Examining the Impact of the Criminal Legal System on Opioid Use Disorder Treatment and Recovery: A Socioecological Perspective

Enter the text here that is the new abstract information for your application. This section must be no longer than 30 lines of text. The proposed R36 dissertation project will advance scientific understanding of the criminal legal system’s (CLS) influence on opioid use disorder (OUD) recovery. CLS involvement is common among those with OUD, and for many, the CLS facilitates access to recovery services, either through provision of treatment or connection to care upon release. There is an inherent role contradiction present here; since the CLS also is tasked with maintaining public safety, there could be unintended consequences on a person's recovery. The proposed mixed-methods study aligns with the NIDA Services Research Branch priority to better understand the impact of CLS involvement on substance use, service engagement, and recovery. This project uses a socioecological framework to enhance understanding of the community, interpersonal, and individual-level influence of CLS involvement on OUD treatment and recovery. Aim 1 examines the impact of the CLS on OUD treatment and recovery language among people residing and working in communities highly impacted by the opioid epidemic (community). This is achieved via qualitative thematic analysis of Photovoice group transcripts (N = 45 participants) from the Kentucky HEALing Communities Study Photovoice protocol. Aim 2 analyzes the effect of social network factors on prison substance use disorder (SUD) treatment completion (interpersonal). Aim 2 is achieved by conducting secondary data analysis using data from the Geographic variation in Addiction Treatment Environment (GATE) study, a longitudinal cohort study examining medication use for OUD treatment and other recovery outcomes of individuals who participated in SUD treatment programming while incarcerated (N = 320). Aim 2 uses logistic regression to analyze whether internalized stigma mediates the relationship between social network factors and SUD treatment completion. Finally, Aim 3 uses GATE study data to evaluate CLS-related predictors of participation in mutual aid support groups (e.g., Narcotics Anonymous) post-release (individual). Negative binomial logistic regression analyzes the effect of CLS-related factors on the number of mutual support groups attended in the 6-months after release. Results of this project highlight the urgent need to address the multi-level impact of the CLS on OUD recovery to combat the opioid epidemic among people involved with the CLS. The R36 aims will serve as the applicant’s dissertation. OUD recovery is not merely an individual process, so barriers to recovery must be addressed at multiple levels of CLS influence to best effect change and have a sustained public health impact. The R36 dissertation project outlined in this application launches the Principal Investigator on a path towards becoming an NIH independent investigator.