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The Connection between Occupational Therapy and Drug Court
By Rebekah Mack
Published: 10/12/2015

Drugabuse As of June 30, 2014, the number of drug courts serving individuals throughout the United States and its territories totaled at 2,968 (National Drug Court Resource Center, 2012). Despite the vast availability of drug courts, there is controversy regarding which measures should be calculated in order to determine an individual’s success within the drug court program. More specifically, there is a need to develop a compromised understanding between the definitions of success in the criminal justice system versus that in the medical field. The inclusion of Occupational Therapy (OT) within the professional team supporting drug court will help provide a more holistic understanding of individuals partaking in drug court, thereby supporting the criminal justice system and medical professionals to arrive at a consensus regarding an individual’s treatment plan.

Caroline Cooper, Director of the United States Department of Justice Bureau of Justice Assistance Drug Court Clearinghouse/Technical Assistance Project, emphasized the disconnect between the perspectives of the criminal justice system and that of the healthcare system regarding success in drug court in her article, “Failure in the Context of Substance User Interventions: Drug Treatment Courts” (2012). She came to the following conclusion: “from a criminal justice perspective, an addict’s use of illegal drugs is considered as a crime; from a medical perspective, this use is reflective of a chronic, relapsing brain disease that requires treatment” (Cooper, 2012, p. 1463). Therein lays a great dilemma founded in the concept of drug court: how does one treat the individual’s disease whilst still recognizing that he/she committed what is regarded as a crime in society? In the world of criminal justice, crimes demand repercussions in order to keep order in society; albeit exceptions exist—such as being found not guilty secondary to insanity—we live in a world which is governed by an organization that seeks to maintain the cause and effect relationship representative of being held accountable for one’s actions. If drug court is viewed solely from a criminal justice perspective, then it is completely appropriate for the person who committed the crime to serve the time. However, what about the extenuating circumstances? After all, that is one of the reasons that we the people are permitted a fair and just trial—in order to be able to share our side of the story. This adds another dimension to the issue of substance use and dependency. While admittedly the person did make the choice to use a substance the first time, there comes a point in time where that action was no longer a decision.

Addiction: the place where drug court participants cross over to also being healthcare patients. The American Society of Addiction Medicine (2015) defines addiction as the following:

A primary, chronic, disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors. Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional response.


Therefore, it is physically impossible for a person who is addicted to a substance to not engage in criminal behaviors without the aid of outside assistance. A person addicted to drugs has changed the anatomy and physiology of his brain; he struggles to identify positive, meaningful activities within his life because he craves only one thing—the drug has consumed his entire being. He lives for it. He uses it and as soon as he has finished he begins planning his next hit, always seeking the high that will never be as great as the first time he utilized that substance. And so the cycle of dependency and relapse continues… Now, with this in mind, how can people struggling to overcome addiction be held accountable for their choice(s) while still receiving the necessary assistance to move forward in life and become a productive member of society? The medical field recognizes the fact that relapse may occur to some degree while the individual is on the road to recovery and a sober lifestyle. Furthermore, since addiction is classified as a chronic disease, relapse is almost expected and this setback is not viewed as failure; after all, does a person battling multiple sclerosis become a failure when he experiences relapse and remission? No. Rather, the person’s medical professionals work together to develop a new treatment plan which will effectively help the person’s fight against his disease. The same mindset must be applied to people battling addiction.

How does one measure success of a participant in drug court while taking into consideration both the legal requirements and the cyclical battle of chronic disease? Due to its foundational principles, OT can aid in providing an additional perspective into the factors impacting individuals on their road to recovery. OT combines a medical background with a deeper understanding that environment and context affect every task that an individual engages in. In addition, the person’s ability to complete that task is impacted by intrinsic and extrinsic factors specific solely to that person. OT strives to view clients holistically, ultimately grading and adapting activities so that they can have the just right challenge and be successful despite limitations. Drug court exists as an opportunity to aid individuals struggling with substance dependency in conquering their addiction and improving their quality of life. The National Association of Drug Court Professionals (n.d.) provides new meaning to the phrase “all rise” because “instead of imprisoning an addict, drug courts insert hope and support into the very lives of people who the traditional justice system says are hopeless”. OT strives to help people live life to its fullest (American Occupational Therapy Association, 2015), and drug court enables individuals convicted of a drug offense to have an opportunity to live a meaningful life despite the barriers which have labeled them otherwise.

OT’s utilization of the KAWA Model supports clients in creating a physical representation of their life, recognizing barriers and supports, and then identifying ways to problem solve past those barriers. Research has revealed that a person’s engagement in treatment, motivation to change, and treatment retention improve when interventions that are based in evidence and culturally competent are incorporated when treating substance use (Gallagher, 2014). OT is an evidence based profession that reinforces its holistic approach with an emphasis on cultural competence in order to better understand the various factors affecting clients. OT can help uncover the reason behind a person’s engagement in risky behavior and drug usage; this insight can aid in developing a better rounded support team for drug court participants. Additionally, OT values the therapeutic use of self in treatment sessions—a characteristic quality which research has revealed as beneficial for drug court participants, especially when trauma is a factor (Powell, Stevens, Dolce, Sinclair, & Swenson-Smith, 2012).

OT provides a unique outlook on mental health because it examines the influence that mental health has on a person’s occupations and overall ability to “do”. As a result of engagement in drug activities, many drug court participants have lost the skills necessary to complete life’s daily occupations, such as money management, employment, home management, appropriate interpersonal skills, and time management. OT supports people in developing these skills in order to prepare them for living a successful and independent life. Consequently, the addition of occupational therapists to the drug court support team will enable participants to not only conquer their addiction, but to become prosocial members of society.

References


American Society of Addiction Medicine (2015). Definition of addiction. Retrieved from http://www.asam.org/for-the-public/definition-of-addiction

Cooper, C. (2012). Failure in the context of substance user interventions: Drug treatment courts. Substance Use & Misuse, 47, 1463-1465. doi: 10.3109/10826084.2012.705682

Gallagher, J. R. (2014). Predicting criminal recidivism following drug court: Implications for drug court practice and policy advocacy. Journal of Addictions & Offender Counseling, 35, 15-29. doi: 10.1002/j.2161-1874.2014.00021.x

The American Occupational Therapy Association, Inc. (2015). Occupational therapy brand toolbox. Retrieved from http://www.aota.org/brand.aspx

National Association of Drug Court Professionals. (n.d.) All rise: All rise and put drug court within reach of every American in need. Retrieved from http://www.nadcp.org/learn/all-rise

National Drug Court Resource Center. (2012). How many drug courts are there?. Retrieved from http://www.ndcrc.org/content/how-many-drug-courts-are-there

Powell, C., Stevens, S., Dolce, B. L., Sinclair, K. O., & Swenson-Smith, C. (2012). Outcomes of a trauma-informed Arizona family drug court. Journal of Social Work Practice in the Addictions, 12, 219-241. doi: 10.1080/1533256X.2012.702624

Bekah is a student at The University of Findlay currently completing her level two fieldwork rotation in order to earn her Master’s in Occupational Therapy. She has had the opportunity to increase her understanding of the world and the way in which OT can make a difference through several nontraditional settings, most recently including the Hancock County Justice Center, Adult Probation, and Drug Court. After passing her board exam, she desires to help make a difference in the community by incorporating OT into nontraditional settings, thereby providing individuals with a second chance at what OT does best—learning how to live life to the fullest by engaging in meaningful occupations.


Comments:

  1. CognitiveEmergenceProgram on 10/14/2015:

    Your analysis of drug addiction as a brain dysfunction is outstanding! We have worked with more than 600 female prisoners in Mabel Bassett Correctional Center, McLoud, OK, for more than 9 years. The cognitive and behavioral development computerized program has had great success as 263 inmates have completed the program and have been released as their time was up. In the past 5 years, only 9 of these women have re-offended and returned to prison. That is a recidivism rate of 3.9%. In their exit interview, they tell me, "Dr. John, don't need that stuff anymore. I think differently." 90% of these women were addicted to meth and 95% had traumatic brain injuries prior to going to prison. This computerized program help build up the areas of the brain that have been damaged or short circuited called the "Implicit Learning Domain". A person is "learning" without awareness. It doesn't teach reading, math and other factual information. However, all purposeful and academic learning is based on how well the Implicit Learning Domain is developed. And, over time, these new neuropathways that are developed can become so robust that they can withstand another brain assault without major rehab requirements, creating a "Cognitive Reserve" that can last a life time. Take a look at the website: www.cog-systems.com Send me you address and I will send you a DVD with unscripted interview of clients/students who have benefited from interacting with this developmental program.


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