Relapse Prevention and Chemically Dependent Offenders 

March 2, 2015

By Terence T. Gorski

Review Gorski’ Books and Publications

From the mid 1970’s to the late 1980’s I worked extensively on projects involving the criminal justice system.

My primary focus was upon setting up programs lower recidivism to substance use and crime. During this project I interviewed many current and released prisoners, correctional and probation officers, and drug court judges.

The project resulted in the development of the three manuals related to relapse prevention among offenders that are still used in many correctional programs and training I institutes.

These are:

1. An Executive Briefing On Addicted Offenders for Judges and Policy Makers.

2. A Guide for Counselors, Therapists, and Criminal Justice Professionals;

3. The Relapse Prevention Workbook Chemically Dependent Offenders (for use by offenders);

4. Relapse Warning Signs for Criminal Behavior;

5. High Risk Situations for Incarcerated chemically Dependent Behaviors.

I also made the book available through the government printing office: https://www.ncjrs.gov/pdffiles1/Digitization/152332NCJRS.pdf

Here is the link to  blog page that briefly describes the information that we have. The publications are old, but the content has stood the test of time. All protocols within these workbooks are based evidenced-based practices of Relapse Prevention Therapy as certified by the National Registry for Evidence-based Programs and Practices (NREPP). The work books have been extensive used in the correctional system both behind the bars and in the community for over twenty-years. They are still valid because: They are based upon a rock-solic foundation of Cognitive-Behavioral Therapy (CBT), they utilize proven principles of Relapse Prevention, and the system is manualized making it easy to use consistently within a program.
We can make the workbooks available on a license tt individual facilities in reproducible PDF files that can be copied within the facility for use with the clients. If you are interested in obtaining a PDF License please email Tresa Watson tresa@cenaps.com or call here at 352-596-8000.

Violence Against Women: Fact Sheet 2014

January 12, 2015

2015/01/img_0873.jpg

Intimate partner and sexual violence against women
Fact sheet N-239
Updated November 2014
http://www.who.int/mediacentre/factsheets/fs239/en/

Key facts:

Violence against women – particularly intimate partner violence and sexual violence against women – are major public health problems and violations of women’s human rights.

Recent global prevalence figures indicate that 35% of women worldwide have experienced either intimate partner violence or non-partner sexual violence in their lifetime.

On average, 30% of women who have been in a relationship report that they have experienced some form of physical or sexual violence by their partner.

Globally, as many as 38% of murders of women are committed by an intimate partner.

Violence can result in physical, mental, sexual, reproductive health and other health problems, and may increase vulnerability to HIV.

Risk factors for being a perpetrator include low education, exposure to child maltreatment or witnessing violence in the family, harmful use of alcohol, attitudes accepting of violence and gender inequality.

Risk factors for being a victim of intimate partner and sexual violence include low education, witnessing violence between parents, exposure to abuse during childhood and attitudes accepting violence and gender inequality.

In high-income settings, school-based programmes to prevent relationship violence among young people (or dating violence) are supported by some evidence of effectiveness.

In low-income settings, other primary prevention strategies, such as microfinance combined with gender equality training and community-based initiatives that address gender inequality and communication and relationship skills, hold promise.

Situations of conflict, post conflict and displacement may exacerbate existing violence and present additional forms of violence against women.
Introduction

Defining Violence Against Women

The United Nations defines violence against women as “any act of gender-based violence that results in, or is likely to result in, physical, sexual or mental harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life.”

Intimate partner violence refers to behaviour by an intimate partner or ex-partner that causes physical, sexual or psychological harm, including physical aggression, sexual coercion, psychological abuse and controlling behaviours.

Sexual violence is any sexual act, attempt to obtain a sexual act, or other act directed against a person’s sexuality using coercion, by any person regardless of their relationship to the victim, in any setting. It includes rape, defined as the physically forced or otherwise coerced penetration of the vulva or anus with a penis, other body part or object.

Scope of the problem

Population-level surveys based on reports from victims provide the most accurate estimates of the prevalence of intimate partner violence and sexual violence in non-conflict settings. The first report of the “WHO Multi-country study on women’s health and domestic violence against women” (2005) in 10 mainly low- and middle-income countries found that, among women aged 15-49:

– Between 15% of women in Japan and 71% of women in Ethiopia reported physical and/or sexual violence by an intimate partner in their lifetime;

– Between 0.3–11.5% of women reported experiencing sexual violence by someone other than a partner since the age of 15 years;

– The first sexual experience for many women was reported as forced – 17% of women in rural Tanzania, 24% in rural Peru, and 30% in rural Bangladesh reported that their first sexual experience was forced.
A more recent analysis of WHO with the London School of Hygiene and Tropical Medicine and the Medical Research Council, based on existing data from over 80 countries, found that globally 35% of women have experienced either physical and/or sexual intimate partner violence or non-partner sexual violence. Most of this violence is intimate partner violence.

– Worldwide, almost one third (30%) of all women who have been in a relationship have experienced physical and/or sexual violence by their intimate partner, in some regions this is much higher. Globally as many as 38% of all murders of women are committed by intimate partners.

– Intimate partner and sexual violence are mostly perpetrated by men against women and child sexual abuse affects both boys and girls. International studies reveal that approximately 20% of women and 5–10% of men report being victims of sexual violence as children. Violence among young people, including dating violence, is also a major problem.

Risk factors

Factors found to be associated with intimate partner and sexual violence occur within individuals, families and communities and wider society. Some factors are associated with being a perpetrator of violence, some are associated with experiencing violence and some are associated with both.

Risk factors for both intimate partner and sexual violence include:

– Lower levels of education (perpetration of sexual violence and experience of sexual violence);

– Exposure to child maltreatment (perpetration and experience);
witnessing family violence (perpetration and experience);

– Antisocial personality disorder (perpetration);

– Harmful use of alcohol (perpetration and experience);v

– Having multiple partners or suspected by their partners of infidelity (perpetration); and
attitudes that are accepting of violence and gender inequality (perpetration and experience).

Factors specifically associated with intimate partner violence include:

– Past history of violence;
marital discord and dissatisfaction;

– Difficulties in communicating between partners.

Factors specifically associated with sexual violence perpetration include:

– Beliefs in family honour and sexual purity;
– Ideologies of male sexual entitlement; and
– Weak legal sanctions for sexual violence.

The unequal position of women relative to men and the normative use of violence to resolve conflict are strongly associated with both intimate partner violence and non-partner sexual violence.

Health consequences

Intimate partner and sexual violence have serious short- and long-term physical, mental, sexual and reproductive health problems for survivors and for their children, and lead to high social and economic costs.

Violence against women can have fatal results like homicide or suicide.
It can lead to injuries, with 42% of women who experience intimate partner reporting an injury as a consequences of this violence.

Intimate partner violence and sexual violence can lead to unintended pregnancies, induced abortions, gynaecological problems, and sexually transmitted infections, including HIV.

The 2013 analysis found that women who had been physically or sexually abused were 1.5 times more likely to have a sexually transmitted infection and, in some regions, HIV, compared to women who had not experienced partner violence. They are also twice as likely to have an abortion.
Intimate partner violence in pregnancy also increases the likelihood of miscarriage, stillbirth, pre-term delivery and low birth weight babies.

These forms of violence can lead to depression, post-traumatic stress disorder, sleep difficulties, eating disorders, emotional distress and suicide attempts.

The same study found that women who have experienced intimate partner violence were almost twice as likely to experience depression and problem drinking. The rate was even higher for women who had experienced non partner sexual violence.

Health effects can also include headaches, back pain, abdominal pain, fibromyalgia, gastrointestinal disorders, limited mobility and poor overall health.

Sexual violence, particularly during childhood, can lead to increased smoking, drug and alcohol misuse, and risky sexual behaviours in later life. It is also associated with perpetration of violence (for males) and being a victim of violence (for females).

Effect On Children

Children who grow up in families where there is violence may suffer a range of behavioural and emotional disturbances. These can also be associated with perpetrating or experiencing violence later in life.
Intimate partner violence has also been associated with higher rates of infant and child mortality and morbidity (e.g. diarrhoeal disease, malnutrition).

Social and economic costs

The social and economic costs of intimate partner and sexual violence are enormous and have ripple effects throughout society. Women may suffer isolation, inability to work, loss of wages, lack of participation in regular activities and limited ability to care for themselves and their children.

Prevention and response

Currently, there are few interventions whose effectiveness has been proven through well designed studies. More resources are needed to strengthen the prevention of intimate partner and sexual violence, including primary prevention, i.e. stopping it from happening in the first place.

Regarding primary prevention, there is some evidence from high-income countries that school-based programmes to prevent violence within dating relationships have shown effectiveness. However, these have yet to be assessed for use in resource-poor settings. Several other primary prevention strategies: those that combine microfinance with gender equality training; that promote communication and relationship skills within couples and communities; that reduce access to, and harmful use of alcohol; and that change cultural gender norms, have shown some promise but need to be evaluated further.

To achieve lasting change, it is important to enact legislation and develop policies that:

– Address discrimination against women;
– Promote gender equality;
support women; and
– Help to move towards more peaceful cultural norms.

An appropriate response from the health sector can play an important role in the prevention of violence.
Sensitization and education of health and other service providers is therefore another important strategy.

To address fully the consequences of violence and the needs of victims/survivors requires a multi-sectoral response.

WHO actions

WHO, in collaboration with a number of partners, is:

– building the evidence base on the size and nature of violence against women in different settings and supporting countries’ efforts to document and measure this violence and its consequences.

This is central to understanding the magnitude and nature of the problem at a global level and to initiating action in countries;

– Strengthening research and research capacity to assess interventions to address partner violence
developing technical guidance for evidence-based intimate partner and sexual violence prevention and for strengthening the health sector responses to such violence;

– Disseminating information and supporting national efforts to advance women’s rights and the prevention of and response to violence against women; and

– Collaborating with international agencies and organizations to reduce/eliminate violence globally.

http://www.who.int/mediacentre/factsheets/fs239/en/

Gorski Books


Get Tough and Be Dumb Approaches To Addiction Don’t Work

August 9, 2014

20140809-215803-79083249.jpg

By Terence T. gorski, Author

Originally Published: 9/16/2010 ·

The abuse and addiction to alcohol and other drugs are primarily and health problems, not criminal problems. Alcoholics and Drug Addicts are sick people who need to get well, not bad people who need to be punished. More investment should be made in early intervention and treatment. Enforcement should once again focus upon major producers and dealers. Individual who break the law while using alcohol and other drugs should be punished for the crime they committed and referred to treatment for the related alcohol or drug use disorder. Treatment has proven to be less expensive and more effective than criminal justice interventions. Imprisonment for drug status offenses is the most expensive and least effective way to deal with the nation’s alcohol and drug problems. A primary focus on enforcement at the expense of treatment is a GET TOUGH – BE DUMB policy that has not, cannot, and will not work.

People should be prosecuted for crimes committed under the influence of alcohol and/or drugs, the only exception being drug status offenses (i.e. personal possession and use). Drunk driving, for example, is a crime and people should be responsible for putting others in harm’s way. Mandatory drunk driving programs that include treatment have much lower recidivism rates than just legal punishment of the drunk driving. Drunk driving is and should be a crime. Public intoxication is not a crime in most states. Separating the symptoms of addiction from other criminal behaviors makes it easier to see when treatment vs. punishment is most appropriate.

We need to separate the disease of alcoholism and drug addiction from criminal behavior. This is hard to do under two conditions:

(1) When people attempt to excuse all criminal behavior as a symptom of addiction and use treatment to avoid punishment; and

(2) When all alcohol and drug use is viewed as a crime to be severely punished under the mistaken belief that punishment will somehow cure addiction.

To make these distinctions we need to carefully think about our drug laws, the war on drugs, and the diagnostic standards used for both addiction and antisocial personality disorder.

Getting convicted of a drug felony can be a real buz-killer when looking for a job in a a crumbling economy. It seems like in America today no one can ever repay their debt to society. I know addicts with over 20 years of sobriety who were arrested and convicted on drug status offenses for personal possession and use who still find it to be a problem when trying to get a job or a security clearance.

“Only alcoholics or addicts can make themselves sober responsible people. The only thing the legal system can do is make them miserable if they refuse to try.” — Judge Dennis Challeen

http://www.relapse.org

GORSKI BOOKS: www.relapse.org


ADDICTION vs PSYCHOPATHY

June 6, 2014

20140606-163003-59403433.jpgby Terence T. Gorski
Author

ADDICTION is a pattern of compulsive use of alcohol and other drugs, described in DSM IV as A Substance Use Disorder.

In this blog I am going to use the term PSYCHOPATHY interchangeably with the terms ANTISOCIAL PERSONALITY DISORDER (ASPD) and SOCIOPATHY. These three terms describe essentially the same personality disorder marked by the following symptoms:
– a lack of empathy,
– a compulsive pattern of challenging authority, breaking rules, and victimizing others;
– the refusal to accept responsibility for the consequences personal behavior;
– the tendency to lie, cheat, steal, and manipulate others with little concern for the consequences; and
– the tendency to avoid responsibility by blame the victim or the enforcer when caught by the consequences of their own behavior.

A PERSONALITY DISORDER is an habitual pattern of believing, perceiving, thinking, feeling, acting, and relating to others that begins in early childhood, persists into adulthood, affects many areas of life and causes problems in social and occupation functioning.

Addictive disorders, described in the DSM as Substance Use Disorders, are not personality disorders. Addiction is a condition marked by:
– the obsession with and compulsion to use alcohol and other mind-altering substances;
– a compulsive pattern of use resulting in a loss of control over the ability to self-regulate the quantity, frequency, and duration of substance use; and
– secondary life and health problems caused by the progressive loss if control.

Psychopathy and addiction, although they share some characteristics, are not the same type of disorder. Some, but not all people suffering from addiction also have psychopathy. Some, but not all people suffering from psychopathy also abuse or become addicted to alcohol and other drugs. These are coexisting or co-occurring disorders that are different in kind.

Psychopathy is a personality disorder. Addiction is not!

There is no evidence that there is any personality style or disorder that causes addiction. People with all variations of healthy personality styles and personality disorders can become addicted.

The research suggests that chronic stage alcoholism and drug addiction creates some symptoms that look like the symptoms of antisocial disorder.

As people stabilize from acute withdrawal and post acute withdrawal (PAW), these symptom rapidly decrease as measured by standard personality tests within the first thirty days of sobriety.

Therefore, it is important to indicate days of sobriety and neuropsychological stability before deciding if antisocial behaviors are long-term personality traits or temporary traits related to the pain and dysfunction of withdrawal.

The diagnostic criteria that separate Psychopathy (Antisocial Personality Disorder), from the other cluster B personality disorders (Histrionic, Narcissistic, and Borderline) are not well established and tend to overlap. It is estimated that about 3-5% of the population suffer from ASPD (which is marked by violating laws and social norm)s, and as many as 20% are socially conforming psychopaths who lack empathy, challenge authority, victimize others, are deceptive, and do not learn from experience.

These socially conforming psychopaths wreak havoc and destruction all around them and destroy lives but are skilled at shifting the blame onto others (flipping the script) and avoiding legal consequences.

Alcoholics and prescription drug addiction have about the same incidence of psychopathy as the general population. In late stage addiction, the severe symptoms of intoxication, withdrawal, and post acute withdrawal can look like the symptoms of ASPD especially in a society that highly stigmatizes addiction.

People who use and/or become addicted to illicit (illegal) drugs are another story. Psychopaths are drawn to illegal drugs by their compulsion to challenge authority, break rules, and find excitement through extreme manipulation and risk-taking behavior. As a result, the incidence of antisocial behavior and psychopathic personality disorders is higher among illegal drug addicts than in alcohol or presciption drug addicts.

LIVE SOBER – BE RESPONSIBLE – LIVE FREE
www.relapse.org
www.facebook.com/GorskiRecovery

 


Solitary Confinement: Research and Experiences

January 10, 2014
Has anyone following this blog been in prison and served time in solitary confinement. Dr. Grassian, a trusted colleague, is interested in interviewing people to further his research on the impact of solitary confinement. Please review the correspondence below.  If you can help Dr. Grassian find people willing to be interviewed please contact him.
Stuart Grassian  M.D.

401 Beacon Street
Chestnut Hill, MA 02467
(617) 244-3315
stgrassian@gmail.com 

Please read our correspondence below for more information.
Dear Mr. Gorski,
Thanks for your words of support.  As you know, addictions and imprisonment are so tightly connected;  I am pleased to learn of your work reaching out to those who have experienced both.
Earlier this year I made a commitment to try to collect stories of individuals who, now released back into the community, had spent a great deal of time in solitary confinement.  I would greatly appreciate any referrals you might have of individuals who have experienced this and might be willing to share their experience (of course, confidentiality would be maintained).
I hope the new year finds you well and that your work continues to make a difference.
Stuart Grassian  M.D.

401 Beacon Street
Chestnut Hill, MA 02467
(617) 244-3315
stgrassian@gmail.com

On Tue, Dec 24, 2013 at 12:46 PM, <stgrassian@aol.com> wrote:
—- original Message—–
From: ttgorski <ttgorski@gmail.com>
To: stgrassian <stgrassian@aol.com>
Cc: Tresa Watson <tresa@cenaps.com>; Terence T. Gorski <ttgorski@gmail.com>; Dr. Stephen Grinstead <sgrinstead@cenaps.com>
Sent: Mon, Dec 23, 2013 2:30 pm
Subject: Thank You For You Work

Dear Dr. Grassian,

I have been delinquent in expressing my gratitude and and telling you about how useful your work has been to me. As a means f introduction I am an author and a trainer/consultant specializing in addiction and related mental health problems. I have developed a popular model of Relapse Prevention Therapy (RPT).  and through me uncountable addiction professionals trying to understand the unusual and difficult to deal problem they have in treating http://salvationist.ca/2011/11/an-ounce-of-prevention/ patients who have been incarcerated. When I started trying to meet the needs of these counselors, I constructed a concept called Post Incarceration Syndrome (PICS). Initially it was very popular, until of course, the economy and climate of addiction treatment radically changed through the influence of Government Policy.
Here are links to several internet resources that show how your work has influenced me:
1. My blog republishing a basic article that has been reference and reposted many times:https://terrygorski.wordpress.com/2013/10/26/the-post-incarceration-syndrome-pics/
6. Relapse Prevention In The Salvation Army programs: http://salvationist.ca/2011/11/an-ounce-of-prevention/
This is just a sample of the many people who have spread your ideas which are contained in the concept of Post Incarceration Syndrome.
I wanted you to know that your has, is, and will continue to make a difference to me and countless lives that your research and writing have changed for the better. Thank you for your contributions and you career work.
Terence T. Gorski

Drug War Policy: Get Tough and Be Dumb Approaches To Addiction That Don’t Work

October 30, 2013

October 30, 2013

BARS_Black_HandsThe abuse and addiction to alcohol and other drugs are primarily and health problems, not criminal problems. Alcoholics and Drug Addicts are sick people who need to get well, not bad people who need to be punished. More investment should be made in early intervention and treatment.

Enforcement should once again focus upon major producers and dealers. Individual who break the law while using alcohol and other drugs should be punished for the crime they committed and referred to treatment for the related alcohol or drug use disorder.

Treatment has proven to be less expensive and more effective than criminal justice interventions.  Imprisonment for drug status offenses is the most expensive and least effective way to deal with the nation’s alcohol and drug problems. A primary focus on enforcement at the expense of treatment is a GET TOUGH – BE DUMB policy that has not, cannot, and will not work.

People should be prosecuted for crimes committed under the influence of alcohol and/or drugs, the only exception being drug status offenses (i.e. personal possession and use). Drunk driving, for example, is a crime and people should be responsible for putting others in harm’s way. Mandatory drunk driving programs that include treatment have much lower recidivism rates than just legal punishment of the drunk driving. Drunk driving is and should be a crime. Public intoxication is not a crime in most states. Separating the symptoms of addiction from other criminal behaviors makes it easier to see when treatment vs. punishment is most appropriate.

We need to separate the disease of alcoholism and drug addiction from criminal behavior.  This is hard to do under two conditions:

(1) When people attempt to excuse all criminal behavior as a symptom of addiction and use treatment to avoid punishment; and

(2) When all alcohol and drug use is viewed as a crime to be severely punished under the mistaken belief that punishment will somehow cure addiction.

To make these distinctions we need to carefully think about our drug laws, the war on drugs, and the diagnostic standards used for both addiction and antisocial personality disorder.

Getting convicted of a drug felony can be a real buzz-killer when looking for a job in a crumbling economy. It seems like in America today no one can ever repay his or her debt to society. I know addicts with over 20 years of sobriety who were arrested and convicted on drug status offenses for personal possession and use who still find it to be a problem when trying to get a job or a security clearance.

“Only alcoholics or addicts can make themselves sober responsible people.
The only thing the legal system can do 
is to make them miserable if they refuse to try.”
~  Judge Dennis Challeen ~

GORSKI BOOKS: www.relapse.org – GORSKI TRAINING: www.cenaps.com

GORSKI ON FACEBOOK: www.facebook.com/GorskiRecovery

LIVE SOBER – BE RESPONSIBLE – LIVE FREE


Obedience To Authority: The Milgram Experiment

October 27, 2013

Obedience_To Authority_Bk_CoverIf you were told by a legitimate authority figure to submit progressive electric shock to a test subject even, if you thought it was killing them — would you do it?

In controlled experiments, replicated many times over the last four decades, between 50% and 65% of normal people continued to administer electric shocks even when they believed it was killing the other person.

What did it take to get them to do it? Surprisingly not much at all.

All that was necessary was for the person administering the shocks to see they were part of a legitimate process, to have clear instructions to follow, and to have a person who appeared t be a legitimate authority figure telling them to continue.

The person administering the shocks didn’t like it. They obviously felt bad and struggled with internal conflict, but over half continued with the process even when the other person begged them to stop and they believed they were administering lethal levels of electric shock to a person who as unconscious.

All that was necessary was a calm and self-assured person with all the trappings of legitimate other calmly saying — the experiment must continue, please go on.

“All That Is Required For Evil To Triumph
Is For Good People To Do Nothing.” 
~ Edmund Burke ~

Watch the Video:
http://youtu.be/qO3R5JcbffM

Read The Book:
Obedience To Authority by Stanley Milgram


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