Prison addiction program scrutinized

By Andrew Graham,

The inmates had broken the rules of the drug treatment program, that much is clear.

The staff’s response was also unambiguous: two weeks in the “tight house.”

What some former participants and at least one counselor question is the validity of peer-policing, physical discomfort and aggressive confrontation as tools for treating addiction in prison. Are such methods painful but productive tough love as some practitioners, participants and prison officials maintain? Or, are they merely punitive — ways to save costs and maintain order that deliver more trauma than therapy?

In January 2018, however, the primary question on Lacey Frost’s mind was how to get herself and her peers through two weeks in the tight house. Frost was an inmate at Wyoming Women’s center, an addict and a participant in the Intensive Treatment Unit — a specialized recovery program for incarcerated addicts run by the Gateway Foundation.  

Participants in the ITU — at the time it could accommodate up to 54 prisoners — live together in a separate wing, segregated from the general population. The program determined nearly every aspect of their days. When they’re in the tight house the arrangement is even more restrictive: no classes, no counseling, no talking or other forms of communication. For the majority of the day — Frost said 8 a.m. to 5 p.m., other participants said 7 a.m. to 7 p.m. — inmates only sit and march in alternating hour-long blocks.  

“It was hard and some people even freaked out,” Frost said, “forcing [them] to leave the program.” At the time, Frost was ”head of house,” a leadership position in the program. She tried to keep her “family” motivated.

“When the counselors would be gone by 5pm … I would speak to the women, as I was allowed for only emergency reasons. And I would try and keep them strong and motivate them to push through this,” she wrote in a message to WyoFile. “The counselors do not even know anything about that.”

To demonstrate the required posture, another former inmate and ITU graduate sent WyoFile a photo of herself sitting, her hands resting on her knees and her shoulders straight. Eyes had to face forward, she wrote. “No smiling, no nothing,” she wrote in a text message accompanying the photo. “Only sitting and marching,” for two weeks.

Another former-inmate who went through the program with Frost said the tight house felt pointless and vindictive. “This isn’t human,” Alta Hanway said. “You don’t treat people like this. This is not OK. No wonder people are walking out.”

Neither Hanway or Frost wrote off the ITU program entirely. Both said it helped them in some ways adjust to life after prison. But the tight house is one of a number of experiences women who went through the ITU program told WyoFile they found discomforting and punitive.

Stakeholders disagree on the treatment program in the Lusk prison, but nearly everyone involved with criminal justice in Wyoming recognizes the importance of treating the drug and alcohol problems that lie behind so many crimes. Addiction drives Wyoming’s prison crowding problem and all of the woes that come with it. How to effectively treat offenders in and out of prison may well be the most pressing question facing the Wyoming Department of Corrections.

While some women said ITU put them on a road to recovery from addiction, others said its methods for correcting behavior sparked anxiety and depression. At best, they kept their heads down and followed the rules to get through the program, these women said, without ever feeling they were addressing their addictions or the causes behind them.

“Hard” is the point, according to the Gateway Foundation, which runs the ITU program in Lusk. The sprawling Illinois-based nonprofit holds a contract with the state of Wyoming to provide substance abuse treatment in the women’s prison, the men’s medium security prison in Torrington and at the Honor Conservation Camp & Boot Camp in Newcastle.

“We want to make sure that you really understand the science behind this and why we do this,” said Dr. Theresa Garate, Gateway’s vice-president of strategic partnerships and engagement, when asked about the two-weeks of punishment. “We’re experts at this and it’s really meant to be therapeutic,” she said.

As Wyoming confronts its crowded prison system, a spotlight is being thrown on how mental health and substance abuse issues often go untreated outside prisons. The Council of State Governments, which studied Wyoming’s criminal justice system for nine months, found startling failures in the treatment available to people on probation and parole. Only slightly more than half of people on supervision who need substance abuse or mental health treatment received it, according to the researchers.

In testimony to legislative committees, judges have suggested they sometimes send people to prison because it’s the best chance for an offender to get treatment. The role of treatment in reducing recidivism is well documented. How those treatment programs are structured gets less scrutiny by the public.

WyoFile spoke with more than a dozen women who had gone through the ITU program in recent years. A few said Gateway’s program provided an invaluable experience.

“It’s a great program, I don’t care what anyone says,” said Erica Silvernagle, who left the prison and ITU in early 2017. The difficult social situations the program created prepared her for the outside world she said.

“You go to a job and there’s always people in the job you’re not going to get along with,” she said, “always some other bullshit you’re going to deal with. It made me stronger to get out and deal with it.”

The program helped Silvernagle burrow to the root of thinking patterns and behaviors that drove a meth addiction that led her to prison four times before she landed in the program. ITU’s toughness and structure of accountability was part of that, she said, even if it wasn’t for everyone.

“Everybody just wants to be petted and loved on all the time and they don’t want to deal with the repercussions when they pee on the floor,” Silvernagle said.

The majority of participants interviewed by WyoFile were less enthusiastic. The program’s structure calls on the inmates to govern each other’s behavior and encourages them to discipline one another. Such peer-policing is touted by Gateway Foundation as essential to changing behavior.

Scholarship on substance abuse treatment programs has found the therapeutic community method to be effective.

But inmates charged that when coupled with staff shortages, peer-based accountability leaves women vulnerable to retribution based on prison social dynamics. “Why are wounded broken women running other broken women?” asked Katrina Hansen, who graduated the program in December 2018.

Outside the prison, several counselors suggested that such concerns were to be expected of addicts undergoing a difficult program and often not by choice — the Wyoming Parole Board often assigns women into ITU. Inmates still in denial of their drug or alcohol addictions are also likely to push back against any rehabilitation program, counselors said.

Addiction professionals in Rock Springs and Cheyenne called the program effective. The women who were able to go through it came into their post-incarceration care in a far better position than those that didn’t, they said.

But one professional, who formerly worked in the Wyoming Women’s Center as a counselor for the general population, including at times those inmates participating in ITU, called the program “cruel.”

“Most of those women are traumatized and then they go into a program and its shame-based … then we expect them to come out better and that’s just really sad,” said Patricia Swan-Smith, who worked in the prison for roughly a year before leaving in October 2018.

Wyoming has pursued a “therapeutic community” model for its in-prison treatment programs since around 2002, said Sam Borbely, WDOC’s treatment program manager. The agency has contracted with Gateway since 2015.

The current ITU program in WWC takes participants between six and eight months to complete on average. Though housed in a wing of the women’s prison in Lusk, inmates are isolated from the prison’s general population and largely prohibited from interacting with it.

The client handbook for the program, which WyoFile received through a public record request, describes an attempt to reshape the criminal offenders’ behaviors through rigid living standards and structured social interactions. Participants are encouraged to judge one another on their interactions and behavior and bring them up for questioning by the group as a whole.

“We are here because there is no refuge, finally, from ourselves,” a treatment philosophy at the start of the handbook reads. “Until a person confronts herself in the eyes and hearts of others, she is running.”

Gateway’s version of the therapeutic community can be traced back to WWII, said Frank Craig, the group’s Wyoming director. Sanatoriums for mental health patients in England found themselves suddenly left with minimal staff because of the mobilization of the war effort.

When the professionals eventually returned to those facilities, they “found the patients themselves had come together recognizing those needs,” Craig said. “Patients themselves were really, in effect, a little bit more successful with being able to pull that off even without trained staff present.”

That original model, born of necessity, has evolved into the therapeutic community used by Gateway and others today, Craig said, with updates to incorporate evidence-based best practices. In the women’s prison, “they’re all part of that structure,” he said, “holding each other accountable, getting down the precepts that … to continue success in recovery, you’ll be dependent on other people.”

The program’s handbook lays out a set of rules governing dress, behavior and interaction with other members’ of the program. Those rules largely reflect the rules of the prison at large, Craig said, but in ITU are more strictly adhered to.

The handbook calls on participants to watch and correct each other through “pull ups,” a form of verbal and written chastisement. “I am my sister’s keeper,” the handbook says.

“All residents are expected to utilize both written and verbal pull-ups,” the handbook reads in a section describing how the women are to govern each other’s behavior. “The failure to engage in the VPU/WPU process will indicate non-participation in the community.”

Some ITU graduates found that expectation exhausting. Friends in the program might work out a deal to appear like they were monitoring each other’s behavior. “I’ll write you up for this, you write me up for this,” said Daisy Walker, who graduated the program in December 2018.

“It’s just what you gotta do to get out,” she said.

Beyond pull ups, inmates whose behavior catches the attention of their peers can face what’s called an “encounter.” In an encounter, the offending member of the program is placed in the center of the room and confronted by the other participants, according to descriptions by women who have gone through encounters, as well a description in the client handbook.

The handbook calls for tough treatment of the woman on the receiving end of the exercise. Suggested tools for the exercise include “humor and ridicule” and “hostility and anger.”

Some women reacted well to the confrontations, they told WyoFile. Silvernagle went through “encounter after encounter after encounter,” she said, but they helped her see flaws in her character. “Sometimes you don’t even recognize your behaviors until people approach you like that,” she said.

Another woman, Jamie Lee Dodd, who completed the ITU program in 2016 and 2017, said encounters were about breaking someone down in order to “sav[e] that person.” Dodd was enrolled during a period when budget cuts reduced the number of participants from 54 to 32. She is one of a number of women who have spoken to WyoFile about broader concerns at the women’s prison at Lusk.

The number of participants in the ITU program was restored to 54 in 2017, when legislators added money back into substance abuse treatment programs in prison.

For other women, the encounters were more haunting than helpful.

The process doesn’t feel like constructive criticism, said former inmate Ashley Houchin: “They put you in the middle of the room in a chair and they put everyone around you in a circle and they just call you names, cuss you out.”

“It’s humiliating,” said Walker. “It’s not like they care about you it’s like they’re scaring you into submission.” Walker called the encounters “traumatizing.”

“You go out of there hating yourself,” she said.

Another woman, Leanne Dozier, agreed. Dozier left the prison in June 2017. “Your worst fear is to end up in the middle of the room,” she said. “You have everyone surrounding you, pointing out all your faults.”

The criticism can be driven as much by friction as realities about your character, she argued. “Maybe it’s not even true. They say ‘my perception is this…’”

The tight houses, pull-ups, encounters and other practices described in Gateway’s ITU handbook are not punishments, the Gateway officials said.

“They’re not intended to be punitive at all,” Craig said. “In fact, we call those activities learning experiences, whereby they learn … patterns in their thinking, thinking errors, ways that they can address and break that cycle.”

Craig defended the tight house in particular as an event that can change the direction of an ITU group. “It’s a very powerful event,” he said. “The positiveness and the reconnection and commitment after a tight house really heightens the therapeutic level or atmosphere of the community.”

For a tight house to last two weeks is not unusual he said. He also countered the women’s recollection of doing little besides sitting and marching. During a tight house, the program participants review the handbook and It’s rules and expectations. There is time for “therapeutic reflection” between the marching and sitting. Beyond punishment, the marching is a form of structured recreation akin to the marching of soldiers, he said.

Denial of an addiction could color some women’s reactions to such measures, Craig said: “They [resist] any activity or action they don’t agree with or that questions their addictive thinking.”

Like any program, ITU program requires commitment from its practitioners, Craig said. “Participation in the program itself … is really voluntary,” he said, “they can discontinue the therapy anytime they want to.”

Former inmates, and some counselors, questioned the depiction of ITU as voluntary, however. Walking away from any treatment program carries risks for an addict. In prison, however, the treatment program is often directly linked to how long an inmate will stay behind bars. Complete the program and they could be paroled, quit, and they’ll have to stay and “kill their number” — finish the sentence given to them by a judge.

As such, unhappy program participants said they pushed through despite the stress of the program, preferring to suffer in silence than quit and spend more time in prison.

“You wake up with just anxiety and you’re like what’s going to happen today and then you just have to hold it together and deal with their shit because they hold the keys to your freedom,” Dozier said.

Craig sees the distinction. But, “it’s still voluntary,” he said. “The person could tell the parole board I don’t accept that and by doing so of course they’re waiving their release date from potentially getting out a little bit earlier.”

The therapeutic community model relies on participants more than staff, Craig said.

Some ITU veterans said they wished for more time with counselors, but staff serve as the “rational authority” for the program, Craig said. Their concern is less with day-long therapy for the clients than with keeping the therapeutic community on track. Gateway’s in-prison treatment programs have therapists on staff who have individual meetings with clients monthly, he said, but “the therapists are not considered the agent of change for a client.”

But like other substance abuse and mental health providers in Wyoming, Gateway Foundation has had trouble getting counselors to stick in rural Wyoming. Though the contract with the state calls for four staff counselors, the ITU program is today half-staffed, he said.

“It’s really hard to attract and keep qualified professionals across the state,” said Borbely, who oversees the Gateway contract for WDOC. “That’s not just in prison.”  

Staffing troubles even inspired Craig to ask for law changes from Wyoming’s legislators. Last year, he pushed a bill to reduce licensing standards for substance abuse counselors in the state, arguing the current standards and the state’s licensing board were making it hard to fill positions.

The bill raised the ire of Wyoming’s mental health and substance abuse lobby, who saw it as one company’s attempt to address staffing challenges by watering down state standards.

“They have a contract they’re struggling to meet so they just want to bring in whoever just to meet it,” said Paul Demple, the vice president of the Wyoming Association of Mental Health and Substance Abuse Centers. “We’re all running into [challenges] and nobody is in favor of lowering the standards.”

Craig argued standards were stricter than other states and were making it difficult to bring in licensed counselors.

The proposed statute change got wrapped into a more complex piece of legislation, that ultimately failed 8-22 on its first Senate vote.

“[Prison] is the place where we need the most qualified, most prepared people to do the job for the folks who have the worst substance abuse problems among us,” Sen. Fred Baldwin (R-Evanston) a member of the Senate Labor, Health and Social Services Committee who voted against the bill, told WyoFile.