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Author ORCID Identifier

https://orcid.org/0000-0003-3991-8196

Date Available

4-30-2027

Year of Publication

2026

Document Type

Doctoral Dissertation

Degree Name

Doctor of Philosophy (PhD)

College

Arts and Sciences

Department/School/Program

Sociology

Faculty

Carrie Oser

Faculty

Robyn Brown

Abstract

While agency (i.e., the capacity to act independently) is important to opioid use disorder (OUD) recovery, structures often define an individual’s recovery options. The Network Episode Model claims that health decision-making is a dynamic process that occurs within formal and informal networks. For example, criminal legal system (CLS) involvement is common among those with OUD, and for many, the CLS facilitates access to treatment services. Recovery limitations may also exist due to network members’ attitudes on acceptable recovery options. To explore the impact of formal and informal networks on OUD recovery, this dissertation has three Aims: 1) to examine the direct and indirect influence of the CLS on OUD recovery, 2) to analyze how formal and informal networks during incarceration affects post-release mutual support group participation, and 3) to understand how network characteristics are associated with post-release preference and use of medications for OUD (MOUD).

Data for this dissertation comes from two sources. Aim 1 uses data from the National Institutes of Health-funded HEALing Communities Study, Kentucky site (HCS-KY) Photovoice protocol. The goal of the HCS-KY Photovoice project was to gather community members’ input on local strengths and concerns in addressing the opioid epidemic. Qualitative analysis of the Photovoice discussion transcripts explores how recovery principles vocalized by participants reflect carceral values. Data for Aims 2 and 3 comes from the National Institute on Drug Abuse-funded Geographic variations in Addiction Treatment Experiences (GATE) study. The GATE study examined predictors of prison- and community-based MOUD initiation among individuals from rural and urban counties who had participated in the prison substance use treatment program. Aim 2 uses quantitative GATE study data and multinomial logistic regression modeling to evaluate the predictors of post-release mutual aid support groups participation. Aim 3 also uses this data to analyze the association between social network characteristics and post-release MOUD preference and use through logistic regression analysis.

Results of this project highlight how formal and informal networks influence OUD recovery outcomes. The values of formal networks, such as carceral structures, have been replicated into recovery principles that influence treatment preferences through adoption of these values among informal networks. While formal and informal networks place constraints on recovery paths, this project finds that the networks in which people are embedded provide opportunities for recovery support and facilitation to recovery resources among those who have been released from prison. OUD recovery is not merely an individual process, thus reducing recovery barriers requires multilevel strategizing to best effect change and have sustained public health impact.

Digital Object Identifier (DOI)

https://doi.org/10.13023/etd.2026.196

Archival?

Archival

Funding Information

This dissertation was funded by the National Institute on Drug Abuse through an R36 Dissertation Award (R36DA061317; PI: Booty) and also uses data from National Institutes of Health-funded HEALing Communities Study (UM1DA049406, PI: Walsh) and National Institute on Drug Abuse-funded Geographic variations in Addiction Treatment Experiences study (R01DA048876, PI: Oser). The content is solely the responsibility of the author and does not necessarily represent the official views of the funders.

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