Polysubstance use and re-incarceration in the 12-months after release from jail: a latent transition analysis of rural Appalachian women

Amanda M. Bunting, Megan Dickson, Michele Staton

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Background: Rural areas have high rates of opioid and stimulant involved polysubstance use which are known to contribute to overdose. Justice-involved women are likely to have multiple substance use disorders and are particularly vulnerable in rural areas where treatment is limited. Objectives: The research had three aims to (1) identify the patterns of polysubstance use of rural Appalachian justice-involved women, (2) examine how women’s engagement in polysubstance use changed in the 12-months following initial release from jail, and (3) determine if women’s changes in substance use patterns were associated with re-incarceration during the 12-months of post-release follow-up. Methods: A total of 339 women with recent substance use histories were randomly recruited from three rural jails. Latent transition analysis of women’s substance use from baseline (in jail) to 6 and 12-months was examined, including the effect of re-incarceration on transitions (changes in substance use patterns). Results: Three latent classes were found: High Polysubstance/injection drug use (IDU) (36.3% baseline), Opioid/Benzo (Benzodiazepine) Involved Polysubstance Use (57.3% baseline), and Low Use (6.4% baseline). Polysubstance use classes were characterized by use of opioids and benzodiazepines; the High Polysubstance/IDU class was distinct in co-use and injection use of methamphetamine. Post-release, women transitioned to latent classes of reduced substance use and/or reduced injection drug use, particularly in the first six months. Women who were re-incarcerated during follow-up were likely to remain engaged in, or transition to, the High Polysubstance/IDU class (ORs: 3.14–46.56). Conclusion: Justice-involved women in Appalachia reported risky polysubstance use. The first six-months post-release were a critical period for changes in substance use.

Original languageEnglish
Pages (from-to)356-366
Number of pages11
JournalAmerican Journal of Drug and Alcohol Abuse
Issue number3
StatePublished - 2022

Bibliographical note

Funding Information:
This work was supported by the National Institute on Drug Abuse/National Institutes of Health under Award [R01DA033866]. The first author (Bunting) was supported by [R25DA037190 and T32-HS026120-01]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality or the National Institute on Drug Abuse.

Publisher Copyright:
© 2022 Taylor & Francis Group, LLC.


  • Opioids
  • justice-involved women
  • latent transition
  • methamphetamine

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Clinical Psychology
  • Psychiatry and Mental health


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