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Abstract
Ex-offenders experience various difficulties in successfully reentering communities post-incarceration. For those with a history of opioid misuse, despite various interventions, long-term recovery rates are relatively low. Additionally, the difficulties ex-offenders experience reintegrating with their families and communities are further compounded by the stigma and structural barriers posed by prior criminal and drug use histories. This qualitative study, using in-depth interviews conducted during an 18-month period between mid 2004 and late 2005 examines the process of creating and maintaining abstinence among 25 former heroin users, mostly Latino and African American New York City ex-offenders who have remained abstinent from heroin use for a period of 5 yr or longer. Focusing primarily on the story of one female respondent and in participants' own words, the factors that they found to be most salient in enhancing their recovery efforts (positive peer support, motivational tools, exercise, meditation, skills enhancement) are examined. The study findings suggest that reentry programs and policies can help ex-offenders sustain long-term abstinence and prosocial lifestyles by supporting the various coping strategies that they identify as being particularly valuable.
Notes
1 Another relevant reality is what appears to be an ongoing situation in which there exists either a lack of knowledge about the “natural recovery” literature [Klingemann H. K. and Sobell L.C. (eds.) 2001, Natural Recovery Research Across Substance Use, Substance Use and Misuse 36:11; Shorkey, C.T. (2004). Spontaneous Recovery and Chemical Dependence: Indexed bibliography of articles Published in Professional Chemical Dependency Journals, University of Texas at Austin http://128.83.80.200/tattc/spontaneousrecovery.html] and/or not relating to it for intervention planning, implementation, process and outcome assessments as well as policy making and assessment.
2 The journal's style utilizes the category substance abuse as a diagnostic category. Substances are used or misused; living organisms are and can be abused. Editor's note.
3 The often used nosology “drugs of abuse” is both unscientific and misleading in that (1) it mystifies and empowers selected active chemicals into a category whose underpinnings are neither theoretically-anchored nor evidence-informed and which is based upon “principles of faith” held and transmitted by a range of stakeholders representing a myriad of agendas and goals, and (2) active chemical substances of any types-“drugs”- are used or misused; living organisms can be and are all-too-often abused; Editor's note.
4 The term triggers is almost always associated in the substance use intervention literature with negative behaviours; returning to drug use-lapsing-relapsing, to crime, etc. The concepts and the posited process do not have to be unidirectional. The literature does not raise the issues about the necessary conditions endogenous as well as exogenous ones which are critical for ‘positive triggers’ to operate. Editor's note.
5 Waldorf, 1970, was one of the first to recognize these patterns in recovering users. Indeed, four decades later, respondents will sometimes still refer to incarceration or treatment bouts as “rescue periods,” as also discussed by others, (CitationBourgois, 1995). Similarly, Vaillant found that in his sample of recovering heroin users, 97% had relapsed after a year (1992) and none of his methadone treated sample failed to relapse to heroin use even after incarceration and voluntary treatment (id).
6 The reader is reminded that although recovery has been and continues to be considered primarily in terms of an abstinence model-value-behaviour-life style that the dimensions and “demands” of the more recent harm-reduction and quality of life (QOL) ideologies necessitate additional exploration and delineation of this complex phenomenon. Editor's note.
7 Social scientists use the assistance of street contacts to assist in their research. For example, in a study examining strategies for gaining the cooperation of drug sellers and their families in order to conduct ethnographic research, Dunlap and Johnson refer to such informants as the “right contacts,” necessary as critical elements in successfully gaining access to hidden populations (CitationDunlap and Johnson, 1999).
8 The study protocol was reviewed and approved by the John Jay College of Criminal Justice Institutional Review Board.
9 “Cattle rustling” refers to a form of shoplifting, which involves taking beef and fish products from larger supermarkets. The most popular products (and easiest to resell) are filleted fish and meat products. Interestingly, respondents reporting engaging in this activity indicated that “really expensive meats” such as filet mignon and similar cuts of beef, are much more difficult to sell as street buyers often refuse to pay the higher prices associated with them”.
10 Over the years I have been involved in various survey research studies and ethnographies and I am well versed in conducting them. I felt confident that immersing in the select cultural milieus and recovery environments was achievable, leading to effective respondent recruitment. This expertise however, in no way diminishes the contributions of my informants. The fact is, without their assistance, I would not likely have recruited the sample I did, nor in as timely a fashion. I remain indebted and grateful to them.
11 All names have been changed to protect respondent confidentiality.
12 Treatment Alternatives to Street Crime (TASC) is an offender management model that has been implemented in various forms since the early 1970s. TASC facilitates treatment for drug-using offenders as a part of an overall strategy to control drug use and associated criminal behaviours.
13 Throughout these interviews, respondents regularly used terminology from their treatment experiences. This particular concept, “acting out” refers to not following certain program rules, thereby meriting sanctions, including program termination.
14 Language makes a difference. The General Semanticist taught us that the map = = the territory. Osgood's Semantic Differential made us aware that meanings and implications of words are context-bound. The reader is asked to consider what are/can be the implications of associating the term graduation with the completion of a planned treatment process for a posited chronic substance use disorder implemented in a specialized substance user treatment program which are distanced from the mainstream of the treatment of nonusers –“NORMED TREATMENT OF NORMED DISEASES”- all-too-often manifest imparity in availability and delivery of needed services, and which utilize policies which are stakeholder –driven and not evidence-based and may be ethically-insensitive. Editor's note.
15 More than 25 years ago NIDA published a volume with 53 theories about the etiology of substance use. Many more theories have been added since then. Lettieri, D. J. et al., (eds.) 1980, Theories on Drug Abuse. NIDA Research Monograph No. 30, Rockville, MD. NIDA Editor's note.
16 A theologian hundreds of years ago noted that “If the question is not a question, then the answer is not an answer.” The question that has been posited, in a most traditional style, can stimulate one to think about substitute options, behaviours, or adaptations. A shorter or longer list can be created and then implemented. Another type of question, for which we currently do not have an answer, let alone THE ANSWER is: What are the critical necessary conditions (endogenous as well as exogenous ones) for the desired change(s) to occur (begin, continue, become anchored and integrate, change as de facto realities change, cease, etc.) as Marisol engages her awareness, judgment, decision making, overt behaviours, assessing the immediate and longer term consequences and learning from them, integrating the changes, etc. Rittel has suggested that problems can and should be usefully categorized into two types: “tame problems” and “wicked problems” The former are solved in a traditional known and tried “water fall paradigm”; gather data, analyze data, formulate solution, implement solution. The latter “wicked problems” can only be responded to individually, each time anew, with no ultimate, repeatable solution. [Rittel, Horst and Douglas Noble (1989) “Issue-Based Information Systems for Design,” Working Paper 492, The Institute of Urban and Regional Development, University of California, Berkeley, California, E-mail: [[email protected]]. The cyberneticist Heinz Von Foerster posited that there are two types of questions: legitimate questions and illegitimate questions. The former are those for which the answer is not known. An illegitimate question is one for which the answer is known. Heinz Von Foerster, Patricia M. Mora and Lawrence W. Amiot, “Doomsday; Friday, 13 November, A.D, 2026,” Science, 132, 1960. pp. 1291–1295. Editor's note.
17 Treatment can be briefly and usefully defined as a planned, goal directed change process, which is bounded (culture, place, time, etc.) and can be categorized into professional-based, tradition-based, mutual-help based (AA, NA, etc.), and self-help (“natural recovery”) models. There are no unique models or techniques used with substance users- of whatever types-, which aren't also used with non-substance users. In the West, with the relatively new ideology of “harm reduction” and the even newer Quality of Life (QOL) treatment-driven model there is now a new set of goals in addition to those derived from/associated with the older tradition of abstinence driven models. Editor's note.