Correctional Service Canada
Symbol of the Government of Canada

Research Reports

Warning This Web page has been archived on the Web.

The Women Offender Substance
Abuse Programming: Interim Research Report

2008 No R-171

Brian A. Grant
April Furlong
Lucy Hume
Tara White
Sherri Doherty

Addictions Research Centre
Research Branch
Correctional Service Canada

July 2008

ACKNOWLEDGEMENTS

This report is a product of many efforts including those of the women offenders whose voices helped shape the Women Offender Substance Abuse Programming (WOSAP) and whose participation has turned their vision into a reality. To the dedicated facilitators who delivered the program, appreciation is extended for the experience they brought to the program, for their administration of assessment material and for their feedback, all of which served to strengthen and solidify the various stages of the demonstration period. The Implementation and Advisory Committees provided guidance and invaluable assistance regarding all aspects of implementation. Many regional and national headquarters staff dedicated their time and expertise in getting WOSAP off the ground. We thank Derek Lefebvre for his generous assistance with the development of data sets and analyses and Dan Kunic for generating the databases used for this study. Ellen Jones provided direction regarding implementation and quality assurance issues, sharing her experience in both programs and operations. Finally, to the staff of the Addiction Research Centre, for their support and assistance we extend our appreciation and thanks.

Executive summary

Substance abuse continues to be a significant concern for correctional agencies in Canada and around the world with estimates of substance abuse problems reaching as high as 80% for men and women offenders (Grant, Kunic, MacPherson, McKeown & Hansen, 2003). Research indicates that this problem can be addressed in part by well- designed, evidence-based substance abuse treatment programs that result in reductions in recidivism (Dowden & Blanchette, 1998; Grant, et al., 2003; T3 Associates, 1999).

In 1999, Correctional Service Canada (CSC) asked a panel of international experts to review existing substance abuse programming for federally sentenced women. The panel's recommendations were integrated with current theoretical addictions models, culminating in the Women Offender Substance Abuse Programming (WOSAP). WOSAP offers a continuum of interventions including Engagement and Education (E & E), Intensive Therapeutic Treatment (ITT), Relapse Prevention and Maintenance, and Community Building and Peer Support. Consistent with current program development best practices, WOSAP was designed specifically for women offenders to provide a continuum of care from admission to the end of a woman's sentence.

WOSAP was implemented as a demonstration program at six institutions for women offenders.[1] During the first six months of the program, 193 women offenders participated in Engagement and Education (E& E) and 45 women progressed to the Intensive Therapeutic Treatment (ITT) module. This study is an interim evaluation of these first two modules of the program.

Completion rates of 93% for E & E and 82% for ITT participants indicate that the modules were well accepted by the women and problems of attrition may not be a concern for the program. In addition, the women were very satisfied with the content and structure of the program, further contributing to the potential success.

As in the women offender population, the majority of women in the program, (two-thirds), were Caucasian and Aboriginal women accounted for between 23% (E & E) and 31% (ITT) of program participants. Almost half of the women in both modules (E & E: 43% and ITT: 44%) were either married or had common law status.

Severity of substance abuse measures indicated that women in the ITT group were the most in need of treatment with 95% assessed as having a moderate to severe substance abuse problem, consistent with the intent of the program design. Overall, more women were assessed as having a drug problem (80%) than an alcohol problem (50%). Results also demonstrate that most women, not just those in the program, require treatment for their substance abuse problem, with 75% of the E & E group (E & E is offered to all offenders) and 71% of the comparison group (all non-participating women) assessed as having a moderate to severe substance abuse problem.

Women reported that substance abuse affects many areas of their lives, including family and other personal relationships. There was a trend to higher levels of static and dynamic risk factors for women in the ITT group, and the women had long histories of substance use starting at an early age (less than 15 years). In addition, there was a strong relationship between drug and alcohol use at the time of their most recent offence, and they reported that drugs and alcohol contributed to the commission of the offences.

Pre- and post-test assessment measures indicate a positive impact on the women offenders in several domains. E & E participants demonstrated an increase in knowledge of the impacts of substance abuse in several life areas and an increase in motivation to change. These results were replicated for ITT participants with additional increases in knowledge of the coping skills needed to prevent relapse and increases in self-efficacy and self-esteem, indicating that the program helped to build confidence in the women for their ability to address substance abuse challenges.

The interim evaluation of the first two modules of the program provides evidence that E & E and ITT are providing women with the requisite tools needed for addressing their substance abuse problems and effectively reducing their chances of recidivism upon release. At the completion of the program's demonstration period in June 2005, a final outcome evaluation will look at whether these tools translate into decreased drug usage within the institution and a reduced recidivism rate in the community.

Table of contents

List of Tables

Table of Figures

[1] Burnaby Correctional Centre for Women, Edmonton Institution for Women, Fraser Valley Institution, Grand Valley Institution for Women, Joliette Institution, Nova Institution for Women, and Okimaw Ohci Healing Lodge (Engagement and Education only).

INTRODUCTION

In 1994, Correctional Service Canada (CSC) established substance abuse programming as a priority in its Correctional Program Strategy for Federally Sentenced Women (Correctional Service Canada, 1994). This priority was based on research demonstrating that substance abuse is a significant problem for offenders. Estimates indicate that 80% or more of men and women offenders have substance abuse identified as a factor contributing to their criminal behaviour (Grant, Kunic, MacPherson, McKeown, & Hansen, 2003). For women, the implications of these statistics were described in Dowden and Blanchette's (1999) report, detailing that women who abused substances had significantly more problems with associates, attitudes, employment and their marital/family situations. They were also twice as likely to have unstable accommodation in the community and to have few skills to manage stress, and they were more likely to have been hospitalised for mental health reasons.

In an earlier report, Dowden and Blanchette (1998) reported that participation in a substance abuse treatment program was associated with reduced recidivism while on discretionary release for federally sentenced women. This research further supported the need for the design and implementation of an effective substance abuse treatment program that addressed the unique needs of women offenders.

Creating Choices, the 1990 report of the Task Force on Federally Sentenced Women, laid the groundwork for the treatment of women offenders with its description of the key programming principles of empowerment, meaningful and responsible choices, respect and dignity, supportive environment and shared responsibility (Correctional Service Canada, 1990). In response to Creating Choices, CSC identified a need for core programming to reflect these principles and to address the many common and interrelated issues women offenders share. Substance abuse programming was one of four programs developed and offered in the five regional facilities for women. The first Women's Substance Abuse Program (Abbott & Kerr, 1995) was introduced in 1995 with a community component added in 1997 (Correctional Service Canada, 1997).

In 1999, CSC asked a panel of internationally recognized experts to review existing substance abuse programming for women. The panel agreed that, while earlier program efforts represented an important beginning, a more comprehensive approach was warranted. They proposed a design to ensure that programming would be:

  • in accord with correctional philosophy with a clear understanding of the role of abstinence within a harm reduction framework;
  • firmly rooted in holistic and gender responsive principles, including relational theory; and
  • balanced, incorporating both cognitive learning and therapeutic needs.

Additionally, the proposed program implementation would need to:

  • identify the linkages between substance abuse and pathways to crime, which differ significantly for women;
  • create linkages to other areas of need and related programming. This is seen as key to fostering an integrated environment where 'connection' and 'community' are actively promoted;
  • train and maintain qualified staff, noting that training and upgrading are integral to effective treatment and program fidelity; and
  • evaluate effectiveness using a combination of behavioural and personal/emotional variables.

The recommendations of the expert panel were summarized and integrated with current theoretical influences in a discussion document (Hume & Grant, 2001), culminating in a proposed structure for substance abuse programming for women. This document emphasized that effective treatment should be multi-dimensional, addressing both the intervention (cognition, affect and behaviour) and the environment (safety, connection and empowerment). Overall, the panel members were emphatic that, in order to maximize treatment efficacy, a substance abuse program must create an environment that permits women an opportunity to integrate information within their own life experiences.

Using the recommendations noted, management, program staff and women offenders were consulted nationally using a semi-structured interview. Management and staff were asked about their experiences with existing programming and their reactions to the recommendations made. Women offenders were interviewed and specifically asked about the impact of existing programming and what they would like to see included in a new model. The women consulted included those in the early stages of treatment, those who had successfully completed treatment, and those who had been released and had been returned to custody following a lapse or relapse (revocation or new offences). A thematic analysis was completed with the interview responses and emerging themes clearly demonstrated that many women did benefit from existing programming. Equally clear, however, were the gaps not addressed by current treatment. The feedback from the women interviewed echoed issues noted by staff and the expert panel. Together, their recommendations offered support for a program model capable of responding to a wide range of complex needs.

Program Description

The Women Offender Substance Abuse Programming (WOSAP) (Hume & Grant, 2001), developed by the Addictions Research Centre and with support from the Women Offender sector, offers a continuum of interventions and services, matched to women's specific needs, as well as peer support and activities designed to foster a positive culture (Hume & Furlong, in progress; Hume & Grant, 2001). The program is gender responsive, which, in this context, refers to an environment (program content, staffing and culture) that reflects a comprehensive understanding of the realities of women's lives. The overall goal of WOSAP is to empower women to make healthy lifestyle choices.

In addition to the structured programming, WOSAP includes a second level of intervention which includes activities to promote and foster connection, community and empowerment and which add an experiential dimension to treatment where program goals are practised and incorporated into daily living. Peer Support and Community Meetings complement program content and foster healthy lifestyles.

WOSAP is comprised of four Modules (summarized in Figure 1), each designed to address separate but related goals. This report will focus on the evaluation of the first two modules. A brief description of each module follows and more complete details may be found in Hume and Furlong (in progress).

Figure 1: WOSAP Program Model

Module 1 - Engagement and Education

Engagement and Education (E & E) is offered to all women in the institution, regardless of use or abuse of substances. WOSAP facilitators meet briefly with each woman within two to three days of her admission to the institution. The contact is intended to introduce the woman to the institutional community and to enhance her motivation to participate in the E & E module. It is anticipated that most women offenders, if not having a substance abuse problem of their own, have lived with or know someone who does. The education component works to increase the participant's understanding of the impact of addiction on women. It consists of eight one-hour sessions, delivered one session per day for eight consecutive days. The sessions were developed for continuous intake and are a mix of psycho-education and coping skills practice.

Module 2 - Intensive Therapeutic Treatment

Intensive Therapeutic Treatment (ITT) is offered to women offenders who have a moderate to high substance abuse need as assessed when admitted. The module is intended to provide a safe environment where women can engage in self-exploration of the underlying issues related to substance abuse, such as trauma and lack of self-awareness, as well as to provide women with concrete, practical skills to help them stop abusing substances. As such, the treatment is an integration of an emotive, experiential approach and a cognitive-behavioural model including relapse prevention theory for substance abuse. It is divided into two parts: Emotive (20 sessions), and Cognitive (20 sessions). One two-hour session is delivered each day with Emotive and Cognitive sessions delivered on alternating days.

The emotive sessions have been divided into five areas: Emotions, Spirituality, Relationships, Sexuality, and Self. The cognitive sessions focus on coping skills, problem solving, goal setting, relapse prevention and lifestyle, and were designed to provide the education and skills necessary to effect change in the area of substance use and crime. The sessions have been structured to allow for skill acquisition and practice, and to encourage greater self-awareness of issues and patterns relating to substance abuse.

Module 3 - Relapse Prevention/Maintenance

In the institution, Relapse Prevention and Maintenance is designed to be taken by all women offenders who have received any type of correctional programming, to address their respective problematic behaviours. This module gives women an opportunity to develop and implement an individualized relapse prevention plan that corresponds to their problematic behaviour. The module can be initiated in the institution and completed in the community. Future research will evaluate the outcome of this module.

Module 4 - Peer Support and Community Meetings

Peer Support and Community Meetings ensure continuous support in an environment where women with substance abuse problems can explore and access resources and information relevant to their recovery. There are two components in this module:

  • The WOSAP Peer Support Program focuses on supporting women offenders with substance use concerns. This peer-led group includes speakers, open discussions and structured discussions, all with a concentration on substance use.
  • Community building activities are meant to promote a feeling of community and connection in the institution among offenders and staff. The goal of the community activities is to effect larger change beyond the immediate goal of treating substance abuse, including the development of pro-social values and behaviours, social support, strength and empowerment.

Evaluation Overview

The results from this interim evaluation of WOSAP focus specifically on offender characteristics such as demographic variables, criminogenic assessments and program assessments. The program assessment data provide intermediate measures of change resulting from program participation. Future research will use follow-up measures to assess program impact. More detailed information on program implementation is described in Hume and Furlong (in progress).

Research Questions

The following four research questions guided the interim evaluation:

1. What are the characteristics of offenders participating in Engagement and Education (E & E) and Intensive Therapeutic Treatment (ITT)?

To determine the characteristics of offenders in E & E and ITT, the following variables were examined: age, marital status, race, sentence length, offence type, risk level based on static and dynamic factors and severity of substance abuse problem. These variables were also considered for a comparison group of women offenders who had not participated in WOSAP.

2. Are the appropriate women offenders participating in WOSAP?

E & E was designed for all women offenders, therefore women participants in this module should not differ from those in the general offender population. ITT was designed for participants with a moderate to severe problem with substances. Therefore all participants in this module should have an assessment indicating this level of severity and should be different in terms of substance abuse need from other women offenders not participating in the program.

3. Did the program change intermediate outcome indicators through changes in knowledge and skills and attitudes and beliefs about substance abuse?

It is expected that participation in E & E and ITT will have a positive impact on outcome indicators as measured by pre- and post-program assessment data.

4. Are WOSAP participants satisfied with the program?

Results from WOSAP participants' feedback collected immediately following the modules will comment on program effectiveness and will provide information on both program strengths and areas in need of improvement.

Method

Study Groups

E & E Sample

A total of 193 women offenders from four regional facilities, Burnaby Correctional Centre for Women, and Okimaw Ohci Healing Lodge participated in the Engagement and Education (E & E) module from June 1, 2003, to January 1, 2004. Of these, 180 offenders (93%) completed the module. For the purposes of analysis, the E & E sample consists of those women who participated in E & E only (n = 148). This group was also divided into completers and non-completers to determine if there were significant differences.

ITT Sample

During the same time period, and drawing from four regional sites and Burnaby Correctional Centre for Women, 45 offenders who had previously completed the E & E module participated in the Intensive Therapeutic Treatment (ITT) module. Of these, 37 offenders (82%) completed the module. This group was also divided into completers and non-completers to determine if there were significant differences.

Comparison Group

A comparison group consisting of 269 women offenders who were incarcerated in federal institutions on May 1, 2003, but who did not participate in WOSAP was created to represent the general population. The E & E and ITT samples were compared to this group to determine if there were appreciable demographic and criminogenic differences from the general population.

The three study groups were also divided into four regions to determine if demographic and outcome data varied by region. Additional descriptive information regarding the samples is presented in the Results section.

Data Sources

Offender information, including age, race, marital status, sentence length, offence type, static and dynamic factors, and severity of substance abuse problems, was obtained from the Offender Management System (OMS). OMS is an automated administrative system used to manage information about offenders under federal jurisdiction. It is used daily by CSC and National Parole Board staff as an electronic filing system to manage offenders. Data from this administrative system are also available for research purposes. The information used in the study is derived from the Offender Intake Assessment (OIA) process completed when offenders are admitted to a federal prison in Canada and subsequently recorded in OMS.

Static and Dynamic Factor Ratings

The static factor rating provides a measure of an offender's risk to re-offend and is based on historical factors such as type of offence, offence characteristics, victim information and offence history, which have been shown to be associated with recidivism through previous research (Andrews & Bonta, 1998). For the OIA, the static factor rating is assessed using 134 indicators (questions requiring a yes/no response to indicate if an item applies to an offender) relating to an offender's criminal activities. Parole officers in the institutions assess each indicator after a systematic review and analysis of official documentation and interviews conducted as part of the OIA process. Offenders are then classified as either high, medium or low on the static factor.

The dynamic factor provides an assessment of criminogenic factors that can change through treatment. For the dynamic factor, 197 indicators (questions requiring a yes/no response to indicate if an item applies to an offender) are used to assess an offender's needs in seven domains: employment and education, marital/family, associates/social interactions, substance abuse, community functioning, personal/emotional orientation, and attitude. Each of these domains has been shown to be related to recidivism (Boland, Henderson & Baker, 1998; Gates, Dowden, & Brown, 1998; Gendreau, Goggin, & Gray, 2000; Goggin, Gendreau & Gray, 1998; Law, 1998; Paolucci, Violato, & Schofield, 1998; Robinson, Porporino, & Beal, 1998). For the seven domains, ratings are on a 3- or 4-point scale: 1) factor seen as an asset to community functioning, 2) no immediate need for improvement, 3) some need for improvement and 4) considerable need for improvement. Substance Abuse and Personal/Emotional Orientation domains are rated on a 3-point scale with the asset rating not being applicable to these domains. Guidelines ensure that criteria are applied consistently during the rating process (Correctional Service Canada, 2003a). For the purposes of this study, an offender is identified as having a need in a domain if she receives a rating of some need or a high need.

In addition to the assessment of individual domains, an overall dynamic factor rating of low, medium or high is provided. The rating is based on an assessment of the domains identified, the rating for each domain and the individual indicators. The overall rating has been shown to be positively correlated with recidivism (Grant & Gillis, 1999; Grant, Motiuk, Brunet, Couturier, & Lefebvre, 1996).

Severity of Substance Abuse Problem

A standardized measure of severity of substance abuse problems was obtained using the Alcohol Dependence Scale (ADS) (Skinner & Horn, 1984), the Drug Abuse Screening Test (DAST) (Skinner, 1982) and the Problems Related to Drinking Scale (PRD). Based on these assessment results, offenders are identified as requiring treatment at one of the following levels: 1) none, 2) low, 3) moderate or 4) high.

Alcohol Dependence Scale (ADS)

The ADS measures severity of alcohol problems, with an emphasis on the identification of physiological symptoms associated with alcohol use. The scale uses 25 items scored on a 2-point, 3-point, or 4-point scale and results are divided into five levels of severity: no substantive alcohol problem (score of 0), low level problem (1-13), intermediate problem (13-21), substantial problem (22-30), and severe alcohol problem (31-47). Examples of items include: 'When you drank, did you stumble about, stagger, and weave?' and 'Did you panic because you feared you might not have a drink when you needed it?' The reported internal reliability Cronbach alpha for the scale is high at .92 using a sample of 225 respondents, 20% of whom were women (Skinner & Horn, 1984).

Drug Abuse Screening Test (DAST)

The DAST measures severity of drug problems using 20 items answered in a yes/no format. Results are used to categorize severity of drug abuse into five levels: no substantive drug problem (score of 0), low level problem (1-5), intermediate problem (6-10), substantial problem (11-15), and severe drug problem (16-20). Example items include: 'Do you abuse more than one drug at a time?' and 'Has drug abuse ever created problems between you and your spouse?' The DAST was originally evaluated using a sample of 223 respondents (28% women) and yielded a high internal reliability Cronbach alpha of .92.

Problems Related to Drinking Scale (PRD)

The PRD was condensed from the Michigan Alcoholism Screening Test (Seltzer, 1971) from 25 to 15 items. The scale measures the number of problems related to alcohol use using 15 items answered in a yes/no format. The PRD scores are divided into four levels: no substantive alcohol problems (score of 0), some problems (1-3), quite a few problems (4-6), and a lot of alcohol problems (7-15). Example items include: 'Were there major arguments in your family because of your drinking?' and 'Did your drinking result in your getting hurt in an accident?'

WOSAP Assessment Model

Both the E & E and ITT modules are designed to create change in several target areas. To measure change, a number of scales are used that are specific to each target area. Figure 2 summarises the WOSAP assessment model for the E & E and ITT modules.

Figure 2: WOSAP Assessment Model

Engagement and Education Intensive Therapeutic Treatment
Pre-Tests Post-Tests Pre-Tests Post-Tests
How Much Do They Matter How Much Do They Matter Semi-Structured Interview Coping Behaviours Inventory
Substance Abuse Education Substance Abuse Education Coping Behaviours Inventory Relapse Attitudes and Knowledge
Readiness to Change (Generic) Readiness to Change (Generic) Relapse Attitudes and Knowledge Rosenberg's Self-Esteem Scale
  Participant Feedback Questionnaire Rosenberg's Self-Esteem Scale Alcohol and Drug Abstinence
Self-Efficacy Scale
    Alcohol and Drug Abstinence Self-Efficacy Scale Readiness to Change
    Readiness to Change Participant Feedback Questionnaire

Engagement and Education Assessment

Substance Abuse Knowledge

In this module, substance abuse knowledge is measured using the Substance Abuse Education Questionnaire (SAE) and the How Much Do They Matter Scale (HMM) (Gunn, Orenstein, Iverson, & Mullen, 1983).

Substance Abuse Education (SAE)

The SAE was designed specifically to measure participant changes (pre/post) for this module and assesses knowledge regarding the effects of substance use. Respondents indicate their agreement for each of the 15 statements using a 5-point Likert Scale (1 indicating strong disagreement, 5 indicating strong agreement). Sample items include: 'Women who have been abused are more likely to use alcohol and/or drugs' and 'Substance abuse and criminal behaviour often go hand in hand.' This scale is scored by adding the point value of each of the responses to form a raw score. The pre- and post-test Cronbach alphas in the present study are good at .79 and .85 respectively. The complete scale can be found in Appendix A.

How Much Do They Matter Scale (HMM)

The HMM, a 14-item scale modified by Millson, Weekes, and Lightfoot (1995) from a 20-item scale developed by Gunn, Orenstein, Iverson, and Mullen (1983), assesses personal attitudes about the effects of drug and alcohol use. Sample items include: 'People under the influence of large amounts of drugs or alcohol endanger other people' and 'People can use large amounts of drugs or alcohol without it affecting their families'. The respondents are asked to indicate, using a 5-point Likert scale, the extent to which they agree or disagree with each statement. An increase in score from the pre- to post-test indicates an increase in the participant's understanding regarding the negative effects of alcohol and drug use. The Offender Substance Abuse Pre-Release Program (delivered to men exclusively) yielded a pre-test Cronbach alpha of .83 (post-test alpha: .84) (T3 Associates, 1999). For the present study, the pre- and post-test alphas were good at .84 and .83 respectively which indicates results are consistent with those found in earlier studies.

Readiness for Change

Readiness to Change Questionnaire

The RCQ is a 30-item questionnaire, based on Prochaska and DiClemente's (1992) Stages of Change model, which was adapted from the Readiness to Change Questionnaire -Treatment Version (RCQ-TV) (Heather, Luce, Peck, and Dunbar, 1996). In the original RCQ-TV, respondents are asked questions related to their readiness to change in regards to their problematic alcohol consumption. For the E & E module, because participants do not necessarily have a substance abuse problem, respondents are asked to identify a behaviour that is problematic for them and to refer to that behaviour when answering the scale's questions. Each of the scale's questions was subsequently adapted to refer to 'my behaviour' rather than to alcohol consumption.

The results from the scale place the respondents into one of five stages of change: Precontemplation, Contemplation, Preparation, Action, or Maintenance. Subscales are scored with the highest score representing the stage in which the respondents are prepared to address their problematic behaviour. In the case of a tie, the stage farthest along the continuum of change (i.e., from Precontemplation to Maintenance) is indicated. Table 1 presents the Cronbach alphas measured for both the E&E and ITT modules. Overall, these coefficients indicate that all subscales have strong internal consistency except for the contemplation subscale.

Table 1: Cronbach Alphas for the RCQ Subscales

Education and Engagement Module Pre-test Alphas Post-test Alphas
Precontemplation .70 .82
Contemplation .36 .53
Preparation .85 .89
Action .89 .91
Maintenance .90 .92
Intensive Therapeutic Treatment Pre-test Alphas Post-test Alphas
Precontemplation .82 .66
Contemplation .45 .68
Preparation .86 .68
Action .86 .77
Maintenance .82 .78

Intensive Therapeutic Treatment Assessment

Semi-Structured Interview

Information regarding the women's past experiences with substance abuse and life areas affected by substance abuse was obtained from the Semi-Structured Interview (SSI). The SSI provides an opportunity to gather both case information for assessment and to engage the women offenders who will participate in the ITT module. It includes both quantitative and qualitative data and is administered the week prior to the offender entering ITT by one of the two program facilitators delivering the module. Refer to Appendix B for the complete SSI.

Prior to the interview, intake information is summarized in the interview booklet (results from the Drug Abuse Screening Test, Problems Related to Drinking Scale, Alcohol Dependence Scale and Readiness to Change Questionnaire), and questions are then posed and matching responses are checked.

The interview covers current perceptions regarding substance abuse, history of substance abuse, previous programming, substance use and life areas, emotional issues, crime and substance use, substance abuse programming and trauma histories. There are 18 drug categories available in the SSI to capture frequency of specific types of drug use. For example, heroin is provided a separate category outside of opiates (which include primarily prescription medications). Likewise, crack, a derivative of cocaine, is provided its own category.

Knowledge ' Substance Abuse and Self

Intensive Therapeutic Treatment (ITT) Questionnaire

The ITT Questionnaire was designed specifically to measure participant changes in knowledge (pre/post) relevant to the content of the program. It targets the specific areas covered in the 20 Emotive sessions of the Intensive Therapeutic Treatment module assessing knowledge in five areas:

  1. Emotions ' 14 items (e.g., Only positive emotions are useful).
  2. Spirituality ' 11 items (e.g., I have a vision for my life).
  3. Relationships ' 9 items (e.g., I have positive relationships in the institution).
  4. Sexuality ' 10 items (e.g., I feel in control of my sexuality).
  5. Self ' 9 items (e.g., I value the person I am).

Participants respond to 53 questions using a 5-point Likert scale. The complete scale can be found in Appendix C. Cronbach alphas for each subscale are presented in Table 2 and indicate a moderate level of reliability for the subscales.

Table 2: Cronbach Alphas for the ITT Subscales

Intensive Therapeutic Treatment Questionnaire Subscales Pre-test Alphas Post-test Alphas
Emotions .69 .57
Spirituality .75 .79
Relationships .59 .64
Sexuality .60 .63
Self .82 .85

Relapse Attitudes and Knowledge Questionnaire (RAK)

The RAK, a 20-item scale adapted by Millson, Weekes, and Lightfoot (1995) from a 47-item scale developed by Lightfoot and Barker (1989), measures an offender's perceptions toward drinking and drug use, coping without alcohol/drugs in various situations, activities promoting healthy lifestyles, and general relapse knowledge. Respondents indicate their level of agreement using five point Likert scale for each of the 20 items. Examples of items that were rated by the offender are: 'When there is a celebration at work, everyone is expected to drink in order to have a good time' and 'If someone relapses, other people will think they are a worthless person'. An increase in score from the pre- to post-test indicates a higher level of understanding and knowledge of potential relapse situations. The Offender Substance Abuse Pre-Release Program (delivered to men exclusively) yielded pre- and post-test Cronbach alphas of .86 and .88 respectively (T3 Associates, 1999). For the present study, the pre- and post-test alphas were .90 and .88 indicating strong internal consistency among the scale's items.

Coping Skills

The Coping Behaviours Inventory (CBI) was modified from the scale developed by Litman, Stapleton, Oppenheim, Peleg, and Jackson (1983), which was designed specifically to assess the behaviours and thoughts used to prevent, avoid or control the resumption of heavy drinking in response to external circumstances or internal mood states. In the revised version of the scale, those items that made reference to alcohol were adapted to refer to both drug use and alcohol consumption. The inventory consists of a list of 14 cognitive and 22 behavioural options. The respondent indicates how often he/she uses each coping behaviour to avoid relapse. Frequency of use is rated on a 4-point scale from 0 ('I have usually tried this') to 3 ('I have never tried this'). Sample items include: 'Remind myself of the good life I can have without drinking/drugs' and 'Cheer myself up by buying something special instead'. The CBI is scored by summing the responses for a total raw score. A decrease in scores from pre- to post-test indicates more frequent use of the coping behaviours described. The pre- and post-test Cronbach alphas for the present study are high at .96 and .94 respectively.

Self-Esteem and Self-Efficacy

Offender self-perceptions were measured using Rosenberg's Self-Esteem Scale (Rosenberg, 1965) and the Alcohol and Drug Abstinence Self-Efficacy Scale (DiClemente, Carbonari, Montgomery & Hughes, 1994).

Rosenberg's Self-Esteem Scale (RSES)

The RSES is used to measure the self-esteem of participants. It is a 10-item questionnaire for which respondents are asked to rate, on a 4-point Likert scale, the extent to which they agree or disagree with each statement. Sample items include: 'On the whole I am satisfied with myself' and 'I certainly feel useless at times'. The scale is scored by adding the point value of every response. The author reports a Cronbach alpha of .78 for this scale. In the present study, the pre- and post-test Cronbach alphas are high at .91 and .94 respectively.

Alcohol and Drug Abstinence Self-Efficacy Scale (ADASES)

Bandura's (1981) social cognitive model theorized that an increase in an individual's coping self-efficacy will decrease the probability of relapse. This theory was subsequently supported by research in the area of addictions (DiClemente, Carbonari, Montgomery, & Hughes, 1994), resulting in the Alcohol Abstinence Self-Efficacy scale (DiClemente et al., 1994). The scale was adapted to allow researchers to examine self-efficacy as it relates to drug use in addition to alcohol consumption by making reference to both drug and alcohol use in the individual items. The ADASES assesses the construct of self-efficacy and evaluates an individual's efficacy (i.e., confidence) to abstain from drinking/drug use in 20 situations that represent typical cues for using. The 20 situations form four subscales, examining cues related to negative affect, social/positive, physical and other concerns, and withdrawal and urges. In addition, these same items, using a different response format, evaluate an individual's temptation to drink/use drugs and provide a measure of cue strength to relate to the efficacy evaluation.

Both efficacy and temptation are rated on 5-point Likert scales ranging from 'not at all' to 'extremely'. A decrease in the temptation subscale score from the pre- to post-test indicates less temptation to use substances in the 20 situations described. An increase in the confidence subscale score from the pre- to post-test indicates a higher level of confidence in resisting the use of substances. Table 3 presents the DeClemente et al.'s Cronbach alphas and those measured in the present study.

Table 3: Cronbach Alphas for the ADASES Subscales

Confidence subscales Alphaa Pre-test Alpha Post-test Alpha
Negative Affect .88 .92 .96
Social/ Positive .82 .89 .95
Physical and other concerns .83 .88 .93
Withdrawal and urges .81 .90 .96
Temptation subscales Alphaa Pre-test Alpha Post-test Alpha
Negative Affect .99 .92 .94
Social/ Positive .86 .94 .95
Physical .60 .91 .90
Withdrawal and urges .70 .89 .92

a As reported in DiClemente, Carbonari, Montgomery & Hughes, 1994.

Readiness to Change

Readiness to Change Questionnaire (RCQ)

The RCQ was adapted for ITT so that each of the scale's questions refer to problematic drug use and/or alcohol consumption (as opposed to just alcohol consumption). For further information regarding this scale, refer to the Engagement and Education subsection of this report.

Program Satisfaction

Participant Feedback Questionnaire (PFQ)

The PFQ was expanded from the Correctional Programs Participant Satisfaction Questionnaire (Correctional Service Canada, 2003b) to include 11 questions regarding the Peer Support Group. See Appendix D for the complete questionnaire. The PFQ measures program participants' feedback, upon completion of the module, regarding their overall impression of the module, its content and methods, module length, group experience, and the peer support component. It is administered at the end of both the E & E and the ITT modules. Participants are asked to respond to 30 items using both Likert Scale responses and checklists. Example items include: 'How has the module helped you to deal more effectively with the problems that led to your crime(s)?' and 'How did you become aware of the Substance Abuse Peer Support group'. The items are scored on a four-point scale (1-4) with the exception of program length, which is scored on a five-point scale. For the 4-point questions, a '4' response indicates the highest degree of satisfaction with that topic area and a '1' response indicates the least degree of satisfaction. For the program length item, a '1' indicates that the program was perceived as too short and a '5' response indicates that the program was too long ' a '3' response indicates that the program's length was appropriate.

Procedure

Referral

Education and Engagement (E & E) is intended for all women offenders in federal correctional institutions. Upon admission, every woman offender receives an Engagement contact with a WOSAP facilitator and is invited to attend the Education component. The module is a prerequisite for those women who have been identified as having a substance abuse problem, as assessed using the Alcohol Dependence Scale (ADS), the Drug Abuse Screening Test (DAST), the Problems Related to Drinking Scale (PRD), and related information gathered during the admission process (see 'Severity of Substance Abuse Problem' section for details) and who will participate in ITT. Additionally, all admissions are actively encouraged to participate.

Before women offenders begin E & E, they are asked to sign the Research Consent Form (see Appendix E) which asks their consent to use the data from the pre- and post-test assessment batteries for the evaluation of the program. If a woman refuses to sign the consent form, the assessment battery will still be administered to provide clinical information to the facilitators but the results will not be used for research purposes. The signed consent form serves for all subsequent WOSAP modules in which the offender participates.

The Intensive Therapeutic Treatment (ITT) module requires that the E & E module be completed first. Referrals to ITT are made based on consideration of each woman's needs and risk as they relate to their substance use. Offenders referred to ITT should be assessed as having a moderate to substantial or substantial to high programming need (see 'Severity of Substance Abuse Problem' section for details).

Data Collection

The pre- and post-test assessment batteries are administered by the WOSAP facilitator at each site. Prior to starting the E & E module, offenders complete a pre-test assessment battery (as summarized in Figure 2). This battery is completed individually or in groups, and the facilitator is always available to answer questions. At the conclusion of the E & E module, a post-test battery is completed which includes all tests used in the pre-test battery in addition to the Participant Feedback Questionnaire.

After completion of the E & E module, offenders requiring the ITT module complete an additional pre-test assessment battery (as summarized in Figure 2). At the conclusion of ITT, a post-test battery is completed including all scales used in the pre-test battery in addition to the Participant Feedback Questionnaire.

Data Coding

Codes for all assessment materials are added directly to the paper copies to reduce data entry errors, and all results are entered into the SAS Version 8.01 (SAS, 1999) database. After each assessment submission is entered, the data is reviewed to check for entry errors for quality control purposes. Data extracted from OMS is also entered into the SAS database.

Data Analyses

Analyses were conducted using the SAS software to identify anomalies and inconsistencies in the data. The principal statistical analyses used were frequency distributions and tests of statistical significance using Chi-square and analyses of variance.

Results

The results are presented in five sections. The first section reports on the program characteristics, including completion rates and reasons for non-completion of Engagement and Education (E & E) and Intensive Therapeutic Treatment (ITT). The next section reports on offender profiles, including age, marital status and race, static and dynamic factors, severity of substance abuse problem, current offence information and self-report of substance abuse. The third section presents the results from assessments measuring substance abuse knowledge and readiness to change for E & E participants. The fourth section reports on the results from assessments measuring knowledge of substance abuse and self, coping skills, self-esteem and self-efficacy and readiness to change for ITT participants. The final section presents results regarding program satisfaction.

Program Characteristics

Completion Rates

For E & E, 194 women started the module and 180 completed for a completion rate of 93%. Completion rates across institutions were 90% or better with a number of institutions reporting better than 95% completion rates. Joliette institution had the lowest completion rate at 77%.

For ITT, 45 women started treatment and 37 completed for a completion rate of 82%. Completion rates across institutions ranged from 78% to 100%. While overall completion rates were lower for the ITT module as compared to the E & E module, it should be noted that ITT is an intensive program, typically delivered over a period of three months, as compared to E & E which is delivered over a two-week period. Completion rates for both E & E and ITT modules by institution are presented in Table 4.

Table 4: Completion Rates Across Institutions and Modules

Institution E & E
% (n)
ITT
% (n)
Burnaby Correctional Centre for Women 89.5 (17) 100.0 (6)
Edmonton Institution for Women 97.0 (32) 77.8 (7)
Joliette Institution 77.1 (27) 66.7 (6)
Grand Valley Institution for Women 97.0 (65) 88.9 (8)
Nova Institution for Women 100.0 (31) 83.3 (10)
Okimaw Ohci Healing Lodge 100.0 (8) N/A
Overall 93.3 (180) 82.2 (37)
Chi Square (df, N) = χ2 (5, 193) = 20.0** (4, 45) = 3.2

** p<.01.

Reasons for Non-Completion

Reasons for non-completion of the program were distinguished to elucidate whether a lack of completion was based on 1) the participant's choice or behaviour or 2) institutional operations independent of the program, such as release to the community or a transfer. For the E & E module, only 4% (n = 8) of participants chose to stop attending or were suspended due to inappropriate behaviour, and 3% ended their participation because of institutional operations. For the ITT module, 9% (n = 4) of the participants chose to stop attending or were suspended due to inappropriate behaviour, and 9% did not complete as a result of institutional operations. These results indicate that the majority of participants chose to complete the program. They also show that the majority of offenders participating in the program are able to demonstrate appropriate behaviour to allow them to complete each module. Results are presented in Table 5.

Table 5: Reasons for Program Non-completion for E & E and ITT Participants

Reason for Non-Completion E & E
% (n)
ITT
% (n)
Combined (n)
Stopped attending by choice or suspended due to behaviour 4.1 (8) 8.9 (4) 12
Related to institutional operations 2.6 (5) 8.9 (4) 9
Total cases of non-completion 6.7 (13) 17.8 (8) 21

Offender Information

Participant profiles include all offenders who started WOSAP regardless of completion. Due to technical difficulties, information on 19 E & E participants could not be extracted from the Offender Management System. For the analysis, three groups are compared: 1) women who participated in E & E only, 2) women who participated in E & E and ITT and 3) the comparison group (federal women offenders who did not participate in WOSAP). The profile information is divided into six sections: 1) age, marital status and race; 2) static and dynamic factors; 3) sentence length; 4) offence type; 5) severity of substance abuse; and 6) self-report of substance abuse.

Age, Marital Status, and Race

Offenders in the E & E, ITT and comparison groups were similar in age (35, 36 and 37 years respectively) with the comparison group being slightly older. In terms of marital status, the groups were also similar, with the comparison group having the lowest percentage of attachment (32% common-law or married) while the percentage for the E & E group was 43% and 44% for the ITT group.

The majority of women in the program, two-thirds, were Caucasian, consistent with the general women offender population, as represented by the comparison group in this study. Aboriginal women accounted for 31% of the ITT group and 23% of the E & E group. The percentage of Aboriginal women in the ITT group was similar to that observed in the comparison group (29%), but the percentage of Aboriginal women was lower in the E & E group. Aboriginal women were represented appropriately in the more intensive ITT group, but women of other races were not (see Table 6).

Table 6: Race for E & E and ITT Participants and the Comparison Group

Race E & E
%
ITT
%
Comparison Group
%
Caucasian 65.6 69.2 59.8
Aboriginal 22.7 30.8 29.0
Black 8.6 0.0 7.9
Other 3.1 0.0 3.3
Total number of cases 128 39 266

Static and Dynamic Factors

Overall, no statistically reliable differences in static [χ2 (4, N = 423) = 4.1, p = 0.39] and dynamic [χ2 (4, N = 423) = 5.5, p = 0.24] risk factors were identified across the three groups. However, the trends in the results suggest that the ITT group was more likely to be rated as having a high static risk based on static factors: 39% of the ITT group versus 26% of the E &E group were rated as high risk. In addition, analyses of the dynamic factor ratings indicate that two thirds (67%) of the ITT group are rated as having high needs as compared to 47% of the E & E group and 55% of the comparison group. These results are consistent with the expectation that women requiring the ITT module require more intensive programming to meet their needs. Table 7 presents these results.

Table 7: Static and Dynamic Factor Ratings for E & E, ITT and Comparison Groups

Risk and Need E & E
%
ITT
%
Comparison
%
Static factors
(criminogenic risk)*
     
High 25.6 38.5 34.1
Moderate 49.6 38.5 46.1
Low 24.8 23.1 19.8
Dynamic factors
(criminogenic need)**
     
High 47.0 66.7 54.7
Moderate 38.5 28.2 33.0
Low 14.5 5.1 12.4
Number of cases 117 39 267

* p =0.39. ** p =0.24.

Recall that most need domains are rated on a four-point scale as follows: 1) factor seen as an asset to community functioning, 2) no immediate need, 3) some need and 4) considerable need. Results in Table 8 combine some and considerable need and therefore report the percentage of women who have the need areas identified as a problem. A substantially higher percentage of ITT participants (92%) were identified as having a substance abuse problem as compared to E & E participants (75%) and the comparison group (67%), confirming that the program is being used primarily by women with a substance abuse need. (Appendix F presents the results for individual items within the Substance Abuse domain for all three groups).

Most other dynamic need areas showed no differences across the three groups. The most commonly identified dynamic need for the women was Personal/Emotional. Attitudes were most commonly identified as a challenge for women in the comparison group who were serving longer sentences (on average) than the women in the treatment groups.

Table 8: Need Ratings for Dynamic Factor Domains E & E and ITT Participants and the Comparison Group

Dynamic Factor Domains E & E
%
ITT
%
Compare
%
χ2
(2, N=419)
Substance abuse 75.2 92.1 66.7 11.7**
Employment/ education 59.8 47.4 56.1 1.8
Marital/family 54.7 55.3 63.6 3.2
Associates/ social interaction 64.1 52.6 55.7 2.8
Community functioning 36.8 42.1 34.1 1.0
Personal/ emotional 82.9 86.8 89.4 3.1
Attitude 29.1 36.8 43.2 6.9*
Number of cases 117 38 264  

* p <.05. ** p <.01.

Results presented in Table 9 indicate the percentage of women for whom each of the need areas are identified as an asset. Note that substance abuse cannot be rated as an asset and is not included in the table. Women in the ITT group were much less likely to have domains identified as assets. While women in the ITT were not more likely to have needs identified in these areas, they were less likely to have strengths identified in these areas. In fact, in three need areas, none of the women in the ITT group were rated as having a strength.

Table 9: Asset Ratings for Dynamic Factor Domains E & E and ITT Participants and the Comparison Group

Dynamic Factor Domains E & E
%
ITT
%
Compare
%
χ2
(2, N=419)
Employment/ education 6.8 0.0 6.4 6.4
Marital/ family 3.4 2.6 5.7 9.5
Associates/ social interaction 3.4 2.6 6.4 5.1
Community functioning 3.4 0.0 5.7 13.9*
Personal/ emotional 17.1 13.2 10.6 12.7*
Attitude 12.0 0.00 7.6 12.3*
Number of cases 117 38 264  

* p<.05.

Sentence Length

Two-thirds of E & E and ITT participants were serving relatively short sentences of 2 to 4 years (see Table 10). The balance of program participants was serving sentences of more than 4 years with life sentences being served by 6% to 8% of the treatment groups (E & E and ITT respectively). For the comparison group, sentences were generally longer, with 22% serving life sentences. The observed difference between the treatment groups and comparison group is the result of the fact that women with longer sentences accumulate in institutions and therefore are over-represented in the general offender population.

Table 10: Current Sentence Length for E & E and ITT Participants and the Comparison Group

Current sentence length E & Ea
%
ITTa
%
Comparisona
%
2 to 4 years 68.4 66.7 46.8
More than 4 years to 10 years 25.6 23.1 24.2
More than 10 years 0.0 2.6 7.4
Life sentence 6.0 7.7 21.6
Total number of cases 117 39 269

aχ2 (6, N = 425) = 32.0, p < .0001

Offence Type

A slightly larger percentage (58%) of women in the ITT group was serving a sentence for a violent offence as compared to E & E participants and women in the comparison group (42% and 53% respectively) but the difference was not statistically reliable (p=0.870). Women in the comparison group were much more likely to be serving a sentence for homicide, a crime which typically results in longer sentences. This result is consistent with this group's longer average sentence length. Table 11 summarizes the frequency of type of offence for the three groups.

A much smaller percentage of ITT participants (5%) were serving sentences related to a drug offence as compared to E & E participants and women in the comparison group (25% and 21% respectively). This result suggests that those offenders with a moderate to substantial substance abuse need are not necessarily more likely to be serving a drug-related offence.

Table 11: Type of Offence for E & E and ITT Participants and the Comparison Group

Type of offence E & E
% (n)
ITT
% (n)
Comparison
% (n)
χ2
(2, N=462)
Non-violent offence 32.8 (38) 36.8 (14) 25.8 (68) 3.3
Violent offence 42.2 (49) 57.9 (22) 53.4 (141) 4.9
Drug related 25.0 (29) 5.3 (2) 20.8 (55) 6.9*
Total number of cases 116 38 264  
Violent offences        
Homicide 12.9 (15) 15.8 (6) 23.9 (63) 6.5*
Sex offence 0.0 (0) 0.0 (0) 1.1 (3) 1.8
Robbery 12.9 (15) 23.7 (9) 10.2 (27) 5.7
Assault 6.0 (7) 7.9 (3) 8.3 (22) 0.6
Attempt/ conspire to murder 0.9 (1) 0.0 (0) 3.0 (8) 0.8
Other violent offence 9.5 (11) 10.5 (4) 6.8 (18) 1.2
Total number of cases 49 22 141  

* p<.05.

Severity of Substance Abuse Problem

Overall, 95% of ITT participants were identified as having a moderate, substantial or severe substance abuse problem based on results from the ADS and/or DAST, indicating that offenders in the ITT group were the most in need of treatment (see Table 12). The E & E and comparison groups were less likely to have a moderate to severe substance abuse problem (75% and 71% respectively), but this rate is still very high, demonstrating the need for substance abuse treatment for women offenders generally. Overall, significantly more women in all three groups were assessed as having a drug problem than an alcohol problem. For example, while about half of the ITT group had alcohol identified as requiring treatment, over 80% were identified as requiring treatment for drug abuse. A larger percentage of women in the ITT group (65%) were assessed on the Problems Related to Drinking Scale (PRD) as having 'quite a few' to 'a lot' of problems related to alcohol compared to the E & E group (32%) and the comparison group (39%).

Table 12: Percentage of Offenders that Scored Moderate, Substantial or Severe on the ADS, DAST and a Combination of Either the ADS or DAST

Scale E & E
%
ITT
%
Comparison
%
χ2
(df, N)
ADS 29.1 46.5 30.3 4.4
(4. 230)
DAST* 69.1 83.7 60.6 9.8*
(4, 230)
ADS or DAST* 74.6 95.4 71.2 11.7*
(4, 230)
PRD 31.5 65.1 39.4 12.2**
(2, 229)
Number of cases 55 43 132  

Note: The results of ADS and DAST scores were available for only 49% of offenders in the comparison group and 37% of the offenders in E & E as compared to 96% of ITT participants.
* p < .05. ** p < .01.

Results from Engagement and Education (E & E)

The E & E module is intended to enhance motivation and to provide knowledge regarding the ways in which substance use affects life areas. As such, offenders' readiness to change and substance abuse knowledge were measured to evaluate the effectiveness of the module.

Readiness to Change

E & E is not restricted to women with a substance abuse problem. Therefore, respondents were asked to identify a personal problematic behaviour for which the Readiness to Change Questionnaire would measure their level of motivation. Drug use was most frequently reported as a problematic behaviour (42%, n = 56) followed by smoking (17%, N = 23) and alcohol (14%, N = 19); details are presented in Table 13. No reliable differences were found in the type of reported problematic behaviour between E & E participants who went on to take the ITT module and E & E participants who did not.

Table 13: Problematic Behaviours Reported in the Readiness to Change Questionnaire for E & E

Problematic Behaviour Yes
% (N)
Drugs 41.8% (56)
Smoking 17.2% (23)
Alcohol 14.2% (19)
Eating 5.2% (7)
Aggression/ Violence 3.7% (5)
Drugs and Alcohol 3.0% (4)
Impulsivity 3.0% (4)
Other 11.9% (16)
Total number of assessment sets 134

Participants in E & E demonstrated a positive shift along the stage of change continuum with 67% at the Maintenance stage after completion of the module, up from 56% at pre-testing (see Table 14). These results suggest that the module has a positive impact on participant motivation.

Table 14: E & E Participants' Stage of Change

Stage Pre-test
% (n)
Post-test
% (n)
Precontemplation 2.0 (3) 2.1 (3)
Contemplation 2.6 (4) 1.0 (1)
Preparation 25.0 (39) 11.3 (16)
Action 14.7 (23) 19.0 (27)
Maintenance 55.8 (87) 66.9 (95)
Total number of cases 156 142

Substance Abuse Knowledge

There was a statistically reliable increase in scores for the Substance Abuse Education Questionnaire [(63 to 67), F(1, 364) = 26.6, p < .0001], indicating that offenders' knowledge regarding the effects of substances increased following participation in the education component.

Pre- and post-test scores for the How Much Do They Matter Scale showed no difference. It may be the case that this assessment had a ceiling effect in that most women offenders scored relatively high during pre-testing, leaving little room for measured change during post-testing. There was no interaction effect found between pre/post scores and institution and no difference in pre-test scores between completers and non-completers.

Results from Intensive Therapeutic Treatment (ITT)

Semi-Structured Interview

Responses to the Semi-Structured Interview, administered to offenders prior to beginning the ITT module, provide self-report information. Offenders' responses focus on current perceptions of their substance use, their history of substance use, substance use and life areas, crime and substance use, and substance abuse programming.

Current Perception

Almost all participants (93%) responded that they believed they have a substance abuse problem. Of these, 40% reported a problem with drugs, 22% reported a problem with alcohol and 38% reported a problem with both drugs and alcohol. Overall, these self-reports are in agreement with the assessments of substance abuse severity in which 95% of women in the ITT group were assessed as having a moderate to severe problem with drugs and/or alcohol (see Table 12). The results suggest that the offenders' self-perceptions regarding their substance use problems are accurate.

Types of substances used and those that are problematic are presented in Table 15. Two-thirds (68%) of women offenders identified cocaine as a substance with which they have a problem, followed by opiates (39%), crack (36%), heroin and barbiturates (each 26%), and benzodiazepines/minor tranquilizers (23%). Almost all women reported having tried marijuana or hashish (93%), followed by cocaine (88%) and LSD (74%). A problem index comparing the ratio of problematic use to reported use over lifetime indicates a relatively low value of .17 for marijuana in contrast to .77 for cocaine and .69 for both opiates and barbiturates (see Table 15).

For reported lifetime use, there were no differences between regional sites for all substances except for PCP, suggesting that, overall, types of substances used may not vary regionally. A significantly higher number of women from Joliette Institution (88%) reported using PCP than women in other sites (χ2 (4, N=43) = 11.6, p<.05). No differences were found between ITT completers and non-completers.

Table 15: Types of Substances Used Over Lifetime, Self-identified Problematic Substances and Problem Index for Participants in ITT

Type of drug Lifetime Use
%
Problematic Usea
%
Problem Indexb
Marijuana or hashish 93.0 16.1 .17
Cocaine 88.3 67.7 .77
LSD 74.4 0.0 0
Benzodiazepines/Minor tranquilizers 55.8 22.6 .40
Opiates 55.8 38.7 .69
Mushrooms 53.5 0.0 0
Crack 51.2 35.5 .69
Heroin 46.5 25.8 .55
Amphetamines 44.2 16.1 .36
Barbiturates 37.2 25.8 .69
PCP 37.2 0.0 0
Other (e.g.: organic drugs, not specified) 30.2 0.0 0
MDA 20.9 3.2 .15
Inhalants 16.3 3.2 .20
Methadone 16.3 3.2 .20
Quaaludes 11.6 0.0 0
Steroids/Performance Enhancing Drugs 9.30 0.0 0
Total number of cases 43 31  

a For offenders who indicated they believed they had a problem with drugs
b Problem index = Problem use / Lifetime use

History of Substance Abuse

On average, ITT participants reported having tried drugs at a slighter older age (13.6 years) than alcohol (12.4 years). Additionally, less time elapsed for drug use to reportedly become regular (2.8 years) as compared to the time to regular drinking (4.6 years). No regional differences were found, nor were completers and non-completers significantly different.

Most women reported having tried to quit or cut down their use of drugs (91%) and alcohol (83%). In general women reported being able to quit or cut down on drug use for twice as long as for alcohol (24 months for drugs ranging from 3 days to 5 years, as compared to 12 months for alcohol ranging from 2 days to 15 years). No differences were found across regions or between completers and non-completers.

Substance Use and Life Areas

The majority of women offenders who participated in ITT reported that drugs and alcohol affected all designated life areas (see Table 16) with rates over 80% in many areas. A significantly larger percentage of women identified drugs as affecting family relationships, relationships with friends, work/school, finances, physical health and emotional health as compared to alcohol. No differences were found across regions or between completers and non-completers.

Table 16: Life Areas Affected by Drugs and Alcohol

Life Areas Drugs
%
Alcohol
%
Past or present relationships with partner 80.0 64.7
Relationships with children a 80.8 76.2
Family relationships* 91.2 77.4
Relationships with friends* 57.1 41.9
Work/School* 62.9 45.2
Finances** 88.6 66.7
Physical health* 80.0 67.7
Emotional health* 74.3 75
Total number of cases 43 43

a 76% (N = 32) of respondents reported having children
* p <.05. ** p <.01.

Fifty-one percent of ITT participants reported being in a relationship at the time of the interview. Of these women, 24% reported that their partner was currently using drugs and/or alcohol. A further 69% reported that they believed at least one family member has a problem with drugs and/or alcohol. These results suggest that women's personal relationships upon release from the institution may be a high risk factor. No differences were found across institutions or between completers and non-completers.

The trauma section in the semi-structured interview is completed prior to the first session of the Relationships block in the ITT module. Sixty-seven percent of women who were interviewed (n=29) responded to the trauma section (19% refused to respond as the content was too emotionally triggering and, for 14% of the cases, the interview was not conducted). Of those women who responded, all reported having experienced trauma in their past. (Trauma was defined as 'an overwhelming experience or a witnessing of an event that provokes feelings of intense fear, helplessness or horror, as well as events such as abuse or violence.') Ninety-two percent (n=24) of those women who experienced trauma reported using drugs and/or alcohol to cope with their experiences. Overall, trauma and the use of alcohol and drugs to deal with the trauma appear to be a problem for most women in the ITT group.

Mental health issues were of significant concern for most women in the ITT group. An equal and high percentage of women reported experiencing feelings of depression and/or anxiety at some point in their life (91%). Of these women, 91% reported using substances to cope with depression, and 70% reported using substances to cope with anxiety. While only 9% of women offenders reported that their current relationship was abusive, 80% reported having been in an abusive relationship in the past.

Crime and Substance Use

Almost all women offenders in the ITT module (91%) indicated that they were under the influence of drugs and/or alcohol for their most recent offence(s). A significantly lower percentage of women from Joliette Institution (62%) reported being under the influence for their most recent offence [(χ2 (4, N=43) = 9.9, p<.05], a finding which will be further explored in the final evaluation. Of those women who reported being under the influence, 41% reported being under the influence of drugs only, 26% reported being under the influence of alcohol only and 33% indicated they were under the influence of both drugs and alcohol. In some cases, offenders indicated that they were under the influence of more than one drug at the time of their current offence.

In terms of the specific type of drug used (see Table 17), 28% reported having used opiates prior to their offence(s), 26% reported having used cocaine and 26% reported having used crack. A reliably higher percentage (80%) of women offenders from Joliette Institution reported using cocaine at the time of their offence [(χ2 (4, N=43) = 10.3, p<.05)]. Only 8% of women reported having used marijuana at the time of their offence, a result that is consistent with the low percentage of women (16%) who report problematic use of marijuana in relation to other drug categories.

Table 17: Type of Drug(s) used During Current Offence

Type of drug Yes
%
Opiates 28.2
Cocaine 25.6
Crack 25.6
Benzodiazepines/Minor tranquilizers 10.3
Marijuana or hashish 7.7
Amphetamines 7.7
Heroin 7.7
Other 7.7
LSD 2.6
Total number of women reporting drug use at time of offence 39

Substance Abuse Programming

More than three-quarters of women offenders in the ITT module (77%) reported having received help for their substance abuse problem or participating in a previous substance abuse program. Of these women, 82% indicated that they believed the most recent treatment program in which they participated was helpful. Most women offenders (95%) reported that they still felt they needed a treatment program to address their substance abuse problem. No differences were found across institutions or between completers and non-completers.

Four areas were assessed for the ITT module: 1) knowledge ' substance abuse and self, 2) coping skills, 3) self-esteem and self-efficacy and 4) readiness to change. The results for these areas follow.

Knowledge ' Substance Abuse and Self

Intensive Therapeutic Treatment Questionnaire

The Intensive Therapeutic Treatment Questionnaire measures change in knowledge for content covered in each of the five session blocks in the ITT module (Emotions, Spirituality, Relationships, Sexuality and Self). There were statistically reliable increases in mean scores with an average increase of 3 points from pre- to post-test for all subscales except the Emotions subscale which had a 2-point increase, as presented in Table 18. There was no interaction effect found between pre/post scores and institution and no difference in pre-test scores between completers and non-completers.

Relapse Attitudes and Knowledge Questionnaire

A significant increase (from a score of 80 to 87) in knowledge regarding relapse attitudes and knowledge was measured from pre- to post-test following completion of the Intensive Therapeutic Treatment, as presented in Table 18. There was no interaction effect found between pre/post scores and institution and no difference in pre-test scores between completers and non-completers.

Table 18: Means, Standard Deviations and F Scores for the ITT Knowledge Measures

Knowledge Measures Maximum Score Pre
Mean (SD)a
Post
Mean (SD)a
Changeb F
ITT Questionnaire          
Emotions subscale 70 49.5 (6.4) 51.7 (5.6) 2.2 2.5
Spirituality subscale 55 41.6 (5.8) 45.2 (4.5) 3.6 9.2**
Relationships subscale 45 35.9 (4.5) 38.4 (3.9) 2.5 6.7*
Sexuality subscale 50 37.2 (4.8) 40.1 (4.2) 2.9 8.1**
Self subscale 9 36.1 (5.6) 39.8 (4.4) 3.7 10.3**
Relapse Attitudes and Knowledge Questionnaire 100 80.3
(11.5)
86.8
(6.9)
6.5 8.6**
Total number of cases   45 35    

a Standard deviation
b Desired change in all pre-post test scores: Increase
* p < .05. ** p < .01.

Coping Skills

Results indicate that the Coping Behaviour Inventory (CBI) scores decreased significantly from the pre-test (M = 64, SD = 22) to the post-test (M = 34, SD = 16), F(1, 80) = 47.4, p <.0001. This indicates a more frequent use of effective coping strategies to avoid or control the resumption of substance use. No differences in average scores were found between regions or between completers and non-completers of the module.

Self-Esteem and Self-Efficacy

Women offenders who participated in the ITT module demonstrated a substantial increase in self-esteem (refer to Table 19), as measured by Rosenberg's Self-Esteem Questionnaire with average scores moving from 28.4 to 31.5. These results suggest that the ITT module is associated with an overall increase in participants' self-esteem. This finding is important as research suggests that self-esteem is a necessary component of recovery from addictions (Bry, 1983; Gray, 2001).

The Alcohol/Drug Abstinence Self-Efficacy Scale (ADASES) measures two domains (temptation and confidence) across the same situations. The desired outcome is an overall increase in confidence with a subsequent decrease in temptation. This result, as presented in Table 19, was obtained for women offenders participating in the ITT module. On average, scores for the four temptation domains decreased by 8 points while average scores for the four confidence domains increased by 7 points. The results suggest that participation in the ITT module is associated with an increase in overall self-efficacy. No reliable differences were found across regions or between completers' and non-completers' pre-test scores.

Table 19: Means, Standard Deviations and F Scores for Self-esteem and Self-efficacy Measures

Assessment Pre
Mean (SD) a
Post
Mean (SD) a
Change F
Rosenberg's Self-Esteem Scale b 28.4 (6.0) 31.5 (6.1) 3.1 5.20*
Alcohol/Drug Abstinence Self-Efficacy Scale c        
Temptation domain d        
Negative Affect subscale 19.6 (4.9) 10.4 (5.5) -9.2 63.0**
Social/Positive subscale 18.4 (5.6) 9.5
(5.4)
-8.9 52.1**
Physical and Other Concerns subscale 15.6 (6.0) 8.4
(4.2)
-7.2 36.1**
Craving and Urges subscale 17.0 (5.8) 10.0 (5.1) -7.0 31.7**
Confidence domain b        
Negative Affect subscale 11.0 (5.4) 18.3 (5.6) 7.3 33.5**
Social/Positive subscale 11.4 (4.9) 19.2 (5.3) 7.8 45.7**
Physical and Other Concerns subscale 12.3 (5.5) 19.6 (5.5) 7.3 34.5**
Craving and Urges subscale 11.4 (5.2) 18.8 (5.6) 7.4 36.6**
Total number of cases 45 35    

a Standard deviation
b Desired change in pre-post test scores: Increase (Maximum score: 40).
c Maximum score for all subscales: 25.
d Desired change in pre-post test scores: Decrease.
* p <.05. ** p <.0001.

Readiness to Change

Participants in ITT demonstrated a positive shift along the stage of change continuum with 74% ranking in the Maintenance stage upon completion of the program, up from 45% as measured during pre-testing (see Table 20). Of those women who completed the program, 41% shifted at least one stage along the continuum. These results suggest that the module has a positive impact on participant motivation.

Table 20: ITT Participants' Stage of Change

Stage Pre-test
% (n)
Post-test
% (n)
Precontemplation 2.3 (1) 0 (0)
Contemplation 2.3 (1) 0 (0)
Preparation 29.6 (13) 11.4 (4)
Action 20.4 (9) 14.3 (5)
Maintenance 45.4 (20) 74.3 (26)
Total number of cases 44 35

Program Satisfaction

The Participant Feedback Questionnaire (PFQ) was used to gather women offenders' feedback and assess their satisfaction with the pilot program. The first 19 questions of the PFQ correspond to four subsections: 1) overall impression, 2) program content and methods, 3) program length, and 4) group experience. Responses were averaged to produce a mean score for each subsection.

Table 21 presents the means and standard deviations of subsection scores for the E & E and ITT modules. For the sections on overall impression, program contents and method and group experiences, average scores for both E & E and ITT respondents were high (3.4 or better out of 4), indicating an overall high degree of satisfaction with both modules. A summary of mean scores for each question from the PFQ is presented in Appendix G.

The program length subsection consists of one question. On average, E & E participants reported a score of 3 indicating that they feel the program length is 'just right.' ITT respondents scored higher (3.3); however, in terms of practical implications, this score still falls within the 'just right' category.

Table 21: Means and Standard Deviations for the Participant Feedback Questionnaire (PFQ)

Subsections E & E Mean
(SD) a
ITT Mean
(SD) a
Overall impression b 3.4 (0.5) 3.7 (0.4)
Program content and methods b 3.5 (0.4) 3.7 (0.4)
Program length c 2.9 (1.1) 3.3 (1.0)
Group experience b 3.6 (0.4) 3.7 (0.3)
Total number of cases 180 40

a Standard deviation
b Scores increase in degree of satisfaction from 1 to 4.
c Scores range from 1 (program perceived to be too short) to 5 (program perceived to be too long).

Discussion

Preliminary results from the WOSAP pilot implementation provide promising support that the program has a positive impact on participants. Specifically, high completion rates indicate that the program is successful in retaining participants, and program participants report a high degree of satisfaction with both the Engagement and Education (E & E) and Intensive Therapeutic Treatment (ITT) modules. Overall results from the assessment batteries indicate that women offenders are increasing their knowledge of substance use effects, are gaining the skills to prevent relapse, and are demonstrating increases in self-efficacy and self-esteem. Additionally, the content in both modules appears to increase participants' preparation for, and receptivity to, change.

A discussion of the results follows within the context of the research questions presented in the introduction. Other significant findings are presented, including the effect of substances on the study participants' relationships, the association between trauma and substance use and, finally, the association between substance use and crime.

Research Questions

1. What are the characteristics of offenders participating in Engagement and Education (E & E) and the Intensive Therapeutic Treatment (ITT) modules?

The women participating in the treatment modules were similar to each other and to the comparison group (representing the general women offender population) in terms of age, race and marital status. It is encouraging to note that Aboriginal women participated in the program at a rate similar to their representation in the women offender population. Women in the program were serving shorter sentences compared to the general population, mainly as a result of a lower percentage serving life sentences.

While statistical analyses indicated that the two treatment groups and the comparison group were similar in terms of their overall ratings on static (criminal history) and dynamic (criminogenic need) factors, there were indications in the data that women in the ITT module were more likely to be rated as high on static and dynamic factors suggesting that these women are in need of the more intensive treatment offered by the ITT module. It may be that the small number of cases reduced the probability of finding a statistically reliable difference in these ratings, but this will be addressed again in the final report on the program evaluation.

Analyses of individual dynamic factors indicated that 92% of the women in the ITT module had substance abuse identified as a criminogenic need, a rate substantially higher than women in E & E and the comparison group (75% and 67%, respectively). Women in the treatment groups were also less likely than those in the comparison group to have attitude identified as a need. Finally, while six of the seven need domains may be identified as an asset for offenders, women in the ITT group were less likely to have needs identified as assets.

2. Are the appropriate women offenders participating in WOSAP?

The two WOSAP modules were targeted toward different groups of women. The E & E module is targeted toward all women entering the institution. Women in the E & E module were more similar to the comparison group than to the ITT group in terms of the severity of their substance abuse problem. While 95% of the ITT group were identified with a moderate to severe problem, only 75% of the E & E group had a problem this severe, indicating that 25% of participants in the E & E group did not have a serious substance abuse problem.

As noted above, 95% of the ITT participants had a moderate to severe substance abuse problem. In addition, they were identified as having higher levels of static and dynamic criminogenic factors and fewer assets in these areas than other offenders. All of the women had experienced serious trauma in their lives, and the use of drugs or alcohol was likely to have had negative impacts on a variety of life areas. Finally, the ITT group was less advanced along the continuum of readiness to change than offenders in the E & E group.

High completion rates for E & E (93%) indicate that most women were able to complete the module, providing them with an opportunity to learn about the impact of drug and alcohol use on their lives. The more seriously addicted women then proceeded to the ITT module suggesting both that the program is attracting the women for which it was intended and that it demonstrates a strong ability to retain these women with an 82% completion rate.

3. Did the program improve intermediate outcome measures through changes in knowledge and skills and attitudes and beliefs about substance abuse?

Pre- and post-test results for both modules indicated that women offenders increased their knowledge about the effects of substance use. Additionally, women in the ITT group increased their knowledge of relapse, attitudes, and knowledge, in the areas of spirituality, relationships, sexuality, emotions and self.

Results also indicated that there were meaningful increases in coping behaviours, self-efficacy and self-esteem. Increasing the repertoire of coping skills should increase the chances that an individual will not relapse when exposed to a high-risk situation. Likewise, the more an individual believes that she or he is capable of avoiding high-risk situations or using coping skills to get through a high-risk situation without lapse or relapse (self-efficacy), the more likely she or he is in actuality experiencing success (Prochaska & DiClemente, 1992). Finally, if women respect and accept themselves (self-esteem), they are more likely to take action to achieve health and safety by avoiding substance use and the situations and circumstances that precipitate substance use. Some authors have argued that improving self-esteem is a necessary component of recovery from addictions (Bry, 1983; Gray, 2001).

Prochaska and DiClemente (1992) have argued that people move along a continuum of change from pre-contemplation to maintenance. Treatment programs that are successful will move people along this continuum, as was demonstrated in this study with more women in the maintenance stage upon completion of the program. One challenging issue with the stages of change in this study is in regards to the fact that most women were already at the action or maintenance stage when they began the program. This suggests that the scale, or its use in this study, was perhaps not sensitive enough to the changes in the women's readiness to change.

In all of the areas evaluated in this study, changes in the positive direction were detected. These changes must be evaluated further to ensure that they result in behaviour changes that will contribute to successful reintegration. The final report on this program evaluation will provide some answers in this area.

4. Are WOSAP participants satisfied with the program?

WOSAP participants in both the E & E and ITT modules reported an overall high degree of satisfaction with all aspects measured by the Participant Feedback Questionnaire (overall impression, program contents and methods, program length and group experience). The high degree of satisfaction supports the use of the program. An equally important measure of program satisfaction is the program retention rate which was relatively high at 93% for E & E and 82% for ITT. Research suggests that satisfaction is linked to the effectiveness of the intervention offered in general mental health programs (Druss, 1999; Lora, Rivolta, & Lanzara, 2003).

Other Findings

A positive finding in the study was the agreement between self-reported (during the interview) and assessed severity of substance abuse. For participants in the ITT group the level of agreement was almost 100%, suggesting that these women recognize the existence of a problem with drugs and alcohol.

A wide variety of drugs were reported as having been used. A high percentage reported having used and having problems with the most addictive drugs: cocaine, opiates, crack or heroin. Although most women reported using marijuana or hashish over their lifetimes, only 16% indicated that their use of this substance resulted in addiction problems.

Substance use started at an early age for many of the women and was initiated by the use of alcohol. More than three quarters of women in the ITT group reported prior attempts at treatment, but the average longest time away from drugs or alcohol was only 24 months.

Relationships

The majority of women reported that their own substance use has negatively impacted relationships with their family, friends, partners and children. Furthermore, many women seemed to have relationships with others who abuse substances, with a quarter of the women reporting that their partner was currently using substances and a further 69% having at least one family member with a substance abuse problem.

These findings are consistent with current feminist, relational theory which explains substance abuse within the context of a woman's relationships. Relational theory posits that women develop a sense of identity and achieve psychological health through mutually supportive relationships and through a sense of connection with others (Jordan, 1992; Miller, 1987; Miller and Stiver, 1998). A lack of such relationships may translate into increased vulnerability to substance use. Covington & Surrey (2000) suggest that women may use substances that initially 'seem to be in the service of making or maintaining connections' (p. 2) but which ultimately serve to further isolate her and inhibit her ability to maintain connection. Women may also use substances as a means of connecting to substance-abusing partners (Covington & Surrey, 2000). The results from this interim study provide empirical evidence for this theory and support the need to focus on developing and sustaining healthy relationships within a substance abuse treatment program. The ITT curriculum is therefore appropriate and necessary in addressing a significant risk factor for substance abusing women.

Trauma

There is longstanding consensus in the literature on the association between the experience of past trauma and substance abuse for women (and women offenders) (Bloom & Covington, 1998; Correctional Service Canada, 1990; Mullings, Hartley, & Marquart, 2004; Stewart, Ouimette, & Brown, 2002). All women who responded to the trauma interview reported having experienced trauma in their past. This fact is compounded by the finding that the majority of women who participated in the ITT module admitted to using substances to cope with their traumatic experiences. It is not surprising that reports of depression and anxiety, and using drugs and alcohol to cope with these emotional states, were also common.

In addition, women may be under-reporting current abusive relationships with only 9% admitting to being in one while 80% admitted to having been in one in the past. This notable difference was also found in a previous study of women offenders with a substance abuse problem incarcerated at Grand Valley Institution for Women (Langevin & Langevin, 2001) in which 86% of the women had been involved in past abusive relationships while only 1.5% reported their current relationship as abusive. It is not clear from this study the reason for these reported discrepancies, but it does seem to support the notion that substance abuse affects a woman's ability to maintain healthy, mutually supportive relationships.

Crime

Almost all women offenders (91%) indicated that they were under the influence of drugs and/or alcohol at the time of their most recent offence. More women reported being under the influence of drugs than alcohol or a combination of both. The drugs most commonly associated with offending were opiates, cocaine and crack. This percentage is somewhat higher than those reported by Pernanen, Cousineau, Brochu, and Sun (2002) who estimated that more than half of male offenders entering federal and provincial custody were found to be under the influence of a psychoactive substance during the committal of their most serious crime on their current sentence. For women offenders under provincial jurisdiction, as reported in the same study, slightly less than half were under the influence of a substance at the time of their most serious crime, with the use of drugs more common than alcohol.

Of the women reporting having been under the influence of drugs, 72% indicated that they felt their involvement with drugs contributed to the commission of the crime. This percentage dropped to 46% for women who were under the influence of alcohol. Pernanen et al. (2002) estimate that the proportion of relatively serious crimes that are in a significant way determined by the use of any psychoactive substance in Canada is between 40% and 50%. They also suggest that the causal role of psychoactive substances may be greater among less serious crimes. They do caution, however, that other factors in addition to the use of substances should be considered in the majority of criminal acts.

Limitations

Three important limitations can be identified for the study: 1) no outcome data (recidivism, substance use, etc.) were available, 2) assignment to groups was not random, and 3) the comparison group was not a matched group. Outcome data were not available as the program had only been implemented for seven months when the study was initiated. Before having outcome information, one must await the release of the women from prison and then follow them for an appropriate period of time in the community. Outcome data will be available in the final report on the program evaluation.

Random assignment to groups is not possible in a correctional setting where all offenders have equal access to available programs. As this was a newly developed program, and unique in its specific design for women offenders, it had to be made available to all women who met the program requirements.

The comparison group for the study consisted of all women not in treatment. While use of this group therefore has some limitations, it was only used to determine how the study group differed in regards to demographic characteristics and substance abuse severity from the general population. The identification of an appropriate comparison group will be a key element in the design of the final study.

Implications

The preliminary results from the WOSAP pilot indicate that there is a substantial need to effectively address the substance abuse problems of women offenders with over 90% of the ITT group having a moderate to severe problem and approximately three quarters of the comparison group (representative of the general population) having a moderate to severe addiction. In addition, there is an apparent need to continue to offer help to women offenders dealing with trauma. Given that most women report using drugs and alcohol to deal with their trauma, increased collaboration with trauma services is appropriate as well as increased training and support for program facilitators in this area.

Before women can implement positive change in regards to their substance abuse, they need the support, knowledge, skills and motivation that will provide them with the foundation upon which to build change. The preliminary results from the WOSAP pilot indicate that women are making gains in these areas as a result of participating in the E & E and ITT modules. The interim evaluation provides strong evidence to support the continued implementation of WOSAP. The next stage of evaluation will determine whether this foundation translates into sustained change in regards to a decrease in detected drug usage within the institution and reduced recidivism in the community.

References

Abbott, B., & Kerr, D. (1995). Substance Abuse Program for Federally Sentenced Women. Edmonton, AB: Alberta Alcohol and Drug Abuse Commission & Kerr Creative Consulting.

Andrews, D.A., & Bonta, J. (1998). The Psychology of Criminal Conduct. Cincinnati: Anderson Publishing.

Bandura, A. (1981). Self-referent thought: A developmental analysis of self-efficacy. In J. H. Flavell & L. Ross (Eds.), Social cognitive development: Frontiers and possible futures. Cambridge: Cambridge University Press.

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

Boland, F., Henderson, K., & Baker, J. (1998). Case Needs Review: Substance Abuse Domain. (Research Report # R-75). Ottawa, ON: Correctional Service Canada.

Bry, B. H.(1983). Predicting drug abuse: Review and reformulation. International Journal of the Addictions, 18(2), Feb 1983, 223-233.

Cannell, M. B. & Favazza, A.R. (1978). Screening for drug abuse among college students: Modification of the Michigan Alcoholism Screening Test. Journal of Drug Education, 8 (2), 119-123.

Correctional Service Canada (1990). Creating Choices: The Report of the Task Force on Federally Sentenced Women. Ottawa, ON: Author.

Correctional Service Canada (1994). Correctional Program Strategy for Federally Sentenced Women. Ottawa, ON: Author.

Correctional Service Canada (1997). Women's Substance Abuse Program: Community Component. Ottawa, ON: Author.

Correctional Service Canada. (2003b). Correctional Programs Participant Satisfaction Questionnaire. Ottawa, ON: Author.

Correctional Service Canada. (2003a). Standard Operating Practice 700-04: Offender Intake Assessment and Correctional Planning. Ottawa, Canada: Author.

Correctional Service Canada (2004). The Woman Offender Substance Abuse Program: Implementation Report. Ottawa, Canada: Author.

Covington, S. S., & Surrey, J. (2000). The relational model of women's psychological development: Implications for substance abuse. Work in Progress, No. 91. Wellesley, MA: Stone Center, Working Paper Series.

DiClemente, C.C., Carbonari, J.P., Montgomery, R.P.G., & Hughes, S.O. (1994). The alcohol abstinence self-efficacy scale. Journal of Studies in Alcohol, 55, 141-148.

Dowden, C. & Blanchette, K. (1998). Success rates of female offenders on discretionary versus statutory release: Substance abusers and non-abusers. Forum on Corrections Research, 10(2), 27-29.

Dowden, C. & Blanchette, K. (1999). An Investigation into the Characteristics of Substance-Abusing Women Offenders: Risk, Need and Post-Release Outcome. Research Report #R-81. Ottawa, ON: Correctional Service Canada.

Druss, B. G. (1999). Patient satisfaction and administrative measures as indicators of the quality of mental health care. Psychiatric Services, 50 (8), 1053-1058.

Gates, M., Dowden, C., & Brown, S.L. (1998). Case need domain: Community functioning. Forum on Corrections Research, 10(3), 35-37.

Gendreau, P., Goggin, C., & Gray, G. (2000). Case Needs Review: Employment Domain. (Research Report # R-90). Ottawa, ON: Correctional Service Canada.

Goggin, C., Gendreau, P., & Gray, G. (1998). Case Needs Review: Associates/Social Interaction Domain. (Research Report # R-77). Ottawa, ON: Correctional Service Canada.

Grant, B., & Gillis, C. (1999). Day Parole Outcome, Criminal History and Other Predictors of Successful Sentence Completion. (Research Report # R-83). Ottawa, ON: Correctional Service Canada.

Grant, B.A., Kunic, D., MacPherson, P., McKeown, C., & Hansen, E. (2003). The High Intensity Substance Abuse Program (HISAP): Results from the Pilot Program. Research Report R-140. Ottawa, ON: Correctional Service Canada.

Grant, B.A., Motiuk, L., Brunet, L., Couturier, P. and Lefebvre, L. (1996). Day parole program review: Case management predictors of outcome. (Research Report # R-52). Ottawa, ON: Correctional Service Canada.

Gray, R. M. (2001). Addictions and the self: A self-enhancement model for drug treatment in the criminal justice system. Journal of Social Work Practice in the Addictions, 1(2), 75-91.

Groth-Marnat, G. (1997). Handbook of Psychological Assessment (3rd Edition). New York, NY: John Wiley & Sons, Inc.

Gunn, W.J., Orenstein, D., Iverson, D.C., & Mullen, P.D. (1983). An evaluation handbook for health education or alcohol and substance abuse. Atlanta, GA: Centre for Disease Control.

Heather, N., Luce, A., Peck, D. & Dunbar, B. (1996). Development of the Readiness to Change Questionnaire (Treatment Version). Report to the Northern and Yorkshire R&D Directorate.

Hume, L. & Grant, B. (2001). Substance Abuse Programming for Women Offenders: A Proposed Structure. Discussion Paper. Ottawa, ON: Correctional Service Canada.

Hume, L. & Furlong, A. (in progress). Implementation status report: The Women Offender Substance Abuse Programming. Ottawa, ON: Correctional Service Canada.

Jordan, J.V. (1992). Relational resilience. Work in Progress. Wellesley, MA: The Stone Center.

Langevin, P. & Langevin, C. (2001). Substance Abuse Treatment Programming for Federally Sentenced Women: A Data Analysis. Gloucester, ON: Ciproca Consulting.

Law, A. M. (1998). Case Need Domains: Attitude. Forum on Corrections Research, 10(3), 42-45.

Lightfoot, L.O. & Barker, J. (1989). A Field Test of the Revised Substance Abuse Pre-Release Program: Joyceville Institution. Ottawa, ON: Correctional Service Canada.

Litman, G. K., Stapleton, J., Oppenheim, A. N., Peleg, M., & Jackson, P. (1983). An Instrument for Measuring Coping Behaviours in Hospitalized Alcoholics: Implications for Relapse Prevention Treatment. British Journal of Addiction, 78, 269-276.

Lora, A., Rivolta, N., & Lanzara, D. (2003). Patient satisfaction with Communty-Based Psychiatric Services. International Journal of Mental Health, 32(2), 32-48.

MacPherson, P. (2001). Random urinalysis program: Policy, practice, and research. Forum on Corrections Research, 13 (2), 54-57.

Miller, J. B. (1987). Toward a New Psychology of Women. Beacon Press.

Miller, J. B. & Stiver, I. P. (1998). The Healing Connection: How Women Form Connections in Both Therapy and in Life. Beacon Press.

Millson, W.A., Weekes, J.R. & Lightfoot, L.O. (1995). The offender substance abuse pre-release program: Analysis of intermediate and post-release outcomes. Research Report R-40. Ottawa, ON: Correctional Service Canada.

Mullins, J. L., Hartley, D. J., & Marquart, J. W. (2004). Exploring the relationship between alcohol use, childhood maltreatment, and treatment needs among female prisoners. Substance Use and Misuse, 39(2), 277-305.

Paolucci, E. O., Violato, C., & Schofield, M.A. (1998). Case need domain: Marital and family. Forum on Corrections Research, 10(3), 20-23.

Paulhus, D.L. (1998). Paulhus Deception Scales (PDS): The Balanced Inventory of Desirable Responding -7. Toronto, ON: Multi-Health Systems, Inc.

Pernanen, K., Cousineau, M., Brochu, S., & Sun, F. (2002). Proportions of Crimes Associated with Alcohol and other Drugs in Canada. Ottawa, ON: Canadian Centre on Substance Abuse.

Prochaska, J.O. & DiClemente, C.C. (1992). Stages of Change in the Modification of Problem Behaviors. Newbury Park, CA: Sage. Robinson, D., Porporino, F., & Beal, C. (1998). A Review of the Literature on Personal/Emotional Need Factors. (Research Report # R-76). Ottawa, ON: Correctional Service Canada.

Rosenberg, M. (1965). Society and the Adolescent Self-Image. Princeton, NJ: Princeton University Press.

SAS Institute Inc. (1999). Statistical Analysis System (SAS), Version 8. Cary, NC: Author.

Seltzer, M.L. (1971). The Michigan Alcoholism Screening Test: The quest for a new diagnostic instrument. American Journal of Psychiatry, 127 (12), 1653-1658.

Solicitor General Canada (2003). Corrections and Conditional Release Statistical Overview. (Catalogue No. JS43-6/2003E-PDF). Ottawa, ON: Author.

Skinner, H.A. (1982). The Drug Abuse Screening Test. Addictive Behavior, 7, 363-171.

Skinner, H.A., & Horn, J.L. (1984). Alcohol Dependence Scale (ADS): User's Guide. Toronto, ON: Addiction Research Foundation.

Stanley, K. D., & Murphy, M. R. (1997). A comparison of general self-efficacy with self-esteem. Genetic, Social & General Psychology Monographs, 123 (1), 81-100.

Stewart, S. H., Ouimette, P. & Brown, P.J. (2002). Gender and the comorbidity of PTSD with substance use disorders. In R. Kimmerling, P. Ouimette, & J. Wolfe (Eds.), Gender and PTSD (pp. 232-270). New York, NY: Guilford Press.

T3 Associates. (1999). An Outcome Evaluation of CSC Substance Abuse Programs: OSAPP, ALTO and Choices Final Report. Ottawa, ON: Correctional Service Canada.

World Health Organization. (2000). Foundation Workbooks & Specialized Workbooks [On-line]. Available: http://www.int/substance_abuse/pubs_pscyhoactive_drugs.html

Appendix A ' Substance abuse education questionnaire

Please indicate the extent to which you agree with the following statements right now.

SD = Strongly Disagree
D = Disagree
U = Undecided
A = Agree
SA = Strongly Agree

1. The institution is a community.
SD D U A SA

2. I can make a positive contribution to the the community I live in.
SD D U A SA

3. I have a safe place to go in order to cope with negative feelings.
SD D U A SA

4. Women often use alcohol and/or drugs to cope with negative feelings.
SD D U A SA

5. If I feel anxious or nervous I have strategies to cope with these feelings.
SD D U A SA

6. I know what to do when I feel unsafe.
SD D U A SA

7. Drinking small amounts of alcohol while pregnant may cause damage to a fetus.
SD D U A SA

8. Substance abuse is a way for women to avoid dealing with physical/emotional pain.
SD D U A SA

9. Substance abuse affects everyone in your life.
SD D U A SA

10. Substance abuse affects only the person using.
SD D U A SA

11. Substance abuse and criminal behaviour often go hand in hand.
SD D U A SA

12. Women who are under the influence of substances are more likely to engage in unhealthy sexual practices.
SD D U A SA

13. Women who are intoxicated are more likely to say yes to sex.
SD D U A SA

14. Substance abuse (my own or someone else's in my life) has had an impact on my life.
SD D U A SA

15. Women who have been abused are more likely to use alcohol and/or drugs.
SD D U A SA

Appendix B ' Semi-Structured Interview

Name: __________________

FPS: __________________

Date (YY/MM/DD): ______/_____/______

Institution: __________________

PRE-PROGRAM SEMI-STRUCTURED INTERVIEW
AND
PARTICIPANT SUMMARY BOOKLET

WOMEN OFFENDER SUBSTANCE ABUSE PROGRAMMING

CORRECTIONAL SERVICE OF CANADA

Please Forward Completed Booklets to:
Addiction Research Centre
23 Brook St., P.O. Box 1360
Montague, P.E.I.
C0A 1R0

Note to Facilitators:

The Semi-Structured Pre-program Interview provides an opportunity to both gather case information for assessment and to engage the women offenders who will be entering Module II ' Intensive Therapeutic Treatment Program. Engagement is especially important in fostering connection and motivation at the initial stages of treatment. Although we have provided potential responses the women may give, the interview is still meant to be a open-ended, qualitative discussion.

You, as the interviewer, are to ask the women the initial question. As the women provide you with their response you check off any responses that match with the ones provided. If the women provide responses that are not included in the list, please add their responses in the space labelled 'Other'.

You are not meant to read out each of the possible responses and get the women to say yes or no. We still want the women to give the responses that come instinctively to them.

You may use some of the responses to prompt information from the women if you feel as though they are misunderstanding a question or may have more information to provide for that question.

If the women provide you with additional information with a particular question or you would like to make a note about something, please provide that information in the space labelled 'Comments'.

When you are filling out the questionnaire please take note of questions that require only one response to be given (i.e. only one of the boxes to be checked off).

Each question is divided so responses are indicated for drug and alcohol abuse separately. In the case where a woman only abuses drugs and does not drink you would only ask questions in reference to drug abuse.

Please complete the entire interview and provide an explanation if any questions are not completed.

Thank you.

1. Women's Substance Abuse Program:

Intake Information Summary

Institution: ___________________________

Offender's Name: _____________________

FPS #: _______________

Assessment Instruments Summary (Pre-program):

1. Drug Abuse Screening Test (DAST) Score
(Raw Score: _______)
None Low Moderate Substantial Severe

2. Problems Related to Drinking Scale (PRD):
(Raw Score: ______)
None Some Quite A Few A Lot

3. Alcohol Dependence Scale (ADS):
(Raw Score: ______)
None Low Moderate Substantial Severe

4. Stage of Change - Readiness to Change Questionnaire (RCQ) (please use most recent scores available):
a. Precontemplation (Raw Score: ____)
b. Contemplation (Raw Score: ____)
c. Preparation (Raw Score: ____)
d. Action (Raw Score: ____)
e. Maintenance (Raw Score: ____)

2. Pre-Program Interview

Interviewer's Name: __________________

Date of Interview: _____/_____/_____ (YY/MM/DD)

Facilitator Note: For each question, unless otherwise indicated, please check off as many boxes as are appropriate.

Current Perception

1. a) Do you believe that you have a substance abuse problem?

No ' Go to 1 e
Yes ' Go to 1 b

b) Do you see yourself as having a drug problem, an alcohol problem, both a drug and alcohol problem, or no problem?

Drug ' Go to 1 c
Alcohol ' Go to 1 c
Both ' Go to 1 c
No problem ' Go to 1 e

c) Specifically, what substance(s) do you feel you have a problem with?

Drugs:

Marijuana or hashish
Cocaine
Heroin (H, horse, junk, smack)
Benzodiazepines/Minor tranquilizers (Librium, Valium, V's)
Opiates (tylenol-3, codeine, percodan, percocet, dilaudid, demerol, morphine)
Mushrooms
MDA (ecstasy)
LSD
Amphetamines (uppers)
Barbiturates (downers)
Methadone (dollies)
PCP (angel dust)
Quaaludes
Inhalants (glue, gas, aerosols, airplane glue, sniff, poppers)
Crack
Steroids/Performance Enhancing Drugs
Organic drugs
Other: ______________________

Alcohol:

Wine
Beer
Liquor
Other (Brew, rubbing alcohol, cough syrup)
Other: ______________________

d) Why do you think you have a substance abuse problem?

Drugs:

Using for a long time
Led to law violations and prison
Problems in my life (relationships, work, etc.)
Affected my relationship with my children
Need it to function
No control over my drug use
Health problems

If none of the above responses apply please choose 'other' and provide a brief description

Other: __________________________________________

____________________________________________

Comments:__________________________________________

____________________________________________

Alcohol:

Drinking for a long time
Led to law violations and prison
Problems in my life (relationships, work, etc.)
Affected my relationship with my children
Need it to function
No control over my alcohol use
Health problems

If none of the above responses apply please choose 'other' and provide a brief description

Other: __________________________________________

____________________________________________

Comments:__________________________________________

____________________________________________

* Go to number 2*

e) What makes you think that you DO NOT have a serious substance abuse problem?

Drugs:

Overcome my drug problem
Not used for a long time
Don't use often
Currently on methadone and I feel better since starting the program
Better understanding of myself
Able to care for my children
Not resulted in law violations
Not caused me financial problems

If none of the above responses apply please choose 'other' and provide a brief description

Other: __________________________________________

____________________________________________

Comments:__________________________________________

____________________________________________

Alcohol:

Overcome my alcohol problem
Not drank for a long time
Don't drink often
Anytime I am offered a drink I think about treatment I have received
Better understanding of myself
Able to care for my children
Not resulted in law violations
Not caused me financial problems

If none of the above responses apply please choose 'other' and provide a brief description

Other: __________________________________________

____________________________________________

Comments:__________________________________________

____________________________________________

History of Substance Abuse

2. Over your LIFETIME, what kinds of drugs and alcohol have you USED or TRIED? (check off all that apply)

Drugs:

Marijuana or hashish
Cocaine
Heroin (H, horse, junk, smack)
Benzodiazepines/Minor tranquilizers (Librium, Valium, V's)
Opiates (tylenol-3, codeine, percodan, percocet, dilaudid, demerol, morphine)
Mushrooms
MDA (ecstasy)
LSD
Amphetamines (uppers)
Barbiturates (downers)
Methadone (dollies)
PCP (angel dust)
Quaaludes
Inhalants (glue, gas, aerosols, airplane glue, sniff, poppers)
Crack
Steroids/Performance Enhancing Drugs
Organic drugs
Other: ______________________

Alcohol:

Wine
Beer
Liquor
Other (Brew, rubbing alcohol, cough syrup)
Other: ______________________

3. a) Have you used Marijuana or hashish more frequently than other drugs?

Yes
No

b) Which drugs have you used most frequently?

Drugs (identify only one):

Marijuana or hashish
Cocaine
Heroin (H, horse, junk, smack)
Benzodiazepines/Minor tranquilizers (Librium, Valium, V's)
Opiates (tylenol-3, codeine, percodan, percocet, dilaudid, demerol, morphine)
Mushrooms
MDA (ecstasy)
LSD
Amphetamines (uppers)
Barbiturates (downers)
Methadone (dollies)
PCP (angel dust)
Quaaludes
Inhalants (glue, gas, aerosols, airplane glue, sniff, poppers)
Crack
Steroids/Performance Enhancing Drugs
Organic drugs
Other: ______________________

c) Did you try alcohol or drugs first?

Alcohol
Drugs

d) Please respond for both drugs and alcohol. What type of drug and/or alcohol did you TRY FIRST?
(Pick only one type of drug and/or one type of alcohol)

Drugs:

Marijuana or hashish
Cocaine
Heroin (H, horse, junk, smack)
Benzodiazepines/Minor tranquilizers (Librium, Valium, V's)
Opiates (tylenol-3, codeine, percodan, percocet, dilaudid, demerol, morphine)
Mushrooms
MDA (ecstasy)
LSD
Amphetamines (uppers)
Barbiturates (downers)
Methadone (dollies)
PCP (angel dust)
Quaaludes
Inhalants (glue, gas, aerosols, airplane glue, sniff, poppers)
Crack
Steroids/Performance Enhancing Drugs
Organic drugs
Other: ______________________

Alcohol:

Wine
Beer
Liquor
Other (Brew, rubbing alcohol, cough syrup)
Other: ______________________

4. a) How OLD were you when you FIRST TRIED drugs and/or alcohol?

Drugs: ______________ Alcohol: ______________

5. a) How old were you when you FIRST started using drugs and/or alcohol REGULARLY (that is, a pattern of use)?

Drugs: ______________
Never used regularly

Alcohol: ______________
Never drank regularly

b) How OFTEN were you using drugs/drinking at that time? (Pick only one)

Drugs:

Yearly (couple of times a year)
Monthly (couple of times a month)
Weekly (couple of times a week)
Daily (couple of times a day)
Once

Alcohol:

Yearly (couple of times a year)
Monthly (couple of times a month)
Weekly (couple of times a week)
Daily (couple of times a day)
Once

Now, I'd like you to give your best estimate for the MOST RECENT TIME WHEN you were using drugs and/or alcohol REGULARLY
(that is, a pattern of use).

6. From what PERIOD of TIME were you LAST using drugs and/or alcohol on a REGULAR basis?
*Note: It is important to establish this time frame. Please note the time period the offender is referring to here:

Drugs:

From: _____/_____ (YY/MM)

To: _____/_____ (YY/MM)

Alcohol:

From: _____/_____ (YY/MM)

To: _____/_____ (YY/MM)

Comments: _________________________________________________

____________________________________________

____________________________________________

____________________________________________

* For #7 and 8 refer to period of time indicated in #6 *

7. Specifically, WHAT was your DRUG and/or ALCOHOL of choice and HOW OFTEN were you using? (Pick only one)

Drugs:

Marijuana or hashish
Cocaine
Heroin (H, horse, junk, smack)
Benzodiazepines/Minor tranquilizers (Librium, Valium, V's)
Opiates (tylenol-3, codeine, percodan, percocet, dilaudid, demerol, morphine)
Mushrooms
MDA (ecstasy)
LSD
Amphetamines (uppers)
Barbiturates (downers)
Methadone (dollies)
PCP (angel dust)
Quaaludes
Inhalants (glue, gas, aerosols, airplane glue, sniff, poppers)
Crack
Steroids/Performance Enhancing Drugs
Organic drugs
Other: ______________________

How often:

Once or a few times a year
About once a month
About once a week
A few times a week
Almost everyday
Everyday

Alcohol:

Wine
Beer
Liquor
Other (Brew, rubbing alcohol, cough syrup)
Other: ______________________

How often:

Once or a few times a year
About once a month
About once a week
A few times a week
Almost everyday
Everyday

8. a) WITH WHOM did you TYPICALLY use drugs and/or alcohol? (Pick only one)

Drugs:

Alone
With close friends or family
With my partner/boyfriend/girlfriend
With acquaintances
With strangers
With anyone
Other: ___________________________________________

Comments: __________________________________________

_____________________________________________

Alcohol:

Alone
With close friends or family
With my partner/boyfriend/girlfriend
With acquaintances
With strangers
With anyone
Other: ___________________________________________

Comments: __________________________________________

_____________________________________________

b) WHERE did you TYPICALLY use drugs and/or alcohol? (Pick only one)

Drugs:

At my home
At friends' or relatives' homes
At bars or hotels
On the street or other outdoor areas
At parties (large groups/strangers)
At a drug/crack house
Anywhere

Other: ______________________________________________

Comments: __________________________________________

_____________________________________________

Alcohol:

At my home
At friends' or relatives' homes
At bars or hotels
On the street or other outdoor areas
At parties (large groups/strangers)
Anywhere

Other: ______________________________________________

Comments: __________________________________________

_____________________________________________

Attempts To Change

9. a) Have you ever tried to QUIT or CUT DOWN using drugs and/or alcohol?

Drugs:

No ' Go to question 10
Yes ' Go to 9 b

Alcohol:

No ' Go to question 10
Yes ' Go to 9 b

b) How many times have you TRIED to quit/cut down using drugs and/or alcohol?

Drugs:

Once
2-3 times
4 or more times
Other: ____________________________________________

Alcohol:

Once
2-3 times
4 or more times
Other: ____________________________________________

c) Think about the longest time period you were able to quit or seriously reduce your use. For HOW LONG were you successful?
(Pick only one for drugs and/or alcohol)

Drugs:

For ___ year(s)
For ___ month(s)
For ___ week(s)
For ___ day(s)
I quit completely

Comment: ___________________________________________

_____________________________________________

Alcohol:

For ___ year(s)
For ___ month(s)
For ___ week(s)
For ___ day(s)
I quit completely

Comment: ___________________________________________

_____________________________________________

d) What did you do to avoid using drugs and/or alcohol?

Drugs:

I kept busy
I did not socialise often
I changed my lifestyle
I didn't use because of health reasons
I thought about my children
I focused on a positive relationship
I did not want to use
I thought about the consequences
I participated in a program(s)
I used different substances
I was in jail
I just said no

If none of the above responses apply please choose 'other' and provide a brief description

Other: ___________________________________________

_____________________________________________

Comments: __________________________________________

_____________________________________________

Alcohol:

I kept busy
I did not socialise often
I changed my lifestyle
I didn't use because of health reasons
I thought about my children
I focused on a positive relationship
I did not want to use
I thought about the consequences
I participated in a program(s)
I used different substances
I was in jail
I just said no

If none of the above responses apply please choose 'other' and provide a brief description

Other: ___________________________________________

_____________________________________________

Comments: __________________________________________

_____________________________________________

e) Did you START using drugs and/or alcohol again after quitting?

Drugs:

No ' Go to question 10
Yes ' Go to 9 f

Alcohol:

No ' Go to question 10
Yes ' Go to 9 f

f) Why did you start using drugs and/or alcohol again?

Drugs:

Relationship problems
I was stressed/depressed/frustrated over my life situation
I was bored
I convinced myself I could handle using once in awhile
Death of a loved one
I wanted to
I used to avoid withdrawal
Because my friends were using
Because my partner was using

If none of the above responses apply please choose 'other' and provide a brief description

Other: ___________________________________________

_____________________________________________

Comments: __________________________________________

_____________________________________________

Alcohol:

Relationship problems
I was stressed/depressed/frustrated over my life situation
I was bored
I convinced myself I could handle using once in awhile
Death of a loved one
I wanted to
I used to avoid withdrawal
Because my friends were using
Because my partner was using

If none of the above responses apply please choose 'other' and provide a brief description

Other: ___________________________________________

_____________________________________________

Comments: __________________________________________

_____________________________________________

Previous Programming

10. a) Have you EVER received HELP for your substance abuse problem? (or participated in any previous substance abuse programming?).
*Note: This includes any substance abuse programming, structured or self-help, in the community or institution.

No ' Go to 11
Yes ' Go to 10 b

b) What types of treatment programs have you participated in? (Check all that apply)

Correctional substance abuse program ____________________________
AA/NA/CA
Residential treatment centre
Community treatment centre
Detoxification
Relapse Prevention/Maintenance Program
Group counselling
Individual counselling
Methadone Maintenance
Other: ___________________

c) How MANY TIMES have you been in a treatment program?

1-2 times
3-4 times
5 or more times
Other: ___________________

d) When was the LAST TIME you were in a treatment program? (Excluding Module 1)

_____/_____ (YY/MM)

e) What was the MOST RECENT treatment program? (Excluding Module 1)
(Pick one; if services were combined pick all that apply)

Correctional substance abuse program ________________________
Self-help group
Residential treatment centre
Community treatment centre
Detoxification
Other: ___________________

f) What services were available in the most recent treatment program you have participated in? (Excluding Module 1)

Group counselling
Individual counselling
Methadone Maintenance
Other: ___________________

g) Was the treatment program HELPFUL for you?

No ' Go to 10 i
Yes ' Go to 10 h only

h) In what ways did you find the program HELPFUL?

It was a support system
Learned about self-awareness
Provided education/knowledge about substance abuse and its effects
I was able to talk about feelings/values/experiences
Made me feel good to be sober/clean
Helped me to plan and set goals
Learned skills to help me stay on track
Learned about my relationships
Learned about spirituality
Learned about sexuality

If none of the above responses apply please choose 'other' and provide a brief description

Other: _____________________________________________

Comments: ____________________________________________

_____________________________________________

i) Why was the treatment program NOT helpful?

Not want to share my feelings/experiences
Not like the program (ideals/basis of the program)
Not participate in the program long enough
Not ready for program/detox
Getting help was not my idea

If none of the above responses apply please choose 'other' and provide a brief description

Other: _____________________________________________

Comments: ____________________________________________

_____________________________________________

Substance Use and Life Areas

Ok, now I'd like to ask you a few more specific questions about HOW drugs and/or alcohol have INFLUENCED YOUR LIFE (now and in the past).

11. a) Have drugs and/or alcohol had a POSITIVE influence on your life?

Drugs:

No ' Go to question 11 c
Yes ' Go to 11 b

Alcohol:

No ' Go to question 11 c
Yes ' Go to 11 b

b) In what ways have drugs and/or alcohol had a POSITIVE influence on your life? (Check all that apply)

Drugs:

Made me feel relaxed
Made me feel more confident socially (less shy)
Helped me forget about my problems
Helped take away physical pain
Helped take away emotional pain
Make me feel good about myself
The negative experiences I had while drinking
helped me to quit
Helped me to cope with prostituting
Helped me financially (trafficking, etc.)

If none of the above responses apply please choose 'other' and provide a brief description

Other: ___________________________________________

_____________________________________________

Comments: __________________________________________

_____________________________________________

Alcohol:

Made me feel relaxed
Made me feel more confident socially (less shy)
Helped me forget about my problems
Helped take away physical pain
Helped take away emotional pain
Make me feel good about myself
The negative experiences I had while drinking
helped me to quit
Helped me to cope with prostituting
Helped me financially (trafficking, etc.)

If none of the above responses apply please choose 'other' and provide a brief description

Other: ___________________________________________

_____________________________________________

Comments: __________________________________________

_____________________________________________

c) Have drugs and/or alcohol had a NEGATIVE influence on your life?

Drugs:

No ' Go to 12 a
Yes ' Go to 11 d

Alcohol:

No ' Go to 12 a
Yes ' Go to 11 d

d) In what ways have drugs and/or alcohol had a NEGATIVE influence on your life? (Check all that apply)

Drugs:

I became involved in criminal activity
Had a negative affect on my relationships
Loss of my children
Impact on my children
Cause financial problems (lost job, problems at work, etc.)
I became depressed
Embarrassed about my behaviour while using
Caused me to have health problems
Had a negative impact on my appearance
I became involved in prostitution

If none of the above responses apply please choose 'other' and provide a brief description

Other: ___________________________________________

_____________________________________________

Comments: __________________________________________

_____________________________________________

Alcohol:

I became involved in criminal activity
Had a negative affect on my relationships
Loss of my children
Impact on my children
Cause financial problems (lost job, problems at work, etc.)
I became depressed
Embarrassed about my behaviour while using
Caused me to have health problems
Had a negative impact on my appearance
I became involved in prostitution

If none of the above responses apply please choose 'other' and provide a brief description

Other: ___________________________________________

_____________________________________________

Comments: __________________________________________

_____________________________________________

12. a) Have drugs and/or alcohol affected your PAST or PRESENT RELATIONSHIPS with your Husband/boyfriend/girlfriend/common-law partner?

Drugs:

No ' Go to question 12 c
Yes ' Go to 12 b
Not applicable ' Go to 12 c

Alcohol:

No ' Go to question 12 c
Yes ' Go to 12 b
Not applicable ' Go to 12 c

b) How have drugs and/or alcohol affected your past or present relationships with your Husband/boyfriend/girlfriend/common-law partner?

Drugs:

Caused a divorce/separation/break-up
It brought me closer to my partner
Became argumentative
Got into fights/arguments
Didn't spend time with him/her
Lied to my partner
Became emotionally withdrawn
Changed my behaviour
Made me violent

If none of the above responses apply please choose 'other' and provide a brief description

Other: ___________________________________________

_____________________________________________

Comments: __________________________________________

_____________________________________________

Alcohol:

Caused a divorce/separation/break-up
It brought me closer to my partner
Became argumentative
Got into fights/arguments
Didn't spend time with him/her
Lied to my partner
Became emotionally withdrawn
Changed my behaviour
Made me violent

If none of the above responses apply please choose 'other' and provide a brief description

Other: ___________________________________________

_____________________________________________

Comments: __________________________________________

_____________________________________________

c) Do you have any children?

No ' Go to 12 f
Yes ' Go to 12 d

d) Have drugs and/or alcohol affected your RELATIONSHIP with your CHILDREN?

Drugs:

No ' Go to 12 f
Yes ' Go to 12 e

Alcohol:

No ' Go to 12 f
Yes ' Go to 12 e

e) How have drugs and/or alcohol affected you relationship with your children?

Drugs:

Not spend enough time with them
Taken away from me
Not have a relationship with them
Lost my temper easily
Got into fights/arguments
They abuse substances
I abused them (emotionally, physically)

If none of the above responses apply please choose 'other' and provide a brief description

Other: ___________________________________________

_____________________________________________

Comments: __________________________________________

_____________________________________________

Alcohol:

Not spend enough time with them
Taken away from me
Not have a relationship with them
Lost my temper easily
Got into fights/arguments
They abuse substances
I abused them (emotionally, physically)

If none of the above responses apply please choose 'other' and provide a brief description

Other: ___________________________________________

_____________________________________________

Comments: __________________________________________

_____________________________________________

f) Have drugs and/or alcohol affected your FAMILY RELATIONSHIPS (e.g., parents, brothers, sisters, relatives, etc.)

Drugs:

No ' Go to 12 h
Yes ' Go to 12 g

Alcohol:

No ' Go to 12 h
Yes ' Go to 12 g

g) How have drugs and/or alcohol affected your family relationships (e.g. parents, brothers, sisters, relatives, etc.)?

Drugs:

It caused fights/arguments
It caused a rift between family members
Avoided them/didn't spend time with my family
They drank/used so it brought us closer together
It caused tension/resentment/disappointment

If none of the above responses apply please choose 'other' and provide a brief description

Other: ___________________________________________

_____________________________________________

Comments: __________________________________________

_____________________________________________

Alcohol:

It caused fights/arguments
It caused a rift between family members
Avoided them/didn't spend time with my family
They drank/used so it brought us closer together
It caused tension/resentment/disappointment

If none of the above responses apply please choose 'other' and provide a brief description

Other: ___________________________________________

_____________________________________________

Comments: __________________________________________

_____________________________________________

h) Have drugs and/or alcohol affected your relationships with your friends?

Drugs:

No ' Go to 12 j
Yes ' Go to 12 i

Alcohol:

No ' Go to 12 j
Yes ' Go to 12 i

i) How have drugs and/or alcohol affected your relationships with your friends?

Drugs:

Got into fights/arguments
Lost friends because I stopped using
Lost friends because I was using
Most of my friends were involved in criminal activities
Never had any real friends

If none of the above responses apply please choose 'other' and provide a brief description

Other: ___________________________________________

_____________________________________________

Comments: __________________________________________

_____________________________________________

Alcohol:

Got into fights/arguments
Lost friends because I stopped using
Lost friends because I was using
Most of my friends were involved in criminal activities
Never had any real friends

If none of the above responses apply please choose 'other' and provide a brief description

Other: ___________________________________________

_____________________________________________

Comments: __________________________________________

_____________________________________________

j) Have drugs and/or alcohol affected your WORK or SCHOOL?

Drugs:

No ' Go to 12 l
Yes ' Go to 12 k

Alcohol:

No ' Go to 12 l
Yes ' Go to 12 k

k) Have drugs and/or alcohol affected your WORK or SCHOOL?

Drugs:

Poor performance
Under the influence at work
Called in sick/late/left early due to drinking
Quit school/work
Fired because of drinking
Kicked out of school because of drinking
Did not go to work/attend school because of drug use

If none of the above responses apply please choose 'other' and provide a brief description

Other: ___________________________________________

_____________________________________________

Comments: __________________________________________

_____________________________________________

Alcohol:

Poor performance
Under the influence at work
Called in sick/late/left early due to drinking
Quit school/work
Fired because of drinking
Kicked out of school because of drinking
Did not go to work/attend school because of drinking

If none of the above responses apply please choose 'other' and provide a brief description

Other: ___________________________________________

_____________________________________________

Comments: __________________________________________

_____________________________________________

l) Have drugs and/or alcohol affected your FINANCES?

Drugs:

No ' Go to 12 n
Yes ' Go to 12 m

Alcohol:

No ' Go to 12 n
Yes ' Go to 12 m

m) How have drugs and/or alcohol affected your finance?

Drugs:

Spent all of my money on drugs
Spent most of my money on my drugs
Any extra money I had was used for drugs
Committed crimes to support my use
Prostituted/trafficked to support my drug use

If none of the above responses apply please choose 'other' and provide a brief description

Other: ___________________________________________

_____________________________________________

Comments: __________________________________________

_____________________________________________

Alcohol:

Spent all of my money on alcohol
Spent most of my money on alcohol
Any extra money I had was used for alcohol
Committed crimes to support my drinking
Prostituted/trafficked to support my drinking

If none of the above responses apply please choose 'other' and provide a brief description

Other: ___________________________________________

_____________________________________________

Comments: __________________________________________

_____________________________________________

n) Have drugs and/or alcohol affected your PHYSICAL health?

Drugs:

No ' Go to 12 p
Yes ' Go to 12 o

Alcohol:

No ' Go to 12 p
Yes ' Go to 12 o

o) How have drugs and/or alcohol affected your physical health?

Drugs:

Weight gain
Weight loss
Poor nutrition
My energy level fluctuates
Scars and other injuries due to fights
Accidents
Car accidents
Serious physical injuries
Serious health problems
Hepatitis C
Hangovers
Blackouts
Withdrawal symptoms
DTs
Overdosed
Seizures
Short-term memory loss
Has affected my menstrual cycle
Infertility
Affected my pregnancy

If none of the above responses apply please choose 'other' and provide a brief description

Other: ___________________________________________

_____________________________________________

Comments: __________________________________________

_____________________________________________

Alcohol:

Weight gain
Weight loss
Poor nutrition
My energy level fluctuates
Scars and other injuries due to fights
Accidents
Car accidents
Serious physical injuries
Serious health problems
Hepatitis C
Hangovers
Blackouts
Withdrawal symptoms
DTs
Overdosed
Seizures
Short-term memory loss
Has affected my menstrual cycle
Infertility
Affected my pregnancy

If none of the above responses apply please choose 'other' and provide a brief description

Other: ___________________________________________

_____________________________________________

Comments: __________________________________________

_____________________________________________

p) Have drugs and/or alcohol affected your MENTAL health?

Drugs:

No ' Go to 13
Yes ' Go to 12 q

Alcohol:

No ' Go to 13
Yes ' Go to 12 q

q) How have drugs and/or alcohol affected your mental health?

Drugs:

Felt depressed
Felt guilty
Felt lonely
Felt lost
Was angry
Was aggressive
Was paranoid
Had anxiety
Had a negative self-image/self-esteem
Was calm/uncaring when under the influence (withdrawn)
Was hyper
Was afraid
Was slow and forgetful
Was frustrated
Felt suicidal
Drinking helped me not feel depressed

If none of the above responses apply please choose 'other' and provide a brief description

Other: ___________________________________________

_____________________________________________

Comments: __________________________________________

_____________________________________________

Alcohol:

Felt depressed
Felt guilty
Felt lonely
Felt lost
Was angry
Was aggressive
Was paranoid
Had anxiety
Had a negative self-image/self-esteem
Was calm/uncaring when under the influence (withdrawn)
Was hyper
Was afraid
Was slow and forgetful
Was frustrated
Felt suicidal
Drinking helped me not feel depressed

If none of the above responses apply please choose 'other' and provide a brief description

Other: ___________________________________________

_____________________________________________

Comments: __________________________________________

_____________________________________________

Emotional Issues

Note to facilitator: The following questions are to gain preliminary information into the offender's emotional issues and are not meant to be probed further (these areas will be addressed at a later date).

13. a) Have you ever experienced feelings of depression?

No ' Go to question 14
Yes ' Go to 13 b

b) Have you ever used alcohol and/or drugs to cope with your depression?

Drugs:

No
Yes

Alcohol:

No
Yes

14. a) Have you ever experienced feelings of anxiety?

No ' Go to question 15
Yes ' Go to 14 b

b) Have you ever used alcohol and/or drugs to cope with your anxiety?

Drugs:

No
Yes

Alcohol:

No
Yes

Current Situation

I would now like to find out more about your current situation.

15. a) Are you currently (Do you currently have a'):

Married
Separated
Divorced
Common Law
Remarried
Boyfriend/Girlfriend
Single

b) How long have you been single, married, common law, etc.? ________

16. a) How supportive is your spouse or partner of your participation in a substance abuse treatment program?

Supportive Go to 16 b
Non-Supportive Go to 16 b
N/A Go to question 17

b) Please elaborate: (Check all that apply)

Supportive:

Wants me to quit using/drinking
Feels I need treatment
Wants me to get treatment so I can get out of prison
Does not think I need treatment but is still supportive
Encourages me
He/she is trying to get clean so they want me to as well

If none of the above responses apply please choose 'other' and provide a brief description

Other: ___________________________________________

_____________________________________________

Comments: __________________________________________

_____________________________________________

Non-Supportive:

Does not think I need treatment
Does not think treatment will help me
Does not think I can change
Thinks I can change on my own

If none of the above responses apply please choose 'other' and provide a brief description

Other: ___________________________________________

_____________________________________________

Comments: __________________________________________

_____________________________________________

17. Is your spouse or partner currently using drugs and/or alcohol?

No
Yes
Unknown
N/A

18. Do you feel your family (parents, brothers, sisters, relatives) is supportive of your participation in a substance abuse treatment program?

No
Yes

19. a) In your opinion, do any of your family members have problems with drugs and/or alcohol?

No ' Go to question 20
Yes ' Go to 19 b

b) Which family members?

Drugs:

Mother
Father
Brother
Sister
Other relative

Comments: __________________________________________

_____________________________________________

Alcohol:

Mother
Father
Brother
Sister
Other relative

Comments: __________________________________________

_____________________________________________

20 a) Do you feel that you have close friends that you can talk to if you have a problem?

No ' Go to question 21
Yes ' Go to 20 b

b) Of these friends, how many do you think have a drinking and/or drug problem?

Drugs:

None
Some
Most
All

Alcohol:

None
Some
Most
All

21. Are any of your friends involved in illegal activities?

No
Yes
N/A
Unknown/Unsure

Comments: _____________________________________________

___________________________________________

22. a) What kinds of activities have you done in your LEISURE time when not in prison?

I had no leisure activities except drug/alcohol use (go to question 23)
Played Sports
Outdoor activities
Spent time with my family
Watched t.v./movies
Reading
Hobbies
Going to bars/clubs
Spending time with my children

If none of the above responses apply please choose 'other' and provide a brief description

Other: _____________________________________________

Comments: ____________________________________________

___________________________________________

b) Have ANY of these activities involved the use of drugs and/or alcohol?

None ' Go to question 23
A Few ' Go to 22 c
Most ' Go to 22 c
All ' Go to 22 c

c) Which activities involved the use of drugs and/or alcohol?

Drugs:

Sports
Outdoor activities
Time with my family
Watched t.v./movies
Reading
Hobbies
Going to bars/clubs
Spending time with my children

If none of the above responses apply please choose 'other' and provide a brief description

Other: ___________________________________________

_____________________________________________

Comments: __________________________________________

_____________________________________________

Alcohol:

Sports
Outdoor activities
Time with my family
Watched t.v./movies
Reading
Hobbies
Going to bars/clubs
Spending time with my children

If none of the above responses apply please choose 'other' and provide a brief description

Other: ___________________________________________

_____________________________________________

Comments: __________________________________________

_____________________________________________

Crime and Substance Use

In the next section of this interview, I'd like to ask you about your criminal history.

23. a) Were you UNDER THE INFLUENCE of alcohol and/or drugs for your most recent offence or offences?

No ' Go to question 23 d
Yes ' Go to 23 b

b) For what OFFENCE(S) were you under the INFLUENCE of alcohol and/or drugs?

Theft (e.g., B & E's, shoplifting, auto theft, unlawfully in dwelling, possession stolen property)
Robbery (e.g., armed robbery, robbery with violence, extortion)
Fraud (e.g., forgery, false pretences, credit card fraud, impersonating)
Drug Offences (e.g., possession, trafficking, import narcotics, cultivation)
Assault (e.g., attempt murder, assault causing bodily harm, threatening, common assault, aggravated assault)
Sexual Assault (e.g., indecent assault, rape, incest, gross indecency)
Murder (e.g., manslaughter, first and second degree murder)
Possession of Weapon (e.g., possession of explosives, dangerous use of firearm, pointing a fire arm)
Escape (e.g., escape lawful custody, unlawfully at large, fail to appear, breach of recognizance, breach of bail, fail to comply, breach of probation)
Kidnapping (e.g., unlawful confinement, abduction)
Arson
Obstruction of Justice (e.g., assault police officer, obstruct peace officer, resist arrest, contempt of court)
Major Driving Offences (e.g., criminal negligence, drive while intoxicated, dangerous driving, driving while ability impaired, fail to remain at scene)
Prostitution
Other (e.g., vandalism, causing disturbance, mischief, willful damage)

Other: (specify):___________________________________________

c) What drugs and/or alcohol were you using?

Drugs:

Marijuana or hashish
Cocaine
Crack
Opiates (tylenol-3, codeine, percodan, percocet, dilaudid, demerol, morphine)
Heroin (H, horse, junk, smack)
Benzodiazepines/Minor tranquilizers (Librium, Valium, V's)
Mushrooms
MDA (ecstasy)
LSD
Amphetamines (uppers)
Barbiturates (downers)
Methadone (dollies)
PCP (angel dust)
Quaaludes
Inhalants (glue, gas, aerosols, airplane glue, sniff, poppers)
Steroids/Performance Enhancing Drugs

Other: ___________________________________________

Alcohol:

Wine
Beer
Liquor
Other (Brew, rubbing alcohol, cough syrup, etc.)

Other: ___________________________________________

d) Do you think that your USE of (or INVOLVEMENT with) DRUGS and/or ALCOHOL CONTRIBUTED TO you committing this offence(s)?

Drugs:

No
Yes
Not sure
N/A

Alcohol:

No
Yes
Not sure
N/A

24. a) Have you ever committed any other crimes in your LIFE, including those for which you were NEVER caught?

No ' Go to question 25
Yes ' Go to 24 b

b) HOW MANY of these crimes were committed while under the influence of drugs and/or alcohol?

Drugs:

None
Some
Most
All

Alcohol:

None
Some
Most
All

Substance Abuse Programming

Before you answer the next question, I'd like you to think back over everything we have discussed today.

25. How would you rate the problems your substance use has caused in your life on a scale from 1 to 5? (To clarify, show the client the scale given below and explain the ratings.)

1 - no problems
2 - minor problems
3 - some problems
4 - significant problems
5 - severe problems

26. a) Do you think you need TREATMENT?

No ' Go to 26 c
Yes ' Go to 26 b

b) Why do you think you NEED treatment?

To turn my life around
To help me get parole
I have a hard time saying no to drugs and/or alcohol
To learn more about substance abuse
To learn how to say no to drugs and/or alcohol
To maintain my abstinence
To keep my children
To get my children back
To keep my family together

If none of the above responses apply please choose 'other' and provide a brief description

Other: _____________________________________________

Comments: ____________________________________________

___________________________________________

c) Why do you think you DO NOT need treatment?

I do not have an addiction
I do not use regularly
I have not used drugs and/or alcohol for a long time
I'm handling it myself
I do not have any cravings
I have relapsed in the past (programs don't seem to work)
I need more support than treatment

If none of the above responses apply please choose 'other' and provide a brief description

Other: _____________________________________________

Comments: ____________________________________________

___________________________________________

27. What other goals do you have for treatment?

To learn more about self-awareness
To learn the effects of my substance abuse (why it happens, triggers)
To learn how to deal with my cravings
To learn how to be stronger (mentally, ways of saying no)
To learn how to stay sober/drug free
To develop a relapse prevention plan
To have a network of support
To get my children back
To get better for my children
I'm only taking WOSAP for parole purposes
I don't know
I don't expect anything from the program

If none of the above responses apply please choose 'other' and provide a brief description

Other: _____________________________________________

Comments: ____________________________________________

___________________________________________

28. Additional Comments:

___________________________________________

___________________________________________

___________________________________________

3. Pre-Program Interview Ratings

* TO BE COMPLETED BY THE INTERVIEWER IMMEDIATELY FOLLOWING THE PRE-PROGRAM INTERVIEW

1. RECOGNITION OF SUBSTANCE ABUSE PROBLEM
(Questions 1 a-e, 5 a-b, 6, 7, 11 a-d, 12 a-q, 23 a-d, 24 a-b, 25, 26 a-c, and 27)

1 2 3 4 5
Refuses to acknowledge that substance abuse is a major problem in her life   Willing to admit some problems, but is not convinced of the full extent of the problem.   Is very willing to admit to a problem.

2. DEGREE OF INSIGHT INTO PROBLEM
(Questions 1 d-e, 8 a-b, 9f, 11 a-d, 12 a-q, 25, 26 a-c, and 27)

1 2 3 4 5
No insight regarding the cause of substance abuse and has no insight on what she should do to avoid the problem.   Has some understanding of the problem and what to do about it, but requires more insight.   Knows why she has a problem and what has to be done to Avoid having
the problem.

3. COPING SKILLS
(Questions 9 a-d, 13b, and 14b)

Note: This scale should be used to estimate the client's general level of coping skill as evidenced by her approach to past life challenges/problems. While this will include coping strategies used to deal with substance use, this should not be the exclusive focus of your rating.

1 2 3 4 5
Is unable to identify and describe coping strategies that she has used to deal effectively with past problems.   Is able to identify and describe some coping strategies, but knowledge and application of strategies appears limited.   Is able to identify coping strategies that she has used effectively to deal with several problem areas.

4. CURRENT RELATIONSHIPS
(Questions 15-21)

a) Relationship with partner or significant other (If client does not have a partner, please check that this is not applicable.)
Not Applicable ___ (Go to 4b)

1 2 3 4 5
Relationship with partner is a significant problem area. partner is not supportive of positive change and/or is abusive. (Note: abusive elements will always result in a rating of 1 or 2)   Some relationship problems, but partner is generally supportive.   Relationship with partner is positive and supportive. Appears to be an area of strength rather than an area of concern.

b) Relationship with family members (including children)

1 2 3 4 5
Relationship with family members is a significant problem area. Could include situations where most family members are non-supportive and/or abusive or where client is estranged from family and distressed by this.   Has some problematic family relationships or issues, but also has some positive and supportive family relationships.   Has positive and supportive relationship with family members. Appears to be an area of strength rather than an area of concern.

c) Relationship with friends

1 2 3 4 5
Relationship with friends is a significant problem area. Could include situations where most friends are non-supportive and/or abusive or where client is socially isolated and has no close friendships   Has some positive, supportive friendships but others are problematic.   Has several positive and supportive friendships. Appears to be an area of strength rather than an area of concern.

d) Degree of substance abuse in social environment

1 2 3 4 5
Majority of family, friends and partner (if applicable) are substance abusers   Several family and friends are substance users although closest family member/friend/partner is not.   Majority of family, friends and partner (if applicable) are not substance abusers.

5. ESTIMATE OF STAGE OF CHANGE / TREATMENT READINESS
(Questions 25, 26 a-c, and 27)

1 2 3 4 5
Precontemplation
Contemplation
Preparation
Action
Maintenance

RECOMMENDED FOR THE PROGRAM? YES NO If NO, why?

___________________________________________

___________________________________________

___________________________________________

4. TRAUMA HISTORIES

** PLEASE COMPLETE THESE QUESTIONS DURING YOUR ONE-ON-ONE SESSION PRIOR TO SESSION 9A (Relationships)**

Please indicate the reason this section is not completed if applicable.

Now that you have had time to become more familiar with the participant, we would like you to take this time to ask them some more questions about their personal histories. Inform the women that the next two blocks of sessions are focused on Relationships and Sexuality. Let them know that the reason we ask personal and difficult questions is so that you, the facilitator, will have the background information you need to be most sensitive to the needs of the woman.

1. a) Using 'Trauma is an overwhelming experience or a witnessing of an event that provokes feelings of intense fear, helplessness or horror'as well as interpersonal events such as abuse of violence' as a definition of trauma, have you experienced events that fit this description?

b) How have you coped with traumatic events in the past?

c) Were these strategies effective?

d) If YES - Why do you think these strategies were effective?
If NO - Why not?

e) Have you ever used alcohol or drugs to cope with traumatic events?
If YES - Could you please describe.

f) Have you ever received professional help for any of your traumatic experiences? If YES, please describe the professional help you have received.

2. a) Have you ever experienced the feeling of depression? (Emphasize that you are talking about more than just feeling blue for just a couple of days.)

b) How have you coped with feelings of depression or sadness in the past?

c) Were these strategies effective?

d) If YES - Why do you think these strategies were effective?
If NO - Why not?

e) Have you ever used alcohol or drugs to cope with feelings of sadness or depression?
If YES - Could you please describe.

f) Have you ever received professional help for depression? If YES, please describe the professional help you have received.

3. a) Have you ever experienced strong feelings of anxiety?

b) How have you coped with feelings of anxiety in the past?

c) Where these strategies effective?

d) If YES - Why do you think these strategies were effective?
If NO - Why not?

e) Have you ever used alcohol or drugs to cope with feelings of anxiety? If YES ' could you please describe.

f) Have you ever received professional help for anxiety? If YES, please describe the professional help you have received.

4. a) From your point of view, is your current relationship abusive in any way?

b) If YES, please describe what is abusive about the relationship.

c) In the past, have you ever been involved in what you consider to be an abusive relationship?

d) If YES, please describe what was abusive about the relationship.

5. PROGRAM INFORMATION

* Please complete the following information upon the conclusion of the offender's participation with Module 2.

Program facilitated by: _______________________________________________

Dates of Offender's Involvement with the Program: ___/___/___ to ___/___/___

Did the Offender successfully complete all sessions of the program?

No
Yes

If the offender did not complete the entirety of the program, please indicate the extent of participation:

Total number of A sessions attended: _______________

Total number of B sessions attended: _______________

Why did the offender not complete the program? ___________________________________________

___________________________________________

Additional Notes: ___________________________________________

___________________________________________

___________________________________________

Appendix C ' intensive therapeutic treatment questionnaire

Please indicate the extent to which you agree with the following statements right now.

SD = Strongly Disagree
D = Disagree
U = U
ndecided
A = Agree
SA = Strongly Agree

1. Only positive emotions are useful.
SD D U A SA

2. By changing the way I think about a situation I can change my feelings as well.
SD D U A SA

3. I know how to communicate my feelings to others.
SD D U A SA

4. I recognise when I am beginning to get depressed.
SD D U A SA

5. I know how to deal with depression.
SD D U A SA

6. I know how to deal with anxiety.
SD D U A SA

7. I can use my anger in a positive way.
SD D U A SA

8. I know how to cope with painful emotions.
SD D U A SA

9. Giving up my substance of choice is a loss.
SD D U A SA

10. Grieving over losing someone important may lead to substance abuse.
SD D U A SA

11. I am ready to say goodbye to my substance abuse.
SD D U A SA

12. Depression can lead to substance abuse.
SD D U A SA

13. Anxiety can lead to substance abuse.
SD D U A SA

14. Anger is a healthy emotion.
SD D U A SA

15. Spirituality and religion are the same thing.
SD D U A SA

16. I have a vision for my life.
SD D U A SA

17. Spirituality is a positive influence in my life.
SD D U A SA

18. I feel I am part of the institutional community.
SD D U A SA

19. I gain strength from those around me.
SD D U A SA

20. Spirituality helps me recover from my substance abuse.
SD D U A SA

21. I practice mindfulness to help manage my life.
SD D U A SA

22. Spirituality helps me feel connected to my inner self.
SD D U A SA

23. I use meditation, faith and/or prayer to help me with my substance abuse recovery.
SD D U A SA

24. Mindfulness is a religious practice.
SD D U A SA

25. Mindfulness can be used to cope with cravings.
SD D U A SA

26. As a woman, I should focus on the needs of others' before my own.
SD D U A SA

27. I have positive relationships in the institution.
SD D U A SA

28. A healthy relationship has no conflict.
SD D U A SA

29. Substance use has created problems in my relationships.
SD D U A SA

30. Substance use can be helpful in keeping relationships together.
SD D U A SA

31. I know what a healthy relationship is.
SD D U A SA

32. It is important for me to stand up for myself in my relationships.
SD D U A SA

33. In healthy relationships, both people are totally dependent on one another.
SD D U A SA

34. Substance abuse is linked to abusive relationships.
SD D U A SA

35. I feel in control of my sexuality.
SD D U A SA

36. Women do not enjoy sex.
SD D U A SA

37. The media affects how women see their bodies.
SD D U A SA

38. I accept my body the way it is.
SD D U A SA

39. My sexuality and substance use are connected.
SD D U A SA

40. Maintaining my boundaries is important in sexual relationships.
SD D U A SA

41. My body is an important part of who I am.
SD D U A SA

42. Drugs and/or alcohol make me feel more comfortable with sex.
SD D U A SA

43. I have the right to demand safe sex with my partner.
SD D U A SA

44. I have the right to stop and say when I am not comfortable with a sexual partner.
SD D U A SA

45. I value the person I am.
SD D U A SA

46. I am living a life consistent with my values.
SD D U A SA

47. I feel safe.
SD D U A SA

48. I know how to create a safe place for myself.
SD D U A SA

49. I have the right to have my personal boundaries respected.
SD D U A SA

50. I feel good about myself.
SD D U A SA

51. I respect others' personal space.
SD D U A SA

52. Using drugs and/or alcohol makes it hard for me to maintain my boundaries.
SD D U A SA

53. My partner has the right to ignore my my boundaries.
SD D U A SA

Appendix D ' Participant feedback questionnaire

Module: ___________

Facilitator: ___________

Date: ___________

The following questionnaire is important for the improvement of this program. All of your answers will remain confidential and will not be seen by the program facilitator. When you have completed the questionnaire the facilitator will give you an envelope to seal your questionnaire in.

Overall Impression

1. How would you rate the overall quality of the module you have just finished?

4 : Excellent
3 : Good
2 : Fair
1 : Poor

2. To what extent has the module met your needs?

4 : Almost all of my needs have been met
3 : Most of my needs have been met
2 : Only a few of my needs have been met
1 : None of my needs have been met

3. Has the module helped you to deal more effectively with the problems that led to your crime(s)?

4 : Yes, it has helped a great deal
3 : Yes, it helped somewhat
2 : No, it didn't really help
No, it made my problem worse

4. Was the information in the module presented in a way that was easy to understand?

4 : Yes, it was very easy to understand
3 : Yes, most of it was easy to understand
2 : No, most of it was hard to understand
1 : No, all of it was hard to understand

5. Would you recommend this module to a friend with problems similar to yours?

4 : Yes, definitely
3 : Yes, I think so
2 : No, I don't think so
1 : No, definitely not

6. In general, how satisfied are you with the module?

4 : Very satisfied
3 : Mostly satisfied
2 : Somewhat dissatisfied
1 : Very dissatisfied

Program Content and Methods

7. The goals of the sessions were clear and made sense to me.

4 : Almost all of the goals were clear
3 : Most of the goals were clear
2 : Only a few of the goals were clear
1 : None of the goals were clear

8. The information in the sessions was useful and important to me.

4 : Almost all were useful and important to me
3 : Most were useful to me
2 : Only a few were useful or important to me
1 : None were useful or important to me

9. To what extent did the group activities help you to learn (e.g. group discussions, role-plays, practice, etc.)?

4 : Considerably
3 : Somewhat
2 : Minimally
1 : Not at all

10. How useful were the practice sessions in helping you to understand your problems and to change your behaviour (e.g. homework, offence cycle, behavioural progression, relapse prevention plan, self-management plan, presentations to the group, etc.)?

4 : All of the assignments were helpful
3 : Most of the assignments were helpful
2 : Only a few of the assignments were helpful
1 : None of the assignments were helpful

11. Overall, how organized was/were the facilitator(s) in running the program?

4 : Very well organized
3 : Mostly well organized
2 : Somewhat disorganized
1 : Very disorganized

Program Length

12. The amount of time I spent in the program was adequate.

5 4 3 2 1
The program was too long   The amount of time was just right   The program was too short

Group Experience

13. How comfortable did you feel talking about your personal experiences in the group (e.g., past events, thoughts, feelings, etc.)?

4 3 2 1
Very comfortable Somewhat comfortable Somewhat uncomfortable Very uncomfortable

14. How well did the group work together to achieve program goals?

4 3 2 1
The group worked
very well together
Worked somewhat
well together
Mostly did not work
well together
Definitely did not work
well together

15. How well did the facilitator(s) respond to your individual needs and goals?

4 3 2 1
Very responsive to my needs Somewhat responsive
to my needs
Somewhat unresponsive
to my needs
Totally unresponsive
to my needs

16. How useful was the feedback you received from the facilitator(s) and the other group members?

4 3 2 1
Very useful Somewhat useful A little useful Not at all useful

17. To what extent did the facilitator(s) show genuine concern for you?

4 3 2 1
Very concerned Somewhat concerned Somewhat indifferent Very indifferent

18. How confident were you in the facilitator(s)'ability to help you meet your program goals?

4 3 2 1
Very confident Somewhat confident Not very confident Definitely not confident

19. How successful was the program in helping you understand the changes you need to make?

4 3 2 1
Very successful Somewhat successful A little successful Not at all successful

Peer Support Participation

20. Are you aware of the Substance Abuse Peer Support group?

Yes ' Go to question 21
No ' Go to question 22

21. How did you become aware of the Substance Abuse Peer Support group?

staff
someone in my house
another offender
a bulletin/advertisement

22. Have you participated in the Substance Abuse Program Peer Support group?

Yes ' Go to question 23
No ' Go to question 30

23. How many times have you attended the Substance Abuse Peer Support group?

0-3
4-8
9-15
16+

24. Why did you choose to attend the Substance Abuse Peer Support group?
(Please check all responses that apply to you)

I needed more support for my substance abuse problems
I thought it could help me
I wanted to find out what the group was all about
I heard good things about the group/meetings
I wanted to hear a specific speaker
My friends were going
There was nothing else for me to do

Other: (please specify) ___________________________________________

25. When you attended the Substance Abuse Peer Support group did the meetings stay on track (i.e. the meeting stayed focused on the goals of the meeting)?

No
Yes

26. When you attended the Substance Abuse Peer Support group was there a speaker?

1 2 3 4 5
Always Usually Not sure Not usually Never

27. If you had the opportunity to hear speakers in the Substance Abuse Peer Support group did you find them interesting/informative?

1 2 3 4 5
Very interesting Somewhat interesting Unsure Somewhat uninteresting Very uninteresting

28. Do you feel that the staff/peer facilitator did a good job in controlling the meetings?

No
Yes

29. Was the Substance Abuse Peer Support group helpful for you?

1 2 3 4 5
Very helpful Somewhat helpful Unsure Somewhat unhelpful Very unhelpful

30. Why did you not attend any of the Women Offender Substance Abuse Peer Support groups/meetings?

I did not know about the Peer Support Group
I did not think it could help me
I heard bad things about the group
I did not have time to go to the groups (another program/meeting at the same time)
I did not get along with someone else that attends the group
I do not have a substance abuse problem so I do not need this Peer Support group

Other: (please specify) ___________________________________________

Thank you for completing this Feedback Questionnaire!

Appendix E ' research consent form

Appendix F ' percentages for individual items within the substance abuse domain

Substance Abuse Domain Item E & E
% (N)
ITT
% (N)
Combined (N)
Early age of drinking* 29.3 (34) 50.0 (19) 39.4 (100)
Drinks frequently* 26.7 (31) 52.6 (20) 34.0 (87)
Has drinking binges 40.5 (47) 51.4 (19) 37.0 (94)
Combines drugs and alcohol 40.5 (47) 52.6 (20) 37.0 (94)
Abuses alcohol 48.3 (56) 60.5 (23) 49.0 (126)
Excessive drinking - leisure 39.7 (46) 55.3 (21) 37.9 (96)
Excessive drinking - social 37.9 (44) 54.1 (20) 38.3 (97)
Excessive drinking ' stress* 36.2 (42) 58.3 (21) 37.8 (96)
Drinking interferes with employment 15.5 (18) 27.8 (10) 18.9 (48)
Drinking interferes with marriage/ family 36.2 (42) 54.0 (20) 36.5 (93)
Drinking interferes with associates* 23.5 (27) 48.6 (18) 29.02 (74)
Law violations due to drinking 33.6 (39) 47.2 (17) 38.5 (99)
Drinking interferes with physical health 19.0 (22) 19.4 (7) 19.3 (49)
Early age of drug use** 45.7 (53) 73.7 (28) 44.3 (113)
Frequent drug use* 60.3 (70) 76.3 (29) 52.2 (133)
Drug use sprees*** 59.5 (69) 78.4 (29) 45.7 (116)
Combines different drugs 45.7 (53) 63.2 (24) 42.2 (106)
Abuses drugs*** 75.0 (87) 92.1 (35) 63.8 (164)
Drug use ' leisure* 68.7 (79) 76.3 (29) 56.6 (145)
Drug use ' social** 67.0 (77) 79.0 (30) 53.7 (137)
Drug use ' stress* 60.9 (70) 75.0 (27) 53.5 (136)
Drugs interfere with employment* 47.0 (54) 47.2 (17) 34.5 (88)
Drugs interfere with marriage/ family** 60.9 (70) 75.7 (28) 49.8 (127)
Drugs interfere with associates* 49.6 (57) 62.1 (23) 40.8 (104)
Law violations due to drugs 58.3 (67) 70.3 (26) 51.2 (131)
Drugs interfere with physical health 47.4 (55) 46.0 (17) 35.6 (90)
Previously assessed for substance abuse* 45.6 (52) 63.2 (24) 41.3 (105)
Participated in substance abuse treatment** 50.9 (59) 71.0 (27) 43.9 (112)
Completed substance abuse treatment 41.4 (48) 55.3 (21) 36.1 (91)
Total number of cases 116 38 254

* p<.05
** p<.01
*** p<.001

APPENDIX G ' mean scores for each question from the participant feedback questionnaire

Subsections E & E
Mean (SD) a
ITT
Mean (SD) a
Overall Impression    
How would you rate the overall quality of the module you have just finished? 3.4 (0.7) 3.7 (0.6)
To what extent has the module met your needs? 3.1 (0.8) 3.5 (0.6)
Has the module helped to deal more effectively with the problems that led to your crime(s)? 3.2 (0.7) 3.7 (0.6)
Was the information in the module presented in a way that was easy to understand? 3.7 (0.5) 3.7 (0.5)
Would you recommend this module to a friend with problems similar to yours? 3.6 (0.6) 3.9 (0.4)
In general, how satisfied are you with the module? 3.4 (0.6) 3.7 (0.5)
Program Content and Methods    
The goals of the sessions were clear and made sense to me. 3.6 (0.5) 3.8 (0.5)
The information in the sessions was useful and important to me. 3.4 (0.7) 3.8 (0.5)
To what extent did the group activities help you to learn? 3.4 (0.7) 3.6 (0.6)
How useful were the practice sessions in helping you to understand your problems and to change your behaviour? 3.3 (0.7) 3.6 (0.7)
Overall, how organized was/were the facilitator(s) in running the program? 3.8 (0.4) 3.9 (0.4)
Program Length    
The amount of time I spent in the program was adequate. 2.9 (1.1) 3.3 (1.0)
Group Experience    
How comfortable did you feel talking about your personal experiences in the group? 3.2 (0.8) 3.1 (0.8)
How well did the group work together to achieve program goals? 3.5 (0.6) 3.7 (0.5)
How well did the facilitator(s) respond to your individual needs and goals? 3.7 (0.6) 3.9 (0.3)
How useful was the feedback you received from the facilitator(s) and the other group members? 3.6 (0.6) 3.8 (0.4)
To what extent did the facilitator(s) show genuine concern for you? 3.8 (0.5) 3.9 (0.3)
How confident were you in the facilitator(s)' ability to help you meet your program goals? 3.7 (0.5) 3.8 (0.4)
How successful was the program in helping you understand the changes you need to make? 3.6 (0.6) 3.9 (0.3)
Total number of cases 185 41

a Standard deviation