Examining trauma and demoralization as factors influencing treatment engagement for Black women with SUD returning from prison

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Program Summary/Abstract People who experience incarceration and have mental health challenges are disproportionately Black and Latinx, and low-income. This group experiences financial hardships regardless of incarceration due to racism and other forms of discriminations, with associated negative health outcomes. These financial issues have a direct impact on health, create barriers to employment and housing, stress social networks, contribute to feelings of exclusion and contribute to recidivism, all of which are health determinants. The goal of the parent award is to intervene at the community level to reduce financial difficulties of individuals with incarceration histories and mental health challenges, who are predominantly Black and Latinx. The proposed diversity supplement will explore experiences of trauma, stigma, and demoralization among Black women with histories of a substance use disorder (SUD) and/ or SUD treatment, recently released from incarceration. Incarcerated populations are often presenting with mental health conditions, including substance use disorders (SUD), with an estimated 60% of those incarcerated meeting criteria for a SUD. In the last two decades there has been an 525% increase in the incarceration rate for women, and in 2021 Black women were incarcerated at 1.6 times the rate of White women. Furthermore, consistent findings highlight high rates of victimization among incarcerated women, and it is hypothesized that trauma exposure is a gender-specific pathway into the carceral system. Research has identified that for several women this pathway is in part due the presence of mental health conditions, including SUDs. Stigma associated with both addiction and legal involvement is one of the many barriers individuals face as they reenter the community and initiate community- based SUD treatment. Embodying multiple stigmatized identities, formerly incarcerated Black women with SUDs navigate a reentry experience that is unique and nuanced. Implementing Community-Based Participatory Research (CBPR) methods this proposal will explore how these intersecting identities (race, gender, person who uses substances, incarceration history) and compounded experiences (pre-incarceration trauma, carceral trauma, internalized stigma, demoralization) impact treatment seeking behaviors and decisions. Our CBPR process incorporates learning from and partnering with community stakeholders to identify opportunities that can improve treatment strategies and reentry experiences for the target population, and inform the development of a harm reduction, community-based, and culturally relevant intervention.