Karen L. Cropsey

Expired Carbon Monoxide Levels in Self-Reported Smokers and Nonsmokers in Prison

Breath carbon monoxide (CO) is a convenient, widely used method for abstinence validation, with cutoffs of 8-10 ppm commonly employed. The goal of the present study was to determine an appropriate CO cutoff to differentiate nonsmokers and smokers within a large sample (N = 374) of female prisoners incarcerated at a correctional facility in Virginia. Mean age of the population was 34.5 years, 49.2% were White, and 29% had less than a high school education. Smoking prevalence was 74.1% within the prison population. Examination of CO levels versus smoking self-report using a receiver operator characteristic (ROC) analysis revealed that a CO cutoff of 3 ppm resulted in the best sensitivity (98.1%) and specificity (95.8%). Overall ROC area under the curve was 99% (95% CI = 98.2%-99.9%). This same cutoff was optimal for smoking subgroups including Black and light (<10 cigarettes/day) smokers. Results suggest that CO cutoffs higher than 3 ppm may misclassify some smokers as nonsmokers and underestimate the prevalence of smoking.

Prescription Opioid Misuse Index: a brief questionnaire to assess misuse.

The Prescription Opioid Misuse Index (POMI) was developed and used in a larger study designed to assess correlates of OxyContin abuse in pain patients prescribed OxyContin, patients treated for OxyContin addiction, and individuals incarcerated for OxyContin-related charges. The POMI was administered to 40 subjects with addiction problems and 34 pain patients who had received OxyContin for pain. Receiver operating characteristic curve analysis indicated that endorsing two or more of six items reliably classified a person as at risk for misuse of their medication. When comparing drug abuse/dependence in subjects classified as misusers or users, significantly more misusers received a diagnosis for alcohol (p < .01), illicit drugs (p < .05), and other prescription medications (p < .05) and reported greater lifetime use of alcohol (p < .002) and illicit drugs (p < .01). No between-group differences were found regarding psychiatric problems. The POMI appears to be a sensitive and specific instrument for identifying patients who misuse opioid medications.

Women physicians and addiction.

Abstract Nine hundred and sixty-nine impaired physicians (125 women and 844 men) enrolled in one of four state physician health programs were evaluated with comprehensive psychosocial, psychiatric and substance abus//dependence profiles. When compared to male impaired physicians at time of entry to physician health programs, the 125 female impaired physicians were younger (39.9 vs. 43.7 years; p < .0001), reported more medical (48.7% vs. 34.4%; OR = 1.81) and psychiatric (76.5% vs. 63.9%; OR = 1.84) problems at intake. They were more likely to report past (51.8% vs. 29.9%; OR = 2.51) or current (11.4% vs. 4.8%; OR = 2.54) suicidal ideation, and more likely to have made a suicide attempt under the influence (20.0% vs. 5.1%; OR = 4.64) or not under the influence (14.0% vs. 1.7%; OR = 9.67) of a substance. Although alcohol was the primary drug of abuse for all physicians studied, women physicians were more likely to abuse sedative hypnotics than men (11.4 vs. 6.4; OR = 1.87). There were no gender differences in employment problems (65.3% vs. 67.5%; ns) or legal problems (15% vs. 21%; OR = .66) due to addiction. These findings suggest different characteristics between male and female impaired physicians which may have implications for identification and treatment of this population.

Pharmacotherapy treatment in substance-dependent correctional populations: a review.

The number of drug or alcohol dependent inmates has increased dramatically in recent years. About half of all inmates meet DSM-IV criteria for dependence at the time of their arrest and require substance use treatment or detoxification. Few inmates receive treatment while in prison, increasing the likelihood that they will continue to use substances in prison and after release. While pharmacotherapy interventions have been shown to be effective with substance users in the community, few studies have investigated these treatments with a prison population. Further research is needed to better understand the feasibility and efficacy of providing pharmacotherapies for substance dependence disorders within this population.

POSTTRAUMATIC STRESS DISORDER TREATMENT IN CORRECTIONAL SETTINGS: A BRIEF REVIEW OF THE EMPIRICAL LITERATURE AND SUGGESTIONS FOR FUTURE RESEARCH

This article reviews the available empirical studies of posttraumatic stress disorder (PTSD) treatments for correctional populations. Despite the large numbers of prisoners and their high rates of victimization and traumatic disorders, few targeted treatments are available, and even fewer have been studied and empirically supported. The treatment modalities that have been studied include two exposure, two cognitive, and two skills-based approaches investigated in a total of eight studies. Four studies that met criteria for this review were conducted with women, three with juvenile males, and one with a single man. The studies possess many methodological weaknesses, and some outcomes have been disappointing. In the hopes of preventing further suffering, revictimization, and recidivism, it is imperative that further development and investigation of targeted treatments continue in this understudied and vulnerable population. Much progress has been made in the treatment of PTSD in the general population, so these approaches could be explored in the correctional system as well. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Relationship Between Smoking Status and Oral Health in a Prison Population

This was a cross-sectional study designed to investigate the relationship between tobacco use and oral health of inmates. Inmates (n = 1,275) randomly selected from the state prison population were given a complete dental exam and were asked about their tobacco use. This study revealed a high prevalence of smoking, with 69% of the sample reporting current smoking. Inmates who smoked or smoked along with using other tobacco products had the worst dental outcomes. The high rate of tobacco use and oral disease is consistent with previous findings among incarcerated samples and suggests the need for smoking cessation programs.