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In an Oct. 20 talk as part of the Haas Institute's Research to Impact series, Erin Kerrison from UC Berkeley's School of Social Welfare, presented on “The Costs and Benefits of an addiction Diagnosis: A Critical Look at Racial Disparities in Prison-Based Drug Treatment Rhetoric Buy-in.”

Drawing from her research in legal epidemiology, and critical race and disabilities studies, Kerrison’s talk focused on how the legal system—its institutions, personnel, and treatment modalities—impact the lives of racial minorities in ways that are often harmful.

Using examples from the Delaware Department of Corrections’ therapeutic communities (TC), her talk highlighted how trauma and opportunity are unevenly distributed by prison-based treatment programs, and unevenly experienced by people based on having a marginalized status and addiction label.

Her main findings—that client perceptions are cast as pathologically inferior, that racial minorities navigate multiple levels and sources of stigma, and that therapeutic community participants negotiate interpersonal and structural reification of white structural norms and values—were illustrated through the narration of former therapeutic community participants.

Her talk underscored the inequitable operations of the legal system, and how socially constructed notions of normalcy, ability, and wellness adversely affect marginalized groups.

Through her examination of injustice in the context of prison-based drug treatment programs, Kerrison interrogated how systems intended to heal actually have the effect of marginalizing and traumatizing. 

One narrative reflected the cynicism of a recently paroled black counselor being employed to support a therapeutic community, similar to the one that traumatized them, and before having sufficient time to heal from their own trauma.

Another narrative reflected the irony of a disbarred white attorney acquiring multiple therapeutic community completion certificates in order to demonstrate their sense of responsibility to future employers.

In relaying these and other stories, Kerrison recounted the tensions, divergent meanings, and inequitable circumstances within which black and white therapeutic community participants attempt to reconcile their drug treatment experiences.

The highly confrontational, and at times highly gendered, practices within these therapeutic community encounter groups were described as perpetuating poor health by traumatizing participants, and forcing them to frequently witness the traumatization and degradation of other participants.

What was supposed to be therapeutic was harmful, and that harm often stayed with participants beyond their release.

In addition to a legal cynicism that questioned the ability of prison-based therapeutic communities to heal and rehabilitate, a skepticism concerning future employment opportunities upon release was described, whereby prison-based job training was insufficient to address the limited employment opportunities available to individuals with a drug addiction and felony label. 

Other takeaways from the talk: Perceived utility of prison-based therapeutic communities varies by race; prison-based substance use disorder treatment rhetoric and culture mimics larger racial hierarchies; there is a crisis of diminished faith in healthcare providing institutions, and this perception adversely affects the well-meaning intentions of these institutions; and, lastly, critical race theory needs to be used in healthcare institutions in order to establish equitable practices that provide care and promote wellness.

Erin Kerrison is an assistant professor of Social Welfare at UC Berkeley. Her work extends from a legal epidemiological framework, wherein law and legal institutions operate as social determinants of health. Specifically, through varied agency partnerships, her mixed-method research agenda investigates the impact that compounded structural disadvantage, concentrated poverty and state supervision has on service delivery, substance abuse, violence and other health outcomes for individuals and communities marked by criminal justice intervention.

Read a full transcript of Kerrison's talk below.


Taeku Lee: I'm very excited to welcome our first speaker in this series, Professor Erin Kerisson. She is a professor here at the School of Social Work, who does a lot of work in this area called legal epidemiology which recognizes the important role that law and legal institutions play in shaping things like health outcomes. You are, I think finishing a book tentatively titled Hustles and Hurdles: Law's Impact on ... Is it desistance? 
Erin Kerrison: Desistance. Mm-hmm (affirmative). 
Taeku Lee: For Job Seeking Former Prisoners. And that's based on 300 interviews of drug involved former prisoners. 
Erin Kerrison: That's right. 
Taeku Lee: And so today you'll be sharing some work that may or may not be related-
Erin Kerrison: It is. 
Taeku Lee: With that project. The costs and benefits of an addiction diagnosis. So please give Dr. Kerrison a warm welcome. 
Erin Kerrison: Thank you. Thank you everyone. Thank you so much for coming. As [Taeku 00:01:09] mentioned, yes my work ... I'm trained in criminology and sociology. I'm an Assistant Professor in the School of Social Welfare, and I'm very very interested in the ways in which law, and legal institutions, and legal institutional personnel affect health outcomes. And that's for victims of crimes, that's for those who are accused of crimes, convicted of crimes, as well as personnel working in those spaces. So very sort of broad, big picture idea of how the law, just like any other sort of social structural determinant of health plays out in ways that can be helpful, but unfortunately within criminal justice settings are typically very harmful. 
So today we're going to talk specifically about the experiences of folks who are drugged involved, who have been through Delaware Department of Corrections system and are diagnosed, and we're going to put some pressure on the word diagnosed, with an addict status or an addict label for using heroin and opioids in the 90s and 2000s. So I'll start by saying despite existing in pretty much a state of operational crisis, the criminal legal system in the United States exists as ... It's emerging as one of the largest dedicated providers of substance use treatment for American citizens, and the majority of this population is also navigating an acutely marginalized socioeconomic status where intersectional and economical disadvantage exacerbates essentially their custodial and post prison reentry experiences. 
So this the setting that's rife for all kinds of problems for this population. Second, as state prison facilities are increasingly relying upon federal aid, particularly Medicaid, for reimbursement support ... There are some that are [inaudible 00:02:59] among them, that treatment that begets treatment, that begets treatment, that begets treatment might actually be a lucrative enterprises in these spaces. So I'm very curious about the extent to which treatment doesn't work, and whether or not that's actually a failing within a carceral setting. And that's something that I want to take on. And finally, related to that, I'm not entirely comfortable with the idea that recidivism, and relapse, and recurring contact with the criminal justice system at large are actually challenges that are faced by the system. I think it's working the way it's supposed to if you buy into what I'm going to talk about this afternoon. 
So instead I argue that these failings are a necessary feature of this system. That it may not be the overall objective to get people well and to get people clean in ways that are sustainable, in ways that are lasting. And I want to talk about marginalized folks in particular, the cynicism that they direct towards these spaces as a result of coming through programs that they believe, and I would argue for good reason, are not really set up to help them. So that's what we're going to talk about today. 
Okay. So what you're looking at here is an encounter group, which is a major major feature of the therapeutic community which is pretty much the gold standard for a drug treatment inside prison settings. Both in ... In prisons, in jails, and in community based supervised situations. And the TC, the therapeutic community, inside prisons is meant to serve as a total environment. So instead of being in general population with everybody else, you live in a different block, or a different ward, or a different pod depending on the architecture of the facility. All your work assignments are there. You sleep there, you eat there, and you have these kinds of programming, these group based mutual aid sort of efforts where you're in this group. It's like retreat if you can call it that, amongst folds who are labeled as drug involved. And that doesn't mean necessarily that you're drug addicted and drug using. You can come in here off of felony possession charges as well. 
So you're not mandated, but highly highly incentivized to join a therapy community. You can earn group time depending on the state that you're in. If you're coming up for a parole hearing, this could look good as far as effort to do well and to go straight. So folks who are incarcerated are highly incentivized to join these groups, and this is what an encounter group looks like, which is going to be the focus of my talk today. So two things are happening in this space. Typically ... So it starts like this with the group counseling, and I'll also add not everyone who's a counselor here is actually a licensed clinician. There are some folks who serve as counselors in this space and lead these circles, who are actually alumni of the teaching program or alumni of the encounter group experience. So just note that. But so you can see the plain clothes, I think they're women over here on the left and the right, would be helping to facilitate group but they may be LCSWs, it could be a number of different hats that they wear. Often volunteers from the community. We'll talk about that too. 
But you start where we're working on issues of coping, issues of stress, issues of defining and identifying problems and how to respond to them, issues of personal responsibility. Focusing a lot of attention on anger management and troubleshooting through issues, and who you rely on and who you talk to help work through those problems et cetera, et cetera. So sort of at face value, this sort of mutual aid, mutual support mechanism it sounds really positive. Except, for this drug involved group the emphasis is really on personal responsibility and extent to which you as a person are ill, or you as a person are incomplete, or unwell, or broken, and your drug addiction is essentially a symptom of that identity. 
So typically you start like this. These groups last anywhere from 45 minutes to three hours depending on sort of the stage that you're at in counseling and programming. And what happens often, I couldn't find a picture of this without revealing who was in my study, there's what's called a hot seat and it's definitely what it sounds like, where you sit in the center. But some of the men and women I spoke to talk about ... Or they referred to what's called a pinball machine. So if you can imagine sort of in an arcade, a pinball popping off of people. What happens is you're sitting in the center and you have essentially insults, curses, allegations, all kinds of things ... Bless you. Lanced at you from all around this encounter group circle, and you have to get to the point demonstrably, reformatively of sufficiently capitulating. And that usually is manifest in tears, some sort of breakdown, some sort surrender that is, like I said, demonstrable enough where you show, "I'm sorry. You're right, I'm broken." 
And this happens over weeks and months. Like most folks come in much more stoic and either are broken down in these spaces, except that addict label ... Excuse me. That addict status that, "I'm diseased. I'm less than," identity or they don't and they fake it. And we're going to talk about the extent to which race moderates the likelihood that they go in one way or another after having participated in this kind of encounter group, TC program setting. And the way I'm doing this ... Or my analysis rather is grounded two theoretical frameworks. So the first is critical race, which is a theoretical tradition that ... An interdisciplinary framework that leverages that social institutions are racially hierarchical. And I'm sure many of you in this room are familiar with this idea. And in my work, I look specifically at the way the criminal legal system does or doesn't operate in equitable ways. And my argument is instead that it's leveraging and sustaining the durability of the white supremacist agenda with respect to othering, with respect to subjects who are legally demonized, or legally propped up and preferred. 
So that's the framework I'm looking in, that people within these sites, doing time in this prison setting, and participating in this therapeutic community group, there's going to be differences in how those experiences are understood depending on race because they're operating within a system that has a legacy of racial hierarchy. Specifically one that bolsters white supremacy. So that's my argument, or my launchpad from criminal race theory. And from critical disability studies, which is newer to me and my work, I'm really interested in the way in which thinkers in this space interrogate ideas of ability, and normalcy, and capacity, and capability. And the extent to which those things are socially constructed. What is health? What sort of goalpost should we aspire to to be well, to be good, to be doers, to be contributors in society. 
All these kinds of things are taking on the critical disability studies thinkers. And they look specifically at the ways in which those constructions disproportionately disadvantage poor folks, queer folks, women, folks who are undocumented, folks who are not English speakers. You name it. Sort of the gamut of the margins. The ways in which we construct what it is to be healthy, and what it is to be pro-social if these folks take up in these spaces.
So just as racial hierarchy exist in the legal criminal system, I argue that they also exist within drug treatment, substance use disorder program spaces. And when you compound the two, a highly supervised population in a carcal context that I believe relies on illness to fund itself through some means, the Medicaid and federal funding mechanisms that I mentioned earlier, and then you have this group of folks who are basically a despised population. That setting is incredibly fertile for the kinds of injustices that the men and women I spoke to wills shed some light on in a few slides. 
So this is my data. This was a long five years worth of work that I'm still mining. This is a National Institute of Justice funded study called Roads Diverge: Long Terms Patterns of Relapse and Recidivism and Assistance for a Cohort of Drug Involved Offenders. Excuse me. And I worked on this study which was a two phase endeavor. The first was to basically collect 30 years worth of arrest and incarceration data for a sample of about 1,250 men and women who had all gone through Delaware DOC. That's Department of Corrections. And we had official corrections data on them from 1990 to 2008. The second phase of that study entered a sub-sample of interviews from that 1,250 men and women where they came into the office between 2010, 2011, little bit of 2012, to talk about their experience just cycling in and out of Delaware DOC as well as the neighboring states. 
So to give you a flavor of what the population looks like, these are the trajectories, the arrest trajectories from which I drew the sub-sample of folks who were going to be interviewed. And what you're looking at there is the mean number of arrests on the Y axis ranging from zero to three and a half, and then the duration of time in which they were observed or followed. And that's 1990 to 2008. And you'll see three distinct desisting groups. What I call desisting are trajectories of folks who at the end of the observation period had an average of less than half of an arrest. Whatever that means. We're not math folks in the room. But fewer than .5 arrests on an annual basis between 1990 and 2008. And the persisters are folks who at the end of the observation period still were showing a mean number of arrests, one and a half, every year. 
And I use these words persisting and desisting on purpose. I'm not in love with the idea of recidivism which is an official capture. It's a measure of criminal justice contact either, depending on the who you ask it could be a probation violation, it could be a rearrest or re-incarceration. I'm much more interested in desistance which for one, is not as concrete as, "Do you or don't you have contact with CJ," but gets at process and gets at folks own constructions of harm reduction, or identify transformation, or the extent to which they're moving from sort of one space, or one pattern, or one kind of social network to another that is allegedly more pro-social. So we're going to focus on how substitution sort of programming affects desistance and the constructions that the men and women in any spaces have about their own desistance trajectories. But before I do so, I want to just give you a flavor of what the full sample of folks look like as they're all included in the study that I'm going to talk about. 
So that sub-sample of 300 men and women who I told you came back to the office to speak with us in 2010, 2011, and 2012. They sat for interviews that ranged anywhere from about 45 minutes, though I think the longest one was seven hours. We had to take them to eat. That was fun to transcribe. But for the most part, about 90 minutes semi-structured interviews where I use event history calendars like, "So 9/11 where you," or "When you got first car, where you were you?" "Your kids birthday, where were you," to try and go back in time to see where folks were at when thinking about sort of their life history and extent to which trauma, substance abuse, violence, CJ supervision shapes their outcomes, or shapes their identity constructions if not both. 
All of those interviews were transcribed verbatim, imported into an NVivo software package that I use. And what I do with that is it allows me to systematically code across demographics, but also around the narratives themselves to look at emergent themes within the stories and see where patterns and overlaps may or may not exist. And so for this particular study that I'm sharing with you today, I'm looking at the treatment experiences of heroin and opioid drug uses in this sample of 300 folks who were interviewed. What do they have to say about the experience of being NTC inside of these prison facilities as well as participating in the post-SEG treatment programming that was offered to them, which I'll talk about, once they got out of prison. Okay. All right. 
Cruising. Oh yeah. Okay. So I want to talk to you about what I found, which shouldn't surprise you too much that drug rehabilitation clients are often characterized as pathologically inferior and dependent. And this does not situate them very kindly or very attractively in a moment of neoliberalism, and social welfare retrenchment, and lots of emphasis on personal responsibility and pull yourself up by your bootstraps. The last thing you want to do is be cast as someone who is less than, and particularly undeserving. So that's one of the major things that came out of the themes with talking to the men and women, that they talked about. That they believe that people think they're garbage. Someone said ... An administrator, deputy, warden, looked at them like they wouldn't scrape them off their shoe. That feeling of absolute garbage. 
In addition to navigating the burdens of an economically constrained reentry context, a lot of racial minoritized drug users also have to reconcile the additional stigma of being a black user. And that's what we're going to talk about in this space. The idea that as these folks will shed light on, white folks get to be addicts, they get to be sick, they get to be healable, they get to be reparable, whereas black folks are junkies and they're inherently criminal, and they're incorrigible, and they believe that that's something that's rooted to these disproportionate expectations around personal responsibility that is not imposed upon white drug users in this sample versus those that have to be navigated by black drug users in this sample. 
And the other main thing that I want to talk about is what black and women in the sample identify both as interpersonal, and a structural reification of white cultural norms within the treatment process, within the recovery process, and how those constructs exist and play out in ways that basically make their buying in to this system, their buying into the rhetoric, the language, the identity adoption, it makes that very problematic for them in ways that have implications for their own recovery experiences, as well as unfortunately the faith that they, or if they can even muster it, for legal institutions to help care providing institutions. 
First we'll talk about organizational culture and interpersonal experiences, and what folks had to say. So as I discussed earlier, a lot of the ongoing carceral TC unfolds in that group based setting with either one counselor/facilitator, or two. Usually approximately ten inmates. That was a larger circle that I showed you, but in the sites that I was working in it was about 10 to 15 incarcerated folks at a given time in an encounter group. They feature the highly confrontational interaction. That sort of ping pong or pinball that one of my respondents described. And you're verbally abused and humiliated essentially until you sufficiently capitulate and apologize. Participants rotate through this ritual and the sessions, everybody said was very very troubling. But the extent to which folks said they want to get out of it differed by race, and found ways to get out of it that differed by race. 
So I'm going to give you a ... Share a clip with you from Karen who's a 46 year old black woman at the time of the interview, and she was absolutely thrilled to take on a new job assignment while she was inside. When I say inside, I mean in custody. While she was incarcerated because it conflicted with the scheduled encounter groups. So the encounter groups are mandatory if you're part of the TC program. You're separated from [inaudible 00:19:28], you have to do this. But if you have a work assignment, because of course you will never find a janitor, or landscaper, or mechanic, or anything like that in a prison facility. That's all done by the folks who are incarcerated. So if you have a job assignment that conflicts with this, it's okay to go. So that's really interesting that treatment is super super important, but if you have to go mop we're good with it. 
So Karen left to do her prison job, and she was so thrilled. And when she was asked why she preferred the work assignment to TC programming, this is what she offered. She said, "I loved it. It would get me out of EG," that's the encounter group nights, "And EG is when everybody's sitting around in a circle, you sit in the middle of that circle, and when they call your name you turn to them and they just blow you right out. Anything they wanted to say, cuss at you, anything like that, all you can do is sit up there and you can't do anything. When I got that job, I wasn't in the EG thing anymore and I'd be so glad that I didn't have to go up and get cussed out, called all kind of names, because I feel something in me wanting to jump. It was just time for me to leave from the program. I ended up losing weight in there. I lost 19 pounds, got down to," this a size nine she's talking about. "Came home after that and nobody knew who I was." 
So Karen went on to talk at length about both the trauma that she experienced when she was sitting in the hot seat in the encounter group, but also the experience of bearing witness to other folks degradation. That sort of public shaming exercise as really really harmful to her own health and well-being. So much so that she lost weight to the point where she said she was unrecognizable. And this is not just solely the experience of a black person. I just chose Karen's narrative to illustrate this clip. But to really drive home that what's supposed to be a recovery exercise, what's supposed to be a mechanism for treatment and healing allegedly, it seems as though these practices affected substantial health declines for at least one of the folks I interviewed, and I can assure there is scores of others who said ... Talked about sleeplessness, anxiety, loss of appetite, paranoia. All kinds of things. 
That's just one example of what the encounter groups do, and to speak to the organizational culture of them. I'll also tell you, not only did black clients report frustration with the rhetoric delivered that, "You are sick. You are ill. You are broken. You are less than," kind of language ... Not only did they problematize that but counselors employed by the company, and mind you this is a private company ... I didn't get into that, but it was. A private company administering the treatment, that also aggravated them. They're role in this space. Rather than operating as positive or nurturing role model, some of these counselors and facilitators, a lot of black respondents reported that many of the counselors were black and former prisoners themselves who were perceived as particularly accusatory of the encounter group members who were incarcerated, and really demanding that black incarcerated folks in the group admit to their inferiority. 
This is like ... This pressure that perceive came down harder from black counselors in the group who were employed by the company. And respondents share that they suspected that these counselors with their own unresolved identity matters clung desperately to sort of this constructed or collective victimhood requiring that all black addicts capitulate, admit to harboring this shared pathos, rather than admitting that their experiences might be a feature of their own individual shortcomings. They suspected that this was this kind of mechanism was going on. So I'm going to share with you some thoughts from Jason, who at the time of the interview was 42 years old. He's a black man. He's a member of the low level. This introductory. If you remember those five groups. So this is like the .2 mean arrest per year. 
And he revealed not only that the TC program was pretty hastily put together and prematurely implemented, but that the counselors were very very poorly trained. They're not equipped to provide diagnosis, they weren't equipped to provide clinical support, no evidence based best practices were being used in that space. And as a result, he was particularly resistant to what they had to say. 
So this is what he said. "Well looking back on it, I think they were trying to get the program started and then expand it into different areas of the system. I think the best way that they," talking about they as the prison administration, "Could deal with being granted to start that process," from the governor, "Was to take the path of least resistance as far as getting us guys to help out. Because I don't really think the Key," that's the prison based TC programming end segment, "Six months before they paroled me to work ..." I'm sorry. I missed a step. "Because I don't really think I was in the Key six months before they paroled me to the work release thing just so I could help build the Crest community." So that's the community based aftercare. There's a prison based TC, that's Key, and then Crest is community based aftercare program. And what he's talking about it that he was rushed out to be a part of this counselor setting that he wasn't prepared for. 
And what he says is, "It was guys that had already been in the Key from July of '88, and then here it was 1990 and they're still getting smacked down." By smacked down he's referring to insufficiently healed and still subjected to the encounter group degradation practices. "And they were still dealing with issues. And I really didn't get an opportunity to deal with my own core issues and that's the stuff that keeps people sick and suffering. Everybody was learning how to identify with, and deal with issues but they were trying to get us to get other people to do it before we did ourselves." So what he's talking about in part is some of these tensions of double consciousness if you will, and having to wear these two hats as a recovering addict himself but also now a counselor who's facilitating these conversations, these discussions within the TC encounter groups. But also what he's describing is a palpable discomfort with making incarcerated folks in these spaces comply with this language, and comply with this rhetoric because he himself, and the other guys from 1988 onwards, they still weren't healed by any measure of the program's metric. 
And so the irony of being paroled, to do the work release, to participate in Crest and facilitate these programs as a counselor wasn't lost on him. Because he himself was dealing with a number of issues related to his substance abuse disorder as were the other counselors. He just talks about this idea of within these exchanges he wasn't really equipped to do so. And that wasn't an uncommon issue apparently. I'll give you one more example of how things are happening at the sort of the micro level and culturally within this space. The majority of black clients seldom reported ever being afforded a space in which they could enjoy any sort of measure of safety, any sort of measure of catharsis with a counselor or with other encounter group and TC community members. 
So consequently they pretty much altogether avoided cultivating any kind of meaningful relationship in that space. If you remember what the encounter group looks like, you don't want to be in the hot seat. You don't want to be vulnerable. You don't want to say something about yourself, your family, your community that can then be used against you. Because these are also spaces that are fraught with really really tight and sometimes very dangerous power dynamics. So a lot of folks wanted to make sure they maintained a distance between themselves, their past, their experiences, and other TC community members including their counselors. So as a result they didn't believe that folks in this space were really working to bolster their recovery experiences. Rather they thought they were trying to undermine it. 
So Linda is a 41 year old black woman at the time of the interview, expressed a really really deep concern and desire to develop that trust. But ultimately she shared that her effort to cultivate a personal connection with others in the TC proved unsuccessful. So the interviewer asked her, "What specifically about this experience didn't you like? What didn't you think was useful?" Because earlier she said that it wasn't. Linda says, "Oh no. I love it now." So the interviewer asked, "All right, you say you love it, but you said you couldn't find your place before. What was problematic about it?" And she said, "For me the main part of recovery is having a connection with people." So this is something that she experienced in later iterations of SEG programming that she didn't get here. And she says, "I really like that part of recovery. The problem is that I had problem with this space. This is my business, and they don't understand. They probably do. Of course they do. But there's a lot of messed up people out there, and I always felt isolated and scared." 
And she goes on later to talk about the desire to experience the unburdening and some of the self reflection that programming ideals, suggested would be available to folks and that other folks, particularly white folks in her co-ward, talked about at times ... Not everyone. I'm not at all pitching that this is a panacea for white people. Everybody had problems with this. But she never got that, and her story was typical of what other black respondents in the space talked about where, "I just never had a time where I could completely be vulnerable. Where I could do some of the gut work, or the gut level work," which is some of the language borrowed from that space, "That's required because I just simply never wanted to vulnerable, and I never trusted these folks." 
So this story's representative of the narrative shared by other black and men and women in the sample who basically thought the risks associated with being vulnerable, the risks associated with playing along and playing into this programming rhetoric were just far too great. And a lot of like respondents expressed a desire to get out from underneath the state's gaze as soon as administratively possible. And I say that because, aftercare and community based corrections requires a lot of reporting. Requires a lot of touching base. It's a lot of paperwork. It's base times. Depending on the conditions of your probation or parole there's urinalysis, and breathalyzers, and phone calls, and ankle monitors, and all this kind of stuff. So folks are like, "I just want to get out. I just want to be done. I want to get out." 
So continued participation in the Crest program, which is the therapeutic community aftercare. Usually you're in a halfway house, or you have to come to a day reporting center pretty regularly. That meant prolonged exposure. So folks were like, "I'm not trying to do this. I don't want to be a part of this." And the appeal of prolonging one's treatment for the sake of earning a certificate of completion, which are handed out to folks in Delaware who finish all the program, that didn't have the same luster for black folks as it did for white folks in this sample. Specifically because the idea of earning the certificate and showing it to folks, "Look I'm better now," for black folks in the sample they said, "I don't want to show a landlord, or an employer this thing and confirm to them what they already suspected. That I was a drug user from Wilmington." 
You know you have this space in your resume. You may have some ink that outs you as far as affiliations. Excuse me. "Why would I put on paper something stamped and signed by the governor of Delaware that says, 'Yes I am the piece of shit you thought I was'?" So folks are like, "No I don't want at all to ever have a piece of paper like that." Which was really different from some of the white folks that I interviewed. So this a more extreme example of sort of playing on that system, of the addict label and the extent to which these certificates are actually really useful. But it's a true one. So I want to share it with you. 
So this Jeffery. He's a graduate of the TC program. He did it inside and out. And he talks about how proof of the disease persona is not the worst thing in the world for him, or at least he learned how to leverage it in ways that were beneficial for him. So he was a white attorney. He was disbarred in the state for a number of issues that were connected what was primarily alcoholism, but his drug of choice was also cocaine. And he made sure to accumulate as many of those rehabilitation certificates as he possibly could, and he was really proud of being able to demonstrate a good faith effort to get clean and really believe in sort of the [cashay 00:32:06] and the clout that that documentation held for him in his reentry journey. So he called himself an expert on therapeutic communities, and I'll tell you what he describes as far as what those certificates did for him. 
"So the bar association sent me to rehab." So check that. The bar association sent him to rehab. This is paid for by them. This is a 20A residential program. "And I didn't take it very seriously at all. In fact the opposite. I took it as a joke. I'm like an expert on therapeutic communities. I did the Key," that's the prison based program, "Because I'm just a manipulator and I have the abilities to manipulate. So I was able to manipulate my way through Key program twice. Get out in six months, and that was minimum. Went in a third time and pulled a rabbit out of my hat and got out of that early. So those programs didn't work for me. I'd just get what I need to get ..." I'm sorry. "I get what I need, and then get out of dodge." 
So experiences like Jeffery's underscore the benefits of white privilege and class privilege really. So he's no different sort of on paper than Karen who I mentioned before, then Jason. They're all coming through the same program, but the paperwork that he gets after having left Key and Crest it doesn't come with the foul stain that it does for black folks in the sample who were like, "I would never show that to anybody." Instead he's like ... You know. And so that is an issue that is recurring. He's the only attorney that was in our sample. But my suspicion is that this happens more often than not, and there's a lot of research that shows that employers specifically are more likely to hire white job candidates with records than black job candidates without. There are all kinds of audit studies that are quite robust out there that say that. 
I want to give you, related to this idea of looking for a job as this is pretty much the most important thing. You come out ... If you're drug involved usually you have to [inaudible 00:34:06] 90 days, but you definitely got to find a place to live, and you definitely have to get a job. So having a record a really really difficult, and it's sort of positive that these certificates of rehabilitation will be a mitigator for any kind of bias that employers have because you're black, because you are CJ involved, and because you're drug addicted or identified as such, labeled as such by the state. So Connie talks about how desperate for her unending search for viable employment in Delaware ... Or Corrine. Excuse me. 
She had to lie about her criminal background basically. She said the only way for her to secure work in this space, because mind you too this is in Delaware, we're looking at the rust spout, so we're coming out of an industrial space. Like it used to be GM, and Dukon, and now everything is service. Everything is money. It's the banking capital of the United states. Like Wilmington, Delaware has all the credit unions and things like that. You can't work in a bank with a felony drug charge. You can't clean a window in a bank with a felony drug charge. So it's really really hard to find a job in this particular service sector, legal market. 
So Corrine talks about basically she had to lie about her criminal background in order to secure work for the only kind of job that vocational programming in prison actually prepared her for, which was a CNA. She got a certified nursing assistant license. Well you can't be around a pharmaceutical cabinet with this felony drug record. So the irony of job training and vocational training within these spaces, also begs some of our attention. But what Connie had to say was this. "We're told to go out and apply ourselves when we're looking for jobs. So I went there, I'd taken a course when I was in prison for CNA," that's her certified nursing assistant certification. She has her CNA license, "And that made me available to them. I got a license as a cardiovascular technician." 
So referring to application responses about prior felony conviction she says, "You know they never know. You just write whatever on the paper. I mean in your life you might be doing right, but you still tell some lies along the way to get what you want and that's for real for real. People don't know that, but we do as we do this." And as I said there's a robust body of literature that suggests that for white job candidates regardless of their backgrounds, they're given the benefit of the doubt in ways that people of color on the job market are not. So for many black candidates in this sample it's believed that revealing one's addiction history, or addiction status, or addiction identity or label, however you want to call it, it just spells the relinquishment of any sort of meager protections they have against bias that exists in the labor market anyways. It's just ... That's just a wrap for them to show basically that they are ... Confirming that they are what they believe employer's suspect them to be anyways. 
Last one I'll tell you about, structural racism and how that plays in to the problems that emerge from this kind of drug treatment rhetoric. So additional examples of diminished stake in state institutions, and their stake in meaningful integration or reintegration depending on what you think, look like throttles which I'll share with you in a second. He's a 42 year old black man at the time of the interview. He noted that he believed that these institutional failures were intentional. These kinds of [inaudible 00:37:25] failures. And in line with Jason's telling a couple slides ago about the hasty implementation of the Key Crest program, what he had to say, Ronald, was that other black peers believe that the TC programming was never actually designed to help black people. Like yeah it was hasty and it was kind of shoddy, but that that was not an accident. That that was quite purposeful that this program not actually be useful. And this is what he had to say about it specifically, that these things were installed to ensure black denigration. 
He said, "I think it was about a particular segment of the government, the Department of Corrections, that really don't want to see our particular population succeed. Even though you might have some people in position that are doing the right thing, they really don't know what's going on behind closed doors." And he's talking about advocates for prison based substance abuse sort of programming. "It's like this is maybe what they want us to be. Useless. Sometimes you get to the point of thinking you're an addict. I know me, when I go zero to state in my thought process," and by state he means meaningfully adopting that deficit rhetoric. "I'm done." The extent to which other black respondents agree with Ronald was not explicitly measured in this study. However when operations in correctional spaces that are designed to ready citizens for the world to be pro-social, to be contributors, mimic a lot of the institutional strains that racially hierarchicalized if you will, and contributing to landing them behind those walls in the first place.
When that stuff is going on, arguments like Ronald's don't seem unfounded. They don't seem farfetched. And I actually in future work want to look at some of legal citizens and that might be embedded in this bucking at treatment rhetoric. That appears racist I would definitely argue. So it's no surprise that the consumption of this treatment, and the adoption of the sick role, would vary across racial groups. It's not netting everybody the same benefits and in fact it's incredibly damaging and dangerous for folks who are already coming into these reentry spaces with a really really stigmatized, marginalized, embodied other identity. And this kind of exclusion and exclusionary social attitudes that emerge as a result of coming into these spaces, they extend to other institutional domains. And the extent to which folks are comfortable with or will approach, or have any kind of faith or trust in personnel and mandates in these other spaces. So this is not just a prison problem, it's a state problem and it's a healthcare problem. And I'll talk about that as we close. 
It appears overwhelmingly that individual perceptions of the purpose and the utility of prison based therapeutic community rhetoric varies by race. And by varies I mean white people are digging it in ways that black people are not in this space. A large part of that is because the treatment and the rhetoric and the culture within these spaces mimic larger racial hierarchies that disadvantage people of color, and particularly if they are poor, if they are uneducated, if they are deemed as civically irresponsible, and worse if they're addicted to the same drug that we're now having a very compassionate and empathetic response to. It's abuse. So that's another huge issue. One of the major takeaways from this study is that multi-marginalized ... And I would actually argue hyper-marginalized people are navigating, is a crisis of diminishing faith in healthcare institutions. 
So even, as Ronald talked about, people who were trying to do good that don't know what's going on behind closed doors, if there's a mismatch in sort of the programming that's offered and the acceptability and the uptake. All these things that people running clinical trials have to deal with, "Why aren't they doing it? Why don't I have adherence? Why do I have all this attrition?" It's because this is happening in the background. So even folks who are trying to do work that's more equitable and promotes safety, and promotes health and well-being across generations, you're dealing with a legacy of mistrust and it's not unfounded and it's not misplaced. And that has to be reconciled first. That's one of the huge takeaways that I wanted to give folks who are listening to this. 
And finally, we wouldn't be running into all these problems, or I think less so if we were better about incorporating critical race, theoretical and critical disability traditions in our thinking about health. In our thinking about public health and well-being, and safety and the ways in which the law and legal institutions can and do, or do not operate in ways that are competent to the way the structures are unfolding. The larger structures that they mimic and the larger structures that condition the experiences of the men and women coming through these doors. So I'm going to stop there because five of and I've been droning. Thank you, thank you, thank you, thank you, thank you. Happy to answer questions. 
Richard: I loved your talk. 
Erin Kerrison: Thank you. 
Richard: It was so depressing. 
Erin Kerrison: What's your name first? I'm sorry. 
Richard: I'm Richard [inaudible 00:42:31]. 
Erin Kerrison: Wonderful to meet you. 
Richard: I was  [inaudible 00:42:33] in the prison study four years ago. Psychoactive drugs. Don't need to go into that. But I have one sort of nitty gritty question for more critical things. 
Erin Kerrison: Okay. 
Richard: Do you believe [inaudible 00:42:46] people with that subset of the 1044 and were they sampled permissively, or did they represent some convenience? 
Erin Kerrison: Yeah. So we tried to get a representative sample across the offending trajectory groups. Because then you can imagine it's much easier to get a hold of folks who are in the lowest level desisting group than it is the persisters group. So to answer you it's a stratified random sample for the five groups and we got 300. We had to work really really hard for persisters. Two of the folks on our team, one had worked in Key Crest and knew a lot of POs who had kept tabs on folks who were in the Crest program. The other ... This is a picture of Southridge in Wilmington. This is a neighborhood from which a lot of my guys come from. They had to hit up these spots nonstop. The barbershop, the bowling alley, the check cashing station. Like all the places where you would find these people, we had to go get them. 
The desisters were much easier to get a hold of. And just like anyone else doing qualitative research with hard to reach populations, if you call and you say, "I'm calling from the University of Delaware because we owe you money, would you call us back?" They will call you back, because these people are part of the study from 1990. Right? And I absolutely believe paying respondents because it's gross if we don't pay them. So if you introduce it that way, you're more likely to get a bit. 
Male Audience: Your work on [inaudible 00:44:11] work where she books at sort of the construction of denial, their relationship versus who owns denial. And I'm wondering if you could speculate a little bit, because I can imagine people who defend the kind of [inaudible 00:44:25] that you're describing as the violence of surgery. It's an incredibly violent procedure that is somehow necessary. That this is the what the person carries with them. They carry denial. To disabuse them of denial is what this therapeutic community is, and their complaints, are they complaints of someone who's having surgery without anesthesia? Or is say someone's been compromised in certain ways that is receiving surgery where it's counter indicated versus someone who is totally healthy and receives surgery. So the white person verus the black person. 
And so I'm wondering, one way, a perverse way to read your talk is to say, "Obviously we need to take into account racial differences [inaudible 00:45:06]. We're going to have the black group and the white group." And I think that your inclusion of the abuse in this within which black counselors and black groups mitigates that in your analysis. But I'm wondering how equitable spaces can be created inside of a cage. 
Erin Kerrison: That's a great question. I'm a 110% an abolitionist, and I just want to get rid of the cage. But insofar as I have to operate within this space, that's ... The reading of this work should not be, "How can we make this fairer," because I'm not interested in that. I don't like the cage. What I'm arguing is that everyone coming out of the cage is not as bad off as everyone else. There are disparities in sort of the experience and also to this idea of the violence of surgery, that it hurts for everybody and that's why everyone is miserable and complaining. But you would argue, I would hope, that someone's going through a surgical procedure so they can be better on the other side. On the other side of this they're not necessarily better. They're not healed. They're not recovered. They're not actually dealing with the sort of root causes of their addiction and substance use disorder behaviors and patterns. And then the sort of label, the certificate that they get afterwards doesn't net them anything. And not only doesn't it net them anything. It leaves them worse off. 
So the analogy I think that you provide is important for us to think about. This violence of surgery. But it'd be different if you came out of surgery and you had a scar, but you had a new kidney. Now you come out a surgery with a scar, and you're still on dialysis if not worse. So it's like, what is the point? And so that's more so the takeaway that I want as far as a reading of these findings goes. Sure. 
Female Audience: [inaudible 00:46:55] Think you had some great thoughts. I have a question about the hot seat and [inaudible 00:47:00] traumatic breakdown of the individual. Did you see the expected response to differ based on gender or was that constant across the board? 
Erin Kerrison: Yeah. So it's actually a very very gendered practice. The encounter group exists in men's and women's facilities in Delaware. It started earlier in the women's facilities. And I think it's important to note that. So this idea of the good girl, and the bad girl and how those constructions are racialized first permeated inside of Delaware's women's facility. And as far as the capitulation, it doesn't look the same. Like the successful or sufficient capitulation. For women it's tears for sure. You must cry, you must talk about how you've lost your kids, how you've only had the worst partners. You ran away from home and it may have been in some respect your fault. Like maybe you were too troublesome as a teenage girl, this that. There's that. 
For the men successful capitulation within those spaces is often just to stop being defiant. To stop challenging the rhetoric. So it doesn't have to be sort of this physical brokenness, this puddle on the floor which is I think more of a performance that's required of the women. But you do ... You have to stop. You have to stop bucking at it, and then counselors will sort of ease off of you. Yeah. 
Female Audience: Was there a relationship between the experiences you talked about and the outcomes? 
Erin Kerrison: Yeah. So that's my next thing that I'm doing is getting back to my quantitative data analysis, those trajectories. So I need to recode these data and map them on ... I need to first categorize sort of what the narrative is as far as are they clean or aren't. And this is why I was saying I liked desistance better than recidivism. But it's harder to capture because with recidivism that's a zero one. Did you get rearrested or didn't you? Harm reduction is a different sort of variable to capture. So what I want to do ideally is to classify who said their experiences were helpful or not. Map those on to each subject number. And then bring it back to the arrest trajectory to see if there's any sort of relationship between experiences of SEG treatment programming, and then subsequent offending patterns as they're picked up by the state. 
Because we also know those numbers are deflated. People are doing a lot more than gets picked up in an arrest. But yes, to answer you, which is why I told Taeku I'm not done with my book. But yes yes yes yes. Yeah. Thank you. 
Male Audience: So the folks who are making and maintaining these cages, folks who are paying for the making [inaudible 00:49:51] cages, what's their response to the research? And what parts of your research are most ... Have the best opportunity to maybe change minds? 
Erin Kerrison: So I haven't presented any of this to an audience beyond the academy. This work is published in social science medicine, but I mean that's another beef of mine that our stuff exists behind a paywall and the folks I want to get it to are not going to shell out $40 for it, nor do they want to read academies. So your first question I cannot answer you just yet. The second thing, what I want them to take away ... This is a huge issue. My whole career, well the whole ten years of it so far, I'm 33. But my whole career I've been working with stakeholders, and policy makers really closely. Wardens, deputy, wardens, DA, probation officers, chiefs, and it's really difficult as someone who is an abolitionist to have meaningful productive conversation with folks who are committed to reform. They really really are, whereas I don't want to fix it. I don't want to fix it. I'm on camera. I don't want to fix it. So I don't. I don't want to fix it. 
So to answer you as far as what I want people to think about, I want people to think about why they are so wedded to this mechanism. Why is this the only sort of reality that you can imagine for social anomalies? Because if you're thinking ecologically, there are always sort of aberrant organisms. Like things happen. But when they happen like this at the scale, that's no longer sort of like an, "Ah shoot." Like a bad genetic thing. That's systematic, and that is structural. So rather than invest all this time and energy, and sort of a what to do with this problem, let's think big. God forbid. What could we do about the structural context that gives rise to these populations for whom you believe a cage is needed? 
So that's more the conversation that I want to have with the folks in this space. Because I do believe in that energy. I'm not cynical about the extent to which folks really want to do good. Drug abuse is not funny. This is definitely something that we need to tackle, and we need to tackle with an open heart and a big imagination. But I don't believe that the cages are the answer. So I just push people, which is not fun to say to a warden. Like, "Well what if you had no job? How awesome would that be?" You know what I mean? Like that tension exists and that's real. And so that's something that I'm always sort of juggling. But that is what I want them to know. Let's think big. Let's all not have a job. 
If this doesn't happen, I don't have a job either. So I'm right behind you. I wish I had nothing to talk about. That's what I would like the policy makers to know. I wish I had no op eds to write. Please. 
Female Audience: Do you have any ideas of what would you dream big? Or what would you imagine the solution? 
Erin Kerrison: In the immediate? Or-
Female Audience: No. Just ... Not necessarily the immediate. But like what would you imagine would work to kind of fix [inaudible 00:53:07]. I snuck in from the outside. I'm not a part of the academic community. 
Erin Kerrison: I love that. I love that. And get more lunch. Yeah that's good. I don't know. I'm being really honest with you. I don't know. And I think part of it too is like, I'm so careful because people are starting to listen to me. This ... Berkeley gets people excited. So I want to be really careful about what I say because I don't want somebody running with something that's no bueno. So one, I don't know. But even if I did I'm going to be honest and say, I wouldn't tell you right now because I want all the evidence and everything to back it. 
I see you Denise, but Katie was asking first. I'm sorry. No no. [inaudible 00:53:57] My friend. I can't answer her question. I'm sorry. Please Katie. 
Katie: Oh. Thanks. Well I loved this and I love your use of kind going through the [inaudible 00:54:08] Fascinating. One thing that really struck me was, I think [inaudible 00:54:15] first participant that you quoted talking about surviving by not making personal connections and that-
Erin Kerrison: Linda. 
Katie: Yeah. Not giving any vulnerability, it made me think of descriptions of what people get by using drugs as survival, and drugs as sort of blocking off sources of pain. And it ... So I am excited to learn about what you find in terms of what people's coping mechanisms for the trauma of these groups are, and then what outcomes are later on. And I'm also just wondering if there have been any studies by people who do substance abuse treatment into this, or any research, or is this just totally made up by the criminal justice system? Where did ... Yeah. 
Erin Kerrison: Yeah. So wait, I'm blanking on your first question. 
Katie: Well it was more of a ... I don't know if you ... I think you had said you'd kind of done this part of the research, but I'm interested in how people with cope. And then what the outcomes. 
Erin Kerrison: Yes. Okay. So as far as how people cope, unfortunately a lot of these folks are coming in and out of this system. So their baseline is considered having left a Delaware facility between 1990 and 1996. But we're watching them through 2008 and invite them to come and talk to us. So between 1990 and basically nowish, they've been in and out. And the facilities have updated what they offer. So as far as coping, some of the toolkits that are constructed within these spaces have gotten better. They're still not perfect, but some cognitive behavioral therapy, monalities, are a lot less dangerous than the encounter group for instance. So people are still able to tap into other treatment programs, and other lessons gleaned from those kinds of spaces to help them cope with the trauma of the EG from years prior. Yeah. 
So there's that. There's also community based settings that are a lot safer. Because the other thing about the encounter group and the therapeutic community, it is a therapeutic community. It's meant to be a wrap around mutual aid sort of hug where you are cut off from everybody else and all the distractions of prison life. But it also means if you do whatever the capitulation exercise is in the middle of the encounter group, and then you go back to whatever pod, you don't have any space from those folks with whom you were just completely naked and totally scared and vulnerable. So to the extent that folks are not participating in TC but still involved in some sort of treatment programming, there are some strides with respect to sort of help. There are ways of going about offering substance abuse disorder treatment inside. 
And to your second question about other research that looks at alternatives, yeah. I'm actually involved in a study right now with colleagues at USC looking at the efficacy of a mindfulness space intervention. And this is for a women's residential treatment facility program. And what I like about mindfulness, and what I like particularly about using mindfulness as a modality with ... Informal mindfulness too. This is actually like practicing yoga. Practicing mindfulness rather. Is that for folks who don't have health insurance, or don't have access to a therapist or a clinician, this is a self-sustaining sort of thing that they can do. And what's nice is you don't have to come back. You don't have to come back for it. So it's not the money maker, the money generator necessarily that some of these other modalities are. 
So that's an example of some of the work that's going on around alternatives to medication assisted treatment, or CBT, or anything else that requires a doctor, a healthcare provider and requires money. Mindfulness is something that's self-sustaining. Denise. 
Denise: Yeah. Well I have a couple comments. One is that there's been work done in places where communities are faced with high levels of drug use, high levels of criminals [inaudible 00:58:39] And their [inaudible 00:58:41] human rights violations. Mexico has these places where relatives drop off their relatives [crosstalk 00:58:49] And so this issue of how populations [inaudible 00:58:54] limitation of human rights and harm that some kinds of things ... Some of them create. But communities are often facing ... Their facing the results of what's going on in terms of people stealing, using et cetera, and shooting. So that is [inaudible 00:59:17]. But the other thing is that the TC model is really old. It's really old. 
Erin Kerrison: Yeah. 1956, or '57 I believe it started. 
Denise: And in terms of some of my work with [inaudible 00:59:32] community activism around alcohol and drug problems which is what grassroots. And the rhetoric is very different. It really talks about the need to deal with structural racism that creates unemployment, that creates inequality, and creates too many liquor stores that creates drugs being in neighborhoods. And so the idea that Delaware, and I don't know nationally how prevalent it is, but that they are adopting an analogy that it just seems like it was all put in years ago and it's still there. 
Erin Kerrison: It's still there in 2017 for sure. 
Denise: In 2017. And when a lot of communities have adopted a more environmental approach. I mean understand the need for treatment, but you need prevention and we need to change our communities. So it's amazing that the criminal justice system would adopt something that's like made from movies in 1950s or something. 
Erin Kerrison: Well this is part of my larger argument too. Like I don't think it's working. I'm very cynical about that. I think this is working the way it's supposed to work. Especially as we move into increasingly privatized treatment provision. There's a lot of money behind this. 
Female Audience: I agree with what Denise was saying. It's such a ... That model's a dinosaur. And you need to see how like harm reduction or-
Denise: Trauma center care. 
Female Audience: Yeah. Trauma center care. I'm interested in trauma intervention for women offenders. But wow. So. 
Erin Kerrison: I'm working on that too. I mean trauma is very racialized and very gender ... [Carhart's 01:01:25] doing some really interesting things in Columbia around this. But the pathologizing of trauma is not evenly distributed I'd say. So even that I have some beef. And I'm learning so much more about this too because as I said here in the beginning, I'm coming from a very different discipline and now I'm working with, and educating, budding social workers. So learning this language, and this rhetoric, an this vernacular, and seeing the structural leanings and lackings that exist in that education too is like a thing. I'm like, "We need to hit this from all different angles." So yeah it's the T word I have problems with too. But I appreciate why you were shaking your head. Yeah. Please. 
Female Audience: Okay. Thank you so much for your talk. I think you said it the beginning that there were folks who found themselves in these groups and sort of this treatment trajectory, who were there for arrest related to maybe sale or something and they hadn't necessarily used themselves. Did you see any ... Did you interview any of those folks, and did you see different themes from them than-
Erin Kerrison: "Just a waste of time. This is not for me." That's pretty much ... So it's not that-
Female Audience: Completely different. 
Erin Kerrison: Yeah. Yeah. I didn't put them in here because they're not speaking to the experience is racialized. They're just like, "Why?" But it's good time. 
Female Audience: But that's another ... Why is an important question too right? 
Erin Kerrison: Because it's a numbers thing too. Like that's another component of these contracts that exist with the TC providing contracts. Just like a private prison. You need to have a certain number of eds. Thank you.