Pilot Test of 12-Step Linkage for Alcohol-Abusing Women in Leaving Jail

Abstract

Background More than a million U.S. women are detained in jails each year; many have alcohol use disorders (AUD). AUD intervention with pretrial jail detainees presents a logistical challenge due to limited jail stays and lack of resources for post release treatment. The availability, no-cost entry, and promise of anonymity of Alcoholics Anonymous (AA) make it a highly accessible resource for underserved populations. However, the outreach of AA volunteers into jails (as opposed to prisons) has been limited, and incarcerated women are unlikely to seek out strangers for help after release. This study pilot tested an enhanced referral approach introducing a twelve-step volunteer to a woman in jail who would attend a meeting with her after release. Methods Participants were 14 unsentenced female pretrial jail detainees with AUD. Intervention consisted of introducing participants detained in jail to female AA volunteers who could accompany them to an AA meeting after release. Assessments took place at baseline and one month after release. This uncontrolled pilot study evaluated the feasibility and acceptability of this enhanced referral approach. We also report pre-post alcohol use, drug use, alcohol problems, and AA attendance. Results Enhanced referral was feasible and acceptable. Many (57%) of the 14 participants who met with AA volunteers in jail were in contact with those volunteers after release from jail. Participants had significantly fewer drinking days, heavy drinking days, alcohol problems, and drug-using days during the post-release follow-up than they did before jail detention. Conclusions Providing linkage between women in jail and female AA volunteers who can accompany them to post-release a meeting is achievable, and may be a disseminable and low-cost method to improve alcohol outcomes in this vulnerable population.

“I know if I drink I won’t feel anything”: substance use relapse among depressed women leaving prison

“…Our team has begun to test interventions to improve mood and relationships in the re-entry period (Johnson & Zlotnick 2012; Johnson & Zlotnick, 2008). We have also begun to test the feasibility of various in-reach and out-reach strategies for helping women bridging the transition from prison to the community, such as bringing community agencies into correctional facilities to meet women before they are released (Johnson et al, in press) and providing women with cell-phones to call prison counselors and other resources as needed in the risky days and weeks after release (Johnson et al, under review b). Additional research on low-cost, accessible, continuous, comprehensive transitional services for women with co-occurring disorders leaving prison is needed.…”

Hazardously Drinking Jailed Women: Post-Release Perceived Needs and Risk of Reincarceration

“…As targeting these basic needs was identified as being critical for the women, themselves, a focus on these specific basic needs may have the potential to be particularly influential in implementation, particularly because women who perceive a need for treatment services may be most willing to take part and more likely to benefit from treatment; continued research is needed to support this possibility. For example, the linkage of women completing brief jail stays to community-based twelve-step programs represents one potential method to facilitate substance treatment during the chaotic period of community re-entry (Johnson, Schonbrun, & Stein, 2014). Evaluation of novel methods to connect women, in an ongoing manner, to a wide range of needed services, is worthy of testing as a means to change the trajectories of lives filled with new hopes and old challenges.…”

Study protocol: Community Links to Establish Alcohol Recovery (CLEAR) for women leaving jail

“…All participants contacted the study counselors with whom they were familiar, and 0 of the 22 women called the BTG hotline where they did not know anyone. 12,13 When this finding was explored in qualitative work, 12,14,21 women and providers consistently described women being willing to reach out to people perceived as familiar and trustworthy (“we will call you because we know you and trust you”), but described personal unfamiliarity and lack of trust as an important barrier to accessing post-release services.…”

“…13 We cooperated with a local BTG group to have its volunteers meet participants one-on-one in jail for 30–45 minutes. After release, the same volunteer reached out to accompany the participant to her first few 12-step meetings.…”

“…17,18 Our pilot work indicates that the same may be true for women leaving jail. 13 The NIAAA-funded randomized effectiveness trial described below is the first to test a 12-step self-help group linkage (i.e., warm handoff) approach in a criminal justice population. Novel aspects of the trial design include planning research procedures to accommodate 12-step principles (e.g., Nonaffiliation and Attraction), rapid turnover and unpredictable jail release times, post-randomization ineligibility if a woman is sentenced, and community volunteers as interventionists.…”