“Crime and Recovery”- a Group Treatment Modality Exploring Crime as a Substance Use Relapse Factor

 

Pavel G. Somov, Ph.D.

Private Practice, Pittsburgh, PA

Copyright, 2007

 

 

Abstract

The article introduces a group protocol, “Crime and Recovery,” designed for a correctional substance use client, with an emphasis on crime as a substance use relapse factor. The proposed group protocol introduces correctional clients to various psychological motives that underlie criminality and assists in examination of how crime challenges one’s recovery status. The proposed protocol further helps correctional substance use clients appreciate the rationale behind the multi-disciplinary approach to drug and alcohol rehabilitation and, finally, serves to remind correctional substance use treatment providers of the clinical utility of understanding and harnessing the phenomenology of the motive behind criminal behavior, in the service of substance use relapse prevention.

 

 

 

 

Key words: crime, lapse, relapse, prevention, addiction, group therapy, substance use

 

 

 

 

 

 

 

 

“Crime and Recovery” - a Group Modality Exploring Crime as a Substance Use Relapse Factor

Crime as a Substance Use Relapse Factor

Substance use and crime go hand in hand; so does crime and substance use. In the United States between 60 and 75 percent of all crimes committed are thought to be related to substance use in one way or another (Read & Daley, 2001). Consequently, the discussion of legal ramifications of substance use is a frequent motivational “whip” both in the context correctional rehabilitation and substance use treatment programs. Read and Daley (2001), in “Getting High and Doing Time: What’s the Connection?,” note that two-thirds of inmates released from the correctional system will commit additional crimes to support their substance use habit and will be re-incarcerated.

While the “connection” between substance use and crime, particularly in a society that criminalizes drug use, is obvious, the connection between crime and substance use appears to largely elude the thematic content of rehabilitation culture. In addressing substance-use motivated crime, the correctional rehabilitation literature appears to lack an emphasis on crime-motivated substance use. Read and Daley (2001), for example, in summarizing the main points of their self-help book for correctional clients, caution the readers: “Problems with alcohol or other drugs increase the chances of your getting into trouble with the law or having to do time” (p. 77). In encouraging clients to “get clean” to prevent a relapse of criminogenic behavior, these authors, however, fail to caution their clients to “get legal” as a means to preventing a substance use relapse. While the importance of being “legal” might be a given for a correctional substance use counselor, getting “clean” and getting “legal,” for a correctional substance use client are two very different ambitions.

The present article explores the interplay between crime and substance use and offers a group modality, “Crime and Recovery” (Somov and Somova, 2003), designed to supplement correctional and substance use rehabilitation programs with an intervention that explicitly targets crime as a lapse/relapse factor that might jeopardize substance use recovery. Furthermore, the “Crime and Recovery” group protocol with its examination of various psychological motives that underlie the co-morbidity of crime and substance use attempts to infuse a degree of humanistic understanding of the phenomenology of a correctional substance user. Stanton Peele (2004), in his otherwise excellent book, “7 Tools to Beat Addiction,” offers a telling stereotype of a correctional substance use client: “One group of addicts – criminal addicts – is particularly resistant to intervention. Criminal addicts are rapacious individuals who view life simply as a smorgasbord for them to grab whatever they want” (p. 42). The “Crime and Recovery” group protocol, among other prevention goals, aims to prevent correctional substance use clients from internalizing this dangerously depressogenic stereotype which, if unaddressed, might be all too readily compatible with the already unnecessarily “diseased” self-view of a substance user in treatment. In paraphrasing Murray’s statement that addiction “serves as a multiplier of crime” (Murray, 1996, p. 90), the “Crime and Recovery” group protocol is specifically an intervention designed to shed light on how crime serves as a multiplier of addiction.

 

Wolves or Sheep in Wolves’ Clothes?

Walker and Logan (Sims, 2005), in writing about treatment of drug court clients, encourage counselors “to have a basic operating theory of the interaction between criminality and substance use” (p. 156) and acknowledge the under-recognized fact that “crime leads to drug use” (p. 156) as well. It would appear that this operating theory of the interplay between criminality and substance use has to begin with an operating theory of criminality in and of itself. Furthermore, to be of clinical utility, such an operating theory of criminality has to be compatible with goals of rehabilitation. A clinician entering the field of correctional substance use rehabilitation without a rehabilitation-compatible operating theory of crime is likely to experience value conflicts oneself and to undermine one’s clinical authority by revealing inconsistencies of his or her clinical platform.

In having reviewed what Millon, Simonsen, and Birket-Smith (1998, p. 3) refer to as “extensive and divergent” literature on the topic of the “elusive category” of psychopathy (p. 13), that has metamorphosed through such labels as delirium without insanity, moral insanity, sociopathy, delinquency, dyssocial personality, antisocial personality and semantic dementia, I was left with the “therapeutic gloom” that Sir Aubrey Lewis referred to in his own 1974 review of the half a century worth of literature on the issue of psychopathy. This “divergent” literature, replete with a “preoccupation with the nosological status of the concept” and “its forensic implications” (Lewis) appears to have largely failed in producing a rehabilitation-compatible operating theory of criminality. This is most immediately apparent from the DSM criteria for the diagnostic category of Antisocial Personality Disorder which in “classifying people by their actions rather than their psychological dispositions or traits… is less useful for the purposes of psychiatry or science” or rehabilitation (Lykken, p. 4). The behaviorally-oriented criteria for Antisocial Personality Disorder (APD) is purposefully non-inferential: by focusing a diagnostician’s attention to the observable and collaterally verifiably behavioral markers of psychopathy, DSM succeeds in inter-rater reliability but overlooks the invaluable information about the subjectivity of the motives that underlie antisocial behavior. As a result, this “cookbooklike” diagnostic criteria set (Lykken, p. 4) offers a recipe for a clinical foreclosure and prognostic doom. And, indeed, diagnosis of APD, instead of informing opportunities for treatment and rehabilitation, becomes an illness in and of itself, a “secondary deviation” (Lemert, 1951), an “accusatory judgment” (Millon, 1981), a diagnostic label that “follows the moral insanity tradition, insofar as psychological abnormality is inferred from social deviance” (Blackburn in Millon, p. 51), and psychopathy a seemingly untreatable psychopathology that “reflects the ‘nothing works’ view of offender rehabilitation” (Blackburn in Millon, p. 51).

The DSM-III of 1980, in introducing a behaviorally-focused diagnostic set for the Antisocial Personality Disorder, for all intents and purposes, heralded a third conceptual wave of the “moral insanity” view of psychopathy by reifying (equating) the antisocial/psychopathic behavior with such an abstraction of an antisocial/psychopathic disorder (Gunn in Millon) “insofar as psychological abnormality is inferred from social deviance” (Blackburn in Millon, p. 51). The first conceptual wave of reification of antisocial behavior with untreatable psychopathology can be traced back to the early 1800s when the well-known American physician, Benjamin Rush, equated antisocial activity with “innate, preternatural moral depravity” (Millon, p. 4). Benjamin Rush appears to have made the classic fundamental attribution error: in disregarding situational variance, he made a forceful dispositional attribution. He further compounded his already severe moral stance by making a globalizing inference that criminality is a function of a structural deficit, “probably an original defective organization in those parts of the body which are preoccupied by the moral faculties of the mind” (Millon, p. 4). This strictly-nature, unforgiving in its determinism hypothesis naturally paved the way for the implication of untreatability with the diagnosis of psychopathy creating “a negative halo that leads directly to a global label, which in turn leads to negative ideas about treatment and often to frank rejection” (Gunn in Millon, p. 37). The first wave of antisocial behavior as indicative of inherent immorality peaked later the century when in 1835 J. C. Pritchard formulated the concept of “moral insanity” (Millon, p. 5) which put the final touches on alienating the criminals from the normals. Pritchard, like Rush, rushed to preach a highly deterministic, rehabilitation-incompatible position that is best illustrated by such pronouncements as “the power of self-government is lost or greatly impaired and the Individual is found to be incapable, not of talking or reasoning upon any subject proposed to him, but of conducting himself with decency and propriety in the business of life” (Millon, p. 6, Pritchard’s quote, p. 85). As evident from Millon’s (1998) observation of similarity between current DSM criteria for APD and the diagnostic and anthropological expositions of such an 18th century scientific darling as Lombroso, the idea of a natural-born delinquent, once born, did not want to die. In the late 19th and early 20th century German psychiatrists redirected the focus of the study of psychopathology from “value-laden theories of the English alienists” (Millon, p. 7) to constitutional factors. J. L. Koch (1891) replaced the concept of “moral insanity” with the concept of “psychopathic inferiority” proposing that individual’s personality was a function of his/her physical constitution.

While the word “inferiority” in the Koch’s term of “psychopathic inferiority” was intended to merely connote a statistical deviation from a norm, this diagnostic designation has with time reacquired the connotation of immorality, thus heralding the second conceptual wave of reifying antisocial behavior with an unproven abstraction of moral insanity. This “fascinating transmutation of the meaning of a diagnostic label” (Millon, p. 8) exemplifies yet another fundamental attribution error. Another German, Adolf Meyer (1904), proposed that psychopathic states are psychoneurotic states, thus suggesting that psychopathy is a form of neurosis and thus primarily psychogenic. Meyer called this “constitutional inferiority,” in contrast with Koch’s term “psychopathic inferiority.” While Meyer’s term did not catch on, his idea that psychopathy is primarily psychogenic did. Meyer’s notion appeared to be the first acknowledgment of the nurture variance in the equation of psychopathy. Meyer’s concept of psychopathy as a “constitutional inferiority” was essentially a precursor of the notion of sociopathy. Ironically, an acknowledgment of nurture/socialization variance that could have opened the door to a rehabilitation-compatible operating theory of criminality, instead, shut the door with another stigmatizing slam that can only be understood in terms of human tendency to make dispositional rather than contextual attributions. In having acknowledged the “ostensible social origins” of antisocial behavior (Millon, p. 8), the term sociopathy now connoted that a “bad” person is “bad” not because of their built-in “moral insanity” but because of acquired “moral insanity.” In speculating about the dynamics of stereotyping and stigmatizing, the fundamental attribution error would predict that when we know that someone was not born bad but became bad, instead of gaining compassion from the situational attribution in which we hold the context responsible, we are more likely to experience a judgmental dispositional attribution along the lines that a truly good person would not allow themselves to acquire bad habits and, to confirm our hypothesis, we would recite the infinite examples of the Phoenix-rising-out-of-the-ashes type of social underdogs that made good. From the public standpoint, the net result of Koch’s and Meyer’s nosological efforts is that the “psychopathy” became synonymous with the term “sociopathy” and both of these terms continued to connote “moral insanity.”

The third and seemingly open-ended comeback of reification of criminality with underlying moral depravity was heralded, as noted above, in the 1980s with the emergence of the DSM-III diagnostic category of the Antisocial Personality Disorder. Both in choice of term and the laundry list of critera that smack of the 19th century Lombroso’s and Gouster’s lists of “stigmata” (Millon, 1998), APD appears to have put final moralizing touches on alienating and excluding a criminal from the benefit of the doubt about his or her capacities for compassion or empathy. Millon (1998, p. 9) expressed this well when he suggested that “the shifting sands of our terminologies and theories in this field should give us good reason to question current formulations that appear to be throwbacks to earlier, discarded notions” and adding that the label “antisocial personality” while “less pejorative” does, nevertheless, “hark back to its ancestral forerunner, ‘moral insanity.’” (p. 9).

Whereas initially explicit, the paradigm of moral insanity continues as an implication. What this means in practice is that by confusing “bad” behavior with characterological “badness,” we, as clinicians, run the risk of entering into a “moral discourse” that results in the belief that “patients may be harder to treat if they are called ‘psychopaths’ or any other name that is synonymous with ‘badness’ and that invites rejection” (Gunn in Millon, p. 34). This equating of the badness of the behavior with the badness of the motive makes it difficult “to treat good and bad people in a similar fashion” whereas “in medicine, the morality of a patient’s symptoms or behavior ought to be irrelevant” (Gunn in Millon, p. 34). The reification of the antisocial behavior with an abstraction of psychopathology of the underlying motive has, in fact, produced a view of criminals as a type of human subclass. Criminals, already outcast, branded and labeled under such diverse names as psychopaths, sociopaths, antisocials, delinquents and deviants, have been further metaphorically demoted to a sub-human class as natural-born predatory animals, wolves that prey on sheep, humans that operate from the “reptilian brain” (Meloy, 1988). Reid (Mellon) notes his dislike for such “animalistic” and “anthropological comments” (p. 113) and correctly reminds us that “human psychopathy involves human experience and human choice,” (p. 113). It is this humanistic perspective that I view as the cornerstone of a rehabilitation-compatible operating theory of crime. “Rehabbing” a house or a person implies a foundational value that is worth preserving. This foundational value, as I detail further below, is the motive behind the behavior, namely, the fact that there are no socially-unacceptable motives, only socially unacceptable behaviors. Expressed in the tradition of anthropological metaphors that so far have been used to alienate and exclude criminals as sub-humans, I propose that we are all sheep except that some of us, that are more neurotic, wear wolf’s clothes. While many a reader, at this controversial pronouncement (of the morality of the motive behind an antisocial behavior), might toss the article aside, the rest of the article is for a clinician who is willing to put his or her moral defaults on hold for a moment to examine a set of principles that constitute an operating model of criminality that is compatible with rehabilitation goals, an approach that instead of breaking down and rebuilding individuals offers to validate and salvage the hidden moral scaffold underneath the offensive façade.

Psychopathy vs Sociopathy: A Case of Fundamental Attribution Error

A reader familiar with social psychology literature will recall that the Fundamental Attribution Error (FAE) is a bias in judgment that manifests as a tendency to ascribe one’s behavior to characteristics of one’s personhood as opposed to the characteristics of the context or circumstance. This person-centered attribution style is known as a personal or dispositional causal attribution, whereas an attribution style that takes situational/contextual factors in consideration is called a situational attribution. The prevailing tendency to reify behavior with motive, to confuse doing bad with being bad, and to underestimate the variance of nurture in favor of the variance of nature illustrates the fundamental attribution error in conceptualizing antisocial behavior as an issue of disordered personhood (with the very notion of antisocial personality disorder being a case of a sweeping personal/dispositional attribution).

The behavioral genetics literature, literature on temperament and studies of the neurological, cognition and affect processing differences associated with psychopathy suggest that psychopathy is not a matter of nature versus nurture but a case of nature manifesting via nurture. This diathesis-stress, environment-gene interaction model of psychopathy serves to best capture the positive feedback loop between the hardware and the software in which the initial parameters of neurological hardware (such as temperament, arousal and habituation thresholds that modulate conditionability) interact with multiple environmental factors in a mutually reinforcing manner to produce the world in which one and the same brain/computer can be used to find a cure for cancer or to hack into a Veteran’s Administration mainframe as part of an identity theft enterprise. Lykken (1995, p. 85) brilliantly points out that “the argument over nature versus nurture is plainly fatuous, like asking whether the area of a rectangle is more dependent on its length or on its width” and adds that in “creating the mental software that is the essence of human individuality, the nature via nurture coupling is looser, leaving greater room both for both accidental and selective intervention.”

The recognition that criminality is at least in part a function of environmental variance as well as the recognition of the randomness with which genes and environment get paired, hopefully, helps to leverage the very compassion and empathy that correctional clinicians diagnostically begrudge the antisocials. On the other hand, the recognition that environmental variance aside, some individuals do have the genetic make-up that serves as a criminogenic liability provides a sobering perspective on how to triage rehabilitation efforts in the unavoidably zero-sum world of correctional mental health budgets. This last point is best understood with the help of Lykken’s (1995) differentiation between psychopaths and sociopaths. In taking a much needed “liberty,” Lykken (p. 21) breaks down the diagnostically “complex family” of antisocial personalities into a dichotomy of formerly synonymous and interchangeable terms by infusing them with new meaning. More specifically, Lykken proposes to use the term “psychopath” for antisocials with abnormal temperaments and to use the term “sociopath” for antisocials with normal temperaments but “who were badly socialized” (p. 21). This distinction offers a clear etymological rationale for each term. Socio-pathy is a pathology of socialization whereas psycho-pathy is a pathology of psyche, more specifically, of temperament as an element of psyche. Thus, it could be said that a sociopath, in Lykken’s use of the term, is a pseudo-psychopath, or, using the anthropological metaphor, not a wolf per se but a neurotic sheep in wolves’ clothes.

In keeping in mind Lykken’s distinction between psychopaths and sociopaths, it appears that current DSM criteria for APD, as would be predicted by the phenomenon of fundamental attribution error, are biased towards psychopathy (dispositional attribution) as opposed to sociopathy (situational/contextual attribution). For example, antisocials, as defined by DSM, are diagnostically distinguished as lacking conscience and capacity for empathy (Winfree & Abadinsky, 1996) or in the terminology of DSM, showing “lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from others” (APA, 2000). While true psychopaths, i.e. “individuals presenting with high levels of antisocial behavior have been consistently reported to present with reduced empathic responses to the distress (notably fear and sadness) of their victims” (Blair, Mitchell & Blair, 2005, p. 53), many of the correctional substance use clients might not be necessarily deficient in empathy but simply proficient in chemical and/or psychological overriding of empathy in order to attain necessary operational apathy to commit a potentially violent crime. In this case a pseudo-psychopath, a neurotic sheep socialized into crime, dons wolves’ clothes to avoid pangs of empathy for a fellow sheep. A correctional substance use clinician who fails to recognize that his or her clients’ substance use might have been motivated by a desire to enhance one’s criminal performance by numbing one’s conscience and/or to reduce post factum cognitive dissonance is likely to miss a valuable rehabilitative opportunity.

Morality predicated on fundamental attribution error is a morality of judgment not forgiveness, a

morality that produces diagnostic categories that pre-judge and invalidate, a morality that incarcerates one’s identity in a narrative of inherent badness rather than rehabilitates and re-socializes one’s conditioned antisocial behavior. And yet, this kind of morality is inevitable and, arguably, necessary. Behavior must be judged, but so must be the motive. That is the dialectic of morality. Whereas the role of judicial infrastructure (law enforcement, courts, correctional and post-release institutions) is to judge (i.e. to enforce penalties for socially unsanctioned (illegal) behavior), the role of clinical rehabilitation, by definition, is to forgive, to assume the possibility of re-integration into a society and to offer an avenue for accomplishing that. But to forgive and rehabilitate a behavior, a clinician has to understand the motive behind it, and, if at all possible, to attempt to validate the understandable morality of the motive and the psychological determinism of the means chosen to fulfill that motive. In other words, a rehabilitation clinician has to move from the righteousness of the dispositional attribution style to the compassion of the situational attribution style.

In closing the discussion of the interplay between the tendency for the fundamental attribution error and the meaning of criminality, let us briefly “zoom out” to a broader, sociological level of abstraction to examine how the meaning of criminality changes depending on the attribution style we exercise. Having grown up in the Soviet Union, I, as many of my fellow compatriots, have witnessed with dismay how in the early post-perestroika 1990s Russia went from being street-safe with law enforcement relying merely on the authority of their uniform to a lawless continent-wide gangland. What happened? How could a previously pious population of millions erupt with such disregard for law? A dispositional attribution on a social scale would suggest that the Soviets were socialized (no pun intended) to be sociopaths by a psychopathic government. And, indeed, one could presuppose that Soviets were a) morally depraved because of their atheism, b) weapons-trained because of the mandatory draft and thus inoculated against inhibitions against violence, and c) were socialized to obviate law because of having to lubricate the Soviet bureaucratic machine with constant bribes for housing and various material privileges, a situation that allowed most Soviets, at one point or another, to have set the precedent of personal criminality. Thinking in this way would lead one to believe that the Soviets were sociopaths in hibernation, kept in check by the tyrannical (and psychopathic in its own right) governmental superego. Following this Freudian repression hypothesis, one could further conclude that once the governmental exoskeleton fell, the sociopathic id of the Russian character (already pre-judged to be prone to lawlessness by misguided Russophiles) broke free turning post-Soviet Russia into a prison courtyard.

A situational attribution would counter the judgmental determinism of the dispositional attribution with an argument of economic necessity and a level of analysis that allows for a consideration of individual motives at play. How would have a civilized Westerner behaved in a situation of economic necessity paired with legal anonymity from lax law enforcement? A review of any basic text on social psychology that talks about “mob psychology,” “crowd behavior,” and “diffusion of responsibility” would quickly cool off any self-serving illusions about moral purity of any society. People’s behavior is a function of their motives and the situational options available to them. Having served in the Soviet Military known for its prison-style hazing culture and having worked as a psychologist in an American jail, I have witnessed seemingly bad people do good and seemingly good people do bad en masse. How are we to make sense of this? Is it Nature? Is it Nurture? What makes morality: behavior or the motive behind it? In constructing an equation of judgment, how shall we weigh the variables of choice and circumstance equally? Behaviors are visible but motives are not. To judge the morality of an action on the basis of whether a given behavior is socially sanctioned or not is akin to judging a book by its cover. To what level of analysis (behavior-level or motive-level) should we calibrate our judgment to decide what can be rehabbed and what cannot? Without answering these questions, without developing an operating model of criminality that is compatible with goals of rehabilitation, without becoming aware of the fundamental pull of judgment of those whose behavior we do not approve, entering a field of correctional rehabilitation appears be a precarious ethical enterprise.

 

Rehabilitation-Compatible Operating Model of Criminality

In completing this long theoretical detour, I would like to propose an operating model of criminality that is compatible with goals of correctional and substance use rehabilitation. This “operating theory” consists of the following several propositions or principles that will be used later in the article to examine the interplay between criminality and substance use with the overall goal of advancing a relapse prevention intervention that targets criminality as a substance use lapse/relapse factor.

 

Principle 1: There Are no Socially-Unacceptable Motives, only Socially-Unacceptable Behaviors

Lykken (1995, p. 9) writes that the “classical theory of criminology” proposes “that human behavior is directed toward the pursuit of pleasure and the avoidance of pain.” Behavior is a tool of the mind, behavior isn’t random, it is directed and motivated, it is instrumental. All behavior is at the service of the motive. To disagree with this is tantamount to proclaiming that humans are random, directionless machines. This Freudian “pleasure principle” that reduces all human behavior to a common denominator of protecting or advancing one’s well-being remains a logically indisputable but culturally unpopular proposition. Unpopular because of the seemingly hedonistic connotation of the word “pleasure.” The word “pleasure” has been narrowly construed to pertain to sensory pleasure as if to exclude such cognitive and affective pleasures as living in accordance with one’s principles or feeling good about belonging to a group of one’s choice. Therefore, as soon as we replace the word “pleasure” with such semantic siblings as “satisfaction,” “fulfillment,” or “well-being” the prudish reaction to the notion of pleasure as a motive begins to subside. Eventually, it becomes apparent that there is absolutely nothing immoral or unethical about wanting to advance one’s well-being (i.e. to pursue pleasure) or to wish to protect one’s well-being (i.e. to avoid pain). While certain means by which we pursue our well-being may be undoubtedly socially inappropriate, the underlying desire for well-being appears to be morally pristine and beyond judgment. Consequently, it seems accurate to say that since all behavior is motivated by a desire to advance and/or protect one’s well-being, all behavior – regardless of whether it is socially acceptable or not, - is predicated on socially acceptable motives. The pursuit of pleasure and the avoidance of pain are the only two motives that we have. There are no other motives but these two. The plethora of motives ranging from wanting an ice-cream to wanting to be on good terms with one’s higher power are but permutations of one and the same idea of wanting to achieve an enjoyable, meaningful state of mind. This isn’t a misplaced reductionistic hedonism, but a reality of inevitable homeostatic self-regulation.

To sum up, all motives (and there is really only one, that of self-regulation with pursuit of pleasure and avoidance of pain being but two sides of one and the same motive coin) are moral. To be able to appreciate this inevitable morality of the motive we have to exercise a motive-level of analysis when interpreting an event such as crime and not be distracted by the unacceptability of a given behavior that served as a means to an end. In evaluating a morality of a given crime, thus, it could be said that while the motive (like all motives) was socially acceptable or moral, the means by which the fulfillment of the motive was pursued was socially unacceptable or immoral (within the context of a particular culture).

Let’s take a classic “psychopath” that admits to enjoying the stimulation of a burglary. How in the world can such behavior be driven by a moral motive?! Let’s ask the perpetrator. Cromwell, Olson & Avary (1991, p. 63 – in Lykken) provide a useful example in their report from their study of active burglars: “the informants unanimously reported a “rush” upon entering the site. Some referred to the feeling as a ‘rush of adrenaline.’ All found the feeling very pleasurable. ‘I know that once I’m inside, everything I find is mine. I can have anything there. It’s like Christmas.’” What is the morality of the motives that underlie this behavior? While obviously socially unacceptable, these behaviors, at the foundation, are motivated by a desire to procure material wealth with minimum of effort expenditure (on the assumption that it is easier to take what one needs than to earn it) and by the promise of stimulation. Reduced to an even deeper level of analysis, these motives can be, as always, deconstructed to wanting to regulate one’s well-being by means of procuring material wealth with minimum of effort and by way of creating a situation of stimulation. Is it morally wrong to want to be comfortable or stimulated? Of course, not! Is the behavior chosen to fulfill this motive for well-being socially unacceptable? Of course, yes! A typical analysis of this situation would result in a moral judgment that the person that performed a burglary is a bad person, fundamentally immoral. An analysis that allows for a differentiation between the motive and the behavior would, however, allow one to conclude that while the behavior was obviously unacceptable, the underlying motive of wanting to preserve and/or enhance one’s well-being through assuring access to material wealth with least effort and through the stimulation of the “adrenaline rush” is morally no different than the motivation that drives most of the “normal” population to try to optimize their cost-to-benefit ratio in the work arena by asking for a raise and to take a yearly trip to Disney to try adrenaline-pumping “death drop” rides.

The fact that a person has committed a crime in order to obtain material wealth is, in essence, driven by the same socially sanctioned motives as a person who goes to work to obtain material wealth is rather straightforward and easy to acknowledge. The fact that a person who has committed a crime in order to feel powerful is driven by socially acceptable Adlerian strivings for superiority (that are akin to any upwardly mobile individual motivated by the narcissistic gains of social recognition and status) is also apparent but is a bit harder to acknowledge. Being able to see the fact that a person who has committed a crime that involves intentional, if not sadistic, element of violence is also motivated by socially acceptable goals is very hard to acknowledge. But let us try. Imagine you had a chance to explore the motivation behind a sadistic urge. What you are likely to hear, assuming that the perpetrators’ comments are frank, is that he or she was stimulated by the opportunity for violence or sadism, that is they wanted to break the law, to hurt someone, to see their victim suffer and plead for mercy. Morality, driven by indignation, and diagnosis, driven by dispositional attribution, would finalize our judgment right here: we would conclude that the person in front of us is motivated by violence and is thus inherently bad and immoral. But let us pursue with the inquiry. Why would inflicting pain onto another and witnessing them suffer motivate certain individuals? Maybe, there is a sense of satisfaction from displaced justice. Maybe, there is a stimulation of trespassing the final social boundary of bodily integrity of another. Maybe, there is an erotic arousal that accompanies the act. Maybe, there is a sense of ultimate power from the use of pain as an uncompromising leverage of manipulation. What this examination of the core motivation reveals is that the violent and/or sadistic behavior, as appalling as it may be, is designed to meet the same socially acceptable needs (for stimulation, pleasure and a sense of power and self-worth) as the rest of the human behavior. A sadist is not motivated by sadism per se but by the pleasure that it yields. A person that carries out a violent vendetta is not motivated by violence per se but by violence as a means of justice, in an attempt to remediate some actual or perceived wrongdoing by punishing the party involved or by symbolically displacing one’s pain onto an unsuspecting, innocent party. A person that rapes is motivated by a need for control or personal power. These needs/motives for pleasure, justice, control and self-worth are the very needs that keep most of the humanity going. The un-sophistication of the means chosen to meet these needs, to fulfill these motives, is proportionate to the sophistication and limitations of the individuals that commit these acts. If, however, as diagnosticians and students of behavior, we make a mistake of thinking that the sadist is motivated by sadism, the satisfaction of such a need naturally becomes largely unavailable outside the sphere of criminality. However, if an urge for sadism is deconstructed to the underlying motivational core of sensory pleasure, stimulation and power (that is established through relational dominance and downward social comparison), then, despite still being prognostically challenging, the case acquires a hope of a legitimate rehabilitation vector in the direction of finding alternative means to meeting one’s need.

The importance of discriminating between the social/moral acceptability of the behavior and the social/moral acceptability of the underlying motive can be usefully illustrated by the findings of the literature on psychophysiology of antisocial personality disorder that suggests that “antisocials,” at a baseline, are “underaroused and needing a “fix” of sensory input to produce normal brain function” (Black, 1999, p. 115). But the very fact of this psycho-physiological deviance is not necessarily synonymous with behavioral or cultural deviance: while one underaroused individual might seek self-regulatory stimulation through the behavioral activation of criminality, another might find it through such socially sanctioned behavioral activation means as extreme sports or extreme professions. It is certainly understandable that from a superficial level of analysis, knowing that a person feels stimulated by the process of crime might suggest that for such a person crime is an end in and of itself. However, by exploring if the same person would perhaps equally appreciate another, more socially sanctioned opportunity for stimulation, might help a clinician differentiate between an otherwise socially normative end and the socially questionable means by which a given individual chose to satisfy it. Blair, Mitchell & Blair (2005) emphasize: “While we would argue that there is a biological basis to the antisocial behavior of the 5 percent of criminals who commit a disproportionate percentage of crimes (mostly individuals with psychopathy), we certainly would not argue that there is a biological basis to the antisocial behavior of most criminals” (p. 154). This recognition of the fact that the majority of antisocial behavior does not have a biological basis allows a correctional substance use treatment provider to appreciate that “individuals classified as presenting with conduct disorder or antisocial personality disorder are not a homogeneous group but rather a highly heterogeneous one” (Blair, Mitchell & Blair, 2005, p. 43) whose criminality might be instrumental in meeting a variety of otherwise normative psychological needs, spanning the entire hierarchy of needs, with crime serving as a means to satisfy one’s basic logistical needs of sustenance, security, belonging, stimulation and narcissistic strivings for accomplishment.

At the risk of over-summarizing, allow me to reiterate the key point of the rehabilitation-compatible operating model of human behavior. When stripped of situational specifics, all human behavior is motivated by a desire to self-regulate by avoiding pain and pursuing pleasure (in its various permutations). Consequently, all human behavior, including crime (that is anti-social only in its means not goals), rests on a moral foundation which, if acknowledged, becomes also a foundation for rehabilitation. Crime is behavior. Robbing, hurting, deceiving, manipulating is behavior. All behavior is motivated. Therefore, crime, like all behavior, is instrumental and as it is in the service of a motive: a mind needs, desires, wants a particular state, and directs the machinery of the body to behave in a way that would yield a target state of mind. Seeing crime as self-regulatory, as a means to one and the same universal end of well-being, as opposed to being an end in and of itself, is essential for understanding rehabilitation opportunities. Such instrumental view of crime allows a rehabilitation clinician to see crime as but one of the many possible strategies for meeting one’s needs and, therefore, allows a clinician an opportunity for exploration of psychologically and physically healthier, legally safer and socially sanctioned alternatives to meeting one’s needs.

Principle 2: To Rehabilitate, Validate the Motive and Sublimate the Behavior

Somov and Somova (1993) proposed five dialectic principles of facilitating change one of which, the “Validate/Sublimate” principle, directly pertains to the scope of this article. This principle conveys a dialectic clinical stance that, on one hand, facilitates validation of one’s personality liabilities, and, on the other hand, facilitates sublimation of these personality liabilities into socially-acceptable assets.

Validation is a process of recognizing the rationality of the seemingly irrational, the internal logic of the seemingly erratic, the morality of the motive behind the unacceptability of the behavior. Sublimation, in its original Freudian sense, is an unconscious process of finding a socially acceptable outlet for socially unacceptable desires. Sublimation, as used in this context, is not an unconscious but a conscious process of choosing to match a socially acceptable motive with a socially acceptable behavior. Note the difference: whereas Freudian sublimation presupposes the immorality of the motive and the unconsciousness with which the person finds a socially acceptable outlet for a socially unacceptable urge, in this context, as stated previously, the rehabilitation involves validation of the morality of the underlying motive and an invitation to consciously select an instrumental behavioral pathway that results in a socially acceptable satisfaction of one’s needs.

Principle 3: Rehabilitative Triage – Sociopath First, Psychopath Second

The importance of Lykken’s distinction between psychopaths (antisocials with abnormal temperaments) and sociopaths (antisocials with normal temperaments but “who were badly socialized” (p. 21) is important in terms of how to apportion rehabilitative efforts: rehabilitation is a process of re-socialization, therefore, it makes sense to offer rehabilitation first to correctional clients whose criminality is more of a function of socialization than of temperament, i.e. to sociopaths rather than to psychopaths, in Lykken’s use of these terms. While review of legal history, type of crimes, social and institutional conduct, as well as use of personality assessment tools can certainly help differentiate between these two types of antisocials, my own clinical experience of directing a residential substance use program housed on the premises of a county jail demonstrated to me that by and large the correctional classification system, in and of itself, performs as a reliable screening protocol between sociopaths and psychopaths, with the latter usually screened out of the admission to chemically-focused rehabilitative programs on the basis of their high security status.

Principle 4: To Rehabilitate Criminality, Understand its Instrumentality

As we have previously established, all crime, as all behavior, is instrumental. To rehabilitate criminality, therefore, it appears important to clearly understand the motive behind the instrumentality of a given criminal act. The psychopathy and APD literature offers various taxonomies of personality organizations that underlie criminality. For example, Millon and Davis (Millon et al. 1998) offer ten subtypes of psychopathy (the Unprincipled, the Disingenuous, the Risk-taking, the Covetous, the Spineless, the Explosive, the Abrasive, the Malevolent, the Tyrannical, the Malignant). Lykken (1995), following a zoologically-inspired, Linnaean scheme for classification, first subdivides all criminals (“the Order Criminalogia”) into three families of Normal Offenders, Psychotic Offenders and Antisocial Personalities. Lykken (1998) further breaks down the family of Normal Offenders into the Innocent, the Victim of Circumstance, the Career Criminal and the White-Collar Criminal. He breaks down the family of Antisocial Personalities into the three main “genera” of Sociopathic Personality, Psychopathic Personality and Character Neurosis. He further distills these three genera into various species and variants. For example, Lykken breaks down the Sociopathic Personality into the four species of Common Sociopath, Alienated Sociopath, Aggressive Sociopath and Dyssocial Sociopath, with further variant sub-levels (e.g. Alienated Sociopath: Disaffiliated type, Disempathic type, Hostile type, Cheated type).

While undoubtedly clinically informative and conceptually rich, these taxonomies, with their tremendous complexity, are arguably cumbersome for the purposes of rehabilitation. Furthermore, these taxonomies are mostly predicated on the analysis of traits or behavior patterns rather than on the motives behind the behavior. As noted above, the approach of the present rehabilitation-compatible model of criminality has to do with validating the socially acceptable motive behind criminal behavior and rehabilitating the behavior. Consequently, the current approach aims to rehabilitate the behavior, not the motive, let alone a personality trait. To this end, a rehabilitation clinician would do well to be guided by a taxonomy of motive rather than by a taxonomy of behavior in order to be able to offer a criminal behavioral alternatives that are motive-specifics. Maslow’s (1962) hierarchy of basic (deficiency) and meta (growth) needs, if rephrased, is a hierarchy of motives. Maslow’s “basic” needs represent physiological drives (hunger, thirst, sex), safety needs, a need for belongingness/social acceptance/love, and esteem needs. These “basic” needs serve as a reasonable way to conceptually organizes criminal behavior by motive. With motives in mind, allow me to offer the following taxonomy of crime: Profit crime, Socialization crime, Stimulation crime, and Ego crime.

Profit crime is crime that is motivated by a desire to obtain material and financial means necessary to satisfy one’s physiological and logistical needs. A substance user boosting your lawnmower is not motivated by the ownership of this gardening equipment per se but by its resale value which, in turn, allows him or her to procure a substance in question to get high or to get well by relieving his or her withdrawal symptoms. Profit crime can be initially ego-dystonic, i.e. distressing to one’s ego. This has to do with the fact that a profit-oriented criminal is not motivated by the process of crime per se but by the material dividends of a given criminal act. Such individuals might initially experience anxiety, fear and pangs of conscience before, during and after the crime. While initially ego-dystonic such crime may with time become a psychological “non-issue,” as the person habituates to the associated emotional distress and/or learns to cope with it, frequently by means of substance use.

Socialization crime is crime motivated by a need for belonging and acceptance, by a desire for identity that is achieved through obtaining a membership in a group and through conformity to the normative behaviors of a given sub-group. A gang member that shoots his or her first victim in a drive-by is not motivated by aggression but by a desire to successfully complete an initiation protocol that allows an entrance into an inner circle of acceptance. Socialization crime is crime that is committed out of peer-pressure, a kind of antisocial inverse of group therapy with its vicarious recapitulation of family of origin dynamics, towards the goal of feeling normalized and accepted. Consequently, a drive-by shooting with its built-in randomness of victim selection or any other peer-pressured crime, is fundamentally impersonal to a prospective victim, and therefore, it is not a form of aggression (aggression is a response to an actual or a perceived threat and is, by definition, personal) but criminality instrumental in satisfaction of the underlying socially acceptable need for social acceptance. Socialization crime can be also construed as being motivated by the considerations of safety. Whether it is in the prison court yard or in an ethnically diverse neighborhood, the vulnerability of difference seeks safety in numbers. Consequently, in understanding peer-pressured crime by members of a given sub-culture it is important to appreciate that regardless of the motives behind a given crime, the original, historical motive in joining a particular criminal sub-cultures might have been as simple and as socially acceptable as a need for safety.

While it is relatively easy to see the instrumental nature of Profit crime and Socialization crime, seeing the instrumentality of Stimulation crime and Ego crime might be less straightforward. Stimulation crime is a socially unsanctioned means to satisfying a morally legitimate psycho-physiological need for stimulation and arousal. In examining Stimulation crime it is easy to mistake it for a crime that is performed for its own sake, for an end in its own right. And, indeed, a person committing such stimulation crime as a joy-ride (in which a person steals a car, baits the police for a speedy chase, and then, having pushed the limits, attempts a get-away) is ostensibly stimulated by the crime and thus appears to have engaged in the crime for its own sake. At a closer level of inspection, however, a clinician or a diagnostician is able to appreciate the object of the joy-ride is not the car but the stimulation of the experience of being chased. Similarly, a person with a knife in his pocket, bumping into random pedestrians in the hope of being provoked, is ostensibly motivated by an opportunity for violence. Again, at a closer level of inspection a clinician might be able to differentiate between the subtle but important distinction between being stimulated by the violence per se (with its unique opportunity for expression of sadistic urges), and being stimulated by the arousal associated with being in a situation of conflict and/or by the stimulation of breaking the norm of non-violence. The literature on the psychophysiology of antisocial personality disorder suggests that antisocials, at a baseline, are “underaroused and needing a “fix” of sensory input to produce normal brain function” (Black, 1999, p. 115). In educating clients about stimulation crime and its alternatives, facilitators are thus encouraged to be clear on the fact that psycho-physiological deviance is not necessarily synonymous with behavioral or cultural deviance: while one underaroused individual might seek self-regulatory stimulation through crime, another one might find it through such socially sanctioned means as extreme sports or extreme professions. With this distinction in mind, stimulation crime only seems to be an end in its own right, but, like profit or socialization crime is a form of socially unsanctioned instrumental behavior that is motivated by a need for a psycho-physiological need for arousal which, in and of itself, is a socially sanctioned, inherently natural motive the satisfaction of which does not have to be limited to the stimulation available through criminal acts.

Ego crime is committed in order to assuage one’s sense of inferiority, to defend one against his or her insecurities, and to allow one to feel superior over others. Ego crime satisfies what Maslow would term as esteem needs (1962). Maslow (197) differentiated between two types of esteem needs: competence-based esteem needs (that allow a person to feel competent, independent, self-sufficient, accomplished) and evaluation-based esteem needs (that allow one to feel valuable by being valued through achieved of status, interpersonal dominance, fame or notoriety). Ego crime can be understood both in terms of its instrumentality in helping one feel skillful, competent and accomplished as well as in terms of presenting an opportunity for downward social comparisons. A successful safe cracker, instead of going legit and retiring, might attempt another heist only as a confirmation of his criminal genius. An unsuccessful actor might try to overcompensate for his insecurities by becoming a con artist both as a way of capitalizing on a skill set that he might consider an unrecognized talent and also as a way of regulating his ego needs by taking advantage of his socially successful victims. An inmate who commits a petty crime to get over on a correctional officer might be motivated by an opportunity to impress his peers and gain status on the cellblock. Whether we like it or not, ego or esteem is a relational estimation, a value that is a function of interpersonal contrast. Ego or esteem, like all value, is relative and is established in comparison. Ego, by definition, is self-serving, therefore, all esteem or ego needs (both of first and second order per Maslow’s dichotomy) are accomplished through the zero-sum juxtapositions and are, therefore, antisocial in theirs inevitably pro-self dynamics. A clinician who is able to frankly acknowledge the narcissistic gains of his behavior-modifying and thus other-manipulating clinical mandate establishes a humbling common denominator with the offender. In my clinical experience, Ego crime is one of the more rehabilitatable types of crime as evidenced by the fact that many a para-clinician in the correctional and chemical rehabilitation settings are reformed narcissists who had learned that they can get satisfy their esteem/ego needs through socially acceptable narcissism. The recognition of the fact that a good bit of crime is driven by a socially sanctioned need to boost one’s ego allows for a clinically invaluable opportunity for sublimation: given an alternative of boosting one’s ego through such socially sanctioned means as being a model person in recovery or enjoying the administrative/hierarchical superiority of, say, a convenience store manager, such a person might feel adequately satisfied.

In examining both Stimulation crime and Ego crime, it could be also said that these forms of criminal behavior are emotionally self-regulatory as they serve the purpose of behavioral activation with the goal of achieving a desired emotional state (of arousal and/or reassurance of one’s worth). Just like the reader might behaviorally activate his or her mood by going for a jog, someone else might choose to commit a crime in an attempt to behaviorally regulate their level of arousal and/or self-esteem. While such behavior appears predatory in nature, the reality is that many of these stimulation- and reassurance-seeking wolves are neurotic sheep in wolves’ clothing that often rely on a chemical “dress-up” in order to carry out a given self-regulating criminal act.

 

Crime as a Substance Use Lapse/Relapse Factor

While appreciating the “anatomy of the motive” is “the key to understanding and catching violent criminals” (Douglas and Olshaker, 1999), understanding the “anatomy of the motive” behind a substance user’s criminality is an important starting point to his or her correctional substance use rehabilitation. In this section we will examine how each of the four criminal motives can jeopardize one’s substance use recovery status and serve as a potential lapse/relapse factor. Additional details on the interplay between crime and substance use are available further below in the discussion of the “Crime and Recovery” group session details. It should be also noted that any of the four types of crime can be superimposed on each other and any given individual who relies on crime to meet his or her

psychological needs might be engaging in more than one type of crime.

 

Profit Crime as a Substance Use Lapse/Relapse Factor

Committing crimes as a means to achieving one’s financial goals, like any career, can be fraught with stress. By definition, crime as a career involves serious physical and legal risks that might trigger feelings of anxiety and fear as well as situationally-appropriate paranoid ideation (about getting “caught”) which a person might be compelled to self-medicate with drugs and/or alcohol. Like all competitive individuals that embark on projects with a “do-or-die” risk profile, criminals might be motivated to use stimulants to enhance their task performance to maximize the likelihood of their criminal success. Contrary to the oversimplifying stereotypes of inhuman nonchalance, some criminals might experience pangs of conscience, guilt, value conflicts, and cognitive dissonance that they might feel the need to palliate with drugs and alcohol. This would appear to be particularly likely for non-career criminals such as individuals who were substance users first and criminals second, and, thus, had not fully habituated to the stress from moral conflicts. Furthermore, living off crime naturally puts one in contact with a variety of social and environmental stimuli that might lead to substance use. In working with inmates seeking drug and alcohol counseling, I have frequently encountered relapsed drug dealers who thought that they could stay clean while dealing drugs. Such individuals would typically share that they had successfully performed the various “job” tasks of drug dealing under the radar of the law until they got back into using, got “sloppy,” and got caught. They would often explain that their relapse into substance use was ironically precipitated by their drug dealing success: as they grew their operations, they either grew more overwhelmed and would use drugs to cope or they would feel that they needed to be more aggressive and more on top of things and would begin to use drugs to calibrate the rigor of their performance to the caliber of their operations. Finally and not surprisingly, crime as a profession can be highly unstructured and unstable. Criminals might go through long dry spells of criminal “unemployment” and financial hardship resulting in depressive states requiring self-medication. Successful completion of crimes, on the other hand, might be accompanied by celebrations that prototypically involve substance use. With these potential substance use triggers in mind, it could be asserted that in the business of crime, substance use is a hardly avoidable professional hazard. Consequently, a correctional substance use client in recovery who chooses to continue with profit crime is likely to eventually jeopardize recovery gains.

 

Socialization Crime as a Substance Use Lapse/Relapse Factor

Individuals motivated by peer acceptance and a sense of belonging, who seek membership in delinquent subcultures, are by definition subject to peer pressure and pressures of conformity and are not exactly in a position to choose and select which of the antisocial norms of a given subculture they will abide by and which of these norms they will ignore. Some of the focal points of the delinquent subculture are on breaking laws, on being tough, on being a good “con,” and on excitement. Continuing with membership in a gang, being back in the “hood” or back to “running” with one’s “crew” poses a formidable challenge for a post-release/post-rehab criminal who is trying to stay “clean” (from drugs) while also trying to stay true to his adopted criminal identity. And, indeed, consider the difficulty of dealing with peer expectations of courage, concentration, physical and emotional endurance necessary to fit in with a given subculture and meeting these stressful expectations without the option of chemical self-regulation. It goes without saying that such criminal socialization naturally involves continuous exposure to drug and alcohol related stimuli both through fellow group members’ substance use behavior and group’s “business” which might be in one way or another related to drug trade. Consequently, a correctional substance use client in recovery who intends to continue meet his or her needs for acceptance through criminal socialization stands a good chance of jeopardizing his or her substance use recovery.

 

Stimulation Crime as a Substance Use Lapse/Relapse Factor

Stimulation crime, crime for “kicks,” as would be in the case of joy-riding or hanging dangerously off an overpass “tagging” it with graffiti, might require some preliminary “amping up” to work up enough courage and confidence to overcome any possible anticipatory anxiety prior to engaging in the act of criminal risk-taking. Following the burst of stimulation, the person might feel over-stimulated and might need to calm down by drinking or drugging. Additionally, to the extent to which a given criminal act might produce any ego-dystonic effects of guilt, cognitive dissonance, or value conflict, the person might be further compelled to self-medicate with drugs and/or alcohol. Dave Grossman (1995) in his book “On Killing” writes about the “killing response stages” in the context of military combat that would seem potentially generalizable to understanding the phenomenology of “urban combat” and stimulation crimes that involve violence as a vehicle for thrill and excitement. The “exhilaration” stage, with its release of adrenaline, can result in “combat addiction” (Grossman, 1995). Grossman quotes Jack Thompson’s description of the combat high: “This combat high is like getting an injection of morphine – you float around, laughing, joking, having a great time, totally oblivious to the dangers around you” (Grossman, 1995, p. 234). According to Grossman, the “exhilaration” stage is followed by the “remorse” stage. It is during this ego-dystonic “remorse” phase of negative affectivity that an individual might attempt to self-medicate. While Grossman, of course, writes about veterans, not criminals, the phenomenology of this progression is useful to understanding the process of stimulation crime. In considering this progression from exhilaration to remorse in the context of stimulation crime, it could be extrapolated that stimulation crime threatens recovery both in terms of reminding a person in recovery of the intense highs and thus possibly kindling the appetite for more such experiences (through crime or drug use) and in terms of the need to medicate the physiological and possibly moral “crash” after the stimulation crime high. Finally, as with all crime, stimulation crime potentially exposes an individual to substance use stimuli that might trigger cravings for use and lead to a lapse or a relapse.

 

Ego Crime as a Substance Use Lapse/Relapse Factor

Motivated by the need to inflate one’s ego, ego crime is ironically fraught with potential wounds to one’s ego. Just like in socially sanctioned pursuits of productivity, making one’s sense of worth contingent on attainment of goals and various markers of success sets up a paradigm of conditioned self-view that is vulnerable to failure. Unsuccessful crimes, arrests, incarcerations can thus be viewed as wounds to narcissistic criminal’s ego and might precipitate lapse and relapse into substance use. Furthermore, a narcissistic criminal, as any narcissist, by definition, lives through reflection and might be thus more likely to flash one’s criminal successes. This might involve celebrations of one’s criminal success through conspicuous consumption and criminal socialization as an arena for flaunting one’s success, which naturally exposes a narcissistic criminal who is in substance use recovery to substance use related stimuli and triggers. Such self-aggrandizing public displays might also more easily render a narcissistic criminal to capture by law enforcement more readily, which, in its turn, can once again precipitate lapse and relapse into substance use.

In distinguishing the psychological motives of crime, it is important to remember that a given criminal act may consist of multiple motives. The following statement by Debra Benveniste (Maniacci, 2006), a clinician analyzing a case of Frank, with antisocial personality disorder, illustrates the multi-faceted motivational complexity behind crime: “Breaking the law is an effective means with which to discharge rage and to “get high.” And getting away with it reinforces a feeling of accomplishment,” (p. 28). In this case, at least three psychological motives for committing crime come into play: a self-regulatory displacement motive, a motive to regulate one’s baseline experience through stimulation, and a narcissistic motive for a sense of accomplishment. In helping correctional substance use clients make sense of their motives behind crime it is useful not to view the above presented categories as mutually exclusive, stand-alone types of crime but, instead, view instrumental crime as multiply-determined and possibly satisfying multiple psychological needs simultaneously.

 

“Crime and Recovery” Substance Use Relapse Prevention Group

Purpose of the “Crime and Recovery” Group

The “Crime and Recovery” group protocol is a substance use relapse prevention intervention designed to address crime as a relapse factor for a correctional substance use client. The group protocol is constructed in accordance with the aforementioned principles of rehabilitation-compatible model of criminality. More specifically, the purpose of “Crime and Recovery” Group is: a) to educate correctional substance use clients about the psychological interplay between crime and substance use, to help correctional substance use clients appreciate the fact that crime involvement is a substance use lapse and relapse factor, and b) to assist correctional substance use clients in developing alternatives for meeting their psychological needs through non-criminogenic, socially-sanctioned means. When “Crime and Recovery” Group is used in the context of a structured substance use rehabilitation curriculum it is recommended that it is offered after clients have been exposed to leisure training or training in “natural highs” (Somov and Somova, 2003).

Target Population

The “Crime and Recovery” treatment module is guided by the operating assumption that most of the correctional substance use clients are not true psychopaths in Lykken’s use of the term, but sociopaths whose criminality is less a function of temperament but of instrumentality and socialization and is, thus, subject to rehabilitative re-socialization. This operating assumption has to do with the fact that many correctional substance use treatment programs assess candidates for admission and attempt to screen out highly temperamental psychopathic individuals through clinical interview, review of histories and/or such actuarial instruments as the Hare-Psychopathy Checklist-Revised (PCL-R; Hare, 1991). Scott & Gerbasi (2005) in their “Handbook of Correctional Mental Health” note that highly psychopathic individuals, with histories of “planned, deliberate, predatory, and sadistic” behavior are “generally considered poorly responsive to treatment” (p. 116). Moreover, such temperamental psychopathic individuals, even if failed to be screened out by the admission process, are likely to violate program rules upon admission and be prematurely discharged for disciplinary reasons. Golden & Sims (Sims, 2005) in reporting on predictors of success and failure in correctional substance use programs, confirm that deficits in “social conformity, or the ability to interact with others absent conflict” as well as other antisocial characteristics contribute to failure rates of typically group-based correctional substance use programs (p. 31).

“Crime and Recovery” Group Format

“Crime and Recovery” Group is a psycho-educational group-based prevention modality with minimal expectations of participants’ self-disclosure. The potentially self-incriminating nature of the clinical content in question demands therapeutic discretion and tact. As part of the role induction to the group, group facilitators should openly acknowledge this and give clients an explicit permission to remain silent so as to not jeopardize their legal standing in any fashion. In order to preserve some balance between discretion and discussion, facilitators are encouraged to pose questions in a way that allows clients to express opinions in general as opposed to discussing personal specifics. For example, instead of making a blunt inquiry “How do you feel when you steal?,” facilitator might invite clients to ponder out loud: “Let us think about how one might feel when he or she commits a crime such as theft? What might be some possible emotional reactions?” Group members, who are interested in a more customized opportunity to examine the issues at hand, are encouraged to discuss the insights and revelations from the group in the context of individual therapy, if that is available to them, or, at least, on their own in order to make necessary attitudinal and behavioral adjustments to protect their substance use recovery. The “Crime and Recovery” Group is designed as a brief group intervention, its brevity being both a function of relatively straight-forward psycho-educational content and because of its minimal reliance on interaction and process.

“Crime and Recovery” Session Agenda

Session 1: Role Induction

Review of the interplay between substance use and crime

Session 2: Crime as a means to an end

Four types of motives behind the behavior of crime

Session 3: Interplay between crime and substance use

Types of interplay

Session 4: Profit crime as a substance use relapse factor

Alternatives to profit crime

Session 5: Stimulation crime as a substance use relapse factor

Alternatives to stimulation crime

Session 6: Ego crime as a substance use relapse factor

Alternatives to ego crime

Session 7: Social crime as a substance use relapse factor

Alternatives to social crime

Session 8: Summary: the vicious cycle of crime and substance use

Treatment Compliance Challenge

 

“Crime and Recovery” Session Details

Session 1 Details: Role Induction/Review of the interplay between substance use and crime

Facilitators begin by providing role induction to the scope and format of the group. Facilitators may hand out a typed up session agenda for the sessions, discuss the logistics of the meetings, session duration and the anticipated number of sessions. When conducting the group in the context of a correctional therapeutic community, particularly, with clients that had not been yet sentenced, the facilitators clearly discuss the potential for self-incrimination associated with self-disclosure. At the same time the facilitators offer ideas about how to participate in the group through expression of opinions rather than through potentially self-incriminating self-disclosure.

Following the role induction, the facilitators invite clients to review the interplay between substance use and crime. The discussion of substance use as a lapse/relapse factor for crime is likely to be a familiar, face-valid and normalizing starting point for correctional substance use clients. As the group leads the participants down this well traveled conceptual path that is likely to have been primed by previous rehabilitation efforts, the group participants benefit from both reinforcing and further clarifying their realizations about the interplay between substance use and crime. In particular, the facilitators engage clients with reviewing various connections between substance use and crime. The facilitators may ask clients: “Why is crime often inevitable if one is a habitual user?” Without much difficulty clients arrive at such realizations that substance use makes it difficult to maintain a job (due to absenteeism, loss in productivity, etc.). Furthermore, clients are helped to see that even if a person could maintain a job, income from a job is often insufficient to provide financial resources necessary to buy drugs on a regular basis. As a person’s tolerance and substance use consumption increases, so does the drug-purchasing budget. Financially, substance use can become a runaway train. Therefore, it is not unusual for substance users to begin to deal in drugs on a small scale in order to support their own habit and/or to resort to other forms of crime. To further illustrate this point, facilitators might invite clients to calculate their substance using budget to argue for the “economic necessity” for crime as a way to meet ever-growing substance use related expenses.

To summarize, the three main connections between substance use and crime are: a) using an illegal substance leads to various legal risks associated with purchase and possession of an illegal substance, b) regular and escalating substance use may be accompanied by an eventual reliance on crime as a means of financial support of one’s substance use, and c) substance use may lead to loss of behavioral inhibition and impairment of judgment that may result in illegal behavior.

 

Session 2 Details: Crime as a means to an end/Four types of motives behind the behavior of crime

While the initial discussion of the interplay between substance use and crime is all too familiar to correctional substance use clients who had been through the rotating door of drug courts and half-way houses, the connection between crime and substance use might be less immediately obvious. Session 2, while presenting a conceptual framework for the intervention, attempts to follow a Socratic format as much as possible. The arc of the session is to prompt clients to ponder why people commit crimes in the first place and to offer the thesis that crime, while a form of socially unacceptable behavior, is motivated by socially acceptable and rather universal motives (of avoidance of pain/distress/hardship and pursuit of well-being).

Following the brainstorming of motives behind crime, the facilitators organize these motives into the four categories of profit, socialization, stimulation, and ego. It is likely that this brainstorming will also produce a “trait” category that will consist of various dispositional explanations for crime. Inmate/correctional substance use clients, in pondering the motives behind crime, are too subject to the fundamental attribution error and, despite an opportunity for contextual attribution style that would be more self-serving given their own circumstance, are likely to explain criminal behavior in terms of criminal traits, i.e. to postulate psychopathy in the sense of “moral insanity,” as a kind of natural-born, predatorial propensity for violence. The challenge of the facilitator is to help clients see that all crime is a means to an end, that all crime, as a form of behavior, is instrumental, that all crime, like all behavior, is, at the deepest level of motivational analysis, driven by socially acceptable motives, and to help client see that, in terms of the morality of the underlying motivation, there is no difference between profit crime (that is ostensibly a means to an end) and, say, stimulation crime (that may appear as an end in its own right, but really isn’t).

On a technical note, the facilitators are encouraged to organize clients’ responses into five categories on the blackboard as clients verbalizes their responses. The first four columns or groups of answers will be subsequently labeled in terms of the four “well-being” motives (i.e. profit, socialization, ego and stimulation). The last column that features the “psychopathy” type responses will be later “arrowed” – idea by idea – back into the first four columns and ceremoniously erased signifying the “death of the myth of inherent (moral) badness.”

In helping clients differentiate between seemingly non-instrumental forms of crime as stimulation and ego crimes and the more obviously instrumental forms of crime (profit and socialization motivated crimes), the facilitators are encouraged to use the “litmus tests” of the “original motive” and the “alternative means.” For example, facilitator presents or elicits an example of stimulation or ego crime and inquires about the original motive behind a given crime (to establish that original motive, in one form or another, represents an attempt to pursue one’s well-being) as well as about whether, given an adequate “alternative means” of satisfying the “original motive,” the crime would have necessarily occurred. The facilitator does not propagandize per se: the answers are suggested, not endorsed.

By examining crime from the standpoint of motives, not means to these motives, the facilitators are making a powerful humanistic point: many criminals (with the exception of psychotics and under-stimulated, hard-to-condition psychopaths, in Lykken’s use of that term ) are arguably normal people with normal motives but with abnormal (physically unsafe, psychologically unhealthy, and illegal) means to achieving their otherwise socially sanctioned needs. Facilitators drive this point further by making such reassuring, validating, normalizing statements as “There is nothing wrong about wanting to make a good living. There is nothing wrong about wanting to feel excited, stimulated or thrilled. There is nothing wrong about wanting to feel important and good about oneself.” The ultimate punch-line of this discussion is that there are no criminal (i.e. morally unacceptable) motives/needs, just criminal (i.e. morally unacceptable) means/behaviors.

Facilitators may also use an element of minimal processing of feelings at the end of the discussion by asking clients about how this taxonomy affects them. Facilitators may encounter self-disclosures about feeling encouraged by a sense of relief from having a more humanistic perspective on one’s behavior (in terms of motives, not necessarily in terms of means of achieving those motives) as well a degree of curiosity and hopefulness about the prospect of learning about alternative, legally safer means of meeting one’s goals. In conducting this type of discussion, facilitators should be also prepared to encounter overt resistance to the proposed perspective and a covert identification with the topic which may or may not “leak out” into the discussion: expressions of guilt and remorse, depending on the specifics of the legal setting of a given correctional program, may serve as one of client’s legal resources in terms of influencing the legal process (since any public self-forgiveness on inmate’s behalf might trigger judgment and loss of sympathy from correctional and programmatic staff who can be reasonably expected to subscribe to a judgmental dispositional attribution style and may not like to hear correctional substance use clients speak of their “good intentions”). Harsh self-judgment is a powerful way to disarm others’ judgment and correctional substance use clients, while probably identifying with the content of the session, are not likely to publicize their self-forgiveness.

In conclusion of this section, I would like to pre-empt a possible sentiment from a reader that the approach described here is coddling and “soft” on the offender. The process of rehabilitation connotes that there is something of value in a person worth rehabilitating. Validating normal human motives while remaining clearly and unambiguously disapproving of the behavior of crime as a means to otherwise normal ends infuses a motivationally invaluable humanistic perspective into the often silently judgmental process of correctional and chemical rehabilitation.

 

Session 3 Details: Interplay between crime and substance use/Types of interplay

Having reviewed the motives behind crime and having organized crime into four subtypes that correspond to four motives (of profit, socialization, stimulation and ego), the facilitators lead clients into a discussion of the types of interplay between crime and substance use. The part and parcel of this session is to explore various ways in which crime can precipitate substance use and thus lapse and possibly relapse into substance abuse. As in previous session, the facilitators begin in a Socratic manner inviting clients to ponder how engaging in crime may necessitate alcohol and drug use. To stir clients’ thinking, the facilitators may offer a couple of hypothetical scenarios with questions designed to help clients hone in on the connection between crime and substance use. For example, the facilitator may offer the following situation: “Let’s say, you are out of the jail, you are out of the half-way house, you have not had any “dirty” urine in two years, you are finally off the paper, working a job… Something happened, you lost a job, maybe it is economy or something you did, now you are a bit strapped… a buddy of yours pays a visit, he’s got this idea, it’s a simple thing, really, but there is some physical risk involved, maybe even a minor confrontation, let alone it’s illegal and you are afraid to get caught again… but you decided to get on board with it… how do you think substance use comes into play here?” Or: “Let’s say that you are out of the rehab, you are done with drugs, but you are not done dealing drugs… You think to yourself: ‘I can do it, I did it before…’ After all, you are only slinging dope out of the back, it’s not even you drug of choice… What do you think is the potential here for substance use lapse and relapse?” One or two such vignettes are likely to jump-start the thinking process and before too long clients are likely to produce a variety of different types of the interplay between crime and substance use. As clients contribute, the facilitators begin to organize the ways in which crime may serve as a factor in substance use relapse. The following are several such ideas to be preferably written down on a blackboard or to be made available to clients in the form of a hand-out.

Crime can precipitate a substance use lapse/relapse by means of exposure to substance use related stimuli (in the course of crime per se or criminal associations, individuals are likely to be exposed to “people, places, and things” associated with substance use). It is important that correctional substance use counselors as well as correctional substance use clients do not underestimate the fact that “cues that trigger crime and drug use (friends, feelings, and situations) are often related if not identical” (Walters in Maniacci, 2006, p. 105). The psychological and physical demands of crime may require of an individual a degree of stimulation, concentration and confidence that may prompt an individual to use legal and illegal substance as a means to enhancing one’s task performance. The process of crime with its imbedded danger of physical and emotional harm to the person committing it as well as the anxiety about being caught may prompt an individual to self-medicate through alcohol and/or drug use. Facilitators may offer the following classic vignette from Maultsby (1978, p. 34), to illustrate self-medication relapse risk: “Bob’s frequent changes in jobs kept him chronically short of money. Like most people, he knew that stealing can be a quick, easy way to get money. But, also like most people, Bob’s anxiety about going to jail kept him from stealing when he was sober. After he had had a few drinks, however, thoughts of stealing no longer triggered his anxiety about going to jail. Without this inhibiting anxiety, stealing seemed like a safe, easy way to get money; so Bob stole welfare checks; and for a while he got away with it.“

Furthermore, crime may lead to emotional trauma for the individual committing it that he or she, for all intents and purposes, might experience an emotional trauma akin to post-traumatic stress disorder and be prompted to chemically self-medicate any residual emotional effects. Similarly, crime may result in physical injuries to the person committing it and thus lead acute and/or chronic pain that a criminal in recovery may choose to self-medicate with substance use. Furthermore, unsuccessful crime may lead to depressive disappointment also prompting a person in recovery to consider substance use as a means of self-medication. Successful crime may prompt personal and collective celebrations that may prompt a lapse or relapse into substance use. Successful criminal lifestyle may be also accompanied by a lack of structure and an imbalance of productivity and leisure (in favor of the latter) that might result in boredom and lack of stimulation thus, in turn, precipitating a possible lapse or relapse into substance use. The stimulation and behavioral challenge of crime may linger after the commission of a given criminal act and, thus, prompt the individual to resort to alcohol and/or “downers” in order to self-regulate back to one’s emotional baseline. Crime may also create states of cognitive dissonance secondary to empathy for one’s victims or due to value conflicts: in such occasions, a criminal in recovery may resort to substance use to anesthetize the pangs of conscience, before or after the criminal event in question.

It should be noted that for a given individual that commits crime, substance use may function as a psychological Swiss Army knife, so to speak, as a complex coping tool that aids in emotional self-regulation, reduces any potential cognitive dissonance allowing for maximum operational apathy, indifference and nonchalance to proceed with the demands of a crime that violates others’ material and/or physical boundaries and, thus, serves the function of criminal performance enhancement. This is well illustrated in the following vignette by Maniacci (2006) that analyzes the case of Frank: “Frank is a bit of an excitement seeker; it (substance use – author’s annotation) gives him a sense of power and immortality that reinforces the fiction that he is top dog that makes him feel free. As it lowers his inhibitions, it allows him to try the (sometimes) dangerous things he is about to do. It is “liquid courage,” so to speak. Along much the same lines, it will dampen down his emotional responsiveness as well, once he overindulges. This dampening down of feelings after the initial euphoria may help him maintain his apathy, and hence control” (Maniacci, in Rotgers & Maniacci, 2006, p. 61).

Summarizing and abbreviating these various facets of interplay between crime and substance use requires forethought and planning from the facilitator. It is useful for facilitators to develop quick, semantic “short-cuts” to accessing these various elements of interplay for future discussions. The following terminology may be of help in this regard. A person in recovery who is considering commission of a crime or has committed a crime may resort to the use of alcohol and/or drugs:

a) as a form of criminal “performance enhancement;”

b) as a form of pre- and post-crime “self-medication”/chemical coping, as a form of emotional self-regulation;

c) as a form of “anesthetizing” one’s conscience, pre- and/or post-crime;

d) as a form of fitting in with partners in crime;

e) as a form of celebration of a successful crime;

f) as a form of dealing with lack of structure of criminal lifestyle;

g) as a form of exposure to substance use triggers as part of criminal lifestyle.

In later sessions, when the facilitator may ask clients to consider ways in which a given type of crime may precipitate of a substance use lapse or relapse, clients are expected to recognize various lapse/relapse factors secondary to crime and label them as, for example, “exposure risk,” or “performance enhancement,” or “self-medication,” or “celebration,” or “fitting in,” or “unstructured lifestyle.” To attain this degree of clarity, facilitators are encouraged to paraphrase and “condense” clients’ future responses to these established categories.

 

Session 4 Details: Profit crime as a substance use relapse factor/Alternatives to profit crime

Facilitators are encouraged by first helping clients see the obvious: if a given individual previously resorted to crime because he or she could not keep a job while using and to also obtain necessary material and financial means to be able to support the substance use habit with its ever-escalating budget, he or she, once in successful recovery, will no longer require to rely on crime as he or she a) will be able to keep a job (when in successful and sustained recovery), and b) will be likely able to obtain adequate discretionary income from a job to afford natural and legal highs.

Following this, facilitators help clients explore and clarify multiple ways in which crime as a “career” can precipitate a substance use lapse and/or relapse. Facilitators provide vignettes and/or elicit a discussion of specific ways in which living a life of crime, as an alternative to legal employment, may jeopardize one’s recovery status. Facilitators help clients appreciate profit crime as an “exposure” risk: a person in substance use recovery living a life of crime is likely to encounter substance use among his or her partners in crime and/or to encounter drugs as a point of criminal trade and barter. Facilitators help clients appreciate how profit crime with its unstructured lifestyle may present a “recreational” substance use risk for a criminal in substance use recovery in terms of boredom stemming from lack of structure. After all, the purpose of profit crime is to make life simple either by cutting corners and sparing oneself the trouble of due process or by accumulating money or goods with minimum expense of effort or time. Not surprisingly, successful life of crime, by definition, means excess of leisure time and excess of money. Clients are thus helped to analyze how successful profit crime with its sudden access to large sums of money (as opposed to a controlled and impersonal direct deposit financial management of a gainfully employed life) and its excess of leisure time can precipitate a substance use lapse or relapse. Facilitators further help clients appreciate profit crime as a “celebration” risk: a person in recovery who has performed a successful crime might be triggered to chemically celebrate his or her criminal success.

Facilitators also help clients examine how unsuccessful profit crime, by definition, incurs various negative emotional and legal consequences, and therefore, can too threaten recovery. Facilitators thus help clients appreciate profit crime as a “self-medication” risk: a person in substance use recovery might be triggered to cope chemically with anticipatory anxiety prior to committing a crime, with the stress of crime process itself, and with various post-crime psychological and physical symptoms (of depression if crime is unsuccessful, or of PTSD-like symptomatology if crime resulted in a degree of emotional trauma, or of pain if crime resulted in physical injury of acute or possibly chronic nature). On a related note, facilitators help clients appreciate profit crime as a “performance enhancement” risk: a person in recovery contemplating a complex and possibly physically and cognitively challenging crime might resort to substance use as a way of enhancing his or her performance during the crime itself. While some inmate clients might admit to themselves that quitting substance use means quitting crime (as they might not be able to exert adequate emotional self-regulation non-chemically in order to perform certain kinds of criminal challenges), others might overestimate their ability to return to crime without the “self-medicating” and “performing-enhancing” function of substance use and thus face the risk of a substance use lapse or relapse.

Following this, facilitators help summarize that profit crime as a career is a challenging choice, not unlike the choice of working as a bartender for a person in alcohol recovery who defines his or her recovery in terms of complete abstinence. Is it possible to be a successful criminal and remain in substance use recovery? Yes. Everything is possible. Is it likely? That is a question for correctional substance use clients to entertain themselves. Facilitators are encouraged to offer their own opinion on the matter, based on their clinical experience.

In summarizing ways in which profit crime, crime as a “career,” may jeopardize one’s recovery status, facilitators make a case for vocational counseling as lapse/relapse prevention measure. A correctional substance use client, when offered vocational counseling, may see it as an offer to reform. This proposal of reformation of self may trigger covert or overt resistance. Pitching vocational counseling as a substance use lapse/relapse prevention measure, however, may result in a better “buy-in” from a correctional substance use client as he or she had presumably already accepted the goal of substance use recovery: with this in mind, vocational counseling is no longer seen as a measure of reformation (of self) but as a measure of (substance use) rehabilitation.

 

Session 5 Details: Stimulation crime as a substance use relapse factor/Alternatives to stimulation crime

 

While the alternative to profit crime can be best explored through vocational counseling, alternatives to stimulation crime can be presented in the context of occupational counseling that may take the form of leisure training or “Natural Highs” training (Somov and Somova, 2003).

Facilitators are first encouraged to normalize a human desire for stimulation: they unequivocally validate the desire for sensory stimulation, and the thrill of risk-taking also known as “joy of fear.” Facilitators may also broaden the meaning of “stimulation” from a thrill accompanied with a somatic arousal to an overall “basic human need to vary normal experience” (Weil, p. 170, 1983), which can be accomplished chemically (through alcohol and/or drug use) or behaviorally through legal and illegal means, such as extreme sports or crime, respectively. Following this acknowledgement, facilitators invite clients to explore the pros and cons of crime as a means to stimulation. In discussing the “cons” of crime as a means to stimulation, facilitators focus on the “cons” that present a substance lapse/relapse risk to a person in recovery who is trying to meet his or her needs for stimulation through crime. This discussion follows the template of lapse/relapse risk discussion described in the section above.

Finally, facilitators encourage clients to explore non-criminogenic, socially, legally, physically, and psychologically healthier ways to obtain the legitimate feeling of stimulation. These can be briefly introduced both in terms of the behavioral stimulation alternatives and, in the spirit of harm reduction, legal chemical “mind-alterants” ranging from coffee to kava (Mayell, 1998, p. 3). It should be noted that specific education of clients about “natural highs” is outside the scope of “Crime and Recovery” group protocol. Occupational counseling is a stand-alone treatment modality that may take the form of individual counseling and/or follow a group format similar to “Natural Highs” group (Somov and Somova, 2003). As in the case of profit crime and vocational counseling, the discussion of occupational counseling as an alternative to use of crime for stimulation introduces a lapse/relapse prevention rationale for occupational counseling that can help leverage clients’ motivation for taking advantage of occupational counseling as a supplemental substance use treatment modality.

 

Session 6 Details: Ego crime as a substance use relapse factor/Alternatives to narcissistic crime

 

While the alternative to profit crime can be explored through vocational counseling and the alternative to stimulation crime can be explored through occupational counseling, the alternative to ego crime is best explored through psychological counseling. As with prior sessions, the session on ego crime begins with the review of what is meant by this type of crime. Facilitators review use of crime as a means to feeling superior, powerful, in control, reassured of one’s sense of worth, and normalize and validate the legitimacy of one’s need to feel positively about oneself. Following this, facilitators discuss how these misdirected strivings for superiority may be grounded in family-of-origin context, in criminal socialization, in personal histories of ego-wounds and familial and environmental interactions that resulted in chronic sense of worthlessness, sense of inferiority, and deficits of self-esteem and ego-strength. Facilitators try to present a compassionate and validating view of one’s choice of crime as a desperate short-cut to self-esteem, as a pattern of compensating ego-boosting behavior. The idea here is not to endorse criminality or to provide excuses for clients’ actions but to assist clients to begin to develop a coherent explanation and an understanding of their life path. Facilitators must be clear, for clients’ and their own sake, that explanation is not an excuse.

Facilitators are further encouraged to be attuned to the fact that some of the correctional substance use clients they are working with may have “high self-efficacy for crime but low self-efficacy for prosocial behaviors” (Walters in Maniacci, 2006, p. 99). The clinical utility of this realization is in harnessing clients’ motivation for change through validation of their hesitation to consider alternatives. This can be accomplished by showing understanding that for some correctional substance use clients crime is nothing less than a point of pride, perhaps, the only source of ego strength in their lives, and that the discussion of the alternatives for meeting one’s narcissistic needs for accomplishment might be as complex, anxiety-provoking, and stressful as a discussion of changing professions for anyone who has found a sense of accomplishment and familiarity in what they do. Therefore, in preparing to discuss the alternatives, it is important that the facilitators do not trivialize, minimize or invalidate the challenge that their clients face: quitting crime, just like quitting substance use, is anything but easy as evidenced by recidivism statistics.

Following this, facilitators engage clients in a discussion of pros and cons of using crime to satisfy one’s search for self-worth. Once again, the emphasis here is on the “cons” of ego crime that can jeopardize one’s recovery status. In particular, facilitators help illuminate that unsuccessful ego crime, with its resultant threat of arrest and incarceration, may prompt a substance use lapse or relapse as it threatens an already wounded ego. Facilitators may examine how even the successful ego crime may be accompanied by anxiety and apprehension about getting caught which is particularly magnified by one’s desire to display one’s criminal success through conspicuous consumption, and thus result in the “self-medication” risk. Furthermore, the narcissistically motivated conspicuous consumption is likely to jeopardize one’s recovery status by presenting an “exposure” risk (a risk of unnecessary exposure to substance use related “people, places, and things”).

Following the discussion of substance use lapse/relapse risks posed by ego crime, facilitators briefly introduce a range of psychologically and physically healthier and legally safer alternatives to ameliorating one’s sense of worth. These self-esteem repair strategies can be grouped roughly into the following four categories:

Self-esteem repair through Achievement: facilitators discuss the use of vocations and avocations as a source of self-efficacy, skill mastery, sense of competence, and sense of accomplishment.

Self-esteem repair through Counseling/Psychotherapy: facilitators introduce professional psychological treatment as a means to addressing possibly long-standing underlying issues of inferiority and low self-appraisal and address any myths or misconceptions about counseling or psychotherapy that inmate clients might verbalize.

Self-esteem repair through Sublimation: Black (1999) writes about “successful bad boys” (p. 152): “Antisocials are not just muggers, rapists, and violent assailants. They sometimes are embezzlers, tax evaders, fraudulent businessmen, corrupt stock brokers, and conniving attorneys.” Sublimation is not the process of transforming street crime into white-collar crime but a process of re-channeling one’s otherwise inappropriate strivings into a socially sanctioned outlet. Black (1999, p. 153) further writes: “antisocial behavior is valued to a degree in certain contexts, and a few professions offer opportunities for antisocials to succeed by expressing tendencies that would be discouraged elsewhere.” Black offers examples: “military service offers antisocials a chance to put their violent streaks at work,” (p. 153), or “in sports, music, movies, and other forms of entertainment, a clear market for professional bad boys exists” (p. 154). Numerous other, more run-off-the-mill opportunities also exist as in the case of repairing one’s self-esteem through benign control and manipulation of others, by way of managerial level of employment or politics. Facilitators are thus encouraged to point out these possibilities for sublimation and encourage clients to consider individual psychotherapy to help them explore their cognitive barriers to self-efficacy about prosocial behaviors (Walters, in Maniacci, 2006).

Self-esteem repair through Affiliation: facilitators briefly mention affiliation as a way to repairing one’s self-esteem, a way to “borrow ego-strength” from an established organization or entity, as a way of feeling vicarious accomplishment through identification. The mention of self-esteem repair through affiliation serves as a segway to the next session that is devoted to the review of social crime as a substance use relapse factor and its alternatives.

 

Session 7 Details: Social crime as a substance use relapse factor/Alternatives to social crime

Facilitators review social crime as crime performed in the service of conformity to the norms of a given delinquent sub-group in exchange for acceptance, as a means to satisfying one’s need for identity, belonging and validation. Facilitators assist correctional substance use clients with exploring how a person’s substance use recovery may be jeopardized by criminogenic behavior in order to fit in. More specifically, facilitators explore the extent to which substance use is a behavioral norm of most delinquent subgroups, drawing out the conclusion that a person in recovery trying to remain accepted by a criminal, delinquent sub-group is likely to be frequently exposed to substance use related stimuli, be it through interfacing with drugs as a point of criminal enterprise or by interacting with substance using fellow group members and dealing with peer pressure to abide by the substance use group norms.

Having drawn out the “exposure” relapse risks of social crime, facilitators explore such numerous and various opportunities for belonging and acceptance as drug-free socialization through volunteering (Big Brothers, Big Sisters, etc.), political activism, interest based socialization (sports, hunting, hobbies, etc.), religious affiliation, participation in various social memberships (various membership clubs such as Elks, etc.), recovery clubs, professional affiliation, and, finally, through familial and cultural socialization.

As with the prior sessions, the trajectory of the argument in this session is simple and straightforward: crime is a substance use lapse/relapse factor, whatever your reasons for committing crime might be, you have psychologically, physically, financially, ethically and legally safer alternatives that do not pose a lapse/relapse risk to your substance use recovery.

 

Session 8 Details: Summary - the vicious cycle of crime and substance use/a Treatment Compliance

Challenge

In the final, summary session, the facilitators make an unequivocal point that crime is a barrier to substance use recovery. This can be best demonstrated through the description of the vicious cycle of crime and substance use in which a correctional substance use client re-engages in crime after the release from the correctional setting which, in its turn, exposes a person in recovery crime to a variety of crime-related substance use triggers which may eventually precipitate a substance use lapse and relapse which, in its turn, will precipitate a further lapse and relapse of criminal behavior now in support of substance use. Facilitators summarize the obvious conclusion that commitment to “being clean” is best kept when it is accompanied by a commitment to “going legal.”

When “Crime and Recovery” group is conducted in the context of a correctional inpatient or therapeutic community, facilitators may encourage clients to ponder any small crimes or infractions they commit in the course of their residence at the inpatient rehabilitation program. Clients are asked to ponder how minor and/or major disciplinary infractions (which parallel the dynamics of crime) in the course of their stay in the therapeutic community might jeopardize their ability to stay on course with their substance use treatment. With this in mind, correctional substance use clients in a therapeutic community or some other residential treatment program are reminded that if they are serious about “cleaning up” chemically, they are likely to be successful if they begin by “cleaning up” criminally in terms of any petty crimes or disciplinary infractions that might commit in the course of their residence at the correctional substance use treatment program.

 

Conclusion

“Crime and Recovery” group is designed as a substance use relapse prevention treatment

modality that allows correctional substance use clients examine return to crime as a substance use lapse/relapse factor. The “Crime and Recovery” group allows clients to examine psychological motives behind their criminal behavior with the hope of identifying psychologically, physically, financially, ethically and legally safer alternative means to the satisfaction of their personal goals. As such, “Crime and Recovery” group infuses a validating and humanistic perspective into the culture of correctional substance use treatment. The “Crime and Recovery” group protocol is predicated on an operating model of criminality that distinguishes between motives and behaviors, and proposes that all behavior, at its foundation, is predicated on socially sanctioned motives of maintaining and/or advancing one’s well-being. While a prospective clinical facilitator does not have to necessarily subscribe to this view of criminality to conduct the “Crime and Recovery” group, an appreciations of the morality of motive and morality of behavior will likely help facilitators present an internally consistent message and leverage a motivationally empowering humanistic stance of validation and hope. Finally, by allowing correctional substance use clients appreciate their psychological motives behind criminal behavior and, thus, the rationale behind psychological, vocational, occupational counseling modalities (as alternatives means to satisfying their personal goals without the reliance on crime), “Crime and Recovery” protocol also serves to cultivate programmatic treatment compliance.

 

 

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“Crime and Recovery”- a Group Treatment Modality Exploring Crime as a Substance Use Relapse Factor

Pavel G. Somov, Ph.D.

Private Practice, Pittsburgh, PA