An Exploration of Community Reentry Needs and Services for Prisoners: A Focus on Care to Limit Return to High-Risk Behavior

Abstract

Prisoner reentry is a stressful process and many prisoners return to behaviors that led to incarceration upon community reentry. We assess how individual-level vulnerabilities interact with system-level barriers that impact the community reentry process. An additional area explored was the impact of reentry services on risk behavior (i.e., sexual risk and substance use). Fifty-one (22 men, 29 women) primarily minority adults returning from the county jail or state prison participated in 4 focus groups in February 2010. Participants took part in tape-recorded focus groups facilitated by research staff trained in qualitative research methodology. Participants reported that a lack of discharge planning led to poor community reentry (basic needs such as stable housing and employment were not met). As a result of a difficulty in accessing services to meet basic needs, many participants used drugs or engaged in sex for drugs, money, or transportation early in the community reentry process. Given the individual-level vulnerabilities of prisoners, they are more likely to reengage in risk behavior, which increases the risk of acquiring and transmitting HIV, reengaging in substance use, and recidivism. In summary, discharge planning should focus not only on sexual and substance use risk reduction, but also confirm that basic needs are met soon, if not immediately, upon release and subsequent community reentry.

Introduction

O ver 630,000 adults leave state and federal prisons and return to their communities each year.^1
–3 In fact, 93% of all prison inmates are eventually released and face the challenge of reintegrating into their families, communities, and society.¹ This reality of inevitable reentry is described as “the iron law of imprisonment”: virtually all prisoners eventually return to society (p. xxi).³ The process of reentry is a time when individuals need to find housing and employment as well as meet the requirements of probation or parole. This process of reentry is impacted by individual vulnerabilities (substance use, mental illness, and chronic health conditions). Additionally, reentry disproportionately affects impoverished and racial–ethnic minority communities. Thus, the communities receiving the highest concentrations of returning prisoners are usually among the least able to provide the supportive services these individuals need for successful integration back into productive society.^4,5 This research explores individual level vulnerabilities that impact community reentry and the basic needs that are necessary for successful community reentry. Specifically, we explored how not having basic needs met upon community reentry (i.e., housing and employment) may be associated with engagement or reengagement in risk behavior. Suggested strategies for addressing these vulnerabilities based on participant's experience are also presented.

Individual Vulnerabilities that Impact Reentry

Overall, returning prisoners face significant health challenges. They are at a considerably higher risk for a range of chronic, infectious, and mental illnesses compared to the general population.⁶ This is due in part to greater socioeconomic disadvantage and substance abuse within this population.⁷ The absence of sufficient discharge planning and continuity of medical and mental health services from correctional facilities to the community leaves many returning prisoners without needed care.^8,9 Lack of health insurance and referrals in the community cause returning prisoners to experience great difficulties accessing health services in the community following release.¹⁰ Many prisoners have chronic illnesses and lose access to prescription medications and basic health care services upon community reentry.⁷

HIV infection is more prevalent among prisoners than within the general U.S. population,¹¹ with approximately 15% of all infected individuals moving through the criminal justice system.¹² Compared to HIV infection in the U.S. population, HIV is almost five times more prevalent in incarcerated populations (1.7% for inmates compared to 0.4% for the general population).¹³ HIV risk factors (i.e., intravenous drug use, risky sexual activities, and the lack of available clean needles and condoms)¹⁴ are much more pronounced for individuals in the criminal justice system than in the population at large.^15,16 In addition, risks of acquiring or transmitting HIV increase significantly during the adjustment period following release from prison¹⁷ because returning prisoners often revert to previous patterns of high-risk behavior or engage in even higher levels of risky behavior upon community reentry.¹⁸ Furthermore, returning prisoners often return to situations and environments that encourage or even necessitate engagement in high-risk activities.¹⁹ Recent evidence also indicates that HIV disease progression can occur quite rapidly postrelease.²⁰ A number of HIV infection and transmission risk factors commonly coincide with the reentry experience that many returning prisoners face. These include lack of permanent housing, injection and non-injection substance abuse, and participation in survival sex and commercial sex work.²¹

Approximately 80% of prison and jail inmates have serious substance abuse problems.^22,23 Of the almost 1.8 million admissions to substance abuse treatment in the United States and Puerto Rico in 2006, 38% resulted from criminal justice referrals.²⁴ Returning prisoners are at high risk of substance abuse relapse, largely due to the fact that this period is characterized by the stress of major life changes. Substance abuse relapse also contributes significantly to recidivism.² For instance, returning prisoners with substance abuse problems engaged in more postrelease substance abuse and criminal behavior, and are more likely to be reincarcerated within 1 year of release compared to those with no substance abuse problems.⁷ One of the greatest barriers to substance abuse treatment for returning female prisoners involves the fact that the majority of programs do not provide care for infants and children.²⁵

Connection to basic needs upon reentry

Returning prisoners often require considerable assistance with basic issues of daily life (i.e., obtaining housing, education, employment, transportation, and personal documentation). The lack of institutional support and infrastructure create a significant barrier to successful reintegration into society for many returning prisoners.³

As many scholars have noted, employment is central to the reentry process, and evidence demonstrates that stable work can reduce the incentives that lead returning prisoners back to crime.^3,26 However, returning prisoners face bleak employment prospects. The stigma of a prison record and the general reluctance of employers to hire former prisoners serve as barriers to job placement, and the impoverished communities to which many prisoners return offer few employment opportunities.²⁷

Housing is another formidable barrier for many returning prisoners. Research has found that returning prisoners who lack stable housing arrangements are more likely to return to prison.^28,29 Securing housing is perhaps the most immediate challenge facing prisoners upon their release.³⁰ Housing options for returning prisoners who cannot rely on family and friends are very limited. While low-income housing is generally scarce throughout the United States, it is significantly more difficult for returning prisoners to obtain.³¹ Ex-felons are ineligible to live in public housing and many landlords and rental agencies refuse to rent to potential tenants with a criminal history.

These barriers (employment and housing) exacerbate the economic marginalization that contributes to many returning prisoners' initial involvement with the criminal justice system.²⁹ Consequently, these challenges contribute greatly to recidivism. Thirty percent of returning prisoners are rearrested in the first 6 months of reentry, 44% are rearrested within 1 year of release, and 67.5% are rearrested within 3 years.³² In addition, barriers in employment and education have also been associated with engagement in drug selling upon community reentry from jail.³³

The period of reentry from incarceration is a particularly important window of opportunity for substance abuse and HIV prevention efforts, as returning prisoners often return to previous patterns of high-risk behavior or engage in even higher levels of risky behaviors in an attempt to make up for lost time.¹⁸ Research shows that HIV and substance abuse prevention and treatment programs are most successful when interventions in prison are linked to treatment in the community after release.² In order to develop more effective programs for prisoners at reentry, we sought to understand the process of reentry for prisoners and explore how the reentry process impacted the expression of risk behavior. There is limited research describing how the process of reentry can impact the expression of individual risk behavior and connection to supportive services as well as descriptions of successful community reentry. The current study focused on the experiences of prisoners in meeting basic needs and connecting to supportive services as well as an exploration of risk behavior upon reentry.

Methods

Study design

Target populations of minority male and female returning prisoners and reentry service providers were chosen in order to represent those groups disproportionately affected by substance abuse and HIV. The researchers debated whether individual qualitative interviews or focus groups would provide the best information. Focus groups were chosen since participants would be able to interact with each other and it was anticipated that more in-depth information would be gathered through the interactive process. In addition, focus group methods were chosen in order to elicit rich descriptive data from which to obtain as much information as possible about the HIV and substance abuse risk factors and protective factors involved in the reentry process in the catchment area.

Participants

Focus group participants were returning prisoners in the greater Indianapolis area and were conducted in February 2010. Participants for each focus group were recruited through three local agencies that worked primarily with returning prisoners. The agencies included a substance abuse recovery center, a reentry service provider, and a minimum security transition center. The length of time from participants' most recent release ranged from still in the pre-release planning phase to returning to the community over a year ago. The majority of focus group participants had been returned to the community less than 6 months ago. Participants were recruited by placing flyers at the agency and asking agency staff to solicit participation of individuals. Fifty-one participants (22 men, 29 women) completed two male (95% African American; 5% white) and two female focus groups (48% African American; 52% white).

Procedures

Each focus group was conducted in a private meeting space at a local social service agency. The same focus group protocol was used for both male and female participants. Focus groups were conducted by staff trained in research and qualitative methods. Participants consented to participate and be audio recorded at the beginning of the focus group session. In order to protect the confidentiality and anonymity of focus group participants, participants were encouraged to use a nickname or pseudonym and to avoid using their last names. Participants were not asked for their full names or any other identifying information. The study was approved by the Indiana University Purdue University Indianapolis Institutional Review Board.

At the beginning of each focus group, a staff member gave an explanation of the needs assessment. Participants were informed that focus group discussions were being held with the purpose of developing programming to prevent the spread of HIV and substance abuse among prisoners returning to central Indiana. They were also told that they would each receive a $15 gift card at the end of the focus group session as compensation.

The original interview questions were developed by one of the researchers (J.L.) based on the goal of the project. Following the creation of the items, the questions were reviewed by service providers where participants would be recruited from and two other researchers out of which the final question set was developed. Questions developed for the focus groups are listed in Table 1. Responses to the focus group questions were then discussed verbally among the group participants, with prompts and follow-up questions used as needed.

Table 1.

List of Focus Group Questions

1. What happened to you the day you were released?

2. What was the first thing you needed when you were released?

3. Was there any place or organization that was really helpful?

4. What services are still available to you several months to a year after release?

5. What was the hardest challenge for you after you were released?

6. What helped you the most?

7. Where would you send someone who was newly released from incarceration to get information about HIV and STDs?

8. Where would you send someone who was newly released from incarceration to get information about substance abuse prevention and treatment?

9. Do you think that risk for HIV and other STDs rises for people following release?

10. Is there anything else you would like to say about your experience of being released from prison?

The current study used a grounded theory approach for data collection and analysis.³⁴ Each recording was transcribed and transcripts were analyzed for emergent themes using a constant comparative method (i.e., comparing incidents, events, and activities to emerging themes).³⁵ The analysis team (J.L. and E.R.) used a combination of open and axial coding called microanalysis: a line by line analysis to generate any additional codes and themes.³⁶ The codes and themes were reviewed and further developed by the analysis team.

Results

In the following section we describe the process of community reentry. This includes a description of immediate experiences upon community reentry. Then, we detail the unique complications of pre-release planning and how poor pre-release planning can lead to subsequent engagement in risk behavior. Thereafter, barriers and facilitators to successful reentry are described and participants are queried to gather their knowledge of community resources for HIV and substance use treatment in order to understand if individuals know about basic community services.

Immediate reentry experiences

A number of participants reported relapsing into substance abuse immediately upon their release from incarceration.

I got high.—African American, male

[I] hit the streets, it's what I had to do. I meet one old friend, that's when getting high got in.—African American, male

After almost 4 ½ years of being locked up, I used the very first day I got out.—African American, female

The above participant went on to describe the process of reentry and reengagement in significant substance use behavior.

I know after all that time, and after going through two drug programs outside the facility, I came out and I went, I mean…I didn't just go smoke a little bit of weed and drink a little bit. I went straight back to crack that day.”

Additionally, many participants described being released from prison with no housing arrangements in place. This occurred in spite of pre-release planning. A number of other participants described how housing arrangements that had been made prior to release fell apart once these prisoners were released.

You might go to five, six, seven, eight, nine, ten addresses. You don't have no resources to maintain a residence when you get out.—African American, male

Family members who had offered space in their homes during pre-release planning rescinded these arrangements for a variety of reasons.

There are a lot of time when you need the places that you thought you were going to be accepted, you're not. If you thought you were staying with family, they said they'd take him, they changed their minds.—African American, male

These participants reported resorting to bunking at homeless shelters, halfway houses, local missions, sleeping on the street, and staying with friends.

That's one of my biggest fears when I get out on the 22nd. ‘Cause my [substance abuse treatment assessment] appointment's not until the 23rd. Do you know what I mean? So where am I going to lay my head that night when I get out on the 22nd? I have no idea. Nowhere to go.—white, female

This pattern is exemplified by the following example.

Interviewee: When I was getting ready to get released from prison, my sister told them I could be paroled to her house, but the day I was released she asked me where you going to stay at tonight.

Interviewer: Do what did you do?

Interviewee: Hit the streets, it's what I had to do. I meet one old friend, that's when getting high got in.—African American, male

Participants also described returning to criminal patterns and high-risk activities for subsistence when unable to secure legitimate employment or housing upon release from prison. The below participant describes the difficulty of not finding employment:

It's just like they say pressure busts pipes and you know you get out there and you get a kids, that birthday roll around you can't get ‘em nothing…You know that, that kind of hurts your pride. You know is you being a man, you know, so you going to do whatever it takes to make yours.—African American, male

I got my girlfriend but, you know, why lean on her and try to move in with her and I can't even pay no bills, you know, so that forces you back out into the street to hustle again.—African American, male

You know it's like you running into a brick wall with every resource you try to turn to and we just a few out of the millions that will come here and try to do it the right way but the easiest way is to just say forget it, I'm going to go back to hustling. I want my money. Getting what I know how to do best. Robbing, you know..—African American, male

Participants also reported uncertainty regarding the time of the release, particularly for jail, led to an increase of risk behavior. The example below details trading sex for transportation when released from jail at 3:30 am. Washington Street is the main thoroughfare near the county jail.

Some of them are in here for prostitution. Say you've got some of them there for prostitution or some of them in here for just doing stuff, and if they go, “Oh, I want to be clean and sober,” then they walk out the door, you got a man, a trick come to pick you up, “Hey, you need a ride?” They know people are getting out. They know what time. This is Washington Street. These men are looking at these women like, “Okay, well, she needs a ride to get to go where she want to go.” Okay, well then, you have to think well, they come back into their old minds, their old way of thinking and stuff. So I say they should let them out at a normal hour like in the daytime. Everything bad happens at nighttime anyway, so I think they should let them out in the daytime to be released from here.—African American, female

Participants noted that due to the above factors, upon reentry their lives were very similar to the lives they led before incarceration.

You getting out, you have no structure, no job, no foundation, no career, no education. The only choice you have is to go back out and do what you had done before the case to take care of your family. And your kids. Everybody already knows you. If you've been walking up the streets, they expecting you to mess up.—African American, female

We already rob Peter and Paul and getting high because we're just putting ourselves back in the same grind. Back in the same old windmill.—African American, male

Focus group participants' observations strongly underscore the profound risks of HIV and substance abuse cited in the literature on reentry. Participants' narratives of recidivism risks also reinforce findings from the reentry literature concerning the role of economic marginalization and absent job opportunities in forcing returning prisoners to revert to previous criminal patterns for survival.

Barriers to successful reentry

A number of participants cited obtaining personal identification such as a birth certificate, Social Security card, and driver's license or state identification card as a significant challenge. Participants also cited finding employment, as well as transportation to employment, as significant barriers for successful reentry. Lastly, when provided information, many participants described receiving outdated and inadequate reentry and employment information.

As far as the shelters, at some places they give you 30 days, and that's, you know, that's a burden off you for right then and there, but after that 30 days, where are you going to go? You know what I'm saying, like if you don't have the educational background, or somebody to help you find your way through this, you're hit. Because a lot of places don't want to hire people that come out of prison, you know. So it's hard for even me. It took me exactly two years to get a Social Security card and a piece of ID because for one thing, if you're homeless, what address are you basically going to use?—white, female

For HIV-positive participants, access to medication and avoidance of AIDS stigma were cited as central concerns during the reentry period.

Dealing with medication, I can't do anything. Kaletra needs to be refrigerated. That's a barrier.—African American, male

Several participants' noted they received pre-release planning, however the employment and social service referrals are outdated. Additionally, focus group participants related that they were constantly bombarded with mandatory fees and charges throughout the reentry process, without regard for their ability to find paid employment or to meet their other financial obligations. They described this as a Catch-22 situation in which they felt that the criminal justice system had set them up to fail.

Facilitators to successful reentry

Participants had difficulty describing agencies, people, or strategies that helped them during the reentry process. Most frequently cited were dedicated case managers, involved peer mentors, supportive reentry programs, and strong family support. In addition, maintaining a persistent attitude in pursuing reentry programs and maintaining contact with friends and mentors in the reentry community were cited as crucial strategies. Avoiding negative community influences, remaining in safe environments, and maintaining sobriety were also seen as critical approaches to reentry.

Really, staying clean. Finding, staying clean. Just trying to stay focused on staying clean, making sure that my environment was safe to be in. Not seeing me grinding and hustling and being the ho again. Tricking with any and everybody to come up. You know, so finding a real support system. Just staying focused…Positive environments.—African American, male

My thing is to be 90 meetings in 90 days and stay close to recovery.—African American, female

Consistent with the literature on reentry, focus group participants cited strong social and familial attachments, helpful social service providers, and safe, supportive environments as critical protective factors. Additionally, peers were also noted to be particularly helpful in identifying and sharing resources.

When I'm saying structure, I need somebody to more than praise, “[participant's name], you can do this. You're a better person. You did a good job. Let's try this. Keep up the good work. Let's go here and do this.” And I have a mentor. I'm willing to have a mentor.—white, female

Common locations for HIV testing

Focus group participants expressed familiarity with the HIV testing services available to them. Participants in one focus group went so far as to respond to questions about their knowledge of HIV prevention resources by repeating a favorite HIV prevention slogan, “No glove, no love.” Although most participants knew where to go for information and testing for HIV and other sexually transmitted diseases (STDs), many participants related that compared to the much more pressing concerns of finding work, housing, and meeting other parole stipulations, protecting themselves and partners from HIV and other STDs became a relatively lower priority. Additionally, one participant expressed her desire to avoid agencies and clinics associated with HIV testing based on fear of the associated AIDS stigma.

They probably wouldn't want to go to (participant names county STD clinic) because they know what that is. You know, we have some type of dignity…You know, I would not be caught within 50 yards of that place. You get me? Then you know people are going in there going for the same reason. It don't matter. Still, you still won't catch me in. The bus would be ridin’ in on the street and somebody sees you on the bus, and you'd be walking…“I seen so-and-so walking into (participant names county STD clinic).” You could have been going to the place around the corner. I'll go to my family practice doctor or Planned Parenthood.—African American, female

Common locations for substance abuse treatment

As with HIV testing services, focus group participants also related that they were familiar with many of the substance abuse treatment providers in the community. Some participants expressed resistance or resentment toward mandatory substance abuse treatment and education programs, with complaints of exorbitant fees and being inapplicable to their life experiences.

If you're on probation if they ask, they give you an assessment they going to ask you, have you ever drank, have you ever smoked, when the last time, when the first time. If you tell them that you drunk a cap of beer ever in your life they're going to put you in the [substance abuse] classes for the simple fact it's all about the money.—African American, male

Some people get offended by it being too much about [substance abuse] because they want to learn about something else. They ain't abusing drugs. Some people might have just used them.—African American, female

In conclusion, a participant did describe a positive experience with a case manager.

Yeah, it shows that because a lot of us as far as addiction, we don't (got) families, and we don't have nobody. Then our self-esteem is so freakin’ low, and we're going through a whole lot of other issues, and you know, when somebody shows that they care, and then sometimes you need that one chance. Sometimes you just need that one little push, and you have some of us that do be struggling, that do want someone fighting nail and tooth, and can't never get to the other side. You know, and sometimes you just need that little, just that one little pull.

Discussion

Upon community reentry, individuals have vulnerabilities that predispose them to poor outcomes. These vulnerabilities interact with system-wide factors, such as returning to impoverished neighborhoods, which can lead to individuals engaging in risk behavior at similar levels prior to incarceration. In the following discussion, we will highlight important factors to consider in pre-release discharge planning, immediate needs at reentry, as well as what constitutes successful reentry.

In order to prevent returning prisoners from homelessness, relapsing into substance abuse, and acquiring or transmitting HIV or other STDs, prisoners need pre-release planning. This includes confirmed arrangements for housing, health care services, mental health care services, transportation, and referrals to social service providers. Ideally, discharge times should be standardized so that no one is released during the night. The reentry process needs to begin in prison. The best models involve prison-based outreach to prisoners slated for release, with subsequent education and planning, followed by community-based care. Prison outreach establishes a foundation for services and creates continuity of care. Providing contact with an outreach worker also enables a smooth transition from prison back into the home community.

Numerous participants described pre-release housing plans falling apart upon release back to the community. When pre-release housing plans fell through, participants described either relying on criminal behavior (such as exchanging sex for money) or connecting with previous social networks, which led to using substances. In addition, the lack of employment options also led to a feeling of hopelessness and increased the possibility of engaging in substance use behaviors. A possible solution for housing as well as employment options when pre-release plans are not effective is peer mentoring, which was a common theme that emerged in all of the focus groups. Prior research and our focus groups reveal that returning prisoners regularly share their reentry experiences with one another.³⁷ Word of mouth and informal networks play a critical role in the sharing of reentry information. In light of the length and complexity of the reentry process, peer mentoring may also ease the burden on service providers by establishing regular one-on-one contact with a support person who can commit to the more time-intensive aspects of the reentry process and can also engage individuals at community reentry in risk reduction techniques.

Returning prisoners can change addresses multiple times over the course of the reentry period. The lack of a stable, reliable mailing address compounds the problem for many returning prisoners of obtaining identification such as a Social Security card, birth certificate, and state ID card or driver's license. All of the returning prisoners experiencing housing instability need a mailing address for correspondence related to job searches, education, and obtaining personal records such as birth certificate, medical records, training certificates, and other identification. Many agencies provide their own mailing address for homeless and insecurely housed clients. With respect to organizational capacity, privacy, and safety, referring clients to providers with these services in place may provide a reasonable solution for clients without a stable mailing address of their own. Alternatively, providing individual mail boxes through a 24-h mail box services business (e.g., Mail Boxes Etc. UPS Store) is another potential solution.

A significant proportion of our focus group participants disclosed that the very first thing they did when they were released from prison or jail was to use drugs or engage in sex for drugs, money, or transportation. Lack of discharge planning renders returning prisoners extremely vulnerable to engaging in these high-risk behaviors. In particular, when prisoners are released during the night without prearranged transportation or housing, many report engaging in commercial sex work in exchange for transportation or a place to stay. Similarly, they report returning to familiar locations associated with drug use due to a lack of housing alternatives.

In order to prevent returning prisoners from relapsing into substance abuse and risking acquiring or transmitting HIV, many returning prisoners need transportation from their release site to a pre-arranged location (i.e., family member's home, half-way house, or residential treatment facility) immediately upon release from incarceration. Transportation to a safe location upon release from prison or jail circumvents a number of the risks returning prisoners experience immediately upon reentry. Providing a one-time use taxi card or “reentry shuttle” service to a safe, predetermined reentry location may help returning prisoners avoid a number of these risks during this period of acute vulnerability immediately following release from incarceration.

Additionally, since transportation plays such a critical role in the ability to obtain and maintain employment, returning prisoners need regular transportation, such as in the form of free or subsidized bus passes.

Given the clear vulnerabilities of prisoners upon community reentry, and the reengagement in risk behavior, returning prisoners are at high risk of acquiring and transmitting HIV as well as reengaging in substance use. Although most respondents reported that they knew where to receive STD/HIV testing, many reported they were not interested in visiting the clinics due to stigma. Providing HIV testing at facilities where prisoners frequent may help to address this problem. Returning prisoners also need education on safer sex techniques, access to free condoms, and other harm reduction measures. Furthermore, the goal of HIV risk prevention needs to be shared across reentry social service providers in the local community in order to be effective. Additionally, focus group participants identified that available substance abuse treatment facilities may be located far away from returning prisoners' home communities. For many women who have primary responsibility for children, the fact that the majority of local substance abuse treatment programs do not allow for infants and children is a barrier to treatment. Finding linkages to agencies that provide transportation and childcare should be considered as part of the discharge planning process.

Limitations

Although the current study added rich description to the process of community reentry and engagement in risk behavior, there are limitations to the project. For instance, we utilized focus groups, rather than qualitative one-on-one interviews. This may have introduced possible bias into the data if individuals were unwilling to describe engagement in risk behavior in a group setting. However, the participants did describe significant rates of risk behavior, hence, the focus group format may have enabled participants to build upon other comments to add depth to the interviews. Additionally, detailed information regarding substance use as well as HIV/sexual risk behavior was not gathered through questionnaire data. Hence, the variety of illegal and legal substance use, as well as sexual risk behavior, is lacking within our sample.

Conclusions

Prisoners face numerous vulnerabilities in returning to the community. However, these vulnerabilities can be overcome through individual motivation, connection to appropriate systems, and through community action. Several themes were identified for positive reentry including dedicated case managers, involved peer mentors, up-to-date social service referrals, and social support. More formidable barriers that were identified include the need for pre-release discharge planning with follow through immediately after discharge, as well as housing and employment programs that target returning prisoners. These will likely require structural intervention, but are critical to breaking the cycle of recidivism among this population.

Footnotes

Acknowledgment

Supported by Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention.

Author Disclosure Statement

No competing financial interests exist.

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