The Substance Abuse Counseling Needs of Women in the Criminal Justice System: A Needs Assessment Approach
Laux, John M., Dupuy, Paula J., Moe, Jeffry L., Cox, Jane A., Lambert, Eric, Ventura, Lois A., Williamson, Celia, Benjamin, Barbaranne J., Journal of Addictions & Offender Counseling
The authors assessed the substance abuse counseling needs of women in the criminal justice system using interviews (n = 304) and surveys (n = 1,170). On the basis of the results, the authors call for gender-specific treatment as well as family-oriented support for women who are mothers.
One consequence of mandatory sentencing laws, decreasing rates of release, and increased lengths of sentences is that the number of women incarcerated in the United States has been on the rise since the 1980s (Hanlon et al., 2005). In fact, the number of females in prison has more than doubled from 1990 to 2001 (Bloom, Owen, & Covington, 2003; Greenfeld & Snell, 1999). An additional 300,000 women are under correctional control (Pastore & Maguire, n.d.). These women have concerns and counseling needs that are different from those of their male counterparts. Following a brief review of the literature related to these needs (with a particular focus on dependent children and the relationship between substance abuse and crime), we identified a gap in the literature related to the counseling needs of these women. To address this paucity of research, we conducted a needs assessment using a mixture of interviews and survey responses.
Needs of Women: Dependent Children
When the woman who offends and is incarcerated has dependent children, her behavior negatively affects persons other than herself. Several statistics support this assertion. First, approximately 75% of women who commit crimes have children (Schram, 1999). Similarly, for those whose crimes result in incarceration, approximately 70% of women in jails, 65% of women in state prisons, and 59% of women in federal prison have minor children (Bloom et al., 2003; Greenfeld & Snell, 1999), with the average being two (Johnson-Peterkin, 2003). Finally, 64% of female offenders lived with their children prior to incarceration, and incarcerations average 3 years in duration (Greenfeld & Snell, 1999).
The stark reality of these statistics is that there are 1.3 million American children whose mothers have been absent to them for a significant period of their lives (Poehlmann, 2005). Because of mothers' roles as primary caregivers, their incarceration is associated with family instability and conflict (Dallaire, 2007). When mothers are incarcerated, 55% of their children end up living with their grandparents, 20% are placed with their fathers, 15% live with other relatives, and 10% end up in the welfare system (Dallaire, 2007). Women with dependent children often experience increased tension and conflict with their extended families and relatives because of the stress of negotiating who will provide for the children while the women are incarcerated. Many of these families are already struggling with poverty and other developmental risk factors, and the increased conflict further alienates incarcerated mothers from already scant and strained support networks. As such, preincarceration factors, such as poverty, limited education, homelessness, employment limitations, and high rates of substance use (Bogart, Stevens, Hill, & Estrada, 2005), create cumulative risks in that they compound the negative effects of a woman's incarceration (Johnson & Waldfogel, 2002).
Needs of Women: Substance Abuse
There is a strong relationship between women's use of alcohol and drugs and illegal behaviors. Greenfeld and Snell (1999) estimated that 25% of women on probation, 29% of women in local jails, 29% of women in state prisons, and 15% of women in federal prisons had been consuming alcohol or other drugs at the time of the offense. In addition to influencing criminal behavior, alcohol and other drug use can produce deleterious personal and physical effects among women that differ in meaningful ways from the way drugs and alcohol impact men. For example, women with alcohol use disorders have death rates between 50% to 100% higher than men with alcohol use disorders. Compared with men, a greater percentage of women die from alcohol-use-related suicides, accidents, circulatory disorders, and cirrhosis of the liven The National Institute on Drug Abuse (1994) estimates that 9 million women use illegal drugs annually. Drug use among women has been associated with physical and mental health disorders, including sexually transmitted diseases, depression, and suicide (Briggs, 2008). Clearly, alcohol and other drug use disorders present challenges to women's health, their ability to maintain gainful employment, avoid rearrest, and parent their children (Briggs, 2008).
Needs of Women: Treatment
Despite the dramatic changes in prison and supervised control demographics, the literature reporting the characteristics and needs of these women is scant (Loper, 2006). Little is known about these offenders, and less is known about their substance abuse counseling needs. These women and their children are at risk for a myriad of problems, such as life in poverty, a greater probability of delinquency, a heightened likelihood of victimization and violence, overall dysfunctional lives, and recidivism (Simons, Simons, & Wallace, 2004). These women require special consideration, especially those whose custody status affects the lives of children.
The limited understanding of these women's needs places addictions and offender counselors at risk of providing ineffective and incomplete interventions. It is important to study this population in order to understand the problems they encounter so that counseling interventions can be crafted to support their recovery, reduce recidivism, and lessen the probability of future delinquency of their children. One potential source of ineffective service provision is the disparity between counselors' versus clients' perceptions of the counseling process. Because there is a dearth of research available to describe the needs and experiences of women in the criminal justice system who have dependent children, it is difficult to compare these women's experiences of receiving treatment with what counselors perceive and experience when providing such treatment.
A needs assessment is warranted to help counselors better understand women's presenting issues so that the counselors can subsequently design and apply counseling interventions to address these needs. According to Steadham (1980), a needs assessment is a systematic exploration of the current state of a population's affairs. Furthermore, a needs assessment can help counselors to understand thoroughly the nature of a problem prior to implementing a solution (Dewit & Rush, 1996). Therefore, our purpose in this study was to conduct a needs assessment of the current and historical substance abuse counseling needs of women who are in the criminal justice system in order to develop treatment recommendations that are tailored and specific to this growing population.
The present needs assessment approach was influenced by Steadham (1980), who advised that data should be collected using a multimethod, multitrait approach. As a consequence, we conducted a gap analysis and reviewed the literature to identify what is, and what is not, known about this population. In needs assessment parlance, a gap analysis is the determination of the difference between what clinicians think they understand about the population of interest and what actually is perceived by consumers. We accomplished the gap analysis by consulting with 60 regional treatment providers, including criminal justice professionals from the courts, jails, and sheriff's office; the county health department; the county social services agency; mental health and children's services boards; the United Way; the Jobs and Family Services; and substance abuse treatment providers. To be specific, we elicited community providers' input with respect to (a) what they observed and believed to be true about this population on the basis of their clinical interactions and (b) what they felt they did not know but would like to know. The results of the literature review and gap analysis yielded a two-pronged approach to the data-gathering phase of the study--a written questionnaire and a series of semistructured interviews.
Needs Assessment Semistructured Interviews
As suggested by Reviere, Berkowitz, Carter, and Ferguson (1996), a thorough needs assessment involves several levels of preparation and input from constituents. Guided by the professional literature, input from community service providers, and feedback from focus groups of jailed women (n = 6) and women on probation (n = 12), we developed a series of 12 interviews to elicit data about these women's needs. These semistructured interviews were designed to gather information that would help us understand women's perceptions and opinions about their needs, issues, barriers, and experiences. Issues related to substance abuse were addressed throughout the 12 interviews; however, 2 interviews (the 3rd and 9th) focused specifically on substance use and abuse, substance abuse treatment experiences, and the women's needs related to their substance use. Our goal in collecting data on the women's perceptions was to identify salient factors that contribute to treatment outcomes as experienced and reported by the women themselves.
Needs Assessment Questionnaire
We wrote items to tap into a wide variety of content areas that surfaced following the literature review and gap analysis. The development of the questionnaire took approximately 1 month and was influenced by input from the same community providers identified above. The length of time spent in the development of the needs assessment questionnaire, as well as the inclusion of guidance from community and university experts on these topics, ensured a high degree of content validity (Walsh & Betz, 2000). The final product consisted of 142 questions that covered substance abuse (6 items) and a wide range of factors believed to interact with substance abuse: criminal behavior, domestic violence, housing, sexual activity, employment, finances, medical status and needs, needs of children, and mental health status.
We recruited seven female graduate research assistants (GAs) from the sponsoring university's criminal justice, social work, and counselor education programs to serve as interviewers. Using role playing and didactic instruction, counseling and social work faculty trained the GAs in interviewing techniques, ways to establish rapport and present a nonjudgmental attitude, and safety issues. The faculty made a conscious effort to teach the GAs to engage in bracketing, which is the setting aside of one's usual assumptions, prejudices, theories, and philosophies about a phenomenon in order to accept the phenomenon for what it is (Boeree, 1998). To minimize interviewer bias, researchers developed a semistructured interview guide and trained the GA interviewers on how to collect information as objectively as possible. The faculty researchers held ongoing meetings with the GAs to discuss interview-related issues.
All female offenders booked through the county jail during the months of June through September 2005 were asked to participate in this study if they were eligible (were mothers) and signed a consent form prior to participation. Interviews took place at public locations (e.g., jail, prison, public libraries, fast food restaurants) to avoid meeting clients at their homes. This decision was made to protect the GAs and to offer the participants increased freedom to share their experiences without the undue influence of the presence of their family members. Each interview lasted from I to 2 hours. Interviewers recorded participants' responses on semistructured interview forms. Interviews were conducted once a month over a total of 12 months. A total of 286 women participated in the first interview, with 1,161 interviews completed throughout the course of the study. Because of the transient nature of the population, the research staff could not reach many women for all of the interviews. The GAs attempted to keep in contact with the women biweekly through phone calls and letters sent to the women's last known address. Interviews 3 and 9, which focused on substance use, consequences, and treatment, were conducted with 125 and 49 women, respectively.
From February through April of 2006, we distributed the needs assessment questionnaire to female offenders who had been processed through the criminal justice system. Questionnaires were distributed at the following locations: a county jail, a municipal court, a county probation department, a county family drug court, a county job and family services organization, a municipal probation department, a residential treatment center, a community agency, and a state women's prison and its prerelease center. To encourage participation, we paid $5 to each woman (except for those in the care and custody of the state, n = 18) who completed the questionnaire. Respondents required about 15 to 20 minutes to complete the questionnaire.
Semistructured interview sample. A total of 1,161 interviews were conducted among 304 women. The women's average age was 34.63 years (SD = 8.96, range = 18-54). Of the 304 women, 42.1% (n = 128) were European American, 45.1% (n = 137) were African American, 7.9% (n = 24) identified as Hispanic, and 4.9% (n = 15) identified as "other." Ethno--racial self-identifications within the other category included mixed, Native American, and Asian. Regarding arrest record, 78.0% (n = 237) of the participants reported that they had an arrest record and 44.1% (n = 134) had been arrested previously for a drug offense. The average years of education completed was 11.58 (SD = 1.67, range = 7-18).
Questionnaire sample. A total of 1,170 women participated in the quantitative portion of this study. The participants' mean age was 34.1 years (SD = 11.2, range = 18-83). Of the 1,170 women, 45.9% (n = 537) were African American, 43.4% (n = 508) were European American, 6.7% (n = 78) were Hispanic, and 0.2% each (n = 2) were Arabic, Asian, or Indian, respectively. Forty-one women (3.5%) did not self-identify their ethnic backgrounds. Regarding educational level, 27.9% (n = 326) of respondents had less than a high school diploma, 33.7% (n = 394) had a high school diploma or general equivalency diploma, 3.5% (n = 41) had some vocational training, 22.2% (n = 260) had some college but no degree, 9.1% (n = 107) had earned a college degree, and 3.6% (n = 42) did not indicate their educational status. On average, the women reported being arrested 5.4 times (SD = 13.3, range = 0-100) and being incarcerated for slightly over 3 years.
We analyzed the semistructured interview data using a qualitative method to uncover patterns and common threads through the process, as suggested by Miles and Huberman (1994). We used four levels of analysis: codes, themes, categories, and metathemes. Research team members coded each interview line by line (response by response) using qualitative methods; like responses were grouped into codes. The next step involved collapsing related codes into themes. For example, the participants were asked what they thought women need to successfully leave prostitution. Some women responded that women would need to have counseling (one code), some responded that women would need drug treatment (one code), a couple responded that women would need to be drug free (one code), and so forth. All of these codes are related under the theme of counseling, treatment, sobriety. The team next grouped related themes into categories (usually corresponding to the major questions asked in the interviews). The counseling, treatment, sobriety theme was grouped with similar themes under the category the substance abuse treatment needs of women wanting to leave prostitution. Finally, the research team grouped related categories into metathemes (e.g., in the preceding example, substance abuse treatment). While focusing on the experiences, perspectives, beliefs, and reasons for the women's behavior, the team sought to gain a better understanding of the experiences of women involved with the criminal justice system and their experiences with substance use and abuse.
We reviewed all quantitative data for completeness and to ensure that the participant met study criteria (i.e., was a mother). We calculated descriptive data (means, standard deviations, range of scores) for each questionnaire item.
Semistructured Interview Results
Several metathemes emerged following the analysis of the qualitative interviews. These themes were titled as follows: trauma and violence, rape and sexual abuse, women's experiences in childhood and adolescence, formal support systems, informal support systems, behavioral health risks, stigmatization--discrimination, participation in the underground economy, commercial sexual exploitation and prostitution, preincarceration factors, factors during incarceration, postincarceration factors, women's self-esteem, future dreams, and spiritual connections. The metatheme most relevant to experiences regarding substance use was behavioral health risks. Roughly half of the women reported a lifetime use history of alcohol, marijuana, and/or cigarettes. About one third of the women, at some point in their lives, had used crack cocaine; one fourth had abused prescription medications; and fewer women used cocaine, LSD, barbiturates, or other drugs. Some lost custody of their children because of their substance abuse. Many women reported using alcohol and other drugs as way of coping with stress, negative life experiences, and even mental illness. Almost half of the women had been in substance abuse treatment over the course of their lives. The respondents received a wide variety of substance abuse treatment modalities, including inpatient, outpatient, and self-help programs (e.g., Alcoholics Anonymous, Narcotics Anonymous, and Cocaine Anonymous). Satisfied 12-step attendees offered their opinion that these meetings assisted them to stop using drugs and increased their self-awareness. Those who had been in treatment for substance abuse felt that treatment could be improved if interventions were individualized, if transportation to and from meetings could be arranged, if treatment was provided free of charge, and if there were greater treatment options and opportunities. In addition, the value of individualized relationships with counselors perceived to be supportive, genuine, and caring was identified as critical for participants' long-term commitment to, and benefit from, substance abuse counseling. Another reoccurring theme was the perception that counselors needed to be more professional and experienced. Women stated that they wanted counselors to "care about our personal lives" and to "do what they have to to help, not just because of a paycheck." Counselors were perceived to be more professional when, according to one respondent, they "didn't use returning to prison as a threat" and when "they tried to educate the prison guards about addiction, that it is a disease."
The women shared their thoughts about receiving treatment in mixed-gender group settings. Responses were mixed, with some of the women reporting positive experiences, most of the women reporting negative experiences, and some reporting ambivalence regarding the issue of mixed-gender treatment groups. Some of the women in mixed-gender groups felt uncomfortable addressing particular experiences and issues with men present. For example, one woman stated that "I didn't want to talk. I'd rather talk around females. I think the stuff that happened to me when I was younger, I feel uncomfortable around them [i.e., men]." Another respondent stated her views on mixed-gender treatment groups: "I don't think it should be that way. It takes the focus off getting clean, caused commotion and chaos." One respondent stated that her discomfort with mixed-gender treatment stemmed from the increased risk of encountering male drug dealers, pimps, and possibly even men who had paid her for sex.
On the other hand, other participants said that they liked the mixed groups because they could see how men express and share their feelings and because they gained different perspectives on their issues. For example, one respondent stated that "for some of the people didn't get involved with drugs 'till their partner got them to do, this way men and women can hear stories that can help them understand both sides." Another respondent stated that "it's good because some females can really see how men feel." An example of an ambivalent response to mixed-gender treatment was "it's a bad idea because these men and women may have a history and it's a good idea because the world is not gender segregated, you have to function."
Six survey questions focused on respondents' self-reported substance use history, behaviors, treatment history, and current treatment needs. Specifically, we asked participants to state whether they felt they had ever needed help for alcohol or drug use. A quarter of the participants (n = 303, 25.9%) answered this question affirmatively. Almost 30% (n = 343) reported being under the influence of alcohol or other drugs at the time they committed their crimes. Nearly 13% (n = 148) reported that they had been arrested for an alcohol-related crime, and 20% (n = 235) stated that they had been arrested on a drug charge. Addressing substance abuse treatment, 22.6% (n = 265) stated that they had received some form of treatment, and 18.4% (n = 215) said that their treatment was court mandated. When asked about treatment received, more women (n = 351) offered their opinions about treatment effectiveness than actually reported having received treatment. Of these women, 74 rated the effectiveness of the alcohol or other drug treatment as poor, 99 said it was fair, 91 described treatment as good, and 87 said their substance abuse treatment was very good. Almost 31% (n = 360) felt that the wait for treatment is not too long, 23% held a contrary opinion, and the remainder held no opinion on the length of the wait for treatment.
The purpose of this study was to conduct a substance abuse needs assessment of women in the criminal justice system. We accomplished this purpose through the use of a questionnaire and semistructured interviews. After describing the study's major findings, we will discuss important implications for practice, note the limitations of the study, and suggest areas for future research.
Despite the different approaches, the samples recruited for both analyses were similar. For example, the mean ages for the groups were only one year apart. Ethnic representation differed across the three largest groups by at most 3% (European Americans) and by as little as 1% (Hispanics). The participants in both analysis groups had comparable levels of education.
Approximately 23% of the structured survey sample reported receiving treatment, as did 50% of the women in the interview sample. The participants in this study identified several barriers to obtaining substance abuse treatment. Despite the general opinion that treatment was effective, many felt that the waiting list to enter treatment was prohibitive. Others reported that they were unable to receive treatment while incarcerated or that they felt as though they had to start all over again with a new treatment paradigm, new counselors, or both, once incarcerated.
Child care was a need for many women who sought substance abuse treatment. Many women were their children's sole caregiver and reported difficulty locating inpatient treatment programs that accommodated their children. Treatment programs that do not provide housing to dependent children, or that provide housing with age limits for dependent children, are prohibitive to women with dependent children.
The women in this study were varied with respect to their views on mixed-gender treatment settings. Many felt it was helpful to see the different perspectives that male clients provided. Others felt that having men in their treatment groups was distracting and made it difficult to focus on their own treatment needs. Some had serious and specific concerns when faced with sharing treatment with former drug dealers or former sex customers. To summarize, many of the women in our study who sought treatment for substance use disorders reported that institutional barriers presented challenges to their long-term recovery. Our findings were consistent with those of Beckerman and Fontana (2001), who demonstrated that women and men have different needs from substance abuse treatment providers. Furthermore, our participants voiced the need for child care and female-specific treatment paradigms, observations that are consistent with those found in the literature (e.g., Matthews & Lorah, 2005).
Implications for Practice
Readiness and motivation to change among substance abusers may wax and wane (Prochaska, DiClemente, & Norcross, 1992). One crucial need that emerged from this study is the need for on-demand substance abuse screening and treatment in the community and judicial systems for women under criminal justice control. Some participants opined that treatment delayed is the same as treatment denied. One step in moving toward the on-demand services paradigm would be for community substance abuse treatment programs to extend services to women in corrections facilities or under community control. For example, a woman who has her release revoked while engaged in treatment would benefit from the continuity of care if conditions allowed for the treating substance abuse counselor to provide counseling services to the woman while she is incarcerated. There needs to be a seamless transition of substance abuse treatment for women entering the penal system and being released from incarceration back into the community. Long-term treatment should be provided by the same professionals with whom the women have already built relationships to enable continuity of service and the best opportunity for success.
Another implication emerging from the study is that it is crucial that substance abuse treatment providers working with women strongly consider their policies about child care for substance-abusing mothers. Substance abuse counselors are encouraged to inquire about the substance abuse treatment needs of the women's children and to assist mothers in identifying appropriate treatment options for their children. We recommend that state or federal assistance (or both) be made available to local jurisdictions to fund collaboration between criminal justice and community services. These partnerships should be designed to increase the availability of substance abuse treatment services to women in local corrections facilities or under community control. This assistance should include residential treatment options where women can stay with their children and should have appropriate treatment services for these children. Counselors who attempt to synchronize policies at treatment programs and agencies with a stage-of-change philosophy would be helping to address some of the issues raised in the current study.
For those treatment facilities that do not already have gender-specific treatment, we suggest that serious consideration be given to providing women-only treatment groups that can address treatment needs specific to mothering and other women's issues. At the very least, it is important that treatment facilities be cognizant of the issues a woman may face if asked to participate openly in a group including men with whom she has had negative personal relationships. In such cases, alternative treatment opportunities should be considered for all parties.
The results of this study have several implications for training and supervision. First, viewing work with incarcerated mothers as a distinct and specialized practice places greater responsibility on experienced counselors to actively mentor and educate trainees and other new professionals. Offering intra-agency workshops on such topics as, for example, successful cases involving women with dependent children in the criminal justice system would be an immediate way for counselors to share their experience with others. Second, collaboration and cross-training between alcohol and other drug counselors and other treatment providers could serve to augment the continuity and professionalism that the respondents in this study seek. Finally, counselors who encounter members of this population for the first time should actively seek mentorship and supervision from their more experienced colleagues. Counselors who assume that their past or preferred ways of treating clients can be easily adapted to work with members of this marginalized and at-risk population may be most at risk of providing ineffective services.
Although we attempted to achieve a rich description of lived experiences, we were not able to account for or follow through on all possible permutations and aspects of experience. For example, though none of the women reported being in same-sex relationships (either past or current), no attempt was made to broach the possibility that some of the respondents might identify as lesbians or as bisexual women. Also, this study did not discriminate between women who acted in the role of mother and women who were biological mothers. The different needs of stepmothers, mothers who had lost custody of their children, and mothers who had adult children did not become foci of the interview protocols because of time constraints.
The results of the study may be further limited in their generalizability and trustworthiness because of the likelihood that the respondents possessed special or specific characteristics that differentiated them from nonrespondents. Fewer and fewer of the initial 286 women chose to or were able to participate in subsequent interviews over the course of the 12 months of data collection. Of the total women whose initial interviews were collected while they were in jail, only 49 women completed all 12 interviews. These 49 women composed the key informants for the present study, and many decisions and conclusions are grounded in the data collected from them. Though we compared responses and themes across interviews over time, it is unclear what special characteristics these women possess and whether they are representative of the present sample or the general population as a whole. Because transportation was a key issue for these women, it is possible that our choice of locations for interviews (although they were accessible on a bus line) posed a barrier to women's long-term participation.
Directions for Future Research
Given the above limitations regarding special characteristics of the present sample, it follows that future research could focus on subgroups of the population of incarcerated women with dependent children. An intensive case study approach could help further develop and explore the themes identified in this study as well as attempt to deepen our understanding of specific processes and critical incidents in addictions counseling that promoted success as perceived by members of this population. A negative case study approach that looks at women who did not confirm the conclusions of the present study would be useful in adding context and richness to our understanding of the diversity of lived experience among incarcerated mothers.
Several quantitative approaches are useful for advancing our knowledge of factors that predict treatment success and reduced risk of future incarceration. Years of experience in the field, direct experience with incarcerated women, and level of empathy for members of this population all emerged as potential quantifiable variables for future regression analysis or analysis of variance. It may be useful to compare subgroups of this population, such as incarcerated biological mothers, stepmothers, and mothers with adult children, to see if the influence of variables such as experience has the same impact on treatment success across subgroups.
This study represents a dual methodology approach to identifying the substance abuse needs of women in the criminal justice system. Our results provide evidence that women involved in the criminal justice system have a wide range of substance abuse treatment needs. Chief among these needs are treatment options that (a) are designed around child care needs, (b) are seamless and uninterrupted despite custody status, and (c) provide programming that recognizes that women do not respond well to male-oriented treatment paradigms (Briggs, 2008).
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John M. Laux, Paula J. Dupuy, Jeffry L. Moe, and Jane A. Cox, Department of Counselor Education and School Psychology, Eric Lambert and Lois A. Ventura, Department of Criminal Justice, Celia Williamson, Department of Social Work, Barbaranne J. Benjamin, College of Health Science and Human Service, all at The University of Toledo. Jeffry L. Moe is now at the School of Education and Human Development, University of Houston-Victoria. Jane A. Cox is now at the Adult, Counseling, Health, and Vocational Education Department, Kent State University. This project was supported by Grant 2005-DD-BX-1066 awarded by the Bureau of Justice Assistance, a component of the Office of Justice Programs. Points of view or opinions in this document are those of the authors and do not represent the official position or policies of the U.S. Department of Justice. Correspondence concerning this article should be addressed to John M. Laux, Department of Counselor Education and School Psychology, The University of Toledo, MS 119, 2801 West Bancroft, Toledo, OH 43606 (e-mail: john. email@example.com).…
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Publication information: Article title: The Substance Abuse Counseling Needs of Women in the Criminal Justice System: A Needs Assessment Approach. Contributors: Laux, John M. - Author, Dupuy, Paula J. - Author, Moe, Jeffry L. - Author, Cox, Jane A. - Author, Lambert, Eric - Author, Ventura, Lois A. - Author, Williamson, Celia - Author, Benjamin, Barbaranne J. - Author. Journal title: Journal of Addictions & Offender Counseling. Volume: 29. Issue: 1 Publication date: October 2008. Page number: 36+. © 2007 American Counseling Association. COPYRIGHT 2008 Gale Group.
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