Drug Use Disorders before, during, and after Imprisonment

Drug-involved offenders have been long overrepresented in prisons. Intensi-fied drug law enforcement in many countries increased both incarceration rates, especially for drug offenses, and numbers of drug-involved prisoners. This is attributable to four features of drugs and drug markets. Drug use disorders typically are not the only problems facing drug-involved prisoners. A high proportion exhibit severe mental health problems such as major depres-sion, personality disorders, and psychotic disorders. Before incarceration, many drug-involved prisoners have unstable housing and are at high risk of homelessness; incarceration increases that risk. The high concentration of drug-involved offenders in prisons presents numerous challenges. After re-lease, the most obvious are high rates of drug relapse and recidivism. Former prisoners have extraordinarily high risks of drug overdoses shortly after release; in the long term, diseases acquired during imprisonment are transmitted in the community. Effective prison-based drug treatment holds promise to break this cycle and mitigate physical and mental health problems of drug-involved prisoners. Unfortunately, access to treatment modalities proven to be effective in reducing drug use and recidivism is limited. A paradigm shift in drug en-forcement and treatment is needed to meet the challenges presented by indi-viduals with drug use disorders more effectively.