43 8. Expand treatment programs after incarceration Research has shown a high rate of overdose deaths from drug abuse following inmates’ release from prison or jail. A key finding in a major study by the Massachusetts Department of Correction was that the likelihood of an inmate released from prison dying from an opioid overdose was 56 times higher than for someone not previously incarcerated.74 The study also showed that “receiving evidence‐based opioid agonist treatment following a nonfatal overdose was associated with a reduced risk of a subsequent fatal opioid overdose. This suggests that overdose survivors have a short window of opportunity after a nonfatal overdose to reduce their risk of death by undergoing an evidence‐based medication‐assisted treatment (MAT).” A focus on offender reentry programs has long been a hallmark of U.S. Department of Justice programs, if only for the attempt to improve the high rates of recidivism nationwide. DOJ grant programs and technical assistance have spurred considerable interest at the state and local levels, where recidivism problems are well known. However, the systematic inclusion of prevention programs for abating the relapse into the misuse of prescription drugs, or the use of illicit drugs, is not as widespread as could be the case given the logical correlation between the use of drugs and criminal activity. An integrated substance use disorder treatment program designed expressly for offenders released from prison or jail will need to encompass a breadth of treatments, which may include both behavior modification and medication- assisted treatment. In a study on the effectiveness of treatment programs in the criminal justice system, the following principles of treatment for offenders were proposed: • tailoring services to fit the needs of the individual • targeting criminogenic factors associated with criminal behavior • incorporating treatment planning into criminal justice supervision and being sure treatment providers are aware of correctional supervision requirements • providing continuity of care for released drug abusers re-entering the community • providing a balance of rewards and sanctions to encourage pro-social behavior and treatment participation • using an integrated treatment approach for offenders with co-occurring drug abuse and mental health disorders.75 Evaluations of post-release substance use disorder treatment have generally shown positive results for reducing both relapse rates and recidivism. The American Psychiatric Association issued a policy statement in 2016 that said: “It is essential for continuity of care that offenders who received some form of substance use treatment while incarcerated have community treatment resources available after release. Aftercare planning should include attention to the medical, mental health and substance use disorder needs of inmates and detainees as well as regular, random testing for substance use, coupled with low-level sanctions for relapses. When indicated, inmates and detainees should be referred to programs specializing in the treatment of individuals with co- occurring psychiatric and addictive disorders. The menu of options for aftercare should include the entire spectrum of addiction programs, including treatment with medications for alcohol and opioid use disorders (e.g. methadone, buprenorphine, extended-release injectable naltrexone), outpatient psychosocial interventions, and residential rehabilitation facilities.”76 It is clear from abundant research, which shows greater success when a MAT program is fully integrated with behavioral health treatment programs, that a collaborative effort between health care providers and behavioral health departments can have a positive effect on preventing the reoccurrence of substance use disorders. Theory of Change The provision of substance use disorder treatment for a sufficient period of time, and including a robust set of methods, will have the effect of diminishing the prospects of relapse, preventing the further use of opioids and other substances, and reducing the probability of recidivism. Examples Studies show that treatment has a positive impact on recidivism and relapse when combined with continuing community care, but caution is needed in drawing conclusions owing to methodological problems with some of the research, as well as the relatively low proportion of inmates who access care following release. More research,