Racial/Ethnic Differences in Drug- and Alcohol-Related Arrest Outcomes in a Southwest County From 2009 to 2018

Trends and disparities in alcohol-DWI license suspensions by suspension duration, North Carolina, 2007-2016

PURPOSE

To examine trends and potential disparities in North Carolina (NC) driving while impaired by alcohol (alcohol-DWI) license suspensions from 2007-2016. Specific objectives included: 1) examining personal (e.g., race/ethnicity) and contextual (e.g., residential segregation) characteristics of alcohol-DWI license suspensions by suspension duration; and 2) examining trends in annual suspension rates by race/ethnicity, sex, and duration.

METHODS

We linked NC administrative licensing and county-level survey data from several sources from 2007-2016. Suspensions were categorized by duration: 1 to <4 years and 4 years or longer (proxies for initial and repeat suspensions, respectively). We calculated counts, percentages, and suspensions rates (per 1,000 person-years) with 95% confidence intervals, examined trends in annual suspension rates by race/ethnicity, sex, and suspension duration.

RESULTS

We identified 220,471 initial and 41,526 repeat license suspensions. Rates among males were three times that of females. 21-24-year-old (rates: 6.9 per 1,000 person-years for initial; 1.5 for repeat) and Black (4.1 for initial; 1.0 for repeat) individuals had the highest suspension rates. We observed decreases in annual initial and repeat suspension rates among males, but only in repeat suspensions for females during the study period. A substantial decrease in annual initial suspension rates was observed among Hispanic individuals relative to other racial/ethnic groups, while annual repeat suspension rates exhibited large decreases for most racial/ethnic groups. The highest overall suspension rates occurred in counties with higher proportions of the population without health insurance and with the highest levels of Black/White residential segregation.

CONCLUSIONS

Potential disparities by race/ethnicity and sex existed by alcohol-DWI license suspension duration (i.e., initial vs. repeat suspensions) in NC. Contextual characteristics associated with suspensions, including a high degree of residential segregation, may provide indications of underlying structures and mechanisms driving potential disparities in alcohol-DWI outcomes.

Regional differences in fatal drug overdose deaths among Black and White individuals in the United States, 2012-2021

BACKGROUND AND OBJECTIVES

The current study examines regional differences in Black/White fatal drug overdoses.

METHODS

Black/White overdose mortality data (2012-2021; N = 537,085) were retrieved from CDC WONDER. We used death counts and corresponding Census Bureau population estimates by the decedent's age and race/ethnicity to calculate mortality rate ratios.

RESULTS

From 2012 to 2021, there were 537,085 reported overdose deaths among White (85%) and Black (15%) individuals in the United States. In the South, Black individuals had lower fatal drug overdose deaths than their same-aged White counterparts. In the Northeast, Midwest, and West regions, Black individuals had around 10%-60% lower likelihood of overdoses among younger ages (15-24, 25-34, 35-44) but about 60%-300% higher likelihood of overdoses among older adults (55-64). Increases in overdose deaths during the pandemic (2020-2021) led to changes in Black/White overdose death patterns, whereas Black individuals of all ages in the Midwest and West regions had approximately 15%-425% higher likelihood of fatal overdoses than their same-aged White counterparts. Sex-stratified analysis suggests that Black females in the South had overdose death rates around 50% lower than same-aged White females, and overdose deaths were relatively equal for Black and White females in the Midwest-patterns not seen among males.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

The findings indicate that the Black/White overdose mortality gap changed after the COVID-19 pandemic across all regions and age cohorts, with state and regional variations in magnitude. Behavioral interventions and policies to curb drug overdose deaths among populations most impacted should consider regional, sex, and age-related differences.

The Unmet Health Care Needs of Indigenous People Incarcerated in Tribal Jails

This Viewpoint investigates the poor quality of health care provided to Indigenous peoples incarcerated in US tribal jails and proposes solutions to address health disparities and strengthen tribal sovereignty.

Emerging models of de facto drug policy reforms in the United States

BACKGROUND

Health and human rights organizations have endorsed drug decriminalization to promote public health-oriented approaches to substance use. In the US, policymakers have begun to pursue this via prosecutorial discretion-or the decision by a prosecutor to decline criminal charges for drug possession in their jurisdiction. This study characterizes drivers of adoption, policy design and implementation processes, and barriers to impact and sustainability of this approach to inform evolving policy efforts promoting the health of people who use drugs (PWUD).

METHODS

We conducted n=22 key informant interviews with policymakers and national policy experts representing 13 jurisdictions implementing de facto drug policy reforms. Analyses were informed by the Exploration, Preparation, Implementation and Sustainment (EPIS) framework and analyzed using a hybrid inductive-deductive approach.

RESULTS

Drivers of policy adoption included racial inequities, perceived failures of criminalization, and desires to prioritize violent crime given resource constraints. Three distinct policy typologies are described with varying conditions for eligibility, linkage to services, and policy transparency and dissemination. Public misinformation, police resistance and political opposition were seen as threats to sustainability.

CONCLUSIONS

Given evidence that criminalization amplifies drug-related harms, many policymakers are adopting de facto drug policy reforms in the absence of formal legislation. This is the first study to systematically describe relevant implementation processes and emerging policy models. Findings have implications for designing rigorous evaluations on health outcomes and informing sustainable evidence-based policies to promote health and racial equity of PWUD in the US.

Comparing Behavioral Health Outcomes and Treatment Utilization of Those With and Without Justice Involvement Within the Past Year Among American Indian and Alaska Native Adults

Similar to other populations, worse health, increased emergency healthcare utilization, and heightened substance misuse are correlated with higher justice involvement among American Indian/Alaska Native (AI/AN) populations. The historical context and resulting contemporary injustices for AI/AN populations have directly contributed to higher rates of these health and behavioral health conditions among this population. As a result, AI/AN individuals have disproportionate rates of incarceration in the USA, with young AI/AN males having the highest odds of incarceration when compared to any other group. American Indian and Alaska Native populations are overrepresented in the criminal justice system across different touchpoints. However, there remains a scarcity of data and research on AI/AN peoples' involvement with the justice system, and what their lives look like prior to, during, and after justice involvement. The current study addresses this gap in the literature by exploring rates of substance use and mental health diagnoses and treatment utilization among justice-involved and non-justice-involved AI/AN samples. Further, we examined correlates associated with past-year service utilization. Data from the 2015-2019 National Survey on Drug Use and Health (N = 214,505 adults aged 18+) was used. For this study, we examined a subsample of 3068 AI/AN adults. Quantitative data analyses using STATA 16 were run to test for differences on service utilization, mental health status, and substance misuse between AI/AN non-justice-involved and justice-involved samples. Among adults in the sample, 446 (15%) reported justice involvement in the past year. Justice-involved AI/AN individuals were significantly more likely to use the emergency department, utilize mental health treatment, and access substance use treatment in the past year. Additionally, justice-involved AI/AN individuals reported significantly higher rates of mental illness and past-year substance use disorder. In regression models, justice involvement was significantly associated with past-year substance use treatment and past-year mental health treatment. The findings from this work highlight the differences among substance use, mental illness, and treatment utilization between justice-involved and non-justice-involved AI/AN individuals. Findings suggest that justice-involved individuals fair worse in all areas and argue for the consideration of interventions that incorporate both culturally sensitive and justice-responsive models to improve the behavioral health outcomes of these populations. Lastly, while justice-involved AI/AN populations utilize treatment services at higher and disproportionate levels, there is reason to believe that there continues to be a mismatch of need and utilization and further exploration is warranted.

Support for Safe Consumption Sites Among Peer Recovery Coaches

Safe consumption sites (SCSs), legally sanctioned facilities where people can use drugs under medical supervision, are an effective strategy to reduce overdose fatalities. Peer recovery coaches (PRCs), substance use service providers with lived experience in recovery, are a key provider group affecting SCS implementation. This study assesses support for SCSs among PRCs and identifies personal and professional characteristics associated with support for these sites. PRCs (N = 260) in Michigan were recruited to complete a web-based survey (July-September 2021), reporting their demographics, lived experience, abstinence orientation, attitudes toward clients, training experiences, and support for legalizing SCSs. Logistic regression was used to identify factors associated with support for SCSs. Half of PRCs (49.0%) expressed support for legalizing SCSs in Michigan. Compared to women, men had greater odds of supporting SCSs (OR = 2.113, p = .014). PRCs who identified as Black (OR = 0.361, p = .014) and other people of color (OR = 0.338, p = .014) had lower odds of supporting SCSs compared to PRCs who identified as white. More stigmatizing attitudes toward clients (OR = 0.921, p = .022) and preference for abstinence-only treatment (OR = 0.452, p = .013) were associated with lower odds of supporting SCSs. Increasing support for SCSs among PRCs is important given their influence on the success of SCS initiatives. Professional training which addresses deeply rooted values and beliefs may help increase support for SCSs. However, policy changes may be necessary to address structural racism affecting SCS acceptability among PRCs of color.

Family history of substance problems among African Americans: Associations with drug use, drug use disorder, and prescription drug misuse

A family history of substance problems is a well-known risk factor for substance use and use disorders; however, much of this research has been conducted in studies with predominantly White subjects. The aim of this study was to examine the associations between family history density of substance problems and drug use, risk for drug use disorder, and prescription drug misuse in a sample of African American adults. Results indicate that family history density of substance problems increased the risk for all drug outcomes in the full sample. However, when subgroup analyses by gender were conducted, family history was not a risk factor among men for prescription drug misuse.

Equity of overdose education and naloxone distribution provided in the Kentucky HEALing Communities Study

Background

Opioid overdoses differentially affect demographic groups. Strategies to reduce overdose deaths, specifically overdose education and naloxone distribution (OEND), are not consistently delivered equitably.

Methods

The HEALing Communities StudySM (HCS) is a cluster-randomized trial designed to implement evidence-based practices, including OEND, to reduce overdose deaths across communities. Individuals receiving OEND in eight Kentucky counties between January 2020 and June 2022 provided demographics and overdose history. Recipient characteristics were compared to opioid overdose decedent characteristics to evaluate whether OEND was equitably delivered to the target population. Recipient characteristics were also analyzed based on whether OEND was delivered in criminal justice, behavioral health, or health care facilities.

Results

A total of 26,273 demographic records were analyzed from 137 partner agencies. Most agencies were in behavioral health (85.6 %) or criminal justice sectors (10.4 %). About half of OEND recipients were male (50.6 %), which was significantly lower than the 70.3 % of overdose decedents who were male, (p<0.001). OEND recipients tended to be younger than overdose decedents, but there were not significant differences in race/ethnicity between OEND recipients and overdose decedents. Over 40 % of OEND recipients had overdosed, and 68.9 % had witnessed a prior overdose. There were notable differences across facility types, as males and Black individuals accounted for fewer OEND recipients in addiction treatment facilities compared to jails.

Conclusion

Although OEND recipients' demographics resembled those of decedents, specific attention should be paid to ensuring equitable OEND access. Variation in OEND uptake by facility type may reflect biases and barriers to care.

Naloxone Knowledge and Attitudes Towards Overdose Response Among Family Members of People who Misuse Opioids

Providing family members of individuals with opioid use disorders (OUD) naloxone is a cost-effective way to prevent overdose deaths. However, misconceptions and negative attitudes towards naloxone hinder family engagement with naloxone programs. This study examines factors associated with knowledge and attitudes toward naloxone among adults with close family members who misused opioids. Adults with family members (parent, step-parent, child, spouse, sibling, or step-sibling) who misused opioids (N = 299) completed a web-based survey. Participants were recruited through treatment providers, community groups, and social media. Surveys assessed naloxone knowledge, attitudes toward overdose response, demographics, completion of naloxone training, attitude toward medications for OUD, and family members' overdose history. Multiple regression was used to identify factors associated with naloxone knowledge (Model 1) and attitudes toward overdose response (Model 2). A graduate degree (B = .35, p < .003) and a history of overdose (B = 0.21, p = .032) were associated with greater naloxone knowledge. Age (B = .11, p < .001), race/ethnicity (B = -1.39, p = .037), naloxone training (B = 2.70, p < .001), and more positive attitude toward medications for OUD (B = 1.50, p = .003) were associated with attitudes toward overdose response. Family members are potential allies in reducing drug overdose deaths, and families may need broader education about naloxone. Awareness of previous overdose was associated with greater naloxone knowledge. Findings related to race/ethnicity suggest the need to reach family members of minoritized racial groups to provide access to naloxone training. Findings point to where education and distribution efforts may focus on increasing knowledge and improving attitudes among those closest to people with OUD.

The criminal justice system in alcohol use treatment: a nationwide analysis of racial disparities in treatment referral and completion

BACKGROUND

Alcohol use and the criminal justice (CJ) system have long been integrally connected in the United States and have both disproportionally impacted Communities of Color. Despite this connection, scholarly literature has largely focused on substance use as a whole, and little literature has examined the influence of race on CJ referral to alcohol treatment and treatment outcomes.

METHODS

A total of 749,349 cases from the treatment episodes dataset discharge were used in the current study. A series of ANOVA and logistic regression analyses were conducted to examine the impact of race on (i) likelihood of referral to alcohol treatment by the CJ system and (ii) the association between CJ referral and treatment completion.

RESULTS

Results revealed significant disparities in both who is referred to alcohol treatment by the CJ system and the association of that referral to treatment completion. Notably, American Indian/Alaska Native people were significantly more likely than people of all other races to be referred by the CJ system. However, American Indian/Alaska Native people showed the smallest association between CJ referral and treatment completion.

CONCLUSIONS

Contrary to previous literature, findings showed that referral of and positive association between CJ referral and treatment completion are not equal across people of different races. Taken together, these results highlight continued racial inequities in the role of the CJ system in alcohol treatment and the unique potential for non-CJ-related treatment to best serve people combatting alcohol use disorder.

Polysubstance mortality trends in White and Black Americans during the opioid epidemic, 1999-2018

BACKGROUND

Psychoactive drug combinations are increasingly contributing to overdose deaths among White and Black Americans. To understand the evolving nature of overdose crisis, inform policies, and develop tailored and equitable interventions, this study provides a comprehensive assessment of polysubstance mortality trends by race and sex during the opioid epidemic.

METHODS

We used serial cross-sectional US mortality data for White and Black populations from 1999 through 2018 to calculate annual age-adjusted death rates (AADR) involving any opioid, opioid subtypes, benzodiazepines, cocaine, psychostimulants, or combinations of these drugs, stratified by race and sex. Trend changes in AADR were analyzed using joinpoint regression models and expressed as average annual percent change (AAPC) during each period of the three waves of the opioid epidemic: 1999-2010 (wave 1), 2010-2013 (wave 2), and 2013-2018 (wave 3). Prevalence measures assessed the percent co-involvement of an investigated drug in the overall death from another drug.

RESULTS

Polysubstance mortality has shifted from a modest rise in death rates due to benzodiazepine-opioid overdoses among White persons (wave 1) to a substantial increase in death rates due to illicit drug combinations impacting both White and Black populations (wave 3). Concurrent cocaine-opioid use had the highest polysubstance mortality rates in 2018 among Black (5.28 per 100,000) and White (3.53 per 100,000) persons. The steepest increase in death rates during wave 3 was observed across all psychoactive drugs when combined with synthetic opioids in both racial groups. Since 2013, Black persons have died faster from cocaine-opioid and psychostimulant-opioid overdoses. Between 2013 and 2018, opioids were highly prevalent in cocaine-related deaths, increasing by 33% in White persons compared to 135% in Blacks. By 2018, opioids contributed to approximately half of psychostimulant and 85% of benzodiazepine fatal overdoses in both groups. The magnitude and type of drug combinations with the highest death rates differed by race and sex, with Black men exhibiting the highest overdose burden beginning in 2013.

CONCLUSIONS

The current drug crisis should be considered in the context of polysubstance use. Effective measures and policies are needed to curb synthetic opioid-involved deaths and address disparate mortality rates in Black communities.

Psychology's Contributions to Anti-Blackness in the United States Within Psychological Research, Criminal Justice, and Mental Health

The mass incarceration of Black people in the United States is gaining attention as a public-health crisis with extreme mental-health implications. Although it is well documented that historical efforts to oppress and control Black people in the United States helped shape definitions of mental illness and crime, many psychologists are unaware of the ways the field has contributed to the conception and perpetuation of anti-Blackness and, consequently, the mass incarceration of Black people. In this article, we draw from existing theory and empirical evidence to demonstrate historical and contemporary examples of psychology's oppression of Black people through research and clinical practices and consider how this history directly contradicts the American Psychological Association's ethics code. First, we outline how anti-Blackness informed the history of psychological diagnoses and research. Next, we discuss how contemporary systems of forensic practice and police involvement in mental-health-crisis response maintain historical harm. Specific recommendations highlight strategies for interrupting the criminalization of Blackness and offer example steps psychologists can take to redefine psychology's relationship with justice. We conclude by calling on psychologists to recognize their unique power and responsibility to interrupt the criminalization and pathologizing of Blackness as researchers and mental-health providers.

Race and ethnicity moderate the associations between lifetime psilocybin use and crime arrests

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.

COVID-related social determinants of substance use disorder among diverse U.S. racial ethnic groups

OBJECTIVE

Black, Asian, and Hispanic/Latino people are disproportionately impacted by the COVID-19 pandemic and were more likely to experience coronavirus-related racial discrimination. This study examined the association between pandemic-related stressors, including employment and housing disruptions, coronavirus-related victimization distress, and perceptions of pandemic-associated increase in societal racial biases, and substance use disorder (SUD) risk among Asian, Black, Hispanic/Latino, and non-Hispanic White adults in the U.S.

METHODS

Data were collected as part of a larger national survey on substance use during the pandemic. Eligible participants for the current study were 1336 adults self-identified as Asian (8.53%), Black (10.55%), Hispanic/Latino (10.93%), and non-Hispanic White (69.99%). Measures included demographic and COVID-19-related employment, housing, and health items, the coronavirus victimization distress scale (CVD), the coronavirus racial bias scale (CRB), and measures of substance use risk.

RESULTS

Across racial/ethnic groups, employment disruption distress and housing disruption due to the pandemic were associated with SUD risk. Binary logistic regression analyses controlling for demographic variables indicated CVD was associated with higher odds of tobacco use risk (AOR = 1.36, 95% CI [1.01, 1.81]) and polysubstance use risk (AOR = 1.87, 95% CI [1.14, 3.06]), yet CRB was unrelated to any SUDs. Logistic regressions for each racial/ethnic group found different patterns of relationships between stressors and risk for SUDs.

CONCLUSIONS

Results highlight the significance of examining how the current pandemic has exacerbated racial/ethnic systemic inequalities through COVID-19 related victimization. The data also suggest that across all racial/ethnic groups employment and housing disruptions and perceptions of pandemic instigated increases in societal racial bias are risk factors for SUD. The study calls for further empirical research on substance use prevention and intervention practice sensitive to specific needs of diverse populations during the current and future health crises.

An integrative literature review of substance use treatment service need and provision to pregnant and postpartum populations in carceral settings

Pregnancy is a critical time to provide access to substance use treatment; this is especially true among incarcerated populations, who are known to be at particularly high risk of poor health outcomes. In this integrated literature review, we (1) report what is known about the prevalence of substance use among incarcerated pregnant and postpartum populations; (2) describe substance use treatment programs and current care practices of pregnant and postpartum populations in carceral settings; and (3) explore recommendations and strategies for increasing access to substance use treatment for incarcerated pregnant and postpartum populations. A comprehensive search of seven electronic databases yielded in the retrieval of 139 articles that were assessed for inclusion. Of the retrieved articles, 33 articles met criteria for inclusion in this review. A review of the literature revealed that the understanding of substance use prevalence among pregnant incarcerated women is limited. We also found that treatment of substance use disorders among pregnant and postpartum populations is not routinely available, enhanced perinatal services are sorely needed, and substance use treatment programs are feasible with the help of community partnerships. More research is required to understand current substance use treatment initiatives and outcomes for pregnant women in prison. In addition, strategies for integrating evidence-based, substance use treatment in carceral settings is also needed. Future directions are discussed.

Alcohol use disorder conceptualizations and diagnoses reflect their sociopolitical context

The present paper highlights how alcohol use disorder (AUD) conceptualizations and resulting diagnostic criteria have evolved over time in correspondence with interconnected sociopolitical influences in the United States. We highlight four illustrative examples of how DSM-defined alcoholism, abuse/dependence, and AUD have been influenced by sociopolitical factors. In doing so, we emphasize the importance of recognizing and understanding such sociopolitical factors in the application of AUD diagnoses. Last, we offer a roadmap to direct the process of future efforts toward the improved diagnosis of AUD, with an emphasis on pursuing falsifiability, acknowledging researchers' assumptions about human behavior, and collaborating across subfields. Such efforts that center the numerous mechanisms and functions of behavior, rather than signs or symptoms, have the potential to minimize sociopolitical influences in the development of diagnostic criteria and maximize the treatment utility of diagnoses.

Prior Drug-Related Criminal Charges and Risk for Intimate Partner Violence Perpetration Among Authorized Purchasers of Handguns in California

Intimate partner violence (IPV) is a considerable public health problem in the US, and evidence suggests that both drugs and firearms contribute to the risk of IPV and its severity. This study uses a retrospective, longitudinal cohort design to explore the association between past arrests, charges incurred in the legal process, and convictions for drug-related crimes, and risk of future arrest for IPV among legal handgun purchasers. The cohort included all legal purchasers of handguns in California in 2001 between the ages of 21 and 49 (n = 79,678), 156 of whom had pre-purchase drug charges and post-purchase IPV charges. We used Cox proportional hazards regression with age at time of handgun purchase, sex, and race/ethnicity, and an array of community characteristics as covariates. Over the study period (2001-2013), in comparison to handgun purchasers who had no charges or convictions prior to their index purchase, risk for future IPV arrest was increased for purchasers whose only prior charges were drug-related (aHR = 3.4 [95% CI: 2.4-4.9]) and purchasers who had both prior drug- and non-drug related charges (aHR = 4.9 [95% CI: 4.1-6.0]). The magnitude of the risk ratio was greater when multiple drug types were involved and when the person had been charged with both the use and sale of drugs. Our findings suggest that, among legal handgun purchasers, prior drug charges are associated with future risk of IPV arrests or convictions. Given the established link between firearm access and IPV severity and fatality, these findings may inform the development and enforcement of policies that reduce firearm access for those at elevated risk of perpetrating intimate partner violence.

The COVID-19 pandemic behind bars: Experimental evidence showing higher support for decarceration when framed as risk to correctional staff

This study examined the effect of framing COVID-19 spread in correctional facilities as impacting imprisoned individuals or impacting correctional staff on public support for decarceration. I employed an experiment in the 2021 Empire State Poll (n = 765) in which participants were randomly assigned to a treatment condition, which highlighted information about the number of COVID-19 cases among imprisoned individuals, or a control condition, which highlighted correctional staff instead. Participants reported how supportive or unsupportive they are of releasing imprisoned individuals to curb the spread of COVID-19. Overall, 35% of New Yorkers supported decarceration. A higher percentage of respondents supported decarceration when the impact on correctional staff was highlighted (40%) relative to imprisoned individuals (31%). There was also higher support among non-Hispanic Black (54%) and Hispanic (51%) participants relative to non-Hispanic White (28%) participants. Within racial/ethnic groups support for decarceration was higher when the impact on correctional staff was highlighted among non-Hispanic Whites, Hispanics, and those of another race, but not among non-Hispanic Blacks where support for decarceration was higher when the impact on imprisoned individuals was highlighted. Inferential analysis using log binomial regression found that the association between treatment condition assignment and support for decarceration was not significant. Public health practitioners and policy makers should consider leveraging the higher support associated with concerns over the health and wellbeing of correction staff found among some racial/ethnic groups to fight the COVID-19 pandemic.

Disparities in functioning from alcohol and cannabis use among a racially/ethnically diverse sample of emerging adults

BACKGROUND

Trajectory studies have consistently shown that alcohol and cannabis (AC) use during emerging adulthood (EA) affect functioning; however, few studies examine whether racial/ethnic disparities may occur at similar levels of use.

METHODS

We conducted web-based surveys across five waves from mean age 18.3 through 22.6. The sample (N = 2945) is 55% female, 46% Hispanic, 23% Asian, 23% White, 6% multi-racial (MR)/other, and 2% Black.

MEASUREMENTS

Past month substance use was defined as number of days used. Outcomes at age 22.6 included negative consequences, delinquency, physical ailments and health, depression and anxiety, peer relationship functioning, life satisfaction, employment, and education.

RESULTS

Compared to White EAs, Hispanic, Asian, and MR/other EAs reported less initial alcohol use; Hispanic and Asian EAs reported less initial cannabis use, whereas Black EAs reported more cannabis use. Greater initial frequency and increased frequency of AC use were associated with poorer outcomes (e.g., worse mental health). In terms of disparities, compared to White EAs, Hispanic EAs reported poorer physical health at the same levels of AC use; Hispanic, Asian, and MR/other EAs reported greater alcohol consequences and delinquency; Black, Hispanic, Asian and MR/other EAs reported lower life satisfaction; and Hispanic and MR/other EAs were less likely to pursue education beyond high school (although Asian EAs were more likely).

CONCLUSIONS

Findings emphasize that trajectories of AC use during EA are associated with a range of functional outcomes. Disparities in functioning at similar levels of AC use highlight the importance of reaching racially/ethnically diverse EAs with prevention and intervention programming.

Impact of Extralegal and Community Factors on Police Officers' Decision to Book Arrests for Minor Offenses

Booked arrests carry greater harms than non-booked arrests. When booked following an arrest, individuals are confined without guilt and an official criminal record forms that carries several negative consequences. Even with these greater harms, police decision to book arrests is understudied with little research on what factors influence this decision. This study utilizes official booking data to determine if suspect extralegal and community factors affect officers' decisions to book arrests across minor offenses. The study uses data from the Chandler Police Department in Arizona and the American Community Survey from 2013 to 2019. These data include suspect legal/extralegal, officer, time, and block-group level factors. Using a cross-classified modeling approach, we examine factors associated with booking arrests across five offenses (cannabis possession, drug paraphernalia, shoplifting, criminal damage, and non-DUI-traffic). Results suggest that legal factors, particularly felony charges, are associated with higher odds of booking after arrest. However, we also demonstrate how extralegal factors significantly impact police decision to book arrests. Native Americans, Blacks, older individuals, and those with prior records had higher odds of booked arrests. While the odds of booked arrest varied across officers and communities, few officer or community factors were related to the decision to book arrests. Results suggest extralegal factors remain significant across minor offenses. These findings highlight the need to examine disparities on police post-arrest outcomes, expand racial categories studied, and incorporate less utilized variables like prior record.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12103-022-09669-6.

Engaging Disability Rights Law to Address the Distinct Harms at the Intersection of Race and Disability for People with Substance Use Disorder

This article examines the unique disadvantages experienced by Black people and other people of color with substance use disorder in health care, and argues that an intersectional approach to enforcing disability rights laws offer an opportunity to ameliorate some of the harms of oppression to this population.

A Review of DNA Risk Alleles to Determine Epigenetic Repair of mRNA Expression to Prove Therapeutic Effectiveness in Reward Deficiency Syndrome (RDS): Embracing "Precision Behavioral Management"

This is a review of research on "Precision Behavioral Management" of substance use disorder (SUD). America is experiencing a high prevalence of substance use disorder, primarily involving legal and illegal opioid use. A 3000% increase in treatment for substance abuse has occurred between 2000 and 2016. Unfortunately, present day treatment of opioid abuse involves providing replacement therapy with powerful opioids to, at best, induce harm reduction, not prophylaxis. These interventions do not enhance gene expression and restore the balance of the brain reward system's neurotransmitters. We are proposing a generalized approach called "Precision Behavioral Management". This approach includes 1) using the Genetic Addiction Risk Severity (GARS, a 10 candidate polymorphic gene panel shown to predict ASI-alcohol and drug severity) to assess early pre-disposition to substance use disorder; 2) using a validated reward deficiency syndrome (RDS) questionnaire; 3) utilization of the Comprehensive Analysis of Reported Drugs (CARD™) to assess treatment compliance and abstinence from illicit drugs during treatment, and, importantly; 4) utilization of a "Pro-dopamine regulator (KB220)" (via IV or oral [KB220Z] delivery systems) to optimize gene expression, restore the balance of the Brain Reward Cascade's neurotransmitter systems and prevent relapse by induction of dopamine homeostasis, and; 5) utilization of targeted DNA polymorphic reward genes to direct mRNA genetic expression profiling during the treatment process. Incorporation of these events can be applied to not only the under-considered African-American RDS community, but all victims of RDS, as a demonstration of a paradigm shift that uniquely provides a novel putative "standard of care" based on DNA guided precision nutrition therapy to induce "dopamine homeostasis" and rebalance neurotransmitters in the Brain Reward Cascade. We are also developing a Reward Deficiency Syndrome Diagnostic Criteria (RDSDC) to assist in potential tertiary treatment.

Adverse Childhood Experiences in relation to drug and alcohol use in the 30 days prior to incarceration in a county jail

Purpose

To characterize the relationship between adverse childhood experiences (ACEs) and substance use among people incarcerated in a county jail.

Design/methodology/approach

A questionnaire was administered to 199 individuals incarcerated in a Southwest county jail as part of a social-epidemiological exploration of converging co-morbidities in incarcerated populations. Among 96 participants with complete ACEs data, the authors determined associations between individual ACEs items and a summative score with methamphetamine (meth), heroin, other opiates, and cocaine use and binge drinking in the 30 days prior to incarceration using logistic regression.

Findings

People who self-reported use of methamphetamine, heroin, other opiates, or cocaine in the 30 days prior to incarceration had higher average ACEs scores. Methamphetamine use was significantly associated with living with anyone who served time in a correctional facility and with someone trying to make them touch sexually. Opiate use was significantly associated with living with anyone who was depressed, mentally ill, or suicidal; living with anyone who used illegal street drugs or misused prescription medications; and if an adult touched them sexually. Binge drinking was significantly associated with having lived with someone who was a problem drinker or alcoholic.

Originality

Significant associations between methamphetamine use and opiate use and specific adverse childhood experiences suggest important entry points for improving jail and community programming.

Social Implications

Our findings point to a need for research to understand differences between methamphetamine use and opiate use in relation to particular adverse experiences during childhood, and a need for tailored intervention for people incarcerated in jail.

Advancing Health Equity through Substance Use Research

Several health inequities exist among racial/ethnic minoritized populations (REMPs) who use substances including disparities in use patterns, inequities in health and legal consequences of use, as well as in treatment access and effectiveness. To address these inequities, more research is needed to examine the associated factors and identify areas for improving treatment. Divided into three categories, this special issue includes papers that examine the social and contextual factors that are associated with substance use among REMPs, papers that consider the role of racism and discrimination on substance use, and papers that explore racial/ethnic differences in treatment access and outcomes. Recommendations for advancing health equity in substance use research are also included.

Association between Temporary Assistance for Needy Families (TANF) and child maltreatment among a cohort of fragile families

BACKGROUND

Child maltreatment disproportionately affects families experiencing poverty and structural discrimination, including African American (AA) families. The generosity of Temporary Assistance for Needy Families (TANF) may reduce child maltreatment disparities.

OBJECTIVE

Our aim is to understand TANF's impact on the mother's perpetration of child maltreatment and whether the effect differs across AA and White mothers.

PARTICIPANTS AND SETTING

Participants are 2457 primary caregiving mothers participating in waves 3 (2001-2003), 4 (2003-2006), and 5 (2007-2010) of the U.S.-based Fragile Families and Child Wellbeing birth cohort study.

METHODS

We use a difference-in-differences study design to estimate overall and race-specific effects of TANF policies on caregivers' self-report of child neglect and physical and psychological maltreatment measured by the Child-Parent Conflict Tactics Scale. State-level TANF policy exposures include the TANF-to-Poverty Ratio (TPR), maximum cash benefits, time limits, sanctions, diversion payments, and family caps.

RESULTS

A $100 increase in TANF benefits was associated with a reduction of 1.8 reported physical abuse events (Beta = -1.80, 95% CI (-3.29, -0.31)). Imposing a time limit on TANF receipt was associated with an increase of 2.3 reported physical abuse events (Beta = 2.27, 95% CI (0.04, 4.50)). No significant differences were found for AA mothers versus White mothers.

CONCLUSIONS AND RELEVANCE

Increasing TANF cash benefits should be prioritized to reduce poverty-related child maltreatment disparities. TANF time limits should be reconsidered.

Elevated risk of substance use disorder and suicidal ideation among Black and Hispanic lesbian, gay, and bisexual adults

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.

Implementing harm reduction in non-urban communities affected by opioids and polysubstance use: A qualitative study exploring challenges and mitigating strategies

BACKGROUND

Harm reduction services, which typically provide overdose education and prevention with distribution of naloxone and other supplies related to safer drug use, help reduce opioid-related overdose and infectious disease transmission. However, structural stigma and the ongoing criminalization of drug use have limited the expansion of harm reduction services into many non-urban communities in the United States that have been increasingly affected by the health consequences of opioid and polysubstance use.

METHODS

We conducted qualitative interviews with 22 professionals working with people who use drugs in cities and towns across Rhode Island and Massachusetts to understand challenges and strategies for engaging communities in accepting harm reduction perspectives and services.

RESULTS

Our thematic analysis identified several interrelated challenges to implementing harm reduction services in non-urban communities, including: (1) limited understandings of harm reduction practice and preferential focus on substance use treatment and primary prevention, (2) community-level stigma against people who use drugs as well as the agencies supporting them, (3) data reporting and aggregating leading to inaccurate perceptions about local patterns of substance use and related health consequences, and (4) a "prosecutorial mindset" against drug use and harm reduction. From key informants' narratives, we also identified specific strategies that communities could use to address these challenges, including: (1) identifying local champions to advocate for harm reduction strategies, (2) proactively educating communities about harm reduction approaches before they are implemented, (3) improving the visibility of harm reduction services within communities, and (4) obtaining "buy-in" from a wide range of local stakeholders including law enforcement and local government.

CONCLUSION

These findings carry important implications for expanding harm reduction services, including syringe service programs and safe injection sites, into non-urban communities that have a demonstrated need for evidence-based interventions to reduce drug-related overdose and infectious disease transmission.