Factors Associated With the Chronicity of Intimate Partner Violence Experiences Among Pregnant Women in Detoxification Services.

The purpose of this study was to assess factors associated with chronicity of intimate partner violence (IPV) among pregnant substance abusers. A total of 114 pregnant women entering an inpatient, detoxification unit voluntarily agreed to participate in a study about women's health and well-being. Face-to-face interviews were used for data collection. A multiple linear regression assessed the relationship between background characteristics, substance use, and IPV chronicity. Protective factors, which were associated with reduced chronicity of IPV, included whether most recent/current intimate partner fathered pregnancy, whether the mother was currently in a relationship with most recent/current intimate partner, whether the mother received greater social support, and increasing age. Childhood sexual abuse was associated with increased chronicity of IPV. Results suggest important prevention, intervention, and treatment implications for this vulnerable population.

Examining substance use among rural Appalachian and urban non-Appalachian individuals participating in drug court.

The study purpose was to examine differences in substance use among individuals in drug court (N = 583) in rural Appalachian (n = 301) and urban non-Appalachian areas (n = 282). A series of logistic regression analyses suggested individuals in the rural Appalachian area were significantly more likely to report lifetime use of cocaine, illicit opiates, and illicit benzodiazepines, but they were less likely to report methamphetamine use when compared with individuals in the urban non-Appalachian area. Regarding past 30-day use, a series of logistic regression analyses suggested individuals in the rural Appalachian area were significantly more likely to use marijuana, illicit opiates, and illicit benzodiazepines, but they were less likely to report crack cocaine use when compared with individuals in the urban non-Appalachian area. Identifying differences which exist in substance use is the first step in generating evidence-based structural changes in treatment drug court programs. Future research should focus on better understanding context in terms of demographic, geographic, and economic conditions, which may be of critical influence on substance use and treatment planning.

Barriers to receiving substance abuse treatment among rural pregnant women in Kentucky.

Research presenting outcomes for women who enter substance abuse treatment during pregnancy consistently shows benefits. While treatment has nearly universal benefits, there are many barriers to seeking substance abuse treatment for pregnant women. The purpose of this study is to explore barriers for rural pregnant women seeking substance abuse treatment. There were three eligibility criteria for study participation: (1) aged 18 and older, (2) pregnant, and (3) undergoing short-term inpatient detoxification at the University of Kentucky Chandler Medical Center. Eighty-five rural women (N = 85) were included in the analysis. Substance use history and previous treatment were assessed with measures adapted from the Addiction Severity Index. Treatment barriers were measured with three qualitative questions and were coded into four overarching categories: availability, accessibility, affordability, and acceptability barriers. This sample had an extensive substance use history. Almost all participants had used alcohol (98%), marijuana (98%), illicit opiates (99%), and cigarettes (97%). On average, participants reported about two barriers to receiving treatment (Mean = 1.8; SD = 1.3), with over 80% of the sample reporting having experienced any barrier to treatment. The majority experienced acceptability (51%) and accessibility (49%) barriers. Twenty-six percent (26%) of the sample reported availability barriers. A smaller percentage of participants reported affordability barriers (13%). Rural pregnant women seeking substance abuse treatment face many obstacles to receiving needed treatment. More studies on barriers to substance abuse treatment among rural pregnant women are needed. Identifying these barriers can help in improving treatment access and services.

Examining barriers to and motivations for substance abuse treatment among pregnant women: does urban-rural residence matter?

Barriers to entering and motivations for substance abuse treatment were examined among rural and urban pregnant women. All pregnant women entering inpatient detoxification at the University of Kentucky Medical Center were approached about participating in a study on health and well-being. One hundred fourteen (N = 114) pregnant women voluntarily participated. Treatment barriers and motivators were measured with open-ended questions. The Treatment Attitude Profile quantitatively measured motivation. Both groups reported approximately two treatment barriers. Top treatment motivators were pregnancy (65.8%), needing help (23.7%), family (18.4%), and being tired of the lifestyle (16.7%). Overall, Treatment Attitude Profile scores were fairly high (Mean = 74.3, SD = 10.7), representing motivation for treatment. Multivariate analyses revealed a significant negative relationship between treatment motivation and gestational age (ß = -0.233; p = 0.012), and a positive relationship between treatment motivation and reporting an acceptability barrier (e.g., denial, stigma) (ß = 0.202; p = 0.024). Few between group differences existed in barriers and treatment motivation. Individuals residing in rural areas have unique beliefs, social ties, attitudes, and financial hardships. Research about the role of these factors in treatment access and motivation could be used to minimize treatment barriers.

Examining gender differences in substance use and age of first use among rural Appalachian drug users in Kentucky.

BACKGROUND: Previous research suggests gender differences exist in types of substances used and age of first use. Recent studies exploring contextual differences in substance use between rural Appalachian and urban environments show different patterns of substance use in rural environments. OBJECTIVE: This study explores whether previously established differences in gender and age of first use exist within a rural Appalachian environment. METHODS: Data are from a community-based study of drug users in rural Appalachia (N=400). Self-reported substance use was recorded using an interviewer-administered questionnaire with questions from the Addiction Severity Index (ASI). RESULTS: On average, participants were 32 years old (X=32.33; median=31.00; interquartile range (IQR)=12) and the majority were male (59%). Examining the past 30-day substance use, more males reported alcohol (adjusted odds ratio (AOR): 2.11, 95% CI: 1.36, 3.23; p=.001) and any illegal drug use (AOR: 1.85, 95% CI: 1.16, 2.95; p=.010), which included heroin, cocaine, crack cocaine, methamphetamine, marijuana, and hallucinogens, after controlling for sociodemographic characteristics. ANCOVA analyses showed that males reported the use of alcohol (p=.000), marijuana (p=.007), and hallucinogens (p=.009) at a significantly younger age than females. CONCLUSION: Findings suggest more men report the use of alcohol and "street" drugs, including heroin, crack cocaine, methamphetamine, marijuana, and hallucinogens. Furthermore, males report the use of alcohol, marijuana, and hallucinogens at a significantly younger age. SCIENTIFIC SIGNIFICANCE: Understanding gender differences in substance use as well as other differences among individuals living in rural Appalachia presents important opportunities to incorporate this knowledge into substance abuse early intervention, prevention, and treatment efforts.

Examining differences in substance use among rural and urban pregnant women.

Substance use during pregnancy is a major public health concern. This study examined differences in substance use among pregnant women from rural and urban areas. Participants were 114 pregnant women entering a hospital-based inpatient detoxification unit primarily for Opiate Dependence who voluntarily agreed to a face-to-face interview. Substance use measures were based on the Addiction Severity Index gathering information about lifetime, past 12 months, and 30 days prior to admission. Rural pregnant women had higher rates of illicit opiate use, illicit sedative/benzodiazepine use, and injection drug use (IDU) in the 30 days prior to admission. Additionally, a greater proportion of rural pregnant women reported the use of multiple illegal/illicit substances in the 30 days prior to entering detoxification. More specifically, pregnant women from rural areas were 8.4 times more likely to report illicit opiate use, 5.9 times more likely to report IDU, 3.3 times more likely to report illicit sedative/benzodiazepine use, and 2.8 times more likely to report the use of multiple illegal/illicit substances in the 30 days prior to entering inpatient detoxification, after adjustment for socio-demographic characteristics (including education and income), pregnancy characteristics, physical and mental health indicators, and criminal justice system involvement. The increased rates of prescription opiate and benzodiazepine use as well as IDU among rural pregnant women are concerning. In order to begin to understand the elevated rates of substance abuse among rural pregnant women, substance use must be considered within the context of demographic, geographic, social, and economic conditions of the region.

Examining Predisposing Factors and Program Performance Indicators Associated With Program Completion: A Comparison of Opioid and Non-Opioid-Preferring Participants in Drug Court.

Opioid use and abuse, as well as criminal justice involvement, have increased dramatically in the past two decades. Drug court is a community-based rehabilitation program for individuals with substance abuse issues involved in the criminal justice system. Given unique treatment needs associated with opioids, the current study examined predisposing factors and program performance indicators associated with drug court completion based on individuals' opioid preference. Secondary data (i.e., participant assessment and drug court Management Information System) as well as conviction information from a statewide database were examined for a sample of drug court participants (N = 534). Data analyses compared opioid-preferring (n = 267) and non-opioid-preferring (n = 267) program participants. For non-opioid-preferring participants, a combination of predisposing characteristics, including both social/demographic characteristics and substance use (i.e., education, drug court site, lifetime benzodiazepine use), as well as program performance indicators (i.e., number of days in drug court, number of positive drug tests, and sanctions/therapeutic responses) influenced drug court completion. For opioid-preferring participants, only program performance indicators emerged as important for program completion, specifically number of days in drug court, number of positive drug tests, and sanctions/therapeutic responses. Findings for non-opioid-preferring participants are consistent with past research, suggesting that individual predisposing characteristics and program performance indicators are influential on program completion. However, findings suggesting that only program performance indicators are influential for opioid-preferring participants adds a unique contribution to the literature. This information may help provide more individualized program planning and ultimately more programmatic success.

Contextual differences in substance use for rural Appalachian treatment-seeking women.

OBJECTIVE: To examine differences in substance use among a sample of women entering treatment from rural Appalachian and non-Appalachian areas. PARTICIPANTS: A total of 2,786 women participating in state-funded substance abuse treatment programs statewide. MEASURES: Substance use measures were based on the SAMHSA CSAT Government Performance and Results Act (GPRA) gathering information on lifetime and past 12-month use of alcohol, marijuana, opiates, sedatives/tranquilizers, cocaine, and stimulants. RESULTS: Women entering treatment in rural Appalachia had disproportionately high rates of opiate and sedative/tranquilizer use while methamphetamine, cocaine, marijuana, and alcohol were more prevalent for women in non-Appalachian areas. CONCLUSIONS: Women entering treatment in rural Appalachia were significantly more likely to report opiate and sedative/tranquilizer use compared to non-Appalachian women. In order to begin to understand the elevated rates of prescription drug abuse in rural Appalachian Kentucky, substance use must be considered within the context of demographic, geographic, social, and economic conditions of the region.

Combining ethical considerations with recruitment and follow-up strategies for partner violence victimization research.

In general, the literature on research ethics and the literature on recruitment and retention of research participants tend to be separated by different purposes and principles. This article uses multiple methods to compile information about research ethics with vulnerable participants as well as with recruitment and follow-up strategies, including (a) literature reviews, (b) key informant interviews, (c) focus group interviews, (d) a pilot study to test ideas for study implementation, and (e) documentation of recruitment and follow-up efforts for a longitudinal study of 757 women with partner violence victimization experiences. This article shows how considering research ethics may actually enhance recruitment and follow-up strategies with women experiencing partner violence victimization.

Women's risk for revictimization by a new abusive partner: for what should we be looking?

The purpose of this article was to examine the prevalence of, as well as risk factors for, revictimization by a new partner. Data was collected via face-to-face interviews at Time 1 (about 5 weeks after obtaining a protective order against a violent partner [DVO partner]) and at Time 2 (approximately 12 months later). Of those women who reported having a new partner at Time 2 (n = 412), 35.2% reported abuse. Findings indicate that there is a subset of women who are at greater risk of experiencing abuse by future partners: women with greater cumulative lifetime victimization and those who abuse or are dependent on illicit drugs. Intervening with women when they obtain a protective order is a critical point of intervention to reduce women's risk for revictimization.

Examining the Impact of Prior Criminal Justice History on 2-Year Recidivism Rates: A Comparison of Drug Court Participants and Program Referrals.

Drug courts seek to break the cycle of substance use and crime by providing a community-based intervention to individuals with criminal justice involvement and substance-related issues. This study examined recidivism over a 2-year follow-up period as well as factors associated with recidivism for a sample of drug court participants (i.e., graduates and terminators) and a non-equivalent comparison group (i.e., individuals referred/assessed for the program who did not enter). In the 2-year follow-up window, fewer drug court graduates had any convictions compared with program terminators and referrals; specifically, fewer drug court graduates had drug trafficking convictions compared with program terminators and referrals. Fewer graduates were arrested and incarcerated in jail and/or prison in the 2-year follow-up; furthermore, graduates had spent less time incarcerated compared with program terminators and referrals. Demographics (i.e., age, race, marital status) and prior criminal justice system involvement were associated with recidivism; however, these factors had differential impacts for the three groups (i.e., graduates, terminators, and referrals). Drug court shows promise as a community-based intervention that helps keep individuals out of the criminal justice system during a 2-year follow-up period.

Examining Individual Characteristics and Program Performance to Understand Two-Year Recidivism Rates Among Drug Court Participants: Comparing Graduates and Terminators.

Drug courts strive to break the cycle of substance use and crime by providing community-based treatment and rehabilitation. The purpose of the present study was to (a) identify significantly different factors between program participants (i.e., graduates/terminators) that may affect recidivism and (b) examine these significant individual and program performance factors associated with two-year recidivism. Secondary data were examined for a stratified random sample of drug court participants ( N = 534). Examining any two-year post-program recidivism (defined as an arrest, conviction, or incarceration), over one third (37.6%) of graduates and almost all program terminators (95.3%) had two-year post-program recidivism ( p < .001). For the overall sample, age, outpatient treatment, marital status, number of times treated for a psychiatric problem in a hospital, substance use (i.e., past-30-day cocaine use and intravenous opiate use), number of positive drug tests, and receiving any sanction/therapeutic response were associated with two-year post-program recidivism. Further analyses suggested age and outpatient treatment were particularly important for program graduates. Findings provide information for early targeting of resources to drug court participants most at risk of poorer post-program outcomes by identifying factors known at program entry and indicators during program participation.

Intimate partner violence, relationship status, and protective orders: does "living in sin" entail a different experience?

The legal status of women's intimate relationships may allow for different experiences with intimate partner violence (IPV) and the protections received from the criminal justice system. There has been limited research examining differences in IPV and protective orders for women in marital and cohabiting intimate relationships. This study examines differences in experiences with IPV and factors related to protective orders: stipulations, violations, and perceived efficacy in a sample of married (n = 392) and cohabiting (n = 307) women with protective orders. Results suggest (a) married and cohabiting women are significantly different on a number of demographic characteristics; however, after controlling for these demographic differences, (b) married and cohabiting women's experiences with IPV are similar in almost all dimensions, except with the psychological tactic of degradation; and (c) married and cohabiting women receive similar protective order stipulations, experience similar rates of violations, and have the same overall perceptions of safety, freedom, and effectiveness pertaining to the domestic violence order. Implications for policy are discussed.

Partner stalking and implications for women's employment.

In general research suggests partner violence has a negative impact on women's employment. However, there has been limited examination of partner stalking and consequences for employment. The purpose of this study was to examine partner stalking and employment consequences among two samples of women. One sample was women who had obtained a protective order against a violent partner and had worked in the prior year (n = 482), about one half of these women were stalked by their violent partner and one half were not. The second study examined qualitative information from women recently stalked (n = 62) by a violent partner. Results from both studies suggest that women who were stalked by a violent partner were significantly more susceptible to on-the-job harassment and problems. Also, women reported that stalking by a partner interfered in their work through on-the-job harassment, work disruption, and job performance problems. Implications for policy and research are discussed.

A mixed-methods examination of sexual coercion and degradation among women in violent relationships who do and do not report forced sex.

Although partner sexual abuse is clearly an important dimension of partner violence, it has received less research attention than partner physical and psychological abuse. This article contributes to the literature by examining similarities and differences in coercive and degrading sexual tactics experienced by women who do (n = 31) and women who do not (n = 31) report forced sex using quantitative and qualitative data. The women in the sample had all been recently (within the past 6 months) stalked by a violent intimate partner. Results suggest that both women who do and women who do not report forced sex experience various coercive and degrading tactics within the context of sexual activity. Results also suggest that multiple sexual abuse dimensions should be considered within the context of partner psychological abuse, physical abuse, and stalking and that more research on understanding the outcomes associated with dimensions of sexual abuse within the context of physical and psychological abuse is needed.

Stalking victimization in the context of intimate partner violence.

This article is one of the first to extensively compare characteristics of women who do and do not report stalking by a violent partner or ex-partner using a large sample of women with civil protective orders. Specifically, the purpose of this study was to examine similarities and differences in relationship and victimization history characteristics, mental health symptoms, help-seeking, and protective order violations for women who report being stalked in the past year (n = 345) by the partner they received a protective order against compared to women who received a protective order against a violent partner but who report no stalking by that partner ever in the relationship (n = 412). Results indicate that women who report partner stalking have more severe partner violence victimization, histories, increased distress, greater fear, and more protective order violations, suggesting that partner stalking victimization warrants more research and practice attention.

Examining implementation and preliminary performance indicators of veterans treatment courts: The Kentucky experience.

Veterans' Treatment Courts (VTCs) are posited as a solution to offer rehabilitation for veterans involved in the criminal justice system. Despite the pervasive implementation of VTCs, there is little research focused specifically on VTC implementation and outcomes, which are based on other problem-solving court models such as drug court. The current study presents qualitative process evaluation data from key stakeholders (n=21) and veteran participants (n=4) to show accomplishments, challenges, and lessons learned during first-year implementation at two VTC sites. Quantitative performance data is also presented on veteran participants (n=19) served during the first year to show: types of services, monitoring, judicial interaction, sanctions/therapeutic responses, and rewards, as well as preliminary data on recidivism. Qualitative data, from both key stakeholders and veteran participants, suggests that offering rehabilitation via various program components, services/referrals, and accountability are critical to the success of the VTC. Data also provides valuable lessons learned for VTC implementation including communication, collaboration, information/protocols, and resources. Performance data shows that a variety of services are utilized and that frequent judicial interaction, drug testing, and sanctions are cornerstones of the VTC. Implications and future directions for research are discussed.

Protective orders: questions and conundrums.

Current media portrayal of protective orders is often negative, focusing on weaknesses in how protective orders are obtained and enforced. This review of research findings on protective orders examines issues and suggests areas in need of future research to clarify and improve public policy. More specifically, this review has five main objectives: (a) to provide background information about partner violence and the need for protective orders; (b) to describe what protective orders are, how many women obtain them, and the advantages and disadvantages of obtaining protective orders; (c) to examine characteristics of women who seek protective orders; (d) to explore research on whether protective orders actually increase women's safety; and (e) to highlight opportunities and gaps in the practice and research literature regarding the use of protective orders for women with violent partners or ex-partners.

Police attitudes toward domestic violence offenders.

Police attitudes are important in facilitating a sense of safety and comfort in women seeking justice-system support for protection from partner violence. This study examined police attitudes toward sanctions and treatment for domestic violence offenders compared with other violent and nonviolent offenders. In addition, police attitudes toward domestic violence offenders who do and do not use substances were examined. Officers from one city police department (n = 315) participated in a survey. Results indicate there is a trend toward attitudes that treatment, rather than sanctions, was more appropriate for domestic violence offenders. In addition, officers rated the use of sanctions higher for domestic violence offenders who abuse alcohol or drugs compared with domestic violence offenders who did not abuse alcohol or drugs. Understanding police attitudes toward domestic violence offenders may have implications for police training and victim services in facilitating the use of the justice system in protecting women from partner violence.

The impact of differential patterns of physical violence and stalking on mental health and help-seeking among women with protective orders.

This study examined the severity of partner violence on women's mental health and help-seeking as well as perceptions of safety and protective-order effectiveness. Three groups based on partner violence victimization in the past year were compared: (a) women who reported experiencing moderate physical violence but no history of severe violence or stalking (n = 102), (b) women who experienced severe violence but no history of stalking (n = 142), and (c) women who experienced severe violence and stalking (n = 145). Results suggest that stalking has a unique impact on victims' mental health and perceived safety, and that protections afforded by protective orders may not be adequate for women experiencing stalking.