Date of Award

2012

Embargo Period

8-1-2024

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Medicine

College

College of Graduate Studies

First Advisor

Jeffrey Korte

Second Advisor

Elisabeth Pickelsimer

Third Advisor

Sudie Back

Fourth Advisor

John D. Corrigan

Fifth Advisor

Valerie Durkalski

Sixth Advisor

Heidi Resnick

Abstract

Offender populations have high rates of substance use disorders (SUDs) as well as violence, traumatic brain injury (TBI), and post traumatic stress disorder (PTSD). The lack of screening and treatment of co-occurring disorders has been cited as a major barrier to treating SUDs in offenders. A significant proportion of the offender population has at least one co-occurring disorder with their substance use. Often co-occurring disorders are related to SUDs. Evidence suggests that interpersonal violence victimization (IPVV), TBI, and PTSD are related to SUD and that PTSD alone may also contribute to criminality. The specific aims of this research are to: 1. Determine factors associated with PTSD. 2. Determine if gender differences exist in the relationship between IPVV and SUDs. 3. Determine whether there are differences by TBI status in the relationship between IPVV and SUD. 4. Determine factors that mediate the relationship between gender and long-term illicit hard drug use (HDU) and also between gender and illicit HDU severity. This research study used a gender-stratified random sample from the Statewide Investigation of Traumatic Brain Injury Among Prisoners (SITBIP) study and follows a cross-sectional study design. Three hundred twenty male and 316 female offenders housed in South Carolina state prisons were interviewed from April 2009-April 2010. We found that rates of lifetime and current PTSD exceeded the rates found in the general population, with females having over twice the prevalence as males. Overall, trauma, psychiatric disorders, alcohol and drug use, poorer health, increased impulsivity, TBI, and lower resiliency scores were associated with lifetime PTSD. Controlling for covariates, a 47% difference was detected in the magnitude of the association between IPVV and SUD, by TBI status. No differences were found in the IPVV-SUD relationship by gender when controlling for covariates. Finally, the relationship between female gender and long-term illicit HDU and illicit HDU severity was found to be partially attributable to direct violence.

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