Breaking the Cycle of Recidivism: Secrets of Criminal Offenders

Welcome everyone. Today we're going to be talking about recidivism, looking at causes and interventions. So basically we're going to start by defining recidivism, compare and contrast relapse and recidivism, and explore motivations and interventions for both of them. So recidivism is the return to criminal behavior after being incarcerated or not offending for. Period. Okay. Relapse is the return to addicted behavior after being clean for a while. So basically both of these are returning to an addictive or returning to an old method of behavior. And I think it's really important to bear that in mind that what we're talking about is a set of behaviors. And that set differs for each individual person, but it's a set of behaviors. So I don't want to say it's a personality type or something that is more enduring and difficult to work with. What we need to look at is what are the motivations for the person to return to this behavior. And from a strict motivational interviewing and motivational enhancement standpoint, we need to ask ourselves, what is this behavior providing the person and what is the alternative behavior not providing? So sober behavior and law abiding behavior are kind of the same thing. Honesty with oneself and others. And we talked before about lies of commission, but also lies of omission. That means telling a lie that you know good and well is a lie as well as lying. By just avoiding the truth, not saying something, we can delude ourselves into thinking that things are fine. We can lie to ourselves by omission. If you want to think about it that way, you know, you just kind of plug your fingers in your ears and scream la la la. And it doesn't exist. So we can lie to ourselves, we can lie to others. The most nefarious one is the self lie that we need to work with people on getting rid of, at least identifying and stopping that behavior as much as possible. Hope and faith. If someone doesn't have hope and faith that this process is going to work, that this general set of behaviors that we're asking them to adopt is going to provide them a happy and fulfilling life, then they're not going to be motivated. I mean, think about the category or the diagnosis for depression. One of the criteria is hopelessness and helplessness. So if you don't have hope, you feel hopeless. If you don't have faith that you do the next right thing and it's going to produce good things, you know, you can feel sort of helpless and out of control. So we need to make sure that people are being honest with themselves about what they really need and why, and that they have hope and faith that this is going to continue. We need to make sure, and this goes back to an earlier presentation, that in early recovery, in early parole, probation, whatever the person state is, that the rewards are frequent and satisfying to them. Sober behavior, discipline and patience. So we're getting rid of that impulsivity, lack of time, perspective, lack of self control that we talked about as common among criminogenic thinking patterns. Courage and self confidence. Thinking that, okay, I am a good person, I may have made some mistakes, but you know, I am a good person, I can do this, I can persevere, I can endure frustration, I can endure some things in order to get to my ultimate goal. Now, a lot of people who are behaving in their addicted or criminal selves generally put up this facade of being powerful and courageous, and deep inside they are scared to death, which makes them defensive and more aggressive oftentimes. So we want to move this fear to actual, grounded self confidence, where the person goes, I can do this, I can get through this. You know, maybe with a little help from people, but I can get through it. And integrity, doing the right thing and living by your values. Well, we talked before about how criminogenic thinking promotes criminogenic or antisocial values. So we're going to need to talk about how to adjust or help people evaluate their value system in order to determine what works for them. So we want to make sure that we remember that people who are coming right out of jail and people who are going into treatment and sometimes coming right out of treatment still have these behaviors ingrained. It's not like you teach them how to not manipulate people and they never do it again. When it becomes more beneficial to manipulate someone than to tell them the truth, guess what? They're going to manipulate. That is human nature. We do what is most rewarding. Now, we can alter those rewards, but we do need to remember that this is a backup set of behaviors that you've got or they've got in the back of their head, that when it is more rewarding or when the need arises, they may fall back on these behaviors. When we talk about relapse, people say, why does this person keep relapsing? And my first thought is, what skills didn't they have or what knowledge didn't they have to prevent the relapse from happening? Because clearly falling back on these old behaviors, as destructive as they are, felt more rewarding than the alternatives. We were handing them. So we need to look at what the dichotomy was, what was the difference and help bridge that gap. So factors facing the parolee, probationer or persons coming out of drug treatment and they can kind of all be one and the same cognitively. They expect discrimination. They expect people to go, oh, I'm not going to hire someone with a felony conviction. I'm not going to hire someone with a history of drug addiction. I'm not going to hire someone, you know, fill in the blank. So they're expecting to hit some walls. They still want this immediate gratification. They did their time in jail, they or in treatment or wherever and they come out and they're in treatment. We call it the pink cloud. They think they're this new person and they've got life by the tail and they expect to just kind of step in and start living a sober person's life. They expect that they will get what they would have had had they been living a sober or law abiding person's life the whole time. So they walk out of treatment going, I'm 40 years old, I have these sets of skills so I should be hired in at mid management. No, not going to happen. They want to have housing immediately. Probably not going to happen. A lot of people that I worked with when they were getting released from jail or prison, they walked out the door with 10 bucks in their pocket and the clothes on their back and they had no idea where they were going to sleep that night. That's really not setting them up for success anyway. Illusion of uniqueness. They think they're different. They think they will be able to go and get housing or get a job. They think they will be able to convince people that they're different than the other people with criminal convictions out there. So they think they're different. They expect immediate gratification. But then there's also the little other person, other shoulder going. You're going to be discriminated against, if you want to use that word. People are not going to want to hire a fill in the blank because there are other persons applying for those jobs who may not have gotten caught. Basically is what it comes down to. Because one of the differences we've talked about between the person who has a drug addiction and a person who has a criminal history that involves drugs. A lot of times it's just getting caught. We also need to focus on the fact that this person comes out with a sense of entitlement. They feel like they've done their time, so the world owes them A second chance, a lack of coping skills to deal with frustration. Lack of frustration tolerance is huge because that also goes back to what we talked about with lack of self control and that criminogenic mindset. And in here I also want to put possible learning disabilities. There are a lot of people, and I'm not going to say, you know, a majority or anything, but I do want us to be sensitive to the fact that some people may have fallen in with the wrong crowd partly because they were failing in school and some of their learning disabilities went undiagnosed. So we do need to be aware of these. And we're going to talk in a second about mental health disorders that also go undiagnosed. When we are asking ourselves, you know, not only proximally the behavior the person did, what was the benefit? But when we look retrospectively to when they started committing criminal behavior or started hanging out with drug using friends and stuff, what was the benefit to them back then? Why did they choose that friend group over a different friend group? And that may give us some insight into some treatment issues. Mood disorders. And this is a big one for me. It just. Well, I'll get on that soapbox in a minute. Depression, anxiety, add, ADHD and bipolar disorder. Sometimes the depression is situationally bound. You know, they created a mess of their life and they're, they feel depressed about it, but they are depressed. Sometimes it is caused by the drug use, the substance use that has made their neurotransmitters kind of wonky and it needs some time to balance out. Been in 90 days in jail or 28 days in treatment. Anxiety, same thing. If the neurotransmitters got wonky because of drug use, if it's a biological predisposition or if they're just stressed because they're trying to do the next right thing and they don't know how in the world they're going to do it. There's a lot of anxiety facing people who are coming out of jail or treatment because we're asking them to change their whole life, change people, places and things. What else is there left to change if you change all those things? So that's stressful and anxiety provoking, ADD and adhd and I will also throw in there gifted. There are some people, you know, if you look back over the over history and you look at some of these geniuses, they did horribly in school and they acted out and they got into all kinds of trouble. Why? Because they were bored, they needed that stimulation, their brains worked too fast and you Know, I really focus when I talk about substance abuse and I talk about co occurring disorders. There's a video that I really love showing where there's a professor from Maryland who talks about the misdiagnosis of Asperger's disorder, ADHD and bipolar and giftedness because there's so much overlap in some of the symptoms. And a lot of times we're pathologizing people who are gifted and you know, you may be scratching your head right now going, well, they're in jail or they're in treatment so they're gifted. And yeah, you know, there is no IQ limit to committing crimes. Sometimes committing crimes is one of the biggest challenges and it's stimulating and it's exciting to people where normal day to day life is just drudgery and boring to them. So you know, I really want us to think about this and consider all of the options and we'll talk about that in a moment, later. And bipolar, you know, bipolar disorder can be misdiagnosed, rapidly cycling. You know, there's a whole list of bipolar. But if someone has a family history of bipolar disorder, we really need to look out for whether it exists and you know, warning label. Here comes the soapbox. I worked with the criminal justice system for many, many, many, many years. And one of the things that frustrated me to no end and it still frustrates me is when you have a person who goes into jail, the person is not causing problems jail, therefore they are not provided their psychotropic medication. Because the party line that I would get from the jail is if they're not causing problems while they're in here, then they don't need the medication. So you're taking somebody who may or may not have been stable on their meds, you're destabilizing them by detoxing them off of all their meds. And then when it's time to release them to, you know, life, not a controlled situation where it's, you know, there are a lot of stressors, they are not stable on any meds. If they needed them, then they need them. Not only do they need them, they need more than a three day supply. You can't expect someone to be released from jail, be able to get an appointment with a doctor and get a refill on a prescription in three days, 30 day supply when they walk out of the door and they need to stay on the medication the entire time they're in there. If they need it, they need it. And you know, I don't care if they're not being A behavior issue that's not, in my opinion, not ethical to just, you know, take them off the meds because you don't want to pay the money for them. The other thing we need to do is, and as clinicians, we can help with this, you know, some of the other stuff. As far as policies of taking them off their meds, we can't necessarily do a whole lot unless, you know, you have supervisors who are willing to make noise. I made a lot of noise. But before they are paroled or put on probation or whatever the case may be, make sure they understand what a patient assistance program is. Every pharmaceutical company that I know of has a patient assistance program. If a person cannot afford their meds, they can go to that pharmacy's website or you can help them. Printout is usually a one page form that takes like 90 seconds to fill out. The doctor signs it, faxes it over to the pharmaceutical company, and the person is given a voucher for free or really, really, really low cost access to that medication. Also informing them about drug formularies that are available at like Walmart and Publix and all the different stores that may provide them their medication for like, you know, nine bucks a month as opposed to, you know, 300. So it is incumbent upon us to do a little bit of linkaging, if you will, helping people understand where they can get their meds to be stable on them. And this isn't just psychotropic meds. This is all your meds, whatever it is. So, you know, help them understand where they can get it so they can at least stay healthy and stable. Because as soon as they start destabilizing, they're going to start frantically trying to feel normal again. Guess what? That usually ends up in recidivism. So, okay, soapbox over social. Family and friends may engage in criminal or addictive behavior, but the person may have to live with them. Like I said, they walk out of jail, they've got 10 bucks in their pocket, the clothes on their back, and they have no idea where they're going to sleep that night. So they may go home to their mama's house, they may go to their ex girlfriend's house or their current girlfriend's house or a buddy's house or whatever, crash on the sofa. They may not be able to get housing because A, they don't have a job yet, they don't have any money and they can't get in subsidized housing because of their criminal convictions and or drug use. So they're in quite a quandary. Now we know. Thinking back to Psych 101 and Maslow's hierarchy of needs, what's the base of the hierarchy of needs? Food, shelter, access to medical care. We have to have people who are functioning physically in order to expect them to be able to function well interpersonally, economically, etc. Other factors facing the parolee are discrimination and judgment from the macro system. This isn't just the parolee. This is also the person who is in recovery. I'm just shortening it. Church fellow parishioners may look down on them and go, oh, that's John. You know, he just got out of, just got out of prison or just got out of jail. You know, we want to help him, but we don't want to actually invite him to our house where he knows where we live. Jobs. You know, I talked earlier about it being harder for people with a history of drug addiction or a history of drug offenses or any family convictions to get a job. Neighbors, neighbors who know who you are may or may not be supportive of your recovery. If you are living in a neighborhood that is supportive of the criminogenic mindset, drug use, that sort of stuff, then neighbors may not be supportive of your new pro social behaviors. So it's important to understand that this can go both ways. And other things like just going to your kids school, you can't supervise field trips. People look at you and they're like, oh, I don't want you anywhere near my kids if they know what your background is. And part of that comes down to us as clinicians helping people understand that it's not once a criminal, always a criminal, once an addict, always an addict. These are sets of behaviors that people used that weren't all that functional. But it doesn't mean they have to use them anymore. It doesn't mean they're bad people. It means they made some poor behavioral decisions. Environmental. So difficulty finding housing or getting loans for cars or housing. So if you can't move into subsidized housing, maybe you want to try to. And a lot of places won't even rent to people that have felony convictions. So you may want to try to figure out how you can get a loan to get a little place out in the country somewhere or something. Difficulty getting the loan, difficulty getting a loan for a car, which in many, many places means it's nearly impossible or very, very difficult to find gainful employment because guess what, you have to have a car. Most people, you know, most inner city living where you could walk to work, probably an apartment Most of those apartments will not let you move in if you have drug offenses or criminal convictions. Now you may be able to crash on somebody's couch. That's not necessarily kosher, but you know, it happens. So understanding that that's a problem. Also understanding that when we look at poverty guidelines, and the same is true for ssdi, our clients face this quandary when they reach a certain level that once, you know, let's say it's a family of four, you know, Jim Bob gets out of jail and he has a wife and two kids at home and they make $49,000 just over that limit, all of a sudden they don't qualify for any assistance, which means a lot of the stuff that they were getting help with, like, you know, hundreds if not thousands of dollars a month all of a sudden become costs. So, you know, you start earning $400 over and you all of a sudden lose all your benefits. Same thing is true with ssdi. Not that we can do a lot about this, but it is worth understanding that there are significant disincentives for exceeding a certain level of success because that bridging that gap between, you know, $49,000 when you lose all your benefits and when you're actually living comfortably takes a while and it's really difficult. So some of these benefits that people would lose, food stamps, ebt, whatever it's called now, Temporary Aid to Needy Families, health insurance and Social Security disability. And I'm not going to go into all the numbers right now. We can do a whole philosophy class on the meta concepts. But I do want you to understand that, you know, all of a sudden you're making $900 more than the minimum poverty level and you lose $600 a month in food stamps, you lose $400 a month in Temporary Aid to Needy families, you lose $600 a month in health insurance. So that's, you know, I didn't add my numbers, but that's over $1,000 you lose just in these things, plus other things that you can't get. So understanding that that's a motivation or a disincentive for not necessarily doing what we want our people to do in recovery. Let's review criminogenic needs. And this came from one of the readings that I have in your class and I thought it was mildly amusing. Give a high risk offender a job, a home and increase their self esteem without addressing their criminogenic needs and what you will have is a thug with a job and a place to crash. That feels good about his or herself? Yeah, pretty much. We can give them all these things, but unless we identify and address the underlying motivations that that particular person had for committing crimes, the chance that they're going to reoffend is extremely high. So criminogenic needs are those factors that which when modified, reduce the likelihood for reoffending. What we need to ask ourselves is what did this lifestyle, what did committing crime do for this person? What did this mindset, what did these cognitive distortions do for this person? How did it make them feel better? How did it protect them? You know, what issues are we dealing with here? Low self control and impulsive behavior, the lack of time, perspective, whatever you want to call it. Remember to identify the function of these behaviors for the individual. Teach coping skills, teach distress tolerance. Distress tolerance is one of the biggies. I mean, if you can get a person to learn to go from, you know, 120, just all revved up, getting ready to completely lose their stuffing, wait until they calm down before they act. You are head and shoulders ahead in the game. So this whole distress tolerance thing is huge. We need to understand what causes the distress for the person. And remember I said before that, you know, a lot of people in the criminal justice system and a lot of people who have addictions have very low self esteem. So when something bad happens, they catastrophize it and they take it personally. It's the end of the world and I am worthless when that happens. They react to protect themselves, so the distress happens. So then they act out in order to get their power back to feel a little less hopeless and helpless. So we need to help them address these cognitive errors and misattributions. Is the sky really falling? Is the world coming to an end? I mean this, whatever it is, may really suck right now, and I'm not telling you it doesn't. However, what are some alternatives or what are some good things that are going on right now? Or what are some alternative worst scenarios? Try to get people to step back and take a look at it externally. And misattributions of saying I'm a worthless person because of this, we want to have them address. What are the facts supporting your statements? What are, are you using emotional reasoning or factual reasoning? If it feels bad and you are catastrophizing because it hurts so much or it makes you so angry, that's emotional reasoning. So we need to have them back off until they can calm down enough that they can use rational, factual, reasoning. And this is one of the hardest things or longest units I guess if you want to look at it that way, for people to learn, because this is sort of the foundation of everything. You need to be able to stop, take a breath and consider your options before you act. Developed self esteem comes in here, people are going to be less likely to bow up and act out. They feel self confident and they're like, you may not like me, but I like me. So too bad. If they have strong self esteem, they're not going to take every incident as a personal assault. They're not going to internalize everything as being about them, which will help reduce their distress and make any coping skills that you provide to them or any coping skills that they have that you work on strengthening more effective antisocial personality traits. And in the reading they call it an antisocial personality. And you know, we talked about that the other day, not every criminal. And for, you know, in reality, the majority of people with substance use issues and who, who may or may not have a criminal record do not have antisocial personality disorder. They may have some antisocial traits. The one we're really most concerned with is the lack of empathy. When you're working with a client. I want you to ask yourself, why did these develop in this person? Or why did the person fail to develop empathy? You know, even when we're talking about personality disorders, that's the first question I ask myself is, you know, when this person was knee high to a grasshopper, how did these dysfunctional behaviors or lack of adopting functional behaviors serve the person? Most of the time, you know, it comes back to something in their past they didn't learn, they didn't learn how to, how to empathize with other people. They were encouraged not to empathize with other people or something happened where they constantly felt disappointed, disenchanted, disempowered, and they quit caring about how other people felt. You know, at a certain point it was like, you know, nobody gives a crap about how I feel, so why should I care about how they feel? It's different for each person, but this is where you can start to say, why does this person just not care? Because it is possible. In the majority of people that I've worked with, they do have empathy, they just don't choose to use it very often. If you hit the right buttons, they have empathy for another person and oftentimes it's a family member. But teach perspective taking. Remind themselves about the three finger rule. You may be pointing out to others and blaming them or being angry at them. What was your part in it. And likewise, put yourself in their shoes, how do you think they perceived the situation? And then address cognitive errors such as blaming and throwing focus. Remind people that a lot of times we blame in order to take the focus off ourselves. We blame when we're angry, to protect ourselves and to keep people from looking too closely what we've been doing. So blaming and throwing focus are common criminogenic thinking patterns, behavior patterns, but they're also protective behaviors and we need to help them figure out how to stop that. And if you have instilled adequate distress tolerance skills, when they get to the point that they're acting instead of reacting, that need to blame will really be diffused quite a bit. If they take a timeout and they're encouraged to state, okay, what was this other person's part in it? But also, what was your part in. I want to hear, you know, both sides because you both had a part. Once they practice that for a while, it will become more ingrained. Antisocial values, disassociation from the law abiding community. So we want to revisit how these values were developed. What was it like growing up in your family? What was it like growing up in your household? Now, from a cognitive perspective, we can say this person is now, you know, say 24, not 4 or 14. So they can make different choices. The past was the past. And you may have had to act or react in a certain way back then, but do you continue to have to act or react in that way now? So we'll explore exceptions to the values that they hold, such as it's okay to take what you want from someone if they already have enough. So, you know, if somebody has what I perceive to be enough of something, then I can go take what I want from the rest. Maybe they have four cars in their driveway. Well, they don't need four cars. So I'll go take that because I need a car. So we want to explore that and why is it okay to take their car? And we also want to kind of perspective take and say, you know, if you were the one that had four cars and somebody came and stole one of yours, how would you feel? Or you can push it a little bit further and take someone who is important to that person. If your daughter or your mom had two cars in the driveway and somebody came and stole one, how would you feel? So help them understand from a different perspective and explore their values in relation to the new situation. I shouldn't have to work at a job. I don't like that. Pays poorly. Well, you know, a lot of people say that. So what, where did they get this value and what are the alternatives? You know, if it's a way for somebody to put food on the table for their family, is it something that they need to do? Other criminogenic needs, Criminal peers. You know, we've talked about this one. If you go back into a situation or into into a peer group where they engage in a lot of criminal behavior, you're going to experience the peer pressure and eventually probably be set, sucked back into it. Substance abuse. A lot of times substance abuse is law breaking anyway. But it's not big step once you start using substances to start needing to break laws either to get the substance or the inhibitions are down that would keep you from breaking laws. So you just, you do it when you're high. Not saying that that's an excuse, but substance use and disinhibition are definitely implicated in a lot of drug related, especially alcohol related criminal activity and a dysfunctional family. I don't care who it is, whether they're coming out of treatment, whether coming out of jail, they need to have sane, sober, stable social supports. And if they don't and they're just learning these new skills and they're trying to do the next right thing and live differently than they ever had before, we what do you think the chances of them succeeding are? So individual needs assessment, safe housing. We need to help, you know, look in your local area, find landlords that are willing to lease to people who are leaving prison, leaving treatment, maybe there are some halfway houses, you know, try to find some resources for them. Call your local United Way and see if they know of any resources that provide safe housing. And safe, you know, is all relative. If they're not going back into their particular microsystem, their particular neighborhood that is safer, you know, even if it's not the best area. Still safer than going back where they have all of their friends and they fall back into all those old needs and they experience all of the discriminative stimuli that say, you know, now it's time to get up, go stand on the corner or hang out with your buddies and do it, do whatever. They need a pro social peer group. So we need to help them figure out what that is for them. For some people it's church. For other people it is the gym for, for other people, you know, brainstorm. Where can you find people doing things that you like to do without using drugs or breaking the law? We need to ensure that they are doing and some of this could be pro social rewarding activities. Dopamine has to be getting sent through the brain to say, you know, this actually isn't so bad. Part of it, part of the reward of pro social behavior is the lack of anxiety and stress caused by having to remember your lies and hide from the cops and worry about if you're going to get arrested. You know, that's part of it. But there also has to be another part that goes, this is really cool. Teach and assess coping and self control skills. They already have some. Don't reinvent the wheel. Go back and say, when you get stressed out, what do you do? What would you like to do? What have you seen other people do? When you get really, really angry at someone but you don't want to hurt them, you don't want to say something wrong, what do you do? How do you calm yourself down? One of the things that I found helpful for a lot of my clients is to create a goal map. And I do mean this very, very literally. Take a piece of paper, make a collage. You have your starting place and you can even print out like a map of your city or country or something. You have a starting place and you have an ending place. The ending place. You can make a collage with pictures of what they want to be doing, what they want to have in their life six months from now. Let's not make it five years. That's overwhelming. Let's do six months and then put themselves back here. They can also put along the route different roadblocks, things that may come up and identify how they're going to deal with those things. But this visual is something that they can look at and they can take a picture of it and have it on their phone or keep it in their wallet. This visual is something they need to look at before they make decisions and go, is this getting me closer to or further away from my goal? Is this one of the roadblocks that I identified and what is the detour? How did I figure out how to deal with that roadblock? So I kept going toward my goal instead of going backwards and just wandering aimlessly through side streets. Look for exceptions when you are not planning, engaging in or recovering from the criminal behaviors or addictive behaviors. What were or are you doing? You know, they may not remember a time they may have been using for a while or engaging in criminal behaviors for a while. They may not remember a time where there was much that they were doing besides that when they were in jail or in treatment. Theoretically, they were not engaging in criminal or addictive behavior. So what were they doing? What were they doing? And those are some of the things that you can start to build on for recreational activities, coping skills, relaxation, whatever. A twist on the miracle question that we ask people would be when you were in jail, you envisioned a different lifestyle. And obviously this is only if they did. But when you were in jail, you envisioned a different lifestyle. Describe that for me. Because so many times I work with people who are, when they are in jail, they tell me all the wonderful things they are going to do when they get out. And they may make it 60 days before they fall back into old behaviors. So I want to paint that picture. That is the goal on the goal map. They envision this different lifestyle. What was in there and how do we get there? Help them start learning how to set small achievable goals to get them toward the end and make sure there's rewards there. Okay, now this is one of my favorite parts. A lot of times clients will say, I don't, I don't have any skills. You know, what are you good at? Not much. Okay, well that's not super helpful. Likely you are good at something. Let's see what you're good at. In rehabilitation counseling, we call one of the things we use is a transferable skills checklist or a transferable skills analysis. The checklist is sort of a quick and dirty way to get a beginning idea of where somebody is at. So we'll take a look at that real quick. Here it is. So it goes through. And I know this is kind of small communication skills. Can you speak effectively? Write clearly and concisely, listen attentively, express ideas, negotiating. A lot of our clients are really good negotiators and persuaders reporting information. There are a lot of things that we don't really think about as skills that we have. And there are a lot of things that our clients don't think of as skills that they actually have. And we can find the ones that they have and they're really good at and mark those with a star and the ones that they have, but they could use some work. Mark those with a check mark. So then that's what you're dealing with. The ones that don't get marked at all, let's leave those for later. Let's build on the strengths that the person already has. Now you can use this transferable skills checklist not only to help them increase their self esteem and feel like they have some skills that are worthwhile, they can use this working on their Resume. They can use this applying for jobs. But then the next question comes, well, what do I want to do? I don't know, I don't really have many skills. And onet online is occupational something online. They've changed it over the years, but basically it allows you to browse different jobs by interests. So if someone is realistic, they frequently involve work activities that include practical hands on problems and solutions. Now this is my brother in law, he really enjoys, he's an electrician. They often deal with plants, animals and real world materials like work tools and machinery. Many of the occupations require working outside and do not involve a lot of paperwork or working closely with others. So if this sounds like a client that you have, you can click on that and it lists according to the Dictionary of Occupational Titles, a whole bunch of different types of occupations that your person may enjoy. So this is one place to begin occupational exploration. So let's say they're realistic and enterprising. How does that narrow it down? So everything from food servers to baristas to crossing guards, there's a whole list of things here, then we can start looking at, okay, how do we help you get training for any of these jobs? A lot of times helping people get training for jobs and connecting them with jobs is out of the scope of what we do. That goes over to workforce development or their caseworker. But these are useful tools to be able to provide somebody to look at to give them a little bit of hope and increase their curiosity about, oh, what could I do? You know, if I'm going to have to work, maybe I can find something that I'm interested in. Go figure. So initially, when we're working with people who are getting out of jail or treatment, they need to be motivated to not reoffend. A lot of times that's not a problem. When they first walk out those doors, they're motivated to not reoffend. Now that motivation can go away in, you know, two shakes of a lamb's tail. If you are working with them in the facility from which they're being discharged, helping them develop a relapse prevention plan, helping them develop a plan to stay motivated, anticipate any hardships, give them a set of activities that they need to do in the first week because we don't want them to be bored either. They need to find where they're going to live. They need to start figuring out what kind of job they want. They need to, you know, a checklist of things, go to treatment, hopefully. So these are all things that they need to do. To stay putting one foot in front of the other to get them toward their ultimate goals. Have them create that goal map. That's something that they can do at home and it can help them focus on really where they want to go when they, you know, as they're going through the recovery process. We need to make sure that there are a set of rewards for positive behavior and punishing sanctions for criminal behavior. I mean, if we're talking about recidivism here, we need to make it unpleasant for that person to go back to jail. What is it that they didn't like about jail? And let's kind of exemplify that. What is it that they like about free life? And how can we increase that? We need to be consistent. You know, when I've worked with drug courts and probation officers, the people who are most successful really established consistency. I worked with one probation officer, his name was Phil Whistler, and he had the office next to mine. And I would hear him every morning in there at 7:30. He would have, you know, a line of 10 probationers in his office. They were expected to show up in the clothes that they were going to go look for a job. So they would pass inspection if you would identify where they were going to go to look for a job and provide business cards from at least three places where they went the prior day to look for a job. And that behavior would be, you know, consistently rewarded. When they got a job, you know, there were greater rewards, but they knew what was expected, they knew what they needed to do. And he wasn't hard about it, he wasn't harsh and, you know, he didn't make them feel like they were less than, but he did make them feel like they needed to be accountable. And it was, you know, interesting to hear them do what they needed to do. And it was interesting to hear him provide corrective feedback when they didn't do what they needed to do. Again, if we have them come in and we set this expectation for behavior and the first time they mess up, we're like, well, we knew you were going to be a screw up. That's not helping. When they mess up, we need to provide corrective feedback and go, okay, why was it more rewarding for you to do this? Or, you know, obviously a more standard way to say it was why did you do that? Why did you make that choice as opposed to what you were supposed to do? Help me understand where your head was and then we can look back and try to figure out how to help them not do that again. One of the things in treatment that another soapbox little, little one here. When I hear people have gone to intensive outpatient treatment programs and they've been threatened at the very beginning, if you relapse, you're kicked out. Well, that's not helpful because you know what that means to the person with the addiction. I need to lie, I need to not be honest because you know, if I relapse, that means I lose all hope, I lose everything. The motivation for the program to say that is to ideally set it up so, you know, we don't. We want the person to fear losing everything so they'll do the next right thing. But, but in reality, in IOP programs, a lot of times people need a whole lot more support than that in order to keep them from relapsing. The person needs employment. We need to help them figure out where they can find employment. Who is hiring? Who is willing to hire people with your background? How do you fill out a resume with your background? How do you explain your, you know, periods of unemployment because you were incarcerated? Safe housing and medication for those underlying mental health issues. Get them set up with patient assistance programs. If they are not stable on medication, you know, they, they either never had any or when they went to jail, it was taken away and they haven't been stabilized on it again. We need to help them understand that the first three months for most medications, especially when we're talking about SSRIs for the first three months, they're not going to feel great. So we need to help them figure out how to navigate that so they don't start getting discouraged. Ultimately know this is after that first kind of three month period, the person still needs to be motivated to not reoffend. There have to be significant reasons why law abiding behavior or sober behavior is more rewarding. One of the great things about support groups is the fact that they do celebrate each other's successes. And a lot of people can attest to the fact of yeah, it was hard at first, but after 20 years I'm still clean and sober and I'm so glad I did it because I have all these things or I've got all these accomplishments that I wouldn't have had had I still been using. The person needs to have the skills that enable him or her to tolerate distress and address cognitive distortions. This isn't something that they're going to learn in 30 days. It's not something they're going to master in 60 or 90 days. If it's something that they learned over the course of their life. It's probably something that's going to take a while, you know, six months or so of practicing and rehearsing to really start to get under their belt the new way of thinking and a supportive pro social group of friends. Now, again, since there is a lot of overlap between substance abuse and criminal behavior in the rooms in 12 step programs, in other support programs, there is not the discrimination against people who have criminal convictions. So this is a place where they can find some pro social friends, not all. If you're not super familiar with the 12 step programs or any of them, Smart recovery or Celebrate Recovery, those are the three big ones right now. Not all meetings are created the same. So it's important to get with people who are going to those meetings, who are in the recovery community in your area and find out where there are good meetings. One of the things, one of the keywords that we use is old timers. These are people who have significant sobriety, clean time under their belt. If you have somebody who's new, who really is trying to do the next right thing, you want to make sure they're going to a meeting where there's a fair number of old timers. If you have a whole bunch of people who are just working on their first 30 days, then they're still embodying a lot of those criminogenic or addictive behaviors. The old timers will call them out on it. So encouraging people to go to smaller meetings where there are more old timers as opposed to large meetings where they can blend in the background and they're surrounded by other people who aren't any better off than they are, is another tactic to helping them develop supportive pro social group of friends. Are there any questions?