A Prospective Examination of High-cost Health Services Utilization among Drug using Prisoners Reentering the Community

  • Carl G. Leukefeld
  • Matthew L. Hiller
  • J. Matthew Webster
  • Michele Staton Tindall
  • Steven S. Martin
  • Jamieson Duvall
  • Valerie E. Tolbert
  • Thomas F. Garrity
Regular Article


The use of health services by prisoners during their incarceration and after their return to the community impacts the U.S. health care system and health care costs associated with this system. These health care costs are expected to increase over the next decade as more prisoners return to their communities. The current study prospectively examines the use of high-cost health care services—emergency room visits and hospitalizations—among 565 male drug-abusing prisoners about 1 year after prison release. A series of structural equation models were used to examine predisposing factors, including health status and drug use, and to estimate the frequency of high-cost health service utilization. As expected, health status was the most robust predictor of high-cost health services. However, the finding that drug abuse had nonsignificant relationships with high-cost health services utilization was not expected. Discussion focuses on health care service issues and health problems as prisoners’ transition from prison to the community.

Key Words

health high-cost health services prisoners re-entry predictors 



This study was supported by Grant R01 DA11309 from the National Institute on Drug Abuse; Carl G. Leukefeld, Principal Investigator; and by the staff and resources of the Center on Drug and Alcohol Research at the University of Kentucky. Opinions expressed are those of the authors and do not represent the position of the National Institute on Drug Abuse.


  1. 1.
    Farabee D, Joshi V, Anglin MD. Addiction careers and criminal specialization. Crime and Delinquency. 2001;47:196–220.CrossRefGoogle Scholar
  2. 2.
    Belanko S. Behind Bars: Substance Abuse and America’s Prison Population. New York, NY: National Center on Addiction and Substance Abuse at Columbia University; 1998.Google Scholar
  3. 3.
    National Institute of Justice. 1999 Annual Report on Drug Use Among Adult and Juvenile Arrestees. Washington, DC: Author; 2000.Google Scholar
  4. 4.
    Mumola CJ. Substance Abuse and Treatment, State and Federal Prisoners, 1997: Bureau of Justice Statistics Special Report. Washington, DC: U.S. Department of Justice, Office of Justice Programs; 1999.Google Scholar
  5. 5.
    Elliot RL. Evaluating the quality of correctional mental health services: an approach survey in a correctional mental health system. Behavioral Sciences and the Law. 1997;15:427–438.CrossRefGoogle Scholar
  6. 6.
    Hammett TM, Harmon P, Maruschak LM. 1996–1997 update: HIV/AIDS, STDs, and TB in Correctional Facilities. Washington, DC: U.S. Department of Justice, Office of Justice Programs; 1999.Google Scholar
  7. 7.
    Lamb HR, Weinberger LE. Persons with severe mental illness in jails and prisons: a review. Psychiatric Services. 1998;49:483–492.PubMedGoogle Scholar
  8. 8.
    Leukefeld CG, Tims F, Farabee D. Treatment of Drug Offenders: Policies and Issues. New York, NY: Springer; 2002.Google Scholar
  9. 9.
    Lindquist CH, Lindquist CA. Health behind bars: utilization and evaluation of medical care among jail inmates. Journal of Community Health. 1999;24:285–303.PubMedCrossRefGoogle Scholar
  10. 10.
    Maruschak LM, Beck AJ. Medical Problems of Inmates, 1997: Bureau of Justice Statistics Special Report. Washington, DC: U.S. Department of Justice, Office of Justice Programs; 2001.Google Scholar
  11. 11.
    Baillargeon J, Black SA, Pulvino J, et al. The disease profile of Texas prison inmates. Annals of Epidemiology. 2000;10:74–80.PubMedCrossRefGoogle Scholar
  12. 12.
    Maruschak LM. HIV in Prisons and Jails, 1999: Bureau of Justice Statistics Bulletin. Washington, DC: U.S. Department of Justice, Office of Justice Programs; 2001.Google Scholar
  13. 13.
    Maruschak LM. HIV in Prisons and Jails, 2004: Bureau of Justice Statistics Bulletin. Washington, DC: U.S. Department of Justice, Office of Justice Programs; 2004.Google Scholar
  14. 14.
    Leukefeld CG, Staton M, Hiller ML, et al. Health problems and health services utilization by HIV serostatus among incarcerated male drug abusers. The Journal of Behavioral Health Services and Research. 2002;29:167–175.CrossRefGoogle Scholar
  15. 15.
    Altice FL, Mostashari F, Selwyn PA, et al. Predictors of HIV infection among newly sentenced male prisoners. Journal of Acquired Immune Deficiency and Human Retrovirology. 1998;18:444–453.Google Scholar
  16. 16.
    Leukefeld CG, Roberto H, Hiller ML, et al. HIV prevention among high-risk and hard-to-reach rural residents. Journal of Psychoactive Drugs. 2003;35:427–434.PubMedGoogle Scholar
  17. 17.
    Travis J. But They All Come Back: Rethinking Prisoner Reentry. (Sentencing and Corrections: Issues for the 21st Century, No. 7). Washington, DC: National Institute of Justice; 2000.Google Scholar
  18. 18.
    Paris JE. Inmate overutilization of health care: is there a way out? Journal of Correctional Healthcare. 1994;1:73–90.Google Scholar
  19. 19.
    Twaddle AC. Utilization of medical services by a captive population: an analysis of sick call in a state prison. Journal of Health and Social Behavior. 1976;17:236–248.PubMedCrossRefGoogle Scholar
  20. 20.
    Inciardi JA, Surratt HL, Martin S, et al. The importance of aftercare in a corrections-based treatment continuum. In: Leukefeld CG, Tims FM, Farabee D, eds. Treatment of Drug Offenders: Policies and Issues. New York: Springer; 2002:204–216.Google Scholar
  21. 21.
    McCorkel JA, Butzin CA, Martin SS, et al. Use of health care services in a sample of drug-involved offenders: a comparison with national norms. American Behavioral Scientist. 1998;41:1079–1090.CrossRefGoogle Scholar
  22. 22.
    Leukefeld CG, Logan TK, Martin S, Purvis et al. A health services use framework for drug-abusing offenders. American Behavioral Scientist. 1998;41:1123–1135.CrossRefGoogle Scholar
  23. 23.
    Garrity TF, Hiller ML, Staton M, et al. Factors predicting illness and health services use among male Kentucky prisoners with a history of drug abuse. The Prison Journal. 2002;82:295–313.CrossRefGoogle Scholar
  24. 24.
    Walker BW, Hiller ML, Leukefeld CG, et al. Head injury among drug abusers: an indicator of co-occurring problems. Journal of Psychoactive Drugs. 2003;35:343–353.PubMedGoogle Scholar
  25. 25.
    Warner B, Leukefeld CG. Rural–urban differences in substance use and treatment utilization among prisoners. American Journal of Drug and Alcohol Abuse. 2001;27:265–280.PubMedCrossRefGoogle Scholar
  26. 26.
    Mateyoke-Scrivner A, Webster JM, Hiller ML, et al. Criminal history, physical and mental health, substance abuse, and services use among incarcerated substance abusers. Journal of Contemporary Criminal Justice. 2003;19:82–97.CrossRefGoogle Scholar
  27. 27.
    Webster JM, Leukefeld CG, Staton M, et al. Lifetime health services use by male drug-abusing offenders. The Prison Journal. 2005;1:50–64.CrossRefGoogle Scholar
  28. 28.
    Aday LA, Andersen R. A framework for the study of access to medical care. Health Services Research. 1974;9:208–220.PubMedGoogle Scholar
  29. 29.
    Aday LA. Establishment of a conceptual base for health services research. Journal of Health Services and Research Policy. 2001;6:183–185.CrossRefGoogle Scholar
  30. 30.
    Aday LA, Begley CE, Lairson DR, et al. Evaluating the Medical Care System: Effectiveness, Efficiency, and Equity. Ann Arbor, MI: Health Administration Press; 1993.Google Scholar
  31. 31.
    Andersen R. Revisiting the behavioral model and access to medical care: does it matter. Journal of Health and Social Behavior. 1995;36:1–10.PubMedCrossRefGoogle Scholar
  32. 32.
    Andersen R. The multiple changing faces of access. Medical Care. 1998;36:252–253.PubMedCrossRefGoogle Scholar
  33. 33.
    Andersen R, Newman JF. Societal and individual determinants of medical care utilization in the United States. Milbank Memorial Fund Quarterly. 1973;51:95–124.CrossRefGoogle Scholar
  34. 34.
    Andersen R, Anderson OW. Trends in the use of health services. In: Freeman HE, Levine S, Reeder LG, eds., Handbook of Medical Sociology, 3rd ed. Englewood Cliffs, NJ: Prentice-Hall; 1979:371–391.Google Scholar
  35. 35.
    Leukefeld CG, Narevic E, Hiller ML, et al. Urban/rural, race, and drug use among incarcerated male substance abusers. International Journal of Offender Therapy and Comparative Criminology. 2002;46:715–728.PubMedCrossRefGoogle Scholar
  36. 36.
    Logan T, Walker R, Staton M, et al. Substance use and intimate violence among incarcerated males. Journal of Family Violence. 2001;16:93–114.CrossRefGoogle Scholar
  37. 37.
    McLellan AT, Kushner H, Metzger D, et al. The fifth edition of the Addiction Severity Index. Journal of Substance Abuse Treatment. 1992;9:119–213.CrossRefGoogle Scholar
  38. 38.
    Chitwood DD, McBride DC, Metsch LR, et al. A comparison of the need for health care and use of health care by injection-drug users, other chronic drug users, and nondrug users. American Behavioral Scientist. 1998;41:1107–1122.CrossRefGoogle Scholar
  39. 39.
    Chitwood DC, McBride DC, French MT, et al. Health care need and utilization: a preliminary comparison of injection drug users, other illicit drug users, and nonusers. Substance Use and Misuse. 1999;34:727–746.PubMedGoogle Scholar
  40. 40.
    Leonard C, Mulvey K, Gastfriend DR, et al. The Addiction Severity Index: a field study of internal consistency and validity. Journal of Substance Abuse Treatment. 2000;18:129–135.CrossRefGoogle Scholar
  41. 41.
    Bentler PM. Comparative fit indices in structural models. Psychological Bulletin. 1990;107:238–246.PubMedCrossRefGoogle Scholar
  42. 42.
    Steiger JH. Structural model evaluation and modification: an interval estimation approach. Multivariate Behavioral Research. 1990;25:173–180.CrossRefGoogle Scholar
  43. 43.
    Bentler, PM. EQS 6 Structural Equations Program Manual. Encino, CA: Multivariate Software; 2001.Google Scholar
  44. 44.
    Hammett TM, Roberts C, Kennedy S. Health-related issues in prisoner reentry. Crime and Delinquency. 2001;47:390–409.CrossRefGoogle Scholar
  45. 45.
    Conklin TJ, Lincoln T, Tuthill RW. Self-reported health and prior health behaviors of newly admitted correctional inmates. American Journal of Public Health. 2000;90:1939–1941.PubMedGoogle Scholar
  46. 46.
    Glaser JB, Greifinger RB. Correctional health care: a public health opportunity. Annals of Internal Medicine. 1993;118:139–145.PubMedGoogle Scholar
  47. 47.
    Leukefeld CG, Tims FM. Drug abuse treatment in prisons and jails. Journal of Substance Abuse Treatment. 1993;10:77–84.PubMedCrossRefGoogle Scholar
  48. 48.
    Freudenberg N. Jails, prisons, and the health of urban populations: a review of the impact of the correctional system on community health. Journal of Urban Health. 2001;78:214–235.PubMedGoogle Scholar
  49. 49.
    Hammett TM. Making the case for health interventions in correctional facilities. Journal of Urban Health. 2001;78:236–240.PubMedGoogle Scholar
  50. 50.
    Hegamin A, Longshore D, Monahan G. Heath services in correctional settings: emerging issues and model strategies. In: Leukefeld CG, Tims FM, Farabee D, eds., Treatment of Drug Offenders: Policies and Issues. 2002;335–347.Google Scholar

Copyright information

© Springer 2006

Authors and Affiliations

  • Carl G. Leukefeld
    • 1
  • Matthew L. Hiller
  • J. Matthew Webster
  • Michele Staton Tindall
  • Steven S. Martin
  • Jamieson Duvall
  • Valerie E. Tolbert
  • Thomas F. Garrity
  1. 1.Professor and Director, Center on Drug and Alcohol Research, Department of Behavioral ScienceUniversity of KentuckyLexingtonUSA

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