Possible selves, psychological well-being, and substance use in young men within 12 months post-incarceration.

OBJECTIVE: Community reentry post-incarceration is fraught with challenges. The investigators examined the influence of highly personalized goals (possible selves) on psychological well-being, drug use, and hazardous drinking in recently incarcerated young men returning to the community. DESIGN AND SAMPLE: In this cross-sectional study, 52 young men released from jail or prison within the past 12 months were recruited from community-based organizations and reentry events. MEASUREMENTS: Participants completed open-ended possible selves measure and psychological well-being and substance use questionnaires. RESULTS: Possible selves accounted for 19%-31% of the variance in sense of purpose, environmental mastery, and personal growth. Having a feared delinquent possible self was associated with lower sense of purpose. Having many feared possible selves was associated with lower environmental mastery. Having an expected possible self related to interpersonal relationships was associated with higher personal growth and environmental mastery. Men having a feared delinquent possible self or an expected possible self related to material/lifestyle were more likely to use marijuana than men who did not. CONCLUSION: The content and number of possible selves may be an important focus for assessment by public health nurses in correctional and community settings serving young men post-incarceration. Longitudinal studies with larger samples are needed.

Examining Trauma and Readiness to Change among Women in a Community Re-Entry Program.

BACKGROUND: Posttraumatic stress disorder (PTSD) and co-occurring substance use disorders (SUDs) are common among women who are incarcerated. OBJECTIVE: The purpose of this study was to examine the relationship between trauma and readiness to change substance use behaviors. METHODS: This study used data from 103 participants enrolled in a residential re-entry program for women with SUDs and trauma history. Women reporting clinically elevated Trauma Symptom Inventory (TSI) subscale scores were compared to those without elevated scores on the University of Rhode Island Change Assessment (URICA) readiness to change instrument. Primary analyses included t-tests and ANCOVA to control for age and ethnicity. RESULTS: In general, women with clinically elevated trauma scores also reported greater readiness to change. The analyses revealed significant differences on the URICA Readiness to Change scores between women who had elevated Defensive Avoidance and Impaired Self-Reference according to the TSI. Results approached significance for women who had elevated TSI subscale scores for Sexual Concerns and Dissociation. CONCLUSIONS: These results point to a need to further understand links between trauma and readiness to change, particularly, the role of posttraumatic growth and psychological distress. This study has implications for social workers and clinicians delivering evidence-based treatment. Women who had high trauma symptoms were more willing to address change. Findings also suggest a need to tailor interventions to include motivational components that are also trauma-informed.

There will be some changes made: A survivor perspective on post-acquired brain injury residential transition.

PRIMARY OBJECTIVE: Brain injury survivors experience many transitions post-injury and it is important that they experience these in the most supportive and integrative ways possible. This study provided a group of chronic brain injury survivors the opportunity to share their insights and experience of residential transition and to suggest strategies to help maximize the transition experience and outcomes. RESEARCH DESIGN: This study used a qualitative design that consisted of semi-structured interviews. METHODS AND PROCEDURES: Twenty-one adults with chronic acquired brain injury residing in community-based supported group houses answered a series of scripted questions. Interviews were recorded and participant statements were transcribed and coded according to prospectively developed transition themes. MAIN OUTCOMES AND RESULTS: Participants discussed positive and negative insights and experiences regarding residential transitions. Themes of balance between support and independence, life purpose and transition to more or less structure were frequently addressed. Participants suggested caregiver-targeted strategies to facilitate successful transitions before, during and after a move. CONCLUSIONS: The insights and suggestions shared by this group of chronic acquired brain injury survivors add to already existing knowledge of post-injury residential transitions and strategies professional caregivers may use to maximize the ease and success of the survivor's transitional experience.

Observations of substance use treatment engagement during the period of community re-entry following residential treatment.

BACKGROUND: The period of community re-entry following residential substance use treatment is associated with elevated risk for return to substance use. Although continuity of care is best practice, many individuals do not engage in follow-up treatment, struggle to engage in follow-up treatment, or continue to use substances while participating in follow-up treatment. There is a need to both characterize treatment engagement during community re-entry following residential substance use treatment as well as understand how treatment impacts substance use during this high-risk period. METHOD: This observational study used retrospective self-report to examine treatment engagement and substance use among individuals who had exited residential substance use treatment. Participants completed a Timeline Follow-back interview reporting substance use and treatment engagement in the 30 days following residential treatment. RESULTS: Most participants (83.1 %) reported engaging in substance use treatment following discharge. The most common treatments were Alcoholics Anonymous/Narcotics Anonymous (61.1 %), medication for addiction treatment (40 %), and outpatient therapy (29.2 %). Participants were less likely to use substances on a day in which they engaged in outpatient therapy (OR = 0.32, 95 % CI [0.12, 0.90], p = 0.030) and more likely on days they engaged in medication treatment (OR = 21.49, 95 % CI [1.46, 316.74], p = 0.025). CONCLUSION: Findings characterize engagement in substance use treatment in the month following residential treatment. Treatment engagement was common during community re-entry; however, only outpatient therapy was found to reduce substance use during this high-risk period. Findings may inform intervention efforts during the high-risk period of community re-entry.

Addressing the complex substance use and mental health needs of people leaving prison: Insights from developing a national inventory of services in Canada.

Internationally, transitions from prison to the community are often precarious experiences for people who are living with substance use and mental health concerns. In Canada, a continuing opioid overdose crisis and overlapping challenges related to the COVID-19 pandemic have generated urgency for scaling up community-based services that can meet the complex substance use and mental health needs of people leaving prison. In this commentary, we reflect on our experience with and knowledge gained by developing a national inventory of substance use and mental health services for criminal justice-involved persons who are re-entering the community. We learned that there is a scarcity of such community-based services specific to criminal justice-involved populations and a glaring lack of information about culturally safe and appropriate supports. Stakeholders from organisations across Canada identified that communities need a comprehensive array of low-barrier services, inclusive of harm reduction and substance use treatment services, to meet the diverse needs of people leaving prison. We recommend building greater investment in and awareness of community-driven, local programs, as well as enhancing efforts to engage people with lived and living experience in service design and provision. We also briefly describe a few programs to highlight examples of how to operationalise the themes that we observed to emerge while developing a national inventory of community-based substance use and mental health services for criminal justice-involved persons.

Rural Re-entry and Opioid Use: Identifying Health-Related Predictors of Relapse Among Formerly Incarcerated Women in Appalachia.

Introduction: Despite improved knowledge of the health care needs of formerly incarcerated women, there exists a gap regarding the relationship between health, health care access, and relapse among rural women returning to the community during the opioid epidemic. Purpose: With an emphasis on health care access, this study examined health-related factors associated with opioid relapse among women reentering the community in rural Appalachia. Methods: As part of a larger study, 400 rural women reporting a history of substance use were recruited from three Appalachian jails in Kentucky. Analyses focused on participants reporting a history of illicit opioid use prior to incarceration, who had also completed follow-up interviews at 6- and 12-months post-release from jail. Results: Fifty-five percent of participants reported relapse to opioids during the 12-month follow-up period. Compared to those who did not use opioids during this time, women who relapsed reported poorer mental and physical health, as well as encountered more barriers to needed health services. They were also more likely to report a usual source of care. Multivariate regression analyses reveal that, even when controlling for other known correlates of opioid use and relapse to any non-opioid drug during the follow-up period, the number of barriers to health service utilization was a significant predictor of opioid relapse. Implications: Stakeholders should address the complex reentry needs of women who use opioids in rural Appalachia. This includes examining innovative approaches to reduce extensive barriers to quality health care utilization, such as implementing telehealth for opioid use treatment.

Perceived need for drug treatment among African American male drug-using prisoners.

Since 2016, African Americans have experienced the largest increase in cocaine-related drug overdose deaths compared to other racial/ethnic groups. African American male prisoners who used drugs prior to incarceration are at an increased risk for relapse and overdose upon community re-entry. Using the Theory of Planned Behavior as a guiding framework, this study examined correlates of perceived need for treatment among 193 drug-using incarcerated African American men nearing release. Linear regression analyses revealed that the number of lifetime drug overdoses, severity of legal problems, and previous drug treatment significantly predicted a need for treatment. Further, more frequent drug use, specifically crack cocaine, in the month prior to incarceration predicted a higher perceived need for drug treatment. Implications suggest this population demonstrates a need for treatment, which may be exacerbated by re-entry stressors. Preventative measures, including culturally tailored treatment and transitional care from prison to community-based services, are necessary to reduce risk of relapse and overdose among this group.

Characteristics, needs, and experiences of U.S. veterans on a specialized prison unit.

The Veterans Service Unit (VSU) in Connecticut is one of several all-veterans prison units that are being created throughout the United States. This study examined the characteristics, needs, and experiences of veterans on the Connecticut VSU. This study utilized data from a quality improvement survey that was completed by 87 of the 110 veterans on the Connecticut VSU (79% response rate). The majority of veterans on the VSU were white, aged 41-56, never married, and had an honorable or general military discharge making them potentially eligible for Veterans Affairs (VA) healthcare upon release. The most common psychiatric diagnoses reported by veterans were substance use disorders and 29% reported posttraumatic stress disorder. Veterans on the unit reported a variety of needs related to legal, housing, basic needs, health, income, and community re-entry. The majority of veterans reported positive experiences on the VSU with 61% reporting the VSU was better than other units they have been on. Together, these findings illustrate how regional partnerships between state Departments of Corrections and VA medical centers may benefit veterans. More rigorous evaluation of the VSU model is needed to inform innovations to address the needs of incarcerated veterans and prepare them for successful community reintegration.

The Impact of Limited Housing Opportunities on Formerly Incarcerated People in the Context of Addiction Recovery.

BACKGROUND: Formerly incarcerated individuals with substance use disorders encounter numerous obstacles following incarceration that threaten their sobriety. Obtaining safe and stable housing is a notoriously difficult task resulting in precarious housing that can increase the likelihood of relapse. The current study examined the relationship between substance use and 11 housing settings in a sample of 211 formerly incarcerated individuals with a history of substance abuse to identify the housing characteristics with the highest risk of use. METHODS: Participants retroactively reported their alcohol and illicit drug consumption as well as their dwelling for the past 180 days using the Timeline Follow-back method. Housing settings were collapsed into four conceptually distinct categories: Regulated, Independent, Precarious, and Homeless. FINDINGS: Results showed differences in alcohol and drug consumption across categories, with Regulated settings having less alcohol and substance use reported. The remaining settings with less oversight had a similar percentage of individuals endorse substance use; however, the Precarious setting was associated with the highest consumption of drug use. CONCLUSION: Formerly incarcerated individuals with a history of substance use problems would likely benefit from housing with some degree of oversight and financial obligation. More resources should be funnelled into programs to help formerly incarcerated individuals with substance use disorders find housing that will facilitate abstinence during community re-entry.

Bringing it all back home: Understanding the medical difficulties encountered by newly released prisoners in New Orleans, Louisiana - a qualitative study.

Formerly incarcerated persons (FIPs) face a disproportionate risk of death and serious illness in the immediate post-release period. Therefore, it is a critical time to initiate community-based care for chronic illnesses and behavioural disorders. Little is known about the unique transitional health and social support needs of FIPs in Louisiana, which has the highest incarceration rate in the world. As the average age of prisoners in the United States rises, the release of older prisoners with chronic conditions will become increasingly common. The aim of this study was to explore the healthcare experiences of FIPs in Louisiana in order to inform delivery of services tailored to this population. This research was done in partnership with a community organisation that advocates for restoration of voting rights to FIPs and helps newly released individuals transition back into society. This organisation identified FIPs in the Greater New Orleans area, and from January to May 2015, we conducted 24 semi-structured, in-person, audio-recorded interviews at the community organisation's transitional living facility. The interviews assessed FIPs' experiences with and barriers to receiving healthcare during and after incarceration. These discussions also explored FIPs' desires for services and attitudes towards health and healthcare. Interviews were transcribed and independently coded by two researchers. Interviewees reported negative experiences with healthcare during incarceration, and limited health guidance during the pre-release process. Post-release concerns included lack of insurance, difficulty accessing care and medication, and interest in learning about healthy lifestyles. Results suggest a need for a formalised system of transitional healthcare for FIPs. Findings are being used to inform a pilot transitional care clinic in New Orleans, Louisiana.

Facilitation of functional independence after neurotrauma: strategies for increasing physiologic readiness.

BACKGROUND: While acute rehabilitation following neurotrauma has evolved over the past 30 years to include the common use of pharmacologic agents to promote synaptogenesis and improve recovery potential, little guidance exists for a similar strategy in the post-acute or community re-entry phases of injury. Drawing upon the existing scientific literature, models of pharmacologic intervention in promoting stability in other disease states and the authors' collective clinical experience, this article provides a potential structure by which to implement methods to create a stable physiologic platform to facilitate behavioral intervention. OBJECTIVES: This article reviews basic foundations for physiologic optimization, pharmacologic strategies for facilitation, and dyscompliance after neurotrauma. METHODS: Literature review, case analysis, clinical experience. RESULTS: Guidelines for facilitation of behavioral intervention with physiologic stabilization and with pharmacologic agents are presented with clinical rationale for their utilization. CONCLUSIONS: Improving physiologic readiness for behavioral intervention in the post-acute and community re-entry phases following neurotrauma has potential to improve both the efficiency and durability of these efforts.