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Women, Addiction and Mental Health Issues in the Drug Courts Hon. Peggy Fulton Hora Judge of the Superior Court (Ret.) LADCP April 11, 2012.

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Presentation on theme: "Women, Addiction and Mental Health Issues in the Drug Courts Hon. Peggy Fulton Hora Judge of the Superior Court (Ret.) LADCP April 11, 2012."— Presentation transcript:

1 Women, Addiction and Mental Health Issues in the Drug Courts Hon. Peggy Fulton Hora Judge of the Superior Court (Ret.) LADCP April 11, 2012

2 “There is nothing more unequal then the equal treatment of unequal people” Thomas Jefferson

3 Female drug use Approximately 6.6% of women aged 12 and older reported past month use of an illicit drug 9,417,840 females Substance Abuse and Mental Health Services Administration, 2009 National Survey on Drug Use and Health (NSDUH), September 2010)2009 National Survey on Drug Use and Health (NSDUH)

4 Women and Alcohol 2.7 million women abuse alcohol “moderate” drinking is < 1 drink a day 4 million women need treatment for substance dependence

5 1:4 cases of dementia caused by alcohol Women are at high risk because more susceptible to alcohol’s “brainwashing” effects Women are less able to deal with alcohol’s toxic effects Develop more severe complications earlier Younger drinkers will experience memory problems sooner Macrae Fiona, Daily Mail Online, May 11, 2009

6 Women and drugs in CJ system Women in the criminal justice system display an even higher rate of substance use 59.3% of state and 47.6% of Federal female prisoners surveyed in 2004 indicated that they had used drugs in the month prior to their offense 60.2% of state and 42.8% of Federal female prisoners surveyed in 2004 met drug dependence or abuse criteria BJA

7 Women and Smoking Women smokers get sicker at a younger age than men COPD reduced lung function at lower level of smoking “Cigarettes More Toxic for Women, Study Finds,” Join Together Online

8 “You’ve come a Long way, Baby”

9 LA Cost of SA and Addiction 17% of Louisiana state budget = $1,375,626 $ per capita “Shoveling Up II: The Impact of Substance Abuse on Federal, State and Local Budgets,” CASA (May 2009)

10 The Burden on SA/Addiction in LA

11 Impact on Kids Females constitute approximately 30% of the substance addicted population in the United States and most are of childbearing age

12 500, ,000 newborns are exposed to illicit drugs each year Among pregnant women aged 15 to 44 years who participated in the 2006 National Survey on Drug Use and Health, 4.0% reported having used illicit drugs within one month of the survey Josh Gunn, Ph.D. and Scott Kriger, Ph.D, “The Prevalence of Maternal Drug Use During Pregnancy”

13 Women/girls use for different reasons A three-year study on women and young girls (aged 8–22) revealed that girls and young women use substances for different reasons than boys and young men. Risk factors such as low self-esteem, peer pressure, and depression make girls and young women more vulnerable to substance use as well as addiction National Center on Addiction and Substance Abuse at Columbia University, The Formative Years: Pathways to Substance Abuse Among Girls and Young Women Ages 8–22 (PDF), February 2003The Formative Years: Pathways to Substance Abuse Among Girls and Young Women Ages 8–22

14 Juvenile prevalence Of youth in post-adjudication placements, 47% have alcohol and drug disorders Among high school seniors in 2008, one in 10 (10.4%) reported that in the two weeks prior to their interview, they had driven a vehicle after smoking marijuana

15 Youth with MH/AOD problems Adolescents with serious behavioral problems are more than 7 x’s more likely to report substance dependence Youth with serious emotional problems are 4 x’s more likely to report AOD dependence

16 Drug Cases Juvenile Courts 193,700 juvenile drug cases drug cases doubled Delinquency caseload for drugs = 7% in 1985 vs. 12% in 2004 Female caseload jumped12%-20% ‘91-04 “Drug Offense Cases in Juvenile Courts, ,” OJJDP Fact Sheet, Feb. 2008

17 Juvenile Justice Up to 67% of youth involved in the juvenile justice system have a substance use problem. Almost ¾ of youth in correctional facilities report mental health problems during screening

18 Co-Occurring “[Co-Occurring] is the expectation, not an exception.” Dr. Ken Minkoff

19 Co-Occurring disorders are more prevalent in men or women? Women

20 Mental health issues Co-morbidity complicates and exacerbates the problems Almost 12% of mothers in the U.S. has serious mental illness; 3.2% had SMI + SA Up to 95% of parents in tx programs have co- occurring disorders

21 Post Traumatic Stress Disorder  30-57% women in treatment meet criteria for PTSD  45-85% of battered women meet criteria  Co-morbidity for PTSD and substance use disorders is 2-3xs higher for females

22 Trauma-informed Care Community corrections, prosecution, defense and the court must become “trauma-informed” Substance abuse and other mental health issues are closely associated with trauma SA/MH drives the justice system—both criminal and child abuse and neglect cases “Understanding women in court,” SAMHSA, Center on Women, Violence and Trauma (2006)

23 Women with Co-Occurring Primary Drugs of Choice OAS, 2002

24 Cocaine / Alcohol Abusers with Comorbid Psychiatric Disorder MEN Anxiety 48% Depression 36% Bipolar 6% Panic disorder 10% Social phobia 14% PTSD24% WOMEN 70% 40% 4% 18% 10% 46%

25 Men vs. Women in Custody Women inmates have >symptomology diagnosed with mental health problems 3xs rate of men Symptoms Diagnosed SP M SP F Jail M Jail F 48% 8% 62% 23% 59% 9% 70% 23%

26 Women with Co-Occurring More Likely Than Men to be: Poor Uneducated Poor job skills Receive public assistance Report more relatives with AOD problems Care for more dependents Depressed, anxious, have eating disorders and lower self-esteem “Women with Co-Occurring Mental Illness and Substance Abuse,” AIA Center (May 2005)

27 Post-Traumatic Stress Disorder (PTSD) Acute traumatic stress is caused by an individual's subjective experience of an extreme traumatic event which can lead to extreme stress that inhibits a person's ability to cope. Trauma is defined as a terrifying event that a person experiences, witnesses or learns about in which grave physical harm occurred or was threatened. The traumatic event causes the person to feel intense fear, terror or a sense of helplessness.

28 Post Traumatic Stress Disorder  30-57% women in treatment meet criteria for PTSD  45-85% of battered women meet criteria Co-morbidity for PTSD and substance use disorders is 2-3xs higher for females  Smokers at higher risk for PTSD  Archives of General Psychiatry (Nov. 05)

29 “Linda” 41 years old Alcoholic Incest survivor but won’t talk about it Battered by > one man Dx? Tx? Action plan? What ?s

30 New app from VA

31 Women with Co-Occurring More Likely Than Men to be: Poor Uneducated Poor job skills Receive public assistance Report more relatives with AOD problems Care for more dependents Depressed, anxious, have eating disorders and lower self-esteem “Women with Co-Occurring Mental Illness and Substance Abuse,” AIA Center (May 2005)

32 Allowing women to have their children with them while in treatment increases treatment success TRUE

33 The number one barrier to treatment for women is: Lack of child care and fear of losing their children

34 The number two barrier to treatment for women is: Being battered

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36 FALSE The number one risk factor for alcoholism is childhood sexual abuse.

37 Childhood Sexual Abuse It is the second most prevalent risk factor Applies to both boys and girls 70-90% of women in tx were sexually abused before age % men in jail report physical or sexual abuse before 18

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39 “A Seducer Is Sentenced” Mary Kay Letourneau, 34, married mother of four, who pled guilty to child rape in The victim was her 6 th grade student, 12- year-old Vili Fualaau. She served 7 ½ years in prison after having two children with him.

40 TRUE Children born to alcoholic parents but adopted during infancy and raised by “teetotalers” are still at greater risk for alcoholism than adopted children who were born to non-alcoholics.

41 Genetic Inheritance: #1 Risk Factor Alcoholic family twin raised by non- alcoholic parents 74% concordance for identical twins 32% concordance for fraternal twins

42 Genetic Inheritance (Cont.) Non-alcoholic family twin raised by alcoholics NO INCREASED RISK

43 Aristotle said, “…women who drink wine excessively give birth to children who drink excessively of wine.” 350 B.C.

44 Health professionals are: well-trained somewhat trained poorly-trained to identify women who have AOD issues Poorly-trained

45 Becoming trauma-informed

46 Community corrections, prosecution, defense and the court must become “trauma-informed” Substance abuse and other mental health issues are closely associated with trauma SA/MH drives the justice system—both criminal and child abuse and neglect cases Understanding women in court SAMHSA, Center on Women, Violence and Trauma (2006)

47 48-90% women with SA/MH issues have histories of interpersonal abuse First occurrence when child or adolescent Intergenerational issues – survivors often lost custody of their own children due to abuse and neglect In dependency cases, AOD is present >50% of the time

48 Traumatic stress during childhood Can affect physical/mental health Relationships School performance Risk taking in childhood and as an adult

49 Summary of Physical and Sexual Assault Across the Lifespan (U.S.A.)[1][1] National Figures (All U.S. Women) Women Living In Poverty Incarcerated Women Severe Physical Violence by Childhood Caretakers Before Age 18 40% 63% 70% Sexual Molestation in Childhood Before Age 16 (Any Perpetrator) 20-27% 42% 59% Any Physical Violence or Sexual Molestation in Childhood Not Available 72% 82% Severe Physical Violence by Adult Intimate Partners 22%61%75% Physical Violence or Sexual Assault by Intimates over Lifespan Not Available 83% 94% [1][1] As cited by Angela Browne, Ph.D., Harvard School of Public Health, Harvard Injury Control Research Center, 2002 Summary of Physical /Sexual Assault Across the Lifespan (U.S.A.)

50 College Students Illicit use of Rx pain medication is second only to marijuana as the most commonly used illicit drug on a college campus now. Young women were more likely than young men to use Rx medication but young men were more likely to divert their prescriptions to contemporaries. McCabe, SE, et al., “Illicit use of prescription pain medication among college students,” Drug and Alcohol Dependence, 77:37-47, 2005

51 25 years to grow a mature one “apprentice adults” Exposure to traumatic stress can affect developmental processes Increases risk of SA, criminal activity, homelessness and revictimization

52 Another recent survey showed: 1:5 girls have been sexually or physically abused The abuse occurred at home (53%) It happened more than once (65%) The abuser was a family member (57%) Or a family friend (13%) 29% told no one Have increased likelihood of SA or eating disorders

53 Tanya’s story “When I was a child, my father used to rape me. It started when I was nine…. After I ran away, I wanted somebody to want me. I ran into this guy, he was older, and I wanted him to want me. He gave me cocaine. I was 13.” Quotation from Tanya, interview on 7/9/98, Hirsch, Amy E., “Some Days are Harder than Hard,” Welfare Reform and Women with Drug Convictions in Pennsylvania, Center for Law and Social Policy, (Dec. 1999)

54 Age of Onset of Drinking Is a Risk Factor Every year before 21 increases likelihood of problem drinking by 12% Early drinkers need more alcohol to get high Age 13: 42% Age16:22% Age21:10%

55 Adolescent Substance Abuse The younger an individual is at the onset of substance use, the greater the likelihood that a substance use disorder will develop and continue into adulthood. More than 90% of current substance abusers started using before the ago of 18; half started before age 15

56 Age of onset of drinking If first drink at 13, 47% risk of becoming alcoholic; if from alcoholic birth parents, 60%; if from non-alcoholic birth parents, 30%

57 Abstinence until 21 A child who reaches age 21 without smoking, using illegal drugs or abusing alcohol is almost certain never to do so. "A drug-free future begins here," CASA 2001 Annual Report

58 Risk/Protective Factors Risk factors include availability of drugs, family history of substance abuse, learning disabilities and other academic difficulties and peers who use. Protective factors include a supportive, involved family which practices abstinence. One supportive adult can make a difference.

59 Kids with addicted parents 12% children live with at least one parent w/ substance abuse 7.3 million kids with alcohol abusing folks 2.1 million kids with drug abusing folks “Many U.S. Kids Have Addicted Parents, SAMNSA Says,” Join Together Online

60 CHILDREN OF ALCOHOLICS Alcoholism affects the entire family Many people are exposed to alcoholism in their families There is strong, scientific evidence that alcoholism tends to run in families. Children of alcoholics are more at risk for alcoholism and other drug abuse than children on non- alcoholics.

61 COA’s Cont. Alcoholism usually has strong negative effects on marital relationships Alcohol is associated with a substantial proportion of human, violence and perpetrators are often under the influence of alcohol There is a strong relationship between parental alcoholism and child abuse

62 COA’s Cont. COAs exhibit depression and anxiety more than non-COAs COAs score lower on tests measuring verbal ability COAs often have difficulties in school

63 COAs, cont. COAs have difficulty with abstraction and conceptual reasoning COAs can benefit from protective factors such as developing a close bond with a caregiver Consistency of family activities can be a protective factor

64 2.5 million children in the U.S. are being raised by grandparents or other relatives Family care has increased by more than 86%

65 “Mindy” 17 years old Thinks baby will solve all her problems Smokes cigarettes and marijuana Drinks a couple 40s per week She’s is worried about harming the baby How can you help her? What do you say? Is it too late? What can she expect?

66 The most important factor in assuring a healthy birth outcome for an addicted, pregnant woman is: Prenatal care

67 Rank the following substances in terms of the number of fetuses effected: Crack cocaine, Tobacco, Alcohol 1.Tobacco 2. Alcohol 3. Crack cocaine

68 Science… …must outweigh stigma, prejudice, and misunderstanding. Addiction is not so much a failure of will as a failure of brain chemistry.

69 Cocaine- Exposed Children Trained research assistants, unaware of a child’s history, cannot tell the difference between a 4-year-old who was exposed to cocaine before birth and one who was not.

70 Children, cont. Most maladaptive behavior and developmental delay in children from urban and impoverished areas is not uniquely due to prenatal cocaine exposure. Conversely, prenatal exposure does not necessarily lead to developmental delay or behavioral problems.

71 Children, cont. Stigma itself is a social and developmental risk to children who were cocaine-exposed prenatally, regardless of the pharmacological effects of the drug or the reasons for assuming cocaine exposure.

72 Children, cont. Labeling children as cocaine-exposed may lead to the imposition of negative expectations, which in turn undermines the children’s cognitive and behavioral development.

73 How to Correct for Exposure? The quality of the care giving environment was the strongest independent predictor of outcomes Cocaine-exposed children placed in homes with a stimulating environment and with caregivers with good vocabulary scores attained full-scale and performance IQ scores Singer, et al., “Cognitive Outcomes of Preschool Children with Prenatal Cocaine Exposure,” 291:20 Journal of the American Medical Association (JAMA) (May 26, 2004)

74 FALSE Babies born of mothers who use drugs during pregnancy are born “addicted.” Addiction required a fully developed nervous system. Not all babies are susceptible. There is no hard evidence that such babies seek drugs or lose control over drugs. Brick, J. and Erickson C.K., Drugs, The Brain, and Behavior: The Pharmacology of Abuse and Dependence. The Hayworth Press, Binghamton, N.Y, (1999)

75 CPS Issues for Using Parents 70% of child abuse/neglect cases are based on AOD abuse Children in alcohol- abusing families are almost 4 times more likely to be victims of maltreatment

76 CPS cont. 1.4 million child abuse/neglect cases in million in ,000 children in foster care in ,000 children in foster case in 1998 In CA, 25% foster children have been in place 5 or more years; 105,000 children living in out-of-home care 80% of welfare agencies report substance abuse and poverty as their top two problems.

77 Fetal Alcohol Spectrum Disorder

78 Alcohol use by pregnant/recent mothers: % pregnant women drink 16% teen pregnant girls drink consuming an average of 4 drinks over 6 days during the past month 42.1% recent mothers drink 54% all women drink “Alcohol Use among Pregnant Women and Recent Mothers: ,” The NSDUH Report (Sept. 11, 2008)

79 FAS/FASD 4 million pregnancies in US annually 40% women drink while pregnant 3-5% drink “heavily” (5 drinks/day) FAS birth rate from heavy drinkers = 6% FASD rate 0.97% - 9.1%/ 1,000 80% of FAS exposed to other drugs Floyd, R.L. & Dishu, J.S. (2004) “Monitoring prenatal alcohol exposure,” Am. J. Medical Genetics 127C, 3-9; Abel, E.L. (1998) Fetal Alcohol Abuse Syndrome Plenum Press, NY NY

80 Mothers of FAS Children 80 % had major mental illness 100% sexually, physically or emotionally abused 80% lived with men who did not want them to stop drinking 60% with phobias, most common agoraphobia, so they are unable to seek help outside their home

81 Role of Genetics Genetics may influence whether or not a child exposed to alcohol in-utero is born with birth defects Mouse models Alcoholism: Clinical and Experimental Research, April 21, 2009

82 Alcohol “We know that substance use by pregnant women is a leading cause of mental, physical and psychological problems in infants and children.” Charles G. Currie, former SAMHSA Administrator

83 Substance Abuse is a Family Disease Mothers’ substance use/abuse may have lifelong effects on children

84 But Treatment Works CSAT study showed 2:3 women not using AOD after tx 86% of mothers had their children fewer than 10% were involved with criminal justice Women are more likely to initiate tx and remain drug free after tx Green, Carla A., Ph.D., M.P.H., “Gender and Use of Substance Abuse Treatment Services,” Alcohol Research & Health 29:1 2006

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87 Unified Family Courts The Center for Families, Children and the Courts, University of Baltimore School of Law One judge, one family Helping and healing families w/SA problems Use a public health approach; not “this is a bad person” Early intervention, less adversarial approach, case coordination focusing on tx and other services

88 FDTC Model The interdisciplinary team develops a service and treatment plan determines its pace and order of delivery and jointly reports to the court all the while avoiding inconsistent or conflicting requirements

89 Holistic issues addressed Domestic violence Parenting skills Mental and physical health Pending criminal charges Housing Childcare Employment/educational development

90 Judicial Role Judicial leadership is key Judge focuses the team on tx, recovery and supportive services Judge may extend services for a total of 18 months

91 CSAT Evaluation, 4 Sites, 2,000 Cases Little difference between regular court and FDTC participants except: 1. FDTC less likely to be married or employed 2. FDTC more likely to have previous AOD tx 3. FDTC more likely to have infants and children with more risk factors More problems with FDTC group Green, Beth L., Ph.D., et al., “How Effective Are Family Treatment Drug Courts? Outcomes From a Four-Site National Study,” Child Maltreatment 12:1 (2007)

92 Reunification Rates FDTC Graduate80% FDTC Non-Graduate21% Regular court44%

93 Evaluations Parents in FDTCs > reunification < have parental rights terminated Case processing time shorter reducing stays in foster care for the children Families > enter tx, complete tx Reduced recidivism for criminal cases and child protective services < behavioral problems for children Cooper, Caroline, “Summary of Impact Findings Reported for Family Drug Court Programs 2000-present,” American University, Washington DC (2004)

94 Engaging Moms Dependency Drug Court (EMDDC) Miami FL Traditional methods not working 87% of mothers giving birth to SEN had multiple SEN births FCTC model + intensive case management 80% unification compared to 57% in ICM Negative urines = 33% in ICM but 100% in EMDDC program

95 Sacramento County Prior to STARS/Dependency Drug Court Reunification rate about 18-20% Parents unable to access AOD treatment Social workers, attorneys, courts often uninformed on parent progress Drug testing not uniform and results often delayed

96 Specialized Tx and Recovery Services (STARS) Sacramento CA 70-90% cases rooted in substance abuse; 50% of them methamphetamine Reunification rate 18-20% before STARS Intensive tx + STARS support services = 45% reunification rate Highest rate were mj users; meth was second Heroin and alcohol used most likely to lose their children

97 STARS, cont. All parties involved in the case are informed at every stage of treatment All parents receive random observed “instant” drug testing

98 Union County, North Carolina Recommended by social worker Voluntary participation in FDTC 1 year/ court twice a week Replicates Mecklenburg County NC where reunification rates went from.05% to >25%

99 Conclusion FDTCs part of problem-solving courts in U.S. Endorsed by Conference of Chief Justices NCSC Futures report states more judicial education needed in therapeutic jurisprudence Have been endorsed as “best practices” model

100 Girls in the Juvenile Justice System

101 Barriers to Tx for Girls in the Juvenile Justice System The Violent Crime Index arrest rate for girls rose 103% between vs. 27% for boys. The biggest increase was for drug abuse and curfew violations

102 Intergenerational incarceration Family stressors include poverty, death, and an intergenerational pattern of arrest/incarceration. 54% of girls have mothers who have been arrested/incarcerated

103 Lack of stability 95% of girls in the Juvenile Justice system lack a stable home environment 91% have been suspended, expelled or repeated one or more grades.

104 Education School is described as a “battleground” with sexual harassment, racism, interpersonal rivalries with peers and inattention from adults. Dropping out is seen as a necessary means of escape.

105 Mental health issues  88% experience serious health problems; 53% need psychological services. 21% have been hospitalized in a psychiatric facility

106 Mental health issues  88% experience serious health problems; 53% need psychological services. 21% have been hospitalized in a psychiatric facility

107 Victimization Girls’ and women’s pathways to offending is victimization.  92% of juvenile female offenders report some form of emotional, physical or sexual abuse.

108 Violence Girls age are most likely to be beaten, stabbed, shot or raped. 25% report being shot or stabbed one or more times 11% of girls witnessed or experienced the death of one or both parents or a sibling

109 Pregnancy 29% of girls had been pregnant one or more times; 16% had been pregnant while in custody 

110 Gangs/Young Women of Color 47% report gang affiliation  2/3 of the girls are of color, primarily African American and Latina

111 Girls underserved  “Girls in and on the edge of the juvenile justice system represent one of the least- served juvenile justice populations. “ “Investing in Girls: A 21 st Century Strategy,” VI JUVENILE JUSTICE JOURNAL 3 NCJ (Oct. 1999)

112 “AA and NA Help Teens” 160 teens inpatient tx (96 boys, 64 girls) Average age 16 Abstinence based, 12-Step model programs Assessed at 6 mo., 2, 4, 6, 8 years after tx Pt w/severe addictions attended most meetings Greater earlier participation = better long- term outcomes Kelly, et al, Alcoholism: Clinical and Experimental Research 32:1 (2008)

113 Barriers to Tx for women What to do with the children? Who will pay for tx? Shame Denial

114 BARRIERS TO TREATMENT FOR WOMEN WITH CHILDREN STIGMA, particularly for drug-using mothers

115 Former First Lady Betty Ford “As a recovering woman, I have personally suffered the scorn of others who are confused, bitter and misled about addiction. …[H]ow could a nice person like me be an alcoholic?”

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117 Keith Ledger vs. Amy Winehouse Video of drug party not used by ET The Sun published her with crack pipe

118 Owen Wilson vs. Brittany Spears One US weekly cover story Six US weekly cover stories

119 Kiefer Sutherland vs. Paris Hilton 48 days DUI = no press World press upon release

120 “Boys Will Be Boys, Girls Will Be Hounded” “Men who fall from grace are treated with gravity and distance while women in similar circumstances are object of derision titillation and black comedy.” “…[M]ale celebrities can often wriggle out of trouble with a rakish bad-boy shrug. …[T]he double standard can reinforce the destructive behavior of female stars, pushing them to further depths of substance abuse and erratic behavior.” Christine Haughney, The New York Times, Feb. 17, 2008 p. 1 SundayStyles

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122 Lack of child care An average of 8% treatment facilities offer child care. When women can take their children to treatment, there is improved retention and treatment success Loss of income and inability to pay for treatment

123 Fear of losing custody More than half (58%) of AOD directors and CPS directors said in 1995 a positive drug test is grounds for reporting a pregnant woman to a state agency compared to 12% in 1992

124 Fear of prosecution Fewer than ½ (45%) of state AOD and CPS directors reported criminal prosecution of drug using women in 1992 in their state compared to 71% by 1995

125 Suppression of violence Suppression of violence including rape, incest and domestic violence can trigger relapse and is a critical issue that must be addressed in treatment. Recovery can be too painful for some women.

126 Programs offering women-specific programming 43.2% Methadone programs 41.7% Residential 35.4% Outpatient 46.9% Residential/Outpatient

127 Gender Specific Services: “…those designed to meet the unique needs of female offenders, that value the female perspective, that celebrate and honor the female experience, that respect and take into account female development and that empower young women to reach their full potential.” Girls, Inc. 1996

128 Women-only Tx During tx, no significant differences After 6 months, continuous reductions in use for those in women-only tx Especially for alcohol tx Women-focused and women-only have long- term positive outcomes Greenfield, et al., “The Women’s Recovery Group study: A Stage 1 trial of women-focused therapy for substance use disorders versus mixed-gender group drug counseling,” Drug and Alcohol Dependence 90:39-47, 2007

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130 Resources: Substance Abuse Treatment for Women Offenders: Guide to Promising Practices (TAP 23) CSAT px?ProductID=15498 A Woman’s Way Through the Twelve Steps by Stephanie Covington Women for Sobriety, Inc. A non-profit organization dedicated to helping women overcome alcoholism and other addictions

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132 Resources

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135 Mental Health webliography Co-Occurring webliography Alcohol and Other Drug webliography Women Specific Websites Listserv


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