The increase in incarcerated women, an underserved population at high risk for a number of life problems including alcohol use disorders, is a growing public health concern. Jails serve 15 times more people per year than do prisons and have very short stays, which pose few opportunities for treatment or treatment planning. Alcohol use is associated with poor post-jail psychosocial and health outcomes including sexually transmitted diseases and HIV. Transition back into the community after release represents a particularly high- risk period for resurgence of alcohol use and concomitant life problems. Although many incarcerated women have attended Alcoholics Anonymous (AA) during their lifetime, AA attendance after release from jail is infrequent. Our group has found that for those who attend at least weekly, AA is associated with improvements in alcohol use and alcohol-related consequences post-incarceration. Therefore, reducing barriers to post- release AA meeting attendance may benefit alcohol abusing incarcerated women returning to the community. AA linkage strategies improve AA attendance and alcohol outcomes among outpatients, but have not previously been tested in criminal justice populations. We propose to conduct a randomized trial (n=400) evaluating the effectiveness of an innovative method to enhance the linkage between alcohol abusing women in jail who are returning to the community and AA resources. In the intervention condition, an AA volunteer will meet once individually with an incarcerated woman while she is in jail and arrange to be in contact immediately after release to accompany the participant to AA meetings. The control condition will consist of providing schedules for local AA meetings, the current standard of care for incarcerated women with alcohol problems. Hypotheses are that, among alcohol abusing women returning to the community from jail: 1. An AA linkage intervention (Link) will result in less alcohol use at follo-up relative to standard of care (SOC), as indexed by greater percent days abstinent (primary); 2. Link will increase AA meeting attendance and involvement relative to SOC; 3. Link, relative to SOC, will result in less HIV/STI sex risk, as indexed by fewer unprotected sexual occasions at all follow-up assessments; 4. AA attendance/involvement will mediate the effect of Link on alcohol use. 5. Percent days abstinent will mediate the effect of Link on STI/HIV risk-taking outcomes. Because AA meetings are so widely available and are free, enhancing the use of AA by incarcerated women returning to the community is an easily disseminable and cost-effective way to reach this vulnerable, difficult- to-reach population. As a result, we anticipate that the Link intervention, if successful, will be widely implemented, dramatically impacting the care of incarcerated women nationwide.
Among jailed women returning to the community, alcohol abuse is associated with poor post-incarceration psychosocial and health outcomes including sexually transmitted diseases and HIV. Because regular Alcohol Anonymous attendance is associated with improvements in alcohol-related consequences, we propose to conduct a randomized clinical trial (n=400) evaluating the effectiveness of an innovative method to enhance the linkage between jailed alcohol abusing women who are returning to the community and AA resources. Because AA meetings are so widely available and are free, enhancing the use of AA is an easily disseminable and cost-effective way to reach this vulnerable, difficult-to-reach population that could dramatically impact the care of incarcerated women nationwide.
