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Roberts K, Smith E, Sousa C, Young JE, Corley AG, Szczotka D, Sepanski A, Hartoch A. Centering persons who use drugs: addressing social determinants of health among patients hospitalized with substance use disorders. SOCIAL WORK IN HEALTH CARE 2024; 63:19-34. [PMID: 37929597 DOI: 10.1080/00981389.2023.2278777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/12/2023] [Indexed: 11/07/2023]
Abstract
Social workers have emerged as leaders within Addiction Consult Services (ACS) due to their ability to provide a wide range of services, from crisis work and brief therapeutic interventions to connecting patients to community resources. Many hospitals have implemented ACS to address the overdose crisis and the sharp rise in drug use-related infections, including skin and soft tissue infections, osteomyelitis, and endocarditis; a result of unaddressed systemic social determinants of health (SDOH). Yet, despite social workers being at the forefront of inpatient substance use work, little guidance exists regarding social work's role in leading person-centered addiction care and addressing SDOH in the hospital setting. The authors of this paper are licensed clinical social workers who have worked across five different health systems, engaging persons who use drugs (PWUD) in the context of an ACS. This paper examines five practice interventions of social work practice within hospitals that represent key points for innovation. Drawing on social work's unique commitments to social justice, strengths, and person-in-environment, these interventions operate within eco-social approaches to help us grapple more effectively with ways that health - and disease - are socially and economically produced by multiple interacting factors. We provide a clinical roadmap of interventions for social workers in hospital settings with PWUD to demonstrate how social work leadership within inpatient care models can help us better address the impacts of various intersecting SDOH on the care of PWUD.
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Affiliation(s)
- Kate Roberts
- Graduate School of Social Work and Social Research, Bryn Mawr College, Bryn Mawr, Pennsylvania, USA
| | - Emily Smith
- Michigan Opioid Collaboratived, University of Michigan Health, Ann Arbor, Michigan, USA
| | - Cindy Sousa
- Graduate School of Social Work and Social Research, Bryn Mawr College, Bryn Mawr, Pennsylvania, USA
| | - J Elaina Young
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Anna Grace Corley
- Addiction Medicine, Prisma Health Internal Medicine, Greenville, South Carolina, USA
| | - Darin Szczotka
- Michigan Opioid Collaboratived, University of Michigan Health, Ann Arbor, Michigan, USA
| | - Abby Sepanski
- Addiction Medicine, Prisma Health Internal Medicine, Greenville, South Carolina, USA
| | - Ashley Hartoch
- Psychiatry, Stanford Health Care, Palo Alto, California, USA
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Dobischok S, Guh D, Marchand K, MacDonald S, Lock K, Harrison S, Lajeunesse J, Schechter MT, Oviedo-Joekes E. The Impact of Injectable Opioid Agonist Treatment (iOAT) on Involvement in Criminalized Activities: A Secondary Analysis from a Clinical Trial in Vancouver, BC. Subst Abuse Rehabil 2023; 14:147-156. [PMID: 38026787 PMCID: PMC10657756 DOI: 10.2147/sar.s438451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose A significant portion of the economic consequences of untreated Opioid Use Disorder (OUD) relate to individuals' involvement in the criminal justice system. The present study uncovers if treatment with iOAT is related to the number of criminal charges amongst participants, what type of crime participants were involved in, and the frequency with which participants were victims of crime. This study contributes to the body of research on the effectiveness of iOAT reducing criminal involvement. Patients and Methods This is a secondary analysis of police record data obtained from the Vancouver Police Department over a three-year period during the Study to Assess Longer-term Opioid Medication Effectiveness clinical trial. The data was obtained from participants (N = 192) enrolled in the trial through a release of information form. Results During the three-year period, most charges (45.6%) were property offences, and 25.5% of participants were victims of crime. Participants with no treatment prior to randomization into the SALOME trial were 2.61 (95% CI = 1.64-4.14) more likely to have been charged with a crime than during the iOAT state. Conclusion IOAT can reduce individuals' involvement with the criminal justice system and is thus a crucial part of the continuum of care. Addiction should be conceptualized as a healthcare rather than criminal issue.
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Affiliation(s)
- Sophia Dobischok
- Department of Education and Counselling Psychology, McGill University, Montreal, QC, Canada
- Centre for Advancing Health Outcomes, Providence Health Care, Vancouver, BC, Canada
| | - Daphne Guh
- Centre for Advancing Health Outcomes, Providence Health Care, Vancouver, BC, Canada
| | - Kirsten Marchand
- Centre for Advancing Health Outcomes, Providence Health Care, Vancouver, BC, Canada
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, Vancouver, BC, Canada
| | - Kurt Lock
- Centre for Advancing Health Outcomes, Providence Health Care, Vancouver, BC, Canada
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, Vancouver, BC, Canada
| | - Julie Lajeunesse
- Providence Health Care, Providence Crosstown Clinic, Vancouver, BC, Canada
| | - Martin T Schechter
- Centre for Advancing Health Outcomes, Providence Health Care, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Eugenia Oviedo-Joekes
- Centre for Advancing Health Outcomes, Providence Health Care, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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Messinger JC, Vercollone L, Weiner SG, Bromstedt W, Garner C, Garza J, Joseph JW, Sanchez LD, Im D, Bukhman AK. Outcomes for Patients Discharged to Involuntary Commitment for Substance Use Disorder Directly from the Hospital. Community Ment Health J 2023; 59:1300-1305. [PMID: 36995493 DOI: 10.1007/s10597-023-01112-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/07/2023] [Indexed: 03/31/2023]
Abstract
To evaluate the outcomes of patients discharged to involuntary commitment for substance use disorders directly from the hospital. We performed a retrospective chart review of 22 patients discharged to involuntary commitment for substance use disorder from the hospital between October 2016 and February 2020. We collected demographic data, details about each commitment episode, and healthcare utilization outcomes 1 year following involuntary commitment. Nearly all patients had a primary alcohol use disorder (91%) and had additional medical (82%) and psychiatric comorbidities (71%). One year following involuntary commitment, all patients had relapsed to substance use and had at least one emergency department visit while 78.6% had at least one admission. These findings suggest that patients discharged to involuntary commitment directly from the hospital universally relapsed and experienced significant medical morbidity during the first year following their release. This study adds to a growing literature recognizing the harms of involuntary commitment for substance use disorder.
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Affiliation(s)
- John C Messinger
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
- Brigham and Women's Hospital, Boston, MA, USA.
| | - Lisa Vercollone
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Brigham and Women's Hospital, Boston, MA, USA
- Brigham and Women's Faulkner Hospital, Boston, MA, USA
| | - Scott G Weiner
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Brigham and Women's Hospital, Boston, MA, USA
- Brigham and Women's Faulkner Hospital, Boston, MA, USA
| | - William Bromstedt
- Brigham and Women's Hospital, Boston, MA, USA
- Brigham and Women's Faulkner Hospital, Boston, MA, USA
| | - Carol Garner
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Brigham and Women's Hospital, Boston, MA, USA
- Brigham and Women's Faulkner Hospital, Boston, MA, USA
| | | | - Joshua W Joseph
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Brigham and Women's Hospital, Boston, MA, USA
- Brigham and Women's Faulkner Hospital, Boston, MA, USA
| | - Leon D Sanchez
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Brigham and Women's Hospital, Boston, MA, USA
- Brigham and Women's Faulkner Hospital, Boston, MA, USA
| | - Dana Im
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Brigham and Women's Hospital, Boston, MA, USA
- Brigham and Women's Faulkner Hospital, Boston, MA, USA
| | - Alice K Bukhman
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Brigham and Women's Hospital, Boston, MA, USA
- Brigham and Women's Faulkner Hospital, Boston, MA, USA
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Jones G, Al-Suwaidi M, Castro-Ramirez F, McGuire TC, Mair P, Nock MK. Race and ethnicity moderate the associations between lifetime psilocybin use and crime arrests. Front Psychiatry 2023; 14:1169692. [PMID: 37692301 PMCID: PMC10484513 DOI: 10.3389/fpsyt.2023.1169692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 08/07/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction Psilocybin use has been linked to lowered odds of crime-related outcomes across a host of observational studies. No studies have investigated how these associations may differ among those of different races and ethnicities. Methods Using a nationally-representative sample of 734,061 adults from the National Survey on Drug Use and Health (2002-2020), we investigated whether race and ethnicity moderate the associations between lifetime psilocybin use and four measures of crime arrests (property crime, assault, serious violence, and miscellaneous crimes). Results First, we replicated prior findings and demonstrated that psilocybin confers lowered odds of crime arrests for all four outcomes in question. Second, we demonstrated that race and ethnicity moderate the associations between lifetime psilocybin use and crime arrests for three of our four outcomes. Third, we examined the associations between psilocybin and crime arrests across different races and ethnicities (White, Black, Indigenous, Asian, Multiracial, and Hispanic participants). Psilocybin conferred lowered odds of at least one crime arrest outcome for all racial and ethnic groups except for Black and Hispanic participants. Discussion Future investigations should take an intersectional approach to studying the interrelationship of sociodemographic factors, psychedelic use, and crime, examine the structural factors (i.e., systemic racism) that may underlie these results, and investigate whether psychedelics can alleviate mental health disorders that contribute to cycles of recriminalization for communities of color.
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Affiliation(s)
- Grant Jones
- Department of Psychology, Harvard University, Cambridge, MA, United States
| | - Maha Al-Suwaidi
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | | | - Taylor C. McGuire
- Department of Psychology, Harvard University, Cambridge, MA, United States
| | - Patrick Mair
- Department of Psychology, Harvard University, Cambridge, MA, United States
| | - Matthew K. Nock
- Department of Psychology, Harvard University, Cambridge, MA, United States
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Delaney DJ, Stein LAR, Bassett SS, Clarke JG. Motivational interviewing for family planning and reducing risky sexual behavior among incarcerated men nearing release: A randomized controlled pilot study. Psychol Serv 2023; 20:538-552. [PMID: 34735198 PMCID: PMC10354667 DOI: 10.1037/ser0000552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Incarcerated men are at high risk for sexually transmitted infections (STIs) and unintended partner pregnancy postrelease. Limited research has been invested in developing and testing treatments targeting risky sexual behavior and unwanted pregnancy for this at-risk population. Motivational interviewing (MI) is a promising behavioral intervention for decreasing risky sexual behaviors. This study assessed the feasibility and acceptability of MI for family planning and risky sexual behaviors with incarcerated men nearing release. Preliminary efficacy of the MI intervention was also compared to an educational control group. Thirty-two men were assessed at baseline and randomized to one 90-min session. Assessment occurred 2 months after release. MI was feasibly administered, and participants were highly satisfied with both treatments. In addition, those who received MI reported higher rates of condom use with casual partners, higher rates of partner use of hormonal contraceptives, and slightly higher rates of sex that was protected against pregnancy. Increases are readiness to discuss family planning with sexual partners, as well as reported frequency of these discussions, and increases in family planning knowledge were also found in those randomized to MI. The findings from this study indicate the need to further assess MI with this population with a full-scale clinical trial. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Daniel J Delaney
- Department of Psychology, Chafee Social Science Center, University of Rhode Island
| | - L A R Stein
- Department of Psychology, Chafee Social Science Center, University of Rhode Island
| | - Shayna S Bassett
- Department of Psychology, Chafee Social Science Center, University of Rhode Island
| | - Jennifer G Clarke
- Center for Primary Care and Prevention, Memorial Hospital, Brown University
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Harris KN, Kulesza C. Exploring the Impact of Adult-use Cannabis Legalization on Legal System Referrals to Treatment for Cannabis Use: Do Age and Race Have a Moderating Effect? Clin Ther 2023; 45:599-615. [PMID: 37414510 DOI: 10.1016/j.clinthera.2023.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/23/2023] [Accepted: 03/09/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE Despite the progression of recreational cannabis legalization, the legal system remains the largest source of referral to treatment for cannabis use. The legal system's continued practice of requiring participation in cannabis treatment programs raises questions regarding the extent to which individuals who interact with the legal system are monitored for cannabis use post-legalization. This article presents trends in justice-system referrals to treatment for cannabis use in legal and nonlegal states for 2007-2019. The relationship between legalization and justice system treatment referrals for black, Hispanic/Latino, and white adults and juveniles was explored. Given that minority and youth populations are subject to disproportionate levels of cannabis enforcement, legalization is expected to have a weaker relationship with justice-system referral rates in white juveniles and black and Hispanic/Latino adults and juveniles compared to white adults. METHODS Using 2007-2019 data from the Treatment Episode Data Set-Admissions (TEDS-A), variables were created for state-level rates of legal system-referred treatment admissions for cannabis use in black, Hispanic/Latino, and white adults and juveniles. Rate trends were compared across populations and staggered difference-in-difference and event analyses were conducted to determine whether legalization is associated with a decline in justice-system referrals to treatment for cannabis use . FINDINGS For the study period, the mean rate of legal system-referred admissions in the total population was 2.75 per 10,000 residents. Black juveniles had the highest mean rate (20.16), followed by Hispanic/Latino juveniles (12.35), black adults (9.18), white juveniles (7.58), Hispanic/Latino adults (3.42), and white adults (1.66). Legalization did not have a significant impact on treatment-referral rates in any population of study. Events analyses indicated significant rate increases in black juveniles in legalized states compared to controls at 2 and 6 years after policy change, and in black and Hispanic/Latino adults at 6 years after policy change (all, P < 0.05). While racial/ethnic disparities in referral rates declined in absolute terms, the relative size of these disparities increased in legalized states. IMPLICATIONS TEDS-A captures only publicly funded treatment admissions and relies on the quality of individual-state reporting. Individual-level factors that may impact decisions regarding treatment referrals for cannabis use could not be controlled for. Despite limitations, the present findings suggest that for individuals who interact with the criminal legal system, cannabis use may still result in legal monitoring after reform. The upward trend in legal system referrals for black (but not white) adults and juveniles several years after states legalize cannabis warrants further examination and may reflect continued disparate treatment of these populations at multiple points along the legal-system continuum.
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Hoffmann JA, Alegría M, Alvarez K, Anosike A, Shah PP, Simon KM, Lee LK. Disparities in Pediatric Mental and Behavioral Health Conditions. Pediatrics 2022; 150:e2022058227. [PMID: 36106466 PMCID: PMC9800023 DOI: 10.1542/peds.2022-058227] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2022] [Indexed: 12/31/2022] Open
Abstract
Mental and behavioral health conditions are common among children and adolescents in the United States. The purpose of this state-of the-art review article is to describe inequities in mental and behavioral health care access and outcomes for children and adolescents, characterize mechanisms behind the inequities, and discuss strategies to decrease them. Understanding the mechanisms underlying these inequities is essential to inform strategies to mitigate these health disparities. Half of United States children with a treatable mental health disorder do not receive treatment from a mental health professional. Children and adolescents in racial, ethnic, sexual, sex, and other minority groups experience inequities in access to care and disparities in outcomes for mental and behavioral health conditions. Suicide rates are nearly twice as high in Black compared to White boys 5 to 11 years old and have been increasing disproportionately among adolescent Black girls 12 to 17 years old. Children identifying as a sexual minority have >3 times increased odds of attempting suicide compared to heterosexual peers. Adverse experiences of children living as part of a minority group, including racism and discrimination, have immediate and lasting effects on mental health. Poverty and an uneven geographic distribution of resources also contribute to inequities in access and disparities in outcomes for mental and behavioral health conditions. Strategies to address inequities in mental and behavioral health among United States children include investing in a diverse workforce of mental health professionals, improving access to school-based services, ensuring equitable access to telehealth, and conducting quality improvement with rigorous attention to equity.
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Affiliation(s)
- Jennifer A. Hoffmann
- . Division of Emergency Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine; Chicago, IL
| | - Margarita Alegría
- . Disparities Research Unit, Massachusetts General Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Kiara Alvarez
- . Disparities Research Unit, Massachusetts General Hospital, Department of Medicine, Harvard Medical School, Boston, MA
| | - Amara Anosike
- . Office of Government Relations, Boston Children’s Hospital, Boston, MA
| | | | - Kevin M. Simon
- . Adolescent Substance use and Addiction Program, Boston Children’s Hospital, Boston, Massachusetts; Division of Developmental Medicine, Boston Children’s Hospital, Boston, Massachusetts; Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital, Boston, MA, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Lois K. Lee
- . Division of Emergency Medicine, Boston Children’s Hospital, Boston, MA
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Baker EA, Hamilton M, Culpepper D, McCune G, Silone G. The effect of person‐first language on attitudes toward people with addiction. JOURNAL OF ADDICTIONS & OFFENDER COUNSELING 2022. [DOI: 10.1002/jaoc.12102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Emily A. Baker
- College of Pharmacy The Ohio State University Columbus Ohio USA
| | - Mark Hamilton
- College of Pharmacy The Ohio State University Columbus Ohio USA
| | | | - Grace McCune
- College of Pharmacy The Ohio State University Columbus Ohio USA
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Pinedo M, Zemore S, Mulia N. Black-White differences in barriers to specialty alcohol and drug treatment: findings from a qualitative study. J Ethn Subst Abuse 2022; 21:112-126. [PMID: 31961283 PMCID: PMC7371514 DOI: 10.1080/15332640.2020.1713954] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The objective of this study was to explore, in-depth, differences in barriers to specialty alcohol and drug treatment services between Black and White participants with recent substance use disorders (SUD). We recruited 34 participants with a recent SUD of White and Black racial/ethnic descent for qualitative interviews. Interviews were coded to identify barriers to specialty treatment. We found that barriers related to stigma and lack of social support were more pervasive in the narratives of Blacks as compared to Whites. Results suggest that stigma and lack of perceived social support may impact Blacks more than Whites in seeking SUD treatment.
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Affiliation(s)
- Miguel Pinedo
- The University of Texas at Austin, Department of Kinesiology & Health Education, 2109 San Jacinto Blvd., Stop D3700, Austin, TX 78712-1415
| | - Sarah Zemore
- Alcohol Research Group, 001 Shellmound St., Suite 450, Emeryville, CA 94608
| | - Nina Mulia
- Alcohol Research Group, 001 Shellmound St., Suite 450, Emeryville, CA 94608
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Volkow ND. Addiction should be treated, not penalized. Neuropsychopharmacology 2021; 46:2048-2050. [PMID: 34404909 PMCID: PMC8369862 DOI: 10.1038/s41386-021-01087-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Nora D Volkow
- National Institute on Drug Abuse, Three White Flint North, North Bethesda, MD, USA.
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Mantha S, Nolan ML, Harocopos A, Paone D. Racial disparities in criminal legal system involvement among New York City overdose decedents: Implications for diversion programs. Drug Alcohol Depend 2021; 226:108867. [PMID: 34216870 DOI: 10.1016/j.drugalcdep.2021.108867] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 06/02/2021] [Accepted: 06/08/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Past studies have identified frequent criminal legal system (CLS) involvement among overdose decedents and highlight the need for connecting individuals at risk of overdose with effective interventions during CLS encounters. While some programs divert individuals at risk of overdose to treatment during CLS encounters, eligibility is frequently restricted to those with limited prior CLS involvement. However, differences by race/ethnicity have not been examined. OBJECTIVE We assessed racial disparities in CLS involvement and eligibility for diversion following arrest for misdemeanor drug possession among New York City (NYC) overdose decedents. METHODS We matched death certificates for 5018 NYC residents who died of an unintentional drug overdose between 2008 and 2015 with CLS data and compared CLS involvement by race/ethnicity. We compared prior felony involvement at the first misdemeanor drug arrest by race/ethnicity among 2719 decedents with at least one misdemeanor drug arrest. RESULTS Higher proportions of Black (86 %, 95 % CI: 83.9, 87.9) and Latino (84 %, 95 % CI: 82.2, 86.0) decedents had ever been arrested than White decedents (73 %, 95 % CI: 71.5, 75.2). At the first misdemeanor drug arrest, Black and Latino decedents were twice as likely as White decedents to have a prior felony conviction, adjusted for age at arrest and gender (RR = 2.08, 95 % CI: 1.71, 2.54 and 2.14, 95 % CI: 1.77, 2.59, respectively). CONCLUSIONS Given racial disparities in CLS involvement among NYC overdose decedents, diversion eligibility is inequitable by race/ethnicity. Diversion programs that restrict eligibility based on prior CLS involvement will have racially disparate effects.
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Affiliation(s)
- Shivani Mantha
- NYC Department of Health and Mental Hygiene, Bureau of Alcohol and Drug Use Prevention, Care, and Treatment, 42-09 28th St, Long Island City, NY, 11101, USA.
| | - Michelle L Nolan
- NYC Department of Health and Mental Hygiene, Bureau of Alcohol and Drug Use Prevention, Care, and Treatment, 42-09 28th St, Long Island City, NY, 11101, USA
| | - Alex Harocopos
- NYC Department of Health and Mental Hygiene, Bureau of Alcohol and Drug Use Prevention, Care, and Treatment, 42-09 28th St, Long Island City, NY, 11101, USA
| | - Denise Paone
- NYC Department of Health and Mental Hygiene, Bureau of Alcohol and Drug Use Prevention, Care, and Treatment, 42-09 28th St, Long Island City, NY, 11101, USA
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Kelly LM, Shepherd BF, Becker SJ. Elevated risk of substance use disorder and suicidal ideation among Black and Hispanic lesbian, gay, and bisexual adults. Drug Alcohol Depend 2021; 226:108848. [PMID: 34214885 PMCID: PMC8431829 DOI: 10.1016/j.drugalcdep.2021.108848] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/04/2021] [Accepted: 05/13/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Black and Hispanic persons who identify as lesbian, gay, or bisexual (LGB) experience health disparities relative to non-Hispanic White and heterosexual groups respectively, including higher rates of suicidal ideation (SI) and substance use disorder (SUD). To elucidate intersectional risk, we used a large national sample to examine rates of SI, SUD, and their co-occurrence (SI + SUD) at the intersection of sexual identity and race/ethnicity. METHOD Data were from five years (2015-2019) of the National Survey of Drug Use and Heath (unweighted N = 189,127). Multinomial logistic regressions with persons without SI and SUD as references were stratified by gender and controlled for survey year, age, education, marital status, and income. RESULTS Compared to same-race and same-gender heterosexual adults, White, Black, and Hispanic LGB men and women showed higher odds of SI (AOR = 2.86-4.45), SUD (AOR = 1.23-3.01), and SI + SUD (AOR = 2.72-6.85). Compared to same-gender White heterosexual adults, Black and Latinx heterosexual men and women showed lower odds of SI (AORs = .54-.65), SUD (AORs = .52-.78) and SI + SUD (AORs = .41-.57). Compared to same-gender White LGB adults, Black and Hispanic women, but not men, showed lower SI odds (AORs = .58-.72). Compared to same-gender White heterosexual adults, Black and Hispanic LGB men and women showed higher odds of SI (AORs = 1.71-2.51) and SI + SUD (AORs = 1.91-2.97). CONCLUSIONS Consistent with research showing effects of multiple minority stress on behavioral health, adults with intersecting racial/ethnic and sexual minority identities showed increased odds of SI, SUD, and SI + SUD relative to Non-Hispanic White heterosexual peers. Black, Hispanic, and White LGB adults may benefit from screening and intervention for SI and SUD.
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Affiliation(s)
- Lourah M Kelly
- University of Connecticut School of Medicine, United States.
| | | | - Sara J Becker
- Brown University School of Public Health, United States; Warren Alpert Medical School of Brown University, United States
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The Effects of Race and Ethnicity on Admission, Graduation, and Recidivism in the Milwaukee County Adult Drug Treatment Court. SOCIAL SCIENCES-BASEL 2021. [DOI: 10.3390/socsci10070261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Drug courts play a key role in the criminal justice system by diverting individuals from incarceration and providing them with resources to address substance use issues and reduce criminal recidivism. However, it is unclear whether drug courts reflect—or even exacerbate—preexisting racial/ethnic disparities in the criminal justice system. While prior literature has offered some insight into the influence of race and ethnicity on drug court success, much of the focus has been on outcomes (i.e., program completion and recidivism) rather than disparities at earlier stages (i.e., referral to admittance). The current study adds to this body of research by evaluating the Milwaukee County Adult Drug Treatment Court to examine whether racial/ethnic disparities exist at several stages of the drug court process: (1) referral to admittance, (2) likelihood of graduation, and (3) likelihood of recidivism. Results of the analyses determined racial/ethnic disparities in the likelihood of admission to the drug court, as well as the likelihood of graduation. There were no racial/ethnic disparities found in the likelihood of recidivism. The analyses also identified several additional variables that were influential in the likelihood of admission (risk score, prior record), likelihood of graduation (age, prior record, custody sanctions), and recidivism (drug court outcome).
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Amaro H, Sanchez M, Bautista T, Cox R. Social vulnerabilities for substance use: Stressors, socially toxic environments, and discrimination and racism. Neuropharmacology 2021; 188:108518. [PMID: 33716076 PMCID: PMC8126433 DOI: 10.1016/j.neuropharm.2021.108518] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 02/17/2021] [Accepted: 03/05/2021] [Indexed: 12/13/2022]
Abstract
Applying a social determinants of health framework, this review brings attention to evidence from social sciences and neuroscience on the role of selected social factors in individual and population-level vulnerability to substance use and substance use disorders (SUDs). The understanding that social vulnerability to substance use and SUDs is multifaceted and occurs across different levels of influence (individual, interpersonal, community, and societal) is underscored. We propose that socially based stressors play a critical role in creating vulnerability to substance use and SUDs, and as such, deserve greater empirical attention to further understand how they "get under the skin." Current knowledge from social sciences and neuroscience on the relationships among vulnerability to substance use resulting from stressors, exposure to socially toxic childhood environments, and racism and discrimination are summarized and discussed, as are implications for future research, practice, and policy. Specifically, we propose using a top-down approach to the examination of known, yet often unexplored, relationships between vulnerability to substance use and SUDs, related inequities, and potential differential effects across demographic groups. Finally, research gaps and promising areas of research, practice, and policy focused on ameliorating social vulnerabilities associated with substance use and SUDs across the lifespan are presented. This article is part of the special issue on 'Vulnerabilities to Substance Abuse'.
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Affiliation(s)
- Hortensia Amaro
- Herbert Wertheim College of Medicine and Robert Stempel College of Public Health and Social Work, Florida International University, United States.
| | - Mariana Sanchez
- Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, United States.
| | - Tara Bautista
- Yale Stress Center, School of Medicine, Yale University, United States.
| | - Robynn Cox
- Suzanne Dworak-Peck School of Social Work, Schaeffer Center for Health Policy and Economics, And Edward R. Roybal Institute on Aging, University of Southern California, United States.
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Rowell-Cunsolo TL, Bellerose M. Utilization of substance use treatment among criminal justice-involved individuals in the United States. J Subst Abuse Treat 2021; 125:108423. [PMID: 33906780 DOI: 10.1016/j.jsat.2021.108423] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
Over six million individuals are involved with the criminal justice system in the United States, of which a large proportion report extensive substance use. We examined the extent to which criminal justice-involvement affects substance use treatment utilization among participants from one of the largest annual surveys on substance use in the U.S., the National Survey on Drug Use and Health (NSDUH). Multivariable logistic regression analyses indicated that criminal justice involvement was significantly associated with receiving substance use treatment in the past year (AOR 8.00, 95% CI: 6.23-10.27, p < 0.001). However, those with criminal justice histories continue to face barriers to treatment. Among individuals ages 12 and older who reported past year criminal justice involvement and met criteria for a substance use disorder, 18.9% reported receiving past year substance use treatment. After controlling for key demographic and drug use characteristics in a multivariable logistic regression model, Black criminal justice involved Americans were somewhat less likely to report receiving substance use treatment in the past year compared to White criminal justice involved Americans, although the association was not significant (AOR 0.87, 95% CI 0.58-1.29, p = 0.481). Treatment programs targeted to increase minority engagement and address persistent barriers to substance use treatment may be valuable for curbing substance use and recidivism among criminal justice-involved individuals.
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Affiliation(s)
- Tawandra L Rowell-Cunsolo
- University of Wisconsin-Madison School of Social Work, 1350 University Avenue Madison, WI 53706, United States of America.
| | - Meghan Bellerose
- Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, United States of America
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Banks A, Fields L. Correlates of Incarceration of Fathers, Socioeconomic Influences, and Mental Illness. SOCIAL WORK IN PUBLIC HEALTH 2021; 36:26-37. [PMID: 33252019 DOI: 10.1080/19371918.2020.1851842] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The United States leads globally in incarceration. Incarceration can disrupt families in both immediate and long-term ways, including finances and mental illness. We examined the relationship between father incarceration during adolescence and the development of mental illness in adulthood as well as the relationship of household assets and debts in relation to the mental illness outcomes. Wave IV data of the National Longitudinal Study of Adolescent to Adult Health were used with a final analytic sample of 2129 participants. Data were analyzed using MANOVA in Stata 13.1. The findings indicated that biological father incarceration correlates with more adolescent mental illness. Enhanced model residuals were also significant for father incarceration, household assets, and household debts. Incarceration of biological fathers correlates with poorer mental health outcomes. Household assets and debts correlate with changes in adolescent outcomes as well, giving us more target areas for intervention development and testing. Clinically, assessing for adolescent experiences with father incarceration may be useful in supporting improved mental health over the life course. Policy work should give more attention to promotion of health and well-being of adolescents via reduction of the negative experience of fathers serving and/or having served time in prison. More discussion on family-level assets and debts is warranted to promote health and well-being for adolescents and adults.
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Affiliation(s)
- Andrae Banks
- Department of Social Work, North Carolina Central University, Durham, United States
| | - LaShawnda Fields
- Brown School of Social Work, Washington University in St. Louis, St Louis, United States
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Kanu LN, Jang I, Oh DJ, Tiwana MS, Mehta AA, Dikopf MS, Vajaranant TS, Aref AA, Edward DP. Glaucoma Care of Prison Inmates at an Academic Hospital. JAMA Ophthalmol 2020; 138:358-364. [PMID: 32077908 DOI: 10.1001/jamaophthalmol.2020.0001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance Glaucoma care for prison inmates is underrepresented in the literature even though managing the treatment of such patients may provide unique challenges. Objectives To evaluate the glaucoma profile of prison inmates treated at an academic ophthalmology center and to report on the medical and surgical management and follow-up metrics. Design, Setting, and Participants This retrospective cohort study assessed data from 82 incarcerated patients treated at the glaucoma clinic, an academic referral center at the University of Illinois at Chicago, between January 2013 and December 2017. Main Outcomes and Measures Diagnosis, glaucoma severity, medical and surgical interventions, and patient-reported medication adherence were recorded for each visit. Recommended and actual follow-up times were recorded and compared. Data analyses were conducted from January 2013 to December 2018. Results In total, 82 patients (161 eyes) had 375 visits during the study period. All patients were male and ranged from 20 to 75 years of age (mean [SD] age, 50.8 [11.9] years). Most participants were black patients (65 [79.3%]). The most common diagnoses were primary open-angle glaucoma (POAG; 53 eyes [32.9%]) and POAG suspect (52 eyes [32.3%]). Glaucoma severity ranged from mild (25 of 77 eyes [32.5%]) to advanced (41 of 77 eyes [53.2%]). Overall, 59 patients (73.2%) were treated medically with up to 4 topical agents (40.0%). Of those treated, 70.0% of patients (95% CI, 57.7%-81.2%) reported medication nonadherence during at least 1 visit. Medication nonadherence was more common among those taking 4 different topical medications (21 of 24 [87.5%]) compared with others taking fewer medications (20 of 35 [57.1%]), for a difference of 30.4% (95% CI, 7.0%-53.6%; P = .02), and among those with advanced disease (22 of 26 [84.6%]) compared with glaucoma suspect (6 of 13 [46.2%]), for a difference of 38.4% (95% CI, 9.3%-67.5%; P = .02). Nineteen office procedures, including laser peripheral iridotomy and laser trabeculoplasty, were performed on 14 eyes. Seventeen incisional glaucoma procedures were performed on 15 eyes, including glaucoma drainage device implant (11 procedures [64.7%]) and trabeculectomy (3 procedures [17.6%]). Only 26.6% of return office visits (95% CI, 21.3%-32.3%) occurred within the recommended follow-up time frame. Furthermore, 93 patients (34.8%; 95% CI, 28.2%-40.0%) were seen more than 1 month after the recommended follow-up. Conclusions and Relevance Despite incarceration in prison, where medication administration and appointment attendance are theoretically controlled, the results of this study suggested that substantial medication and follow-up nonadherence exists among inmates.
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Affiliation(s)
- Levi N Kanu
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago
| | - Inae Jang
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago
| | - Daniel J Oh
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago
| | - Manpreet S Tiwana
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago
| | - Amy A Mehta
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago
| | - Mark S Dikopf
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago
| | | | - Ahmad A Aref
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago
| | - Deepak P Edward
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago.,King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Pickard JG, Sacco P, van den Berk-Clark C, Cabrera-Nguyen EP. The effect of legal mandates on substance use disorder treatment completion among older adults. Aging Ment Health 2020; 24:497-503. [PMID: 30588828 DOI: 10.1080/13607863.2018.1544209] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objective: This study seeks to determine the relationship between referral type (legally mandated versus non-mandated) and substance use disorder (SUD) treatment completion among older adults and by primary substance used.Method: We used data from the Treatment Episode Data Set - Discharges (TEDS-D) from 2011. Using data for persons age 55 and over (n = 104,747), we used propensity score matching (PSM) to address selection bias and attenuate the likelihood of a type I error. Logistic regression models estimated the effect of referral type on treatment completion based on treatment for a primary substance for five categories of substances.Results: In the matched sample, those who faced treatment mandates had 71% greater odds of completing treatment compared with those who entered treatment voluntarily (OR =1.71, 95% CI [1.64, 1.79]). Based on the primary drug used, odds of treatment completion were highest for alcohol, with 86% greater treatment completion for the mandated individuals compared with those entering treatment without a legal mandate (OR =1.86, 95% CI [1.75, 1.97]).Conclusion: These findings suggest that the motivating influence of treatment mandates may encourage completion of SUD treatment among older adults. Although the legal mandates for treatment are punitive, they may act to keep older adults with SUD engaged in treatment, an important factor as treatment completion is inversely related to relapse of a SUD.
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Affiliation(s)
- Joseph G Pickard
- University of Missouri-St. Louis, School of Social Work, St. Louis, MO, USA
| | - Paul Sacco
- University of Maryland-Baltimore, School of Social Work, Baltimore, MD, USA
| | - Carissa van den Berk-Clark
- Saint Louis University School of Medicine, Department of Family and Community Medicine, St. Louis, MO, USA
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Vélez-Pastrana MC, González RA, Ramos-Fernández A, Ramírez Padilla RR, Levin FR, Albizu García C. Attention Deficit Hyperactivity Disorder in Prisoners: Increased Substance Use Disorder Severity and Psychiatric Comorbidity. Eur Addict Res 2020; 26:179-190. [PMID: 32615575 DOI: 10.1159/000508829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/18/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Attention deficit hyperactivity disorder (ADHD) and substance use disorders (SUD) are overrepresented among incarcerated populations. We examined whether ADHD was associated with increased severity of comorbid SUD and with increased psychiatric comorbidity among prisoners. METHODS Cross-sectional study of 500 randomly selected Latino male prisoners in the Puerto Rico Correctional System using validated diagnostic measures to assess Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) ADHD and SUD diagnosis, antisocial personality disorder (ASP) and borderline personality disorder (BPD), major depression, and generalized anxiety disorder (GAD). We defined SUD severity by symptom count and by presence of at least 2 current SUD diagnoses (polysubstance). RESULTS Participants with ADHD had increased risk for lifetime (p < 0.05) and current (p < 0.01) SUDs, all comorbid psychiatric disorders, and suicidality (p < 0.001). They had more severe SUD, both in number of symptoms and number of SUD (polysubstance) diagnoses (p < 0.01). ADHD was associated with increased psychiatric comorbidity, as participants with ADHD were more likely to have a second diagnosis, and a greater number of comorbid disorders (p < 0.001). ASP, BPD, major depression, and GAD, but not ADHD, were significant predictors of SUD severity in adjusted models. CONCLUSIONS Findings highlight the complex mental health needs of incarcerated populations, where SUD, ADHD, and other psychiatric disorders are prevalent and interrelated.
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Affiliation(s)
- María C Vélez-Pastrana
- PhD Program in Clinical Psychology, Universidad Carlos Albizu, San Juan, Puerto Rico, .,Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, Rio Piedras, Puerto Rico, USA,
| | - Rafael A González
- National Adoption and Fostering Service & National Conduct Problems Team, Michael Rutter Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom.,Centre for Psychiatry, Division of Brain Sciences, Department of Medicine, Imperial College London, London, United Kingdom
| | | | - Rafael R Ramírez Padilla
- Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, Rio Piedras, Puerto Rico, USA
| | - Frances R Levin
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Carmen Albizu García
- Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, Rio Piedras, Puerto Rico, USA
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20
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State criminal justice policy context and opioid agonist treatment delivery among opioid treatment admissions, 2015. Drug Alcohol Depend 2020; 206:107654. [PMID: 31735533 PMCID: PMC7377924 DOI: 10.1016/j.drugalcdep.2019.107654] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/23/2019] [Accepted: 09/10/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Criminal justice referral to treatment is associated with reduced odds of receiving opioid agonist treatment (OAT), the gold-standard treatment for opioid use disorder. States vary substantially in the extent of criminal justice system involvement in opioid treatment; however, the effects on treatment provision are not clear. We examined whether state-level criminal justice involvement in the substance use treatment system modified the association between criminal justice referral to treatment and OAT provision among opioid treatment admissions. METHODS We conducted a random effects logistic regression to investigate how the effects of criminal justice referral to treatment on OAT provision differed in states with high vs. low state-level criminal justice involvement in opioid treatment, adjusting for individual and state-level covariates, among 22 states in the 2015 Treatment Episode Dataset-Admissions. RESULTS Criminal justice referral to treatment was associated with an 85% reduction in the odds of receiving OAT, compared to other sources of treatment referral (OR = 0.15; 95% CI: 0.15, 0.16). Among opioid treatment admissions resulting from criminal justice referral in 2015, receiving treatment in high criminal justice involvement states was associated with a 63% reduction in the odds of OAT provision, compared to opioid treatment received in low criminal justice involvement states (interaction OR = 0.37, 95% CI: 0.11, 0.89). CONCLUSION The effects of criminal justice referral to treatment on OAT provision varied by criminal justice involvement in opioid treatment at the state level. Targeted interventions should increase access to OAT in states that rely on the criminal justice system for opioid treatment referrals.
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21
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Ferrer B, Connolly JM. Racial Inequities in Drug Arrests: Treatment in Lieu of and After Incarceration. Am J Public Health 2019; 108:968-969. [PMID: 29995492 DOI: 10.2105/ajph.2018.304575] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Barbara Ferrer
- Barbara Ferrer is the Director of the Los Angeles County Department of Public Health, Baldwin Park, CA. John M. Connolly is the Division Director of the Substance Abuse Prevention and Control at the Los Angeles County Department of Public Health
| | - John M Connolly
- Barbara Ferrer is the Director of the Los Angeles County Department of Public Health, Baldwin Park, CA. John M. Connolly is the Division Director of the Substance Abuse Prevention and Control at the Los Angeles County Department of Public Health
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22
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Mooney AC, Giannella E, Glymour MM, Neilands TB, Morris MD, Tulsky J, Sudhinaraset M. Racial/Ethnic Disparities in Arrests for Drug Possession After California Proposition 47, 2011-2016. Am J Public Health 2018; 108:987-993. [PMID: 29927653 DOI: 10.2105/ajph.2018.304445] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate the effects of California Proposition 47, which reclassified felony drug offenses to misdemeanors in 2014, on racial/ethnic disparities in drug arrests. METHODS Using data on all drug arrests made in California from 2011 to 2016, we compared racial/ethnic disparities in drug arrests between Whites, Blacks, and Latinos, immediately and 1 year after policy changes, controlling for secular and seasonal trends. RESULTS In the month following passage, absolute Black-White disparities in monthly felony drug arrests decreased from 81 to 44 per 100 000 and continued to decrease over time. There was an immediate increase of 27% in the relative disparity, however, because a higher proportion of felony offense types among Whites was reclassified. Total drug arrest rates also declined, suggesting drug law enforcement was deprioritized. During the first year after enactment, felony drug arrests fell by an estimated 51 985 among Whites, 15 028 among Blacks, and 50 113 among Latinos. CONCLUSIONS Reducing criminal penalties for drug possession can reduce racial/ethnic disparities in criminal justice exposure and has implications for improving health inequalities linked to social determinants of health.
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Affiliation(s)
- Alyssa C Mooney
- Alyssa C. Mooney, M. Maria Glymour, and Meghan D. Morris are with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Eric Giannella is with the California Department of Justice, Oakland. Torsten B. Neilands is with the Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco. Jacqueline Tulsky is with the Department of Medicine, University of California, San Francisco. May Sudhinaraset is with the Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles
| | - Eric Giannella
- Alyssa C. Mooney, M. Maria Glymour, and Meghan D. Morris are with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Eric Giannella is with the California Department of Justice, Oakland. Torsten B. Neilands is with the Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco. Jacqueline Tulsky is with the Department of Medicine, University of California, San Francisco. May Sudhinaraset is with the Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles
| | - M Maria Glymour
- Alyssa C. Mooney, M. Maria Glymour, and Meghan D. Morris are with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Eric Giannella is with the California Department of Justice, Oakland. Torsten B. Neilands is with the Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco. Jacqueline Tulsky is with the Department of Medicine, University of California, San Francisco. May Sudhinaraset is with the Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles
| | - Torsten B Neilands
- Alyssa C. Mooney, M. Maria Glymour, and Meghan D. Morris are with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Eric Giannella is with the California Department of Justice, Oakland. Torsten B. Neilands is with the Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco. Jacqueline Tulsky is with the Department of Medicine, University of California, San Francisco. May Sudhinaraset is with the Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles
| | - Meghan D Morris
- Alyssa C. Mooney, M. Maria Glymour, and Meghan D. Morris are with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Eric Giannella is with the California Department of Justice, Oakland. Torsten B. Neilands is with the Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco. Jacqueline Tulsky is with the Department of Medicine, University of California, San Francisco. May Sudhinaraset is with the Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles
| | - Jacqueline Tulsky
- Alyssa C. Mooney, M. Maria Glymour, and Meghan D. Morris are with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Eric Giannella is with the California Department of Justice, Oakland. Torsten B. Neilands is with the Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco. Jacqueline Tulsky is with the Department of Medicine, University of California, San Francisco. May Sudhinaraset is with the Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles
| | - May Sudhinaraset
- Alyssa C. Mooney, M. Maria Glymour, and Meghan D. Morris are with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Eric Giannella is with the California Department of Justice, Oakland. Torsten B. Neilands is with the Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco. Jacqueline Tulsky is with the Department of Medicine, University of California, San Francisco. May Sudhinaraset is with the Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles
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The 21st Century Cures Act Implications for the Reduction of Racial Health Disparities in the US Criminal Justice System: a Public Health Approach. J Racial Ethn Health Disparities 2017; 5:885-893. [PMID: 29124683 DOI: 10.1007/s40615-017-0435-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/08/2017] [Accepted: 09/25/2017] [Indexed: 10/18/2022]
Abstract
Past drug epidemics have disproportionately criminalized drug addiction among African Americans, leading to disparate health outcomes, increased rates of HIV/AIDS, and mass incarceration. Conversely, the current opioid addiction crisis in the USA focuses primarily on white communities and is being addressed as a public health problem. The 21st Century Cures Act has the potential to reduce racial health disparities in the criminal justice system through the Act's public health approach to addiction and mental health issues. The 21st Century Cures Act is a progressive step in the right direction; however, given the historical context of segregation and the criminalization of drug addiction among African Americans, the goals of health equity are at risk of being compromised. This paper discusses the implications of this landmark legislation and its potential to decrease racial health disparities, highlighting the importance of ensuring that access to treatment and alternatives to incarceration must include communities of color. In this paper, the authors explain the key components of the 21st Century Cures Act that are specific to criminal justice reform, including a key objective, which is treatment over incarceration. We suggest that without proper attention to how, and where, funding mechanisms are distributed, the 21st Century Cures Act has the potential to increase racial health disparities rather than alleviate them.
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24
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Jäggi LJ, Mezuk B, Watkins DC, Jackson JS. The Relationship between Trauma, Arrest, and Incarceration History among Black Americans: Findings from the National Survey of American Life. SOCIETY AND MENTAL HEALTH 2016; 6:187-206. [PMID: 27795871 PMCID: PMC5079438 DOI: 10.1177/2156869316641730] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Prior research indicates an association between exposure to trauma (e.g., being victimized) and perpetration of crime, especially in the context of chronic victimization. This study examines the relationship between trauma exposure, posttraumatic stress disorder (PTSD), and history of arrest and incarceration among a representative sample of black Americans from the National Survey of American Life (N = 5,189). One-third had a history of arrest, and 18 percent had a history of incarceration. Frequency of trauma exposure was associated with involvement with the criminal justice system. Relative to never experiencing trauma, experiencing ≥4 traumas was associated with elevated odds of arrest (odds ratio [OR] = 4.03), being jailed (OR = 5.15), and being imprisoned (OR = 4.41), all p <.01. PTSD was also associated with likelihood of incarceration among those with a history of trauma (OR = 2.18, p <.01). Both trauma exposure and trauma-associated psychopathology are associated with increased likelihood of arrest and incarceration in adulthood among black Americans.
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Affiliation(s)
| | - Briana Mezuk
- Virginia Commonwealth University, Richmond, VA, USA
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25
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McElrath K, Taylor A, Tran KK. Black-White Disparities in Criminal Justice Referrals to Drug Treatment: Addressing Treatment Need or Expanding the Diagnostic Net? Behav Sci (Basel) 2016; 6:bs6040021. [PMID: 27706092 PMCID: PMC5197934 DOI: 10.3390/bs6040021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 09/11/2016] [Accepted: 09/28/2016] [Indexed: 11/23/2022] Open
Abstract
Slightly more than half of admissions to U.S. publicly-funded treatment for marijuana use are referred by the criminal justice system; this pattern has remained for at least 20 years. Nationally, Blacks comprise nearly a third of treatment admissions for marijuana use. This article explores the interplay between race and criminal justice referrals to treatment for marijuana use. Using data from the (U.S.) 2011 Treatment Episode Data Set, we examine the relationship between race and diagnosis of cannabis use disorder (dependence versus abuse) among referrals to community-based treatment in North Carolina. We compare Black/White differences in cannabis diagnoses across four referral sources: the criminal justice system, healthcare providers, self, and other sources. Race was significantly related to type of diagnosis across all four referral sources, however, the nature of the relationship was distinctly different among criminal justice referrals with Whites being more likely than Blacks to be diagnosed with cannabis dependence. Moreover, the marijuana use profiles of criminal justice referrals differed substantially from individuals referred by other sources. The findings suggest that diagnoses of cannabis abuse (rather than dependence) may have worked to widen the diagnostic net by “capturing” individuals under control of the criminal justice system who manifested few problems with marijuana use, other than their involvement in the criminal justice system. The potential for a net-widening effect appeared to be most pronounced for Blacks.
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Affiliation(s)
- Karen McElrath
- Department of Criminal Justice, Fayetteville State University, 1200 Murchison Road, Fayetteville, NC 28301, USA.
| | - Angela Taylor
- Department of Criminal Justice, Fayetteville State University, 1200 Murchison Road, Fayetteville, NC 28301, USA.
| | - Kimberly K Tran
- Department of Psychology, Fayetteville State University, 1200 Murchison Road, Fayetteville, NC 28301, USA.
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Lum K, Swarup S, Eubank S, Hawdon J. The contagious nature of imprisonment: an agent-based model to explain racial disparities in incarceration rates. J R Soc Interface 2015; 11:20140409. [PMID: 24966237 PMCID: PMC4233690 DOI: 10.1098/rsif.2014.0409] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We build an agent-based model of incarceration based on the susceptible–infected–suspectible (SIS) model of infectious disease propagation. Our central hypothesis is that the observed racial disparities in incarceration rates between Black and White Americans can be explained as the result of differential sentencing between the two demographic groups. We demonstrate that if incarceration can be spread through a social influence network, then even relatively small differences in sentencing can result in large disparities in incarceration rates. Controlling for effects of transmissibility, susceptibility and influence network structure, our model reproduces the observed large disparities in incarceration rates given the differences in sentence lengths for White and Black drug offenders in the USA without extensive parameter tuning. We further establish the suitability of the SIS model as applied to incarceration by demonstrating that the observed structural patterns of recidivism are an emergent property of the model. In fact, our model shows a remarkably close correspondence with California incarceration data. This work advances efforts to combine the theories and methods of epidemiology and criminology.
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Affiliation(s)
- Kristian Lum
- Network Dynamics and Simulation Science Laboratory, Virginia Bioinformatics Institute, Virginia Tech, Blacksburg, VA, USA
| | - Samarth Swarup
- Network Dynamics and Simulation Science Laboratory, Virginia Bioinformatics Institute, Virginia Tech, Blacksburg, VA, USA
| | - Stephen Eubank
- Network Dynamics and Simulation Science Laboratory, Virginia Bioinformatics Institute, Virginia Tech, Blacksburg, VA, USA
| | - James Hawdon
- Department of Sociology, Virginia Tech, Blacksburg, VA, USA
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Nowotny KM. Race/ethnic disparities in the utilization of treatment for drug dependent inmates in U.S. state correctional facilities. Addict Behav 2015; 40:148-53. [PMID: 25270722 DOI: 10.1016/j.addbeh.2014.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 08/23/2014] [Accepted: 09/03/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Research has documented racial and ethnic disparities in utilization, access, continuity, and quality of care for psychiatric disorders including treatment for substance use disorders among those with similar need in the general community. Currently, the extent of racial and ethnic disparities in treatment within U.S. correctional facilities is unknown. METHODS This study examines race/ethnic disparities in treatment for drug dependent inmates using the 2004 Survey of Inmates in State Correctional Facilities. Fixed effects logistic regression is used to analyze treatment outcomes for 5180 inmates housed within 286 prisons. The analysis accounts for differences in background characteristics (i.e., age, gender, marital status, foreign born status, veteran status), socioeconomic characteristics (i.e., education, employment prior to incarceration), mental health (i.e., diagnosis with a serious mental illness), and incarceration experiences (i.e., current conviction, previous incarceration episodes, time served, additional sentencing requirements, external social support, disciplinary violations). RESULTS The findings identify a remarkable unmet need among drug dependent inmates in that less than one-half of drug dependent inmates had received any type of treatment in prison at the time of the interview with the most common treatment type being self-help groups. Compared to whites, drug dependent Latino inmates have significantly lower odds of utilizing treatment, yet there are no significant black--white disparities found. CONCLUSION The current study suggests that treatment for drug dependent inmates needs to be expanded to include clinically or medically based treatment since the failure to address addictions in the criminal legal system has been identified as the single most significant reason for rearrest and recidivism once released.
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Gender and race/ethnicity differences for initiation of alcohol-related service use among persons with alcohol dependence. Drug Alcohol Depend 2014; 140:48-55. [PMID: 24780308 PMCID: PMC4079072 DOI: 10.1016/j.drugalcdep.2014.03.010] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 03/04/2014] [Accepted: 03/05/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND Prior studies on treatment for alcohol-related problems have yielded mixed results with respect to gender and race/ethnicity disparities. Additionally, little is known about gender and racial differences in time to first alcohol-related service contact amongst persons with alcohol dependence. This study explored gender and race/ethnicity differences for first alcohol-related service utilization in a population-based sample. METHODS Primary analyses were restricted to Blacks, Whites and Hispanics, ages 18-44, with lifetime alcohol dependence (n=3311) in Wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions. We compared time to service use among men and women within and across race/ethnicity strata using multivariable Cox proportional hazard methods. RESULTS In the sample of individuals age <45 with alcohol dependence, only 19.5% reported alcohol-related service use. Overall, women were less likely than men to receive alcohol-related services in their lifetime. However, women who did receive treatment were younger at first service utilization and had a shorter interval between drinking onset and service use than men. Gender differences were consistent across racial/ethnic groups but only statistically significant for Whites. There were no appreciable race/ethnicity differences in hazard ratios for alcohol-related service use or time from drinking initiation to first service contact. Results of sensitivity analyses for persons ≥45 years old are discussed. CONCLUSIONS There are important gender differences in receipt of and time from drinking initiation to service utilization among persons with alcohol dependence. Increased recognition of these differences may promote investigation of factors underlying differences and identification of barriers to services.
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MacDonald J, Arkes J, Nicosia N, Pacula RL. Decomposing Racial Disparities in Prison and Drug Treatment Commitments for Criminal Offenders in California. THE JOURNAL OF LEGAL STUDIES 2014; 43:155-187. [PMID: 25382877 PMCID: PMC4219536 DOI: 10.1086/675728] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Blacks convicted of drug-related offenses in the U.S. have higher prison-commitment rates than Whites. Studies have been largely unsuccessful in explaining these disparities. This study uses administrative data from a random sample of individuals arrested for drug offenses in California to examine this issue. We use a decomposition model to estimate whether Black-White disparities in commitments to prison or diversions to drug treatment are attributable to differences in the characteristics of criminal cases and whether case characteristics are weighed differently by race. We also examine whether the influence of case characteristics changes after California implemented Proposition 36, which was a mandatory prison diversion program for eligible drug offenders. Our results suggest that Black-White differences in prison commitments are fully explained by criminal case characteristics, but that a significant portion of the differences in treatment diversions remain unexplained. The unexplained variation in drug treatment also does not change after Proposition 36. These findings suggest that case characteristics play a larger role in explaining prison commitments for drug offenders than the discretion of prosecutors and judges. By contrast, diversion to drug treatment appears to be driven more by the discretion of court officials and Black-White disparities remain prominent.
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