Bradley Ray
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The opioid epidemic is taking an increasingly severe toll on the well-being of Hoosiers. Drug overdose deaths between 1999 and 2014 increased by 500 percent in Indiana. In 2016, more than 80% of the record-number 345 drug overdose deaths in Marion County showed signs of an opioid. Misconceptions about drug users can hinder effective dissemination and implementation of scientific findings into opioid-related prevention and treatment. Dr. Bradley Ray, with colleague Dennis P. Watson, evaluates policy and programmatic responses to the opioid crisis in Indiana.
Dr. Ray’s interdisciplinary research examines the nuances of opioid-related policies and practices to identify and implement evidence-based responses rooted in a harm reduction approach, and his findings have shaped opioid-related policy and practice. With federal support, Dr. Ray and his team recently studied the implementation of Aaron’s Law and found that fear of arrest undercuts the law that shields anyone who administers naloxone, a lifesaving emergency antidote for opioid overdose, from criminal charges. The Indiana State Department of Health uses these results to inform future efforts around naloxone access and use. Other findings have helped guide medication-assisted treatment in Porter, Starke, and Scott counties.
Dr. Brad Ray’s work to disseminate and implement scientific findings into opioid-related policy and practice in Indiana is another example of how IUPUI faculty are TRANSLATING RESEARCH INTO PRACTICE.
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Item Access to Recovery and Recidivism Among Former Prison Inmates(Sage, 2015) Ray, Bradley; Grommon, Eric; Buchanan, Victoria; Brown, Brittany; Watson, Dennis P.; Department of Health Policy and Management, Richard M. Fairbanks School of Public HealthAccess to Recovery (ATR) is a SAMHSA-funded initiative that offers a mix of clinical and supportive services for substance abuse. ATR clients choose which services will help to overcome barriers in their road to recovery, and a recovery consultant provides vouchers and helps link the client to these community resources. One of ATR’s goals was to provide services to those involved in the criminal justice system in the hopes that addressing substance abuse issues could reduce subsequent criminal behaviors. This study examines this goal by looking at recidivism among a sample of clients in one state’s ATR program who returned to the community after incarceration. Results suggest there were few differential effects of service selections on subsequent recidivism. However, there are significant differences in recidivism rates among the agencies that provided ATR services. Agencies with more resources and a focus on prisoner reentry had better recidivism outcomes than those that focus only on substance abuse services.Item Anticipated Stigma and Defensive Individualism during Post-Incarceration Job Searching(Wiley, 2016-08) Ray, Bradley; Grommon, Eric; Rydberg, Jason; School of Public and Environmental AffairsObtaining employment is one of the most difficult challenges for individuals released from prison. This research explores the strategies recently released male parolees employ in attempting to find work, with specific attention to the role of anticipated stigma from their ex-convict status. Through the use of in-depth longitudinal interviews, this research contributes to our understanding of returning prisoner's experiences in job searching. We find that although a majority of the sample anticipated stigma as a barrier to employment, those who did expressed an extreme self-reliance consistent with defensive individualism. This reluctance to draw on social networks may ultimately be counter-productive to the search for employment.Item Barriers and facilitators to implementing an urban co-responding police-mental health team(Springer, 2018-11-22) Bailey, Katie; Paquet, Staci Rising; Ray, Bradley R.; Grommon, Eric; Lowder, Evan M.; Sightes, Emily; School of Public and Environmental AffairsBackgroundIn an effort to reduce the increasing number of persons with mental illness (PMI) experiencing incarceration, co-responding police-mental health teams are being utilized as a way to divert PMI from the criminal justice system. Co-response teams are typically an inter-agency collaboration between police and mental health professionals, and in some cases include emergency medical personnel. These teams are intended to facilitate emergency response by linking patients to mental health resources rather than the criminal justice system, thus reducing burdens on both the criminal justice systems as well as local healthcare systems. The current study examines the barriers and facilitators of successfully implementing the Mobile Crisis Assistance Team model, a first-responder co-response team consisting of police officers, mental health professionals, and paramedics. Through content analysis of qualitative focus groups with team members and interviews with program stakeholders, this study expands previous findings by identifying additional professional cultural barriers and facilitators to program implementation while also exploring the role of clear, systematic policies and guidelines in program success.ResultsFindings demonstrate the value of having both flexible and formal policies and procedures to help guide program implementation; ample community resources and treatment services in order to successfully refer clients to needed services; and streamlined communication among participating agencies and the local healthcare community. A significant barrier to successful program implementation is that of role conflict and stigma. Indeed, members of the co-response teams experienced difficulty transitioning into their new roles and reported negative feedback from other first responders as well as from within their own agency. Initial agency collaboration, information sharing between agencies, and team building were also identified as facilitators to program implementation.ConclusionThe current study provides a critical foundation for the implementation of first-responder police-mental health co-response teams. Cultural and systematic barriers to co-response team success should be understood prior to program creation and used to guide implementation. Furthermore, attention must be directed to cultivating community and professional support for co-response teams. Findings from this study can be used to guide future efforts to implement first-response co-response teams in order to positively engage PMI and divert PMI from the criminal justice system.Item Developing a Culturally Proficient Intervention for Young African American Men in Drug Court: Examining Feasibility and Estimating an Effect Size for Habilitation Empowerment Accountability Therapy (HEAT)(2018) Marlowe, Douglas B.; Shannon, Lisa M.; Ray, Bradley; Turpin, Darryl P.; Wheeler, Guy A.; Newell, Jennifer; Lawson, Spencer G.African American males between 18 and 29 years of age are substantially less likely than many other participants to graduate successfully from drug court. Unsuccessful termination from drug court can have serious repercussions for these young men, including possible incarceration and negative collateral consequences associated with having a criminal record. This article reports preliminary results from two pilot studies that examined the feasibility of implementing a culturally proficient intervention for young African American men in drug court, and estimated an effect size for the intervention in improving treatment retention and reducing termination rates. Results confirmed that participants with serious criminal and substance use histories were willing and able to complete the lengthy 9-month curriculum, were satisfied with the intervention, and graduated from drug court at substantially higher rates than are commonly observed in this at-risk population. A sufficient basis has been established to justify the effort and expense of examining this intervention — Habilitation Empowerment Accountability Therapy (HEAT) — in fully powered randomized controlled trials.Item Developing Substance Use Programming for Person-Oriented Recovery and Treatment (SUPPORT): protocol for a pilot randomized controlled trial(BMC, 2017-12-15) Watson, Dennis P.; Ray, Bradley; Robison, Lisa; Xu, Huiping; Edwards, Rhiannon; Salyers, Michelle P.; Hill, James; Shue, Sarah; Social and Behavioral Sciences, School of Public HealthBackground There is a lack of evidence-based substance use disorder treatment and services targeting returning inmates. Substance Use Programming for Person-Oriented Recovery and Treatment (SUPPORT) is a community-driven, recovery-oriented approach to substance abuse care which has the potential to address this service gap. SUPPORT is modeled after Indiana’s Access to Recovery program, which was closed due to lack of federal support despite positive improvements in clients’ recovery outcomes. SUPPORT builds on noted limitations of Indiana's Access to Recovery program. The ultimate goal of this project is to establish SUPPORT as an effective and scalable recovery-oriented system of care. A necessary step we must take before launching a large clinical trial is pilot testing the SUPPORT intervention. Methods The pilot will take place at Public Advocates in Community Re-Entry (PACE), nonprofit serving individuals with felony convictions who are located in Marion County, Indiana (Indianapolis). The pilot will follow a basic parallel randomized design to compare clients receiving SUPPORT with clients receiving standard services. A total of 80 clients within 3 months of prison release will be recruited to participate and randomly assigned to one of the two intervention arms. Quantitative measures will be collected at multiple time points to understand SUPPORT’s impact on recovery capital and outcomes. We will also collect qualitative data from SUPPORT clients to better understand their program and post-discharge experiences. Discussion Successful completion of this pilot will prepare us to conduct a multi-site clinical trial. The ultimate goal of this future work is to develop an evidence-based and scalable approach to treating substance use disorder among persons returning to society after incarceration. Trial registration ClinicalTrials.gov (Clinical Trials ID: NCT03132753 and Protocol Number: 1511731907). Registered 28 April 2017.Item Emergency department-based peer support for opioid use disorder: Emergent functions and forms(Elsevier, 2019) McGuire, Alan B.; Gilmore Powell, Kristen; Treitler, Peter C.; Wagner, Karla D.; Smith, Krysti P.; Cooperman, Nina; Robinson, Lisa; Carter, Jessica; Ray, Bradley; Watson, Dennis P.; School of Public and Environmental AffairsEmergency department (ED)-based peer support programs aimed at linking persons with opioid use disorder (OUD) to medication for addiction treatment and other recovery services are a promising approach to addressing the opioid crisis. This brief report draws on experiences from three states' experience with such programs funded by the SAMHSA Opioid State Targeted Repose (STR) grants. Core functions of such programs include: Integration of peer supports in EDs; Alerting peers of eligible patients and making the patient aware of peer services; and connecting patients with recovery services. Qualitative data were analyzed using a general inductive approach conducted in 3 steps in order to identify forms utilized to fulfill these functions. Peer integration differed in terms of peer's physical location and who hired and supervised peers. Peers often depend on ED staff to alert them to potential patients while people other than the peers often first introduce potential patients to programming. Programs generally schedule initial appointments for recovery services for patients, but some programs provide a range of other services aimed at supporting participation in recovery services. Future effectiveness evaluations of ED-based peer support programs for OUD should consistently report on forms used to fulfill core functions.Item Erratum to: Examining Fatal Opioid Overdoses in Marion County, Indiana(Springer-Verlag, 2017-04) Ray, Bradley; Quinet, Kenna; Dickinson, Timothy; Watson, Dennis P.; Ballew, Alfarena; School of Public and Environmental AffairsItem Examining Fatal Opioid Overdoses in Marion County, Indiana(Springer, 2017-04-01) Ray, Bradley; Quinet, Kenna; Dickinson, Timothy; Watson, Dennis P.; Ballew, Alfarena; School of Public and Environmental AffairsDrug-related overdoses are now the leading injury-related death in the USA, and many of these deaths are associated with illicit opioids and prescription opiate pain medication. This study uses multiple sources of data to examine accidental opioid overdoses across 6 years, 2010 through 2015, in Marion County, IN, an urban jurisdiction in the USA. The primary sources of data are toxicology reports from the county coroner, which reveal that during this period, the most commonly detected opioid substance was heroin. During the study period, 918 deaths involved heroin, and there were significant increases in accidental overdose deaths involving both heroin and fentanyl. In order to disentangle the nature and source of opioid overdose deaths, we also examine data from Indiana’s prescription drug monitoring program and the law enforcement forensic services agency. Results suggest that there have been decreases in the number of opiate prescriptions dispensed and increases in law enforcement detection of both heroin and fentanyl. Consistent with recent literature, we suggest that increased regulation of prescription opiates reduced the likelihood of overdoses from these substances, but might have also had an iatrogenic effect of increasing deaths from heroin and fentanyl. We discuss several policy implications and recommendations for Indiana.Item Examining Mental Health Court Completion: A Focal Concerns Perspective(Wiley, 2013-09) Ray, Bradley; Dollar, Cindy Brooks; School of Public and Environmental AffairsSociologists have long-raised concern about disparate treatment in the justice system. Focal concerns have become the dominant perspective in explaining these disparities in legal processing decisions. Despite the growth of problem-solving courts, little research has examined how this perspective operates in nontraditional court settings. This article used a mixed-method approach to examine focal concerns in a mental health court (MHC). Observational findings indicate that gender and length of time in court influence the court's contextualization of noncompliance. While discussions of race were absent in observational data, competing-risk survival analysis finds that gender and race interact to predict MHC termination.Item Exploring Stigmatization and Stigma Management in Mental Health Court: Assessing Modified Labeling Theory in a New Context(Wiley, 2014-09) Ray, Bradley; Dollar, Cindy Brooks; School of Public and Environmental AffairsDrawing on Link and colleagues' modified labeling theory, this article examines whether the stigma management strategies defendants anticipate using after mental health court exit are associated with their reported experiences during court. Using survey data from 34 mental health court graduates, we find that respondents generally perceive the mental health court as procedurally just, did not experience stigmatizing shame, and anticipate using the inclusionary coping strategy of education over the exclusionary strategies of secrecy and withdrawal. Moreover, findings reveal that the anticipated use of stigma management strategies is associated with mental health court experiences in that procedural justice is associated with inclusionary coping strategies, while stigmatizing shame is associated with exclusionary coping strategies. We conclude by encouraging researchers to further explore the role of stigmatization and shame in specialty court contexts and to continue investigating these defendant perceptions of these courts' process.