Is There Life After Prison?

RWJF scholar studies ways to help former inmates survive the difficult—and often deadly—transition to freedom.

    • March 26, 2012

It’s one of the great ironies of the nation’s justice system: After surviving life behind bars, newly freed former prisoners are at much greater risk of dying than their peers in the general population.

But a new lease on life doesn’t have to be so risky for ex-prisoners, says Ingrid Binswanger, MD, MPH, an alumna of the Robert Wood Johnson Foundation (RWJF) Physician Faculty Scholars program (2008-2011) and the lead author of a new study published in Addiction Science & Clinical Practice that outlines ways to help former inmates successfully re-enter society.

One key way to do that, she and her co-authors assert, is to help former inmates avoid drug overdose—a leading cause of death in this population, particularly in the weeks after release.

“Despite the high prevalence of substance abuse disorders among individuals in prison, our results suggest that former inmates with a history of drug use disorders and criminal drug charges are often released into environments with significant social and economic challenges, little structure, and ubiquitous drug activity,” the article states. “These challenges made it difficult for former inmates with drug use disorders to remain abstinent from drugs and alcohol.”

Binswanger’s co-authors include John Steiner, MD, MPH, an alumnus of the RWJF Clinical Scholars program (1985-1987), senior director of the Institute for Health Research at Kaiser Permanente Colorado and a professor of medicine at the University of Colorado. Binswanger and her colleagues conducted the study to learn more about the causes of relapse among recently released inmates from the perspective of the former inmates themselves.

They found that former inmates identified a number of triggers that make them particularly vulnerable in the immediate aftermath of their release. These include drug trafficking at and around homeless shelters, where many ex-prisoners reside because they lack transitional housing; stress due to lack of financial security, health problems, and unsafe housing; and a lack of social and community-based supports. They also found that lack of knowledge about lower tolerance for narcotics after incarceration and increased potency of street drugs can also lead to accidental overdose and death.

“People experience a lot of transitional challenges during the post-release period,” says Binswanger, an assistant professor of medicine at the University of Colorado. “It can be very hard for individuals to avoid relapsing and even potentially overdosing.”

Small Study Has Potentially Large Effect

For the study, Binswanger and her colleagues conducted face-to-face interviews with 29 former inmates in Denver within two months after prison release, most of whom reported having used or abused drugs and/or alcohol prior to incarceration.

Although small in scale, the study has the potential to affect a large number of people. At the end of 2010, more than 7.1 million people—many with histories of substance abuse—were in prison or on probation or parole, according to the Bureau of Justice Statistics.

Binswanger’s study builds on an earlier one she conducted that found the risk of death among former inmates is 3.5 times as high as in the general population. That study, published in 2007 in the New England Journal of Medicine, analyzed the mortality rate of former inmates in Washington state. The first two weeks after release are especially dangerous, it found. During this period, the risk of death among former inmates is more than 12 times that of similar groups in the general population.

The problem threatens to worsen thanks to the recent economic crisis, Binswanger says. In an attempt to balance budgets in tight fiscal times, state legislatures have cut funding for prisons and are releasing more inmates, she says, adding that community services have also suffered from budget cuts.

Supporting former inmates during this critical time has the potential to prevent hospitalizations and repeat incarcerations, reduce health care costs, and—because minorities comprise a disproportionate share of the prison population—narrow health disparities, Binswanger says.

Effective intervention services could include support from drug treatment programs, community-based organizations, and groups like Narcotics Anonymous, and from individuals such as case managers and patient navigators, the study suggests. Former inmates could also benefit from transitional housing; supportive relationships with family and friends; spirituality; awareness programs about successful re-entry; and continued medication for health problems, according to the study.

Binswanger’s next step is to use the findings to develop and study interventions to reduce the risk of relapse and overdose among ex-prisoners soon after their release. “We absolutely have to address the problems that inmates face when they return to their home communities so that they are successful,” she says.

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