Within the research literature, support for well-financed, accessible, comprehensive, gender-based substance abuse services for women in the criminal justice system is well-documented (Adams et al., 2008
; Grella, 2008
; Kassebaum, 1999
; Scroggins & Malley, 2010
; Simpson & McNulty, 2008
). What are less well documented and supported are the interpersonal aspects of treatment that emerged from this systematic review. Based on findings from this investigation; attributes of treatment that may require new or renewed attention include diminishment of client ambivalence, instillation of hope, trust-based provider-client relationships, individualized care, and the establishment and maintenance of personal dignity and respect.
These findings are similar to recommendations that have been made in other areas of healthcare. For example, in acute care settings, providers are being asked to assess and communicate with patients using back-to-basics methods: eye-to-eye contact, hand-to-skin assessments, and empathic-voice-to-anxious-ear interactions (Verghese, 2008
). In effect, patients/clients appear to be asking for personalized care, opportunities to hope and trust, and attainment and preservation of personal integrity across treatment settings. Of particular interest in terms of future research and practice, is how these types of treatment attributes can be implemented and sustained in highly complex and demanding clinical settings over time.
It is noteworthy that evidence-based motivational interventions (Miller & Rose, 2009
) did not appear to be a part of the substance abuse treatment programs that were described in the reports that comprised the sample for this systematic review. The absence of this type of therapeutic intervention seems particularly relevant given the high level of ambivalence that women within the criminal justice system appear to have prior to entering and fully participating in community-based substance abuse treatment programs. In the future, it is recommended that researchers evaluate the potential effectiveness of intervention strategies such as motivational interviewing in this treatment context.
Although length of treatment varied greatly (3 to 24 months) among the programs that were studied, time enrolled was not identified as a relevant factor in terms of treatment success. Instead, what was articulated to be important was intermittent and ongoing access to supportive treatment personnel after formal programming was over. This finding is relevant in terms of the potential for less costly long-term follow-up services.
A relatively small number of reports of qualitative research met the inclusion criteria for this systematic review. It is also notable that all of the studies that constituted the database were conducted in the United States (US). Thus, it cannot be assumed that the findings are fully intra- or internationally generalizable. For comparative purposes, the execution of US and non-US-based qualitative investigations of the type included in this systematic review are recommended.