Incarcerated populations are both more likely to suffer from and be more vulnerable to mental health (MH) and substance use disorders (SUDs) and from violent and self-harm behaviors than the general population (American Academy of Family Physicians, n.d.). Eighty-five percent of incarcerated individuals were either struggling with active SUDs themselves or were under the influence of alcohol and/or drugs at the time of their crime (National Center on Addiction and Substance Abuse, 2010). Despite 1.5 million inmates meeting clinical criteria for SUD, only 168,000 received treatment (National Institute on Drug Abuse [NIDA)], 2020). Between 2004 and 2006, one-third of the 2.3 million persons incarcerated in the United States had a diagnosis of a mental illness, with roughly 25 percent experiencing a co-occurring SUD (NIDA, 2020).

During periods of transition, such as community reentry after incarceration, individuals with SUDs are vulnerable. Upon reentry, many individuals face barriers to reestablishing a healthy life outside of jail or prison, including inadequate access to health insurance, MH or SUD treatment, medical care, employment, and housing. Many individuals with SUDs return to their community and start using drugs again, not realizing they do not have the same tolerance they had before incarceration, which in turn can lead to an increased risk of overdose and death (Hanna et al., 2020) and a relapse-driven return to incarceration (NIDA, 2020). The risk of opioid overdose in the first 2 weeks following an individual’s release from prison is 40 times higher than for the general population (Hanna et al., 2020).

Individuals who are incarcerated and living with SUDs face challenges both behind the walls and after release, particularly in transitioning back to the community. Separately, neither the correctional system nor the community behavioral health system can adequately meet their needs. Prison behavioral health staff members often lack the resources needed to address the emotional regulation, stress management, relapse, and overdose prevention needs of incarcerated persons or adequately prepare individuals for reentry into the diverse communities to which they return. Overburdened and under-resourced, community behavioral health systems, in turn, often lack the expertise and resources to address the unique needs of returning individuals confronting both SUD and readjustment to the community.

Peer support is a proven resource to address these demands in correctional and community settings to support recovery from SUD and MH conditions, prepare for release, and facilitate reentry. Peer support has proven to be effective for a range of emotional, informational, and instrumental supports; improved sense of wellbeing; and linkage to services for individuals in or seeking recovery from SUD and/or MH conditions (Bellamy, Schmutte, & Davidson, 2017; Bassuk et al., 2016; Reif et al., 2014). Peer support can be delivered while an individual is incarcerated and can follow the individual through release planning, reentry, and community supervision. Adding peer recovery specialists to existing multidisciplinary teams of correctional officers and staff, court staff, behavioral health clinicians, and social workers can reap both operational and fiscal benefits. Those benefits include successful community integration, connection to services, increased prosocial connections, and decreased recidivism (Bagnall et al., 2015; Taylor & Becker, 2015; Rowe et al., 2007).

In theory, adding peer support in correctional settings is as simple as hiring a peer specialist. In practice, it is more complex. There is an inherent tension between peer practice approaches and traditional correctional approaches. Peer support focuses on healing practices that are strengths-based, holistic, trauma-informed, and person-centered. It can be challenging to foster these peer program attributes in a corrections environment, which is punitive by design, relies on control, and can induce or trigger trauma. While peer support can augment behavioral health services, it can easily be undermined and thwarted by the overarching correctional culture, policies, and procedures. Successful integration of peer recovery support services (PRSS) requires a thoughtful, deliberate approach. The purpose of this technical assistance (TA) package is to assist organizations in that approach. This document will:

1. Define peer support in correctional settings.
2. Describe the core competencies for peer support in correctional settings.
3. Highlight the use of peer support in short-term, medium-term, long-term, and community corrections settings to improve recovery and reentry outcomes.
4. Identify emerging and best practices for integrating peer support into correctional settings.
5. Provide recommendations for program design and implementation. 

The document contains implementation tools, including a start-up checklist and sample job descriptions.