Hi, my name is Tina Nadeau and I'm the Chief Justice of the New Hampshire Superior Court. I was fortunate enough to be in Reno with some specialists on addiction psychiatry and other judges and we had a chance to get together and talk about the nature of addiction and how we need to be understanding it and addressing it in our courtrooms. And in this module, you'll hear from Dr. Moreland about several things, about trauma and how that affects recidivism, about family systems and how important they're to recovery and about restorative justice and how that can assist us in making sure that we are addressing the needs of people with substance use disorder. So, when you listen to this module, I want you to keep in mind something that I think we hear in the courtroom from time to time. And what we hear sometimes is someone who says, "I know somebody who suffered from sexual abuse trauma or from physical abuse from their parents and they've gone on to become a doctor. So, if they can do it, anyone can do it." Unfortunately, that's the exception and not the rule and what we need to do as judges is to listen to and understand the science around trauma and how deeply trauma can affect someone's ability to recover from substance use disorder and how we need to make sure that the trauma is treated as well as substance use disorder. So, you'll learn about these and many other issues in this module, enjoy. Oh, I'm super excited today to join all of you to talk a little bit about something that's really important to me. And I will say in this particular time right now, it's interesting and I think timely as we're having discussions in the era of COVID-19 about how to best manage and employ humane practices in the prisons and jails and of course, hot topic currently is whether or not non-violent individuals who are incarcerated should be released to create the space to allow for the public health measure of physical distancing to happen. And so it is an interesting question, some states are a little bit more ahead of the curve on others, but the argument can be made that individuals... If we're applying the public health measures to schools and to jobs and to places of business and to the homes and society that our incarcerated population should have those same measures employed. So, it's an interesting discussion, today, I've been asked to kind of talk about the intersection of many things, going to talk about trauma, addiction, relationships, restorative justice, reintegration and recidivism and I've tried to really tell a story, I will say that a number of the topics that we'll discuss, this is what I would consider to be a have you considered moment to make very thoughtful suggestions on the way forward for how we take a system and the criminal justice system in this particular instance. I will use it interchangeably, but when I talk about the criminal justice system, I'm referring to very specifically policing at every level, prisons and jails, lawyers, jail sentencing, all the way up to community supervision as ran by probations and parole. So, I know I'll spend a lot of time talking about community supervision but I can't do that absent of talking about the criminal justice system so we'll address many parts of that and we'll end with giving a conclusion about sort of some concluding thoughts about what each system in particular judges, lawyers can do to consider making some changes. I don't have any relevant disclosures to make at this time. By the end of this talk, I hope you'll be able to understand the family as a system of care, to really comprehend the role of trauma and addictions as threats to reducing recidivism, to appreciate the complexities and contradictions of restorative justice, reintegration and recidivism and then to really look at the current policies and practices that may intentionally or unintentionally compromise the family as a system of care. And when I talk about at the end of the day, really what I'm talking about when I talk about family as a system, is I'm talking about relationships and in the context of the work that I believe that we all seek to do and what compelled us to come to the table to consider listening to a talk like this is that we're looking at family and what family means to the individual, so I always ask, well, who is family? Who do you consider to be family? But at the end of it, family is relationships and relationships at its core means the state of being connected and so with that being said, I think it's critical to state that every human being, I don't care who you are, incarcerated, non-incarcerated, every single living human being in every part of the world seeks to be connected and it is required. Connection is required in order for us to persist, to be well and to continue to thrive as human beings. So, that is core to I think the conversation and where I want to go. So, as I was saying as we're working to really work to set the context, a part of what I was trying to explain is that we've got two very important systems here, the family as a system and then as I've described, the criminal justice system which includes policing, prisons, jails, lawyers, sentencing judges and of course, probation and parole. So, it's all of that. So, I'll use sort of criminal justice interchangeably, but we'll talk more specifically about community supervision which I think is really, really important in giving many of the nation's criminal justice reform efforts, we are going to be moving in the very near future to more community-based supervision. So, it really is an opportunity for us to reconsider, reevaluate and to think about what we could and might be able to do a little differently to ensure that the system gets the outcome that it desires. So with that, as we had discussed, a number of the stats are concerning, but one of the most concerning is that a large portion of our nation's prisoners are parents. About 52% are in state prisons and about 63% are in federal prisons and then the Bureau of Justice estimated in 2007, their estimates indicated that our nation's prisoners or incarcerated report, they report having an estimated 1.7 million minor children. So, my question is if parents are incarcerated, where are their children? What are happening? And what we can see are the downstream impacts of parents being incarcerated, it has implications for our community, for society, for department of human services in communities and for child and child protective custody, these types of things and so what we have are two very important systems of family as a system and the criminal justice system and in order for the criminal justice system to adapt and change, it must have and take into consideration family as a system and also bringing a better understanding of that system as a means of improving its service to the folks that it seeks to serve, but also in order to improve in outcomes. Remember we talked about beginning relationships, the very important aspect of being connected and belonging as core, as core to any family, but core to any human being and core to any change process is going to happen, it has to be consideration for family and connection. So, to drive this point home a little further, there're particular slides that set the context, I think I found this one very interesting, there was a lot of debate when I actually pulled this slide up at the National Judicial College and a part of it was as folks were really sort of wanting to debate, "Well, what is it? What do you mean by technical violations?" And it can mean different things for different jurisdictions, but here's the main point that I want to make and I think it should cause all of us to pause and to consider whether or not the system is doing what it should be doing at this particular point and if, just maybe if we have a point of consideration that something could change for the better. So, as we look at this slide, we're looking at individuals who went from either probation or parole, probation is represented in the slides to the left and parole is represented on the right. And on your x-axis, you have the different sort of populations of individuals, so you have folks who were formerly incarcerated, who were on probation, who had a new sentence and were then re-incarcerated and then look at the proportion of folks who had no new, no new crimes or didn't do anything else, but for the same basically sentence essentially went back to being incarcerated and then folks who went from drug and alcohol treatment or any form of treatment that then went back to incarceration and then of course, the other unknown are things around, you didn't show up for court for various reasons or you didn't show up to a treatment program. Concerning to me is all of it, but the proportion of folks that have the same sentence treatment and then other unknown who went from being on probation back to being incarcerated, the question that I ask and looking at this data it popped out to me is, "Whoa, what are we missing here? Are there upstream factors that we haven't considered? Are there things that we just have not done to really support this particular population and helping them move to the intended goal of reducing recidivism?" And the answer to that in my mind is yes. I mean, I'm also concerned with the fact that there were new sentences. Are the structures and things that set in place for folks when they re-enter into a community, are they sufficient? Are we supporting them well enough? Again, there're multiple, multiple questions that come up. Similarly, you see the same trend for folks who went from parole to incarceration and again, the trend runs similar for folks who didn't have any new charges or sentences, you can see here that it represents the largest group of those who went back from parole back to being incarcerated treatment and then other unknown, if we clump all three of those subgroups together, it represents a large portion of the population that once were on parole and then went back to being incarcerated. Again, it begs the question, have we done enough? Have we considered the upstream factors that contribute to this? And might there be an opportunity to make some adjustments? In this second slide, you can see the Bureau of Justice Statistics continues, it looks at individuals who are rearrested for a similar... So essentially, if you were incarcerated for a low-level drug crime and you got out and then you essentially, three years later or two years later or a year later ended up with another drug offense. Let's just look at this, it's very interesting. You see that for drug offense, 51%, public order, 50%, property, 45% and violent crimes 25%, it's interesting because I would say this is that folks who usually were concerned about violent, folks who were incarcerated for purposes of their crimes were violent, most folks are concerned about them getting out, but they tend to do a little better interestingly enough once they are out for multiple reasons, but more concerning and I think more interesting is highlighted the fact that individuals with drug offenses who end up going back to prison after being released, again it begs the question, are we doing enough? There're specific assessments and things that are done, are folks getting any treatment? Are they sufficiently getting the mental health services that they require? Are there additional things that could be be done both pre-release and in post, sort of post incarceration supervision that could help to really effectively reduce these numbers? Those are the kinds of questions that I am posing and asking us all to consider today. So, when we think about the goals of community supervision, there're many, but if we were to sort of boil them down for the purpose of being judicious with our time, really the goals of community supervision are to reduce recidivism, to make sure that the public can be safe and by the way, public safety is also public health so I believe that all public safety should be viewed from a public health frame and we could actually all be doing a lot better, but it also is about restoring families. We talked about at the very beginning and I'm going to present some data later on about how ensuring that connectedness, relationships, belonging, that they are all incredible, incredible pieces to helping the criminal justice system really move towards its goal of keeping people out of the system, of restoring safety, of reducing recidivism. So, to that end, I want to talk a little bit about some of the basic core principles of community supervision, their core correctional practices and it's actually very interesting. I do a lot of work in the trauma-informed space and trauma-informed... We'll talk again, we'll have some time to kind of touch on what that is, but the core correctional practices at base interestingly enough, actually have some very important trauma-informed aspects and it's all ready. So, I just want to briefly go through these because I want to make a point that a lot of the things that the system needs, it already has, it just might not be optimally using. So, I want to encourage us to actively think about what's already in place. So, these core correctional practices, there is appropriate use of authority. I think when people think of the word authority, oftentimes it can feel a little bit adversarial and cause tension, but interestingly enough in the core correctional practices, it encourages parole officers and probation officers in community supervision who are doing... Basically, it wants them to employ a direct, respectful approach, but get this, that leaves room for intermittent negotiation, so it leaves room for bi-directional exchange. Well, what we know from being trauma-informed is allowing others to share in the decision-making and to have something to say in that process actually improves the risk that they will do what you're asking them to do. Then there also is in the core correctional practices or what I'm going to refer to as CCPs moving forward, is the appropriate modeling and reinforcement. But there is room for role plays and to model the kind of behavior that they seek so in other words, is this basic principle that I am more likely to be able to facilitate healing and to facilitate change if I myself as the individual who's doing the facilitating is also open to healing and also open to change. So again, it feeds off of this bi-directional exchange, it's a parallel process. Core correctional practices has already acknowledged this in their strategy. However, I'm not sure that it's always adhered to and there's an opportunity here to get back to some things that are actually already in writing and codified within the context of the criminal justice system. So, there's also the structural learning process. Now, the piece that I will point out here is that a lot of the community supervision models are heavily based on cognitive behavioral therapeutic model. Now, the interesting piece about that is that it really indicates that there is an assumption, the system makes the assumption that everyone who is participating in it is cognitively intact or cognitively ready to participate actively and I'm going to challenge that thought a little bit. Again, this is an opportunity to rethink how we do what's done, all for the sake of improving the ability to be more effective in the system doing what it's set out to do. And then more on the CCPs, there's effective use of community resources. It involves essentially evaluating basic need of an individual and then getting them appropriately connected to the resources. I didn't make this up, this is already a part of core part of CCPs. And then the relationship factors. The relationship factors, also very much a part. It focuses on connection and empathy and acknowledges the importance of relationships. And it matches quite nicely with Maslow's hierarchy of need, we all know that at the base of that triangle, before you can ever reach the acme of self actualization which is the top of that triangle or pyramid, whatever you want to call it, there're basic needs, food, water, shelter, safety, but more importantly, belonging, connection. Very important, all connected. So, I got to be able to eat, I should have a roof over my head, I should be able to have good sleep, there should be a sense of safety and I should be connected. All of those things increase the risk that I will then can get to at least touch the surface of self actualization. All of these are already in the CCPs, how do we get there? I think that there's some training and coaching that's going to be required for the criminal justice system to get in there, that's going to be my core argument at the end is that, if we can get consistent in what we do, if there's a shared understanding, if there's a shared understanding of both the need to change and the need to make some readjustments, where there's a will, there's a way. So, we know that needs met equals lower risk of recidivism and in this case, I want to offer that when I talk about recidivism, I'm talking about the risk of re-incarceration one year after release which is the working definition of recidivism. And then there are principles of effective intervention, all are part of CCPs as well, but here's one of the tools and maybe a wild idea that I'm going to throw out there. When we think about principles of effective intervention already in play in terms of when folks are pre-released and they know they're going into community supervision, there is a tool that is used, it is a case management Level of Service Inventory. It is a validated tool, they have a youth version as well, the Youth Level of Service Case Management Inventory as well, but this LSI or the Level of Service, it assesses 10 different domains. So, this is information already used. It is a requirement, a prerequisite that many of the folks are using in the system before folks go into community supervision or as a part of a requirement for them to engage in community supervision. So, you've got legal... These are the parts of the domains that are assessed, legal, history, education, employment, financial, family, marital, accommodation, leisure, recreation, companion, alcohol and drugs, emotional, personal and attitudes and orientation. It's actually quite comprehensive. You can get a total score of 54 and here's what we know, that the higher the score, the higher the need. And so what we have is that there's a lot of information that's obtained in the community sort of supervision setting or even in preparing to go to community supervision, but what we find is that there's an inconsistent use of that information. In other words, what would it look like if at every level of the criminal justice system, the question is, have we looked at that Level of Service Inventory? Have we made sure that those needs were met? Because to the extent that those needs are met is the extent that we lower the risk. And that is the risk of recidivism. So, these are already working tools available and they actually tend to already be trauma-informed. There're just some specific elements that I'm asking the criminal justice system judges who have wonderful opportunity and a lot of circle of influence and power to make changes I want them to consider. So, this is a have you considered moment. In this particular model, there're two that I want to mention because I know that a lot of folks are very familiar with them. I have worked with here in Multnomah County specifically with EPICS which is the Effective Practices in Community Supervision and it is a model that employs those core correctional practices that I just spoke about in a risk-need-responsivity and it's really based on a cognitive behavioral therapeutic model. And then there is the STARR model which is Strategic Training Initiative in Community Supervision or, I'm sorry, Staff Training Aimed at Reducing Rearrest which is used in federal supervision models, community supervision models, there's also Strategic Training Initiatives in Community Supervision or STICS. These are all models that use the risk-needs-responsivity and Core Corrective Practices. So, it's built in, the only thing that I will say again is that this model is so heavily cognitive. The question becomes before you can get to the cognitive aspects and get people to learning, there's some basic needs that have to be met. Safety has to be created first and I'm going to talk a little bit more about that. So, generally in this part because I like it to be interactive, there's an exercise that I give to sort of further illustrate the points that I was trying to make prior. And so, what I typically ask folks to do is I tell them, "Buddy up, if you were with me, standing..." And actually I'm going to ask you to wherever you are and maybe with your team, to ask your team, ask folks to buddy up, get together and then give them this set of instructions. So, tell them the first, what they're going to do is each one is going to spell their first and last name backwards to each other. And they only get 60 seconds to do it. And then the second time around, you're going to... And that is for both of them to complete the task of spelling their first and last name backwards. And then the second task is you get another 60 seconds and then each are going to spell their first and last name backwards, however, while the other partner is holding a full conversation with them. So, there's some distraction in place and the expectation is that you complete the task so you each basically have 30 seconds to do that. Now, generally when we complete this task and I'll take the time and pause and say to folks, "Hey, can you tell me why you think I would have you do this?" And many people will say, "Well, I don't know, you probably had us do it because you want to test like how well our brain is working or to wake us up." And I'll say, "Okay." And then I'll ask the second question is, "Well, what assumptions do you think I made by asking you to do this?" And then, that's a more deeper question and people pause for the cause and they say, "Well, that's interesting." So, I'm going to tell you some of the answers that come up and you may have different answers which I think still meets the goal of this exercise. So, a lot of folks will say, "Huh, well, you made the assumption that we all speak English," number one, you also made the assumption that we all learn the same, you also made the assumption that we could execute the task in the time allotted, you also made the assumption that we knew our name which was interesting people say that and you made the assumption that in our ability to spell our names backwards, that we could do it in the presence of distraction. And there're so many, I mean, I could go on and on, I have about over a hundred different assumptions that are all different that people said that were made with this particular exercise. And so goal met, the goal was to get folks thinking about how particular systems make assumptions with their demands. So, you walk into a community supervision... So, I'm already making... And am, I also making assumption that the audiences that I am working with are learned, so that they have an education that they can read, that they can write, these are all unspoken assumptions. And so with that, I'm like, "Well, you can execute the task because I ask you." I assume that everyone also does not have any learning challenges. There were a number of assumptions that were made and so when folks can identify with that reality because they just experienced it themselves through this exercise, then if you've experienced that kind of sort of effective response to this exercise, what do you think the folks that you're trying to serve experience with you as a part of and attached to a system when they come in There're a set of assumptions that the system makes. That they can read, that they can understand what's being asked of them at the moment, that they've eaten, that they slept, that they can follow instructions, that they understand that there's reading, but sometimes no comprehension. So, folks start to kind of get it, "Huh." So, then all I ask is this with this exercise because it's the same thing that I asked about the core correctional practices. The core correctional practices are heavily driven on the assumption that the cognitive ability of the folks that we're seeking to serve, that it is intact. They're assuming that people are coming in and they're not anxious. It assumes that people are coming in and they're not afraid. We know this as human beings, it is very difficult to learn if we're anxious, if we're afraid, if we're hungry, if we're scared. So, I essentially ask people to back up one step to recognize our own humanity in the moment. we want to get to the exercises so that people can get to the skills building so that they can change, but we've got to go further upstream. And being trauma-informed calls us, it compels us to go further upstream to create safety, to meet basic needs, to make people feel connected and like they belong. That does not take long to do, those things create safety. Once safety is created, Huh, now I can engage in what the system is asking me to do and I actually increase the risk of getting the outcomes that the system has called for. So, this is actually a very powerful exercise and I just ask everyone, do it, do it and you'll be amazed at what you come up with, but really it is about this idea of checking your underlying assumptions. So, we know this to be sure as we think about the particular cohort that we're seeking to serve. This is the same although I focus on... A lot of the work that I have done has been on serving individuals between the ages of 15 and 33, is actually, you can look at even folks who are in that what I call emerging adulthood phase which is actually between 20 to 45. Individuals who have a history, most of the individuals who are incarcerated, over 90% have similar characteristics. There's some early childhood trauma, early exposure to substances of abuse, maybe poverty, lack of educational opportunity, food scarcity, there are specific elements that come up. And this is not to make an excuse. I say this, this is an explanation. It is to help us better understand what's going on because I'm a firm believer that where there is understanding, we increase the risk for change. And the reason I take the time to do these types of trainings is because I want change. Again, I believe that you're listening to it because maybe, just maybe you want that too. And we want to get the outcomes that the system seeks, so this is about also helping the system become more optimal in its effectiveness to serve the individuals that it is set out to serve and to get the outcomes that it seeks to get. So with that, I think going back upstream, so I said to you all, we understand that the family is really very much a system, Maslow said it right, connections, relationships, they're core, they're important. We understand that when we involve the family in the process of healing and to keep young people but also individuals out of the prison system, that families can play a key role in doing that and so the criminal justice system's keen attention and care of the family, not just the individual turns out that it actually can be key in the kind of work that we want to do, again, to help people heal and to reduce recidivism to keep neighborhoods safe and all that good stuff. So, with that, I think going back upstream, we have to appreciate the connection then between fear, trauma and addiction because it's real. Again, I just said to you the individuals who are more at risk of incarceration have similar qualities. With that being said, again, how do we create safety? How do we adjust the system? We got to move further upstream. So, there're a few things that I feel like are really important, I'm going to move through these slides relatively quickly and not to get too wonky, but the goal is for understanding and so I'm going to tell a story and then we'll come back. Again, the training that I'm doing right now is usually four weeks, it's a four-week training that I've boiled down into about an hour. So, when we think about this process of sort of trauma, I don't think you can talk about trauma, I don't think you can talk about some of the risk factors that I've talked about without first helping us to understand that there's a neurobiological sort of physiologic frame to this. I want us to consider this, that the brain... We're looking at a portion of the brain here, I want to help us appreciate the brain and the way that it develops. First, I want to say this, which is an important point, it's not on the slide because it's a whole nother presentation in itself. The brain development, when I ask people where it starts, brain development starts at the point of conception when sperm hits egg and within the first week to four weeks, in utero, there is a process by which it's called the neural plate, it folds and becomes the neural tube. And that neural tube is the blueprint for what you see here, the brain and the spinal cord, we have an automatic nervous system and a central nervous system. All of that, the blueprint is set within three to four weeks in utero. Now, the reason I say that as a prelude to what I'm going to talk about here is because it is the fact that we're breathing, walking individuals, it is a miracle because that process of the folding of the neural plate to become the neural tube which becomes the blueprint for the brain and the spinal cord which is like the core of our existence and ability to live and survive, that is a tenuous, precious, miraculous process, yet it happens for all of us. Here's another key important point. It happens at a time when most women, if you're not planning, don't know that they're pregnant. So, you mean to tell me that this most precious, tenuous, miraculous aspect of brain development is happening when most folks don't know that it's happening and when there's a risk for many things that could potentially impact it deleteriously. So, if I don't know that I'm pregnant, things like stress, things like substance use, things like domestic violence, things like hunger, all of these things can impact that process early on. And that's not where the story ends, the beautiful thing is that the brain can heal and we'll get to that piece, but I want us to appreciate this point. That some of what individuals who are incarcerated are being held accountable for are things that they did not have control over at the very beginning. You and I had no control over the environment we were in when our neural tube was folding. You and I had no control over the environment that we were in when our brain continued to develop in utero and then what we know from research is that in the third trimester, it is a very... Well, you're still in utero where the child can hear, the growing, developing person can hear, there's a strong response to what's happening in the outside in their environment, actually those sensory inputs further drive either healthy or unhealthy brain development, this is all still in utero. And then of course, we have had a lot of focus on when babies come out from from day zero up until year five, but again, I'm asking people to go further upstream and to consider these things that happened when folks had no ability to change it. So, while we can't change what happens to people in utero or even in the first five years, when we do understand that trauma has happened, we do have a responsibility though to help them heal and that's the point that I want to make. That every system, no, we can't change what happened in utero or even at the point of conception, those are important points, but we do have a responsibility to help people heal once we do know that it exists and that's where these systems come in. But the way that you do that, one way that you do that is understanding what has happened and that very much is a trauma-informed frame. So, let's talk about it. I want to talk about trauma, but we can't talk about trauma until we talk about fear, so here it is quickly. Fear is something that we have all experienced, there's no body... I've given lectures all around the world and literally. And when I ask the question, "Is there anybody in this room who's never been afraid?" There's not one person, not one who will answer, "No, I've never been afraid." So, the reality is this, that every single person, every single human life has experienced fear because fear is the mechanism by which we seek safety appropriately in the presence of perceived or real threat, that's it. We were all born with this natural proclivity for survival because the brain... Also I talked about when the brain develops, but I'm going to tell you real quickly how it develops. It develops from the bottom up and the inside out. Well, we know that the bottom part of the brain with this brainstem area that's then attach to the midbrain also known as the limbic area and then the most top part of the brain known as the cortex which has multiple components; frontal lobe, parietal lobe, the occipital lobe, but we know that the bottom part of the brain is responsible for our ability to breathe, it's responsible for our heart beating, it also has tracks on it that's responsible for mediating the fear response and interestingly enough in that third trimester when we're still in utero, if there's a sense of a lot of chaos kind of going on out there, the part of the brain that sort of becomes more robust is that part of the brain that is responsible for that kind of stress response. And you become sort of more bottom brain-driven because now, "Oh, my gosh, now all I know how to do is survive," which is again another interesting talk unto itself. But here is our brain on fear. Something happens on the outside that makes us afraid, we sense that, the thalamus is involved, the thalamus is this sort of... It sits right on top of the brainstem and it essentially acts as a giant switchboard. So, it is a sensory sort of aspect of fear. Now, this is just our brain on fear normally, we've all experienced this because I ask the question, "Is there anybody who's never been afraid?" And everybody says, "Oh, no, no, yeah, that's me." So, it directs the information appropriately and says, "Okay, okay, body," because fear is a full-body response so it says it, "Okay, we got to get everything in gear so that we can appropriately seek safety in the face of threat," whether it's perceived or real. So thalamus does this thing sensory, then we've got the frontal and the temporal lobes involved and that's where dopamine is released and we get this sense of panic and irrational behavior, but there's also a cognitive awareness of the fact that we're needing to seek safety and then the hippocampus and amygdala which are midbrain structures and sit next to each other. Hippocampus is, it looks like the... Interesting to me as... I've always taught, it looks like a little seahorse as a midbrain structure and the hippocampus is really interesting because it's responsible for things like memory, declarative memory, but also emotional memory. The amygdala also plays a role in emotional sort of memory as well because the interesting thing is this, that it is appropriate... You want to remember at some point the things that made you afraid so that you can avoid them and to a certain extent it's adaptive until it's not, you want to be able to avoid the things that hurt you before so you at some point, you've got to remember them, so there's an emotional memory aspect of it that's mediated, a fear that's mediated by the hippocampus and the amygdala. And then of course the more common one that everyone talks about which is just a part of this larger sort of response is the hypothalamus which is what I call the physiologic aspect of fear and it's involved in the fight-or-flight or freeze response and it activates... I mean, again, this is a full-court press. It activates a little structure that sits on top of the kidney called the adrenal glands and that's where we get sort of the hypothalamic pituitary adrenal axis also known as HPA not to get too wonky, but the point here is that that adrenal gland that sits on top of the kidneys is responsible for releasing the stress hormones like cortisol and epinephrine and norepinephrine so that we can do what we need to do to appropriately flee the threat. And of course, there's all these other downstream effects and about 30 or 40 other neural hormones that are released. Bottom line is that whatever that threat is is gone... I ask the audience, "Well, what should happen to all these regulatory mechanisms?" The body is beautiful, the way that it is designed is that for every off, there's an on, for every action, there's an equal and opposite reaction so, if the fear response turns on to help us appropriately skip threat, that we may seek safety in the context of threat, what should happen when that threat dissolves? Or when it goes away? And people will answer, "Oh, well, oh, of course, once the threat goes away, then the system should pretty much go back to... We shouldn't have as much cortisol, our heart shouldn't be beating as fast, we shouldn't be..." Everyone can identify with what it feels like to be afraid. And they give the right answer. So, once the threat is gone, then we should not feel like we have to flee or fight or freeze anymore. We should, theoretically and if you could see me I'm doing air quotes, go back to baseline. And I want to point out one other thing before I move forward... So, the interesting piece about this fear response is that we all share it, it's primitive, it is a part of all of our human proclivity for survival and we were all born with that natural proclivity to survive. The way that the brain develops is from its ability to interact healthily, it's built from sensory cues that are then interpreted internally and that support overall growth or changes in the brain, it's a very interesting process. It is also meant to be a time-limited response. That's how it's designed. Most folks can understand it because they've experienced it. So, the key point I want to make here too, I ask people to identify with their own fear as a means of helping them understand the fear that the folks that they're trying to serve might be under. So that's one, but then number two, if you can understand fear and the response and the fact that it's supposed to be time-limited, then you can understand my next point. And my next point is that essentially what happens is that when that fear response does not go off, the question becomes what happens when the fear response does not shut off? It's meant to be time-limited, but when it doesn't turn off and it's still on and you're still responding in a way that you are constantly, chronically, seeking safety, that is my friends, one of the working definitions of the neurobiological definition of trauma. Fear that does not turn off. Let me give you an example just to cement it and solidify this. I used to watch scary movies, one of which was "Freddy Krueger." And I described this phenomenon, I used to watch these movies in the 80s and you would always have a big character running with a set of keys in their hand and the said threat is behind them, they're running, they're trying to get to the door, they try to get the key in the lock and what happens to those keys? Yep, you're right, they drop them, they drop those keys and you're just like, you better get up and get those keys. What I've come to realize is this in my understanding now of fear. The way that fear works is the part of the brain that is required in order for someone to have the level of sophistication that is needed to get that key in the lock, that part of the brain when you're afraid is not working. That's the top part of the brain. But what we understand is that we're not in the top part of our brain, we're not in the frontal, we're not in the top, we're not in the frontal lobe, we're not in the cortex, when we're afraid, we're in the bottom and the middle. We're in the bottom brain surviving part. And so, now I understand why he couldn't get the... The said character couldn't get the key in the lock when they're afraid and running from the said threat. So, then I ask folks to consider that and to consider the fact that the individuals who are a part of the system that we're looking to change very much feel like they have Freddy Krueger running after them and that everything, sometimes unfortunately feels and looks like Freddy Krueger. So, it's a constant feeling of threat. So, folks adapt to a certain extent where then the predominant response is one of fear, not an excuse, but a reality because that's what trauma is. So, a minute means that anything that's remotely close to what feels like a perceived or real threat can easily throw someone into this response. And we also know that when we're afraid, we're not thinking straight. You drop several IQ points that also you're not able to do calculus when you're trying to survive. So, I ask people to think about this because we've all been there, we've been so afraid that we have cognitively not been able to function optimally. An important point that I'm going to come back to because I also just said that the core correctional practices really hone in and focus heavily on cognitive behavioral therapy and it makes assumptions and we have to check those assumptions. So, I want to say one other thing about this slide, I get excited about the brain, but what we see in the case of fear and in the case of trauma is what the neuroscientists, of course I consider myself to be one, would describe as a loss of top-down control. Because what typically happens is that the top part of the brain is able to help us regulate emotions, to exercise good judgment, to think before we act, to be calm, it really helps to keep that amygdala in control in many ways and regulate our sort of responses to things, all of those things in the stage of constant fear, fear that doesn't turn off also known as the neurobiological, one of the neurobiological definitions of trauma, you lose the ability of the top part of the brain to control that middle sort of bottom part of the brain. I mean, it's just sort of like all acceleration and no break. And some folks live in that state chronically. <v Moderator>For free, localized education</v> and training designed to meet your needs, contact the Opioid Response Network.

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