Nena Messina

Childhood Trauma and Women’s Health Outcomes in a California Prison Population

OBJECTIVES We sought to describe the prevalence of childhood traumatic events among incarcerated women in substance abuse treatment and to assess the relation between cumulative childhood traumatic events and adult physical and mental health problems. METHODS The study was modeled after the Adverse Childhood Events studys findings. In-depth baseline interview data for 500 women participating in the Female Offender Treatment and Employment Program evaluation were analyzed. RESULTS Hypotheses were supported, and regression results showed that the impact of childhood traumatic events on health outcomes is strong and cumulative (greater exposure to childhood traumatic events increased the likelihood of 12 of 18 health-related outcomes, ranging from a 15% increase in the odds of reporting fair/poor health to a 40% increase in the odds of mental health treatment in adulthood). CONCLUSIONS Our findings suggest a need for early prevention and intervention, and appropriate trauma treatment, within correctional treatment settings.

Self-Control and Social Bonds: A Combined Control Perspective on Deviance

With longitudinal data from a sample of adult male drug offenders, this study tested 4 aspects of social bonding (attachment, involvement, religious commitment, and moral belief) and association with substance-using peers as outcomes of low self-control and as mediators of the relationship between low self-control and drug use. Low self-control was negatively related to social bonds and positively related to drug use and association with substance-using peers. The relationship between low self-control and drug use was fully mediated by moral belief and association with substance-using peers. These results support the utility of integrating self-control and social bonding perspectives on deviance.

A randomized experimental study of gender-responsive substance abuse treatment for women in prison

This experimental pilot study compared postrelease outcomes for 115 women who participated in prison-based substance abuse treatment. Women were randomized to a gender-responsive treatment (GRT) program using manualized curricula (Helping Women Recover and Beyond Trauma) or a standard prison-based therapeutic community. Data were collected from the participants at prison program entry and 6 and 12 months after release. Bivariate and multivariate analyses were conducted. Results indicate that both groups improved in psychological well-being; however, GRT participants had greater reductions in drug use, were more likely to remain in residential aftercare longer (2.6 vs. 1.8 months, p < .05), and were less likely to have been reincarcerated within 12 months after parole (31% vs. 45%, respectively; a 67% reduction in odds for the experimental group, p < .05). Findings show the beneficial effects of treatment components oriented toward womens needs and support the integration of GRT in prison programs for women.

Childhood Adverse Events and Current Traumatic Distress A Comparison of Men and Women Drug-Dependent Prisoners

This study describes the prevalence of childhood adverse events (CAEs) among men and women prisoners and assesses the relationship of CAEs to adult symptoms of traumatic distress. Interview data for 427 men and 315 women were analyzed assessing childhood abuse and household dysfunction, drug and criminal histories, and symptoms of traumatic distress. Women offenders had much greater exposure to CAEs than did men and more often reported continued sexual abuse in adolescence and as an adult. Linear regression results showed that the impact of CAEs on traumatic distress was strong and cumulative for both men and women (greater exposure to CAEs increased the likelihood of 6 out of 7 mental health outcomes, although women had higher levels of traumatic distress overall). The findings indicate the need for early prevention and intervention as well as trauma-based treatment within the correctional setting.

Assessing the Needs of Women in Institutional Therapeutic Communities

Abstract This study outlines the treatment needs of women offenders entering prison-based therapeutic communities, known as institutional therapeutic communities (ITCs). Intake data for 4,509 women and 3,595 men from 15 ITCs were compared. Results show that men and women entering prison treatment differ with regard to their substance abuse problems, psychological functioning, sexual/physical abuse histories, employment histories, and child support activity. Women have more severe drug use histories and psychological impairment, were more likely to use prescription drugs, and to report histories of sexual/physical abuse. Men were more likely to have been employed, completed high school, and to plan to support their children upon release. It appears that women entering treatment programs in state prisons are at a substantial disadvantage compared with their male counterparts.

The California Treatment Expansion Initiative: Aftercare Participation, Recidivism, and Predictors of Outcomes:

This study explored possible predictors of participation in aftercare and 12-month return-to-custody (RTC) among 4,155 inmates who participated in prison-based therapeutic community treatment in California. The most consistent theme that emerged from this study was the importance of duration of time spent in treatment. Increased time spent in prison-based treatment predicted increased participation in aftercare and decreased 12-month RTC. Similarly, increased time spent in aftercare predicted decreased 12-month RTC. Those who participated in aftercare in urban counties spent longer periods of time in treatment and were less likely to be returned to custody within 12 months. The findings suggest that Hispanics rely more successfully on social and/or familial support systems than on aftercare postrelease. The findings also highlight the importance of education in facilitating postrelease reintegration and ensuring successful outcomes.

Antisocial personality disorder and TC treatment outcomes.

There is a belief that persons diagnosed with antisocial personality disorder (APD) do not respond well to treatment, but the existing research has not supported this hypothesis. This study examined the relationship of APD to therapeutic community (TC) treatment outcomes. A total of 275 men and women were randomly assigned to two TCs. It was hypothesized that clients diagnosed with APD via the Millon Clinical Multiaxial Inventory (MCMI-II) would have poorer treatment outcomes than those with no APD. The MCMI-II was used to diagnose APD because of its focus in underlying pathological personality traits, as opposed to strict behavioral criteria as used in the Diagnostic and Statistical Manual of Mental Disorders classifications for APD; this hypothesis was not supported. Logistic regression analyses indicated that an MCMI-II diagnosis of APD was unrelated to treatment outcomes. Treatment completion was the most important factor in reducing recent drug use and post-discharge arrests. The results indicate that persons diagnosed with APD, with histories of substantial drug abuse and criminality, can benefit from TC treatment with aftercare in the community or at the very least, do as well as those with no APD. In light of the high prevalence rates of APD in substance-abusing populations, future research should continue to explore the many issues surrounding the diagnosis of APD, as well as its relationship to treatment outcomes.

Who Benefits From Gender-Responsive Treatment?: Accounting for Abuse History on Longitudinal Outcomes for Women in Prison

This study explores outcome variation among women offenders who participated in gender-responsive substance abuse treatment (GRT). To identify subgroups of participants that may differentially benefit from this treatment, secondary analyses examined the interaction between randomization into GRT and a history of abuse (physical/sexual) on depression and number of substances used post treatment. The sample consisted of 115 incarcerated women assessed at baseline and 6 and 12 months post parole. Longitudinal regression showed that women reporting abuse randomized into GRT had significantly reduced odds of depression (odds ratio [OR] = .29, p < .05, 95% confidence interval [CI] = [0.10, 0.86]) and lowered rates of number of substances used (incidence rate ratio [IRR] = .52, p < .05, 95% CI = [0.28, 0.98]), in comparison with those who reported abuse and were randomized to the non-GRT group. Findings suggest that GRT for women offenders who have experienced prior abuse may maximize the benefits of the trauma-informed, gender-sensitive intervention.

Long-term Outcomes among Drug Dependent Mothers Treated in Women-only versus Mixed-gender Programs

This study examined the long-term outcomes of women who were pregnant or parenting at admission to women-only (WO; n = 500) versus mixed-gender (MG; a matched sample of 500) substance abuse treatment programs. Administrative records on arrests, incarcerations, mental health services utilization, and drug treatment participation were collected, covering 3 years preadmission and 8 years postadmission. Women treated in WO programs had lower levels of arrest, mental health services utilization rates, and drug treatment participation during the first year after drug treatment. No differences were found between the two groups in the long-term trajectories except that the WO program participants had lower incarceration rates during the third year after treatment. The study findings suggest a positive short-term impact of WO versus MG programs with regard to arrest and mental health services utilization. Limited long-term gain is shown in the reductions in posttreatment incarceration. The study findings suggest the added value of specialized WO programs and begin to address the gap in knowledge regarding long-term outcomes for substance-abusing women.

Prison-Based Treatment for Drug-Dependent Women Offenders: Treatment Versus No Treatment

Abstract This outcome study compared six- and 1 2-month return-to-custody data for 171 treatment participants and 145 nontreated general population inmates at the Central California Womens Facility (implementing a traditional TC program). Findings showed that there were no differences between the TC treatment group and the no treatment comparison group with regard to six- and 12-month return-tocustody rates (six-month: 16% vs. 16% and 12-month: 36% vs. 27%). The only significant difference in six-month return-to-custody rates was found between treatment-only participants (21%) and the treatment plus aftercare participants (6%). Treatment participants who participated in community-based aftercare were significantly less likely to be returned to custody compared with those who did not participate in aftercare. Multivariate analysis was also used to control for the large difference in psychological impairment between the two groups and other background factors related to reincarceration, while assessing the effect of treatment group status on return-to-custody. Findings indicated that treatment/notreatment status was not significantly related to a six- or 12-month return-to-custody. However, success on parole was associated with participation in community-based aftercare. The lack of a prison-based treatment effect could be an indication that drug-dependent women offenders need gender-responsive treatment that is designed specifically for their complex needs.