Messina 2006

The American Journal of Drug and Alcohol Abuse, 32: 7–28, 2006
Copyright Q Taylor & Francis, Inc.

ISSN: 0095-2990 print/1097-9891 online
DOI: 10.1080/00952990500328463
Predictors of Prison-Based Treatment Outcomes:

Am J Drug Alcohol Abuse Downloaded from informahealthcare.com by University of California Irvine on 10/25/14
A Comparison of Men and Women Participants
Nena Messina, Ph.D., William Burdon, Ph.D.,

Garo Hagopian, J.D., and Michael Prendergast, Ph.D.
UCLA Integrated Substance Abuse Programs, Criminal Justice
Research Group, Los Angeles, California, USA
Abstract: The purpose of this study was to examine differences between men
and women entering prison-based therapeutic community (TC) treatment and
to explore the relationship of those differences to posttreatment outcomes (i.e.,
For personal use only.
aftercare participation and reincarceration rates). Extensive treatment-intake

interview data for 4,386 women and 4,164 men from 16 prison-based TCs in
California were compared using chi-square analyses and t-tests. Logistic regres-
sion analyses were then conducted separately for men and women to identify
gender-specific factors associated with post-treatment outcomes. Prison intake
data and treatment participation data come from a 5-year process and outcome
evaluation of the California Department of Corrections’ (CDC) Prison Treatment
Expansion Initiative. The return-to-custody data came from the CDC’s Offender
Based Information System. Bivariate results showed that women were at a sub-
stantial disadvantage compared with their male counterparts with regard to
histories of employment, substance abuse, psychological functioning, and sexual
and physical abuse prior to incarceration. In contrast, men had more serious
criminal justice involvement than women prior to incarceration. After controlling
for these and other factors related to outcomes, regression findings showed that
This study is supported by an Interagency Agreement (Contracts #C97.355

and #C98.346) between the California Department of Corrections (CDC), the
Office of Substance Abuse Programs (OSAP), and UCLA Integrated Substance
Abuse Programs (ISAP). The findings and conclusions of this article are those
of the authors and do not necessarily represent the official policies of the Depart-
ment.
We would like to give a special thanks to the contracted substance abuse pro-
grams for providing prison intake data, to Bubpha Chen for providing us with
reincarceration data for our sample.
Address correspondence to Nena Messina, Ph.D., UCLA Integrated Substance
Abuse Programs, Criminal Justice Research Group, 1640 S. Sepulveda Blvd.,
Suite 200, Los Angeles, CA 90025. E-mail: nmessina@ucla.edu
7
8 N. Messina et al.
there were both similarities and differences with regard to gender-specific predic-
tors of posttreatment outcomes. Time in treatment and motivation for treatment
were similar predictors of aftercare participation for men and women. Psychologi-
cal impairment was the strongest predictor of recidivism for both men and
women. Substantial differences in background characteristics and the limited
number of predictors related to posttreatment outcomes for women suggests

the plausibility of gender-specific paths in the recovery process.
Keywords: Gender-specific pathways, prison-based treatment, treatment outcome
INTRODUCTION
From 1995 to 2002 the nation’s state prison population increased by

27%, and the nation’s federal prison population increased by 71% (1).
Moreover, annual increases in the number of incarcerated women have
been consistently larger than the increases in the number of incarcerated
men for the past two decades (1–3). The growth in the nation’s prison
population largely has been due to the increased use of incarceration

for drug-related offenses (1), which also has created an increased demand
for appropriate drug treatment programs for men and women within
prison settings.
The therapeutic community (TC) treatment model has been shown to
be an effective method of substance abuse treatment (4) and many TC pro-
grams have been incorporated into American prisons over the past two
decades. Despite the increase in prison-based TC treatment, little is known
about the individual characteristics and specific treatment needs of drug-
dependent men and women participating in prison-based programs (5, 6).
Moreover, many of the existing evaluations of prison-based treatment
focus specifically on the programs for men (similar to community-based
treatment evaluations). Only a handful of studies have assessed outcomes
of women in prison-based treatment programs designed specifically for
women, and even fewer studies have compared and contrasted specific
factors that are associated with outcomes relative to men or women (7).
Understanding possible differences in the needs and recovery processes
of drug-dependent men and women offenders is important to help design
appropriate prison-based substance abuse programs.
This study begins to address the gap in the literature regarding gen-
der issues and treatment outcomes. We compare and contrast intake data
from a large sample of drug-dependent men and women offenders who
paroled from prison-based treatment programs within California. We
further assess posttreatment outcomes for men and women separately
to identify the correlates of success specific to gender, and to examine
Prison-Based Treatment Outcomes 9
the plausibility of ‘‘gender-specific’’ paths in the recovery process. The

following literature review pieces together the available information on
the background characteristics and treatment needs of men and women
in prison-based treatment, their postrelease treatment outcomes, and
gender-specific predictors of success.
Characteristics of Men and Women Entering Prison-Based Treatment
A review of the literature identified only 3 published studies that directly

compared the characteristics of incarcerated men and women in drug
treatment programs. Peters, Strozier, Murrin, and Kearns (8) compared
data from the intake assessments of 1,225 men and 430 women referred
to a short-term cognitive behavioral jail treatment program in Tampa,
Florida. Langan and Pelissier (9) compared 1,332 men and 312 women
who volunteered to participate in cognitive behavioral drug treatment
programs at 20 minimum, low, and medium security federal prisons
around the country. Messina, Burdon, and Prendergast (10) replicated
the design of the previous studies, comparing the characteristics

of 4,509 women and 3,595 men from 16 prison-based TCs throughout
California.
The findings from these 3 studies were strikingly consistent and par-
alleled findings on gender differences found in nonoffender populations
(11, 12), indicating that women were more likely than men to present
greater challenges to treatment practitioners. For example, incarcerated
women in treatment were significantly more likely than incarcerated
men to have severe substance abuse histories (e.g., using hard drugs,
using more frequently, using polysubstances, or taking drugs intrave-
nously), to have grown up in homes where drug use was present, to have
coexisting physical health and psychological problems, to be taking pre-
scribed medications for psychological problems, and to have been sexu-
ally and physically abused as children. However, men were found to
have more serious criminal histories than women (8–10). Although the
findings from the above offender populations are consistent, the extent
to which the outlined differences among men and women at treatment
entry may affect posttreatment outcomes largely is unknown.
Posttreatment Outcomes of Men and Women in Prison-Based Treatment
Fairly consistent findings from prison-based treatment evaluations for men

have been reported: Treatment reduces posttreatment recidivism and drug
use; men who continue treatment in the community after release from prison
do better than men who do not continue treatment; and length of time in
10 N. Messina et al.
treatment is positively correlated with greater success on parole (13–16). The

effect of treatment tends to disappear at about 3 years (13, 14, 17).
However, findings from studies of men cannot be generalized to
women for several reasons. First, men and women have different path-
ways to crime and addiction (18–20) and continue to use drugs for differ-
ent reasons (21, 22). Women’s patterns of drug abuse have been described
as more socially embedded than men’s and primarily revolve around inter-
personal relationships (23, 24). In fact, women are frequently initiated to
drug use by their male partners, and often continue to use drugs to cope
with abusive relationships (18, 22, 25). Histories of sexual and=or physical
abuse are also major preexisting conditions in subsequent addiction and
criminality for women (6, 21, 26). Second, men and women tend to enter
treatment for different reasons (27). Women cite family problems and
health as motivation for entering treatment, while men are more likely to
cite employment and legal issues (28). Third, the resources and services
available in women’s correctional facilities may be different than those
available to men (21).
A small body of literature has evaluated posttreatment outcomes for
women in prison-based TC treatment. The existing research, however, is

limited, and findings are sometimes contradictory (for a full review, see
Messina & Prendergast (7)). For example, two studies found that women
in prison-based treatment had more success on parole compared with a
no-treatment group of inmates (16, 29); whereas another study found
there was no difference between women in a prison treatment group ver-
sus women in a no-treatment group (30). Two other studies found that
women in prison-based treatment had reductions in recidivism and drug
use compared with a no-treatment group of women (31, 32). However,
Wexler’s study (16) found no difference in recidivism rates between
treated and untreated women. Moreover, Rhodes and associates (33)
conducted a 3-year follow-up of the women in Pelissier’s study (32)
and found that there was no evidence of long-term treatment effective-
ness (33). (For a comprehensive review of community-based treatment
outcomes for women, see Ashley, Marsden, and Brady (11)). Additional
limitations of the existing research include reliance on bivariate compar-
isons within relatively small sample sizes, which does not allow for the
control of pre-existing differences between groups or proper power to
detect treatment effects.
Predictors of Treatment Outcomes for Men and Women
Only two studies were found that directly explored gender-specific predictors
of treatment outcomes from men and women. Messina, Wish, and Nemes
(34) compared and contrasted the correlates of success for 296 men and 116
women who were randomly assigned to community-based residential TC
treatment differing primarily in the length of inpatient and outpatient phases.
Pelissier and colleagues (35) compared and contrasted the correlates of suc-
cess for 1,842 men and 473 women who participated in prison-based cogni-
tive behavioral treatment in a multisite federal prison evaluation.

Both studies found that there were similarities and differences with
respect to predictors of outcomes for men and women. For example,
Messina et al. (34) found that men and women who completed residential
treatment followed by outpatient treatment had substantial reductions in
drug use and arrests and increased employment. However, the longer resi-
dential treatment program had a particularly beneficial impact on women.
Number of prior arrests and a history of physical abuse also were associated
with negative postdischarge outcomes for women, but not for men. Pelissier
et al. (35) found that a history of prior commitments and disciplinary
actions during incarceration increased the likelihood of post-treatment
drug use and recidivism for both men and women. In addition, being Black
similarly increased the likelihood of drug use for both men and women, and
age at release from prison (older) decreased the likelihood of drug use. A
variety of other factors predicted outcomes for men only. Positive predic-
tors of outcomes included living with a spouse at follow-up, participating
in treatment (versus the no-treatment group), and employment. In con-
trast, only one additional factor was found to decrease posttreatment drug
use among women—participation in mental health treatment.
The different pathways and patterns of drug abuse for men and
women, and the availability of gender-specific services, are all considered
to be directly related to the likelihood of treatment entry and recovery
(11, 27). However, the limited research on gender issues does not provide
enough information to fully understand how treatment impacts men and
women differently. Yet, the available evidence does suggest that outcomes
for men and women should be assessed separately to identify specific factors
that affect behavioral outcomes following treatment.
The purpose of this study is to determine if the characteristics of
participants who paroled from the California prison-based TCs are dif-
ferentially correlated with treatment outcomes for men and women. This
study includes separate models for men and women assessing treatment
graduation, aftercare participation, and recidivism, and uses multivariate
analyses with appropriate independent variables selected specifically for
men and women. Based on the prior research comparing treatment
outcomes of men and women separately (34, 35), we formulated the
following research question: Do factors that predict aftercare partici-
pation and reincarceration differ substantially for men and women who
participated in prison-based treatment?
METHODS
The CDC Prison Treatment Expansion Initiative
Based on previous research in California testifying to the effectiveness of

prison-based TCs (16, 29, 30), the legislature and the California Depart-
ment of Corrections (CDC) began an initiative in the mid 1990s to
expand treatment opportunities for inmates. As part of this initiative,
the CDC established TC treatment programs in designated housing units
within many of its prisons, including all of the institutions that house
women. The data for this study were collected as part of an evaluation
of the CDC prison treatment expansion initiative.
This initiative includes two 5-year evaluation studies of the drug
treatment programs within the California state prison system. The Uni-
versity of California, Los Angeles (UCLA), Integrated Substance Abuse
Programs (ISAP; formerly known as the UCLA Drug Abuse Research
Center (DARC)) was contracted by CDC to evaluate these programs,
with contract management provided by CDC’s Office of Substance
Abuse Programs. The two evaluation studies cover 16 substance abuse

programs in 10 prisons, totaling approximately 3,300 beds (8 male pro-
grams totaling 1,600 beds and 7 female programs totaling 1,700 beds).
These programs became operational between July 1998 and December
1999 and include participants at all levels of security (Level I-Minimum
through Level IV-Maximum).
Prison-Based TCs in California
CDC contracts with community-based organizations experienced in the

TC model to provide services in the prisons (i.e., Amity Foundation,
Center Point, Inc., Civigenics Inc., Mental Health Systems, Phoenix
House, and Walden House). Although all of the programs provide treat-
ment services using the TC model, each provider has adapted the model
somewhat to conform to its own treatment philosophy and the specific
needs of its population, including providing appropriate programming
for women. Characteristics of the prison-based TCs include: (1) activities
that embody positive values that start a process of socialization; (2) treat-
ment staff who provide positive role models (and many of whom are
recovering addicts themselves); (3) an alternative concept of inmates that
is usually much more positive than prevailing beliefs and attitudes held
by correctional staff; and (4) an aftercare component for graduates from
the prison-based TC programs that provides funding for up to 6 months
of continued treatment (residential or outpatient services) in the com-
munity following release to parole (36).
Data Collection
Client-level data were collected by the treatment providers upon admis-

sion into the TC using the Intake Assessment (IA) instrument. The IA
is designed to assess a client’s pretreatment=preincarceration sociodemo-
graphic background, criminality, employment, and substance use, abuse,

or dependence. Adopted from the Initial Assessment developed at the
Institute of Behavioral Research at Texas Christian University (37), the
IA has been used extensively with criminal justice populations and pro-
vides information that is useful for both clinical and evaluation purposes.
The programs provided the intake data and treatment admission and dis-
charge data to UCLA ISAP through disclosure agreements under CFR
42 Part 2, Section 2.52. The UCLA General Campus Institutional Review
Board approved the study protocol. Postrelease return-to-custody rates
came from the CDC’s Offender Based Information System and include
incarceration for both parole violations and new charges.
Eligibility
Participation in these programs is open to inmates who have a documented

history of substance use or abuse (based on a review of their criminal back-
grounds as documented in their inmate central files), and who have between
6 and 24 months left to serve on their current sentence. Those who meet
these eligibility requirements are mandated into the treatment programs.
There are, however, certain exclusionary criteria that preclude otherwise
eligible inmates from entering the programs (e.g., gang-related enemy
situations, documented membership in a prison gang, time spent in admin-
istrative segregation for violence or weapons charges within the last 12
months, and felony and Immigration and Naturalization Service holds).
Participants
The current study focuses on 4,164 women and 4,386 men who entered
the participating programs between July 1998 and March 2001, paroled
prior to February 1, 2002 (i.e., in order to be at risk for one year prior
to our obtaining return to custody data), and for whom intake data were
available. Participants in the study were predominately White (39%)
or Black (31%), were 35-years-old on average, and had completed
approximately 11 years of education prior to their current incarceration.
About half (45%) had never been married. Thirty-two percent were
employed during the 30 days prior to their current incarceration, and
60% were parents. Participants reported an average of 15.5 arrests in
their lifetime. Approximately 93% met DSM-IV criteria for alcohol or

drug abuse or dependence, and 57% were serving time for a drug-related
offense at the time of their treatment admission.
Data Analyses
The analyses for the current study are designed to examine the relevance
of pretreatment differences between men and women on treatment out-
comes (i.e., aftercare participation and reincarceration). The distributions
(shown in Table 1) of demographic characteristics, substance use, crimi-
nal, and psychological histories prior to incarceration by gender were
evaluated using chi-square tests (for categorical variables) and t-tests
(for continuous variables). Preliminary analyses (chi-square and t-tests
results not shown) examining correlates of aftercare participation and
reincarceration were conducted separately for men and women to identify
gender-specific predictors of outcomes for inclusion in the logistic
regression models (see below).
Logistical regression analyses were conducted separately for men and
women for each dependent variable (aftercare participation and return-

to-custody). Aftercare participation was defined as any participation in
aftercare treatment (dummy coded; 0 ¼ no and 1 ¼ yes) and return-to-
custody was defined as any return-to-custody during the 12 months since
parole (dummy coded; 0 ¼ no and 1 ¼ yes). All logistic regression models
included demographic variables and other correlates that were signifi-
cantly related to the above outcomes (i.e., age, race, education, employment,
marital status, number of years incarcerated, primary drug disorder, and the
presence of cooccurring disorders). Additional independent variables were
included depending on the appropriateness to gender and the dependent
variable. For example, histories of sexual and physical abuse were included
in the regression models for the women offenders only, as they were not
significantly correlated with outcomes for the men. The logistic regression
models examining predictors of participation in aftercare included a motiva-
tion for treatment score (yielding a distribution of motivation ranging from
0 to 6; see Burdon et al. (5)). Length of time in treatment also has been
shown to be a strong predictor of treatment outcomes (15, 38). Therefore,
we included a variable in the aftercare and return-to-custody regression
models that defined total time in prison-based treatment. We also included
a variable that defined total time in aftercare treatment in the return-to-
custody regression models.
Adjusted odds ratios were used to interpret the statistically signifi-
cant effect size at the p < .05 level: [Exp(Beta) 1] 100 ¼ adjusted odds
ratio (e.g., the percentage increase or decrease in the odds of being
returned to custody).
Table 1. Sample characteristics at treatment admission, by gender
Men Women Total

(n ¼ 4,164) (n ¼ 4,386) (N ¼ 8,550)a
Characteristics % M(SD) % M(SD) % M(SD)
Race=ethnicity
White 42 37 39
Black 32 31 31
Hispanic 20 21 21
Other 6 11 9
Marital status
Never married 48 41 45
Married 26 24 25
Previously married 26 34 30
Age at admission 34.5 (8.9) 36.0 (7.6) 35.4 (8.2)
Number of years of education 11.4 (2.0) 11.0 (2.2) 11.2 (2.1)
Employed 30 days prior to incarceration 53 33 41
Ever sexually=physically 13 27 22
abused as a childb
Ever sexually=physically 3 27 18
abused as an adultb
Primary drug problem (self-report)
Methamphetamine=amphetamines 40 30 35
Cocaine=crack 19 34 28
Heroin 14 21 18
Otherc 16 10 12
None 11 5 7
Drug use 60 days prior to incarceration:
Amphetamines=meth. daily 42 37 40
Cocaine=crack daily 19 38 29
Opiates daily 33 50 42
Alcohol=marijuana daily 37 42 39
2 or more drugs daily 19 24 22
Age first arrested 17.1 (6.1) 21.3 (7.5) 19.5 (7.3)
Number of arrests in lifetime 15.8 (26.2) 17.4 (28.1) 14.7 (24.6)
Number of years incarcerated in lifetime 5.5 (5.8) 3.2 (4.1) 4.2 (5.0)
Cooccurring disorders during treatment 14 27 21
Motivation for treatment (0 to 6) 1.1 (1.2) 1.3 (1.3) 1.2 (1.2)

All bivariate analyses are statistically significant at p < .001.
a
N’s vary slightly due to missing data.
b
Data collected from partial sample due to survey revisions (men ¼ 801;
women ¼ 1,933).
c
Includes marijuana=hashish, PCP, hallucinogens, barbiturates, sedatives,
alcohol, and inhalants.
RESULTS
Bivariate Comparisons of Men and Women at Admission
Table 1 displays the sample characteristics for men (n ¼ 4,164) and

women (n ¼ 4,386) entering the prison-based TCs during the selected

study period. Gender differences were found with regard to demographic
characteristics, sexual and physical abuse histories, primary drug prob-
lem, substance abuse and criminal justice histories, and the presence
of cooccurring disorders. However, some of the differences that reached
significance are quite small (i.e., years of education and motivation for
treatment scores), as the large sample size substantially increased the
likelihood of finding statistically significant differences between men
and women.
Although the majority of men and women were White or Black,
women were significantly more likely than men to be of Asian or
American Indian decent (11 vs. 6%; p < .001) and to be divorced or sepa-
rated (34 vs. 26%; p < .001). Women were older than men (36.0 vs. 34.5
years; p < .001), had slightly less education (11.0 vs. 11.4 years;
p < .001), and were less likely to have been employed prior to incarcera-
tion (33 vs. 53%; p < .001). Women also were much more likely than
men to report having been sexually and physically abused as a child
(27 vs. 13%; p < .001) and as an adult (27 vs. 3%; p < .001). Women were
more likely to report cocaine=crack as their primary drug problem (34 vs.
19%; p < .001), while men were more likely to report methamphetami-
ne=amphetamine as their primary drug problem (40 vs. 30%; p < .001).
With the exception of methamphetamine=amphetamine, women were
more likely to report daily drug use prior to incarceration and to report
daily use of two or more drugs (24 vs. 19%; p < .001). Compared with
women, men were younger at the age of first arrest (17.1 vs. 21.3 years;
p < .001), had been arrested more often in their lifetime (17.4 vs. 14.7
arrests; p < .001), and had been incarcerated longer in their lifetime (5.5
vs. 3.2 years; p < .001). However, women were more likely than men to
have a cooccurring psychiatric disorder (27 vs. 14%; p < .001) and to have
a slightly higher motivation for treatment score (1.3 vs. 1.1; p < .001).
Gender and Posttreatment Outcomes
Bivariate comparisons between men and women were conducted for the
two posttreatment outcomes: aftercare participation and a return-to-
custody within 12 months from parole. Men were significantly more
likely to participate in aftercare than women (46% of men vs. 41% of
women; p < .001); yet, men who participated in aftercare did not stay as
long as women (4.6 months for men vs. 5.1 months for women; p < .001).
In addition, men were significantly more likely than women to be
returned to custody within 12 months from parole (40% of men vs.
31% of women; p < .001), and were returned sooner than women (8.4
months for men vs. 9.2 months for women; p < .001).
Logistic regression analyses assessing the relationship of gender to
aftercare participation and 12-month return-to-custody rates were con-
ducted previously with this CDC sample (see Burdon et al. (5)). These
results (not shown) indicated that when other factors (e.g., demographics,
number of years in prison, substance abuse disorder, time in prison treat-
ment, and motivation) were controlled, gender was no longer a signifi-
cant predictor of aftercare participation. The most important predictor
of aftercare participation was motivation for treatment regardless of
gender. However, gender remained associated with a return-to-custody
within 12 months from parole. After controlling for various other factors,
men still were significantly more likely to be returned to custody com-
pared with women.
Gender-Specific Paths (Logistic Regression Models for Men

and Women)
Aftercare Participation
Separate logistic regression models assessing predictors of aftercare

participation for men and for women are shown in Table 2.
Men: Seven out of 10 variables significantly predicted aftercare
participation among the men (length of prison-based TC treatment,
age, race, motivation for treatment, length of lifetime incarceration,
employment, and primary drug problem). For each additional day in
prison-based treatment, the odds of participating in aftercare increased
by .4% ( p < .001). For each additional year of age, the odds of aftercare
participation increased by 5% ( p < .001). Compared with Hispanic male
participants, the odds of White males participating in aftercare were
increased by 79% ( p < .001), and the odds of Black males participating
in aftercare were increased by 45% ( p < .05). For each additional score
on the motivation for treatment scale, the odds of participating in
aftercare were increased by 26% ( p < .001). For each additional year
of lifetime incarceration, the odds of aftercare participation decreased
by 3% ( p < .01). Compared with men who were unemployed prior to
incarceration, the odds of aftercare participation for those who were
employed were reduced by 26% ( p < .01). Compared with men who
Table 2. Logistic regression predicting aftercare participation
Effect
Variable B df Sig Exp(B) size (%)
Men (N ¼ 1,743)
Time in prison treatment .004 1 .000 1.004 0.4

Cooccurring disorders .106 1 .516 1.114
Age .046 1 .000 1.047 5
Education (years) .015 1 .599 1.015
Recent employment history .296 1 .011 .743 26
Number of years incarcerated .032 1 .003 .969 3
Race [Hispanic]a 3 .005
White .584 1 .000 1.793 79
Other .386 1 .180 1.471
Black .370 1 .037 1.447 45
Marital status [never married]a 2 .106
Married=living together .192 1 .190 .825
Divorced=separated .147 1 .327 1.159
Primary drug problem [Opiates]a 3 .000
Cocaine .208 1 .306 1.232

Alcohol=other .743 1 .000 .476 52
Methamphetamine .059 1 .749 1.060
Motivation .230 1 .000 1.259 26
Constant 3.695 1 .000 .025 75
Women (N ¼ 1,192)
Time in prison treatment .002 1 .000 1.002 0.2
Cooccurring disorders .056 1 .685 1.057
Age .002 1 .818 1.002
Education (years) .039 1 .150 .961
Recent employment history .036 1 .792 1.037
Number of years incarcerated .019 1 .261 .981
White .286 1 .106 1.331
Other .032 1 .900 1.032
Black .277 1 .164 1.320
Marital status [Never Married]a 2 .432
Married=living together .091 1 .589 1.096
Cocaine .209 1 .275 .811
Alcohol=other .153 1 .424 1.165
Methamphetamine .582 1 .006 .559 44
Abused as child .014 1 .924 .986
Motivation .125 1 .012 1.133 13
Constant 1.020 1 .020 .361 64
a
Brackets indicate reference category.

p < .05.

p < .01.
reported opiates as their primary drug problem, the odds of aftercare

participation for men who reported alcohol=other as their primary drug
problem were reduced by 52% ( p < .001). The presence of cooccurring
disorders, prior education, and prior marital status were not significantly
related to aftercare participation among the men.
Women: Three out of 11 variables significantly predicted aftercare

participation among the women (length of prison-based TC treatment,
motivation for treatment, and primary drug problem). For each
additional day of prison-based treatment, the odds of participating in
aftercare increased by .2% ( p < .001). For each additional point on the
motivation scale, the odds of participating in aftercare were increased
by 13% ( p < .01). Compared with women who reported opiates as their
primary drug problem, the odds of participating in aftercare for women
who reported amphetamine=methamphetamine as their primary drug
problem were reduced by 44% ( p < .01). The presence of cooccurring
disorders, sexual=physical abuse histories, prior education, prior employ-
ment, age, race, prior marital status and length of lifetime incarceration
were not significantly related to aftercare participation among the
women.
Return-to-Custody
Separate logistic regression models assessing predictors of a 12-month

return-to-custody for men and for women are shown in Table 3.
Men: Six out of 10 variables significantly predicted a 12-month
return-to-custody among the men (the presence of cooccurring disorders,
race, length of lifetime incarceration, age, employment, and total days in
aftercare). Compared with men with only a substance abuse disorder, the
odds of men with cooccurring psychiatric disorders being returned to cus-
tody within 12 months were increased by 40%, ( p < .05). Compared with
Hispanic men, the odds of white men being returned to custody were
increased by 55% ( p < .01), and the odds of black men being returned
to custody were increased by 63% ( p < .001). For each additional year
of lifetime incarceration, the odds of returning to custody within 12
months were increased by 8% ( p < .001). For each additional year of
age, the odds of men returning to custody within 12 months were reduced
by 4% ( p < .001). Compared with men who were unemployed prior to
incarceration, the odds for those who were employed of returning to cus-
tody within 12 months were reduced by 29% ( p < .001). For each
additional day of aftercare, the odds of returning to custody within 12
months were reduced by 1% ( p < .001). Time in prison-based treatment,
education, primary drug disorder, and prior marital status were not
significantly related to a return-to-custody within 12 months.
Table 3. Logistic regression predicting return to custody within 12 months
Effect
Variable B df Sig Exp(B) size (%)
Men (N ¼ 1,744)
Time in prison treatment .000 1 .373 1.000

Cooccurring disorders .338 1 .022 1.402 40
Age .037 1 .000 .964 4
Education (years) .030 1 .250 .970
Recent employment history .338 1 .001 .713 29
Number of years incarcerated .074 1 .000 1.077 8
Race [Hispanic] 3 .004
White .437 1 .002 1.548 55
Other .286 1 .267 1.331
Black .487 1 .001 1.627 63
Marital status [Never married]a 2 .784
Cocaine .082 1 .674 .922

Alcohol=other .018 1 .916 .982
Methamphetamine .066 1 .703 .936
Aftercare participation .007 1 .000 .993 1
Constant 1.055 1 .005 2.872 187
Women (N ¼ 1,192)
Time in prison treatment .001 1 .019 .999 0.1
Cooccurring disorders .455 1 .001 1.576 58
Age .038 1 .000 .963 4
Education (years) .067 1 .020 .936 6
Recent employment history .220 1 .124 .803
Number of years incarcerated .036 1 .024 1.036 4
White .113 1 .540 1.120
Other .135 1 .592 1.145
Black .164 1 .415 1.178
Marital status [Never married]a 2 .364
Divorced=separated .166 1 .325 .847
Cocaine .222 1 .281 1.248
Alcohol=other .235 1 .297 .790
Methamphetamine .157 1 .429 .854
Abused as child .049 1 .743 1.050
Aftercare participation .007 1 .000 .993 1
Constant 1.667 1 .000 5.297 430
a
Brackets indicate reference category.

p < .05.

p < .01.
Women: Six of the 11 variables significantly predicted a 12-month

return-to-custody among the women (length of prison-based TC treat-
ment, age, education, total days in aftercare, the presence of a cooccur-
ring psychiatric disorder, and length of lifetime incarceration). For
each additional day in prison-based treatment, the odds of returning to
custody within 12 months were reduced by .1% ( p < .02). For each
additional year of age and education, the odds of returning to custody
within 12 months were reduced by 4% ( p < .001) and 6% ( p < .05),
respectively. For each additional day spent in aftercare, the odds of
returning to custody within 12 months were reduced by 1% ( p < .001).
Compared with women with only a substance abuse disorder, the odds of
codisordered women returning to custody within 12 months were increased
by 58%, ( p < .001). For each additional year of lifetime incarceration,
the odds of returning to custody within 12 months were increased by
4% ( p < .05). Sexual=physical abuse histories, prior employment, race,
primary drug problem, and prior marital status were not significantly
associated with a return-to-custody within 12 months.
DISCUSSION
The purpose of this study was to outline the differences between men and
women offenders entering TC treatment and to explore the relationship
of those differences to post-treatment outcomes. The differences found
between men and women entering prison-based treatment in California
mirrored the findings of previous studies of incarcerated treatment popu-
lations; whereby women were at a substantial disadvantage compared to
their male counterparts in all areas of life history except for their past
criminal involvement (8, 9, 35). The degree to which these differences
affected posttreatment outcomes was less clear, as very little research
had previously examined gender-specific paths of recovery.
Table 4 provides a summary of the significant predictors of the two
outcome measures in the regression models, by gender. One of the most
notable findings from this table is that there were fewer predictors of out-
comes for women than for men (similar to findings reported in Pelissier
et al. (35)). Even though women were significantly more likely than
men to have more severe substance abuse histories, sexual and physical
abuse histories, and cooccurring psychiatric disorders prior to incarcer-
ation, these variables were not associated with the outcome measures.
For example, after controlling for other related factors, a history of sex-
ual and=or physical abuse as a child was no longer related to aftercare
participation or reincarceration among the women. However, a fairly
small percentage of women and men in our sample reported histories
22
Table 4. Summary of significant predictors of outcomes in men and women
Significant predictors for men Significant predictors for women
Increased likelihood Decreased likelihood Increased likelihood Decreased likelihood

Outcomes of outcome of outcome of outcome of outcome
Aftercare Whites > hispanics Prior employment Total days in prison Meth. < opiate
participation Blacks > hispanics Total years in prison treatment
Age (older) Alcohol=other < opiate Motivation
Total days in prison
treatment
Motivation
Return-to-custody Whites > hispanics Age (older) Cooccurring disorders Age (older)
Blacks > hispanics Prior employment Total years in prison Prior education
Cooccurring disorders Total days in aftercare Total days in prison
Total years in prison treatment
Total days in aftercare
of sexual and physical abuse. Previous studies have shown percentages

ranging from 19% to 55% among offender populations (8, 9). The low
percentages reported here could be due to the fact that these particular
questions were asked by treatment personal prior to treatment entry
and not experienced researchers. Since these questions were only asked
from a partial sample of participants, the regression analyses might not

have detected variability due to histories of sexual=physical abuse.
Similarities Between Men and Women
Consistent with previous findings from incarcerated populations, age,

motivation for treatment, time in prison treatment, and time in aftercare
were positively associated with at least one (and in some cases both) of the
outcomes for men and women (13–16, 29, 31). In addition, both men and
women who reported opiates as their primary drug problem were most
likely to go to aftercare treatment compared to those who reported other
drug dependencies. The direction of the correlation for age and motiv-
ation for treatment to outcomes are often replicated in offender popula-

tions, as older parolees often ‘‘age-out’’ of criminal behavior and those
with substantial internal motivation are highly likely to succeed upon
release from prison. Moreover, selection bias was not likely to be an
important factor in producing the ‘‘time in treatment’’ finding since length
of time in prison treatment was not within the control of the inmate (which
would create selection bias), but rather was determined by when CDC
placed the inmate in the treatment program and the length of their sen-
tence. Since the mean time spent in prison treatment for men was 7.1
months (SD ¼ 4.8) and 6.9 months (SD ¼ 4.5 months) for women, it
appears that a substantial number of inmates in this sample were assigned
to these TCs with approximately 7 months remaining on their sentence.
Predictors that negatively affected outcomes for both men and
women included the cooccurrence of psychiatric disorders during treat-
ment and total years in prison over one’s lifetime. Codisordered inmates
and those with more total years in prison in one’s lifetime were more
likely to be reincarcerated regardless of gender, a finding consistent with
previous research indicating that those with the most severe psychological
problems and those with serious criminal histories are more likely to
recidivate (34, 39).
Differences Between Men and Women
Time in treatment warrants further clarification (discussed above), as it

was also differentially associated with reincarceration among men and
women. Total time in prison-based treatment and aftercare were related

to a reduced likelihood of reincarceration for women only, indicating
the positive effect of continuous and long-term treatment episodes
(similar to that reported in Messina et al. (34)). In contrast, only time
in aftercare was related to a reduced likelihood of reincarceration for
men. This finding creates an interesting dilemma, as it also appears that

men were more likely to go to aftercare treatment than women, but did
not stay as long as the women. The lower aftercare participation rate
reported for women may have been due to gaps in reporting pro-
cedures. The Female Offender Treatment and Employment Program
(FOTEP) aftercare treatment program was an additional option for
women paroling from prison in California. Women entering the
FOTEP program did not access aftercare treatment using the same pro-
cedure as men or women parolees opting for other forms of aftercare
(e.g., outpatient, sober living, residential). As a result, data on the num-
ber of women entering the FOTEP aftercare program may not have
been complete.
Another difference between men and women was that race was a sig-
nificant predictor of both outcomes for men, but not at all for women.
Among the men, Whites and Blacks were more likely than Hispanics to
participate in aftercare treatment and to be returned to custody. Previous
findings from this sample (see Burdon et al. (5)) have shown that a great-
er proportion of Hispanics reported living with family=relatives prior to
their current incarceration. In addition, a recent review of studies that
examined drug use behaviors among Hispanics found that social support
systems (including familial factors) are important factors in preventing
drug abuse among this population (40). These findings suggest that the
familial support systems for Hispanics are stronger, and that they may
tend to rely on these support systems to a greater degree and with greater
success following release to parole than Whites or Blacks.
Finally, being employed prior to incarceration decreased the likeli-
hood of aftercare participation and a return to custody for men (similar
to that reported in Pelissier et al. (35)), but was not related to outcomes
for women. In contrast, prior education decreased the likelihood of
reincarceration for women, but was not related to outcomes for men.
Limitations
It should be noted that the current study relied on general intake data
collected by treatment personnel for a large sample of men and women
entering prison-based treatment. Due to the overall scope of the CDC
initiative, the questions available on the IA instrument were limited in
both range and depth. The IA instrument was not originally designed to
capture detailed differences between men and women entering prison-
based treatment, and, therefore, many factors that may be predictive of
posttreatment outcomes for women were absent. For example, the ques-
tions on the IA regarding histories of sexual and physical abuse were
dichotomous (yes=no) questions, which did not inquire about the specific
type of abuse, the perpetrator of the abuse, the age at which it occurred,
or the duration of the abuse, which have previously been shown to be
related to women’s recovery (6, 21). In addition, the findings generated
by this study are limited to inmates who were selected for treatment par-
ticipation and thus, cannot be generalized to general inmate populations
in state prison.
Implications and Conclusion
The results of this study have highlighted relevant individual-level factors

that serve as predictors of participation in aftercare treatment and
12-month return to custody rates among men and women parolees of

prison-based TC treatment programs. One of the most consistent find-
ings, relative to previous research, is the success for both men and women
associated with aftercare participation. The consistency of this finding
indicates the need to place greater emphasis on promoting appropriate
aftercare treatment for inmates in the prison-based treatment programs,
regardless of gender.
In contrast, consistent findings regarding the increased likelihood of
reincarceration among inmates with cooccurring psychiatric disorders
highlights the difficulty involved in delivering effective treatment services
to codisordered men and women in correctional settings. Because treat-
ment staff may not be adequately trained to treat certain psychiatric
disorders that offenders present upon entry into prison-based programs,
perhaps there should be separate treatment tracks for codisordered
offenders to provide effective treatment to this high-risk population. At
the very least, referrals to appropriate aftercare treatment should be in
place upon release from prison programs, which would require increased
communication, coordination, and collaboration between substance
abuse and psychiatric treatment systems (41). The high prevalence rates
of psychiatric disorders among incarcerated drug offenders across the
nation suggest that these issues are probably not unique to California (39).
In conclusion, the limited number of identified predictors of out-
comes for women is notable. It would appear that we know more about
what leads to successful outcomes for men than for women. Indeed, the
limitations of the available data of our study may have drawn further
attention to the gap in our knowledge of gender-specific paths to

recovery. Future studies will need to explore and incorporate addi-
tional predictors of posttreatment outcomes that more appropriately
reflect paths of recovery for women. Future studies also may need
to explore additional posttreatment outcomes for women such as
improved relationships with children, living situations, and psychological

status.
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The American Journal of Drug and Alcohol Abuse, 32: 7–28, 2006

Copyright Q Taylor & Francis, Inc.

Predictors of Prison-Based Treatment Outcomes:

A Comparison of Men and Women Participants

Nena Messina, Ph.D., William Burdon, Ph.D.,

aftercare participation and reincarceration rates). Extensive treatment-intake

This study is supported by an Interagency Agreement (Contracts #C97.355

number of predictors related to posttreatment outcomes for women suggests

Keywords: Gender-specific pathways, prison-based treatment, treatment outcome

From 1995 to 2002 the nation’s state prison population increased by

population largely has been due to the increased use of incarceration

the plausibility of ‘‘gender-specific’’ paths in the recovery process. The

Characteristics of Men and Women Entering Prison-Based Treatment

A review of the literature identified only 3 published studies that directly

the design of the previous studies, comparing the characteristics

Posttreatment Outcomes of Men and Women in Prison-Based Treatment

Fairly consistent findings from prison-based treatment evaluations for men

treatment is positively correlated with greater success on parole (13–16). The

women in prison-based TC treatment. The existing research, however, is

Predictors of Treatment Outcomes for Men and Women

tive behavioral treatment in a multisite federal prison evaluation.

The CDC Prison Treatment Expansion Initiative

Based on previous research in California testifying to the effectiveness of

Abuse Programs. The two evaluation studies cover 16 substance abuse

Prison-Based TCs in California

CDC contracts with community-based organizations experienced in the

Client-level data were collected by the treatment providers upon admis-

graphic background, criminality, employment, and substance use, abuse,

Participation in these programs is open to inmates who have a documented

their lifetime. Approximately 93% met DSM-IV criteria for alcohol or

women for each dependent variable (aftercare participation and return-

Table 1. Sample characteristics at treatment admission, by gender

Men Women Total

Bivariate Comparisons of Men and Women at Admission

Table 1 displays the sample characteristics for men (n ¼ 4,164) and

women (n ¼ 4,386) entering the prison-based TCs during the selected

Gender and Posttreatment Outcomes

Gender-Specific Paths (Logistic Regression Models for Men

Separate logistic regression models assessing predictors of aftercare

Table 2. Logistic regression predicting aftercare participation

Time in prison treatment .004 1 .000 1.004 0.4

Cocaine .208 1 .306 1.232

reported opiates as their primary drug problem, the odds of aftercare

Women: Three out of 11 variables significantly predicted aftercare

Separate logistic regression models assessing predictors of a 12-month

Table 3. Logistic regression predicting return to custody within 12 months

Time in prison treatment .000 1 .373 1.000

Cocaine .082 1 .674 .922

Women: Six of the 11 variables significantly predicted a 12-month

Significant predictors for men Significant predictors for women

Increased likelihood Decreased likelihood Increased likelihood Decreased likelihood

of sexual and physical abuse. Previous studies have shown percentages

from a partial sample of participants, the regression analyses might not

Similarities Between Men and Women

Consistent with previous findings from incarcerated populations, age,

ation for treatment to outcomes are often replicated in offender popula-

Differences Between Men and Women

Time in treatment warrants further clarification (discussed above), as it

women. Total time in prison-based treatment and aftercare were related

men. This finding creates an interesting dilemma, as it also appears that

Implications and Conclusion

The results of this study have highlighted relevant individual-level factors

12-month return to custody rates among men and women parolees of