Changes in Jail Inmates’
Substance Use, Substance
Dependence, and Mental Illness
from Pre- to Post-Incarceration
June Tangney and Jeffrey Stuewig
George Mason University
Today’s 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?
The GMU Jail Study
Funded by NIDA (2002-present)
Conducted in partnership with:
•Fairfax County Sheriff’s Office
•OAR, Fairfax
Participants
• Upon Incarceration (n=553)
– 69% male
– 44% African American, 36% Caucasian, 9% Mexican
American/Hispanic, 11% Other/Mixed
• One year post-release (n=324)*
– 71% male
– 48% African American, 35% Caucasian, 6% Mexican
American/Hispanic, 11% Other/Mixed
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 postrelease
• 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.
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

Does substance use and dependence change
from the year pre-incarceration to the first
year post-release?
How often did participants use
substances in the past 12 months?
p<.01
p<.01
p<.01
p<.01
0=never, 1= < once a month, 2= 1 a month, 3=1 to 3 times a month, 4= 1 to 2 times a week,
5=3 to 4 times a week, 6= 5 to 6 times a week, 7=daily, 8= > once a day
Mean scores on dependency symptoms
p<.01
p<.01
p<.01
p<.01
Percentage of Participants
Percentage of individuals classified as
substance dependent
p<.01
p<.01
p<.01
p<.01
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
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)
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.)
Participants
N
Male
African
American
Caucasian
Hispanic
Other
Age (SD)
Baseline
514
70%
45%
Pre-release
230
70%
45%
36%
9%
10%
32 (10)
37%
9%
9%
33 (10)
• No difference between those interviewed at Time 2 and
those not interviewed on gender, race, age, or symptoms
of mental illness
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
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
Level of Symptoms Upon Incarceration
Clinical Scale
Mean (SD)
α
Somatic
52.77 (10.94)
.88
Anxiety
55.33 (11.27)
.89
Obsessive-Compulsive
53.71 (10.76)
.56
Phobias
49.05 (10.63)
.56
Traumatic Stress
63.42 (15.19)
.86
Depression
58.03 (12.88)
.89
Mania
58.62 (11.78)
.83
Paranoia
59.73 (11.47)
.83
Schizophrenia
55.43 (13.12)
.85
Borderline Features
63.22 (12.80)
.89
Antisocial Features
64.34 (12.01)
.85
Alcohol Problems
59.88 (17.31)
.92
Drug Problems
71.40 (20.46)
.91
N=511-514
•76% reported clinically
significant symptoms (a Tscore >70) 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 (M=50, SD=10) (Morey, 1991)
* p < .05; ** p < .01
Level of Symptoms Upon Incarceration
Clinical Scale
Mean (SD)
α
Somatic
52.77 (10.94)
.88
Anxiety
55.33 (11.27)
.89
Obsessive-Compulsive
53.71 (10.76)
.56
Phobias
49.05 (10.63)
.56
Traumatic Stress
63.42 (15.19)
.86
Depression
58.03 (12.88)
.89
Mania
58.62 (11.78)
.83
Paranoia
59.73 (11.47)
.83
Schizophrenia
55.43 (13.12)
.85
Borderline Features
63.22 (12.80)
.89
Antisocial Features
64.34 (12.01)
.85
Alcohol Problems
59.88 (17.31)
.92
Drug Problems
71.40 (20.46)
.91
N=511-514
•76% reported clinically
significant symptoms (a Tscore >70) 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 (M=50, SD=10) (Morey, 1991)
* p < .05; ** p < .01
Change in Symptoms Over the Course of Incarceration
Baseline
Pre-Release
r
Difference
t-value
Somatic
53.16 (11.24) 50.93 (9.94)
.77
-2.23 (7.35)
-4.59**
Anxiety
56.13 (11.93) 53.67 (10.60)
.75
-2.46 (8.14)
-4.56**
Obsessive-Compulsive 53.64 (10.93) 52.14 ( 9.64)
.61
-1.50 (9.11)
-2.50*
Phobias
49.37 (10.91) 49.78 (10.57)
.69
0.41 (8.48)
0.74
Traumatic Stress
63.43 (15.68) 60.05 (15.36)
.81
-3.38 (9.62)
-5.31**
Depression
58.59 (13.13) 55.05 (12.01)
.78
-3.54 (8.45)
-6.34**
Mania
58.59 (12.23) 56.69 (11.19)
.75
-1.90 (8.37)
-3.43**
Paranoia
59.64 (11.64) 57.31 (11.05)
.75
-2.33 (8.10)
-4.35**
Schizophrenia
56.03 (14.20) 53.33 (12.88)
.73
-2.69 (9.99)
-4.08**
Borderline Features
63.60 (12.78) 60.75 (12.78)
.78
-2.85 (8.39)
-5.15**
Antisocial Features
65.39 (11.74) 64.26 (11.54)
.81
-1.13 (7.12)
-2.40*
Alcohol Problems
61.17 (17.43) 62.41 (17.37)
.84
1.25 (9.86)
1.92
Drug Problems
72.30 (20.44) 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 (M=50, SD=10) (Morey, 1991)
* p < .05; ** p < .01
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 firsttime 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
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
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?)
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
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.
Future Directions
• Examine predictors of changes in substance use and
dependence (e.g., P&P, SA Tx, employment)
• Investigate how symptoms of mental illness change from
pre-release to 1 year post-release
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 Knauss, Greg Kramer, Stephanie Kowal, Chris Krause, Shilpa Krishnan, Maria Lacayo, Allan 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
What is related to decreases in symptoms
Decrease in Symptoms
Male
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 < .05; ** p < .01
Age
White Education Income
Unstable Living
Situation
What is related to decreases in symptoms
Decrease in Symptoms
Prior
Incarceration
Prior MH
Time Incarcerated
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 < .05; ** p < .01