Substance use treatment and county incarceration: Reducing inequities in substance use treatment need, availability, use, and outcomes

药物滥用治疗和县监禁：减少药物滥用治疗需求、可用性、使用和结果方面的不平等

• 批准号: 10585508
• 负责人: Pia M. Mauro
• 金额: $ 72.99万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-15 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10585508
• 关键词: Accident and Emergency department; Accounting; Address; Admission activity; Adult; Affect; Alcohol consumption; Biometry; Black race; Cessation of life; Communities; Community Health; County; Criminology; Data; Data Set; Data Sources; Dependence; Discrimination; Disparity; Drug usage; Emergency Situation; Emergency department visit; Ensure; Epidemic; Epidemiology; Equation; Ethnic Origin; Exposure to; Face; Funding; Gender; Health; Health Policy; Health Services; Health Services Research; Health system; Imprisonment; Individual; Inequity; Investments; Jail; Justice; Knowledge; Latinx; Legal; Legal system; Link; Methodology; Methods; Minority Groups; Modeling; Morbidity - disease rate; National Institute of Drug Abuse; Outcome; Overdose; Pathway interactions; Patient Self-Report; Persons; Pharmaceutical Preparations; Policies; Policy Maker; Prevalence; Prisons; Process; Public Health; Race; Research; Research Personnel; Services; Substance Use Disorder; Suicide; Supervision; Surveys; System; Testing; Thinking; Time; Trauma; Treatment outcome; United States; Visit; Vital Statistics; Vulnerable Populations; Woman; anti-racism; community engagement; community reentry; dissemination strategy; ethnic disparity; ethnic minority population; evidence base; experience; gender disparity; health care delivery; improved; innovation; interest; medical specialties; medication for opioid use disorder; men; mortality; multilevel analysis; outcome disparities; overdose death; overdose risk; parole; population health; probation; programs; racial disparity; racial minority population; recidivism; reduced substance use; reincarceration; service delivery; social culture; substance abuse treatment; substance use; substance use treatment; treatment disparity; treatment services; trend

PROJECT SUMMARY: Substance use disorder (SUD) treatment availability and use remain low despite an ongoing drug overdose epidemic in the United States. In 2019, 19.3 million non-institutionalized adults met the criteria for SUD, but only 2.6 million received specialty treatment services. People referred to SUD treatment through the criminal legal system are less likely to receive evidence-based services (e.g., medication for opioid use disorder) than those who self-refer to specialty treatment. Because racial/ethnic minoritized groups are more likely to be criminalized than their white counterparts, as are men versus women, criminal-legal-system-based referrals may contribute to racialized and gendered inequities in SUD treatment use and outcomes. Substantial knowledge gaps remain about how the criminal legal system, specifically county-level incarceration, affects community-level SUD treatment need, availability, use, and related outcomes. These gaps are exacerbated by the siloing of healthcare delivery system and criminal legal system data. To fill these gaps, we will link comprehensive multi-level data from counties in all 50 states from 2004-2023. We will quantify how county jail and prison incarceration rates are associated with: (Aim 1) community SUD treatment need (drug-related mortality rate, drug-related emergency department visit rate, SUD prevalence); (Aim 2) SUD treatment availability (number and types of available treatment services); and (Aim 3) SUD treatment use (self-reported, admission rates) and treatment outcomes (completion, retention) across communities and individuals. We hypothesize that greater county incarceration is associated with greater SUD treatment need (and vice versa), lower treatment availability, smaller increases in treatment use, and worse treatment outcomes. We anticipate that these relationships will have important spatial dependencies and be modified by race/ethnicity and gender. Our hypothesized pathways are grounded in the Socio-Cultural Framework for the Study of Health Service Disparities; our research process is informed by Public Health Critical Race Praxis and the CDC Policy Analytical Framework adapted for systems thinking. Our team, led by an Early-Stage Investigator, has expertise in substance use epidemiology and treatment, criminology, criminal legal systems, health policy and health systems, structural discrimination, minoritized populations, biostatistics, and spatial methods. We will apply this expertise to study the criminal legal system, focusing on modifiable reform targets that can perpetuate and worsen inequities in SUD treatment over time. Our study addresses NIDA’s Notice of Special Interest (NOT-DA- 19-037) calling for multi-level health services research on SUD treatment for vulnerable populations. By leveraging multi-level data sources and engaging with stakeholders, this innovative R01 examines how multiple systems converge to affect community health. We will incorporate experts and people with lived experience in the research process. Our multi-pronged dissemination plan will ensure that findings reach target audiences and inform antiracist health policies and programs that improve community-based SUD treatment-related outcomes.

项目摘要：药物使用障碍（SUD）治疗可用性和使用仍然是低目的地 美国正在进行的药物过量流行病。 2019年，有1930万非机构化的成年人遇到了 SUD的标准，但只有260万获得特殊治疗服务。人们提到SUD治疗 通过犯罪法律制度不太可能接受循证服务（例如，阿片类药物的药物 使用障碍）比那些自我参考专业治疗的人。因为种族/族裔少数群体更多 与白人对应者一样，可能被定为犯罪 转诊可能会导致SUD治疗和结果中的种族化和性别不平等。重大的 知识差距仍然存在有关犯罪法律制度，特别是县级影响的如何影响的知识差距 社区级的SUD治疗需求，可用性，使用和相关结果。这些差距被加剧了 医疗保健提供系统和犯罪法律体系数据的散型。要填补这些空白，我们将链接 从2004 - 2023年开始，来自所有50个州的县的全面多层次数据。我们将量化如何县监狱 与监狱监禁率有关：（目标1）社区盐肿块治疗需求（与毒品有关 死亡率，与毒品有关的急诊室就诊率，急诊室患病率）； （AIM 2）SUD治疗 可用性（可用治疗服务的数量和类型）； （AIM 3）SUD治疗使用（自我报告， 入院率）和社区和个人的治疗结果（完成，保留）。我们 假设更大的计数进化与更大的SUD治疗需求（反之亦然）有关 较低的治疗可用性，治疗使用量的增加以及治疗结果较差。 这些关系将具有重要的空间依赖性，并通过种族/种族和性别来修改。 我们假设的途径基于卫生服务研究的社会文化框架 差异；我们的研究过程由公共卫生关键种族实践和CDC政策分析所告知 适用于系统思维的框架。由早期调查员领导的我们的团队在 药物使用流行病学和治疗，危机，刑事法律制度，卫生政策和卫生 系统，结构歧视，少数人群，生物统计学和空间方法。我们将应用此 研究犯罪法律体系的专业知识，专注于可修改的改革目标，该目标可以使和 随着时间的推移，SUD治疗的不平等问题恶化。我们的研究介绍了NIDA的特殊关注通知（NOT-DA- 19-037）呼吁对脆弱人群的SUD治疗进行多层健康服务研究。经过 利用多层次数据源并与利益相关者互动，这项创新的R01考试如何多次考试 系统会收敛以影响社区健康。我们将结合具有现场经验的专家和人 研究过程。我们的多管齐下的传播计划将确保发现结果达到目标受众和 为反种族主义的健康政策和计划提供信息，以改善基于社区的SUD治疗结果。