University of Oklahoma Health Sciences Center, 800 NE 15th Street, Suite 410, Oklahoma City, OK 73104 and
1 State of Oklahoma Department of Corrections, Oklahoma City, OK, USA
Received 6 November 1998; in revised form 17 May 1999; accepted 20 May 1999
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ABSTRACT |
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INTRODUCTION |
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Although few studies have examined substance misuse in female prison inmate populations, the exceptions have consistently reported extensive substance misuse histories (e.g. Blount, et al., 1991; Eronen, 1995; Jordan et al., 1996; Marcus-Mendoza and Briody, 1996; McClellan et al., 1997). Given the prevalence of substance misuse in inmate samples, it is tempting to conclude that there is a direct relation between substance misuse and criminality. However, not all substance misusers serve time in jail. Identifying distinguishing characteristics of incarcerated and non-incarcerated substance misusing women may aid in the development of more effective intervention and treatment efforts. One question particularly relevant to early prevention and intervention efforts is whether aspects of personal or familial substance misuse histories serve to differentiate incarcerated from non-incarcerated women. Thus, the primary purpose of this study was to compare personal and familial substance misuse histories between female prison inmates and female substance misusers recruited from treatment units.
Based on the literature, we constructed three hypotheses. The first hypothesis was that the inmates would have more extensive substance misuse histories than the treatment sample. This hypothesis was based on data linking the severity of substance misuse to several measures of criminality, such as rate of prior arrests and incarcerations among female inmates (Blount et al., 1991) and on the assumption that more extensive substance misuse would lead to more severe consequences, such as incarceration. Our second hypothesis was that the inmates would have an earlier age of onset for alcohol and drug use. This hypothesis was based on prior research documenting an inverse relationship between severity of substance misuse and age at first arrest (Blount et al., 1991
) and an association between antisocial personality disorder and criminal behaviour often characterized by early onset of alcohol and drug abuse (Randolph and Yates, 1993
). Our third hypothesis was that inmates would be more likely to report extensive family histories of substance misuse, although we expected both samples to report high rates. This hypothesis was based on the increased risk for temperament traits, such as behavioural disinhibition among children of alcoholics (COAs) compared to non-COAs (Sher, 1991
). In summary, we expected that the inmates would have more extensive personal and family histories of substance misuse and would have initiated substance misuse at an earlier age than did the treatment sample.
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METHODS |
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Of the 164 inmates, 161 reported a primary offence for their current incarceration. Primary offences were categorized as violent (e.g. murder, manslaughter, child abuse, assault, robbery), property (e.g. burglary, larceny, motor theft, arson, fraud, stolen property), drug-related (e.g. possession, trafficking), public order (e.g. weapons, prostitution), and other. One-half (50.9%) of the inmates were incarcerated for a violent offence, 24.8% for a property offence, 21.7% for a drug-related offence, 0.6% for a public order offence, and 1.9% for other types of offence. Because a minority of inmates were incarcerated on drug-related charges, the entire inmate sample was combined for analyses, unless otherwise indicated.
The comparison group was a sample of 164 female substance misusers. The 164 participants were selected randomly from a database of 480 female participants recruited from chemical-dependency treatment facilities between January 1994 and December 1996. These data were collected as part of the screening procedures for an on-going study of cognitive deficits associated with polysubstance misuse. Participation was voluntary and participants were not paid for participation in the screening phase of the project from which the database was constructed.
All participants provided written informed consent prior to participation. Procedures to protect confidentiality were explained carefully to all prospective participants. This project was approved by the University of Oklahoma Health Sciences Center Institutional Review Board.
Materials and procedure
All participants were administered a battery of penciland-paper questionnaires in groups. Inmates were tested in the prison and treatment participants were tested in the treatment facilities. The battery consisted of demographic information, the Beck Depression Inventory (BDI; Beck et al., 1988), the Spielberger StateAnxiety Inventory (AI; Spielberger, 1983), the Shipley Institute of Living Vocabulary and Abstraction Scales (SILS-V, SILS-A; Zachary, 1986), substance misuse histories, and a detailed four-generation family history tree of substance misuse adapted from Mann et al. (1985).
Substance misuse history
Alcohol histories included the Quantity Frequency Index (QFI; Cahalan et al., 1969) for the 6 months prior to treatment or incarceration, problem-drinker status, ages at first alcohol consumption and first intoxication, and lifetime alcohol-related consequences. The QFI is a measure of quantity and frequency of alcohol consumption that estimates the average number of ounces of absolute ethanol consumed per day. Problem-drinker status involved a self-report of whether the participant considered herself to be, now or ever have been, an alcoholic or problem drinker, and, if so, for how long (chronicity). All participants, regardless of problem-drinker status, were asked to report whether they had ever experienced any of a list of 10 alcohol-related consequences. These self-reported lifetime consequences of alcohol abuse were dichotomously coded for presence vs absence and then divided into three categories. Specific consequences by category were as follows. (1) Psychosocial consequences, these were marital or relationship problems, job problems, disapproval of family or friends, abusive behaviour, and attendance at Alcoholics Anonymous meetings. (2) Medical consequences, these were severe withdrawal, cirrhosis, black-outs, and passing out. (3) Legal consequences, these were arrests. The terms passing out and black-outs are commonly used phrases in the USA. Passing out refers to the behavioural phenomenon of an alcohol-related sleep-like state. This state contrasts with black-outs, which are conscious states during which the individual engages in typical or normal behaviours, but for which he or she later has no memory. In either case, no reference to underlying physiology or aetiology is intended. Illicit drug-use histories included queries as to whether illicit drugs had been used, the respondent's drug of first choice, and years of use.
Family history
Participants completed a four-generation family tree by indicating whether family members never used alcohol, were social drinkers, had an alcohol problem, a drug problem, both an alcohol and drug problem, or that the substance-use history was unknown regarding the family member. Participants were instructed that the only criterion for endorsing a relative's alcohol or drug problem was the participant's subjective opinion.
Four types of family-history analyses were conducted (Alterman et al., 1987; Tivis et al., 2000
). First, family history positive (FH+) for substance abuse was defined as one or more primary relatives or three or more secondary relatives reported by the participant to have an alcohol, drug, or alcohol and drug problem. Participants reporting a positive family history were further classified according to family members' type of substance problems: alcohol, drug, or both alcohol and drug. Across all methods of considering family history, family members labelled unknown were grouped as if they had no substance misuse problem. This approach results in a conservative estimate of FH+.
Second, to assess lineality of substance misuse, percentages of participants reporting the presence of substance misuse in mother only, father only, or both parents were calculated. Third, a multigenerational classification of family history of substance misuse (alcohol and/or drug) included: (a) single generation (FH+SG; self only, no substance misusing parent); (b) double generation (FH+DG; self, at least one substance misusing parent, and no substance misusing grandparents); (c) triple generation (FH+TG; self and at least one substance-misusing parent and one or more substance-misusing grandparents). Fourth, a quantitative classification was made by assigning 1 point for each primary relative and 0.5 point for each secondary relative with a substance misuse problem. To account for differences in family size, point totals were divided by the total number of family members.
Race
Because the two samples differed in racial composition, 2 (4, n = 328) = 41.19, P = 0.001, comparisons were made to determine if selected variables differed as a function of race. Because of the small number of participants representing some minorities, racial groups were collapsed into white and non-white. The non-white group included all subjects self-identified as African American, Hispanic, Native American, and other. Table 1
depicts the racial composition of both samples. Although the analyses were based on a dichotomous classification, percentages of each racial group comprising the non-white category are provided in Table 1
.
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RESULTS |
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Family history
Family-history data are presented in Table 5. Both samples reported extensive family histories of substance misuse, but significantly more of the treatment sample reported positive family histories of substance misuse than did the inmate sample. Further, the majority of both samples reported a family history of both alcohol and drug problems.
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Because our conservative family-history approach classified unknowns as not having an alcohol or drug problem, the question arose as to whether more treatment sample participants were FH+ because they had greater knowledge of their family members. For this reason, we compared the percentage of relatives reported unknown for the two samples. The treatment sample responded unknown to a significantly smaller percentage of primary (M = 2.3% vs M = 9.9%) and secondary relatives (M = 21.6% vs M = 32.6%) than did the inmates [t(326) = 4.19, P < 0.0001 t(326) = 3.4583, P = 0.0006 and respectively].
Race
As previously mentioned, the racial composition of the two samples differed. For this reason, comparisons between whites and non-whites were made to determine if race accounted for observed differences between the inmate and treatment samples. White and non-white participants did not differ in years of education [M = 11.9 years for whites and M = 11.7 for non-whites, t(323) < 1] or QFI [M = 6.3 for whites and M = 6.0 for non-whites, t(296) < 1]. White and non-white participants differed on percentages self-reporting as problem drinkers' [58% of whites and 42% of non-whites, 2(1, n = 321) = 8.08, P = 0.004] and white participants (M = 7.3) reported more alcohol-related negative consequences than non-white participants [M = 6.3, t(316) = 2.13, P = 0.03]. White participants reported a younger age at first alcohol consumption (M = 11.9) than non-white participants [t(296) = 2.6, P = 0.01], but not at first intoxication, [t(289) = 1.7, P = 0.09]. White and non-white participants differed in reported drug of first choice [
2(4, n = 274) = 39.8, P = 0.001]. White participants' drug of first choice was distributed across marijuana (24%), cocaine (19%), amphetamines (24%), and other (20%). A majority of non-white participants (55%) reported cocaine as the drug of first choice, followed by marijuana (16%), amphetamines (10%), and other (10%). White and non-white participants did not differ in the percentage reaching criteria for FH+. Eighty-four per cent of white subjects and 88% of non-white participants were classified as FH+ [
2(1, n = 328) = 1.03, P = 0.31].
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DISCUSSION |
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Family history
Although both groups reported extensive family histories of substance misuse, a greater percentage of the treatment sample met criteria for FH+. However, a comparison of the percentages of family members with an unknown substance-use history suggested that the higher rate of FH+ among the treatment sample may have been an artifact of differences in knowledge about family members. Even given this bias in the family-history description, the inmates reported a greater density of substance misuse within their families. Thus, a high density of substance-misusing family members was associated with incarceration.
Perceptions
Although the two groups reported similar alcohol consumption, fewer inmates (34%) than participants in the treatment sample (66%) identified themselves as alcoholics or problem drinkers. When data for only the participants endorsing problem drinker status were compared, these inmates reported consuming on average 6 oz. of pure ethanol more per day than the equivalent treatment subgroup. Interestingly, the inmates reported fewer alcohol-related consequences than did the treatment sample.
Several explanations may account for these differences. Subjects in the treatment sample may have been influenced by their treatment experiences in acknowledging the problematic nature of their drinking. The inmates may have been unable or unwilling to acknowledge the problematic nature of their alcohol use, in spite of experiencing serious problems associated with drinking. Alternatively, alcohol-related consequences among the inmates may have appeared trivial relative to their non-alcohol-related problems, and thus resulted in their failure to note the association. Whatever the reason, the dissociation between use levels and the perception of negative consequences suggests that substance misuse treatment relying on participants' acknowledgement of this association may be relatively ineffective in this group.
These results are consistent with the report by El-Bassel et al. (1998) on female inmates who completed the University of Rhode Island Change Assessment Scale (URICA). The majority of inmates in their sample were classified in the denial cluster. Similar to our inmate sample, the denial cluster failed to acknowledge the association between negative consequences and their behaviour. Taken together, these studies identify a common area of challenge in addressing substance misuse treatment with female inmates. Further research addressing readiness to change (DiClemente and Prochaska, 1985; DiClemente and Scott, 1997
) and motivation enhancement techniques (Miller and Rollnick, 1991
) within this population may be fruitful.
Limitations
Differences in many of the self-report variables may be a function of temporal or environmental differences between the samples. For example, temporal differences between the period of interest (the 6-month period prior to treatment or incarceration) and the time of report probably differed between the two samples. That is, treatment samples generally were reporting recent events, whereas inmates reported more distant events. Environmental differences may have differentially affected participants' truthfulness in answering sensitive questions, such as those pertaining to illegal drug activity. Similarly, affective measures may be a function of temporal and environmental differences. However, the similarities between the two samples diminishes our concerns about the impact of temporal and environmental factors.
In summary, these data did not support our hypotheses that the inmates would have more extensive substance misuse histories, either personal or familial, than the treatment sample. Of clinical relevance, however, was that inmates were less likely to perceive a relation between substance misuse and adverse consequences. This observation suggests in particular a need for prison-based treatment programmes to emphasize the link between substance misuse and negative consequences, to encourage inmates to examine the role of substance use in their offending, and to foster the development of support networks during and after incarceration.
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ACKNOWLEDGEMENTS |
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FOOTNOTES |
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REFERENCES |
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