the correctional and treatment cultures is particularly notable with substance-abuse treatment programs delivered I through the use of therapeutic communities (TCs). TCs rely on the therapeutic environment as an important influence in encouraging individuals to adopt...

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