“I know if I drink I won’t feel anything”: substance use relapse among depressed women leaving prison

Abstract

Purpose The purpose of this article is to explore treatment needs and factors contributing to engagement in substance use and sobriety among women with co-occurring substance use and major depressive disorders as they return to the community from prison. Design This article used qualitative methods to evaluate the perspectives of 15 women with co-occurring substance use and major depressive disorders on the circumstances surrounding their relapse and recovery episodes following release from a U.S. prison. Women were recruited in prison; qualitative data were collected using semi-structured interviews conducted after prison release and were analyzed using grounded theory analysis. Survey data from 39 participants supplemented qualitative findings. Findings Results indicated that relationship, emotion, and mental health factors influenced women’s first post-prison substance use. Women attributed episodes of recovery to sober and social support, treatment, and building on recovery work done in prison. However, they described a need for comprehensive pre-release planning and post-release treatment that would address mental health, family, and housing/employment and more actively assist them in overcoming barriers to care. Practical implications In-prison and aftercare treatment should help depressed, substance using women prisoners reduce or manage negative affect, improve relationships, and obtain active and comprehensive transitional support. Originality/value Women with co-occurring mental health and substance use disorders are a high-risk population for negative post-release outcomes, but limited information exists regarding the processes by which they relapse or retain recovery after release from prison. Findings inform treatment and aftercare development efforts.

Hazardously Drinking Jailed Women: Post-Release Perceived Needs and Risk of Reincarceration

“…These findings reflect previous qualitative research reflecting how common such needs are (e.g. Johnson et al, 2013; Pogorzelski et al, 2005). Not only were perceived treatment needs common, but both mental health and substance treatment needs were also associated with subsequent reincarceration in our sample.…”

“…In contrast to van der Knap and colleagues’ study, our study involved a shorter 5-month follow-up window (versus 2 years) and participants from jail (versus prison) suggesting that the association between unmet housing need and reincarceration is significant even in the immediate period following an incarceration period. This finding also plausibly fits with prior qualitative research (e.g., McLean et al, 2006; Pogorzelski et al, 2005; Johnson et al, 2013) suggesting that women rank housing among their most important needs following an incarceration period.…”

“…In fact, the most prevalent concerns reported were finding a means to earn an income and locate safe housing. In our earlier mixed methods study evaluating treatment needs in a prison sample, women similarly reported that lack of housing represented a challenge during the period of re-entry into the community after prison (Johnson et al, 2013). A greater number of residence changes has also associated with greater risk for re-arrest among women releasing from prison (Makarios et al, 2014).…”

Effects of incarceration on risky Sex: focus group data from Two New England states

“…However, publicly funded treatment is either not present or difficult to access in many communities, especially for women without childcare or reliable transportation (Johnson et al (in press; Kellett and Willging 2011; Ritchie 2001). Day-to-day survival (food, housing, a safe and legal way to make money) often takes precedence over treatment even for life-threatening medical conditions among re-entering populations (Johnson et al (2013), Johnson et al (in press; Stephenson et al 2005; Blank 2013). Other research has noted that psychologically empowering women during incarceration does little in the long-term if women have little real power in the form of access to basic resources and safety in the communities to which they will return (Johnson et al (in press; Kellett and Willging 2011; Ritchie 2001).…”

“…Focus group moderators encouraged open discussion by: a) explaining that the purpose of the research was to get information about the thoughts and experiences of incarcerated women in order to design a new intervention to women’s HIV and revictimization risk and that participants’ honest answers would help us do that; b) emphasizing that there were no right or wrong answers; c) emphasizing that researchers valued each woman’s ideas and wanted to hear from all participants; d) explaining confidentiality carefully; e) asking less threatening questions first; and f) asking about how “incarcerated women” (in general) think about sexual health, sexual behavior, HIV/STI risk, substance use and violence (see Table 1), not necessarily any single woman in particular. Our experience with incarcerated women in previous research (Johnson et al (2013); Johnson et al (in press)) is that many are open to sharing their opinions and their stories, especially if they feel they will be heard and respected, and that doing so might help another woman in a similar situation. The groups were audio recorded and these recordings were transcribed using a secure transcription service.…”