Offenders with substance usedisorders are unique andresearch reveals that they

benef it fromForensic Peer Services

How arethey unique?

Stats

• 2016: 2.3 million incarcerated in jails and prisons• 2016: 4.7 million on parole/probation

• Studies show that upwards of 80% have substance abuse problems.

• CASA: 65% unquestionably have substance abuse and dependence.

• Numerous research projects in U.S., U.K., and Australia: • Average age of onset 14 years old (use, abuse, dependence), vs. gen. pop

16.5 in the U.S.

• Recent U.K. study, 2015, reported median age of onset for alcohol was 9 years old

• A 2013 study, showed that “Repeat DUI offenders also reported f irst using alcohol at a signif icantly earlier age” compared to single DUII offenders

• 2008 Study of Incarcerated African Americans: “Onset of a substance use disorder by age 16, but not later onset, was associated with a fourfold greater risk of adult incarceration for substance related offenses as compared to no disorder”

HMCIPSS, 2015; CASA, Shoveling it up II, 2009; J Offender Rehabil. 2013; 52(6): 421–437; Drug Alcohol Depend. 2008 May 1; 95(1-2): 1–13.

Europeans teach their children to drink responsibly from an early age?

• True• False

U.S. vs. U.K. Annual Alcohol death rate per 100,000U.S. has more DUII deaths than the U.K. However, the U.K. has signif icantly more alcohol related health disorders (Cirrhosis, Pancreatitis, Ascites, etc,).

U.K. Office of National Statistics, published January 27, 2011

CDC, National Vital Statistics Report, Volume 57, Number 14, published April 17, 2009

United Kingdomalcohol death

rate per 100,000is nearly double

that of theUnited States.

“Globally, the highest rates of morbidity and mortality due to alcohol occur within the WHO

European Region.”

2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC),n=43,000

Age of onset

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Age of onset is one of thebest predictors of the severityof later SUD’s

DSM V: Introduction to the Substance Use Disorders

• Prevailing Theory:• Early onset substance use (and other developmental problems) interferes with frontal lobe development, where impulse control is housed.

Accelerator

Brakes GO

You've had enough"Bad Idea" "Stop Now"

GREEN AREA: Medial OFC evaluates positivereinforcing rewards; food, drugs, sexual orgasms, etc.

ORANGE AREAS: Lateral OFC evaluates negative reinforcers(punishments); being overweight, coming down off drugs,

hangovers, sexual regrets, STD’s, other consequences, etc.

Meta-analysis of 267 OFC activation exams, Kringelbach, 2004.

Stop Stop

Poor parenting, trauma, child abuse, bipolar disorder, poverty?

Frontal Lobes: Brakes

If you want to learn more about addiction and the frontal lobes…• Read the Introduction to the Substance Use Disorders in the DSM V,• Watch episode one of the HBO Addiction series.

Today’s Forensic Peers arenot the peers of

yesteryear

The idea of incorporatingreformed felons into

criminal justice rehabilitation is old.

The early peer movement in Criminal Justice

The failure of Synanon evolved into the Therapeutic Community Model

Old vs. New Peer Models

• Old Models 1960’s-70’s:• Peers were all new in the recovery process

• Limited supervision

• Recovery process was secretive

• No prerequisite education/training

• No certif ication – no public accountability

• New Model:• Peers are established in recovery (minimum of 2 years of abstinence under

independent living conditions)

• Peers receive supervision from two supervisors (clinical supervisor and peer supervisor)

• Peers receive mandatory core training (client rights, applicable laws, regs, etc)

• Peers are individually certif ied (accountability), continuing education, etc.

• Trained in Evidence-based Best Practices

SUD Forensic Best Practices

Forensic peers assist criminal justice staff by monitoring and reporting on compliance.

• True• False

Best Practice One: Supporting Positive Engagement in the Criminal Justice System• Forensic Peer Mentors support positive engagement in the

criminal justice system, but do not enforce compliance.  Forensic Peer Mentors provide aid, support, and motivation for meeting required mandates attached to any processes in the entire continuum of criminal justice involvement. Forensic Peer Mentors are involved during f irst responder crisis, detention, arraignment, jail, court dates, sentencing, and supervision encounters in order to minimize continuing criminal sanctions as individuals progress in recovery and meet criminal justice obligations.  Peer mentors are not agents of the criminal justice system, and do not act as “compliance off icers,” or “junior probation off icers.”  

Forensic peers identify the court’s goals for the client and implement a plan with offenders to achieve those goals.

• True• False

Best Practice Five: Eliciting Individual Needs & Goals• Forensic Peer Mentors help individuals assess their own needs

and provide them with referrals to appropriate community resources. While Forensic Peer Mentors support individuals in f inding their own pathways to recovery, they are also sensitive to the directive nature of the criminal justice system, the child welfare system, including the Adoptions and Safe Family’s Act (ASFA), and family court.

Forensic peers maintain professional boundaries and avoid personal self-disclosure regarding personal information.• True• False

Best Practice Six: Inspiring Hope and Change• Forensic Peer Mentors act as credible role models to individuals

transitioning from criminal activity to pro� social behaviors. Forensic Peer Mentors inspire hope and the possibility of positive change through appropriate self� disclosure of their own histories,   by consistently modeling recovery behaviors,  and being a continual role model in recovery from addiction and crime.

Personal experience inspires change.

Best Practice Seven: Person-Centered Trauma-Informed• Forensic Peer Mentors have suff icient knowledge of the

relationship between incarceration and trauma to offer trauma�informed Peer Mentor Services. Additionally, Forensic Peer Mentors are aware of trauma arising from individuals’ criminal justice experiences, including but not limited to: disparate sentencing, incarceration, threats, intimidation, and stigmatizing labels within incarceration and criminal justice environments. Forensic Peer Mentors understand the historical and contemporary trauma, marginalization, and oppression of diverse populations, including: cultural and ethnic minorities, LGBTQ individuals, those with mental health challenges and addictions, those with physical and developmental disabilities, and veterans.

Best Practice Ten: SUD Forensic Peer Mentor Qualif ications• Forensic Peer Mentors have lived experience in all or most of

the continuum of the criminal justice system including: arrests, detention, arraignment, court proceedings, sentencing, diversion, incarceration, probation, and/or parole. Forensic Peer Mentors have specialized training in the delivery of forensic peer delivered services.