Dr. Vaughan is submitting this application as a new, less experienced investigator. Dr. Vaughan has several years of health services research experience, and this is her first submission as principal investigator for a NIH grant. This study proposes to describe gender differences in the need for, utilization of, and access to health and social services prior to drug abuse treatment. Specific attention will also be given to differences across ethnic minorities within gender. Clients will be recruited and interviewed at intake at a central referral center for drug treatment. More specifically, this study has the following aims: 1. To compare characteristics of male and female adult drug abusers. Clients interviewed will be assessed at treatment intake on the following characteristics: drug/alcohol use history, physical health, mental health, family and social relationships, legal involvement, and financial resources. 2. To evaluate differences in the utilization of health and social services prior to referral to drug treatment, for male and female adult clients. Where possible, comparisons within gender will be made between clients of different races. 3. To evaluate gender differences in access to health services, including drug abuse treatment. If clients do not receive necessary services, we will determine the barriers to obtaining services, including drug abuse treatment. A major outcome of this study will be identification of services used frequently prior to referral to substance abuse treatment. This information has enormous potential to assist outreach and prevention efforts by identifying likely environments in which drug abusers may be found. One of the most difficult aspects of treatment is identifying substance abusing women and drawing them into care. Research is needed to examine how women in treatment came to be there and identify differences among sub-populations of women in the route by which they entered treatment. There is relatively little awareness among health care professional regarding sex-based differences in physiology and cultural environment. Such factors as sexual abuse, depression, poverty, single parenthood, under-employment, and self-esteem may affect males and females differently, leading to greater risk of drug abuse for females than males. Identification of these risks, service utilization associated with these risks, and barriers to services may assist early identification of women at risk for drug abuse. This research will also enhance the understanding of barriers to drug treatment for women.
