Geographic Differences in Perceptions of Problematic Substance Use Among Persons with Community Corrections Involvement

Background and Purpose: The geographic context of substance use is important for persons with community corrections involvement (i.e., probation or parole). Importantly, patterns of substance use vary by geographic area residence among persons with community corrections involvement. Higher rates of stimulant use are found in nonmetropolitan areas, whereas heroin use is more prevalent in large metropolitan areas. This geographic heterogeneity also extends to the availability of specific substances, attitudes towards substance use, and access to treatment. However, whether insight into problematic substance use differs by geographic area residence remains under investigated for those in community corrections. This is an important gap considering that insight into problematic substance use is an antecedent of substance use behavior change and treatment utilization. As such, the purpose of the present study was to examine geographic area differences in perceptions of problematic substance use among persons with community corrections involvement who engaged in past-year substance use.

Methods: Data for the present study came from the 2022 National Survey on Drug Use and Health. The analytic sample included persons in community corrections who reported past-year substance use (N=855). The main predictor of interest was geographic area residence, which was operationalized as residence in a large metropolitan, small metropolitan, or nonmetropolitan county. The outcome variable was perceived problematic substance use. χ2 tests of independence were employed to measure bivariate associations of geographic area residence with perceived problematic substance use. Multivariable logistic regression was then used to test for associations of geographic area residence with perceived problematic substance use when adjusting for covariates.

Results: Among adults in community corrections who reported past-year substance use, rates of perceived problematic substance use significantly differed by geographic area residence (p=.008). The prevalence of perceived problematic substance use was highest among adults in small metropolitan areas (54.99%), followed by nonmetropolitan (50.06%) and large metropolitan areas (29.68%). When adjusting for race/ethnicity, health conditions, and past-year mental illness, small metropolitan area residence was associated with higher odds of perceived problematic substance use relative to the odds of large metropolitan area residence (AOR = 2.56, 95% CI = 1.22-5.36). Furthermore, African Americans in community corrections had lower odds of perceived problematic substance use whereas persons with chronic health conditions had higher odds of perceived problematic substance use.

Conclusions and Implications: Study results indicated clinically significant differences in perceived problematic substance use based on geographic area residence for persons in community corrections. Our findings indicate that treatment providers in large metropolitan areas may need to prioritize increasing awareness into problematic substance use for adults in community corrections who engage in substance use. More permissive attitudes towards substance use behaviors and increased availability of alcohol and illicit substances are found in large metropolitan areas. These factors may contribute to the lower likelihood of perceived problematic substance use that was associated with large metropolitan area residence in the present study. Future studies may consider testing for interactions between types of specific substance use behaviors with geographic area residence among adults in community corrections.