Examining predictors of substance use and treatment adequacy among formerly incarcerated opiod and cocaine users

项目摘要 目前，220万人被关押在美国，大约 每年有60万辆汽车上映。物质使用障碍(SOD)在这一人群中很常见： ~65%的人符合SUD诊断标准(占总人口的5%)。邮寄- 监禁，药物使用大幅增加，吸毒过量的风险是9-17倍 在以前被监禁的个人中比在一般人群中更高。然而， 我们对监禁后的结构性和个体性途径的理解存在重大差距 物质使用限制了治疗效果。拟议的研究将检查各种因素 与物质使用和物质使用治疗充分性的变化有关- 纽约市(NYC)以前被监禁的人获释后的一年， 在2015至2017年间，与阿片类药物相关的过量服药率翻了一番以上， 在高贫困社区的有色人种和居民中，这一比例不断上升。我们将研究 参与者接受药物使用治疗服务的程度 他们在美国成瘾医学会(ASAM)患者安置标准上的得分 (PPC)。我们将使用新颖的空间信息多层次建模策略来研究 影响个人物质使用的个人和环境因素在 来自纽约州惩教和社区部门的机构 监督(NYSDOCCS)，美国最大的刑事司法惩戒机构之一。 在社会生态学理论的指导下，我们将解决以下具体目标：1)。刻画 12个月期间五个时间点的药物使用情况(基线和3、6、9和12个月 在最近获释的人中)；2)。确定个人身份-和 监禁后物质使用的环境水平预测因素；以及3)调查 ASAM PPC综合得分之间的差异(成瘾严重程度的衡量标准) 随着时间的推移，药物使用治疗的产生和水平。拟议的研究将确定 药物使用、治疗差距和可干预的影响因素 对对有问题的物质使用提出有效回应的兴趣。

Project Summary Currently, 2.2 million individuals are incarcerated in the United States (US), and approximately 600,000 are released annually. Substance use disorders (SUDs) are common in this population: ~65% meet the criteria for an SUD diagnosis (vs 5% of the general population). Post- incarceration, substance use increases considerably, – the risk of drug overdose is 9-17 times higher among formerly incarcerated individuals than in the general population. However, significant gaps in our understanding of structural and individual pathways of post-incarceration substance use limit treatment effectiveness. The proposed study will examine factors associated with changes in substance use and substance use treatment adequacy over a one- year period post-release among formerly incarcerated individuals in New York City (NYC), where opioid-related overdose rates more than doubled between 2015 and 2017 and are increasing among people of color and residents in high poverty communities. We will examine the extent to which participants receive substance use treatment services recommended by their scores on the American Society of Addiction Medicine (ASAM) patient placement criteria (PPC). We will use novel spatially informed multi-level modeling strategies to investigate individual and environmental factors that influence substance use among individuals released in NYC from institutions in the New York State Department of Corrections and Community Supervision (NYSDOCCS), one of the largest U.S. criminal justice correctional agencies. Guided by social ecological theory, we will address the following Specific Aims: 1). Characterize substance use at five time points over a 12-month period (at baseline and 3-, 6-, 9-, and 12- months) among those recently released from incarceration; 2). Identify individual- and environment-level predictors of post-incarceration substance use; and 3) Investigate discrepancies between ASAM PPC composite scores (a measure of addiction severity) generated and levels of substance use treatment over time. The proposed research will identify substance use treatment gaps and influential factors that are amenable to intervention in the interest of informing effective responses to problematic substance use.