Participant Evaluation of Twelve-Step Group Linkage for Jailed Women With Alcohol Use Disorder
| Author | Yael Chatav Schonbrun,Jennifer Johnson,Michael Stein,Christine Timko,Megan Kurth |
| DOI | 10.1177/0306624X18805598 |
| Published date | 01 March 2019 |
| Date | 01 March 2019 |
| Subject Matter | Articles |
research-article2018
Original Manuscript
International Journal of
Offender Therapy and
Participant Evaluation of
Comparative Criminology
2019, Vol. 63(4) 610 –623
Twelve-Step Group Linkage
© The Author(s) 2018
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for Jailed Women With
https://doi.org/10.1177/0306624X18805598
DOI: 10.1177/0306624X18805598
journals.sagepub.com/home/ijo
Alcohol Use Disorder
Yael Chatav Schonbrun1,2, Megan Kurth2,
Jennifer Johnson3, Christine Timko4,5,
and Michael Stein1
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.
Keywords
alcohol, criminal justice, linkage, women, twelve-step
1Brown University, Providence, RI, USA
2Butler Hospital, Providence, RI, USA
3Michigan State University, East Lansing, MA, USA
4VA Palo Alto Health Care System, Palo Alto, CA, USA
5Stanford University School of Medicine, Palo Alto, CA, USA
Corresponding Author:
Yael Chatav Schonbrun, Department of Psychiatry and Human Behavior and Butler Hospital, The
Warren Alpert Medical School, Brown University, 345 Blackstone Boulevard, Providence, RI 02906, USA.
Email: yael_chatav_schonbrun@brown.edu
Schonbrun et al.
611
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 demon-
strates 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 sur-
prising 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 incar-
cerated 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 incar-
cerated women.
In large part, unmet substance treatment need faced by women in jail can be attrib-
uted 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 particu-
larly 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) member-
ship in the United States is estimated at 1.3 million, with approximately 40,000 mem-
bers housed in correctional facilities (AA, 2010). TSMGs also represent a low-cost,
familiar, and widely accessible community resource. Given the high need, but
612
International Journal of Offender Therapy and Comparative Criminology 63(4)
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 indi-
viduals can form personal bonds, even if there are differences in background charac-
teristics 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 dur-
ing their jail stay, with the expectation of the volunteer meeting the woman and accom-
panying 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 effec-
tiveness, 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 wom-
en’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 individu-
ally 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 orga-
nization to them. Members often consider twelve-step work to be an ongoing respon-
sibility 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...
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