GENDER DIFFERENCES AMONG PRISONERS ENTERING DRUG TREATMENT

Executive Summary - 2000

Overview of Study

Results from the Treating Inmates Addicted to Drugs (TRIAD) study found that the Federal Bureau of Prisons’ residential drug abuse program (DAP) reduced arrests and drug use in both the six months and three years following subjects’ release from prison, taking into account the effects of self-selection into treatment. The TRIAD study improved upon previous research by considering the entire population of eligible subjects in comparing the outcomes for those who entered and completed treatment and those who did not.

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 which are not met by programs originally designed for male prisoners. However, most of the empirical support for the existence of such special needs relies 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. This paper directly addresses this generalizability problem with an examination of gender differences between male and female federal prisoners who were enrolled in a substance abuse treatment program.

The study used a sample of 1,326 male and 318 female treatment subjects who participated in DAP between June 1992 and January 1996. We compared and contrasted the history of drug use, the history of previous substance abuse treatment, criminal history, employment history, and family characteristics of men and women. Our study also included information on DSM-III-R diagnoses of lifetime major depression and antisocial personality. Because of gender differences in the demographic profile which could be related to the characteristics of interest, our analyses controlled for age, race, ethnicity, prior commitments and marital status.

The results indicated that, net of group differences in demographic characteristics, women were statistically significantly different from men for 14 of the 17 items examined. The results concerning drug use history indicated that women were significantly more likely to have used drugs daily, to have engaged in daily use of two or more hard drugs, to have engaged in daily use of heroin and cocaine, and to say they used drugs to alleviate physical or emotional pain (men were more likely to report that they used drugs because they "enjoyed it"). Notably, there was no gender difference in having used marijuana on a daily basis in the year before incarceration or in the likelihood of being alcohol dependent.

An examination of gender differences for education and employment stability indicated that women were less likely to have completed the twelfth grade or to have obtained a GED. However, there was no difference with respect to the number of periods of previous unemployment – defined as a period of unemployment which lasted 30 days or longer - reported by each gender.

Gender comparisons of childhood family backgrounds showed that women were more likely to have grown up in homes where drug use was present, and were more likely to have experienced physical or sexual abuse in those homes. We also found gender differences in adult social environment. Women were more likely to report that prior to their arrest they had a close friend with a drug problem and that they had a spouse with a drug problem.

An examination of mental health indicators showed that women were more likely to have a diagnosis of depression. In contrast, women and men were equally likely to have a diagnosis of antisocial personality. Lastly, we examined gender differences in physical health and responsibility for children. We found that women were more likely to give an unfavorable report about their physical health and that they were more likely to report plans for living with their children after release from prison.

Clinical Implications

Having found significant gender differences in a sample of drug treatment participants, we turn now to the question of implications of these differences for designing and implementing substance abuse treatment programs. That women presented with a more severely impaired profile than men along with their acknowledgment that they use drugs in response to emotional and physical pain indicates that in-prison substance abuse treatment represents a unique opportunity for incarcerated women to obtain much needed relief from their psychological distress. Therefore, treatment programs need to address women’s emotional distress and behavioral impairment using gender-specific methods. Recent research on community-based programs which treat women indicates that women respond more favorably to programs that have a nurturing rather than a confrontational environment. To demonstrate their responsiveness to women’s issues like those found in this study, programs should also provide comprehensive assessment and reassessment before, during, and after treatment to identify the individual diagnosis which will be used to developed an appropriate treatment plan. It is likely that holistic treatment which provides more intensive individual counseling and emphasizes adjuncts to counseling such as psychotropic medication and physical health care may be required. Additionally, clinicians in prison-based programs should be aware that they are dealing with women who are significantly behaviorally impaired (e.g., antisocial personality disorder) relative to community samples of women in addition to their drug-related behaviors and emotional and physical issues. Therefore, attention must also be given to imposing very clear boundaries and implementing consistent behavioral guidelines for the women within the context of a more nurturing treatment environment. Finally, it should be noted that men with similar profiles as the women in this study might also benefit from the programmatic elements suggested above.