Incarceration as a teachable moment for substance use treatment

Incarcerated women have higher rates of substance use disorders (45-60%) than women in the general population (6%) or incarcerated men (29%). The Sentinel Event Model (SEM) is a dynamic model based on the observation that attempts for positive behavior change (e.g., quitting substance use), are often preceded by negative events that may be perceived as consequences of negative behaviors (e.g., incarceration). We explored how the SEM may apply to incarcerated women who use illicit drugs by interviewing 15 female substance-using inmates within 48 hours of incarceration or sentencing. Questions assessed perceptions about drug use, intention to quit, and surrounding factors. Executive summaries were written for each interview and reviewed for key themes and relationship to the SEM. Preliminary thematic analyses yielded core features of the SEM including factors perceived to contribute to positive behavior change. Themes related to incarceration and drug use revealed associations between intention to quit and causal attributions, event-related severity, event-related affect/emotional response, outcome expectancies, and viewing prison as an opportunity for change. Factors associated with intention to quit were prior incarceration experience, outside environment factors, social responsibility, social support, mental illness, locus of control/self-efficacy, and having a substance use disorder. Formal testing of the model constructs in longitudinal and factor analytic studies is needed to further elucidate the relationship and directional associations of model factors and decisions to stop using substances or enter substance use treatment programs. If supported, this model might aid with predicting inmates' response to incarceration and facilitate decision-making regarding substance use treatment.