Objectives. We evaluated the effectiveness of the Community Relapse Prevention and Maintenance (CRPM) program, developed by Correctional Service Canada to better meet the needs of women offenders with drug problems.

Methods. Using survival analysis, we investigated the association between exposure and nonexposure to CRPM and return to custody among a national sample of women offenders released from 1 of 6 federal institutions across Canada during the period May 1, 1998 to August 31, 2007.

Results. After control for other risk factors, women who were not exposed to CRPM were 10 times more likely than were women exposed to CRPM to return to custody 1 year after release from prison, with more than a third returning to prison within the first 6 months.

Conclusions. Aftercare is a critical component of a woman's support system after she leaves prison. Strategies that improve access to community aftercare are imperative for improving the life chances and health of these women.

In 2009, the World Health Organization (WHO) and the United Nations Office on Drugs and Crime (UNODC) published a Declaration on Women's Health in Prison.1,2 Under the declaration, these organizations recognized that the special needs of women and their health are often overlooked in prison policies. Among the recommendations—highly relevant to the work being done at the federal level in Canada—is that prerelease preparations be adequately planned and provided to ensure continuity of care and access to health and other services after release. The aftercare program that we describe and appraise is part of a holistic treatment program designed to ensure that women are connected to drug abuse treatment after release from prison.

The prevalence of substance misuse in Canada is approximately 11%. A recent national survey found that between 1994 and 2004, the proportion of Canadians who reported having used an illicit drug in their lifetime rose from 28% to 45%. Cannabis was found to be the most widely used type of drug, followed by hallucinogens, cocaine (or crack), speed, and heroin.3 Generally, substance misuse is more prevalent in eastern and western Canada and less so in Ontario and Quebec. Furthermore, higher problematic use occurs in midsized cities than in larger cities and rural areas.4

Among women in 2009, past-year prevalence of illicit drug use was 7.6% and past-year prevalence of pharmaceutical use (i.e., pain relievers, sedatives, or stimulants) was 27.6%; of the latter, 1.5% reported using pharmaceuticals to get high.5 Women who abuse drugs represent a particularly vulnerable segment of society.6,7 They are likely to have experienced childhood trauma and to continue to be victimized as adults; they also have an increased likelihood of developing health problems and often engage in criminal behavior.6,8,9 These women are also viewed by society as “fallen women,” highly susceptible to addiction.7 When they come into contact with the criminal justice system, they become further marginalized, enduring heavier shame as society doubly stigmatizes them as both drug users and women offenders. In Canada, approximately 1079 women are serving federal sentences; of these women, 47% are currently incarcerated and 53% are living in the community under correctional supervision. Women represent 5% of the federal prison population10; in the past 20 years, the number of admissions to federal women's prisons has tripled, reaching 501 admissions during the 2009–2010 fiscal year.10

The strong link between drug abuse and criminality for women is supported in the literature. Women prisoners are up to 10 times more likely to be dependent on drugs than are women in the general population.11,12 Eight of 10 women offenders in Canada have a substance abuse problem.13 A recent survey revealed that during the 6 months before their admission, 60% of these women had engaged in noninjection drug use and 29% had engaged in injection drug use.14

Drug-using women offenders are twice as likely to have unstable accommodation in the community; they are also less able to manage stress, experience greater hospitalizations for mental health reasons, and have higher recidivism rates than do non–substance-abusing women.15 A Texas study showed that women prisoners were significantly more likely than were male prisoners to engage in daily drug or polydrug use.16 In addition, these women are likely to face more difficulties than are men in areas linked to substance abuse, such as educational background, childhood family environment, adult social environment, and mental and physical health.1618 Women offenders who are mothers experience considerable anxiety as a result of their estrangement from their children—and the risk of losing access to them—through their continued substance abuse.19 Upon release, such women continue to have multiple areas of need that are predictive of recidivism, including substance abuse, education, employment, poverty, victimization, and unhealthy living conditions.12 These emotional and physical issues must be addressed when a drug treatment strategy for women offenders is mounted.

Women-focused programs are relatively new to the criminal justice system, first emerging in the United States in the late 1980s.20,21 A national substance abuse program designed for women offenders was introduced in the Canadian federal prison system in 1995.22 Research suggests that treatment of drug abuse during incarceration can reduce the probability of rearrest, drug relapse, or return to prison for a parole violation.23 Treatment programs can also have a positive impact on employment rates, especially among women,23 and may be instrumental in reducing drug-related deaths among newly released offenders.2427 In California, a trauma-informed and gender-responsive intervention among women with substance use problems, many of whom had criminal histories (55%), demonstrated significant reductions in substance use, depression, and trauma symptoms.28

The idea of continuity of care for women offenders with substance use problems is gaining ground within the criminal justice system. Continuity of care is often missing in women's transition from prison to the community, which represents a considerable barrier to positive outcomes for these women.22,2931 Moreover, little information is available on drug-using women offenders under community supervision and on assessing the effectiveness of aftercare treatment among women offenders. The majority of studies on aftercare focus on men offenders or present aggregated findings for men and women.3234 Yet what we know about aftercare among offenders is positive. Studies based in the United States3438 have shown that aftercare is effective in reducing, separately or in combination, return to custody and relapse into drug use. Evaluations of the Forever Free Substance Abuse Program for women incarcerated in California suggest a lower recidivism rate within 1 year after release for women who received both in-prison treatment and residential aftercare treatment (20%) relative to those who only received in-prison treatment (33%).39,40

We examined the Community Relapse Prevention and Maintenance (CRPM) program, developed as part of a continuum of treatment of women offenders under federal supervision in Canada. CRPM is the aftercare component of Women Offenders Substance Abuse Programming (WOSAP), which was implemented by Correctional Service Canada in May 2003. WOSAP represents a comprehensive substance abuse treatment program for women offenders that offers a continuum of interventions and services designed specifically to match the needs of women offenders.41 It is unique in its approach to treatment in that it is:

    woman-centered and strongly anchored in relational theory;

    a continuum of care that begins upon admission to prison and endures until a woman's warrant expiry date;

    a holistic program in that it is designed to address other areas of need that are often intertwined with substance abuse;

    based on a multifaceted theoretical framework that includes cognitive-behavioral therapy, relapse prevention, and harm reduction; and

    a multisite program that has been nationally implemented in Canada.

The CRPM program, a vital piece of WOSAP, is offered to women who are on parole. This program combines cognitive-behavioral treatment, experiential exercises, and coping skills practice; it also provides each woman with the opportunity to develop and implement an individualized drug relapse prevention plan. The program consists of 20 two-hour group sessions offered on a weekly basis. The theoretical basis of the program is relapse prevention based on social learning theory. Facilitators use motivational interviewing techniques throughout to help prepare and maintain lifestyle changes. The program is generally delivered as a recommended component of the offender's correctional plan. Participants must complete a detailed relapse prevention plan, be assessed as having made progress toward their goals, have a positive reason for leaving the group early (e.g., employment schedule or warrant expiry), and have completed a minimum of 4 sessions. Since women are particularly vulnerable to drug relapse in the first 1 to 2 weeks after release,27 community aftercare treatment facilitators meet individually with each woman immediately after her release and before her entering the group to engage her and increase her chances of success.

We examined the association between participation in CRPM and return to custody among a national sample of federal women offenders with substance abuse histories. Our central hypothesis was that women offenders with substance abuse problems who completed CRPM (aftercare) would be less likely to return to custody in the year after release than would women offenders with equivalent substance abuse problems who did not participate in CRPM.

The sample consisted of 361 women offenders who had been released from 1 of 6 federal institutions across Canada. All women began their sentence after May 1, 2002, participated in WOSAP in the institution, and experienced their first release during the period August 2003 to August 2007. The women were followed from their first release until they either were returned to custody or had been in the community for 1 year. More than 90% of the women in the sample were serving sentences less than 4 years in length. Two study groups were examined: women who participated in CRPM (n = 56) and those who were not exposed to CRPM (n = 305).

Correctional staff assessed each woman on intake for substance abuse using 3 standardized measures: the Alcohol Dependence Scale,42,43 the Drug Abuse Screening Test,44 and the Problems Related to Drinking Scale45; the last scale is a short form of the Michigan Alcoholism Screening Test. On the basis of these assessment results, offenders required treatment at one of the following levels: (1) none, (2) low, (3) moderate, or (4) high. The study included only women with moderate to high treatment needs.

Data Sources

We extracted data for this study from the Offender Management System, an automated administrative database used to manage data about offenders under federal jurisdiction. Data are collected as part of the offender intake assessment process that is completed when offenders are admitted to a federal prison in Canada. We identified WOSAP participants using the Offender Management System programs database, which tracks program participation within the institution and during parole.

Measures

The dependent variable was return to custody within 1 year after release. Return to custody can occur for a variety of reasons, including a new offense, an outstanding charge, or a violation of 1 or more release conditions, with most women returning for the last reason.

Community aftercare treatment status, which was documented by community treatment facilitators, reflected whether a woman completed CRPM or did not participate. Demographic variables used in the analysis included age (in years), ethnicity (White, Aboriginal, and other), marital status (married or not married), and educational status (with or without high school diploma). Unemployment status reflected whether or not a woman was employed at any point during her conditional release.

We included in the analysis several variables related to risk of reincarceration. Criminogenic risk for reoffending at the time of admission to a federal institution, which was derived from the criminal history and offense severity of each offender, was categorized as low, medium, or high. We also considered a variable reflecting type of release (nondiscretionary vs discretionary). Nondiscretionary release, which is the legal right of most offenders, means serving the last third of one's sentence in the community under the supervision of a parole officer. Discretionary release is the granting of day or full parole before two thirds of one's sentence is served.

We included offender participation in the Methadone Maintenance Treatment Program as a separate variable. We classified each offender on the basis of her involvement in a drug-related or violence-related offense during her current sentence (women could be involved in both types of offenses). We also classified offenders according to whether or not they violated a condition of abstinence during release (yes or no).

Statistical Approach

We first compared baseline characteristics for the 2 groups (those exposed to CRPM and those not exposed) using the χ2 or student t test where appropriate. We conducted Cox proportional hazard regression analyses to estimate the effect of the treatment exposure and to adjust for the effects of other covariates. This method allowed for modeling the length of time until the occurrence of an event—return to custody—during the 1-year postrelease period. We obtained survival curves for time to first return to custody for both groups with the Kaplan-Meier method.

The results of this analysis reflect the impact of no exposure to CRPM and other risk factors on the survival time—that is, time until first return to custody. We performed tests for proportionality and interactions with time, which were not significant. We used SAS version 9.1 (SAS Institute Inc, Cary, NC) for data manipulation and statistical analyses. We used the SAS PHREG procedure for Cox proportional regression, and report 95% confidence intervals (CIs).

Descriptive statistics describing the sample population by study group (CRPM status) are presented in Table 1. The study groups were similar on most characteristics; only unemployed status and type of release were significantly different. Fewer women in the CRPM group (60.7%) were unemployed after leaving prison than were women with no exposure to CRPM (74.1%). More women in the CRPM group (94.6%) were granted discretionary release than were those not exposed to CRPM (76.4%).

Table

TABLE 1 Characteristics of Women Offenders Participating or Not Participating in the Community Relapse Prevention and Maintenance (CRPM) Program: Canada, 1998–2007

TABLE 1 Characteristics of Women Offenders Participating or Not Participating in the Community Relapse Prevention and Maintenance (CRPM) Program: Canada, 1998–2007

CharacteristicCRPM (n = 56), Mean (SD) or % (No.)No CRPM (n = 305), Mean (SD) or % (No.)
Age, y33.8 (10.13)33.3 (8.34)
Ethnicity
    Aboriginal33.9 (19)34.4 (105)
    White58.9 (33)60.7 (185)
 Othera7.1 (4)4.9 (15)
High school diploma25.0 (14)24.3 (74)
Married37.5 (21)37.4 (114)
Drug offense42.9 (24)34.1 (104)
Violent offense50.0 (28)53.4 (163)
Criminogenic risk
    High16.1 (9)25.3 (77)
    Medium48.2 (27)44.3 (135)
    Low35.7 (20)30.5 (93)
MMTP participation12.5 (7)16.1 (49)
Unemployed during release,*60.7 (34)74.1 (226)
Abstinence violation (during release)17.9 (10)17.1 (52)
Type of release,**
    Discretionary94.6 (53)76.4 (233)
    Nondiscretionary5.4 (3)23.6 (72)

Note. MMTP = Methadone Maintenance Treatment Program. Offenders serving a life sentence are not included in the analysis.

a“Other” includes Arab, West Asian, Black, Latin American, South Asian, Southeast Asian, and unknown.

*P ≤ .05; **P ≤ .01.

Detailed substance use histories for the complete sample were not available. However, we obtained information on 66.5% (n = 240) of the sample from data gathered during their participation in institution-based substance abuse treatment programming. On the basis of this information, 80% (n = 192) of respondents self-identified as having a drug problem and 40% (n = 96) as having an alcohol problem; 28.0% (n = 67) identified both alcohol and drugs as problems. Table 2 shows the proportion of respondents experiencing problems by drug type. The most-used drugs were cocaine (58.9% of women) and crack cocaine (44.3%); more than one quarter of the women reported having problematic opiate use. The mean age of onset was 14 years for drug use (SD = 4.37) and 13 years for alcohol use (SD = 3.44). On the basis of the same supplemental data, 87% (n = 209) reported that they were under the influence of alcohol or drugs during their most recent offense(s).

Table

TABLE 2 Drug Problems Identified by Women Offenders Participating in the Community Relapse Prevention and Maintenance Program: Canada, 1998–2007

TABLE 2 Drug Problems Identified by Women Offenders Participating in the Community Relapse Prevention and Maintenance Program: Canada, 1998–2007

Drug Categories% (No.)
Cocaine58.9 (113)
Crack44.3 (85)
Opiates28.1 (54)
Heroin17.7 (34)
Marijuana/hashish13.0 (25)
Benzodiazepines11.5 (22)
Amphetamines (uppers)9.4 (18)
Othera12.0 (23)

Note. The participants (n = 192) could report more than 1 drug type.

a“Other” includes, MDA (ecstasy), LSD, barbiturates (downers), methadone (dollies), PCP (angel dust), and inhalants.

Table 3 shows the estimates and hazard ratios for all covariates and CRPM status from Cox proportional survival analysis for return to custody within 1 year after release. The regression analysis showed that women with no exposure to CRPM had a hazard ratio of 10.90 (95% CI = 3.43, 34.66) after controlling for other covariates, which means that women not exposed to CRPM were more than 10 times more likely to return to prison within 1 year after release from prison than were women exposed to CRPM. The hazard ratio for age was 0.95 (95% CI = 0.93, 0.98), suggesting that with each additional year of age, the risk of rearrest decreased by 5%. The hazard ratio for nondiscretionary release was 1.70 (95% CI = 1.04, 2.78), suggesting that women on nondiscretionary release were 1.7 times more likely to return to custody than were women on discretionary release. Women offenders who were assessed as having medium criminogenic risk were twice as likely to return to custody as were women with low criminogenic risk (hazard ratio [HR] = 2.29; 95% CI = 1.36, 3.85). Those with high criminogenic risk were 3 times more likely to return to custody than were low-risk women (HR = 2.96; 95% CI = 1.57, 5.57). Women who violated a condition of abstinence were 1.9 times more likely to return to custody than were those who did not (HR = 1.90; 95% CI = 1.25, 2.89). Women who were unemployed while on parole were more than 2 times more likely to return to custody than were those who were employed (HR = 2.17; 95% CI = 1.30, 3.60).

Table

TABLE 3 Cox Proportional Regression for Time of Women Offenders’ Return to Custody: Canada, 1998–2007

TABLE 3 Cox Proportional Regression for Time of Women Offenders’ Return to Custody: Canada, 1998–2007

CharacteristicsParameter Estimate (SE)Hazard Ratio (95% CI)
No CRPM exposure2.39*** (0.59)10.90 (3.43, 34.66)
Age−0.05*** (0.01)0.95 (0.93, 0.98)
Married0.11 (0.21)1.12 (0.75, 1.67)
Aboriginal0.34 (0.20)1.40 (0.94, 2.09)
High school diploma−0.13 (0.24)0.88 (0.55, 1.41)
Nondiscretionary release0.53* (0.25)1.70 (1.04, 2.78)
Medium criminogenic risk0.83** (0.27)2.29 (1.36, 3.85)
High criminogenic risk1.09*** (0.32)2.96 (1.57, 5.57)
Drug offense−0.03 (0.24)0.97 (0.61, 1.55)
Violent offense−0.35 (0.23)0.70 (0.45, 1.11)
MMTP participation0.09 (0.28)1.10 (0.64, 1.88)
Abstinence violation0.64** (0.21)1.90 (1.25, 2.89)
Unemployed during release0.77** (0.26)2.17 (1.30, 3.60)

Note. CI = confidence interval; CRPM = Community Relapse Prevention and Maintenance program; MMTP = Methadone Maintenance Treatment Program. Total sample size was 361.

*P ≤ .05; **P ≤ .01; ***P < .001.

Kaplan-Meier survival curves for women with and without CRPM exposure are shown in Figure 1. After controlling for the covariates in Table 3, the probability of returning to prison was greater for the group of women without CRPM exposure than for those exposed to CRPM. Both groups were fairly similar in survival rates during the first 6 weeks after release, as can be seen in Figure 1; thereafter, the survival curves began to diverge. By 6 months (24 weeks), 26% of the women without exposure to CRPM had returned to custody; this represents 68% of all women in this group who returned to custody.

We also conducted Cox proportional hazard regression (data not shown) among a subsample of women (n = 341; 95%) to assess differences between moderate and severe levels of substance abuse treatment need. Findings showed that women offenders with high treatment need were almost twice as likely to return to custody (HR = 1.72; 95% CI = 1.01, 2.91) as those with moderate need for treatment. Although treatment need is an important risk factor for reincarceration, it did not change the impact of CRPM status on return to custody. Women with no CRPM exposure were still 10 times more likely to return to custody than were women who completed aftercare (HR = 11.04; 95% CI = 3.47, 35.20) when treatment need was considered.

This study contributes to a growing dialogue in public health on the need for continuity of treatment for women with substance abuse problems.21,3440,46 Available information suggests that aftercare for substance abuse is particularly important for female offenders.22,2931 Indeed, findings from the present study suggest that women offenders who were not exposed to CRPM were more than 10 times more likely to return to prison within 1 year after release than were women who were exposed to CRPM. Divergence in the survival curves for women who completed CRPM and for those who were not exposed to CRPM began to emerge approximately 6 weeks after release. By 6 months, close to one third of women who were not exposed to CRPM returned to custody.

The percentage of women exposed to CRPM was 15.5%, and these women's rate of reincarceration within 1 year after release was quite low (5%). Low completion rates for treatment of substance abuse among women offenders is a concern and has been documented in other studies. Indeed, studies on inpatient dropouts suggest that rates have ranged from 19% to 63%.47,48 Higher dropout rates have been found for outpatient treatment, with proportions above 70% being the norm.49 The reasons for nonparticipation may be varied. Programming is more difficult to implement in less-populated urban and rural areas, where fewer women complete their supervised release and staff resources are scarcer; program scheduling may conflict with women's employment or child care commitments; and finding a reliable and affordable source of transportation may be a challenge. Factors that are both intrinsic (e.g., motivation) and extrinsic (e.g., access to child care) to potential participants can therefore have an impact on program participation. Retention in treatment programs requires coordination and integration of services for newly released women offenders. With the overall goal of reducing crime and drug use among women offenders, it is necessary to consider the nature of relationships between service providers and correctional agencies, current capacity among service providers (including community corrections) to engage and retain the women, and the degree to which linkages between services are facilitated.

Several other covariates were significantly predictive of return to custody. As age increased, the likelihood of returning to custody decreased, a finding that is consistent with crime literature pointing to an aging-out effect for criminal activity.50,51 Consistent with previous research, those who were on discretionary release were less likely to return to custody than were those on nondiscretionary release.52 Our findings support previous research showing that women who had a lower level of criminogenic risk and who were employed during their release were less likely to return to custody.39,53 The overwhelming majority of women who returned to custody had not completed high school or were unemployed during their release. Research clearly shows that a disproportionate number of offenders are undereducated,17,54 which underscores the need for educational programs for offenders. According to the Federal Bureau of Prisons, an inverse relationship exists between recidivism and education; the more education received, the less likely an individual is to be rearrested or reimprisoned.55 Prison programs that provide education for offenders are most likely to reduce rates of return to prison.

The study findings should be interpreted within the context of the study design. The sample is drawn from women offenders who participated in prison-based substance abuse treatment in Canada and who had the opportunity to participate in CRPM. Most of these women participated in CRPM as a condition of their release; however, others self-selected (i.e., voluntarily entered) CRPM. In the context of research on offenders, randomly assigned treatment groups are often not possible; however, self-selection may lead to “creaming,” resulting in the best or most motivated clients choosing to participate in the treatment program. The reasoning is that more motivated clients are more likely to volunteer for treatment and to succeed with or without the intervention. An alternative view challenges the use of classical research designs with random selection, suggesting that they are difficult to implement in treatment environments—especially with such specialized populations as offenders—and limit the generalizability of findings to individuals who are not necessarily interested in recovery and who are often free to leave treatment.56,57 A woman's level of motivation or readiness to change will affect her success in the program. It seems prudent to identify approaches that can enhance readiness to change and embed these strategies into the aftercare treatment program.

While our findings suggest that aftercare is critical for women in their desire to remain free of prison, they are based on a relatively small sample size and, as a consequence, the confidence intervals for CRPM were quite wide. This problem is inherent in studies of women offenders, who make up a small percentage of the prison population.

An additional limitation was our inability to include some important risk factors when considering engagement in treatment. For instance, we were unable to assess level of motivation, neighborhood characteristics, or urban–rural locale (which could be a proxy for more specific measures such as availability of services). If such effects are associated with both the exposure and the outcome, failing to control for these effects could produce biased estimates.

Women offenders with substance abuse problems face a myriad of issues when transitioning from prison to the community. They face challenges in locating affordable housing, seeking employment, and arranging transportation and child care, all the while coping with their substance use problems; moreover, they also have physical and mental health problems.5860 During the reentry period, the availability of a positive social environment (peer, family, and community support) is of utmost importance. Aftercare treatment is a critical component of a woman's support system; however, women often encounter many barriers to participation in aftercare treatment, such as geographic barriers that reduce access to treatment services (especially in rural areas), lack of transportation, mobility issues, and lack of child care. It is important to ensure that aftercare is as far-reaching as possible, especially during the weeks immediately following release.

Women in Canada have a range of treatment services located in the community, depending on geographic location; rural areas have fewer services than more urban centers. Many women serve parole at halfway houses and become connected to community resources through this pathway. In addition to CRPM, Correctional Service Canada also offers the Social Integration Program for Women, which is administered before a woman's release and increases women's awareness of community resources and services to assist them in transitioning back into the community. Women may access services other than CRPM; we could not track their participation in other community-based programs, but this factor should be considered in future research designs.

Mental illness and its co-occurrence with substance abuse is an important consideration for treatment among women offenders because this group is at especially high risk of reoffending.61 It is plausible that the greater risk of recidivism among women with no CRPM exposure may be related to co-occurring mental health issues. Findings from earlier studies suggest that women offenders who suffered from both drug and mental health problems were more likely to be returned to custody, and significantly sooner, than were those without co-occurring problems and were also less likely to complete aftercare.53,61,62 Recognition of these issues and practical solutions that address the multiple needs of female offenders would reduce a shortfall in services and increase treatment participation and retention. Correctional Service Canada researchers, including 2 of the present authors, are presently conducting a qualitative study exploring the experiences of women offenders who are released from prison.

For women offenders, aftercare treatment of substance abuse is imperative. Although women constitute a small minority of incarcerated persons, a significant percentage of women in Canadian prisons are incarcerated for offenses related to drug use, often linked to underlying factors such as experiences of sexual or physical abuse or violence. Effective treatment, most notably aftercare, is critical for reducing the probability that women will return to prison after release. With the length of prison sentences increasing, it becomes even more important to ensure that women who are under the responsibility of correctional systems receive interventions that will reduce their likelihood of returning to crime after release.

While the findings we present are from a Canadian context, women in prison in Canada are remarkably similar to those in other countries. In general, women in prison worldwide face complex social and health issues, and prison and public policies often are not gender-responsive to women's unique life circumstances and needs.63 Their specific treatment and health needs are challenging for prison policy; meeting their needs is complex in a system generally oriented toward males, who make up the larger proportion of prison populations internationally. Release planning and continuity of care have been identified by the WHO and UNODC as key service issues for women leaving prison. The conclusions from this study, although based on women offenders in Canada, are applicable to women prisoners in other countries and support the WHO–UNODC assertion that imprisoned women require continuity of care for their health and substance abuse needs.1,2

Acknowledgments

Support for this study came from the Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, and the Ontario Ministry of Health and Long-Term Care.

Note. The views expressed in this article are those of the authors and do not necessarily reflect the views of the Ontario Ministry of Health and Long-Term Care.

Human Participant Protection

Ethics approval for this study was obtained from the St. Michael's Hospital Research Ethics Review Board.

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Flora I. Matheson, PhD, Sherri Doherty, MA, and Brian A. Grant, PhDFlora I. Matheson is with the Centre for Research on Inner City Health, Keenan Research Center in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, and the Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Sherri Doherty and Brian A. Grant are with the Research Branch, Correctional Service Canada, Montague, Prince Edward Island. “Community-Based Aftercare and Return to Custody in a National Sample of Substance-Abusing Women Offenders”, American Journal of Public Health 101, no. 6 (June 1, 2011): pp. 1126-1132.

https://doi.org/10.2105/AJPH.2010.300094

PMID: 21493930