Putting Justice into the System: Helping Incarcerated Women Who Face Addiction

0:00:13 William Moyers
It's me, your host, William C. Moyers, with another edition of Let's Talk, a podcast series produced and brought to you by Hazelden Betty Ford. We're glad you're with us. And I'm honored to have with me today Dr. Stephanie Covington, a pioneer in the fields of addiction, trauma, and recovery. A clinician, author, and renowned speaker who also has developed a comprehensive, gender-responsive, trauma-informed approach to helping people to get well. Including women in jails and prisons. Thank you Stephanie for joining us today from California, I believe!

0:00:47 Dr. Stephanie Covington
Yes! Thanks for the invitation.

0:00:49 William Moyers
Well let's just start off. Why do we need to focus on women incarcerated with substance use problems?

0:00:57 Dr. Stephanie Covington
Well I think it's really important that we think about women in general in the criminal justice system because they have been ignored. They're probably the most invisible—women in our society. And for many of them, they've come into the justice system, jails and prisons, because of their substance use disorders. And you and I both know incarcerating someone because they have an addiction problem is not what they need. People need treatment.

0:01:23 William Moyers
Now of course, some people might hear that as saying so you're making an excuse! For the fact that they broke the law. But that's not what you're saying.

0:01:33 Dr. Stephanie Covington
No I'm not trying to excuse behavior. I'm trying to help us work smart. If someone has a problem, a woman has a—an addictive disorder—if we want to help her get into recovery, then we need to provide her with tools. The justice system does not provide those tools. It's a form of punishment. And also people don't realize for women who don't have a problem with alcohol and drugs, often they develop a problem inside the jail or prison. People think that jails and prisons are drug-free. They are not.

0:02:07 William Moyers
How does that work? [smiles]

0:02:09 Dr. Stephanie Covington
[chuckles] Well, creativity on some level. In terms of alcohol, people learn how to brew and make alcohol inside prisons. And also contraband, things come in that aren't supposed to be there. And when you have addicts who really want something, it makes it quite a commodity in terms of tradeoffs.

0:02:36 William Moyers
Why is it Stephanie that women incarcerated seem to have more substance use issues than men who are incarcerated?

0:02:45 Dr. Stephanie Covington
It's interesting, isn't it? I think a couple of reasons. Number one, women get incarcerated for crimes that are often less violent than what a man might do. There are ways that sometimes judges are more punitive, you know. Women aren't supposed to be doing these things, therefore, I'm gonna teach her a lesson. And so, you know, when this whole idea of the War on Drugs happened you know decades ago, the people most impacted were women. And particularly women who were street drug users. The idea was they were gonna pick up all these drug kingpins, but in fact they picked up a lot of low-level drug users, many of them women. And that started this sort of mass incarceration of people and a significant number of them being women.

0:03:37 William Moyers
I remember when I first came into the field 25 plus years ago, you were renowned in what you did back then. Tell us a little bit—and I was fascinated by it and learned a lot way back then too—but Stephanie tell us how you got interested in the advocacy around incarcerated women and substance use disorders.

0:03:59 Dr. Stephanie Covington
It was one of those flukes of life, really. It was towards the end of the '80s, I was at a women's addiction conference in North Carolina. During a break, I was standing with a circle of the attendees and people had on nametags. And one nametag said 'Warden.' And I was like, Warden? So I said, 'Warden, what are you the Warden of?!' And she said, 'Oh, a women's prison here.' I said, 'You know, I've done all this work around women and I haven't even thought about women in prison.' She said, 'Nobody does.' And she said, 'Tonight I'm bringing five or six of the honorees out to the presentation you're doing in the community.' So that night after my talk, I'm now standing with a group of women who are incarcerated, are out for the evening, and I'm hit by this [thought] why are you in there and I'm out here. And it was very clear to me it was about privilege. That being white and educated and with resources and a family with resources, if I got into trouble, I'd be able to get out of it. And I was haunted by that actually. And so I contacted the Warden and said, 'Next year when I'm back in North Carolina, I'd like to come to the women's prison.' And over time I realized what I wanted to do was live in the prison for a few days. And I convinced her to let me come inside and stay for a couple days in the women's prison. And it changed the trajectory of my work. I just knew this is a group of women I wanted to work with.

0:05:35 William Moyers
And certainly you've done a lot of good work over the decades. It changed the trajectory of your pursuit. What's changed in public policy around this issue, if anything?

0:04:50 Dr. Stephanie Covington
Well, you know, there are two things. Sometimes policy changes but nothing changes on the ground. I think what we have today, if I think about the last couple of decades, I think there's slightly more visibility about women in prison. I think that has helped in a way. Certainly women's prisons have more programming today than they did 20, 25 years ago. That prison I stayed in for a couple days, they did no programming. End of the '80s, no programming whatsoever. The women cleaned, they ate junk food, they watched television, and they smoked. That's what they did. So, that's changed today in a lot of ways. I think that some of the work being done now, a lot of it that I'm involved in, is trying to have a criminal justice system understand trauma. And the impact of trauma on people's lives. How that's connected to addiction. And how that's connected to crime.

0:06:50 William Moyers
Talk more about that, the connection between trauma, or the intersection between trauma, substance use disorder, and incarceration.

0:07:00 Dr. Stephanie Covington
Well one of the things we know, and there's a lot of research on this, that for example, children who are physically and/or sexually abused in their childhood, and grow up particularly in poverty, have much higher rates of criminal activity in their adult lives. We also know that people who have high rates of physical and sexual abuse in their childhood also have high rates of addiction to alcohol and other drugs. So you've got these three things all coming together. We also know that violence is one of the responses, particularly for men, that men have in terms of having a trauma history. So, when we can begin to address these issues, that may have occurred much earlier in their life, I believe we can help people to make changes in their lives.

0:07:55 William Moyers
How do you address substance use disorders inside the system?

0:08:02 Dr. Stephanie Covington
Well we have a couple of programs. There's helping men recover, there's helping women recover, there's a community version, and there's a criminal justice version. And so for example in California, those are the core programs in the 35 prisons here. And those programs, while the focus is on substance use disorders, there's also a trauma piece in that. Then we have brief interventions. Exploring trauma, healing trauma, that talk about trauma as the primary theme. Substance use is a sub-theme. Well those are—Hazelden has published those, we have a lot of research on that. And then for women I have a program called Beyond Violence. And that works on two levels. It works on the violence she's experienced, it works on the violence she's perpetrated, and substance use disorders are a sub-theme in that. So I connect them in the program materials to help people begin to put the pieces of their lives together.

0:09:04 William Moyers
Is it an advantage or a disadvantage to have your client locked up while you're treating them?

[Both chuckle softly]

0:09:12 Dr. Stephanie Covington
Well, I haven't yet found any advantage for people being locked up. Here's what I believe. In fact, every prison—every women's prison I've ever been in, I've asked the Warden, what percentage of the women under your custody need to be here? And wardens aren't—they're usually a pretty traditional group of people. They tell me 75 percent of the women in those prisons don't need to be there. Okay? I believe that our men and women's prisons, there's a small percentage of people that probably need to be there because we don't know how to help them. Okay? They are so wounded and very difficult and I think they probably need to be in a safe place. But the majority of people would do much better in programming that's in the community. Much better.

0:10:07 William Moyers
What else do women with a substance use disorder who are incarcerated also need to know or need to learn, or need to do, if they're going to stay clean and sober and stay out of trouble once they get out? Which they're all gonna do, get out?

0:10:27 Dr. Stephanie Covington
Right, right. The majority of people do come out. And the way I think about it, treatment on the inside well I have to tell you, in some prisons what they call treatment, you and I would call drug and alcohol education. It really is not treatment. It's education. [Moyers nods] But if indeed this is a prison that does provide what I would consider treatment, that needs to be followed up with treatment also in the community. Because a woman's environment changes when she moves from the prison to the community. And the stressors are different. I mean prisons are very stressful. But coming back into the community after you've been incarcerated, there are a lot of thinking if she's a mother they're gonna try—she's gonna try to reunite with her children. She's gonna have to find a job, she's gonna have to find housing. She may have a Parole Officer she has to report to. Other kinds of social service agencies. So, she needs to have support for recovery in the community. She may need treatment but certainly, a really strong support system.

0:11:33 William Moyers
And you've been around long enough to continue to do this work, which tells me that you know that this work makes a difference. How do you measure success?

0:11:46 Dr. Stephanie Covington
Well we measure success on a whole variety of ways. For people who are interested, they look on my website, there's a prompt to research and it lists all the research articles. So, when we have an opportunity, which means having like a five-year, heavily funded grant. I don't do the research, I don't research my own material, I have colleagues that research them. But they look, if we have a three-to-five-year federal grant, and we're able to track people when they leave, we're looking at recidivism. But we're also looking at substance use, we're looking at depression, we're looking at anxiety, we're looking at a whole variety of different parts of life. We're never looking just at one thing. When we're inside the prison, and we're not checking—we're not able to track people on the inside—which happens a lot when people have ten, twenty, thirty-year sentences, then we're looking again at substance use but we're also looking at the mental health. We're looking at emotional regulation. We're looking at how they connect to other people. We're looking at how they're expressing anger. And so forth. So, you know, the one researcher at UCLA, she has about twenty different inventories, assessment tools she's looking at to try to evaluate change.

0:13:13 William Moyers
And what about once women come out the system, the criminal justice system, they've been incarcerated whether it's for a couple of months or for years or decades, they are recovering from their substance use disorder. What are the most important assets or what's part of the support fabric that they really need?

0:13:37 Dr. Stephanie Covington
When women come out, they really need a way to make a living wage. The women are very clear that there're two jobs waiting for them when they walk out of a prison. One is the drug dealer and the other's the pimp. And so that's gonna lead you right back into the system. So, being able to have a living wage, a place to live, and a support system. I mean, William, and you know this, that people do not recover from addiction in isolation. They just don't. And they need support around them. Maybe it's family, but many women come from families where the drug abuse totally permeates that family. So that may not be her support system for recovery. So she needs some other supports.

0:14:32 William Moyers
And what about the family of the incarcerated woman? Are there resources available for them?

0:14:40 Dr. Stephanie Covington
Boy, not many. That also is a huge challenge. In most states, the women's prisons are in rural areas, but the women come from urban areas. So that means family members if they're going to visit, or family members who might be taking care of children and bringing them to visit, it's a long drive. Often there's no public transportation. Often these aren't family with extra resources. Think about gas prices right now. You know? Visitation is a huge issue for families. And for children, there's so much shame attached, you know? When you talk to families and you listen to women's kids, often they make up stories about where their mother is. She's in the hospital, she moved away. Saying my mom's in prison is like--not a place a child wants to go.

0:15:40 William Moyers
Mmm. Do you ever take women who have successfully completed a substance use treatment and served their sentences, do they ever go back into the system to share their experience, strength, and hope?

0:15:55 Dr. Stephanie Covington
We try to. Some systems really prohibit people from coming back in. Depends on how long she was in, what kind of crime it was. Sometimes it's the length of time she needs to be out. We do that whenever we can. It's really powerful to be able to have women who are making it on the outside come in and say, 'Look, I made it, you can too.' It's very different than someone like me, right? So, having someone come back makes a difference. There's a group of us here in California that run programs on the inside. And many women in this group are formerly incarcerated. So often right now, we're working on a video that can go in. Of the women talking about their lives on the outside and being successful. And, you know, providing hope! A sense of hope.

0:16:49 William Moyers
We have about a minute left, Stephanie, I've got two questions for you. One, if you could—when you look down the road over the next three to five years, what is your hope for how communities, states, and the federal government will not just see women with a substance abuse problem behind bars, but what do you—what's your hope for how we as a society respond to it?

0:17:14 Dr. Stephanie Covington
Well I'll give you my wish list. [smiles] One is I wish those of us living in the free world would realize that prisons are part of our society. Just like our schools and hospitals. We need to own those and be responsible for what happens on the inside. And in terms of state governments and the federal government, I think we have to acknowledge the system doesn't work. There's a lot of discussion about reform. This is like taking a house that does not have a good foundation and trying to remodel it. There's a point where you say, 'This house is a teardown.' And the criminal justice system needs to be totally re-thought, re-developed, new foundation.

0:18:06 William Moyers
In the meantime, we really appreciate the good work that you're doing. And please share with us where can people find resources through your website?

0:18:15 Dr. Stephanie Covington
If you go on my website, you'll find the prompt to the bookstore that has resources. You'll find a prompt to articles and book chapters I've written about this. And a prompt to research. You go on the Hazelden bookstore, you'll find materials there. For working with women in the criminal justice system. [smiles]

0:18:34 William Moyers
Stephanie Covington, thank you for being with us today.

0:18:37 Dr. Stephanie Covington
Thank you, William.

0:18:39 William Moyers
[to camera] And thanks to all of you for tuning in. Remember, addiction does not discriminate. And neither should recovery. Everyone deserves access to treatment. Including women and men who are incarcerated. Because treatment works and we know that recovery is real. We'll see ya again.