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

Abstract

Background The rising rates of women in prison is a serious public health issue. Unlike men, women in prison are characterised by significant histories of trauma, poor mental health, and high rates of substance use disorders (SUDs). Recidivism rates of women have also increased exponentially in the last decade, with substance related offences being the most imprisoned offence worldwide. There is a lack of evidence of the effectiveness of post-release programs for women. The aim of this systematic review is to synthesise and evaluate the evidence on post-release programs for women exiting prison with SUDs. Methods We searched eight scientific databases for empirical original research published in English with no date limitation. Studies with an objective to reduce recidivism for adult women (⩾18 years) with a SUD were included. Study quality was assessed using the revised Cochrane Risk of Bias tool for randomized trials (RoB2) and the Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) tools. Results Of the 1493 articles, twelve (n = 3799 women) met the inclusion criteria. Recidivism was significantly reduced in five (42%) programs and substance-use was significantly reduced in one (8.3%) program. Common attributes among programs that reduced recidivism were: transitional, gender-responsive programs; provision of individualised support; providing substance-related therapy, mental health and trauma treatment services. Methodological and reporting biases were common, which impacted our ability to synthesize results further. Recidivism was inconsistently measured across studies further impacting the ability to compare results across studies. Conclusions Recidivism is a problematic measure of program efficacy because it is inconsistently measured and deficit-focused, unrecognising of women’s gains in the post-release period despite lack of tailored programs and significant health and social disadvantages. The current evidence suggests that women benefit from continuity of care from prison to the community, which incorporated gender-responsive programming and individualised case management that targeted co-morbid mental health and SUDs. Future program design should incorporate these attributes of successful programs identified in this review to better address the unique challenges that women with SUDs face when they transition back into the community.

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

“…Similarly, a recent review of post‐release programs for women with substance use problems reported that of 12 programs involving 3799 women, only five were associated with a significant reduction in recidivism, and only one was associated with a significant reduction in substance use [ 44 ]. The authors concluded that women in prison with substance use problems benefit most from continuity of care from prison to the community and that such care must incorporate gender‐responsive programming and individualised case management to target comorbid mental health and substance use problems [ 44 ].…”

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

“…While not independently predicting future violence it manifests through related risk factors ( 46 ). This seems to be particularly true for the present population of patients with SUD as substance abuse frequently serves to cope with symptoms of other mental health issues ( 47 ). Hence, our findings should not be construed as diminishing the relevance of this clinical factor.…”

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

“…It is often reported by women in prison that experiences of trauma and mental illness precede substance-use, with women reportedly using substances to alleviate distress associated with trauma and to manage mental health issues [ 13 , 14 , 19 ]. Mental health and substance-use are therefore interrelated and complex health issues that not only increase a woman’s risk of imprisonment [ 36 , 37 ] but may also impact women’s integration into the community post-release, and therefore reimprisonment.…”