Reducing Recidivism Through Rehabilitation

Reducing Recidivism Through Rehabilitation

We have important tools to help reduce recidivism through rehabilitation, namely the Affordable Care Act and post-release support, such as that offered by San Francisco’s Transitions Clinic.  I am highlighting this combination having listened to a news segment, titled: “Obamacare in Jail: How San Francisco Policy Helps Inmates,” filed by April Dembosky’s for KQED’s The California Report: State of Health, April 30, 2014. The whole story is encouraging, but I especially liked her coverage of what helps with rehabilitation, which, in turn, reduces recidivism, namely that those IN and LEAVING jails or prisons have:

Taking advantage of the Affordable Care Act and Transitions Clinic model reduces recidivism through mental health and substance use disorders treatment and after care.

Taking advantage of the Affordable Care Act and the Transitions Clinic model can reduce recidivism through mental health and substance use disorders treatment and ongoing after care support upon release.

  • readily accessible mental health and/or substance use disorders treatment AND
  • readily accessible transition support to acclimate “on the outside.”

The first point is a huge problem with a huge need. As The Department of Justice writes in its April 17, 2014 post, “Reentry and the Affordable Care Act,” “…men and women in this population suffer three times the rate of mental illness and four times the rate of substance abuse problems as compared to the general public.”

Substance use and mental health disorders are brain changers – in other words, they change how the brain functions. Given the brain controls everything a person thinks, feels, says and does and is in turn influenced by all that comes at it – treating these disorders requires an integrated, long-term approach to re-wiring all that goes into causing them. It also requires the two (substance use and mental health disorder) be treated concurrently if they are both present. Treating these disorders can include help with stress triggers (such as what am I going to do now!), proper diagnosis, help for the family members still involved in their lives, help with underlying childhood trauma and access to properly prescribed and monitored medications for substance use cravings and mental illnesses. And it is imperative this sort of treatment happen otherwise the brain is left to its old devices, so to speak, and the individual’s  long-standing embedded brain maps will take the individual (brain) down its old road and thus it’s old behaviors. In other words, relapse.

To help with this specific need of effective mental health and substance use disorders treatment, we now have the Affordable Care Act, which requires insurance plans to provide coverage for both mental health and substance use disorders treatment and has the potential to open coverage to millions of low-income adults (like the formerly incarcerated). As 21st century brain and addiction-related research shows, integrated, co-occurring mental health and substance use treatment is key to healing the brain of both disorders and thereby helping a person change distractive behavioral patterns.

And to the second point, transition clinics, Dembosky writes about Wanda Fain, recently released after 21 years behind bars, “Fain has seizures, lymphoma, and bipolar disorder. In prison, the guards regulated all of her care for her. She wasn’t allowed to eat a meal until she took her meds. But on the outside, it’s up to her to find the right doctor, the right pharmacy –- and to figure out which four buses she needs to take to get there.

“’It’s little things like that that people think are so easy,’ she (Fain) said, shaking her head. ‘They are so overwhelming.’”

Re-entry clinics help with this and in that vein provide the missing piece in many treatment programs – long-term, continuing care (aka aftercare). As 21st century brain, mental health and substance use / addition-related research also shows, long-term aftercare (in other words, care long after detox and rehab) is also imperative. It must address the individual and be a carrying forward of that which was started during rehab: continued medications and monitoring, help with job searches, effective co-occurring disorders treatment, therapy around trauma… treatment and after care are not one-size-fits-all endeavors.

One such re-entry clinic now being held up as a model is San Francisco’s Transitions Clinic. As Dembosky writes in her article, it is “a specialized program designed for former prisoners, where doctors, psychiatrists, and social workers all consult together on the same patients. But its key staff are community health workers who have all spent time behind bars, too….”

These are exciting times when it comes to making solid inroads to reducing recidivism: Affordable Care Act + Transitions Clinics = Win Win for successful rehabilitation of the formerly incarcerated, their families and our communities.

© 2014 Lisa Frederiksen

Lisa Frederiksen

Lisa Frederiksen

Author | Speaker | Consultant | Founder at
Lisa is the author of hundreds of articles and 11 books, including "If You Loved Me, You'd Stop!," "Addiction Recovery: What Helps, What Doesn't," and "Secondhand Drinking: the Phenomenon That Affects Millions." She is a national keynote speaker with over 25 years speaking experience, consultant, and founder of She has spent more than 14 years studying 21st century brain research in order to write, speak, and consult on substance use disorders prevention, intervention and treatment; mental disorders; addiction (aka substance use disorders) as a brain disease; adolescent addiction treatment vs adult addiction treatment; effective treatment for co-occurring disorders (having both a substance use and mental disorder); secondhand drinking | drugging; help for the family; and related subjects. In 2015, she founded SHD Prevention, providing training and consulting to companies, public agencies, unions, nonprofits and other entities to address the workplace impacts of employee secondhand drinking and alcohol misuse.

14 Responses to Reducing Recidivism Through Rehabilitation

  1. Lisa,

    Thanks so much for both this informative article and your positive spirit. I volunteered in the San Francisco County Jail quite a while ago (and blogged about my experiences here: I was inspired by the strength of the women I had the opportunity to serve, and am so glad to learn about Transitions Clinic. They so deserve the support of people who are well-trained and believe in them.

    • Thank you, Laura! I very much appreciate your comment and found your article VERY informative. You (and it sounds like the documentary film, as well) raise so many, many important points. This part really jumped out at me, “Thus, if we want inmates to show remorse for their actions, to become reflectively aware of their impact on those around them, we must begin by showing them empathy, listening to their stories, acknowledging their victimhood. By making space for the old story to be told, we also create opportunities for new positioning in society.” Thanks for sharing this resource!

  2. Kyczy Hawk says:

    YES – we need far more robust and integrative re-entry programs and the ones that include people who have been there are more powerful and authentic. Recovery Cafe San Jose is hoping to move that direction here, in the San Jose area. I work in the jail and I hear the women’s stories. I know when they leave it is difficult for them to maintain a community of healing -particularly with those who understand the first many months of their journey: there is no place for them to continue the programs that have been so helpful behind bars. That is a lost opportunity for all of society. Dignity and self esteem are brought bout by reaching out and helping others; reentry programs can provide this. Nicely articulated and presented. Thank you@!

    • Thank you so much for sharing your experience and work with women in jail. For readers – the Recovery Cafe model she references is fantastic! You may wish to replicate it in your area. Here’s the link to their site: Quoting from their website, “Recovery Café offers a cost effective way of providing the support and stability individuals need to break the cycle of addiction, mental illness and homelessness. Sustained recovery reduces the societal costs of addiction and mental illness and by reducing the drain on our public and community resources. It is available at no charge and is immediately available to anyone who is willing to meet the membership agreements. There is no limit to how long you can be part of RCSJ, which is a good thing because recovery is a long-term process that requires on-going support.” Thanks again Kyczy!

  3. Herby Bell says:


    A really important post in view of the confusion the ACA has brought in its debut. These programs will be the grass roots efforts to really affect change, build bridges and allow people the chances they need and deserve to address these very present issues in our culture. I was reminded of the serious problems the Veterans Administration has with their “analog” to this phenomenon of bringing people back, “into the fold.”

    Your clarity and ability to heighten awareness about what we’re actually endeavoring to do here; change “longstanding embedded brain maps” is MOST refreshing and as you know, no small, short term task. To think that we’ve been up to something else in the not so recent past seems rather preposterous with all we know now about how our brains actually function. VERY nicely presented. Thank you, Lisa.

  4. This is such an important piece, Lisa. Without the continuing care, the cycle so often just begins again. I’m so glad to hear about the San Francisco’s Transition’s Clinic as well as the Recovery Cafe in San Jose that Kyczy mentioned. We do need more of these types of clinics, so that people have the support that is so needed. Thanks so much for sharing this information!

    • We sure do, Cathy, and not only do these provide necessary support, but as I understand it, there is no cost, which is also important. I appreciate you adding your comment!

  5. I don’t know about you Lisa, but I hear so much negativity about the ACA that I am pleased to hear an ‘upside’! Thanks for bringing that to us with this article – this is important information which I will share!

  6. Hiya Lisa!

    You always present such well-considered/written work. And I always respect and appreciate that. I paused for 24 hours before commenting, because I knew in my heart how I felt about the content of your article – and didn’t want to play the negative “heavy.” However, I’ve decided to go ahead and lay it out.

    First of all, I have major problems with the ACA, economically and politically. Getting into the details here isn’t necessary – I only wanted to express my opinion. Secondly, I spend quite of bit of time doing community mental health work here in Michigan. The agency with whom I work facilitates state-funded programming for parolees. Yes, it’s all about providing necessary services (case management, housing, psych and substance treatment, psychotropics) in an effort to minimize recidivism. No doubt, the programming does that; however, my concern is the enabling and dependency that’s generated. Unfortunately, the presenting attitude is often “What are you going to do for me next?” A true sense of expectation and entitlement is obvious. Granted, it’s not everyone; however, it’s there and I find it disturbing. I don’t know that I have the fix. Perhaps it’s simply a liability of the work we do. Still, I wanted to provide a report on what often goes on in the trenches.

    Always good stuff here – even if we’re all not in agreement. I appreciate you, Lisa…


    • And I so appreciate you sharing the bigger picture because you’ve been there, in the trenches. It’s critical to the whole effort of making effective change that we hear and learn all the various aspects of this issue. Thank you so much for sharing!

  7. Great article! More re-entry programs are definitely needed. In addition, it is critical that we look to alternatives to incarceration on the front end for those who really need treatment.

    One issue in California that remains a barrier to individuals getting SUD treatment is the IMD exclusion that does not allow for more than 16 beds in a residential program. Although California stepped up to the plate and added a residential benefit to it’s Medi-Cal expansion benefits, there very few providers in the State where people needing help can actually go for residential treatment.

    • Thank you, Cassandra, and you raise a significant barrier concern, as well as the excellent point, “it is critical that we look to alternatives to incarceration on the front end for those who really need treatment.” If you’d like to write a guest post to expand further on your points, I’d love to run it. Thanks for your comment!

  8. don Johnson says:

    Most of those who work “behind the walls” would agree that at least 80% of recidivism is caused by drug and alcohol addictions. Teaching inmates how to read, write, and count, job skills, or social skills, will all be in vain if the only thing on the inmates mind upon release is where they can score some booze or drugs! Again,… LET’S PUT THE HORSE IN FRONT OF THE CART!
    I believe that when drunkenness causes divorce, broken families, unemployment, homelessness, anger, violence, crime, incarceration, disease, mental health issues, depression, suicide, and every other form of dysfunctional and immoral behavior known to man, the first and foremost logical remedy is to stop the drunkenness! The most logical answer to solving and stopping drunkenness can be found in my new book “Addiction Recovery in One Step”…

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