“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

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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

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

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