Date of Award

5-2026

Access Control

Open Access

Degree Name

Master of Science (MS)

Advisor

Molly Holinger, Ph.D.

First Reader

Molly Holinger, Ph.D.

Second Reader

Susan Keller-Mathers, Ph.D.

Abstract

Substance use disorders (SUDs) and opioid use disorder (OUD) represent one of the most pressing yet poorly understood public health crises in the United States. Despite decades of clinical intervention, recovery outcomes remain deeply unequal, not because individuals lack motivation, but because the structural systems surrounding them are fundamentally broken. This project explored that reality through a comprehensive literature review examining how systemic barriers across educational systems, labor markets, poverty dynamics, and healthcare infrastructure shape vulnerability, treatment access, and recovery outcomes for individuals with SUDs. Major findings revealed a consistent socioeconomic gradient of harm: individuals with lower educational attainment, unstable employment, and economic marginalization face significantly elevated risks of overdose mortality and treatment disengagement. Adolescent substance use and school noncompletion were identified as mutually reinforcing processes, while labor market discrimination and fragmented treatment systems further constrain long-term recovery. Drawing on these findings, a social determinant of health framework was developed, repositioning addiction as a structural phenomenon rather than an individual failing. This framework recommends that future research prioritize integrated intervention models connecting education, employment, housing, and healthcare as unified recovery supports. Policy efforts should focus on trauma-informed school environments, vocational rehabilitation within treatment programs, and equitable access to medication for opioid use disorder. Sustained progress requires systemic reform grounded in equity, dignity, and structural accountability.

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