Just an unfair score: Perceptions of gender inequity in the treatment of substance use disorders among women involved in the criminal legal system

Introduction: Increasing overdose deaths and criminal legal involvement among women necessitate women-specific solutions to curb the adverse consequences of substance use disorders (SUDs). The current study is the pre-implementation phase of an implementation science study that works with various stakeholders—affected women, criminal legal professionals, and SUD treatment professionals—to identify and address high-priority needs for criminal-legal involved women with SUDs. Methods: This study uses semi-structured interviews (N = 42) administered in 2022 to women with a history of SUD and criminal legal involvement (n = 20), SUD treatment professionals (n = 12), and criminal legal professionals (n = 10). Interviews focused on participants' history of substance use and criminal legal involvement, facilitators and barriers to initiating and completing treatment, and gender-specific issues encountered during treatment and criminal legal involvement. Drawing on the social ecological model of health, analyses identified gender-specific challenges impacting criminal-legal involved women's treatment and recovery processes. Results: Participants identified five gender-specific challenges impacting women across social ecological levels. At the relational level, challenges stemmed from women's roles as mothers and from victimization within healthcare and criminal legal settings; at the community level, from unequal resource allocation for treatment; and at the societal level, from stigma associated with certain intersectional identities and cultural norms that constrict job opportunities. Participants noted that providing women with effective care coordination and women-specific guidelines and spaces within the criminal-legal system could mitigate some of these challenges. Discussion: Findings highlight the need to consider gender-specific challenges faced across relational, community, and societal levels when implementing medical interventions and criminal legal proceedings for women. Given these findings and extant literature, the authors are developing an all-female, trauma-informed intervention that includes case management with female certified recovery specialists who are in recovery and have navigated the criminal legal system. By reducing some of the gender-specific barriers identified in this study, this future intervention aims to improve the substance use and criminal legal outcomes of participating women.