Advertisement

Longitudinal Health Outcomes and Treatment Utilization Among Emerging, Early-Mid, and Older Rural Adults Using Stimulants

  • Erin L. Woodhead
  • Brenda M. Booth
  • Christine Timko
  • Amanda Tjemsland
  • Xiaotong Han
  • Michael A. Cucciare
Article

Abstract

There is limited knowledge about age-related differences in health outcomes and treatment utilization among rural stimulant users. The current study examined physical health, mental health, and treatment utilization (hospital, mental health, and substance use care) among 710 stimulant users living in rural areas of the United States. Generalized estimating equations (GEE) were used to examine associations between age and physical health, mental health, and treatment utilization over a 3-year period. Analyses controlled for participants’ gender, race, and education. To capture age-related differences, participants were grouped into emerging adults (18–25 years old, n = 223), early-mid adults (26–44 years old; n = 384), and older adults (45–61 years old; n = 103). At baseline, older stimulant users were in significantly poorer health even though they had significantly fewer substance use problems than emerging adult users. GEE models indicated that substance use outcomes improved for all participants over the course of the study but other outcomes remained stable. Older stimulant users continued to have worse physical health and mental health, even though they had fewer substance use problems, than the other age groups. Older adults also used more hospital and mental health services than the other age groups. White participants tended to be at higher risk for negative outcomes than nonwhite participants. We conclude that rural older adults who use stimulants have poor health despite having milder substance use problems and using more health care resources, and need targeted intervention to improve health outcomes.

Keywords

Older adults Rural health Stimulant use Health care utilization Health outcomes 

Notes

Funding

This research was supported by the National Institute on Drug Abuse (R01 DA15363 to Brenda M Booth, and R01 DA14340 to Harvey A Siegel, and then to Robert Carlson). Dr. Timko was supported by VA HSR&D (RCS 00-001).

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical Approval

Study approval was obtained from the Institutional Review Boards at the investigators’ institutions. All participants provided informed consent. A certificate of confidentiality was obtained from the National Institute on Drug Abuse.

References

  1. American Psychological Association. (2014). Guidelines for psychological practice with older adults. American Psychologist, 69, 34–65.  https://doi.org/10.1037/a0035063.CrossRefGoogle Scholar
  2. Arnett, J. J. (2000). Emerging adulthood: A theory of development from the late teens through the twenties. American Psychologist, 55, 469–480.  https://doi.org/10.1037/0003-066X.55.5.469.CrossRefPubMedGoogle Scholar
  3. Bacsu, J. R., Jeffery, B., Johnson, S., Martz, D., Novik, N., & Abonyi, S. (2012). Healthy aging in place: Supporting rural seniors’ health needs. Online Journal of Rural Nursing and Health Care, 12, 77–87.Google Scholar
  4. Bartels, S. J., Coakley, E., Oxman, T. E., Constantino, G., Oslin, D., Chen, H., … Sanchez, H. (2002). Suicidal and death ideation in older primary care patients with depression, anxiety, and at-risk alcohol use. The American Journal of Geriatric Psychiatry, 10, 417–427.  https://doi.org/10.1097/00019442-200207000-00008.CrossRefPubMedGoogle Scholar
  5. Bartels, S. J., & Naslund, J. A. (2013). The underside of the silver tsunami: Older adults and mental health care. The New England Journal of Medicine, 368, 493–496.  https://doi.org/10.1056/NEJMp1211456.CrossRefPubMedGoogle Scholar
  6. Bertoni, N., Burnett, C., Cruz, M. S., Andrade, T., Bastos, F. I., Leal, E., & Fischer, B. (2014). Exploring sex differences in drug use, health and service use characteristics among young urban crack users in Brazil. International Journal for Equity in Health, 13, 70.  https://doi.org/10.1186/s12939-014-0070-x.CrossRefPubMedPubMedCentralGoogle Scholar
  7. Blonigen, D. M., Bui, L., Britt, J. Y., Thomas, K. M., & Timko, C. (2016). Internalizing and externalizing personality subtypes predict differences in functioning and outcomes among Veterans in residential substance use disorder treatment. Psychological Assessment, 28, 1186–1197.  https://doi.org/10.1037/pas0000250.CrossRefPubMedGoogle Scholar
  8. Blonigen, D. M., Hicks, B. M., Krueger, R. F., Patrick, C. J., & Iacono, W. G. (2005). Psychopathic personality traits: Heritability and genetic overlap with internalizing and externalizing psychopathology. Psychological Medicine, 35, 637–648.  https://doi.org/10.1017/S0033291704004180.CrossRefPubMedPubMedCentralGoogle Scholar
  9. Bolin, J. N., Bellamy, G. R., Ferdinand, A. O., Vuong, A. M., Kash, B. A., Schulze, A., & Helduser, J. W. (2015). Rural health people 2020: New decade, same challenges. The Journal of Rural Health, 31, 326–333.  https://doi.org/10.1111/jrh.12116.CrossRefPubMedGoogle Scholar
  10. Booth, B. M., Curran, G., Han, X., Wright, P., Frith, S., Leukefeld, C., … Carlson, R. G. (2010). Longitudinal relationships between psychological distress and multiple substance use: Results from a three-year multisite natural-history study of rural stimulant users. Journal of Studies on Alcohol and Drugs, 71, 258–267.CrossRefPubMedPubMedCentralGoogle Scholar
  11. Booth, B. M., Leukefeld, C., Falck, R., Wang, J., & Carlson, R. (2006). Correlates of rural methamphetamine and cocaine users: Results from a multisite community study. Journal of Studies on Alcohol, 67, 493–501.CrossRefPubMedGoogle Scholar
  12. Borders, T. F., Booth, B. M., & Curran, G. M. (2015). African American cocaine users’ preferred treatment site: Variations by rural/urban residence, stigma, and treatment effectiveness. Journal of Substance Abuse Treatment, 50, 26–31.  https://doi.org/10.1016/j.jsat.2014.10.004.CrossRefPubMedGoogle Scholar
  13. Borders, T. F., Booth, B. M., Falck, R. S., Leukefeld, C., Wang, J., & Carlson, R. G. (2009). Longitudinal changes in drug use severity and physical health-related quality of life among untreated stimulant users. Addictive Behaviors, 34, 959–964.  https://doi.org/10.1016/j.addbeh.2009.06.002.CrossRefPubMedPubMedCentralGoogle Scholar
  14. Borders, T. F., Booth, B. M., Han, X., Wright, P., Leukefeld, C., Falck, R. S., & Carlson, R. G. (2008). Longitudinal changes in methamphetamine and cocaine use in untreated rural stimulant users: Racial differences and the impact of methamphetamine legislation. Addiction, 103, 800–808.  https://doi.org/10.1111/j.1360-0443.2008.02159.x.CrossRefPubMedGoogle Scholar
  15. Calabria, B., Degenhardt, L., Briegleb, C., Vos, T., Hall, W., Lynskey, M., … McLaren, J. (2010). Systematic review of prospective studies investigating “remission” from amphetamine, cannabis, and cocaine or opioid dependence. Addictive Behaviors, 35, 741–749.  https://doi.org/10.1016/j.addbeh.2010.03.019.CrossRefPubMedGoogle Scholar
  16. Cherry, D. K., Woodwell, D. A., & Rechtsteiner, E. A. (2007). National ambulatory medical care survey: 2005 summary. Advance Data, 387, 1–39.Google Scholar
  17. Curran, G. M., Ounpraseuth, S. T., Allee, E., Small, J., & Booth, B. M. (2011). Trajectories in use of substance abuse and mental health services among stimulant users in rural areas. Psychiatric Services, 62, 1230–1232.  https://doi.org/10.1176/ps.62.10.pss6210_1230.CrossRefPubMedGoogle Scholar
  18. Cutler, D. M., & Lleras-Muney, A. (2006). Education and health: Evaluating theories and evidence. Retrieved from http://www.nber.org/papers/w12352.
  19. Darke, S., Kaye, S., McKetin, R., & Duflou, J. (2008). Major physical and psychological harms of methamphetamine use. Drug and Alcohol Review, 27, 253–262.CrossRefPubMedGoogle Scholar
  20. Draus, P. J., Siegal, H. A., Carlson, R. G., Falck, R. S., & Wang, J. (2005). Cracking the corn fields: Recruiting illicit stimulant drug users in rural Ohio. Social Science Quarterly, 46, 165–189.Google Scholar
  21. Durell, T. M., Kroutil, L. A., Crits-Christoph, P., Barchha, N., & Van Brunt, D. L. (2008). Prevalence of nonmedical methamphetamine use in the United States. Substance Abuse Treatment, Prevention, and Policy.  https://doi.org/10.1186/1747-597X-3-19.PubMedPubMedCentralGoogle Scholar
  22. Galea, S., & Vlahov, D. (2002). Social determinants and the health of drug users: Socioeconomic status, homelessness, and incarceration. Public Health Reports, 117, S135–S145.PubMedPubMedCentralGoogle Scholar
  23. Gallo, J. J., Morales, K. H., Bogner, H. R., Raue, P. J., Zee, J., Bruce, M. L., & Reynolds, C. F. (2013). Long term effect of depression care management on mortality in older adults: Follow-up of cluster randomized clinical trial in primary care. BMJ.  https://doi.org/10.1136/bmj.f2570.PubMedPubMedCentralGoogle Scholar
  24. Garrity, T. F., Leukefeld, C. G., Carlson, R. G., Falck, R. S., Wang, J., & Booth, B. M. (2007). Physical health, illicit drug use, and demographic characteristics in rural stimulant users. The Journal of Rural Health, 23, 99–107.  https://doi.org/10.1111/j.1748-0361.2007.00076.x.CrossRefPubMedGoogle Scholar
  25. Goins, R. T., Williams, K. A., Carter, M. W., Spencer, S. M., & Solovieva, T. (2005). Perceived barriers to health care access among rural older adults: A qualitative study. The Journal of Rural Health, 21, 206–213.  https://doi.org/10.1111/j.1748-0361.2005.tb00084.x.CrossRefPubMedGoogle Scholar
  26. Grant, B. F., Goldstein, R. B., Saha, T. D., Chou, P., Jung, J., Zhang, H., … Hasin, D. S. (2015). Epidemiology of DSM-5 alcohol use disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. JAMA Psychiatry, 72, 757–766.  https://doi.org/10.1001/jamapsychiatry.2015.0584.CrossRefPubMedPubMedCentralGoogle Scholar
  27. Grant, K. M., Kelley, S. S., Agrawal, S., Meza, J. L., Meyer, J. R., & Romberger, D. J. (2007). Methamphetamine use in rural Midwesterners. American Journal on Addictions, 16, 79–84.  https://doi.org/10.1080/10550490601184159.CrossRefPubMedGoogle Scholar
  28. Greenfield, S. F., Back, S. E., Lawson, K., & Brady, K. T. (2010). Substance abuse in women. Psychiatric Clinics of North America, 33, 339–355.  https://doi.org/10.1016/j.psc.2010.01.004.CrossRefPubMedGoogle Scholar
  29. Heckathorn, D. D. (1997). Respondent-driven sampling: A new approach to the study of hidden population. Social Problems, 44, 174–199.CrossRefGoogle Scholar
  30. Hirsch, J. K., Duberstein, P. R., Chapman, B., & Lyness, J. M. (2007). Positive affect and suicide ideation in older adult primary care patients. Psychology of Aging, 22, 380–385.CrossRefGoogle Scholar
  31. Kessler, R. C., Birnbaum, H. G., Shahly, V., Bromet, E., Hwang, I., McLaughlin, K. A., … Stein, D. J. (2010). Age differences in the prevalence and comorbidity of DSM-IV major depressive episodes: Results from the WHO World Mental Health Survey Initiative. Depression and Anxiety, 27, 351–364.  https://doi.org/10.1002/da.20634.CrossRefPubMedPubMedCentralGoogle Scholar
  32. Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.CrossRefPubMedPubMedCentralGoogle Scholar
  33. Lopez-Quintero, C., Hasin, D., de los Cobos, J. P., Pines, A., Wang, S., Grant, B. F., & Blanco, C. (2011). Probability and predictors of remission from life-time nicotine, alcohol, cannabis or cocaine dependence: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Addiction, 106, 657–669.  https://doi.org/10.1111/j.1360-0443.2010.03194.x.CrossRefPubMedGoogle Scholar
  34. Luoma, J. B., Martin, C. E., & Pearson, J. L. (2002). Contact with mental health and primary care providers before suicide: A review of the evidence. The American Journal of Psychiatry, 159, 909–916.  https://doi.org/10.1176/appi.ajp.159.6.909.CrossRefPubMedPubMedCentralGoogle Scholar
  35. McLellan, A. T., Luborsky, L., O’Brien, C. P., & Woody, G. E. (1980). An improved diagnostic instrument for substance abuse patients: The Addiction Severity Index. Journal of Nervous & Mental Diseases, 168, 26–33.CrossRefGoogle Scholar
  36. Meier, M. H., Caspi, A., Cerdá, M., Hancox, R. J., Harrington, H., Houts, R.,… Moffitt, T. E. (2016). Associations between cannabis use and physical health problems in early midlife: A longitudinal comparison of persistent cannabis vs tobacco users. JAMA Psychiatry, 73, 731–740.  https://doi.org/10.1001/jamapsychiatry.2016.0637.CrossRefPubMedPubMedCentralGoogle Scholar
  37. Molfenter, T., Boyle, M., Holloway, D., & Zwick, J. (2015). Trends in telemedicine use in addiction treatment. Addiction Science and Clinical Practice, 10, 14.  https://doi.org/10.1186/s13722-015-0035-4.CrossRefPubMedGoogle Scholar
  38. Moos, R. H. (2003). Addictive disorders in context: Principles and puzzles of effective treatment and recovery. Psychology of Addictive Behaviors, 17, 3–12.  https://doi.org/10.1037/0893-164X.17.1.3.CrossRefPubMedGoogle Scholar
  39. Moyer, V. A. (2013). Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine, 159, 210–218.  https://doi.org/10.7326/0003-4819-159-3-201308060-00652.PubMedGoogle Scholar
  40. Mukamal, K. J., Chung, H., Jenny, N. S., Kuller, L. H., Longstreth, W. T., Mittleman, M. A., … Siscovick, D. S. (2005). Alcohol use and risk of ischemic stroke among older adults: The cardiovascular health study. Stroke, 36, 1830–1834.  https://doi.org/10.1161/01.STR.0000177587.76846.89.CrossRefPubMedGoogle Scholar
  41. Oliffe, J. L., Bottorff, J. L., & Sarbit, G. (2012). Supporting fathers’ effort to be smoke-free: Program principles. Canadian Journal of Nursing Research, 44, 64–82.PubMedGoogle Scholar
  42. Pope, S. K., Falck, R. S., Carlson, R. G., Leukefeld, C., & Booth, B. M. (2011). Characteristics of rural crack and powder cocaine users: Gender and other correlates. The American Journal of Drug and Alcohol Abuse, 37, 491–496.  https://doi.org/10.3109/00952990.2011.600380.CrossRefPubMedPubMedCentralGoogle Scholar
  43. Pringle, A., Zwolinsky, S., McKenna, J., Daly-Smith, A., Robertson, S., & White, A. (2013). Delivering men’s health interventions in English Premier League football clubs: Key design characteristics. Public Health, 127, 716–726.  https://doi.org/10.1016/j.puhe.2013.04.011.CrossRefPubMedGoogle Scholar
  44. Richards, J. R., Bretz, S. W., Johnson, E. B., Turnipseed, S. D., Brofeldt, B. T., & Derlet, R. W. (1999). Methamphetamine use and emergency department utilization. Western Journal of Meicine, 170, 198–202.Google Scholar
  45. Robertson, S., Witty, K., Zwolinsky, S., & Day, R. (2013). Men’s health promotion interventions: What have we learned from previous programmes? Community Practitioner, 86, 38–41.PubMedGoogle Scholar
  46. Substance Abuse and Mental Health Services Administration. (2013). The NSDUH report: Need for and receipt of substance use treatment among Blacks. Retrieved from http://archive.samhsa.gov/data/2k13/NSDUH124/sr124-african-american-treatment.htm.
  47. Theeke, L. A., Goins, R. T., Moore, J., & Campbell, H. (2012). Loneliness, depression, social support, and quality of life in older chronically ill Appalachians. The Journal of Psychology, 146, 155–171.CrossRefPubMedGoogle Scholar
  48. Wang, J., Carlson, R. G., Falck, R. S., Siegal, H. A., Rahman, A., & Li, L. (2004). Respondent-driven sampling to recruit MDMA users: A methodological assessment. Drug and Alcohol Dependence, 78, 147–157.CrossRefPubMedGoogle Scholar
  49. Wang, P. S., Lane, M., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2005). Twelve-month use of mental health services in the United States: Results from the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 629–640.CrossRefPubMedGoogle Scholar
  50. Weeks, W. B., Kazis, L. E., Shen, Y., Cong, Z., Ren, X. S., Miller, D., … Perlin, J. B. (2004). Differences in health-related quality of life in rural and urban Veterans. Journal of Public Health, 94, 1762–1767.  https://doi.org/10.2105/AJPH.94.10.1762.Google Scholar
  51. Wong, S., & Regan, S. (2009). Patient perspectives on primary health care in rural communities: Effects of geography on access, continuity, and efficiency. The International Electronic Journal of Rural and Remote Health Research Education, Practice, and Policy, 9, 1142.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Erin L. Woodhead
    • 1
  • Brenda M. Booth
    • 2
  • Christine Timko
    • 3
    • 4
  • Amanda Tjemsland
    • 3
  • Xiaotong Han
    • 2
    • 5
    • 6
  • Michael A. Cucciare
    • 5
    • 6
    • 7
  1. 1.Department of PsychologySan José State UniversitySan JoseUSA
  2. 2.Division of Health Services Research, Psychiatric Research InstituteUniversity of Arkansas for Medical SciencesLittle RockUSA
  3. 3.Center for Innovation to ImplementationVeterans Affairs (VA) Health Care SystemMenlo ParkUSA
  4. 4.Department of Psychiatry and Behavioral SciencesStanford University School of MedicineStanfordUSA
  5. 5.Center for Mental Healthcare and Outcomes ResearchCentral Arkansas Veterans Healthcare SystemNorth Little RockUSA
  6. 6.VA South Central (VISN 16) Mental Illness Research, Education, and Clinical CenterCentral Arkansas Veterans Healthcare SystemNorth Little RockUSA
  7. 7.Department of PsychiatryUniversity of Arkansas for Medical SciencesLittle RockUSA

Personalised recommendations