Gender-Responsive Strategies

The U.S. is the world leader in incarceration, housing about 5% of the world’s population, but 20% of the world’s prison population (Vera Institute of Justice, 2022; Walmsley, 2015). From 1980 to 2016, the incarceration of women increased twice as high as the increase in men’s incarceration over the same timeframe (Equal Justice Initiative, 2018). The incarceration of women increased dramatically during the 1980s due to the enactment of strict drug and property offense laws that widened the net for prison admissions and lengthy sentences.

Women and girls in the general population and in carceral settings report a higher prevalence of PTSD and depression than men or boys (Cabeldue et al., 2019; McLaughlin et al., 2013). Research indicates that girls and women are more likely to experience adverse childhood experiences, especially sexual abuse, and intimate partner violence leading to Post-Traumatic Stress Disorder (PTSD; McLaughlin et al., 2013). Cumulative childhood trauma can cause complex PTSD with additional symptoms reflecting disturbances in emotional and interpersonal self-regulatory capacities, including aggressive or socially avoidant behaviors. As summarized by Center for Substance Abuse Treatment (2014), initial reactions to trauma can manifest in various ways such as fatigue, confusion, sadness, anxiety, restlessness, emotional detachment, disorientation, heightened arousal, and a diminished emotional response. Delayed responses to trauma include ongoing tiredness, sleep disturbances, nightmares, fear of the traumatic event recurring, anxiety related to flashbacks, depression, and avoidance of activities remotely connected to the traumatic experience.

While men exhibit a higher tendency of using various forms of prohibited substances, developing dependency, and overdose fatalities as compared to women, women are equally susceptible to developing a substance use disorder as men (Anthony et al., 1994; Center for Behavioral Health Statistics and Quality, 2017). About 70% of women involved in the criminal legal system have a substance use disorder, which is a larger percentage compared to that of men (about 60%). Women’s substance use is often interrelated to responses to trauma and co-occurs with mental health symptoms, such as anxiety and depression (McKee & Hilton, 2019; Ullman et al., 2013). Through in-depth interviews with women under community supervision, Boppre and Boyer (2019) found that system-involved women use substances to self-medicate and cope with symptoms of underlying untreated trauma responses. Women also engage in treatment differently than men and are more likely to seek help for substance use problems (Galdas et al., 2005).

Despite the increase in women’s incarceration and susceptibility to substance use disorder diagnosis, not all substance use programming reflect the distinct needs of women or are available. As women are more often the primary caregivers of their children, the effects of their trauma and substance use can be intergenerational. Sixty-four percent of system-involved women are mothers (Glaze & Maruschak, 2008). Children with incarcerated mothers are nearly two times as likely to become incarcerated later in life relative to children without an incarcerated mother (Burgess-Proctor et al., 2016).

In 1990, Barbara Bloom, Barbara Owen, and Stephanie Covington partnered with the National Institute of Corrections to conduct research on girls/women and develop gender-responsive guidelines for agencies. They used the results of their research to develop gender responsive strategies with six principles to guide programming and services for women. These principles have been applied to substance use treatment for both system-involved women and women in the community (see summary below).

Gender-responsive treatment starts with the acknowledgement that gender shapes trauma, mental health, and substance use. As women have extensive histories of abuse and trauma, it is crucial to provide a safe environment through trauma-informed care. As defined by Substance Abuse and Mental Health Services Administration (SAMHSA, 2023), a trauma-informed approach broadly incorporates awareness of trauma and its impact into all aspects of organizational functioning and is reflected in certain general principles. Given the importance of women’s relationships, including with their children, programming and services must also promote healthy relationships and help women connect with their families and significant others. In addition, gender-responsive services must provide holistic substance use treatment. This involves treating substance use jointly with mental health and trauma. As women/girls have decreased economic opportunities relative to men, it is vital to provide them with skills and access to gainful employment. Finally, women must be supported with wraparound services to support all of their needs, especially when exiting jail or prison.

Research consistently demonstrates that gender-responsive programming is effective at reducing women’s substance use, improving mental health symptoms, and keeping women out of the criminal legal system (Gobeil et al., 2016). Additional research indicates that integrated gender-responsive treatments are a promising approach to treat women with co-occurring substance use and mental health concerns (Johnstone et al., 2023). Future directions for gender-responsive programming include expansions to account for men’s gendered mental health, trauma responses, and substance use as well as LGBTQ2S+ clients’ needs.

References

Anthony, J.C., Warner L.A., Kessler R.C. (1994). Comparative epidemiology of dependence on tobacco, alcohol, controlled substances, and inhalants: Basic findings from the National Comorbidity Survey. Experimental and Clinical Psychopharmacology, 2(3), 244-268. doi:10.1037/1064-1297.2.3.244

Boppre, B., & Boyer, C. (2021). “The traps started during my childhood”: The role of substance abuse in women’s responses to adverse childhood experiences (ACEs). Journal of Aggression, Maltreatment & Trauma, 30(4), 429-449. https://doi.org/10.1080/10926771.2019.1651808

Burgess-Proctor, A., Huebner, B. M., & Durso, J. M. (2016). Comparing the effects of maternal and paternal incarceration on adult daughters’ and sons’ criminal justice system involvement: A gendered pathways analysis. Criminal Justice and Behavior, 43(8), 1034-1055. https://doi.org/10.1177/0093854816643122

Cabeldue, M., Blackburn, A., & Mullings, J. L. (2019). Mental health among incarcerated women: An examination of factors impacting depression and PTSD symptomology. Women & Criminal Justice, 29(1), 52-72. https://doi.org/10.1080/08974454.2018.1433099

Center for Behavioral Health Statistics and Quality. Results from the 2016 National Survey on Drug Use and Health: Detailed Tables. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2017. https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2016/NSDUH-DetTabs-2016.pdf.

Center for Substance Abuse Treatment (US). Trauma-Informed Care in Behavioral Health Services. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014. (Treatment Improvement Protocol (TIP) Series, No. 57.) Chapter 3, Understanding the Impact of Trauma. Available from: https://www.ncbi.nlm.nih.gov/books/NBK207191/

Equal Justice Initiative, (2018). Incarceration of women is growing twice as fast as that of men. Equal Justice Initiative. https://eji.org/news/female-incarceration-growing-twice-as-fast-as-male-incarceration/

Galdas, P. M., Cheater, F., & Marshall, P. (2005). Men and health help‐seeking behaviour: literature review. Journal of advanced nursing, 49(6), 616-623. https://doi.org/10.1111/j.1365-2648.2004.03331.x

Glaze, L. E., & Maruschak, L. M. (2008). Parents in prison and their minor children (NCJ 222984). Washington, D.C.: Bureau of Justice Statistics.

Gobeil, R., Blanchette, K., & Stewart, L. (2016). A meta-analytic review of correctional interventions for women offenders: Gender-neutral versus gender-informed approaches. Criminal Justice and Behavior, 43(3), 301-322. https://doi.org/10.1177/009385481562110

Johnstone, S., Dela Cruz, G. A., Kalb, N., Tyagi, S. V., Potenza, M. N., George, T. P., & Castle, D. J. (2023). A systematic review of gender-responsive and integrated substance use disorder treatment programs for women with co-occurring disorders. The American journal of drug and alcohol abuse, 49(1), 21–42. https://doi.org/10.1080/00952990.2022.2130348

McKee, S. A., & Hilton, N. Z. (2019). Co-occurring substance use, PTSD, and IPV victimization: Implications for female offender services. Trauma, Violence, & Abuse, 20(3), 303-314.

McLaughlin, K. A., Koenen, K. C., Hill, E. D., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2013). Trauma exposure and posttraumatic stress disorder in a national sample of adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 52(8), 815-830. https://doi.org/10.1016/j.jaac.2013.05.011

Substance Abuse and Mental Health Services Administration. (2023). Practical Guide for Implementing a Trauma-Informed Approach. https://lnkd.in/dhzx5sae

Ullman, S. E., Relyea, M., Peter-Hagene, L., & Vasquez, A. L. (2013). Trauma histories, substance use coping, PTSD, and problem substance use among sexual assault victims. Addictive behaviors, 38(6), 2219-2223.

Vera Institute of Justice. (2022). People in jail and prison in spring 2021. Retrieved July 12, 2022, from https://www.vera.org/publications/people-in-jail-and-prison-in-spring-2021

Walmsley, R. (2015). World female imprisonment list, 4th ed. King’s College London, International Centre for Prison Studies. Retrieved from http://www.prisonstudies.org/world-prison-brief-data

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