moving targets: critical considerations for dwi court ... · dwi court population presented by:...

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, LSWJulie@cadt.org

Shane Wolf, NCDC Project Directorswolf@allrise.org

NADCP National Conference July 10, 2017