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Old 08-15-2003, 05:40 PM
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Default Post Incarceration Syndrome and Relapse

Articles like these I find fascinating but also difficult to read and accept that I may be faced with this kind of situation.... but I also feel that knowledge is power and all the information that we can have to identify and work towards a successful reintegration is important...

Post Incarceration Syndrome and Relapse
By Terence T. Gorski (Terry Gorski is available to speak or consult on these issues)
Permission is given to reproduce this article with proper referencing.

17900 Dixie Highway, Suite 14, Homewood, Illinois 60430

The Post Incarceration Syndrome (PICS) is a serious problem that contributes to relapse in addicted and mentally ill offenders who are released from correctional institutions. Currently 60% of prisoners have been in prison before and there is growing evidence that the Post Incarceration Syndrome (PICS) is a contributing factor to this high rate of recidivism. [i]

The concept of a post incarceration syndrome (PICS) has emerged from clinical consultation work with criminal justice system rehabilitation programs working with currently incarcerated prisoners and with addiction treatment programs and community mental health centers working with recently released prisoners.

This article will provide an operational definition of the Post Incarceration Syndrome (PICS), describe the common symptoms, recommend approaches to diagnosis and treatment, explore the implications of this serious new syndrome for community safety, and discuss the need for political action to reduce the number of prisoners and assure more humane treatment within our prisons, jails, and correctional institutions as a means of prevention. It is my hope that this initial formulation of a PICS Syndrome will encourage researchers to develop objective testing tools and formal studies to add to our understanding of the problems encountered by released inmates that influence recovery and relapse.

Post Incarceration Syndrome (PICS) - Operational Definition
The Post Incarceration Syndrome (PICS) is a set of symptoms that are present in many currently incarcerated and recently released prisoners that are caused by being subjected to prolonged incarceration in environments of punishment with few opportunities for education, job training, or rehabilitation. The symptoms are most severe in prisoners subjected to prolonged solitary confinement and severe institutional abuse.

The severity of symptoms is related to the level of coping skills prior to incarceration, the length of incarceration, the restrictiveness of the incarceration environment, the number and severity of institutional episodes of abuse, the number and duration of episodes of solitary confinement, and the degree of involvement in educational, vocational, and rehabilitation programs.

The Post Incarceration Syndrome (PICS) is a mixed mental disorders with four clusters of symptoms:

(1) Institutionalized Personality Traits resulting from the common deprivations of incarceration, a chronic state of learned helplessness in the face of prison authorities, and antisocial defenses in dealing with a predatory inmate milieu,

(2) Post Traumatic Stress Disorder (PTSD) from both pre-incarceration trauma and trauma experienced within the institution,

(3) Antisocial Personality Traits (ASPT) developed as a coping response to institutional abuse and a predatory prisoner milieu, and

(4) Social-Sensory Deprivation Syndrome caused by prolonged exposure to solitary confinement that radically restricts social contact and sensory stimulation.

(5) Substance Use Disorders caused by the use of alcohol and other drugs to manage or escape the PICS symptoms.

PICS often coexists with substance use disorders and a variety of affective and personality disorders.

Symptoms of the Post Incarceration Syndrome (PICS)
Below is a more detailed description of four clusters of symptoms of Post Incarceration Syndrome (PICS):

1. Institutionalized Personality Traits
Institutionalized Personality Traits are caused by living in an oppressive environment that demands: passive compliance to the demands of authority figures, passive acceptance of severely restricted acts of daily living, the repression of personal lifestyle preferences, the elimination of critical thinking and individual decision making, and internalized acceptance of severe restrictions on the honest self-expression thoughts and feelings.

2. Post Traumatic Stress Disorder (PTSD)
Post Traumatic Stress Disorder (PTSD) [ii] is caused by both traumatic experiences before incarceration and institutional abuse during incarceration that includes the six clusters of symptoms: (1) intrusive memories and flashbacks to episodes of severe institutional abuse; (2) intense psychological distress and physiological reactivity when exposed to cues triggering memories of the institutional abuse; (3) episodes of dissociation, emotional numbing, and restricted affect; (4) chronic problems with mental functioning that include irritability, outbursts of anger, difficulty concentrating, sleep disturbances, and an exaggerated startle response. (5) persistent avoidance of anything that would trigger memories of the traumatic events; (6) hyper vigilance, generalized paranoia, and reduced capacity to trust caused by constant fear of abuse from both correctional staff and other inmates that can be generalized to others after release.,

3. Antisocial Personality Traits
Antisocial Personality Traits [iii] [iv] [v]are developed both from preexisting symptoms and symptoms developed during incarceration as an institutional coping skill and psychological defense mechanism. The primary antisocial personality traits involve the tendency to challenge authority, break rules, and victimize others. In patients with PICS these tendencies are veiled by the passive aggressive style that is part of the institutionalized personality. Patients with PICS tend to be duplicitous, acting in a compliant and passive aggressive manner with therapists and other perceived authority figures while being capable of direct threatening and aggressive behavior when alone with peers outside of the perceived control of those in authority. This is a direct result of the internalized coping behavior required to survive in a harshly punitive correctional institution that has two set of survival rules: passive aggression with the guards, and actively aggressive with predatory inmates.

4. Social-Sensory Deprivation Syndrome:
The Social-Sensory Deprivation Syndrome [vi] is caused by the effects of prolonged solitary confinement that imposes both social isolation and sensory deprivation. These symptoms include severe chronic headaches, developmental regression, impaired impulse control, dissociation, inability to concentrate, repressed rage, inability to control primitive drives and instincts, inability to plan beyond the moment, inability to anticipate logical consequences of behavior, out of control obsessive thinking, and borderline personality traits.

5. Reactive Substance Use Disorders
Many inmates who experience PICS suffer from the symptoms of substance use disorders [vii]. Many of these inmates were addicted prior to incarceration, did not receive treatment during their imprisonment, and continued their addiction by securing drugs on the prison black market. Others developed their addiction in prison in an effort to cope with the PICS symptoms and the conditions causing them. Others relapse to substance abuse or develop substance use disorders as a result of using alcohol or other drugs in an effort to cope with PICS symptoms upon release from prison.

PICS Symptoms Severity
The syndrome is most severe in prisoners incarcerated for longer than one year in a punishment oriented environment, who have experienced multiple episodes of institutional abuse, who have had little or no access to education, vocational training, or rehabilitation, who have been subjected to 30 days or longer in solitary confinement, and who have experienced frequent and severe episodes of trauma as a result of institutional abuse.

The syndrome is least severe in prisoners incarcerated for shorter periods of time in rehabilitation oriented programs, who have reasonable access to educational and vocational training, and who have not been subjected to solitary confinement, and who have not experienced frequent or severe episodes of institutional abuse.

Reasons To Be Concerned About PICS
There is good reason to be concerned because about 40% of the total incarcerated population (currently 700,000 prisoners and growing) are released each year. The number of prisoners being deprived of rehabilitation services, experiencing severely restrictive daily routines, being held in solitary confinement for prolonged periods of time, or being abused by other inmates or correctional staff is increasing. [viii]

The effect of releasing this number of prisoners with psychiatric damage from prolonged incarceration can have a number of devastating impacts upon American society including the further devastation of inner city communities and the destabilization of blue-collar and middle class districts unable to reabsorb returning prisoners who are less likely to get jobs, more likely to commit crimes, more likely to disrupt families. This could turn many currently struggling lower middle class areas into slums. [ix]

As more prisoners are returned to the community, behavioral health providers can expect to see increases in patients admitted with the Post Incarceration Syndrome and related substance use, mental, and personality disorders. The national network of Community Mental health and Addiction treatment Programs need to begin now to prepare their staff to identify and provide appropriate treatment for this new type of client.

The nation's treatment providers, especially addiction treatment programs and community mental health centers, are already experiencing a growing number of clients experiencing the Post Incarceration Syndrome (PICS). This increase is due to a number of factors including: the increasing size of the prisoner population, the increasing use of restrictive and punishing institutional practices, the reduction of access to education, vocational training, and rehabilitation programs; the increasing use of solitary confinement and the growing number of maximum security and super-max type prison and jails.

Both the number of clients suffering from PICS and the average severity of symptoms is expected to increase over the next decade. In 1995 there were 463,284 prisoners released back to the community. Based upon conservative projections in the growth of the prisoner population it is projected that in the year 2000 there will be 660,000 prisoners returned to the community, in the year 2005 there will 887,000 prisoners returned to the community, and in the year 2010 1.2 million prisoners will be released. [x] The prediction of greater symptom severity is based upon the growing trend toward longer periods of incarceration, more restrictive and punitive conditions in correctional institutions, decreasing access to education, vocational training, and rehabilitation, and the increasing use solitary confinement as a tool for reducing the cost of prisoner management.

Clients with PICS are at a high risk for developing substance dependence, relapsing to substance use if they were previously addicted, relapsing to active mental illness if they were previously mentally ill, and returning to a life of aggression, violence, and crime. They are also at high risk of chronic unemployment and homelessness.

Post Release Symptom Progression
This is because released prisoners experiencing PICS tend to experience a six stage post release symptom progression leading to recidivism and often are not qualified for social benefits needed to secure addiction, mental health, and occupation training services.

· Stage 1 of this Post Release Syndrome is marked by Helplessness and hopelessness due to inability to develop a plan for community reentry, often complicated by the inability to secure funding for treatment or job training;

· Stage 2 is marked by an intense immobilizing fear;

· Stage 3 is marked by the emergence of intense free-floating anger and rage and the emergence of flashbacks and other symptoms of PTSD;

· Stage 4 is marked by a tendency toward impulse violence upon minimal provocation;

· Stage 5 is marked by an effort to avoid violence by severe isolation to avoid the triggers of violence;

· Stage 6 is marked by the intensification of flashbacks, nightmares, sleep impairments, and impulse control problems caused by self-imposed isolation. This leads to acting out behaviors, aggression, violence, and crime, which in turn sets the stages for arrest and incarceration.

Currently 60% of prisoners have been in prison before and there is growing evidence that the Post Incarceration Syndrome (PICS) is a contributing factor to this high rate of recidivism.

Reducing The Incidence Of PICS
Since PICS is created by criminal justice system policy and programming in our well intentioned but misguided attempt to stop crime, the epidemic can be prevented and public safety protected by changing the public policies that call for incarcerating more people, for longer periods of time, for less severe offenses, in more punitive environments that emphasize the use of solitary confinement, that eliminate or severely restrict prisoner access to educational, vocational, and rehabilitation programs while incarcerated.

The political antidote for PICS is to implement public policies that:

(1) Fund the training and expansion of community based addiction and mental health programs staffed by professionals trained to meet the needs of criminal justice system clients diverted into treatment by court programs and released back to the community after incarceration;

(2) Expand the role of drug and mental health courts that promote treatment alternatives to incarceration;

(3) Convert 80% of our federal, state, and county correctional facilities into rehabilitation programs with daily involvement in educational, vocational, and rehabilitation programs;

(4) Eliminate required long mandated minimum sentences;

(5) Institute universal prerelease programs for all offenders with the goal of preparing them to transition into community based addiction and mental health programs;

(6) Assuring that all released prisoners have access to publicly funded programs for addiction and mental health treatment upon release.
Ken aka Teb aka tebkrg
PTO Site Administrator

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Old 08-15-2003, 08:11 PM
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thank you for posting that. i know billy will be released one day (soon i hope), and i have been worried about PTSD--i was diagnosed with it, and i know that it is not fun, and i am just worried that HE will have it upon release. anyways, when i have the time, i will be reading it more closely...but from what i read now. YIKES! the stats. are too scary.

oh yeah where did you get this info from??
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Old 08-15-2003, 09:33 PM
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Thanks Teb...very interesting for sure!
" You know that place between asleep and awake, where you still remember dreaming? That's where I will always think of you." Tinkerbell

"Don't be dismayed at good-byes. A farewell is necessary before you can meet again. And meeting again, after
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Old 08-16-2003, 08:47 AM
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I enjoy reading articles like this.
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Old 08-22-2003, 10:53 PM
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Great article and very true. This frightens me because my husband will be home in a few months and I know all I can really offer him is support, a safe, clean and stable home, and understanding. But, what if he makes a bad choice. I dont want to put my daughter or myself in any unsafe situations. I want to be prepared for his release---should I contact the local outpatient facility and set us up for sessions? I guess all I can do is pray about it for now. Thanks for the education
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Old 08-23-2003, 08:33 AM
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For once I agree with a lot of what Gorski has to say... He's known for his relapse prevention program philosophies and years ago when I worked as a substance abuse therapist some agencies used his stuff. I always saw it as pretty rigid, behavioral, and negative.... He seemed to have a "one size fits all" approach back then. This seems to be more right on and includes the fact that not all go thru this but why some do and what we need to do to change that... Thanks for sharing....


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Old 09-14-2003, 01:56 PM
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This was such a good article, tebkrg. I would like to share this article and other supporting information to someone who may be able to make a difference in the system here. I don't know if it will work but one can only hope, or at least to educate him.
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Old 07-31-2004, 06:57 PM
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Wow!! I just now came across this article. Fantastic!!

So much information packed into this article. It is a shame that so many of these needed programs are being voted down. I hope someday, people, citizens, society, will come to the understanding needed to provide the proper care....

And like tebkrg said, something that I will have to deal with in the future.

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Old 07-31-2004, 07:05 PM
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WOW... I am stunned by this article and its implications... thanks for posting.
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Old 07-31-2004, 07:15 PM
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Thanks Teb for posting this. The more society is aware of this the more they wil realize things need to change on the inside. MOST prisoners are released. Programs need to stay put in prisons and MORE need to be added. Hopefully this won't fall on deaf ears as it has in the past.

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Old 07-31-2004, 09:15 PM
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Thanks for the posting. Being well informed is crucial to this struggle. Thanks again.
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Old 10-12-2006, 10:57 AM
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Default Mental treatment

My husband was just released from pirosn and was struggling with every day life and commited another crime to get away from his problems is there any way that he can be diagnosed with this and put into a mental ward because I would rather him go their than prison. He has been in and out of juvenile halls and jail in his teenage years and was out in orison from age 18 to 27 and he was just put back in but he needs mental help amyone with an answe please respond. Thanks alot.
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