There are no cookie-cutter treatments in the world of recovery. Alcoholics and Narcotics Anonymous remain the standards, but new research is showing that those programs only effect individual-level change, and for a lot of substance “abusers” the reasons for their addictions are engrained on a community-wide level. In many cases, treatment needs to be individualized, especially for those on the margins of society where racism, sexism, and classism rear their ugly head in the form of prison sentences, discrimination, and poverty. Those with a history of incarceration and substance use disorder need to get help on multiple-levels to decrease their alcohol and illegal drug use when they reenter society.
Enter Integrity House, a Newark Community Collaborative Board project that launched “Community Wise,” a newly funded community-based research program that is seeking people with histories of substance use disorders and incarceration to participate. Community Wise knows that returning citizens face significant challenges as they are released from prison. The program wants to address this problem by offering an innovative, multi-level intervention to reduce alcohol and illegal drug use among this population. The intervention program started at Integrity House in January.
“Participants are motivated to be part of the study because they haven’t seen an intervention like it before,” the program director, Dr. Liliane Windsor, from the University of Illinois at Urbana-Champaign, says. “We use images to stimulate discussion about the impact of social determinants of health on health inequalities and community organizing strategies to foster change at the community level.” The Fix sat down with Dr. Windsor to learn more about this program, individualizing treatment, and what Integrity House hopes to accomplish.
What do you think of traditional treatment methods like AA? Why don’t they always work for people coming out of prison?
No program will work for everyone. Currently we have a few evidence-based interventions and AA has certainly earned the respect of professionals in the field. It has been an important path to sobriety for many people. However, these interventions only focus on individual-level change. They ignore the macro-level forces that research show having a significant impact. These include discrimination, poverty, increased exposure to violence and to the drug markets. Community Wise comes to close that gap. It will not work for everyone either, but it will certainly change the way we typically think of addiction and recovery.
What is the goal of the program? How does it work and what will be expected of participants?
Alcohol and illicit drug use has significantly higher negative consequences for individuals residing in marginalized communities, those that have higher incarceration and HIV/HCV infection rates. Thus, developing effective interventions to combat substance use and its related health inequalities in these communities is critical.
In previous work, we developed and pilot-tested Community Wise, a manualized, multi-level, community-based intervention to reduce substance use frequency among individuals with histories of incarceration and substance use disorders. Recently, we obtained funding from the National Institute on Minority Health and Health Disparities (NIMHD) to optimize Community Wise. That means that we will be working closely with our community partners to develop the most efficient and sustainable version of Community Wise that can be delivered under $250 per person.
In order to accomplish our goal, we will conduct a randomized controlled trial where we will randomly assign 528 men with histories of substance use disorders and incarceration into 16 experimental conditions. This means that we will create 16 different versions of the Community Wise intervention to find out which components or combination of components is most efficacious in reducing substance use frequency. The conditions’ length ranges from three weeks to 15 weeks.
Can you explain the key components of your program?
Critical Dialogue: Group meetings where participants reflect on the images above and engage in dialogue to develop a deeper understanding of how marginalizing processes like racism, sexism, and classism impact their lives and behavior.
Quality of Life Wheel: An exercise designed to increase self-efficacy and help participants develop a vision for their future, breaking this vision down into small, feasible, measurable goals they can implement on a weekly basis such as quitting smoking, improving relationships with family members, or paying down debt.
Capacity Building Projects: Group projects designed and implemented by participants with support from the NCCB and other community members and organizations to address community problems like educating the community about health, community mobilizing, engaging in the political process, and creating community services.
Any components that do not contribute to reduced alcohol and illicit drug use will be eliminated from the intervention. We will also examine if using peer facilitators or licensed clinicians to deliver Community Wise has an impact on reducing alcohol and illicit drug use.
How is this intervention program different from others, and what will make it more impactful?
Community Wise was designed to be effective with marginalized groups. More specifically, those who use substances to cope with marginalized and oppressive conditions such as poverty, racism, classism, and sexism. The intervention is innovative in two specific ways—it seeks to create change at the micro level through cognitive and behavioral processes, on the meso level by building relationships with individuals and organizations, and the macro level through political and cultural processes.
In other words, traditional treatments only seek to change individual cognitions and behaviors, while Community Wise changes cognitions and individual behaviors along with improving health and the conditions of entire communities.
The intervention empowers marginalized groups by joining them together with other community members—other residents, service providers, political representatives—to leverage community resources in addressing their challenges. We also have specific components to address the impact of racism, classism, and sexism on drug use and community health.
What type of addictions does your program focus on? Only substance abuse, or do you address the criminal lifestyle that some ex-cons feel trapped in and get addicted to even more so than the drugs?
At the individual level, Community Wise is designed to reduce substance use, criminal behavior, and HIV/HCV risk behaviors. We work with all substance use disorders.
What kind of tools are you going to give the people in your program to help them survive and live life better than they have been?
The intervention works through critical consciousness development. Critical consciousness is an individual’s ability to understand the structural roots of personal and societal problems and to address social determinants of health while changing individual behaviors and reducing drug use. Participants learn critical thinking skills and how to apply them to understand how macro-level forces impact their behaviors and lives. They then learn community organizing skills to address the problems they identify in their communities.
Do you want your graduates to go back to their communities as agents of change? Why or why not?
Yes, the idea is to reconnect them in their communities so that they spend their time doing community activities such as volunteer services, civic engagement, mentorship, or anything that improves the conditions of the community.
Are you going to keep track of your graduates as they assimilate back into society and check up on them for study purposes? What do you hope to find?
This study will follow participants for up to one month after treatment. We hope that after the intervention is over, they will continue to work on their community issues and remain healthier.
It’s a proven fact that education combats recidivism. Do you feel your program is more treatment or education orientated? Or is it a juxtaposition of the two? Please explain.
Community Wise is a juxtaposition of both, in addition to community organizing. There is a strong clinical component in the form of group therapy and a strong educational component in the form of research, readings of scientific articles, community organizing training, and critical thinking. We strongly believe that both education and treatment are important components of a successful recovery.
What type of individuals are you looking for to enroll in Community Wise?
We are looking for men aged 18 or older that reside in Essex County, New Jersey, and are willing to have their voice recorded during group sessions.
The individual has to have the ability to speak English, suffer from a substance use disorder, and been incarcerated at one time during the past four years.
*The project will take place in Newark, NJ. Recruitment started in December of 2016. If you are interested in participating or have any questions, e-mail: NCCB@newarkccb.org