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Monday, September 04, 2006

Therapeutic Recreation and Substance Abuse

Topic Summary.

Examining the role of Therapeutic Recreation upon Substance Abuse treatment of incarcerated individuals. Specifically the cognitive, social, and conflict resolution capacities of T.R. as applied to the treatment and relapse prevention intervention initiatives of Treatment Communities and other prison based programs.
Although Therapeutic Recreation is used in the field of Corrections for the inmate population as a whole, it has seldom been used specifically within the Substance Abuse phase of treatment as a valid treatment modality in its own right.
The role of recreation within the justice system is most often limited to the mandated legal provision to provide recreation to inmates. Because all inmates must have some degree of recreation, those in treatment are afforded the same measure of recreation which may or may not be inclined toward a therapeutic tendency. My basic premise is Therapeutic Recreation offers a beneficial and highly engaging modality for the treatment and prevention of AOD, currently being underutilized by the prison system. A systematic evaluation of the effectiveness of TR as an integral component to AOD treatment within the penal system is needed to encourage the use of TR as more than an “add-on” to standardized counseling and treatment.

Literature Review and annotated bibiliography follows.
Literature Review

Bell, Wilson. C. (1992). Florida Dept. Of Corrections Substance Abuse Programs.
National Institute on Drug Abuse Research Monograph #118, Drug Abuse
Treatment in Prisons and Jails. U.S. Dept. Of Health and Human Services,
Rockville MD.

Bradovich, Milan O. (1993). From Residential Treatment through Aftercare-South
Carolina’s Collaborative Approach. Communique. U.S. Dept. Of Health and
Human Services, CSAT. Rockville, MD.[abc1]

Brill, L. (1972). The De-addiction Process. Springfield, Ill.: Charles C. Thomas

Center for Substance Abuse Treatment (1994). Combining Substance Abuse
Treatment with Intermediate Sanctions for Adults in the Criminal Justice
System. Treatment Improvement Protocol Series #12. U.S. Dept. Of Health
and Human Services, Rockville MD.

Center for Substance Abuse Treatment (1993). Communique: Forging Links to
Treat the Substance-Abusing Offender. CSAT Treatment Improvement
Exchange. SAMHSA, Rockville MD.

Center for Substance Abuse Treatment (1993). Relapse Prevention and the
Substance-Abusing Criminal Offender. Technical Assistance Publication Series
#8. U.S. Dept. Of Health and Human Services, Rockville MD.

De Leon, George. (1991). Retention in Drug Free Therapeutic Communities. NIDA:
Improving Drug Abuse Treatment. U.S. Dept. Of Health and Human Services.
Rockville MD. (Pg. 218-244).[abc2]

Frohling, R. (1989). Promising Approaches to Drug Treatment in Correctional
Settings. National Conference of State Legislatures. Criminal Justice Paper #7.
U.S. Dept. Of Justice, Bureau of Justice Assistance, Washinton D.C.

Gorski, T.T., and Miller, M. (1981). The Management of Aggression and Violence.
The CENAPS Corporation, Homewood Ill..

Hall, Sharon M., Wasserman, David A., and Havassy, Barbara E., (1991). Relapse
Prevention. NIDA: Improving Drug Abuse Treatment. U. S. Dept. Of Health
and Human Services. Rockville MD. (Pg. 279-292). [abc3]

McCall, Gail. E. (Unpublished original material). Corrections and Social Deviance.
University of Florida. Gainesville, Florida. [abc4]

Peters, R.H., Kearns, W. D., (1990). Drug Treatment Services in Jails: Results of a
National Survey. U.S. Deptarment of Justice, Bureau of Justice Assistance
Monograph, Washinton D.C.

Wilkinson, F. & Doggett, L. (1996). Effectiveness of recreation in a correctinal
system. Proceedings of the Ninety-sixth congress of the American Prison
Association Held in Baltimore, Maryland August 28-Sept. 1.

Woody, George E., McLellan, Thomas A., O’Brien, Charles P. And Luborsky,
Lester. (1991). Addressing Psychiatric Comorbidity. NIDA: Improving Drug
Abuse Treatment. U.S. Dept. Of Health and Human Services. Rockville MD.
(Pp. 152-166). [abc5]

Page: 2 [abc1] The author begins by citing the extent of South Carolina’s need for adequate Substance Abuse within the justice system: more than 60% of inmate offense are related to alcohol or other drugs, and more than 35% of all arrests are related to AOD’s. Not until 1989 did the state of South Carolina begin to implement a comprehensive drug treatment program to address this issue. The program, ATU, is a residential program in a TC styled modality which incorporates various forms of therapy including Individual, group, and family counseling,; lectures and educational components, recreation, health, and wellness activities,; 12 step program, and urinalysis testing. In addition to the residential phase, a strong transitional emphasis is maintained. Between August of 1989 and the beginning of 1993, 950 inmates graduated from program. Outcome studies indicate initial findings of fewer relapse among participants however, long term analysis is still needed.

Page: 2 [abc2]
The author, George De Leon, examines the correlation between Substance Abuse intervention program retention rates and overall program effectiveness. According to the author, little emphasis has been placed upon methods designed to increase the length of duration within TC’s. Findings demonstrate a 14% one year post treatment outcome for participants who reside in a TC from 1-90 days. This increases to 38% for participants who reside in a TC for over 90 days. Comparisons between a 1970 and 1974 two year follow-up of male opiod abusers found a strong correlation between programmatic success and improvement rates upon released substance abusers. Approximately 30% of participants will drop-out of the TC program within the first 14 to 30 days. By 90 days, approximately 50% of participants will drop-out of the TC program. Thereafter, retention rates remain fairly stable. Due to the nature of a TC, it is not surprising to find a high level of non-participation during the early stages, and in fact, complaints over the regiment and other personal indicators of dissatisfaction are often cited as reasons for dropping out. Primary recommendations include the use of varied treatment personnel and methods in combination with standardized TC modalities of intervention.

Page: 2 [abc3]
The author begins by defining relapse, the generally recognized stages of relapse, and the two major models used to explain relapse: cognitive-behavioral and conditioning models. The status of key variables including commitment and motivation, coping skills, social support, affect, cue reactivity, stress, and abstinence violation effect (AVE), are each examined in context to the major models. A strong argument for generalizability from the TC to the “real world” environment is supported by the often cited reasons for relapse upon release from a highly structured environment into a less structured environment. Recommendations include building non drug networks, identification and engagement of positive social support and contacts, and applied social skill building.

Page: 2 [abc4]
An overview for the need of recreation within the correctional environment. The author examines the historical account of the penal system and the role of recreation within a correctional environment, the theoretical foundations supporting the inclusion of recreation as a necessary and useful intervention to discipline and rehabilitation, and related terminology. The article continues by discussing the application of Therapeutic Recreation and the Leisure Education Model. Assessment, planning, implementation and evaluation as related to the individual are each discussed with trends within the field of correctional recreation provision providing a summation of future needs and challenges.

Page: 3 [abc5]
This article examines the needs of “dually diagnosed” within the area of substance abuse treatment. Due to the nature of substance abuse and alcoholism, there is a strong incidence of psychiatric symptomology. Psychiatric disorders may be drug induced, result from the withdrawal of drugs, or the result of primary psychiatric disorders. An emphasis on secondary psychiatric manifestations (resulting from the inclusion or withdrawal of drugs) was the emphasis of this paper. Common psychiatric manifestations include anxiety, depression, paranoia, hallucinations, aggression, etc. And must be distinguished from primary psychiatric disorders. Treatment patterns and implications for treatment of agonistic (acute drug effects), antagonistic (withdrawal effects), residual (persistent drug effects), or underlying (non drug effects) vary substantially especially in regard to behavioral intervention treatments which demonstrate a high level of effectiveness with substance abusers and secondary psychiatric manifestations however, a poor level of effectiveness with underlying psychiatric manifestations. Recommendations adamantly support the training of professional staff acquainted with and trained in the recognition, assessment, and intervention techniques needed for each intervention rather than using primary staff as a “jack of all trades” required to respond to all levels and methods of treatment and intervention.


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