Author ORCID Identifier

Date Available


Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation




Educational, School, and Counseling Psychology

First Advisor

Dr. Danelle Stevens-Watkins

Second Advisor

Dr. Jeff Reese


Women in Central Appalachia represent a significant proportion of those engaging in problematic patterns of opioid use, which is concerning given the limited available services in the region and gender specific treatment barriers. This investigation seeks to understand the role of mental health and substance use symptoms among incarcerated Central Appalachian women and build on the conceptual model of substance use treatment utilization purposed by Leukefeld and colleagues (1998). Data for this study was drawn from a larger longitudinal investigation (NIDA 1R01-DA033866) and baseline data collected during initial interviews was analyzed. The sample included 400 women incarcerated at one of three central Appalachian jails. Bivariate analyses determined significant relationships between symptoms of depression, anxiety, trauma and substance use. Binary logistic regression was used to assess the factors influencing treatment utilization. The overall multivariate model of treatment utilization with eight factors (income, overdose history, injection drug use, entered detox, attended self-help groups, substance use problems, number of children, and no way to get to their provider) significantly improved the prediction of treatment utilization. Implications of this study highlight the importance of continued interventions at the individual, community, and policy level.

Digital Object Identifier (DOI)