Date Available

11-8-2019

Year of Publication

2017

Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation

College

Education

Department/School/Program

Educational, School, and Counseling Psychology

First Advisor

Dr. Danelle J. Stevens-Watkins

Abstract

The purpose of this dissertation was to examine substance use-related outcomes among criminal justice-involved African Americans using a multiple manuscript format. The Centers for Disease Control and Prevention has deemed nonmedical prescription opioid use an epidemic. National estimates indicate approximately 3.9% of African Americans engage in nonmedical prescription opioid use. Research suggests African Americans involved in the criminal justice system may be significantly at risk of substance use more generally; yet, there are no known estimates of nonmedical opioid use among this subgroup. Rising rates of nonmedical opioid use also has implications for discussing barriers to treatment among socioeconomically marginalized African Americans. Scholars have noted persistent health disparities are associated with a paucity of research examining: 1) the social and contextual paradigm in which substance use exists; 2) women’s health; and 3) longitudinal studies examining determinants of substance use treatment among African Americans with criminal justice histories. The current multiple manuscript dissertation sought to directly contribute to the literature by: a) proposing a culturally specific conceptual framework of substance use among African Americans; b) examining trends and correlates of nonmedical opioid use among criminal justice-involved African American men; and c) investigating psychosocial predictors of substance use treatment among African American women across criminal justice status. In the first manuscript, preexistent health behavior theories were used as a premise to formulate and propose a culturally relevant conceptualization of substance use among African Americans. The proposed framework posited substance use exists within a psychosocial context and is associated with a host of related outcomes, including criminal justice involvement and HIV. In the second manuscript, Smart’s (1980) availability- proneness theory of opioid addiction was used to conduct cross-sectional analyses of nonmedical opioid use. Descriptive statistics illustrated nonmedical opioid use among African American men in corrections-based drug treatment (n = 4, 021), were commensurate with national averages. Fitted logistic regression models revealed significant positive linear trends in nonmedical opioid use across five cohorts (2010-2014). A stepwise logistic regression model indicated age, years of education, depressive symptoms, anxiety symptoms, and self-reported use of prescription drugs to attenuate psychological distress were significantly related to nonmedical opioid use. Psychosocial context and systemic interventions were discussed. Future directions called for further examination of the potential progression of nonmedical prescription opioid use into heroin use, among socioeconomically marginalized African American communities. In the third manuscript, Gelberg and colleagues’ (2000) behavioral model for vulnerable populations was used to examine psychosocial predictors of substance use treatment over 18-months. A hierarchical logistic regression indicated African American women involved in the criminal justice system (n = 320) encounter several impediments to substance use treatment related to their marginalized status related to age, years of education, criminal justice status, a history of trauma, and perceived barriers to care. Implications for developing culturally- adapted treatment interventions and healthcare reform were discussed. The dissertation concludes with a synthesized discussion of the findings in relation to the proposed conceptual framework, overall strengths and limitations, and future directions for psychologists.

Digital Object Identifier (DOI)

https://doi.org/10.13023/ETD.2017.428

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