Comparing Substance Use Behaviors of Individuals on Probation and Parole By Population Density in the U.S

Background: Despite significant heterogeneity in communities throughout the United States, little is known about differences in substance use behaviors across the geographic areas for individuals on probation or parole. Among the general population, evidence suggests that nonmetropolitan adults report lower rates of alcohol and illicit drug use but higher rates of methamphetamine use than metropolitan adults. Understanding use patterns of those on probation and parole across geographic area has the potential to allow social workers and other service providers to better respond to the needs and deleterious outcomes associated with those substances.

Purpose:In the current study, we examined rates and sociodemographic correlates of substance use behaviors among adults on probation or parole in large metropolitan, small metropolitan, and nonmetropolitan areas. We aimed to address the following research questions with a sample of adults on probation and parole:

• Do rates of substance use behaviors vary by level of metropolitan area?
• Do rates of frequent substance use behaviors vary by level of metropolitan area?
• Is level of metropolitan area associated with past-year and past-month substance use behaviors after adjusting for the effects of covariates?

Methods: Data from the 2015-2018 National Survey on Drug Use and Health (NSDUH; N = 4,266 adults on parole or probation) was used. Alcohol, marijuana, opioid, and methamphetamine use were the substances examined in this study. Primary outcome variables included past-year use, past-month use, and frequent past-month use. Metropolitan area residence was the primary independent variable in this study. Control variables included: sex, age, race/ethnicity, education, and health insurance status.

Analytic Plan: Weighted chi-squares tests of independence and multivariable logistic regression models were run to test for differences of substance use behaviors across metropolitan areas.

Results: Past-year methamphetamine use was highest in nonmetropolitan areas (12.41%), and frequent marijuana use was highest among nonmetropolitan marijuana users (57.72%). Nonmetropolitan area residence was associated with lower odds of marijuana use (AOR = 0.78, 95% CI = 0.61, 0.98), opioid misuse (AOR = 0.74, 95% CI = 0.56, 0.96), and higher odds of methamphetamine use (AOR = 1.95, 95% CI = 1.44, 2.64) respective to large metropolitan area residence. Nonmetropolitan area residence was associated with lower odds of past-month alcohol use (AOR = 0.73, 95% CI = 0.59, 0.90), marijuana use (AOR = 0.72, 95% CI = 0.55, 0.95), and higher odds of methamphetamine use (AOR = 2.21, 95% CI = 1.51, 3.25) respective to large metropolitan area residence.

Conclusions: The findings from this work highlight the differences among substance use behaviors between levels of metropolitan areas for those on probation and parole. These differences argue for the consideration of incorporating different modalities to treat substance use based on the geographic area of service. Lastly, this may be informative to probation and parole working with individuals who are abusing substances as each substance has unique impact on an individual’s life. Prevention and treatment of substance use behaviors for adults on parole or probation need to consider the geographic context of substance use behaviors.