Substance Use Disorders in Correctional Health: Evolving Challenges and Emerging Strategies in Prevention, Diagnosis, and Treatment —Integrated SUD Care in Corrections

Abstract

Substance use disorders (SUDs) are markedly overrepresented in correctional populations and reflect the convergence of neurobiological vulnerability, trauma exposure, psychiatric comorbidity, and structural inequity. This narrative review synthesizes contemporary evidence (2015-2025) on the epidemiology, neurobiology, genetic influences, treatment strategies, digital innovations, and policy frameworks shaping SUD care in prisons, jails, and community reentry settings. SUDs affect more than half of incarcerated individuals compared with roughly 5% of the general U.S. population, and are strongly associated with adverse childhood experiences and co-occurring psychiatric disorders ( Bronson et al., 2017 ; Fazel et al., 2017 ). Robust evidence demonstrates that medications for opioid use disorder (MOUD)—including methadone, buprenorphine, and extended-release naltrexone—substantially reduce post-release overdose mortality and improve treatment continuity, particularly when integrated with structured behavioral interventions such as cognitive-behavioral therapy and motivational interviewing. Although no FDA-approved medication exists for methamphetamine use disorder, emerging evidence supports combined extended-release naltrexone and bupropion as a promising approach. Digital modalities, including telehealth and secure tablet-based programming, expand access in resource-limited facilities and support continuity-of-care during high-risk custody transitions. Policy reforms, notably Medicaid Section 1115 Reentry Demonstrations and ADA-aligned standards recognizing MOUD as a clinical necessity, are reshaping correctional health delivery by reducing coverage disruptions and institutionalizing continuity-of-care models. Emerging precision approaches, including pharmacogenomics and digital therapeutics, offer potential scalable pathways toward more individualized treatment. Collectively, the evidence supports a shift from fragmented, crisis-driven responses toward coordinated, recovery-oriented systems that integrate pharmacologic, behavioral, digital, and reentry supports to reduce overdose mortality and improve reintegration outcomes among justice-involved populations.