Substance abuse is a significant problem for all Americans. Research has revealed increased risk factors including exposure to drugs among African-American males, making a race-specific intervention program necessary to ensure recovery success rates (Wallace & Muroff, 2002). Moreover, psychological counseling and intervention programs need to be culturally sensitive if they are to be successful. Variables such as communication styles, worldviews, family values, gender roles and norms, urban vs. rural living environment, and socio-economic class status will all impact attitudes toward treatment, treatment decisions, and treatment outcomes. Moreover, comorbidity issues also vary by racial category, including comorbidity with alcohol abuse, anxiety, depression, personality disorders, and affective disorders (Ziedonis, Rayford, Bryant & Rounsaville, 1994). Research comparing prevalence of substance abuse between white and black patients is contradictory in nature, with Nauert (2011) claiming that "substance abuse issues are more prevalent among African-Americans than other groups," but Broman, Neighbors & Jackson (2008) finding contrary results. Broman, Neighbors & Jackson (2008) found that, "Whites have higher prevalence rates of substance abuse disorders than do other racial and ethnic groups, but racial and ethnic minorities have been shown to have substance abuse disorders that persist for longer periods of time," (p. 2). Regardless, the African-American community is in need of culturally relevant treatment interventions. However, there is a relative lack of research considering the unique factors that might make a treatment intervention more effective for African-American males. Recent research is filling the gap in evidence, especially with regards to using motivational enhancement therapy. Motivational enhancement therapy is based on cognitive behavioral theories, and is built on the assumption that treatment prognosis is influenced by motivation to change. Nauert (2011) defines motivational enhancement therapy as "behavioral change approach that assesses an individual's readiness to live a substance-free life or whether they're against any treatment," (p. 1). Carroll (2009) found that motivational enhancement therapy was effective for Hispanic alcohol abusers, showing that the treatment can be adapted for cultural and linguistic relevance. Hettema, Sorensen, Uy & Jain (2009) also found that motivational enhancement therapy was effective for specific population groups.

The treatment process used in motivational enhancement therapy addresses ambivalence, and takes into account the person's positive behavioral reinforcements for using drugs and alcohol, such as anxiety reduction or social anxiety reduction. Many users might believe that the positive effects of using drugs do not outweigh the negative effects, or they might not care enough about the negative consequences of using drugs. Motivational enhancement therapy is designed to help the individual realize what negative effects drug use is and will have on the user. Research by Crits-Christoph, et al. (2009), Walker, et al., (2011), Montgomery et al. (2011) and others highlight the importance of incorporating group therapies that utilize motivational enhancement therapy into anti-recidivism programs for African-American males. Among at-risk males, motivational enhancement therapy can not only improve outcomes with regards to substance abuse, but also lead to transformative behavioral changes that reduce recidivism and promote re-integration in the community.

Proposed Intervention

With the ultimate goal of reducing recidivism, this proposed treatment program addresses the needs of African-American males aged 21 to 42. The target population has a history of criminal activity as well as substance abuse. Based on the research, it is believed that the African-American male participants in motivational enhancement therapy will have better long-term treatment outcomes and reduced rates of recidivism after release from prison.

A total of 150 males between the ages of 21 and 42 are included in the current treatment intervention. Therapy will focus on both individual and group meetings, with greater emphasis on group meetings. Groups will contain no more than twelve individuals plus the facilitator at any given session. Sessions of group therapy will take place twice weekly. Individualized counseling using motivational enhancement therapy will take place one every two weeks. The meeting location will be at community centers located in strategic locations to ensure that all participants can easily make it to the meetings.

To focus on re-integration in the community, the group leaders will also invite members of the community without criminal records to participate in the motivational enhancement therapy. These participants will have substance abuse problems, and therefore participate in the group therapy with their shared values, beliefs, and stories. However, it is critical that the participants develop strong networks of supportive individuals when working on a concerted program of recovery. Reducing recidivism cannot emphasize just staying sober. The process of re-integration in the community is also dependent on building and strengthening social skills, and working with community leaders...

Motivational enhancement therapy will help the participants recognize that positive feelings that are associated with drugs can be re-associated with health promoting behaviors such as family time, exercise, and meaningful work activities. As Nauert (2011) points out, motivational enhancement therapy is non-confrontational and promotes pro-social behaviors too.
Eight Week Therapy Group

This eight-week therapy group will have specific weekly goals, to help keep the individuals focused and aware of their progress.

Week One: The goal of the first week is to discover and elucidate the root causes of substance abuse issue. Participants will introduce themselves, and share as little or as much as they would like within the non-confrontational group setting. After a little background information and explanation of what motivational enhancement therapy is, and what its overall goals are, the group will be focusing on negative beliefs or feelings including fatigue, worry, anxiety, and anger. The group will also focus on the positive aspects of community re-integration. Issues like family and community will be raised, to help the participants place their problems in perspective from the first of these eight sessions.

The participants will keep a weekly journal, and are encouraged to share at least one element of that journal with the group each week. At the introductory first session, the participants will receive their journals and introduce themselves to the other participants. The participants are encouraged to use drawings, poetry, and music to enhance their journals. Participants with smartphones or computers are encouraged to start blogs as well.

Topics of discussion on week one include the notion that substance abuse is a symptom of underlying issues. Discovering the negative beliefs and irrational thoughts beneath the surface, the participants will see why they believe that substance use is helping them. Before change can take place, it is necessary to elucidate the factors that are preventing the individuals to be motivated to change.

Week Two: At the start of this and each successive week, a journal sharing exercise will begin each day. The participants will share some aspect of their journal, including artwork or poetry. Group members are not encouraged to give feedback, because this is a non-confrontational environment and feedback on journals could elicit fear and embarrassment. Instead, the participants will be reaching deeper to discover the cognitive and emotional reasons for their need to use drugs and alcohol. However, this week will focus on the theme of cause and effect.

The group leader will encourage the group members to meditate on incidents in which lying, cheating, stealing, and other behaviors are connected to drug and alcohol abuse. Similarly, participants will be asked to explore the ways substance abuse has impacted interpersonal relationships with parents, friends, siblings, coworkers, and members of the community. By examining the effects that substance abuse has on others, the person recognizes that he is part of a greater whole. As part of the motivational enhancement therapy, it is important to point out positive effects of remaining sober and clean. The goal is for the participants to associate drug use with negative situations in life, and to associate clean living with positive relationships and situations. Week Two begins that process of change.

Week Three: During this session, the leader will acknowledge that some members will continue to resist recovery. This week will focus on lingering doubts and beliefs shaping attitudes toward recovery. The goal of this week will be to encourage full honesty and disclosure about how the person feels when using their drug(s) of choice. Feelings like calm, elation, and numbness will be explored. The leader will elicit as many feelings as possible, so as to help the participants identify with the core reasons why they like drugs and might not want to quit. The goal is to increase willingness and readiness to change.

Week Four: Week four marks the midpoint of the sessions, and it is an apt time to review personal stories. The goal of this week will be to identity the spiritual issues in the person's life. Each participant will be asked to share his attitudes and beliefs about God, religion, and prayer in a non-judgmental manner. The participants will also explore how religion plays an important role in their community and in their family life. The psychological and sociological facets of religion will be discussed, in order to show that positive emotions can come from places other than drugs. For participants that resist religion…