605490

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TPJXXX10.1177/0032885515605490The Prison JournalScott et al.

Article
The Prison Journal
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Trauma and Morbidities © 2015 SAGE Publications
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DOI: 10.1177/0032885515605490
Detainees in a Large tpj.sagepub.com

Urban Jail

Christy K. Scott1, Arthur J. Lurigio2,

Michael L. Dennis1, and Rod R. Funk1

Abstract
Using data from 810 women entering the Department of Women’s Justice
Services in the Cook County Jail (Chicago) from 2010 to 2013, this study
examines patterns of trauma exposure and the relationship between trauma
exposure and mental disorders. Female detainees averaged 6.1 (SD = 4.90)
types of trauma in their lifetimes, with greater trauma exposure associated
with earlier age of trauma onset, more recent trauma exposure, and higher
rates of fear for life or injury. Higher rates of trauma exposure were also
correlated with higher rates of past-year symptoms of posttraumatic
stress disorder as well as other internalizing, externalizing, and substance
use disorders. Behavioral health programming for female detainees in jail
settings should include more trauma-sensitive mental health and substance
use disorder treatments.

Keywords
trauma, addiction, female detainees, internalizing disorders, externalizing
disorders

1Chestnut Health Systems, Chicago, IL, USA

2Loyola University Chicago, Chicago, IL, USA

Corresponding Author:
Christy Scott, Lighthouse Institute, Chestnut Health Systems, 221 West Walton, Chicago, IL
60610, USA.
Email: cscott@chestnut.org

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2 The Prison Journal 

Since the 1980s, the number and proportion of incarcerated women in the
United States have increased steadily. The war on drugs and punitive crime
control policies were largely responsible for narrowing the gender gap in cor-
rectional populations (Minton, 2012). Women have outpaced men in terms of
not only their comparative growth in jails and prisons (Bureau of Justice
Statistics, 2000; Harrison & Beck, 2004), but also the range and severity of
their behavioral problems. Many more women are in local jails than in state
and federal prisons (Beck, & Karberg, 2001), and these women’s problems are
particularly abundant and serious with respect to substance use and other psy-
chiatric disorders (Green, Miranda, Daroowalla, & Siddique, 2005; National
GAINS Center, 2004).

Gender-Specific Experiences and Needs

Women and men entering jails differ relative to their life experiences and
service needs. For example, female detainees are much more likely than male
detainees to live below the poverty level. Justice-involved women are also
much more likely than justice-involved men to have co-occurring psychiatric
disorders—in particular, combinations of substance use disorders and other
mental illnesses (Ney, Ramirez, & Van Dieten, 2012). Addictions and other
psychiatric disorders lock women into patterns of criminal activity that can
be long-standing and protean, preventing them from completing their educa-
tion, securing employment, and providing their children with adequate hous-
ing and parenting (Diamond, Wang, Holzer, Thomas, & Cruser, 2001).

Polyvictimization and Trauma

In addition to high rates of substance use and other psychiatric disorders,
incarcerated women report lifelong experiences with trauma, childhood sex-
ual abuse, intimate partner violence, and other types of victimization (Clark,
2002; Cook, Smith, Tusher, & Raiford, 2005; Singer, Bussey, Song, &
Lungerhofer, 1995). The occurrences of these experiences are much higher
than those found in the general female population; they often commence with
childhood abuse and neglect (McDaniels-Wilson & Belknap, 2008) and
encompass a variety of adverse life events that continue into early adulthood
and beyond (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995), including
physical and sexual violence at the hands of intimates (Battle, Zlotnick,
Najavits, Gutierrez, & Winsor, 2002). Serious and repeated trauma in various
forms, known as polyvictimization, is common among incarcerated women.
These and other types of victimizations are often linked to women’s criminal
and substance use behaviors and associated with many psychological

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Scott et al. 3

disorders, such as posttraumatic stress disorder (PTSD), chronic anxiety, and

depression (Lynch, Fritch, & Heath, 2012).
Childhood trauma can set women on a critically destructive path that
begins with running away from home, dropping out of school, and experi-
menting with alcohol and other substances in preadolescence, which increases
their susceptibility to subsequent addiction. Indeed, substance use disorders
among women often develop from trauma (Stewart & Conrod, 2003) and can
propel women into the sex trade and other criminal activities for financial
survival (DeHart, 2008). Women who were abused or neglected as children
are twice as likely to be arrested as adults than women who were not (Widom,
2000). Similarly, women who experienced interpersonal violence as children
are more likely to engage in delinquent behaviors as youth and in criminal
behaviors as adults (Grella, Stein, & Greenwell, 2005). Traumatic experi-
ences can change brain chemistry and structure, both of which affect wom-
en’s ability to respond to behavioral health care interventions and to control
their behaviors, leading to poor adjustment in jail and high incidents of mis-
conduct (Ney et al., 2012). Simply put, the experience of trauma is a likely
determinant in women’s involvement in criminal activities and other self-
defeating behaviors (DeHart, 2008; Lynch et al., 2012).
In summary, numerous studies have shown that female detainees are more
likely than their male counterparts to suffer from a wide range of behavioral
problems, including symptoms of addiction and other psychological disor-
ders. Female offenders are also more likely than male offenders to have expe-
rienced interpersonal trauma and the attendant symptoms of PTSD (Carlson
& Shafer, 2010; Green et al., 2005; Lynch et al., 2012). Incarcerated women
are more likely than their male counterparts to suffer from psychological dis-
orders, trauma—including physical and sexual abuse—and multiple morbidi-
ties. Therefore, female detainees require gender-responsive services, which
are of a different nature and intensity than those designed for male detainees
(Green et al., 2005).

Jails as Hubs for Service

Jails frequently afford female detainees their first opportunity to have
their substance use and other psychiatric disorders assessed and treated,
and to receive referrals for continued care in the community (Peters &
Matthews, 2002). In fact, many offenders’ initiation into substance abuse
treatment occurs in jail (Mumola, 1999). To be most effective, drug treat-
ment services for women must be sensitive to women’s manifold needs
and comorbidities (Peters, Strozier, Murrin, & Kearns, 1997; Westermeyer
& Boedicker, 2000).

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4 The Prison Journal 

Service-related policies and practices in jails, however, often fail to appre-

ciate the risk, needs, and responsivity of female detainees because much of
the empirical research that forms the basis for criminal justice programming
was conducted only with male offenders. Gender differences are often
ignored in assessment and classification procedures in correctional facilities
(Van Voorhis & Presser, 2001). For example, a comprehensive national sur-
vey of women’s programs in the criminal justice system found that classifica-
tion, screening, and assessment protocols were poorly adapted for women
(Hardyman & Van Voorhis, 2004).
The present investigation examined the life experiences and behavioral
health care needs of justice-involved women; such knowledge could contrib-
ute to the development of more effective assessment tools and treatment
strategies that are tailored to this population. The preceding studies empha-
size the importance of understanding women’s pathways into addiction and
crime to identify risks for offending, as well as potential points for prevention
and intervention (Belknap & Holsinger, 2006).

Current Study
Based on this previous research, the current investigation explored women’s
histories of trauma and current psychological distress using baseline data
from the Recovery Management Checkups for Women Offenders (RMCWO)
experiment (Scott & Dennis, 2012). Specifically, the current study was
designed to illuminate the exposure of female detainees to a wide range of
traumatic events (numbers and types) and the relationship between exposure
to trauma and internalizing (e.g., PTSD and mood disorders) and externaliz-
ing (e.g., attention-deficit/hyperactivity disorder [ADHD] and conduct disor-
der) disorders, as well as alcohol and other substance use disorders.

Method
Procedures
The data for this study were drawn from the RMCWO experiment (Scott &
Dennis, 2012), which included an evaluation of the risk of recidivism for
women entering Cook County Department of Corrections’ (CCDOC) sub-
stance use treatment program. Conducted under the supervision of the
Chestnut Human Subject Institutional Review Board and an independent
Data Safety Monitoring Board, women were recruited for extensive, confi-
dential interviews in accordance with the standards of the Committee on
Human Experimentation. Independent research staff collected the data and

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Scott et al. 5

provided the women with informed consent, assuring them that their partici-
pation in the study was voluntary. The data were collected under a federal
certificate of confidentiality to prevent any subsequent forced disclosure of
participants’ responses. Participants were offered refreshments, allowed to
take breaks, and provided an incentive. Overall, the process was a respite
from the typical jail routine.

Recruitment Site
The women were recruited while awaiting the disposition of their cases in the
CCDOC. The CCDOC is the largest single-site jail in the United States in
terms of daily population and rated capacity, houses an average of nearly
10,000 detainees each day, and is located in the City of Chicago on 96 acres
of property (Olson, 2013). Women constitute nearly 13% of CCDOC’s popu-
lation and are charged mostly with drug, property, domestic violence, driving
under the influence (DUI)/traffic, and prostitution offenses (Escobar &
Olson, 2012). This study focused on women who participated in CCDOC’s
Department of Women Justice Services’ (DWJS) gender-specific and gender-
responsive substance abuse treatment program, which offers jail-based (resi-
dential) and furlough-based (outpatient) treatment programs for female
detainees with drug problems and nonviolent charges (Scott & Dennis, 2012).

Participants
The target population consisted of adult female detainees who were reenter-
ing the community from CCDOC’s substance abuse treatment program.
Women were deemed ineligible if they had not used substances in the 90 days
before detention, had no substance use disorder symptoms in the year before
detention, were younger than age 18, lived or planned to move outside
Chicago within the next 12 months, were fluent in neither English nor
Spanish, were cognitively unable to provide informed consent, or were
released before their 14th day in DWJS. Of the 866 women who were eligi-
ble, 810 (93%) agreed to participate and completed the initial interview. Of
those, 3 women did not complete the trauma exposure section. Hence, the
final sample consisted of 807 women.
Most of the participants (82%) described themselves as African American,
followed by 9% as Caucasian, 5% as Latina, and 4% as other/mixed. A small
percentage (6%) of the women were between 18 and 20 years old, 20% were
21 to 29 years old, 29% were 30 to 39 years old, 34% were 40 to 49 years old,
and 11% were 50 years old or older. Nearly three fourths (72%) of the women
reported that they had never been married; 16% had been divorced,

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6 The Prison Journal 

separated, or widowed and 12% were married or living with a partner.

Compared with women admitted to the CCDOC in 2012, those in our sample
were less likely to be Caucasian and more likely to be married and older
(Olson, 2013).

Measures
The measures for this study were drawn from several standardized measure-
ment tools that were contained in the baseline assessment and are summa-
rized below.

Trauma exposure count.  The specific trauma experiences included in the inter-
view were based on the Life Stressor Checklist–Revised (e.g., Kimerling, Traf-
ton, & Nguyen, 2006), the National Women’s Survey (e.g., Kilpatrick, Acierno,
Resnick, Saunders, & Best, 1997), and the Global Appraisal of Individual Needs
(GAIN; Dennis et al., 2003).These sources yielded a count of lifetime exposure
to 25 types of life-threatening situations (e.g., major disaster, very serious acci-
dent or fire, being physically assaulted or raped), seeing another person killed,
dead, or badly hurt, or hearing about a horrible incident that has happened to a
loved one. The count varied mostly along a single dimension (α = .97), and was
divided into optimal groups that were derived empirically by performing Chi-
Square Automatic Interactive Detection (CHAID) analyses (Biggs, De Ville, &
Suen, 1991; Ngo, Govindu, & Agarwal, 2015). CHAID creates groups based on
minimizing the within-group variance and maximizing between group variance
of a predictor and uses chi-square statistics between a criterion and the predictor
for segmentation. The percentages meeting criteria for PTSD (Table 2) and
count of 15 disorders (Table 3) were used as criterion variables and the count of
trauma exposures as the predictor. The groups that emerged from those analyses
were 0 to 1, 2 to 4, 5 to 6, and 7 to 25 lifetime exposures to trauma.

PTSD. A diagnosis of PTSD was based on responses to the Structured Clinical

Interview for Diagnostic and Statistical Manual of Mental Disorders (4th ed.;
DSM-IV; American Psychiatric Association [APA], 1994) Axis I Disorders for
nonpatients (First, Spitzer, Gibbon, & Williams, 2002) with the scoring modified
to reflect Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-
5; APA, 2013). Specifically, trauma exposure (Criterion A) was determined by a
positive response to either of the following questions: “Did you believe that you
or someone else could die or be seriously injured or killed?” or “Did you feel
afraid, terrified, or helpless?” Reexperiencing the event (Criterion B) and avoid-
ance of associated stimuli (Criterion C) were assessed by asking about each pos-
sible trauma exposure symptom listed in the DSM-IV and coding as present, if
one or more items was endorsed for Criterion B, and three or more items were

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Scott et al. 7

endorsed for Criterion C. Negative alternations in cognitions, mood, arousal, and

reactivity (Criterion D and E) were determined by two or more positive responses
to questions gauging difficulty falling or staying asleep, irritability or outbursts of
anger, difficulty concentrating, hypervigilance, or exaggerated startle response.
Duration of 1 month or more (Criterion F) was assessed for each of the trauma
exposure symptoms determining Criteria B, C, and D by asking “How long did
this last?” Functional Impairment was assessed by asking respondents whether
they felt they could not go on and whether the problems resulted in failure to meet
responsibilities at home, work, or school, or in the use of alcohol or other sub-
stances to dampen memories or feelings. Criteria A through F had to be met to
qualify for a PTSD diagnosis.

Internalizing and externalizing disorders. Measures of internalizing disorders

(e.g., anxiety, trauma, depression, and suicidal ideation) and externalizing dis-
orders (e.g., attention-deficit/hyperactivity, conduct, and pathological gam-
bling) came from the GAIN scales. Measures of borderline personality disorder
and antisocial personality disorder were based on the Structured Clinical Inter-
view for DSM-IV Axis II Disorders (SCID-II; First, Spitzer, Gibbon, Williams,
& Benjamin, 1994). Symptom counts for each of the above measures had an
alpha higher than .9 and were categorized based on DSM-IV.

Substance use disorders.  The GAIN’s Substance Problem Scale measure was
based on the recency (e.g., past month, 2-12 months, more than 12 months ago
or never) of 16 symptoms: 7 corresponding to DSM-IV criteria for dependence,
4 for abuse, 2 for substance-induced health and psychological problems, and 3
for lower severity symptoms of use (i.e., hiding use, people complaining about
use, weekly use). For each symptom endorsed, women were asked to attribute
it to one or more of the substances they had ever used (followed by probes for
“any other” until no more were endorsed). Across alcohol and other drugs
(AOD) and for six classes of substances (alcohol, amphetamine, cannabis,
cocaine, opiate, other), the women were categorized as having a disorder if they
endorsed 3 or more of the 7 dependence symptoms or 1 or more of the 4 abuse
symptoms. Symptom counts for each of the above measures had an alpha
higher than .9 and were categorized based on DSM-IV criteria.

Findings
Trauma Experiences
Overall direct exposure to trauma. As shown in Table 1, female detainees
experienced a wide range of adverse life events. Excluding their current
detention in CCDOC, nearly three-quarters (72%) reported previous stays in

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8 The Prison Journal 

Table 1.  Patterns of Trauma Exposure Overall and by Range of Exposure.

Lifetime exposures to trauma

  Total (%) 0-1 (%) 2-4 (%) 5-6 (%) 7-25 (%)

  n = 807 n = 155 n = 189 n = 150 n = 313 χ2 or F p

You ever experienced

  Being sent to jail or 72 10 72 89 93 379.37 <.001
prison
  Having someone 64 5 62 80 87 323.60 <.001
close to you die
  Serious money 47 0 31 57 76 264.70 <.001
problems
  Trading sex for drugs 34 1 22 40 55 146.93 <.001
or money
  A close family 31 0 23 31 51 133.07 <.001
member in jail
  Emotional abuse or 30 0 6 17 66 315.52 <.001
neglect
  Abortion or 29 1 14 30 52 154.54 <.001
miscarriage
  Serious accident or 19 0 6 15 37 127.96 <.001
injury
  Physical neglect 18 0 1 6 44 220.24 <.001
  Separation or divorce 13 1 4 12 25 71.02 <.001
  Physical or mental 11 1 3 10 22 64.63 <.001
illness
  Separation from child 8 1 3 3 18 62.66 <.001
against your will
  Caring for someone 8 0 2 4 17 59.50 <.001
with a severe
handicap
  Fear of being 6 0 2 4 13 40.68 <.001
attacked or robbed
  Placement in foster 4 0 4 3 7 12.30 <.01
care
  A serious natural 3 0 1 3 6 20.47 <.001
disaster
  Having a child with a 3 0 1 4 5 15.72 <.01
disability
Someone you know or felt close to
  Abused you 26 1 8 16 54 213.75 <.001
physically
  Raped or forced you 24 1 12 23 43 120.79 <.001
to have sex
  Attacked you with a 19 0 6 16 38 130.49 <.001
weapon
(continued)

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Scott et al. 9

Table 1. (continued)
Lifetime exposures to trauma

  Total (%) 0-1 (%) 2-4 (%) 5-6 (%) 7-25 (%)

  n = 807 n = 155 n = 189 n = 150 n = 313 χ2 or F p

  Robbed you without 6 0 1 1 15 43.82 <.001

a weapon
  Deliberately killed or 4 0 0 1 9 69.59 <.001
murdered someone
Someone you did not know
  Attacked you with a 21 1 7 16 41 141.87 <.001
weapon
  Raped or forced you 14 0 7 8 29 94.90 <.001
to have sex
  Abused you 11 0 1 3 26 124.31 <.001
physically
  Robbed you without 8 0 0 3 20 92.89 <.001
a weapon
What you saw
  A serious accident 23 0 4 17 50 216.47 <.001
  Violence between 20 0 3 13 45 191.36 <.001
family members
  A robbery or 16 0 1 9 37 170.44 <.001
mugging
  Someone seriously 15 1 4 8 33 124.76 <.001
injured or killed
violently
  Other extremely 8 1 5 6 13 26.94 <.001
upsetting events
Summary measures
  Count of lifetime trauma exposures
  M (SD) 6.1 (4.9) 0.2 (0.4) 3.1 (0.8) 5.4 (0.5) 11.2 (3.7) 901.31 <.001
  Recency of trauma exposure
  In past year 62 8 55 75 86 657.43 <.001
   1 + years ago 24 16 45 25 14  
  Never 15 76 0 0 0  
   Believing you or 81 17 87 98 100 509.73 <.001
someone could
die
  Feeling afraid, 75 10 80 92 96 448.46 <.001
terrified, or
helpless

jail or prison. Incarceration is an understudied but recognized traumatic expe-

rience (e.g., DeVeaux, 2013; Toch, 2007), in itself, and it was common
among the women in our sample. Nearly one-third (31%) noted that they

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 10
Table 2.  PTSD Criteria by Range of Trauma Exposure.

Lifetime exposures to trauma

  Total (%) 0-1 (%) 2-4 (%) 5-6 (%) 7-25 (%)

  n = 807 n = 155 n = 189 n = 150 n = 313 χ2 or F p

PTSD criteria
A. Stressor 85 24 100 100 100 581.37 <.001
  Self-report of most traumatic event
   Someone close to you died 30 22 41 36 21 62.64 <.001
   Raped or forced to have sex 21 5 14 21 26  
   Attacked by someone with a weapon 10 3 5 9 13  
  Abused physically 7 5 6 7 7  
  Accident/accident-related injury 4 0 3 5 4  
  Other trauma 29 65 30 21 28  
B.  Intrusion symptoms 65 4 69 77 86 312.59 <.001
C. Avoidance 40 1 30 43 63 171.82 <.001
D/E. Negative alterations in cognitions, mood, arousal, 49 3 36 54 76 161.59 <.001
and reactivity
F.   Duration of more than 1 month 14 0 7 17 22 49.75 <.001
G.  Functional significance 43 1 35 47 67 184.83 <.001

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Met all PTSD criteria 13 0 7 13 21 47.85 <.001

Note. Criterion D used items from traumatic stress scale for persistent blame and persistent negative emotions. No items were included for
persistent negative beliefs and expectations. For Criterion E, no items were included for self-destructive or reckless behavior.
PTSD = posttraumatic stress disorder.
Scott et al. 11

have had a close family member incarcerated—also a stressful event with

social, interpersonal, and economic repercussions that stem from the confine-
ment of a loved one; these repercussions are among the so-called collateral
consequences of imprisonment (Mauer & Chesney-Lind, 2002).
A large proportion of participants (64%) indicated that they had suffered
the loss of a loved one (i.e., someone close to them had died). In stressful life
events that were probably related, 47% of respondents reported serious
money problems, and 34% reported that they had traded sex for drugs or
money in a likely effort to alleviate their financial strain. A fair number of
female detainees reported emotional abuse (30%) and a lesser but not insub-
stantial number (18%) mentioned physical neglect. Approximately 30%
stated that they had had an abortion or miscarriage, nearly 20% stated that
they had experienced a serious accident or injury, and nearly 10% stated that
they had been separated from their children against their will.

Direct exposure to violence.  Violent victimization can be a highly traumatic

experience for women. In this sample of women, 68% reported such victim-
izations. Attacks occurred at the hands of both intimates and strangers. With
respect to the intimates, one-fourth indicated being physically abused (26%)
or being raped or forced to have sex (24%), and 19% reported being attacked
with a weapon. With respect to the strangers, 21% reported being attacked
with a weapon, and 14% reported being raped or forced to have sex. In addi-
tion, female detainees reported that they were victims of aggravated battery
(i.e., attacked with a weapon) and armed robbery (8%).

Witnessed exposure to traumatic events.  Female detainees also noted that they
had witnessed several traumatic events. Such encounters can lead to emotional
distress and dysfunction. Thus, witnessed exposures to traumatic occurrences
have been incorporated in the diagnostic criteria for PTSD (American Psychi-
atric Association, 2013). Specifically, respondents reported that they had wit-
nessed a serious accident (23%), violence among family members (20%), a
robbery or mugging (16%), a person being seriously injured or murdered
(15%), or other extremely upsetting events (8%).

Summary measures of trauma exposure.  On average, women reported experi-

encing 6.1 (SD = 4.9) different types of trauma exposure. Most of these
reported exposures (62%) had occurred in the past year. Nearly 9 of 10
women (86%) who reported the highest lifetime numbers of trauma exposure
(7 to 25 exposures) had experienced at least one traumatic event within the
past year. With every type of lifetime trauma exposure (from the most to the
least common), the percentages of participants reporting traumatic

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12 The Prison Journal 

experiences rose monotonically and significantly with the count of types of

trauma (ps < .001). For example, the proportion of those who reported being
emotionally abused or neglected rose from 0% with 0 to 1 exposure, to 17%
with 5 to 6 types of exposures, and to 66% with 7 to 25 exposures. Similarly,
the proportion of those who reported suffering from a physical or mental ill-
ness rose from 1% with 0 to 1 exposure, to 10% with 5 to 6 types of expo-
sures, and to 22% with 7 to 25 types of exposures.
Across all types of traumatic experiences, large percentages of women
believed that they or someone else could die (81%), or they felt afraid, terri-
fied, or helpless (75%), indicating that the traumatic events were generally
experienced as quite serious. Such cognitions and affective states are corre-
lated with high degrees of arousal and lasting emotional impact, even if the
current diagnostic criteria for PTSD do not require that these intense emo-
tional responses had to be present at the time of the original occurrence of the
traumatic event (American Psychiatric Association, 2013).

PTSD Symptoms of Trauma Exposure

Stressors (Criterion A).  As noted above, most women had been exposed to
multiple types of trauma, many severe, and most within the past year. The
five events that respondents regarded as the most traumatic among all those
reported were the death of someone close to them (30%), being raped or
forced to have sex (21%), being attacked by someone with a weapon (10%),
being abused physically (7%), or being in an accident or having an accident-
related injury (4%). All other types of most traumatic events were less than
1% individually, but added up to 29% overall.

Intrusion symptoms (Criterion B).  Symptoms of intrusion and reexperiencing

were common (65%). These included upsetting memories of the event such
as distressing images and thoughts, bad dreams about the event, flashbacks to
the event (i.e., reliving the situations), and psychological and physical reac-
tivity in response to reminders of the event.

Avoidance symptoms (Criterion C).  People who experience trauma attempt to

cope by avoiding any triggers of the event. Such avoidance behaviors were
reported by 40% of the sample and included efforts to avoid thoughts, feel-
ings, and conversations about the event, as well as staying away from activi-
ties, places, and reminders of the event.

Negative alterations in cognitions, mood, arousal, and reactivity (Criteria

D and E).  About half (49%) of the sample reported PTSD symptoms that

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Scott et al. 13

involved negative alterations in mood, cognition, arousal, or reactivity in

response to thoughts or reminders of the events. These symptoms included
being less interested in doing things regarded as previously important
(e.g., seeing family and friends), feeling disconnected from others, and
feeling numb. They also included having trouble falling asleep, being irri-
table and experiencing angry outbursts, having trouble concentrating,
being overly watchful, alert, and “on guard” for no reason (hyper vigilant),
and being excessively jumpy (easily startled).

Disruptions in functioning. Exposure to trauma and its attendant symptoms

were related to disruptions in functioning. For example, 43% of respondents
reported being unable to meet their responsibilities at work, school, or home;
using alcohol or other drugs to forget or block out memories; and feeling like
they could not go on.

Symptoms by breadth of trauma exposure.  Similar to the steadily growing

proportion of respondents who reported increasing numbers of lifetime
exposure to traumatic events (from 0 to 1 to 7 to 25), all measures of symp-
toms also increased significantly and uniformly with the count of lifetime
types of exposure to trauma (ps < .001). For example, the proportion of
those who reported intrusion symptoms increased from 4% with 0 to 1
exposure, to 69% with 2 to 4 exposures, to 77% with 5 to 6 exposures, and
to 86% with 7 to 25 exposures (Table 2). The proportion of those who
reported avoidance symptoms increased from 1% with 0 to 1 exposure, to
30% with 2 to 4 exposures, to 43% with 5 to 6 exposures, and to 63% with
7 to 25 exposures. Overall, 13% of the sample met the criteria for a diag-
nosis of PTSD, which is 30% higher than the prevalence of the diagnosis
among women in the general U.S. population (Lenzenweger, Lane, Lor-
anger, & Kessler, 2007). Those who reported 7 to 25 exposures were 3
times more likely to meet the diagnostic criteria than those who reported
only 2 to 4 exposures (7% vs. 21%).

Comorbidity and Exposure

Table 3 presents past-year internalizing and externalizing disorders as well as
alcohol and other substance use disorders, symptoms of stress, and suicidal
thoughts. As shown, 39% of the female detainees met the criteria for any
past-year internalizing disorder: 33% for a mood disorder, 12% for general-
ized anxiety disorder, and as noted above, 22% for traumatic stress across
events, 13% for PTSD from the most traumatic event, and 5% reported sui-
cidal thoughts.

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 14
Table 3.  Comorbidity by Range of Trauma Exposure.

Lifetime exposures to trauma

  Total (%) 0-1 (%) 2-4 (%) 5-6 (%) 7-25 (%)

  n = 807 n = 155 n = 189 n = 150 n = 313 χ2 or F p

Internalizing disorders (past year)
  Any internal disorder 39 3 26 43 62 169.13 <.001
  Mood disorder 33 3 22 34 55 144.55 <.001
  Generalized anxiety disorder 12 0 8 8 23 59.28 <.001
  Suicidal thoughts 5 0 1 5 11 33.61 <.001
  High traumatic stressa 22 1 10 23 39 109.55 <.001
 PTSD 13 0 7 13 21 47.85 <.001
Externalizing disorders (past year)
  Any external disorder 35 8 26 34 55 61.69 <.001
  Any ADHD 18 3 15 15 28 49.38 <.001
  Conduct disorder 17 6 11 19 26 36.66 <.001
  Pathological gambling 2 0 2 1 4 11.55 <.01
Substance use disorders (lifetime)

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  Any AOD disorder 92 90 87 91 96 14.03 <.01
  Any cocaine disorder 50 45 38 51 59 21.83 <.001
(continued)
 Table 3. (continued)

Lifetime exposures to trauma

  Total (%) 0-1 (%) 2-4 (%) 5-6 (%) 7-25 (%)

  n = 807 n = 155 n = 189 n = 150 n = 313 χ2 or F p

  Any opiate disorder 50 52 43 55 52 5.08 0.165
  Any alcohol disorder 20 17 19 21 22 1.46 0.689
  Any marijuana disorder 17 17 14 16 19 2.36 0.493
  Any amphetamine disorder 1 2 1 0 1 2.92 0.413
  Any other drug disorder 3 1 3 5 3 3.14 0.380
Summary measures
  Count of above disorders
  M (SD) 2.6 (2.0) 1.4 (0.9) 1.9 (1.6) 2.7 (1.9) 3.6 (2.1) 65.89 <.001
  Grouped count of disorders
  0 8 12 11 9 4 167.50 <.001
  1 27 46 39 22 12  
  2 24 32 25 23 20  

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  3+ 42 10 25 47 65  

Note. PTSD = posttraumatic stress disorder; ADHD = attention-deficit/hyperactivity disorder; AOD = alcohol and other drugs.
aEndorsed 5+ past-year symptoms related to traumatic stress that was independent of a specific event or PTSD criteria.

15
16 The Prison Journal 

Approximately 35% of the respondents met the criteria for any past-year
externalizing disorder, which included ADHD (18%), conduct disorder
(17%), and pathological gambling (2%). In addition, 39% were diagnosed
with borderline personality disorder and 11% with antisocial personality
disorder—20 and 10 times higher, respectively, than the prevalence of these
disorders in the adult general population (Lenzenweger et al., 2007).
As expected, 92% of the participants had been diagnosed with a lifetime
substance use disorder; the most common were cocaine use disorder (50%)
and opiate use disorder (50%), followed by alcohol use disorder (20%) and
marijuana use disorder (17%). Women met the diagnostic criteria for an aver-
age of 2.6 of these internalizing, externalizing, or substance use disorders;
24% had 2 disorders and 42% had 3 to 14 disorders.
Note the consistent pattern showing that the percentage of women who
met the diagnostic criteria for each internalizing disorder rose consistently
and significantly with increasing numbers of exposures to traumatic events.
For example, the percentage of female detainees who reported symptoms of
any past-year internalizing disorder increased from 3% with 0 to 1 exposure,
to 30% with 2 to 4 exposures, to 47% with 5 to 6 exposures, and to 69% with
7 to 25 exposures (p < .001). Similarly, but somewhat less dramatically, the
percentage of female detainees who reported symptoms of any past-year
externalizing disorder increased from 6% with 0 to 1 exposure, to 21% with
2 to 4 exposures, to 23% with 5 to 6 exposures, and to 38% with 7 to 25 expo-
sures (p < .001). The percentage of female detainees who reported symptoms
of conduct disorder increased from 6% with 0 to 1 exposure, to 11% with 2
to 4 exposures, to 19% with 5 to 6 exposures, and to 26% with 7 to 25 expo-
sures (p < .001). The patterns across and for specific types of substance use
disorders varied more widely, but did generally rise.
As presented in Figure 1, female detainees who reported higher numbers
of exposures were also more likely to have one or more disorders. This rela-
tionship was quite substantial and especially apparent for women who
reported 5 to 6 and 7 to 25 exposures (χ2 = 167.50, p < .001). Among the
former, 22% had 1 disorder and 47% had 3 to 14 disorders; among the latter,
12% had 1 disorder and 65% had 3 to 14 disorders. Nonetheless, in our sam-
ple many of the women had one or more psychiatric disorders, even among
those with 0 to 1 reported exposures to trauma (i.e., 32% had 2 disorders, and
10% had 3 to 14 disorders).

Demographic Characteristics and Exposure

Increases in the number of exposures by race were uneven. Specifically, in
Table 4 the percentage of African American female detainees who reported

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Scott et al. 17

Figure 1.  Number of disorders by range of trauma exposure.

Note. χ2(9) = 167.5.
p < .001.

lifetime exposure to trauma rose from 18% with 0 to 1 exposure to 39% with
7 to 25 exposures. However, the percentage of African American women who
reported 2 to 4 exposures (24%) was lower than the percentage of those who
reported 5 to 6 exposures (20%). Among Latinas, the percentage of women
who reported 0 to 1 exposure (31%) was higher than the proportions of
women who reported 5 to 6 exposures (12%), and 7 to 25 exposures (26%).
Among women of Other/mixed race, the percentage who reported 5 to 6
exposures (52%) was nearly 6 times higher than the percentage who reported
0 to 1 exposure (9%).
A significant difference among women of different marriage status was
found (χ2 = 22.76, p < .01). For example, in the highest category of lifetime
exposures to trauma (7 to 25), those who reported being divorced/separated/
widowed also reported the highest percentage of exposures (53%), compared
with those who reported being married/living with someone (45%) or never
married (35%). Also significant was the relationship between lifetime expo-
sures to trauma and age at first drug use (χ2 = 20.00, p < .01). Most notably, a

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 Table 4.  Demographic Characteristics by Range of Trauma Exposure.

18
Lifetime exposures to trauma

  Total (%) 0-1 (%) 2-4 (%) 5-6 (%) 7-25 (%)

  n = 807 n = 155 n = 189 n = 150 n = 313 χ2 p

Characteristics
 Race/ethnicity
  African American 82 78 83 86 82 14.90 .088
  Caucasian 9 12 6 8 9  
  Hispanic 5 8 7 3 4  
  Mixed/Other 4 2 5 3 5  
Age
 18-20 6 9 7 2 5 16.37 .176
 21-29 20 20 20 21 20  
 30-39 29 34 28 25 29  
 40-49 34 30 34 37 35  
 50+ 11 7 11 15 12  
Marital status
  Married/living with someone 12 7 12 15 14 22.76 <.01
 Divorced/separated/widowed 16 12 11 15 22  
  Never married 72 81 78 71 64  

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  Age of first use
  13 or younger 15 16 11 10 20 20.00 .017
 14-15 16 14 15 19 15  
 16-17 18 21 13 18 19  
  18 or older 52 49 61 53 46  
Scott et al. 19

higher proportion of female detainees who reported that they began using
alcohol or other substances at age 13 or younger also reported the highest
percentage of lifetime exposure to trauma (7 to 25 exposures; 51%), com-
pared with those who reported that they first starting using at ages 14 to 15
(38%), ages 16 to 17 (41%), and ages 18 or older (35%).

Discussion
Women in the CCDOC experienced a variety of adverse life events. Repeated
trauma at the higher end of the frequency range was found for all measures of
trauma exposure. Their traumas were quite extensive, ranging from economic
pressures to the witnessing of violence to direct, serious victimization at the
hands of strangers and intimates, including battery, armed robbery, and rape.
All these types of violent victimizations are known to produce symptoms of
PTSD and other types of psychological distress (Breslau, Chilcoat, Kessler,
& Davis, 1999; Lurigio, 2015). Furthermore, female detainees were more
likely to experience recurrent victimizations and other adverse life events
than to experience such incidents in isolation or as rare occurrences.
As demonstrated in the current and many previous investigations, men
and women with repeated exposures to trauma appear to be at higher risk of
developing psychological problems (DeHart, 2009; Hedtke et al., 2008;
Messina & Grella, 2006; Turner, Finkelhor, & Ormrod, 2006). For exam-
ple, PTSD, depression, and substance use disorders are not only coinciden-
tal with lifetime experience of trauma but also increase with the accumulation
of different types of traumatic experiences (cf. Hedtke et al., 2008). Other
studies have found that the number of different types of interpersonal vio-
lence experienced by incarcerated women significantly predicted current
symptoms of depression, PTSD, and substance dependence (e.g., Lynch
et al., 2012). Among female inmates, experiences of interpersonal violence
are clearly linked to entry into the criminal justice system (Carlson &
Shafer, 2010).
A highly consistent finding of this study was the growing percentages of
women in categories with increasing numbers of exposures (i.e., from 0 to 1
to 7 to 25). These incremental rises were found for every type of stressor and
disorder and generally applied across race, age, marriage status, and age at
first drug use. Especially pertinent is the finding that symptoms of PTSD and
other psychiatric disorders were more prevalent among female detainees with
higher numbers of lifetime exposure to trauma. For example, 10% of the
women with no or 1 exposure to trauma reported the symptoms of internal-
izing or externalizing disorders, whereas 65% of women with 7 to 25 expo-
sures reported such symptoms—a sixfold differential.

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20 The Prison Journal 

These results support the sensitization hypothesis, initially proposed to

account for the relationship between childhood trauma and PTSD among
Vietnam veterans (Bresleu, Chilcoat, Kessler, & Davis1999). Specifically,
our findings demonstrate that respondents who experienced previous epi-
sodes of trauma appear to be more vulnerable to the effects of subsequent
trauma than those with no previous trauma and are therefore more likely to
develop symptoms of PTSD and other types of disorders.
Incarceration was a common experience for participants and their
family members. More studies should be done to explore the traumatic
effects of jail stays. An in-depth study of CCDOC detainees uncovered
an extensive array of deleterious consequences of detention on detainees’
lives, irrespective of whether they were ultimately convicted of a crime.
Even relatively short periods of detention can result in damaged interper-
sonal relationships, diminished academic progress, and the loss of health
care benefits, jobs, cars, apartments, and homes. These events individu-
ally and collectively are traumatic and can produce or exacerbate a vari-
ety of mental health problems (Rubinowitz, 2011). In short, similar to
other adverse life events, jail stays can change the trajectories of people’s
lives. Focused attention should be directed to detention as a specific
stressor in itself and how that experience itself might be directly
addressed to reduce detention-specific trauma and preclude its interfer-
ence with the benefits of substance abuse treatment and other behavioral
health care interventions. Finally, many women reported having lost a
loved one. This finding suggests the usefulness of incorporating grief
counseling into jail programming.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research,
authorship, and/or publication of this article.

Funding
The author(s) disclosed receipt of the following financial support for the research,
authorship, and/or publication of this article: This research was supported by a grant
from the National Institute on Drug Abuse (No. DA011174) awarded to Chestnut
Health Systems.

References
American Psychiatric Association. (1994). Diagnostic and statistical manual of men-
tal disorders (4th ed.). Washington, DC: Author.
American Psychiatric Association. (2013). Diagnostic and statistical manual of men-
tal disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Downloaded from tpj.sagepub.com at BRIGHAM YOUNG UNIV on November 30, 2015

Scott et al. 21

Battle, C., Zlotnick, C., Najavits, L. M., Gutierrez, M., & Winsor, C. (2003).
Posttraumatic stress disorder and substance use disorder among incarcerated
women. In P. Ouimette & P. J. Brown (Eds.), Trauma and substance abuse:
Causes, consequences, and treatment of comorbid disorders (pp. 209-225).
Washington, DC: American Psychological Association.
Beck, A. J., & Karberg, J. C. (2001). Prison and jail inmates at midyear 2000.
Washington, DC: U.S. Department of Justice, Office of Justice Programs, Bureau
of Justice Statistics.
Belknap, J., & Holsinger, K. (2006). The gendered nature of risk factors for delin-
quency. Feminist Criminology, 1, 48-71.
Biggs, D., De Ville, B., & Suen, E. (1991). A method of choosing multiway partitions
for classification and decision trees. Journal of Applied Statistics, 18, 49-62.
Breslau, N., Chilcoat, H. D., Kessler, R. C., & Davis, G. C. (1999). Previous exposure
to trauma and PTSD effects of subsequent trauma: Results from the Detroit area
survey of trauma. American Journal of Psychiatry, 156, 902-907.
Bureau of Justice Statistics. (2000). Prisoners in 1999. Washington, DC: U.S.
Department of Justice.
Carlson, B., & Shafer, M. (2010). Traumatic histories and stressful life events of
incarcerated parents: Childhood and adult trauma histories. The Prison Journal,
90, 475-493.
Clark, C. (2002). Addressing histories of trauma and victimization in treatment. Retrieved
from http://gainscenter.samhsa.gov/pdfs/women/series/AddressingHistories.pdf
Cook, S. L., Smith, S. G., Tusher, C. P., & Raiford, J. (2005). Self-reports of traumatic
events in a random sample of incarcerated women. Women & Criminal Justice,
16, 107-126.
DeHart, D. D. (2008). Pathways to prison: Impact of victimization in the lives of
incarcerated women. Violence Against Women, 14, 1362-1381.
DeHart, D. D. (2009). Polyvictimization among girls in the juvenile justice sys-
tem: Manifestations and associations to delinquency. Washington, DC: U.S.
Department of Justice.
Dennis, M. L., White, M., Titus, J. C., & Unsicker, J. (2008). Global appraisal of indi-
vidual needs: Administration guide for the GAIN and related measures (Version
5). Retrieved from http://www.gaincc.org/gaini
DeVeaux, M. (2013). The trauma of the incarceration experience. Harvard Civil
Rights-Civil Liberties Law Review, 48, 257-277.
Diamond, P. M., Wang, E. W., Holzer, C. E., Thomas, C., & Cruser, A. (2001). The
prevalence of mental illness in prison. Administration and Policy in Mental
Health, 29, 21-40.
Escobar, G., & Olson, D. E. (2012). A profile of women released into Cook County
communities from jail and prison (Criminal justice and criminology: Faculty
publications and other works, Paper 8). Retrieved from http://ecommons.luc.edu/
cgi/viewcontent.cgi?article=1007&context=criminaljustice_facpubs
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (2002). Structured
clinical interview for DSM-IV-TR Axis I disorders, research version, non-patient
edition. New York: Biometrics Research, New York State Psychiatric Institute.

Downloaded from tpj.sagepub.com at BRIGHAM YOUNG UNIV on November 30, 2015

22 The Prison Journal 

First, M. B., Spitzer, R. L., Gibbon, M., Williams, J. B. W., & Benjamin, L. (1994).
Structured clinical interview for DSM–IV axis II personality disorders (SCID-II)
(Version 2.0). New York: Biometrics Research Department, New York State
Psychiatric Institute.
Green, B. L., Miranda, J., Daroowalla, A., & Siddique, J. (2005). Trauma expo-
sure, mental health functioning and program needs of women in jail. Crime &
Delinquency, 51, 133-151.
Grella, C. E., Stein, J. A., & Greenwell, L. (2005). Associations among childhood
trauma, adolescent behavior problems, and adverse adult outcomes in substance-
abusing women offenders. Psychology of Addictive Behaviors, 19, 43-53.
Hardyman, P., & Van Voorhis, P. (2004). Developing gender-specific classifica-
tion systems for women offenders. Washington, DC: U.S. Department of Justice,
National Institute of Corrections.
Harrison, P. M., & Beck, A. J. (2004). Prisoners in 2003. Washington, DC: U.S.
Department of Justice, Bureau of Justice Statistics.
Hedtke, K. A., Ruggiero, K. J., Fitzgerald, M. M., Zinzow, H. M., Saunders,
B. E., Resnick, H. S., & Kilpatrick, D. G. (2008). A longitudinal investigation of
interpersonal violence in relation to mental health and substance use. Journal of
Consulting and Clinical Psychology, 76, 633-647.
Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995).
Posttraumatic National Comorbidity Survey. Archives of General Psychiatry, 52,
1048-1060.
Kilpatrick, D. G., Acierno, R., Resnick, H. S., Saunders, B. E., & Best, C. L. (1997).
A 2-year longitudinal analysis of the relationships between violent assault and
substance use in women. Journal of Consulting and Clinical Psychology, 65,
834-847.
Kimerling, R., Trafton, J. A., & Nguyen, B. (2006). Validation of a brief screen for
posttraumatic stress disorder with substance use disorder patients. Addictive
Behaviors, 31, 2074-2079.
Lenzenweger, M. F., Lane, M. C., Loranger, A. W., & Kessler, R. C. (2007). DSM-IV
personality disorders in the National Comorbidity Survey Replication. Biological
Psychiatry, 62, 553-564.
Lurigio, A. J. (2015). Violent victimization in the United States: Major issues and
trends. Washington, DC: National Institute of Justice.
Lynch, S. M., Fritch, A. M., & Heath, N. M. (2012). Looking beneath the surface:
The nature of incarcerated women’s experiences of interpersonal violence, men-
tal health, and treatment needs. Feminist Criminology, 7, 381-400.
Mauer, M., & Chesney-Lind, M. (2002). Invisible punishment: The collateral conse-
quences of mass imprisonment. New York: The New York Press.
McDaniels-Wilson, C., & Belknap, J. (2008). The extensive sexual violation and sexual
abuse histories of incarcerated women. Violence Against Women, 14, 1090-1127.
Messina, N., & Grella, C. (2006). Childhood trauma and women’s health outcomes
in a California prison population. American Journal of Public Health, 96(10),
1842-1848.

Downloaded from tpj.sagepub.com at BRIGHAM YOUNG UNIV on November 30, 2015

Scott et al. 23

Minton, T. D. (2012). Jail inmates at midyear 2011—Statistical tables. Washington,

DC: U.S. Department of Justice, Bureau of Justice Statistics.
Mumola, C. J. (1999). Substance abuse and treatment: State and federal prisoners,
1997. Washington, DC: Bureau of Justice Statistics.
National GAINS Center. (2004). The prevalence of co-occurring mental illness and
substance use disorders in jails. Washington, DC: Substance Abuse and Mental
Health Services Administration.
Ney, B., Ramirez, R., & Van Dieten, M. (2012). Ten truths that matter when working
with justice involved women. Silver Spring, MD: National Resource Center on
Justice Involved Women. Retrieved from http://cjinvolvedwomen.org/sites/all/
documents/Ten_Truths.pdf
Ngo, F. T., Govindu, R., & Agarwal, A. (2015). Assessing the predictive utility of
logistic regression, classification and regression tree, chi-squared automatic
interaction detection, and neural network models in predicting inmate miscon-
duct. American Journal of Criminal Justice, 40, 47-74.
Olson, D. E. (2013). An examination of admissions, discharges, and the population
of the Cook County Jail, 2012 (Cook County Sheriff’s Reentry Council Research
Bulletin). Chicago, IL: Cook County Sheriff’s Office.
Peters, R. H., & Matthews, C. O. (2002). Jail treatment for drug abusers. In C. G.
Leukefeld, F. M. Tims, & D. F. Farabee (Eds.), Treatment of drug offenders:
Policies and issues (pp. 186-203). New York, NY: Springer.
Peters, R. H., Strozier, A., Murrin, M., & Kearns, W. (1997). Treatment of substance-
abusing jail inmates: Examination of gender differences. Journal of Substance
Abuse Treatment, 14, 339-349.
Rabinowich, M. (2011). Holding cells: Understanding the collateral consequences
of pretrial detention. (Unpublished dissertation). Northwestern University,
Department of Sociology, Evanston, IL.
Scott, C. K., & Dennis, M. L. (2012). The first 90 days following release from jail:
Findings from the Recovery Management Checkups for Women Offenders
(RMCWO) experiment. Drug and Alcohol Dependence, 125, 110-118.
Singer, M., Bussey, J., Song, L.-Y., & Lungerhofer, L. (1995). The psychosocial issue
of women serving time in jail. Social Work, 40, 103-113.
Stewart, S. H., & Conrod, P. J. (2003). Psychosocial models of functional associations
between posttraumatic stress disorder and substance use disorder. In P. Ouimette
& P. J. Brown (Eds.), Trauma and substance abuse: Causes, consequences,
and treatment of comorbid disorders (pp. 29-55). Washington, DC: American
Psychological Association.
Toch, H. (2007). Men in crisis: Human breakdowns in prison. New Brunswick, NJ:
Transaction Publishers.
Turner, H. A., Finkelhor, D., & Ormrod, R. (2006). The effect of lifetime victimiza-
tion on the mental health of children and adolescents. Social Science & Medicine,
62, 13-27.
Van Voorhis, P., & Presser, L. (2001). Classification of women offenders: A national
assessment of current practices. Washington, DC: U.S. Department of Justice,
National Institute of Corrections.

Downloaded from tpj.sagepub.com at BRIGHAM YOUNG UNIV on November 30, 2015

24 The Prison Journal 

Westermeyer, J., & Boedicker, A. E. (2000). Course, severity, and treatment of sub-
stance abuse among women versus men. American Journal of Drug and Alcohol
Abuse, 26, 523-535.
Widom, C. S. (2000). Childhood victimization and the derailment of girls and
women to the criminal justice system: Plenary papers of the 1999 Conference
on Criminal Justice Research and Evaluation. Enhancing Policy and Practice
Through Research, 3, 27-36.

Author Biographies
Christy K. Scott, PhD, is the director of the Lighthouse Institute and the Illinois
Survey Laboratory, Chestnut Health Systems, Chicago, IL. Her research focuses on
understanding and predicting how people move through the cycles of substance use,
crime, treatment, incarceration, and periods of recovery, as well as how to experimen-
tally test strategies for improving recovery management over time. Publishing widely
on recovery management, how to achieve greater than 90% follow-up rates in longi-
tudinal studies, and intensive data collection with smart phones, she has developed
and tested different interventions for managing addiction over time.
Arthur J. Lurigio, PhD, a psychologist, is senior associate dean for faculty in the
College of Arts and Sciences and a professor of criminal justice and criminology and
psychology, Loyola University Chicago. Named a 2003 Faculty Scholar, the highest
honor bestowed on senior faculty at Loyola, he was named a Master Researcher in
2013 by the College of Arts and Sciences in recognition of his continued scholarly
productivity.
Michael L. Dennis, PhD, is a senior research psychologist at the Lighthouse Institute
and director of the GAIN Coordinating Center at Chestnut Health Systems, Normal,
IL. His research focus is understanding and predicting how people move through the
cycles of substance abuse, crime, treatment, incarceration, and periods of recovery, as
well as how to experimentally test strategies for improving recovery management
over time. He has published widely on recovery management, integrating clinical and
research assessment, measurement, intensive data collection with smart phones, and
evaluation research.
Rod Funk is a research associate at the Lighthouse Institute of Chestnut Health
Systems in Normal, IL. He holds the highest SPSS certification for data mining meth-
ods and modeling. His research interests are in the analyses of complex hierarchical
and intensive data analytic models, as well as the use of clustering techniques to
interpret heterogeneous samples and trends over time.

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