Alcoholics Anonymous and hazardously drinking women returning to the community after incarceration: predictors of attendance and outcome

Randomized controlled trial of twelve-step volunteer linkage for women with alcohol use disorder leaving jail

BACKGROUND

Alcohol use disorder predicts poor health outcomes among women returning to the community from jail. Twelve-step self-help groups are free and accessible to women leaving jail, but reaching out to strangers can pose a barrier. Pilot work suggested that a volunteer-led "warm handoff" may increase post-release twelve-step self-help group attendance.

METHODS

This randomized trial evaluated the effectiveness of a warm handoff intervention on post-release twelve-step attendance and alcohol use. Participants (189 women with alcohol use disorder) were recruited in jail and followed for 6 months after release. Participants were randomized to: (1) a warm handoff, in which a female twelve-step volunteer met with each woman individually in jail and the same volunteer attended the woman's first twelve-step meeting with her after release; or (2) enhanced standard care (a list of meetings and community resources). Outcomes included days abstinent from alcohol, drinks per drinking day, alcohol-related problems, twelve-step attendance, twelve-step affiliation, network support for abstinence, number of unprotected sexual occasions, and drug using days.

RESULTS

Among intervention participants, only 66 % were aware that the volunteer tried to contact them after jail, only 38 % reported post-jail contact with their volunteers (typically phone), and only four went to meetings with their volunteers post-release. Of 8 post-release outcomes, intervention effects differed on only one (alcohol-related problems).

CONCLUSION

Although twelve-step self-help group attendance predicted alcohol abstinence, the volunteer-led warm handoff intervention did not increase twelve-step attendance. The twelve-step tradition of Attraction may inhibit the active outreach required to connect women to services after jail release.

Correlates of alcoholics anonymous affiliation among justice-involved women

BACKGROUND

Alcohol use disorder (AUD) constitutes a major public health problem and is associated with a substantial amount of disability and premature death worldwide. Several treatment and self-help options including Alcoholics Anonymous (AA) meetings are available. Nevertheless, factors associated with AA affiliation in some disadvantaged groups such as justice-involved women are not well understood. The purpose of this study is to report on previously unexamined correlates of past year AA affiliation among women in pretrial jail detention.

METHODS

The current study used cross-sectional data from 168 women with DSM-5 diagnosis of  AUD in pretrial jail detention. The study examined factors related to women's concept of self and others (i.e., disbelief that others are trustworthy, lack of autonomy to choose who they interact with, experience of violent victimization, low investment in self-care, higher stress levels, and homelessness) as correlates of past-year AA affiliation, controlling for severity of AUD and demographic factors.

RESULTS

Women who believe that others are inherently trustworthy, women who met less AUD criteria, and women who are older reported more past-year AA affiliation in both univariate and multivariate analyses.

CONCLUSION

Introducing AA outreach and alternative interventions for younger, less severely addicted women might improve AUD outcomes. Moreover, designing more individualized treatment plan for women who believe others are not trust worthy might help AUD treatment engagement in this population.

TRIAL REGISTRATION

NCT01970293 , 10/28/2013.

Study protocol: Community Links to Establish Alcohol Recovery (CLEAR) for women leaving jail

PURPOSE

This article describes the protocol for a randomized effectiveness trial of a method to link alcohol use disordered women who are in pretrial jail detention with post-release 12-step mutual help groups.

BACKGROUND

Jails serve 15 times more people per year than do prisons and have very short stays, posing few opportunities for treatment or treatment planning. Alcohol use is associated with poor post-jail psychosocial and health outcomes including sexually transmitted diseases and HIV, especially for women. At least weekly 12-step self-help group attendance in the months after release from jail has been associated with improvements in alcohol use and alcohol-related consequences. Linkage strategies improve 12-step attendance and alcohol outcomes among outpatients, but have not previously been tested in criminal justice populations.

DESIGN

In the intervention condition, a 12-step volunteer meets once individually with an incarcerated woman while she is in jail and arranges to be in contact after release to accompany her to 12-step meetings. The control condition provides schedules for local 12-step meetings. Outcomes include percent days abstinent from alcohol (primary), 12-step meeting involvement, and fewer unprotected sexual occasions (secondary) after release from jail. We hypothesize that (Minton, 2015) 12-step involvement will mediate the intervention's effect on alcohol use, and (O'Brien, 2001) percent days abstinent will mediate the intervention's effect on STI/HIV risk-taking outcomes. Research methods accommodate logistical and philosophical hurdles including rapid turnover of commitments and unpredictable release times at the jail, possible post-randomization ineligibility due to sentencing, 12-step principles such as Nonaffiliation, and use of volunteers as interventionists.

Criminal typology of veterans entering substance abuse treatment

Criminal justice involvement among veterans is a critical and timely concern, yet little is known about criminal histories and clinical characteristics among veterans seeking treatment for substance use disorders (SUDs). The present study examined criminal typology, clinical characteristics, treatment utilization, and 12-step mutual-help group (MHG) participation among veterans (N = 332) at intake to SUD treatment at the Department of Veterans Affairs (VA), and 6 months and 1 year post-intake. Cluster analysis yielded three types of criminal histories mild-(78.9%), moderate (13.6%), and severe (7.5%)-distinguished by type of offense, number of convictions, and number of months incarcerated. At intake, participants with mild criminal histories reported more alcohol problems and fewer legal and employment problems than participants with moderate and severe criminal histories. Participants with severe criminal histories were most likely to attend a 12-step MHG meeting in the year post-intake, but all groups had high attendance. When only participants who had attended at least one meeting in the year post-intake were compared, participants with mild criminal histories worked more steps and were more involved in 12-step practices. All groups improved between baseline and follow-up and did not differ at follow-ups on substance use or other clinical outcomes. Multiple regressions identified treatment utilization and MHG attendance, but not baseline criminal history, as significant predictors of improved substance use problem severity at follow-up. Outpatient treatment and 12-step MHG attendance appear to be important components of recovery for veterans with varying criminal histories. Clinicians in SUD treatment programs should screen for criminal histories at treatment intake to ensure appropriate treatment planning.

Pilot test of 12-step linkage for alcohol-abusing women in leaving jail

BACKGROUND

More than a million US women are detained in jails each year; many have alcohol use disorders (AUDs). AUD intervention with pretrial jail detainees presents a logistical challenge due to limited jail stays and lack of resources for postrelease treatment. The availability, no-cost entry, and promise of anonymity of Alcoholics Anonymous (AA) make it a highly accessible resource for underserved populations. However, the outreach of AA volunteers into jails (as opposed to prisons) has been limited, and incarcerated women are unlikely to seek out strangers for help after release. This study pilot tested an enhanced referral approach introducing a 12-step volunteer to a woman in jail who would attend a meeting with her after release.

METHODS

Participants were 14 unsentenced female pretrial jail detainees with AUD. Intervention consisted of introducing participants detained in jail to female AA volunteers who could accompany them to an AA meeting after release. Assessments took place at baseline and 1 month after release. This uncontrolled pilot study evaluated the feasibility and acceptability of this enhanced referral approach. Pre-post alcohol use, drug use, alcohol problems, and AA attendance are also reported.

RESULTS

Enhanced referral was feasible and acceptable. Many (57%) of the 14 participants who met with AA volunteers in jail were in contact with those volunteers after release from jail. Participants had significantly fewer drinking days, heavy drinking days, alcohol problems, and drug-using days during the postrelease follow-up than they did before jail detention.

CONCLUSIONS

Providing linkage between women in jail and female AA volunteers who can accompany them to a postrelease meeting is achievable, and may be a disseminable and low-cost method to improve alcohol outcomes in this vulnerable population.

Integrating psychotherapy research with public health and public policy goals for incarcerated women and other vulnerable populations

OBJECTIVE AND METHOD

In this article, I review my research applying interpersonal treatments and interpersonal principles from psychotherapy for major depression and substance use to broader public health goals for incarcerated women and other vulnerable populations.

RESULTS

A public health focus has led me to expand the boundaries of psychotherapy research to include partners such as prisons, parole officers, and bachelor's level providers; behaviors like risky sex; service delivery challenges; and ultimately to research with an eye toward informing policy and advocacy.

CONCLUSIONS

A public health perspective provides context and rationale for conducting sound psychotherapy research; the combination of public health and psychotherapy-specific perspectives can lead to novel research.