Research That Matters (January 17 - 20, 2008)

Purpose: Previous literature demonstrates substance use disorders, trauma exposure and post traumatic stress disorders are associated (Johsnson et al., 2006 ;Abram et al., 2003). It is important to understand the extent of trauma exposure in women with substance use disorders because of the barriers to recovery that are created by trauma. Women in the criminal justice system are frequently court-ordered to receive some form of alcohol and other drug abuse treatment. This presentation will focus on types of violence exposure and trauma among a sample of incarcerated women with substance use disorders and address screening and assessment issues to foster treatment engagement and treatment completion. Method:. Women were selected from the general detainee floors at an urban, full service jail. Women with a diagnosis for schizophrenia or schizo-affective disorder were excluded. Interviews lasted approximately 90 minutes and were conducted by trained interviewers in the jail. This federally funded study was approved by a university IRB review committee. Measures: The Computerized Diagnostic Interview Schedule (C-DIS) was used to measure post-traumatic stress disorder, alcohol abuse/dependence and drug abuse/dependence. Demographic information included service use and criminal justice histories. Exposure to violence was measured by the self and witness subscales using the Singer/Song Exposure to Violence Scale. The C-DIS schedule for post traumatic stress disorder was used to measure trauma events. Sample Description: The sample was disproportionately minority: 107 Black, African American (54%); 33 Biracial/Latina (17%). 33% were awaiting trial and 40% were incarcerated for a probation violation. Drug and drug related charges were most often cited as the reason for the current jail stay. 116 women met criteria for lifetime post traumatic stress disorder and 198 women met criteria for substance use disorder. Results: Women in this sample of jail detainees report high levels of exposure to traumatic events. 196 women endorsed at least one C-DIS traumatic event category and the remaining two women endorsed victim/exposure to violence on a separate scale. The most frequently reported “worst” trauma was rape by a non-relative (n=131). Women reported they had been exposed to violent threats and acts at home, in the community, at school and at work. In the past year, 79 women (41.8%) were threatened in their neighborhoods and 66 (35%) were threatened in their homes (chi square=5.259,df=1,p,.05). Women were more likely to have been made to do a sexual act than to have been forced to watch as sexual act (chi square-28.241,df=1,p,.001). Higher numbers of women report having been stabbed (19%) or shot (7%) than those in the general population. Logistic regression showed that women with both a mental health disorder such as PTSD and a substance use disorder were less likely to complete residential substance abuse treatment. Implications for Practice: Women who fail at court-ordered treatment are likely to be incarcerated rather than maintained on community controls. Failure to assess and treat trauma and victimization can result in treatment failures and add to the growing numbers of women in jail and prison.