New UCI study suggests behavioral therapy may increase drug and alcohol abstinence and reduce recidivism

Research compares intervention methods specifically targeting homeless women

Irvine, CA – January 8, 2018 – A new UCI study on drug and alcohol intervention programs used among homeless women upon release from jail or prison suggests behavioral therapy may be more effective than other programs at increasing drug and alcohol abstinence and reducing recidivism.

Entitled, “Achieving Drug and Alcohol Abstinence Among Recently Incarcerated Homeless Women: A Randomized Controlled Trial Comparing Dialectical Behavioral Therapy Corrections-Modified With a Health Promotion Program,” the study compares two different types of intervention therapies: dialectical behavioral therapy-corrections modified (DBT-CM) and traditional health promotion (HP) intervention programs. Results indicate a significant improvement in women participating in the DBT program as compared to those in the HP program. 

Published in Nursing Research, the study was led by Adeline M. Nyamathi, PhD, ANP, FAAN, founding dean of the UCI Sue & Bill Gross School of Nursing. This new research built upon prior studies, which indicate drug and alcohol issues lead to higher recidivism and increases in the likelihood of future criminal justice involvement by recently incarcerated homeless women.

“Upon exiting jail or prison, homeless female offenders are at a critical juncture as they attempt to transition from life in a correctional facility to life in a community setting,” said Nyamathi.  “Along with other challenges, many of these women have unmanaged drug issues and up to two-thirds do not complete treatment programs.”

In California, more than 45 percent of offenders return to prison within the first year of release.  That number rises to over 65 percent within the first three years.    Among women, recidivism associated with drug-related violations is high.

“To reduce recidivism, we must address some of the causes that we can control,” said Nyamathi.  “In our study, we sought to improve individuals’ ability to control or regulate their emotional responses to certain situations.  We also worked to better prepare these individuals so they could adjust to certain situations appropriately." Both of these techniques appear to increase the percentage of women who abstained from drugs and alcohol following their release, which in turn could positively affect recidivism as indicated by other research.  “To our knowledge, this is the first study to show that a DBT-CM intervention is more successful in achieving higher rates of drug and alcohol abstinence than the more traditional HP programs delivered by community health workers and registered nurses,” said Nyamathi. 

During the study, at the six-month follow-up visit, 65.5 percent of DBT-CM participants had abstained from drug use as compared to 48.3 percent of HP participants.  Similarly, participants in the DBT-CM group were more likely to become or remain alcohol-abstinent during the study period, while abstinence among the HP group did not change.

“Women offenders have a higher recidivism rate associated with drug-related violations than male offenders, and there are virtually no gender-sensitive intervention programs available to them,” said Nyamathi.  “It is critical for policymakers to engage homeless paroled adults in behavioral interventions that not only reduce risky behaviors, such as drug and substance use, but enable positive coping and communication skills in the continuity of their life course trajectory.  Based on our study, DBT is an effective behavioral intervention for recently released offenders who are engaged in these risky behaviors.”

Nyamathi said more research should be done.

Each program was delivered by a program specific nurse and two community health workers (CHW). The DBT-CM intervention consisted of six weekly group sessions and six weekly one-on-one sessions, each lasting on average 45-60 minutes, for a total of 12 weeks.  One of the main goals of the DBT-CM program was to replace maladaptive coping methods, like substance use, with more positive coping methods.  Over the six-month program, participants were assisted with referrals to social services and housing, and provided support in identifying risk factors that trigger their use of substances including drugs and alcohol.

The HP programs focused on managing or preventing common chronic diseases that homeless women face.  Similar to the DBT-CM program, the women met in small groups to discuss a particular chronic disease and they participated in one-on-one sessions to discuss more personalized health and wellness strategies.  Topics explored during the HP sessions included: diabetes, heart disease, sexually transmitted infections, including HIV, parenting skills, community and family reintegration. Unlike the DBT-CM intervention, the HP program provided no behavioral health intervention strategies, nor did they provide referrals or ongoing support. 

 “A larger randomized-controlled trial is needed to validate our findings and generate more robust estimates of the effect of DBT-CM on drug and alcohol use,” concluded Nyamathi.

 Nyamathi is the founding dean and a distinguished professor at the UCI Sue & Bill Gross School of Nursing.  She has been lead investigator in more than a dozen NIH-funded research grants related to populations experiencing significant health and social disparities.  Other researchers who participated in this study included: Sanghyuk S. Shin, PhD, assistant professor at the UCI Sue & Bill Gross School of Nursing; Jolene Smeltzer, MSN, RN, a student at the Mervyn M. Dymally School of Nursing; Benissa E. Salem, PhD, MSN, RN, an assistant adjunct professor and project director, at the UCLA School of Nursing; Kartik Yadav, MSCR, a project director at the UCI Sue & Bill Gross School of Nursing; Maria L. Ekstrand, PhD, a professor at the University of California, San Francisco School of Medicine; Susan F. Turner, PhD, a professor in the Department of Criminology, Law and Society, at UCI, and Mark Faucette, BS, Vice President for Amistad de Los Angeles, California.

About the UCI Sue & Bill Gross School of Nursing

The University of California, Irvine Program in Nursing Science was established in 2007 and designated the Sue & Bill Gross School of Nursing in 2017 following a $40 million gift from the William and Sue Gross Family Foundation.  The school of nursing offers bachelor, master and doctoral degree programs, and it is part of the Susan & Henry Samueli UCI College of Health Sciences which includes the UCI School of Medicine, the Department of Pharmaceutical Sciences and the Program in Public Health.  Through the nursing school programs, students acquire academic and professional education in the discipline of nursing, which prepares them for basic clinical and advanced practice roles. The programs also prepare students for educational, administrative and research positions across the healthcare delivery system, as well as faculty positions in academic institutions. The school's bachelor’s degree and master’s degree programs are accredited by the Commission on Collegiate Nursing Education and California Board of Registered Nursing (BRN). To learn more, visit