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

项目摘要 目前，美国有220万人被监禁，其中大约 每年释放60万人。物质使用障碍（SUD）在这一人群中很常见： 约65%符合SUD诊断标准（vs 5%的一般人群）。后 监禁，物质使用大大增加，-药物过量的风险是9-17倍 以前被监禁的人比一般人高。然而，在这方面， 我们对监禁后的结构和个人途径的理解存在重大差距 物质使用限制了治疗效果。拟议的研究将审查各种因素， 与物质使用和物质使用治疗充分性的变化相关， 纽约市以前被监禁的个人在释放后一年期间， 在2015年至2017年期间，阿片类药物相关的过量服用率增加了一倍多， 在有色人种和高度贫困社区的居民中增加。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 影响释放人员使用药物情况的个人和环境因素 来自纽约州惩教和社区部的机构 监督（NYSDOCCS），美国最大的刑事司法惩教机构之一。 在社会生态学理论的指导下，我们将致力于以下具体目标：1）。表征 在12个月期间的5个时间点（基线和3、6、9和12个月）的物质使用 （2）最近被释放的人;（2）。识别个人-和 监禁后物质使用的环境水平预测因素; 3）调查 ASAM PPC综合评分（成瘾严重程度的衡量标准）之间的差异 随着时间的推移，物质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影响因素， 对通报对有问题的物质使用的有效对策的兴趣。

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.