How competing needs after incarceration lead to adverse health outcomes among people who use criminalized drugs

Abstract In the USA, people with a history of criminalized drug use and drug use disorders reentering the community after incarceration frequently experience adverse health outcomes including overdose, suicide, and infectious disease acquisition. This review presents a conceptual model for understan...

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Main Authors: Catherine Paquette, Kate Ehle, Margaret Roach, Tasia Danns, Katherine LeMasters, Betsy Craft, Lauren Brinkley-Rubinstein
Format: Article
Language:English
Published: BMC 2025-05-01
Series:BMC Global and Public Health
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Online Access:https://doi.org/10.1186/s44263-025-00152-y
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author Catherine Paquette
Kate Ehle
Margaret Roach
Tasia Danns
Katherine LeMasters
Betsy Craft
Lauren Brinkley-Rubinstein
author_facet Catherine Paquette
Kate Ehle
Margaret Roach
Tasia Danns
Katherine LeMasters
Betsy Craft
Lauren Brinkley-Rubinstein
author_sort Catherine Paquette
collection DOAJ
description Abstract In the USA, people with a history of criminalized drug use and drug use disorders reentering the community after incarceration frequently experience adverse health outcomes including overdose, suicide, and infectious disease acquisition. This review presents a conceptual model for understanding risk pathways for these outcomes related to post-release psychosocial needs. We first summarize the literature on post-release needs experienced by people who use criminalized drugs during reentry in multiple domains, including basic needs and those related to relationships as well as medical, mental health, and substance use problems. Drawing from a socioecological model, we demonstrate how vulnerability factors related to criminal legal involvement and criminalized drug use operate at intrapersonal (i.e., individual), interpersonal, institutional, community, and policy levels to negatively affect the ability of people who use drugs to meet each of these types of needs. We present research demonstrating that when people leaving incarceration are met with the overwhelming task of addressing competing demands, they often experience strong negative affect, which can lead to risk-conferring behaviors including criminalized drug use. Competing needs also create environmental conditions that amplify risk. We argue for the importance of interventions that address determinants of post-release health at individual and social-environmental levels to prevent adverse outcomes.
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spelling doaj-art-510e435e1c414a6eb0ff9fbc5a5a99f62025-08-20T02:10:46ZengBMCBMC Global and Public Health2731-913X2025-05-013111210.1186/s44263-025-00152-yHow competing needs after incarceration lead to adverse health outcomes among people who use criminalized drugsCatherine Paquette0Kate Ehle1Margaret Roach2Tasia Danns3Katherine LeMasters4Betsy Craft5Lauren Brinkley-Rubinstein6Department of Population Health Sciences, Duke University School of MedicineDepartment of Population Health Sciences, Duke University School of MedicineDepartment of Population Health Sciences, Duke University School of MedicineDepartment of Population Health Sciences, Duke University School of MedicineDepartment of Medicine – Internal Medicine, University of Colorado Anschutz Medical CampusDepartment of Medicine – Internal Medicine, University of Colorado Anschutz Medical CampusDepartment of Population Health Sciences, Duke University School of MedicineAbstract In the USA, people with a history of criminalized drug use and drug use disorders reentering the community after incarceration frequently experience adverse health outcomes including overdose, suicide, and infectious disease acquisition. This review presents a conceptual model for understanding risk pathways for these outcomes related to post-release psychosocial needs. We first summarize the literature on post-release needs experienced by people who use criminalized drugs during reentry in multiple domains, including basic needs and those related to relationships as well as medical, mental health, and substance use problems. Drawing from a socioecological model, we demonstrate how vulnerability factors related to criminal legal involvement and criminalized drug use operate at intrapersonal (i.e., individual), interpersonal, institutional, community, and policy levels to negatively affect the ability of people who use drugs to meet each of these types of needs. We present research demonstrating that when people leaving incarceration are met with the overwhelming task of addressing competing demands, they often experience strong negative affect, which can lead to risk-conferring behaviors including criminalized drug use. Competing needs also create environmental conditions that amplify risk. We argue for the importance of interventions that address determinants of post-release health at individual and social-environmental levels to prevent adverse outcomes.https://doi.org/10.1186/s44263-025-00152-yMental healthIncarcerationSubstance-related disordersDrug overdoseCommunicable diseasesPolicy
spellingShingle Catherine Paquette
Kate Ehle
Margaret Roach
Tasia Danns
Katherine LeMasters
Betsy Craft
Lauren Brinkley-Rubinstein
How competing needs after incarceration lead to adverse health outcomes among people who use criminalized drugs
BMC Global and Public Health
Mental health
Incarceration
Substance-related disorders
Drug overdose
Communicable diseases
Policy
title How competing needs after incarceration lead to adverse health outcomes among people who use criminalized drugs
title_full How competing needs after incarceration lead to adverse health outcomes among people who use criminalized drugs
title_fullStr How competing needs after incarceration lead to adverse health outcomes among people who use criminalized drugs
title_full_unstemmed How competing needs after incarceration lead to adverse health outcomes among people who use criminalized drugs
title_short How competing needs after incarceration lead to adverse health outcomes among people who use criminalized drugs
title_sort how competing needs after incarceration lead to adverse health outcomes among people who use criminalized drugs
topic Mental health
Incarceration
Substance-related disorders
Drug overdose
Communicable diseases
Policy
url https://doi.org/10.1186/s44263-025-00152-y
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