May 2019

Lying and dishonesty in Treatment Courts and what to do; using ACCEPT with dishonesty; update on my grief process.

Welcome to the May edition of Tips and Topics (TNT). A special welcome and thanks to those readers who have been with me from the beginning and wrote to express their appreciation through all the years.

In SAVVY and STUMP THE SHRINK, I respond to a question on what to do about lying and dishonesty in Drug Courts – what is the role of sanctions?

In SKILLS, what is the role of treatment and judges and court teams when participants lie? Using ACCEPT as a structure to guide what to do.

In SOUL, I update where I am in my grieving process. It helps me to reflect and I hope helps you understand grief too.

savvy and stump the shrink

Last month, I introduced an acronym to help think through what to do when a client, patient or participant is not doing well in treatment – ACCEPT © David Mee-Lee 2019.
This month, I received a question from a Treatment Court Coordinator that provides an excellent opportunity to apply ACCEPT to a specific important issue: honesty, or more specifically, what to do when a treatment court participant is dishonest, lies and does not act with integrity. I had presented at a Treatment Court professionals conference on the role of sanctions for dishonesty; and I had questioned the usual practice of court sanctions for dishonesty.
So in a combined SAVVY and STUMP THE SHRINK, here’s the question the Coordinator posed:
“I am writing to you at the request of our Judges who are having a hard time processing what was presented at the conference a couple of weeks ago in regards to sanctioning for dishonesty.  
 
We heard that we should not sanction for dishonesty as this is part of addiction.  We have sanctioned for dishonesty in the past as we were under the impression that this is a proximal goal and should be expected.  One of our Judges is also very adamant on integrity and honesty being the key points to our program.  Typically any dishonesty along with a violation increases the sanction.  Wondering what your thoughts are on that subject?  
 

Thank you for your time.”

Whether you work with a Drug or Treatment Court or not, the response I gave to the Treatment Court Coordinator can apply to any client. But before I include my response, here is a Tip about the interface between Treatment Courts and Treatment.
DISCLAIMER:
The following tips and opinions are not the official position of the American Society of Addiction Medicine (ASAM), nor of The ASAM Criteria, nor of any other organization. I offer them in hopes of promoting accountable, lasting change in treatment court participants; improving treatment court retention rates and enhance outcomes to achieve public safety and recovery and well-being.
TIP 1
Consider the respective roles and responsibilities of each member of the treatment court team*,the mandates of the systems and the policies, programs and practices within those agencies.
 
[* The “treatment court team” includes but not limited to a judge or judicial officer, program coordinator, prosecutor, defense counsel representative, treatment representative, community supervision officer, and law enforcement officer. (Adult Drug Court Best Practice Standard VIII (2018)]
The power of drug and treatment courts is the balance between the mission of the justice system with the mission of treatment. A collaborative, interdisciplinary court and treatment team can achieve the goals we all want: accountable, lasting change in participants to achieve public safety and foster recovery and well-being.
  • The justice system’s appropriate mission to enforce the law, ensure public safety and apply penalties such as fines or serving time under incarceration and ensure fair and impartial administration of justice, may at times appear to conflict with a treatment provider’s mission of helping people change through collaboration on treatment goals and motivational enhancement. https://www.justice.gov/about
  • However high rates of incarceration for drug use, high costs of incarceration, high rates of relapse and recidivism, and the effectiveness of mandated treatment have guided many criminal justice administrators and policymakers to embrace the habilitative/rehabilitative role of addiction treatment among criminal justice populations.
    (The ASAM Criteria (2013) Pages 350-351)
  • “The judge relies on the expert input of duly trained treatment professionals when imposing treatment-related conditions and adjustments to treatment levels of care and services” (Adult Drug Court Best Practice Standards (2018) Page 21, 27, 31). While many drug court judges follow this best practice stipulation, some judges, other court officials, and probation and parole officers still mandate specific levels of care (e.g., residential treatment) and lengths of stay (e.g., 1 year).
  • It is understood that judges, other court officials, and probation and parole officers, often do what they do because they are following sentencing and supervision guidelines given to those in the criminal justice system by a legislature or an executive branch authority.
  • Setting supervision conditions that prohibit some addiction-related behaviors is something that should happen routinely in drug court. As long as the consequence of failure is not too harsh, such prohibitions make it clear to the participant that it is time to get serious about getting help. These supervision conditions engage the participant to make positive changes and start right away doing real work with treatment to meet supervision conditions.
  • It is the treatment community’s role, and challenge, to assist the justice system in applying the guidelines in a manner that offers the best match to the treatment options for this population within the guidelines they operate under. For example, to focus on mandating comprehensive assessment and ongoing treatment adherence, so that participants can learn from mistakes and develop new attitudes, thoughts and behaviors to increase public safety.
  • The justice system’s role, and opportunity, is to assist the treatment community in understanding the guidelines they operate under and the behaviors they must eventually see in a participant. The justice system provides information that will help clinicians assess and address the nature and extent of substance use and those criminogenic risk and need factors. It is those factors that contributed to the participant’s behaviors that initially brought them to the attention of the justice system in the first place.
  • Supervision conditions and expectations such as abstinence, honesty, and non-association with justice-involved peers is not inconsistent with treatment goals if communicated respectfully and with a focus on the participant working in treatment to begin showing progress. Such conditions and expectations are only counter-therapeutic if failure to meet expectations is met with immediate, harsh responses like revoking the participant’s probation and sending them to prison; or sanctioning them to jail right away, even if for a few days until they can see the judge. (Most drug courts are not required to respond to violations in that way.) If their guidelines don’t require these kinds of zero tolerance, automatic responses, then merely setting the expectation regarding what kind of behavior must begin to be exhibited can actually support treatment progress.
  • This support of treatment progress is particularly true if the court overtly and reliably reinforces and incentivizes a participant’s progress e.g., public praise in court for successful progress. The expectation for honesty or abstinence is not the problem. The supervision condition is not the problem. The problem is if the court or probation is required to respond right away, too harshly when a participant fails to meet the expectations, without being able to consider treatment perspectives, effort, and progress. Most drug courts have this kind of flexibility in how they respond.
  • It is critical to involve all parties (e.g., judges, probation and parole officers, law enforcement and other court officials) as well as the justice-involved individual in the decision making process. It is also important to create learning opportunities for criminal justice personnel to understand more about substance-related and addictive disorders and also co-occurring mental health conditions. (The ASAM Criteria (2013) Pages 350-351)
  • Treatment court team members gain up-to-date knowledge about best practices on topics including substance use disorder and mental health treatment, complementary treatment and social services, behavior modification, community supervision, drug and alcohol testing, team decision making, and constitutional and legal issues. (Adult Drug Court Best Practice Standards (2018) Pages 80-81 https://www.nadcp.org/standards/)
  • The treatment court recognizes and acknowledges the nature and extent of substance use disorder as a chronic, relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences. Such a complex disorder, that is often found co-occurring with other conditions, requires the work of multiple disciplines and collaboration between multiple systems to provide individuals suffering from this complex condition the opportunity to achieve long-term recovery and wellbeing.
 
TIP 2
Create learning opportunities for particpants who lie and con using the power of the Court balanced with the effectiveness of incremental progress in treatment
Returning to the STUMP THE SHRINK question of the Treatment Court Coordinator –
My response:
Thanks for your good question.  Here are some thoughts in no particular order:
1. Of course we want all participants to be honest and have integrity. We actually want all people to be honest and act with integrity in any setting. If we could effectively achieve that lasting change in people just by mandating honesty and integrity; and then sanctioning and punishing people when they lie or con, treatment would be easy. Just tell them what to do and punish them when they don’t do it.
2. Drug courts, in contrast with other criminal justice settings, are based on the understanding that mandating is not enough. Drug courts make it clear what behavior is legally expected – even while responding patiently and reasonably while the participant gains the motivation, insight, and skills to be able to meet those expectations. I believe the right approach is setting the expectations, rewarding tiny steps in the right directions, and progressively imposing sanctions whenever a participant shows no effort to learn from and correct addiction-related attitudes, thoughts and behaviors that threaten the public safety.
3. In treatment courts, judges and the justice system are gracious enough to realize that people suffering from trauma, addiction and other personality and antisocial thinking and behavior and have family and friends with the same or similar characteristics. Such people might actually improve public safety and cost less if we gave them a chance to change attitudes, thinking and behavior in treatment.  But you have to allow treatment to work as participants learn from their mistakes and incrementally make progress to change old patterns of lying. After a lifetime of surviving by lying as part of criminogenic and addiction thinking, few participants have the ability for honesty and integrity perfectly from day 1. To sanction a participant when they manifest what is common in addiction and criminogenic thinking, disincentivizes honesty and integrity.
4. Ask any recovering judge, attorney or physician if, in the throes of their addiction, whether they ever lied or acted without integrity and broke rules doing things against their better judgment when they were active in their addiction. You will find that is common behavior to be treated, not punished. When treatment court participants exhibit normal behaviors of addiction, for a yet untreated addiction and they lie, con or act without integrity, that is not OK and we don’t condone it and look the other way. Lying in court is against the law and cannot be overlooked. Lying in treatment is a red flag that the therapeutic relationship has broken down and needs repair.
5. The power and role of the judge and court team is in being clear that lying is both against the law and against all effective treatment. Both the judge and the treatment provider emphasize with the participant that lying is not acceptable and a clear problem to learn from and work on in treatment.
6. The judge admonishes the participant that if s/he does not work on this issue of lying in treatment in good faith, then escalating sanctions will be forthcoming. It is treatment’s role to then let the judge and court team know whether the participant is acting in good faith in treatment to work on these normal behaviors of addiction (dishonesty and lack of integrity). If the participant is willing to change their treatment plan in a positive direction and work on honesty and integrity, that is a treatment issue. The judge’s admonishment of this behavior during the court hearing is the initial treatment court response and is a sanction, followed by escalating sanctions for lack of good faith and effort in doing their treatment.
7. Examine what policies and procedures are in place that actually encourage dishonesty e.g., requiring abstinence from all mood altering substances immediately upon entrance into the treatment court; and then sanctioning the participant if they test positive. If the participant is mandated to be abstinent and then immediately sanctioned for a positive drug screen, the participant will avoid being honest at all costs. They do not want to jeopardize moving through drug court phases and graduating.
Replace such policies with practices that encourage honesty.  Such a policy is: “Participant, you are expected to be abstinent and avoid any illegal use of substances. But you will not automatically be sanctioned if you use. If you are have the disease of addiction and are “doing treatment” in good faith and effort then you will not be sanctioned – even though you didn’t comply with the mandate to be abstinent. But you are expected to be honest about your use and to learn from any mistakes and improve your treatment plan to work on abstinence. If you do not show good faith and effort in treatment to learn from mistakes and change your substance use, you will receive escalating sanctions.”

skills

Using the construct of ACCEPT, here is guidance for treatment providers and court teams applied to lying and dishonesty. If you are not involved with a court team, then the Treatment Provider column is relevant to any treatment setting.
TIP 1
Compare and contrast the respective roles of treatment provider and court team in how to manage lying and conning
First, an overview of ACCEPT © David Mee-Lee 2019.
A ssess what is and is not working in the treatment plan
C hange the treatment plan to address those identified problems or priorities
C heck the treatment contract if the participant is reluctant to modify treatment plan
E xpect effort in a positive direction – “do treatment” not “do time”
P olicies that permit mistakes and honesty; not zero tolerance
T rack outcomes in real time – functional change (attitudes, thoughts, behaviors) not compliance with a program.
ACCEPT as applied to lying and dishonesty:
Treatment Provider
Treatment Court Team
ASSESS
  • Why did you lie? What was going on that you chose to lie rather than be honest?
  • Do you and I understand how lying is an indication that something has gone wrong in the therapeutic alliance?
  • When has lying and lack of integrity manifested itself in your life before and how has it gotten you into more trouble?
  • Do you even see dishonesty as an issue you need to work on? If so, why; and if not, why?
  • What can we do to make it easier for you to be honest and open?
  • What are you fears or obstacles if you were to be honest?
CHANGE
  • What are you going to do in your treatment plan to address dishonesty?
  • How could you use individual or group sessions to work on a tendency to lie and con?
  • Change goals or strategies in the treatment plan in a positive direction e.g, practice being totally honest for one day in treatment and see what feels good or bad about that and report back to group; e.g., when someone asks “How are you?” practice pausing and answer honestly rather than a quick automatic “Fine”.
  • Changing the treatment plan about lying is a learning opportunity to be embraced and expected of the participant.

 

CHECK

  • If you are doing more work than the client e.g., putting more energy in urging the client to be honest than they are; chasing the client to be sure they follow through with treatment plans while they watch you passively, as they just go through the motions.
  • The participant should be as active in figuring out changes in the treatment plan as you are.
  • If they are not, then check whether they are really commited to do treatment or not.
EXPECT
  • Continued treatment after lying or conning is dependent on whether the participant is changing their treatment plan in a positive direction and putting in a good faith effort.
  • If, after using Motivational Interviewing and Motivational enhancement treatment, the participant continues passive involvement in treatment, that is “doing time” not “doing treatment and change”. An escalated sanction is then recommended to the Court team.

 

POLICIES

  • Examine policies that inadvertently encourage dishonestythat disincentivizes participants to be open and honest with mistakes, substance urges and actual use; and pushes illicit use by themselves and others underground.
  • Fellow participants are then more focused on “snitching” and antisocial, criminogenic behavior to scam the system than on learning how to be honest and confronting others when they see lying.
TRACK
  • Track whether participants are actually working on attitudes, thoughts and behavior that have contributed to lying and dishonesty.
  • Track whether outcomes are improving – Is there is less lying or successful full honesty?
  • If participants aren’t able to explain what attitudes, thoughts and behaviors they are working on to avoid further lying, then they are not doing treatment in good faith.
ASSESS
  • Collaborate with the treatment provider (in the Pre-court meeting) to assess if the participant is working in good faith treatment or not.
  • Does the treatment provider recommend a sanction for a participant who is not taking treatment seriously and is just “doing time”?
  • Does the treatment provider recommend that the judge admonish the participant (sanction) that lying is not acceptable, but then praise them (incentive) for the new treatment plan s/he has embraced to work on lying.
CHANGE
  • The judge gives a clear message to the participant that lying is not acceptable in a court of law nor in treatment if it is to be effective.
  • However the judge also engages in a dialogue with the participant to determine if they are clear on the expectation and can articulate what s/he is working on in an updated treatment plan to address lying.
  • If the participant is not changing the treatment plan in a positive direction and working on lying as a treatment priority, then escalated sanctions will be forthcoming.
  • Treatment providers, probation/parole and other court team members should work together and share any information on the participant’s functioning in the community e.g., continued active association with justice-involved people or people who are known substance-users. Such behaviors inform needed changes in the treatment plan.
  • All treatment court team members reaffim the message delivered by the judge (lying is not acceptable in a court of law nor in treatment if it is to be effective) as appropriate and during their on-going, day-to-day interaction with the participant.
CHECK
  • The treatment court team checks that the participant is actively working in treatment not passively complying with court mandates.
  • The participant should be active in figuring out changes in the treatment plan to address lying; and be able to explain to the judge and probation or parole officer what they are doing to prevent or decrease lying and dishonesty.
EXPECT
  • A judge could ask a participant:
     “To what extent have you
       assessed with your treatment
       provider what went wrong that
       you ended up lying?”
  • “What are you working on in your treatment plan to address lying?”
  • If the participant is unable to answer such questions, check whether the treatment provider has done an adequate assessment and changed the treatment plan to address lying. Is it a treatment provider’s lack of skill? Or is the client not working in good faith?
POLICIES
  • Examine policies that inadvertently encourage dishonesty that disincentivizes participants to be open and honest with mistakes, substance urges and actual use; and pushes illicit use by themselves and others underground.
  • Examine how the judge and probation/parole address lying. Do they reinforce the need for the participant to take responsility and work on this in treatment? Or just impose an immediate sanction?
TRACK
  • Track whether participants are making progress on lying; and improving in their active participation in good faith effort or are not.
  • Collaborate in the interdisciplinary team of judge, attorneys, probation/parole, treatment providers and law enforcement to gather all data on level of function in the community.
  • Is the participant improving in attitudes, thoughts and behaviors that threaten public safety and lying not at all or less frequently?

soul

I had always thought that Sigmund Freud had suggested that as humans we have three main parts of our lives – work, love and play.  But Alan Elms studied Freud’s famous quotations and says that “Freud was once asked what he thought a normal person should be able to do well.” He responded: “Lieben und arbeiten,” which translates into English as, “To love and work.”
This SOUL is not about Freud. It is an update on my grieving process having lost my wife in February and sharing the beginning of my grief process in March.
It helps me to reflect, review and reveal some of where I am in this grief journey. I hope it helps others in some small way. The “work, love and play” balance seemed a good structure to organize my thoughts and feelings. So here goes…..
Work
I am taking care to not bury myself in work, which is so easy to do. I love what I do and it is meaningful to me and others; and I have no shortage of invitations to train and consult. But we all need to learn how to balance and put work into perspective, but especially now.
  • I have ended any contracts and leadership responsibilities that require me to plan months and years ahead; and lock in dates that restrict freedom for more spontaneous travel and adventures.
  • I am careful to agree only to work that is in line with my mission; is most effectively provided by my talents and experience; and is enjoyable to do.
  • I am putting more spaces in my schedule and looking for any ways to decrease stress e.g., fewer back to back training days that require late night travel, early morning starts, all the while hoping there isn’t a plane cancellation or thunderstorm or tornado.
 
Love
Nora McInerny left me with some very helpful perspectives in her TED Talk. She articulately explains we don’t “Move On” from grief we Move Forward with it. You can see a brief 4 minute version of her longer talk.
I am fortunate to have a very close knit nuclear family and an equally supportive extended family. Marcia and I did a great job of raising three smart, emotionally intelligent and present children. That is good for their relationships and so important for me as we all move forward with our grief.
  • We have all embraced the advice of tidying expert and guru, Marie Kondo – to keep in your life only what “sparks joy”. This has become a prime criterion for what I do in work, love and play.
  • The mutual love and support of my children has been healing and hopeful in our moments of tears, loss and missing her, but also with the memories that “spark joy” of how she influenced us all to be who we are today.
  • Every day, I notice something I just saw, read or experienced that I would have wanted to share with my wife. We talked everyday whether I was on the road or not. It is taking time to really get that she is not just a phone call away.
  • I would ask her about what tie or shirt goes best with this suit (she was my wardrobe consultant); or what were the best directions to get to a destination (she was my live GPS navigator); or what is the name of that new neighbor again? (she was my name and event memory bank). I am learning to stretch and test new wardrobe, and memory “muscles”. Google Maps takes care of the directions issue.
  • For the first time in nearly 50 years, I am seeing the world through the eyes of a single man. Of course anyone who has divorced has encountered the same situation and maybe it feels the same. I don’t know as this was my one and only marriage.
  • It is a fascinating and unsettling experience. I am vigilant about avoiding a quick rebound intimate relationship. When I am ready, there will be a world of people to meet; have D&Ms as my wife and I would say – “Deep and Meaningful” conversations; and be open to the blush of new relationship energy.
Play
I’ve vowed for years to stop and smell the roses. It is a pity I had to lose my wife to strengthen my resolve to take time to play. But that’s why they invented phrases like “Better late than never”; and “If not now, when?”.
  • The time will come when I will be ready to do one of the things I love – to travel and experience new cultures, people and places. Of course that would be fun to do with compatible travel companion(s).
  • Finding that person(s) will be part of play too. I’ll need advice from those of you who are the more experienced “singles” of the world.
  • Marcia was the family Vice President of Social Activities and I went along for the ride. Now I have to step it up and take personal responsibility. So I am in the process of building my network of like-minded old and new friends.
‘Sparking joy’ in work, love and play will be a process….just like my grief.