The forgotten offender: Women in prison have unique substance use treatment needs

CrossCurrents

By Astrid Van Den Broek

If the events that took place in 1994 at the Prison for Women in Kingston, Ontario, taught us anything, it’s that women offenders should not be treated the same way as men in correctional facilities. That incident, in which confrontations between six female inmates and staff boiled over, culminating in a strip search of several inmates by a male institutional emergency response team, taught that very hard lesson.

While under less dramatic circumstances, it is also becoming clear that when it comes to addressing substance abuse, women offenders have different issues than men. A 2001 Health Canada best practices report about the substance use treatment needs of women identified a lack of appropriate services for women offenders. Female offenders are more likely to be addicted to prescription drugs than street drugs; they’re more likely to have experienced violence and its corresponding trauma; they often don’t have family support and probably have had their children taken away from them.

Given these unique issues, it makes sense that female offenders require gender-specific treatment for substance abuse. The Women Offenders Substance Abuse Program (WOSAP), introduced in 1999 by Correctional Service Canada (CSC), was designed with a mission: to specifically help women offenders in federal penitentiaries with substance use problems.

“About 80 per cent of the women in our prison system are using alcohol or drugs at a level that requires some kind of intervention,” says Brian Grant, director of the Addictions Research Centre for CSC in Montague, Prince Edward Island, which developed the program. “It tends to be higher for women than men. And drugs tend to be more significant for women than alcohol, and at a higher level. We’re also seeing a high level of use of prescription drugs – benzodiazepines being one of the major ones.” Not only are the type of drugs more unique to women, but their backgrounds are as well: In a sample survey of about 50 WOSAP participants, Grant notes that all of them suffered trauma in their past, be it physical or sexual abuse or severe family dysfunction. These women also carry feelings of guilt and shame, particularly related to parenting.

Women also differ from men in how their substance use began. “Women often come to addiction through their relationships,” says Grant. “Unlike men, who may start drinking at a young age for bravado, women are more likely to have done it to be part of a group.” Women tend to use drugs and alcohol to deal with problems in their relationships. And women are often using drugs and alcohol to deal with the trauma associated with some experience in their lives. It’s a way of self-medicating to suppress challenges they’re facing.”

Yet these unique needs have not translated into targeted treatment approaches. “What has been done traditionally is to try to adapt men’s services,” says Dr. Stephanie Covington, co-director of the Center for Gender and Justice in La Jolla, California. “This ends up being a very different intervention than if you look at women’s lives, see what’s reflected back and design programs accordingly.” That kind of men’s programming traditionally involved cognitive behavioural therapy, which seems to work well with male offenders.

“Not surprisingly, when programs developed for and empirically validated with male substance users were applied to women, women did not fare as well as their male counterparts. They had higher drop-out rates and lower success rates,” says Dr. Rebecca Dempster, a psychologist at the Centre for Addiction and Mental Health (CAMH) in Toronto, and part of the CAMH team that developed the WOSAP treatment protocol and trained WOSAP facilitators in the federal prisons.

“Treatment has been based on the premise that if you deal with the thinking function, you’re dealing with feelings. That’s a huge assumption and you can only work at a certain level if you work from a cognitive behavioural perspective,” says Covington. “There’s an old party line in substance abuse treatment: ‘Yes, we know you’ve been abused, but when you’ve been clean and sober for a year, you’ll be ready to deal with the trauma,’ says Covington. “Unfortunately, for some women, they never get the year because the interconnection between trauma and substance abuse is so powerful.”

The WOSAP program, which for the past two years has been a demonstration program in five Canadian penitentiaries, recognizes this interconnection. “In developing WOSAP, we had the opportunity to address women’s unique needs in a women-centred manner,” says Dempster. “We were guided by principles of empowerment, mutual help and community in developing the program and training for staff who would be delivering the program.”

It involves three essential stages: the initial engaged in education phase, the intensive therapeutic model and the maintenance phase. “When women arrive, staff meet with them within a day or two for the engagement phase,” says Lucy Hume, a consultant on the program who now works with the Jean Tweed Centre in Toronto, which provides treatment for women with substance use problems. “We want to engage women immediately before they get sucked into the counter-culture of the institution. It’s not an interview, but a way of connecting with the women and letting them know there’s a human being on the other side [of the prison bars].”

Every woman coming into the facility participates in this part of the program, which focuses on substance abuse education. “Substance abuse affects everyone in the institution,” says Hume. “Whether it’s someone in their family or the woman in the cell next door, they’re going to be affected by substance abuse. We strive to do education-prevention and peer support, all rolled into that first series.”

From there, women who have significant abuse histories go on to participate in a series of intensive, therapeutic workshops on a variety of subjects that weave together psycho-education and skill building. The workshops also introduce a more “relational” approach – one where discussions around sexuality, family and relationships run throughout the program. “It’s in the combination of cognitive and relational approaches that women will benefit because we’re teaching women the skills needed to be adaptable and to adjust to what’s going on in the world around them,” says Grant. “At the same time, we’re dealing with some of the underlying issues associated with drug and alcohol use.”

The third part of the program is another unique aspect of WOSAP – community follow-up and support, which the 2001 Health Canada report identified as lacking in women offender treatment programs. “With WOSAP, community treatment continues for several months in the community, delivered by the parole officers and by community programs,” explains Hume. “This is probably the first time in the justice system where we’ve taken relapse prevention and looked at its applications right across behavioural changes, as opposed to just relating it to substance use.”

While the program seems to have been well received, it could use a little fine-tuning says Kim Pate, executive director of the Ottawa-based Canadian Association of Elizabeth Fry Societies, an advocacy organization for women in the justice system. Part of her criticism is the attitude toward drugs to begin with. “One of the areas that isn’t often addressed by substance abuse programs is the presumption that street drugs are the ones of choice,” says Pate. “Even when it’s prescription drugs, the onus is so often put on the individual woman to address that issue, when in fact that pusher is almost the very system that’s supposed to be interfering with that.” She notes that former female prisoners tell her that prescription drugs are often handed out (and sometimes forced to be taken) freely. “There’s a great focus on stopping drugs from coming into the institution, but prescription drugs are often, if not encouraged, then at least seen as acceptable.”

The other issue Pate has is labeling WOSAP under a substance abuse heading. “Many of the women talk about the fact that it’s unfortunate it has to be framed as a substance abuse program as opposed to having support and ongoing sorts of personal development opportunities,” she says.

These are concerns to be taken into account as WOSAP moves forward (it is currently being evaluated to roll it out to other institutions). “One area that is incorporated now but that needs strengthening is the community development component,” says Grant. “We’re trying to work within the institution to change the characteristics of the institutional climate. That’s been slow to develop and get off the ground. The recovery process has to take place in a supportive environment, and if we don’t create that within an institution, then we won’t have as large an effect. We need to build more opportunities to have those positive experiences.”

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