Effects of scarcity on women’s cognitive ability to manage mental health and substance use after prison release

This study examines how the scarcity women experience returning to the community after prison affects cognitive functioning, leading to impulsive decisions that harm their health. Women (n = 92) with co-occurring mental health and substance use disorders were assessed 5–6 months before, 1 month before (n = 59), and 1 month after (n = 66) prison release using cognitive functioning (fluid intelligence, impulsiveness, persistence, attention, pre-occupation), clinical (cravings, mental health, substance use, treatment received), and scarcity measures. We examined: (1) effects of hypothetical scarcity during incarceration on transient cognitive, craving, and clinical variables; (2) real-world changes in cognitive and clinical variables from baseline through release and their correlation with scarcity. Exposure to hypothetical scarcity during incarceration resulted in reduced cognitive persistence and increased craving for drugs or alcohol but did not induce immediate effects on other outcomes. During real re-entry, 6 of 7 cognitive functioning indicators worsened from baseline to post-release. More post-release scarcity was associated with worse cognitive functioning, more cravings, worse mental health, more substance use, and less treatment received. Worse post-release cognitive functioning partially mediated effects of scarcity on post-release cravings and mental health. Findings suggest scarcity at re-entry can limit women’s choices and their ability to think clearly to make those choices.