An Effective Framework for Responding to Substance Use Disorders in the Justice System

Substance use disorders present one of the most significant and complex challenges facing the justice system. Every day, judges, prosecutors, defense attorneys, law enforcement officers, correctional professionals, probation and parole officers, treatment providers, and policymakers encounter individuals whose criminal behavior is directly or indirectly driven by alcohol or drug use. Yet despite decades of experience, many justice systems continue to struggle with the same questions: How do we improve public safety while promoting recovery? How do we hold individuals accountable while recognizing the medical realities of addiction? How do we reduce recidivism, prevent overdose deaths, and help individuals build stable, productive lives?

These are old questions. What is changing is our understanding of the answers.

Why Substance Use Disorders Challenge the Justice System

Over the past twenty-five years, an extraordinary body of research has emerged from the fields of medicine, neuroscience, public health, behavioral health, criminology, implementation science, and corrections. Numerous studies have examined medications for opioid use disorder (MOUD), treatment courts, community supervision, correctional healthcare, reentry programs, overdose prevention, peer recovery services, implementation strategies, and cross-system collaboration.^[1]Although these studies differ in their methods, populations, and settings, they repeatedly arrive at remarkably consistent conclusions.^[2]

Taken together, this body of research leads to several consistent conclusions: Substance use disorders are treatable,^[3]recovery is possible, ^[4] evidence-based interventions improve outcomes,^[5] accountability and recovery are complementary rather than competing goals,^[6] stigma undermines recovery,^[7] and long-term success depends upon collaboration and sustained support across multiple systems.^[8]

These findings call for more than individual program improvements. They require a comprehensive framework for how the justice system responds to substance use disorders.

Five Principles for Addressing Substance Use Disorders in the Justice System

That framework is built upon five fundamental principles^[9]:

• Treatable – Substance use disorders are chronic but treatable conditions, and recovery is possible.
• Accountability – Recovery and accountability are complementary, not competing, goals.
• Evidence – Justice decisions should be guided by research, science, and proven practices.
• Stigma – Reducing stigma improves engagement, treatment participation, and recovery outcomes.
• Support – Recovery requires coordinated support that extends beyond the courtroom and correctional facility.

These are not abstract ideals. They are practical principles grounded in decades of research and the experience of justice professionals across the country. Together, they provide a framework that helps justice systems make better decisions, improve public safety, and create greater opportunities for long-term recovery.

Why Accountability and Recovery Work Together

Importantly, these principles should not be viewed in isolation. They are interconnected and mutually reinforcing.

Recognizing that substance use disorders are treatable without maintaining accountability risks minimizing individual responsibility. Demanding accountability without recognizing the effectiveness of treatment ignores decades of scientific evidence. Implementing evidence-based practices while allowing stigma to influence decision-making undermines fairness and engagement. Providing treatment without ensuring long-term support and continuity of care leaves individuals vulnerable during the very transitions when they are at the greatest risk of relapse or overdose.

The research consistently demonstrates that successful outcomes occur when these principles work together.

Perhaps the most significant development in recent years has been the shift in the questions researchers are asking. Early studies focused primarily on whether treatment worked.^[10] Researchers compared treatment approaches, measured reductions in substance use, examined criminal justice outcomes, and evaluated the effectiveness of medications for opioid use disorder.^[11] Those questions were essential, and they produced a strong body of evidence demonstrating that evidence-based treatment improves both health and public safety outcomes.^[12]

Today, however, the conversation has evolved. The question is no longer simply whether treatment works. The more important question is whether justice systems are structured to support treatment, recovery, and long-term success.^[13]

Building Justice Systems That Support Long-Term Recovery

Research increasingly focuses on implementation, organizational leadership, cross-system collaboration, continuity of care, reentry planning, community supervision, and sustained engagement in treatment.^[14] These studies recognize that even the most effective interventions cannot succeed if they are poorly implemented, interrupted during critical transitions, or delivered within systems that fail to coordinate their efforts.

This represents an important shift in perspective. Recovery does not begin and end in a courtroom. It does not begin and end in a treatment program. It does not begin and end in a correctional facility.

Recovery occurs across a continuum that includes law enforcement, the courts, jails and prisons, community supervision, behavioral healthcare, peer support, housing providers, employers, families, and community organizations. Every transition along that continuum presents both an opportunity and a risk. Every agency plays a role. Every decision matters.

One theme appears repeatedly throughout the research and deserves particular attention: continuity.

Continuity of Care and Recovery Support

Individuals leaving incarceration face one of the highest risks of overdose, relapse, and treatment interruption.^[15]Research consistently demonstrates that outcomes improve when treatment continues without interruption, when reentry planning begins before release, when community providers are engaged early, and when justice agencies collaborate rather than operate independently.^[16]

Continuity extends beyond treatment. It includes consistent expectations, coordinated supervision, effective communication among agencies, ongoing evaluation of programs, and long-term recovery supports. In many respects, continuity is the thread that connects all five principles discussed in this series.

Justice systems have long recognized the importance of accountability.^[17] Increasingly, they are recognizing that accountability is most effective when paired with evidence-based practices and meaningful opportunities for recovery. Holding individuals accountable does not require abandoning compassion, and providing treatment does not require sacrificing public safety. In fact, the evidence suggests that these objectives are closely aligned.^[18]

Communities are safer when substance use disorders are effectively treated. Victims benefit when individuals successfully recover and are less likely to reoffend. Families are strengthened when parents achieve recovery and maintain stability. Justice agencies operate more effectively when they rely on research rather than assumptions. These are not competing goals; they are complementary ones.

This series is designed for the multidisciplinary professionals who make up today’s justice system. Judges, prosecutors, defense attorneys, law enforcement officers, correctional administrators, probation and parole professionals, treatment providers, behavioral health specialists, policymakers, and community leaders each approach substance use disorders from different perspectives and carry different responsibilities. Yet the research increasingly demonstrates that no single profession and no single agency can achieve lasting success alone.

The Future of Substance Use Disorder Responses in the Justice System

The future of responses to substance use disorders in the justice system will depend upon our ability to work collaboratively, apply the best available evidence, reduce unnecessary barriers to treatment and recovery, and maintain accountability while recognizing the realities of addiction and recovery.

The Five Principles presented in this series are intended to provide a practical roadmap for accomplishing those goals.

In the articles that follow, we will examine each principle individually, explore the research supporting it, discuss its implications for justice professionals, and identify practical strategies that can be implemented in courts, correctional institutions, community supervision agencies, and communities across the country.

Our hope is not simply to encourage discussion, but to help justice professionals build systems that are more effective, more evidence-based, and more responsive to the realities of substance use disorders. When justice and science work together, accountability and recovery can reinforce one another, public safety can be strengthened, and more individuals can successfully transition from involvement in the justice system to productive lives in their communities.

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^[1] Alexandra Duncan & Maria Schiff, Opioid Use Disorder Treatment in Jails and Prisons, The Pew Charitable Trusts(Apr. 23, 2020).

^[2] Id.

^[3] Dagmar Hedrich, Paula Alves, Michael Farrell, Heino Stöver, Lars Møller & Soraya Mayet, The Effectiveness of Opioid Maintenance Treatment in Prison Settings: A Systematic Review, 107 Addiction 501 (2012).

^[4] Id.

^[5] Id.

^[6] Judge Brian MacKenzie, How Treatment Courts Can Transform OUD Recovery, Justice Speakers Institute (Mar. 18, 2025). 

^[7] Id.

^[8] Julie Hanna, Sheryl Kubiak, Emily Pasman, Ayorkor Gaba, Michael Andre, David Smelson & Debra A. Pinals, Evaluating the Implementation of a Prisoner Re-entry Initiative for Individuals with Opioid Use and Mental Health Disorders: Application of the Consolidated Framework for Implementation Research in a Cross-System Initiative, 108 J. Substance Abuse Treatment 104 (2020). 

^[9] The Five Principles described herein represent the Justice Speakers Institute’s synthesis of the current literature regarding effective justice responses to substance use disorders. They are derived from a substantial body of research demonstrating that substance use disorders are treatable; that evidence-based interventions improve health and criminal justice outcomes; that successful implementation requires accountability, leadership, and organizational fidelity; and that long-term recovery depends upon coordinated support across correctional systems, healthcare providers, community supervision agencies, behavioral health providers, peer support organizations, and community resources. See, e.g., Simon Larney, The Effectiveness of Opioid Maintenance Treatment in Prison Settings: A Systematic Review, 105 Addiction 501 (2010); Julie Hanna et al., Evaluating the Implementation of a Prisoner Re-entry Initiative for Individuals with Opioid Use and Mental Health Disorders: Application of the Consolidated Framework for Implementation Research in a Cross-System Initiative, 108 J. Substance Abuse Treatment 104 (2020); Alexandra Duncan & Maria Schiff, Opioid Use Disorder Treatment in Jails and Prisons, The Pew Charitable Trusts (Apr. 23, 2020); Adam J. Yatsco et al., Developing Interagency Collaboration to Address the Opioid Epidemic: A Scoping Review of Joint Criminal Justice and Healthcare Initiatives, 83 Int’l J. Drug Pol’y 102849 (2020).

^[10] Hedrich et al., supra note 3.

^[11] See Hedrich et al., supra note 3; Elizabeth A. Evans et al., Criminal Justice Outcomes Over 5 Years After Randomization to Buprenorphine-Naloxone or Methadone Treatment for Opioid Use Disorder, Drug & Alcohol Dependence (2019); Sarah Larney, Barbara Toson, Lucy Burns & Kate Dolan, Effect of Prison-Based Opioid Substitution Treatment and Post-Release Retention in Treatment on Risk of Re-incarceration, 107 Addiction 372 (2012). 

^[12] Id.

^[13] MacKenzie, supra note 6.

^[14] See Hedrich et al., supra note 3; Adam J. Yatsco et al., Developing Interagency Collaboration to Address the Opioid Epidemic: A Scoping Review of Joint Criminal Justice and Healthcare Initiatives, 83 Int’l J. Drug Pol’y 102849 (2020); Emily A. Wang et al., The Transitions Clinic Network Post-Incarceration Addiction Treatment, Healthcare, and Social Support (TCN-PATHS): A Hybrid Type 1 Effectiveness Trial of Enhanced Primary Care to Improve Opioid Use Disorder Treatment Outcomes Following Release from Jail, Contemporary Clinical Trials(2021).

^[15] Leo Beletsky, Lindsay LaSalle, Michelle Newman, Janine Paré, James Tam & Alyssa Tochka, Fatal Re-Entry: Legal and Programmatic Opportunities to Curb Opioid Overdose Among Individuals Newly Released from Incarceration, 7 N.E. U. L.J. 155 (2015).

^[16] Emily A. Wang et al., The Transitions Clinic Network Post-Incarceration Addiction Treatment, Healthcare, and Social Support (TCN-PATHS): A Hybrid Type 1 Effectiveness Trial of Enhanced Primary Care to Improve Opioid Use Disorder Treatment Outcomes Following Release from Jail (2021); Leo Beletsky et al., supra note 15; Hanna et al., supra note 8.

^[17] MacKenzie, supra note 6.

^[18] Id.