Justice-Involved Recovery: Treatment and Support After Incarceration

In 1976, Operation Understanding broke new barriers and helped change the recovery movement forever. Now, 50 years later, we’re honoring that legacy—and building what comes next.

Part of this effort is sharing the latest evidence-based information on topics that are important to you.

This toolkit was created in partnership with Mobilize Recovery and Recovery.com for Operation Understanding.

Justice-involved recovery combines two ideas: the recovery process itself and the unique path people take through it when the justice system is part of their story. SAMHSA defines recovery broadly as a process of change where a person improves their health and wellness, lives a self-directed life, and works toward their full potential.¹ Justice-involved recovery applies that same process to people navigating incarceration, release, or supervision at the same time, whether that means starting treatment while still in jail, continuing care after release, or building a stable life while on probation or parole.

What makes this path distinct is timing and continuity. Treatment that begins during incarceration and continues seamlessly into the community, rather than stopping at release, gives someone the best chance of staying well and staying out of the system.²

A criminal record does not close the door on recovery. Law enforcement, courts, and corrections systems increasingly work alongside treatment providers to connect justice-involved people with substance use and mental health care rather than relying on incarceration alone.¹

Why Substance Use and Mental Health Treatment Matter

Substance use disorder and mental health conditions are common among people who come into contact with the justice system, and the two frequently occur together as co-occurring disorders.² According to a 2016 Department of Justice survey cited in peer-reviewed research, 41% of state and federal prisoners had a history of mental illness, with 27% of state prisoners reporting a major depressive disorder and 22% reporting an anxiety disorder.²

These behavioral health needs often go unaddressed while someone is incarcerated, which is part of why the transition back to the community carries so much risk. Left untreated, both substance use disorder and mental health disorders raise the likelihood of further justice involvement.²

Depression is one of the most common of these conditions among incarcerated people, and it's often diagnosed alongside SUD rather than on its own, which is why treatment approaches typically screen for both together as co-occurring depression and other conditions rather than treating substance use in isolation.²

Why Language Matters in Justice-Involved Recovery

The words used to describe someone can shape how that person sees themselves, and that self-perception affects what happens next. When a judge, officer, or case worker uses a label like "junkie," it can reinforce the belief that change isn't possible, which makes someone more likely to withdraw from treatment and end up back in the justice system.

Person-first language, like calling someone "a person in recovery" instead of defining them by a past label, supports a different mindset: one where change feels possible, engagement in treatment feels worthwhile, and reintegration feels within reach. This isn't just a courtesy. It matters at every point of contact, from law enforcement and courts to corrections, probation, treatment, and reentry.

How Recovery and Recidivism Are Connected

The weeks immediately following release from incarceration are the highest-risk period for both relapse and reoffending, largely because reduced drug tolerance during incarceration makes a return to previous use levels far more dangerous.³ A CDC-led review of the research found that the risk of fatal overdose is several times higher in the first two weeks after release than in the weeks that follow, before gradually declining over the following months.³

This reentry window is also when reintegration into housing, employment, and family life is hardest, which is why long-term recovery depends on support that starts before release and continues after it.³ Treatment that continues across the transition from incarceration to the community, rather than stopping at release, is associated with reduced recidivism and lower relapse rates over time.⁴

Treatment Courts and Alternatives to Incarceration

Many jurisdictions now offer treatment courts, sometimes called drug courts, that mandate and coordinate substance use treatment as an alternative to incarceration for eligible defendants.⁵ These programs monitor progress in treatment while connecting participants to other services, one of several diversion points within the Sequential Intercept Model that SAMHSA uses to map where people with behavioral health needs can be redirected toward care instead of deeper justice involvement.⁵

Probation and parole can also include treatment conditions instead of additional jail time, letting someone remain in the community while receiving care. These court-supervised programs go by a few different names depending on how they're structured and who orders them, though in practice the terms are often used interchangeably. When a judge requires treatment as a condition of sentencing, it's often called court-mandated rehab.

Court-ordered rehabilitation programs are not the same, and the specific program that the judge orders depends on factors such as the severity of the issue, the nature of the offense, and what’s available in the state. The American Society of Addiction Medicine (ASAM) has established criteria that many states use to determine which types of court-rehab programs should be implemented.

Sareen Khodabakhsh, LMFT

A related, and often overlapping, arrangement covers treatment ordered as part of a plea agreement or a formal diversion program before sentencing. Recovery.com's guide to court-ordered rehab covers how that version of the process typically works.

Evidence-Based Treatment Approaches

The most effective, evidence-based treatment approaches for justice-involved individuals combine behavioral therapy with medication where appropriate. The National Institute on Drug Abuse has found these approaches reduce both drug use and recidivism when they continue across the transition from incarceration to the community.⁴

• Cognitive behavioral therapy helps someone identify the thought patterns that contribute to substance use and criminal behavior, and it remains one of the most studied approaches for this population.⁴
• Motivational interviewing is another widely used approach in these settings. It helps someone build their own reasons for change, which tends to work better under legal pressure than approaches that rely on external pressure alone, according to NIDA's research.⁴
• For opioid use disorder specifically, medication-assisted treatment (MAT) pairs FDA-approved medications with counseling and has strong evidence behind it for people leaving incarceration.⁴ Few correctional facilities currently offer this care on-site, even though the evidence supporting it is well established.⁴
• Starting or continuing MAT for opioid use disorder directly in a jail or prison setting, before someone is released, improves the odds that treatment continues without a gap.⁴

Reentry Support and Continuity of Care

Continuity of care, meaning treatment started during incarceration continues without interruption after release, is one of the strongest predictors of a successful reentry.⁶ Case management connects someone to a single point of contact who can coordinate behavioral health services, housing, and other reentry needs both before and after release.⁶

Reentry services also include help with benefits and identification paperwork, transportation to appointments, and warm hand-offs from corrections staff to community-based providers, so someone doesn't leave custody without a plan already in place.⁶ Care coordination across corrections, treatment providers, and community organizations helps close the gaps where people are most likely to fall out of care.⁶

Peer support groups, often led by people with their own history of recovery or justice involvement, can also help ease the isolation many people feel in the first weeks after release.

My life is proof that recovery is possible. Our pasts do not define us, and every challenge can become a source of resilience and purpose.

Suzula Bidon, Atty.

Paying for Treatment: Medicaid and Coverage

Medicaid eligibility doesn't have to end when someone is incarcerated. States are increasingly moving toward suspending Medicaid coverage during incarceration rather than terminating it, which allows coverage to resume quickly once someone is released instead of requiring a new application.⁶

Where this suspension policy is in place, someone can leave custody with active health coverage for medication, therapy, and other treatment already in effect.⁶ For anyone without Medicaid, or navigating other coverage questions, Recovery.com's guide on paying for rehab breaks down insurance, financing, and assistance options in more detail.

Justice involvement does not have to define someone's path forward. Whether someone is currently incarcerated, newly released, or several years into supervision, treatment for substance use disorder and mental health works, and support exists at every stage, from arrest through long-term recovery. Reaching out to a treatment provider, case manager, or community organization is often the first step toward finding the right level of care.

How Recovery.com Can Help

Recovery.com is a free, impartial treatment navigation platform that helps people find evidence-based addiction and mental health care quickly, with clinically reviewed content, transparent center profiles, and tools designed to enhance treatment access.

This toolkit was created in collaboration with Mobilize Recovery for Operation Understanding.