Substance Abuse Treatment for Women Offenders: A Research Review

Adams, S, Leukefeld, C.G., & Peden, A.R. 2008. Substance Abuse Treatment for Women
            Offenders: A Research Review. Journal of Addictions Nursing, 19, 61-75.
            doi: 10.1080/10884600802111648

Finfgeld-Connett, D & Johnson, E.D. 2011. Therapeutic Substance Abuse Treatment for Incarcerated
              Women. Clinical Nursing Research, 20(4), 462-481.
              doi: 10.1177/1054773811415844

 This article written by Deborah Finfgeld-Connett and E. Diane Johnson looks at the importance of substance abuse treatment being gender-specific when it comes to incarcerated individuals.

Lanza, P.V. & Menéndez, A.G. 2013. Acceptance and Commitment Therapy for drug abuse in
              incarcerated women. Psicothema, 25(3), 307-312.
              doi: 10.7334/psicothema2012.292
 In this article, the authors set out to test the hypothesis that Acceptance and Commitment Therapy (ACT) would be beneficial in treating substance abuse in incarcerated women. This is a very important hypothesis, in that treatment for substance abuse in incarcerated persons has not been addressed as often as one would hope. In the research that has addressed this issue, the findings most often seem to be from an all-male inmate population.
This study included 31 participants, all women, who were diagnosed with a substance use disorder, were convicted of a sentence of more than 6 months, and voluntarily agreed to participate in the study. Lanza and Menendez collected data on the participants for 3 years between 2009 and 2012 at the specific prison. The participants were assigned to one of two groups: ACT (Acceptance and Commitment Therapy) or CG (control group), and all were given a 75-minute assessment at the beginning of treatment. The treatment itself consisted of 16 weeks of 90-minute weekly sessions and took place in separate groups of 4 female inmates per group. The participants would self-report their drug use throughout treatment while also completing a urinalysis to confirm that they were accurately reporting. The participants in the control group were only given the self-reporting and urinalysis check-ups throughout the 16-week period. Post-treatment, the participants in the ACT group showed a significant difference when it came to abstinence from substances compared to the control. The most interesting finding according to the authors, was that at the 6-month follow-up, 43.8% of the ACT group was able to maintain their abstinence compared to the 18.2% in the control group.
This study reported that the conclusions were consistent with other findings regarding ACT and substance abuse treatment. Perhaps the most interesting and beneficial finding was the 6-month follow-up. It is so important to give individuals who are incarcerated a fighting chance at overcoming addiction. While 12-step programs are extremely popular, ACT may be able to give inmates struggling with addiction the coping skills to overcome triggers, address their own struggles, and learn new ways of dealing with stressors. Though this study only looked at a population of 31 inmates, the findings were extremely compelling and interesting. It is important to know that one major limitation of this study is that it did not test for comorbidity, which is important to address when looking at treatment methods and outcomes. It is also important that we as a country look at the most beneficial ways to help inmates struggling with substance use to overcome their addiction. By teaching coping skills that will aid them in daily life outside of prison, they may have a much higher chance of avoiding relapse and potential incarceration.

Fernandez, P., Menendez, A.G., Rodriguez, F., & Villagra, P. 2013. Long-term outcomes of Acceptance
              and Commitment Therapy in drug-dependent female inmates: A randomized controlled trial.
              International Journal of Clinical and Health Psychology, 14, 18-27.

 This study is also looking into the use of Acceptance and Commitment Therapy (ACT) as a treatment for substance use disorders in incarcerated women. This study however, does not solely look at ACT as a treatment method, but set out to compare ACT and Cognitive Behavioral Therapy (CBT) in long-term efficacy. This research looks at an important aspect of treatment comparisons; their effectiveness long-term. For an incarcerated population, the most efficient treatment long-term could dramatically increase their quality of life during and after serving their sentence, potentially keeping them away from the possibility of future incarceration once their time has been served.

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 This study included 37 participants, all were female inmates who had been diagnosed with current substance abuse or dependence, and most were incarcerated for drug-oriented crimes. Data for this study was collected over a 2-year period between 2010 and 2012. Each participant underwent a 90-minute assessment prior to treatment. Both of the treatment interventions occurred simultaneously in 90-minute sessions over a 16-week period in groups. The Psychologist providing the ACT treatment outlined the main goals throughout treatment as: identifying ineffective strategies, understanding that control is the problem, acceptance and willingness to change, as well as values and commitment. The Psychologist providing the CBT treatment identified their main goals for treatment as: recognizing behavioral patterns, analyzing different drug use/abuse situations, identifying negative emotional states, cognitive restructuring, alternative behaviors, and relapse prevention.

The results of this study were very interesting as the researchers continued to track the progress of the participants for up to 18 months post-treatment. The findings showed a significant difference in abstinence between the CBT group and the ACT group. It was found that the ACT group had 27.8% abstinence immediately after treatment, 84.6% 12 months post-treatment, and 85.7% at 18 months post-treatment. This was calculated to be significantly higher than the CBT treatment, as that group had percentages of 15.8% immediately after treatment, 54.5% 12 months post-treatment, and finally just 50% at 18 months post-treatment. One of the important things to notice when looking at these findings is that both CBT and ACT seem to be efficacious as they both showed significant increases in abstinence up to 18 months post-treatment. However, in this specific study, ACT presented with significantly higher rates of abstinence than did CBT.

Some limitations of this study include the presence of other disorders that may have gone unnoticed throughout treatment and may have potentially had an impact on the outcome of treatment. Another limitation could potentially be that these treatments were given by different therapists, and though the treatment consists of following protocol, there is a significant importance of the therapeutic relationship in both of these treatment methods. However, the findings in this article present very interesting evidence into treatments for incarcerated women struggling with SUD’s. While CBT is a very popular and efficacious therapy used to treat substance use in individuals, ACT seems to have a long-lasting and possibly higher positive impact on incarcerated women specifically.

Garcia, P.F., Lamelas, F.R., Lanza, P.V., & Menendez, A.G. 2014. Acceptance and Commitment Therapy Versus Cognitive Behavioral Therapy in the Treatment of Substance Use Disorder with Incarcerated Women. Journal of Clinical Psychology, 70(7), 644-657.
doi: 10.1002/jclp.22060

The objective of this study was to compare Acceptance and Commitment Therapy (ACT), Cognitive Behavioral Therapy (CBT), and a control group to understand the differences in efficacy between the two therapies when it comes to treating incarcerated women with substance use disorders (SUD’s). This study looks deeper into the differences seen at post-treatment regarding both therapies that may help to give insight into what needs to be incorporated into future therapies in order to see the highest level of abstinence post-treatment for incarcerated women.

The participants of this study consisted of 50 incarcerated women in a state prison who met the diagnostic criteria for currently having an SUD. They also were individuals serving a sentence of 6 months or more. All of the participants were given an assessment involving a questionnaire prior to treatment, an assessment immediately after treatment, and then a follow-up 6 months post-treatment. The data was collected over a span of 3 years from 2009 to 2012. All participants participated in 16 weeks of group sessions lasting 90 minutes each. The CBT group focused on altering the behavior resulting from their negative schemas and understanding how that may affect their behavior in relation to their SUD. The ACT group was focused more on how they could respond to events in a novel way while trusting themselves, becoming empowered, and taking back control of their behaviors. The control group received mental health assessments at the same time as both experimental groups and they would receive treatment after the 6-month follow-up had been complete.

The results were seen to show a significant difference between the ACT group and the control. At post-treatment, the CBT group was reported to have 15.8% abstinence, the ACT group 27.8%, and the control group 7.7%. At the 6-month follow-up, the CBT group was at 26.7%, the ACT group was at 43.8%, and the control was at 18.2% abstinence. The ACT group had the highest percentage of abstinence at both post-treatment and the 6-month follow-up compared to the CBT group as well as the control. The study also found that 86% of the participants assessed displayed criteria for at least one other mental disorder. One very important finding was looking at anxiety and avoidance in the participants. It was seen that anxiety was progressively decreasing throughout the course of treatment for both the ACT and CBT groups, however, the CBT group change at post-treatment seemed to fade when observed at the 6-month follow-up while the ACT group’s change was maintained. ACT also showed that anxious and depressive symptoms significantly decreased over the course of treatment compared to the other groups.

Some of the limitations of this particular study involve the sample size as well as the environment. This study was completed using inmates from one specific prison, it may be much more beneficial to use a variety of inmates over many different prisons to determine whether or not there is a significant difference based on the specific prison environment. Again, the therapies were completed by two different psychologists, and as the therapeutic relationship is very important in both treatments, it may have influenced the study in some way. The study was stronger than some of the previous studies discussed because of the use of resources to determine whether or not the inmates were presenting with comorbid disorders. These studies are very beneficial to incarcerated persons in the way that they pave the way for improvement in not only the incarcerated individuals with SUD’s, but our justice system as well. It is easy to lock people up, release them, lock them up again, etc. but if we could just provide them with the resources to make this change in themselves, there is potential to decrease the number of re-incarcerations.