Sheryl Pimlott Kubiak

The Effects of PTSD on Treatment Adherence, Drug Relapse, and Criminal Recidivism in a Sample of Incarcerated Men and Women

Objective/Method: Given the relationship between post-traumatic stress disorder (PTSD) and substance use disorders (SUD), and the prevalence of SUD among offenders, the inattention to trauma before, during, and after incarceration is troubling. This exploratory study compared those with and without co-occurring PTSD among men (n = 139) and women (n = 60) involved in prison-based substance abuse treatment. Results: More than one half the sample met criteria for lifetime PTSD with women experiencing a greater number of events and men experiencing more recent events. Women with PTSD were significantly more likely to relapse than women without. Men with PTSD were more likely to enter community aftercare treatment and recidivate than those without. Conclusion: The findings suggest that trauma-related disorders, among those with SUD, affect postincarceration outcomes. Therefore, from a practice and policy perspective, interventions addressing this co-occurring disorder should be available to men and women within the criminal justice system.

Trauma and Cumulative Adversity in Women of a Disadvantaged Social Location

This study expands conceptual and empirical perspectives on stress exposure by evaluating cumulative exposure in 79 drug-convicted women. Logistic regression determined that (a) posttraumatic stress disorder (PTSD) increased 40% with each trauma and (b) adding chronic stressors increased the predictability of PTSD. This study supports cumulative adversity models and the importance of social location.

Treatment at the front end of the criminal justice continuum: the association between arrest and admission into specialty substance abuse treatment

BackgroundTo reduce criminal recidivism and drug use, it has been proposed that the substance abuse treatment delivery system cut across different components of the criminal justice continuum. Arrest, at the front end of this continuum, may represent a critical moment to motivate people with substance use disorders (SUD) to seek treatment but is often over looked as an intervention point. We used data from the 2002 National Survey on Drug Use and Health (NSDUH) to compare treatment need and recent treatment admission for participants with no criminal justice (CJ) involvement in the past year, past-year arrest, and CJ supervision (i.e., probation or parole status).ResultsOf those arrested, 44.8% met criteria for an SUD. However, only 14% of those arrested with an SUD received treatment in the year of their arrest. In multivariate modelling, arrest was an independent predictor of treatment admission (odds ratio (OR) = 8.74) similar in magnitude to meeting criteria for an SUD (OR = 8.22). Those further along the continuum – under supervision – were most likely to receive treatment (OR = 22.62).ConclusionArrest involves the largest number of individuals entering the criminal justice system. The NSDUH suggests that nearly 6 million individuals in the US experience an arrest annually and that nearly half meet criteria for an SUD. Although arrest involves the largest number of individuals entering the criminal justice system, it is also the most fleeting point as individuals can move in and out rather quickly. Minimally, arrest imposes contact between the individual and a law enforcement person and can be an opportunity for early intervention strategies such as pre-arraignment diversion into treatment or brief intervention strategies. Using brief intervention at this early point in the continuum may motivate a greater number of individuals to seek treatment or decrease drug and alcohol use. Training and procedural shifts at this point of contact could have important policy implications in reducing the number of subsequent arrests or preventing individuals moving further along the criminal justice continuum, as well as decreasing the fiscal and resource burdens associated with criminal justice processing and confinement.

Testing the Validity of the K6 in Detecting Major Depression and PTSD Among Jailed Women

Despite high prevalence rates of mental illness, jails often lack validated measures for detecting it, and many of the screening instruments used do not adequately identify depression and trauma-related disorders in women. The authors assessed the validity of the K6 in identifying major depression and PTSD among 515 jailed women, comparing it to two valid and reliable screening tools, the PHQ-9 and the Short Screening Scale for DSM-IV PTSD. The K6 identified 37% of women as having serious mental illness using the customary cut score of 13, with an ROC-AUC value of .92 in detecting major depression or PTSD. However, this cut score misclassified a substantial proportion of women; therefore, a modification of this score may be warranted. Lowering this cut score would increase the number of women identified but may be justified by incarcerated women’s high rates of exposure to trauma and the consequences of unmet mental health needs.

Service Needs for Incarcerated Adults: Exploring Gender Differences

Although men comprise the largest segment of the jail population, women are entering jails at increasingly higher rates than men. Previous research has found that incarceration is associated with multiple factors, including homelessness, substance use disorders, and mental illness, however, gender differences in services needs for female and male inmates is understudied. This study explores gender differences among a representative sample of incarcerated individuals (n = 725) from a Midwestern, urban jail. Women in the sample presented with higher rates of homelessness prior to incarceration, anticipated postincarceration homelessness, serious mental illness, substance use disorder, and trauma histories than men, as well as higher rates of multiple and co-occurring risk factors. These findings point to the need for social work interventions initiated at jail intake. Such interventions could impact parenting, housing stability, and mental health and prevent future incarceration, reoffending and relapse for this high-risk population of women.

Pregnant, Substance-Abusing, and Incarcerated: Exploratory Study of a Comprehensive Approach to Treatment

Interventions addressing the multiple needs of incarcerated women are rare. In this study, several measures were used to assess functional changes among pregnant, substance-dependent, incarcerated women transferred to a community-based residential treatment program that allowed their infants to reside with them. Women engaged in comprehensive therapeutic and skill-building activities for 6 to 9 months. The programs goal was to assist women in childbirth and in the continuing relationship with their child while improving psychological and social functioning. Examination of changes were limited to those who completed treatment and all measures (n = 27). Although significant improvements were noted, nearly half were discharged with symptoms indicative of a depressive disorder. Assessment of long-term outcomes comparing this group with pregnant women who remained in prison is under way.

Public Attitudes Toward Juveniles Who Commit Crimes The Relationship Between Assessments of Adolescent Development and Attitudes Toward Severity of Punishment

In this article, the authors used a statewide survey to investigate the extent to which beliefs regarding the age at which youth reach maturity, the role of peer influences, and other factors, such as abuse during childhood, are associated with measures of how harshly juveniles should be treated by the justice system. The results of this study provide strong support for the hypothesis that assessments of adolescent development are important predictors of attitudes about how juveniles should be treated in the justice system. In all cases, variables measuring attitudes surrounding adolescent development explained substantially more of the variance in attitudes toward punishment than did demographic and socioeconomic variables.

Using the K6 to Assess the Mental Health of Jailed Women.

Despite high prevalence rates, many jails lack validated measures or consistent processes for detecting mental illness. In this study, we examined the utility of the K6, an internationally used brief mental health screening measure within an urban jail. The K6 and several other mental health measures were administered to 515 jailed women. The K6 identified 36% as having a serious mental illness. There was a high concordance with the other measures, particularly when using the highest level of symptom distress (top quartile) as the comparison. These findings are promising, particularly when other mental health screening tools have less success in detecting depression and trauma-related disorders among women.

Assessing Short-Term Outcomes of an Intervention for Women Convicted of Violent Crimes

Women convicted of violent offenses represent a small but important subpopulation of women involved in the criminal justice system. Correctional administrators working with these women often rely on treatment and rehabilitation programs developed for violent male offenders. Although women’s trajectories into violent behavior—as well as their trajectory out—differ from their male counterparts, the field is marked by the absence of interventions designed specifically for women with violent offenses. As attention grows in the research literature and in community settings about “women who use force” it is important to develop interventions that effectively modify aggressive behavior as well as the underlying precursors of such aggression. This paper describes a pilot study as one step in a developmental approach to intervention research. Beyond Violence, a gender specific and trauma-informed intervention, was piloted with 35 women incarcerated in a state prison with a conviction for a felony-level assault. Short-term outcomes assessed through changes in pre- and posttest measures show reductions in mental health symptoms associated with depression, anxiety, posttraumatic stress disorder, and serious mental illness. The encouraging results of this pilot study have led to the next step in the intervention research process of testing the program in a randomized controlled trial that is currently underway.

Acculturation and Polysubstance Abuse in Arab-American Treatment Clients:

Acculturation to U.S. culture by Latinos and Asian Americans has been associated with increased prevalence of substance abuse. However, little is known about the association between acculturation and substance use among Arab Americans, or more specifically, among Arab-American treatment clients. In 156 Arab-American male treatment clients, we found that higher levels of U.S. acculturation were positively associated with increased prevalence of polysubstance abuse. This first report on a large series of Arab-American clients also found considerable within-group variability. These results can be used to develop treatment plans and work-force training on the importance of U.S. acculturation and variability within Arab Americans.