Inmates with opioid addiction report peer navigators are crucial for successful community reentry

Recently incarcerated people with opioid use disorder have trust in working with peer support specialists who recovered from addiction and faced similar life experiences, according to a Rutgers study.

The study, published in the journal Psychiatric Services, found that peer support specialists were most valued for providing emotional and community-based addiction recovery support as well as housing and employment information — crucial when going back into the community.

More than half of people incarcerated in state prisons have been diagnosed with a substance use disorder, according to the U.S. Department of Justice. They are most vulnerable in the months following their release, when they are at high risk of unemployment, homelessness, recidivism and overdose.

“The risk of a fatal drug overdose in the two weeks after release is 129 times that of the general population, in part because of the high risk of relapse and the loss of drug tolerance while incarcerated,” said Margaret Swarbrick, associate director of the Center of Alcohol & Substance Use Studies at Rutgers, research professor at the Graduate School of Applied and Professional Psychology and an author of the study.

The researchers interviewed 39 adult inmates diagnosed with an opioid use disorder who worked with peer support specialists upon their release from a New Jersey state prison between July 2020 and April 2021. Thirty completed a follow-up interview about four months later.

They found that participants appreciated working with someone with a shared life experience with whom they could establish a trusting relationship. However, they reported that policy barriers to recovery and community reintegration presented challenges to meeting certain needs, such as housing, food, employment and access to timely medical and recovery services, even with the peer navigator’s assistance.

Participants reported the peer support specialists were most valued for providing emotional support and housing and employment information and for navigating barriers to medical and community-based treatment. This was especially true for people with a conviction for drug distribution charges, which precludes access to resources for housing and employment, according to Michael Enich, an M.D.-Ph.D candidate at Rutgers Robert Wood Johnson Medical School, who reported on the findings.

“Studies have shown that trained peer support specialists who have experienced addiction, incarceration or both, who assist newly released offenders significantly improve the success rates of their reentry into society, especially when it comes to mental health treatment and sobriety,” said Enich. “However, few studies have examined the role of peer services for substance use disorders during the early months after prison release.”

Many participants viewed their peer navigators as role models who have overcome similar challenges, which was valued especially when they felt at risk of relapse, said Stephen Crystal, director of the Center for Health Services Research at Rutgers Institute for Health, Health Care Policy and Aging Research and an author of the study. “Having someone who was there for them ‘no matter what’ and whom they could call at any time was the most important aspect of the program as it gave them a sense of security,” said Crystal, who is also Board of Governors Professor at Rutgers School of Social Work.

The participants reported the most effective peer health navigators were empathetic, open-minded and good listeners.

The authors said more research is needed to rigorously examine the long-term impact of peer services on factors such as overdose reduction, treatment engagement and sustained recovery.

Other Rutgers researchers involved in the study are Peter Treitler, Leigh Belsky and Micah Hillis.