Exploring the Intersection of Substance Use and System(s) Involvement: A Mixed Methods Community-Based Participatory Research Study

The United States continued overreliance on criminalization and punitive policy in response to substance use has not only failed to reduce the negative impacts of substance use but instead further marginalized people who use drugs (PWUD) by increasing their involvement in criminal and child welfare systems. Unfortunately, the perspectives of PWUD with system(s) involvement are often not amplified in social work practice and research, particularly among those who are marginalized by factors such as race, ethnicity, disability, income, gender, and sexual orientation. To disrupt this harmful trajectory and re-center the voices of those most impacted, this presentation will present findings from a mixed-methods community-based participatory research (CBPR) study at the intersection of substance use and system(s) involvement.

Methods: This CBPR study utilizes a sequential mixed-methods research design. In collaboration with a substance use clinic and its patients, research questions were developed and analyzed. To begin, secondary data analysis was conducted using the clinic's electronic medical records, in which descriptive and inferential analysis was conducted in collaboration with clinicians at the clinic to better understand the outcomes of the patient population. This data was used to inform the next phase of research, in which patients at the clinic were invited to complete an in-depth interview about their experiences with system involvement and substance use. Interview responses were then converted to prompts for a photovoice phase of the research, in collaboration with the patients. Patients were provided with cameras and asked to take photographs that represented their experiences with system involvement, substance use, and recovery.

Findings: Descriptive and inferential statistics were completed on the dataset, which contained 430 cases with 418 unique individuals served at the clinic from December 2018 to December 2022. Utilizing chi-square and regression analysis, sexual orientation was found to have the most significant impact on treatment outcomes, such as successful completion of treatment, length of stay, and level of care, than any other demographic information provided. Individuals who identified as LGBTQIA were more likely to have system involvement, not complete treatment, and have a shorter length of stay. These findings informed semi-structured interviews in which specific questions about sexual orientation were asked about treatment.

Key themes from interviews included 1) isolation caused by system involvement, 2) criminalization for experiencing poverty, and 3) the multiple marginalizing effects of system involvement on individuals with minority identities. The photovoice project revealed that patients experienced stigma and discrimination related to their substance use and both negative physical and mental health impacts of system(s) involvement. The photovoice data also illuminated methods of community resilience and resistance.

Implications: The study's use of mixed methods design and CBPR methods allowed for a more comprehensive understanding of the experiences and perspectives of PWUD with system(s) involvement. The findings identified areas for improvement that are responsive to the needs and priorities of the community. The study's findings support a shift away from punitive responses to societal substance use and toward compassionate, harm-reduction approaches.