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Appendix A: Case Studies
Case Study: One
Demographic Information
Case I.D. Number
Date of Birth
02/27/50
Education
High School graduate/GED
Marital Status
Single, Never Married
Occupation Cook
Age of First Arrest
Age of First Conviction
Current Offence(s)
Kidnapping, Aggravated Assault, Gross Sexual
Assault, Attempted Murder
Age First Substance Use
Substance(s) Used
Marijuana
Questionnaire Summary Scores
Three Alcohol Tests
Test Name Test
Score/Level
Area Measured
Michigan Alcohol Screening Test
27- Severe
Consequences
Short-Form Alcohol Dependence Data
Questionnaire
6- Low Dependence
Dependence
Stages of Change Readiness and
Treatment Eagerness Scale
(Socrates)
36.5-Recognition (Moderate)
Motivation
Questionnaire Summary Scores
Three Drug Tests
Test Name Test
Score/Level
Area Measured
Drug Abuse Screening Test
15-Moderate
Consequences
Severity of Dependence Scale
1) Marijuana: 7-Moderate
2) Amphetamine: 8-High
Dependence
Stages of Change Readiness and
Treatment Eagerness Scale
(Socrates)
36.5-Recognition (Moderate)
Motivation
Case Study One
Offense History
This 29 year old male inmate is serving a sentence of 35 years with all but 20 years
suspended at the Maine State Prison (MSP) for kidnapping, aggravated assault, gross
sexual assault and attempted murder. The inmate was admitted to the MSP on 3/14/97.
During the interview assessment, the inmate recounted that he was under the influence of
marijuana and amphetamines at the actual time of his current offenses, and had been
drinking alcohol and using LSD the day prior to the offenses. He was reluctant to discuss
the offense itself in any detail The official version of the offense indicated that he
abducted the victim while she was walking alone along a street, took her to a secluded
area and beat and sexually assaulted her, also attempting to strangle her. He apparently
then was seized with remorse and apologized to the victim before helping her to get
dressed and dropping her off in the town where she was abducted.
The inmate has no known prior criminal history, nor has he been previously incarcerated,
other than in the county jail awaiting trial on the present offenses.
The inmate has been classified as maximum custody since his arrival at MSP in 1997.

Substance Use History
The inmate recognizes that he has a substance abuse problem with both alcohol and drugs
and specifically identified alcohol, marijuana and amphetamines as the main drugs with
which he has problems. He has also used cocaine, hallucinogens, and tranquilizers, and
described his drug use as “everything but crack and heroin.” He first tried marijuana at
age 17, followed by amphetamines at 18, cocaine at 19 and alcohol at 20. He reports
using marijuana daily from the beginning, with regular use of stimulants beginning at age
18 (amphetamines), and regular use of alcohol at age 21. He reports using cocaine daily
for about a year, but says he “got tired” and stopped. He continued to use alcohol on a
weekly basis on weekends, and marijuana and amphetamines on a daily basis. He reports
being indiscriminate with respect to situations in which he would use substances,
especially marijuana which he indicated he “always had on me.”
The inmate states that his first attempt at quitting drugs and alcohol lasted about 2
months, with his second attempt resulting in a reduction in use, but not abstinence. He
state that both attempts were prompted by his desire to date women who were not drug
users. He states that even when abstinent, drugs were “always on my mind.” The inmate
reports that his parents were both substance abusers, with his father alcohol dependent
and his mother dependent on tranquilizers (Xanax). He also reports that his brother is a
heavy user of marijuana and alcohol. He acknowledges that his alcohol and drug use
have had a negative impact on his life including failed relationships, poor mental health,
being a contributor to his current situation, and creating what he described as significant
personality changes (“when I used I was promiscuous, dangerous and irrational”).
It should be noted that there were some discrepancies between the inmate’s account of his
substance use history to this examiner and information contained in his official records.
The discrepancies seem to be in the direction of a less favorable view of himself now
than what is presented in official records, i.e. he now seems to show less “denial”.
Prior Treatment History

Prior to the current incarceration the inmate had participated in no substance abuse
treatment. He reports that he began meeting with a substance abuse counselor while in
the county jail, and has continued to meet with a counselor since his arrival at MSP. He
reported his belief that he no longer needs substance abuse treatment in that he now
thinks he could benefit from co-dependency treatment.
Pre-Program Interview Rating Scales

The inmate was assessed on five separate rating scales that were ranked at the end of the
comprehensive interview. The rating scales range from a score of 1 to 5 (generally
covering low to high ratings). The inmate was rated in the following manner:
1) High recognition of substance abuse problem (5/5). The inmate is very willing to
admit to his problems and explicitly made the link between his substance use and criminal behavior. The inmate further recognized how substances have negatively impacted on several life areas including: all manner of relationships, finances, and mental health.
2) Low insight into substance abuse problem (2/5). The inmate demonstrates a low
level of insight into his substance abuse problem, particularly with respect to measures he should take to avoid the problem recurring in the future. This is demonstrated by a response to one of the problem solving scenarios in which he would go into a bar to listen to music despite knowing that it was a difficult high risk situation for him. Nonetheless, the inmate demonstrated a moderate level of coping skills on one of the other problem solving scenarios and clearly recognizes the link between his substance abuse and criminal behavior, and the negative impact substance abuse has had on his life.
3) Moderate recognition of high risk situations (3/5). The inmate demonstrated a
moderate level of recognition of high risk situations and how they impact on his substance use behavior. However, he appears to lack adequate skills for coping with high risk situations, despite being able to recognize them. This is especially true with respect to interpersonal pressures to use. Also of concern is his pervasive, constant pattern of marijuana and amphetamine use prior to incarceration, in contrast to individuals whose use is linked to specific problematic situations (i.e. being alone, being with other people, when depressed). 4) Moderate problem solving abilities (3/5). The inmate demonstrated a mixture of
adequate and clearly inadequate coping strategies when presented with several problem solving scenarios. He tended to employ “low level” avoidance strategies most frequently, rather than more sophisticated assertiveness and coping strategies. He also tended to employ sexual behavior as a coping strategy in interpersonal situations involving women.
5) Low motivation (1/5). The inmate reported that he does not believe he needs any
further substance abuse treatment. However, he reports having engaged in regular counseling since shortly after his arrest, so this may be a largely accurate perception of his current need. However, he failed to recognize the need for ongoing support and vigilance, tending to view his substance abuse problems as fully resolved even though he is not in a position where he might encounter any of his significant high risk situations. Assessment of Risk/Need:
The inmate received the following ratings on the key areas of his alcohol and drugs use: Dependence (SADD)
Consequences (MAST)
Motivation Moderate-High
Dependence (SDS)
Marijuana (Moderate)
Amphetamines (High)
Consequences (DAST)
Moderate
Motivation Moderate-High

Overall Substance Abuse Rating:
The inmate’s combined substance abuse level is rated as moderate. He displays
recognition of the need to change his behavior, but at a low level of recognition of need
for further treatment. An inmate with a moderate substance abuse problem is at a
moderate risk for recidivism (based on studies conducted with the Correctional Service of
Canada).
The correctional file review supports the finding of moderate dependence. The inmate’s
substance use was focused largely are marijuana, less frequent use of other substances. In
addition, his use was of relatively late onset and relatively shorter duration than is typical
among individuals with severe dependence problems.
The Maine Department of Corrections’ Initial and Reclassification Custody rating scale
ranked the inmate at 37 in 1997.
Treatment Intervention Needs/Level of Treatment
The inmate’s moderate level of substance abuse problems (which are directly linked to,
but not the sole factor in his criminal behavior) warrant a treatment intervention of
moderate intensity (Level III). This treatment should begin in the institution at a point
closer to his release date, and consist of a focus on motivational enhancement followed
by relapse prevention skills training. Treatment should be continued in the community
with periodic booster sessions.
Special Issues/Questions
This inmate’s offenses were ones of a sexually aggressive nature. Two psychological
reports done prior to his sentencing both point to the possibility of a sexual sadism
diagnosis which interacts with his substance abuse problems to produce disinhibited,
sexually aggressive behavior. This “comorbidity” will need to be addressed in his overall
correctional programming.
Case Study: Two
Demographic Information
Case I.D. Number
Date of Birth
08/05/63
Education Some
Marital Status
Occupation Heating
Age of First Arrest
Age of First Conviction
Current Offence(s)
Violation of Probation
Age First Substance Use
Substance(s) Used
Cigarettes
Questionnaire Summary Scores
Three Alcohol Tests
Test Name Test
Score/Level
Area Measured
Michigan Alcohol Screening Test
33-Severe
Consequences
Short-Form Alcohol Dependence Data
Questionnaire
Dependence
Stages of Change Readiness and
Treatment Eagerness Scale
(Socrates)
33-Recognition (Low)
Motivation
Questionnaire Summary Scores
Three Drug Tests
Test Name Test
Score/Level
Area Measured
Drug Abuse Screening Test
N/A-No reported drug use.
Consequences
Severity of Dependence Scale
N/A-No reported drug use.
Dependence
Stages of Change Readiness and
Treatment Eagerness Scale
(Socrates)
N/A-No reported drug use.
Motivation
Case Study Two
Offense History
This 35 year old male inmate is serving a sentence of 3 years for Violation of Probation
at the Downeast Correctional Facility (DCF). He was originally sentenced to probation in
1994 as a result of conviction in a series of burglaries. His probation was violated when
he stole a carpenter’s level from his place of employment in 1997. He was admitted to the
Maine Correctional Center (MCC) on 12/31/97 and subsequently transferred to DCF.
During the interview assessment, the inmate reported that he was under the influence of
alcohol at the time of the original offense, but not the offense which resulted in the
violation of his probation. However, his recognition of the link between drinking and his
criminal behavior seems a recent phenomenon, occurring only since his present
incarceration. He stated that his probation was violated because his parole officer caught
him drinking at a wedding in contravention of his probation agreement. This is at odds
with official records indicating that his probation was violated for theft. With respect to
the original offense, he indicated that he and a friend were caught inside a motel room
where he asserts they had broken in to find a place to sleep.
The inmate’s official records detail a long history of offenses as an adult dating back to
1981. The offenses include four DWI/OUI convictions as well as several convictions for
theft. The inmate has been incarcerated six times previously in both county and state
facilities.
The inmate has been classified as medium custody since his arrival at MCC in 1997.

Substance Use History
The inmate recognizes that he has a severe drinking problem and characterized himself as
“an alcoholic” in the past. However, he tended to minimize the current seriousness of his
drinking problems, tending to localize them in the past. The inmate first tried cigarettes at
age 13, first using alcohol shortly after at age 13-14. He reports regular use of alcohol
beginning in high school at age 17and stated that he drank on weekends through college,
but stated that “it wasn’t in moderation.” He reports spending all his money on alcohol
and drinking up to a fifth of bourbon in a day.
The inmate states that he has only tried to stop drinking once, and that attempt began
following his being sentenced to probation. He indicated that since that sentence he has
consumed alcohol on two occasions over the last four years. He could not say why he
drank even though he knew it was hazardous for him to do so, and stated “I just got
caught up in the moment.” He reports drinking in a wide variety of situations, but states
that his drinking has reduced since he married. He indicated that none of his family have
problems with alcohol or other drugs. He acknowledged that alcohol consumption has
resulted in negative effects on his family relationships, school work, finances, and both
physical and mental health.

It should be noted that there were some discrepancies between the inmate’s account of his
drinking and indications in official records, with the inmate appearing to minimize the
extent of his alcohol consumption somewhat. There is also the suggestion in official
records that this inmate may be dependent on prescription medications (specifically
benzodiazepine tranquilizers and opioid painkillers), however the inmate did not identify
his use of these substances as being problematic.

Prior Treatment History

The inmate reported that he was treated at Eastern Maine Medical Center in 1997. He
stated that he completed the program, but official records suggest that he failed to follow
through with aftercare recommendations. His probation was violated and he was
incarcerated on the present sentence six months after his discharge. In addition, the
inmate reports that he has attended AA meetings in the past and stated that he found them
“extremely helpful.” He also stated that the program at Eastern Maine Medical Center
made him “realize a lot of things about myself.”

Pre-Program Interview Rating Scales

The inmate was assessed on five separate rating scales that were ranked at the end of the
comprehensive interview. The rating scales range from a score of 1 to 5 (generally
covering low to high ratings). The inmate was rated in the following manner:
1) Moderate recognition of substance abuse problems (3/5). The inmate
acknowledged that his drinking has created problems for him, but did not acknowledge any problems with other drugs that are documented in official records. He recognized the relationship between his drinking and criminal behavior, and further was able to recognize that alcohol use has had a negative impact on several life areas including: finances, personal relationships, and school.
2) Moderate insight into substance abuse problem (3/5). The inmate demonstrates
some insight into his problems with alcohol, but tends to minimize their current impact or seriousness. He has some recognition of the need to cope with high risk situations, but his responses to problem solving scenarios suggest that he needs a broader range of such coping skills. He tends to use simple avoidance tactics, but does have some knowledge of more direct, active coping strategies.
3) Moderate recognition of high risk situations (3/5). The inmate was able to recognize
high risk situations and to formulate reasonably adequate coping responses to several of them. However, his coping repertoire appears somewhat restricted and limited, and he could benefit from learning additional coping skills. Of special concern was his willingness to put himself in a very high risk situation (a bar) if invited to do so by a superior. 4) Moderate to good problem solving abilities (4/5). Although his solutions to high risk
situations tended to be restricted and limited he was able to generate likely very
effective solutions to several of the problem solving scenarios. He tended to employ
both “low level” avoidance strategies as well as more active coping strategies such as
drink refusal and cognitive rehearsal.
5) Low motivation (1/5). The inmate stated flatly that he does not need treatment. He
stated that he is confident that he can avoid drinking because he has no desire to drink
while incarcerated. This suggests that he does not clearly recognize the link between
drinking and specific environmental circumstances. He also does not appear to
recognize the need for continued vigilance and refinement of coping skills over time.

Assessment of Risk/Need:
The inmate received the following ratings on the key areas of his alcohol and drugs use:
Dependence (SADD)
Consequences (MAST)
Motivation Low
Dependence (SDS)
Consequences (DAST)
Motivation N/A/

Overall Substance Abuse Rating:
Despite his being, by his admission, “alcoholic” this inmate’s overall substance abuse
level is rated as low. He has clearly established a reasonable, positive link with AA and
appears to have better than average coping skills. An inmate with a low substance abuse
problem is at a low risk for recidivism (based on studies conducted with the Correctional
Service of Canada). It may be, however, this rating underestimates the severity of this
inmate’s problem drinking.

Treatment Intervention Needs/Level of Treatment
The inmate’s low level of substance abuse problems warrant a treatment intervention of
low intensity (Level II). This treatment begin with motivational enhancement to help
rekindle this inmate’s commitment to continuing changes he states he has already made
in his drinking. Treatment should begin inside the institution, shortly before release and
should continue into the community. It should focus on teaching additional coping skills
to supplement those this inmate already appears to possess. He is also approaching an age
at which substance users tend to begin to moderate their use, and to demonstrate less
florid associations between substance use and criminal behavior. This also suggests that a
low intensity intervention may be the choice at this point, and given the limited amount
of time in which to accomplish any additional learning.
Special Issues/Questions
Of some concern with this inmate is that he may be developing a cross addiction to
benzodiazepine tranquilizers and opioid pain medications. This situation should be
carefully monitored, even though there are clear medical indications for the use of those
medications.
Case Study: Three
Demographic Information
Case I.D. Number
Date of Birth
06/07/60
Education
High school graduate/GED
Marital Status
Occupation Construction
Age of First Arrest
Age of First Conviction
Current Offence(s)
Age First Substance Use
Substance(s) Used
Alcohol, cigarettes, marijuana
Questionnaire Summary Scores
Three Alcohol Tests
Test Name Test
Score/Level
Measured
Michigan Alcohol Screening Test
42-Severe
Consequences
Short-Form Alcohol Dependence Data
Questionnaire
34-Severe
Dependence
Stages of Change Readiness and
Treatment Eagerness Scale
39.9-High
(Socrates)
Motivation
Questionnaire Summary Scores
Three Drug Tests
Test Name Test
Score/Level
Measured
Drug Abuse Screening Test
20-Severe
Consequences
Severity of Dependence Scale
1) Cocaine: 1, Low
2) Marijuana: 2, Low
Dependence
Stages of Change Readiness and
Treatment Eagerness Scale
(Socrates)
Motivation
Case Study Three
Offense History
This 38 year old married inmate is serving a 5 year sentence at the Maine Correctional
Center (MCC) for OUI. He was sentenced as a Habitual OUI offender. The inmate was
admitted to MCC on 12/17/96.
During the interview assessment the inmate recounted that he was under the influence of
alcohol and prescribed psychiatric medications at the time of his most recent OUI arrest.
He was unable to recall the details of that arrest or the events leading up to it.
The inmate recognized that his substance abuse was a direct causal factor in his criminal
behavior. Official records reveal a long series of alcohol-related offenses dating back to
1979, including five OUI convictions, as well as convictions for manslaughter, breaking
and entering, assault, criminal threatening, eluding a police officer, aggravated forgery
and criminal trespass. The inmate reported that he has been under the influence of alcohol
or other drugs during every offense he has committed.
The inmate has been classified as medium custody since his arrival at MCC in 1996. This
appears due, at least in part, to the fact that in addition to substance abuse, the inmate has
been diagnosed as suffering from Bipolar Disorder, and is currently prescribed lithium,
Vistaril, and Zoloft, all of which require close psychiatric monitoring.

Substance Use History
The inmate recognizes that he has a severe substance abuse problem with both alcohol
and drugs. He reports first use of substances in the form of alcohol, marijuana and
cigarettes at age 9. He reports having experimented with nearly every psychoactive
substance available including marijuana, cocaine, heroin, Demerol, Dilaudid,
amphetamines, LSD, mescaline and mushrooms. He reported that his preferred drugs are
vodka, cigarettes, cocaine and marijuana. He reported that prior to his most recent
incarceration he was drinking and using cocaine daily, with alcohol being his primary
drug. He reported that his drug and alcohol use were pervasive, and not limited to any
particular situations or settings. He described his use as “waking up with and going to
sleep with it.” He described his lifestyle as “going to work, then to the liquor store, then
drinking all night.”
The inmate states that he made his first, unsuccessful attempts to stop using alcohol and
drugs in 1980, and that he has made many attempts since then, none resulting in more
than a month of abstinence except when he was incarcerated. He recognizes that his
alcohol and drug use has had a variety of negative effects on his life including legal
problems, family and relationship problems, some work problems, financial difficulties,
and numerous medical problems including a perforated ulcer, and broken bones suffered
while intoxicated. While in the Marine Corps he was involved in a drunken altercation
with an officer which led to him serving time in the brig. Nonetheless, he received an
honorable discharge from the Marines. The inmate reports that his father is an alcoholic,
and that all of his siblings have had problems with alcohol or drugs. He also reports that
everyone in his family is sober now, except him.
Prior Treatment History
The inmate reported having participated in a number of treatment programs in the past
with frequent admissions to the Togus VA and Seton Hospital. He was unable to recall
exactly how many treatments he has undergone. Official records indicate that he has been
treated for bipolar disorder since 1980 and has been hospitalized at Bridgewater State
Hospital, MA. He has also been detoxed several times. His hospitalizations have been
both for treatment of bipolar disorder, depressed and for treatment of substance abuse. In
addition to formal treatment, the inmate reports sporadic participation in AA in the
community, and stated that he has attended AA meetings on a weekly basis while
incarcerated at MCC.
Pre-Program Interview Rating Scales
The inmate was assessed on five separate rating scales that were ranked at the end of the
comprehensive interview. The rating scales range from a score of 1 to 5 (generally
covering low to high ratings). The inmate was rated in the following manner:
1) High recognition of substance abuse problem (5/5). The inmate is very willing to
admit to problems with alcohol and drugs, and explicitly made the link between his substance use and criminal behavior. The inmate further recognized how substances have negatively impacted on several life areas including all manner of relationships, finances, mental and physical health and legal difficulties.
2) Low insight into substance abuse problem (2/5). The inmate demonstrates a low to
moderate level of insight into his substance abuse problem, particularly with respect to the interaction of psychiatric illness with substance abuse. He has some recognition of the measures needed to avoid future problems, however his problem solving skills are quite limited. There are indications in his responses to problem solving scenarios that he still hopes that he can drink in the future, despite the many problems alcohol has created in his life. Confronted with a situation that involved a choice between driving while intoxicated and using other means to get home, he indicated that he would drive. 3) Moderate recognition of high risk situations (3/5). The inmate demonstrated a
moderate level of recognition of high risk situations and how they impact on his substance use behavior. However, he lacks adequate skills for responding appropriately to such situations, even though he recognizes them as problematic. Of some concern, as well, is the pervasiveness of his alcohol use, and its combination with severe mental illness. This suggests that he will require substantial assistance in learning to cope with a wide variety of potential drinking situations without drinking. 4) Low problem solving abilities (1/5). As noted, the inmate is able to recognize high
risk situations, but appears to have few coping skills with which to deal with those
situations in an effective manner. When he was able to respond with an effective
strategy to problem solving scenarios, these tended to be “low level” avoidance
strategies. Even these would seem to be of limited effectiveness as he would append
an indication of a continued desire to drink after his statement of a coping strategy.
5) High motivation to participate in treatment (5/5). The inmate was very willing to
participate in treatment, however he appears to be still quite ambivalent about
abstinence from alcohol. He reports a strong need for treatment, however he fails to
recognize that he may have to commit himself to abstinence and active coping with
high risk situations if he is to avoid future alcohol and drug related problems. He does
report having made and followed through on a continuing commitment to AA during
his incarceration.
Assessment of Risk/Need:
The inmate received the following ratings on the key areas of his alcohol and drug use:
Dependence (SADD)
Consequences (MAST)
Motivation High
Dependence (SDS)
Cocaine (Low)
Marijuana (Low)
Consequences (DAST)
Motivation Low

Overall Substance Abuse Rating:
The inmate’s combined substance abuse level is rated as severe, despite minimal
evidence of dependence on illegal drugs. He displays strong recognition of a need to
change his behavior, however, he is ambivalent as to abstinence as the best course of
action for himself at present. An inmate with a severe substance abuse problem is at a
high risk for recidivism (based on studies conducted with the Correctional Service of
Canada).
The correctional file review supports the finding of severe dependence complicated by
comorbid bipolar disorder, depressed.
The Maine Department of Corrections’ Initial and Reclassification Custody rating scale
ranked the inmate at 53 in 1996.

Treatment Intervention Needs/Level of Treatment

The inmate’s severe level of substance abuse problems, which are directly linked to his
criminal behavior, warrant a treatment intervention of high intensity (Level V). The
complicating factor of bipolar disorder makes him a likely poor candidate for a
therapeutic community (TC) intervention as he may have difficulty coping with the
pressures of total, confrontational milieu treatment. A more skills focused treatment
would be most beneficial while still maintaining a high degree of treatment intensity. Any
treatment needs to be preceded by a motivational enhancement component focused on
helping the inmate to become committed to abstinence as a viable treatment goal.
Treatment should be continued in the community with regular attendance at support
groups as well as professional interventions aimed at providing support and helping the
inmate to continue to engage in relapse prevention skills upon his release into the
community. Any treatment should include regular psychiatric assessment and medication
monitoring. In addition, antidipsotropic medications such as ReVia (naltrexone) should
also be considered as part of his treatment as he reports continuing urges to drink.
Special Issues/Questions

The presence of bipolar disorder complicates both the treatment delivery
recommendations and the likelihood of ongoing success at avoiding alcohol and drug
related problems once the inmate is released into the community. This comorbid disorder
mediates against a TC intervention as being most appropriate for this inmate as he may
not have the psychological resources to benefit from that sort of intensive,
confrontational intervention. In addition, the presence of bipolar disorder will require
close coordination between psychiatric and substance abuse treatment components both
inside the institution and in the community once the inmate is released. Transitional
services from institution to community will be essential in assisting this inmate to avoid
future alcohol and drug related problems and criminal behavior.
Case Study: Four
Demographic Information
Case I.D. Number:
Age: Thirty
Date of Birth:
06/03/66
Education: Some
Marital Status:
Divorced
Occupation: Construction
Age of First Arrest:
Age of First Conviction:
Eighteen
Current Offense(s):
OUI and Burglary
Age First Substance Use:
Fourteen
Substance(s) Used:
Marijuana, Alcohol, Pills
Questionnaire Summary Scores
Three Alcohol Tests
Test Name Test
Score/Level
Area Measured
Michigan Alcohol Screening Test
45 Severe
Consequences
Short-Form Alcohol Dependence Data
Questionnaire
25 – High
Dependence
Stages of Change Readiness and
Treatment Eagerness Scale
(Socrates)
32 – Recognition (Low)
Motivation
Questionnaire Summary Scores
Three Drug Tests
Test Name Test
Score/Level
Area Measured
Drug Abuse Screening Test
20 – Severe
Consequences
Severity of Dependence Scale
3) Cocaine: 07 – Moderate
4) Heroin: 12 – High
5) Valium: 02 – Low
Dependence
Stages of Change Readiness and
Treatment Eagerness Scale
(Socrates)
32 – Recognition (Low)
Motivation
Case Study #4

Offense History

The 30 year old inmate is serving a sentence of 4 years and 182 days at the Maine
Correctional Center (MCC) for operating a motor vehicle under the influence while a
revocation prohibiting such operation was in effect - pursuant to the habitual offender
law. In addition, the inmate was found guilty of three counts of theft (Class C crime).
The inmate was admitted to the MCC on January 18, 1994 with a projected release date
of July 6, 1995
During the assessment interview, the inmate recounted that he was under the influence of
heroin, alcohol, and valium at the actual time of his offenses. The offender stated that he
first stole a boat motor and placed it in the trunk of his car. A few days later, he was in a
car accident at which point he was charged for operating a vehicle while under the
influence and theft. This verbal description appears to correspond to the offense list
found on the inmate’s Universal Face Sheet.
The inmate’s criminal history covers a fifteen year period that dates back to 1984 when
he was found guilty of operating a vehicle under the influence. The inmate’s criminal
history reveals a consistent pattern of offenses that are mainly linked to driving offenses
(e.g., OUI’s and habitual offender charges) as well as property offenses (e.g., theft and
burglary). The offender spent time in CCJ three times between 1984 and 1989, the
remainder of his sentences were served in the adult correctional system.
The offender has been classified at the medium custody level since his arrival at MCC in
1996.
Substance Use History

The inmate recognizes that he has a substance abuse problem with both alcohol and drugs
and specifically identified the following problem areas of abuse: heroin, valium,
percodan, tylenol and alcohol (vodka). The inmate openly admits that his substance
abuse problem is directly linked to his incarceration. The inmate started using alcohol
and drugs at age 14 when he used substances once a week. By the time the inmate turned
17 years old he began using alcohol and drugs on a daily basis. The inmate followed his
pattern of everyday drug use, mainly tranquilizers (Xanax) and alcohol (Vodka), while he
was last in the community in 1996. The inmate also noted that he was using illicit drugs
during his current sentence.
The inmate states that his single attempt at quitting alcohol and drugs was unsuccessful.
He did not elaborate on the circumstances under which he attempted to quit using. The
inmate stated that his natural parents were alcoholics but were both abstinent for at least
the last six years. The inmate was raised by his maternal grandparents (who do not have
a substance abuse problem) from the time he was a few months old. The inmate admits
that his alcohol and drug use had a negative impact on several areas of his life, including
dropping out of high school, divorce from his ex-wife, and fines and loss of license due to
driving offenses.
Prior Treatment History

The offender has attended five alcohol treatment programs since 1989. His records do
not reveal any involvement in treatment that targets licit and illicit drugs (e.g., heroin,
painkillers, valium) despite the inmate’s abuse of these substances since his early teens.
The inmate’s official records indicates that he continued to use alcohol throughout his
treatment history.
It is worth noting that a contradiction arose between the offender’s official correctional
records and some of the information discussed during the assessment interview. More
specifically, the offender denied any prior involvement in substance abuse treatment
despite that fact that his Universal Face Sheet identified five separate occasions when he
received alcohol treatment inside prison and while in the community.
Pre-Program Interview Rating Scales

The inmate was assessed on five separate rating scales that were ranked at the end of the
comprehensive interview. The rating scales range from a score of 1 to 5 (generally
covering low to high ratings). The inmate was rated in the following manner:
1) High recognition of substance abuse problem (5/5). The inmate is very willing to
admit to his problems and explicitly made the link between his criminal behavior and
substance abuse problem. The inmate further recognized how substances have negatively
impacted on several areas of his life, including: school, family, and finances.
2) Low insight into substance abuse problem (2/5). The inmate demonstrates a fairly
low level of insight regarding the cause of substance abuse and little insight on what he
should do to avoid the problem. The inmate’s lack of insight was best demonstrated
when he stated he would drink and drive as a solution to one of the problem solving
scenarios that were covered during the interview. However, the inmate should be
credited for recognizing that his substance abuse directly contributed to his criminal
behavior. In addition, the inmate admitted that alcohol and drugs had a negative impact
on his family, school, and finances.
3) Low recognition of high risk situations (1/5). The inmate has very little
understanding regarding what are his high risk situations and how they impact on his
substance using behavior. The inmate’s pattern of being unaware of his high risk
situations was evidenced throughout the interview. The inmate characterized his use
pattern as taking place “everywhere” and “any time of the day”. This generalized pattern
is in contrast to individuals that have insight into specific high risk situations (e.g., being
alone, being with other people, when depressed).
Research demonstrates that the five most common high risk situations that are linked to
relapses include: negative emotional states; interpersonal conflict, social pressure;
positive emotional states, and cravings. Overall, the inmate was not aware of these high
risk situations (or others) and how they impact on his behavior.
4) Low problem solving abilities (1/5). The inmate responded to five problem solving
scenarios over the course of the interview. The inmate employed negative or socially
inappropriate responses (e.g., driving home while intoxicated) or ineffective strategies
(e.g., staying in the presence of drug using friends) to handle the various problem
scenarios. The inmate’s weak problem solving skills is exacerbated by the fact that there
is a high number of driving offenses in his criminal history.
5) High “External” Motivation (4/5). The inmate’s motivation is assessed as “high”
based on his statements that he “needs treatment badly” and his admission of his pattern
of substance abuse and criminal behavior. This type of motivation appears to be
externally driven (i.e., the inmate’s primary motivation is to avoid future incarceration) as
opposed to an internal driver (i.e., the inmate’s internal understanding and appreciation of
the need to change his behavior).
Assessment of Risk/Need

The inmate received the following ratings in the key areas of his alcohol and drug use:
Dependence (SADD)
Consequences (MAST)
Motivation Recognition
Dependence (SDS)
Cocaine (High)
Heroin (High)
Valium (Moderate)
Consequences (DAST)
Motivation Recognition

Overall Substance Abuse Rating:
The inmate’s combined substance abuse level is ranked as severe. He displays
recognition of the need to change his behavior but at a low level of insight into his
problems. An inmate with a severe substance abuse problem is at a high risk for
recidivism (based on studies conducted with the Correctional Service of Canada).
The correctional file review supports the finding a severe dependence. For example, the
inmate is identified as an alcoholic in the “Special Needs/Risks” category of his
Universal Face Sheet. Hospital records show that the inmate experienced alcohol
withdrawal seizures during a period of incarceration in 1989. Furthermore, liver damage
was detected at this time.
The Maine Department of Correction’s Initial and Reclassification Custody rating scale
ranked the inmate at 33 in 1997.
Treatment Intervention Needs/Level of Treatment

The inmate’s severe level of substance abuse problems (which are directly linked to his
criminal behavior) requires a high intensity treatment service (Level V). This treatment
should begin at the institution and extend into the community.
This inmate is a good candidate for treatment based on his willingness recognize he has a
substance abuse problem despite his low level of insight into the causes and possible
solutions to his problem. The inmate weak problem solving abilities and lack of
knowledge about his high risk situations could be directly addressed in a skills based
treatment program.
Special Issues/Questions

Institutional Behavior
During his current sentence, the inmate was found guilty of two disciplinary charges,
consisting of two positive urinalysis test for marijuana use.
Case Study: Five
Demographic Information
Case I.D. Number:
Age: Twenty-Nine
Date of Birth:
25/09/69
Education: High
School/GED
Marital Status:
Single, never married
Occupation: Construction
Age of First Arrest:
Nineteen
Age of First Conviction:
Nineteen
Current Offense(s):
Age First Substance Use:
Substance(s) Used:
Alcohol (Rum), Cigarettes
Questionnaire Summary Scores
Three Alcohol Tests
Test Name Test
Score/Level
Area Measured
Michigan Alcohol Screening Test
27 (Severe)
Consequences
Short-Form Alcohol Dependence Data
Questionnaire
25 (High)
Dependence
Stages of Change Readiness and
Treatment Eagerness Scale
(Socrates)
44 - Recognition (High)
Motivation
Questionnaire Summary Scores
Three Drug Tests
Test Name Test
Score/Level
Area Measured
Drug Abuse Screening Test
14 (Substantial)
Consequences
Severity of Dependence Scale
1) Marijuana 04 – Low
2) Hashish 03 – Low
3) Cocaine 01 – Low
Dependence
Stages of Change Readiness and
Treatment Eagerness Scale
(Socrates)
43 – Recognition (High)
Motivation
Case Study #5

Offense History

The 29 year old inmate is serving a sentence of 70 years at the Maine State Prison (MSP)
for committing murder. The inmate was admitted to the MCC on April 19, 1990 with a
projected release date of June 6, 2048. During the assessment interview, the inmate
stated that he was under the influence of alcohol, marijuana, and PCP at the time of his
offense. The inmate went on to recount that the crime took place during the winter of
1989 when he was unemployed and “hanging around the wrong people”. During the
actual day of the offense, the inmate was drinking and using drugs with a friend while
they were ice fishing. The two decided to break into a nearby cottage where they found a
woman inside, and then they proceeded to murder the victim.
The inmate’s verbal description of the crime matches the official record in that he
admitted to committing murder. The inmate’s verbal description does not acknowledge
the seriousness and violence associated with his offense. For example, the police report
notes that the victim’s body was beaten and stabbed to the point whereby the victim
could not be immediately identified due to the trauma. In addition, the Maine Division of
Probation and Parole’s Pre-Sentence Investigation (1990) notes that, “…reports indicate
[the inmate] continues to minimize his actions during this offense, and each interview
with the police and psychologist has produced a different version of events”.
The inmate had no prior criminal history before committing the murder. The inmate is
the fourth of six children who grew up with his parents and family in Maine. He
graduated from high school in 1987 and moved out of the family home to live in an
apartment with his brother and a friend (i.e., the co-defendant in the murder). The inmate
held several unskilled laborer positions following his graduation from high school (and
prior to his arrest in January 1989).
The inmate has been classified at the maximum custody level since his arrival at MSP in
1990.
Substance Use History

The substance abuse history covered during the assessment interview is fairly consistent
with official records although more detailed information was collected during the face to
face assessment interview. For example, the inmate states that he first used alcohol and
drugs at age 11 whereby he used alcohol (rum) and drugs (marijuana) on a weekly basis.
The inmate admits that he has a substance abuse problem, particularly with alcohol. The
inmate mentioned early alcohol use, difficulty in stopping his use, early age of first use,
and lack of control as factors that lead him to believe he has a problem.
The inmate reports that the last time he used substances regularly was between 1988 and
1989 (prior to arrest). During this period, the inmate recalls that his use had increased
from a once weekly pattern to a daily pattern with both alcohol (beer and whiskey) and
drugs (marijuana and hashish). When asked if he plans to continue at this level in the
future the inmate responded, “I hope not”. The inmate went on to view his past use in a
more serious tone by stating that he understood the danger of abuse (negative effects on
himself and his family). The inmate went on to say that he viewed himself as having a
“serious” substance abuse problem that has impacted on several areas of his life (e.g.,
relationships, family, friends, finances).
The inmate stated that alcohol and drugs contributed to the offense he was charged with
committing and stated that alcohol changed his personality (i.e., caused him to become
agitated, angry, tense).
The inmate made two attempts to quit using, including one attempt to join Alcoholic
Anonymous, but always returned to use due to cravings and peer pressure.
Prior Treatment History

The inmate has not been involved in any type of formal substance abuse treatment
services (with the exception of attending a few AA meetings) since arriving at MSP. The
inmate was not involved in treatment prior to incarceration. Several reports
(Classification Department and Psychological Services) contain recommendations for the
inmate to get involved in substance abuse counseling.
Pre-Program Interview Rating Scales

The inmate was assessed on five separate rating scales that were ranked at the end of the
comprehensive interview. The rating scales range from a score of 1 to 5 (generally
covering low to high ratings). The inmate was rated in the following manner:
1) High recognition of substance abuse problem (4/5). The inmate is very willing to
admit to his alcohol and drug problems. The inmate recognizes the link between
substance abuse and crime although he was reluctant to acknowledge the seriousness of
his offense. The inmate also recognizes that substances have negatively impacted on
several life areas, including relationships, family, and finances.
2) Low insight into substance abuse problem (2/5). The inmate has a low level of
insight regarding the cause of substance abuse and little insight on what he should do to
avoid the problem. The inmate’s strengths are that he realizes that he craves alcohol (and
drugs) and his substance abuse has had a negative effect on his life, including his current
incarceration. At the same time, the inmate does not appear to know how to deal with
the causes of his substance abuse (e.g., cravings and peer pressure). In fact, the inmate
placed himself directly in high risk situations with drug using friends in the problem
solving scenarios.
3) Moderate recognition of high risk situations (3/5). The inmate has a moderate level
of recognition of his high risk situations. The inmate recognized a number of situations
that are linked to his abuse, including cravings, peer pressure, and heightened stress
levels. The inmate does not appear to appreciate the actual risk associated with these
situations in a detailed fashion. Currently, the inmate can superficially identify a few
events but more time must be spent on detailing and understanding his high risk
situations.
4) Low problem solving abilities (2/5). The inmate primarily resorted to negative or
socially inappropriate coping skills when faced with the problem scenarios. For example,
the inmate discussed using drugs, driving while intoxicated, and quitting a job as options
for dealing with various problem solving scenarios. The inmate’s solutions often
appeared to be impulse driven (e.g., quitting a job) instead of working through a series of
steps and testing alternative solutions when faced with a high risk situation. The inmate
did identify some passive coping skills (e.g., leaving the room) as well as one instance in
which a range of coping options were considered (e.g., avoid the situation or doing
something else such as running or lift weights).
5) High Motivation (4/5). The inmate’s motivation is assessed as “high” based on his
statements that he “needs treatment badly” and his willingness to recognize that he has a
serious substance abuse problem.
Assessment of Risk/Need

The inmate received the following ratings in the key areas of his alcohol and drugs use:
Dependence (SADD)
Consequences (MAST)
Motivation Recognition
Dependence (SDS)
Marijuana (Low)
Hashish (Low)
Cocaine (Low)
Consequences (DAST)
Substantial
Motivation Recognition

Overall Substance Abuse Rating:
The inmate’s combined substance abuse level is ranked as severe. An inmate with a
severe level of substance abuse problems is at a high risk for recidivism (based on studies
conducted with the Correctional Service of Canada).
The Maine Department of Correction’s Initial and Reclassification Custody rating scale
ranked the inmate at 37 in 1998.
Treatment Intervention Needs/Level of Treatment

The inmate’s severe substance abuse problems requires the most intensive treatment
service available (Level V). Given the lengthy sentence for the inmate, the majority of
his treatment can be initially directed at the institutional level with long range planning
for community treatment.
Special Issues/Questions

Institutional Behavior
The inmate has one incident report whereby he was found guilty of a Class “A” violation
(Demonstration) resulting from a incident that occurred on August 31, 1997.
Case Study: Six
Demographic Information
Case I.D. Number:
Age: Thirty
Date of Birth:
26/11/65
Education: Some
Marital Status:
Separated/Divorced
Occupation: No
Response
Age of First Arrest:
Eighteen
Age of First Conviction:
Eighteen
Current Offense(s):
Age First Substance Use:
Fourteen
Substance(s) Used:
Cocaine, Alcohol, Marijuana
Questionnaire Summary Scores
Three Alcohol Tests
Test Name Test
Score/Level
Area Measured
Michigan Alcohol Screening Test
24 (Severe)
Consequences
Short-Form Alcohol Dependence Data
Questionnaire
Dependence
Stages of Change Readiness and
Treatment Eagerness Scale
(Socrates)
35 –Taking Steps
Motivation
Questionnaire Summary Scores
Three Drug Tests
Test Name Test
Score/Level
Area Measured
Drug Abuse Screening Test
9 (Moderate)
Consequences
Severity of Dependence Scale
Cocaine 07 – Moderate
Marijuana 05 – Low
Dependence
Stages of Change Readiness and
Treatment Eagerness Scale
(Socrates)
33 – Taking Steps
Motivation
Case Study #6

Offense History

The 32 year old inmate is serving a sentence of 20 years (and 4 years probation) at the
Down East Correctional Facility (DCF) for committing manslaughter. The inmate was
admitted to the DCF on July 10, 1992 with a projected release date of July 7, 2001.
During the assessment interview, the inmate claims that he was under the influence of a
½ gallon of vodka at the time of the offense. The inmate went on to recount that the
crime could be traced to his decision to go to a bar with his girlfriend on New Years Eve
1990. At the time, the inmate and girlfriend were living together in a shared apartment.
Once the couple arrived at the bar the inmate stated that his girlfriend became jealous
because he was speaking to another woman. His girlfriend then met another man and
proceeded to bring this man home to their apartment. The offender returned home to his
apartment and during an ensuing fight with the girlfriend’s new male acquaintance, the
offender stabbed the man. The actual stabbing took place during the early morning of
January 1, 1991.
The inmate’s verbal description of the crime matches the official record in that he
admitted to committing manslaughter. The inmate provided details surrounding the
offense but did not provide information on the actual offence. The official version of the
crime includes the inmate’s attempts to conceal the body of the murder victim, to deny
involvement in the crime, to provide false identity to the police, and to provide various
misleading accounts of the crime before admitting guilt. The official records show that
the defendant expressed remorse at the time of the conviction. However, court officials
characterized this response as “questionable sincerity” given that the inmate boasted
about the crime to fellow inmate following his conviction.
The offender’s criminal history includes several periods on probation since 1986 for a
series of criminal convictions (e.g., theft, motor vehicle convictions, probation
violations). The inmate has a very problematic personal history that includes
abandonment as an infant, several years in State custody (as an child and adolescent),
residence in several foster homes, a failed adoption, and periods of psychiatric care
(residential and out-patient). The inmate has received psychiatric treatment since the age
of 4 years old and has been diagnosed with various psychiatric disorders (e.g.,
hyperactivity, conduct disorder and attention deficit syndrome). These behavioral
problems are linked to the inmate’s history of aggressive behavior and fascination with
knives for the purpose of defense and intimidation. The offender dropped out of school
at grade 11 and has had very little employment history.
A 1992 report from the Maine State Prison’s Psychological Services Department
provides a review of the inmate’s lengthy history of behavioral and emotional problems
(already discussed), including his history of substance abuse problems. The 1992 report
notes that the inmate does not a have a major psychiatric disorder but episodes of acting
out and impulsive behavior are likely to occur. Finally, the report recommends the
inmate’s ongoing need for medication and psychiatric care as well as substance abuse
counseling.
The inmate has been classified at the medium custody level since his arrival at the DCF
in 1998, prior to this time he was classified at a maximum custody level.
Substance Use History

The inmate opened the interview by stating that he thought he might have a substance
abuse problem right now but it was not a great temptation due to lack of availability of
alcohol and drugs. He stated that he would probably use alcohol and drugs “right now” if
he was on the street. The inmate stated that he was able to stop drug use at “any time”
while he was on the street. As a result, he viewed himself as having only an alcohol
problem.
During the interview, the offender stated that his alcohol abuse was directly related to his
crime. The offender recounted that at the age of 19 he only used drugs occasionally (bi-
weekly) while his drinking took place every weekend. The inmate associated his
drinking as taking place with friends, on weekends, and at bars. The offender was
ambivalent about characterizing his substance abuse problem as serious. At times, the
inmate did recognize the seriousness of his problems with statements such as “I was
hooked on it” and “I would use if I returned to the street”.
The inmate stated that he tried quitting once while inside prison and that he has been
successful at achieving abstinence for seven years. The inmate noted that with the
exception of AA (which he does not like), he has never been involved in any substance
abuse treatment due to his “strong will” and in state of independence. The inmate
acknowledged that alcohol abuse had a negative impact on his relationships and work.
Prior Treatment History

The inmate has not been involved in any type of formal substance abuse treatment
services (with the exception of attending a few AA meetings) since his incarceration.
The inmate was not involved in substance abuse treatment prior to incarceration. Several
reports (Classification Department and Psychological Services) contain recommendations
for the inmate to get involved in substance abuse counseling.

Pre-Program Interview Rating Scales

The inmate was assessed on five separate rating scales that were ranked at the end of the
comprehensive interview. The rating scales range from a score of 1 to 5 (generally
covering low to high ratings). The inmate was rated in the following manner:
Low recognition of substance abuse problem (2/5). The inmate partially recognizes his
substance abuse problems. The inmate expressed ambivalence about the degree of
seriousness associated with his substance abuse problem despite the lengthy history of
substance abuse documented in the official records. This low level of recognition is
somewhat surprising given that the inmate recognized that alcohol abuse was at the root
of his offense. There were time during the assessment interview when the inmate did
admit that he had a alcohol problem (“I would use on the street”), including recognizing
the negative impact that alcohol had on his relationships and work.
2) Low insight into substance abuse problem (2/5). The inmate has a low level of
insight regarding the cause of substance abuse and little insight on what he should do to
avoid the problem. The inmate’s strengths are that he recognizes some of the situations
where alcohol abuse has been a problem in the past. However, the inmate appears to
attribute his problem to issues of willpower alone and independence without exploring
gaining control over his emotional and behavioral problems, including his impulse driven
behavior.
3) Low recognition of high risk situations (3/5). The inmate has a low level of
recognition regarding his high risk situations. The inmate recognized a few events and
places (e.g., weekends and bars) associated with his alcohol abuse but fails to recognize
how his personal history (e.g., aggressive behavior patterns, acting out, problematic
relationships, limited academic and work skills) have impacted on his substance abusing
behavior.
4) Low problem solving abilities (2/5). The inmate mainly relied on socially
inappropriate and ineffective coping strategies to deal with the problem scenarios. For
example, on three of five occasions the inmate chose to enter directly into a high risk
situation (e.g., birthday party, bar, party) without employing realistic coping strategies or
avoiding the situation altogether. For example, the inmate notes that he would go into
bar but not drink or stay with drug using friend but refuse to use. On some occasions the
inmate attempted to identify single coping strategies (e.g., asking for a drive to avoid
drinking and driving) to deal with the problem scenarios.
5) Low Motivation (2/5). The inmate’s motivation is assessed as “low” based on his
ambivalence about the seriousness of his substance abuse problem. The inmate’s
ambivalence is demonstrated with his early statement that he does not require treatment
to a later statement whereby he agrees that he “needs treatment to some extent”.

Assessment of Risk/Need

The inmate received the following ratings in key areas of his alcohol and drugs use:
Dependence (SADD)
Consequences (MAST)
Motivation
Taking Steps
Dependence (SDS)
Cocaine (Moderate)
Marijuana (Low)
Consequences (DAST)
Moderate
Motivation Taking

Overall Substance Abuse Rating:
The inmate’s combined substance abuse level is ranked as substantial. An inmate with a
moderate level of substance abuse problems is at a substantial risk for recidivism (based
on studies conducted with the Correctional Service of Canada). It should be noted that a
comprehensive needs/risk assessment must be conducted to adequately address the
inmate’s overall level of risk.
The Maine Department of Correction’s Initial and Reclassification Custody rating scale
ranked the inmate at 56 in 1998.
Treatment Intervention Needs/Level of Treatment

The inmate’s substantial substance abuse problems requires a substantial intensity
treatment program (Level IV). The inmate’s past level of support in the community
stresses the important of a treatment plan that includes institutional and community
planning.
Consideration should also be given to offering a specialized treatment service for this
inmate, given his lengthy history of emotional and behavior problems, particularly a
substance abuse program that directly addresses anger and emotions management.
Special Issues/Questions

Institutional Behavior
The offender’s Classification reports reveals numerous disciplinary charges (e.g.,
assaults) and job suspensions since 1992. His recent institutional behavior has improved
as evidence by his current custody classification as medium.
Psychological Services The offender’s lengthy history of emotional and behavioral problems must be addressed in relation to his substance abuse treatment. For example, the treatment providers should closely monitor the offender’s emotional state as well as working in cooperation with psychological services to ensure proper overall treatment. Drug Dependence Treatment should explore both alcohol and drugs (based on the psychometric results) despite the offender’s contention that he has an alcohol problem alone.

Source: http://www.maineosa.org/pubs/correct/1999/dsat99case.pdf