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Full Chapter Changing Substance Abuse and Criminal Behavior Through Therapeutic Relationships 1St Edition Debra H Benveniste Auth PDF
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Changing
Substance Abuse
and Criminal Behavior
through Therapeutic
Relationships
DEBRA H. BENVENISTE
Changing Substance Abuse and Criminal
Behavior Through Therapeutic Relationships
Debra H. Benveniste
Changing Substance
Abuse and Criminal
Behavior Through
Therapeutic
Relationships
Debra H. Benveniste
Dayville, Connecticut, USA
Although I am the author of this book, in many ways I have only been a
conduit for others. A great many of the people who contributed to this
book will have to go unnamed. I know that many of them had hoped
that there was something positive about themselves that they could
give to others to make up for the damage they have caused. Others are
deceased and never had the chance to realize their potential in life. I have
attempted to convey what was compelling, wise, and important about all
of them, so that those qualities can live on in some way.
I started out in this field as a drug counselor, working without the
benefit of a clinical degree. My first clients, particularly Billy, Bobby, and
Jeff, patiently and thoroughly schooled me about the nature of heroin
addiction. They helped me to be wise beyond my young age and lack of
experience. Many of those clients succumbed to the AIDS pandemic just
as it was beginning.
The Smith College School for Social Work provided me with an
excellent education in psychodynamic theory and therapy. Post master’s,
the incarcerated clients I worked with, particularly Marc and Ron,
allowed me into their internal worlds and helped me to understand the
complexity of violent crime. Since then in private practice, I have worked
with clients with substance abuse problems and those in secondary
desistance from criminal behavior. A thank you to Terry, Jeff, and Bill,
who helped me to understand the role of trauma in substance abuse.
v
vi Acknowledgments and Dedication
To all of my clients who have lost hard-fought battles with their demons,
may they rest in peace.
I am thankful to Simmons College School of Social Work and my
doctoral committee for supporting the dissertation which produced the
results used for this book. I am especially grateful to Dr Heith Copes for
his wisdom and availability. A very special thanks to Sam Williams, the
community advisor for the project, whose help with the pilot study was
invaluable. I am very grateful to the “group of 11,” my respondents who
gave of their time and of themselves to share their desistance process with
me. I thoroughly enjoyed meeting with them and wish them all the very
best in their journeys. Thank you to Nicola Jones and Eleanor Christie
at Palgrave Macmillan for their support of this work. I am grateful to
Shannon Dohar for her reading of the manuscript and for her advice
and suggestions. This book is dedicated to my husband, Steve, who has
provided me with unfailing support and encouragement throughout all
of these endeavors.
Contents
Part I Overview 1
1 Introduction 3
Issues in Analyzing and Presenting the Data 5
Psychodynamic Theory as a Framework
to Explore Relational Dynamics 6
Strange Bedfellows 8
Treatment Models Which Integrate CBT
and Psychodynamics 10
A Relational Analytic Practice Model for Desisters 12
References 13
vii
viii Contents
3 Theoretical Context 43
Relational Analytic Theory 44
Dissociation and Its Impact on Identity
Formation: The Descent into Crime 49
The Developmental Formation of Identity 51
Trauma and Dissociation in Respondents’ Stories 56
Addiction 59
Turning Points 60
References 61
4 Pathways to Desistance 65
Primary and Secondary Desistance Pathways 66
The Role of Significant Relationships in Desistance 68
Societal Obstacles to Secondary Desistance 85
Summary 86
References 88
5 Diagnostic Considerations 93
Antisocial/Dissocial Personality Disorder 94
Substance Abuse 96
ASPD/DPD and Psychopathy 99
Treatability 101
Diagnostic Impressions of the Respondent Group 102
Applying for Treatment 109
Relational Diagnosis 110
References 112
Contents ix
References 211
Index 213
List of Figures and Tables
Figures
Fig. 4.1 Desistance pathways 66
Tables
Table 2.1 Respondents’ reports of criminal histories, estimated
length of time incarcerated, and years in the community
since last incarceration 20
Table 2.2 Characteristics of the respondent group 21
Table 2.3 Health status: substance abuse, mental illness,
and HIV disease 22
Table 4.1 Respondents’ descriptions of their secondary
desistance pathways 68
Table 4.2 Respondents’ descriptions of their primary
desistance pathways 69
xi
Part I
Overview
Abstract The first chapter provides an overview of the scope of the book
and introduces its basic concepts and goals. Specifics of the research
project which generated the interviews are discussed including special issues in
analysis and presentation of the data. The author argues for the choice of psy-
chodynamic theory to explain the data and derive a practice model. Cognitive
behavioral therapy (CBT) with the substance abuser and offender populations is
the current treatment of choice, yet some practice models are evolving to incor-
porate psychodynamic principles. Examples of treatment programs for sub-
stance abusers and offenders that integrate CBT and psychodynamic concepts
are presented. The author’s practice model integrating relational analytic theory,
interview data, and case examples with these client populations is introduced.
2010). However, the Institutional Review Board which authorized this study
did not permit employing any other source material such as criminal records
or treatment documentation. Because the study’s focus was on an internal psy-
chological process, it was determined that self-report alone would provide suf-
ficient information. Some researchers concur. In discussing interview-based
research with offenders, Brookman (2010) asserted, “The further one moves
from observable, factual events towards internal thoughts and perceptions,
the less feasible and desirable validation becomes” (p. 95). Therefore, Curtis
(2010) stated that it is possible to collect reliable self-report information from
respondents who have engaged in stigmatizing or marginalizing behavior and
that “more often than not they tell the truth” (p. 152). He said that researchers
often get far more cooperation than they expect.
Results of qualitative studies such as this are not designed to be general-
ized or definitive. Although the desistance processes that study respondents
described are utilized in this book to formulate a treatment model, it is not
my intention to posit that all substance abusers and offenders will desist if
these methods are employed. Substance abuse and criminal behavior can
become areas of difficulty for many different reasons and for many different
types of clients, and as such, their treatment needs will vary. The popula-
tions of those desisting from crime and substance abuse do not all respond
to the same types of interventions, nor would they necessarily rely on inter-
personal relationships in ways similar to this respondent group.
Generalizing or universalizing data is the task of quantitative methodology,
research based on statistical analyses. Given the heterogeneity of the offender
and substance abuser populations, I believe that evidence-based treatment
derived from quantitatively based outcome studies can inadvertently lead to
a “one size fits all” mentality of treatment intervention. Given the severity of
substance abusers’ and offenders’ multiple psychological, behavioral, social,
and cultural problems and stressors, one size does not fit all.
Strange Bedfellows
In the current treatment climate, offending, substance abuse, and
psychoanalytic theory make strange bedfellows. The prevailing treatment
of choice for those both with substance abuse problems and who commit
1 Introduction 9
References
Ainsworth, M. D. S., & Bowlby, J. (1991). An ethological approach to personal-
ity development. American Psychologist, 46, 333–341.
Andrews, D. A., & Bonta, J. (2010). The psychology of criminal conduct (5th ed.).
Newark, NJ: Matthew Bender.
14 Changing Substance Abuse and Criminal Behavior
view data occurred after the fact and for the purposes of this book.
Demographic information about the respondents is presented followed
by their individual stories.
Demographic Information
The 11 men who consented to one-time interviews for this study were as
similar as they were different. Each had been convicted of at least one act
of violence and suffered societal ostracism pertaining to one or more cul-
tural vulnerabilities including racial minority status, history of substance
abuse and mental illness, being raised in poverty and urban ghettoes,
and HIV disease. Within this common bond of societal marginalization,
there were threads that connected most of the men. Ten had never been
married, ten were heterosexual, and ten committed non-sexual offenses.
Only one was homeless and one completed a college degree.
Beyond these basic commonalities however, much about the group was
divergent. Criminal history, estimated length of time incarcerated, and years
in the community since the last incarceration varied tremendously. Five
respondents committed multiple, serious acts of violence; four committed
one assault that did not involve the use of a weapon but was treated as seri-
ous by the criminal justice system; two committed multiple non-serious acts
of violence. Non-serious violent acts are defined as brief interactions which
do not inflict serious harm and do not involve the use of a weapon.
Five men spent less than 5 years incarcerated. Two of the respondents
spent less than 1 year in prison while six spent over 6 years in prison.
Three were imprisoned multiple times totaling more than 15 years of
incarceration each. Four respondents had been living in the community
for over 10 years at the time of the interview. Three had been released
from prison less than 3 years before they met with me. Table 2.1 displays
respondents’ criminal histories.
Demographically, the men were diverse as well. Their ages ranged from
31 to 60, with six men between 41 and 50 years old. Eight were African
American or a blend of African American and Caucasian or Native
American. Three were Caucasian. Seven of 11 respondents were raised in
urban ghettoes. Two grew up poor outside of major urban areas and two
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Quod constat clare non debet verificare.
What is evidently certain, ought not to be verified.
Reddere, nihil aliud est quam acceptum restituere: seu, reddere est
quasi retro dare; et redditur dicitur a redeundo, quia retro it.
To render is nothing else than to restore what is
received; or to render is, as it were, to give back; and it
is called render from returning, because it goes back.
Regula est quæ rem quæ est breviter enarrat, non ut ex regula jus
sumatur, sed ex jure, quod est, regula fiat. Per regulam igitur brevis
rerum narratio traditur, et quasi causæ conjectio est, quæ, simul cum
in aliquo vitiata est, perdit officium suum.
The rule is that which briefly relates the matter, not that
law may be taken from a rule, but that which is of the
law may be made a rule. By a rule, therefore, a short
relation of things is delivered and there is, as it were, a
summary account of the cause, which at the same
time, when it is corrupted, loses its office.
Reputatio est vulgaris opinio ubi non est veritas. Et vulgaris opinio
est duplex, scil. opinio vulgaris orta inter graves et discretos
homines, et quæ vultum veritatis habet; et opinio tantum orta inter
leves et vulgares homines, absque specie veritatis.
A report is common opinion, where there is not truth;
and opinion is twofold, viz. a common opinion arises
between prudent and discreet men, which has the
appearance of truth, and opinion only arises between
giddy and vulgar men, without the appearance of truth.
Respondeat superior.
Let a superior answer.
Rex ipse non debet esse sub homine, sed sub Deo et lege, quia lex
facit regem: attribuat igitur rex, lege quod lex attribuit ei, viz.
dominationem et imperium. Non est enim Rex ubi dominatur
voluntas et non lex.
The king himself ought not to be under man, but under
God and the law; because the law makes the king,
therefore let the king give lawfully what the law hath
given to him, viz. dominion and authority; for it is not
the will of the king that rules, but the law.
Scire leges non hoc est, verba earum tenere, sed vim ac potestatem.
To know the laws, is not to understand their words, but
their force and power.
Sicut pœna ex delicto defuncti hæres teneri non debet, ita nec
lucrum facere, si quid ad eum pervenisset.
As the heir ought not to be punished in consequence
of the transgression of the deceased, so neither ought
he to make gain, if any advantage had come to him.