Health care issues involving substance users have taken on increased significance with the advent of managed care in our current cost-conscious era. The war on drugs has led to arrest of increasing numbers of substance users, adding salience to the role of the criminal justice system as a """"""""trouser"""""""" of drug users, and as a conduit to the drug treatment system. The termination of the addiction disability within the SSI program presents the possibility that many substance users will lose, or have already lost, Medicaid benefits that covered health care and pharmaceutical costs. The goal of this study is to gain a detailed understanding of the health care needs and service utilization of a sample of chemically dependent criminal offenders taking into account their current chemical dependency status, co-occurring psychiatric disorders, baseline medical conditions including HIV status, and significant mediating factors such as participation in drug treatment, utilization of medical services within incarcerate and community settings, age, and injection drug use. The study will employ a prospective, longitudinal, repeated measures design with a sample of 600 predominantly African-American male felony offenders and 200 predominantly African-American female felony offenders, screened for lifetime chemical dependency. The study has four aims: 1) Identify and assess a sample of addicted criminal offenders for their baseline chemical dependency status, psychiatric status, health status, utilization of health care services, and perceived barriers to utilization of health services; 2) Validate participants' self-reported baseline health status through physician administered medical examinations; 3) Develop a multivariate statistical model of the interrelationship over a three-year follow-up period between chemical dependency status, psychiatric status, health status, barriers to service utilization, and actual utilization of health care services controlling for baseline health status, participation in drug treatment, age, injection drug use, and health insurance coverage; 4) Determine the relative impact of medical conditions and injuries related to violent victimization on the utilization of medical services through collection of detailed information on violent victimization of study participants.
