Biomedical subjects

Carl Leukefeld

Publications and source records attributed to Carl Leukefeld.

At least 19 recordsLinked to original sources

PubMed2006

Developmental patterns of African American and Caucasian adolescents' alcohol use.

This study examined the developmental alcohol use trajectories of Caucasian and African American adolescents. Participants were 1,358 adolescents (77.6% Caucasian). Results suggest that not only do patterns of alcohol use differ for Caucasian and African American adolescents, but that there is substantial within group variation as well. Results suggest that using a within-groups developmental approach is one promising way to identify subgroups of adolescents at greatest risk for substance use.

Adolescent↗

PubMed2006

Correlates of rural methamphetamine and cocaine users: results from a multistate community study.

OBJECTIVE: Use and production of methamphetamine (MA) has dramatically increased in the United States, especially in rural areas, with concomitant burdens on the treatment and criminal justice systems. However, cocaine is also widely used in many rural areas. The purpose of this article is to contrast MA and cocaine users in three geographically distinct rural areas of the United States. METHOD: Participants were recent not-in-treatment adult cocaine and MA users living in rural Ohio, Arkansas, and Kentucky, who were recruited by a referral recruitment method for sampling hidden community populations. Participants were interviewed for demographics, drug and alcohol use, criminal justice involvement, and psychological distress (Brief Symptom Inventory). RESULTS: The sample of 706 comprised 29% nonwhite and 38% female participants; the average age was 32.6 years; 58% had a high school education or higher, and 32% were employed. In the past 6 months, they had used either MA only (13%), cocaine only (52%), or both (35%). MA users were seldom (8.2%) nonwhite, but type of stimulant use did not vary by gender. Combined MA/cocaine users reported significantly greater use of alcohol and other drugs, including marijuana and nonprescribed opiates and tranquilizers, and reported significantly higher psychological distress. MA users (with or without cocaine use) had greater odds of recent criminal justice involvement compared with cocaine-only users. CONCLUSIONS: There is a clear need for accessible substance-use treatment and prevention services in rural areas of the United States, including services that can address MA, cocaine, polydrug use, and mental health needs. There is a particular need of these services for polydrug users.

Adult↗

PubMed2005

Informed consent to undergo treatment for substance abuse: a recommended approach.

With more than 3 million persons receiving substance abuse treatment per year in the United States and with increasing interest in treatment outcomes, there is a need for closer attention to all aspects of the treatment process. However, minimal attention has been given to informed consent as a way of enlisting client engagement and active participation in treatment. Although there is some literature on informed consent in substance abuse research, the literature on informed consent to undergo substance abuse treatment is very limited. Incorporating informed consent into substance abuse treatment is recommended as part of motivational interviewing. Standard treatment consent issues include (1) the clinical characteristics of the problem, including diagnosis; (2) treatment recommendations; (3) the risks and benefits of treatment; (4) the financial costs of the intervention; (5) alternative services or interventions should a client refuse the recommended form of care; and (6) freedom to choose or refuse treatment. This article provides a background for informed consent procedures to facilitate client engagement in substance abuse treatment and suggests needs for future research on informed consent to undergo substance abuse treatment.

Ethics, Professional↗

PubMed2005

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.

Adolescent↗

PubMed2005

Exploring the type-of-crime hypothesis, religiosity, and spirituality in an adult male prison population.

This study examined the association between measures of spirituality and religiosity and characteristics of current criminal conviction in a male prison population. Spirituality was operationalized as spiritual well-being and existential well-being. Religiosity was operationalized as frequency of religious service attendance, whether an individual considered himself to be religious, and how strongly an individual believed his religious beliefs influenced his behavior. Inmates whose convictions were property related reported greater spiritual wellbeing, were more likely to consider themselves religious, and to say that religious beliefs influenced their behavior than inmates whose crimes were not property related. Inmates whose convictions were drug related were less likely to consider themselves religious, and inmates whose conviction involved violence were more likely to consider themselves religious but less likely to endorse statements that religious beliefs influenced their behavior. The distinction between religiosity and spirituality is discussed in terms of the type-of-crime hypothesis.

Adult↗

PubMed2005

Barriers and pathways to diffusion of methamphetamine use among African Americans in the rural South: preliminary ethnographic findings.

There are no studies of African Americans methamphetamine use in the South where it is widespread among whites. We describe factors that inhibit or facilitate the diffusion of methamphetamine use among African Americans based on qualitative interviews with 86 drug users in rural Arkansas and Kentucky. Results suggest low prevalence of methamphetamine use among African Americans, and interviewees cited several barriers to its diffusion which were linked to the drug's ingredients, psychoactive and physiological effects, difficulty in accessing distribution networks, and established African-American preference for cocaine. Fourteen African Americans reported methamphetamine use and discussed pathways to it. Possible increases in African- American methamphetamine use merits further investigation.

Adult↗

PubMed2005

Prisoners with substance abuse and mental health problems: use of health and health services.

Individuals with substance abuse and mental health problems are common in prisons and jails, but relatively little is known about the health or health services utilization of inmates with these types of problems. This study, therefore, focuses on prisoners who self-reported receiving a prior diagnosis from a physician or a psychologist who indicated they had 1) substance abuse problems only, 2) mental health problems only, and 3) substance abuse and mental health problems. A fourth group of prisoners who reported no diagnoses were included as the "no problems" group. Comparisons were made on reports of lifetime health problems, use of preventive health services, and use of medical services. Findings showed the substance abuse and mental health problems group had the most serious health problems profiles. Use of preventive health services was similar across all four groups, but the substance abuse and mental health problems group reported significantly greater use of the emergency room and more hospital stays both for their lifetime and in the year prior to their current incarceration. The policy and practical relevance of the findings are discussed.

Adult↗

PubMed2004

Early adolescent through young adult alcohol and marijuana use trajectories: early predictors, young adult outcomes, and predictive utility.

The present study takes a developmental approach to subgrouping and examines the trajectories of substance use from early adolescence through young adulthood among a community sample of 481 individuals. The patterns of use were examined, subgroups were identified separately for men and women and for alcohol and marijuana, and psychosocial predictors and psychopathology outcomes that differentiated the groups were identified. The results revealed three substantially overlapping subgroups for both alcohol and marijuana: early onset, late onset, and nonuser. Although the general patterns of which dependent variables were related to group were similar for alcohol and marijuana, a closer examination revealed important subgroup differences. For alcohol use, the early-onset group was more dysfunctional in terms of predictors and outcomes whereas the late-onset and nonuser groups were better adjusted. In contrast, for marijuana, the early- and late-onset groups were both more dysfunctional than the nonuser group. In a final analysis, we examined the predictive utility of our developmental approach to subgrouping compared to a traditional, static approach.

Adolescent↗

PubMed2004

Comparing the developmental trajectories of marijuana use of African American and Caucasian adolescents: patterns, antecedents, and consequences.

Adolescent marijuana use has tripled recently, and the once-noted race gap between African American and Caucasian adolescents in marijuana use appears to have disappeared. Yet, relatively little research has examined marijuana use among African American adolescents. In this study, we examined developmental trajectories of marijuana use among Caucasian and African American adolescents to identify whether and when differences in marijuana use appear and whether the precursors and outcomes associated with these developmental trajectories differ by race. Findings indicate that both the developmental patterns and outcomes associated with marijuana use are different for African American and Caucasian adolescents. Early-onset Caucasian and mid-onset African American adolescents experienced the greatest number of negative outcomes later in life associated with their marijuana use, suggesting that groups to target for intervention may vary by race.

Adolescent↗

PubMed2004

Treatment motivation and therapeutic engagement in prison-based substance use treatment.

Studies of community-based substance use treatment show that motivation for treatment is critical for clients becoming therapeutically engaged. Little research, however, has been conducted on therapeutic engagement in corrections-based substance use treatment. The current study examines the association between internal treatment motivation and therapeutic engagement for a sample of 220 male substance-using offenders enrolled in a corrections-based treatment program. Findings showed that problem recognition and desire for help were associated with cognitive indicators of therapeutic engagement, specifically confidence in and commitment to treatment. Increased focus on internal motivation for treatment may lead to more effective treatment for substance-using offenders. Pretreatment motivational interventions therefore are recommended for substance-using offenders with low internal motivation for treatment.

Adult↗

PubMed2004

Treatment retention predictors of drug court participants in a rural state.

Factors distinguishing clients who complete drug court treatment from those who do not complete drug court have been documented, but differences between urban and rural drug court participants have not been examined. The present study focuses on examining mental health, drug use, criminal activity, and education/employment as factors that are associated with treatment retention, which is measured by graduation from a rural and urban drug court. Study findings indicate that for the urban drug court, marital status, employment, drug use, and criminal activity predicted graduation. For the rural drug court, however, graduation was only predicted by age and juvenile incarceration. Findings from this study suggest there are different factors associated with drug court retention/graduation between urban and rural drug court settings. It is suggested that drug court administrators and other could use this information to better assess potential participants and to target services.

Adolescent↗

PubMed2004

Employment, employment-related problems, and drug use at drug court entry.

The literature indicates that employment may be an important factor for retaining substance misusing clients in treatment. Given the link between employment problems and treatment retention for Drug Court clients, the current project builds upon the existing services provided by Drug Courts in order to develop and implement an innovative model that focuses on obtaining, maintaining, and upgrading employment for Drug Court participants. The purpose of this article is to (1) describe the employment intervention used in Kentucky Drug Courts, which is grounded in established job readiness and life skill training approaches; and (2) profile those participants who were employed full-time prior to Drug Court and those who were not. Findings suggest that those employed full-time were more likely to have higher incomes and more earned income from legitimate job sources, although there were no differences in the types of employment (major jobs included food service and construction). In addition, study findings suggest that full-time employment was not "protective" since there were few differences in drug use and criminal activity by employment status. Employment interventions need to be examined to determine their utility for enhancing employment and keeping drug users in treatment. This article focuses on the initial 400 participants, who began entering the study in March, 2000.

Adult↗

PubMed2004

An exploratory examination of the Spiritual Well-Being Scale among incarcerated black and white male drug users.

A number of studies have examined the link between criminality and religiosity. However, only a limited number of studies have examined the relationship between spirituality and criminality. Because spirituality has been identified as a fundamental attribute of the personalities of Blacks, studies examining differences in the association between spirituality by ethnicity could provide information to understand the disparity of incarceration rates among Blacks and Whites. For this study, data were collected from 661 male prisoners with prior histories of drug use to examine spirituality that was assessed using two factors from a modified version of the Spiritual Well-Being Scale: relationship with a higher power and satisfaction with oneself in the world. Analyses revealed that White men reported significantly higher scores on both factors than Black men. The unexpected findings are discussed in light of the existing literature that identifies the significance of spirituality in the personality and coping style of Blacks.

Adult↗

PubMed2004

Rural and urban women's perceptions of barriers to health, mental health, and criminal justice services: implications for victim services.

The purpose of this study was to examine rural and urban women's perceptions of barriers to health and mental health services as well as barriers to criminal justice system services. Eight focus groups were conducted, two in a selected urban county (n = 30 women) and two in each of three selected rural counties (n = 98 women). Results were classified into a barrier framework developed in the health service utilization literature which suggests there are four main dimensions of barriers: affordability, availability, accessibility, and acceptability. Results indicate that: (1) women face many barriers to service use including affordability, availability, accessibility, and acceptability barriers; (2) it takes an inordinate level of effort to obtain all kinds of services; however, women with victimization histories may face additional barriers over and above women without victimization histories; (3) barriers to health and mental health service utilization overlap with barriers to utilizing the criminal justice system; and (4) there are many similarities in barriers to service use among rural and urban women; however, there are some important differences suggesting barriers are contextual. Future research is needed to further clarify barriers to service use for women with victimization histories in general, and specifically for rural and urban women. In addition, future research is needed to better understand how women cope with victimization in the context of the specific barriers they face in their communities.

Adult↗

PubMed2003

Relation between childhood disruptive behavior disorders and substance use and dependence symptoms in young adulthood: individuals with symptoms of attention-deficit/hyperactivity disorder and conduct disorder are uniquely at risk.

Most prior literature examining the relations among attention-deficit/hyperactivity disorder (ADHD), conduct disorder (CD), and substance use and abuse suggests that CD fully account for the ADHD-substance abuse relation. This study sought to test an alternate theory that individuals with symptoms of both ADHD and CD are at a special risk for substance abuse. Relations between childhood ADHD and CD symptoms, and young adult tobacco, alcohol, marijuana, and hard drug use and dependence symptoms, were examined in a sample of 481 young adults. ADHD and CD symptoms interacted to predict marijuana dependence symptoms and hard drug use and dependence symptoms, such that individuals with high levels of both ADHD and CD had the highest levels of these outcomes.

Adult↗

PubMed2003

Targeting HIV prevention on African American crack and injection drug users.

The use of drugs in the African American community, particularly crack cocaine, has been linked to sexual risk-taking behavior, which increases the likelihood that persons will become infected with Human Immuno Virus. In order to more fully understand risk-taking behavior and to target interventions among African American men and women, this study used data collected from 1277 individuals residing in Lexington and Louisville, Kentucky, who were recruited into National Institute on Drug Abuse (NIDA) Cooperative Agreement Project from 1993 to 1998. The study compared African Americans treated for Sexually transmitted diseases (STDs) (n = 292) with African Americans who reported never being treated for a STD (n = 504) with regard to HIV information, awareness, and the number of HIV tests between those with and without STD exposure. Additionally, we examine gender differences among African Americans who have and have not been exposed to STDs on risk behaviors and HIV knowledge, awareness, and testing. It was hypothesized that African American drug users in the STD group would engage in more risk behaviors than those who reported no STDs. Results indicated that individuals in both groups, the STD exposure group and the no STD group, engaged in similar HIV-risky behaviors. However, the STD group used a greater number of different drugs in their lifetime. The STD group reported they were more likely to get HIV and were more frequently tested for HIV. Females with an STD history were more likely to have been in drug user treatment and to perceive themselves as homeless. Both males and females in the STD group were more likely to report involvement in exchanging sex.

AIDS Serodiagnosis↗

PubMed2003

Substance use, health, and mental health: problems and service utilization among incarcerated women.

This article profiles self-reported substance use, health, and mental health problems among a sample of incarcerated women in Kentucky as well as lifetime service utilization. Findings indicate that a high percentage of women reported use of alcohol, cocaine, and multiple substances during the month before incarceration. In addition, participants reported common health problems such as dental, female reproductive, physical injuries, and mental health problems including depression and anxiety. Participants reported moderate use of emergency room and mental health treatment but limited substance abuse treatment utilization. Implications for criminal justice programs and linkages with community-based aftercare services for women are recommended based on findings that health and mental health problems are associated with service utilization before incarceration.

Adult↗

PubMed2003

Gender differences in the context of sex exchange among individuals with a history of crack use.

Although sex exchange among crack users is associated with risky sexual behavior, research suggests that there is a subgroup of crack users who do not engage in high-risk sex exchange. The purpose of this study is to understand differences among individuals with a history of crack use who have and have not engaged in sex exchange; and to better understand gender differences in the context of sex exchange. The study sample included 148 male (64.2% reported sex exchange) and 149 female heterosexual individuals with a history of crack use (59.1% reported sex exchange). Results suggest that HIV prevention interventions should incorporate gender specific information related to sex exchange for heterosexual crack users. Future research is needed to address the gap in understanding the transition into sex exchange practices for heterosexual male and female drug users.

Adult↗