Substance Use Disorders: Assessment and Treatment, 2nd Edition _ ___________________________________
their current offense under the influence of drugs. One in six state inmates committed their current offense to get money for drugs. Marijuana remained the most commonly used drug, with 22% reporting use in the month before the offense, fol- lowed by cocaine or crack (16%), stimulants (11%), and heroin and other opiates (7%). Among prisoners who were dependent on or abusing drugs, 40% of state and 49% of federal inmates had taken part in drug abuse treatment or programs since admission to prison (Bureau of Justice Statistics, 2020). Treatment in prison employs virtually every approach known— from a therapeutic community approach to mindfulness meditation. Unfortunately, there is almost no information on the effectiveness of these treatment protocols. Lanza and colleagues (2014) conducted a small study in Spain that compared a group of incarcerated women receiving CBT, a group receiving acceptance and commitment therapy (ACT), and a group in a waiting-list control condition. Subjects were evaluated at pretreatment, 3-month, and 6-month follow-up. At the two follow-up intervals, both the CBT group and the ACT group did significantly better than the control group on abstinence from substance use. The ACT group did better than the CBT group. Clinicians may have contact with individuals while they are incarcerated, who are on probation or parole, or who may be involved in diversion programs. Just as a significant proportion of incarcerated individuals have a SUD, so do a large propor- tion of individuals on probation or parole (as well as individu- als in diversion programs). It is interesting to note the gender disparities in the use of treatment services by female as com- pared to male ex-offenders. Compared with male ex-offenders, female ex-offenders are 52% less likely to use substance-abuse treatment services and 51% less likely to use rehabilitation pro- grams (Mahmood et al., 2013). However, female ex-offenders are about 10 times more likely to use substance abuse treat- ment services than are women in the general population. Why this disparity between male and female ex-offenders exists is not known, but it may have something to do with the lack of gender-specific treatment programs for women with SUD, the greater incidence of mental health problems among women ex-offenders, and the need for trauma-informed treatment. Whether an ex-offender is male or female, special needs arise as an individual moves from the prison to the community environment. Ex-offenders need to make the adjustment from an environment in which someone else makes all of their decisions to one in which ex-offenders must take responsibil- ity for decision making and the outcomes of those decisions. Additionally, ex-offenders are moving from a situation in which they may have had some status to one in which they have virtually no status at all. Obtaining and maintaining employment can be difficult after release from incarceration and may be especially difficult for women ex-offenders since many jobs that usually employ large numbers of women, such as childcare, health care, and teaching may not be available to a person with a criminal record. Challenges also emerge in
And your drinking may be your way of trying to deal with all of this. Unfortunately, even though it may seem to help in small ways, my guess is that it tends to make everything worse. I wonder, do you have any thoughts about all that? Client : I know I wasn’t the way I am before the blast. So, it must have something to do with how things are now. I just don’t know if I can ever get back to how I was. Therapist : I don’t know if you can, either, but I know that you can be a whole lot better than you are now. There are a lot of people who are willing to help you – some who have been where you are now. Would you let me introduce you to some of them? Client : I guess I don’t have anything to lose, so OK. But is there something you can do to help my wife and me? I don’t know what I’ll do if she leaves me. Therapist : I think that’s an excellent place to begin. I would like to meet with you together as soon as we can arrange it. You both need to understand what you’re dealing with so you can make a commitment to move forward and know that what you’re suffering with does not have to be permanent. I cannot guarantee that she will be willing to stick with you, but unless you both understand the challenges you face; she will probably leave. INCARCERATION According to government data, women in the criminal justice system have a particularly high rate of substance use problems. For example, approximately 69% of state female prisoners surveyed between 2007 and 2009 met the criteria for SUD (NIDA, 2021i). The recent increase in the number of women who are incarcerated in the United States has been largely attributed to harsher punishment for substance-related (non- violent) offenses. Additionally, a significant number of incar- cerated women have histories of physical and/or sexual abuse (Asberg & Renk, 2012). For example, one half to two thirds of incarcerated women report that they have had childhood sexual abuse experiences and PTSD. These prevalence rates are significantly higher than those found among community samples. Not surprisingly, incarcerated women with substance use problems perceive that they have little social support and very limited social networks. The more severe the substance use problem and the earlier incarceration began, the smaller the sense of social support and the more restricted the social net- work (Brady & Moran-Santa Maria, 2014; Greenfield, 2016). In the 2020 Survey of Inmates in State and Federal Correc- tional Facilities, during 2007-2009, about 4 in 10 state pris- oners (425) and sentenced jail inmates (37%) said they used drugs at the time of the offense for which they are currently incarcerated. Among state prisoners, drug offenders (44%) and property offenders (39%) reported the highest incidence of drug use at the time of the offense. Among federal prison- ers, drug offenders (32%) and violent offenders (24%) were the most likely to report drug use at the time of their crimes. A majority (56%) of state inmates used drugs in the month before the offense in 2004, while a third (32%) committed
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