COMMUNITY BASED TREATMENT PROGRAMS FOR DRUG USING WOMEN BEING RELEASED FROM PRISON OR JAIL
Approved:______________________________ Date:___________________ Dr. Susan Hilal, Advisor
COMMUNITY BASED TREATMENT PROGRAMS FOR DRUG USING WOMEN BEING RELEASED FROM PRISON OR JAIL
A Seminar Paper Presented to The Graduate Faculty
University of Wisconsin- Platteville
In Partial Fulfillment Of the Requirement for the Degree Master of Science in Criminal Justice
By Katie Werren
COMMUNITY BASED TREATMENT PROGRAMS FOR DRUG USING WOMEN BEING RELEASED FROM PRISON OR JAIL
Katie A. Werren
Under the Supervision of Susan Hilal Statement of the Problem
The number of women going to jail or prison for drug related offenses began to rise during the war on drugs in the 1980’s. Women are the fastest growing population in jails and prisons for drug charges. This is due to the mentality that focuses on incarceration instead of rehabilitation. The factors associated with why women begin to use drugs are extremely different than those factors associated with men. It is important to understand these factors in order to better address them through treatment. Current treatment options tend to utilize strategies that are based upon the reasons men begin using drugs. This creates a block in rehabilitation for women due to the fact that women have unique reasons for initiating drug use. Treatment strategies for women need to be identified and incorporated into programs to be more effective for the rising female population of drug users.
Methods
Information was collected from a variety of internet resources, such as the Bureau of Justice statistics and the National Criminal Justice Reference Service in order to identify statistics related to the rising numbers of women in jails and prisons for drug charges. These resources also identified the quantity of treatment facilities and recidivism rates. Empirical research was collected through the use of
Karmann Library Online. Textbooks accumulated throughout this program were also used as references. These references were necessary to understand the scope of the problem, the factors associated with women beginning to use drugs, and identified factors influencing treatment. Theoretical framework was identified through these sources to help explain why women use drugs and to structure treatment options.
Summary of Results
Therapeutic communities are by far the best type of treatment program at this time for drug using women. Therapeutic communities that begin in prison are more effective than programs that begin in the community. The KEY/CREST program found in Delaware is currently the most effective program in the United States. A few modifications and additions to the program are necessary to make it even more effective. This program should further develop the environment of the
therapeutic community to make it more friendly and welcoming in order to generate a sense of community among the women. Aftercare services should provide more resources to women that focus on housing, employment, assisting the women in finding a drug-free social environment, and family services. More training for staff should be mandatory for a more comprehensive understanding of the unique needs of women. The curriculum that is being used at KEY/CREST should be reviewed to ensure that it is up to date and gender appropriate.
TABLE OF CONTENTS Page APPROVAL PAGE i TITLE PAGE ii ABSTRACT iii TABLE OF CONTENTS iv C HAPTER I. INTRODUCTION 1 Introduction 1
Statement of the problem 4
Purpose 5
Methods 5
The significance of the study 6
Limitations 7
II. LITERATURE REVIEW 8
Factors associated with women beginning to use drugs 10
Factors influencing treatment 17
Prevailing programs 25
III. THEORETICAL FRAMEWORK
General Strain Theory 31
Application of general strain theory 32
Life Course Perspective 33
Application of life course perspective 35
IV. CURRENT PROGRAMS 37
KEY/CREST 37
Methadone Maintenance 40
V. RECOMMENDATIONS, SUMMARY AND CONCLUSION 42
SECTION I. INTRODUCTION Introduction
Women are the fastest growing population in prisons and jail (Arditti & Few, 2008; The National Center on Addiction and Substance Abuse at Columbia University, 2002). According to the U.S. Department of Justice, Bureau of Justice Statistics (2007), the number of female prisoners in the United States in 1990 was 44,065. The number of women incarcerated in 2007 in the United States was 115,779. The rate (per 100,000) of sentenced prisoners under state and federal correctional authorities in 1980 was 139; whereas in 2006 it jumped to 501 (Bureau of Justice Statistics). The increase is related to the number of women receiving drug related sentences (Arditti & Few, 2008; Messina, Burdon, Hagopian & Prendergast, 2006). Not only are women being arrested and
convicted more often, but women are now being sent to prison and jail more often for drug violations (The National Center on Addiction and Substance Abuse at Columbia University, 2002). Women drug users in jails and prisons have unique reasons for using drugs, compared to men, which results in unique treatment needs. With the recent increase in the number of drug using women offenders, current punishment and treatment programs have frequently failed to meet these needs.
Punishment options generally lean towards imprisonment, which
developed during the “get tough” mentality since the 1980’s (Messina, Wish, & Nemes, 2001). Mandatory minimum sentencing was designed to prevent future drug use and to appropriately deal with drug offenders. In 1970, the percentage of
inmates in federal prison for drug charges was 16.3%. In 2002, the percentage of inmates in federal prison for drug charges rose to 54.7% (Bureau of Justice Statistics). However, the “get tough” attitude towards drug offenders has had limited success because it does not address the underlying issues that lead to drug use in the first place. For addicted offenders to stop using drugs, underlying causes must be dealt with for the offender to move forward in life.
Treatment programs were often geared towards the needs of male offenders, but with the increase in female offenders these programs need to be modified to address the unique needs of women. Some research has begun to address and understand the treatment needs of women; however, more often than not these needs have not been incorporated into community based treatment programs designed specifically for women. It is important to determine what components of these programs are effective for women, specifically as it relates to drug offenders.
Incarcerated women have unique circumstances to deal with compared to men. More than half of substance-involved women who are incarcerated have children under the age of 18 living with them prior to incarceration (The National Center on Addiction and Substance Abuse at Columbia University, 2002). Children that have witnessed their mothers incarcerated are much more likely to come into contact with the criminal justice system compared to children who did not have an incarcerated mother (Parsons & Warner-Robbins, 2001).
The connection between crime and drug use is substantial. In 2003, the Arrestee Drug Abuse Monitoring program found that 60% of all arrestees tested
positive for illicit drug use, not including alcohol (Zanis, Mulvaney, Coviello, Alterman, Savitz, & Thompson, 2003). Females are more likely to test positive for drugs than males at time of arrest (Alemagno, 2001). In 2004, the Bureau of Justice Statistics estimated that 28.7% of women in state correctional institutes were in prison for drug offenses, whereas male drug users only accounted for 19.6% of state inmates (Bureau of Justice Statistics, 2004). There is a high rate of recidivism for drug using female offenders. . In 2004, there were 46,415 people under community supervision in the United States for drug offenses, making up 42.4% of all felony offenses under community supervision (Bureau of Justice Statistics). Chronic, untreated drug abuse leads to re-arrest results that have a high probability of reincarceration (The National Center on Addiction and Substance Abuse at Columbia University, 2002). Drug use has been a key factor contributing to the growth of the inmate population and the number of offenders behind bars.
The criminal justice system has adjusted to the rising numbers of drug using offenders by developing new sentencing alternatives and providing more rehabilitative programs in order to reduce the recidivism rates, along with reducing prison overcrowding (Zanis et al., 2003). Providing drug treatment programs is necessary for the criminal justice system to have a lower rate of recidivism. Having a reduction of drug use among women is essential to make lasting effects on their children and in the community. It is important to
understand the different characteristics of women drug users in order to develop appropriate treatment services.
Statement of the problem
Women who are on parole for drug offenses have high recidivism rates (Deschenes, Owen, & Crow, 2006). There are a variety of needs that these drug abusing women have when they are released from prison, including, but not limited to: drug counseling, housing, childcare, mental health counseling, education and training, and financial aid (Parsons & Warner-Robbins, 2001). There are different comprehensive community based options available to help women on parole with drug abuse issues, although the current options are not highly effective, as evidenced by the recidivism rate. The Bureau of Justice Statistics found that in 1999, 65% of women in state prisons had a history of prior convictions (Bureau of Justice Statistics). Current community based options include therapeutic communities (Messina et al., 2006), triad drug treatment, cognitive therapy, and methadone treatment programs (Lundgren, Schilling, & Peloquin, 2005).
It is important to look at the different variables and components of each of the different programs in order to identify what specific aspects are effective in each program. It is also important to look at the reasons why women begin using drugs prior to their incarceration in order to develop better community based programs. The general strain theory and the life-course perspective will be used to explain why women use drugs. If these reasons are not addressed through in-prison programming, they must be addressed post-release to prevent persistent drug crimes from being committed.
Purpose
The purpose of this seminar paper is to provide recommendations for an ideal comprehensive community based program, or components of programs, that are the most effective for paroled, drug using women in order to reduce the rate of recidivism. By looking at why women begin using drugs, the most effective components of community based treatment programs, and the needs of paroled women, specific recommendations can be made to find better treatment for women with drug issues in order to prevent relapse and recidivism. After identifying the important components and factors involved in women drug users and programs available, recommendations can be made for an ideal community-based drug treatment program that incorporates all of the needs for drug using paroled women. These recommendations will be comprehensive in order to reduce the recidivism rate of paroled women drug users.
Methods
Information is collected from a variety of internet sources including the National Criminal Justice Resource Service, and U.S. Department of Justice, Bureau of Justice Statistics. These websites provide a wealth of information and statistics regarding the rate of incarceration, recidivism, the numbers of
community based programs currently available, along with their effectiveness. Empirical research is also collected through the use of Karrmann Library Online to address the issues of why women begin using drugs and why they continue to re-offend. These empirical studies will also assist in finding the needs of paroled women. Information pertaining to the general strain theory and the life
course perspective will also be reviewed and applied to factors associated with beginning to use drugs and drug treatment programs. Text books that have been accumulated throughout this program may also be used for additional references and sources of information.
Significance of the Study
The significance of this study is to understand the factors that are
associated with women beginning to use drugs, along with identifying aspects of treatment that are effective for women. By finding the most effective program, or combination of programs, paroled drug using women will be able to address their issues, stop using drugs, and be able to move forward in their lives instead of continuing with their negative cycle of offending and re-offending. The information from this study can be used to further develop current community based treatment options, and/or assist in developing a new, more comprehensive system that addresses the issues and aspects related to community based drug treatment programs for women specifically.
This study can be used for people currently working in treatment programs in order to help them identify what aspects could be missing from their program. It can assist them by adding more services to develop a more comprehensive program and will be more effective and efficient. A new program could also be developed to incorporate the recommendations of this study. This can potentially help reduce the recidivism rate of drug using female offenders if
recommendations are followed because the program is then better able to meet the needs of participants. By having a more efficient program, women are helped by
resolving their issues leading to drug abuse, which leads to a chain reaction. Families are helped, along with the community through the reduction in crime and saving tax payer money.
Limitations
There are a few limitations to this seminar paper. The first limitation will be the lack of previous research geared specifically towards community based treatment programs for women. Much of the research regarding community based treatment programs is based upon programs developed for men. This limits the amount of research available to make a recommendation for an ideal
community based treatment facility designed specifically for women. Also, much of the research for drug treatment facilities relates to prison therapeutic
communities, instead of community based. This negatively affects the
recommendations due to a lack of research based evidence for community based treatment programs. Another limitation will be the lack of information relating to paroled drug using women that are involved in community based treatment settings. Most of the information appears to be geared solely towards men until the last ten years. Finally, primary data is not being collected nor secondary data analyzed here, so recommendations are grounded only in theoretical ideas and a comprehensive review of the empirical literature related to the topic.
SECTION II. REVIEW OF THE LITERATURE
The following literature review is divided into four parts. The first part looks at the scope of the problem to include the rising number of women going to jail or prison for drug charges as well as the number of treatment facilities
available for those inmates. The second part looks at the different factors that are associated with women beginning to use drugs (understanding why women begin using drugs will be addressed more thoroughly in section III, through the use of general strain theory and life course perspective). The third part of this literature review looks at factors that have been identified to improve success in treatment. The fourth part looks at the programs currently available that have been the most prevalent in the literature review. A summary of the literature review will close this section.
Scope of the Problem
The number of females incarcerated has dramatically increased since the get-tough policies on the war on drugs began in 1986. The Bureau of Justice statistics demonstrates that drug offenses represent the largest source of growth in correctional facilities (Deschenes, Owen, & Crow, 2006). Although the arrest rate of women for drug offenses has only risen 13% between 1995 and 2004, there was a 53% increase in the number of women incarcerated (Deschenes, et al., 2006). Deschenes et al. (2006) found that 60% of the women released from prison were rearrested within three years. This increase in the amount of women in prison affects the family system, as many of these women are mothers.
factor in child maltreatment (Lundgren, Schilling, & Peloquin, 2005). Children with mothers in prison face emotional problems, lack contact with their mother, and may not even live with their mother upon her release from prison (Seymour, 1998).
The Bureau of Justice Statistics reported that in 2004, 17% of state prisoners and 18% of federal prisoners said that they committed their current offense to obtain money for drugs. In 2002, 24.7% of jail inmates were being held for a drug offense and 24.9% were being held for a public-order offense, which included driving while intoxicated and drunkenness. Together, these charges represent half of the jail inmate population in 2002. The Bureau of Justice Statistics reported that there were an estimated 207,700 females held in jails or prison at midyear in 2008, which went up 33 percent from midyear of 2000.
With all of these statistics regarding the incarceration rates of drug users, it is important to looks at the number of treatment facilities available that focus on drug abuse issues. There were 13,771 drug and alcoholism treatment facilities available in 2006; 290 of those available in Wisconsin (Bureau of Justice Statistics). In the United States, there were 1,130,881 people in drug and alcoholism treatment facilities in 2006 (Bureau of Justice Statistics Online). 17,846 of those people were in treatment facilities in Wisconsin (Bureau of Justice Statistics Online).
It is important to look at the rising number of women that are going to jail and prison for drug charges so that appropriate treatment can be found to help
reduce the rate of recidivism. To find the appropriate treatment, the dynamics associated with why women begin to use drugs needs to be identified. Drug treatment programs need to work around these factors to make it comprehensive to meet all of the different needs of women. Statistics can help identify a wide range of information, including different trends in drug patterns and use, along with effectiveness of different programs.
Factors associated with women beginning to use drugs
Men and women have different pathways to begin using drugs (The National Center on Addiction and Substance Abuse at Columbia University, 2002). Most studies have focused on why men begin using drugs, however, these findings cannot be generalized to women because women turn to drugs for
different reasons than men. There has been some research done to understand why women begin using drugs, many of which demonstrate similar factors that are associated with beginning to use. Although the research does contain a range of factors, it is important to look at the research that agrees upon certain ones, such as abuse, survival, lack of coping techniques, stress, observation of others, mental illness, entertainment, and control in order to better address the common factors in treatment. By examining the common characteristics of drug use provided in the literature, possible treatment strategies can be explored that can assist women in abstaining from drugs.
Abuse
Women that have been verbally, physically, or sexually assaulted in their lives are at a higher risk for using or abusing drugs than those who have not been
abused (Pelissier & Jones, 2005). Females that have experienced abuse may turn to drug use, which can result in incarceration. Bloom, Owen, and Covington (2004) find that women incarcerated for drugs have a much higher rate of abuse than those not incarcerated. Freeman, Collier, and Parillo (2002) report that 60-84% of adult women in drug treatment programs have been sexually victimized during their childhood. The researchers came to this conclusion by assessing self-reports of 1,478 community recruited women that participated in the Women Helping to Empower and Enhance Lives project. The participants were sexual partners of male injection drug users. Substance abusing women in prison and jail have experienced abuse at much higher rates than incarcerated men (The National Center on Addiction and Substance Abuse at Columbia University, 2002).
Sexual abuse that happens before puberty can affect a woman’s sexual identify, ability to trust others, lowered self-esteem, and sense of control (Freeman et al., 2002). Freeman et al. (2002) found this be looking at 1,478 participants recruited through the community. This study assessed the association between child/adolescent sexual abuse, including the specific type of abuse and perpetrator of abuse, and lifetime crack use. In logistic regression analyses, any sexual abuse in childhood, penetrative sexual abuse in childhood, and sexual abuse by a family member in childhood were significantly associated with lifetime crack use. Abuse can also create a sense that the world is unfair and can lead to problems later in life, such as substance abuse. Any type of sexual abuse in childhood is significantly associated with lifetime crack use (Freeman et al.,
2002) and alcohol problems (The National Center on Addiction and Substance Abuse at Columbia University, 2002).
Survival/ Coping/ Stress
There is a positive relationship between stress and/or tension and drug use (Hatch, 2007; Slocum, Simpson, & Smith, 2005). Many women turn to drugs during times of stress or anxiety (Klein, Elifson, & Sterk, 2003). Even if women are trying to stop using drugs, stress can lead to cravings (Klein et al., 2003). Not only can strain turn women towards drugs, it can also lead to continual usage of these drugs (Slocum et al., 2005). Slocum et al. (2005) used 36 months of retrospective data collected from female inmates to explore the relationship between intra-individual changes in strain and changes in offending and drug use. They found that changes in strain are associated with changes in violence, drug use, and property crime and that these relationships remain after the addition of control variables. If women have been exposed to drug use and have a lack of alternative coping skills, drugs may be seen as an option to deal with stressful situations and life events.
Women who have high levels of stress sometimes use drugs to alleviate their physical, as well as, emotional pain. Women will self-medicate to cope with their abuse or the threat of abuse (Sales & Murphy, 2000; Freeman et al., 2002). This self-medication is a coping technique that women use when they don’t have other coping strategies. Hunt, Joe-Laidler & Evans (2002) reported that gang girls would use drugs to lessen interpersonal conflicts within the gang, similar to women who are abused. Hunt, et al. (2002) studied 168 female gang members in
the San Francisco Bay area using both quantitative and qualitative interview methods.
Stress that can lead to drug use includes daily stressors related to economic circumstances and daily subsistence (Hatch, 2007), strain within relationships, and family members using drugs (Boyd & Holmes, 2002). Some women feel that these stressors are overwhelming and look to drugs to ease their pain, even for a short amount of time. They may also take drugs to attempt to have a better relationship with family members that use drugs (Boyd & Holmes, 2002). They see this as a source of bonding. Boyd and Holmes (2002) retrieved this information from self-reported data from women drug users.
Women may find a source of comfort through drugs to diminish their daily hardships and suffering (Sales & Murphy, 2000; Slocum et al., 2005) and may become a primary support system when other support systems are weak or non-existent (Sales & Murphy, 2000; Freeman et al., 2002). Some women enjoy using drugs so that they feel better about themselves (Sales & Murphy, 2000) during their “high.” Comfort is a common incentive for women to use drugs.
Women have uniquely stressful situations, such as child-care and under-employment, which plays a large role in drug use (Pelissier & Jones, 2005). Bloom et al. (2004) reported that approximately 70% of women under
correctional supervision have at least one child under the age of 18. Mothers, especially single mothers, have a stressful job of keeping up with young children, along with all of the financial needs. Hatch (2007) reported that there is an association between chronic substance abuse and women’s lack of employment
and earning potential. Women who are dependent on social welfare as well as drugs show a symptom of larger problems in these women (Luck, Elifson, & Sterk, 2004).
Slocum et al. (2005) found that women are more likely to engage in drug use when they are exposed to higher levels of neighborhood strain and negative life events. Slocum et al. (2005) feels that negative life events and drug use are possibly intertwined. Women who are exposed to bad neighborhoods find higher amounts of stress which may ultimately result in drug usage. Drug using women who witness others taking drugs in their neighborhood are more tempted to use drugs primarily due to the exposure and cravings (Klein et al., 2003). If women who use drugs are in an environment that is conducive of drug use, they are highly tempted to use (Klein et al., 2003). Women who have stressful lives tend to be tempted to use drugs as soon as they wake up to help them cope with their daily lives (Klein et al, 2003). Poor coping skills are related to higher chances of drug use (Klein et al., 2003).
Some women do report stress in their lives due to their own drug use. They may say that their use of drugs has led to exacerbating their situation and stress. Some feel that they have created new stressors, such as their children being taken away (Hatch, 2007; Slocum et al., 2005). This may lead them to continue using drugs due to a lack of coping skills. It appears that women in this situation get into a bad cycle of stressful situations and attempting to cope through addiction.
Overall, the literature has shown that there are many stressors in a woman’s life that can possibly lead them to drug usage. Fortunately, not all women who experience these stressors will turn to drugs as a source of coping. There are many unique situations for women that can possibly lead to addiction. Observation of Drug Use
Many women learn to accept drug use as “normal” by witnessing other loved ones using drugs. Many women were raised with one or both parents using drugs (Boyd & Holmes, 2002). Sales and Murphy (2000) reported that 94% of their subjects in prison had witnessed family members abusing drugs. Women observing drug use within interpersonal relationships may develop a habit themselves. Boyd and Holmes (2002) have observed high rates of drug using male family members among women crack users. Women who have close relationships with others that use drugs are engaged in negative support systems that may increase the likelihood that they will use or continue to use drugs (Hatch, 2007). Women who are married to drug users tend to use drugs more frequently and are resistant to treatment (Klein et al., 2003).
Drug use in gangs is a normal pattern of street life (Hunt et al., 2002). Many of these women gang members have had their initial drug experience by witnessing family members use drugs, especially their parents (Hunt et al., 2002). When they became involved in the gang lifestyle, drugs became a way of bonding and group identity. They learn through other members the social rules of drug use, such as appropriate times to use.
Mental Illnesses
Women substance users tend to have greater psychological issues than men (Pelissier & Jones, 2005). Depression and psychological disorders play a role in drug use and abuse (Pelissier & Jones, 2005). Many of their mental health issues are compounding, which creates a larger problem for mental health
professionals working with this population (The National Center on Addiction and Substance Abuse at Columbia University, 2002). Drug using women often suffer from more intense emotional distress, depression, and self-esteem problems than men (The National Center on Addiction and Substance Abuse at Columbia University, 2002).
Low self-esteem is associated with substance abuse (Klein et al., 2003). Freeman et al. (2002) reports that there is an association between childhood sexual abuse and substance abuse due to the woman needing to enhance her self-esteem and identify with a group of people. This allows for the woman to feel a sense of interpersonal closeness. Women who have been abused may suffer from Posttraumatic Stress Disorder and may turn to drug abuse and addictions to relieve their emotional pain (Bloom et al., 2004; Freeman et al., 2002). Entertainment
Many women use drugs to enjoy the euphoric effect. Some women use drugs to connect with others, such as a boyfriend or lover (Sales & Murphy, 2000). Some women feel that drug use can bring together two people and enhance their relationship (Sales & Murphy, 2000).
Some women drug users are even more tempted to use drugs to celebrate or when they are feeling happy (Klein et al., 2003), similar to how people celebrate with alcohol. Hunt et al. (2002) found, through self-reported data, that female gang members will use drugs for recreational purposes while they are “partying.” Regardless of which circumstances women are in, they do enjoy the euphoric effects of drugs and will initially begin using to feel the “high” that others talk about.
Control
Women may use drugs to establish a sense of control over their lives. They may feel that they can control a small portion of their world by using drugs (Luck et al., 2004). These women lack opportunities to be economically
independent and feel that controlling their thoughts through drugs can achieve a small sense of control over their life. Many drug-using women do not have control over their lives, such as their children, their jobs, or their relationships. The ability to control their own thoughts puts them in a position of power, whereas they feel they lack control in other areas of their lives. It does not necessarily mean that they are out of control of their own lives, but they feel that way, which may lead them to use (Luck et al., 2004).
Factors influencing treatment
Treatment of drug use can come in many different forms when it is in the prison system. In-prison treatment deals with substance abuse, anger
management, other mental health treatment, vocational development, life skills training, and risk assessment (Community Education Centers, Inc.). Treatment
for offenders is geared towards getting the offender ready to move back into the community successfully.
There has been research done identifying certain factors that influence treatment. It is important to incorporate certain factors that have found to be influential on drug treatment and reducing recidivism among drug using offenders. Increasing self-efficacy, reducing maternal distress, increasing motivation, providing early release from jail and prison, and increasing length of stay in treatment programs have all been identified as important factors related to treatment success.
Self-efficacy
Pelissier and Jones (2005) researched the sex differences in cognitive-behavioral treatment facilities that focused on identifying, confronting, and altering attitudes, values, and thinking patters that led to criminal behaviors and drug use. They found that women reported less confidence in their ability to remain abstinent, regardless of their drug of choice, during high-risk situations. They also found that women were less confident in their ability to plan and attain goals. In this study, the female participants were more likely to attribute negative events to transient causes, whereas men attributed them to stable causes. Pelissier and Jones (2005) also found a major difference in sexes when it came to coping skills. They found that women were more likely to use social support, accepting responsibility, and escape as coping skills in stressful situations. Finally, they found that women are more likely than men to acknowledge that they have a substance abuse problem, however, there were not any sex differences in their
motivation towards making changes in their lives. The researchers suggested that treatment for women with substance abuse problems should address underlying causes for lower self-efficacy levels to be more effective. They also suggested future research to evaluate the effectiveness of treatment programs regarding relational orientation of women.
Therapy can be influential on self-efficacy. Washington (1999)
researched the effects of cognitive and experiential group therapy on self-efficacy and perceptions of employability on drug using women. She used a
quasi-experimental design with pre and post test assessments. Participants were randomly assigned to two treatment groups. A self-efficacy scale was used. Washington found that with the use of cognitive and group therapy, self-efficacy and decisiveness significantly increased over time, which are both indicators for employability. She asserted that increasing women’s self-efficacy and control over outcomes can be used to increase employability skills and reduce recidivism. Maternal Distress
Maternal distress can be described as depression, physiological issues, and unhappiness. Arditti and Few (2008) coined the term “triple threat” regarding the threats that drug using mothers’ experience that can inhibit healthy parent-child relationships. The three threats include: depression, violence, and addiction. The researchers focused strictly on incarcerated mother reentering the community with a history of drug use. They used a multiple case study methodology to identify supportive relationships, their ability to secure resources, and relationships with their children. They found that maternal distress in this study related to
dysfunctional intimate relationships, loss related trauma, guilt about children, and economic inadequacy. Further, they found that the punitive nature of prison worsened maternal distress, but was helped when given treatment opportunities, as well as support upon reentry into the community. They recommended that professionals working with reentry mothers focus on alleviating maternal distress and better address their needs during incarceration and reentry.
Children of incarcerated parents suffer from many consequences.
Children often experience emotional consequences, such as fear, anxiety, sadness, guilt, low self-esteem, depression, and loneliness when their parent is incarcerated (Seymour, 1998). Children may often demonstrate behavioral issues in areas of their life, such as issues in school and anti-social behaviors in the community (Seymour, 1998). Children who have mothers incarcerated often suffer from a lack of contact with them and multiple placements. Due to the significance of these issues, many children with incarcerated mothers may end up incarcerated later in their lives.
Motivation
Offenders may enter treatment facilities for a variety of reasons, including legal, family, desire to end addiction, and medical pressures (Messina et al., 2001). Both external and internal motivation play important roles in treatment and rehabilitation. Those with greater motivation stay in treatment longer (Messina et al., 2001).
Melnick, De Leon, Thomas, Kressel and Wexler (2001) studied the motivation of offenders in therapeutic communities to participate in aftercare
services. Melnick et al. (2001) tested a sample of 110 participants in a prison-based therapeutic community that volunteered to participate in aftercare. A CMR (Circumstance, Motivation, and Readiness) scale was used to measure motivation. The researchers used a Client Rating Progress Scales (CRPS) and Staff Rating Progress Scales (SRPS) to measure client participation in the program. There was a 12 month follow up on relapse and recidivism. Melnick et al. (2001) found that those participants that were highly motivated in the treatment process and
demonstrated high participation, were influenced to participate in aftercare services. This indicates that getting offenders motivated in their own treatment from the start can result in more motivation to continue treatment through
aftercare services. They found that internal motivation is a necessary process for prison-based therapeutic communities. External motivation due to pressure does not play as large of a role in motivation to continue treatment because compliance with external pressures may no longer be felt at some point; therefore their
motivation is reduced or eliminated. It is important to increase internal
motivation early in the treatment process instead of relying on external pressures to participate in treatment. Melnick et al. (2001) found a loop regarding
motivation and change: an increase in internal motivation leads to an increase in participation, which results in positive change. Positive change leads to continued increase in motivation and participation.
Length of Stay
Not only is the quality of the program important to facilitate change, but the amount of time spent in the program can make an impact. Messina et al.
(2006) found that residential treatment programs were more effective for women than men if the programs were longer in length of time. They found that the total time in prison-based treatment, including aftercare, was directly related to the recidivism of women. The longer that women participated in treatment, including aftercare, reduced their likelihood of becoming reincarcerated (Messina et al., 2006). Completion of treatment is associated with considerable reductions in recidivism (Messina et al., 2001). They recommended that there needs to be a greater emphasis on aftercare and transitioning into the community for women that received treatment in a prison setting.
Parsons and Warner-Robbins (2001) conducted research with women who were released from jail/prison and attended a community faith-based program. Parsons and Warner-Robbins (2001) found twelve common themes during interviews with the women regarding what they believed would help them successfully transition to the community after incarceration. The themes are slightly skewed since they were participating in a faith-based program, but do have some similar themes to other research. The themes are: a belief in a higher power as a source of strength an peace, freedom from drug addiction and the importance of rehabilitation, role of support groups and their “sisters” in the program, the Nurse-Chaplin’s jail visit and support, the role of supportive friends (not former drug using friends), the role of supportive family, significance of role models, personal strength of determination, role of children as a driving force to change, significance of employment, role of helping others, and the role of learning to deal with feelings and issues from the past (Parsons and
Warner-Robbins, 2001). Although some of these themes are unique to this research, many of the themes do echo other research, such as the role of supportive people that are not drug users and the role of learning to acknowledge and deal with feelings.
The National Center on Addiction and Substance Abuse at Columbia University (2002) conducted research to identify trends in substance abuse and treatment needs among inmates. They found that treatment for drug using women offenders would “be most effective if it addresses the financial and practical needs of these incarcerated mothers by offering family services and transition and aftercare programs” (The National Center on Addiction and Substance Abuse at Columbia University, 2002, p. xxiii). Access to aftercare must be made available immediately upon release in order to reduce the chance of relapse. They also found that educational and vocational training would help these women gets jobs upon release in order to help them raise their children (The National Center on Addiction and Substance Abuse at Columbia University, 2002).
Multi-dimensional needs
When drug using women are asked what they need upon release, there are several different needs identified. Alemagno (2001) examined the self-reported needs of 165 drug-abusing women incarcerated in an urban jail in Ohio.
Alemagno (2001) conducted surveys with these women asking demographic questions, services used in the past year, and their general history. Alemagno conducted open-ended questions in her survey regarding what they would need upon release from jail. The women also ranked their needs. Alemagno found that these drug-abusing women reported that they needed housing, drug treatment
services, mental health counseling, education, job training, medical care, family support, and parenting assistance when released from jail. The most frequently reported need was for housing (84%). This study supports the need for
multidimensional services for drug-using women during aftercare. Early Release from Jail/Prison
One strategy that is being used for incarcerated female drug users is early parole directly to a community based substance abuse treatment facility. This allows for the woman to finish her sentence in a rehabilitation program in the community setting. This also helps alleviate some of the overcrowding found in jails and prisons (Zanis et al., 2003).
Zanis et al. (2003) looked at whether early parole for substance abusing offenders was effective in reducing the rate of recidivism. The study involved releasing offenders to either an Intensive Outpatient Program (IOP) or a Non-Hospital Residential treatment program (NHR) prior to parole. They looked at 569 offenders incarcerated in an urban jail in the Northeastern United States. All of the participants in this study were male, however, this study provides a great start to understanding if early release to a treatment facility can also be beneficial for women drug users in prison or jail. The researchers conducted a chi-square analysis consisting of two factors that represented parole condition and 24-month post-jail release conviction status.
Zanis et al. (2003) found that their study supports that early parole to a substance abuse treatment facility may reduce criminal recidivism, along with reducing prison overcrowding. Regardless of the type of treatment facility, IOP
vs. NHR, offenders who completed treatment were less likely to be convicted of new criminal offenses. They did suggest future research should identify the characteristics of offenders that may benefit from treatment facilities and then use these factors to determine appropriateness of alternative sentencing.
Prevailing Programs
Through the literature review, two types of programs continued to appear; therapeutic communities and triad drug treatment. Although there are quite a few similarities between the two programs, there are many differences that play large roles in the rate of recidivism for women drug users.
Therapeutic Communities
A therapeutic community (TC) is a treatment environment that promotes rehabilitation in a safe environment. This environment is all inclusive, which means it is separate from drugs, violence, and other aspects that can negatively influence rehabilitation. Prison based TC’s are within the prison, but completely separated from the general population. Treatment is based upon the Therapeutic Community Model, in which “drug addiction is viewed as a symptom of the dysfunctional behavior in the addicts’ life and not the cause of the dysfunction in the life of the addict” (Delaware Criminal Justice Council, 2002, p.5). The Therapeutic Community Model asserts that the person is in need of habilitation, not rehabilitation. Rehabilitation focuses on helping the person go back to their way of life previously known, whereas habilitation teaches the person how to develop positive social skills and socialize into a productive citizen. Through habilitation, they can return to the community with new skills and live their life in
a newer, healthier way. Therapeutic communities focus on the use of a positive peer culture to facilitate change in individuals through group therapy.
Therapeutic communities were developed to address the individual with a holistic approach, which encompasses behavioral, cognitive, and emotional therapy (Garrison, 2002). Behavioral therapy is used to encourage positive social behaviors and to have the offenders assimilate to the program and become
engaged in treatment. Cognitive therapy is used to help offenders understand their errors in thinking that they have developed over time. This helps allow them to develop new, healthier ways of thinking. Cognitive therapy is used during individual and group therapy sessions. Emotional therapy is used to help offenders deal with unresolved issues they have that can influence drug use and abuse. Emotional therapy can help offenders understand how and what they think about themselves and eventually turn that around to be more positive (Delaware Criminal Justice Council, 2002).
Therapeutic communities can be found both in the prison and community settings. Prison based therapeutic communities have three stages of treatment. The first stage is called the intake or primary stage, in which the goal is to make behavioral changes in the client in order for them to continue to participate in the TC. Introduction to the rules and goals of the TC is important in this stage. The second stage is called the transition or secondary stage, in which the focus is having the person participate in a work-release program and beginning to learn how to successful participate in society. The final stage is the tertiary or third stage, in which the goal is to have the individual successfully complete the TC
and fully transition into the community with supervision. Therapeutic communities are one of the most common residential treatment modalities available for substance abusers with any type of drug addiction (Messina et al., 2001).
TC’s were originally developed for male drug offenders. However, research has shown that the Therapeutic Community Model is successful for women as long as there have been changes made to the program to encompass more factors to help women (Delaware Criminal Justice Council, 2002).
Research has shown that there are certain elements needed specifically for women to be successful in the TC environment (Delaware Criminal Justice Council, 2002).
Triad Drug Treatment
The Federal Bureau of Prisons (BOP) developed a residential drug abuse treatment program that involved three stages: residential treatment for 9-12 months, institutional transition, and community transition. Stage one includes confinement to a drug abuse treatment unit where treatment strategies involve inmate responsibility for their behavior and acknowledgement that they can change their behavior. Stage two includes transition back into general population, upon stage one completion, where they continue to meet with drug abuse
counselors, along with group activities consisting of prevention planning and reviewing treatment techniques they learned in the treatment unit. They can remain in this stage for up to one year. Stage three involves community transition to a halfway house prior to custody release. Similar treatment and activities in
stage two are continued through community based treatment providers (Pelissier, Rhodes, Saylor, Gaes, Camp, Vanyur, & Wallace, 2001).
The residential drug abuse treatment programs are separate from the general population. Each unit on the federal level houses approximately 100 inmates to build a community. Treatment is provided in two, two hour sessions, whereas the rest of the day consists of daily living activities (i.e., chores and school). When not in treatment groups, this population interacts with the general population.
Participation in the treatment program requires inmates to “identify, confront, and alter the attitudes, values, and thinking patterns that lead to criminal and drug-using behavior” (Pelissier et al., 2001). During institutional and
community transitions, inmates are continuing to engage in treatment to ensure successful transitions.
Pelissier et al. (2001) conducted a three year study looking at 2,315 inmates, 473 of them women. These participants were from 20 different institutions that had residential drug treatment programs. They found that there was a lower number of women to complete treatment compared to the men. Pelissier et al. (2001) had comparison subjects from 40 different institutions who would have met criteria for entering the residential drug treatment programs. There were 228 female comparison participants. Employment information was obtained through their probation officers. Pelissier et al. (2001) struggled to untangle the problem of selection bias in their study based upon the fact that inmates can request or refuse treatment.
The BOP found that of the women that completed the program, 24.5% were arrested or revoked within three years after release. They also found that 35.2% of women were likely to use drugs again within three years after
completion of the program (Pelissier et al., 2001). Out of the women that completed the program, 70.5% of women were employed three years after their release. They found that the use of their drug treatment triad plan reduced the chances of future criminal behavior, as well as drug use, while increasing the employment rate for women.
Summary
The number of women going to prison for drug charges is staggering. What society is currently doing to try to help reduce the number of drug using women going to jail or prison for drug charges has not been working, as
evidenced by the rate and numbers of women returning to prison for more drug charges. The literature review has provided many different factors that influence women beginning to use drugs, including; past abuse, a lack of healthy coping skills, stress, survival, observing others use drugs, mental illness, control, and for entertainment.
The literature review also provided insight as to what works for women in treatment programs. Understanding what works for women in drug treatment programs is essential in developing and creating a treatment program/facility that is effective in dealing with the underlying issues that lead women to begin using drugs. The literature identified multiple factors that positively affect women in drug treatment programs, which include; increasing self-efficacy, decreasing
maternal distress, increasing motivation, increasing length of stay, early release, and assistance regarding their children. In the study conducted by Alemagno (2001), women most frequently reported a need for housing. They also indentified needs for; drug treatment services, education, job training, mental health counseling, medical care, family support, and parenting assistance.
Two popular programs in the literature are therapeutic communities and triad drug treatment. Although there are many similarities between these two types of programs, there are quite a few differences that affect the success of each type. Therapeutic communities have their participants completely separated from the general population at all times, whereas in the triad drug treatment programs, participants are only separate from the general population during therapy and sleeping. In therapeutic communities, treatment stages are slightly different, with more emphasis placed upon the community, working on their treatment within the community, then moving forward in life. Triad drug treatment programs
incorporate sending individuals back to the general population after the first stage. These differences may appear to be minimal, but play a large role in women’s recovery and habilitation.
SECTION III: THEORETIC AL FRAMEWORK
When looking at incarcerated women for drug charges, it is important to look at different theories that may help explain why women begin using drugs. Theory can give a better answer as to why they begin using drugs and why they continue to use drugs after they have been incarcerated and released. The following theories used in the present study are the general strain theory and the life course perspective. These theories provide the best explanations and insight as to why women begin using drugs.
General Strain Theory
General strain theory, developed by Robert Agnew, believes that people who experience strains and stressors will engage in criminal behavior, for
example, doing drugs. This is to help the individual reduce or escape their strains because they do not have appropriate coping mechanisms that are legal. There are many different types of strains in the general strain theory, including objective and subjective strains, and experienced, vicarious, and anticipated strains (Agnew, 2006).
Objective strains are events and conditions that are generally disliked by most people. Subjective strains are events or conditions that are disliked by one person. Experienced strains are events and conditions that are personally
experienced by the individual, whereas vicarious strains are events and conditions that happen to a close family member or friend. Anticipated strains are strains that the individual is currently dealing with and the expectation that it will
continue into the future along with new strains (Agnew, 2006). These types of strains do not always lead to criminal activity, such as drug use.
There are four common characteristics of strains that lead to criminal activity. First, the strain must be seen as severe. Secondly, the strain must be seen as unfair. Thirdly, the strain is associated with low social control. Low social control consists of lack of direct control, or sanctions for criminal behavior. There is also low emotional bonding to others, and low investments in
conventional institutions, such as school, work, and church. Finally, low social control relating to crime involves an individual believing that it is okay to engage in criminal actions, such as drug use. The final characteristic of strains that can lead to criminal behaviors is that the strain promotes criminal coping (Agnew, 2006).
Agnew (2006) believes that some individuals’ turn to criminal activity when they have strains because they do not have coping skills that are legal, the costs of criminal coping are low, and they may be more disposed to crime as a result of strain. Agnew (2006) states that abuse as a child, chronic
unemployment, criminal victimization, and discrimination are all specific events that can lead to criminal behaviors, such as drug use.
Application of General Strain Theory
When looking at the general strain theory and drug use among women, there are stressors and strains that arise from the lack of necessary resources to deal with their daily struggles, such as income, unemployment, food, housing, clothing (Hatch, 2007). Especially for women in poverty, there are social statuses
and resulting inequalities that they have to deal with on a daily basis, in which they do so by using drugs (Hatch, 2007). Objective and experienced stressors include, for some women drug users, a history of abuse, lack of positive coping skills, mental illnesses, and environmental stressors. Many of these women will anticipate strains in their future such as daily stressors, possibly abuse, and fear of losing their children.
Therapeutic communities are grounded by the general strain theory, meaning that the structure of the program is based upon this theory. This type of treatment can address the strains that women have that led them to using drugs. Therapeutic communities address coping strategies, vocational training, parenting education, and other common strains found in women who use drugs.
Therapeutic communities provide a safe, community atmosphere that can help women talk about their issues while allowing them to understand why they turned to drug use.
Life-Course Perspective
The life-course perspective is a model that examines delinquency and crime that exists from childhood through adulthood. With this perspective, it is important to understand “how lives and societal or historical change both influence each other, and how early events and influences in an individual’s life may influence behavior and other outcomes throughout the life-course” (Laub, Sampson, & Allen, 2001, p. 100). This perspective focuses on both macro-level events that affect a person, along with micro-level events. Macro-level events would include wars, Jim Crow laws, economic recession, and terrorism.
Micro-level events would include choice of friends, education Micro-level attained, having children, and conflicts within the family.
This perspective looks at the life-course of individuals to see the patterns of change that have or have not occurred from childhood into adulthood.
Sampson and Laub (1993) argue that the family processes of social control are a major factor that can lead to delinquency, such as low parental supervision, harsh discipline, and weak parental attachment. Not only are family processes
important to understand, but also school processes. This is where children are developing peer attachments, where they can be either positive or negative, possibly leading to delinquency. If any type of abuse is occurring at home or at school, serious results may happen to the child, possibly leading to a life of delinquency and other issues (Sampson & Laub, 1993). Depending on the
interactions of school and family processes, kids can develop low self-control and social bonds (Sampson & Laub, 1993).
Two main concepts of the life-course theory are trajectories and transitions (Laub et al., 2001). Trajectories can be thought of as pathways of development throughout an individual’s life. These are long-term patterns of behavior, such as marriage, parenthood, and criminal behaviors. Transitions are short-term events that are incorporated into trajectories, such as getting married. These events may be serious enough to alter trajectories. These events may be found at the micro or macro level. A macro level event that could possibly alter an individual’s
the war on drugs has a devastating impact on women, specifically poor women of color (Bloom et al., 2004).
Application of the Life-Course Perspective
The life-course perspective can be used to better understand the factors associated with why women begin to use drugs, many of which go to jail or prison for drug related charges. First, these women could have had negative life
experiences as children on both the micro and macro levels. At the macro-level, drug using women may have been from an economically disadvantaged family due to racial or ethnic prejudices, or the war on drugs. The war on drugs
negatively affected women drug users through higher rates of incarceration, even though the number of drug users has not increased (Bloom et al., 2004). Bloom et al. (2004) believe that the most common pathway for women to become involved in drugs is based upon survival of abuse and poverty. At the micro-level, drug using women could have experienced problems such as abuse, problems in the family dynamics, and job loss. These experiences could have led to beginning to use drugs. As these women continued to age, they may have continued to have negative life experiences, which reinforced them to continue using drugs due to a lack of alternative, legal coping skills.
The first time a woman used drugs could be considered a transition because it is a short term event. However, if a woman perceived this transition to be helpful to their situation, it may turn into a trajectory or long term behavior because transitions can greatly affect trajectories. Transitions and trajectories can alter a woman’s long term behavior. If a woman is in a healthy, long term
relationship, but an incident occurs in which her marriage is no longer stable, then her long term behavior may change. Both macro and micro-level transitions may change a woman’s trajectory.
SECTION IV: CURRENT COMMUNITY BASED PROGRAMS The literature review from section II identified multiple factors that positively affect women in drug treatment programs, which include; increasing self-efficacy, decreasing maternal distress, increasing motivation, increasing length of stay, early release, and assistance regarding their children. It is important to look at these factors in order to identify strong programs that are currently available.
This section looks at two current programs to see what makes these programs effective. By looking at the effective techniques and evaluating what could be changed to make a better program, recommendations can be made. KEY/CREST
The KEY program is a female therapeutic community located at Baylor Women’s Correctional Institute. The CREST program is a work-release program that opened in 1994 to help offenders begin a transition from the KEY program to community supervision. To enter CREST, one must successfully graduate from the KEY program or be court ordered to participate. KEY/CREST is a program that is cited often in the literature. The CREST program incorporates five phases that lasts for approximately six months (Delaware Criminal Justice Council, 2002).
Phase one of CREST lasts approximately two weeks and provides new clients with program rules, structure, and materials. Phase two lasts
approximately eight weeks, which incorporates learning how to operate in the community by doing basic jobs and meeting obligations, for example, group
meetings. Participation is key in this phase. Phase three last for about five weeks. This phase requires clients to continue participating in the community and act as a positive role model for new clients. Phase four last approximately two weeks. This is the phase in which clients begin to find employment in the community. The focus is to teach clients appropriate interview skills and how to impress potential employers. The last phase, phase five, last about seven weeks and requires clients to obtain and maintain a job in the community. Although the participants still live at CREST, they are searching for housing in the community. At the end of these phases, clients are released to the community and have
successfully completed the program. However, they continue to be under supervision, generally by a probation/parole agent.
The Delaware Criminal Justice Council evaluated the KEY/CREST program in 2002 and had multiple findings that are important to this study. First, the council found that women have a higher risk of failing the program if they have: a psychiatric history (formal diagnoses/difficulties), ever contemplated suicide, attempted suicide, or has difficulty controlling her anger (Delaware Criminal Justice Council, 2002). The results found that if a new participant is able to make it through the first five weeks, she will be more likely to be successfully discharged from the KEY program.
The council found six months after leaving prison, 94.1% of those participants who completed both the KEY and CREST program were drug free, whereas 54% of those who only completed the KEY program were drug free, and 84.5% of the CREST only group was drug free. Looking at recidivism, 97.1% of
the KEY/CREST program was arrest free six months after discharge from the prison, whereas 86.5% of the CREST group was arrest free, 75% of the KEY group was arrest free six months after discharge (Delaware Criminal Justice Council, 2002). They found that a comparison group that did not participate in any program, only 71% of the group was arrest free after six months. In a self-report interview, relapse for the comparison group was 45%, while the relapse for the KEY/CREST group was 6% (Delaware Criminal Justice Council, 2002).
The council recommended that there should be a review on how people are placed at CREST. Currently, people can be placed at CREST by court order, as a condition of release, or by request. However, the program needs to ensure that it is not overcrowded and only those that want to make a difference in their life should be placed there to ensure the therapeutic milieu of the program. The second recommendation is for more outside training of staff. They also suggested that the curriculum should be reviewed to ensure that it is gender appropriate and current with the literature. The final recommendation made by the council was for an assessment to determine what actually needs to be changed to improve the environment and therapeutic value of the program. The council had found difference of opinions as to what is “therapeutic” when different people in the program were asked (program directors, counselors, and “family” members). The council reported that “this is significant because research has shown that people in treatment are more successful when they view program modality as treatment” (Delaware Criminal Justice Council, 2002, p. 56).
Methadone Maintenance Programs
Methadone Maintenance (MM) programs are designed for opiate-dependent individuals. MM can be beneficial for opiate-opiate-dependent women coming out of the prison setting in order to reduce the rate of relapse. Methadone is a synthetic narcotic that acts like a long-acting opiate, such as heroin, that provides similar effects, such as sedation and respiratory depression, but is much safer for the user (Lundgren et al., 2005). MM can be beneficial for opiate dependent women that have failed other types of treatment programs. MM can provide women opportunities to find an avenue to reduce or eliminate their drug use, which can result in a better life for themselves, along with their children. Lundgren, Schilling, Ferguson, Davis, and Amodeo (2003) found that MM is an important resource in preserving family units.
Lundgren et al. (2005) did a literature review of social work journals that consisted of child welfare and substance abuse. They also examined policies in 27 states regarding treatment recommendations for substance abusing parents. State welfare policy websites were also reviewed, along with phone calls to organizational representatives to determine whether states had specific substance abuse policy for heroin using parents whose children were involved with the child welfare system. Lundgren et al. (2005) found that many articles recommended the development of more gender-based substance abuse treatment because much of the research is based upon results from treatment programs traditionally
designed for men. They found in many articles that substance abuse treatment for women is interrupted by basic needs, such as transportation, childcare, and lack of
resources. Lundgren et al. (2005) also found that MM is a treatment option for mothers, however, social networking needs to be addressed in methadone clinics. Professionals working in clinics need to help these mothers develop a social network to make MM more effective. They found that many of the state child welfare policies did not provide specific treatment recommendations for specific substance abuse. Lundgren et al. (2005) recommended that there needs to be better integration of child welfare policies and substance abuse treatment services for mothers. Integration is key to reduce harm to the mother, child, and society. They suggested that more training should be done for professionals working with drug addicted mothers in order to better understand the wide range of programs available and what the benefits and deficits are of each program.
SECTION V: RECOMMENDATIONS, SUMMARY, AND CONCLUSION Based upon reviewing the literature, it is apparent that therapeutic
communities that start in prison and assist with transitions back into the
community are the most effective treatment programs for drug using women at this time. Assisting women early in their incarceration to address their underlying issues leading to drug use, it can better help them once they are released from prison or jail due to earlier intervention.
Recommendations
For incarcerated women, the best way to help them work out their issues begins with early intervention. Starting them out in a prison based therapeutic community can help them develop the sense of community and start changing their behaviors. Once their behaviors have changed, then they can begin working on the underlying causes that led them to drug use/abuse in the first place. Once some of these issues have been worked out several months later, then women can begin a transition into working while maintaining sobriety. This is important to teach women that they can be working and going about daily tasks while
remaining sober. The final phase is one of the most important- transition into the community. This is the most important phase in which these women need support because they are going back to the same environment that led them to drug abuse. They need to be supported in a variety of ways to make a successful transition back into the community.
The KEY/CREST program that is being used in Delaware is currently the most effective program available. However, modifications need to be made to the program to make it even more effective and to meet more needs of the women.
The first modification should be made to the therapeutic community so that the women participants feel that they are receiving quality treatment. This can be established by making the environment more welcoming and conducive to changing their behaviors and attitudes. The environment in the community would need to be nurturing for the women in order for them to deal with their issues and develop a healthy sense of family and community. This sense of community would promote learning appropriate social skills within the community and the family. They can learn how to develop healthy relationships with friends, family, and men that would further their sobriety and reduce the risk for recidivism.
This program could even try to incorporate having their children living with them in order to keep the women in the program longer, which has shown that women will have more positive changes the longer they are there. By participating in treatment longer, this can increase their self-efficacy. Dealing strictly with women, staff would need more education regarding the issues that are unique to women.
Increasing their internal motivation has also been proven in the literature to improve their treatment, as they are more motivated to do well. The prison based therapeutic community should be trauma focused therapy, as many of these women have suffered from a trauma in their past that led them to begin using drugs as a way to cope with the pain.
