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In Episode 8 of our ASAM Criteria Unplugged series, we had the pleasure of speaking with Cathy Thompson. Dr. Thompson is a licensed clinical psychologist with over 25 years of experience assessing and treating mental health and substance use disorders in both state and federal prisons. She began her career with the Federal Bureau of Prisons in 1999 and over the course of her career, has coordinated numerous substance use and mental health treatment programs for incarcerated people within institutions of all security levels.
Dr. Thompson also served as the Chief of Drug Treatment Programs for the Federal Bureau of Prisons. It was in this capacity that Dr. Thompson oversaw administrative and clinical aspects of substance use treatment at all of the Bureau’s 122 facilities, including intensive residential treatment programs as well as medication-assisted treatment (MAT).
Sitting down with The Change Companies Chief Program Officer Valerie Bagley and Train for Change Senior National Director Scott Boyles, Dr. Cathy Thompson shares her experience and insights on effective treatment of substance use disorders within the limitations of the prison environment.
This is an episode preview. To watch the webinar in full, please visit the Fidelity Platform.
Q: How has substance use treatment for incarcerated people evolved over the course of your career?
Cathy Thompson: "We developed modified therapeutic communities for our really intensive residential drug treatment programs. [We] helped folks learn that aspect of positive community living and helping others be accountable, and developing a peer support culture. I am pleased to say in the last several years where we have made significant strides is in integrated treatment — understanding that substance use disorders don’t occur in a silo. And historically, I think at least in the federal prison system, we had really siloed approaches to treatment.
You had mental health treatment over here, substance use treatment over here, trauma treatment and sex offender treatment… But understanding that all of those things need to come together? Treatment is best when it's provided in an integrated fashion. And so looking at how we can do that, maintaining fidelity and integrity of our programs, and at the same time incorporating an integrated approach."
"Healthy people, people who are in recovery from mental illness and substance use disorders, make better choices. They might still behave in criminal ways because criminality, while related, is also a separate construct. But getting somebody into recovery is in itself a wonderful thing, regardless of what happens with their criminal behavior outside of that. So I really encourage folks who are listening to think about that relationship and to think about it when you're talking with your leadership and within your own systems; helping people recognize that the value in treatment is because it's the right thing to do and because we provide treatment to people who are sick — it's not always related solely to recidivism."
Q: How do we motivate and engage people who start out very disengaged?
Cathy Thompson: "Sometimes folks enter treatment because they're externally motivated to do so. And there's an enormous amount of evidence to support contingency management as it relates to substance use treatment, and folks in carceral settings are no different. Whether you can offer referred housing, whether you can offer time off sentence, extra rec time… whatever you can do, the incentives really help.
Do I want to see someone in front of me who's there because they have a deep internal desire to make positive changes in their lives? Surely. If that's not present, if that's not what's going on with them, I just want to see them there. Give me a chance. Give me a chance to work with you and over the course of treatment. We may not see an entirely different person emerge from this treatment program, but I guarantee you, I can move the needle. I can help shine some light and you may have to come back to treatment again and again and again and again. And that's okay. Because every time I have an opportunity to sit down with somebody, they're going to learn a little something."
Q: How can we shift our attitude toward clients like that who aren’t internally motivated right away?
Cathy Thompson: "Change is hard, right? We really underestimate how hard it is for people to make changes. I'm always fascinated. There was a research project that I learned about years and years and years ago, where somebody asked this group of people: go home and make changes, just every little change. If you normally cook on this burner on your stove, cook on this burner. If you park on this side of the driveway, park on the other side of the driveway or in the street. If you eat cereal for breakfast, eat toast instead. If your toilet paper hangs over, then hang it under. And people came back and reported.
That was the biggest stressor. People were like, “I can't change the way I hang my toilet paper. That's crazy. I'm not going to change that.” Well, if you can't change the way you hang your toilet paper, you cannot change your life. And these are people who were so resistant to change as human beings. And so then we act surprised when the people in front of us are resistant to change as human beings.
Change is hard. This is hard. Whatever the motivations are matter less than the willingness to do the work."
Q: Can you say more about the role peer support might play in a prison-based treatment program?
Cathy Thompson: "Absolutely. In the Bureau of Prisons, we were using a model of peer support for a long, long time. We would have senior program participants who supported newer participants in our program and in different ways. Whether it's responsibility, community jobs, and any number of ways.
And we saw real magic happen. There's an extraordinary amount of evidence to support this peer support model as it relates to both mental health and substance use treatment. I think sometimes prison and jail settings are reluctant to engage in that because there's a real fear about giving one group of inmates or detainees... you know, authority over another group.
And so it has to be done carefully. I know that they're doing some incredible work in Arkansas under peer support as well. I know it can happen in state DOCs. It can happen in a prison setting, jail settings, because they're a little bit more fluid. It's harder. The clinical value of that is having somebody that's not the police, that's not the staff, that's not walking around with a radio and a set of keys.
Having this individual who sort of walked a path very similar to mine, had experiences similar to mine, shared some experiences that I've had, supports my recovery or helps engage with me or encourage me along — the value of that is just extraordinary and cannot be overstated. So wherever possible, implementing a thoughtful, robust peer support program leads to significantly improved engagement and outcomes."
Q: Are there recommended curricula for prison-based treatment programs?
Cathy Thompson: "I would say this even if I wasn't sitting on a Change Companies-sponsored webcast right now. The Change Companies has fabulous curricula that have been developed not by people who think they know what prison treatment looks like, but by people who do prison treatment and carceral treatment and can help. We've talked a number of times throughout this hour of meeting people where they are and recognizing that you may need a different treatment approach depending upon what the presenting issue and the current circumstance is. And you guys have programs that address all of those things."
"Residential treatment programs, non-residential treatment programs, drug education, medication-assisted treatment, helping folks to prepare for transition… And what I would say to folks out there is there's no need to reinvent the wheel. There are fantastic resources available in terms of curricula that [The Change Companies] have done."
Q: Is there anything else you’d like to say before we wrap up?
Cathy Thompson: "I know so many incredibly gifted, talented clinicians at every level, from treatment specialists who are doing the day-to-day groups to folks working in administration at the highest levels who are really cheering you on. And you are, as a colleague of mine would often quote a former supervisor of his: You're doing righteous work. Righteous work. You're truly making a difference…
Every time we have a conversation about this work, we're moving the needle. Every single time that you engage with somebody, that you deliver service — even if it feels like you're banging your head against a wall — you're moving the needle. We didn't talk about just how compartmentalized things can be. So if I had one last piece of advice that I would give both folks doing the service delivery in institutions, prisons, jails… [It's] take time to educate yourself about what the next steps are for those people.
If you've never visited a halfway house, if you've never met with a probation officer or a parole officer, if you don't know what that looks like, it's hard to best prepare your people for that. I've done a lot of great work with United States Probation and love to engage with those folks.
And just thank you for all that you do. You'll never know the lives that you touch. You will never know the sons and the daughters and the parents and the spouses. You'll never know the neighbors who are better off because the individual that you worked with benefited from your care and dedication."