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					                                                               ADDICTION T DAY
COVER STORY | TECHNIQUES                                                                                                    January | February

Stephen Valle’s accountability model yields dividends in clinical effectiveness and
cost effectiveness. It can cut re-offending rates by an extra 10-40%, and has
been applied to domestic violence programmes, courts, community and in-prison
therapeutic communities. He gives us the inside story.
The most essential function of corrections, be       their insurgency”2. “Our prison system is at a        probation caseloads, incarceration and re-
they prison- or community-based interventions,       crossroads,” states the Conservative paper Prisons    offending – those with an addiction to alcohol
is to ensure public safety. Yet despite enormous     with a purpose: Our sentencing and rehabilitation     and/or drugs. There is convincing evidence in
investment in building more prisons over the         revolution to break the cycle of crime. “There is     the professional literature that science-based
past 25 years in an earnest attempt to enhance       real risk we will move towards large scale penal      interventions and treatment for the drug and
public safety, this effort alone has not yielded a    containment, spending more to accomplish less,        alcohol offender can reduce recidivism from 10-
significant decline in re-offending. Costs for this    losing hard won gains and stifling innovation.”5       40% and create huge savings for taxpayers.
undertaking have been staggering and                                 Alarming as these facts are, it
are now burdensome.                                                  is only a fraction of the story.      SPEED UP RETURNS ON INVESTMENT.
     It has become clear that the US                                     Significant progress has been      Research has established that every dollar/pound
– and similarly the UK – cannot                                             made over the past 25 years    spent on quality treatment of addiction can
build themselves out of the problem                                          in understanding what         deliver a return of 12 or more dollars/pounds in
of chronic recidivism. Nor can we                                              works best for changing     reduced substance-related crime and criminal-
afford the economic burden imposed                                               the    behaviour      of   justice and healthcare costs6.
by policies which do not meaningfully                                                 offenders who              But we have been slow to implement
decrease the cycle of re-offending.                                                        account for      these principles, policies, and practices on a
     Recently came the shocking fact that                                                   the rapid      large-scale basis. Fewer than 20% of offenders
one in every 100 US adults is behind bars:                                                    ascent in    with an addiction problem receive the type
2.3million adults. If we also include offenders                                                  arrests,   of programming needed to effectively address
under some form of community correctional                                                                  their addiction and related criminality. By not
supervision, the ratio jumps to an astounding one                                                          applying what we know can significantly change
in every 31 adults – more than 7.3million adults                                                           the cycle of drug offenders returning over and
in the US are under some form of correctional                                                              over again to prison or community corrections
control1.                                                                                                  settings, we have allowed ourselves to continue
     In the UK, the prison population is a lower                                                           to be victimised by this cycle of re-offending.
82,000. But that is higher than the capacity of                                                                 We allow ourselves to remain hostage to the
the overcrowded prisons3 so, in 2009 alone,                                                                   staggering social and economic burden that
30,000 prisoners were released early. 65% of                                                                      addiction-related problems cause. And, for
those discharged from prison are reconvicted                                                                          this, we all are accountable. Offenders
within two years of release4; if we include those                                                                        are accountable to address their
who are not caught, the real re-offending rate is                                                                            addiction and change their
likely to be far higher, and in the case of young                                                                             criminal behaviour. We are
offenders it is likely to be over 90%. Because of                                                                                accountable to implement
overcrowding, 40% of violent offenders are                                                                                       what the evidence tells us will
merely given community orders.                                                                                                 work in reducing recidivism
     In both the US and UK, most of                                                                                          and breaking the cycle of re-
these offenders have an alcohol and/or                                                                                       offending.
drug problem.
     This costs americans over $68billion                                                                            ACCOUNTABILITY
a year, ripping families apart and eroding                                                                          TRAINING®.
the very fabric of society. In addition, it is now                                                                Accountability + respect + community
threatening national security as the media report                                                               = the formula for offender recovery
that “Taliban and other insurgents have been                                                                  and change (see diagram on page 26).
using proceeds from the drug trade to fund                                                                  Accountability Training is a paradigm and

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                                                                  ADDICTION T DAY

Accountability Training Content
and Process Variables

model for changing the                                                                                                                what one’s role was and
behaviour of offenders                                                                                                                 what are the consequences
with addiction which has                                                                                                             of the choices he/she
evolved over the past 25 years                                                                                                     made. And then making the
of implementing addiction                                                                                                        choice of what to do, or not
intervention      and     treatment                                                                                           to do about it, and accepting
programmes in various correctional                                                                                         the consequences involved. Or, in
venues. Its origins are in the mid-                                                                                   inmate language, as one offender put
1980s in the Massachusetts Department of                                                                          it succinctly, accountability simply means,
Corrections where researchers discovered a new                                                               “manning up”.
tool for reducing recidivism. Evaluation of this        Office                                Jail and            In the programme, offenders learn that the
pioneering programme at the DOC Longwood                House of Corrections, and in several community       best way to deal with the hard realities which
treatment facility indicated a recidivism rate          corrections centres throughout Massachusetts.        the consequences their choices have had on
for multiple drunk-driving offenders and other           How can it apply to the UK?                          them and others is with respect. Respect for
offenders with chronic substance-abuse problems                                                               themselves, and respect for others. And they learn
of less than 10%7.                                      WIDESPREAD APPLICATIONS.                             this in community; first, in their community
     This Accountability Training model was             A unique feature of Accountability Training is       of peers under supervision and monitoring by
replicated over the years with offender populations      that it is peer driven, though staff directed. It     staff (rational authorities), then in the larger
in Texas, Florida and Maryland. Since the mid-          incorporates evidenced-based practices as core       community in which they live.
1990s, under the auspices of AdCare Criminal            content variables, applied in the context of three        One of the enduring principles which have
Justice Services – part of AdCare Hospital in           core process variables which have been identified     shaped the development of Accountability
Massachusetts – Accountability Training has been        as essential ingredients for working effectively      Training as a behaviour change model for
applied in several institutional and community          with offenders.                                       offenders is the following realisation: offenders
correctional settings. Over time, it evolved into a          The three core process variables in what        learn best how to stay clean and sober and to
highly structured, integrated, curriculum-based,        has been termed “the offender change formula”         change their thinking and behaviour by learning
continuing-care intervention and treatment              are: accountability, respect and community.          to be accountable to one another. The power of
model for offenders with addiction.                      Accountability Training is conceptualised as a       the peer group is harnessed to effect change in
     It uses evidence-based modalities such as risk/    series of process and content variables, visually    one’s attitude and in one’s behaviour.
needs assessments, motivational interviewing,           portrayed for training and teaching purposes as           Staff function as recovery life coaches and
stages of change, cognitive behavioural techniques,     the Recidivism Reduction Pyramid (see above).        teachers, more so than as traditional clinicians.
standardised curriculum and continuity of care          Accountability involves four components:                  In this model, offenders learn that, by being
principles for successful re-entry.                        awareness                                         accountable to one another, they learn a key
     An evaluation of the Accountability Training          understanding the choice that one made            variable of living in a pro-social environment: that
programme at the Barnstable County (MA)                    owning one’s role in the consequences that        everyone answers, in some fashion, to someone
Sheriff’s Office, conducted by a National Institute        one’s choices brought about, and                     else. At some point, as part of the socialisation
of Justice-funded research firm, concluded                  taking meaningful, empathic action to change.     process, we all have to give an account of our
that offenders who completed the residential                  There are no excuses, no blaming others, no     behaviour to an authority greater than ourselves.
substance abuse treatment programme have more           victim mentality permitted in Accountability              Offenders learn, in the process of the peer-
than a 30% lower rate of recidivism three years         Training programmes. While explanations and          to-peer community, how to respect authority
after release.                                          reasons for one’s choices are given voice, there     and to experience structure as a positive resource
     The study also concluded that the programme        is limited processing of the reasons why or the      for change. They learn that one’s choices have an
was a significant cost saving8 (see graph on page 27).   feelings associated with the behaviour being         impact on others and that they are accountable for
     The Accountability Training model is being         addressed.                                           the choices they make, and often for the choices
replicated at the Essex County (MA) Sheriff’s                 The focus of accountability is on identifying   they don’t make. As the offenders make progress

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                                                                ADDICTION T DAY
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                                                                                                                                        Re-Offending Rates of Six Month Jail Based
                                                                                                                                        Treatment Programme:
                                                                                                                                        Comparison of Programme Completers and
                                                                                                                                        Non- Completers

                                                                                                                              abuse field. He has served
in the programme,                                                                                                             as president of the National
they are challenged to                                                                                                        Commission for the
take meaningful and                                                                                                           Accreditation of Alcoholism
empathic action to                                                                                                            and Drug Abuse Counselor
change their thinking                                                                                                         Credentialing Bodies for six
                                                                                                                              years. He provides technical
and behaviour.
                                                                                                                              assistance to treatment
     So, by addressing                                                                                                        centres, hospitals, prisons,
offenders’ addiction                                                                                                           jails and other agencies in
problems directly with                                                                                                        the criminal-justice system.
immersion in science-                                                                                                         Dr Valle is the author
based programming, we know how to hold                   The offender with addiction is accountable to       of over a dozen journal articles, author
offenders accountable for taking charge of             change, to take right action – and so are we.         of Alcoholism Counseling: Issues for
                                                                                                            an Emerging Profession and editor of
their recovery, and for changing their criminal
                                                                                                            Drunk Driving in America: Strategies and
behaviour.                                            REFERENCES.                                           Approaches to Treatment. He was associate
     We can definitively know how to reduce re-        1 Pew Center On The States, One in 31: The Long       editor of Alcoholism Treatment Quarterly,
offending considerably – and, at the same time,        Reach of American Corrections. (Washington, DC;       and held several editorial review assignments
to save taxpayer resources.                           The Pew Charitable Trusts, March 2009)                for leading professional journals.
                                                      2 USA Today, 30 March 2009                            Before joining AdCare, Dr Valle was chief
RAISING THE BAR FOR OURSELVES.                        3 Monthly Population and Accommodation                of psychology and programme director for
We now need to raise the accountability bar for       Bulletin, NOMS, 31 January 2007                       an 80-bed addiction treatment hospital for
                                                                                                            10 years, provided consulting services to
ourselves – the families and significant others in     4 Re-Offending by Adults; Results from the 2004
                                                                                                            leading medical institutions throughout the
the offenders’ life, and the social, healthcare and    cohort, Home Office, 2007                               country such as the Johns Hopkins Hospital,
criminal-justice systems charged with protecting      5 Annual Report 06/07, HM Chief Inspector of          and operated several community-based and
public health and safety. As with the offender,        Prisons for England and Wales, January 2008           institutional treatment programs.
creating appropriate incentives for change            6 The National Center on Addiction and Substance      As founder and president of Valle
and accountability is vital. Since the evidence       Abuse at Columbia University. (2009). Shoveling       Associates and Right Turn, Dr Valle created
demonstrates clearly that we can reduce recidivism    up: The Impact of Substance Abuse on Federal, State   Accountability Training®, a public safety
                                                                                                            treatment model for use with substance-
significantly and benefit economically, are we not      and Local Budgets. New York. CASA
                                                                                                            abuse offenders in the criminal-justice
accountable to do so?                                 7 LeClair DP & Guarino-Ghezzi S (1997). Prison        system. His model has been applied in
     By applying the formula for offender change       Reintegration Programs: An Evaluation. Corrections    domestic violence programs, boot camps, in-
– accountability + respect + community – to           Management Quarterly, 1 (4).                          prison therapeutic community programmes,
providers who deliver services, and the social and    8 A Study on the Habilitation of Chronic Offenders     and in various courts, community corrections
justice organisations and systems which support       in a Massachusetts House of Correction, 2003.         and criminal-justice settings. The concepts
them, recidivism can be reduced significantly and      BOTEC Analysis Corporation. Waltham, MA               introduced in this article are explained
taxpayers benefit.                                                                                           more fully in: Accountability Training: How
                                                                          DR STEPHEN VALLE                  Offenders With Addiction Can Change and
     Accountability involves awareness, choice,
                                                                          (photographed with                What We Need to Do To Make it Happen
owning those choices, and taking meaningful,                                                                (expected publication, Spring 2010).
                                                                          lookalike!) is president
empathic, action to change. When offenders have
                                                                          and CEO of AdCare                 MEET THE AUTHOR!
the opportunity to learn better and the training
                                                                          Criminal Justice Services,        We are delighted that Dr Stephen Valle has
to know better, many will – as the evidence                               Worcester, Massachusetts.         agreed to fly to London in May to present
indicates – do better.                                                    As a licensed psychologist,       a day-long workshop at UKESAD on the
     Perhaps the time has come for all of us to be    and certified addictions counsellor, he is             techniques in this article – see programme
accountable also, to do our part to break the cycle   recognised for his leadership in developing           with this issue of Addiction Today.
of re-offending.                                       national standards for the alcohol and drug           Image page 25: Christophe Boisson .

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