Returning Home: The Role of Recovery Management Checkups on Housing, Employment, Abstinence Self-Efficacy and Quality of Life Among Formerly Incarcerated Black Women with a History of Substance Use Disorder

Background: Over the past 40 years, there has been a dramatic increase in the number ofwomen incarcerated. The majority of incarcerated women are serving time on a drug-related charge, economic crime, or crime against public order. In addition to leading to criminal justice involvement, substance use can cause unstable housing, unemployment, economic losses, exposure to violence, social stigma, family and peer relationship problems, and decreased quality of life (QoL). Black women are more likely than other groups to use drugs that are highly addictive and associated with greater harm, and as a result, suffer more severe consequences. Further, research has found that Black women have among the lowest substance use treatment retention rates./nRecovery capital has been defined as the aggregate of resources a person can access that cansupport initiating treatment for substance use disorder, maintaining treatment and continuing abstinence. This three-paper dissertation investigated "recovery capital" outcomes among Black female participants in a longitudinal randomized controlled trial of a treatment linkage intervention. It was hypothesized that by participating in the intervention, participants would receive proactive linkage services in which substance use problems would be immediately identified, allowing women to access treatment sooner. In addition, involvement in treatment would reduce risk factors associated with persistent substance use, such as unstable housing and unemployment, low abstinence self-efficacy, lower quality of life, as well as problems with mental health and family problems./nMethods: Participants were Black adult females (N=400) recruited from the Cook County, IL jailsystem during two phases. For phase one, inclusion criteria required that participants were incarcerated adult females who participated in the Cook County jail-based SUD treatment program operated by the Department of Women’s Justice Services. Participants were randomized to receive recovery checkups or reentry as usual services and were assessed quarterly for 36-months. A Generalized Estimating Equations (GEE) procedure was used to estimate population-based parameters of the effects of the intervention on housing, employment, recovery and quality of life domains. For the abstinence self-efficacy outcome, an ordinal logistic regression was used to estimate the effect of the intervention on self-efficacy over time among participants in the experimental condition compared to those in the control group./nResults: The findings represent models that tested the predictive relationship withoutcomes over time by using time-varying covariates. Housing- After adjusting for covariates, housing decreased for both groups over time. More years of exposure to the criminal justice system, including being under legal supervision, was associated with decreased odds of housing. Employment- Having additional years of education was associated with higher odds of employment, but older participants had lower odds of employment. Participants who were housed had higher odds of employment suggesting greater stability over time. Social support was inversely related to employment. Over the course of the study, greater social support was strongly associated with abstinence self-efficacy, suggesting that such support increased the odds that participants would rate themselves as having higher self-efficacy. Lower levels of abstinence self-efficacy were linked to both older age and substance use, indicating that continued substance use and low levels of self-efficacy are mutually reinforcing. Abstinence self-efficacy was strongly associated with recovery, which was a composite variable defined as living in the community, past month abstinence from all substances, and no past month substance use problems. Quality of life (QoL)- After adjusting for covariates, there were no significant effects for the intervention across any of the models however, the variable of time was found to be associated with quality of life, with both groups improving in QoL over time. Mental distress which was negatively associated with QoL and there was a large and significant relationship with abstinence self-efficacy and QoL. Self-efficacy, social support, education, and employment (to a smaller degree) were found to be significantly associated with higher QoL across domains, while mental distress, substance use, and past year trauma symptoms were found to be significantly associated with lower QoL, but to a lesser extent./nConclusions: These papers’ results highlight the need for recovery-oriented approaches tosubstance use disorder treatment that focus on enhancing recovery capital for Black women who are returning from jail to the community. Treatment services should be structured and monitored with the goal of building participants access to recovery capital such as stable housing, employment, self-efficacy, and quality of life. Future research should also focus on examining disparities among to better understand the experiences and needs of diverse groups as a way to address inequalities and support short and long-term recovery.

Advisor: Herd, Denise