Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Purpose: Women in criminal justice settings face a myriad of emotional, psychological, and social problems, but these systems are often poorly equipped to address these needs. For instance, findings from surveys in individual institutions indicate that psychiatric distress is high among these women: Almost 81% of female jail detainees had at least one lifetime DSM IV diagnosis (i.e., affective, substance use, anxiety, or antisocial personality disorders) and about 70% met criteria for a disorder in the past six months; 64% of female inmates were identified as “clinically distressed; 11% of female arrestees reported a major depressive episode; and 25% of female jail inmates reported current Major Depressive Disorder. Rates of substance use and abuse are also alarming. Approximately 6 in 10 women in state prisons describe themselves as using drugs in the month before the offense and 5 in 10 described themselves as a daily user, and many report experiencing recent substance use problems. Cocaine and alcohol are the most frequently abused substances reported by incarcerated women. Although the use of each of these drugs alone contributes to significant social and medical problems among women in criminal justice settings, their use in combination may have an additive or synergistic effect that leads to higher rates of physical, cognitive, behavioral and psychiatric problems. This study aimed to determine how pre-incarceration abuse of alcohol and cocaine affected current psychiatric distress among female jail inmates. Methods: A probability sample of women in a large urban jail (n= 469) presenting for a mandated medical examination were assessed for use of alcohol and cocaine for the 6 months prior to incarceration and for their current psychiatric distress. They were grouped based on their level of alcohol consumption and cocaine use: High Cocaine/High Alcohol; High Cocaine/Low Alcohol; Low Cocaine/High Alcohol; Low Cocaine/Low Alcohol. Profile analysis and logistic regression were used to determine whether the characteristics and severity of psychiatric distress as measured by the Brief Symptom Inventory, are associated with the level of alcohol and cocaine use. Results: Psychiatric distress is highest (and similar) among women in the High Cocaine groups, regardless of alcohol use (p<.05), and psychiatric distress is lowest among those who used both substances infrequently (p<.001). Characteristics of psychiatric distress differed based on level of alcohol use, but only when cocaine use was low. High alcohol and cocaine use alone (OR = 2.03 and 4.51, respectively) and together (OR = 4.06) also predict the likelihood of psychiatric distress reaching a diagnosable level of severity. Implications for Practice or Policy: Women should be screened at the time of incarceration, and women who have alcohol and other drug problems should receive treatment that includes mental health services.