The purpose of this integrative review is to examine and synthesize extant literature pertaining to barriers to substance abuse and mental health treatment for persons with co-occurring substance use and mental health disorders (COD). Electronic searches were conducted using ten scholarly databases. Thirty-six articles met inclusion criteria and were examined for this review. Narrative review of these articles resulted in the identification of two primary barriers to treatment access for individuals with COD: personal characteristics barriers and structural barriers. Clinical implications and directions for future research are discussed. In particular, additional studies on marginalized sub-populations are needed, specifically those that examine barriers to treatment access among older, non-white, non-heterosexual populations.

This study identifies novel barriers and facilitators to substance use care in the rural South and highlights essential areas for consideration when developing and implementing substance use care in this geographic region. These findings can be used as guidelines to provide better care to individuals with substance use disorders living in rural communities.

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for assistance interviewing and research contributions. We also give special thanks to the women who shared their stories and experiences with the hope of making a difference for those who will follow them. PATHWAYS TO JAILiii ABSTRACT This multi-site study addressed critical gaps in the literature by assessing the prevalence of serious mental illness (SMI), posttraumatic stress disorder (PTSD), and substance use disorders (SUD) in women in jail and pathways to offending for women with and without SMI. Using a randomly selected sample (N = 491) from rural and urban jails, this study employed a structured diagnostic interview to assess current and lifetime prevalence of SMI (e.g., major depression, bipolar, and psychotic spectrum disorders), PTSD, and SUD in women in jail. Women's prior access to treatment and level of functional impairment in the past 12 months was also assessed. Next, qualitative Life History Calendar (LHC) interviews were conducted with a subset of the sample (N = 115) to examine how onset of different types of criminal activity and delinquency vary as a function of mental health status and trauma exposure. Finally, we also interviewed corrections staff members (N = 37) at participating jail sites to assess staff members' perceptions about the prevalence of mental health difficulties in women in jail as well as staff beliefs about women's pathways to jail. Notably, 43% of participants met criteria for a lifetime SMI, and 32% met SMI criteria in the past 12 months. Substance use disorders were the most commonly occurring disorders, with 82% of the sample meeting lifetime criteria for drug or alcohol abuse or dependence. Similarly, PTSD rates were high with just over half the sample (53%) meeting criteria for lifetime PTSD. Women also met criteria for multiple lifetime disorders at high rates. Finally, 30 to 45% of individuals who met criteria for a current disorder reported severely impaired functioning in the past year. Women with SMI reported greater rates of victimization and more extensive offending histories than women who did not meet criteria for lifetime SMI. In a test of our proposed model, experiences of childhood victimization and adult trauma did not directly predict offending histories; instead both forms of victimization increased the risk of poor mental health, and poor mental health predicted a greater offending history. Next, quantitative LHC data were analyzed to elucidate patterns of offending over the lifespan. SMI significantly increased women's risk for onset of substance use, drug dealing/charges, property crime, fighting/assault, and running away. In addition, experiences of victimization predicted risk of offending. The third component of this study included interviews with corrections staff including supervisors, health practitioners, and corrections officers/deputies. These staff members indicated a general awareness that women's experiences of victimization were linked with their entry into the criminal justice system. Further, many staff were aware of women's mental ...

Little consensus exists regarding which particular behaviors constitute psychological abuse. In this study, a national sample of psychologists rated behaviors by a husband toward his wife as to whether each behavior constituted psychological abuse. For behaviors viewed as “possibly abusive,” psychologists indicated whether their judgments would depend on contextual factors of frequency/duration, intent to harm by the perpetrator, and/or perception of harm by the victim. Frequency/duration was more influential than intent to harm or perception of harm in determining whether a behavior was viewed as abusive. Cluster analyses revealed conceptual groups that were labeled (a) threats to physical health; (b) control over physical freedoms; (c) destabilization through intimidation, degradation, isolation/monopolizing, and control; (d) dominating/controlling behaviors; and (e) “inept” relationship behaviors. Threats to physical health, control over physical freedoms, and destabilization were most likely to be perceived as psychological abuse, whereas inept behaviors were rarely viewed as inherently abusive.