Author ORCID Identifier

Date Available


Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation


Arts and Sciences



First Advisor

Dr. Carrie Oser


Research has consistently demonstrated that criminal legal system (CLS)-involved women are distinct from men in initiation and course of drug use, with important differences on biological, environmental, and sociocultural levels. Thus, the unique pathways and transitions into and out of drug use for women with CLS involvement are critical to consider from a research perspective, but also from a need to develop and support evidence-based, women-centered services in correctional contexts. This dissertation project uses a three-paper format to investigate three aims: (1) to understand CLS-involved women’s initiations to injection drug use and their experiences providing injection initiation assistance (IIA) to others; (2) to explore unique correlates of CLS-involved women’s experiences with overdose and overdose reversal, including relationships between overdose and traumatic stress; and (3) to examine community reentry and recurrences of drug use post-incarceration for women who have completed corrections-based substance use treatment services.

This project utilizes secondary data from two studies. Aim 1 includes cross-sectional data from the Women’s Intervention to Stop HIV/HCV, conducted with women incarcerated in rural Appalachia. Aims 2 and 3 use data from the Criminal Justice Kentucky Treatment Outcome Study (CJKTOS), a longitudinal state-funded evaluation of corrections-based substance use treatment in Kentucky. Aim 2 is conducted using baseline CJKTOS data collected from women at treatment entry, describing their experiences during the 12 months prior to incarceration. Aim 3 uses a mixed-methods analysis of follow-up CJKTOS data collected from a stratified random sample of women who graduated from corrections-based treatment, 12 months after their release to the community.

Collectively, findings from the three papers contribute to a complex portrait of factors that are associated with CLS-involved women’s risk of substance misuse-related harm. Specifically, findings from Aim 1 suggest that women who exhibit trajectories of drug use characterized by faster transitions and more severe patterns, and who are more enmeshed in social networks of others who use drugs, are more likely to have provided IIA. Results from Aim 2 indicate that witnessing and/or experiencing overdose is common among treatment-seeking incarcerated women and independently associated with mental health issues, although knowledge of where to obtain naloxone is also related to lower odds of meeting PTSD criteria among women who have witnessed overdose. Finally, findings from Aim 3 show that, across factors at all social ecological levels, employment demonstrates the strongest relationship to abstinence from drug use after release from incarceration. However, women’s qualitative appraisals of risk and protective factors emphasized internal/individual qualities (e.g., motivation), complex relational influences, and environmental triggers as critical for recovery.

The use of multilevel theoretical models to guide selection of variables across all three papers emphasizes the need to frame substance misuse transitions not just from an individual-level perspective, but also from interpersonal, community, and intersectional standpoints. Implications for prevention, intervention, and recovery support services for CLS-involved women are also discussed, as well as the value of comparing quantitative findings alongside women’s subjective understanding of events.

Digital Object Identifier (DOI)

Funding Information

Research reported in this dissertation was supported by the National Institute On Drug Abuse of the National Institutes of Health under Award R01DA033866, and the Criminal Justice Kentucky Treatment Outcome Study (CJKTOS), a project funded by the Kentucky Department of Corrections.