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. Author manuscript; available in PMC: 2021 Sep 2.
Published in final edited form as: Alcohol Clin Exp Res. 2020 Sep 2;44(9):1834–1841. doi: 10.1111/acer.14403

Perceived Substance Use Norms Among Jailed Women with Alcohol Use Disorders

Christine Timko a, Yael Chatav Schonbrun b,c, Bradley Anderson c, Jennifer E Johnson d, Michael Stein c,e,f
PMCID: PMC7722182  NIHMSID: NIHMS1620045  PMID: 32876998

Abstract

Background:

Social norms regarding substance use predict substance use behaviors. In a sample of jailed women with alcohol use disorders (AUDs), we compared (1) jailed women’s perceptions of the US women population’s rates of substance use, with US women’s actual rates of substance use; (2) jailed women’s perceived rates of substance use by US women, with their perceptions of use by their own friends, and (3) US women’s actual rates of substance use, with observed sample substance use rates.

Methods:

Participants were 205 jailed women who met criteria for an AUD. We used the 1-sample or dependent samples t-test to make the comparisons.

Results:

Participants overestimated US women’s rates of substance use and incarceration rates. They perceived their friends’ substance use as less common than US women’s. The jailed women reported higher rates of their own substance use than actual rates by US women. In addition, jailed women self-reported less cannabis use, but more alcohol and cocaine use and cigarette smoking, than they perceived their friends to have used. The more women perceived their friends as drinking, the less they had a goal to drink less or abstain from drinking post-incarceration; in contrast, perceptions of US women’s drinking were not related to personal goals for drinking.

Conclusions:

Interventions that correct misperceptions about substance use norms may have utility for jailed women with AUDs.

Keywords: social norms, alcohol use disorder, criminal justice, treatment, women

INTRODUCTION

Beliefs about how typical a given behavior is (i.e., social norms) are associated with substance use behaviors among adolescents and college students (Hagman et al., 2007; Janssen et al., 2018; Lewis & Neighbors, 2006) and in adult populations (Pedersen et al., 2017; Riper et al., 2009). When heavy drinking is considered atypical, individuals may experience pressure to refrain from initiating use or else to limit their use. On the other hand, individuals who perceive that regular or heavy drinking is normal might feel freer to drink more regularly and may even be encouraged to participate in greater frequency and quantity of drinking. Notably, the vast majority of normative belief research has been conducted on college campuses where drinking culture and heavy substance use are considered typical (McAlaney et al., 2011; Miller et al., 2013). But beyond college campuses, other at-risk populations, including individuals involved in criminal justice, also confront the impact of social norms on drinking behavior.

Justice-involved individuals drink more than the general population, and consider their drinking to be normative (Sondhi et al., 2016). Substance use is more prevalent among incarcerated populations than in the general population, with two-thirds of incarcerated adults meeting criteria for a substance use disorder compared to 9% of adults in the general population (Saloner et al., 2016). More justice-involved women than men meet criteria for a substance use disorder (Fazel et al., 2017). Furthermore, substance use plays a larger role in both incarceration and recidivism for women than for men (Bacskai et al., 2011; Swan & Goodman-Delahunty, 2013), making substance use disorders among justice-involved women a particularly important public health concern. For example, women offenders had greater alcohol use severity (higher Alcohol Use Disorders Identification Test scores) than women non-offenders (Brown et al., 2015), and having a substance use disorder and negative consequences of substance use were predictors of recidivism among women offenders (Robertson et al., 2019).

Because the national population of jailed men has historically been much larger than that of women (recent statistics suggest men were incarcerated at a rate of 5.7 times as much as women; Zeng, 2019), the needs of incarcerated women have historically been overlooked (Cortoni, 2017; Covington, 2007). But while the population size of women who pass through criminal justice settings remains small compared to that of men, this population is growing at a more rapid rate than that of men, with a 20% growth in the population of female jail inmates from 2005 to 2017 and a 3% drop in the population of male inmates over the same time span (Zheng, 2019).

As a result of the growing incarceration rates and the salience of substance use problems among justice-involved women, increasing attention has been paid in developing and testing treatments that are tailored to the needs of incarcerated women with substance use problems (Fedock et al., 2013; Finfgeld-Connett & Johnson, 2011; Johnson et al., 2015; Stein et al., 2019). Substance use disorder interventions with women have the potential to reduce both use of substances and recidivism rates, suggesting that efforts here are valuable. Because time in jail is so short in duration (often on the order of days), and because incarcerated women’s needs are unique to those of men (Lewis, 2006), it is critical to identify ways to intervene with women that are brief and which target areas that are likely to influence their substance use behavior.

One potential way is the Social Norms Approach (SNA), a widely-used strategy for promoting positive health behaviors (Dempsey et al., 2018). The SNA operates on the premise that individuals misperceive their peers’ attitudes and behaviors, and has accumulated evidence of peer approval and overestimations of activities for a range of negative behaviors. The greater these misperceptions, the more likely an individual is to sustain unhealthy behaviors such as heavy consumption of alcohol and other substances. The SNA’s primary assumption is that misperceptions of social norms drive engagement in negative health behaviors, but such behaviors can be mitigated by challenging these misperceptions through informational feedback about actual reported norms (McAlaney et al., 2011). SNA-based interventions aim to reduce unhealthy behaviors by challenging misperceptions of social norms. A number of studies of the SNA have suggested that gender-specific feedback reduces alcohol use more among women than men (Lewis et al., 2007; Neighbors et al., 2010). However, not all social norms interventions attempt to change misperceptions of social norms. This has led to a conflation of generic social norms interventions with those that explicitly test the SNA’s assumptions that misperceptions of peer norms drive behaviors.

Consistent with the SNA, stand-alone interventions to clarify norms, in which an individual’s own drinking is compared to her perceptions of drinking norms for a specified reference group and to actual drinking for the reference group, have demonstrated positive effects, though these tests largely occurred in the realm of college campus research (Dotson et al., 2015). Dotson et al.’s (2015) review showed that such interventions created a small (d=0.3) but clinically significant effect on drinking outcomes. Although this research has not yet focused on applications within criminal justice settings, such interventions may be ideally suited for jails where time to deliver interventions is limited. Evidence highlighting the influence of social norms on post-release drinking behavior further underscores the potential utility of such interventions. One study of adult jail inmates revealed, for example, that changes in substance use from the pre-incarceration period to one-year post-release were fully mediated by friends’ substance use (Malouf et al., 2012). To develop SNA interventions for incarcerated women, further information regarding their perceptions of normative substance use must be gathered. This is the first study to compare incarcerated women’s perceptions of normative substance use with actual US rates of substance use and perceptions of substance use by their friends.

Study Aims

The current study examined the normative perceptions of substance use in a sample of incarcerated women with AUDs who were participating in a randomized controlled trial. We expected that: (1) jailed women would overestimate the use of substances by women outside of their immediate social network, that is, women in the US population, (2) jailed women would perceive lower rates of use by individuals in their close network (i.e., their friends), and (3) jailed women would engage in more substance use than women in the US population. We also examined these incarcerated women’s perceptions of incarceration rates among the general population and their close social network. Further, we considered associations of perceived substance use by US women and friends with participants’ planned post-release drinking behavior.

MATERIALS AND METHODS

Participants

Participants were 205 women in the participating jail who met eligibility criteria for the randomized controlled trial (registered at clinicaltrials.gov; Clinical Trials NCT01970293): (1) 18 years of age or older; (2) unsentenced or sentenced to jail time of less than 60 days, (3) lived within 20 miles of the research offices and planned to remain in the area for the next six months, (4) met DSM-5 criteria for alcohol use disorder in the last 90 days (according to the Structured Clinical Interview for DSM-5 [SCID-5]; First et al., 2015), (5) did not expect to attend residential alcohol or drug treatment upon release, (6) spoke English well enough to understand study measures when read aloud, and (7) could provide the name of at least two verifiable locator persons who would know where they could be found. The study was approved by Butler Hospital’s Institutional Review Board as well as regulatory bodies overseeing jail research in Rhode Island.

Procedure

In the jail, research assistants approached women who were unsentenced or sentenced to less than 60 days, and asked them if they were interested in being screened for a research study. Interested women were screened for the additional eligibility criteria, and when they were eligible, informed consent and the baseline interview were administered to them the same day. Of 661 women screened, 222 (34%) met eligibility criteria, and of these, 205 (92%) enrolled in the study.

Measures

Background Characteristics.

To obtain demographic data, participants were asked their date of birth (from which we calculated their age), whether or not they considered themselves to be Hispanic or Latina, their race (White, African American/Black, Native American/Alaskan Native, Asian, Pacific Islander/Hawaiian, Other, More than one race), and number of years of school. To obtain substance use data, participants were asked how many days, out of the past 90, they drank alcohol, or drank heavily (i.e., had four or more drinks on a given day), and the average number of drinks they had on the days they drank. Participants were also asked whether they smoked cigarettes in the past 90 days, and how many days in the past 90 they had used cannabis (e.g., “marijuana, hash”), cocaine (e.g., “freebase, crack, powder”), heroin, and other opioids or painkillers (e.g., “oxycontin, fentanyl”).

Normative Rates of Substance Use.

Participants were asked what percentage of adult women in the United States has, in the last month, had at least one drink of alcohol, smoked cigarettes, used marijuana, and used cocaine. They were asked the same questions regarding their social network (i.e., friends, “people you hang out with,” outside the jail). Participants were asked what percentage of adult women in the US is incarcerated in any given year, and what percentage of their friends has been incarcerated in the past year.

Normative Rates of Substance Use by US Women.

The rate for having used alcohol in the past month among US women (46.0%) was from the Centers for Disease Control and Prevention’s (CDC) Behavioral Risk Factor Surveillance System survey data (CDC, 2016). The rate for having smoked cigarettes in the past month among US women (12.2%) was also from CDC data (CDC, 2018). The rates for having used marijuana and having used cocaine in the past month among US women (11.0% and 0.5%, respectively) were from National Survey on Drug Use and Health data (SAMHSA, 2018). The rate for having been incarcerated (jail, prison) in the past year among US women was from the Prison Policy Initiative’s report on women’s incarceration (Kajstura, 2018).

Planned Post-Release Drinking Behavior.

Participants were asked: After you leave jail, what is your goal in regard to your drinking? Response options were: Make no changes (0), Drink less (1), and Abstinence (quit drinking) (3).

Analytical Methods

We present descriptive statistics to summarize sample demographics and substance use behaviors. We used the 1-sample t-test to compare study participants’ perceptions of rates of substance use by US women to the actual rates of use as reported in our sources. We used the dependent samples t-test to compare the perceived rate of substance use by US women to the perceived rate of substance use among participants’ friends. We computed correlations between perceptions of drinking by ++US women and by friends with planned post-release drinking behavior.

RESULTS

Participants

Participants had a mean age of 35.8 (± 10.0) years (see Table 1). On race, 69.8% were White, 12.7% were Black, and 17.6% identified having other or multiple racial backgrounds; on ethnicity, 10.4% were Hispanic or Latina (Table 1). Of the 21 Hispanic or Latina participants, 9 also identified as White and 12 also identified as “Other.” The mean years of education was 11.8 (± 2.2). AUD severity was mild (2–3 symptoms) for 6.4% of participants, moderate (4–5 symptoms) for 18.5%, and severe (6 or more symptoms) for 75.1%. When participants were asked how long they had a problem with drinking, the mean was 12.6 years (±11.2; median=10). Participants drank a mean of 8.2 (± 8.5; Median = 5.9) drinks per day in the three months prior to incarceration. Among participants, 89.6% were current cigarette smokers, 46.3% had used cannabis during the past 90 days, and 45.8% had used cocaine, 26.3% had used heroin, and 20.5% reported use of other opioids during that same period.

Table 1.

Background Characteristics (n = 205).

N (%) Mean (± SD) Median Range
Demographics
Age 35.8 (± 10.0) 34 18 – 68
Race
 White 143 (69.8)
 Black 26 (12.7)
 Other 36 (17.6)
LatinX (Yes) 21 (10.4)
Education (Years) 11.8 (± 2.2) 12 7 – 21
Substance Use
Days Used Alcohol 57.9 (± 23.9) 63 1 – 90
Heavy Drinking Days 50.8 (± 26.8) 53 0 – 90
Mean Drinks/Day 8.2 (± 8.5) 5.9 0.1 – 81.1
Current Cigarette Smoker 180 (89.6)
Cannabis Use 95 (46.3)
Cocaine Use 94 (45.8)
Heroin Use 54 (26.3)
Other opioid use 42 (20.5)
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Note: Race and ethnicity are reported using standards of the US National Institutes of Health (the funder of this study), which contain categories for race (e.g., Black or African American, White) and two categories for ethnicity: Hispanic or Latino/a and Not Hispanic or Latino/a.

Perceived Normative Rates of Substance Use among US Women

Jailed women perceived that US women used alcohol, cigarettes, marijuana, and cocaine significantly more (p < .001) than they actually did (Table 2). Specifically, jailed women perceived that 1.6 times as many US women used alcohol in the past month than actually did. In addition, they perceived that 5.4 times as many smoked cigarettes, 5.6 times as many used marijuana, and 93.2 times as many used cocaine than actually did.

Table 2.

Normative Rates of Substance Use by US Women Versus Rates of Use Perceived by Participants (valid n = 201).

RATES
Actual Perceived Δ t (p = )
Used Alcohol Past Month 46.0% 73.1% (70.4 – 75.9)a 27.1% 52.25 (<.001)
Smoked Cigarettes Past Month 12.2% 65.3% (62.3 – 68.3) 53.1% 42.91 (<.001)
Used Marijuana Past Month 11.0% 61.2% (57.9 – 64.5) 50.2% 36.61 (<.001)
Used Cocaine Past Month 0.5% 46.6% (43.2 – 50.1) 46.1% 26.59 (<.001)
Incarcerated Past Year 0.1% 6.5% said <1%
5.0% said 1%
33.8% 2–10%
54.7% >10%
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Δ

= Normative Perception % - Actual %.

a

95% confidence interval estimate

Note: All group differences are statistically significant when the Bonferroni correction is applied.

When participants were asked about the percentage of adult women in the US that are incarcerated in any given year, 13 (6.5%) said “much less than 1%,” 10 (5.0%) said “about 1%,” 68 (33.8%) said “between 2% and 10%,” and 110 (54.7%) said “more than 10%.” Even though not directly testable statistically given our observed data, it is clear that participants generally perceived that incarceration rates were considerably higher than the actual 0.12% rate of incarceration among adult women in the US.

Perceived Normative Rates of Substance Use in Social Network

As shown on Table 3, participants’ perceived rate of alcohol use among friends was 6.4% (p = .011) lower than their perceived rate of alcohol use by US adult women (and much higher than actual rates of alcohol use among US women on Table 1). Participants also perceived significantly lower rates of marijuana (61.1% vs 52.5%) and cocaine use (46.7% vs 32.8%) among their friends than they thought was normative among US adult women. Respondents’ perceptions of rates of cigarette smoking among US women and their friends did not differ. The sample of jailed women reported that a mean of 20.6% (SD=29.7) of their friends had been incarcerated in the past year.

Table 3.

Perceived Rates of Substance Use by US Women Versus Perceived Normative Rates of Use by Participants’ Friends (valid n = 194).

PERCEIVED RATES
US Women Friends Δ t (p = )
Used Alcohol Past Month 73.3% (70.5 – 76.2) 66.9% (62.0 – 71.8)a −6.4% −2.56 (.011)
Smoked Cigarettes Past Month 65.1% (62.0 – 68.1) 67.4% (62.6 – 72.2) 2.3% 0.88 (.385)
Used Marijuana Past Month 61.1% (57.7 – 64.5) 52.5% (47.5 – 57.5) −8.6% −3.35 (.001)
Used Cocaine Past Month 46.7% (43.1 – 50.3) 32.8% (27.7 – 37.8) −13.8% −5.11 (<.001)
Incarcerated Past Year M=20.6% (SD=29.7)
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Δ

= Normative Perception % - Actual %.

a

95% confidence interval estimate

Note: All statistically significant group differences remain so when the Bonferroni correction is applied.

Actual Rates of Substance Use

For actual rates of substance use, the women in our sample reported on their use in the past three months, whereas normative data for US women reported use in the past month. Therefore, data on actual use are not directly comparable. In our sample, 100% of women had used alcohol in the past three months (having an AUD was a study eligibility criterion), compared to 46.0% of women in the US population. Almost one-half of women in our sample had used marijuana (46.3%) or cocaine (45.8%) in the past three months, compared to 11.0% and 0.5% of women in the US population, respectively, having used these substances in the past month. Finally, 89.3% of women in our sample had smoked cigarettes in the past three months, compared to 12.2% of US women having smoked in the past month.

Associations of Perceived Normative Rates with Planned Post-Release Drinking Behavior.

A significant correlation between the percentage of friends who had used alcohol in the past month and planned drinking after leaving jail showed that a lower percentage of friends was associated with greater change toward a goal of abstinence (r=−.28, p<.001). In contrast, the correlation between the percentage of US women who had used alcohol and planned drinking was not significant (r=−.04, p=.58).

DISCUSSION

This sample of jailed women with alcohol use disorders overestimated the prevalence of alcohol, cigarette, marijuana, and cocaine use among women in the US population. In addition, they perceived their friends as using alcohol, marijuana, and cocaine less than they perceived US women did. The women in the sample were more likely to use marijuana, cocaine, and cigarettes compared to US women.

These findings have implications for treating substance use disorders among jailed women. Drawing on studies with college students and with public health programs using the SNA (Bewick et al., 2013) it is possible that correcting misperceptions about US women’s substance use norms may reduce jailed women’s substance use. Studies show that students misperceive descriptive norms for alcohol use at their college or university in that they estimate that students drink more frequently, drink more per drinking occasion, and drink more total drinks per week, relative to observed averages on these outcomes. These studies also show that higher perceived norms are significantly related to more drinking, more alcohol-related negative consequences, and a lower likelihood of being a non-drinker by student participants (Dumas et al., 2019; Larimer et al., 2020). As correcting misperceptions in drinking norms is now an established method of reducing college student drinking (Merrill et al., 2018), this approach should be examined among women who are incarcerated and have alcohol use disorders, and could be applied to use of any of the substances studied here.

That a SNA intervention could be fruitful with jailed women to lessen AUD severity is supported by a review concluding that the use of single-session personalized-feedback interventions without therapeutic guidance is viable and probably cost-effective for reducing problem drinking in both student and general populations. The review recommended that future studies focus on intervening with groups required to appear in court because of, for example, being charged with and convicted for alcohol-impaired driving (Riper et al., 2009). The potential usefulness of the SNA with jailed women with AUD is also based on the success of this approach in studies of nonstudent samples (Lau-Barraco et al., 2018; McDevitt-Murphy et al., 2014; Pedersen et al., 2017). These studies show that the SNA intervention need not rely on traditional recruitment methods targeting people already seeking care, and may require little or no contact with clinicians. It is possible for SNA interventions to reach members of a target population, such as jailed women, who may be unlikely to seek conventional treatment for problematic drinking, often have co-occurring mental health disorders (e.g., PTSD, depression), and may be difficult to locate for intervention delivery (Pedersen et al., 2017). These studies also show that participants are satisfied with SNA interventions and find them to be personally relevant and provide a new way of looking at their drinking (Lau-Barraco et al., 2018).

We do not want to underestimate the challenges of delivering SNA interventions to jailed or recently-jailed women with AUD, however (Bewick et al., 2013). One challenge, overcome successfully in the present study, would be working with multiple collaborators, including stakeholders in the correctional system, who may have additional intervention goals. Another challenge would be having adequate resources to sustain interventions over time should they effectively reduce women’s alcohol use. Yet a third challenge would be this population possibly having co-occurring opioid or cocaine use disorders for which more intensive treatments such as medications or behavioral interventions would be needed. Indeed, medications are an effective yet under-used treatment for AUD (Witkiewitz et al., 2019), and the delivery of SNA interventions may present an opportunity to begin to link women to this and other treatment options, if common barriers to health care access and utilization among formerly incarcerated women (Timko et al., 2019) do not interfere.

Interventions that correct misperceptions have been shown to be effective when they are delivered in person, online, or by text (Cadigan et al., 2015; Merrill et al., 2018). Because jail stays are often quite brief, texting or emailing women after release would offer a feasible method for delivering interventions that correct normative misperceptions. Further, because such interventions may be more effective with individuals reporting higher pre-intervention normative perceptions and greater substance use severity (Lau-Barraco et al., 2019), they could be targeted to women who are assessed as having this combination of high normative perceptions and greater severity; women in our study would therefore be appropriate targets. Broadening personalized normative feedback interventions to include education may help to increase effects on reduced substance use, although the SNA and education components would need to be tested separately and together to determine which components are effective and whether they are synergistic. In this regard, Cunningham et al. (2002, 2005) found that heavy drinkers (identified in general population surveys) who received both an SNA intervention and an educational self-help book improved more on drinking outcomes at a 6-month follow-up than those who received just one or no intervention. For jailed women with diagnosed substance use disorders, an educational component could include the link between substance use and incarceration, since these women also overestimated incarceration rates among US women, and reported that their own friends were incarcerated at a higher rate than the US female population.

Other questions raised by studies on normative perceptions of drinking need to be answered for jailed women with AUDs through additional research. For example, it is not clear how normative perceptions vary with specificity of the reference group and of the substance used. That is, are substance use norms more accurate and more closely related to substance use behavior as reference group and substance specificity increases? The women in our sample estimated rates of substance use to be higher among US women than among their friends. However, compared to reports of their own use by these jailed women with AUDs, the women also estimated alcohol, cocaine, and cigarette use to be lower among their friends, whereas the rate of marijuana use among friends was seen as higher. Specifically, 46.3% of women in our sample reported using marijuana in the past three months, compared to 52.5% of their friends in the past month; 45.8% of the sample reported cocaine use in the past three months, compared to 32.8% of their friends in the past month; and 89.3% of the sample reported cigarette smoking in the past three months compared to 67.4% of their friends. Thus interventions to reduce substance use among this study’s population may need to not only correct overestimations of use by some groups (e.g., US women), but also consider perceptions of the close social network’s use to facilitate women’s reduction of their own use. That this is likely is underscored by our finding that estimations of alcohol use were related to planned drinking behavior only for perceived use by friends but not for perceived use by US adult women as a group.

Similar to our findings for the sample’s estimates of US women’s and their friends’ substance use, college students generally reported the highest perceived norms for the most distal reference group (typical student), with perceptions becoming more accurate as individuals’ similarity to the reference group increased (Latimer et al., 2011; Labrie et al., 2013). However, despite increased accuracy, college students perceived that all reference groups, ranging from non-specific to specific, drank more than was actually the case (Latimer et al., 2011). Together, the results from Latimer et al.’s (2011) study and ours suggest that interventions targeting normative misperceptions among women in jail may need to provide feedback based on participant group membership that includes similarity as to which substance-related disorders are of concern. In addition, interventions may need to consider not only descriptive norms (estimates of substance use behaviors) as the present study did but also injunctive norms (the approval of substance use) by the selected reference groups, as injunctive norms were positively associated with drinking behavior among college students in some studies (e.g., Lee et al., 2007) although not others (e.g., Steers et al., 2016).

Also important to consider in any future studies using the SNA with jailed women to reduce their drinking will be the women’s social identification with the referent groups included in the norms measures (e.g., US jailed women of their own race and ethnicity, friends in and out of jail, family members). In a study by Rinker and Neighbors (2014) of college students, perceived norms were associated with drinking, but this relationship varied as a function of social identification. Specifically, the association between norms and drinking was stronger among students who viewed the university’s student body as part of their own identity and who were more committed to their fellow students; it was weaker among students who deferred more to student leaders. Future studies of jailed women may also consider the closely related concept of social identity. In studies of formerly incarcerated mothers with a substance use history, a main factor shaping recovery was creating a “replacement” social identity post-incarceration in which women disconnected from their substance-using identity (Gunn & Samuels, 2020; Gunn et al., 2018).

Limitations

Limitations of this study were the absence of a non-jailed comparison sample, the lack of assessment of perceptions regarding incarcerated women’s substance use, and that the sample was accrued in only one jail. However, our participating jail was similar to jails nationally in that it covered a geographic area similar in size, the majority of prisoners were charged with misdemeanor offenses, and the median length of stay was less than one week. Another limitation was that the measures, although previously well-validated, did not all refer to the same time frame. In addition, we recognize that although the measure of normative rates of substance use among friends referred to friends outside of jail, participants’ friends may include other women who have been incarcerated. Finally “actual use” was measured by self-report and not confirmed biologically, that is, with urine, hair, blood, sweat, or saliva testing.

Conclusions

Women who are jailed and have an alcohol use disorder represent an at-risk, understudied population. Our findings that these women overestimate both substance use and incarceration by other US women, and perceive less substance use among their friends compared to other US women while also using substances much more than the general population of women, suggest treatment approaches that involve correcting these estimates and would be feasible to deliver to this population. Effective interventions for women offenders who use drugs are greatly needed, as shown by a recent systematic review that found limited evidence of benefits for treatments tested in this population for reducing drug use or criminal activity (Perry et al., 2019). Given that substance use post-incarceration can carry severe consequences (Chamberlain et al., 2019), the present findings may help to guide development of treatments to deliver during incarceration to reduce substance use.

Acknowledgments

Funding: This research was funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA; R01 AA021732; PIs Stein and Johnson) and the Department of Veterans Affairs (VA), Health Services Research and Development Service (RCS 00–001 to Dr. Timko). The trial is registered at clinicaltrials.gov (Clinical Trials NCT01970293). NIAAA and VA did not participate in the design, collection, analysis, or interpretation of the data, the writing of the manuscript, or the decision to submit the manuscript for publication.

Footnotes

Conflicts of interest: none

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