Year of Publication



Public Health

Date Available


Degree Name

Master of Public Health (M.P.H.)

Committee Chair

William Pfeifle, Ed.D., MBA

Committee Member

Jennifer Havens, Ph.D., MPH

Committee Member

Frank Romanelli, Pharm.D, MPH

Committee Member

Jeffrey Talbert, Ph.D



Background: Inhabitants of Appalachian Kentucky are encumbered by tremendous health disparities, exhibit high rates of prescription drug abuse, and often co-present with psychiatric disorders. Compared to opioids, little research has focused on the nonmedical use of benzodiazepines.

Objective: To examine the association between nonmedical benzodiazepine use and major depressive disorder (MDD), generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), and anti-social personality disorder (ASPD) in a population of opioid drug abusers.

Methods: Data for this cross-sectional study was obtained from the Social Networks among Appalachian People (SNAP) study. Contingency tables analysis and the

X2statistic were used to examine the association between past 30 day benzodiazepine (i.e., alprazolam, clonazepam, diazepam) use and psychiatric diagnoses. The independent correlates of recent benzodiazepine use were determined using multiple logistic regression.

Results: 503 participants were included in this analysis. All reported a lifetime history of opioid drug abuse and 98% (n=493) reported use within the past 30 days. 71% (n=355) reported past

30 day benzodiazepine (i.e., alprazolam, clonazepam, or diazepam) use. The presence of MDD (Odds Ratio [OR]: 1.9, 95% Confidence Interval [CI]: 1.2-3.0) or GAD (OR: 1.9, 95% CI: 1.2-

3.0) were significantly (

p<0.05) associated with recent benzodiazepine use. Other variables associated with benzodiazepine use were: illicit methadone use (Adjusted OR [AOR]: 2.94, 95% CI: 1.9-4.56, marijuana use(AOR: 2.57, 95% CI: 1.64-4.01), oxycodone use (AOR: 2.52, 95% CI: 1.6-3.97), GAD (AOR: 1.67, 95% CI: 1.01-2.77), poor/fair health (AOR: 1.65, 2.6), and years living in eastern Kentucky (AOR: 1.03, 95% CI: 1.0-1.1).

Discussion: The results show a strong association between nonmedical benzodiazepine use and psychiatric disorders (i.e., MDD, GAD). A lack of accessible mental healthcare providers may be a contributing factor to the high rates of nonmedical benzodiazepine use found in this study. Longitudinal studies are needed to examine the effect of prescription drug monitoring programs on benzodiazepine abuse.

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