Changes in Jail Inmates

1
Changes in Jail Inmates Substance Use, Substance
Dependence, and Mental Illness from Pre- to
Post-Incarceration

• June Tangney and Jeffrey Stuewig
• George Mason University

2
Todays Topics

• Are there changes in substance use and dependence
  from pre- to post-incarceration?
• What is the prevalence of substance use and
  dependence?
• For the year prior to incarceration
• For the first year post-release
• How do symptoms of mental illness change over the
  period of incarceration?
• Do inmates deteriorate or improve ?
• What inmate characteristics predict changes in
  mental illness?

3
The GMU Jail Study

• Funded by NIDA (2002-present)
• Conducted in partnership with
• Fairfax County Sheriffs Office
• OAR, Fairfax

4
Participants

• Upon Incarceration (n553)
• 69 male
• 44 African American, 36 Caucasian, 9 Mexican
  American/Hispanic, 11 Other/Mixed
• One year post-release (n324)
• 71 male
• 48 African American, 35 Caucasian, 6 Mexican
  American/Hispanic, 11 Other/Mixed

5
Retention

• 508 participants completed the full baseline
  assessment and were followed longitudinally.
• Due dates for phases are staggered because of
  rolling enrollment (June 2002-May 2007) and
  because sentences and hence release dates -- of
  inmate participants vary considerably.
• 75 of eligible participants were assessed at 1
  year post-release
• There were very few differences between eligible
  individuals who were re-interviewed vs. those who
  were not on 34 baseline variables.
• Non-respondents tended to be younger and
  Hispanic.

6
Substance Use and Dependency TCU
Correctional Residential Treatment Form, Initial
Assessment (TCU-CRTF Simpson and Knight 1998)

• Frequency of alcohol, marijuana, cocaine, and
  opiate use during prior year
• (0 never to 8 more than once a day).
• Dependency symptoms in the prior year
• (0 never to 4 7 or more times).
• How often did you find that your usual number of
  drinks had much less effect on you or that you
  had to drink more in order to get the effect you
  wanted?
• Alpha .90-.98

7

• Does substance use and dependence change from the
  year pre-incarceration to the first year
  post-release?

8
How often did participants use substances in the
past 12 months?
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0never, 1 lt once a month, 2 1 a month, 31 to
3 times a month, 4 1 to 2 times a week, 53 to
4 times a week, 6 5 to 6 times a week, 7daily,
8 gt once a day
9
Mean scores on dependency symptoms
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10
Percentage of individuals classified as substance
dependent
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Percentage of Participants
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11
Summary

• High levels of substance use and dependence
• For the year prior to initial incarceration
• Also for the first year post-release
• Frequency of use and symptoms of dependence were
  lower at one year post-release compared to
  pre-incarceration levels

12
Mental Illness in Jail

• Jail inmates suffer from mental illness at rates
  far higher than in the community.
• Recent estimates based on DSM criteria are as
  high as 70.
• Most studies have only examined a few diagnostic
  categories such as Substance Dependence,
  Antisocial Personality, Depression and Psychosis.

(Teplin, 1994 James Glaze, 2006 Veysey
Bichler-Robertson, 2002)
13
Changes in Symptoms over Incarceration?

• Key Questions Assessing a wider range of
  symptoms....
• Do symptoms of mental illness increase or
  decrease over the period of incarceration?
• What factors predict who does and who does not
  deteriorate or improve while incarcerated?
• (10 key factors gender, age, race, education,
  income, stability of living situation (year
  prior), previous incarceration experience, length
  of incarceration, history of mental health
  treatment, and symptoms of substance dependence.)

14
Participants
Baseline Pre-release
N 514 230
Male 70 70
African American 45 45
Caucasian 36 37
Hispanic 9 9
Other 10 9
Age (SD) 32 (10) 33 (10)

• No difference between those interviewed at Time 2
  and those not interviewed on gender, race, age,
  or symptoms of mental illness

15
Retention

• 508 participants completed the full baseline
  assessment and were followed longitudinally.
• Only those who remained incarcerated 6 weeks
  following baseline were eligible for
  reassessment.
• 77 of eligible participants were assessed at
  pre-release
• No differences beyond chance between eligible
  individuals who were re-interviewed vs. those who
  were not on 34 baseline variables.
• Average length of incarceration about 7 months

16
Personality Assessment Inventory (PAI Morey,
1991)

• 344 item self-report measure of psychopathology
  and personality traits.
• Respondents indicated whether each item was
  False, Sometimes True, Mainly True, and
  Very True.
• Clinical scales
• Somatization, Anxiety, OCD, Phobias, Traumatic
  Stress, Depression, Mania, Paranoia,
  Schizophrenia, Borderline Features, Antisocial
  Features, Alcohol Problems and Drug Problems

17
Level of Symptoms Upon Incarceration
   Clinical Scale    Clinical Scale  
Mean (SD) a
Somatic 52.77 (10.94) .88
Anxiety 55.33 (11.27) .89
Obsessive-Compulsive Obsessive-Compulsive 53.71 (10.76) .56
Phobias 49.05 (10.63) .56
Traumatic Stress Traumatic Stress 63.42 (15.19) .86
Depression Depression 58.03 (12.88) .89
Mania 58.62 (11.78) .83
Paranoia 59.73 (11.47) .83
Schizophrenia Schizophrenia 55.43 (13.12) .85
Borderline Features Borderline Features 63.22 (12.80) .89
Antisocial Features Antisocial Features 64.34 (12.01) .85
Alcohol Problems Alcohol Problems 59.88 (17.31) .92
Drug Problems Drug Problems 71.40 (20.46) .91
  N511-514

• 76 reported clinically significant symptoms (a
  T-score gt70) on a least one PAI clinical scale.
• Most prevalent were
• Drug Problems (47)
• Traumatic Stress (34)
• Antisocial Features (31)
• Borderline Features (31)
• Alcohol Problems (26).
• Even when excluding antisocial, drug, and alcohol
  problems, 57 still reported clinically
  significant symptoms.

Note scales were transformed to T-scores based
on norms from the census sample (M50, SD10)
(Morey, 1991) p lt .05 p lt .01
18
Level of Symptoms Upon Incarceration
   Clinical Scale    Clinical Scale  
Mean (SD) a
Somatic 52.77 (10.94) .88
Anxiety 55.33 (11.27) .89
Obsessive-Compulsive Obsessive-Compulsive 53.71 (10.76) .56
Phobias 49.05 (10.63) .56
Traumatic Stress Traumatic Stress 63.42 (15.19) .86
Depression Depression 58.03 (12.88) .89
Mania 58.62 (11.78) .83
Paranoia 59.73 (11.47) .83
Schizophrenia Schizophrenia 55.43 (13.12) .85
Borderline Features Borderline Features 63.22 (12.80) .89
Antisocial Features Antisocial Features 64.34 (12.01) .85
Alcohol Problems Alcohol Problems 59.88 (17.31) .92
Drug Problems Drug Problems 71.40 (20.46) .91
  N511-514

• 76 reported clinically significant symptoms (a
  T-score gt70) on a least one PAI clinical scale.
• Most prevalent were
• Drug Problems (47)
• Traumatic Stress (34)
• Antisocial Features (31)
• Borderline Features (31)
• Alcohol Problems (26).
• Even when excluding antisocial, drug, and alcohol
  problems, 57 still reported clinically
  significant symptoms.

Note scales were transformed to T-scores based
on norms from the census sample (M50, SD10)
(Morey, 1991) p lt .05 p lt .01
19
Change in Symptoms Over the Course of
Incarceration
  Baseline Pre-Release   r Difference t-value
Somatic 53.16 (11.24) 53.16 (11.24) 50.93 (9.94) 50.93 (9.94) .77 -2.23 (7.35) -4.59
Anxiety 56.13 (11.93) 56.13 (11.93) 53.67 (10.60) 53.67 (10.60) .75 -2.46 (8.14) -4.56
Obsessive-Compulsive 53.64 (10.93) 53.64 (10.93) 52.14 ( 9.64) 52.14 ( 9.64) .61 -1.50 (9.11) -2.50
Phobias 49.37 (10.91) 49.37 (10.91) 49.78 (10.57) 49.78 (10.57) .69 0.41 (8.48) 0.74
Traumatic Stress 63.43 (15.68) 63.43 (15.68) 60.05 (15.36) 60.05 (15.36) .81 -3.38 (9.62) -5.31
Depression 58.59 (13.13) 58.59 (13.13) 55.05 (12.01) 55.05 (12.01) .78 -3.54 (8.45) -6.34
Mania 58.59 (12.23) 58.59 (12.23) 56.69 (11.19) 56.69 (11.19) .75 -1.90 (8.37) -3.43
Paranoia 59.64 (11.64) 59.64 (11.64) 57.31 (11.05) 57.31 (11.05) .75 -2.33 (8.10) -4.35
Schizophrenia 56.03 (14.20) 56.03 (14.20) 53.33 (12.88) 53.33 (12.88) .73 -2.69 (9.99) -4.08
Borderline Features 63.60 (12.78) 63.60 (12.78) 60.75 (12.78) 60.75 (12.78) .78 -2.85 (8.39) -5.15
Antisocial Features 65.39 (11.74) 65.39 (11.74) 64.26 (11.54) 64.26 (11.54) .81 -1.13 (7.12) -2.40
Alcohol Problems 61.17 (17.43) 61.17 (17.43) 62.41 (17.37) 62.41 (17.37) .84 1.25 (9.86) 1.92
Drug Problems 72.30 (20.44) 72.30 (20.44) 73.00 (19.61) 73.00 (19.61) .87 0.69 (10.10) 1.03
Note scales were transformed to T-scores based
on norms from the census sample (M50, SD10)
(Morey, 1991) p lt .05 p lt .01
20
Who Improved the Most?

• In general symptoms of mental illness decreased
  (modestly) over time.
• More Improvement
• for women than men
• for those with prior jail experience as opposed
  to first-time offenders
• for inmates with a history of prior mental health
  treatment as opposed to those without
• for inmates with higher substance dependence
  symptoms as opposed to those reporting lower or
  no dependence on drugs or alcohol

21
Who Improved the Most?

• Changes in symptoms were not a function of
• Race
• Age
• Education
• Income
• Stability of living situation prior to
  incarceration
• Length of incarceration

22
Conclusions

• Although symptoms of mental illness decreased
  during jail incarceration, they were still very
  high
• 73 of participants reported clinically
  significant symptoms on a least one PAI clinical
  scale at pre-release
• Even when excluding antisocial, drug, and alcohol
  problems, 48 still reported clinically
  significant symptoms
• Effects are most pronounced for women, repeat
  offenders, and those with substance abuse
  problems.
• (Why?)

23
Is Mass Incarceration a Good Idea?

• No
• Decreases in substance use and dependence likely
  tied to probation and parole
• Decreases in symptoms of mental illness were
  modest
• Reflects changes over the period of incarceration
• NOT what happens once an inmates steps back into
  the community facing myriad barriers and
  challenges

24
Limitations

• Findings reflect symptoms of mental illness, not
  formal diagnoses.
• Cannot distinguish if the decrease in symptoms
  over time was due to a large spike of symptoms
  due to initial incarceration or whether these
  symptoms were present before incarceration.
• Based on data from felony offenders at a single
  jail.

25
Future Directions

• Examine predictors of changes in substance use
  and dependence (e.g., PP, SA Tx, employment)
• Investigate how symptoms of mental illness change
  from pre-release to 1 year post-release

26
MANY THANKS...
To the many graduate and undergraduate students
who have worked in the Human Emotions Research
Lab
Tania Abi-Najm, Leah Adams, Nicole Adock,
Gayathri Adikesavan, Kauser Ahmed, Cecilia Anon,
Molly Appel, Jalmeen Arora, Chris Arra, Zara
Arshad, Brian Athey, Judy Back, Deb Hill-Barlow,
Sheri Bailey, Ruth Barrientos, Rebecca Beam, Kim
Becker, Mary Bolton, Angie Boone, Eleni Boosalis,
Elly Bordeaux, Julie Borenstein, Laura Bowling,
Thea Bowling, Lorenzo Bozzelli, Adam Brode,
Phyllis Brodie, Tracey Brown, Lorenzo and Mina
Bozzelli, Crystal Brothers, Heather Buller, Dalo
Burje, Rachel Burroughs, Hannah Bustamante,
Daniela Butler, Phyllis Byrne, Rhonda Campagna,
Lisa Cannaday, Solange Caovan, Kyle Carlson,
Eliana Castano, Meredith Cato, Tina Chan, Ericka
Cho, David Choi, Lauren Christensen, Margaret
Claustro, Luis Clavijo, Sarah Clements, Emily
Clime, Erin Clyne, Eddie Codel, Bill Connell,
Lisa Conner, Joe Constantin, Kenny Corson, Susan
Cottrell, Michelle Covert, Brit Creelman, Helena
Crick, John Crum, Sheila Cunningham, Ingrid
Czintos, Chrissy Dale, Devra Dang, Zermarie
Deacon, Ronda Dearing, Deanna DeGidio, Steve
Devers, Bronwyn Devlin, Rosangela Di Manto,
Ashley Dobbins, Robin Dold, Karisa Dominguez,
Bertille Donohoe, Andy Drake, Amy Drapalski,
Rebecca Duckworth, Robert Dumville, Kristen
Durbin, Leigh Earley, Keesha Edwards, Kate
Egbert, Rebekka Eilers, Drew Emery, Pam Estilong,
Daniela Ettlinger, Barbara Evans, Samantha Fede,
Kate Federline, Diana Fitek, Michelle Flanagan,
Naheed Flanagan, Carey Fletcher, Laura Flicker,
Jen Floor, Bridget Fonseca, Kerry Ford, Peter
Forkner, Megan Formeck, Faye Fortunato, Marcelle
Fozard, Karen Friedman, Juan Funes, Dee Dee
Atkinson-Furr, Emi Furukawa, John Gavlas, Casey
Gilchrist, Lynn Glikbarg, Lauren Gonzales,
Melissa Gonzalez, Monica Gonzalo, Gerica Goodman,
Kimberely Goodman, Jennifer Gosselin, Richard
Gramzow, Theresa Grant, Beth Gunzelman, Logaina
Hafez, Angela Hall, Sarah Hall, Alice Hansburger,
Barbara Harding, Bill Harman, Sharie Harman,
Angie Harris, Laura Harty, Mark Hastings, Kim
Havenner, Marna Hayes, Ashley Heald, Courtney
Heffernan, Caron Heigel, Nancy Heleno, Charlie
Hendricks, Jolene Hering, Sheena-Dave Heslop,
Dustin Higgins, Rachel Hite, Junellyn Hood, Kelly
Hughes, Leslie Hughes, Mark Hyer, Miguel
Iglesias, Nikki James, Rebecca Jackson, Tricia
Jacobsen, Christina James, Margaret Jefferies,
Ashley Jennings, Charlotte Joelsson, Heather
Johnson, Karen Johnson, Mark Johnson, Caydie
Jones, Heather Jones, Sarah Jones, Sara Julian,
Sahair Kaboli-Monfared, Kristina Kallini, Ramineh
Kangarloo, Marc Kaplan, Lesley Kato, Stephanie
Kendall, Amy Kiernan, Nicole Kierein, Agnes Kim,
Elysha Kim, Leslie Kirk, Sarah Klein, Linda
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Langley, Patrick Lechleitner, Sylvia Lederman,
Norman Lee, Elizabeth Leon, Jennifer Lerch, Pete
Lielbriedis, Julie List, Claudia Lopez, Conrad
Loprete, Charmaine Lowe, Michaela Lynch, Devon
Madison, Jessica Magrath, Harry Malik, Elizabeth
Malouf, Terri Markel, Andrea Martinez, Debra
Mashek, Donna Marschall, Luis Mateus, Narges
Maududi, James Maxfield, Lauren McGill, Heather
McGraw, Megan McKenny, Mary McKnight, Amy
McLaughlin, Patrick Meyer, Natalie Migliorini,
Kimberly Minnema, Katie Mitchell, Sean Mitchell,
Tim Mohr, Joanne Moller, Kelly Moore, Julie
Morig, Corkie Morrill, Noha Mostafa, Kristen
Mudrezow, Amy Muntz, Sara Mutnick, Melody Myers,
Yvette Nageotte, Yasi Nejat, Nhu Nguyen, Thuy
Nguyen, Vienna Nightingale, Jean No, Kyle Novak,
Amanda Nuber, Beverly Nyokabi, Windi Oehms, Lia
Ojeda, Judy Okawa, Dulce Orozco Martinez, Gabriel
Ortiz, Jose Osorio, Erica Otter, Troy Pafenberg,
Helen Pak, Gita Parlier, Caite Partamian,
Elizabeth Patchen, Akhil Pathania, Jeff Pattison,
Ray Payton, Chad Peddie, Phillip Pegg, Julie
Pelch, Will Pennell, Geoffrey Pennoyer, Enrique
Peralta, Marc Perez, Jill Perkins, Erica Perry,
Amy Peterson, Dave Petersen, Greg Petrecca,
Heather Phillips, Giorgia Picci, Kayla Pope,
Steve Potter, Michelle Price, Erin Quigley, Adam
Rabinowitz, Sara Rahai, Paula Raikkonen, Samira
Ramezan, Michael Raumer, Candi Reinsmith, Megan
Remener, Justin Reznick, Claudia Reyes, Katie
Rich, Nakiia Robeson, Diana Rodriguez, Fernando
Rodriquez, Monique Romeo, Charles Rong, Lori
Roop, Karen Rosenberg, Tricia Roy, Melissa Rudy,
Karey Rush, Candice Russell, Gary Russell, Provie
Rydstrom, Paul Saenz, Leila Safavian, Dolly
Saini, Jackie Sakati, Veronica Sanchez, Jennifer
Sanftner, Lauren Saunders, Karen Schaefer, Ann
Scharff, Heather Sevier, Danielle Sewell, Vicki
Shaffer, Ann Shannon, Gordon Shaw, Kay Shows,
Farhad Siahpoush, Jenn Sims, Deb Sinek, Chris
Smart, Alison Smith, Deena Smith, Erika Smith,
Steve Smith, Caryn Smonskey, Alisa Sneiderman,
Jonathan Sollinger, Larry Spahr, Sabrina
Speights, Brad Starring, Gary Stone, Stephanie
Storck, Jeff Stuewig, Bianchi Suarez, Jenn
Sullivan, Lauren Tangney, Tina Tehrani, Angela
Termini, Dave Testa, Gia Thi, Rebecca Thompson,
Chris Tiller, Andrea Thorson, Tammy Tower, Mike
Tragakis, Berrin Tutuncuoplu, Tony Tzoumas, Kim
Udell, Lisa Unrine, Jocelyn Valenzuela,
Jacqueline Valdes, Suchi Vatsa, Jennifer Vaught,
Marilyn Vivanco, Ivan Voronin, Svenja Wacker,
Patti Wagner, Tammy Walker, Katherine Wallace,
Rebecca Warden, Abigail Wear, Julie Weismoore,
Kristine Welch, Dane Westermeyer, Simone Whyte,
Dina Wieczynski, Rebecca Wilbur, Layla Wilder,
Kelsey Wilkerson, Lauren Williams, Tara Williams,
Brittany Wilson, Edward Witt, Sabura Woods, Susan
Wyman, Autumn Yang, Tim Yerington, Siyon Yi,
Kerstin Youman, Doris Yuspeh, Parin Zaveri, Nancy
Zenich, Kate Zinsser, Patty Zorbas, and Tev Zukor

27
What is related to decreases in symptoms
Decrease in Symptoms Male Age White Education Income Unstable Living Situation
Somatic -.19 .20 -.03 -.03 -.10 .09
Anxiety -.14 .10 .02 -.04 -.06 .03
Obsessive-Compulsive -.10 .14 .04 .04 .01 -.02
Phobias -.05 .03 -.02 -.01 -.08 -.08
Traumatic Stress -.12 .07 -.11 .03 -.11 .14
Depression -.14 .07 .01 -.04 -.04 .05
Mania -.07 -.00 .02 -.03 -.09 .05
Paranoia -.07 -.03 -.07 .22 -.06 .03
Schizophrenia -.10 .09 -.07 .02 -.10 -.01
Borderline Features -.05 .07 .03 .12 .05 -.01
Antisocial Features -.03 .02 .06 .16 .00 .02
Alcohol Problems -.04 -.03 -.01 .07 .06 -.07
Drug Problems -.14 .05 .02 .03 .03 .09
Total Score -.17 .11 -.02 .07 -.06 .04
p lt .05 p lt .01
28
What is related to decreases in symptoms
 Decrease in Symptoms Prior Incarceration Time Incarcerated Prior MH TX Substance Dependence
Somatic .09 .13 .21 .19
Anxiety .15 .11 .06 .19
Obsessive-Compulsive .11 -.08 .11 .03
Phobias -.01 -.04 .03 .02
Traumatic Stress .13 .06 .01 .12
Depression .05 .12 .16 .21
Mania .05 -.06 .04 .07
Paranoia -.06 .09 .12 .05
Schizophrenia .14 .08 .15 .14
Borderline Features .06 .11 .03 .25
Antisocial Features .02 .04 .13 .15
Alcohol Problems .07 -.01 .04 .00
Drug Problems .14 -.05 .08 .23
Total Score .14 .06 .16 .23
p lt .05 p lt .01