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In Rural and Frontier America, It Takes a Whole Community To Habilitate A Substance Abusing Criminal

Boyd D. Sharp, M.S., LPC
Consortium Executive Director

Rodney (Roadrunner) Clarke, Esq.
Consortium Board Chairman

Richard Pohl, Ph.D.
Consortium Evaluator

Klamath County Treatment and Correctional Providers Consortium
Klamath Falls, Oregon

Abstract This paper consists of three major parts. The first describes the treatment obstacles faced by substance abuse treatment providers and criminal justice system personnel in a small Oregon town. To overcome these obstacles, they created a network aimed at reducing substance abuse and drug-related crime by chronic repeat offenders. The coalition was successful in securing a CSAT grant to address this population, beginning a drug court program, assisting in developing a jail program, and is now being included in countywide criminal justice planning. The second part describes the CSAT funded project they created to fight substance abuse and crime. The project's treatment model is an intensive, outpatient, antisocial therapeutic community emphasizing the cognitive approach of Yochelson and Samenow. The third part presents data suggesting that the model created is effective at reducing arrests. In fact, arrest rates of clients in the program 9 months or more fell 88 percent from what they were in the 3 months before program entry. The reduced arrest rate was not caused by attrition of clients with the most severe alcohol/substance abuse problems. Over two-thirds of clients had lower arrest rates after they entered the program than before they entered it. The reductions in arrest rates increased the longer the clients were in the program. These results suggest that the Consortium model is effective on an outpatient basis.

This paper first describes the process by which the Klamath County Treatment and Correctional Providers Consortium was developed, including the research into the repeat offender problem in Klamath County. Second, from a therapy/corrective perspective, we outline implementation of an outpatient program for chronic nonincarcerated repeat offenders who have substance abuse problems. We describe the major components of treatment in this program, which is known as the Consortium treatment program. Third, we examine outcome studies and the latest demographic data on Consortium clients from an evaluative perspective.

Consortium Program Development

Background

Klamath County, in Southern Oregon, covers an area of 8,000 square miles of high desert and mountainous terrain. The population density is approximately nine persons per square mile, and agriculture and timber are the major industries. The rural community of Klamath Falls is the economic hub of the county. There are approximately 18,000 residents within the city limits, an additional 20,000 residents within the adjacent urban growth boundary, and 10,000 residents in outlying areas, for a total of 48,000 residents in the county. The primary minority populations are Native Americans and Hispanics, each comprising 5 percent of the county's population.

History

In the fall of 1991, an auspicious staff meeting of probation and parole officers employed by the Klamath County Department of Corrections took place. During the course of the meeting, Jackquelyn Hoffmann, a nurse employed by the sheriff's office at the Klamath County Jail, presented some astonishing and disconcerting information. Jacki presented statistics on repeat offenders arrested five or more times since establishment of a new local jail in the fall of 1989.

The statistics Jacki presented made it quite clear that an overwhelming proportion of local crime was being committed by the repeat offender population. The growing population of repeat offenders was exacting a disproportionate local cost in terms of personal and property damage, while causing social costs through creating an atmosphere of fear, concern, and frustration among local residents. Additionally, the sheer magnitude of the level and frequency of arrests was adding financial burdens to local government at all levels of operations of the criminal justice system, including investigation, arrest, prosecution, incarceration, and supervision.

Several difficulties in addressing the social and financial costs created by repeat offenders were discussed during the course of the corrections staff meeting. First, the State of Oregon had placed severe restrictions on the ability of probation and parole officers to send our clients to prison. In addition, due to severe financial difficulties of county government, the sheriff's office had lost approximately 40 percent of its active officers due to layoffs. Among the consequences of the layoffs and reduction in budget was the loss of two-thirds of the operating capacity of the local jail. Only one of the three jail pods was open, and a revolving door situation reflected our local inability to hold offenders for significant periods of time.

The consensus of the corrections staff was that more than 90 percent of the identified repeat offenders had histories of drug and/or alcohol abuse and/or dependence. Local financial capacities to treat these offenders were inadequate to cover more than one-quarter of actual treatment costs for corrections clients. There was complete agreement regarding the social and financial impact of the repeat offender population, the lack of adequate sanction capacity through either prison or jail incarceration, and the inadequacy of treatment resources. Discussions turned to possible solutions. Rodney (Roadrunner) Clarke, a Klamath tribal drug and alcohol program director, suggested, and parole officers and the agency director, Chuck Edson, agreed, to begin a cooperative effort to engage in the planning, community organizing, and fundraising necessary to address the repeat offender problem.

Chuck Edson enlisted the local sheriff's office and jail representation. Rod Clarke involved Stepping Stones, Lutheran Family Services, Consejos, and the other local treatment programs, as well as the County Department of Mental Health.

Jan Kelley, Stepping Stones planner, attended a regional workshop on new Center for Substance Abuse Treatment funds and reported her findings back to our planning group. CSAT funding appeared to be available and appropriate to our plans. For a full year, our coalition met at least monthly to discuss and plan a project intended to:

• Positively impact the target repeat offender population through treatment
• Improve local sanctioning capacities, especially at the county jail
• Increase funding to local treatment providers to enhance their capacity to treat the target population.

We followed our principles in planning the project. Although we could have designed program delivery to award the lion's share of funding to the four treatment providers involved in the planning, instead, we decided after analysis and discussion that a new and separate program with its own staff to focus on the target population would be more likely to be effective than would referrals to our own agencies. We designed our treatment program accordingly, providing the opportunity only for the providers to contract to perform group therapy.

A team of Consortium members traveled to Salem, Oregon for the first CSAT workshop on their new funding. We were pleased to discover that we appeared to be the embodiment of the community partnership model supported by CSAT policy and philosophy. However, we were surprised and disappointed to find that CSAT had made a change in programming and would no longer be accepting applications for projects at local jails outside Target Cities project sites.

We returned and called a Consortium meeting to discuss the situation and reconsider our direction. Captain Linville of the sheriff's office encouraged us to apply for a CSAT grant even though there would no longer be any financial benefit to the jail operation from a prospective grant. As a result, we developed a consensus to accelerate the frequency and duration of our planning meetings, targeting CSAT as a funding source to develop outpatient rather than incarcerated treatment for the target population.

Various proposal components were assigned to Coalition members, drafted, and brought back for discussion. Jan Kelley took the completed components and developed our actual proposal to CSAT. Ultimately, it was reported to us that CSAT received 198 proposals and funded a total of 13. We also found out that our proposal was reviewed favorably at CSAT. As a small rural community, with a diverse planning group involving the Hispanic and Klamath Tribal communities, as well as other established agencies and departments, we were and are very proud of our sustained planning efforts and proposal success.

After receiving our notice of award, the Coalition formally organized through the efforts of our membership as a nonprofit corporation. We applied for and received corporate status from the State of Oregon as the Klamath County Treatment and Correctional Providers Consortium, also referred to as The Consortium. We promptly filed for and received 501(c)(3) status as a charitable organization from the Internal Revenue Service.

Other Coalition Benefits

The Consortium, for nonincarcerated repeat offenders with five or more arrests, funded federally through the Center for Substance Abuse Treatment (CSAT), is the first project initiated by our broader local consortium of providers, criminal justice participants, and lay people. Of note is that the original long-term planning engaged in by the coalition participants has had significant and substantial additional benefits for our community.

As stated, one of the key original purposes of the coalition was the critical need to supplement jail operations capacities. Primarily through the efforts of Chuck Edson, the Klamath County Jail is now a regional facility funded in part by the financial contributions of departments of corrections from adjoining counties. A jail that once operated at one-third capacity now operates at two-thirds capacity or better.

Local coalition building and planning has also now become part of the fabric of our community. Klamath County Commissioners have formally appointed local individuals to a Criminal Justice Planning Committee as well as to a local Public Safety Planning Council. Both entities do comprehensive planning on behalf of local government, and both include many individuals from our original coalition. Treatment providers are now part of the criminal justice system, with treatment providers playing a central role in policy development. In the past, providers were included in such groupings and activities as an afterthought, if considered at all.

Finally, our coalition is gradually but constantly growing, to the benefit of our community as a whole. For example, local judges have recently become part of the loop by providing leadership and facilitating the development and implementation of a drug court out of local resources. The ripple effect of having cast our concerns into a pond of previous indifference is fully expected to continue. As with our Consortium treatment program, we expect to continue to improve the conditions and quality of life in our community through planning that follows our principles and coordinated, concerted, and comprehensive efforts.

Program Implementation

Beginning the Program

During the period between the grant's approval and the start of funding, a major destructive earthquake, 5.9 on the Richter scale with the epicenter about 15 miles from Klamath Falls, occurred. It eliminated the proposed physical location. As a result of the earthquake, the program lost the in-kind use of a county facility. The county courthouse was closed due to earthquake damage, and county departments immediately took up virtually all available space, a total of at least 30,000 square feet. Loss of the county facility forced staff and Consortium members to spend considerable time locating a building to house the project. This added $15,000 to $20,000 to the cost of the project. We are currently located downtown in a remodeled old office building.

Just as critically as the physical damage that it inflicted, the earthquake affected the psychological condition of the community. Worry and concern over personal impact was devastating to many. Recovery within the greater community was slow. The physical acts necessary in tearing down blocks of buildings and the emotional reminders of damaged buildings not yet torn down also had an impact on the community. Although an earthquake affects any community, in a rural and frontier area any major disaster touches practically every citizen because of the interrelatedness evident in rural and frontier communities.

The first executive director was hired in February of 1994, with other staff subsequently hired. There were delays in developing contracts between the County of Klamath, the State of Oregon, and the Board of Directors, which were needed to make CSAT funds available to the project. These delays cost the program a good 5 months of operation. In addition to the above, the first executive director resigned in September 1994 and the present director was not hired until December, causing further delay.

In this environment, trying to continue the original excitement, cooperation, and progress was difficult. The entire implementation process was relegated to a snail's pace. Nevertheless the commitment, dedication, and earnest efforts of the Board of Directors, the staff, and the community officials functioning as supporters was unwavering.

A clear outcome of the grant was furthering a team/community sense of purpose in the treatment and correctional personnel who had contact with the project staff. The grant served as a breath of fresh air in a professional community racked by budget cuts, personnel layoffs, and resource depletion. The sense of innovation and the rejuvenation produced by professional recognition of the problem in the community combined to involve and motivate the staff of the numerous agencies connected to the project. Given the overall attitude of this community, this has been a very noteworthy and positive outcome.

Program Description Revisited

The Project's ability to make an impact in Klamath County increased immensely with the hiring of a new executive director who had previous experience in developing and supervising a successful 50-bed alcohol and drug therapeutic community in a similar rural environment (Powder River Correctional Facility in Baker, Oregon).1 His arrival increased the possibility of developing a model that satisfactorily treats the nonincarcerated offender and reduces his or her reoffense rate, which in turn would reduce the overall crime rate in Klamath Falls.

Beginning on December 5, 1995, the program initiated a number of changes that improved program accountability and progress toward program goals. The project seriously reevaluated the initial program design. A move toward an antisocial treatment model, as opposed to a prosocial treatment model, was made. This model is described in Bush and Bilodean (1993), and Sharp and Beam (1995). The Hazelden's Design for Living series, which is designed to specifically address the offender population, was incorporated into the program format. Also incorporated was Yochelson and Samenow's Thinking Error material as a major portion of the program (Yochelson and Samenow 1976, 1977, 1986).

Antisocial Treatment Model

The program employs a cognitive-behavioral approach that includes strict use of sanctions for program rule violations, cognitive restructuring of criminal thought patterns, and a therapeutic community. The antisocial treatment model embraces (among other things) the belief that criminals commit crimes because their thinking rationalizes, justifies, and excuses their behavior. Criminal behavior is the result of erroneous thinking. The "criminal thinking" component is the therapeutic heart of the program. It is examined and addressed in all group and individual sessions and activities.

The program model avoids causation issues. Criminal acts are acts of choice. Each client in the program made individual choices to get where he or she is. The choice of whether to benefit from the program is the client's alone, too. The client is asked to take responsibility for his or her thinking, and the optimum opportunity for success in the program requires that the client be held accountable for all of his or her actions, past, present, and future.

Thus, for a client to take responsibility for his or her thinking and behavior, it is important for that client to admit that he or she is a criminal. The word "criminal" is used the same as the word "alcoholic." The alcoholic must admit and accept that he or she is an alcoholic in order to begin recovery. We believe the criminal must also admit and accept the fact that he or she is a criminal in order to begin recovery.

Dual Track

As the program developed, it was clear that a dual track, not envisioned in the grant application, was necessary. There were many clients who were working or going to school in the daytime. For them to participate in treatment, an evening track was therefore necessary. The program is now open from 7:00 a.m. to 11:00 p.m. Monday through Friday. This allows a day reporting/ day treatment program as envisioned by the grant and also the ability to accommodate clients in an evening program. Thus we have parallel programs, one for day clients and one for evening clients. A benefit of parallel programs is that it allows clients from each track to make up sessions in the other track. All in all, the program seems to be strengthened by the parallel tracks.

Therapeutic Community

The program is structured in an attempt to develop an outpatient therapeutic community that provides a variety of opportunities for practicing personal growth and change, including both individual and group settings. The therapeutic community (TC) can be distinguished from other major drug treatment settings in two basic ways. First, the primary "therapist" and teacher in the TC is the group of people in treatment itself, including peers and staff, who as role models of successful personal change, serve as guides in the recovery process. Second, unlike other programs, the TC offers a more systematic approach to achieve its main objectives. In the case of the Consortium, this objective is to help clients stop using alcohol and drugs, and to stop committing crimes and hurting people.

A therapeutic community is a positive environment where people who have similar problems, such as criminality and alcohol and drug abuse, live and work together to better their lives. The structure of such a community is set up like a large family. Staff and all its service providers represent the parent or authority figures. The program follows a chain of command, in which all participants strive to earn better privileges, jobs, and status within the community and its level system. In order to demonstrate positive growth and change, the resident moves up the ladder or chain of command by complying with the rules, attending on a consistent basis, participating in all program activities and doing any and all current jobs well. Peers and staff work together to help all clients achieve these objectives. This may include clients addressing issues with clients in groups and other sessions to hold one another accountable for these goals on a community and on an individual basis. The new program format was initiated on February 27, 1995.

Community Training

Prior to the initiation of the program, a 2-day training, "Treatment Perspectives on Criminal Personalities," was held. All Consortium staff and 57 people from mental health, alcohol and drug programs, the Oregon Institute of Technology College, Parole/Probation, the jail, the medical community, Klamath Tribal Health, and other organizations attended. The training provided, for the first time, a clear definition of how the program was to work. It also gave staff and the other area providers a clear picture of the difference between prosocial and antisocial treatment modalities.

Removing Barriers To Treatment

The program removes as many barriers to treatment as possible. Clients are often released from jail without adequate housing, utilities, food resources, or clothing. They sometimes come to treatment with medical problems and prescriptions that they need to fill. Arranging affordable and adequate child care is often difficult for this clientele. Clients often can only find housing so far away as to make walking impossible, and most have had their driver's licenses revoked, which creates transportation problems. These social and financial circumstances create barriers to treatment. A client benefit fund was created to provide limited term financial assistance to clients who face these barriers when entering treatment. Programs that are designed to be an enhancement to treatment have been developed to address the clients' housing, clothing, transportation, child care, and medical needs.

The Consortium believes that proper diet is important to the treatment process and recognizes that clients may not always have food. Accordingly, the Consortium developed a program to provide food at the treatment center. Clients are provided with breakfast, lunch, an evening meal, and snacks.

Parole Officer

A parole/probation officer was hired by the Klamath County Community Corrections Department using State dollars and the dollars in the Consortium grant budget authorized for a parole/probation officer. The officer is assigned to the Consortium. This allows the project to have the officer full time and dedicate the officer's time to the clients initially admitted into the Consortium. The officer tracks the client, makes home visits, administers sanctions, etc. The initial few weeks of treatment are critical to engaging and retaining the correctional client. The officer's assistance enhances these first weeks and the delivery of service by the project. With the parole officer and a solid relationship with Parole and Probation, client participation and accountability have risen dramatically. The parole officer allows quicker enforcement of sanctions against clients for noncompliance. Clients receive the message that they will be held accountable for their actions. Without the immediate sanctions, an outpatient program for chronic nonincarcerated repeat offenders is impractical.

Linkages

The program has actively attempted to establish or improve community linkages with organizations such as Partnership for Drug Free Klamath County, Klamath County Corrections, Klamath County Court system, and other AOD treatment providers. It is represented at several statewide organizations (Oregon Institute for Addiction Studies, Northwest Frontier Addiction Training Centerùa CSAT funded project, and Drug Abuse Program Directors Association of Oregon). The program has membership in local committees pursuing the possibility of bringing a drug court program to Klamath County, in helping to reestablish a detoxification center coupled with a sobering station, and in determining the future direction of corrections services in Klamath County.

Evaluation Findings

Data Collection System

The Addiction Severity Index (ASI) was chosen as the data collection instrument for the project. It is a 161-item multidimensional clinical and research instrument for diagnostic evaluation and for assessment of change in client status and treatment outcome. It assesses seven life problems areas. They are: (1) medical status, (2) employment/support status, (3) drug/alcohol use, (4) legal status, (5) family history and relationships, (6) social relationships, and (7) psychiatric status.

Computer software in the form of the Easy-ASI and Easy-Track was obtained from QuickStart Systems, Inc. to analyze data produced by the ASI. This software allows compilation of more than 400 reports, completion of the quarterly report, evaluation of the project, pre/post evaluations, and a 5-page evaluation narrative on each client.

The software has been enhanced by our administrative supervisor. The reporting functions of the Easy-Track and Easy-ASI have been modified to print data reports (demographics, client status, etc.) specific to the needs of our agency, as well as adding several "user definable" fields to help capture other data relevant to our agency. Another enhancement has been the utilization of the dBase IV database package in tandem with the Easy Track/ASI software. Through the dBase software, we track individual client activities while in treatment, and group data (number of clients attending, average attendance across quarter, week, and month, etc.).

Evaluation Procedures and Studies

Program staff meet weekly with a member of the evaluation team. The evaluation team works closely with the project to determine the most appropriate data to be collected to ensure that the goals and objective of the project are being met as well as being sensitive to additional areas that could properly be evaluated by the work this project is accomplishing.

Several evaluative studies have been accomplished during the first 2 years of the project. They include:

• A client profile
• A community survey
• Arrest data
• Program performance data

We will detail only three of these. Because of the relatively short duration of the project, the numbers are small in most of the samples. However, they seem to indicate that the program is making an impact on reducing the arrest rates of the clients.

We examined client profiles of all 112 clients admitted during the second year of the program's operation on 18 variables. ASIs were first administered June 1, 1995, and thus were only given to the last 62 clients admitted to the program. Data on these clients are presented in table 1.

Table 1. Client characteristics

Variable
Drug	60% amphetamine
Program	40% day
Marital status	11% m, 536% ds
Work	32% f, 26% p, 36% u
Race	87% white
Gender	69% male
Age	31.4
Education (mos.)	135.3
Prior alcohol treatment (no.)	2.43
Prior drug treatment (no.)	2.59
Income/month	$243.11
ASI scores
Alcohol severity	5.40
Drug severity	7.55
Employment severity	5.35
Family severity	5.08
Legal severity	6.31
Medical severity	1.79
Psychiatric severity	3.46

m=married; ds=divorced/single; f=full time; p=part time; u=unemployed.

Consortium clients are mostly white, male amphetamine abusers. Although most clients are male, the Consortium admits a higher percentage of women than exists in the target population. Clients average slightly over an 11th grade education and are rarely married. Amphetamine is often manufactured locally; Klamath Falls is a manufacturing center for it. The high levels of amphetamine abuse suggest that Consortium clients have been involved in drug trade. This conjecture is supported by the low legal monthly earnings of clients.

We studied arrest records of all 47 Consortium clients who had been in the program for at least 3 months as of December 1, 1995. We began 2 years before program entry, and followed them from that point until December 1, 1995. In the 2 years prior to program entry, arrest rates increased steadily. For all 47 clients, arrest rates were down 33 percent from what they were before program entry. Arrest rates of clients in the program 9 months or more fell 88 percent from what they were in the 3 months before program entry. The reduced arrest rate was not caused by attrition of clients with the most severe alcohol/substance abuse problems. Over two-thirds of clients had lower arrest rates after they entered the program than before they entered it. The reductions in arrest rates increased the longer the clients were in the program. These results suggest that the Consortium model is effective on an outpatient basis. Data on changes in arrest rates are presented in table 2 and figure 1.

Table 2. Arrest rates

	3-5 mo. Tx	6-8 mo. Tx	9 mo. + Tx
No. of clients	23	10	14
Total Klamath Falls arrests at admission	11.08	12.1	10.86
Arrest rate before entry	1.34	1.57	1.41
Arrest rate after entry	1.14	1.53	0.55
Percentage of decrease in arrest rate	15%	3%	61%
Percentage of clients with lower rate	43%	80%	86%

We also conducted a study on the extent to which the first 18 clients, in the program for 6 months, had met goals for individual clients established in the grant. These goals are:

__ Goal/Objective 5: 50 percent of enrolled clients will successfully complete treatment as indicated by completing two-thirds of their treatment goals identified in treatment planning during year 3.
__ Goal/Objective 6: In year 3, 55 percent of clients unemployed at the beginning of treatment will improve their employability or be employed at the successful completion of treatment.
__ Goal/Objective 7: 75 percent of clients will have attended a minimum of five self-help groups in the quarter prior to successful completion of treatment.
__ Goal/Objective 8: 85 percent of individuals remaining in treatment during year 3 for a minimum of 6 months will reduce their rate of arrest for new criminal activity during treatment. New criminal activity does not include arrests for probation/ parole violations or noncompliance with the treatment program, sanctions for relapse, or dirty urine.
__ Goal/Objective 9: During year 3, 60 percent of clients will be abstinent from substances prohibited by the program as indicated by random alcohol and/or drug testing for the 30-day period prior to the termination of their probation or parole status and/or successful completion of treatment.
__ Goal/Objective 10: 60 percent of clients remaining in treatment for a minimum of 6 months will report progress toward meeting the goals identified in their initial assessment/evaluation and/or treatment planning.

Although the numbers in this study are small, the results are encouraging. All six goals were exceeded by percentages ranging from 8 percent to 34 percent (see figure 2).

Recommendations

After considering our experiences we would like to make the following recommendations to criminal justice and treatment provider personnel in rural areas.

First, for progress in treating criminal substance abusers, the first step is often simply collection of data documenting the extent of the problem. Without the efforts of the jail nurse, Jacki Hoffman, in this area, we never would have made an impact. Efforts to obtain funds to make progress must often begin with data collection.

Second, in small rural towns sufficient expertise to make progress exists, but it is likely to be split among criminal justice and substance abuse providers working for many different organizations. For us, and very likely for many rural areas, only coalitions that bring together these organizations are likely to have the resources to succeed. Such coalitions can also succeed in many other rural areas.

Third, sufficient cooperation can be achieved among these diverse organizations to make progress if members of these organizations are willing to devote the time (for us it was several years) and put aside short-term personal goals. While this was difficult for us, we all feel the effort was well worthwhile. You will also.

Fourth, chronic repeat offenders require an intensive, consistent, antisocial treatment model to be successful. It was difficult for many treatment providers to consider our antisocial model, and difficult to staff it in a small town. Nonetheless, with sufficient patience and attention to selling the need for this approach, we were able to do it. You will be also.

Fifth, the evaluation MIS and the evaluation as a whole required close contact between evaluation staff and program people. For example, when we tried implementing the computer system using a contractor from out of town, the system did not work. After we went to a local contractor, the system caught up rapidly. The local contractor was simply able to be around more when he needed to be. Our evaluation worked best when the evaluation staff was part of the treatment team and the treatment team was part of the evaluation staff.

Sixth, a parole officer assigned to the program is essential to ensure that sanctions are applied consistently and immediately.

References

Bush, J.M., and Bilodeau, B. Options: A Cognitive Change Program. Washington, DC: U.S. Navy and the National Institute of Corrections, U.S. Department of Justice, 1993.

The Hazelden Foundation. Design for Living (The Hazelden Substance Abuse Curriculum for Offenders). Center City, MN: The Hazelden Foundation, 1992.

Sharp, B.D., and Beam, K.J. Treatment perspectives on criminal personalities in a rural setting. In: Center for Substance Abuse Treatment. Treating Alcohol and Other Drug Abusers in Rural And Frontier Areas. Technical Assistance Publication (TAP) Series, No. 17. DHHS Pub. No. (SMA) 95-3054. Rockville, MD: Center for Substance Abuse Treatment, 1995. pp. 93-102.

Yochelson, S., and Samenow, S.E. The Criminal Personality: A Profile for Change. Vol. 1. Northvale, NJ: Jason Aronson, 1976.

Yochelson, S., and Samenow, S.E. The Criminal Personality: The Change Process. Vol. 2. Northvale, NJ: Jason Aronson, 1977.

Yochelson, S., and Samenow, S.E. The Criminal Personality: The Drug User. Vol. 3. Northvale, NJ: Jason Aronson, 1986.

Last Updated 11-7-02