A significant proportion of survivors of rape do not utilize formal services to cope with the aftermath of rape. Understanding victimization experiences in environments that differ on resources, such as rural versus urban areas, may be an important dimension to consider in understanding barriers. Thirty women (18 rural and 12 urban) were recruited from rape crisis centers to participate in focus groups. Study results suggest that (a) survivors of rape experience many barriers to service utilization, (b) there were some differences in barriers to service utilization that were mentioned only in rural areas and some that were mentioned only in urban areas that may suggest that community context is important to consider in understanding barriers to service use, and (c) barriers to health and mental health services overlap with barriers to criminal justice system services.

The purpose of this study was to examine rural and urban women's perceptions of barriers to health and mental health services as well as barriers to criminal justice system services. Eight focus groups were conducted, two in a selected urban county (n = 30 women) and two in each of three selected rural counties (n = 98 women). Results were classified into a barrier framework developed in the health service utilization literature which suggests there are four main dimensions of barriers: affordability, availability, accessibility, and acceptability. Results indicate that: (1) women face many barriers to service use including affordability, availability, accessibility, and acceptability barriers; (2) it takes an inordinate level of effort to obtain all kinds of services; however, women with victimization histories may face additional barriers over and above women without victimization histories; (3) barriers to health and mental health service utilization overlap with barriers to utilizing the criminal justice system; and (4) there are many similarities in barriers to service use among rural and urban women; however, there are some important differences suggesting barriers are contextual. Future research is needed to further clarify barriers to service use for women with victimization histories in general, and specifically for rural and urban women. In addition, future research is needed to better understand how women cope with victimization in the context of the specific barriers they face in their communities.

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Background and Objectives: An increased percentage of individuals entering opioid addiction treatment programs also report the presence of chronic non-cancer pain (CNCP). This study examined associations between the presence of CNCP and 6-month medication assisted addiction treatment (MAT) outcomes. Methods: The sample included 585 individuals at opiate treatment programs who completed a structured intake interview and a 6-month follow-up telephone interview between March 2007 and December 2010. Of the sample, 115 individuals reported CNCP at intake and 6-month follow-up. Bivariate analyses compared individuals with CNCP (n ¼ 115) and without CNCP (n ¼ 470) at MAT intake. Results: A greater percentage of individuals with CNCP were older, were retired or disabled, and had experienced depression or anxiety before intake compared to individuals without CNCP. Results of binomial logistic regression models found that having CNCP was associated with increased odds of depression/anxiety at follow-up, but had no association with employment or substance use. Conclusions and Scientific Significance: The correlations between CNCP and co-occurring depression/anxiety among MAT clients indicate an area of special concern for providers. A full biopsychosocial, including a focus on history of chronic physical pain, might be beneficial to help highlight potential co-morbidities and to encourage closer monitoring of the intertwining relationships between addiction, CNCP, and depression/anxiety. (Am J Addict 2014;XX: 1-6)

Every day lawyers provide counsel and advocacy to individuals, groups, and businesses in a multitude of settings. From court room to board room, attorneys are relied upon to guide their clients through difficult situations. In doing this, attorneys all too often internalize the stresses of those that they help. The legal system has long been considered a stressful occupation. This stressful environment was further taxed by the wider societal disruptions in 2020 as we dealt with the onset of the COVID-19 pandemic. Beyond the illness itself, the pandemic forced widespread court closures and made it more difficult to communicate with clients. Based upon a survey of the membership of the Kentucky Bar Association, this paper considers the impact of the pandemic on attorney wellness in a variety of categories. These results demonstrated marked negative impacts on a variety of wellness measures which may result in significant reductions in service provision and efficacy for the people who need legal services. The pandemic made the practice of law harder and more stressful. Attorneys suffered increased incidence of substance abuse, alcohol consumption, and stress during the pandemic. These results were generally worse among those practicing in the areas of criminal law. In light of these adverse psychological effects facing attorneys, the authors argue the need for increased mental health support resources for attorneys, as well as establishing clear steps to raise awareness among the legal community about the importance of mental health and personal wellness.