Date on Master's Thesis/Doctoral Dissertation


Document Type

Doctoral Dissertation

Degree Name

Ph. D.

Cooperating University

University of Kentucky


Social Work

Degree Program

Social Work, PhD

Committee Chair

Archuleta, Adrian

Committee Co-Chair (if applicable)

Hall, Martin T.

Committee Member

Hall, Martin T.

Committee Member

Higgins, George E.

Committee Member

Lawson, Thomas

Committee Member

Staton, Michele

Author's Keywords

Opioids; stimulants; decision-making; drug use; behavioral economics


In the United States, high-risk drug use remains a significant social problem. Opioids and stimulants are two drug classes that have contributed to substantial recent increases in drug-related arrests, overdose, and mortality. Kentucky has been particularly devastated by high rates of opioid and stimulant use. Opioid and stimulant effects, while highly rewarding, can result in adverse consequences. Still, some people choose to use these drugs, and choose to continue using even after experiencing adverse consequences, such as incarceration. The aim of this study was to explore high-risk drug use among a sample of corrections-involved adults in Kentucky and to identify endogenous and exogenous factors with the potential to have influenced drug-related decision-making prior and subsequent to incarceration. Attention was paid to understanding concomitant opioid and stimulant use and heroin use. Survey data collected as part of an ongoing corrections-based substance use treatment program outcomes study were examined. The final sample (N=1,563) included adults released into Kentucky counties between 2012-2017. Non-parametric statistical tests and multinomial logistic regression were used to identify factors associated with opioid, stimulant, and concomitant use; binary logistic regression was used to identify factors associated with heroin use. Results indicate that opioid and stimulant use was endemic in this sample, though rates of use subsequent to incarceration were lower than pre-incarceration rates. During the 30-day period prior to incarceration, 29.0% of participants reported concomitant use, 28.5% reported opioid use, and 18.0% reported stimulant use. During the one-year post-release period, 11.9% of participants reported concomitant use, 12.5% reported opioid use, and 8.3% reported stimulant use. During this post-release period, 10.7% reported heroin use. Concomitant and heroin use positively correlated with many factors with the potential to adversely influence cognition and constrain choice. Similar relationships between many of these factors and outcomes involving other drug or no drug use were not observed. Behavioral economics, a molar view of choice and behavior, was used to conceptualize how factors in the lives of participants had the potential to influence and constrain decision-making in respect to high-risk drugs. Findings are discussed in light of how they may inform future research, policy, and practice.