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Race Differences in Inmates Substance Use History, Program Involvement and Relapse

Race Differences in Inmates Substance Use History, Program Involvement and Relapse. Kerstin Youman, Jeff Stuewig and June Tangney George Mason University November 16, 2007. Funding.

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Race Differences in Inmates Substance Use History, Program Involvement and Relapse

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  1. Race Differences in InmatesSubstance Use History, Program Involvement and Relapse Kerstin Youman, Jeff Stuewig and June Tangney George Mason University November 16, 2007

  2. Funding • This research was supported by an NIH Ruth L. Kirschstein National Research Service Award Individual Pre-doctoral Fellowship (F-31)

  3. Overview • Drug, Crime and Treatment Statistics in Jail • Current Study Descriptives and Methods • Race Differences in Substance Use Prior to Incarceration • History of use • Clinically significant problems • Frequencies for those who used • Participation in Substance Use Programs • Effects of Drug and Alcohol Programs on Post-Release Substance Use

  4. Jails, Drugs and Race • Jail Inmates Substance Use History (BJS, 2005) • Lifetime history of drug use is high 75.7% marijuana, 48.1% cocaine or crack, and 20.7% opiates • A majority of convicted offenders (55%) reported using illegal drugs in the month prior to their offense • Rates of drug abuse and dependence are high among jail inmates and vary by race 78% of Whites 64% of African Americans 59% of Hispanics • Drugs and Crime (BJS , 2007) • About 16% of convicted jail inmates said getting money for drugs was their motive • About 29% of convicted jail inmates reported using illegal drugs at the time of the offense • About 27% of violence victims believed the offender was using drugs or alcohol when the crime was committed

  5. Substance Abuse Treatment in Corrections • Less than half of jail inmates with substance dependence or abuse (40.7%) had some form of substance treatment while in a correctional facility (BJS, 2005) • Of the substance abusing or dependent inmates, a higher proportion of Whites (57.9%) participated in substance use treatment than African Americans (44.6%) while under correctional supervision (BJS, 2005) • Little is known about the effectiveness of jail-based substance treatment, though prison programs have been shown to be effective in reducing substance use (Sacks, McKendrick & Kressel, 2007).

  6. Sample Descriptives • Intake N = 479 Age = 33.4 Male Female Whites 61.6% 38.4% A-As 69.6% 30.4% • Pre-Release or Pre-Transfer N = 237 Age = 33.6 Male Female Whites 63.2% 36.8% A-As 72.5% 27.5% • 1 Year Post Release N = 189 Age = 34.1 Male Female Whites 75.6% 24.4% A-As 82.0% 18.0%

  7. Measures The Personality Assessment Inventory (PAI: Morey, 1991). • A 344 item self-report measure of psychopathology and personality traits. Includes scales for perceived alcohol and drug problems. Texas Christian University Correctional – Residential Treatment Form (TCU-CRTF; Simpson & Knight, 1998). • Measures substance use variables – number of substances used in past year, frequency of use, number of symptoms of dependence based on DSM-IV criteria.

  8. Measures Texas Christian University Correctional – Residential Treatment Form (TCU-CRTF; Simpson & Knight, 1998). Frequency scaleDependence Criteria • 0 = Never Tolerance • 1 = Less 1 time / month Withdrawal • 2 = 1 time / month Taken in larger amounts • 3 = 1 to 3 times / month Desire to cut down • 4 = 1 to 2 times / week Time spent on drugs • 5 = 3 to 4 times / week Activities given up • 6 = 5 to 6 times / week Use despite problems • 7 = Daily Dependence Scale • 8 = More than once daily 0 (never) – 4 (7 or more x)

  9. Research Question • Are there race differences in the pattern of substance use prior to incarceration?

  10. Percentage of Whites and A-As who had Ever Used Prior to Incarceration

  11. Percentage of Whites and A-As who had Used Year Prior to Incarceration

  12. Percentage with Clinically Significant Drug and Alcohol Problems at Intake on the PAI

  13. Mean Differences of Alcohol Use at Intake

  14. Mean Diffs for Drug Use at Intake

  15. Research Question • Are there race differences in program utilization? • Do drug and alcohol programs make a difference in post-release drug use frequency? • Does the effectiveness of substance use programs vary by race?

  16. Participation in Drug or Alcohol Treatment • A total of 38.2% of inmates participated in drug or alcohol programs, which did not vary by race (χ2 = .66, p = .42) • Of the 25.3% with PAI clinically significant alcohol problems, 54.1% participated in programs, which did not vary by race (χ2 = .13, p=.72) • Of the 51.1% with PAI clinically significant drug problems, 49.6% participated in programs, which did not vary by race (χ2 = .67, p=.41) • Of the 69.1% meeting alcohol or drug dependence criteria 42.7% participated in programs, which did not vary by race (χ2 = 2.85, p=.13)

  17. Alcohol Use • 1 year frequency • At Intake 3.52 • Post-release 2.86 t = 3.49, p = .001 • 45.7% decreased alcohol usage • 28.8% stayed the same • 25.5% increased alcohol usage

  18. Alcohol Frequency • Substance use program involvement significantly predicted decreased alcohol frequency post-release (β = -.37, t = -4.01, p = .000) accounting for 14% of the variance in alcohol frequency in the year after release into the community. • For inmates meeting alcohol dependence criteria at intake, substance use program involvement significantly predicted decreased alcohol frequency post-release (β = -.47, t = -4.00, p = .000) accounting for 24% of the variance in alcohol frequency in the year after release into the community. • Race was not a significant predictor, nor was there a race by program interaction.

  19. Marijuana Use • 1 year frequency • At Intake 2.18 • Post-release 1.24 t = 4.96, p = .000 • 41.5% decreased marijuana usage • 44.4% stayed the same • 14.2% increased usage

  20. Marijuana Frequency • Substance program involvement did not significantly predict decreased marijuana frequency post-release for the overall sample(β = .01, t = 0.06, p = .95) nor for those meeting marijuana dependency criteria at intake (β = -.06, t = -0.31, p = .76) . • Race was not a significant predictor nor was there a race by program interaction.

  21. Cocaine Use 1 year frequency • At Intake 2.06 • Post-release 1.09 t = 5.00, p = .000 • 31.1% decreased cocaine usage • 55.2% stayed the same • 13.7% increased usage

  22. Cocaine Frequency • Substance program involvement significantly predicted decreased cocaine frequency post-release (β = -.23, t = -2.41, p = .02) accounting for 6% of the variance in cocaine frequency in the year after release into the community. • There was no main effect for race in predicting decreased cocaine frequency in the year after release into the community (β = .07, t = 0.75, p = .46) . • There was no race by program interaction (β = -.13, t = -0.69, p = .49) . • For those meeting at least 1 dependence criteria programs did not predict decreased usage

  23. Opiate Use • 61.9% had never used opiates prior to incarceration • 88% did not use in the year after release • 1 year frequency • At Intake 1.13 • Post-release 0.52 t = 4.33, p = .000 • 18.4% decreased opiate usage • 77.1% stayed the same • 4.5% increased usage

  24. Opiate Frequency • There is a main effect for race in predicting opiate frequency post-release where Whites decreased opiate usage more than African Americans (β = .33, t = 3.55, p = .001) • There is a main effect for program involvement in reducing opiate usage (β = -.20, t = -2.1, p = .032) . • Together race and program involvement account for 15% of the variance of change in opiate use from pre-incarceration to post. • There was no race by program interaction (β = .07, t = 0.38, p = .71) • For those meeting at least 1 dependence criteria at intake, programs did not predict decreased frequency of opiate use

  25. Opiate Use Relapse • Of those participants who had ever used at intake (N=65), 22.9% of Whites and 33.3% of African-Americans used opiates post-release (χ2 = 0.88, p = .35). • Of those participants who had never used at intake (N = 114), 5.1% of Whites and 2.7% of African-Americans used opiates post-release. • Of those participants who had used in the year prior to intake (N= 43), 33.3% of Whites and 42.1% of African-Americans used opiates post-release (χ2 = .35, p = .56). • Of those participants who had not used in the year prior to intake (N= 136), 4.0% of Whites and 4.7% of African-Americans used opiates post-release (χ2 = 0.03, p = .86).

  26. Summary • A significantly larger percentage of Whites at intake had ever used *Alcohol, ***Cocaine and ***Opiates, however, there were no race differences in the percentage of inmates at intake who had ever used Marijuana. • Whites versatility of drug usage was significantly greater (for lifetime and year prior to incarceration) than A-As. • There were no race differences in Alcohol, Marijuana or Cocaine dependence for those who used, but Whites were more likely to be Opiate dependent.

  27. Summary • Only 42% of inmates who were substance use dependent participated in programs • Program involvement predicted decreased usage post-release for alcohol, cocaine and opiates, but not marijuana • For those meeting dependency criteria at intake, programs were only predictive of decreased usage of alcohol • There were no race differences in program involvement or in responses to program involvement

  28. Implications • Alcohol interventions in jail can be effectively aimed at all alcohol users, regardless of dependence status • Since drug programs were only effective in decreasing drug usage for those not already dependent, resources might be better used with those individuals not dependent or, alternatively, current approaches for treating dependence could use improvement • Substance use programs can be delivered without modifications for the race of the offender

  29. Limitations • Sample was limited to felony offenders in one suburban jail • Dosage of program delivery was not measured • Program involvement was voluntary

  30. Future Directions • Examine gender differences • Examine changes in abstinence rates as a function of program involvement • Examine whether disposition of wave 2 (release to community vs. transfer to another facility) impacts program effectiveness • Look at whether changes in substance use are predictive of recidivism

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