The Role of Health Policy in Improving Access to Substance Use Disorder Treatment, Influencing Substance Use, and Promoting Public Safety 公开

Abstract

In the United States, substance use has historically been treated as a legal and moral issue that deserves to be punished rather than a public health issue that can be effectively treated. However, the ongoing implementation of the Affordable Care Act (ACA) and the Mental Health Parity and Addiction Equity Act (MHPAEA) has presented opportunities for people in need of substance use disorder (SUD) treatment to gain access to treatment. This dissertation seeks to provide rigorous evidence on the potential of health policy levers and financial incentives to encourage treatment seeking, reduce criminal involvement, and influence substance use behaviors. The three essays of my dissertation examine: the impact of insurance expansions and regulations on improving SUD treatment use; the potential spillovers of improved SUD treatment use on reducing substance-related violent and property crimes; and the implications of liberalizing drug laws for substance use. The findings of this dissertation provide evidence that, through improving coverage for SUD treatment, insurance expansions and regulations can effectively improve access to SUD treatment. Improved access to treatment, in turn, can effectively and cost-effectively promote public safety by reducing substance use-related crimes. The findings also add a caution that simply liberalizing drug laws may have unintended consequences for a certain range of substance use outcomes that are interrelated and sensitive to policy shocks. Thus, drug liberalization policies should be designed with public health concerns in mind and paired with additional public health strategies to mitigate an undesirable surge in substance use.

Table of Contents

TABLE OF CONTENTS CHAPTER 1: Introduction 1 1.1 Introduction to Essay 1: State Parity Laws and Access to Treatment for Substance Use Disorder in the United States 5 1.1.1 Motivation of Essay 1 5 1.1.2 Conceptual Framework and Hypotheses of Essay 1 5 1.1.3 Data and Methods of Essay 1 8 1.2 Introduction to Essay 2: The Effect of Substance Use Disorder Treatment Use on Crime 10 1.2.1 Motivation of Essay 2 10 1.2.2 Conceptual Framework and Hypotheses of Essay 2 11 1.2.3 Data and Methods of Essay 2 13 1.3 Introduction to Essay 3: The Effect of Medical Marijuana Laws on Adolescent and Adult Use of Marijuana, Alcohol, and Other Substances 16 1.3.1 Motivation of Essay 3 16 1.3.2 Conceptual Framework and Hypotheses of Essay 3 17 1.3.3 Data and Methods of Essay 3 19 References 25 CHAPTER 2: State Parity Laws and Access to Treatment for Substance Use Disorder in the United States: Implications for Federal Parity Legislation 29 2.1 Introduction 30 2.2 Methods 33 2.2.1 Data Sources 33 2.2.2 Analytic Sample 34 2.2.3 Variable Measurement 34 2.2.4 Statistical Analysis 37 2.3 Results 39 2.4 Discussion 41 References 49 CHAPTER 3: The Effect of Substance Use Disorder Treatment Use on Crime: Evidence from Public Insurance Expansions & Health Insurance Parity Mandates 52 3.1 Introduction 53 3.2 Background 56 3.2.1 Theories of Substance Use, SUD Treatment and Crime 56 3.2.2 Literature on SUD Treatment and Crime Reduction 63 3.3 Data 64 3.3.1 Dependent Variable: Crime Rates 65 3.3.2 Primary Independent Variable: SUD treatment rate 65 3.3.3 Other Controls 66 3.4 Estimating the Effect of the SUD treatment rate on Crime Rate Using OLS 68 3.5 HIFA-Waiver Expansions and SUD Parity Mandates: Instrumental Variables 71 3.5.1 Endogeneity of the SUD treatment rate with Respect to Crime Rates 71 3.5.2 Treatment Gap & Limited Insurance Coverage for SUD Treatment 73 3.5.3 Insurance Expansions under HIFA Waivers 74 3.5.4 Parity Mandates for SUD treatment 75 3.6 Re-estimating the Effect of the SUD treatment rate on Crime Rates Using TSLS 76 3.6.1 Estimating the Effect of Instrumental Variables on Endogenous SUD treatment rate 76 3.6.2 Estimating the Effect of the SUD treatment rate on Crime Rates: Main Results 79 3.6.3 Checking for the Validity of the Instrumental Variables 81 3.7 Discussion 82 References 90 CHAPTER 4: The Effect of Medical Marijuana Laws on Adolescent and Adult Use of Marijuana, Alcohol, and Other Substances 95 4.1 Introduction 96 4.2 Background 98 4.2.1 Medical Marijuana Law and Potential Risks and Medical Value of Marijuana 98 4.2.2 Literature on the Effect of MML on Marijuana Use in the General Population 100 4.2.3 Spillover from Marijuana Use to the Use of Alcohol and Other Substances 102 4.2.4 Literature on the Relationship between Marijuana Use & Other Substance Use 106 4.2.5 Significance of Our Study 108 4.3 Methods 109 4.3.1 Data Sources 109 4.3.2 Variable Measurement 110 4.3.3 Identification Strategy 115 4.4 Results 118 4.4.1 Estimated Effect of MML Implementation on Marijuana Use 118 4.4.2 Estimated Effect of MML Implementation on Alcohol Use 120 4.4.3 Immediate and Delayed Effect of MML Implementation on Downstream Outcomes 121 4.4.4 Policy Heterogeneity between Key MML Provisions 122 4.4.5 Policy Endogeneity of MML Adoption 124 4.4.6 State-Aggregate Effect of MML Implementation 124 4.5 Discussion 125 References 138 CHAPTER 5: Conclusion 144 5.1 Key Findings of Essay 1: State Parity Laws and Access to Treatment for Substance Use Disorder in the United States 144 5.2 Key Findings of Essay 2: The Effect of Substance Use Disorder Treatment Use on Crime 145 5.3 Key Findings of Essay 3: The Effect of Medical Marijuana Laws on Adolescent and Adult Use of Marijuana, Alcohol, and Other Substances 146 5.4 Main Conclusions 147 References 151

About this Dissertation

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Laney Graduate School
Department	Health Services and Research Health Policy
Degree	PhD
Submission	Dissertation
Language	English
Research Field	Health Sciences, Public Health
关键词	Behavioral Health Policy Substance Use
Committee Chair / Thesis Advisor	Cummings, Janet, Emory University
Committee Members	Druss, Benjamin G, Emory University Gaydos, Laurie, Emory University Hockenberry, Jason Michael, Emory University

最新修改

Primary PDF

Thumbnail	Title	Date Uploaded	Actions
	The Role of Health Policy in Improving Access to Substance Use Disorder Treatment, Influencing Substance Use, and Promoting Public Safety ()	2018-08-28 14:46:55 -0400	Press to Select an action Download

Supplemental Files

Thumbnail	Title	Date Uploaded	Actions