The Effectiveness of Interventions for Incarcerated Females with Substance Abuse Histories: A Systematic Review

Background: Women are one of the largest growing populations in the criminal justice system. More than half of incarcerated women report histories of substance abuse, yet only less than a quarter of women receive treatment while incarcerated. Although there have been intervention studies and systematic reviews published examining drug treatment interventions for women impacted by the criminal justice system, there has not been a systematic review that has examined the effectiveness of interventions performed in prison while considering the methodological rigor of the studies. The purpose of the review was to 1) identify and describe the types of interventions delivered to females in prison/jail reporting substance abuse histories, 2) describe the methodological rigor of the intervention studies, and 3) to determine what interventions are most effective when considering the study’s methodological rigor.

Methods: A systematic search of the literature was conducted to identify articles in peer-reviewed journals from 1970 and 2017. Studies were included if they met the following criteria: 1) included women with substance abuse histories and 2) conducted in a prison/jail setting, and 3) measured alcohol and/or drug use as an outcome. Methodological rigor was assessed using an adapted version of Miller’s (1985) Methodological Quality Rating Scale (MQRS). A total scale score was used (10 items) to determine high and low levels of rigor, and to identify the strengths and weaknesses of study quality. An outcome attainment score was created to evaluate studies on methodological rigor, as well as significance, for each outcome of interest. The primary outcomes of interest were alcohol and/or drug use and mental health/trauma; comparisons were made by type of intervention and by number of outcomes.

Results: The search yielded 10 studies that met inclusion criteria. All interventions included group interventions and were primarily ‘cognitive behavior based’ (n=7) and ‘other’ (n=3); ‘cognitive behavior based’ included interventions based in cognitive behavioral therapy or a related framework focusing on cognition and behavior change and ‘other’ included interventions studying therapeutic communities or gender responsive treatment. On a possible range of 0-12 on the MQRS scale, a mean score of 9.65 and median score of 9.5 indicated high methodological rigor. The strengths of the studies included theoretical foundation, treatment integrity, and analyses; areas of improvement included reporting psychometric properties of measures used and using an additional verification measure for self-report items. Cognitive behavior based studies were more effective than other studies as measured by methodological rigor and significance of outcomes.

Conclusions and implications: Group level interventions with a cognitive behavior base have the strongest evidence for effectively decreasing alcohol and/or drug use and decreasing mental health/trauma symptoms. This review also highlights the importance of monitoring the impact of the intervention on both alcohol and/or drug abuse and mental health/trauma symptoms. Suggestions for future research include conducting more studies examining the effects of individual interventions in the prison/jail setting, as well as including at least a 90- day post-release follow up assessment.