Substance use substantially increases the risk for incarceration. To understand what psychosocial and medical factors can be addressed to prevent it, or which types of individuals need additional support post-release, this study examined predictors of reincarceration among individuals with a history of injection drug use or HIV.
l
One in ten individuals on probation or parole and 65% percent of the US prison population have a current substance use disorder, and another 20% were under the influence of a substance when their crime was committed. Unfortunately, individuals with a substance use disorder in the criminal legal system are likely to encounter many types of barriers that get in the way of developing recovery capital, i.e., the internal and external resources that support recovery and slow their recovery journey.
For example, they may face discrimination or stigma that gets in the way of finding safe housing or steady work. These are barriers that can increase stress levels, reduce acquisition of coping skills or other necessary resources for daily life, and lead back into substance use and behaviors that initially got them into trouble. This study examined what factors are most likely to contribute to an individual’s reincarceration among individuals who use drugs. By understanding the factors that predict reincarceration, policies and services can be geared to best prevent recidivism in these vulnerable groups of individuals who use drugs.
This was secondary data analysis using longitudinal data from two cohorts in Vancouver, Canada. The first cohort, the AIDS Care Cohort to Evaluate Exposure to Survival Services (ACCESS), enrolled adults that used any illicit substance other than or in addition to cannabis and are living with HIV. The second cohort, the Vancouver Injection Drug Users Study (VIDUS), enrolled adults who injected drugs and are HIV-negative. In this secondary analysis, participants were included if they were in either cohort from June 2006 to November 2018, reported an incarceration event at any point during the study period, and had one subsequent study visit. A participant’s baseline in this analysis was considered their time of first reported incarceration during the study period. Participants who had not had an interview in the 2 years before the study period end of 2018 were considered lost to follow-up. The total sample across both cohorts was 2350, but only 468 of those experienced incarceration and completed a follow-up visit and are included in this analysis.
The assessments were conducted by trained interviewers with participants at baseline and every 6 months. The assessments covered substance use, sexual experiences, and other things like criminal legal involvement. The primary outcome – reincarceration – was defined as a reincarceration event during the study period in a provincial (i.e., the Canadian equivalent of a US state) prison or federal penitentiary.
The analysis explored the following factors that should not change over time (time invariant) as binary indicators (yes/no) associated with reincarceration: self-identified men (versus women and non-binary gender), ethnicity/ancestry (white vs. Indigenous vs. other), education at baseline (less than high school diploma vs. high school diploma or more), service use in jail during baseline incarceration (e.g., including services such as anger management or substance use), and baseline HIV status. There were also factors included in the models that were updated over time, as appropriate, including age at study visit, HIV status, homelessness, sex work, engagement in community judicial supervision, stimulant use, opioid use, any injection drug use, and heavy alcohol use (defined using the NIAAA 2010 criteria for men and women), self-reported mental illness diagnosis, calendar year of study visit, reincarceration events during the study period (none, one, two or more), and accessing addiction treatment.
Of the 468 participants in this study, the median age was 40 years (75% of the sample was between 34-46 years), 74% were men, and 38% identified as Indigenous. Individuals were reincarcerated between 0 and 11 times with nearly half experiencing at least one reincarceration event.
Environmental-level factors were most strongly associated with reincarceration.
In the analysis that adjusted for several factors at once, the presence of 4 factors were more likely to be linked to reincarceration while the presence of 3 other factors were likely to reduce the potential of reincarceration. Experiencing homelessness, being under community judicial supervision, and heavy alcohol use were factors related to an increased risk of reincarceration. Reincarceration during the study period was also associated with increased risk of reincarceration, suggesting that among those who were reincarcerated once, their risk of being incarcerated again increased. Among those factors found to increase one’s risk for reincarceration, being under community judicial supervision presented the greatest risk, nearly double that of the other factors with the exception of homelessness. Yet, participation in addiction treatment, the presence of a mental illness, and older age, were negatively related to reincarceration risk. Among those factors found to decrease one’s risk for reincarceration, being older was the strongest predictor, but was similar in magnitude to the other factors.
In this study of individuals who used drugs in Canada and had been incarcerated, the odds of being reincarcerated no better than the flip of a coin, suggesting there are a lot of opportunities to make a difference. Importantly, several of the factors implicated in this relationship are areas that communities can address with targeted programming, intervention, and recovery supports.
Experiencing homelessness was linked to increased reincarceration while engagement in addiction treatment was linked to reduced reincarceration. These findings suggest that actively linking individuals leaving jail or prison with stable housing, including recovery-supportive housing such as sober homes, may be an important way to reduce their risk of reincarceration.
When exiting jail or prison, it is important to ensure individuals have access to treatment and recovery supports that may help address their substance use behaviors and increase their opportunities to build their recovery capital while back in the community. Without adequately addressing individuals’ substance use, scholars have proposed that the criminal legal system can become a “revolving door” for continued substance use, crime, and incarceration. This could be one reason why individuals under community judicial supervision were more likely to return to incarceration. These individuals were more closely supervised and thus more likely to be caught in criminal activity after incarceration. The use of peer recovery coaches to facilitate an individual’s transition from incarceration to the community may be an efficient way to buffer the gap for individuals leaving a prison setting and to address basic needs for health and well-being. Similarly, as the presence of a mental illness was an indicator of reduced likelihood of reincarceration, this may have meant that individuals with mental health challenges were more connected with service professionals and support that ultimately supported their community re-entry process.
Notably, although many of the factors reflect aspects of the broader community and available services, heavy use of alcohol was also linked to reincarceration. Alcohol, a legal and regulated substance, was the only substance in the analysis to be associated with reincarceration and unfortunately, is also associated with a variety of costs to society, including those that involve the criminal legal system such as violent crime and intimate partner violence. This is an important area for early intervention as there are several evidence-based programs to address heavy alcohol use or alcohol use disorders that could be used in justice settings or to support individuals exiting these settings.
Finally, there may be a need to rethink programming and policies around substance use and criminal behavior. If there are opportunities to intervene and engage individuals in diversion programs, or drug treatment or recovery courts prior to incarceration for those who struggle with substance use, these could fill a critical need and avoid the need for incarceration, breaking the vicious cycle of incarceration and reincarceration.
In this study of individuals who used drugs in Canada and had been incarcerated, nearly half were reincarcerated. Several system-level factors were linked to greater odds of reincarceration, including experiencing homelessness, while receiving treatment was linked to reduced odds of reincarceration. These findings suggest that criminal justice efforts – to prevent the additional financial and human costs of reincarceration – should seek to increase access to these key supports for individuals leaving a supervised setting. One key individual-level factor linked to increased reincarceration was heavy alcohol use, suggesting that greater attention be paid to addressing alcohol use among incarcerated populations.
Brooks, O., Hayashi, K., Cui, Z., Milloy, M. J., Kerr, T., & Fairbairn, N. (2023). Reincarceration and associated social, structural and behavioural factors among people who use drugs in an urban Canadian setting. International Journal of Drug Policy, 115, 104018. doi: 10.1016/j.drugpo.2023.104018
l
One in ten individuals on probation or parole and 65% percent of the US prison population have a current substance use disorder, and another 20% were under the influence of a substance when their crime was committed. Unfortunately, individuals with a substance use disorder in the criminal legal system are likely to encounter many types of barriers that get in the way of developing recovery capital, i.e., the internal and external resources that support recovery and slow their recovery journey.
For example, they may face discrimination or stigma that gets in the way of finding safe housing or steady work. These are barriers that can increase stress levels, reduce acquisition of coping skills or other necessary resources for daily life, and lead back into substance use and behaviors that initially got them into trouble. This study examined what factors are most likely to contribute to an individual’s reincarceration among individuals who use drugs. By understanding the factors that predict reincarceration, policies and services can be geared to best prevent recidivism in these vulnerable groups of individuals who use drugs.
This was secondary data analysis using longitudinal data from two cohorts in Vancouver, Canada. The first cohort, the AIDS Care Cohort to Evaluate Exposure to Survival Services (ACCESS), enrolled adults that used any illicit substance other than or in addition to cannabis and are living with HIV. The second cohort, the Vancouver Injection Drug Users Study (VIDUS), enrolled adults who injected drugs and are HIV-negative. In this secondary analysis, participants were included if they were in either cohort from June 2006 to November 2018, reported an incarceration event at any point during the study period, and had one subsequent study visit. A participant’s baseline in this analysis was considered their time of first reported incarceration during the study period. Participants who had not had an interview in the 2 years before the study period end of 2018 were considered lost to follow-up. The total sample across both cohorts was 2350, but only 468 of those experienced incarceration and completed a follow-up visit and are included in this analysis.
The assessments were conducted by trained interviewers with participants at baseline and every 6 months. The assessments covered substance use, sexual experiences, and other things like criminal legal involvement. The primary outcome – reincarceration – was defined as a reincarceration event during the study period in a provincial (i.e., the Canadian equivalent of a US state) prison or federal penitentiary.
The analysis explored the following factors that should not change over time (time invariant) as binary indicators (yes/no) associated with reincarceration: self-identified men (versus women and non-binary gender), ethnicity/ancestry (white vs. Indigenous vs. other), education at baseline (less than high school diploma vs. high school diploma or more), service use in jail during baseline incarceration (e.g., including services such as anger management or substance use), and baseline HIV status. There were also factors included in the models that were updated over time, as appropriate, including age at study visit, HIV status, homelessness, sex work, engagement in community judicial supervision, stimulant use, opioid use, any injection drug use, and heavy alcohol use (defined using the NIAAA 2010 criteria for men and women), self-reported mental illness diagnosis, calendar year of study visit, reincarceration events during the study period (none, one, two or more), and accessing addiction treatment.
Of the 468 participants in this study, the median age was 40 years (75% of the sample was between 34-46 years), 74% were men, and 38% identified as Indigenous. Individuals were reincarcerated between 0 and 11 times with nearly half experiencing at least one reincarceration event.
Environmental-level factors were most strongly associated with reincarceration.
In the analysis that adjusted for several factors at once, the presence of 4 factors were more likely to be linked to reincarceration while the presence of 3 other factors were likely to reduce the potential of reincarceration. Experiencing homelessness, being under community judicial supervision, and heavy alcohol use were factors related to an increased risk of reincarceration. Reincarceration during the study period was also associated with increased risk of reincarceration, suggesting that among those who were reincarcerated once, their risk of being incarcerated again increased. Among those factors found to increase one’s risk for reincarceration, being under community judicial supervision presented the greatest risk, nearly double that of the other factors with the exception of homelessness. Yet, participation in addiction treatment, the presence of a mental illness, and older age, were negatively related to reincarceration risk. Among those factors found to decrease one’s risk for reincarceration, being older was the strongest predictor, but was similar in magnitude to the other factors.
In this study of individuals who used drugs in Canada and had been incarcerated, the odds of being reincarcerated no better than the flip of a coin, suggesting there are a lot of opportunities to make a difference. Importantly, several of the factors implicated in this relationship are areas that communities can address with targeted programming, intervention, and recovery supports.
Experiencing homelessness was linked to increased reincarceration while engagement in addiction treatment was linked to reduced reincarceration. These findings suggest that actively linking individuals leaving jail or prison with stable housing, including recovery-supportive housing such as sober homes, may be an important way to reduce their risk of reincarceration.
When exiting jail or prison, it is important to ensure individuals have access to treatment and recovery supports that may help address their substance use behaviors and increase their opportunities to build their recovery capital while back in the community. Without adequately addressing individuals’ substance use, scholars have proposed that the criminal legal system can become a “revolving door” for continued substance use, crime, and incarceration. This could be one reason why individuals under community judicial supervision were more likely to return to incarceration. These individuals were more closely supervised and thus more likely to be caught in criminal activity after incarceration. The use of peer recovery coaches to facilitate an individual’s transition from incarceration to the community may be an efficient way to buffer the gap for individuals leaving a prison setting and to address basic needs for health and well-being. Similarly, as the presence of a mental illness was an indicator of reduced likelihood of reincarceration, this may have meant that individuals with mental health challenges were more connected with service professionals and support that ultimately supported their community re-entry process.
Notably, although many of the factors reflect aspects of the broader community and available services, heavy use of alcohol was also linked to reincarceration. Alcohol, a legal and regulated substance, was the only substance in the analysis to be associated with reincarceration and unfortunately, is also associated with a variety of costs to society, including those that involve the criminal legal system such as violent crime and intimate partner violence. This is an important area for early intervention as there are several evidence-based programs to address heavy alcohol use or alcohol use disorders that could be used in justice settings or to support individuals exiting these settings.
Finally, there may be a need to rethink programming and policies around substance use and criminal behavior. If there are opportunities to intervene and engage individuals in diversion programs, or drug treatment or recovery courts prior to incarceration for those who struggle with substance use, these could fill a critical need and avoid the need for incarceration, breaking the vicious cycle of incarceration and reincarceration.
In this study of individuals who used drugs in Canada and had been incarcerated, nearly half were reincarcerated. Several system-level factors were linked to greater odds of reincarceration, including experiencing homelessness, while receiving treatment was linked to reduced odds of reincarceration. These findings suggest that criminal justice efforts – to prevent the additional financial and human costs of reincarceration – should seek to increase access to these key supports for individuals leaving a supervised setting. One key individual-level factor linked to increased reincarceration was heavy alcohol use, suggesting that greater attention be paid to addressing alcohol use among incarcerated populations.
Brooks, O., Hayashi, K., Cui, Z., Milloy, M. J., Kerr, T., & Fairbairn, N. (2023). Reincarceration and associated social, structural and behavioural factors among people who use drugs in an urban Canadian setting. International Journal of Drug Policy, 115, 104018. doi: 10.1016/j.drugpo.2023.104018
l
One in ten individuals on probation or parole and 65% percent of the US prison population have a current substance use disorder, and another 20% were under the influence of a substance when their crime was committed. Unfortunately, individuals with a substance use disorder in the criminal legal system are likely to encounter many types of barriers that get in the way of developing recovery capital, i.e., the internal and external resources that support recovery and slow their recovery journey.
For example, they may face discrimination or stigma that gets in the way of finding safe housing or steady work. These are barriers that can increase stress levels, reduce acquisition of coping skills or other necessary resources for daily life, and lead back into substance use and behaviors that initially got them into trouble. This study examined what factors are most likely to contribute to an individual’s reincarceration among individuals who use drugs. By understanding the factors that predict reincarceration, policies and services can be geared to best prevent recidivism in these vulnerable groups of individuals who use drugs.
This was secondary data analysis using longitudinal data from two cohorts in Vancouver, Canada. The first cohort, the AIDS Care Cohort to Evaluate Exposure to Survival Services (ACCESS), enrolled adults that used any illicit substance other than or in addition to cannabis and are living with HIV. The second cohort, the Vancouver Injection Drug Users Study (VIDUS), enrolled adults who injected drugs and are HIV-negative. In this secondary analysis, participants were included if they were in either cohort from June 2006 to November 2018, reported an incarceration event at any point during the study period, and had one subsequent study visit. A participant’s baseline in this analysis was considered their time of first reported incarceration during the study period. Participants who had not had an interview in the 2 years before the study period end of 2018 were considered lost to follow-up. The total sample across both cohorts was 2350, but only 468 of those experienced incarceration and completed a follow-up visit and are included in this analysis.
The assessments were conducted by trained interviewers with participants at baseline and every 6 months. The assessments covered substance use, sexual experiences, and other things like criminal legal involvement. The primary outcome – reincarceration – was defined as a reincarceration event during the study period in a provincial (i.e., the Canadian equivalent of a US state) prison or federal penitentiary.
The analysis explored the following factors that should not change over time (time invariant) as binary indicators (yes/no) associated with reincarceration: self-identified men (versus women and non-binary gender), ethnicity/ancestry (white vs. Indigenous vs. other), education at baseline (less than high school diploma vs. high school diploma or more), service use in jail during baseline incarceration (e.g., including services such as anger management or substance use), and baseline HIV status. There were also factors included in the models that were updated over time, as appropriate, including age at study visit, HIV status, homelessness, sex work, engagement in community judicial supervision, stimulant use, opioid use, any injection drug use, and heavy alcohol use (defined using the NIAAA 2010 criteria for men and women), self-reported mental illness diagnosis, calendar year of study visit, reincarceration events during the study period (none, one, two or more), and accessing addiction treatment.
Of the 468 participants in this study, the median age was 40 years (75% of the sample was between 34-46 years), 74% were men, and 38% identified as Indigenous. Individuals were reincarcerated between 0 and 11 times with nearly half experiencing at least one reincarceration event.
Environmental-level factors were most strongly associated with reincarceration.
In the analysis that adjusted for several factors at once, the presence of 4 factors were more likely to be linked to reincarceration while the presence of 3 other factors were likely to reduce the potential of reincarceration. Experiencing homelessness, being under community judicial supervision, and heavy alcohol use were factors related to an increased risk of reincarceration. Reincarceration during the study period was also associated with increased risk of reincarceration, suggesting that among those who were reincarcerated once, their risk of being incarcerated again increased. Among those factors found to increase one’s risk for reincarceration, being under community judicial supervision presented the greatest risk, nearly double that of the other factors with the exception of homelessness. Yet, participation in addiction treatment, the presence of a mental illness, and older age, were negatively related to reincarceration risk. Among those factors found to decrease one’s risk for reincarceration, being older was the strongest predictor, but was similar in magnitude to the other factors.
In this study of individuals who used drugs in Canada and had been incarcerated, the odds of being reincarcerated no better than the flip of a coin, suggesting there are a lot of opportunities to make a difference. Importantly, several of the factors implicated in this relationship are areas that communities can address with targeted programming, intervention, and recovery supports.
Experiencing homelessness was linked to increased reincarceration while engagement in addiction treatment was linked to reduced reincarceration. These findings suggest that actively linking individuals leaving jail or prison with stable housing, including recovery-supportive housing such as sober homes, may be an important way to reduce their risk of reincarceration.
When exiting jail or prison, it is important to ensure individuals have access to treatment and recovery supports that may help address their substance use behaviors and increase their opportunities to build their recovery capital while back in the community. Without adequately addressing individuals’ substance use, scholars have proposed that the criminal legal system can become a “revolving door” for continued substance use, crime, and incarceration. This could be one reason why individuals under community judicial supervision were more likely to return to incarceration. These individuals were more closely supervised and thus more likely to be caught in criminal activity after incarceration. The use of peer recovery coaches to facilitate an individual’s transition from incarceration to the community may be an efficient way to buffer the gap for individuals leaving a prison setting and to address basic needs for health and well-being. Similarly, as the presence of a mental illness was an indicator of reduced likelihood of reincarceration, this may have meant that individuals with mental health challenges were more connected with service professionals and support that ultimately supported their community re-entry process.
Notably, although many of the factors reflect aspects of the broader community and available services, heavy use of alcohol was also linked to reincarceration. Alcohol, a legal and regulated substance, was the only substance in the analysis to be associated with reincarceration and unfortunately, is also associated with a variety of costs to society, including those that involve the criminal legal system such as violent crime and intimate partner violence. This is an important area for early intervention as there are several evidence-based programs to address heavy alcohol use or alcohol use disorders that could be used in justice settings or to support individuals exiting these settings.
Finally, there may be a need to rethink programming and policies around substance use and criminal behavior. If there are opportunities to intervene and engage individuals in diversion programs, or drug treatment or recovery courts prior to incarceration for those who struggle with substance use, these could fill a critical need and avoid the need for incarceration, breaking the vicious cycle of incarceration and reincarceration.
In this study of individuals who used drugs in Canada and had been incarcerated, nearly half were reincarcerated. Several system-level factors were linked to greater odds of reincarceration, including experiencing homelessness, while receiving treatment was linked to reduced odds of reincarceration. These findings suggest that criminal justice efforts – to prevent the additional financial and human costs of reincarceration – should seek to increase access to these key supports for individuals leaving a supervised setting. One key individual-level factor linked to increased reincarceration was heavy alcohol use, suggesting that greater attention be paid to addressing alcohol use among incarcerated populations.
Brooks, O., Hayashi, K., Cui, Z., Milloy, M. J., Kerr, T., & Fairbairn, N. (2023). Reincarceration and associated social, structural and behavioural factors among people who use drugs in an urban Canadian setting. International Journal of Drug Policy, 115, 104018. doi: 10.1016/j.drugpo.2023.104018
SIGN UP FOR THE BULLETIN
