Women's Substance Use and Disorders Issues (2010-2012)

A Long-term Follow-up Study of
Drug-Dependent Mothers and their Children

Yih-Ing Hser, Ph.D., Principal Investigator (yhser@ucla.edu)
Nena Messina, Ph.D., Co-Investigator
Elizabeth Evans, M.A., Project Director

Risky health behavior causes serious health problems for drug-dependent mothers and their children.  In recent years, an increased number of women-only programs have offered special services to address the unique problems and service needs of mothers, including child care and parenting services. However, few studies have examined short-term and long-term outcomes of mothers and children served in women-only programs. We conducted a long-term follow-up study of 4,500 mothers treated for risky health behaviors via their administrative records, and by interviewing a subsample of mothers (n = 1,000) to provide complementary data on their status. Additionally, we collected assessment data from the mothers interviewed on their target children (mostly aged 8 to 10). The specific aims of the study were: (1) to investigate mothers’ long-term outcomes measured by administrative records (e.g., treatment, mental health, arrest) in relation to their index treatment in women-only versus mixed-gender programs; and (2) to locate and interview a subset of mothers to determine, in relation to mothers’ index treatment in women-only versus mixed-gender programs, (a) mothers’ status (social support, parenting behaviors, health behaviors, mental health) and (b) children’s status (custody, school achievement, behavioral problems). The study provided empirical data with treatment and policy implications for improving services and outcomes for mothers and their children.

For more information, please see the following publications:

  • Hser, Y.I., Hunt, S., Chang, Y., Evans, E., & Messina, N. (in press). Hispanic parenting women in women-only versus mixed-gender drug treatment: A 10-year prospective study. Addictive Behaviors.
  • Hser, Y., Kagihara, J., Huang, Y., Evans, E., Messina, N. (2012).  Mortality among substance-using mothers in California: A 10-year prospective study. Addiction, 107(1): 215-222.
  • Hser, Y.-I., Evans, E., Huang, D., & Messina, N. (2011). Long-term outcomes among drug dependent mothers treated in women-only versus mixed-gender programs.  Journal of Substance Abuse Treatment, 41(2):115-123.

A Long-term Follow-up Study of Drug-Dependent Mothers and their Children was funded by the National Institute on Drug Abuse, grant 1 R01 DA021183, from June 2009 to May 2011.

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Enhancing Substance Abuse Treatment
Services for Women Offenders

Nena Messina, Ph.D., Principal Investigator (nmessina@ucla.edu)
Maria Zarza, Ph.D., Project Director (September 2005 to Sepember 2007)
Stacy Calhoun, M.A., Project Director (September 2007 – 2010)

This 3-year study examined Mental Health Systems, Inc.’s (MHS), readiness and capacity for practice improvement as it incorporated women-focused treatment into four MHS program sites serving female drug-court participants. This study also included an experimental component to determine the relative effectiveness of a women-focused (WF) treatment program based on relational theory, compared to the standard mixed-gender (MG) outpatient treatment program delivered to women offenders deferred from incarceration through drug court to promote positive behaviors (e.g., reducing criminal offending and substance abuse) and improve psychological functioning. The WF curricula had been fully developed by Stephanie Covington (i.e., Helping Women Recover and Beyond Trauma); however, this was the first empirical test of the curricula in a community treatment setting.  Specifically, 150 women participating in four MHS drug court programs in San Diego, California, were randomly assigned to the WF or MG treatment program groups. The proposed study had the following specific aims:

  1. To identify and address barriers to coordinating and integrating new and appropriate WF services, including HIV prevention, for substance-dependent women offenders;
  2. To coordinate and integrate a theoretically based women-focused protocol into the existing MHS program curriculum;
  3. To develop effective fidelity measures to assess staff performance, adherence, and retention to the newly integrated curriculum;
  4. To pilot test the efficacy of the theoretically based, multi-faceted, WF curriculum to promote positive behaviors among women offenders, compared to the impact of the standard MG program;
  5. To qualitatively assess women’s perceptions of their treatment experience, comparing those of  women in the newly integrated WF program with those of women in the standard MG program.


Findings from the staff focus groups revealed that the facilitators were very supportive of implementing the WF curriculum in their drug court treatment program and showed a strong willingness to be trained in the new curriculum.  However, they were concerned that they were not trained enough to deal with traumatic events that might come up in group.  In particular, they were worried about “opening a can of worms” and being unable to resolve the situation before a session is finished and thereby placing the client at risk for using again.  Findings indicate the need to provide the counselors with an on-site experienced clinician to help them deal personally and professionally with their daily work.

Results from the experimental component of the study showed that the WF participants had significantly better in-treatment performance, more positive perceptions related to their treatment experience, and positive trends indicating reductions in PTSD symptomatology. Both groups improved in their self-reported psychological well-being and reported reductions in drug use (this comparison approached significance, p < .06), and arrest (a diagnosis of PTSD was the primary predictor of reductions in re-arrest, p < .04). Findings show the beneficial effects of treatment components oriented toward women’s needs. Significant questions remain, particularly around PTSD and whether these symp­toms should be targeted to improve substance use outcomes for women offenders.

Enhancing Substance Abuse Treatment Services for Women Offenders was funded by Mental Health Systems, Inc., grant 720 (R01 DA022149), from September 2005 to July 2010.

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Evaluation of HealthRight 360 Pregnant and
Parenting Women’s Treatment Program

Christine E. Grella, Ph.D., Principal Investigator (cgrella@mednet.ucla.edu)
Luz Rodriguez, Project Director

The Families Living our Recovery (FLOR) project will provide comprehensive services to women offenders with a history of substance abuse problems at the HealthRight 360 residential treatment program in El Monte, CA.  FLOR participants are recruited into the project at the time of their parole from prison. The program goals are to improve participants’ family functioning, employment status, and psychosocial functioning; to provide treatment for substance abuse, mental health, and trauma-related problems; and to assist participants as they transition to the community, including family reunification.  The FLOR project utilizes evidence-based parenting and family strengthening interventions within the context of intensive case management services.  Participants also receive vocational training and training in life management skills.  Children of FLOR participants may reside in the residential treatment program and are provided with prevention, early intervention, and medical services through community partnerships.  The program also aims to promote the development of a comprehensive, integrated service delivery system through community partnerships that utilize family-centered treatment planning. UCLA ISAP will conduct a process and outcome evaluation study of the FLOR project. The evaluation study will examine whether the project recruits the intended target population, the degree to which the program model is successfully implemented, and participant outcomes at follow-up, including substance use, psychosocial functioning, family status, and employment and housing status. 

Evaluation of Pregnant and Parenting Women’s (PPW) Program was funded by the Haight-Ashbury Free Clinic (now HealthRight 360), contract 20114625, from October 2011 to September 2014.

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Evaluation of Horizon's Integrated AODA Treatment/HIV
Services for Justice-Involved Women

Nena Messina, Ph.D., Principal Investigator (nmessina@ucla.edu)
 Kira Jeter, M.P.H., Project Director

The purpose of this SAMHSA-funded project was to expand Community Advocates - Horizons Campus’ program to increase access to integrated outpatient AODA treatment and HIV services for a minimum of 600 justice-involved women, who are less likely to enter treatment through formal systems. Objectives were to: (1) increase the number of women who participate in integrated outpatient AODA/HIV services from 25 to 125 women per year; (2) enhance Community Advocates-Horizons Campus’ program with research-based AODA/HIV curricula that engaged hard-to-reach women, their children, and their partners; and (3) increase the number of women and partners who receive rapid HIV testing from 90 to 200 per year. ISAP conducted the evaluation, which (1) included process and outcome components to monitor the implementation of the planned intervention and (2) measure observed changes in participants from before to after their participation in the project in the following domains of functioning: (a) alcohol and drug use; (b) parenting behaviors and family functioning; (c) quality of life and social functioning; (d) criminal behavior and legal status; (e) mental health and physical health status; (f) HIV/AIDS risk reduction behaviors; and (g) treatment and services received. The program worked with parole and probation departments in the Milwaukee area to recruit participants.  Horizons’ has been successful in completing follow-up interviews. Once engaged, participants continued to stay well connected to the staff and/or services offered by the program.

Evaluation of Community Advocates - Horizons Campus Integrated AODA Treatment/HIV Services for Justice-Involved Women was funded by the Substance Abuse and Mental Health Services Administration, grant TI18592 to Community Advocates-Horizons Campus, from October 2007 to September 2012.

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Evaluation of the Liberating our Families
from Drugs and Incarceration Program

Christine E. Grella, Principal Investigator (grella@ucla.edu)
Luz Rodriguez, Project Director

ISAP conducted the evaluation of the SAMHSA-funded project “Liberating our Families from Drugs and Incarceration (LOFFDI),” which was part of the Pregnant and Parenting Women’s Treatment Initiative at the Center for Substance Abuse Treatment.  The LOFFDI program was provided at the Walden House program in El Monte, CA, and the target population was women parolees who had a history of substance use problems and who were pregnant or had young children.  The program’s objectives were to improve the mental and physical health status, employment status, and parenting skills of participants so that they could successfully reintegrate into the community following their release from prison.  Intensive case management services were provided within the context of residential substance abuse treatment, which included children’s services, family counseling, parenting skills training, vocational services, mental health services, trauma-related services, and referral for medical services for the women and their children. The evaluation study showed that approximately 60% of participants (N = 110) completed the LOFFDI treatment, compared with an average of 39% for participants in other aftercare programs for female offenders in California.  Moreover, LOFFDI participants demonstrated significant improvements in their alcohol and drug use, psychological status, family functioning, employment, and quality of life at the 6-month post-discharge follow-up.  Participants had a high level of satisfaction with the services received, and staff improved their competency in delivering parenting and other services over the course of project implementation. Overall, the evaluation demonstrated that LOFFDI participants improved in targeted domains that address the multiple and complex problems faced by female offenders and their families as they re-integrate into the community following parole.

Evaluation of the Liberating our Families from Drugs and Incarceration Program was funded by Walden House, Inc., contract 20064370, from October 2006 to September 2010.

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Evaluation of Trauma Informed Substance Abuse Treatment (TI-SAT)

Christine E. Grella, Ph.D., Principal Investigator (cgrella@mednet.ucla.edu)
Nena Messina, Ph.D., Co-Investigator
Luz Rodriguez, B.A., Project Director

The Trauma-Informed Substance Abuse Treatment (TI-SAT) program was established at the Leo Chesney Community Correctional Facility in 2008 to provide gender-responsive and trauma-informed substance abuse treatment for women offenders.  The treatment approach recognizes that childhood and adult trauma exposure is pervasive among women offenders and intricately related with their substance abuse problems.  ISAP conducted an evaluation of the TI-SAT to (1) determine whether the trauma-informed treatment components were implemented as planned; (2) determine whether obstacles were encountered in the implementation process, and if so, to determine the strategies used to address these obstacles; and (3) determine the characteristics of participants, their treatment retention and aftercare participation, and their outcomes on parole.  A total of 106 participants were recruited to participate in the outcome study; interviews were conducted at study intake and at 6-month follow-up.  Outcome analyses examined the effects of program participation on status and functioning of participants, including their relapse to substance use, criminal behavior involvement, employment, parenting and family relationships, and overall mental health and psychosocial functioning.  In addition, surveys with program staff and observational site visits were conducted to determine whether the gender-responsive and trauma-informed program components were successfully implemented. Findings demonstrated that the program components were successfully implemented and that participants in the TI-SAT had higher levels of treatment retention and aftercare participation than women in other prison-based treatment programs.

Evaluation of Trauma Informed Substance Abuse Treatment (TI-SAT) was funded by the State of California Department of Corrections and Rehabilitation, contract C08.106, from October 2008 to March 2011.

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Gender-Responsive Treatment for Women Offenders

Michael Prendergast, Ph.D., Principal Investigator (mlp@ucla.edu)
Nena Messina, Ph.D., & Elizabeth Hall, Ph.D., Co-Investigators

This 5-year study was designed to determine whether drug abuse treatment programs designed specifically for women offenders result in better outcomes than do mixed-gender programs. Consistent findings regarding the greater severity of women’s drug abuse, past trauma, and psychological disorders have led many researchers to advocate the use of gender-responsive treatment for women as a more appropriate and effective way to facilitate their recovery. As policymakers and treatment providers consider expanding treatment options for women offenders, it is critically important to determine whether women-only (WO) treatment programs do produce better outcomes than standard mixed-gender (MG) programs. This study involved the cooperation of community-based drug abuse treatment agencies providing Drug Court, Substance Abuse Crime and Prevention Act (SACPA, or Prop. 36), perinatal, and other outpatient treatment within Los Angeles County. The study used a quasi-experimental design with study intake into two treatment conditions (MG vs. WO) and had the following specific aims: (1) To evaluate the impact of WO programs on drug use, criminal activity, and social functioning (e.g., employment, education, parenting behavior) for women offenders, compared to the impact of MG programs, and (2) To qualitatively assess women’s perceptions of their treatment experiences in the WO and MG treatment programs. Using a propensity-score approach to balance the two groups on baseline characteristics, analysis indicated that at 12-months following treatment entrance, women who participated in WO programs were significantly less likely to use drugs and to commit crimes than were women in MG programs, but the groups did not differ significantly on arrest and employment.

For more information, please see:

  • Prendergast, M., Messina, N., Hall, E., & Warda, U. (2011). The relative effectiveness of women-only versus mixed-gender substance abuse treatment. Journal of Substance Abuse Treatment, 40(4), 336-348. (PMCID: PMC3081899)

Gender-Responsive Treatment for Women Offenders was funded by the National Institute on Drug Abuse, grant 1 R01 DA016277, from September 2004 through August 2010.

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Prenatal Methamphetamine Exposure
and School Age Outcome

Barry Lester, M.D., Brown University, Principal Investigator
Richard A. Rawson, Ph.D., Co-Investigator (rrawson@mednet.ucla.edu)
Dave Bennett, Project Director

The rapidly escalating abuse of methamphetamine (METH) in the United States, places a sense of urgency on understanding the consequences of METH use during pregnancy for the developing child. To our knowledge, the IDEAL (Infant Development Environment and Lifestyle) study is the only prospective longitudinal NIH study of prenatal METH exposure and child outcome. This is the continuation of a multi-site, longitudinal study that includes four diverse data collection sites where METH use is prevalent (Iowa, Oklahoma, California, and Hawaii) and three data coordinating centers (Brown Center for the Study of Children at Risk, the Data Management Center at UCLA ISAP, and the Center for Substance Abuse Research (CESAR) at the University of Maryland.  The responsibilities of the three data coordinating centers included study development and oversight, data management, communication and documentation. The children were enrolled at birth and assessed at multiple age points until 36 months old during Phase I of this study (IDEAL I). The cohort was then followed during Phase II, which spanned the age range from 5 years through 7.5 years old (IDEAL II).  We followed 204 METH-exposed and 208 comparison children since birth. We studied a relatively narrow band of executive function domain outcomes supported by the published preclinical and clinical literature and our own preliminary findings. We also studied how these executive function domains affected school-related academic skills. In addition, we examined the effects of prenatal METH exposure on emerging executive function domains including higher order motivation, attention, memory, inhibitory control, visual motor integration, and motor control, and how the effects of prenatal METH exposure are affected by psychosocial risk factors and by postnatal passive drug exposure (e.g., smoke).

Publications from this study include:

  • LaGasse LL, Wouldes T, Newman E, Smith LM, Shah R, Derauf C, Huestis MA, Arria AM, DellaGrotta S, Wilcox T, & Lester BM. (2011). Prenatal methamphetamine exposure and neonatal neurobehavioral outcome in the USA and New Zealand. Neurotoxicology and Teratology, 33; 166-175. PMCID: PMC2974956.
  • LaGasse LL,  Derauf C, Smith LM, Newman E, Shah R, Neal C, Arria AM, Huestis MA, DellaGrotta S,  Hai, L, Dansereau LM, & Lester BM. (2012) Prenatal methamphetamine exposure and childhood behavior problems at ages 3 and 5.  Pediatrics. Epub ahead of Print March 19, 2012. PMID:22430455.
  • Derauf C, MD , LaGasse LL,  Smith LM, Newman E, Rizwan Shah, Neal C , Arria AM, Huestis MA, Della Grotta S, Lynne M. Dansereau LM, Lin H, & Lester, BM. (2012). Prenatal methamphetamine exposure and inhibitory control among young school-age children. The Journal of Pediatrics. Epub ahead of print March 15, 2012. PMID: 22424953.
  • Derauf C, LaGasse LL, Smith LM, Newman E, Shah R, Arria AM, Huestis MA, Haning W, Strauss A, DellaGrotta S, Dansereau L, Lin H, & Lester BM. (2011). Infant temperament and high risk environment relate to behavior problems and language in toddlers. Journal of Developmental & Behavioral Pediatrics, 31(1).  PMCID: PMC3095893.
  • Shah R, Copes, SD, LaGasse LL, Derauf C, Newman E, Arria AM, Huestis MA, Haning W, Smith LM,  Strauss A, DellaGrotta S, Dansereau L, Roberts M, & Lester BM. (in press). Prenatal methamphetamine exposure and short-term maternal and infant medical outcomes. American Journal of Perinatology.
  • Zabaneh R,  Smith LM, LaGasse LL, Derauf C, Newman E, Shah R, Haning W, Arria AM, Huestis MA, Strauss A, DellaGrotta S, Dansereau L, Lin H, and Lester BM.  The effects of prenatal cethamphetamine exposure on childhood growth patterns from birth to three years of age.  American Journal of Perinatology. [Epub ahead of print]. PMID:21818727.
  • Smith LM, Paz MS, LaGasse LL, Derauf C, Grant P,  Shah R, Arria AM, Huestis MA, Haning, W, Strauss A, DellaGrotta S, Dansereau L & Lester BM. (in press). Prenatal exposure to methamphetamine and maternal depression:  Neurodevelopmental findings from the infant development, environment, and lifestyle (IDEAL) study.  Depression and Anxiety Journal.
  • Liles B, Newman E, LaGasse LL, Derauf C, Shah R, Smith LM,  Arria AM, Huestis MA, Haning W, Strauss A, Della Grotta S, Dansereau LM, Neal C, & Lester BM. (in press). Parenting stress among prenatal methamphetamine users: The moderating role of maternal depressive symptoms.” Child Psychiatry and Human Development.
  • Prenatal Methamphetamine Exposure and School Age Outcome was funded by the National Institute on Drug Abuse to Women & Infants Hospital with collaboration by UCLA ISAP, from September 2007 through May 2012.
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TOWAR: A Comprehensive Training on
Women’s Addiction and Recovery

Nena Messina, Ph.D., Principal Investigator (nmessina@ucla.edu)
Stacy Calhoun, M.A., Project Manager

The UCLA Integrated Substance Abuse Programs in collaboration with Social Solutions International, Inc., received funding from the National Institute on Drug Abuse to develop TOWAR: a comprehensive Training on Women's Addiction and Recovery specifically for use in drug courts.  The specific aims of this Phase I Small Business Technology Transfer (STTR) project were as follows:

  1. To develop a woman-focused training program (i.e., TOWAR) to educate drug court personnel (i.e., the judge, district attorney, public defender, bailiff, sheriff, etc.) on the specific issues relevant to the recovery of drug-dependent women offenders (e.g., HIV-risk behavior, mental health, physical health, prostitution, child-custody, trauma, domestic violence, etc.);
  2. To develop a specific drug court model of care for women offenders that includes an appropriate treatment protocol for drug-dependent women offenders that can be easily integrated into any treatment facility, a woman-focused schedule of rewards and sanctions (i.e., positive reinforcement for short-term successes and/or consequences for failure to meet program requirements), and a systematic link between the court and social service partners in the county both during treatment and for the purpose of establishing aftercare;
  3. To qualitatively assessthe feasibility of a woman-focused drug court model of treatment.

All of the above specific aims have been accomplished.  With the help of the offices of the Los Angeles County Alcohol and Drug Abuse Program Administration (ADPA), the UCLA Addiction Technology Transfer Center (UCLA ATTC), and ONTRACK Program Services, three separate trainings were conducted. At the completion of the trainings, project staff asked participants to fill out evaluations.  The evaluations captured data on participants’ perceptions of the materials’ and guidelines’ usefulness and appropriateness.  Each of the three trainings resulted in very positive feedback from the participants. In fact, the TOWAR team was extensively questioned about when the TOWAR training and toolkit would be complete. Feedback obtained during this study will be used to finalize materials during the Phase II portion of this study.

TOWAR: A Comprehensive Training on Women’s Addiction and Recovery was funded by the National Institute on Drug Abuse, grant No. 1 R41 DA022101-01A2, from January 2009 to December 2010.

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Women, Methamphetamine, and Sex

Alison Hamilton, Ph.D., M.P.H. Principal Investigator (alisonh@ucla.edu)

This 5-year project focused on the relationship between methamphetamine (MA) and sex among women MA users. Thirty women in residential treatment participated in in-depth interviews. They were asked about their history of using MA and other substances, their life experiences (including any trauma or abuse they may have experienced), and their perspectives on how MA has affected their lives, specifically their intimate relationships and sexual behaviors. In the follow-up phase, these participants were interviewed about their experiences since the first interview. Recovery, relapse, intimate relationships, and several other topics were explored. As a career development award, the project also involved training for the principal investigator (PI) in public health and community health sciences. This study adds to the body of literature on the impact of substance abuse on life experiences. Considering that women who abuse substances such as MA typically have multiple factors placing them at risk for poor sexual decision-making (e.g., histories of violence and abuse), a more in-depth understanding of how women MA users conceptualize their sexual behaviors and experiences could assist in developing interventions for them. The PI’s co-mentors on the project were Drs. Richard Rawson (UCLA ISAP), Yih-Ing Hser (UCLA ISAP), and Vivian Brown (PROTOTYPES).

Related Publications:

  • Hamilton, A., Goeders, N. (2010). Violence perpetrated by women who use methampethamine. Journal of Substance Use, 15 (5), 313–329.
  • Hamilton, A. (In press). The vital conjuncture of methamphetamine-involved pregnancy: Objective risks and subjective realities. In Responsible Reproduction? Social and Biomedical Constructions of Reproductive Risk, Lauren Fordyce & Aminata Maraesa, Editors. Vanderbilt University Press.
Women, Methamphetamine and Sex was funded by the National Institute on Drug Abuse, grant 1 K01 DA017647, from April 2006 through March 2011.

Last Updated:  12/06/2012

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2016 ISAP Publications
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