Bernadette Pelissier

Gender differences among prisoners in drug treatment.

PURPOSE Nearly all prison-based substance abuse treatment programs have been designed with male prisoners in mind. Administering these male-oriented programs to women prisoners has been the standard correctional practice. Recently, this practice has received considerable criticism. Critics argue that female prisoners have special needs that are not met by programs originally designed for male prisoners. However, most of the empirical support for the existence of such special needs rely on two inappropriate samples: prisoners who are not in treatment and treatment participants who are not incarcerated. Findings from these two different groups may not be generalizable to the population of prisoners in treatment. METHODS This paper directly addresses this generalizability problem with an examination of gender differences among 1,326 male and 318 female federal prisoners who were enrolled in a substance abuse treatment program. RESULTS Women used drugs more frequently, used harder drugs, and used them for different reasons than men. Women also confronted more difficulties than men in areas linked to substance abuse such as educational background, childhood family environment, adult social environment, mental health, and physical health. CONCLUSION We find support for the argument that substance abuse treatment programs which were originally designed for men may be inappropriate for the treatment of women.

A Review of Gender Differences Among Substance Abusers

This article provides a review of various types of literature on gender differences among substance abusers. The authors begin this literature review by summarizing the literature on the differing treatment needs of men and women. The authors continue with a review of the empirically based literature on gender differences in background characteristics of substance users. They conclude with a review of treatment outcome studies. This review provides a context for identifying the gaps in the literature and identifies a research agenda that will help improve treatment services for women in both community-based and prison settings.

Gender differences in outcomes from prison-based residential treatment

This study examines gender similarities and differences in background characteristics, the effectiveness of treatment, and the predictors of post-release outcomes among incarcerated drug-using offenders. The sample of 1,842 male and 473 female treatment and comparison subjects came from a multi-site evaluation of prison-based substance abuse treatment programs. Three-year follow-up data for recidivism and post-release drug use were analyzed using survival analysis methods. Despite the greater number of life problems among women than men, women had lower three-year recidivism rates and rates of post-release drug use than did men. For both men and women, treated subjects had longer survival times than those who were not treated. There were both similarities and differences with respect to gender and the other predictors of the two post-release outcomes. Differences in background characteristics and in factors related to post-release outcomes for men and women suggest the plausibility of gender-specific paths in the recovery process.

Federal prison residential drug treatment reduces substance use and arrests after release.

Objective: The effectiveness of federal prison-based residential drug and alcohol treatment programs was evaluated using event history procedures that addressed the problem of selection bias and included a wide range of control variables. Methods: The sample comprised 760 treatment subjects and 809 comparison subjects. Treatment subjects were from 20 different prisons of medium, low, and minimum security levels. Comparison subjects were drawn from over 30 prisons. Results: The results indicated that individuals who entered and completed in-prison residential treatment were less likely to experience the critical postrelease outcomes of new arrests and substance use during the first 6 months following release. Conclusions: Without controlling for selection bias, the effects of treatment would most likely have been attenuated. The results have greater generalizability than other studies of prison-based treatment. This study occurred within a multisite context of 20 programs serving both male and female inmates and operating within different security levels and different geographic regions.

Alternative solutions to the problem of selection bias in an analysis of federal residential drug treatment programs.

In an evaluation of prison-based residential drug treatment programs, the authors use three different regression-based approaches to estimating treatment effects. Two of the approaches, the instrumental variable and the Heckman approach, attempt to minimize selection bias as an explanation for treatment outcomes. Estimates from these approaches are compared with estimates from a regression in which treatment is represented by a dummy variable. The article discusses the advantage of using more than one method to increase confidence in findings when possible selection bias is a concern. Three-year outcome data for 2,315 federal inmates are used in analyses where the authors separately examine criminal recidivism and relapse to drug use for men and women. Statistical tests lead the authors to conclude that treatment reduces criminal recidivism and relapse to drug use. The treatment effect was largest when the inference was based on the Heckman approach, somewhat smaller when based on the instrumental variable approach, and smallest when based on the traditional dummy variable approach. Treatment effects for females were not statistically significant.

Antisocial personality and depression among incarcerated drug treatment participants.

PURPOSE The co-occurrence of antisocial personality (ASP) and depression among drug-dependent individuals was examined in a sample of federal inmates participating in residential or outpatient drug and alcohol treatment to increase our understanding of the co-occurrence of these disorders. METHODS We examined drug dependence patterns both by the number of drugs of dependence as well as by type of drug, and separately studied men and women. The Diagnostic Interview Schedule (DIS) was used to obtain DSM-III-R diagnostic information on a sample of 609 men and women participating in a multi-site drug treatment evaluation project. Logistic regression results are reported that compared lifetime rates of ASP and major depression by number of drugs of dependency for men and women. ASP and major depression diagnostic rates were also examined by type of drug dependency pattern among men. RESULTS We found that both the number of drugs as well as the type of drug(s) are related to prevalence patterns for both diagnoses. The high rates of ASP and major depression among specific subgroups of drug-dependent inmates highlight the need for thorough psychiatric assessment and the tailoring of treatment programs to the issues associated with these diagnoses. IMPLICATIONS Our results suggest that although there are similarities in co-morbidity between men and women, the differences point to the need to study men and women separately.

Substance Abuse Treatment Outcomes: A Multi-Site Study of Male and Female Prison Programs.

Abstract The present study examined whether there were program differences with respect to post-release outcomes in 20 federal in-prison substance abuse programs which used a cognitive-behavioral treatment approach. Recidivism and post-release drug use were examined for a sample of 1,343 individuals—1,065 men and 278 women. Discrete time proportional hazards regression models showed that, after controlling for individual characteristics, no differences were detected among the 16 programs for men. In contrast, one of the four female programs had significantly higher drug use rates and one had significantly lower recidivism rates. Our results suggest that implementation of a treatment approach which has been shown to be effective—cognitive-behavioral treatment—can result in comparable outcomes across programs, despite differences in program implementation. However, specific types of variation in program implementation may affect outcomes.

Correlates of Drug Treatment Outcomes for African American and White Male Federal Prisoners: Results from the TRIAD Study

The purpose of this study was to compare the effects of family background and preincarceration socioenvironmental variables on three‐year post‐release drug use for African American and white prison‐based drug treatment participants in order to explain the previously found disparities in rates of three‐year post‐release drug use between the two groups. There were two hypotheses: 1) for both groups, family background and preincarceration socioenvironmental variables would predict postrelease drug use more strongly than sociodemographic characteristics and preincarceration behaviors, and 2) the predictors would be different for each group. The sample included 279 African American and 512 white male treatment participants who were supervised by a U.S. probation officer following incarceration. Event history analyses were used to model time to first drug use during postrelease supervision. The results indicated that none of the family background factors or socioenvironmental variables predicted postrelease drug use. The variables predictive of drug use for one or both racial groups were limited to sociodemographic characteristics and preincarceration behaviors such as age at release, prior commitments, and preincarceration employment. Yet, there were no significant between‐group differences for these predictors. The authors concluded that future assessment of the effects of socioenvironmental variables on postrelease drug use likely requires evaluation of the postrelease social environment at the time of release.