Table 1 Themes and Implications for Design of Interventions and Policies to Minimize Drug Relapse and Overdose Risk among Former Prison Inmates

Relapse occurred in the context of poor social support, re-entry challenges and lack of financial resources.

Attention to the psychosocial and practical needs of re-entry is necessary to reduce risk.

Participants reported medical and mental-health problems combined with limited access to health care and medications.

Re-entry services should include attention to meeting basic medical needs.

Participants described ubiquitous exposure to drugs, alcohol, and drug trafficking in the environments to which they were released.

Transitional housing should be away from neighborhoods with ubiquitous drug activity. Encourage avoidant behaviors and skills to avoid exposure.

Perception of high risk of overdose after release from prison because of diminished tolerance.

Educate inmates about lower drug tolerance at release and provide bystander naloxone training and distribution.

Overdose perceived as a means of coping with unbearable stress and anxiety.

Teach new coping mechanisms for the stress and anxiety that accompanies release.

Relapse after release perceived as a coping mechanism for depression, anxiety, and frustration.

Enhance coping skills and ensure medication continuity for mental-health conditions. Motivate inmates to seek and preserve healthy relationships for support. Connect inmates with religious/spiritual institutions and community-based organizations.

Preventive factors included structured drug-treatment programs, spirituality/religion, community-based services, self-help programs, and family.

Offer inmates structured treatment for substance use disorders after release, help them link to community-based services, encourage use of self-help programs, and support positive family roles and relationships.