Relapse Prevention In The Criminal Justice System: Applications of the CENAPS Model

By Terence T. Gorski

BARS_Defeated_HandThis article based on material presented at the Mental Health and Correction Symposium 1993 conducted on June 9, 1993 in Kansas City, Mo  sponsored by The Federal Bureau Of Prisons Of The United States Penitentiary at Leavenworth, Kansas The United States Disciplinary Barracks, Fort Leavenworth, Kansas  and The American Association for Correctional Psychologists.  The material in this article is copyrighted by Terence T. Gorski (Copyright, Terence T. Gorski, 1993)

The purpose of this article is to explore recovery and relapse prevention for chemically dependent criminal offenders and to explain how the CENAPS Model of Treatment is being applied to the treatment of chemically dependent criminal offenders. This article will provide methods for treating the chemically dependent criminal offender, as well as specific strategies for recovery and relapse prevention in the criminal justice system.  Effective treatment strategies and relapse prevention therapy for chemical dependency will be applied to the population of chemically dependent criminal offenders.

Alcohol And Drug Use Among The General Population

Alcohol use is common in the United States.  Approximately 33% of adults are abstainers.  Light drinkers who drink less than three times per month and consuming one or two drinks per drinking occasion represent about 34% of the population and consume 7.9% of all alcohol sold.  Moderate drinkers, who represent 24% of the population, consume 26.3% of all alcohol sold.  Moderate drinkers drink two to three times per week and consume an average of two to three drinks per drinking occasion.  Heavy drinkers represent 9% of the population.  They tend to be daily drinkers, consume three drinks or more per day, and consume 65.8% of the alcoholic beverages sold.

Type Of Drinker % Of Population % Alcohol Consumed
Abstainers  33% 0%
Light Drinkers 34% 7.9%
Moderate Drinkers 24% 26.3%
Heavy Drinkers 9% 65.8%

Incidence Of Chemical Dependence

Conservative estimates indicate that approximately 10% of the adult population in the United States is suffering from alcohol dependence and 5% of the United States population is drug dependent.  Therefore, a total of 15% of the general population of the United States is chemically dependent at any given time.  Alcohol and drug use and dependence among criminal offenders is more common.  Nearly 100% use both alcohol and drugs on a regular basis.  The vast majority of criminal offenders fall into the moderate or heavy drinking categories.  Approximately 70% of all inmate populations across the United States are incarcerated for alcohol and drug related crimes ranging from intoxication at the time of the crime to illegal drug trade.

Chemical Dependency In The United States
Use Pattern General Offenders
1.  A/D Use

66%

100%

2.  A/D Dependence

15%

70%

Alcohol Use And Crime

Statistics show that 54% of violent criminals are under the influence of alcohol at the time of the crime and 40% are under the influence of alcohol when committing property crimes.  With drug crimes, meaning illegal drug trade, 29% are drunk or high on drugs while engaging in those transactions and 64% are under the influence of alcohol when committing public order offenses.  This is a total average of 48% of the criminal population being under the influence of alcohol at the time they commit a crime.

The statistics are striking when looking at violent crimes and the violent criminal.  Fifty-four percent of all violent criminals are under the influence of alcohol and drugs at the time of the crime.  Many report using alcohol and drugs to gain the courage to facilitate the violent acts.  Others say that alcohol or drugs break down impulse control which causes them to react spontaneously with violent behavior in high stress situations.

A breakdown of violent crime reveals that 49% of murderers are intoxicated at the time of the murder.  Statistics show that 68% of manslaughter convictions, 52% of rapes and sexual assaults, and 62% of non-sexual assaults occur while the offender is intoxicated.

Types Of Alcohol And Drug Problems Among Inmates

When focusing on the types of alcohol and drug problems among criminal offenders, it is essential to use DSM-IIIR categories and the two subcategories of substance use disorders.  The first subcategory is chemical abuse disorders.  People with chemical abuse disorders get into trouble as a result of their alcohol and drug use, but they are not physiologically addicted.  They have not achieved high levels of tolerance and dependence, and do not go through withdrawal when they attempt to stop.  It is estimated that about 28% of all inmates in the United States or 40% of all inmates committing alcohol and drug related crimes are diagnosed as having chemical abuse disorders.

The next DSM-IIIR subcategory is chemical dependency disorders or substance dependency disorders.  Forty-two percent of all inmates in the United States have chemical dependency disorders and approximately 60% of those committing alcohol and drug related crimes are diagnosed as having chemical dependency disorders..

Alcohol And Drug Abuse And Antisocial Personality

Offenders with alcohol and drug related crimes can be divided into three categories.  In the first category, the crime is a symptom of the non-addictive use of illegal drugs in persons who do not have chemical use disorders or criminal personalities.  A good example of this is the man who does not have a drug problem getting arrested for using and selling marijuana.  Only 5% of criminal offenders fall into this category of people who are arrested on drug charges who are not chemically dependent.

In the second category, crime is a symptom of chemical dependency.  For example, a heroin addict begins to commit burglaries to support his habit.  Another example is an alcoholic who is down on his luck and, at moments of poor impulse control, steals money to purchase alcohol or shoplifts in a liquor store in order to get alcohol.  Approximately 15% of the inmate population falls into this category.  Once the chemical dependency goes into remission and the person gets sober, the criminal behavior will spontaneously disappear.

In the third category, alcohol and drug use is a symptom of a criminal personality.  These people basically have DSM-IIIR Cluster B personality disorders in conjunction with their chemical use, but are not chemically dependent.  They have the personality disorder that predisposes them to act out against authority, break rules, and commit crimes primarily for thrill seeking behavior.  They are abusers, but are not addicted.  They comprise approximately 15% of the population where alcohol and drugs are involved.

By far, the largest category is where crime is both a symptom of chemical dependency and criminal personality traits which is approximately 65% of the chemically dependent criminal offenders.  This is important information to consider in determining treatment strategy because many criminals who are chemically dependent seek sobriety so they can become more efficient criminals.  They realize that because of the loss of control they are getting caught and their goal is to get sober so they will not get caught again.

The conclusion here is a very simple one.  Most criminal offenders who commit alcohol and drug related crimes have serious chemical use disorders.  Few criminal offenders are social drinkers or recreational drug users.  There will always be the exception, but they are few and far between.

Alcohol And Drug Problems and Criminal Recidivism

Alcohol and drug problems are related to criminal recidivism.  Fifty-one percent of repeat offenders have chemical use disorders, the majority of them untreated.  In inmate populations among the United States, less than 15% of the chemically dependent criminal offenders today get any type of treatment for their chemical dependency.  Of the 15% that do receive chemical dependency treatment, for 70% of them the only intervention available is voluntary attendance at Alcoholics Anonymous and other twelve step meetings with only about 30% of the current inmate population being exposed to structured chemical dependency programs across the entire inmate population of the United States.

Alcohol and drug use among parolees is associated with three things – breaking parole and probation, renewed criminal behavior, and re-arrest for criminal activity.  If a parolee starts to drink and use drugs, the likelihood of engaging in criminal activity that leads to re-arrest is very high and results in new arrests and convictions.  The basic sequence is breaking parole and probation requirements, going back into criminal behavior, getting caught, and returning to the legal system to start the entire cycle all over again.

Antisocial Behavior Is Common Among Criminal Offenders

Commit Antisocial Acts – 100%

Habitual Criminals – 75%

Antisocial Personality Disorders

How many criminal offenders commit antisocial acts?  One hundred percent of the inmate population commits antisocial acts.  Stanton Samenow and Dr. Samuel Yochelson studied hard-core criminal offenders and found that for every one time a criminal is caught, most have committed at least 100 previous crimes for which they have not been caught.

Habitual criminals represent 75% of the offender population.  Seventy-five percent of habitual criminals have a criminal personality disorder, criminal personality style, or a collection of criminal personality traits that need to be dealt with and addressed if they are going to be successfully rehabilitated.

Let’s look at the incidence of antisocial personality disorder in various populations.  In the general population, approximately 4% of males and approximately 1% of females are diagnosed at any given time as having antisocial personality disorder.  Fifteen percent of alcoholic males, a little over three times the incidence of the general population males, have diagnosable antisocial personality disorder and 10% of the alcoholic females have diagnosable antisocial personality disorder, which is  nine times that of the general population females.

Of all male narcotics addicts, 32% have diagnosable antisocial personality disorder.  Statistics of female narcotics addicts are not readily available as there are so many more male narcotics addicts than female narcotics addicts.

In prison inmate populations, 50 to 80% of the inmates have diagnosable antisocial personality disorder.

Criminal Personality Disorders

Criminal personality disorder consists of deeply entrenched, highly destructive tendencies.  There are basically four DSM-IIIR Cluster B personality disorders that tend to coexist to some degree as a mixed personality disorder.

 DSM-IIIR Cluster B Personality Disorders

1. Antisocial (Rule Breakers)

2. Narcissistic (Egotistical and Self-Centered)

3. Histrionic (Disruptive Attention Seekers)

4. Borderline (Chaotic and Volatile)

The antisocial personality disorder features compulsive, rule-breaking behavior.  People with antisocial personality disorder have difficulty with authority; they have poor impulse control; they have no respect for established authority; they tend to find it thrilling and exciting to break the rules and laws; and they enjoy this behavior.

The second personality disorder is the narcissistic personality disorder.  People with narcissistic personality disorder are egotistical and self-centered;  they tend to believe that other people exist merely as instruments to their well-being; and they have a tremendous tendency to personalize everybody else, turn them into objects, and simply use them to enhance their own ego.  People with antisocial personality disorder usually possess significant narcissistic traits.  The stronger the narcissistic tendencies in the antisocial person, the more difficult the rehabilitation challenge.

These are the personality styles and disorders that coexist to some degree or another in chronic, habitual criminals.

Punishment Alone Does Not Work

It is proven that punishment alone will not stop criminals with chemical use disorders from using alcohol and drugs.  Threatening consequences will not stop chemical use either.  Monitoring for alcohol and drug use through urinalysis is not enough to interrupt the obsession, compulsion, craving, and the maladaptive life patterns that lead these people back to chemical use.

Similarly, punishment alone will not stop criminals with criminal personality disorders from committing crimes because of the fact that the higher the risk, the greater the attraction to the crime.  People who have severely antisocial personalities are attracted to criminal thrill-seeking behavior.  The higher the risk of a criminal act, the greater the high produced when the act is committed.  Many people with antisocial personalities are excitement junkies who are addicted to criminal and sexual thrill seeking.  Criminal grandiosity also programs criminals to “put themselves to the test” by proving that they can commit high risk crimes and get away with it.

Criminal behavior is expanding and reaching epidemic proportions.  The simple humane warehousing of criminal offenders will not meet the needs of this nation.  Jails are overcrowded and are getting more so every day.  The solution is not to build more jails as the criminal population will expand to fill the jails that are available.

There is significant evidence that treatment alternatives to incarceration are reducing recidivism and increasing positive adjustment back into society following episodes of incarceration.

For Treatment Alternatives To Work …
Criminal Offenders Must Be Screened
And Concurrently Treated For …
1.         Chemical Use Disorders
2.         Criminal Personality Disorders
3.         Mental Disorders

In order for treatment alternatives to work, every criminal offender must be screened and concurrently treated for three distinct categories of disorders.  The first category is chemical use disorders; the second category is criminal personality traits and disorders, i.e. DSM-IIIR Cluster B personality disorders; and the third category is mental disorders as many people with severe substance use disorders and personality disorders also have another Axis I diagnosis of schizophrenia, panic disorders, or phobias.

Policies must be established universally at county and local levels were diagnostic and treatment procedures are integrated into the criminal justice system as   a standard operating procedure.  Until this level of integration exists, the chemical dependency and behavioral health programs will be viewed as add-on programs.  The goal must be integration.  How do we integrate these programs into the criminal justice system, into the prison systems, into the probation and parole systems so they become the normal way of doing business in an enforcement and incarceration environment?

First, screening needs to be done prior to sentencing.  Technology must be enhanced and proper evaluation tools must be used to screen for chemical use disorders, criminal personality disorders, and mental disorders.

Secondly, treatment must be concurrent with punishment.  There must be treatment during incarceration.  The ideal, of course, is to turn all of our criminal institutions into rehabilitation environments, set up varieties of therapy to address different needs, and provide concurrent treatment to every criminal offender.

Limited resources must be applied to their best advantage.  Intensive rehabilitation should occur towards the end of the inpatient incarceration period.  In this way, the offender learns sober and responsible coping strategies while they are in the criminal justice system population which prepares them for the transition period out of the criminal justice system population.

Ongoing treatment must be a mandatory condition of parole and probation.  This is becoming a widespread practice.  Criminal offenders are being sentenced to ongoing treatment as a mandatory condition of probation and parole and there are very strict consequences if this condition is not adhered to.  Any person breaking the treatment protocol must receive rapid disciplinary action where the offender is returned to incarceration.  Contingencies should be devised where the first break in treatment structure results in a return to jail for three days; the second break results in a two week incarceration; the third break results in a return to jail for 30 to 60 days, and the fourth break results in returning to jail to finish off the entire sentence.

Inmates need to know that there are consequences to breaking their rehabilitation structure after they are out of the institution.  These people must be kept on a long-term continuum of care.  This must be linked into the probation, parole, and the court procedures so that if a person breaks the treatment regimen, strict consequences follow.

Criminal Personality Disorders and Chemical Use Disorders
Are Coexisting Disorders That Are Best Treated Together

There should be treatment alternatives to incarceration for criminals who have two coexisting disorders —  criminal personality disorders and chemical use disorders.  People having these two disorders should be screened and evaluated for placement in  specialty programs when they enter the criminal justice system.  Some offenders will go

into incarceration environments; some will go into primary treatment; some will go into relapse prevention programs.  A profile of specialty programs should be made available to them.

Criminal personality disorders and chemical use disorders are coexisting disorders that must be treated together.  If you attempt to treat the chemical dependency while not treating the criminal personality traits of a chemically dependent criminal offender, the offender is at high risk of relapse to alcohol and drug use.  Similarly, if a person has severe antisocial traits and the antisocial traits are treated but the chemical use disorder is not focused upon, the person will relapse into drinking and drug use and all of the antisocial traits will return.

Why is this?  The reason is because there is a very definite relationship between chemical dependency and criminal personality disorders.  There are three links in the chain that bind these disorders together.  The first link in the chain is mutual predisposition.  Predisposition is a term used to describe the factors that set the person up to get the disorder.  Criminal personality disorder increases the risk of chemical dependency.  Substance use and abuse is a feature of criminal personality disorder.  People with Cluster B personality disorders, especially antisocial personality disorder, drink and drug heavily.  If they have the genetics that make them sensitive for physiological dependence and addiction to alcohol and drugs, they are very likely to become addicted.

Chemical dependency increases the risk of criminal personality traits and disorders.  If a person moves into a progressive history of alcoholism or drug addiction, he turns to illicit antisocial behaviors and to an illegal drug culture in order to survive and maintain his active addiction.  For example, a drug addict enters a criminal underground of illicit behaviors to acquire and use a drug.  The addict enters a dangerous criminal underworld which conditions his behavior and creates criminal personality traits as        an adjustment reaction to moving into the criminal underground life.

People in this type of underground existence have antisocial tendencies.  They are entranced or excited about the prospect of this underground existence, but once they get into it, there is a progressive involvement in more violence and more criminality.  This mutual predisposition forms the first link in the chain between chemical dependency and criminal personality disorder.  Alcohol abuse brings a person right back into their contact with the illicit drug culture.

The second link between chemical dependency and criminal personality disorder is symptom reinforcement.  Once chemical dependency and criminal personality traits develop, there is symptom reinforcement.  Criminal personality disorder promotes alcohol abuse as a condition and a necessary prerequisite for its existence.  Large numbers of criminal offenders who use alcohol and drugs will tell you that the reason they use is to give them courage to get ready for the act, it allows them to recover from the act, or it enhances the thrill of the criminal behavior.  Alcohol and drugs are being used purposefully as an extension and exaggeration of the benefits that the criminal gets from criminal behavior.

Alcohol and drug abuse promotes antisocial behavior by lowering habitual and impulse control making criminals susceptible to poor judgment that results in renewed criminal behavior.  The third link in the chain between chemical dependency and criminal personality disorder is reciprocal relapse where alcohol and drug use triggers criminal behaviors and criminal behaviors trigger alcohol and drug abuse.

Because chemical dependency and criminal personality disorder are closely linked, there needs to be concurrent diagnosis and treatment.  Abstinence from alcohol and drug use must be the primary goal in our rehabilitation setting in the criminal justice system.  Controlled drinking and controlled use of illicit drugs should not be on the criminal justice agenda for this nation.

Another goal should be abstinence from criminal behaviors.  Of course, this is very clear within the criminal justice system.  There is an intrinsic link between alcohol and drug use and abuse and criminal recidivism and the goals for both must be tied together.

Alcohol, drug, and criminal life style patterns must be changed through internal changes in thinking patterns, emotional management patterns, behavioral patterns, and making external structural changes in the person’s life style.

All programs need to have a very strong foundation in holistic health.  Physical rehabilitation, proper diet and exercise, proper stress management, psychological rehabilitation focusing on changing thinking and emotional management strategies, behavioral control strategies, behavior enhancement techniques, and social rehabilitation are necessary.

The CENAPS Model of Treatment

The CENAPS Model of Treatment is different from other models in that it is integrative and it is evolutionary.  The CENAPS Model is not a revolutionary, new model.  Revolutionary models tear down the past and propose a bold, new approach to the future.  They believe what came before is basically irrelevant.  The CENAPS Model takes various approaches and tries to come up with a unified field theory and united systematic approaches.  The goal is to integrate what is already known, consolidate it, and overcome the language problems that are so divisive among different therapeutic specialties.  A uniform set of terms and uniform nomenclatures must be established to continue this movement.

The CENAPS Model Combines …

A Biopsychosocial Disease Mode
Of Chemical Dependence
With Criminal Personality Theory
To Create A Practical System For Treating
Chemically Dependent Criminal Offenders

The CENAPS Model is a biopsychosocial disease model for chemical dependency.  Rehabilitation must consist of broad-based biopsychosocial intervention.

The CENAPS Model of Treatment is being integrated with criminal personality theory.  The model is taking the chemical dependency treatment field and is integrating it with the psychotherapy community and the criminal justice rehabilitation program to create a unified, evolutionary understanding of how to treat chemically dependent criminal offenders.

The goal is to create a practical system for treating chemically dependent criminal offenders.  The CENAPS Corporation has developed this tool.  With the assistance of the Office of Treatment Improvement, The CENAPS Corporation has developed three manuals.  One of these manuals is a relapse prevention workbook for criminal offenders.  Another manual is an instruction guide for counselors, probation and parole officers, and prison guards.  Anyone who is working with criminal offenders can access an instruction guide to use this practical technology.  The third manual is a briefing document containing figures and statistics which will be available to administrative judges and high level decision makers to help them in supporting this thrust in rehabilitation.

 The CENAPS Model Integrates …
1.         Cognitive Therapy
2.         Affective Therapy
3.         Behavioral Therapy
4.         Social Systems Therapy

The CENAPS Model integrates cognitive therapy techniques.  The CENAPS Model is primarily an applied cognitive therapy interested in changing addictive and criminal thinking patterns.  Stanton Samenow’s book Understanding the Criminal Mind and the three-volume series on the criminal personality by Samuel Yochelson and Stanton Samenow contain excellent illustrations of the criminal personality.

The CENAPS Model of Treatment is also based upon a broad spectrum of cognitive therapy principles.  Affective therapy is used to cope with unmanageable feelings that drive addictive and criminal behaviors.  There is an emotional charge, an emotional drive, and a thrill seeking or sensation seeking component.  Emotional integration is necessary for a person to recover.  A specific emotional management strategy must be developed for coping with addictive and criminal behaviors.

Crime is the end product of a sequence of maladaptive, self-defeating behaviors.  Chemical use is the end result of a long sequence of maladaptive, self-defeating, coping behaviors that have become deeply entrenched and associated with cues and triggers in a person’s life style.  This type of behavioral reconditioning or behavioral programming strategies must be integrated into every comprehensive treatment program.

Social system therapy is designed to change addiction-centered and crime-centered social networks with particular focus upon employment, social, and intimate networks.

Almost all criminal offenders with criminal personality traits have significant problems achieving and maintaining intimate relationships.  Almost always, their intimate and family relationships are exploited and abusive where their mate or family members are relegated to objects and are used and abused for criminal, violent, and sexual thrill seeking behaviors.  When addressing rehabilitation in these populations, intimate relationships must also be addressed.  Dysfunctional intimate relationships are a major relapse trigger.  My book Getting Love Right is a simple guide for relapse-prone alcoholics on how to have healthy relationships.

An instrument called the Biopsychosocial Assessment Grid (BAG) is a biopsychosocial disease model for diagnosis and assessment.  The Biopsychosocial Assessment Grid is a way of looking at relevant physical, psychological, and social valuables for the purpose of differential diagnosis of chemical dependency and criminal personality traits.  The BAG system can be extended simply by adding columns for any other dual diagnosis you wish to add.  You can create the BAG categories by simple analysis of symptomatology and breaking it down physically, psychologically, and socially in a similar format.

The Developmental Model of Recovery emphasizes that recovery unfolds over a long period of time in stages.  Each stage requires a different primary treatment focus. There are different goals and tasks in each stage of recovery, and the treatment plan must shift with each stage of recovery.  A chemically dependent criminal offender must be locked into a long-term, accountable rehabilitation program for a minimum period of three to five years if he is going to see any significant changes occur.

The CENAPS relapse prevention therapy model deals with the problem of recidivism.  Relapse prevention strategies are very powerful in preventing relapse, but unless they are coupled with biopsychosocial models of diagnosis to treat coexisting illnesses that surface and treat the physical, psychological, and social symptoms of the disorders, relapse prevention is going to be very limited.

Relapse prevention therapy is a vitally needed link in the rehabilitation chain, but of and by itself it is insufficient to handle the massive problem of chemical dependency and criminal relapse.

The CENAPS Model has been expanded to meet the needs of the criminal justice system by integrating the diagnosis and treatment of chemical use disorders, both abuse and dependency with criminal personality disorders.

The CENAPS Model is compatible with twelve step principles.  This model follows the twelve step tradition.  It is practical and easy to use.  It is easily adaptable to inpatient, residential, and outpatient programs and is adaptable to working in residential and camp-like environments in the criminal justice system.  The CENAPS Model of Treatment is oriented to the real world of the criminal justice system and is adaptable and flexible.

The CENAPS Model Provides Diagnostic And Treatment Methods For :

1.         Transitional Patients
2.         Primary Patients
3.         Relapse-Prone Patients
4.         Family Members

The CENAPS Model provides diagnostic methods for basically four categories of clients or patients.  The first is what we call transitional patients.  These are involuntary patients who are in strong denial and definitely have alcohol and drug problems.  Everyone knows this except them.  They may be willing to abstain from alcohol and drug use for a little while to avoid the consequences, but still want to be social drinkers.  They are actively antisocial in everyone’s mind except their own.  They believe they are simply innocent victims of the system.  If they weren’t victimized by that rape victim who screamed too loud or the police officer that came to arrest them, they would not be in this trouble.

The CENAPS Model provides diagnostic and treatment methods for primary patients.  Primary patients know they have a problem and realize that if they do not change their alcohol and drug use patterns and their personality, they are going to be incarcerated again.  When you mix transitional patients and primary patients together, the transitional patients destroy the efficacy of treatment for the primary patients.  Differential screening and differential placement of transitional patients and primary patients is strongly recommended.

The CENAPS Model also provides diagnostic and treatment methods for relapse-prone patients.  Relapse-prone patients know they are chemically dependent and have antisocial tendencies.  They have learned recovery strategies and have attempted to use them, but have failed.  They have encountered some obstacle that they could not manage.  Relapse prevention therapy is a special treatment designed for people who are unable to stay in recovery in spite of their desire to do so.

The CENAPS Model also provides treatment for family members.  Family members may relapse into codependent behaviors of enabling, controlling, and care taking.  When the chemically dependent person is surrounded by these types of people, their reality testing and sanity checking disappears, they lapse back into inappropriate, irresponsible behaviors, and relapse rates go up.

What is diagnosis?  Diagnosis in the CENAPS Model is an organized system for identifying the symptoms of the disease or disorder.  The patient must recognize and take ownership of his disease or disorder.  CENAPS diagnostic methods are designed to provide professional diagnosis, but most importantly to guide patients through self-diagnostic procedures so that they use themselves and other clients in their groups as an active laboratory to learn about what is wrong with them that is causing them to get into trouble.

 Components Of The CENAPS Model

                      1.         Biopsychosocial Addiction Model

2.         Developmental Model of Recovery (DMR)

3.         Relapse Prevention Therapy

Treatment in the CENAPS Model is defined as an organized system for bringing the symptoms of a disease or disorder into remission.  Effective treatment produces changes in the way a person thinks, feels, and acts and, as a result, produces changes in their life style.  This is a goal-oriented, change-oriented strategy which looks at internal changes in thinking, feeling, and action urges.

Chemical use disorders are the regular, heavy use of alcohol and drugs resulting in psychosocial dependence.  “I need alcohol and drugs to psychologically feel good about myself and to socially function.”

This results in personal, social, and occupational impairment.  “I cannot function personally.  Things are happening personally that upset me and I cannot function socially.  When I get into social situations, I upset people and create problems.”

It also creates occupational impairment.  “I cannot maintain a productive job.       I cannot work in a problem-free manner.

Chemical use disorders basically involve the pathological use of alcohol and other mood-altering drugs.  This results in the development of physical problems, withdrawal-related complications, illnesses, organ system problems, psychological problems, the development of irrational thinking, the development of maladaptive, self-defeating emotional management strategies, and the development of self-defeating and destructive social relationship patterns.  Marty Mann has an excellent rule of thumb, “If a person has a problem with alcohol and they continue to drink in spite of the problem, they are probably alcoholic.”

If a person has problems with chemical use and they continue to use alcohol and drugs in spite of the problem, he or she probably has a chemical use disorder.  This is a very simple, practical, diagnostic standard.

Chemical use results from chemical use in psychosocial predisposed persons.  Abuse does not require a genetic predisposition which is where many hard-line chemical dependency disease concept people get into trouble.  They do not recognize that there are non-addictive abusers who get into trouble with alcohol and drugs.  They are psychosocially predisposed.  Their chemical use causes personality disorganization and life style problems, but does not cause major physiological changes or high levels of tolerance, dependence, and withdrawal.  Chemical abuse is often a symptom of antisocial personality disorder.  Many people with antisocial personality disorders, about 15% of the criminal population, will show up as non-addicted abusers.

Substance dependence disorders can be defined as chemical use in genetically predisposed persons that causes brain dysfunction resulting in tolerance and withdrawal, personality disorganization resulting from a toxic brain, life style problems, and progressive biopsychosocial deterioration.  The chemical use problems take on a life of their own, independent of life style circumstances.  For genetic research distinguishing between the progression of abuse disorders and the progression of dependency disorders, refer to George Valiant’s book The Natural History of  Alcoholism, which reports on a forty-year study of young men diagnosed in their teens who became alcohol and drug dependent.

The Relapse Progression

                 1.         Stable Recovery

2.         Relapse Warning Signs

3.         Renewed Alcohol/Drug Us And Criminal Behavior

There is progression from abuse to dependence.  Genetically predisposed people who use and abuse chemicals become addicted.  Chemical abuse can, but does not always, progress to chemical dependency.  The majority of chemically dependent people go through a progression of stages.  Approximately one-third of patients will be instant alcoholics and instant addicts, whereas the other two-thirds will follow through a progression of stages.

The CENAPS Model of Treatment focuses upon the concept of a continuum of alcohol and drug problems and mirrors the President’s commission which explained in their report entitled Broadening the Base of Alcoholism Treatment that it is helpful to think of degrees of severity of alcohol problems from mild, to moderate, to severe.  The CENAPS Model does differ with that report in that it recognizes that people with severe alcohol and drug problems have dependence disorders.  These dependence disorders constitute an objective and verifiable disease state.  Once people have severe problems with alcohol and drugs, less than 2% of those people are able to return to controlled drinking.  Therefore, chemically dependent people with severe alcohol and drug problems should not have the goal of controlled drinking.

On the other end, we have people with abuse disorders who have mild problems with alcohol and drugs, but are not addicted.  These people will benefit from self-control training if they do not have a coexisting mental or emotional disorder that is aggravated by alcohol and drug use.

Borderline cases, the most difficult cases, either are severe abusers or early stage addicts, but it is difficult to determine which.  Treatment principles are essentially the same for both disorders.  How people deal with borderline cases depends upon their theoretical bias.

What are these treatment principles?  Basically, recovery from chemical dependency requires three things.  First, recovery requires abstinence from alcohol and drugs.  A definite abstinence goal must be set and measurement techniques, such as blood alcohol and urinalysis surveillance, must be used to make sure this is being maintained.

Secondly, recovery requires identifying and changing thoughts, feelings, and behaviors and isolating the specific thoughts, feelings, and behaviors that lead a person back to chemical use.  We must identify and change irrational thinking, unmanageable feelings, and self-defeating behaviors and identify and change addiction-centered life style patterns.

Thirdly, recovery requires deep personality and value change which is often called advanced recovery work or Stage II recovery work.  If this deep personality change and value change does not occur, the person will relapse.

Criminal personality is defined as an habitual way of perceiving, thinking, feeling, acting, and relating to others that results in constant opposition to established authority, acting out against others, and chronic and compulsive rule breaking and criminal behaviors.

Criminal personality disorders fall under Cluster B personality disorders which are:  antisocial (compulsive rule breakers), narcissistic (egotistical, self-centered people), histrionic (disruptive attention-seekers), and chaotic (volatile).

As there is a continuum of alcohol and drug problems, there is also a continuum of criminality.  The assessment of the continuum of criminality is not black or white.  Problem arise with people who fall into the mid range of the continuum of criminality.  There are mild, moderate, and severe problems with criminal behavior and antisocial tendencies.  A majority of people have at least low level antisocial potential.  This may grow into actual, observable traits that may cause people to act out in criminal ways until this escalates into criminal personality disorder where the person is out of control.

Recovery is a long-term process of biopsychosocial rehabilitation.  Brief therapies will not work with chemically dependent criminal offenders who have antisocial personality traits.  The CENAPS Model is the tool necessary for integrating chemical dependency and the treatment of criminal personality disorders.

Remember, there is hope!  Chemically dependent criminal offenders are difficult to treat; they are not impossible to treat.  Recovery is possible if both disorders are concurrently addressed and long-term treatment is provided systematically in an integrated context in the criminal justice system.

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Glen, Susan Wagner, Austin, Eririco L., Parsons, Oscar A., King, Andrea c., and Nixon, Sara Jo,  The Role of Antisocial, Affective, and Childhood Behavioral Characteristics In Alcoholics Neuropsychological Performance, Alcohol Clin Exp Res, Vol 17, No 1 1993, pp. 162-169

Gorski, T., and Miller, M. Counseling for Relapse Prevention. Independence, Missouri: Herald House – Independence Press, 1982.

Gorski, T., and Miller, M. Staying Sober – A Guide for Relapse Prevention. Independence, Missouri: Herald House – Independence Press, 1986.

Gorski, T. The Staying Sober Workbook – A Serious Solution for the Problem of Relapse. Independence, Missouri: Herald House – Independence Press, 1988.

Gorski, T. How to Start Relapse Prevention Support Groups. Independence, Missouri: Herald House – Independence Press, 1989.

Gorski, T. Passages Through Recovery – An Action Plan for Preventing Relapse. Center City, Minnesota: Hazelden, 1989.

Gorski, T. Understanding the Twelve Steps – A Guide for Counselors, Therapists, and Recovering People. Independence, Missouri: Herald House – Independence Press, 1989.

Gorski, Terence T. Relapse Prevention Therapy With Chemically Dependent Criminal Offenders, Part 1: An Executive Briefing For Policy Makers And Judges, Herald House Independence Press, Independence, MO 1993

Gorski, Terence T. and Kelley, John M.,  Relapse Prevention Therapy With Chemically Dependent Criminal Offenders, Part 2: A Guide For Counselors, Probation, And Parole Officers, Herald House Independence Press, Independence, MO 1993

Gorski, Terence T. and Kelley, John M.,  Relapse Prevention Therapy With Chemically Dependent Criminal Offenders, Part 3: The Relapse Prevention Workbook For The Criminal Offender, Herald House Independence Press, Independence, MO 1993

Miller, M.; Gorski, T.; and Miller, D. Learning To Live Again – A Guide For Recovery From Alcoholism. Independence, Missouri: Herald House – Independence Press, 1980.

Miller, M., and Gorski, T. Staying Sober Recovery Education Modules -Exercise Manual. Independence, Missouri: Herald House – Independence Press, 1989.

Millon, Theodore and Everly, George S. Jr.,  Personality and Its Disorders, John Wiley and Sons, New York, 1985

Walker, Robert, Substance Abuse and B-Cluster Disorders I:  Understanding The Dual Diagnosis Patient, Journal Of Psychoactive Drugs, Vol 24(3), Jul-Sep 1992, pp. 223 – 232

Walker, Robert, Substance Abuse and B-Cluster Disorders II:  Treatment Recommendations, Journal Of Psychoactive Drugs, Vol 24(3), Jul-Sep 1992, pp. 233 – 241

Yochelson, Samuel and Samenow, Stanton E.  The Criminal Personality, Volume 1:  A Profile For Change, Jason Aronson Inc., Northvale, New Jersey, London, 1976

Yochelson, Samuel and Samenow, Stanton E.  The Criminal Personality, Volume 2:  The Change Process, Jason Aronson Inc., Northvale, New Jersey, London, 1985

Yochelson, Samuel and Samenow, Stanton E.  The Criminal Personality, Volume 3:  The Drug User, Jason Aronson Inc., Northvale, New Jersey, London, 1986

Information Resources

1.         National Clearinghouse For Alcohol And Drug Information (NCADI) p 1-800-729-6686

2.         National Criminal Justice System Reference Service (NCJRS) – 1-800-851-3420

3.         Drugs and Crime Data Center and Clearing House – 1-800-666-3322

4.         The CENAPS Corporation, 18650 Dixie Hwy, Homewood Il 60430, 708-799-5000

5.         Herald House Independence Press, 1-800-767-8181, 816-252-5010

 

10 Responses to Relapse Prevention In The Criminal Justice System: Applications of the CENAPS Model

  1. Linda R says:

    Terry, I was unfamiliar with the CENAPS Model until reading this blog. The focus of this blog is applications of the CENAPS model to relapse prevention in the criminal justice system. The criminal justice system cuts a pretty wide swath across many forms of criminal behavior. I’m wondering about your take on where the criminal behavior of dui offenders fits into the continuum of crime that the justice system addresses. In the past, dui offenders were typically referred to Twelve Step Programs. With the court decisions about Twelve Step Programs being religious, for all practical purposes the justice system no longer has the option of sentencing a dui offender to a Twelve Step Program. Do you have an opinion on other options that the criminal justice system should use for dui offenders?

    • Linda, once again, the court decisions effects only the state they may be in. In Canada, same thing, depends on the province. My brother runs Point Finale for 25 years in Montreal, so far so good, still highly respected in the courts regarding DUI and placement in re-habs. It is 12-step based .

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