Participant Evaluation of Twelve-Step Group Linkage for Jailed Women With Alcohol Use Disorder

Abstract

Jailed women are an underserved population with elevated rates of alcohol use disorders. Brief jail stays make delivery of case management and traditional alcohol treatment impractical yet women face significant reentry challenges with few help resources. Accounting for these challenges, linking jailed women with a twelve-step program volunteer for a one-on-one meeting has been hypothesized to provide a means of support that can transition with women after jail discharge. In-jail meetings are theoretically consistent with the common twelve-step practice of conducting twelve-step calls. The acceptability and content of a one-on-one, in-jail meeting with a twelve-step volunteer were explored using qualitative data collected through interviews with 72 women directly following their in-jail volunteer meeting. Participants found the meeting to be acceptable and to contain many useful elements, and content was in line with the standard twelve-step calls. Findings are encouraging both for the potential utility of the intervention and for dissemination of similar linkage approaches.

Jailed women are a growing and underserved population with high rates of alcohol use disorders (AUDs; Abram, Teplin, & McClelland, 2003) and associated life problems, including unemployment, physical health problems, and mental health problems (Jordan, Schlenger, Fairbank, & Caddell, 1996; Martin & Bryant, 2001). A recent review of prevalence rates of substance use disorders in incarcerated settings demonstrates that about 50% of women meet criteria for a drug use disorder, and that one in four women prisoners meets criteria for an AUD (Fazel, Yoon, & Hayes, 2017).

Given the prevalence of substance use disorders among jailed women, it is not surprising that self-reported substance-related treatment needs are high. Indeed, in a jailed urban population, more women than men reported needs for substance treatment services, as well as more willingness to receive such services (Spjeldnes, Jung, & Yamatani, 2014). Yet, despite the self-reported need and willingness, much of the need for substance-related support goes unmet. For example, one third of a sample of incarcerated women with substance use and co-occurring mood disorders (including major depression, bipolar disorder, and schizophrenia) had not received treatment from a health care professional in the past year (Nowotny, Belknap, Lynch, & DeHart, 2014). It is clear that greater support for substance-related disorders is needed among incarcerated women.

In large part, unmet substance treatment need faced by women in jail can be attributed to the significant challenges women face in gaining access to help resources. One particular challenge is that jails have incarceration periods that are short—on the order of days. For example, published statistics from the state of Rhode Island suggest that the average length of jail stay is 24 days, although the median length is 3 days (Rhode Island Department of Corrections, 2016). In contrast, prison stays are longer (typically weeks or months) and provide more time to offer treatment or develop a discharge plan for services after release; the average length of prison sentences in Rhode Island is 30.4 months (Rhode Island Department of Corrections, 2016).

Adding to the challenge of short jail stays, transition back to the community after discharge from jails presents a high-risk period for resurgence of alcohol and other associated life problems (Scott & Dennis, 2012) due to reentry into nonsober social networks (Bui & Morash, 2010), lack of stable housing or employment (Langan & Pelissier, 2001; Messina, Burdon, Hagopian, & Prendergast, 2006; Pelissier, Camp, Gaes, Saylor, & Rhodes, 2003), and lack of treatment or other social services that would support transition back to the community (Alemagno, 2001). Perhaps particularly important for women releasing from jail, the lack of a trusted support person to help them overcome barriers to entry into support resources can preclude effective help-seeking behaviors (Parsons & Warner-Robbins, 2010). Given the high unmet need, looking to supports outside of traditional treatments (which can be difficult to access due to financial and transportation constraints) may be important.

Twelve-step mutual help groups (TSMGs) represent one viable source of support for incarcerated women with AUDs. Indeed, Alcoholics Anonymous (AA) membership in the United States is estimated at 1.3 million, with approximately 40,000 members housed in correctional facilities (AA, 2010). TSMGs also represent a low-cost, familiar, and widely accessible community resource. Given the high need, but numerous challenges, in accessing formal treatment support, connecting jailed women with alcohol problems to TSMGs may be a viable means of enhancing support that can directly address problems associated with AUDs during the high-risk time following return to the community.

By creating an opportunity for women in jail to form a connection with a support person during a jail stay, such a connection can later be leveraged to facilitate use of easily accessible help resources. It is during an intimate, one-on-one meeting that individuals can form personal bonds, even if there are differences in background characteristics between a jailed woman and a TSMG volunteer. In our previous work, we developed a method to accomplish this task (Johnson, Schonbrun, & Stein, 2014). The approach included linking women to a volunteer from community-based TSMGs during their jail stay, with the expectation of the volunteer meeting the woman and accompanying her to a TSMG meeting after release. Our initial test of this approach suggested that such a one-on-one meeting during a jail stay may help women to get to meetings and improve their AUD-related outcomes following their jail discharge. However, our pilot test did not explore women’s perceptions of this one-on-one meeting (i.e., the acceptability for the women of the in-jail meetings with a volunteer) or the specific content of those meetings. Effectiveness of this one-time, in-jail meeting may depend, in part, on the acceptability of the overall meeting to the women involved. Acceptability is multifaceted, but has components that include affective attitude, perceived effectiveness, ethicality, and self-efficacy (Sekhon, Cartwright, & Francis, 2017). Using open-ended questions, we sought to explore how acceptable the intervention was for participants. Data collected in postmeeting interviews was used to explore jailed women’s perceptions and content of these one-on-one meetings.

In-Jail Meetings With a Volunteer

In the current study, female TSMG volunteers doing twelve-step work met individually with women during jail stays. Volunteers approached the in-jail meetings as a part of their twelve-step calls. According to twelve-step traditions, twelve-step calls involve current members helping others in their recovery by carrying the messages of the organization to them. Members often consider twelve-step work to be an ongoing responsibility and may take part by engaging in various activities, including offering meetings in locations including criminal justice settings.

Whereas twelve-step programs frequently offer TSMG exposure in criminal justice settings (including jails), the approach taken is almost exclusively in a group format. Contact postdischarge is facilitated by group leaders who hand out flyers and business cards with an 800 number; women can call that 800 number after their discharge and leave a message as to their interest in being put in touch with a TSMG member (personal communication, May 11, 2011). Personal communication with a coordinator of TSMG members volunteering at a local jail setting revealed that women very rarely called the 800 number and never followed through with making contact with a member through the 800 number (Johnson et al., 2014). It may be that the lack of personal connection with a twelve-step member limits incentive and comfort in reaching out for help during the tumultuous period following release. Moreover, because jail stays are so short, opportunities to make meaningful contact with an individual from a TSMG may be unlikely when left to chance.

The current study design created a unique opportunity for women in jail to develop a personal connection with a twelve-step volunteer through a one-on-one, in-jail meeting with a TSMG volunteer who could meet with them after release. Compared with an approach that relies on a call to an 800-number for contact initiation, this novel approach is hypothesized to work better by linking women to a support during their jail stay and then leveraging that personal connection for support following jail release to encourage and facilitate meeting attendance. We used postmeeting, in-jail interviews to explore the women’s overall experience of the in-jail meeting. We also asked women about what aspects of the meetings with the volunteer they found to be most and least helpful.

In addition to exploring acceptability and perceptions of meetings, we also examined how closely in-jail meetings resembled traditional twelve-step calls by comparing themes discussed with themes recommended for discussion during twelve-step calls. Standard twelve-step calls involve members sharing their own drinking experiences and personal stories; sharing their views of alcoholism; sharing their experiences in the twelve-step program; sharing about their recovery, including spirituality; and providing meeting schedules, personal contact information, offers of help attending a meeting (Reading-Berks Intergroup, 2008). TSMG members are often committed to engaging in twelve-step calls as a part of their ongoing sobriety work. Therefore, it is important to explore whether the one-on-one, in-jail meetings are consistent with what is expected of a twelve-step call. To explore this question, qualitative data analysis was used to explore how closely meeting content resembled standard twelve-step calls.

Interviews with participants directly following the meeting provided insights into their acceptability and perceived usefulness, as well as into the content of in-jail, one-on-one meetings with a volunteer. Analysis of the qualitative data captured during interviews may provide useful feedback to organizations, including both criminal justice settings and TSMGs, in enlisting in-jail meetings between TSMG volunteers and women in jail.

Method

Recruitment of participants from a single jail site occurred in October 2013. All participation was voluntary with confidentiality assured through a Federal Certificate of Confidentiality. All procedures were approved by the hospital institutional review board, and the larger trial is registered at clinicaltrials.gov (NCT01970293).

Participants

Seventy-two women participating in a clinical trial evaluating an approach to linking jailed women with AUDs to a twelve-step mutual help group (TSMG) were interviewed during their jail stay (Johnson, Schonbrun, & Stein, 2014). Participants averaged 36.4 (±10.1) years of age, and 66.7% were Caucasian; 91.7% were non-Hispanic. Almost a quarter (23.9%) of the sample had never attended an AA meeting during their lifetime. There were an average of 216.6 (±360.3, range = 1–2,000) meetings attended during the lifetime of those who had attended at least one meeting. Thirty-two (44.4%) participants had attended a meeting during the past year (M = 70.8 ± 126.5, range = 1–700). The mean length of stay for participants included in this investigation was 25.88 days (SD = 19.00 days, median = 19.5, range = 2–88; seven individuals had missing data).

Eligibility criteria for the parent clinical trial were as follows: (a) age of 18 years and older, (b) unsentenced or a sentence shorter than 60 days, (c) preincarceration residence close to the recruitment site, (d) meeting criteria for an AUD within the 6 months prior to baseline interview, (e) expectation of discharging to the community (vs. discharging to residential treatment), and (f) English speaking. Only participants assigned to the intervention arm were included in the current investigation; a total of 146 participants comprised the entire sample of whom 72 were intervention participants who received the TSMG volunteer visit. A total of 397 women were recruited to yield the 146 participants. Reasons for ineligibility included the following: participants not wishing to continue after completing consent procedures (n = 17), not living in close enough proximity (n = 8), not meeting criteria for an AUD (n = 77), inability to provide two primary contacts (n = 17), expecting to be released to a residential treatment facility (n = 53), or expecting to be sentenced (n = 76). The remaining three individuals were ineligible due to language barriers or incompetence.

Volunteers

There were a total of 21 TSMG volunteers who met with participants. Because volunteers were not research participants, and due to anonymity considerations of TSMGs, we were unable to capture demographic information about the volunteers other than the fact that they were adult females (a requirement to volunteer). To cooperate with the TSMG group, the research study also needed to support the group’s traditions of nonaffiliation and attraction (Johnson et al., 2014). This was implemented in several ways: (a) The TSMG recruited, trained, and supervised their own volunteers; (b) the research study agreed to refrain from stating or implying in any way that we or the study were/was endorsed by the TSMG; (c) the intervention was framed as offering an opportunity for twelve-step work for the TSMG and an opportunity for them to do their twelve-step work with a difficult-to-reach population.

Procedures

Participants were interviewed immediately following the in-jail meeting with their TSMG volunteer, which occurred, on average, 1 day after incarceration. Meeting lasted for an average of 29.3 min (SD = 15.7 min, range = 9–74 min). To ensure adherence to the twelve-step tradition of nonaffiliation, research staff did not manualize, script, audio record, or influence the TSMG–participant meeting content in any way. Immediately following the meeting, participants met with a research assistant (with whom they had met for a baseline interview assessment 1–2 days prior) and completed a semistructured interview. Participants answered open-ended questions about (a) overall experiences, (b) helpful and unhelpful aspects of the TSMG meeting, and (c) the topics discussed during the meeting. Researchers took detailed notes on participant responses; these data were analyzed for the current study.

Data were analyzed using traditional open coding strategies that attach phenomenological concepts to the data through the coding process. Open coding strategies applied involved the identification, naming, and categorizing of relevant phenomena that emerged in the interview text (Strauss & Corbin, 1998). All interviews were independently coded by two of the authors (YCS and MK). Each coder reviewed, selected, and coded utterances reflecting an emerging concept. During coding meetings, interview text was discussed line by line and coding between the two coders was reconciled to reach consensus regarding the meaning of text.

Initial coding was done on the specific concept level (e.g., participant sharing her personal story about alcohol use). Specific concepts were subsequently grouped together during consensus meetings to generate broader themes (e.g., sharing experiences) for the final codebook. After 40 interviews were coded, new broad codes ceased to emerge (i.e., data saturation was achieved; Strauss & Corbin, 1998). Granular codes continued to emerge, however, so coding continued until both coders were confident that new granular codes were not influencing the overall coding scheme.

Results

The goals of data analysis were to evaluate incarcerated women with AUDs’ perceptions of the acceptability of the in-jail meetings with a TSMG volunteer; document the specific meeting topics, including those that were helpful or unhelpful; and explore whether meeting content was consistent with traditional twelve-step calls.

Overall Feelings

With one exception, all participants reported positive (e.g., “good,” “very positive,” “enjoyed it,” “it was helpful,” “uplifting”; N = 65) or neutral (e.g., “ok,” “alright”; N = 6) feelings about the meeting.

Topics Discussed

A thematic analysis of the interviews revealed several higher order themes of topics discussed: (a) individual, (b) interpersonal, (c) AA/treatment related.

Individual topics.

At the individual level, participants discussed their readiness for change. Some conversations focused on being ready, and others focused on reasons the participant might not yet be ready. Participants also described sharing personal stories around substance use with their volunteer, and the volunteer sharing her own personal story, as well. As one participant described, she and her volunteer discussed “how drinking caused the volunteer to crash and burn.” Participants also described discussing the various life circumstances they were facing. For example, one participant listed the circumstances she shared with her volunteer: “Why [I] started alcohol, how [I] started alcohol, [my] upcoming surgery, court tomorrow, meeting willingness, overcoming obstacles, family relationships, life now.” Several participants described hearing a message of hope from their volunteer.

Interpersonal topics.

A variety of interpersonal topics were also discussed, such as the nature of social support in the participant’s life, including presence versus lack of support, and brainstorming how to obtain needed support. In addition, five participants identified that the volunteer made tangible caring gestures including offering her contact information, offering to make herself available to the participant after her jail discharge, and listening intently to the participant during their meeting.

TSMG/treatment-related topics.

Participants described their volunteers as providing concrete details about TSMG options, including what barriers might arise and review of meeting options. Participants and volunteers also discussed “what to do to stay sober,” including meeting attendance, engaging deeply in TSMGs by reading the literature, doing the step work, and connecting with social supports. Finally, participants described discussing spirituality with their volunteers, including “God as a higher power.”

Helpful Topics

In response to the question about what “was particularly helpful,” participants named topics in each of the higher order themes identified as topics discussed (i.e., individual, interpersonal, and AA/treatment related).

Individual topics.

Among the individual topics, participants reported that discussing how to overcome obstacles to alcohol recovery was helpful for them. As one participant described, it was helpful to discuss “the different kinds of programs [and] how to help myself when I want to drink. [My volunteer] said not to be ashamed.” Related to this utterance, themes of acceptance were also identified as being particularly helpful for participants. So, too, was self-care.

Participants reported discussing their future plans with their volunteer, including how they would find housing and how they would remain sober. Participants also found it helpful to discuss motivation to quit drinking. As one participant stated, the meeting was good because it “helped change my mind about drinking.” Another stated that her volunteer “said if you’re willing there’s a way.” A message of hope by the volunteer was also described as being helpful. One participant described that her volunteer said “don’t give up. Things will get better.” As another participant said, “she gave me hope.”

Interpersonal topics.

With regard to interpersonal topics, topics that demonstrated the volunteer’s caring including plans to attend meetings with their volunteer, plans to introduce the participant to others at TSMG meetings, sharing contact information, and nonjudgmental listening were found to be particularly helpful. As one participant described, the volunteer said “that she would go with me the day I am released and provide transportation to AA.” Moreover, participants found sharing personal stories with their volunteer (i.e., sharing their own as well as hearing the volunteer’s) to be helpful. As one participant noted, “[I] could relate a lot to her. [We] were the same age at the time and had the same job.”

TSMG/AA-related topics.

Various TSMG- and treatment-related topics were also found to be helpful, including discussion of spirituality as it related to TSMG philosophy and practice. Participants also found discussion of specific strategies to getting and remaining sober to be helpful. Specific TSMG strategies included reading content of the Big Book, reviewing steps toward sobriety, and discussing the types of supports that are available through TSMGs. As one participant described, her volunteer “told me about some young meetings, goals of not drinking, reading the AA Big Book, 12 steps, why we want to get clean.” Participants also noted that the meeting content was not always restricted to TSMG resources; sometimes, conversation ventured over to non-TSMG programs such as detoxification programs and various forms of outpatient care.

Unhelpful Topics

According to participants, there were few unhelpful topics discussed. Only one participant noted that sharing experiences was found to be unhelpful; this participant stated that “involvement in meetings is not something I’m interested in.” Although the interview asked explicitly about topics discussed that were unhelpful, there was little other mention of unhelpful topics.

Standard Twelve-Step Call Topics Covered

As shown in Table 1, analysis of topics revealed that, taken together, the one-on-one, in-jail meetings covered almost all the recommended (e.g., Reading-Berks Intergroup) twelve-step call topics. No participant mentioned one of the twelve-step call topics as an item of discussion with their volunteers: alcoholism as disease.

Table 1.

Twelve-Step Call and Relevant Meeting Topic Covered.

Twelve-step goal	Corresponding topic(s) covered during jail meeting
Suggest detox/rehab if needed	Discussion of non-TSMG treatment options, including detox and outpatient
Share how it was (your own drunkalog)	Volunteer’s sharing of her own experiences, discussion of the volunteer’s overcoming obstacles in their her own life
Share your understanding of the disease of alcoholism
Share exactly what happened to you	Discussion of the volunteer’s overcoming obstacles in her own life
Share your TSMG experience	Sharing experiences between the participant and volunteer
Share how it is now—your recovery program and spirituality	Conversation about God/spirituality as it relates to AA philosophy and practice
Leave a meeting schedule, TSMG pamphlets, and your phone numbers and make one follow-up visit or phone call	Volunteer’s offers to introduce the participant to others; sharing of contact information; review of AA themes, including content of the Big Book, steps toward sobriety, and the types of supports available through AA; discussion of what the participant might expect from AA including barriers to attending and various options for attending meetings; the volunteer’s sharing of her contact information and otherwise making herself available following the participan’s jail discharge

Source. TSMG topic themes taken from Reading-Berks Intergroup (2008).

Note. TSMG = twelve-step mutual help group; AA = Alcoholics Anonymous.

Discussion

Previous research indicates that incarcerated women with AUDs may refrain from twelve-step meeting attendance after release from jail because they do not like reaching out to strangers (Johnson et al., 2017; Johnson et al., 2014; Johnson, Williams, & Zlotnick, 2015). As a result, it may be useful for women to make a connection to a volunteer who can meet with the woman after release from jail while still in jail. Such a connection has the potential to help women attend a community TSMG meeting postdischarge so as to continue a period of abstinence begun during incarceration. The current study explored whether participants found such an in-jail, one-on-one meeting with a volunteer acceptable, and what they found helpful (or unhelpful) about these meetings. We also sought to capture information about the meeting content and to evaluate whether meeting content lined up with traditionally recommended twelve-step call content.

Overall, participants were enthusiastic about in-jail meetings with a TSMG volunteer. With few exceptions, participants described their meetings with TSMG volunteers in positive terms. They described topics covered at the individual, interpersonal, and AA/treatment-related levels, and noted various aspects of the meetings that were particularly helpful, including practical items such as finding out more about TSMG (e.g., meeting types that were available), tips for getting and staying sober (e.g., “90 meetings in 90 days”), talking through future plans for how to secure housing, and how they might attend meetings. Participants also described more abstract guidance as helpful. For example, participants found it helpful to talk about their readiness for change with regard to drinking. At an individual level, the one-on-one meetings with volunteers helped participants reflect on their alcohol use and consider options for making changes.

Women also spoke enthusiastically about various interpersonal aspects of the meeting they had with their volunteer. They noted that sharing experiences, both hearing about the volunteer’s experiences and telling the volunteer about their own, was a useful element of the meetings. Indeed, sharing experiences can amplify the experience (Boothby, Clark, & Bargh, 2014) and can create connection to the person with whom the experience is shared. The connection provided through TSMG sponsorship has been documented to be associated with abstinence over time (Zemore, Subbaraman, & Tonigan, 2013), and a stronger alliance with a sponsor was associated with more TSMG participation and better alcohol outcomes over time (Kelly, Greene, & Bergman, 2016). Although volunteers in the current study did not offer to be sponsors, a one-on-one meeting perhaps modeled what a sponsor relationship might look like. The qualitative evidence from the current study demonstrates that participants experienced the connection formed with their volunteers during their in-jail meeting to be impactful. Future exploration of the impact of the connection on meeting attendance and alcohol outcomes following jail discharge is still needed. In addition, investigation of how much care the women felt from their volunteers and the impact of that perception on meeting outcomes and future use of both informal and treatment services is also needed.

Gaining familiarity with TSMGs, both in terms of the philosophies and the way that meetings work was also useful for participants. An open question remains as to whether increasing familiarity facilitates meeting attendance after jail discharge.

Consistency With Recommended Content for Twelve-Step Calls

The current study also evaluated whether in-jail meetings between women and a TSMG volunteer resembled traditional twelve-step calls. The prescribed content for twelve-step call content includes members suggesting detox/rehab if needed, sharing their own symptoms, drinking habits, and other personal experiences with alcohol, and several other content areas listed in Table 1 (Reading-Berks Intergroup). Our research study did not incentivize or otherwise encourage coverage of any of these content areas, so the topics that were addressed during the meetings were entirely generated by the volunteer and the interaction between the volunteer and the participant. Our results suggest that almost all recommended twelve-step call topics were covered during the meetings, as a whole. This finding is encouraging insofar as the TSMG organization that cooperated with the research protocol conceptualized its involvement as a means for its members to complete their twelve-step work. It appears that the aims of the twelve-step calls were completed as all recommended topic areas were covered, with one exception: discussion of alcoholism as a disease. It is not clear why this topic was not identified as one discussed during the one-on-one meetings, and further investigation into how important addressing this topic is during jail-based twelve-step calls is warranted.

The results from the current study can offer a specific policy suggestion. Facilitation of one-on-one meetings between a TSMG volunteer and an incarcerated woman, with the expectation that the two will meet after release from jail, is both feasible and acceptable. Although the current study does not provide postincarceration outcome data, results suggest that women found these meetings motivational, connecting, and helpful in paving the way for postrelease meetings attendance and other behavioral change related to their drinking.

Given the limited financial and personnel resources found in most criminal justice settings, programs that provide opportunities for individual volunteers to meet with women during incarceration periods may be a low-cost and acceptable way to help women reflect on drinking and behavioral change during the period of incarceration-enforced abstinence. Cooperation between criminal justice settings and TSMG groups may increase opportunities for women to connect to help resources that are easily accessible for them during incarceration, as well as during the period directly following their discharge from the facility. Evidence from the current study further suggests that content of meetings closely resembled traditional twelve-step calls. This finding indicates that it is appropriate for TSMGs and their members to view this kind of work as part of members’ twelve-step work.

Although the current study offers an important glimpse into the acceptability and content of one-on-one meetings between a TSMG volunteer and an incarcerated woman, there are a number of limitations that should be noted. First and foremost, acceptability data do not ensure positive outcomes. Future research examining the impact of in-jail meetings with a volunteer is needed to confirm whether these meetings influence drinking and other outcomes. Second, results from this study may not generalize to cooperative relationships between criminal justice settings and other TSMG groups. Indeed, each TSMG operates independently, and each criminal justice setting may have unique practices. Nevertheless, this approach is a fairly simple one that may easily be adapted to other TSMG groups and criminal justice settings. In addition, results from this small sample of women recruited from a single criminal justice setting may not generalize to men, to individuals who primarily use substances other than alcohol, or to individuals whose problems are severe enough that they expect to be discharged into residential treatment facilities. Similar approaches to gathering data regarding acceptability and content of meetings may be useful to conduct in varied settings to determine whether similar approaches taken in other settings are as acceptable and whether meeting content might diverge. Finally, twelve-step programs often have less racial and ethnic diversity than criminal justice settings, and it is possible that differences between women and their volunteers may affect the formation of alliances. Future research investigating the formation of this relationship will be helpful.

Conclusion

The current study offers some important insights. The linkage approach being tested in the current study is a novel method to facilitate community-based support for women with AUDs who are likely to be released rapidly from jail settings. By connecting women with a TSMG member during their jail stay, a connection is formed that can be leveraged after jail discharge. Participants in the study found the meeting to be acceptable and to contain many useful elements, including allowing them to create a personal connection with a TSMG member. The a priori conceptualization of the meeting as a twelve-step call for TSMG was tested and found to be consistent with the content of standard twelve-step calls. This is an important finding for TSMG groups, who may be encouraged that cooperating with research teams, for criminal justice settings which can provide members with an opportunity to conduct their twelve-step calls, and for researchers, who may wish to cooperate with TSMG members in similar endeavors.

Future research testing whether the in-jail meeting influenced postrelease TSMG meeting attendance and alcohol outcomes remains to be conducted. For example, factors influencing the utility of such meetings, including length of the meeting with volunteers (which ranged considerably in the current study), warrant investigation as to how they relate to overall satisfaction and impact of the meetings. In addition, future research evaluating the effect of jail-based linkage interventions in other high-risk populations remains an important area of inquiry.