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Friday, October 16, 2015

Comments

There are multiple issues with this piece.

1. There is scant evidence to support the author's assertion that "the phenomenon, as I see it, of the brain reacting to certain risky situations and environments in much the same way as the addicted brain reacts when relapsing to drugs/alcohol." The jump from brain to mind to behavior is not so directly made, but provides a convenient rationale for the treatments typically offered to correctional and criminal justice clients.

2. While he correctly asserts that there is little benefit to the psychoeducational approaches favored in the majority of prisons, many of the ancillary programs cited are standard psychoeducational approaches. It would have been interesting to describe the "clinically rich" programs by their potential content instead of by the educational level of the staff.

3. Naltrexone does not "keep the body from wanting alcohol and opioids." It blocks opiate receptors so that the opiate high cannot be obtained if they are used. The mechanism of its effects with alcohol are not well understood but are believed to be related to the release of endogenous opioids as part of the alcohol high; it diminishes some of the pleasure of the alcohol high making it less rewarding to some; it does not prevent the alcohol high.

4. What treatment do they actually receive once they are outside of prison? This is where it is needed the most. Usually it is didactic and morality based psychoeducation for the "criminal mind," sadly masquerading as CBT.

There is little new in this article that gives much hope for substance abusing offender treatment.

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