When people hear “reducing recidivism,” they often think of tougher supervision, longer sentences, or more surveillance. The research points somewhere else. One of the most effective public safety strategies we have is good behavioral health treatment, delivered at the right time, with fidelity, and continued after release.
The need is enormous
Substance use and mental health disorders aren’t a side issue in corrections. They’re central to it. Most people in American prisons and jails meet the criteria for a substance use disorder, and rates of serious mental illness behind bars are several times higher than in the general population. For many people, the behavior that led to arrest, whether possession, theft, or a crime committed while intoxicated, is closely tied to an untreated health condition.
Even in states with relatively low reincarceration rates, the need is clear. In Texas, about 17% of people released from prison in 2021 returned within three years, one of the lowest rates in the country. Yet historically close to half of people released are rearrested within three years. Low reincarceration rates don’t mean the problem is solved. They mean the system catches people before the cycle completes, and treatment is how we break it.
Not all treatment is equal
Funding a “program” isn’t enough. Decades of correctional research have identified what separates treatment that works from treatment that just fills a schedule.
1. It matches risk and need. The Risk-Need-Responsivity (RNR) model has guided effective correctional practice for more than 30 years. Its principles: focus the most intensive services on people at the highest risk of reoffending, target the needs most closely tied to criminal behavior (substance use, antisocial thinking, peer influences), and deliver services in ways that fit each person’s learning style, culture, and readiness. Validated assessment tools and the ASAM Criteria help make these decisions systematically rather than by guesswork.
2. It’s evidence-based and delivered with fidelity. Cognitive-behavioral approaches have some of the strongest track records for reducing reoffending because they address the thinking patterns that drive both substance use and criminal behavior. Manualized curricula help programs deliver those approaches consistently, even with staff turnover and mixed workforces. A strong program delivered loosely can lose much of its impact.
3. It treats co-occurring disorders together. Substance use and mental health conditions often travel together. Treating one while ignoring the other sets people up to fail. Integrated care for co-occurring disorders is the standard, not a luxury.
4. It includes medications for opioid use disorder. The weeks after release are among the most dangerous in a person’s life, with overdose risk many times higher than in the general population. Correctional systems that offer MOUD before and after release have seen substantial drops in post-release overdose deaths, and people on MOUD are more likely to engage in treatment in the community.
5. It doesn’t stop at the gate. This may be the most important point. In-prison treatment followed by community aftercare consistently produces better outcomes than in-prison treatment alone. Without continuity, gains made inside can disappear quickly under the pressures of reentry: housing, employment, family stress, and old environments.
Peer support: the missing link in reentry
Peer Recovery Support Specialists bring something no clinician can: lived experience of recovery and, often, of incarceration. Peers help people navigate the first critical days after release, connect to treatment and services, and see that recovery is possible for someone like them. Peer support is increasingly recognized as an evidence-informed part of the reentry continuum, and it addresses a gap that clinical services alone often leave open.
The funding landscape is shifting in our favor
For the first time in a generation, major funding streams are aligning with what the research says:
Medicaid reentry waivers. Federal guidance now allows states to use Section 1115 waivers to cover certain services for incarcerated people in the period before release, including care coordination, MOUD, and connections to community providers.
Opioid settlement funds. Many state and local abatement plans list treatment for justice-involved people, MOUD in jails and prisons, and reentry services as approved uses.
State investment in community corrections. Probation and diversion treatment programs are increasingly seen as cost-effective alternatives to incarceration.
These resources give corrections and treatment partners a real opportunity to build sustainable, continuous systems of care rather than short-lived pilot programs.
Why it matters
Every person who leaves prison with untreated addiction or mental illness is at higher risk of overdose, homelessness, and returning to the justice system. Every person who leaves with treatment, a plan, and a connection to care has a better chance of staying home, staying healthy, and staying out.
Treatment works best when we stop thinking of it as a favor to people who are incarcerated and recognize it for what it is: one of the most effective public safety investments a state can make. When we treat substance use and mental health disorders as health conditions, assess carefully, deliver proven programs with fidelity, and bridge the gap from incarceration to community, we reduce crime, save lives, and save taxpayer dollars.