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 |
|
Department |
|
Degree |
|
Submission |
|
Language |
|
Research Field |
|
关键词 |
|
Committee Chair / Thesis Advisor |
|
Committee Members |
|