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

项目摘要：物质使用障碍(SUD)治疗的可获得性和使用率仍然很低，尽管 毒品过量在美国持续流行。2019年，1930万非制度化成年人满足了 但只有260万人接受了特殊治疗服务。被转介到SUD治疗的人 通过刑事法律系统获得循证服务(例如阿片类药物)的可能性较小 使用障碍)，而不是那些自我推荐的专科治疗。因为种族/民族小型化群体更多的是 与白人同龄人相比，男性和女性更有可能被定为刑事犯罪，基于刑事法律制度 转诊可能会导致SUD治疗的使用和结果中的种族主义和性别不平等。相当可观 关于刑事法律制度，特别是县级监禁如何影响 社区水平的SUD治疗需求、可获得性、使用和相关结果。这些差距因以下原因而加剧 医疗保健提供系统和刑事法律系统数据的孤岛。为了填补这些空白，我们将把 2004年至2023年所有50个州的县的综合多层次数据。我们将量化县监狱 监狱监禁率与：(目标1)社区精神疾病治疗需求(与毒品有关)有关 死亡率、毒品相关急诊科就诊率、性传播疾病患病率)；(目标2)传播疾病治疗 可获得性(可获得的治疗服务的数量和类型)；和(目标3)使用SUD治疗(自报， (入院率)和治疗结果(完成、保留)跨社区和个人。我们 假设县监狱越多，需要的SUD治疗就越多(反之亦然)， 治疗可获得性较低，治疗使用增加较少，治疗结果较差。我们期待着 这些关系将具有重要的空间依赖性，并因种族/族裔和性别而改变。 我们假设的路径是基于卫生服务研究的社会文化框架 差异；我们的研究过程受到公共卫生关键种族实践和疾控中心政策分析的启发 适用于系统思维的框架。我们的团队由一名早期调查员领导，拥有以下专业知识 物质使用流行病学和治疗、犯罪学、刑事法律制度、卫生政策和卫生 系统、结构歧视、人口小型化、生物统计学和空间方法。我们将应用这一点 研究刑事法律制度的专门知识，重点是可持续和可修改的改革目标 随着时间的推移，SUD治疗中的不平等现象会恶化。我们的研究解决了NIDA的特殊利益通知(非-DA- 19-037)呼吁对弱势人群的SUD治疗进行多层次的卫生服务研究。通过 这款创新的R01利用多层次数据源并与利益相关者接触，考察了多个 系统的融合会影响社区健康。我们将吸收专家和有生活经验的人在 研究过程。我们的多管齐下的传播计划将确保调查结果到达目标受众，并 告知反种族主义卫生政策和计划，以改善基于社区的SUD治疗相关结果。

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.