A systematic review of post-release programs for women exiting prison with substance-use disorders: assessing current programs and weighing the evidence

New trends of drug abuse in custodial settings: A systematic review on the misuse of over-the-counter drugs, prescription-only-medications, and new psychoactive substances

The article presents a systematic literature review on the use and the psychiatric implications of over-the-counter drugs (OTC), prescription-only-medications (POM), and new psychoactive substances (NPS) within custodial settings. The searches wer carried out on 2 November 2022 on PubMed, Scopus, and Web of Science in line with PRISMA guidelines. A total of 538 records were identified, of which 37 met the inclusion criteria. Findings showed the most prevalent NPS and OTC and POM classes reported in prisons were synthetic cannabinoids receptor agonists (SCRAs) and opioids, respectively. NPS markets were shown to be in constant evolution following the pace of legislations aimed to reduce their spread. The use of such substances heavily impacts the conditions and rehabilitation of persons in custody, with consequent physical and mental health risks. It is important to raise awareness of the use and misuse of such substances in prisons (i) from an early warning perspective for law enforcement and policy makers (ii) to prompt doctors to cautiously prescribe substances that may be misused (iii) to improve and increase access to treatment provided (iv) to add such substances to routine toxicological screening procedures (v) to improve harm reduction programmes.

Expanding Treatment, Recovery, and Reentry Services for Female Offenders: Improving Outcomes through Client-Centered Interventions

This study investigated the impact of a specialized program aimed at improving substance use disorder and trauma treatment, recovery, and reentry services for adult female offenders. Trained recovery coaches delivered pretreatment interventions such as prescreening, motivational interviewing, and support-building to facilitate treatment entry and improve outcomes. Of 113 participants, 40% identified as racial/ethnic minorities, and 72% fell within the 25-45 age range. A notable 44.5% reduction in self-reported psychiatric symptoms was observed, alongside significant improvements in abstinence and trauma symptoms. Recovery capital and psychosocial functioning showed marked improvement including significant changes in employment status and housing stability and a decrease in criminal justice involvement. The results suggest that targeted, client-centered approaches can effectively improve recovery and psychosocial functioning among female offenders while reducing re-incarceration rates. These findings underscore the importance of addressing the unique needs of this population in both pre-and post-release settings to ensure equitable access to reentry services.

Predicting violence in female forensic inpatients with substance use disorders - the utility of a gender-responsive assessment

Introduction

Given that risk assessment tools are commonly based on male samples, the applicability to justice-involved women remains to be clarified. This study aimed at assessing (1) the predictive validity of the HCR-20 V3, the prevailing, yet primarily male-based violence risk assessment instrument, and (2) the incremental validity of the FAM, a gender-responsive supplement, for both inpatient violence and violent recidivism in justice-involved women.

Methods

The sample included 452 female forensic inpatients with substance use disorder discharged from German forensic psychiatric care between 2001 and 2018.

Results

ROC analyses revealed good predictive accuracy for the HCR-20 V3 while the FAM failed to provide incremental validity. Further, binary logistic regression determined several predictors of violence including personality disorder, covert/manipulative behavior, suicidal behavior/self-harm, and problematic intimate relationship.

Discussion

These findings support the applicability of the HCR-20 V3 in justice-involved women with substance use disorder, while highlighting the clinical relevance of the FAM in supporting a gender-informed risk management.

The associations between social determinants of health, mental health, substance-use and recidivism: a ten-year retrospective cohort analysis of women who completed the connections programme in Australia

BACKGROUND

Women with substance-use issues are overrepresented in prison. Research on women's recidivism often focuses on offending behaviour rather than the health and social circumstances women are experiencing when reimprisonment occurs. This study examines the relationship between social determinants of health (SDOH), mental health, substance-use and recidivism among women exiting prison with histories of substance-use.

METHODS

A retrospective cohort study of women exiting prison who completed the transitional support programme "Connections" between 2008 and 2018. Recidivism was measured up to two years post-release. Women's support needs were measured at baseline (4 weeks pre-release) and follow-up (four weeks post-release). Ongoing needs in relation to well-established SDOH were calculated if: (1) at baseline women were identified as having a re-entry need with housing, employment, finances, education, domestic violence, child-custody and social support and (2) at follow-up women reported still needing help in that area. Women's self-reported substance-use and mental health since release were captured at follow-up. Descriptive statistics were calculated for all measures. Associations between SDOH, mental health, substance-use and recidivism were estimated by multiple logistic regression, adjusting for potential confounders. We also evaluated the mediating effects of mental health on the relationship between SDOH and substance-use.

RESULTS

Substance-use was associated with increased odds of recidivism (adjusted odds ratio (AOR) 1.8, 95% confidence interval (CI) 1.1-2.9; p = 0.02). Poor mental health (AOR 2.9, 95% CI 1.9-4.6; p =  < 0.01), ongoing social support (AOR 3.0, 95% CI 1.9-5.0; p =  < 0.01), child-custody (AOR 1.9, 95% CI 1.0-3.3 p = 0.04), financial (AOR 2.0, 95% CI 1.3-3.2; p =  < 0.01) and housing (AOR 1.8, 95% CI 1.1-2.9; p = 0.02) needs were individually associated with increased odds of substance-use. Mediation analysis found mental health fully mediated the effects of ongoing housing (beta efficiency (b) = - 033, standard error (SE) 0.01; p = 0.05), financial (b = 0.15, SE 0.07; p = 0.05), child-custody (b = 0.18, SE 0.01; p = 0.05) and social support (b = 0.36, SE 0.1; p = 0.05) needs onto substance-use, and partially mediated the effects of domestic violence (b = 0.57, SE 0.23; p = 0.05) onto substance-use.

CONCLUSION

This study underscores the critical importance of addressing the interplay between SDOH, mental health, substance-use and recidivism. An approach that targets SDOH holds the potential for reducing mental distress and substance-use, and related recidivism.

Effects of the Connections program on return-to-custody, mortality and treatment uptake among people with a history of opioid use: Retrospective cohort study in an Australian prison system

BACKGROUND AND AIMS

Connections is a voluntary health program that facilitates access to opioid agonist treatment (OAT) and social services for people with opioid use exiting prison. This study aimed to measure the effectiveness of Connections in reducing recidivism and improving health outcomes for people with a history of opioid use on leaving prison.

DESIGN

Retrospective cohort study with quasi-random allocation to the program.

SETTING

Public adult prisons in New South Wales, Australia, 2008-2015.

PARTICIPANTS

Adults released from custody with a history of opioid use. Of 5549 eligible releasees, 3973 were allocated to Connections and 1576 to treatment-as-usual.

MEASUREMENTS

Outcomes were return-to-custody, all-cause mortality, and OAT participation.

FINDINGS

Regression analyses on an intention-to-treat basis, and adjusting for baseline propensity scores, comparing patients allocated to Connections versus treatment-as-usual showed no difference in rates of return-to-custody within 2 years (hazard ratio [HR]: 1.01; 95% confidence interval [CI]: 0.92 -1.12). Patients allocated to the Connections program were more likely to access OAT (odds ratio [OR]: 1.21; 95% CI: 1.06-1.39) and had lower mortality within 28 days of release (0.25% vs. 0.66%; HR: 0.38; 95% CI: 0.14-1.03). Differences in mortality did not persist beyond 28 days. Subgroup analyses showed that allocation to Connections was associated with higher risk of return-to-custody within 28 days for Aboriginal and/or Torres Strait Islander (Indigenous) and female releasees.

CONCLUSIONS

The Connections program for people with opioid use exiting prison did not reduce the likelihood of return-to-custody but did facilitate opioid agonist treatment participation on release from prison.

Substance use among pregnant women in NSW prisons

INTRODUCTION AND AIMS

Little is published about pregnant women in custody. Existing data on the prevalence of substance use among incarcerated pregnant women or their needs are scant. This study sought to determine the prevalence and characteristics of women with substance use histories who present to prison pregnant in New South Wales (NSW), Australia.

DESIGN AND METHODS

A retrospective review of prison medical health records was completed for pregnant women entering New South Wales custodial settings between January 2020 and June 2021.

RESULTS

We identified 158 prison receptions among 141 pregnant women (median age 28 years [IQR 25-33 years]), 42 % identified as Aboriginal or Torres Strait Islander. Eighty four percent of the women (n = 119) reported recent use of one or more than one substance and 36 % had injected drugs. The most commonly used substances were (meth)amphetamine (60 %), cannabis (40 %) and opioids (28 %). We found discrepancies between drug problems self-reported at reception screening on entry to prison and self-reported drug use collected during the subsequent drug and alcohol specialist assessment while incarcerated. Most (88 %) women described their current pregnancy as unplanned and half (52 %) were unaware they were pregnant before incarceration.

CONCLUSIONS

These findings highlight the high prevalence of substance use in incarcerated pregnant women and that many women are unaware of their pregnancy prior to incarceration. Findings emphasize the importance of timely and appropriate drug and alcohol assessment and treatment to minimize harm for both the mother and foetus and also underscore the urgent need for enhanced access to contraception for these women.

Structural racism and health: Assessing the mediating role of community mental distress and health care access in the association between mass incarceration and adverse birth outcomes

Research has linked spatial concentrations of incarceration with racial disparities in adverse birth outcomes. However, little is known about the specific mechanisms of this association. This represents an important knowledge gap in terms of intervention. We theorize two pathways that may account for the association between county-level prison rates and adverse birth outcomes: (1) community-level mental distress and (2) reduced health care access. Examining these mechanisms, we conducted a cross-sectional study of county-level prison rates, community-level mental distress, health insurance, availability of primary care physicians (PCP) and mental health providers (MHP), and adverse birth outcomes (preterm birth, low birth weight, infant mortality). Our data set included 475 counties and represented 2,677,840 live U.S. births in 2016. Main analyses involved between 170 and 326 counties. All data came from publicly available sources, including the U.S. Census and the Centers for Disease Control and Prevention. Descriptive and regression results confirmed the link between prison rates and adverse birth outcomes and highlighted Black-White inequities in this association. Further, bootstrap mediation analyses indicated that the impact of spatially concentrated prison rates on preterm birth was mediated by PCP, MHP, community-level mental distress, and health insurance in both crude and adjusted models. Community-level mental distress and health insurance (but not PCP or MHP) similarly mediated low birthweight in both models. Mediators were less stable in the effect on infant mortality with only MHP mediating consistently across models. We conclude that mass incarceration, health care access, and community mental distress represent actionable and urgent targets for structural-, community-, and individual-level interventions targeting population inequities in birth outcomes.

Impacts of intergenerational substance use and trauma among black women involved in the criminal justice system: A longitudinal analysis

INTRODUCTION

Intergenerational substance use and trauma disproportionately impact racialized women. Yet, how these factors impact outcomes in women involved in the criminal justice system is understudied.

METHODS

Using data from 443 participants in the Black Women in a Study of Epidemics, we assessed the impact of intergenerational substance use and trauma on participant drug use and open Child Protective Services (CPS) cases over 18 months. In repeated-measures logistic regression, intergenerational substance and trauma were independent variables, while participants' drug use at each follow-up and any open CPS case (s) served as separate dependent variables. Models were adjusted for criminal justice involvement, age, marital status, education, childhood guardian, number of children, and prior year homelessness.

RESULTS

On average, participants were aged 35 years, 64 % had never married, and 44 % were raised by both parents. Two-thirds of women (67 %) reported intergenerational substance use (≥1 parent and/or grandparent with alcohol/drug problems), while only 13 % reported intergenerational trauma. Each increase in the number of parents/grandparents with drug/alcohol problems was associated with 30 % increased odds of participants' drug use (aOR 1.30, 95 % CI: 1.07,1.57) and 40 % increased odds of having an open CPS case (aOR 1.40, 95 % CI: 1.11, 1.78). The association of intergenerational trauma and CPS cases was attenuated with sociodemographic/contextualizing factors.

CONCLUSIONS

Intergenerational substance use and trauma are associated with negative outcomes. Our findings highlight the need for substance use treatment to address the pervasive generational effects of substance use and trauma faced by racialized women in the criminal justice system.

Developing best practice principles for the provision of programs and services to people transitioning from custody to the community: study protocol for a modified Delphi consensus exercise

INTRODUCTION

There is a lack of standard nomenclature and a limited understanding of programmes and services delivered to people in prisons as they transition into the community to support their integration and reduce reoffending related risk factors. The aim of this paper is to outline the protocol for a modified Delphi study designed to develop expert consensus on the nomenclature and best-practice principles of programmes and services for people transitioning from prison into the community.

METHODS AND ANALYSIS

An online, two-phase modified Delphi process will be conducted to develop an expert consensus on nomenclature and the best-practice principles for these programmes. In the preparatory phase, a questionnaire was developed comprising a list of potential best-practice statements identified from a systematic literature search. Subsequently, a heterogeneous sample of experts including service providers, Community and Justice Services, Not for Profits, First Nations stakeholders, those with lived experience, researchers and healthcare providers will participate in the consensus building phase (online survey rounds and online meeting) to achieve consensus on nomenclature and best-practice principles. Participants will indicate, via Likert scale, to what extent they agree with nomenclature and best-practice statements. If at least 80% of the experts agree to a term or statement (indicated via Likert scale), it will be included in a final list of nomenclature and best-practice statements. Statements will be excluded if 80% experts disagree. Nomenclature and statements not meeting positive or negative consensus will be explored in a facilitated online meeting. Approval from experts will be sought on the final list of nomenclature and best-practice statements.

ETHICS AND DISSEMINATION

Ethical approval has been received from the Justice Health and Forensic Mental Health Network Human Research Ethics Committee, the Aboriginal Health and Medical Research Council Human Research Ethics Committee, the Corrective Services New South Wales Ethics Committee and the University of Newcastle Human Research Ethics Committee. The results will be disseminated via peer-reviewed publication.

The Predictive Accuracy of the LSI-R in Female Forensic Inpatients-Assessing the Utility of Gender-Responsive Risk Factors

Female reoffending has long been a neglected research interest. Accordingly, risk assessment instruments were developed based on the criminological knowledge of male recidivism. While feminist researchers have repeatedly criticized the failure to incorporate gender-responsive risk (GR) factors, opinions on the gender neutrality of existing instruments remain inconsistent. In order to substitute the existing literature, while extending the scope to mentally disordered offenders, the aim of the given study was the prediction of general recidivism in a sample of 525 female forensic inpatients who had been discharged from forensic psychiatric care in Germany between 2001 and 2018. Primarily, ROC analysis was conducted to assess the predictive accuracy of the LSI-R. Subsequently, separate binary logistic regression analyses were performed to determine the predictive utility of GR factors on recidivism. Lastly, multiple binary logistic regression was used to assess the incremental validity of the GR factors. The results showed that the GR factors (i.e., intimate relationship dysfunction, mental health issues, parental stress, adult physical abuse, and poverty) significantly contributed to the prediction of recidivism, while a mixed personality disorder, a dissocial personality, an unsupportive partner, and poverty added incremental validity to the predictive accuracy of the LSI-R. However, given that the added variables could only improve classification accuracy by 2.2%, the inclusion of gender-specific factors should be cautiously evaluated.

Beyond "pains" and "gains": untangling the health consequences of probation

BACKGROUND

Research on the health consequences of criminal legal system contact has increasingly looked beyond imprisonment to understand how more routine forms of surveillance and punishment shape wellbeing. One of these sites is probation, the largest form of supervision in the U.S. Drawing on an interview study with 162 adults on probation in Hennepin County, MN, in 2019, we map how adults on probation understand the consequences of supervision for their health and how these self-reported health changes correlate with individual, social, and structural circumstances.

RESULTS

Roughly half of participants described their health as having improved since starting probation, while the remainder were split between no change and worsened health. Examining both closed-ended survey questions and open-ended interview prompts, we find that the "gains" of supervision were correlated with substance use treatment (often mandated), reduced drug and alcohol use, increased housing and food security, and perceptions of support from their probation officer. However, these potentially health-promoting mechanisms were attenuated for many participants by the significant "pains" of supervision, including the threat of revocation, which sometimes impacted mental health. In addition, participants in the most precarious circumstances were often unable to meet the demands of supervision, resulting in further punishment.

CONCLUSIONS

Moving beyond the "pains" and "gains" framework, we argue that this analysis provides empirical evidence for the importance of moving social services outside of punishing criminal legal system interventions. People with criminal legal contact often come from deeply marginalized socio-economic contexts and are then expected to meet the rigorous demands of supervision with little state aid for redressing structural barriers. Access to essential services, including healthcare, food, and housing, without the threat of further criminal legal sanctions, can better prevent and respond to many of the behaviors that are currently criminalized in the U.S. legal system, including substance use.

Depopulation or vaccination? Tackling the COVID-19 crisis in prisons in Africa

Several attempts have been made by the global public health efforts and national governments to contain the spread and vulnerabilities to COVID-19. Evidence, however, shows a disproportionate upsurge in COVID-19 cases in correctional facilities such as prisons, particularly, in low- and middle-income countries (LMICs). The poor adherence to COVID-19 preventive protocols in these settings has raised a serious "moral panic" among the public. There are public health concerns about the most effective and state-of-the-art approach to tackling the continuous spread of the virus in prisons. This paper discusses the feasibility of depopulation and vaccination rollouts in combating COVID-19 in correctional facilities with a particular focus on African prisons. The paper proposes selective and strategic depopulation of prisoners, effective prioritization of vaccination among prisoners, and general sensitization of prisoners toward vaccine disbursement in this total institution.