Drug use vs. abstinence after incarceration: associations with competing psychosocial needs and their relevance to the importance of treatment

Abstract Background Many people with histories of criminalized drug use resume using drugs after leaving incarceration, yet limited research explores the specific needs and vulnerabilities of these individuals compared to those who remain abstinent. We examined the relationship between post-incarceration drug use and competing psychosocial needs, as well as these needs’ association with views regarding substance use disorder (SUD) treatment. Aims (1) Compare psychosocial needs between individuals with recent drug use post-incarceration and those who were abstinent. (2) Examine which needs are associated with participants’ views on the importance of SUD treatment. Methods Among 244 participants with a history of drug use who were previously incarcerated, currently on community supervision, and had elevated risk of HIV, we compared those who used drugs within 30 days post-release (n = 97) to those who did not (n = 147) on health insurance coverage, alcohol use, food security, employment status, housing stability, social support, and depressive symptoms. We analyzed bivariate associations between these needs and the importance of SUD treatment using Wilcoxon-Mann-Whitney and Jonckheere-Terpstra tests. Results Participants with recent drug use reported higher rates of hazardous alcohol consumption (35.4% vs. 18.1%), food insecurity (58.8% vs. 42.9%), un- or under-employment (61.7% vs. 49.0%), low social support (44.3% vs. 24.7%), and depressive symptoms (50.5% vs. 21.8%). Substance-related problems were significantly linked to higher treatment importance for both groups. Multiple additional competing needs correlated with treatment importance among abstinent individuals. Conclusions Individuals who return to drug use post-incarceration face greater psychosocial challenges. Results highlight the need for disentanglement of access to services from treatment and the provision of comprehensive services regardless of stage of recovery.