Understanding carceral pathways and outcomes of marginalized adults who use drugs.

This dissertation is an examination of outcomes among substance users at various stages of the incarceration process divided among five chapters. Chapter One provides an overview of substance use disorder (SUD), incarceration, and wider justice system-involvement, and explores how the political economy of health theoretical framework can be applied to examine how the criminal justice system creates and perpetuates inequality among marginalized people who use substances. Chapter Two examines post-release health outcomes among the population of incarcerated people who use substances using a scoping review and finds that people in reentry with SUD have poorer overall outcomes that without transitional supports can lead to higher risks of relapse and recidivism. Chapter Three investigates how changes to cannabis criminal penalties affects racial disparities in arrests between Black and White individuals charged with both drug and non-drug offenses and finds that reducing cannabis penalties has led to a reduction in both overall drug crime arrests and racial disparities in arrests for drug crimes. Chapter Four explores political and socio-ecological pre-incarceration factors that impact the behavioral trajectories of incarcerated women who use substances and finds that women incarcerated for felonies with SUD have an array of healthcare, financial, and other resource needs that if addressed could disrupt trajectories to long-term incarceration. And finally, Chapter Five synthesizes the results of the previous chapters and provides recommendations on future areas of research as well as potential policies and interventions that expand access to treatment and social support of people with SUD. Policy and program recommendations supported by the findings of this research include continuing to reduce and remove criminal penalties for drugs; expanding insurance cover to people who are in reentry from incarceration; and expanding interventions with all-encompassing supports such as housing, employment, healthcare, transportation and other services to justice system-involved people.