How can we use what we know about women and the War on Drugs to create real drug policy reform?

In our first installment about women, addiction, and the criminal justice system, we shared some stark facts about the impact of “War on Drugs” policies on American women.  Here are two:

  • The number of women in prison has grown by over 800% in the past three decades. The female prison population grew by 832% from 1977 to 2007. The male prison population grew 416% during the same time period.
  • Two thirds of women in prison are there for non-violent offenses, many for drug-related crimes. In the 10-year period from 1999 to 2008, arrests of women for drug violations increased 19%, compared to 10% for men.

For more, see Women have been particularly affected by the War on Drugs (11/8/13).

If you’re surprised by these numbers, you’re not alone.  As is so often the case, advocates and researchers have been pointing to these trends for years, but the general public remains ignorant of them, leading some to refer to women as “silent casualties of the war on drugs”

As the conversation about drug policy reform heats up, we hope that statistics about incarcerated women can serve as a jumping off point.  Because drug policy reform is so much more complex than the question of whether to legalize marijuana.

Last year, former ONDCP Director Kerlikowske criticized any drug policy “that fits on a bumper sticker.”

It’s certainly time for a conversation about drug policy reform that no sticker could hold.  For starters: we’ve imprisoned a whole lot of women in the name of the War on Drugs, many of whom have substance use disorders. Real drug policy reform will address those lopsided effects.

Consider this message from the ACLU and keep reading.

Far from offering rehabilitative services, prisons envelop women in an atmosphere of violence and abuse that fails to address their psychological, physical, or socioeconomic needs—the very factors that contribute to their involvement with drugs. Instead, the prison experience exacerbates these concerns, inflicting further damage.  (Caught in the Net: The Impact of Drug Policies on Women and Families)

Three ways to make drug policy reform matter to women

This post looks at some of the issues of particular importance to justice-involved women that offer opportunities for meaningful improvements in their lives.  To repair some of the damage wrought specifically on women as a result of the War on Drugs, consider these areas for reform:

  1. Expand alternatives to incarceration
  2. Improve access to treatment for incarcerated women
  3. Make prisons and correctional services more gender-responsive

Each recommendation is explored in more detail below.

Expand Alternatives to Incarceration

Imprisoning fewer women is a good place to start redressing the 800% increase of incarcerated women in three decades and, fortunately, policy makers at the federal level are paying attention.  Federal drug policy reforms have loosened mandatory minimums and placed a new emphasis on diversion programs and alternatives to incarceration (ATIs).  Individual states and localities are beginning to follow suit.

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Image: The CHJ’s report on diversion programs, No Entry

At the end of last year, the Center for Health and Justice (CHJ) released a National Survey of Criminal Justice Diversion Programs and Initiatives.  Although diversion programs are generally still in the early stages of development, they exist at every phase of justice involvement, from pre-to post-adjudication.  They are multiple and varied, from crisis intervention teams (CITs) at the law enforcement level to drug treatment alternatives at the sentencing level.While criminal convictions and incarcerations are expensive for states and their taxpayers, many diversion programs cost a fraction of the amount.

The CHJ notes that substance use and mental health care involvement top the list as the most pressing issue in reducing the criminal justice population.

In particular, the CHJ recommends a risk-needs-responsivity (RNR) approach that “assesses both the risk of recidivism as well as needs related to substance use, mental health, and other social and environmental conditions, and determines the appropriate type and dose of treatments and other services necessary to maximize justice and health outcomes.”

For women, the RNR approach recognizes their gender-specific and relational needs and implements programs that address their pathways to crime, including trauma and substance use disorders (SUDs).

New York City’s Women’s Prison Association has these approaches in mind. It recently instituted an alternative program to incarceration called JusticeHome that will allow some women to serve their sentences at home, remaining with their families. As 64% of women live with their minor children prior to their arrests (41% of these are single-parent households), it’s an example of a practical response to women’s circumstances.

The New York Times reports that JusticeHome will be open to 45 women at the outset. The cost of the program, per woman, is $15,000. In light of the $129,000 it costs to incarcerate a woman in the state institution, the savings are substantial.

But more than that, JusticeHome intends for its atmosphere to be truly one of “correction” instead of “punishment”—women in JusticeHome will receive counseling, education, help with the management of their households and treatment for SUDs.

And women can be available to their children, important for disrupting the cycle of incarceration of juveniles whose parents were also imprisoned.

Improve access to treatment

For those women with SUDs who are already incarcerated, however, treatment access is essential.  One of the more critical elements lacking in women’s corrections is adequate and widely-available SUD treatment, both during and after incarceration.  According to the Sentencing Project, 60% of incarcerated women have a history of dependence.

Incarcerated women are more likely than men to have a SUD (66.1 percent vs. 64.3 percent), and nearly twice as likely to suffer from co-occurring mental health disorders (40.5 percent vs. 22.9 percent).

Furthermore, only 1 in 5 women in state prisons with a history of substance abuse and 1 in 8 women in federal prisons receives treatment for substance abuse.

The Residential Drug Abuse Treatment Program (RDAP), a federally developed correctional treatment program for addiction, is touted as a successful program.  But it is only available in 11 out of 28 women’s federal prisons.

An in-state example of this need lies in SCI Muncy, a close-security female-only correctional institution here in Pennsylvania. SCI Muncy has 1,455 beds, but Wings for Life, its inpatient substance abuse treatment program has only 60 beds. House of Hope, its treatment center for women with an SUD and a background of violence and trauma, has just 26 beds.

While the problem of inadequate treatment behind the wall is certainly not restricted to women–male inmates also suffer from lack of SUD services–the fact that a full 2/3 of women in prison are there for non-violent, often drug-related, offenses points directly at the importance of improving access to treatment among incarcerated women.

And access to treatment prevents recidivism: one study found that women prisoners were 10 times more likely to return to prison if they did not receive treatment.

Make prisons and correctional services more gender-responsive

Cristina Rathbone, author of A World Apart: Women, Prison, and Life Behind Bars, writes that in the 19th century United States, women who had committed criminal offenses (like adultery, stubbornness (!), public drunkenness, homelessness, and prostitution) were incarcerated in the basements of male prisons and largely ignored.  There was no place else for them.

There’s a historical thread of neglect between then and now. Women are still serving time in places that were designed for violent men.

“Traditional criminal justice policies and practices have largely been developed through the lens of managing men, not women,” writes the National Resource Center on Justice Involved Women (NRCJIW).

The NRCJIW specifies that appropriate healthcare, programs and services that support transition into the community for women are often inadequate because they do not consider how gender changes their particular needs.

For instance, medical services are lacking not only in reproductive care for incarcerated women, but also in addressing and treating “higher rates of HIV than men, incidences of breast and gynecological-related cancers, higher mortality rates from cardiovascular disease, [and the] prevalence of eating disorders.”

Similarly, reentry services don’t always consider challenges that women are more likely to face.  For instance, many women need help finding employment, childcare and transportation, safe housing for themselves and their children, and reunifying with their children.


The research literature on justice-involved women talks a lot about pathways to incarceration.  We know that women follow different pathways to prison and, increasingly, we know that that matters.

Female inmates are more than seven times likelier to have been sexually abused and almost four times likelier to have been physically abused before incarceration than male inmates. Relatedly, they have high levels of diagnoses for depression and post-traumatic stress disorder, among other mental illnesses (Wright et al, 2012).

And women’s substance involvement may have significant ties to social relationships, their connections (or disconnections) with others.

It’s not unusual, says the NRCJIW, for women to “override their personal values and beliefs in the commission of a crime to meet the needs of their children, or to please or demonstrate loyalty to a significant other (e.g., they may become involved in substance abuse or prostitution at the demands of a boyfriend or abuser, or be coerced by a male to participate in criminal activity or assume responsibility for his crime, etc.).”

These gender-specific pathways mean that assessment tools and treatment services, most of which were designed for men in mind, can completely overlook relevant issues.

Experts have criticized assessment instruments used to categorize female inmates’ level of risk and need for services as inadequate. Inadequate assessments have significant implications for risk assessment, treatment services, and other prison services (White, 2012).

In response, a team at the University of Cincinnati received support from the National Institute of Corrections to develop a risk-needs assessment for women prisoners, with a full list of implementation considerations.  Their new women’s assessment identifies needs in these categories: 1) trauma and abuse; 2) unhealthy relationships; 3) parental stress; 4) depression; 5) self-efficacy, and 6) current mental health symptoms.” In 2013, over 20 jurisdictions throughout the country had adopted it.

And studies of women’s different pathways to prison and patterns of drug use have tended to conclude that substance abuse treatment programs designed for men may be inappropriate for women. But have gender-responsive programs been effective for women so far?

There is a growing body of research that suggests they are.  According to a 2011 study assessing the relative effectiveness of gender-responsive outpatient treatment programs compared to outpatient programs treating both men and women, women treated in the gender-specific program reported significantly less substance use and criminal activity than women in the traditional treatment program.

Another 2011 study examining the long-term outcomes of gender responsive treatment  for women who were pregnant or parenting found lower levels of arrest in the first year after treatment. During the third year after treatment, gender-specific program participants had lower incarceration rates.  And a 2012 study reported significant reductions in post-traumatic symptoms in women receiving gender responsive treatment compared with women in regular treatment programs (Messina, Calhoun and Warda, 2012).

Beyond Trauma, by Dr. Stephanie Covington, a strengths-based gender-responsive program, is one of the gender-responsive curricula used in prisons today


References and further reading

Bergman, Joseph. “Mothers Convicted of Felonies May Get Chance to Stay Out of Prison.” New York Times May 8, 2013.

Kerman, Piper. (2011). Orange Is the New Black. New York: Spiegel & Grau.

Messina, N., Calhoun, S. and Warda, U. (2012). “Gender-Responsive Drug Court Treatment: A Randomized Controlled Trial.” Criminal Justice and Behavior 39: 1539.

Rathbone, Cristina. (2005).  A World Apart: Women, Prison and Life Behind BarsNew York: Random House.

Solinger, Rickie, et al., eds. (2010). Interrupted Life: Experiences of Incarcerated Women in the United States. Berkeley: University of California Press.

Talvi, Silja J. A. (2007). Women Behind Bars: The Crisis of Woman in the U.S. Prison System. New York: Seal Press.

White, Gale D. (2012). “Gender-Responsive Programs in U.S. Prisons: Implications for Change.” Social Work in Public Health 27:3, 283-300.

Wright, E. M., Van Voorhis, P., Salisbury, E. J., and Bauman, A. (2012). “Gender-Responsive Lessons Learned and Policy Implications for Women in Prison: A Review.” Criminal Justice and Behavior  39: 1612.

Organizational Guides

Kassebaum, Patricia A. (1999). Substance Abuse Treatment for Women Offenders, Guide to Promising Practices. Technical Assistance Publication Series 23. CSAT-SAMHSA. Reprinted 2008.

Achieving Successful Outcomes with Justice-Involved Women: A Review of the Research, Tools and Resources for Practitioners

Ten Truths that Matter When Working with Justice Involved Women (2012).


National Resource Center on Justice Involved Women

Women’s Prison Association

The Sentencing Project

American Civil Liberties Union: Women in Prison

Families Against Mandatory Minimums