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Women, Addiction and Mental Health Issues in the Drug Courts

Women, Addiction and Mental Health Issues in the Drug Courts. Hon. Peggy Fulton Hora Judge of the Superior Court (Ret.) LADCP April 11, 2012. “There is nothing more unequal then the equal treatment of unequal people” Thomas Jefferson. Female drug use.

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Women, Addiction and Mental Health Issues in the Drug Courts

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  1. Women, Addiction and Mental Health Issues in the Drug Courts Hon. Peggy Fulton Hora Judge of the Superior Court (Ret.) LADCP April 11, 2012

  2. “There is nothing more unequal then the equal treatment of unequal people” Thomas Jefferson

  3. Female drug use • Approximately 6.6% of women aged 12 and older reported past month use of an illicit drug • 9,417,840 females Substance Abuse and Mental Health Services Administration, 2009 National Survey on Drug Use and Health (NSDUH), September 2010)

  4. Women and Alcohol • 2.7 million women abuse alcohol • “moderate” drinking is < 1 drink a day • 4 million women need treatment for substance dependence

  5. 1:4 cases of dementia caused by alcohol • Women are at high risk because more susceptible to alcohol’s “brainwashing” effects • Women are less able to deal with alcohol’s toxic effects • Develop more severe complications earlier • Younger drinkers will experience memory problems sooner • Macrae Fiona, Daily Mail Online, May 11, 2009

  6. Women and drugs in CJ system • Women in the criminal justice system display an even higher rate of substance use • 59.3% of state and 47.6% of Federal female prisoners surveyed in 2004 indicated that they had used drugs in the month prior to their offense • 60.2% of state and 42.8% of Federal female prisoners surveyed in 2004 met drug dependence or abuse criteria BJA

  7. Women and Smoking • Women smokers get sicker at a younger age than men • COPD reduced lung function at lower level of smoking • “Cigarettes More Toxic for Women, Study Finds,” Join Together Online 5-20-09

  8. “You’ve come a Long way, Baby”

  9. LA Cost of SA and Addiction • 17% of Louisiana state budget = $1,375,626 • $320.83 per capita “Shoveling Up II: The Impact of Substance Abuse on Federal, State and Local Budgets,” CASA (May 2009)

  10. The Burden on SA/Addiction in LA

  11. Impact on Kids Females constitute approximately 30% of the substance addicted population in the United States and most are of childbearing age

  12. 500,000 - 750,000 newborns are exposed to illicit drugs each year Among pregnant women aged 15 to 44 years who participated in the 2006 National Survey on Drug Use and Health, 4.0% reported having used illicit drugs within one month of the survey Josh Gunn, Ph.D. and Scott Kriger, Ph.D, “The Prevalence of Maternal Drug Use During Pregnancy”

  13. Women/girls use for different reasons • A three-year study on women and young girls (aged 8–22) revealed that girls and young women use substances for different reasons than boys and young men. • Risk factors such as low self-esteem, peer pressure, and depression make girls and young women more vulnerable to substance use as well as addiction National Center on Addiction and Substance Abuse at Columbia University, The Formative Years: Pathways to Substance Abuse Among Girls and Young Women Ages 8–22 (PDF) , February 2003

  14. Juvenile prevalence • Of youth in post-adjudication placements, 47% have alcohol and drug disorders • Among high school seniors in 2008, one in 10 (10.4%) reported that in the two weeks prior to their interview, they had driven a vehicle after smoking marijuana

  15. Youth with MH/AOD problems • Adolescents with serious behavioral problems are more than 7 x’smore likely to report substance dependence • Youth with serious emotional problems are 4 x’smore likely to report AOD dependence

  16. Drug Cases Juvenile Courts • 193,700 juvenile drug cases 2004 • 1991-2004 drug cases doubled • Delinquency caseload for drugs = 7% in 1985 vs. 12% in 2004 • Female caseload jumped12%-20% ‘91-04 “Drug Offense Cases in Juvenile Courts, 1985-2004,” OJJDP Fact Sheet, Feb. 2008

  17. Juvenile Justice • Up to 67% of youth involved in the juvenile justice system have a substance use problem. • Almost ¾ of youth in correctional facilities report mental health problems during screening

  18. Co-Occurring • “[Co-Occurring] is the expectation, not an exception.” • Dr. Ken Minkoff

  19. Co-Occurring disorders are more prevalent in men or women? Women

  20. Mental health issues • Co-morbidity complicates and exacerbates the problems • Almost 12% of mothers in the U.S. has serious mental illness; 3.2% had SMI + SA • Up to 95% of parents in tx programs have co-occurring disorders

  21. Post Traumatic Stress Disorder • 30-57% women in treatment meet criteria for PTSD • 45-85% of battered women meet criteria • Co-morbidity for PTSD and substance use disorders is 2-3xs higher for females

  22. Trauma-informed Care • Community corrections, prosecution, defense and the court must become “trauma-informed” • Substance abuse and other mental health issues are closely associated with trauma • SA/MH drives the justice system—both criminal and child abuse and neglect cases “Understanding women in court,” SAMHSA, Center on Women, Violence and Trauma (2006)

  23. Women with Co-Occurring Primary Drugs of Choice OAS, 2002

  24. Cocaine / Alcohol Abusers with Comorbid Psychiatric Disorder MEN Anxiety 48% Depression 36% Bipolar 6% Panic disorder 10% Social phobia 14% PTSD 24% WOMEN 70% 40% 4% 18% 10% 46%

  25. Men vs. Women in Custody • Women inmates have >symptomology • diagnosed with mental health problems 3xs rate of men Symptoms Diagnosed

  26. Women with Co-Occurring More Likely Than Men to be: • Poor • Uneducated • Poor job skills • Receive public assistance • Report more relatives with AOD problems • Care for more dependents • Depressed, anxious, have eating disorders and lower self-esteem “Women with Co-Occurring Mental Illness and Substance Abuse,” AIA Center (May 2005)

  27. Post-Traumatic Stress Disorder (PTSD) • Acute traumatic stress is caused by an individual's subjective experience of an extreme traumatic event which can lead to extreme stress that inhibits a person's ability to cope. • Trauma is defined as a terrifying event that a person experiences, witnesses or learns about in which grave physical harm occurred or was threatened. • The traumatic event causes the person to feel intense fear, terror or a sense of helplessness. http://www.attcnetwork.org/learn/topics/ptsd/index.asp

  28. Post Traumatic Stress Disorder • 30-57% women in treatment meet criteria for PTSD • 45-85% of battered women meet criteria Co-morbidity for PTSD and substance use disorders is 2-3xs higher for females • Smokers at higher risk for PTSD • Archives of General Psychiatry (Nov. 05)

  29. “Linda” • 41 years old • Alcoholic • Incest survivor but won’t talk about it • Battered by > one man • Dx? Tx? Action plan? • What ?s

  30. New app from VA

  31. Women with Co-Occurring More Likely Than Men to be: • Poor • Uneducated • Poor job skills • Receive public assistance • Report more relatives with AOD problems • Care for more dependents • Depressed, anxious, have eating disorders and lower self-esteem “Women with Co-Occurring Mental Illness and Substance Abuse,” AIA Center (May 2005)

  32. Allowing women to have their children with them while in treatment increases treatment success TRUE

  33. The number one barrier to treatment for women is: Lack of child care and fear of losing their children

  34. The number two barrier to treatment for women is: Being battered

  35. FALSE The number one risk factor for alcoholism is childhood sexual abuse.

  36. Childhood Sexual Abuse It is the second most prevalent risk factor Applies to both boys and girls 70-90% of women in tx were sexually abused before age 16 7-16% men in jail report physical or sexual abuse before 18

  37. Aristotle said, “…women who drink wine excessively give birth to children who drink excessively of wine.” 350 B.C.

  38. Becoming trauma-informed

  39. Community corrections, prosecution, defense and the court must become “trauma-informed” • Substance abuse and other mental health issues are closely associated with trauma • SA/MH drives the justice system—both criminal and child abuse and neglect cases Understanding women in courtSAMHSA, Center on Women, Violence and Trauma (2006)

  40. 48-90% women with SA/MH issues have histories of interpersonal abuse • First occurrence when child or adolescent • Intergenerational issues – survivors often lost custody of their own children due to abuse and neglect • In dependency cases, AOD is present >50% of the time

  41. Traumatic stress during childhood • Can affect physical/mental health • Relationships • School performance • Risk taking in childhood and as an adult

  42. Summary of Physical and Sexual Assault Across the Lifespan (U.S.A.)[1] Summary of Physical /Sexual Assault Across the Lifespan (U.S.A.) National Figures (All U.S. Women) Women Living In Poverty Incarcerated Women Severe Physical Violence by Childhood Caretakers Before Age 18 40% 63% 70% Sexual Molestation in Childhood Before Age 16 (Any Perpetrator) 20-27% 42% 59% Any Physical Violence or Sexual Molestation in Childhood Not Available 72% 82% Severe Physical Violence by Adult Intimate Partners 22% 61% 75% Physical Violence or Sexual Assault by Intimates over Lifespan Not Available 83% 94% [1]As cited by Angela Browne, Ph.D., Harvard School of Public Health, Harvard Injury Control Research Center, 2002

  43. 25 years to grow a mature one • 18-25 “apprentice adults” • Exposure to traumatic stress can affect developmental processes • Increases risk of SA, criminal activity, homelessness and revictimization

  44. 1:5 girls have been sexually or physically abused The abuse occurred at home (53%) It happened more than once (65%) The abuser was a family member (57%) Or a family friend (13%) 29% told no one Have increased likelihood of SA or eating disorders Another recent survey showed:

  45. Tanya’s story • “When I was a child, my father used to rape me. It started when I was nine…. After I ran away, I wanted somebody to want me. I ran into this guy, he was older, and I wanted him to want me. He gave me cocaine. I was 13.” • Quotation from Tanya, interview on 7/9/98, Hirsch, Amy E., “Some Days are Harder than Hard,” Welfare Reform and Women with Drug Convictions in Pennsylvania, Center for Law and Social Policy, (Dec. 1999)

  46. Age of Onset of Drinking Is a Risk Factor Every year before 21 increases likelihood of problem drinking by 12% Early drinkers need more alcohol to get high Age 13: 42% Age 16: 22% Age 21: 10%

  47. Adolescent Substance Abuse • The younger an individual is at the onset of substance use, the greater the likelihood that a substance use disorder will develop and continue into adulthood. • More than 90% of current substance abusers started using before the ago of 18; half started before age 15

  48. Age of onset of drinking • If first drink at 13, 47% risk of becoming alcoholic; • if from alcoholic birth parents, 60%; • if from non-alcoholic birth parents, 30%

  49. Abstinence until 21 • A child who reaches age 21 without smoking, using illegal drugs or abusing alcohol is almost certain never to do so. "A drug-free future begins here," CASA 2001 Annual Report

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