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Program Profile: Helping Women Recover Program (in a Drug Court Setting)

Evidence Rating: No Effects - One study No Effects - One study

Date: This profile was posted on June 15, 2015

Program Summary

A gender-responsive program designed to treat drug-addicted female offenders in a drug court setting. The program intends to specifically address the needs of female addicts and treat symptoms identified as distinct to female pathways to criminality and drug involvement. This program is rated No Effects. Female offenders assigned to gender-specific treatment did not display any significant differences in number of arrests and reports of drug use than those assigned to mixed-gender treatment.

This program’s rating is based on evidence that includes at least one high-quality randomized controlled trial.

Program Description

Program Goals:
Helping Women Recover and Beyond Trauma are two interactive, gender-responsive curricula designed for drug-dependent women, under the supervision of the criminal justice system. Both curricula use cognitive–behavioral approaches; experiential therapies (such as guided imagery and art therapy); mindfulness meditation; and psychoeducational, relational, and expressive arts techniques that are compatible with women’s interactional styles. The goal is to demonstrate the need to implement gender-specific treatment programs to improve outcomes for female offenders.

In San Diego County (California), the gender-responsive approaches to treatment were provided in a drug court setting in addition to the regular drug court standards of care. Drug court programs in San Diego combine intensive supervision, mandatory drug testing, graduating sanctions, and community-based treatment for eligible offenders, to break the cycle of addiction and repeated criminal activity. Standard drug court treatment usually includes men and women, and does not incorporate gender-specific elements of treatment for women. The gender-responsive (GR) treatment approaches enhanced the regular standards of care provided by drug courts by being female-only and facilitated only by women, and using the Helping Women Recover and Beyond Trauma treatment curricula.

Program Components
Helping Women Recover (2008) is a 17-session program organized into four modules.
  1. Self module: topics that are discussed by women in the program include discovering what the “self” is; learning about addiction as a disorder within the self; self-esteem; effects of sexism, racism, and stigma on sense of self; and how recovery includes growth of the self.
  2. Relationship module: topics include exploring roles in their families of origin, discussing motherhood and the women’s relationships with their mothers, relationship histories, and building healthy support systems.
  3. Sexuality module: topics include exploring connections between addiction and sexuality, and discussing body image, sexual identity, sexual abuse, and fear of sex when sober.
  4. Spirituality module: topics include concepts of spirituality, prayer, and meditation.
The Beyond Trauma (2003) curriculum focuses on assisting women in understanding what has occurred in the past that has been traumatizing. Using a strengths-based approach, 11 sessions are condensed into three specific target areas: teaching women about trauma and abuse, helping them understand typical reactions to trauma and abuse, and developing coping skills.  

In addition, women in the GR treatment programs received copies of Covington’s A Woman’s Way through the Twelve Steps (2000) and Women in Recovery: Understanding Addiction (2002). The first book helps women understand the 12 steps of Alcoholics Anonymous. The second is an interactive workbook meant to be used as an educational journal during treatment.

Program Theory
Research on women and offending suggests that gender matters; and that, therefore, gender-specific programming is important for female offenders. For example, according to the pathways theory (Steffensmeier and Allen 1998) there are “profound differences” between the lives of women and men that shape criminal offending patterns. This research has identified key issues such as abuse, mental illness early in life, substance abuse and addiction, homelessness, and relationships that produce and sustain female criminality.

Furthermore, female development is also a pivotal factor in female criminality. As explained in the relational theory (Miller 1976), females develop a sense of self and self-worth through connections with others. In relation to drug offense, women are more likely to turn to drug use in the context of relationships with drug-abusing partners in order to feel connected (Covington and Bloom 2006). 

Evaluation Outcomes

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Study 1
Arrests
Messina and colleagues (2012) found there were no significant differences in the number of arrests between the treatment group that received gender-responsive (GR) drug court services and the mixed-gender (MG) group that received standard drug court programming.
 
Drug Use
Both the GR and MG treatment groups improved in the Addition Severity Index (ASI) drug score, yet there were no significant differences between the improvement scores of both groups.
 
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Evaluation Methodology

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Study 1
Messina and colleagues (2012) collected data from four drug court programs throughout San Diego County, California, between 2007 and 2010. To be eligible, participants had to be at least 18; with no more than three prior nonviolent, non-drug felony convictions; and no current driving under the influence (DUI) charge. The sample consisted of 150 women, predominantly white (58 percent), with an average age of 36. The women, on average, had a high school education and also a history of depression (55 percent). The women were randomly assigned to either the gender-responsive (GR) treatment program (n=85) or the mixed-gender (MG) treatment program (n=65). There were no significant differences between the control and intervention groups at baseline.

Both programs consisted of group counseling and one-on-one counseling given on an as-needed basis, in addition to 12-step meetings, group discussions, and random drug testing. Each of the four drug court program sites received an experimental GR program, modified to be a woman-only treatment program. At each site, the GR and MG programs maintained separate staff, rooms, and schedules. The GR treatment included curricula from two programs: Helping Women Recover and Beyond Trauma. The participants in the MG program received the standard drug court program for San Diego County. Both the GR and MG programs were delivered to participants 2–3 hours a day, 5 days a week.

Interviews capturing behavior up to 4 months before arrest were conducted within the first 30 days after entry into one of the four specific drug court programs. Treatment duration ranged from 15 to 24 months. Follow-up interviews were delivered 18 months after program entry to 94 participants (77 percent of the GR group, and 71 percent of the MG group). The Addiction Severity Index (ASI) was used to collect data on participants’ drug use and retention outcomes.  An intent-to-treat design was used to analyze the differences in outcomes between the GR and MG groups. A t-test was used to compare the outcomes represented by a single continuous variable, and chi-square analysis was used for categorical and binary outcome variables.
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Cost

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Materials are available at http://stephaniecovington.com/books-and-curricula.php for both Beyond Trauma and Helping Women Recover. The complete set for Beyond Trauma is available for $595.00; materials are also sold separately. Materials for Helping Women Recover include a facilitator and participant guide, sold separately.
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Implementation Information

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Both programs include a facilitator guide and workbook for participants. Beyond Trauma also includes a two-volume DVD set and client DVD. 

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Evidence-Base (Studies Reviewed)

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These sources were used in the development of the program profile:

Study 1
Messina, Nena, Stacy Calhoun, and Umme Warda. 2012. “Gender-Responsive Drug Court Treatment: A Randomized Controlled Trial.” Criminal Justice and Behavior 23(12):1539–58.
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Additional References

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These sources were used in the development of the program profile:

Covington, Stephanie. 2000. A Woman's Way through the Twelve Steps Workbook. Center City, Minn.: Hazelden.

Covington, Stephanie. 2002. Women in Recovery: Understanding Addiction. Carson City, Nev.: The Change Companies.

Covington, Stephanie S. 2003. Beyond Trauma Facilitators Guide. Center City, MN; Hazelden Publishing.

Covington, Stephanie S., and Barbara Bloom. 2006. “Gender-Responsive Treatment and Services in Correctional Settings.”  Women and Therapy 29(3/4): 9–33.

Covington, Stephanie S. 2010.  A Woman's Journal: Helping Women Recover. Hoboken, NJ; John Wiley & Sons.

Miller, J. B. 1976. Toward a New Psychology of Women. Boston: Beacon Press.

Steffensmeier, Darrell, and Emilie Allan. 1998. "The Nature of Female Offending: Patterns and Explanations." Female Offenders: Critical Perspectives and Effective Interventions. Gaithersburg, Md.: Aspen, 5–29.
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Related Practices

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Following are CrimeSolutions.gov-rated practices that are related to this program:

Adult Drug Courts
Drug courts are specialized courts that combine drug treatment with the legal and moral authority of the court in an effort to break the cycle of drug use and drug related crime. The practice was rated Promising for reducing recidivism; Promising for reducing alcohol and drug-related offenses (with a 13 percent lower rate compared to nonparticipants); but No Effects for reducing multiple substance use.

Evidence Ratings for Outcomes:
Promising - More than one Meta-Analysis Crime & Delinquency - Multiple crime/offense types
Promising - One Meta-Analysis Crime & Delinquency - Drug and alcohol offenses
No Effects - One Meta-Analysis Drugs & Substance Abuse - Multiple substances
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Program Snapshot

Age: 18+

Gender: Female

Race/Ethnicity: Hispanic, White

Geography: Suburban, Urban

Setting (Delivery): Courts

Program Type: Alcohol and Drug Therapy/Treatment, Cognitive Behavioral Treatment, Drug Court, Gender-Specific Programming, Group Therapy, Individual Therapy

Targeted Population: Females, Alcohol and Other Drug (AOD) Offenders

Current Program Status: Active