Author ORCID Identifier

https://orcid.org/0009-0007-9062-0746

Semester

Spring

Date of Graduation

2025

Document Type

Dissertation

Degree Type

PhD

College

College of Business and Economics

Department

Economics

Committee Chair

Daniel Grossman

Committee Co-Chair

Nathaniel Burke

Committee Member

Nathaniel Burke

Committee Member

Alicia Plemmons

Committee Member

Shishir Shakya

Abstract

Substance use in the United States has remained an area of concern with rates of overdose deaths increasing steadily over the years. Historically, the United States has relied on abstinence based treatment options for individuals with substance use disorder. Economists have long been interested in the affects of various supply and demand side policy interventions to help reduce the instance of substance use disorder, especially following the prescription opioid crisis of the 1990s and early 2000s. Supply side policies are most commonly enacted as a way to reduce the supply of illicit substances that enter the market. However, these supply side interventions have led to unintended consequences and substitution to alternative and more potent substances such as heroin. This dissertation investigates the effectiveness of alternative treatment and intervention options for substance use disorder as well as the regulatory environment that impacts the accessibility for abstinence based treatment.

Chapter 1 evaluates the role of supply side changes in the illicit market supply on the evaluation of harm reduction services. Following the passing of SB 192, the state of Kentucky legalized the provision of syringe service programs (SSPs). Harm reduction is an alternative option for intervening during active substance use in order to reduce the associated risks. Using the National Vital Statistics System’s restricted-use multiple cause of death data I track overdose deaths before and after a syringe exchange is opened in a county. Using a synthetic difference in differences design, I find that counties with a SSP experience an additional 2 overdose deaths per 100,000 population. However, when separating by substance type listed at the time of death, these increases are primarily driven by increases in fentanyl related overdose deaths. Further, when I account for the proportion of fentanyl within the illicit market supply, the difference in outcome is indistinguishable from zero. This indicates that the makeup of the supply within the illicit substance market must be accounted for when evaluating the effectiveness of these programs otherwise there is risk of over estimating the effects.

In Chapter 2, alongside Dr. Shishir Shakya, we evaluate the effect of substance use facility certificate of need state laws on access to abstinence based treatment facilities. Using the National Directory of Drug and Alcohol Abuse Treatment Facilities we measure the differences in access in states with these laws compared to those without. We develop a novel access indicator that accounts for the duration and distance of traveling to and from a facility from a county population weighted centroid. Findings suggest that states with certificate of need laws have approximately 10% less spatial accessibility to facilities in terms of driving time. This means that patients in these states have to travel longer to access services as a result of policy.

Chapter 3, in collaboration with Dr. Nathaniel Burke, investigates the behavioral affects of binding and non-binding goals on worker productivity. Labor market regulation often includes licensing and certifications that are used as signals of quality and regulatory compliance. These licenses and certifications can be seen as binding and non-binding goals, respectively, when applied to a labor market environment. We implement a lab experiment to test how individuals respond to different types of goals in the context of occupational regulation. We find that when participants set goals, there is an increase in productivity compared to non-goal setting participants. We use these results to provide a framework for evaluating how workers, producers, and regulators respond to different types of goals in simulated labor market.

Download

Share

COinS