GRAY MATTERS

Gray, Richard M. (2001). "Addictions and the Self: A Self-Enhancement Model for Drug Treatment in the Criminal Justice System. The Journal of Social Work Practice in the Addictions. Vol. 2, no. 1.

This paper was originally presented as a workshop for The National Association of Social Workers Institute on Addictions: Addictions Through the Lifecycle, Fordham University, New York, NY, on May 7, 1999. For reprints contact the author at The United States Probation Department, Eastern District of New York, 75 Clinton Street, Brooklyn, NY 11201. Email: <richard_gray@ce2.uscourts.gov>

Abstract

This paper describes an experimental, strengths-based program for the treatment of substance abusing offenders under criminal justice supervision in the United States Probation Department. The program is based upon new physiological evidence that links addictions to the experience of hope, and consistent research that identifies self-efficacy, futurity and self-esteem as crucial elements in recovery. Rooted in concepts taken from Jungian and Maslowian ideas of the Self, the program uses techniques gleaned from Neuro-linguistic Programming (NLP) and Ericksonian hypnosis to provide a continuing sense of Self and the possibility of positive, self-actualizing futures. This article explores the theoretical background of the program, specific tools employed, program results and suggestions for further research.

Addictions and Hope

Addictions have been subject to multiple understandings over the last hundred years. They have been defined as moral failures, diseases, and pharmacologically mediated brain dysfunctions. Most recently the action of all drugs of abuse has been traced to the activity of dopaminergic neurons in the midbrain, specifically those responsible for learning new behaviors and setting up the expectancy of reward. This change in understanding occurs almost simultaneously with the appearance of a view of addiction as a learned behavior (Blomqvist, 1998,; Changeux, 1998; Doweiko, 1996; Malapani, et al., 1998; Schultz, et al., 1997).

More specifically, there is evidence that one of the important functions of the Nucleus Accumbens is to calculate the probability of reward. The brain calculates this probability by comparing the levels of dopamine activity associated with various behaviors. After correlating with strongly reinforcing effects in early trials, the mechanism takes on the characteristics of reward expectancy. That is, there is an apparent shift from experiencing a present reward to expectancy of future rewards (Schultz and Fuchs, 1995). Consequently, the simple anticipation of reward--at the basic level of physiology--translates into the root of the mature human emotion that we call hope. Addiction can then be viewed as a pharmacologically enhanced, and yet misplaced sense of hope. This dynamic is subtly suggested in the statements by many addicts that they continued to use addictive substances in hope that they would recapture the impact of their initial experiences with the substance, or achieve the elusive "perfect high."

Recovery is often linked to an experience of a new direction or hope. Those interventions that have worked most consistently have been those which appeal to a spiritual or hope-centered change. This suggests that there exist natural activities and events which more fully match the brain's natural means of function and are identified by the mind as better hopes than the drugged state (Glasser, 1985; Peele and Brodsky, 1991). Sometimes, hope works to identify paths worth exploring. At other times, it awakens long forgotten potentials and perspectives. In general, we believe that natural human experience and the hope it engenders are capable of providing a more powerfully reinforcing set of experiences than substances of abuse and that those experiences can be defined and created for each client in treatment.

In espousing a learning/expectancy theory of addiction, we redefine the task of recovery in terms of the need to find a set of behaviors, experiences or personal directions that are inherently more rewarding than the drugged state. By so doing, we provide a firm basis for choice as we orient the client towards a possible positive future. Moreover, following Scott Peck and his definition of spirituality as knowing one's place in the universe (Peck, 1998), we might suggest that knowing one's place in the world -- having a sense of Self -- is a crucial part of recovery. Stanton Peele (Peele and Brodsky, 1991) points in similar directions as the lesson to be learned from self-changers. It is also the foundation of the move from pre-contemplation to contemplation, the single most important index of success in recovery (Prochaska, et al., 1994).

Elements of Successful Treatment

There are three elements of treatment that seem to reappear with great consistency throughout the literature. These are Self-Efficacy, Futurity and Self-Esteem. In addition, spirituality plays a crucial role in recovery from addiction and is intrinsically connected to the above concepts.

Self Efficacy describes the individual's sense of control about themselves and their environment (Bandura 1982). By definition, addiction entails a narrowing of focus and loss of control to the addictive behavior. By restoring a sense of control, choice and mastery, effective treatment provides options for new behaviors, options that are not focused in addictive behavior.

Futurity is seen by Prochaska, Norcross and DiClemente (1994) as a crucial predictor of treatment success. They point to the necessity if shifting from focusing on the loss suffered by giving up addictive behaviors to the expectancy of better things that can be gained by moving on to a sober future. This is the telltale sign of the shift from the stage of pre-contemplation to contemplation. The idea of a personal future can be understood in terms of a direction for personal development, closely related to C. G. Jung's idea of individuation and Abraham Maslow's self-actualization. It presumes that every individual has a call or direction, an image of their personal developmental goal that can make life simultaneously challenging, exciting and positively addictive. It is in the flow of this living stream that addictions are relativized into misadventures.

Self-Esteem has been viewed as the elusive panacea for all manner of problems. Here, however, we may understand that self-esteem flows out of a developing sense of self-efficacy and the more intimate sense of self that develops from the realization of the Call, or personal direction. We have in the past misunderstood self-esteem as flowing from power, position, possessions or other more-or-less concrete entities. Here we understand that Self-Esteem flows from a true knowledge of the Self. It is in finding the essential core of self and living harmoniously with that core calling that the Self receives the esteem it so vitally requires (Hillman, 1996; Peele and Brodsky, 1991).

Spiritual Dimensions In Effective Treatment

In addition to the factors already noted, religious affiliation has been regarded as one of the strongest predictors of successful recovery (Laundergan, 1982; Doweiko, 1996). More recently it has been directly correlated with prediction of treatment success in twelve-step programs compared with Cognitive Behavioral methods (Shine, 2000).

Spirituality, in the last several years, has come to be separated from the narrow realm of religion. M. Scott Peck (1998) has related spirituality to the idea of finding one's place in the world, in the sense of a divine ecology. This accords well with the archetypal idea of the axis mundi, often represented as the center of the home, the city and the nation as the place where secular and eternal realities meet. In every culture, sacredness has its special places. Conceived as an understanding of one's place in the fabric of life, spirituality can often be understood in terms of context and meaning (Eliade, 1954; Gray, 1996; Hillman 1996).

Having a sense of who one is and a sense of one's place or purpose in the world is related to both self-efficacy and selfeesteem. Simple efficacy, powerful in itself, represents the ability to purposefully and successfully interact with the world. The spiritual ideal that finds its expression in efficacy may speak not only to interaction with the world but to the understanding that such action has purpose and direction. Not only are there things that I can do well, but the sum of such things suggests an underlying identity direction or purpose; these equate to my sense of Self.

In the sense of spirituality as place, self-esteem is not simply feeling good about oneself. It is feeling good about who you are and implies a place, a way of being in the world, a unique identity. This sense of place and identity stands in direct contrast to the Durkheimian anomie and placelessness that characterizes so much of modern life (Berger et al., 1974).

James Hillman has suggested that every person has a calling, a specific purpose for which he or she is uniquely suited. In The Soul's Code (1996), he suggests that fulfillment of this call is the key to individuation. Not only does this call provide an impetus for personal growth, it may be argued that a congruent alignment with the call of the Self also provides for self-esteem on a deep and empowering level. For the purposes of the behavior/expectancy model of addiction, this idea of calling with its implied increase in self-esteem provides the behavioral counterbalance for addictive behavior on a deep spiritual level. From the Jungian perspective, the person moving towards individuation is the person who is realizing this call. A similar idea is referred to by Maslow as self-actualization (1954). In the context of addictions, it is the awakening of a the individual to the possibility of flexibility and growth along the path of individuation that provides the strongest counterbalance to addictive behavior.

Operationally we have defined self-actualizing behaviors as behaviors which

1. enhance self-efficacy

2. enhance self-esteem.

3. identify and move the individual towards realization of personal potential,

4. focus personal effort and energy in the direction of an attainable and desirable future.

In order to build behavior sets that will produce movement in the direction of self-actualization, we have provided specific tools and strategies.

Application of Concepts to Treatment

The Brooklyn Program centers around a technique developed by Gray (1997b) based on Jungian presuppositions regarding the nature of the Self. It consists of an inventory of past, positive experiences and the unifying life themes that develop from them. The process is referred to as the Feeling Toned Vector (FTV). The awakening of a sense of Self with its implicit set of personal definitions and directions provides a foundation for linking other exercises to a sense of personal identity and place. It provides a core experience that helps to define Self as a continuing reality that implies a place in the universe. For many participants the exercise provides a unique sense of Self that transcends the needs of the moment and locates the individual in the flow of a more abstract, spiritually ordered life.

Neurolinguistic Programming (NLP) is an integrative discipline drawing successful strategies for communication and change from various sources. Central to its approach are cognitive interventions based upon visualized representations of various mental processes (Bandler and Grinder, 1975; 1979; Dilts, 1980;1983;1990).

Among the most useful tools to emerge from the NLP community is the smart outcome generator . Versions of the technique appear in Robbins (1986) and Linden and Perutz (1998). This technique consists of rules for constructing and evaluating goals or outcomes. Consistent with the original linguistic presuppositions of NLP, the technique provides a syntax for motivation and decision making. In the process, it provides a vivid, multisensory, internal representation of the goal state and uses the Ericksonian technique of pseudo-orientation in time to provide an encounter with a future self (Hammond, 1990). In our implementation, the future self provides instructions to the present self as to how he/she has successfully reached the goal in question and helps to coalesce individual directions, capacities and potentials in actualizing that aim.

Extensive use is made of Ericksonian hypnosis (the permissive style of suggestion pioneered by Milton Erickson, MD) and guided imagery. Hypnosis is used to teach relaxation skills and provide an opening to creative possibilities. It is actively engaged as a means of integrating each day's learnings and to seed the process for the coming weeks. On some level it represents a reward: a pleasant, altered state to reinforce the session's efforts. All of the trances are scripted and with minimal training can be used with a great deal of success.

Method

Program Organization

The U.S. Probation Department for the Eastern District of New York has undertaken an experimental protocol for the treatment of substance abusing offenders in the federal criminal justice system. The program is 16 weeks long with each session lasting 90 minutes. Groups range in size from five persons and one facilitator to 16 participants with two facilitators. The groups are of mixed gender and ethnicity. Since the groups are for the most part didactic, group size is less of a problem than it might be in a less structured setting.

Selection of participants and referral

Participants are referred by probation officers using the following criteria: All participants must have been mandated by the Court or the U.S. Parole Commission to obtain drug treatment as a condition of supervision (probation, parole or supervised release). All participants must be currently enrolled in the Probation Department's random urine program, and must be either totally abstinent or have a documented record of urinalysis and admitted use of three or fewer incidents of drug abuse during the preceding 3 month period. Further requirements include fluency in the English language and the ability to read and write. Offenders who are dually diagnosed and offenders in full blown relapse are excluded from the program.

Copies of the presentence investigation of the judgment ordering substance abuse treatment are reviewed and cases are conferenced with the referring officer before acceptance. A one page intake form including personal data, dates of last use and drug of choice is completed by the participants during the first group session. Information on attendance, level of participation and problem behavior is provided on a weekly basis to the referring probation officer. The probation officer, in turn, provides updates on urinalysis results, personal issues which may need to be dealt with in treatment and general feedback regarding the program.

Program rules

After completing the intake form in the first session the participants receive a copy of the following program rules and expectations:

The following rules are designed so that you receive maximum benefit from the Brooklyn Program. Please remember that other outpatient treatment programs may require two or more visits per week and multiple trips to the location where the program is offered. This program represents a bargain in time, effort and travel expenses. Please take full advantage of it.

1) The program is 16 sessions long and lasts two hours per session. Please be sure to arrive on time so that we can start on time.

2) There may be weeks when we will not meet as a group. These weeks will not count in the calculation of the 16 weeks.

3) You are expected to be here for all of the sessions. No unexcused absences will be allowed. If you have an emergency, you should contact one of the program facilitators ahead of time.

4) Each week there will be specific exercises that you are expected to complete at home. The work must be done on time and as instructed. If the work is not done, you may be required to return on another day to complete it. Make sure that you bring the current exercise with you and remember to bring something to write with.

5) This is an abstinence program. You will be expected to remain drug and alcohol free. Should you return a positive urine during the course of the program, you will be asked to attend one or more individual sessions with staff.

A hard line is taken on missing the earlier sessions to the extent that no absences are tolerated. After the behavioral foundations are laid, in sessions one through four, up to three excused absences may be permitted. If a specific session is deemed more important than others, the facilitator will announce that the session is mandatory.

Objections raised to the propriety of individual assignments to the group (due to claimed abstinence or unfair assignment by their probation officer), are met with the assertions that the core of the program is a personal development program for which people without drug problems often pay several thousands of dollars. It is emphasized throughout the program that the exercises and meditations provide tools for living that have value independent of an individual's substance abuse history.

Process

Session 1

After the intake forms have been completed, participants are given a brief lecture on the relationship of the dopaminergic systems in the medial forebrain to substance abuse and addiction. The intent of the lesson is to teach the participants to equate substance abuse with other learned behaviors that are automatically performed but are nonetheless subject to choice. Specific parallels are drawn between substance abuse and reading or bicycle riding as learned, automatic behaviors which, under certain circumstances, become "irresistible". Bicycle riding, for instance, becomes irresistible once one gets on the bike and reading is often an automatic behavior outside of one's conscious awareness.

Following the introduction, there are three specific exercises which lie at the heart of the program. These include a conditioning exercise, an exercise rooted in an inventory of personal resources and an outcome generator. The following outlines the three crucial elements of the program.

Conditioning exercise

Much of the first session is devoted to building a positive expectancy for the possibility of change. In support of this we begin the exercises with the evocation of a past experience of success. Starting with success has the effect of starting the whole program off on a positive note. Moreover, starting the program with a felt experience of success eliminates a great deal of resistance. In addition, by framing this initial experience "Just as an example" pressure to do it right is eliminated and participants can take the necessary time to question the process and to become competent in it before we "really" start.

The initial exercise, including the introductory "success" drill follows a straightforward conditioning paradigm using an imagined stimulus object. Generic instructions for accessing a resource state, or good feeling, include the parenthetical instruction to use success as an example. The instructions as provided to the participants follow:

1) Choose a resourceful state of mind (success). Identify one specific time in which you fully experienced that state.

2) Close your eyes and re-live the experience. Choose the best part of the experience, without reference to what came before or after. Use your imagination to see through your own eyes, hear through your own ears, and feel the sensations in your body. Pay close attention to all the things that let you know that you are there:

Listen for any sounds that are part of the memory. Listen for anything that you might have been saying to yourself. Look through your mind's eye at the scene. Look for details in the people and things around you in the memory. Feel the sensations and emotions that you felt in the experience. Notice your posture, your breathing. How do you hold your head? What kinds of tension do you feel in your body and in your face? Breathe deeply and remember any smells or tastes related to the memory.

When you have finished going through all of your senses, stop thinking of the experience, shake off the state and open your eyes.

3) Select a unique anchor stimulus. You could use a gesture, a word or a touch. If you use a word, say it in a special way, a way that makes it special here.

4) Go back to the memory that you have chosen. Re-experience the feelings, sights, and sounds that are part of it. As you feel that the state is about to peak, say the word, make the gesture or touch the part of your body that you have chosen as your anchor.

As the experience moves into its peak, release any touch-stimulus. Relax, drift and enjoy the state. After a few seconds, stop thinking of the experience and shake off the state.

5) Repeat 'Step 4' several times. Each time you go back, the state will get stronger. You can improve this further by turning up the intensity of any part of the experience (color, movement, brightness, etc.) and by adding other sensory experiences to it. Remember, the more senses that you use, the stronger the experience will be.

6) Come back to the here and now. Clear your mind and say the word, make the gesture or touch the part that you have chosen to be your anchor. The experience of your state should come into consciousness automatically. It may come slowly through your body, or it may produce a rush of experience. Continue to repeat steps 4 and 5 until you have easy access to the resource state.

7) Once you are able to access the resource state by using the anchor alone, identify some situations where you could use these feelings. Imagine being in one such situation. As you imagine yourself in that situation, touch your anchor, or say the word, and discover how your feelings about that situation change.

During the first session, the entire group is led through at least one example state, success, using the technique. Questions and explanations are freely received and given to ensure that every participant has a positive experience and fully understands the procedure.

At the end of the session a work sheet with the above instructions, and with further process notes are provided to each participant. The instructions are reviewed and the participants are directed to the following introductory statement and list of resource states (The list is derived from Baffa,1997):

For each of the following, think of a time when you experienced the kind of state listed. Any positive example will do, no one memory is better than any other. Just pick one and stick with it. When you have chosen the state, you will learn to use a special word that you can say to yourself to evoke this feeling in the future. For the five states below, use the following names: focus, solid, good, fun and yes.

FOCUS: Think of a time when you were younger. Perhaps you met someone new that you were very interested in getting to know. Perhaps it is someone of the opposite sex. Choose a time when you would be able to spend hours with that person, but it only seemed like minutes had gone by.

SOLID: Think of a time when you made a good decision, one that continues to be satisfying even today.

GOOD: Think of a time when you totally surprised yourself by being able to do something, and do it well, despite the fact that you didn't think that you would be able to do it. What might make this experience special is that it wasn't until you had already learned and were already doing the new thing that you finally realized you were doing it!

FUN: Think of a time of absolute playfulness. An experience where you were having fun just for the sake of having fun.

YES: Think of something that you can do competently, reliably and repeatedly. Something that you know that you can do well without a doubt.

These instructions are reviewed, possible examples of resources are given and the utility of each class of resource is provided. The participants are advised that they should do their best to try all 5 states, using the same techniques practiced with "success." It is emphasized that this practice needs to be done outside of the group situation because it is important that each participant realize that they are "learning to push their own buttons." In this way, they are told, "You can be assured that you are learning to make your own choices, not mine, not the program's, but your own." If one or another of the states becomes too daunting, they should leave it for the moment and try another. They can always return to the missed state.

Later sessions

During the second session, progress in accessing the 5 basic states are reviewed, successes and problems are discussed and the entire group is led through the process of accessing and conditioning the resource states several times. Time is spent emphasizing enhancement of the states and ensuring that they can be accessed at will.

Future pacing

Once all of the participants have created reliable, conditioned links to all 5 resources, they are trained in the simple skill of future pacing. Future pacing is the common NLP term for higher order conditioning using an imagined stimulus context. Participants are asked to identify a number of situations where each of the anchored states would be of value. They imagine themselves in the situation and using the stimulus word or gesture, "fire off" the anchored state (elicit the conditioned response). This enhances response generalization across contexts and increases the probability that they will use the new behavior in the imagined context.

During the following two to four sessions, variations on these two exercises are assigned. Practice is aimed at allowing the participants to discover their own ability to choose and anchor resource states at will.

The positive experiences exercise

By the fifth session, the participants have developed a significant level of expertise in accessing positive resource states. They almost universally report an increase in access to positive memories and more time spent in positive states. At this time they are introduced to the Positive Experience Exercise, the second of the three core exercises. The task consists of making a list of the following kinds of memories:

What did you dream about doing when you were a child? How did you see yourself in the future?

Jobs and roles since childhood. Think of 6 jobs or roles that you have filled that were really meaningful for you.

Things you do well. Pick 2 from childhood, 2 from adolescence and 2 from adulthood.

Things you learned easily. Any subject, skill, talent or ability that came easily to you or that you really enjoyed learning. Pick 2 from childhood, 2 from adolescence and 2 from adulthood.

Times you really felt good about yourself. Even if it got ruined later, even if it was just for a second. Pick 2 from childhood, 2 from adolescence and 2 from adulthood.

For each of the questions, the participants are asked to consider the following questions: What made you feel good about it? How did it feel? When completed, each of the participants is led individually through a discussion of the commonalties that unite the chosen experiences and how these themes have appeared throughout their lives. In the group session, they are encouraged to discuss with the facilitator(s) the means by which the emerging felt sense of self (as exemplified by the feelings produced by the exercise) might be expressed in their current life. Finally, they are invited to enhance the feeling that emerges and anchor it to a word or gesture of their choosing.

Smart outcome generator exercise

The next exercise focuses on the Smart Outcome Generator. The exercise works to create the experience of a goal or outcome that obeys certain rules.

Using the resource state from the positive experiences exercise create a goal or outcome that adheres to the rules implied by the following questions:

1) Is it stated in the positive, or can it be stated in the positive? (e.g., "I want x, y and z." Not "I don't want x, z, or z.") State it.

2) Is it under your personal control? How?

3) Can you specify 3 different ways in which you will know that you've gotten it if you get it? (E.g., I will feel the diploma in my hand. I will see my family cheering in the bleechers.)

4) Do you want this all the time? Is it appropriate everywhere? Should it be limited to a specific context? When do you want it? When don't you want it? When is it right? When is it wrong?

5) What will it change in your life and in the lives of the people around you? Be specific.

6) Experience now, in your imagination, how you will look and feel, what you will see and hear when this is a reality. Describe what you see and hear and feel. Who is there? What is it like? Be there Now.

7) Move backwards from the final realization of the goal to discover the steps that make it possible. List the steps.

An essential part of the exercise is the use of the accessing skills learned earlier in the conditioning exercises. The sensory experience of enhancing remembered resource states is now used to enhance an experience of an imagined possible future. During the entire process the facilitator asks questions designed to enhance the participant's felt presence in the desired future. At the end of the exercise the facilitator encourages the production of specific steps and decisions that will make the outcome a real possibility. Sensory specificity is an essential requirement In every part of the exercise.

Results

The Brooklyn Program has been in existence for two years. It has graduated over 100 participants. Program data and follow up reports from the referring probation officers indicate that: the retention rate is currently 70% (discounting persons who fail to return after the first session). The bulk of dropouts have been persons with dual diagnosis issues and persons in need of referral for inpatient detoxification. The relapse rate, defined as any person needing referral for other treatment, is under 20% and the recidivism rate, defined as persons who have subsequently been revoked from supervision for any reason, is under 3%. According to The Compendium of Criminal Justice Statistics for 1998 (the last year for which statistics are available), 25% or more of offenders terminated from federal supervision (probation, parole and supervised release) are revoked and sent to prison (U.S. Department of Justice, 2000).

Discussion

While responses to the program have been overwhelmingly positive, in light of the lack of formal research data collection, they must be treated as anecdotal evidence. An inability to obtain current information on persons who have completed their terms of criminal justice supervision and persons who have been transferred to other probation officers or other federal districts, make complete follow-up difficult.

The high rate of treatment retention is believed to be the result of the interplay of the treatment context and the treatment techniques with these clients. As a program for mandated clients whose treatment results are reported directly to probation officers, it would be naive to believe that the high retention rate is not context related. Nevertheless, by the second or third session, most attendees report overwhelmingly positive responses to the exercises. Multiple instances of perfect attendance over the entire 16 week period, even before the more rigorous attendance policy was instituted, were not unusual.

One of the major factors that may account for the positive results is the specific treatment approach. From the outset, we emphasize the themes of personal potential, positive resources and feeling good. Participants are encouraged to enjoy the exercises and to discover just how much enjoyment they can create for themselves by using them.

Participants are treated as valued contributors and their unique experiences during the development of the various skills become positive exemplars for the other participants. Experiences of personal efficacy and self-esteem grow as a direct result of the exercises and the open attitude of the facilitators. Moreover, as the conditioning exercises are practiced in the presence of a facilitator, there is a strong presumption that the facilitator is transformed into a conditioned stimulus (anchor) for those same feelings. This has the net result of fostering positive feelings towards the facilitators and the program generally.

Program participants indicate that they are more in control of their feelings, and many report using the anchored states to achieve a sense of peace or control in difficult situations. Some graduates report using the resource states on a daily basis, often as part of a meditative regimen. Others report that they feel like they have more meaning in their lives and have more of a sense of personal direction. Many report a keener sense of what they want from life and a more well defined plan to achieve it.

Increased self-efficacy and self-esteem are expressed by graduates who report that they feel more in control of their lives, that they experience enhanced choice and generally feel better about themselves. Development of efficacy is often described by the clients as the sudden appearance of confusion and the need to choose in circumstances where compulsive drug abuse or other reactive behavior had been normal. Many clients express new-found feelings of self-acceptance. Graduates often report that for the first time in their lives, they feel like they have a direction or purpose. For many, this sense of futurity and purpose represents a significant foundation for continuing sobriety.

Insofar as spirituality is reframed in terms of finding one's place in the world, reports of enhanced efficacy, self-esteem and futurity suggest that spiritual values are supported by the program. Graduates regularly report increased access to meditative states using anchors; encounters with future selves in the Smart Outcome exercise are often experienced as dramatic spiritual events. Many participants have indicated that their experience of the spiritual has been enhanced through a sense of personal deepening and centering which they attribute to program participation.

Client responses suggest strongly that the wholeness approach, overcoming addictive behavior by enhancing access to personal resources and developing a strong positive sense of Self, provides a significant tool for treatment providers. Participants are overwhelmingly positive in their response to the program and recognize by program's end that they are thinking less about drugs and more about their futures. They report enhanced familial relations and more enjoyment of life in general. On an intuitive level, most participants understand that they have grown in some significant manner into a place of personal choice and empowerment.

Recommendations For Further Research

The current analysis is limited by lack of formal research methodology, incomplete followup, lack of specific controls and does not adequately address the impact of the coercive supervision situation on program results. Future research will compare outcomes of this treatment program with other treatment modalities used with substance abusers under federal supervision. The impact of self-efficacy and self-esteem enhancement on treatment outcome might be addressed through the use of appropriate clinical measures as pre- and post tests. However, the ultimate measure of the program's effectiveness would continue to be viewed in terms of relapse and recidivism in this population of involuntary clients.

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Note:

The Feeling Toned Vector (FTV) was originally developed in collaboration with A. Stanley Cunningham in 1993.