Pubdate: Tue, 07 Jan 2003 Source: Charleston Gazette (WV) Copyright: 2003 Charleston Gazette Contact: http://www.wvgazette.com/ Details: http://www.mapinc.org/media/77 Author: Jack Berkley Note: Dr. Berkley, a licensed psychologist, lives at Shepherdstown. Depression, Substance Abuse High Among Incarcerated Youths MISSING THE DIAGNOSIS I worked as a substance abuse counselor in a Maryland jail for three years and later as a licensed psychologist in adult Maryland correctional facilities for several years, working exclusively with youths sentenced as adults. Dawn Miller's report of the high rate of mental problems among incarcerated youths is in line with my experience. Two additional observations: youth substance abuse in prison is underreported, especially by those inmates who continue regular or occasional use in prison or those who have buddies doing so. The best chance of knowing the true picture is through counseling relationships. During working therapy, substance abuse reporting increases, compared to what inmates report on questionnaires or brief interviews. Why? Youthful inmates generally do not trust health-care professionals or others with information they fear will result in further scrutiny or charges, unless it will benefit them - for instance, if they think it will transfer them to a better treatment situation and contribute to earlier release. Therefore, I think the substance abuse rate would be considerably higher than what the federal government study reported. Another point I would make is that dysthymic disorder, a long-term low-intensity depression, is very common among youthful - and older - offenders. Two reasons explain why this is underidentified: First, youthful offenders frequently do not identify long-term depression when they have it because they have become ego-syntonoic, which means they've been down so long it seems normal to them. Secondly, many professionals miss the diagnosis not only because the youths report they are fine, but because depression in youths often lacks the display or report of being sad, which most persons regard as the hallmark of depression. Youths may be irritable, touchy, resentful, spiteful or belligerent instead. These manifestations of depression (blended with personality traits and attitudes) often engender negative reactions in professionals that throw them off the diagnostic track. Especially when combined with substance use and/or prior trauma, many of these youths experience alexithymia, the numbing of emotional experience, so that they are disconnected from experiencing and expressing their own feelings. They cannot report feelings. The clinician is therefore left to make inferences about the uncooperative youth's angry depressed mood. Also, in the past, professionals used to take an either-or perspective regarding acting-out youth. The youths either had an externalizing disorder (e.g. acting aggressively, as in conduct disorder) or an internalizing disorder (e.g. depression). Research and experience confirms that youths often have both. They can rob someone on the street and also be depressed - even though to most of us, aggressive behavior and depression don't seem to mix well. Many of these youths often display a below-normal capacity for empathic regard for others, even though they often express deep concern and loyalty for their own mothers, a touching feature that does not erase their aggressive actions elsewhere to someone else's mother or child. Both the aggressive behavior and the depression must be treated. Despite their many common experiences before prison, youth inmates are individuals, especially regarding their degree of empathic capacity and responsiveness to treatment. Early release is no favor to them or to us when they have not demonstrated a capacity to change and have no new place, education, job training, routine and well-monitored, semi-structured living arrangement to which they can return. One of our studies indicated that a high percentage of re-offenders came from the same four zip codes of an urban area. Youths' pre-incarceration environments are the training grounds that lead to prison. Returning them there retrains them to recycle. Treatment starts in prison, but if it ends there without the other features I mentioned, it is often - though not always - like a Band-Aid for an internal hemorrhage. - --- MAP posted-by: Beth