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

> **NIH NIH R01** · COLUMBIA UNIVERSITY HEALTH SCIENCES · 2024 · $722,566

## Abstract

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 an...

## Key facts

- **NIH application ID:** 10929937
- **Project number:** 5R01DA055606-02
- **Recipient organization:** COLUMBIA UNIVERSITY HEALTH SCIENCES
- **Principal Investigator:** Pia M. Mauro
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $722,566
- **Award type:** 5
- **Project period:** 2023-09-15 → 2028-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10929937

## Citation

> US National Institutes of Health, RePORTER application 10929937, Substance use treatment and county incarceration: Reducing inequities in substance use treatment need, availability, use, and outcomes (5R01DA055606-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10929937. Licensed CC0.

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