Russel S. Falck

Illicit drug use by school-aged teens can adversely affect their health and academic achievement. This study used a survey administered in schools to assess the prevalence of problematic drug use among teenagers in a Midwestern community. Self-report data were collected from 11th- and 12th-grade students (N = 3974) in 16 school districts in the Dayton, Ohio, area. Students responded to a drug use survey that also included CRAFFT, a brief substance abuse screening instrument. Binomial and zero-inflated Poisson regressions were used to examine the association between CRAFFT scores and drug use practices, including abstinence. More than one third of students had CRAFFT scores suggestive of problematic use. Of these, 14.1% had scores suggesting drug dependence. Although alcohol, marijuana, and tobacco were the drugs most commonly used, an array of other drugs including opioids, benzodiazepines, stimulants, hallucinogens, and dextromethorphan were also commonly used. Higher CRAFFT scores were associated with a greater number of drugs used (p < .0001). Proportionately more 12th graders than 11th graders had CRAFFT scores indicating problems (p < .0001). Among 12th graders, boys were more likely than girls to have CRAFFT scores indicating dependence (p = .01). The results suggest that problematic drug use among high school students is more prevalent than has been recognized previously. CRAFFT can be used easily to assess the prevalence of problematic drug use among teenagers in school settings. CRAFFT results can also inform prevention and intervention activities, particularly if the CRAFFT instrument is paired with a drug use survey.

The purpose of this study is to use a modified version of Andersen’s Behavioral Model of Health Services Use to identify the correlates of the number of substance abuse treatment episodes received by rural drug users. Data were collected from face-to-face interviews with 711 drug users in rural areas of Ohio, Arkansas, and Kentucky. Descriptive analyses examine rural drug users’ substance use histories and retrospective substance abuse treatment service utilization patterns. A negative binomial regression model indicated that selected predisposing, historical health, and enabling factors were significantly associated with the utilization of substance abuse treatment among rural drug users. Despite high levels of recent and lifetime self-reported substance use among these rural drug users, treatment services were underutilized. Future studies are needed to examine the impact of the health care system and characteristics of the external environment associated with rural substance abuse treatment in order to increase utilization among drug users.

Despite the increase in media attention on “meth cooking” in rural areas of the United States, little is known about rural stimulant use—particularly, the criminality associated with stimulant use. Data were collected from community stimulant users in rural Ohio, Arkansas, and Kentucky (N = 709). Findings from three logistic regression models indicate that younger stimulant users (M = 32.55, SD = 10.35), those with more convictions, and those who used crack frequently were significantly more likely to have been arrested for committing a substance-related crime, a property crime, or another crime in the 6 months before entering the study. Implications include the need for longitudinal studies to further understand rural stimulant use, as well as increased community and corrections-based drug abuse prevention and treatment interventions for stimulant users who live in rural areas.

The SF-8 health survey was used to assess the physical and mental health status of a community sample of not-in-treatment, illicit stimulant drug-using adults (n = 249) living in rural Ohio. Physical health status scores indicative of poor health were present in 30.5% of the sample. Poor physical health was associated with older age (OR = 1.06; 95% C.I. = 1.02-1.11), chronic disease (OR = 2.24, 95% C.I. = 1.14-4.40), and frequent opioid use (OR = 3.14, 95% C.I. = 1.16-8.50). Poor mental health status scores were present in 63.9% of the sample. Men were less likely (OR = 0.25, 95% C.I. = 0.11-0.53), and Whites more likely (OR = 3.97, 95% C.I. = 1.56-10.13), to have poor mental health scores. Frequency and type of drug use had no measurable effect on mental health status. Physical and mental health problems are likely to be pervasive among nonmedical drug users in rural areas.

Research suggests that methylenedioxymethamphetamine (MDMA)/`ecstasy' can cause serotonin depletion as well as serotonergic neurodegradation that may result in depression. This longitudinal study used the Beck Depression Inventory (BDI-II) to assess depressive symptomatology every six months over a two-year period among a community sample of young adult MDMA/`ecstasy' users (n = 402). Multilevel growth modeling was used to analyze changes in BDI scores. Between baseline and 24 months, the mean BDI score declined from 9.8 to 7.7. Scores varied significantly across individuals at baseline and declined at a rate of 0.36 points every six months. Persons with higher baseline scores were more likely to have their scores decrease over time. Several factors were significantly associated with score levels, independent of time: gender — men's scores were lower than women's; ethnicity — whites' scores were lower than those of non-whites; education — persons with at least some university education had scores that were lower than those without any college experience; benzodiazepines — current users' scores were higher than non-users'; opioids — current users' scores were higher than non-users'; and cumulative ecstasy use — people who had used MDMA more than 50 times had scores that were higher than persons who had used the drug less often. The results reported here show low levels of depressive symptoms among a sample that, after 24 months, consisted of both current and former MDMA users. The low and declining mean scores suggest that for most people MDMA/`ecstasy' use does not result in long-term depressive symptomatology.

Aims  Although crack cocaine first appeared in cities in the United States in the mid‐1980s, little is known about its use over long periods of time. This study identified crack cocaine user groups on the basis of long‐term trajectories.Design  Following a natural history approach, data were collected periodically from 1996 to 2005. Group‐based modeling assessed the probability of a crack smoker becoming abstinent during the observation period.Setting  A targeted sampling plan guided the recruitment of a community sample of crack cocaine users in Dayton, Ohio.Participants  Crack smokers (n = 430) 18 years or older whose urine tested positive for cocaine metabolites at the baseline interview.Measurements  Interviewer‐administered and audio computer self‐administered, structured questionnaires were used to collect data on a range of variables, including frequency of crack use. Abstinence was defined as not having used crack for at least 6 consecutive months during the study.Findings  Three trajectory‐based groups were identified: (1) No Change, characterized by a very low probability of abstinence; (2) Some Change, characterized by a low to moderate probability of abstinence; and (3) Dramatic Change, characterized by a high probability of abstinence. African Americans and men were significantly less likely to become abstinent. For the majority of the people (63.6%), crack use was uninterrupted by extended periods of abstinence during the study.Conclusion  Crack cocaine use that persists for a decade or longer may well be the norm for a large proportion of people who have experience with the drug.

ABSTRACT:  Context: Although the nonmedical use of stimulant drugs such as cocaine and methamphetamine is increasingly common in many rural areas of the United States, little is known about the health beliefs of people who use these drugs. Purpose: This research describes illicit stimulant drug users’ views on health and health‐related concepts that may affect their utilization of health care services. Methods: A respondent‐driven sampling plan was used to recruit 249 not‐in‐treatment, nonmedical stimulant drug users who were residing in 3 rural counties in west central Ohio. A structured questionnaire administered by trained interviewers was used to collect information on a range of topics, including current drug use, self‐reported health status, perceived need for substance abuse treatment, and beliefs about health and health services. Findings: Participants reported using a wide variety of drugs nonmedically, some by injection. Alcohol and marijuana were the most commonly used drugs in the 30 days prior to the interview. Powder cocaine was used by 72.3% of the sample, crack by 68.3%, and methamphetamine by 29.7%. Fair or poor health status was reported by 41.3% of the participants. Only 20.9% of the sample felt they needed drug abuse treatment. Less than one third of the sample reported that they would feel comfortable talking to a physician about their drug use, and 65.1% said they preferred taking care of their problems without getting professional help. Conclusions: Stimulant drug users in rural Ohio are involved with a range of substances and hold health beliefs that may impede health services utilization.