Policy determinants of substance use and treatment access for individuals registered as sex offenders in Philadelphia: a Qualitative investigation

PROJECT SUMMARY The purpose of this resubmitted Dissertation Research Award (R36) is to support the completion of a dissertation research project that will lay the foundation for a successful career as an independent investigator who conducts place-based, policy-relevant research examining and addressing the structural determinants of substance use among vulnerable, criminal-legally involved populations. People convicted of sexual offenses and required to register as sex offenders (PRR) under sex offender registration and notification (SORN) policies are a particularly stigmatized subpopulation of people involved in the criminal legal system, and are an important but understudied subgroup who may be disproportionately impacted by substance use and treatment need. Evidence consistently demonstrates that SORN policies do not deter sexual offending or serve a public safety function but do have wide-ranging and significantly destabilizing collateral consequences for PRR, who face material and social restrictions as direct and indirect results of SORN policies. These include: housing instability, unemployment, isolation/alienation, poor mental health, abandonment by social networks, exclusions from community spaces, and overt discrimination, harassment and vigilantism. Simultaneously, SORN policies limit PRR access to and eligibility for substance use treatment and harm reduction services. While no existing literature has examined harms associated with substance use in the context of collateral consequences for PRRs, it is likely that, given the known relationships among economic, social, and structural vulnerabilities and substance use, SORN policies increase PRRs’ risk of substance related harms, and contribute to elevated levels of substance use disorder among PRRs. The goal of this proposed research is to address this important gap in knowledge and provide evidence for future interventions that will improve both public health and public safety. This goal will be achieved by qualitatively exploring the relationship between SORN policies and patterns of substance use and treatment access through 1) 30 semi-structured stakeholder interviews with attorneys, probation officers, substance use and sex offender treatment providers, and reentry case managers to elucidate the substance use and policy landscape for PRR and 2) 50 semi- structured interviews with PRR to reveal how the policy environment impacts access to substance use treatment and other social services, and influences the lived experiences of people subject to SORN. This dissertation project will support growth towards research independence, and will lay the groundwork for a future program of policy-relevant research examining and addressing how SORN policies operate as structural determinants of behavioral and social health.