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Manuscript version of

Reentry Interventions That Address Substance Use: A Systematic Review

Kelly E. Moore, Robyn L. Hacker, Lindsay Oberleitner, Sherry A. McKee

Funded by: • National Institute on Drug Abuse• State of Connecticut

© 2018, American Psychological Association. This manuscript is not the copy of record and may not exactly replicate the final, authoritative version of the article. Please do not copy or cite without authors’ permission. The final version of record is available via its DOI: https://dx.doi.org/10.1037/ser0000293

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https://dx.doi.org/10.1037/ser0000293

SUBSTANCE USE REENTRY INTERVENTIONS 1

Reentry Interventions that Address Substance Use: A Systematic Review


Abstract

Justice-involved individuals with substance use problems have heightened risk of relapse

and recidivism after release from incarceration, making reentry a critical time to provide

evidence-based treatments (EBTs) for substance use; however, the extent to which reentry

interventions incorporate EBTs for substance use is unclear. This systematic review identified

studies of reentry interventions in the past 10 years that address substance use, assessed whether

EBTs were used, and explored which interventions were effective in reducing substance use and

recidivism post-release. Eligible studies included interventions that began during incarceration

and continued post-release or began within 3 months of release, and addressed substance use in

some capacity. 112 full text articles were reviewed and 38 met inclusion criteria, representing 34

unique interventions. Of the 34 interventions, 21 provided substance use treatment whereas 13

facilitated connections to treatment. Of the 21 interventions providing treatment, the primary

modalities were cognitive behavioral therapy (n = 6), motivational interviewing (n = 2),

medication assisted treatment (n = 2), therapeutic community (n = 2), psychoeducation/12-step

(n = 5), and 4 did not specify the modality. Of the 31 studies that assessed recidivism outcomes,

18 found reduced recidivism for the treatment group on at least one indicator (e.g., re-arrest, re-

incarceration). Of the 13 studies that assessed substance use outcomes, 7 found reduced

substance use for the treatment group on at least one indicator. Results were not consistent for

any particular treatment approach or modality and highlight the need for consistent integration of

EBTs for substance use into reentry interventions.

Keywords: reentry intervention; substance use; offenders; cognitive-behavioral therapy;

evidence-based treatment


Reentry Interventions that Address Substance Use: A Systematic Review

Over 12 million people enter the criminal justice system each year (Minton, 2013) and

95% of these individuals are released back into the community (Hughes & Wilson, 2004). The

period of reentering the community after incarceration (i.e., “reentry”) is fraught with challenges

such as finding housing and employment, obtaining documents (e.g., valid driver’s license),

connecting with mental health providers for counseling and medication, accessing food, clothing,

and money, and finding transportation to and from parole/probation meetings (Lattimore,

Steffey, & Visher, 2010; Morani, Wikoff, Linhorst, & Bratton, 2011). In addition, many justice-

involved individuals have untreated health problems (Schnittker & John, 2007) and strained

relationships with family and children upon release (Gust, 2012). These challenges are

exacerbated by the stigma associated with a criminal record, which restricts eligibility for certain

types of housing, employment (Batastini, Bolanos, & Morgan, 2014; Pager, Western, & Sugie,

2009), and mental health services (Pogorzelski, Wolff, Pan, & Blitz, 2005) and may decrease

self-esteem and motivation to reenter the community (Moore, Tangney, & Stuewig, 2016).

Alongside the above-mentioned challenges, many justice-involved individuals reentering

the community are trying to maintain abstinence from alcohol and/or drugs, which is often a

condition of their community supervision. Between 58% and 68% of incarcerated individuals

have substance use disorders (Bronson, Stroop, Zimmer, & Berzofsky, 2017; D. J. James &

Glaze, 2005), between 63% and 83% test positive for alcohol or drugs upon arrest (Peters,

LeVasseur, & Chandler, 2004), and between 72% and 75% report having used drugs at least

once per week before their incarceration (Bronson et al., 2017). Although 63% of inmates

identify substance use treatment as a primary need upon reentry, significant barriers to accessing

and staying engaged in community treatments exist (Begun, Early, & Hodge, 2016). In the first


few months post-release, justice-involved individuals with substance use problems have

heightened risk of relapse (Kopak, Haugh, & Hoffmann, 2016), fatal and non-fatal overdose

(Kinner et al., 2012; Merrall et al., 2010), death (Kinner et al., 2015), and recidivism (i.e.,

technical violations, re-arrest, re-incarceration; Scott, Grella, Dennis, & Funk, 2014). Taken

together, reentry is a critical time to provide effective substance use treatment (Visher & Travis,

2011).

Broadly, reentry interventions aim to facilitate the transition from incarceration to the

community and reduce recidivism (Petersilia, 2004; Visher, Lattimore, Barrick, & Tueller,

2017). Reentry interventions often plan to accomplish these goals by using multifaceted

approaches that increase access to community resources (e.g., housing) and/or directly provide

treatment for areas of need (e.g., substance use). Within reentry interventions, there is substantial

variability between approach, content, and quality (Visher et al., 2017). Like many correctional

treatment services, reentry interventions are not always developed based on theories of behavior

change (Lipsey & Cullen, 2007), lack therapeutic integrity (i.e., well-trained, skilled staff; Smith,

Gendreau, & Swartz, 2009), do not use evidence-based treatments (EBTs; Belenko, Hiller, &

Hamilton, 2013), and struggle with effective implementation (Wilson & Davis, 2006). Indeed,

research on the effectiveness of reentry interventions has been mixed, with only some

interventions showing effective connections to treatment (Gill & Wilson, 2017), reduced

substance use (Kouyoumdjian et al., 2015), and reduced recidivism (James, Stams, Asscher, De

Roo, & der Laan, 2013; Mackenzie, Mitchell, & Wilson, 2011).

In the past decade, reentry interventions have moved toward becoming more evidence-

based (Drake, 2014; Wexler & Fletcher, 2007). Several effective strategies have been identified,

such as matching services to individuals’ risk level and needs (Andrews & Bonta, 2010; Smith et


al., 2009), delivering services in individual rather than group formats (James et al., 2013),

providing EBTs (e.g., cognitive behavioral therapy) rather than generic services (e.g., life skills,

employment assistance; Smith et al., 2009; Visher et al., 2017), and extending services received

during incarceration post-release (Prendergast, 2009; Serin, Lloyd, & Hanby, 2010). Further,

research suggests the use of gender-specific reentry interventions (Spjeldnes & Goodkind, 2009;

Spjeldnes, Jung, & Yamatani, 2014) and interventions specifically tailored to jail (vs. prison)

reentry (Osher, Steadman, & Barr, 2003) to address the unique needs of specific populations.

Despite developments in best practices for reentry, the extent to which reentry

interventions use EBTs for substance use (e.g., cognitive behavioral therapy, therapeutic

communities, motivational interviewing, contingency management, medication assisted

treatment [Prendergast, 2009]) and evidence-based adjunct treatment strategies such as peer

mentoring (i.e., individuals with a history of addiction or incarceration act as mentors; Bassuk,

Hanson, Greene, Richard, & Laudet, 2016) is still unclear. Research among community

corrections populations (i.e., people on probation/parole, not necessarily reentering the

community) shows that the most commonly offered form of substance use treatment is

psychoeducation (Taxman, Perdoni, & Harrison, 2007), which has mixed effectiveness in

reducing substance use (Kouyoumdjian et al., 2015) and is typically recommended for low-risk

(not high-risk) offenders (Prendergast, 2009). Significant barriers to the adoption of EBTs for

substance use within the criminal justice system exist, including stigma toward addiction (i.e.,

addiction viewed as a choice rather than a disease) that makes staff reluctant to support treatment

efforts (Wakeman & Rich, 2018), lack of money and resources to pay for more

intensive/individualized treatments, and lack of collaboration between community and


correctional systems that is key for continuity of care (Belenko et al., 2013; Pelissier, Jones, &

Cadigan, 2007).

Present Study

The period after release from incarceration (i.e., reentry) is a critical time to effectively

provide treatment for substance use; however, the extent to which reentry interventions utilize

EBTs for substance use, and more broadly use evidence-based reentry practices, is unclear. The

purpose of this systematic review was to identify a comprehensive list of studies in the past 10

years that evaluate reentry interventions addressing substance use, determine the extent to which

these interventions include EBTs for substance use as well as other evidence-based reentry

practices (e.g., individualized treatment tailored to risk level, aftercare), and better understand

which reentry interventions that address substance use are most effective in reducing substance

use and recidivism post-release.

Method

Search Strategy and Inclusion Criteria

PsycInfo, PubMed, and MedLine databases were searched for the following combination

of search terms: reentry/post-release, treatment/intervention/program,

prison/jail/incarceration/offender, substance abuse/addiction/alcohol use/drug use (n = 1,079

records). In addition, crimesolutions.gov programs were filtered to identify “reentry/aftercare”

programs with a focus on “drug/substance use” (n = 38 records). Peer-reviewed articles and

published program evaluation reports to agencies that were written in English and published

between 2007 and July 2017 were eligible. The population of interest included participants who

were currently or recently incarcerated and received an intervention that addressed substance

use. Eligible interventions began during incarceration and continued post-release or began within


3 months of release, and addressed substance use in some capacity. Interventions that only

occurred during incarceration (and did not extend post-release) were not included, and reentry

interventions that did not identify substance use as a program target were not included. Eligible

studies were quantitative and included outcome data; no studies were excluded based on the type

of outcomes analyzed or the type of study design used in order to compile a comprehensive list

of reentry interventions being delivered in the field.

The PRISMA chart detailing search processes and study selection is shown in Figure 1.

In addition to the articles identified though database searching, 10 potential articles were

identified when reviewing full text articles for eligibility. A total of 112 full text articles were

reviewed and 74 studies were excluded (Figure 1). For articles analyzing multiple studies in

aggregate (i.e., systematic reviews, multi-site evaluations), individual study eligibility was

assessed when possible, and studies meeting eligibility criteria were included. A total of 38

studies met all eligibility criteria and were included in this review. Table 1 in the online

supplement contains details for the 38 studies.

Study Elements

This review documents key elements of reentry interventions that address substance use,

including the sample size and gender breakdown of participants who received the treatment (and

those in the comparison group, if applicable), eligibility criteria used to select inmates for

participation, type of institution the intervention was delivered in (i.e., jail vs. prison), and study

design (i.e., single group, quasi-experimental, or randomized controlled trial [RCT]). Elements

of the intervention structure were coded, including whether the intervention began during

incarceration and extended post-release (i.e., in-reach with aftercare) and length of the

intervention during the reentry period after release. We documented specific elements of the


intervention content including 1) the primary substance use treatment modality (e.g., cognitive

behavioral therapy [CBT], motivational interviewing [MI], therapeutic community [TC],

contingency management [CM], medication assisted treatment [MAT], self-help [e.g.,

Alcoholics Anonymous], psychoeducation, or not specified), 2) whether peer mentors were used,

3) the general intervention approach (i.e., categorized as outpatient individual/group counseling;

case management [i.e., referrals/facilitated connections to services], residential individual/group

counseling, or reentry court), 4) other areas addressed by the intervention in addition to

substance use (i.e., housing, employment/education, mental health, physical health/dental, basic

needs, finances, documents [e.g., driver’s license, social security card], transportation, family,

religion/spirituality, or antisocial attitudes/behaviors), and 5) results of outcomes analyzed.

Coding of study and intervention elements was based on information presented in the

article and elements that were unclear/difficult to code were discussed and resolved. When

studies used multiple analyses with varying quality (e.g., bivariate correlations and multivariate

analyses including control variables), the most rigorous analysis is reported. In addition, single

group pre- to post-test results are only reported when no other analysis was conducted. For

studies that used both official records and self-report methods to assess substance use or

recidivism, official records are reported.

Risk of Bias

This review is inclusive with regard to study design in order to generate a comprehensive

list of reentry interventions being implemented in the field, and therefore study quality varied

greatly. Intervention details documented in this review are based on information provided in the

study description, which varied across articles. For instance, although the inclusion of non-peer

reviewed studies (e.g., program evaluation reports to agencies) serves to reduce publication bias,


such studies varied in the degree of analysis details reported. Further, due to page limits, some

published articles may have included fewer details about specific intervention services offered

and thus may have been coded as not including certain intervention elements compared to studies

that provided extensive intervention details. These factors may have introduced reporting bias

into this review.

Results

Participant Characteristics and Study Design

The 38 studies reviewed here represent 7 program evaluation reports and 31 peer-

reviewed publications. Of the 38 studies, 35 are original studies evaluating intervention

outcomes and 3 are follow-ups on the same sample at a later point in time. Of the 35 original

studies, 24 were implemented with prison inmates/people exiting prisons, 9 were implemented

with jail inmates/people exiting jails, and 2 were implemented with combined jail/prison

samples. Twenty one of the 35 original studies used quasi-experimental study designs, 9 used

RCTs, and 5 used single group designs. Thirteen of the 35 studies delivered the intervention to

an all-male sample, 17 were provided to both men and women (though 6 of these studies had

treatment samples over 90% male), 4 were provided to only women, and 1 program evaluation

report did not specify the gender of participants. Nine of the 35 original studies excluded inmates

due to serious mental illness or the seriousness of their index offense (e.g., violent, sex, arson

offenses), whereas 10 studies only included inmates deemed to be at heightened risk (i.e., scored

high on violence risk assessment, had serious mental illness), and 16 studies did not mention

excluding/including inmates based on level of risk. Over half (n = 18) of the 35 studies reported

selecting inmates based on the presence of self-reported substance use problems or co-occurring

mental health and substance use disorders. Less than half (n = 13) of the 35 studies reported


selecting inmates based on the length of their sentence or amount of time remaining on their

sentence. Interventions generally described excluding individuals who would not be returning to

a particular geographic location post-release, and other common exclusion criteria included the

presence of pending charges (see supplemental Table 1).

Intervention Structure

Within the 35 original studies, 1 intervention (Serious and Violent Offender Reentry

Initiative [SVORI]) is represented twice (i.e., 34 unique interventions). The majority (n = 23) of

the 34 unique interventions used an in-reach approach, initiating some level of service prior to

release from jail or prison, while 11 interventions only offered services post-release. Of the 23

interventions utilizing in-reach, all included an assessment of reentry needs prior to release,

though the point at which this occurred varied from entry into the correctional facility to 1 month

prior to release. The length and characteristics of the intervention offered during incarceration

varied, ranging from one meeting with a case manager to determine reentry needs to 12 months

of group/individual counseling (see supplemental Table 1). The duration of intervention post-

release also varied; 4 studies did not specify the duration of post-release services, 3 studies

described that services were no longer provided upon connection with a community provider

post-release, and the other 27 studies had post-release services ranging from 1 month to 4 years.

Intervention Content

Almost all of the interventions included multiple treatment approaches to address the

many needs of offenders returning to the community after incarceration and were tailored in

some way to the individual offender. Thirteen of the 34 interventions described providing case

management only (rather than providing direct treatment services), in which a case manager or

team of people conducted needs assessments and provided referrals and/or facilitated connection


to substance use and other services in the correctional facility and/or community post-release.

Within these 13 interventions, some only provided referrals to treatment while others facilitated

connections with needed services by making appointments for inmates, providing transportation

to appointments or accompanying them to appointments, or providing vouchers or financial

assistance to pay for treatment (see supplemental Table 1). In contrast, 21 of the 34 interventions

described directly providing some form of treatment services and often also provided case

management. Within these 21 interventions, the primary overall therapeutic approaches

described were individual/group counseling during incarceration and/or on an outpatient basis

post-release (n = 16), post-release residential treatment programs involving a combination of

individual/group counseling (n = 3), and reentry courts which mandated individuals to needed

treatments and used court-imposed sanctions for non-engagement (n = 2).

There was variability in the use of EBTs for substance use within the 21 interventions

that provided direct treatment services and many used multiple substance use treatment

modalities. The primary substance use treatment modalities described in the 21 interventions

included MI around substance use (n = 2), MAT for opioid use (n = 2), cognitive-behavioral

therapy for substance use (e.g., n = 4; moral reconation therapy [MRT] n = 1; community

reinforcement and family treatment [CRAFT] n = 1), therapeutic communities (n = 2), and

psychoeducation (i.e., chemical dependency, overdose prevention, relapse prevention) and/or 12-

step (n = 5). Four interventions did not specify the substance use treatment modality used in

therapy. Within the two therapeutic communities, 1 described using a CBT and psychoeducation

curriculum (Sacks, Chaple, Sacks, McKendrick, & Cleland, 2012) and the other used “milieu

therapy” as is typical in TCs, but did not specify the modality of group counseling around

substance use (Robbins, Martin, & Surratt, 2009). No interventions reported using contingency


management explicitly, though one reentry court intervention (Hamilton, 2010) and one

individual/group counseling intervention (Friedmann et al., 2013) described using incentives or

contingent reinforcers to encourage positive behavior change. Only 9 interventions included a

peer mentorship component in which people with a history of addiction and/or incarceration

were available to provide informal support, case management, and mentoring to offenders.

All but 1 of the 34 reentry interventions described addressing other problem areas (either

by referral or direct access to treatment) in addition to substance use, depending on individual

needs. The issues most often reported to be addressed were employment and/or education (n =

28), housing (n = 25), and mental health (n = 21). Less often addressed areas included instruction

in finances (n = 12), family or parenting services (n = 10), and social support (n = 11).

Interventions rarely reported addressing transportation (n = 9), physical health (n = 8), basic

needs such as food or clothing (n = 7), documentation such as driver’s license or social security

card (n = 6), antisocial behavior/attitudes (n = 5), and religion/spiritual needs (n = 5). Only 2

interventions reported addressing sexual health/HIV risk. It is important to note that some

articles may not have provided a comprehensive list of all services offered in the intervention.

Outcomes

Recidivism. The primary outcome analyzed across the 38 studies included in this review

was recidivism (i.e., re-arrest, re-conviction, re-incarceration, technical violations/revocation of

probation or parole; n = 33). Excluding the 5 single group studies, out of the 31 quasi-

experimental or RCT studies analyzing recidivism, 11 found no differences in recidivism

indicators between the treatment and control/comparison groups, and 18 found that at least one

indicator of recidivism decreased more for intervention participants compared to the

control/comparison group, though 5 of these 18 studies also found no differences between


treatment and control/comparison groups on additional indicators of recidivism (see

supplemental Table 1). The length of follow up for recidivism outcomes varied widely from 3

months to 4 years. In addition, the type of recidivism assessed (arrest vs. conviction vs.

incarceration vs. probation violation vs. number of arrests vs. time to arrest) varied between

studies, as did the use of control variables (e.g., initial risk level, criminal history) in analyses.

Two studies found that the treatment group had more recidivism than the

comparison/control group; Hamilton (2010) found no differences in rearrest rates between

reentry court participants and the comparison group, but reentry court participants had lower re-

conviction rates and higher rates of reincarceration, technical violations, and revocations at 1, 2,

and 3 years post-release. Another study (Severson, Bruns, Veeh, & Lee, 2011) found that the

SVORI intervention participants had a greater risk of returning to prison than the comparison

group, but they were less likely to get new convictions.

Substance use and substance use treatment. Excluding the single group studies (n = 5),

13 quasi-experimental or RCT studies analyzed substance use outcomes and 5 of these found that

substance use was lower for intervention participants compared to the control/comparison group,

5 found no differences in substance use between groups, 2 found that some indicators of

substance use were lower for treatment participants whereas there were no differences on other

indicators of substance use, and 1 (Grommon, Davidson, & Bynum, 2013) found treatment

participants had higher substance use compared to the control group. Of note, some studies

utilized urinalysis to detect substance use and others used self-report. Eight studies examined

engagement in community-based substance use treatment as an outcome; 5 studies found

intervention participants were more likely to engage in substance use treatment and 3 found no

differences in engagement between treatment and control/comparison groups.


Discussion

The purpose of this systematic review was to identify studies of reentry interventions in

the past 10 years that address substance use, determine the extent to which these interventions

use EBTs for substance use, and describe the effectiveness of these interventions in reducing

substance use and recidivism post-release. We included both peer-reviewed publications as well

as program evaluation reports to identify a comprehensive list of interventions being

implemented in the field. The 38 studies reviewed here represent a wide variety of reentry

interventions that address substance use, ranging in length, approach, treatment modality, and

effectiveness.

Out of the 34 unique reentry interventions reviewed herein, 21 provided some degree of

treatment within the community agency itself, whereas 13 utilized case managers to facilitate

connections to outside agencies. The use of a case management approach to reentry for

substance-using offenders has been somewhat debated over the past decade (Prendergast, 2009).

Meta-analyses have shown case management to be ineffective for reducing substance use and

recidivism among offenders with substance use problems (Aos, Miller, & Drake, 2007);

however, the type of case management strategy utilized may matter. The 13 interventions that

primarily utilized case management approaches reviewed here often described offering more

intensive or personalized case management than is typical for offenders reentering the

community. For example, several programs reported that their case managers had reduced

caseloads (e.g., 20 offenders per case manager as opposed to 80), provided transportation or

vouchers that facilitated access to treatment, or emphasized participant preference for service

type/location (Ray, Grommon, Buchanan, Brown, & Watson, 2017). Difficulties with case

management approaches typically involved lack of follow up on referrals; some studies that used


a case management approach note that less than half of participants received services they were

referred to (Severson et al., 2011). In addition, the disconnect between community-based

substance use treatment systems and correctional systems is longstanding (Prendergast, 2009),

and in addition to strained communication between systems, providers may also be less

comfortable interacting with clients referred from the criminal justice system (Skeem & Louden,

2006), leading to less effective treatment.

The modality of substance use treatment was rarely described in the 13 interventions that

referred offenders to outside agencies for treatment, and thus we focused on the 21 interventions

that directly provided treatment when examining the extent to which EBTs for substance use

were utilized. Of the 21 interventions that provided treatment, 12 explicitly described using

EBTs for substance use (i.e., CBT, therapeutic community, MI, MAT). The most common EBT

was CBT (n = 6) provided in an individual or group format, though the specific type of CBT

protocol was only mentioned in 2 of the 6 studies (i.e., CRAFT and MRT). CBT is an effective

treatment for substance use among offenders that also reduces recidivism (Landenberger &

Lipsey, 2005) and thus its inclusion in reentry interventions is encouraging. Six interventions

reported using psychoeducational groups or self-help; however, these are not EBTs for substance

use and are recommended only for low-risk offenders (Prendergast, 2009). Four interventions

reported non-descript counseling (i.e., no treatment modality mentioned), which is problematic

because that may indicate that the reentry intervention lacks theoretical or research foundations

(Lipsey & Cullen, 2007).

Almost all studies assessed recidivism outcomes; however, despite all interventions

noting substance use as a primary concern for reentering offenders, very few (13 out of 31)

assessed substance use outcomes. Over half of the studies comparing substance use (7 out of 13


studies) and recidivism (18 out of 31 studies) between reentry intervention participants and

controls found positive effects for intervention participants. Follow-up timepoints varied widely

across interventions, and there was evidence that intervention effects may not persist over time.

Zortman et al. (2016) found that participants in the Pennsylvania Reentry Program had lower re-

incarceration rates (19% vs. 28%) 1 year post-release, but this difference was not significant 3

years post-release (Zortman, Powers, Hiester, Klunk, & Antonio, 2016). In their study of MAT

provided at release from jail, Kinlock and colleagues (2008, 2009) found participants were less

likely to report engaging in crime at 3 and 6 months post-release, but there were no differences in

re-arrest 12 months post-release (Kinlock, Gordon, Schwartz, Fitzgerald, & O’Grady, 2009;

Kinlock, Gordon, Schwartz, & O’Grady, 2008). In addition, a few studies found a negative effect

of the reentry intervention on recidivism or substance use, which was attributed to increased

oversight and monitoring that detected misbehavior more readily in intervention participants

compared to controls (Hamilton, 2010; Severson et al., 2011).

Research on reentry best practices for offenders with substance use problems suggests

matching services to risk level, with the highest risk offenders getting more intensive services

such as individual CBT (Prendergast, 2009). Almost half of the studies reviewed selected

inmates based on some categorization of risk level and only some interventions selected

offenders based on the presence of problematic substance use. Because justice-involved

individuals reentering the community have so many potential challenges, interventions were

often broadly offered to offenders and intended to tackle several areas of need; however, this

may lead to a dilution of treatment for those at the highest risk. In addition, although most

reentry interventions reviewed here were multifaceted, very few addressed antisocial

attitudes/behaviors; this is concerning given that solely treating mental health or substance use


alone, without addressing other criminogenic needs contributing to recidivism risk, is unlikely to

reduce recidivism.

Limitations

The methodological quality of studies varied, and many studies did not specify the

treatment modality used, impacting our ability to draw conclusions about the effectiveness of

strategies across studies. In addition, factors that may have a significant impact on the

effectiveness of reentry intervention, such as therapist level of training, adherence to the

intervention protocol, or therapeutic alliance with clients, were not assessed or reported and thus

could not be commented on in relation to intervention effectiveness. The operationalization of

recidivism (e.g., technical violations vs. rearrest vs. reincarceration) and methods used to assess

recidivism (official records vs. self-report) varied greatly, which may have contributed to the

mixed findings. Further, only some analyses controlled for sociodemographic variables, leading

to different levels of confidence in the results. Finally, substance use was rarely tracked as an

outcome in reentry intervention studies and when it was, biochemical confirmation was often not

used, which is problematic given that reentering offenders under community supervision may not

be forthcoming about relapse and substance use.

Conclusions

Only a subset of reentry interventions that address substance use currently utilize EBTs

and reentry best practices. Reentry interventions for substance-using offenders should utilize best

practice approaches which involve matching the intervention to the client risk level and needs,

utilizing evidence-based approaches to treat substance use including effective therapeutic

structure (i.e., individualized), modality (i.e., CBT, MAT, TC, CM, MI), and dose, treat

additional areas of need that impact reintegration (e.g., physical health, mental health, antisocial


behaviors), and use wrap-around approaches that foster continuity of care between treatments

delivered during incarceration and services received post-release. Further, reentry interventions

(and correctional interventions, broadly) should continue striving to be methodologically

rigorous, including the use of appropriate study designs (i.e., RCTs or quasi-experimental

designs), high-quality assessment techniques (e.g., biochemical confirmation of substance use,

official records of arrest), and comprehensive assessment of key impact and process outcomes of

interventions. Further, cost-effectiveness analyses are critically important, as they often indicate

the benefit of providing high-quality treatment services and can be used to tackle system-level

barriers to implementing EBTs in correctional systems.


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