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Moving Targets: Critical Considerations for DWI Court PopulationPresented by:
Julie Seitz, LADC, LSWClinical Director, Center for Alcohol & Drug Treatment
Shane WolfNCDC Project Director
NADCP National Conference July 10, 2017
OBJECTIVES
How bias effects our target population
“Assuming they can do it”
Affects of Trauma
You know my name, not my story.
You’ve heard what I’ve done, not what I’ve been
through.
What is his story?
POTENTIAL CLIENT’S HISTORY
They will never change
They’re always drunk
Treatment hasn’t worked in the past
They’re the problem family of the town
Jail is the best place for them
Motivational Interviewing
Why What
When WhoWhere
DON’T ASSUME
Validated Assessment ToolsLegal ScreeningsClinical Screening
Allow their side of the story be told
Share Information Gathered!!!
Risk/Need Level+
Eligibility Criteria=
Program Entry
HOW TO COMBAT BIAS?
Collecting Data
Does your program adequately represent your community?
Focus on the facts
Base decisions on Risk/Need Level and Eligibility criteria – not if you think they will be successful
STRENGTH BASED
APPROACH
Recognize tools client has:
• Tools that are pro-social/anti-social
• How the client has survived
• What is their reality
REPROGRAMMING OUR BRAINS
Program expectations realistic?
Do we set our clients up for success?
Do we take advantage of teachable moments?
Do we live in black and white?
WHO ARE
OUR CLIENTS?What is their home life like?
What adversities do they face on a daily basis?
Is there generational mistrust of criminal justice system?
Is there a history of being “pushed through the system”?
EMPOWER
THE CLIENT
Use Motivational Interviewing and Strength Based case management strategies
Look for teachable moments and alternatives to sanctioning
Recognize High Risk/High Need clients have baggage but
research shows they do the best in these programs
Psychiatric comorbidity is
not only highly prevalent
in repeat DWI offender
populations but also a
significant risk factor for
criminal behavior
Mental Health & DWI Offenders
PSYCHIATRIC COMORBIDITY
AMONG FIRST-TIME AND
REPEAT DUI OFFENDERS
Repeat DUI offenders screened positive in their lifetime for an
average of 6.2 disorders, whereas first-time offenders screened positive
for an average of 3.6 disorders
Psychiatric comorbidity is severe and pervasive among repeat DUI offenders
compared to first-time offenders
Symptoms of anxiety disorders appear to be highly prevalent in both DUI offender populations compared
to the general population
COMPUTERIZED ASSESSMENT AND
REFERRAL SYSTEM (CARS)www.carstrainingcenter.org
Research has found that 45% of repeat drunk drivers have a major mental health disorder in addition
to substance use disorder
45%
DUI offenders who suffer from psychiatric disorders other than
alcohol or use disorders re-offend more, and more quickly than others
Screening for mental health issues beyond alcohol use disorders is rare
within DUI treatment programs
Over two-thirds of people seeking treatment for substance use
disorder report one or more traumatic
life events(Back et al., 2000)
Trauma
Trauma is when our ability to cope in everyday ways is overwhelmed.
The traumatic event does not define a trauma reaction. It is our perception of the event, our past
experiences, our past coping patterns, and our present resources and ability to cope that determine
the outcome.
What is Trauma?
Major Types of Trauma• Natural disasters
• Mass interpersonal violence
• Large-scale transportation accidents
• Fires
• Vehicle Accidents
• Sexual Assault
• Stranger Physical Violence
• Partner Violence
• Torture
• War
• Childe Abuse
• Emergency Worker
Combined &Cumulative Trauma
Complex Trauma
Developmental Trauma
Multiple Traumas
Re-victimization
ACE Study
Recurrent physical abuse
Recurrent emotional abuse
Contact sexual abuse
An alcohol and/or drug abuser in the household
An incarcerated household member
Someone who is chronically depressed, mentally ill, institutionalized, or suicidal
Mother is treated violently
One or no parents
Emotional or physical neglect
Growing up and experiencing any of the following conditions in the household prior to the age of 18:
Complicating Variables
Female gender
Age: young or old
Race
Lower SES
Hyperactive or dysfunctional nervous system
Genetic predisposition
Previous psychological dysfunction
Less functional coping
Family dysfunction
Past trauma
Distress at the time of trauma
Trauma Pathway
• Sensory stimulus triggers
• Hypothalamus which releases
• Corticotropin releasing factor which stimulates
• Pituitary which releases
• Adrenocorticotropin hormone which stimulates
• Adrenals which release
• Cortisol which regulates
• Stress responses and immune functioning
ANATOMY OF FEAR
Within seconds of perceiving a threat, the primitive amygdala sounds a general alarm. The adrenal system promptly floods the body with adrenaline and stress hormones. Nonessential physiological processes switch off. Digestion stops, skin chills, and blood is diverted into muscles in preparation for a burst of emergency action. Breathing quickens, the heart races, and blood pressure skyrockets, infusing the body with oxygen while the liver releases glucose for quick fuel. The entire body is suddenly in a state of high alert, ready for fights or flight.-J.S.
Trauma Cycle Resolved
Trauma
FightFlightFreeze
Overwhelmed ResolutionNo Lasting
Effects
Trauma Cycle Unresolved
Trauma
FightFlightFreeze
Overwhelmed Resolution No Lasting Effects
Unresolved
Coping
Trigger – F/F/FOverwhelmed –
Coping Cycle
ACE Study Major Findings
• Alcohol use
disorders
• COPD
• Depression
• Obesity
• Fetal death
• Health related
quality of life
• Liver disease
• Risk for intimate
partner violence
• Multiple sexual
partners
• STI’s
• Smoking
• Suicide attempts
• Unintended
Pregnancies
Power of ACE’s
ACE’s are common
ACE’s are cumulative
ACE’s account for a significant percentage of both social and health related problems
Trauma-Informed Approach:The 3 R’s
Realizing the prevalence of trauma
Recognizing how trauma affects all individuals involved in the program, organization, or system, including its own workforce
Responding by putting this knowledge into practice
Underlying Principles:A Trauma-Informed Approach
Safety
Trustworthiness and transparency
Collaboration and mutuality
Empowerment
Voice and choice
Underlying Principles:A Trauma-Informed Approach
Peer support and mutual self-help
Resilience and strength-based
Inclusiveness and shared purpose
Cultural, historical and gender issues
Change process
The point is not to survive addiction. The point is to
thrive in recovery.–Tommy Rosen
Questions?
Julie Seitz, LADC, [email protected]
Shane Wolf, NCDC Project [email protected]
NADCP National Conference July 10, 2017