Adverse effects of criminal legal system involvement: a qualitative study examining the role of incarceration and reentry on substance use trajectories among women with opioid use disorders

Abstract

Background Women with substance use disorders (SUDs) often experience adversity related to incarceration and reentry that can impact their substance use outcomes. This study aims to examine the adverse effects of incarceration and reentry on substance use outcomes among women with a history of opioid use disorder (OUD). Methods We carried out 42 semi-structured interviews (May–July 2022) with women with a history of criminal legal involvement and OUD (n = 20), criminal legal professionals (n = 10), and SUD treatment professionals (n = 12). The interviews focused on women’s substance use trajectories, barriers to treatment, and the intersection of the criminal legal system and treatment. None of the women were presently incarcerated during their interviews. Results Participants expressed the severe adverse impact of criminal legal involvement on women with OUD. Many women felt traumatized by experiencing detox while incarcerated, especially as they received minimal aid for withdrawal symptoms. Women seeking recovery while incarcerated felt unsupported, being afforded few treatment options, and experiencing stigma. Reentering society after incarceration also posed significant challenges to women’s individual recovery goals. Reentry-related challenges such as returning to unsupportive environments, facing difficulties finding employment, lacking secure housing, and facing the stigma of incarceration triggered adverse outcomes, such as relapse among those who were seeking to avoid illicit substances. Conclusions Findings suggest a need to evaluate detox protocols, medication for opioid use disorder (MOUD) access, and stigma in the criminal legal system. Interventions facilitating women’s reentry, reducing the combined stigma of incarceration and OUD, and restoring agency for women with OUD are also needed.