Background
Rehabilitation within prisons and for incarcerated individuals is a necessary step for
reintegration into society. Current major health risks within prisons include substance
addiction, specifically opioid and alcohol addiction. For example, almost two-thirds of
incarcerated individuals in the United States have a substance use disorder (Evans et al., 2022; Treatment for Opioid Use, 2022). Despite this prevalence, prison systems consistently fail to provide adequate treatment, leaving individuals vulnerable to relapse and overdose after release (Impact of Incarceration, 2013).
While substance addiction poses a significant challenge for the broader incarcerated population, the impact is particularly severe for vulnerable groups, such as pregnant incarcerated women. Many prison staff view addiction as a moral failure rather than a treatable medical condition, resulting in insufficient care (Ahlbach et al., 2020). In fact, only seven states have statutes related to the treatment of substance use disorders in pregnant incarcerated populations, despite the high prevalence of substance use among these individuals (Augustin et al., 2023). Without proper treatment, addiction and its associated health consequences follow incarcerated individuals as they re-enter society, hindering their ability to secure employment, housing, and safety— essential components for meaningful and effective reintegration (Reentry, 2019). Thus, preventive substance addiction systems are necessary within prisons for effective reintegration among the incarcerated population.
Alcohol and Drug Addiction
Over half of currently incarcerated women report ongoing substance use disorder
(SUD). Compared to male prisoners, women are reportedly 10% more likely to have an SUD in the 12 months preceding incarceration (Maruschak et al., 2021). They also face unique vulnerabilities, including higher rates of childhood abuse, post-traumatic stress disorder (PTSD), and socioeconomic instability, which heightened susceptibility to addiction (Lingerfelt et al., 2023).
Secure housing is a critical component of successful reentry. Christina Mancini’s research demonstrates that formerly incarcerated women in unstable living conditions are significantly more likely to relapse into substance use (Mancini et al., 2021). Supportive housing programs, such as Oxford House, have proven effective in promoting long-term sobriety, with women in these programs showing higher rates of recovery after six months (Mancini et al., 2021). Ensuring that incarcerated individuals have access to stable, recovery-oriented housing upon release is essential for breaking the cycle of addiction and incarceration. This would offer pregnant women and new mothers a foundation for maternal health. Without it, the risks of relapse, poor birth outcomes, and family separation increase significantly.
Call to action:
The United States faces a public health crisis in its failure to rehabilitate incarcerated
individuals, particularly women. With respect to incarcerated women, failing to prescribe
treatment for SUDs—especially when an overwhelming amount of incarcerated women report an ongoing SUD—contributes to a continuous cycle of recidivism. For pregnant women specifically, the discontinuation of prescribed MOUD poses severe health risks to the life of the mother. Due to the health and societal risks that follow the failure to rehabilitate, there is an urgent need for policies that aid incarcerated women. Passing policies that would require prisons and jails to administer MOUDs and maintain this treatment would preserve the health of women and expecting mothers in the incarcerated system. Additionally, there is a need for policies that fund rehabilitation programs such as proper housing and employment post-incarceration. Providing individuals with an ease into life post-incarceration can end the continuous cycle of recidivism and addiction while creating stability for mothers and their children. Failing to rehabilitate incarcerated women, especially those who are pregnant or who have an addiction constitutes a public health emergency that must be tended to on a local, state, and federal level.
References
Ahlbach, C., Sufrin, C., & Shlafer, R. (2020). Care for incarcerated pregnant people with opioid use disorder: Equity and justice implications. Obstetrics and Gynecology, 136(3), 576. https://doi.org/10.1097/AOG.0000000000004002
Augustin, D., Steely Smith, M. K., Zielinski, M. J., Sufrin, C., Kramer, C. T., Benning, S. J., Laine, R., & Shlafer, R. J. (2023). State laws on substance use treatment for incarcerated pregnant and postpartum people. Center for Leadership Education in Maternal and Child Public Health, University of Minnesota.
Benck, S., Maurer, L., Hochl, G., Haffajee, R. L., & Zaller, N. D. (2021). Access to medications for opioid use disorder in state and federal prisons. Substance Abuse Treatment, Prevention, and Policy, 16, Article 45. https://doi.org/10.1186/s13011-021-00392-w
Bureau of Justice Statistics. (2021). Alcohol, drug use treatment reported by prisoners: Survey of prison inmates, 2016. Targeted News Service. https://bjs.ojp.gov/sites/g/files/xyckuh236/files/media/document/adutrpspi16st.pdf
Column: Don’t imprison heroin mothers and babies. (2014, July 24). Valley News. Retrieved from https://proxy.lib.umich.edu/login?url=https://www.proquest.com/newspapers/column-dont-imprison-heroin-mothers-babies/docview/1548022243/se-2
Evans, E. A., Wilson, D., & Friedmann, P. D. (2022). Recidivism and mortality after in-jail buprenorphine treatment for opioid use disorder. Drug and Alcohol Dependence, 231, 109254. https://doi.org/10.1016/j.drugalcdep.2021.109254
Garcia, M., Hiller, P., & Stimpson, J. P. (2020). County jail treatment and care of pregnant incarcerated persons with opioid use disorder. Drug and Alcohol Dependence, 209, 107926. https://doi.org/10.1016/j.drugalcdep.2020.107926
Impact of incarceration on health. (2013). In Health and incarceration: A workshop summary. National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK201966/
Lingerfelt, C., Hutson, S., Thomas, S., & Morgan, K. H. (2024). An interpretive description of drug withdrawal among pregnant women in jail. Nursing for Women’s Health. https://doi.org/10.1016/j.nwh.2023.11.005
Mancini, C., Baker, T., Sainju, K. D., Golden, K., Bedard, L. E., & Gertz, M. (2016). Examining external support received in prison and concerns about reentry among incarcerated women. Feminist Criminology, 11(2), 163–190. https://doi.org/10.1177/1557085115579483
Reentry: Effects on the individual and the community. (2019). In The effects of incarceration and reentry on community health and well-being: Proceedings of a workshop. National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK555730/
Sawyer, W., & Wagner, P. (2024). Mass incarceration: The whole pie 2024. Prison Policy Initiative. Retrieved from https://www.prisonpolicy.org/reports/pie2024.html
Soto-Nevarez, A., Stevens, E., & Jason, L. A. (2021). Housing, relationships, and substance use among formerly incarcerated females. Alcoholism Treatment Quarterly, 39(3), 242–258. https://doi.org/10.1080/07347324.2021.1917363
Treatment for opioid use disorder in jail reduces risk of return. (2022, February 7). National Institutes of Health (NIH). Retrieved from https://www.nih.gov/news-events/nih-research-matters/treatment-opioid-use-disorder-jail-reduces-risk-return
Volkow, N. D., & Blanco, C. (2023). The role of opioid medications in the treatment of opioid use disorder in pregnancy. The New England Journal of Medicine, 389(7), 585–587. https://doi.org/10.1056/NEJMp2212473
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