There's a distinction between, I know the distinction between addiction, right, and substance use disorders, but for all intents and purposes, today I'm going to talk specifically about addiction, which is defined as a chronic and relaxing disorder that has a compulsory component, right? There's the behavioral component. And there are some brain changes that come along with it. So I talk about addiction and how essentially the risk for addiction increases significantly in individuals who have probably no surprise, a history of trauma, right? No different from the Adverse Childhood Experiences study, but I want to demonstrate it by showing sort of similar brains side by side. So this is what I'm showing is from the National Institutes of Drug Abuse have beautiful images, and this is one that shows the pathways that are involved in the reward system. And the reward system is intimately involved in addiction and how a person becomes addicted. There are specific some of these areas of the brain you'll see are similar, right? You see the hippocampus there. Where do we see the hippocampus? We saw the hippocampus in our fear response, in that fear conditioning sort of process. But then I'm going to introduce just a few other, you also saw the frontal cortex in there, right? So we've got sort of that top bottom still divide in this particular process. I want to really demonstrate for you the similarities between a brain on fear and trauma, and a brain that's addicted, which is, there are huge similarities, which may not be surprising to most folks. But does that mid-brain area just above the hippocampus, you have some pretty important areas that are involved in the reward pathway, which is how we manage pleasurable experiences, how we remember them and how we seek them out, and what they're driven by. So there's a VTA, which is also known as the ventral tegmental area and the nucleus accumbens. They have dopaminergic, or these yellow projections are where dopamine leads, dopamine comes from and then goes out to other areas. And you can see that from the ventral tegmental area, that dopamine goes from the ventral tegmental area to the striatum, but also to the prefrontal cortex, right? So essentially what happens is, let's just take for instance, cause I like cake, I like chocolate cake. When I eat that chocolate cake, I have a pleasurable experience, dopamine is released into the prefrontal cortex, and it creates salients for me. So it's like, "Oh, that was so enjoyable" I remember it. And because we are all human beings and we'd like to do the things that bring us pleasure, we often want to remember it so that we can come back to it. But for some folks, the ability to stop after one piece of cake is compromised, and we'll talk about that. So, the dopaminergic pathways are responsible for things like pleasure, motivation, fine tuning the behavioral aspects of it, right, and sort of going back. But then you also have, interestingly enough, serotonin pathways that come from this reward pathway, that lead from the ventral tegmental area to the nucleus accumbens, from the nucleus accumbens to the frontal cortex. And essentially, cerebellum is responsible for things like memory processing, sleep, cognition, mood. The only reason I wanted to bring this up is to show that the multiple areas of the brain that are also responsible for and play a role in fear, and in trauma, also have a similar path in addiction, right? In this reward pathway. And addiction is really a reward pathway that's unregulated, right? Because in the case of addiction, it is similar to trauma that you lose top down control. And I wanted to, this picture just essentially is just a fancier way of demonstrating what I've just described to you. These are all the parts of the brain that are responsible in the brain becoming addicted. You have something pleasurable, it creates a sense of reward, there are neurochemicals, dopamine is a primary one, but there are other, glutamate, we don't get into all that GABA, but there are a number of different neurochemicals that help to create and make that reward or that pleasurable experience salient, and then, you know, there's a motivational aspect of it, there's a memory learning aspect of addiction, right? And generally what happens is, again, you have some inhibitory control from the anterior cingulate gyrus sort of area and the prefrontal cortex that helps to regulate that. It says, "Okay, you've had enough pleasure." But here's what happens in the case of addiction, right? So normally when we have a reward, happy, pleasurable experience, we experience it, and then there's some inhibitory control, there's some top down control that says, "Okay, enough is enough." So one of the, so again, the important sort of, a thing about this particular slide is that what happens similarly as what happens in the case of trauma and fear that never turns off is that you lose top down control. So, essentially in the case of addiction, the ability to modulate pleasurable experiences and to regulate it is lost, and so there's a similar connection in those two things. As I discussed sort of earlier in, as sort of a prelude to talking about fear, we had specifically talked about the way that the brain develops and how that brain development process can be compromised very early on, and these are some of the things. And I did not say that as a means of providing an excuse, but as a way of giving an explanation, and I believe when we know better, we have a responsibility to do better. And so there are things that I think the systems in terms of criminal justice and even other systems, education, there are many other systems, but we're talking criminal justice system in this particular case, hold folks accountable for things that they were not responsible for, and these are the particular things that we don't often talk enough about going further upstream. It doesn't mean that we can't hold folks accountable, but if we understand what happened, then I think we have a, we're better positioned to support them in getting better. So I want to explore the threats to safety or creating safety, and the threats to healthy brain development, because it turns out that the threats to safety and healthy brain development also increased the risk for substance use. So we know that poor nutrition, lack of connection, early exposure to substances of abuse, both in utero exposure and use, environmental toxins, infection, poor sleep, lack of safety. And I mean, financial, physical, all of those things, toxic stress, even the stress of racism and Adverse Childhood Experiences actually do pose threats to safety, healthy brain development, and especially early on, and the significantly increases the risk for substance use, which leads me to talk about sort of intergenerational trauma, adverse childhood experiences and recidivism. As demonstrated in some of the earlier slides, and I'll give a little bit more of this data, what we find in individuals who are incarcerated is that there is a large, there is a large and disproportionate history of early childhood trauma that has never, in some cases, been addressed or impacted. And to that extent, however, in the level of service inventory it is assessed for, but once it is assessed and you have the information, it has overwhelmingly kind of been put on the shelf, and maybe there's an opportunity to take those assessments and that information employ it so that we actually help people get better. So I want to talk briefly about the "Adverse Childhood Experiences" study by Felitti and Anda, the original study. Now there've been 60 some odd plus spinoff studies, but I want to talk about the original study which was done in 1998. Many people don't know that it actually started out as an obesity study, as a part of Kaiser, and some important things to know is this particular model, interestingly enough, they use the pyramid. Here we go again, right? Similar to Maslow, where we're looking at some of the things that we've just finished talking about. We're looking at it from conception to death, this model as laid out by Felitti and Anda, in this Adverse Childhood Experiences study talks about the early experiences and exposure to trauma, stress and what we call toxic stress. And again, toxic stress can be defined as living in states of poverty, anything that causes, in the case of in utero, what we're understanding from studies now, we're looking at the stress of mothers. So, here at OHSU, we have several studies in our neuro science labs, where they're looking at mothers who are pregnant, who have had the stress of either poverty, limited housing, substance use, poor nutrition, and the impact of that that has on internal inflammatory factors. And then the impact that that has by being in that stress state, as evidenced by these inflammatory factors, the impact that that has on structural brain development. So they're following these women while they're pregnant and then getting functional MRIs of babies, of their children at age three months, six months. And it actually is fascinating to confirm some of the things that we kind of know from a common sensical standpoint, that if there's early trauma, that it does impact the way the brain develops. And then that impacts the social sort of cognitive. Again, these are the studies that are showing us that if that history exists, it's going to impact cognitive capacity, and that changes, it significantly changes how someone adopts certain risky behaviors, certain risky behaviors have impact on disease states, and of course can lead to early death, which is what we see. Important to note and important to appreciate this pyramid. Here's how the study was designed because, and I think that this is important to look at the demographics. The number was huge, of course, a little over 17,000 overwhelmingly caucasian. This was a cohort in the original, overwhelmingly middle and upper-class, college educated, employed. They were San Diego residents, and they also had healthcare coverage. So as I said, it started out as an obesity study, they found out that folks were falling in and out of, that the folks would come to a certain point where they lost a certain amount of weight and were dropping out of the study. Once they dropped out of the study, essentially they said, "Oh, well, that number is too high, we should probably do some sort of post-talk analysis and figure out why." When they started to assess and evaluate this group, they found that they had some core characteristics, and those core characteristics actually can be seen in the original ACE survey. What they were able to, the punchline is this, what they were able to demonstrate in assessing for early experiences that may have been deemed as traumatic, that there was a link between trauma and chronic disease states that developed over the adult lifespan. And it also increased the proclivity for emotional dysregulation. So there was a behavioral impact and in a physical impact that early childhood had on adult, early childhood trauma. And these are just some important aspects. Again, there was a direct link between childhood trauma and adult onset of chronic disease, but also depression, suicide, proclivity for violence, those types of things. Now this was the original survey, and I know a lot of people look at the scores and they're like, "Okay, what do you have an ACE score? ACE score greater than four, this or that together?" And folks are wondering where it comes from. Well, this was the original survey, and of course it has been adapted, adjusted all of those things, and it should, but I wanted you to see the original data. So essentially for every single question here, you are asked to either say yes or no, and for every, yes, it was affirmative, you got a point of one. So now you can see how you get the score, so it was basically out of 10 questions. You know, if those who, if you had two or more, it was concerning. So I just gave you the demographics because we're talking about right now when we're talking about trauma, we're talking about communities of color, disproportionately being represented in the criminal justice system. And the fact that many of them don't have as much education as the original group had, many of them are not middle class, right? So you can imagine why the ACE scores will be higher in that particular cohort. But here are some of the questions that the Adverse Childhood Experiences original survey asks. It asks questions about whether or not an adult parents swear at you or insulted you or put you down, whether you were physically hurt, whether your parents divorced, whether you were slapped or pushed, whether, and I mean, it goes into details about, you know, about sort of being sexually violated, which is why I say to people. Notice that it says prior to your 18th birthday, I am not a fan of giving these ACE surveys out to folks younger than 18. And even when you do, it's really important to how you word things. I mean, these were the original surveys and, you know, when you know better, you do better, and they have, but I wanted you to see the original. They'd also ask about, you know, again about divorce or abandonment. It asks about whether or not now this, again, it speaks to Maslow's hierarchy of needs. Did you often feel that you didn't have enough to eat or that you wore dirty clothes, that no one was there to protect you? It asks about parents sort of alcoholism, incarceration, mental health, street drug use, it asks about all of that, okay. And the fact that this particular group, original group of 17,000 had ACE scores between two and four, I mean, that's it's incredible, right? So you think about all the things that happened to people over time and how it shapes, how their brain develops and who they could potentially become. Now, I can't talk about the ACE survey without talking about the resilience survey, because here's the important thing to note, we're talking about families today, we're talking about trauma, we're talking about how we get to a better place. What the resilience questionnaire does. So we're saying yes, things happened to people over the course of time, but we also know that to the extent that folks can be resilient, is also the extent that we reduce those, the impacts of the adverse childhood experiences. And we increase the likelihood that they go on to be functional members and do well. But look at these questions, the questions that determined resilience, they're all based on what I talked about at the very beginning, relationships. It asks about, do you have somebody who loves you? Even if it was, you know, when you were little, did you have someone who believed in you? Did you have someone who took care of you and seem to love you, right? I heard, you know, or if you heard stories about that when you were an infant, someone in your family played with you and spent time with you. It's all about belonging and relationship. So what we see is that resilience occurs where there's connection. So again, just a as a key point, addiction and its relationship to trauma, what they both share as loss of top down control. And, oh, this was a slide I was looking for. So this basically demonstrates that, right, that you have, as I was describing to you, and I won't spend too much time on it 'cause I had described it earlier that you have, you know, the reward, which is driven by amygdala ventral tegmental area of the brain. And then there's sort of drive and motivation to do something like eat the cake. We remember the cake experience because it is so good. But then look at this, my cortex or my prefrontal cortex or my orbital frontal cortex specifically, or my anterior singular cortex, they help to modulator that dry, right? So it says, "Okay, stop, you've had enough cake." This is in the non-addictive brain. In the addicted brain, which again is a chronic relapsing condition that has a compulsitory component that also has brain changes. Look at what happens to the top. The top effectively loses its ability to stop the drive. Now I should say that the adolescent brain looks a little bit like the addicted brain at some point you know, as it's developing and which is a natural course, but again, that's a whole nother talk, but that's why we have to have good environmental supports and parental controls in place to really help shape, right, to really help adolescents get to a place where the top, the cortex is taking more control. And that happens over time with supports and with learning. So being trauma-informed does these things, it helps to heal the brain, it reduces the addiction risk. Being connected, having good nutrition, avoiding substances, of course, being in a safe environment, getting adequate sleep, which I didn't get a chance to talk a lot about. But sleep is really, really important, it helps to kind of hit the reset button. So now I want to switch gears just a little bit and talk to you about what it means to be trauma-informed. We started the conversation a little bit early and so I'm going to say you get a gold star for that, if you already understand the connection between fear and trauma, you get a gold star. But it also means paying attention to the words we use. So at the very beginning, I don't know if you caught note of the fact that in some of the early literature, like in the first sets of slides, they're using words like offender, not my words, but these are words in the literature. One of the things that I have encouraged and continue to encourage is watching the narrative, because the narrative actually does drive behavior. And if we want to change behavior, we have to change narratives. So I ask folks, for instance, what's the distinction between calling someone an offender versus saying, you're a young person or a person who's made a mistake? In one of those, one statement feels more permanent, another feels like, "Oh, okay, there's some room to make change and to be better and to do better." And being trauma-informed is paying attention to that, and it's saying we want our narrative to match the outcomes that we desire. So that's one example. Being trauma-informed also restores a sense of basic humanity, partly because I'm asking you to identify with your own fear, understanding that you had it, knowing that when you're in a state of fear, you're not in a state of being able to think straight and to do meet all the expectations. Oftentimes the system has what I call top brain mandates for folks who are bottom brain functioning. And you have to, in order to get what we needed to get to the outcomes, we have to reconcile the gap between that, right? So you're asking me to do homework, but I haven't eaten. You're asking me to learn a new skill in communication, but I did not sleep all night because for whatever. To the extent that we can see ourselves in individuals, meaning we understand the things that have hurt us, and to the extent that we understand the things that can hurt others, is the extent that we can be more humane while holding people accountable. That also builds a greater capacity for empathy, right? Our ability to be more humane, build that capacity to understand more. I'm going to encourage you for the sake of time, look at this clip. And here's what I asked you to do in this exercise. This is a clip from, I used to love John Grisham novels, and I still do actually. And most of them were turned into movies, but I read the book "A Time to Kill" before I watched the movie. But this is a clip with a very young Matt McConaughey, and he is representing an African American man who is played by Samuel L. Jackson in the south. And he's representing him in a courtroom with jurors who are all white in the south. And without giving the full story away, there's some very powerful things that happen in this five minute clip that I want you to watch. And, no, let me just put this out there. No, I do not condone killing. No, I do not believe that people should not pay for the crimes that they commit. There is a larger message here, and I'm hoping that when you watch this clip, which you get to, I want to ask you to consider what question Matt McConaughey asked. He was asked by a black man in the south, who said to him, "This is a man whose daughter had been killed and raped." I mean, had not been killed, but had been raped by some men. And he didn't believe that the law was going to take care of it, so he took it into his own hands. And instead of letting the courts take it into their hands, he ended up killing these two men. And instead of the two men who raped his daughter being on trial, Samuel L. Jackson ends up being on trial. So essentially what ended up, what ends up happening is while Samuel L. Jackson is in prison, he gets Matt McConaughey as his attorney. And he says to him, "It's going to be your job to convince the people who are all white, that an all white jury. Again, they're in the south. He says, "I need you to convince them that I did what any parent would do." So essentially what he's telling Matt McConaughey to do is "I need you to convince them to look beyond my color and to see that I acted as any human being who wanted to protect their innocent daughter would." And so Matt McConaughey, what you see is this very powerful scene of him in the jury, you know, talking and engaging with the jury and tells them to do the following. He tells them to close their eyes, and then he tells to imagine, and then he begins to describe this very gruesome scene of this little black girl who is innocent, who gets raped and thrown onto the side of the ravine, who was left for dead. And the way he describes it as masterful, the juror's eyes are closed, they start to cry as he's describing it. And he also gets choked up as he's describing it, right? He's emotive. And then he says to them, now I want you to imagine that she was white. Very, very powerful. So you watched this scene, and I say that it is actually a profound lesson. And even though whether you agree with what happened or not, the way that we start the process of building empathy and increasing our capacity for it, is even if you could just imagine for a millisecond of what it feels like to be in someone's shoes, you have effectively increased your capacity for empathy, and I'll take it, we'll take it. So watch the scene. <v ->I'm here to apologize.</v> I am young and I am inexperienced. You cannot hold Carl Lee Hailey responsible for my shortcomings. You see in all this legal maneuvering, something has gotten lost. That is something is the truth. And it is incumbent upon us lawyers not to just talk about the truth, but to actually seek it, to find it, to live it. Let's take Dr. Bass, for example. And obviously I would have never knowingly put a convicted felon on the stand, I hope you can believe that. But what is the truth, that he's a disgraced liar? What if I told you that the woman he was accused of raping was 17, he was 23, that she later became his wife, bore his child, and is still married to the man today. Does that make his testimony more or less true? What is it in us that seeks the truth? Is it our mind, or is it our heart? I set out to prove a black man could receive a fair trial in the south, that we are all equal in the eyes of the law. That's not the truth, because the eyes of the law, human eyes, yours and mine, and until we can see each other as equals, justice is never going to be even handed, it will remain nothing more than a reflection of our own prejudices. So until that day, we have a duty under God to seek the truth. Not with our eyes, not with our mind, with fear and hate commonality and prejudice, but with our heart. I want to tell you a story. May I ask you all to close your eyes. It's a story about a little girl, walking home from the grocery store one sunny afternoon. I want you to picture this little girl, suddenly a truck races up. Two men jump out and grab her, and drag her into a nearby field, and they tie her up. And they rip her clothes from her body, now they climb on, first one then the other, raping her, shattering everything innocent and pure, vicious thrusts, in a fog of drunken breath and sweat. And when they're done, after they've killed her tiny womb, murdered any chance for her to bear children, to have life beyond her own, they decided to use her for target practice. They start throwing full beer cans at her, they throw them so hard, that it tears the flesh, all the way to her bones, and they urinate on her. Now comes the hanging, they have rope, they tie a noose. Imagine the noose pulling tight around her neck and in a sudden blinding jerk. She is pulled into the air and her feet and legs go kicking and they don't find the ground. The hanging branch isn't strong enough, it snaps and she falls back to the earth. So they pick her up, throw in the back of the truck, and drive out to Foggy Creek Bridge, pitch her over the edge. I want you to picture that little girl. Now imagine she's white. What we're asking folks to do in this process is, how do we understand and imagine what it might be like to be in someone else's shoes, not as an excuse, but to change how we engage. Now, there are some antidotes to trauma, and one is a what's called narrative therapy is a form of therapy that essentially views people separate from their issues. So again, it's like the example I gave you, it separates people from the problem. So it says, you're a person who did this, not you are the problem. It is you're person who had an issue, and it leaves room to start the change process and just start to rewrite the narrative. As Descartes says, I think therefore I am, it's a true statement, it's a true cognitive behavioral, therapeutic model. If I think it, my narrative drives the way I think, my thinking impacts my behavior, and my behavior dictates, you know, my actions. Okay, so it's a frame. So we're going further upstream, and narrative therapy is one form. And so any program that's working with you, and in a community supervision setting should be asking what kinds of therapies are being done outside of just CBT. And then there's the informative sort of trauma-informed approach. Which considers narrative, it asks what happened as opposed to what's wrong. It considers meeting basic needs as a way of creating safety and it increases opportunities for basic connection. And then more importantly that has a lot of data behind it as mindfulness. You know, it's one of the things that I encourage both the staff to do, but what would it look like if at every level everybody was expected to practice mindfulness? Well, here's all of the data. Here's what practicing mindfulness actually does. It decreases negative effects, so it decreases those feelings of negativity and anxiety. It reduces anxiety, it allows us to adapt more positively to stress. It decreases the physiologic response to stress. It helps us to better regulate our emotion, our mindfulness, that is. What it does structurally to the brain, the areas of the brain that are responsible for controlling, helping us to regulate our emotion. Guess what happens? That part of the brain is strengthened. This is just after six months by the way of practicing mindfulness. And there are many ways to be mindful, observational mindfulness, of course is imaginative mindfulness. There are many ways to be mindful, but just after six months of practicing it, being able to be single-minded in your effort, taking the time to pause, to breathe, to allow thoughts to pass through without responding to them is a very powerful exercise. And it actually heals the brain. What it actually does, interestingly enough, is it increases the brains top down ability, right? So it improves the areas of the brain that regulate emotion, the cortex, and guess what it does? It also reduces effectively the volume and the parts of the brain that are involved in impulses. So it decreases the size of the amygdala, and it increases the size of the cortex. So in other words, what mindfulness does as a trauma-informed practices is it heals the areas of the brain that have been negatively impacted by fear and trauma. And I should also mention that there are multiple studies that demonstrate DBT and mindfulness-based relapse prevention that is more effective than CBT, in terms of helping to keep people out, in terms of increasing relapse, in terms of increasing days to relapse. In other words, it is more effective in helping keeping people away from substance use, essentially mindfulness-based relapse prevention, that is. I want to make sure that I word that correctly. So here are some of the challenges in community supervision that really kind of, I've already kind of said this, and I'm going to move through this. And we've got about 10 more minutes, is that there are, in the case of community supervision, there's too much of a greater focus on conditions, and less on meeting needs, right? So it's the conditions of the parole, it's the conditions of the, and it's less about, and it has been less focused on meeting those needs as determined by the level of service inventory, which I'm asking people to use more consistently. There are assumptions that are made with the CBT driven model. And then a trauma-informed lens is not consistently applied. These are some of the challenges, but what we do know helps in community supervision and to reduce recidivism are things like education, drug and alcohol treatment, mental health treatment and family involvement. This is just some data that shows essentially when folks have access to treatment both in and outside of incarceration, that they actually do better in terms of relapse prevention, that they're able to stay away from substances, more likely to do that. Where there is education, and folks have access to basically learn, you reduce recidivism. They also found that for every dollar spent on prisoner education, that the government was able to save $2 in reincarceration costs. So there definitely is a fiscal impact, but there's human impact. And we were able to help people heal better when we give them a sense of purpose, turns out education does that. And then there are many, this is one of several policy reviews that look at involving family while folks are incarcerated and then post incarceration. That both involvement with family in that process reduces recidivism significantly. And I want to just point out that there is a relationship between community supervision and prison. In other words, that the stats on family involvement in reducing recidivism, they are similar between both, right? So if we involve the folks while folks are in prison, they are more likely to get out and to do well. And then if we involve them in the post-prison, they're more likely to continue to stay well. So here's just some data, and you can look through this, but what they found is that while folks were in prison, that recidivism rates were associated with the amount of contact that they received while they were there. So there's an argument to, they were less likely to recidivate, basically when they had family who were able to see them there. And when they were connected, had a sense of purpose, again that relationship piece. And so there's an argument to be made that it's important to allow folks to stay involved with their families, and to create opportunities to do so. Instead of having someone 200 miles away from their family, not able to see them or call them if we really want them to get better, put them in a place where a family can actually come and visit to really support the efforts in helping them to become functional members once they're outside of being incarcerated, and get to the community. States like Pennsylvania have included family programs in their corrections system, and these programs are designed to help incarcerated individuals improve their family relationships, because again, being connected is important. Similarly in their women's program, they've offered things like parenting classes, child development classes, and other child retreats, many things answering kind of this question. There are a few things that we know that have sort of interrupted a family as a system, this Federal Adoption and Safe Families Act of 1997 essentially has been interesting because there are a number of things that have happened as a consequence under this sort of act, we've had more termination of parental rights. And I would argue that the termination of parental rights at this particular stage has not really helped us in terms of meeting the goal of restoring families. And so it's something that actually should be, you know, revisited. The other thing that I wanted to sort of mention in terms of relationships is that when Williams in about 2012, did this study on sort of, the incarcerated individuals' childhood and family backgrounds, and discovered what we've actually already kind of known to be true, but I wanted you to see the data on it, that in this study, there was a little over 1400 families. And this is what he found in terms of looking at some of the characteristics of individuals who were more likely to be rearrested or to continue to be involved in the system. That 24% of them had been in care at some point, like foster care at some point. So these are the characteristics. 24% were, as I said, of those in care, were younger when they were first arrested. So essentially that there is some correlation between the earlier you were involved in sort of foster care, the increased or doubling risk of being incarcerated or are being at the risk of being incarcerated, which is interesting but not surprising. 9% had experienced abuse, 41% had been in situations where they had been subject to violence or experiencing or witnessing violence. 37% of them had reported family members who had been convicted or been in prison themselves. And then interestingly enough, 84% of the 37% who reported family members who'd been convicted of a crime, 84% of them had been in prison as a juvenile or been in some sort of incarcerated system. Here's an important point I want to make from this slide, out of these individuals, which was a pretty significant subset, many of them wanted their families to be involved in their lives over 88%. So there are a few questions, I guess, to sort of be asked from this and understanding some of these data, you can go through, but as a part of the systems that we're in, if we're saying we really, really want to make the changes, there are a few things that have to be considered, whether and how mass incarceration has affected social and economic structure of American communities, and how residential neighborhoods affect the social and economic reintegration. I think of returning prisoners, but also our folks who have been formerly incarcerated, but also how they successfully reenter our community or not. Our system set up to support folks being successful so that they can get education, so that they can get a job, so they can get education. It's inconsistent across states, some states have done, are ahead of others in this particular issue. But to the extent that we again consider upstream factors and then also create conditions that support folks being able to heal to the extent that we do better. And these are just some re-entry numbers, but also looking at what happens when people, when individuals reenter back into a community without the strong, without the strong infrastructure in place. And there are certain conditions that drive individuals back into incarceration, and also back into dysfunctional relationships. And that is this lack of employment, feelings of shame, right? So not getting the behavioral supports they need, limited options in terms of environments and natural support, there are certain places, as I know, it's like, "Oh, only felons can live here" or, right? So there's a lot of things that can potentially get in the way that I think we can maybe reevaluate while we still maintain our goal of safety accountability, but also making sure humanity is at the center of that. And then some of the connections are this is that the incarcerated tend to come from intense histories of cumulative disadvantage, that's characterized by multiple risks, that that actually is historical, right? That goes to their whole family, that's intergenerational. So again, this just drives home the point and makes the argument that we really have to consider the family. If we're going to help an individual, we got to consider families in this process. And then imprisonment also catalyzes a series of adversities, right? So there are collateral costs. I talked about when I showed the data on 53%, and 63% of parents in states and federal prisons, respectively. I asked the question, where are their children? well, and that represented 1.7 million children were impacted by that, a little under 3% of our populations' children are impacted by, which is significant, impacted by parents being imprisoned. That's the collateral costs. And I would say collateral damage. So, and I move to a close, I really appreciate your time here and your patients. There's a few things that I'd like you, that I'd like to maybe, this is an have you considered moment to ponder moving forward. We have a tremendous opportunity to make some changes, especially now more than ever. And in order to do that, it causes us to really take stock and to review all I'm asking us to really take the time to review the information that was presented in this presentation today, and really ask ourselves, are there spaces in places where we might be able to do better? If we are of a growth mindset, which I believe many of us are will say, yeah, there's always an opportunity to do something a little different, here are questions that I'd like us to ponder together. What's the goal of the judicial system? Is it prevention or intervention? Are we intervening to prevent? What's the goal? What assumptions does the judicial system make? And I would say the criminal judicial system. And this is written a little weird, but I would like consider it a priority to understand who your client identifies as family, right? So in other words, recognizing the important need, not just based on what we need as human beings, not from a personal understanding, but also professionally from what the literature suggests, being connected, being understood, belonging are all important parts to helping someone become self-actualized, which is what we're wanting people to do, right? We're wanting our clients to get to that place, but the system can't get its outcomes until it recognizes and appreciates and employs, it may not be a new understanding, this understanding. To be intentional and engaging whomever your client considers or defines as family in their treatment planning. Core, the needs assessments are being done, right, I'd mentioned the level of service, inventory that's being done. I'm not sure that they're consistently being applied. So here's a question, what would it look like if when, you know, police picks Johnny, I'm just going to use Johnny, and Johnny had just, you know, had been released, you know, and now community supervision he had to release from, you know, from juvenile detention, about three months ago. Johnny is hanging out on the block and the police sees him and, you know, pulls up Johnny's name, so there's a police contact. And as soon as he pulls up Johnny's name in his system, it says Johnny's level of service inventory said that he should be engaged in education or some behavioral health care. So the first thing that the police officer asked Johnny about is, "Hey, hey man, how are you doing? Have you gotten to, how have we gotten you into, you know, have you been able to engage in, you know, in services? How can we help you?" So it's what we call sort of a law enforcement like diversion, assisted diversion, right? Where now we all have shared information, 'cause you're already collecting the data why not use it in a meaningful way? So now we said, instead of you then get in with a parole officer and being like, "Well, I saw Johnny on the corner, and you know, he wasn't really doing anything, and so we just arrested him because, you know," or whatever. It is, "I'm going to make a contact with your parole officer and see what we're doing moving towards these goals." So now I'm reminding the parole officer now who also has the data from the level of service inventory, and we're using it. And then when Johnny goes to court, the next month, he says, "Oh, okay, well, the police officer said that he talked to you then talked to parole officer, where are we with these LFI?" And the lawyer, so now we're using a similar tool to understand what the needs are. And I'm saying this is the world that I imagined, but the way we get to this kind of coordinated, thoughtful response, is a willingness to, but also there's a very much a need for more consistent, training and coaching, which I hope you all call on me to do 'cause I would love to do it. There's a way to do this in such a meaningful way. So that's one example, okay. To advocate for familial involvement, right? That's going to be important. And then always consider parent education and support as a critical part of your treatment planning and needs assessment. And then I also want us to consider has a trauma-informed lens been applied? So that everything we've talked about. You know, do we understand fear? Yes we do. Do we understand fear and his connection to trauma? Do we understand trauma and its connection to substance use? Do we understand, there's been an introduction here, and now that we all know better, my assumption is that we can do better. I really appreciate the opportunity to talk with you all today. If you are, in fact, again, this was a part of a four week training that I literally, a four week, almost 200 hour training that I've pared down to this 90 minute section. If you have interest in wanting to know more or dig deeper, I do have a whole entire textbook that outlines this from chapter one through chapter 12, called training for change, transforming systems to be trauma-informed, culturally responsive and neuroscientifically-focused. So we deal with the science, we deal with the literature. Then I give some very practical approaches for how systems, including systems that I've worked with can gain some success in becoming more effective in getting the outcomes that they deserve while serving the client, but also serving the members of their system to ensure that they're poised to do the work that's required. Thank you so much for your time, and email me if there are further things that I can be of assistance with. For free localized education and training designed to meet your needs, contact the Opioid Response Network.

addiction

trauma

brain

compulsive component

reward system

family involvement

holistic approach

mindfulness