Date of Award

January 2012

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Frederick L. Altice

Subject Area(s)

Public health, Mental health, Public policy

Abstract

In light of the dramatic rise in incarceration due to the "War on Drugs," we explored the contributing factors to substance abuse treatment (SAT) programming - in particular, evidence-based treatments like medication assisted therapy (MAT) - implementation in United States correctional settings (including jails, prisons, and community corrections facilities). We hypothesized that current funding availability would be the primary factor preventing and contributing to program implementation, but further hypothesized that an array of secondary factors such as overcrowding, geographic location, facility type, and attitudes and knowledge about MAT would also play a role. We mailed a survey to an enriched sample of 225 correctional units' administrators (57 jails, 129 prisons, and 40 community corrections units) across the country, selecting for units previously identified by a national survey as being located in areas particularly likely to be affected by high rates of drug-related crime. 54.9% responded. As was previously recognized, a majority (81.5%) of units reported some form of SAT programming, but low levels of MAT implementation were identified (16.1%, a majority of which was methadone). Funding cuts were identified as the most pressing barrier to future treatment implementation as well as the greatest contributor to recent SAT program closure. However, Other factors, such as offender need and recidivism reduction were identified as factors contributing to program opening. Some geographic trends were noted, with respondents from the Southeastern US reporting less MAT availability as well as less willingness to implement it. Some differences were also noted across facility types, with jails much more likely than either prisons or community corrections to implement MAT. In a multivariate regression model, respondent score on a scale measuring attitudes towards methadone programming was the only factor significantly associated with current implementation of MAT. Both attitudes score and recent increases in SAT-specific budget were significantly associated with a willingness to consider implementing MAT in the future. We concluded that the bias towards counseling-based programming seen in our study was not unique and, taken along with the result that attitudes were more important than funding for current MAT implementation, this indicated that facility administrators' comfort with a program was the most important factor and that funding would be allocated accordingly. In the interest of expanding evidence-based SAT programming in this high-need population, we suggest that a targeted education campaign may be useful in improving attitudes, and that pilot programs to show proof of concept in regions that lack MAT (Southeast and Southwest) would likewise be beneficial.

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