Federal Prison Residential Drug Treatment: Gender Comparisons in Three-Year Outcomes

Results from the Treating Inmates Addicted to Drugs (TRIAD) study found that the Federal Bureau of Prisons’ residential drug abuse program (DAP) reduced arrests and drug use in both the six months and the three years following subjects’ release from prison, taking into account the effects of self-selection into treatment. The TRIAD study improved upon previous research by considering the entire population of eligible subjects in comparing the outcomes for those who entered and completed treatment and those who did not.

An important step in this evaluation was to evaluate the effects of treatment by gender. Despite the large body of literature discussing the special treatment needs of women, treatment outcome studies, particularly prison-based studies, seldom examine gender differences. In general, literature on gender differences among drug users has consistently found that women have different life problems than men before they enter treatment. Women are more likely to have psychiatric problems, employment problems, and histories of physical abuse. However, the literature on treatment outcomes by gender is mixed. Based on the available research, it is clear that we do not know enough about how treatment impacts women and what other factors affect women’s behavioral outcomes following treatment. Therefore, this study examined gender similarities and differences in the effectiveness of treatment and in predictors of post-release outcomes.

The study used a sample of 1,842 male subjects and 473 female subjects, which included 1,193 treatment subjects and 1,122 untreated comparison subjects. Our predictor measures included demographic characteristics, substance use and treatment history, psychiatric diagnoses, history of mental health treatment, employment history, behavior during incarceration ( e.g., disciplinary infractions in the 6 months prior to release from prison), and post-release living conditions. Three-year follow-up data included two outcome measures – recidivism and drug use.

Recidivism. Twenty-eight percent of the women recidivated within the 3-year follow-up period as compared with 49% of the men. Although both men and women who were treated were less likely to recidivate, the results also indicated that women had lower recidivism rates than did men three years following release from prison. There were gender similarities as well as differences among the other predictors of the two post-release outcomes. Having a prior commitment and the occurrence of one or more serious disciplinary infractions in the six months before release were associated with recidivism after release for both men and women. However, men but not women, who lived with a spouse after release were less likely to recidivate.

Drug Use. With respect to drug use, 40% of the women had evidence of post-release drug use as compared with 55% of the men. In addition, both men and women who were treated were less likely to use drugs after release.

We found both similarities and differences between men and women when looking at the predictors of post-release drug. For both men and women, a history of prior commitments, African American race, and a drug related disciplinary infraction before release were associated with a higher likelihood of drug use, while older age at release was associated with a lower likelihood of drug use. Women, but not men, who had a history of previous mental health treatment were less likely to engage in post-release drug use.

Despite the small number of gender differences in factors predictive of post-release outcomes, we cannot clearly conclude that men and women have similar recovery processes. Rather, similarities and differences in predictive factors must be assessed within the context of both the initial differences in the background characteristics and in rates of post-release success. Women had lower rates of recidivism and post-release drug use than did men. These more positive post-release outcomes among women occurred despite the fact that women in our sample had more severe life problems. Women were more likely to have had a spouse with a drug use problem, were less likely to have been employed part- or full-time before incarceration, were more likely to have a lifetime DSM-III-R diagnosis of depression, were more likely to have a history of mental health treatment and were more likely to have used one or more illegal drugs other than marijuana in the year before arrest. The only area where women had a less serious life problem was criminal history. Women were less likely to have a prior incarceration and were older at the time of their first commitment. The question about why women who have more severe life problems than men prior to treatment have lower drug use than men following treatment remains unanswered.

Clinicians can view these results as a road map for delivering treatment to their participants. Specifically, the results most clearly suggest that, although men and women have different backgrounds at the start of treatment, they achieve positive outcomes following treatment. Being careful to follow the roadmap presented by participants from each gender group, whatever the similarities or differences, by addressing the specific issues participants bring to treatment will likely help both men and women reach their goals of successful recovery. Because of the nature of women’s life problems, it is particularly important to provide them with comprehensive assessment and reassessment before, during, and after treatment to identify the individual diagnosis which will be used to develop an appropriate treatment plan. It is possible that in some cases individual therapy and psychotropic medication may need to be provided prior to the formal beginning of treatment participation in order to prepare them for treatment by freeing the psychological resources needed to benefit most from treatment.