Creating Gender-Responsive Program: The Next Step For Women's Services.

Some of the most neglected, misunderstood and unseen women in our society are those in jails, prisons and community corrections. The female rate of incarceration has increased dramatically, tripling in the last decade.

The primary reason for the growing numbers is the increase in drug-related convictions, along with the advent of mandatory sentences for these offenses. According to the Federal Bureau of Prisons, more than 60 percent of women in custody are serving sentences for drug offenses. In many state prisons, the rate is even higher, yet, our society does not provide a comprehensive continuum of care for these women.

A high correlation also exists between drug abuse and incarceration and probation and parole violations for women. Historically, treatment, research and recovery from addiction have been primarily geared toward men. This has had a serious impact on women and treatment programs in both the criminal justice system and the free world.

Women in the Criminal Justice System

The 1986 mandatory drug sentencing laws were designed to rid society of drug dealers and major players in the illegal drug trade, and specified that anyone caught in possession of a drug would automatically be sentenced. Unfortunately, the war on drugs has led to an explosive increase in the number of women who are incarcerated. Since 1980, the rate of incarcerated female drug offenders has surpassed the rate of incarcerated male drug offenders. Between 1995 and 1996, the number of women in state prisons for drug offenses increased by 95 percent, compared to a 55 percent increase for men. Between 1986 and 1996, the number of women incarcerated for drug offenses rose by 888 percent (Mauer, Potler and Wolf, 2000). Currently, 35.9 percent of women serving time for drug offenses were charged solely with possession.

We must ask ourselves if incarceration is always necessary. In a private conversation, a warden at one of the largest women's prisons in the United States stated that 75 percent of the women in her custodial care would be better served in the community. The warden, as well as many women who work in the corrections field, thinks this would be a more humane and economical solution to the crowding of our prisons by women who have committed nonviolent, petty offenses.

Characteristics of Female Offenders

A basic principle of clinical work is to know who the clients are and what they bring into the treatment setting. In order to design a treatment program that matches female offenders' needs, it is important to consider their demographics and histories, as well as how various life factors impact their substance abuse and offending patterns.

Nature of crime. Female prison populations differ from male prison populations in several significant ways. First, women are less likely to have committed violent offenses and more likely to have been convicted of crimes involving alcohol, drugs or property. One study showed that 71.9 percent of female offenders in California had been convicted of drug or property charges, vs. 49.7 percent of male offenders. These statistics are consistent with national trends (Bloom, Chesney-Lind and Owens, 1994). Many of these property crimes are economically driven, often motivated by the abuse of and addiction to alcohol and other drugs and/or by poverty.

Response to treatment. Besides being significantly less violent than men, women show more responsiveness to prison programs, although they have less opportunity to participate in them due to lack of availability. Another difference is that men often deal with their anxieties through physical activity, but women tend to deal with their anxieties with too much sleep, food and prescription pills (LeBlanc, 1996).

Demographics. Most female inmates are poor, undereducated, unskilled single mothers, and a disproportionate number of them are minorities. In one state, more than half the women inmates were African-American (35 percent) and 16.6 percent were Hispanic. One-third were Caucasian and the remaining 13 percent were composed of other minorities. Of those who had been employed before incarceration, many were on the lower rungs of the economic ladder, with only 37 percent working at legitimate jobs. Twenty-two percent were on some kind of public support, 16 percent made money from drug-dealing and 15 percent were involved in prostitution, shoplifting or other illegal activities (Bloom, Chesney-Lind and Owen, 1994).

Health and mental illness. In a study conducted of 400 female volunteers in a Massachusetts prison, 35 percent tested HIV-positive. In addition to health problems, nearly one-quarter (24 percent) of women in state prisons have been identified as being mentally ill. (Ditton, 1999).

Motherhood. Two-thirds of incarcerated women have children younger than 18. Many feel enormous guilt about being absent from their children's lives and worry about whether they will have custody of their children when they are released (Bloom and Steinhart, 1993). These and other concerns, including unresolved issues of physical and sexual abuse, lead female inmates to make requests for psychological counseling that far exceed those made by men. Penal experts agree that women would benefit from these additional services.

Abuse. Many women in prison have histories of physical and sexual abuse. In one study, nearly 80 percent reported experiencing some form of abuse, 29 percent reported being physically abused as children and 60 percent reported abuse as adults, usually by their partners. In some cases, abuse in childhood and adulthood overlapped. Thirty-one percent experienced sexual abuse as children and 23 percent as adults; 40 percent reported emotional abuse as children, and 48 percent as adults (Bloom, Chesney-Lind and Owen, 1994).

Women also are abused within the prison system. A report by the Human Rights Watch Women's Rights Project documented verbal degradation, sexual assault, unwarranted visual supervision, denial of goods and privileges, and use or threat of force.

Available vs. Optimal Treatment

With nearly 60 percent of women in prison for drug-related crimes, and with the number of addiction and abuse issues that women bring with them, it would not be unreasonable to expect prisons to invest substantial resources in alcohol and drug recovery programs, support groups and psychological counseling. Unfortunately, the current programs for men in prison are few and inadequate, and there are even fewer for women. The term "correctional institutions" becomes a sad euphemism in a system that provides few programs to help redress the most basic needs and concerns of women inmates.

There also is a lack of integration and too little coordination among the programs that do exist. For example, a woman can be in a therapeutic community that regards addiction as a secondary issue, while also attending 12 Step meetings that view addiction as a primary disease and that advocate abstinence, as well as participating in a cognitive-behavioral program that treats addiction as a learned behavior. These built-in contradictions can create confusion and lead to relapse. A female also is likely to be in one type of treatment program while incarcerated and then be treated from a different theoretical perspective when in a community continuing-care facility. In a nationwide survey conducted under the auspices of the U.S. Department of Justice, the National Criminal Justice Association found that "virtually every survey respondent reported that there is too little funding for treatment services, that there are not enough drug treatment facilities or appropriate placements for drug-dependent clients, and that there is a lack of qualified personnel to staff treatment programs" (Zawistowski, 1991).

Gender-Responsive Issues

The Center for Substance Abuse Treatment (CSAT) has developed the following list of issues that reflect a comprehensive treatment model for women:

* The etiology of addiction, especially gender-specific issues related to addiction, including social, physiological and psychological consequences of addiction, and factors related to onset of addiction;

* Low self-esteem;

* Race, ethnicity and cultural issues;

* Gender discrimination and harassment;

* Disability-related issues, where relevant;

* Relationships with family members and significant others;

* Attachments to unhealthy interpersonal relationships;

* Interpersonal violence, including incest, rape, battering and other abuse;

* Eating disorders;

* Sexuality, including sexual functioning and sexual orientation;

* Parenting;

* Grief related to the loss of alcohol or other drugs, children, family members or partners;

* Work;

* Appearance and overall health and hygiene;

* Isolation related to a lack of support systems (which may or may not include family members and/or partners) and other resources;

* Life plan development; and

* Child care and custody.

Women's issues

When women across the country who recovered in 12 Step programs described what had changed the most for them in their journeys to recovery and the issues that contributed to relapse, they listed the self, relationships, sexuality and spirituality as most important (Covington, 1994). It is interesting to note that these four issues incorporate the CSAT list above. Thus, if recovery programs are to be created for women in correctional settings, these issues need to be understood and addressed.

One example of a program that addresses women's issues is Helping Women Recover A Program for Treating Substance Abuse (Covington, 1999), a 17-session program with a module for each of the issues identified below,

The self. Addiction clearly is a disorder of self. The generic definition of addiction I use is: the chronic neglect of self in favor of something or someone else. Many women enter the prison system with a poor self-image and histories of trauma and abuse. One of the first questions women in recovery address is, "Who am I?" They find words to describe who they are from a deep, inner place, rather than through roles such as wife, mother or daughter.

Relationships. Some women use addictive substances to maintain relationships with using partners, while some use them to fill relationships void and still others use them to deal with the pain of being abused (Covington and Surrey, 1997). One of the tasks of any recovery program is to teach women self-soothing techniques to address the myriad of feelings that surface during abstinence.

Women in prison often have unhealthy, illusory or unequal relationships with spouses, partners, friends and family members. For that reason, it is important for recovery programs to model healthy relationships among both staff and participants, providing a safe place for healing (Bloom and Covington, 1998). The greatest challenge is to overcome the alienation that is fostered within prison walls and to replace it with a greater sense of relationship in the community.

Sexuality. Sexuality is one of the most neglected areas in addiction treatment and one of the major causes for relapse. Healthy sexuality is integral to one's sense of self-worth. It represents the integration of the biological, emotional, social and spiritual aspects of who one is and how one relates to others.

Many women entering the early stages of recovery report: sexual dysfunction, shame and guilt, sexual identity issues, prostitution, sexual abuse and fear of sex while clean and sober. These issues must be addressed if women are expected to maintain their recovery (Covington, 2000).

Spirituality. The design of the criminal justice system is anti-thetical to spiritual values. Although we live in a secular culture, helping women reconnect with their own spirituality is critical to the recovery process. Religion and spirituality are not the same and may or may not be connected. Religion is about form, dogma and structure, and is institutionally based. Spirituality is about transformation, connection, wholeness, meaning and depth.

It is essential that women find their own definitions of a "higher power." In recovery groups, it often is useful to give women art history books to look at how, for thousands of years, the female was revered. It also is helpful to show women that they are part of a long history of birthers, growers and caregivers, helping them reconnect with that energy.

Conclusion

Even though most professionals believe addiction is a disease or disorder, societally, we respond to it chiefly as a crime. With women being incarcerated for drug-related offenses at an alarming rate, it is imperative to design treatment services that reflect the realities of their lives. There is a critical need for comprehensive, integrated programs that address the interrelationships among race, class, gender and addiction. A definition of gender-responsive that can help guide our work is: creating an environment through site selection, staff selection, program development and content that reflects an understanding of the realities of women's lives and is responsive to the participants' issues.

The task of corrections is to provide better services for the invisible women caught in our criminal justice system, imprisoned for substance abuse and their attempts to survive poverty and trauma. It is crucial that the link between the crimes and each woman's drug addiction, mental illness, and/or economic distress be acknowledged. It is equally important to challenge the belief that incarceration is the answer. Perhaps substance-abusing females could be treated more effectively and economically in community-based gender-responsive programs. We must understand the reality of the lives of the women who come into the system in order to develop programs to serve them.

Stephanie S. Covington, Ph.D., LCSW, is co-director of the Center for Gender and Justice in La Jolla, Calif. Her consulting work includes the Pennsylvania Department of Corrections and the National Institute of Corrections. She has more than 20 years of experience in the design and implementation of treatment services for women.

REFERENCES

Bloom, B., M. Chesney-Lind and B. Owen. 1994. Women in California prisons: Hidden victims of the war on drugs. San Francisco: Center on Juvenile and Criminal Justice.

Bloom, B. and S. Covington. 1998. Gender-specific programming for female offenders: What is it and why is it important? Presented at the 50th Annual Meeting of the American Society of Criminology in Washington, D.C.

Bloom, B. and D. Steinhart. 1993. Why punish the children? A reappraisal of incarcerated mothers in America. San Francisco: National Council on Crime and Delinquency.

Center for Substance Abuse Treatment. 1999. Substance abuse treatment for women offenders: Guide to promising practices. TAP#23. Rockville, Md.: U.S. Department of Health and Human Services, Public Health Service, Substance Abuse and Mental Health Services Administration.

Covington, S. 2000. Awakening your sexuality: A guide for recovering women. San Francisco: Hazelden.

Covington, S. 1999. Helping women recover: A program for treating substance abuse (special edition for the criminal justice system). San Francisco: Jossey-Bass.

Covington, S. 1994. A woman's way through the 12 steps. Center City, Minn.: Hazelden.

Covington, S. and J. Surrey. 1997. The relational model of women's psychological development: Implications for substance abuse. In Gender and alcohol: Individual and social perspectives, S. Wilsnak and R. Wilsnak, eds (pp. 335-351). New Brunswick, N.J.: Rutgers Center of Alcohol Studies.

Ditton, P. 1999. Mental health and treatment of inmates and probationers. Washington, D.C.: Bureau of Justice Statistics.

Human Rights Watch Women's Rights Project. 1996. All too familiar: Sexual abuse of women in U.S. state prisons. New York: Human Rights Watch.

LeBlanc, A.N. 1996. A woman behind bars is not a dangerous man. The New York Times Magazine, pp. 35-40. (June).

Mauer, M., C. Potler and R. Wolf. 2000. Gender and justice: Women, drugs and sentencing policy. Washington, D.C.: The Sentencing Project.

Zawistowski, T.A. 1991. Criminal addiction/illegal disease. The Counselor, pp. 8-11. (March/April).