Michele Staton Tindall

Methamphetamine Use in Nonurban and Urban Drug Court Clients

Population-based surveys suggest that methamphetamine use and abuse may be rising in the United States. However, little is known about methamphetamine use in eastern sections of the United States, particularly nonurban areas. The purpose of the present study was (a) to explore reported methamphetamine use and its correlates among Kentucky drug court clients and(b) to determine whether differences exist between methamphetamine users by drug court location. Of the 500 drug court clients surveyed, approximately 32% n = 161) reported lifetime methamphetamine use. Methamphetamine users and nonusers differed in their drug-use profiles, self-reported criminal history, and number of criminal offenses. Nonurban and urban methamphetamine users differed in their drug-use profiles, psychological functioning, self-reported criminal history, and number of criminal offenses. These results suggest that differences exist between these populations and clinicians, and criminal justice officials may need to consider these differences when planning treatment and rehabilitation strategies.

A Prospective Examination of High-cost Health Services Utilization among Drug using Prisoners Reentering the Community

The use of health services by prisoners during their incarceration and after their return to the community impacts the U.S. health care system and health care costs associated with this system. These health care costs are expected to increase over the next decade as more prisoners return to their communities. The current study prospectively examines the use of high-cost health care services—emergency room visits and hospitalizations—among 565 male drug-abusing prisoners about 1 year after prison release. A series of structural equation models were used to examine predisposing factors, including health status and drug use, and to estimate the frequency of high-cost health service utilization. As expected, health status was the most robust predictor of high-cost health services. However, the finding that drug abuse had nonsignificant relationships with high-cost health services utilization was not expected. Discussion focuses on health care service issues and health problems as prisoners’ transition from prison to the community.

Rural Drug Users: Factors Associated With Substance Abuse Treatment Utilization

The purpose of this study is to use a modified version of Andersen’s Behavioral Model of Health Services Use to identify the correlates of the number of substance abuse treatment episodes received by rural drug users. Data were collected from face-to-face interviews with 711 drug users in rural areas of Ohio, Arkansas, and Kentucky. Descriptive analyses examine rural drug users’ substance use histories and retrospective substance abuse treatment service utilization patterns. A negative binomial regression model indicated that selected predisposing, historical health, and enabling factors were significantly associated with the utilization of substance abuse treatment among rural drug users. Despite high levels of recent and lifetime self-reported substance use among these rural drug users, treatment services were underutilized. Future studies are needed to examine the impact of the health care system and characteristics of the external environment associated with rural substance abuse treatment in order to increase utilization among drug users.

Factors Predicting Unmet Health Services Needs Among Incarcerated Substance Users

Negative health consequences of illicit drug use, such as cardiovascular complications and infectious diseases, increase the likelihood of the need for health care. However, evidence suggests that, with the exception of emergency services, drug users generally are medically underserved. Furthermore, the effect of illicit drug use on health care utilization is becoming an especially important issue for the criminal justice system, because an increasing proportion of inmates in correctional institutions have a history of drug use. This 1998–1999 study of 661 incarcerated men in the Kentucky prison system focused on predictors of unmet physical, behavioral, and overall health care needs among chronic substance users. Analyses revealed that White incarcerated drug users were more likely to report unmet physical and overall health care needs than non-Whites and those with high school education or above were more likely to report unmet physical, behavioral, and overall health care needs. In addition, more episodes of serious illness, more mental health problems, and poorer self-rated health were predictive of all three types of unmet health care needs. A longer career of drug use emerged as a significant predictor of unmet behavioral health care needs, whereas more frequent drug use in the year before incarceration predicted unmet physical health care needs. Further research directions and implications for in-prison health care planning are discussed.

The Relationship of Stress, Impulsivity, and Beliefs to Drug Use Severity in a Sample of Women Prison Inmates:

There is a paucity of research examining substance abuse issues among women prisoners. This study explored relationships between perceived stress, impulsivity, and beliefs in the efficacy of drugs as these variables pertain to self-reported drug use severity. Women prisoners (N = 100) participated in structured face-to-face interviews based on established research instruments. Although there was no significant correlation between demographic characteristics and substance use severity, positive relationships were found between substance use severity, perceived stress, impulsivity, and beliefs. A multiple linear model was estimated regressing drug use severity on beliefs, impulsivity, and perceived stress. Only the measures of beliefs and impulsivity were significant correlates of drug use severity. Implications are discussed for prison substance abuse programming and future research.

Correlates of Subjective Stress Among Drug Court Clients

Psychosocial stress is consistently found to promote initiation, intensification, and relapse in drug abuse. It would, therefore, be desirable to identify characteristics of offenders who are at heightened risk for stress-induced exacerbations of addictive behavior. In this cross-sectional, correlational, interview study, 500 clients of two Kentucky drug courts averaged 30 years of age and were predominantly male, White, employed, high school educated, single, and adjudicated in small- and medium-size cities. Five independent correlates of greater subjective stress emerged in stepwise multiple regression analysis (R 2 = .395): use of escape-avoidance coping, positive reappraisal coping (inversely associated), more negative life events, better self-rated health (inversely associated), and access to social support related to work problems (inversely associated). Treatment interventions emphasizing effective coping styles and building of social support as well as managing of negative life events and perceptions of health may serve to lessen subjective stress and its consequences in drug-abusing criminal populations.

Factors Affecting the Completion of Trauma-Focused Treatments What Can Make a Difference?

This study expands our understanding of treatment attrition by investigating factors predicting treatment dropout in a large national data set of clinic-referred children and parents seeking trauma...

Baseline Subjective Stress Predicts 1-Year Outcomes Among Drug Court Clients

Psychological stress has long been known to predict negative changes in physical and behavioral health in the general population. The same relationships have been found in research on drug abusers. In this longitudinal study, 477 clients of two Kentucky drug courts were followed for 1 year to examine the relationship between subjective stress at intake and outcomes 1 year after the baseline of this 18-month drug court program. Greater baseline subjective stress was significantly associated with poorer employment, substance use, criminal justice, and health outcomes at 1-year follow-up, even after adjusting for selected demographic characteristics and baseline levels of the outcomes of interest. If these results are replicated in these and other drug courts, then a stress reduction treatment trial within the drug court context should be attempted and evaluated.

Lifetime Health Services Use by Male Drug-Abusing Offenders:

A modified version of the Andersen and Newman model of health services use was used to examine how male drug-abusing offenders use health services during their lifetimes. Hierarchical regression models were employed to determine the extent to which (a) sociodemographic information, (b) drug use and criminal history, and (c) illness-level factors were predictive of the use of these services. In general, these models explained a moderate level of the variance in services use, with illness-level factors accounting for the majority of variance. Implications for health services in criminal justice settings are discussed.

An Evaluation of Six Brief Interventions That Target Drug-Related Problems in Correctional Populations

Finding brief effective treatments for criminal justice populations is a major public need. The CJ-DATS Targeted Intervention for Corrections (TIC), which consists of six brief interventions (communication, anger, motivation, criminal thinking, social networks, and HIV/sexual health), was tested in separate federally-funded randomized control studies. In total, 1,573 criminal justice-involved individuals from 20 correction facilities participated (78 % males; 54 % White). Multilevel repeated measures analyses found significant gains in knowledge, attitudes, and psychosocial functioning (criteria basic to knowledge, attitude, and practices (KAP) and TCU treatment process models). While improvements were less consistent in criminal thinking, overall evidence supported efficacy for the TIC interventions.