Saudi Cultural Missions Theses & Dissertations
Permanent URI for this communityhttps://drepo.sdl.edu.sa/handle/20.500.14154/10
Browse
1 results
Search Results
Item Restricted Access to Care, Structural Barriers, and Recovery Identity in Mental Health and Substance Use Disorder Treatment(Saudi Digital Library, 2025) Alnashri, Yahya; Becker, David J; Dantzler, John; Giannouchos, Theodoros V; Jaiswal, Jessica; Sen, BisakhaSubstance use disorders (SUDs) remain one of the most pressing public health and economic challenges in the United States, with growing recognition that recovery is a multidimensional process shaped by clinical, social, and structural factors. This dissertation explores recovery at the levels of health policy, population, and experiential levels to assess gaps in access to recovery support services, identify patterns and predictors of recovery identity, and highlight the lived experiences of individuals with opioid use disorder. First, we evaluated whether state Medicaid expansion under the ACA (2010–2019) was associated with changes in the availability of consumer-run peer support services in mental health treatment facilities, based on data from the National Mental Health Services Survey (N-MHSS). Through a staggered difference-in-differences (DiD) design, we found no significant post-expansion increase in peer support offerings, suggesting that insurance coverage expansion alone did not lead to growth in recovery-oriented service integration. Second, we estimated the prevalence and predictors of self-identified recovery among U.S. adults reporting lifetime substance use problems, using pooled data from the 2021–2023 National Survey on Drug Use and Health (NSDUH). We found that approximately three-quarters of individuals with lifetime substance use problems identified as being in recovery or recovered. Recovery identity was associated with a variety of demographic, psychosocial, and behavioral characteristics, including rural residence, religious involvement, lower income, public insurance, having a chronic health condition, co-occurring mental health recovery and those who reported reduced substance use during the COVID-19 pandemic. Third, through semi-structured interviews (n=26) with adults living with opioid use disorder in Alabama, we explored how they define recovery and navigate structural and social barriers to accessing care. Thematic analysis identified recovery as “rebuilding a normal life” across housing, employment, relationships, and well-being; persistent logistical obstacles (financial hardship, insurance instability, transportation) and pervasive stigma undermined treatment engagement despite recognition of MOUD’s lifesaving role In conclusion these papers underscore that recovery is shaped by more than individual behavior; it reflects the broader health policy landscape, social support systems, and lived experiences. Policymakers and practitioners must address structural and relational barriers to improve equitable access to recovery-oriented care.8 0