“I know if I drink I won’t feel anything”: substance use relapse among depressed women leaving prison

Trajectories of mental health symptoms, suicide attempts and substance use disorders among women after prison release in Santiago, Chile

PURPOSE

Limited research has characterized how mental health changes or persists during reentry, particularly among women, who are a minority in the criminal legal system. We aimed to describe the mental health symptoms trajectory groups, suicide attempts, substance use dependence, and mental healthcare utilization among formerly incarcerated women in Santiago, Chile, during 1-year after release.

METHODS

We assessed 200 women in a five-wave prospective cohort study using three different mental health indicators: the Symptom Checklist 90-Revised (SCL-90-R) scale before release and at one week, two, six, and twelve months after release, self-reported suicide attempts, and substance use dependence using the Mini Neuropsychiatric Interview. We used latent class growth analysis to identify groups following similar symptom trajectories using the Global Severity Index of the SCL-90-R. We performed multinomial and logistic regressions to identify correlates of these outcomes.

RESULTS

Three trajectory groups were identified: Low (85.8%), Increasing (6.8%), and High (7.4%) symptom severity. 19.3% attempted suicide during follow-up. 18.9% met the criteria for substance use dependence at both baseline and twelve months. In multivariate regression analysis, the previous number of convictions and victimization experiences were associated with all outcomes. 10% or less received mental health services at any measurement.

CONCLUSION

Most women had stable severity of mental health symptoms during the first year after release. Pre-release cross-sectional screening misses a group with increasing symptom severity and substance use dependence during reentry. Routine mental health assessments would be useful during reentry and guidance to make better use of services during this critical period.

Barriers and facilitators for social inclusion among people with concurrent mental health and substance use problems. A qualitative scoping review

BACKGROUND

People with concurrent mental health and substance use problems are among the most socially excluded groups in our society, yet little attention has been paid to what socially excluded people see as central to promoting their social inclusion. The aim of this qualitative scoping review is to provide an overview of barriers and facilitators for social inclusion among people with concurrent mental health and substance use problems, based on first-person perspectives, to help guide future research, policies, and practice.

METHODS

We explored first-person perspectives on social inclusion among people with concurrent mental health and substance use problems, employing Arksey and O'Malleys framework. We searched Medline, PsycINFO, Embase, Scopus, Cinahl, and other sources for studies published between January 2000 and September 2023. We employed content analysis and followed the PRISMA checklist.

RESULTS

We included 55 articles included in our review and identified sub themes of: Intrapersonal baseline (identity, belonging), Components of social inclusion (relationships, meaningful activities, employment, economy), and Systemic failure or success (housing, public health and welfare services, the criminal justice system).

CONCLUSION

Social inclusion is rarely studied outside the context of direct services. Our results point to knowledge gaps in addressing social inclusion in a broad, societal context; implementing gaps in services; and developing policies to assure the fundamental needs and human rights of socially excluded persons.

The impact of State of Surrender on the relationship between engagement in substance use treatment and meaning in life presence: a pilot study

The current study examined the construct of State of Surrender (SoS)-defined as a willingness to accept, without resistance, what is to come-and investigated SoS as a statistical mediator of the relationship between engagement in substance use treatment and meaning in life (MIL). Using a cross-sectional design, participants were 123 people involved with the legal system participating in a 6-month residential treatment program for substance use. Results showed that measures of treatment engagement, including treatment participation, counselor rapport, and peer support, were all positively associated with SoS scores (R 2s ≥ 21.16). Moreover, while controlling for time spent in treatment, SoS statistically mediated the positive association between aspects of treatment engagement and MIL. State of Surrender may be a targetable process in substance use treatment that aids in recovery by orienting clients toward what they find meaningful in life. Future directions and practical considerations are discussed.

Her village: experiences of drug-involved women in a female-only aftercare program in the Philippines

PURPOSE

Women are exposed to vulnerabilities that can lead to drug use or hinder recovery. However, there is a dearth of studies on recovery programs for women. This study aims to add to the literature by examining the feasibility of a women-only aftercare program for recovering users in the Philippines.

DESIGN/METHODOLOGY/APPROACH

The study used a mixed-method design with pre and post-program surveys used to measure changes in participants' recovery capital. Focused group discussions elicited participants' context, their reactions, perceived outcomes and suggestions on the program.

FINDINGS

Women in the program shared narratives of pain, trauma and abuse before treatment. Participants reported significant improvements in personal, community and family recovery capital dimensions. The program enabled personal growth in the form of new knowledge, skills and self-confidence. The women-only program also provided a safe space for women, to receive support from other women, community members and family. However, the women continue to face continuing challenges related to stigma and discrimination and a lack of livelihood opportunities.

RESEARCH LIMITATIONS/IMPLICATIONS

A limitation of the study was its small sample size and the lack of a control group. Another limitation was the variability in treatment received by the women, which could have affected overall outcomes. Future studies using a randomized control trial and longitudinal designs may provide more robust conclusions on the effectiveness of the program.

PRACTICAL IMPLICATIONS

Given punitive contexts, gender-sensitive and trauma-informed programs and services for women involved in drug use could potentially mitigate the abuse, stigma and vulnerabilities they experience.

ORIGINALITY/VALUE

This study contributes to the sparse literature on women-only aftercare, particularly in countries that criminalize drug use.

The associations between social determinants of health, mental health, substance-use and recidivism: a ten-year retrospective cohort analysis of women who completed the connections programme in Australia

BACKGROUND

Women with substance-use issues are overrepresented in prison. Research on women's recidivism often focuses on offending behaviour rather than the health and social circumstances women are experiencing when reimprisonment occurs. This study examines the relationship between social determinants of health (SDOH), mental health, substance-use and recidivism among women exiting prison with histories of substance-use.

METHODS

A retrospective cohort study of women exiting prison who completed the transitional support programme "Connections" between 2008 and 2018. Recidivism was measured up to two years post-release. Women's support needs were measured at baseline (4 weeks pre-release) and follow-up (four weeks post-release). Ongoing needs in relation to well-established SDOH were calculated if: (1) at baseline women were identified as having a re-entry need with housing, employment, finances, education, domestic violence, child-custody and social support and (2) at follow-up women reported still needing help in that area. Women's self-reported substance-use and mental health since release were captured at follow-up. Descriptive statistics were calculated for all measures. Associations between SDOH, mental health, substance-use and recidivism were estimated by multiple logistic regression, adjusting for potential confounders. We also evaluated the mediating effects of mental health on the relationship between SDOH and substance-use.

RESULTS

Substance-use was associated with increased odds of recidivism (adjusted odds ratio (AOR) 1.8, 95% confidence interval (CI) 1.1-2.9; p = 0.02). Poor mental health (AOR 2.9, 95% CI 1.9-4.6; p =  < 0.01), ongoing social support (AOR 3.0, 95% CI 1.9-5.0; p =  < 0.01), child-custody (AOR 1.9, 95% CI 1.0-3.3 p = 0.04), financial (AOR 2.0, 95% CI 1.3-3.2; p =  < 0.01) and housing (AOR 1.8, 95% CI 1.1-2.9; p = 0.02) needs were individually associated with increased odds of substance-use. Mediation analysis found mental health fully mediated the effects of ongoing housing (beta efficiency (b) = - 033, standard error (SE) 0.01; p = 0.05), financial (b = 0.15, SE 0.07; p = 0.05), child-custody (b = 0.18, SE 0.01; p = 0.05) and social support (b = 0.36, SE 0.1; p = 0.05) needs onto substance-use, and partially mediated the effects of domestic violence (b = 0.57, SE 0.23; p = 0.05) onto substance-use.

CONCLUSION

This study underscores the critical importance of addressing the interplay between SDOH, mental health, substance-use and recidivism. An approach that targets SDOH holds the potential for reducing mental distress and substance-use, and related recidivism.

Adverse childhood experiences and mental health among incarcerated women: Self-esteem as a mediating mechanism

BACKGROUND

Adverse childhood experiences (ACEs) and mental health problems are interrelated. However, less is known about this relationship in incarcerated women and how self-esteem impacts this relationship.

OBJECTIVE

To investigate the relationship between ACEs and mental health problems (traumatic stress, depression, and anxiety) in incarcerated women with opioid use disorder (OUD) and, the possible role of self-esteem as a mediator of the relationship.

PARTICIPANTS AND SETTING

Incarcerated women (N = 500) were randomly selected from eight Kentucky jails, screened for OUD, and interviewed by research staff.

METHODS

Regression analyses and mediation models were used to examine the relationship between ACEs, mental health, and self-esteem.

RESULTS

ACEs were positively correlated with present mental health problems (traumatic stress, r = 0.407, p < .001; depression, r = 0.177, p < .001; and anxiety, r = 0.213, p < .001) and negatively correlated with current self-esteem (r = -0.241, p < .001). Linear regression analyses established that ACEs and self-esteem were significantly related to all three mental health variables of interest. Additionally, self-esteem mediated the relationship between ACEs and mental health.

CONCLUSION

This study shows that incarcerated women's experiences with ACEs are significantly related to poor mental health. Self-esteem plays a critical role in this relationship.

Assessing Loneliness among Adults Receiving Outpatient Treatment with Medication for Opioid Use Disorder (MOUD)

Loneliness is a significant risk factor for substance use, however, impacts of treatments on loneliness are relatively unexplored. Living in a rural location is a greater risk factor for loneliness. This study examined data from a quasi-experimental study in rural Appalachia, comparing the effectiveness of Mindfulness-Based Relapse Prevention (MBRP) versus Treatment as Usual (TAU) among adults receiving MOUD in outpatient therapy. Our objective was to determine whether observed reductions in self-reported craving, anxiety, depression, and increased perceived mindfulness would also improve loneliness reports. Eighty participants (n = 35 MBRP; n = 45 TAU) were included in the analysis from a group-based Comprehensive Opioid Addiction Treatment program. Outcomes tracked included craving, anxiety, depression, mindfulness, and loneliness as measured by the Revised UCLA Loneliness Scale (R-UCLA). A linear mixed model ANOVA determined the significance of the treatments on changes in loneliness scores at baseline, 12 weeks, 24 weeks, and 36 weeks post-recruitment. Both groups reported significantly reduced loneliness over the course of the study (F = 16.07, p < 0.01), however there were no significant differences between groups. Loneliness was also significantly positively (p < 0.01) correlated with anxiety (0.66), depression (0.59), and craving (0.38), and significantly (p < 0.01) inversely correlated (-0.52) with mindfulness. Results suggest that participation in MOUD group-based outpatient therapy has the potential to diminish loneliness and associated poor psychological outcomes. Thus, it is possible that a more targeted intervention for loneliness would further diminish loneliness, which is important as loneliness is linked to risk for relapse.

Promoting Adaptation in Female Inmates to Reduce Risk of Opioid Overdose Post-Release Through HOPE

The purpose of the project was to develop a sustainable pre-release education program to reduce the risk of opioid overdose post-release in female inmates in a rural county jail in Middle Tennessee. The project was supported and guided using Roy's adaptation model. Content analysis resulted in common themes (initiation, moral failure, ineffective strategies, supportive environment, new beginnings, and adaptive domains), identified within the pre- and post-implementation surveys. The implementation of a successful reentry program for the vulnerable female incarcerated population has the potential to reduce the risk of opioid overdose death and negative health outcomes post-release.

'You're setting a lot of people up for failure': what formerly incarcerated women would tell healthcare decision makers

BACKGROUND

Incarcerated women have a higher prevalence of health problems than the general population; however, little is known about their perspectives on the healthcare they receive. Here, we conducted semi-structured interviews with women who had been incarcerated (n = 63) which asked what they would tell healthcare decision-makers about their experiences of healthcare in prisons and the community post-incarceration if provided the opportunity. All participants had a history of sexual violence victimization and had at least one period of incarceration in a community corrections center in Arkansas due to the goals of the larger study from which data were drawn.

RESULTS

Four themes arose when participants were asked what they would tell people who make decisions about community healthcare: 1) the healthcare system is not working (52%; n = 33), 2) have compassion for us (27%; n = 17), 3) recognize that we have specific and unique needs (17%; n = 11), and 4) the transition from incarceration is challenging and requires more support (22%; n = 14). Three themes arose when we asked participants what they would tell people who make decisions about healthcare in prisons: 1) we had experiences of poor physical healthcare in prison (44%; n = 28), 2) more specialty care is needed in prison (49%; n = 31), and 3) healthcare providers treat women in prison poorly (37%; n = 23).

CONCLUSIONS

Our findings underscore the need for systemic changes including greater oversight of prison-based healthcare services, enhanced access to medical subspecialties in prisons, and healthcare provider training on the unique needs of incarcerated and previously incarcerated women. Polices that expand healthcare access are also likely to benefit formerly incarcerated women given the challenges they experience seeking community-based care.

An Economic Analysis of the Cost of a Regional Crisis Stabilization Unit

Crisis stabilization units (CSUs) are one type of "alternative to arrest" program used for jail diversion. We aimed to estimate the economic costs of starting and operating a CSU in Arkansas. We estimated the economic costs of the Pulaski County Regional CSU (PCRCSU) located in Little Rock, Arkansas, from September 1, 2018, to August 31, 2019. We collected data through interviews about start-up and ongoing management costs. We calculated total annual economic cost, average admission cost, and average 24 hr admission cost. There were 536 admissions to the CSU during the study period. The average length of stay was 60.27 hr. The total annual cost of the PCRCSU was $1,636,831 and average per admission cost was $3,054. Our results provide valuable economic data to government stakeholders who are considering establishing a CSU.

A systematic review of post-release programs for women exiting prison with substance-use disorders: assessing current programs and weighing the evidence

BACKGROUND

The rising rates of women in prison is a serious public health issue. Unlike men, women in prison are characterised by significant histories of trauma, poor mental health, and high rates of substance use disorders (SUDs). Recidivism rates of women have also increased exponentially in the last decade, with substance related offences being the most imprisoned offence worldwide. There is a lack of evidence of the effectiveness of post-release programs for women. The aim of this systematic review is to synthesise and evaluate the evidence on post-release programs for women exiting prison with SUDs.

METHODS

We searched eight scientific databases for empirical original research published in English with no date limitation. Studies with an objective to reduce recidivism for adult women (⩾18 years) with a SUD were included. Study quality was assessed using the revised Cochrane Risk of Bias tool for randomized trials (RoB2) and the Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) tools.

RESULTS

Of the 1493 articles, twelve (n = 3799 women) met the inclusion criteria. Recidivism was significantly reduced in five (42%) programs and substance-use was significantly reduced in one (8.3%) program. Common attributes among programs that reduced recidivism were: transitional, gender-responsive programs; provision of individualised support; providing substance-related therapy, mental health and trauma treatment services. Methodological and reporting biases were common, which impacted our ability to synthesize results further. Recidivism was inconsistently measured across studies further impacting the ability to compare results across studies.

CONCLUSIONS

Recidivism is a problematic measure of program efficacy because it is inconsistently measured and deficit-focused, unrecognising of women's gains in the post-release period despite lack of tailored programs and significant health and social disadvantages. The current evidence suggests that women benefit from continuity of care from prison to the community, which incorporated gender-responsive programming and individualised case management that targeted co-morbid mental health and SUDs. Future program design should incorporate these attributes of successful programs identified in this review to better address the unique challenges that women with SUDs face when they transition back into the community.

Randomized controlled trial of twelve-step volunteer linkage for women with alcohol use disorder leaving jail

BACKGROUND

Alcohol use disorder predicts poor health outcomes among women returning to the community from jail. Twelve-step self-help groups are free and accessible to women leaving jail, but reaching out to strangers can pose a barrier. Pilot work suggested that a volunteer-led "warm handoff" may increase post-release twelve-step self-help group attendance.

METHODS

This randomized trial evaluated the effectiveness of a warm handoff intervention on post-release twelve-step attendance and alcohol use. Participants (189 women with alcohol use disorder) were recruited in jail and followed for 6 months after release. Participants were randomized to: (1) a warm handoff, in which a female twelve-step volunteer met with each woman individually in jail and the same volunteer attended the woman's first twelve-step meeting with her after release; or (2) enhanced standard care (a list of meetings and community resources). Outcomes included days abstinent from alcohol, drinks per drinking day, alcohol-related problems, twelve-step attendance, twelve-step affiliation, network support for abstinence, number of unprotected sexual occasions, and drug using days.

RESULTS

Among intervention participants, only 66 % were aware that the volunteer tried to contact them after jail, only 38 % reported post-jail contact with their volunteers (typically phone), and only four went to meetings with their volunteers post-release. Of 8 post-release outcomes, intervention effects differed on only one (alcohol-related problems).

CONCLUSION

Although twelve-step self-help group attendance predicted alcohol abstinence, the volunteer-led warm handoff intervention did not increase twelve-step attendance. The twelve-step tradition of Attraction may inhibit the active outreach required to connect women to services after jail release.

Pre-incarceration polysubstance use involving opioids: A unique risk factor of postrelease return to substance use

OBJECTIVE

Justice-involved populations are at increased risk of overdose following release from prison and jail. This risk is exacerbated by polysubstance use, including the use of opioids with other substances. This study explored pre-incarceration polysubstance use involving opioids as a unique risk factor for postrelease return to substance use.

METHODS

The study examined data from a cohort of 501 justice-involved persons who were enrolled in a therapeutic community treatment program while incarcerated. Latent profile validation identified profiles of polysubstance use involving opioids prior to incarceration. Multivariate logistic regression examined return to substance use, defined as self-reported relapse, and a time series model examined time in the community until a relapse event occurred.

RESULTS

A latent profile validation found six unique polysubstance opioid patterns prior to incarceration. Two of these profiles, primarily alcohol and primarily buprenorphine, were at increased and accelerated risk for relapse postrelease relative to a less polysubstance use profile. Both profiles at increased risk had pre-incarceration co-use of marijuana (≈45% of month) and nonmedical use of opioids (≈40% of month) but were unique in their respective near daily use of alcohol and nonmedical buprenorphine.

CONCLUSIONS

Among persons who use opioids returning to the community, return to substance use occurs along a continuum of risk. Providers' consideration of polysubstance use patterns during treatment may assist in mitigating adverse outcomes for patients postrelease.

Housing, Relationships, and Substance Use among Formerly Incarcerated Females

The need for housing is an important concern for most women about to be released from prison, especially by those that need substance use treatment. This study explored the association between housing settings, relationships, and substance use. Two hundred adult females that had endorsed previous incarceration within the past two years participated in the initial baseline study. This study used multi-level modeling to analyze if housing settings and/or relationships within a living condition are associated with substance use. Results indicated that participants in homeless, and mutual settings used substances significantly more than participants in their own house or apartment. Participants that were in controlled, residential and transitional settings used significantly less than those living in their own house or apartment. Living with parents, family, or sexual partner significantly increased substance use. Utilizing these results to plan housing arrangements before women are released from correctional facilities may be beneficial for substance use recovery. Currently, there is no literature that directly measures the relationship between distinct housing settings, as well as the relationships that exist within them and substance use.

Social Support and Suicidal Ideation Among Prisoners with Major Depressive Disorder

This study explored the impact of social support on suicidal ideation in 169 prisoners with major depressive disorder, accounting for known demographic, criminological, and clinical risk factors. Greater social support was associated with a lower likelihood of the presence of current suicide ideation. This effect remained significant even after adjusting for other significant predictors of suicide ideation including sex, length of sentence served, severity of current depression, and having prior suicide attempts. This study is the first to explore social support and other known risk factors for suicide ideation in a prison population with major depressive disorder. Our findings demonstrate that, even in the presence of significant risk factors for suicidal ideation, social support remained a strong predictor, suggesting the importance of fostering social support in correctional settings.

'Maybe It Is Only in Prison That I Could Change Like This' The Course of Severe Mental Illnesses During Imprisonment - A Qualitative 3-Year Follow-Up Study From Chile

BACKGROUND

Severe mental illness (SMI) among imprisoned individuals is a global health concern. Quantitative research indicates on average mental health symptom improvements during imprisonment, however, it cannot reflect multifaceted factors influencing the course of SMI. This study aimed to explore the subjective course of SMI during imprisonment and to identify influencing factors.

METHODS

The study has a 3-year-follow-up design of imprisoned individuals in Chile. We conducted semi-structured interviews with 10 men and 9 women at follow-up who had either major depression or psychosis (severe mental illnesses) at baseline. We included individuals who deteriorated, remained stable or improved their mental health according to quantitative assessments. We explored the subjective course of their mental health condition during the follow-up period. Qualitative data was transcribed and coded using NVivo Software for quantitative content analysis. Qualitative data was also manually coded and was subsequently analyzed using the thematic analysis method with an inductive approach. We developed the final themes using the results of this analysis in combination with the inclusion criteria.

RESULTS

The mental health of 10 individuals subjectively improved, 6 experienced deteriorations, and 3 did not perceive any change. Good infrastructure, structure/occupation, intrapersonal resources (will to change, spirituality) and supportive relationships were identified as factors improving mental health. Factors deteriorating mental health were identified as bad infrastructure (e.g., no running water and bad housing conditions) and crowding, lack of psychological treatment, exposure to violence, interpersonal stress (conflictive relationships and separation from family), perceived injustice through sentencing, intrapersonal stressors and previous medical conditions.

DISCUSSION

SMI in prison can improve in a supportive environment under certain conditions. These conditions include the improvement of infrastructure (housing and healthcare), the opportunity to work or study, protection from violence during imprisonment, and to develop intrapersonal resources and family relationships. To reduce SMI in prisons the improvement of these conditions should become a priority.

Correlated factors of depression among male and female inmates

INTRODUCTION

The prevalence of depression is high in the prison system, and the differences between sex regarding associated risk factors are still not clear. We analyzed the correlated factors of depression among incarcerated men and women in the state of São Paulo, Brazil.

METHODOLOGY

A cross-sectional study with stratified and multi-stage probabilistic sample was performed. Composite International Diagnostic Interview (CIDI) was applied for psychiatric diagnostic classification, as well as a questionnaire on criminal history with 1,192 men and 617 women. Lifetime prevalence of mental disorder was calculated, and association analysis performed by multinomial logistic regression stratified by sex. A dependent variable was categorized into depression, any other mental disorder and no mental disorder (reference).

RESULTS

The prevalence of depression was of 33.3% -(30.3 - 36.5) in women and 12.9% (11.1 - 15.0) in men. Depression was associated with disciplinary penalty, being in a stable relationship, physical health problems and history of infringement in adolescence in men. Regarding other mental illnesses, the correlated factors were historical transgression during adolescence and re-offense. Among women, depression was associated with physical health problems, drug crimes, violent crimes and being imprisoned.

DISCUSSION

Results confirmed the differences between associated factors with depression regarding sex.

CONCLUSION

Differences in the profile between men and women require effective specialized programs, considering the need for coping strategies for incarcerated men and health-related rehabilitation for women with depression.

Personal agency and alcohol abstinence self-efficacy among incarcerated women

Incarcerated women with alcohol use disorders (AUDs) have unique treatment needs. Behavior change models emphasize self-efficacy in making changes to alcohol use, but have not been tested in samples of incarcerated women. Personal agency in several domains was examined as a correlate of alcohol abstinence self-efficacy in a sample of 173 incarcerated women with AUDs. Lower alcohol cravings (β = -0.19, p = .029), greater self-care (β = 0.17, p = .012), and less engagement in transactional sex (β = -0.48, p = .007) were associated with greater self-efficacy. Intrapersonal and interpersonal agency influence incarcerated women's self-efficacy.

Factors Associated with Community Corrections Involvement among Formerly Incarcerated People in Recovery

The current study examined whether current community supervision status was associated with differences in demographic characteristics, lifetime substance use patterns, and criminal history among a sample of formerly incarcerated individuals with a history of substance use problems. Results of multivariate analyses revealed participants on community supervision were more likely to have graduated from high school or earned a GED (OR = 1.60; 95% CI [0.15, 17.24]) and were less likely to have a history of psychiatric hospitalization (OR = .88; 95% CI = [0.08, 9.35]). These characteristics may be proxies for social and emotional functioning that influence eligibility for community supervision. Despite these apparent advantages, the community supervision group did not significantly differ from the formerly incarcerated group without current justice involvement on lifetime substance use patterns or criminal history, suggesting formerly incarcerated individuals with substance use disorders may require more intensive interventions to promote existing strengths.

Correlates of alcoholics anonymous affiliation among justice-involved women

BACKGROUND

Alcohol use disorder (AUD) constitutes a major public health problem and is associated with a substantial amount of disability and premature death worldwide. Several treatment and self-help options including Alcoholics Anonymous (AA) meetings are available. Nevertheless, factors associated with AA affiliation in some disadvantaged groups such as justice-involved women are not well understood. The purpose of this study is to report on previously unexamined correlates of past year AA affiliation among women in pretrial jail detention.

METHODS

The current study used cross-sectional data from 168 women with DSM-5 diagnosis of  AUD in pretrial jail detention. The study examined factors related to women's concept of self and others (i.e., disbelief that others are trustworthy, lack of autonomy to choose who they interact with, experience of violent victimization, low investment in self-care, higher stress levels, and homelessness) as correlates of past-year AA affiliation, controlling for severity of AUD and demographic factors.

RESULTS

Women who believe that others are inherently trustworthy, women who met less AUD criteria, and women who are older reported more past-year AA affiliation in both univariate and multivariate analyses.

CONCLUSION

Introducing AA outreach and alternative interventions for younger, less severely addicted women might improve AUD outcomes. Moreover, designing more individualized treatment plan for women who believe others are not trust worthy might help AUD treatment engagement in this population.

TRIAL REGISTRATION

NCT01970293 , 10/28/2013.

Hazardously Drinking Jailed Women: Post-Release Perceived Needs and Risk of Reincarceration

Women who drink hazardously face a high risk for re-arrest and reincarceration when they return to their communities after a jail stay. This study is the first to examine the associations between women's own reports of basic needs 1 month after jail release, and reincarceration (defined as spending at least one night in jail) during the next 5 months among unsentenced, female pretrial jail detainees who drink hazardously. Perceived needs for housing (adjusted odds ratio [AOR] = 3.63; p < .01), substance treatment services (AOR = 2.65; p < .01), assistance/benefits (AOR = 2.37; p < .05), and mental health counseling (AOR = 2.07; p < .05) at 1 month after jail release were associated with reincarceration during the next 5 months for the 165 hazardously drinking jailed women in this study. These findings demonstrate that self-reported needs during the high-risk period immediately following jail release are associated with heightened odds of reincarceration among hazardously drinking jailed women.

Study protocol: Community Links to Establish Alcohol Recovery (CLEAR) for women leaving jail

PURPOSE

This article describes the protocol for a randomized effectiveness trial of a method to link alcohol use disordered women who are in pretrial jail detention with post-release 12-step mutual help groups.

BACKGROUND

Jails serve 15 times more people per year than do prisons and have very short stays, posing few opportunities for treatment or treatment planning. Alcohol use is associated with poor post-jail psychosocial and health outcomes including sexually transmitted diseases and HIV, especially for women. At least weekly 12-step self-help group attendance in the months after release from jail has been associated with improvements in alcohol use and alcohol-related consequences. Linkage strategies improve 12-step attendance and alcohol outcomes among outpatients, but have not previously been tested in criminal justice populations.

DESIGN

In the intervention condition, a 12-step volunteer meets once individually with an incarcerated woman while she is in jail and arranges to be in contact after release to accompany her to 12-step meetings. The control condition provides schedules for local 12-step meetings. Outcomes include percent days abstinent from alcohol (primary), 12-step meeting involvement, and fewer unprotected sexual occasions (secondary) after release from jail. We hypothesize that (Minton, 2015) 12-step involvement will mediate the intervention's effect on alcohol use, and (O'Brien, 2001) percent days abstinent will mediate the intervention's effect on STI/HIV risk-taking outcomes. Research methods accommodate logistical and philosophical hurdles including rapid turnover of commitments and unpredictable release times at the jail, possible post-randomization ineligibility due to sentencing, 12-step principles such as Nonaffiliation, and use of volunteers as interventionists.

Mental Health Issues of Women After Release From Jail and Prison: A Systematic Review

The aim of this review article is to gain an understanding of the mental health issues of women released from jail or prison. Thirty-six studies were synthesized using the biopsychosocial model. Results indicate that released women's mental health issues include psychiatric diagnoses, psychological trauma, substance use disorders; access to psychological medications and services; and motherhood challenges, support, access to basic needs, and criminalized behaviors. Nurses can promote released women's mental health through pre-release assessment and treatment of mental health issues and ensuring access to post-release resources.  Future research should examine released women's mental health experiences.

Study protocol: Hybrid Type I cost-effectiveness and implementation study of interpersonal psychotherapy (IPT) for men and women prisoners with major depression

PURPOSE

This article describes the protocol for a Hybrid Type I cost-effectiveness and implementation study of interpersonal psychotherapy (IPT) for men and women prisoners with major depressive disorder (MDD). The goal is to promote uptake of evidence-based treatments in criminal justice settings by conducting a randomized effectiveness study that collects implementation data, including a full cost-effectiveness analysis.

BACKGROUND

More than 2.3 million people are incarcerated in the United States on any given day. MDD is the most common severe mental illness among incarcerated individuals. Despite the prevalence and consequences of MDD among incarcerated populations, this study will be the first fully-powered randomized trial of any treatment for MDD in an incarcerated population.

DESIGN

Given the politically charged nature of the justice system, advantageous health outcomes are often not enough to get an intervention implemented in prisons. To increase the policy impact of this trial, we sought advice from prison providers and administrators about outcomes that would be persuasive to policy-makers and defensible to the public. In this trial, effectiveness questions will be answered using a randomized clinical trial design comparing IPT plus prison treatment as usual (TAU) to TAU alone, with outcomes including depressive symptoms (primary), suicidality, and in prison functioning (enrollment and completion of correctional programs; disciplinary and incident reports; aggression/victimization; social support). Implementation outcomes will include cost-effectiveness; feasibility and acceptability of IPT to clients, providers, and administrators; prison provider intervention fidelity, attitudes, and competencies; and barriers and facilitators of implementation assessed through surveys, interviews, and process notes.

Provider Experiences with Prison Care and Aftercare for Women with Co-occurring Mental Health and Substance Use Disorders: Treatment, Resource, and Systems Integration Challenges

Incarcerated women with co-occurring mental health and substance use disorders (COD) face complex psychosocial challenges at community reentry. This study used qualitative methods to evaluate the perspectives of 14 prison and aftercare providers about service delivery challenges and treatment needs of reentering women with COD. Providers viewed the needs of women prisoners with COD as distinct from those of women with substance use alone and from men with COD. Providers described optimal aftercare for women with COD as including contact with the same provider before and after release, access to services within 24-72 hours after release, assistance with managing multiple social service agencies, assistance with relationship issues, and long-term follow-up. Providers also described larger service system and societal issues, including systems integration and ways in which a lack of prison and community aftercare resources impacted quality of care and reentry outcomes. Practice and policy implications are provided.

Development and Feasibility of a Cell Phone-Based Transitional Intervention for Women Prisoners with Comorbid Substance Use and Depression

This article describes the development and feasibility testing of a cell phone-based intervention (Sober Network IPT) among 22 women with comorbid substance use and depressive disorders transitioning from prison to surrounding communities. Feasibility/acceptability measures included phone logs, exit interviews, and pre-post measures of substance use and depressive symptoms up to 9 months post-release. Results indicated that phone-based transitional treatment is feasible and acceptable. Participants valued the opportunity to maintain contact with familiar prison treatment providers by phone after release, and used the cell phones for help with service linkage, support, and crisis management. We describe relational and practical lessons learned.

Effects of incarceration on risky Sex: focus group data from Two New England states

Background

Human Immunodeficiency Virus (HIV) risk and interpersonal violence are interconnected public health problems facing incarcerated women. Prison may provide an opportune time to conduct HIV prevention activities with high-risk women.

Methods

This study used qualitative analysis to explore how incarceration affected women’s experiences of and thoughts about sex and sex risk. Twenty-one incarcerated women who had engaged in unprotected sex with a male in the 90 days prior to incarceration and experienced interpersonal violence in their lifetime participated in semi-structured focus groups at four women’s prison facilities in two New England States.

Results

Themes that emerged from these focus groups include: a) incarceration increased sexual desire for some women but decreased it for others, b) education and exposure to women with HIV during incarceration increased women’s intentions to use condoms after release, c) women recognized that partners were often unfaithful while women were incarcerated, d) women felt empowered by mental health/substance use treatment and sobriety in prison, and e) practical difficulties of re-entry challenged women’s resolve to practice safe sex after release.

Conclusion

Themes illuminate possible directions for public health interventions for this population at high risk for HIV.

Electronic supplementary material

The online version of this article (doi:10.1186/2194-7899-2-8) contains supplementary material, which is available to authorized users.

Pilot test of 12-step linkage for alcohol-abusing women in leaving jail

BACKGROUND

More than a million US women are detained in jails each year; many have alcohol use disorders (AUDs). AUD intervention with pretrial jail detainees presents a logistical challenge due to limited jail stays and lack of resources for postrelease treatment. The availability, no-cost entry, and promise of anonymity of Alcoholics Anonymous (AA) make it a highly accessible resource for underserved populations. However, the outreach of AA volunteers into jails (as opposed to prisons) has been limited, and incarcerated women are unlikely to seek out strangers for help after release. This study pilot tested an enhanced referral approach introducing a 12-step volunteer to a woman in jail who would attend a meeting with her after release.

METHODS

Participants were 14 unsentenced female pretrial jail detainees with AUD. Intervention consisted of introducing participants detained in jail to female AA volunteers who could accompany them to an AA meeting after release. Assessments took place at baseline and 1 month after release. This uncontrolled pilot study evaluated the feasibility and acceptability of this enhanced referral approach. Pre-post alcohol use, drug use, alcohol problems, and AA attendance are also reported.

RESULTS

Enhanced referral was feasible and acceptable. Many (57%) of the 14 participants who met with AA volunteers in jail were in contact with those volunteers after release from jail. Participants had significantly fewer drinking days, heavy drinking days, alcohol problems, and drug-using days during the postrelease follow-up than they did before jail detention.

CONCLUSIONS

Providing linkage between women in jail and female AA volunteers who can accompany them to a postrelease meeting is achievable, and may be a disseminable and low-cost method to improve alcohol outcomes in this vulnerable population.

Integrating psychotherapy research with public health and public policy goals for incarcerated women and other vulnerable populations

OBJECTIVE AND METHOD

In this article, I review my research applying interpersonal treatments and interpersonal principles from psychotherapy for major depression and substance use to broader public health goals for incarcerated women and other vulnerable populations.

RESULTS

A public health focus has led me to expand the boundaries of psychotherapy research to include partners such as prisons, parole officers, and bachelor's level providers; behaviors like risky sex; service delivery challenges; and ultimately to research with an eye toward informing policy and advocacy.

CONCLUSIONS

A public health perspective provides context and rationale for conducting sound psychotherapy research; the combination of public health and psychotherapy-specific perspectives can lead to novel research.