Association between Lifetime Criminal Justice Involvement and Substance Use Disorders in U.S. Adults with Diabetes

Background: Criminal justice involvement (CJI) is a social risk in adults with both diabetes and substance use, however, the relationship between CJI, diabetes, and substance use disorders is not well studied. Methods: Data from a nationally representative sample of U.S. adults with diabetes from the National Survey of Drug Use and Health (2015-2018) were used to establish the prevalence of the following substance use disorders: Alcohol, opioid, cannabis, cocaine, and methamphetamine, or a composite variable for any substance use disorder. Multiple logistic regression was used to test the association between CJI and each substance use disorder in adults with diabetes controlling for relevant covariates. Results: Of 11,594 respondents representing 25,834,422 U.S. adults with diabetes, 17.1% reported prior CJI. Prevalence of substance use disorders was significantly higher in individuals with CJI compared to those without CJI (alcohol: 8.3 vs. 2.2; opioid: 2.1 vs. 0.4; cannabis: 1.4 vs. 0.2; cocaine: 1.2 vs. 0.1; methamphetamine: 1.2 vs. 0.1; any substance: 11.86 vs. 2.78; p<0.001 for all). In fully adjusted models, odds of substance use disorders were significantly higher in individuals with CJI (alcohol: odds ratio [OR] 2.76, 95% confidence interval [CI]: 2.01-3.82; opioid: OR 5.08, 95% CI: 2.25-11.47; cannabis: OR 5.05, 95% CI: 2.60-9.81; cocaine: OR 23.62, 95% CI: 5.59-99.82; methamphetamine: OR 40.66, 95% CI: 13.23-124.95; any substance: OR 7.19, 95% CI: 4.47-11.56). Conclusion: In adults with diabetes, prevalence of substance use disorder is high among those with CJI. Interventions that target substance use disorders are needed in this population.