239244 Incarceration as a teachable moment for substance use treatment

Monday, October 31, 2011

Jennifer Clarke, MD, MPH , Department of Medicine and OB/GYN, The Warren Alpert Medical School of Brown University, Pawtucket, RI
Diana Stewart, PhD , Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, TX
Rachel Simon, HSD , Centers for Behavioral and Preventive Medicine, Alpert Medical School at Brown University, Providence, RI
Rochelle K. Rosen, PhD , Centers for Behavioral and Preventive Medicine, Alpert Medical School at Brown University, Providence, RI
Joshua Magee, PhD , Centers for Behavioral and Preventive Medicine, Alpert Medical School at Brown University, Providence, RI
Edwin Boudreaux, PhD , Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA
Beth Bock, PhD , Centers for Behavioral and Preventive Medicine, Alpert Medical School at Brown University, Providence, RI
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.

Learning Areas:
Diversity and culture
Public health or related research

Learning Objectives:
To describe how the Sentinel Events Model applies to incarcerated women who use illicit substances.

Keywords: Women, Prison

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because much of my previous research has been conducted in the context of addictive disorders and health disparities in underserved populations.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.