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Rural Health Information Hub
Rural Health Information Hub

SUD Program Implementation Considerations for People Who Are Justice-Involved

Substance use disorders (SUD) are prevalent among people who are incarcerated. However, treatment for SUD within criminal justice settings — such as drug courts, jails, and prisons — remains significantly underutilized. The lack of treatment during incarceration often leads to unaddressed health needs, increasing the risk of relapse and overdose, particularly after release. Individuals who experience enforced abstinence without treatment for their underlying SUD face heightened vulnerability to fatal overdoses upon reentry into the community.

Research has shown that individuals who receive evidence-based treatment for SUD during incarceration are more likely to engage in treatment after release, initiate treatment sooner, and maintain long-term recovery. Treatment also reduces the likelihood of testing positive for illicit substances, returning to substance use, or experiencing overdose after release.

Approaches to SUD Treatment During Incarceration
Several models exist for delivering SUD treatment within correctional settings, with unique considerations for implementation:

  • Medications for SUD: This approach includes medications such as methadone, buprenorphine, and naltrexone for OUD, as well as medications for alcohol and tobacco use disorders. Treatment can be provided onsite by licensed providers or offsite through transportation to external facilities.
  • Behavioral health interventions: These include counseling, cognitive-behavioral therapy (CBT), motivational interviewing (MI), and peer support programs, which can be integrated in jail and prison systems.
  • Comprehensive treatment models: Programs that combine medication, behavioral therapies, and post-release support provide holistic care. These models can involve partnerships between criminal justice systems and community-based treatment providers to ensure continuity of care after release.
  • Peer support: Peer support networks and recovery coaches embedded within correctional facilities can help individuals develop recovery skills and establish connections to community resources before release.

Implementing SUD treatment in correctional settings presents logistical challenges, such as staffing, transportation logistics, stigma, and the need for specialized licensing. Additionally, rural correctional facilities may face unique barriers, including limited access to treatment providers and support services. However, innovative partnerships between correctional facilities and community organizations have shown promise in addressing these challenges. For example, the First Day Forward program in rural Kentucky leverages partnerships between the Northeast Kentucky Substance Use Response Coalition, jails, and peer specialists to provide support for individuals with SUD both before and after release.

Drug Courts as an Alternative to Incarceration for Individuals with SUD
Drug courts are specialized courts that offer an alternative to incarceration for individuals with SUD who have also committed a crime. Drug courts supervise, test, and treat individuals through evidence-based curricula. Some focus on juveniles, families, and specific substances or offenses like driving under the influence. For more information on how drug courts have been used to support people with SUD in rural communities, see Module 2.