Scientific Article | Special IssueTable 3: Wilcoxon Signed Rank Sum test for Intake and Second (One Month) Follow-up Surveys (n=89)*Questionnaire Item%(Intake)%1 st Follow-up) Difference* P valueUse prescription drugs non-medically?Every daySome daysNot at all80.713.36.031.318.150.6-49.4-4.8+44.6
Special Issue | Scientific Articleto quit, and the use of quit aids)and approximately 19% of callersreported enroll<strong>in</strong>g <strong>in</strong> treatment asa result of us<strong>in</strong>g <strong>WV</strong>PDAQ servicerecommendations at the one-monthfollow-up. In addition, satisfactionwith services provided appears to bequite good, as <strong>in</strong>dicated by the selfreportedcaller satisfaction survey.Furthermore, the high percentage ofcallers who requested follow-up calls(from 79% at the Intake survey and<strong>in</strong>creas<strong>in</strong>g to 93% at the 2 nd followup)demonstrates the effectivenessof the <strong>WV</strong>PDAQ <strong>in</strong>terventionscarried out by the educators andthe value and importance of the<strong>WV</strong>PDAQ to callers <strong>in</strong> help<strong>in</strong>g themimplement changes <strong>in</strong> their lives.The trend of callers report<strong>in</strong>ga significant decl<strong>in</strong>e <strong>in</strong> request<strong>in</strong>ga referral for treatment across thesurveys deserves further comment.Given the challenges <strong>in</strong> access<strong>in</strong>gtreatment <strong>in</strong> <strong>West</strong> Virg<strong>in</strong>ia andthe short duration of time betweenthe <strong>in</strong>itial Intake and 1 st followup call, although speculative, it ispossible that those who requested areferral for treatment at the Intakewere still <strong>in</strong> the process of try<strong>in</strong>gto access treatment options afterone week, and thus did not makea request for additional referral.For example, some may have beenplaced on wait<strong>in</strong>g lists, or <strong>in</strong> the caseof detoxification treatment, weretold to call back daily to check onbed availability. Qualitative datalogs kept by staff confirm this is thecase, at least for some. However,others may have had a negativeexperience try<strong>in</strong>g to engage <strong>in</strong> thetreatment process, which may haveresulted <strong>in</strong> feel<strong>in</strong>gs of stigmatization.Tests of sample <strong>in</strong>dependencesuggest that callers who <strong>in</strong>itiatedtheir drug use at a younger age areless likely to utilize <strong>WV</strong>PDAQ longterm service recommendations. Whileit is unclear why this phenomenaexists, one speculation may be thatthese callers are further progressed <strong>in</strong>their addiction, and may have mademultiple attempts to quit their druguse and called the <strong>WV</strong>PDAQ look<strong>in</strong>gfor a “magic fix.” On a percentagebasis, 52% of younger callers reportedhav<strong>in</strong>g no <strong>in</strong>surance compared to25% of older callers, which mayalso suggest a socioeconomicfactor beh<strong>in</strong>d this discrepancy.Although the <strong>WV</strong>PDAQ isrelatively new and more longtermfollow-up data is needed toverify these prelim<strong>in</strong>ary f<strong>in</strong>d<strong>in</strong>gs,the methodology employed by the<strong>WV</strong>PDAQ is based on the successfultobacco quitl<strong>in</strong>e models. Tobaccotelephone quitl<strong>in</strong>e effectiveness iswell known. 11,19, 20, 21, 22 For example,tobacco quitl<strong>in</strong>e counsel<strong>in</strong>g has beenreported as be<strong>in</strong>g 1.5 times moreeffective than self-help materialsalone or brief <strong>in</strong>terventions. 22 Thesef<strong>in</strong>d<strong>in</strong>gs suggest that the <strong>WV</strong>PDAQwill also demonstrate similar success,given time, for <strong>West</strong> Virg<strong>in</strong>ians.On the other hand, the <strong>WV</strong>PDAQfaces challenges dissimilar fromits tobacco quitl<strong>in</strong>e peers. First,the stigma faced by prescriptiondrug users and/or abusers ismultifaceted. Unlike tobaccousers, prescription drugs are oftenobta<strong>in</strong>ed illegally from family orfriends, stolen, or purchased fromthe street and because the use ofdrugs is strongly moralized, thoseviolat<strong>in</strong>g moral norms are subjectto marg<strong>in</strong>alization. 23 The lower callvolume to the <strong>WV</strong>PDAQ relative toits tobacco quitl<strong>in</strong>e counterparts maypartially reflect this stigmatizationwhere callers are often hesitantto reveal their identity despiteassurances of complete confidentialityfor the fear of ‘gett<strong>in</strong>g caught’.Second, the stigma fac<strong>in</strong>g thosewho seek treatment, particularlywhen accompanied by a mentalillness, is well-documented. 24,25 Thisfactor may also contribute to theapproximately 63% <strong>in</strong>crease <strong>in</strong> callerswho report that they do not wish tohave a referral to treatment by theone-month follow-up survey. Thesefactors limit the potential reach of the<strong>WV</strong>PDAQ, which is disappo<strong>in</strong>t<strong>in</strong>gwhen the annual mean reach forsuccessful tobacco quitl<strong>in</strong>es is only1% of smokers <strong>in</strong> the United <strong>State</strong>s. 26Third, even if this stigmatizationcan be overcome, prescription drugabuse treatment is limited <strong>in</strong> thestate of <strong>West</strong> Virg<strong>in</strong>ia. In a statewith a population of 1.8 millionpeople, 88,000 <strong>West</strong> Virg<strong>in</strong>iansreported non medical pa<strong>in</strong> relieveruse (opioid abuse/dependence) <strong>in</strong>2005-2006. 27 However, <strong>in</strong> 2006, only1,249 were admitted to treatmentfor opiate abuse or dependence. 28<strong>West</strong> Virg<strong>in</strong>ia has only 10 residentialtreatment centers which providefewer than 300 beds. There are eighthalfway houses, eight methadonecl<strong>in</strong>ics and approximately n<strong>in</strong>eadditional centers which offer statewideoutpatient treatment. Many ofthe more rural counties have littleto no substance abuse treatment.There are only 13 CommunityBehavioral Health programs <strong>in</strong> thestate and they have long wait<strong>in</strong>glists for treatment appo<strong>in</strong>tments.Furthermore, of the substance abusetreatment available <strong>in</strong> <strong>WV</strong>, 79%is private for profit, which meansthey do not accept Medicaid. 29LimitationsAlthough many <strong>WV</strong>PDAQsurvey questions were modifiedfrom established and standardizedsources from the tobacco quitl<strong>in</strong>eliterature, 14 additional questions stillneeded to be developed specificallyfor prescription drug abuse. Forexample, questions regard<strong>in</strong>g drugprocurement strategies (e.g., doctorshopp<strong>in</strong>g, from friends or familymembers, etc.) were developedspecifically for the <strong>WV</strong>PDAQ andhave not undergone psychometricevaluation. Conversely, <strong>WV</strong>PDAQservices are not <strong>in</strong>tended to impact acaller’s drug procurement methods,as this is seen as realm for lawenforcement. Thus, the significantdecl<strong>in</strong>e among callers who reportsteal<strong>in</strong>g their drugs from friends orfamily members from the <strong>in</strong>take tothe first follow-up survey may be aspurious f<strong>in</strong>d<strong>in</strong>g. Second, althoughstudy results are encourag<strong>in</strong>g,SUBSTANCE ABUSE IN <strong>WV</strong> | Vol. 106 45
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