Supporting Your Child Through Dual Diagnosis and Incarceration: A Parent’s Guide to Understanding and Recovery

by Dr. Wesley Sassaman, DNP, MSN-NE, MPH, MBA, FNP-C, CARN-AP

Introduction

Having a teen or young adult in prison is one of the most challenging experiences a parent can face, and those struggles are only deepened when dual diagnosis—substance use combined with mental health disorders—is involved. Dual diagnosis doesn’t just impact their day-to-day life behind bars; it creates a ripple effect that follows them long after their release. The prison environment, with its high stress, isolation, and limited access to adequate mental health or substance use treatment, can worsen existing conditions like anxiety, depression, PTSD, or psychosis, leaving your child more vulnerable and less equipped to cope with their challenges.

Upon release, these untreated or under-treated disorders often present new barriers, increasing the likelihood of relapse, overdose, and even reincarceration. For parents, understanding this complex web of mental health and substance use issues is crucial to helping your incarcerated child not only survive this tumultuous period but also find a path toward recovery and reintegration. This article sheds light on how dual diagnosis impacts those behind bars and the importance of comprehensive care, highlighting what loved ones like you can do to support healthier outcomes during and after incarceration.

Psychological Consequences

Mental Health Disorders: Inmates with SUDs frequently experience co-occurring mental health disorders, such as anxiety, depression, and PTSD. The prison environment can exacerbate these conditions, particularly when inmates are placed in restrictive housing, which has been linked to increased PTSD symptoms (Hammock et al., 2024). Additionally, the stress of incarceration and lack of mental health support can lead to severe depression and suicidal tendencies, especially during turbulent events like prison riots (Tomassini et al., 2024).

If your teen or young adult is in prison and struggling with ongoing substance use, it's important to understand the significant link between illicit drug use and mental health challenges in such settings. The high-stress prison environment, compounded by limited mental health care, can worsen existing conditions like depression, anxiety, PTSD, and even psychotic disorders. For example, major depression affects 11.4% of inmates over six months, often overlapping with substance use disorders (Favril et al., 2024; Bukten et al., 2024). Anxiety disorders, including generalized anxiety disorder (GAD), are also prevalent, especially among younger inmates (Kung et al., 2023). PTSD is notably common among those with drug use histories, particularly for those subjected to solitary confinement, with a prevalence of 9.8% (Hammock et al., 2024; Favril et al., 2024). Psychotic illnesses affect around 3.7% of inmates and are often worsened by prison-related stress and isolation (Favril et al., 2024; Kung et al., 2023). Substance use disorders are widespread, with nearly 38.9% of inmates meeting criteria for drug use disorders, particularly involving opioids and synthetic cannabinoids (Favril et al., 2024; Chiappini et al., 2024). The co-occurrence of mental health and substance use disorders creates complex challenges, further aggravated by overcrowded and resource-limited prison conditions (Shah et al., 2024; Plettinckx et al., 2023). A holistic approach that integrates mental health and substance use treatment is essential to address these issues, emphasizing the dire need for improved health services in prisons (Volkow et al., 2024).

Overdose and Suicide Risk: The risk of drug overdose and suicide is significantly higher among inmates, particularly during and after release from prison. The chaotic environment of prison riots can lead to mass intoxication and overdose, as seen in the case study from Italy (Tomassini et al., 2024). Moreover, individuals released from prison face an increased risk of suicide and drug-related deaths due to insufficient access to mental health and substance use services (Savinc et al., 2024).

For parents supporting a teen or young adult in prison grappling with substance use, it’s vital to understand that the chaotic prison environment, especially during events like riots, can exacerbate the risk of drug overdose and suicide. Such situations heighten stress and loss of control, often leading inmates to dangerous behaviors, as seen in cases of overdose during riots in Italian prisons (Tomassini et al., 2024). Many incarcerated individuals bring pre-existing mental health vulnerabilities that are worsened by the harsh conditions of prison life, leading to increased risks of suicide (Goyes, 2024). Unfortunately, access to mental health and substance use treatment during incarceration is often limited, despite its critical role in identifying and supporting at-risk individuals (Konrad et al., 2025; Chin et al., 2024). The post-release period poses even greater dangers, with heightened rates of overdose and suicide due to insufficient transitional care. However, evidence shows that programs such as Medicaid prerelease services and medications for opioid use disorder (MOUD) during incarceration can reduce these risks significantly (Michener et al., 2024; Lewer & Edge, 2024). Overcoming these challenges requires a coordinated approach to treatment and reintegration while addressing the stigma and systemic barriers that can hinder access to care across this vulnerable period (Silver et al., 2024; Fix et al., 2024).

Social Consequences

Social Isolation and Stigma: Drug use in prison often leads to social isolation, as inmates may be stigmatized by both peers and staff. This isolation can exacerbate feelings of loneliness and dependence on others, further impacting mental health (Plettinckx et al., 2023). The lack of social support networks within the prison system can hinder recovery and reintegration into society upon release.

Reincarceration: Inmates with SUDs are at a higher risk of reincarceration due to the persistent cycle of drug use and criminal behavior. Studies have shown that individuals with co-occurring disorders are more likely to be reincarcerated compared to those without such disorders (Butler et al., 2024). This cycle is perpetuated by inadequate treatment and support within the prison system.

If your teen or young adult is struggling with substance use while incarcerated, it's important to understand how social isolation, stigma, and a lack of support can deeply affect their mental health, recovery, and ability to reintegrate after release. Social isolation often leads to severe mental health challenges like depression, anxiety, and even psychosis, worsening preexisting conditions and complicating recovery efforts (Danzig et al., 2024; O’Sullivan et al., 2024). Stigma from both peers and prison staff can shame individuals into secrecy and withdrawal, further hindering access to treatment and perpetuating negative mental health outcomes (Earnshaw et al., 2025; Larsen et al., 2025). Similarly, without a supportive network, inmates often lack the encouragement needed to cope with stress or stay motivated in recovery programs (McFadden et al., 2024; Machado et al., 2024). This stigma and isolation can persist post-release, impairing relationships and employment opportunities, which increases the risk of recidivism (Paseda & Hall, 2024). However, solutions exist—peer support programs, stigma-reduction initiatives, and efforts to enhance social networks can create a more supportive environment both inside and outside prison, strengthening resilience and fostering personal growth (Walton et al., 2024; Kleinman et al., 2024; Machado et al., 2024; Earnshaw et al., 2025; McFadden et al., 2024).

Treatment and Policy Implications

Need for Comprehensive Treatment: There is a critical need for evidence-based treatment programs within prisons to address SUDs and associated mental health issues. The UNODC-WHO emphasizes the importance of treating SUDs as health conditions rather than criminal behaviors, advocating for accessible treatment both in prison and as an alternative to incarceration (Volkow et al., 2024). However, the effectiveness of prison-based treatment programs remains inconsistent, highlighting the need for transparency and research to improve these interventions (Kentor, 2023; Beaton & Gerber, 2023).

For parents with a teen or young adult in prison struggling with ongoing substance use, understanding the potential of evidence-based treatment programs is vital. These programs have shown varying success in addressing substance use disorders (SUDs) and related mental health issues among incarcerated youth, especially when implemented as health interventions rather than punitive measures. Treating SUDs as health conditions aligns with public health strategies and international standards, often promoting recovery, reducing recidivism, and improving overall well-being (Volkow et al., 2024). Integrated approaches that address both substance use and mental health disorders show promise, particularly when they are tailored to the unique needs of young people (Marshall et al., 2025). Programs rooted in trauma-informed care are also gaining traction, helping to reduce substance use and mental ill-health, though more research is needed to confirm their long-term efficacy (Bailey et al., 2024). Alternatives to incarceration, such as drug courts, have demonstrated effectiveness in reducing recidivism and improving health outcomes when emphasizing treatment over punishment (Virtanen et al., 2024). However, the success of these programs depends on factors like resource availability, staff training, and ensuring continuity of care post-release, as seamless transitions to community-based programs are crucial to maintaining progress and preventing relapse (Savinc et al., 2024; Graves & Fendrich, 2024). Programs like Cognitive Behavioral Therapy and Therapeutic Communities, though theoretically effective, often yield mixed results in practice due to inconsistent implementation (Kentor, 2023; Beaton & Gerber, 2023). Tailored interventions, often seen in juvenile drug treatment courts, tend to perform better but require rigorous implementation (Tanner-Smith et al., 2023). Parents often face profound concerns during this time, making it essential for these treatment programs to involve families, provide support, and ease anxieties by fostering accessible and effective care (Vidal et al., 2024). While great progress has been made, more well-powered, scalable research is needed to optimize these programs, ensuring they meet the needs of incarcerated youth and their families effectively (Bailey et al., 2024).

Harm Reduction Strategies: Implementing harm reduction strategies, such as needle and syringe programs, can mitigate the health risks associated with drug use in prisons. Despite their effectiveness in reducing disease transmission, these programs are not widely adopted due to security concerns and misconceptions about encouraging drug use (Moazen & Stöver, 2024).

If your teen or young adult is in prison and dealing with ongoing substance use, it’s important to understand the role harm reduction strategies can play in improving their health and safety. Programs like needle and syringe programs (NSPs) and opioid substitution treatments have been proven to reduce the transmission of infectious diseases like HIV and hepatitis C, successfully lowering drug-related deaths and infections in various settings, including prisons (Goosdeel, 2024; Moazen & Stöver, 2024). However, despite their effectiveness, these programs are underused in prisons due to security concerns—such as fears that syringes could be misused as weapons—and misconceptions that providing syringes encourages drug use, a claim unsupported by substantial evidence (Moazen & Stöver, 2024). Low participation in Canada’s needle exchange programs also highlights barriers like limited access and structural issues (Lafferty et al., 2024). Potential solutions include piloting NSPs in prisons to address concerns and involving both inmates and staff in designing these programs to make them more effective (Moazen & Stöver, 2024). The United Nations provides guidelines for creating programs that emphasize treatment and care for incarcerated individuals with substance use disorders to ensure effectiveness and acceptance (Moazen & Stöver, 2024). Additionally, while harm reduction has seen success globally, particularly in Europe and to a limited extent in the United States, broader adoption is hindered by policy environments and a lack of sustained support, despite evidence proving these strategies save lives and improve health outcomes (Goosdeel, 2024; Saloner et al., 2024). Addressing these challenges requires advocacy and reforms to bring evidence-based policies into practice, ultimately providing better care for incarcerated loved ones.

While the psychological and social consequences of illicit drug use among prison inmates are severe, addressing these issues requires a multifaceted approach that includes comprehensive treatment, harm reduction strategies, and policy reforms. By shifting the focus from punitive measures to public health strategies, the well-being of inmates can be significantly improved, reducing the cycle of drug use and reincarceration. However, the implementation of such strategies faces challenges, including security concerns and the need for systemic changes in prison policies.

Conclusion and Take Home

Navigating the complexities of dual diagnosis—substance use and mental health disorders—when your teen or young adult is incarcerated can be overwhelming. These intertwined challenges don’t simply affect your child’s time behind bars; they cast long shadows that extend into their life after release. Within prison, untreated mental health conditions like anxiety, depression, PTSD, or psychosis, coupled with substance use, can lead to worsening symptoms, social isolation, and increased vulnerability. Sadly, the prison system often lacks the resources to provide effective care, leaving these disorders to fester in stressful, isolating conditions. Upon release, your child may face heightened risks of relapse, overdose, or reincarceration due to insufficient transitional support and ongoing stigma.

Supporting a teen or young adult who is incarcerated and dealing with the combined challenges of drug addiction and mental health issues is an emotional and complex journey for families. Dual diagnosis creates unique obstacles that extend well beyond the prison walls, affecting their ability to heal, grow, and reintegrate into society. However, with the right tools, support, and evidence-based strategies, families can play a critical role in fostering resilience and recovery.

Evidence-Based Recommendations for Parents

Encourage Access to TreatmentAdvocate for your loved one to engage in evidence-based mental health and addiction treatment programs. This may include cognitive behavioral therapy (CBT), trauma-focused interventions, and medications such as those addressing opioid use disorder. Programs like [support resource] can help bridge gaps in prison healthcare systems and ensure continuity of care during and after incarceration.

Learn About Harm Reduction StrategiesEducating yourself on harm reduction measures, such as Needle and Syringe Programs (NSPs) or medication-assisted therapies, can help you advocate in settings where these life-saving strategies are underutilized. Initiatives endorsed by organizations like [support resource] are proven to reduce health risks and improve outcomes for individuals with substance use disorders in prison settings.

Prepare for Transitional Support Post-ReleaseThe period immediately following release is a critical time, often marked by increased risks of overdose and mental health crises. Work with transitional programs that provide case management and link individuals to housing, employment, and healthcare support. Look for re-entry programs such as [support resource] or Medicaid prerelease programs to help ensure a smoother transition.

Supporting Effective Communication and Resilience

Develop Compassionate Communication SkillsOpen and honest communication is key when supporting someone grappling with mental health and addiction. Use empathetic listening techniques, focusing on understanding rather than judgment. Resources such as [support resource] offer guides and training on maintaining productive dialogues, even during challenging discussions.

Reduce Stigma and Build TrustAcknowledge the stigma your loved one may face from others and even from themselves. Show them unconditional support and encourage them to share their feelings without fear. This will foster trust and reassure them that they have an ally in you, no matter their circumstances.

Strengthen Your Support NetworkSupporting a loved one can take a toll on your own mental health. Seek out family support groups through organizations like [support resource], or participate in counseling to process your emotions. Connecting with other families in similar situations can provide perspective and strength.

Fostering Resilience and Recovery

Encourage a Holistic Recovery ApproachRecovery involves more than addressing substance use. Encourage your loved one to participate in activities that build life skills, mindfulness, and self-esteem. Programs offering education, vocation training, and peer support, such as [support resource], can enhance their readiness to reintegrate into society.

Set Realistic Goals TogetherWork collaboratively with your loved one to set achievable milestones for their recovery and reintegration process. Small, measurable steps can build confidence and reduce feelings of being overwhelmed.

Create a Stable Environment Post-ReleaseTo support a successful transition, help establish a stable and supportive environment post-release. Whether it’s providing a safe living space, connecting them to community resources, or helping them access therapy, stability is a crucial foundation for recovery. Organizations such as [support resource] can assist with these efforts.

However, while the situation is undeniably challenging, there is hope. Understanding the profound impact of dual diagnosis and advocating for evidence-based care and harm reduction strategies can make a significant difference. Comprehensive treatment, family involvement, and access to tailored support programs—both in and out of prison—can help break the cycle, paving the way toward recovery and reintegration. Remember, as a parent, your support and persistence can be a lifeline, encouraging your child to seek the help they need and showing them that they are not alone in this difficult journey. Together, with compassion and the right resources, recovery is possible.

References

Bailey, S., Newton, N., Perry, Y., Grummitt, L., Tiko, R., Baams, L., & Barrett, E. (2024). Effectiveness, efficacy, acceptability, and feasibility of trauma-informed depression, anxiety, and substance use prevention programs for young people aged 12-25 years: A mixed-methods systematic review. Journal of Adolescence. University of Sydney.

Beaton, B., & Gerber, J. (2023). Drug addiction and incarceration: A call for research and transparency among prison-based substance abuse treatment programs. International Journal of Offender Therapy and Comparative Criminology. Advance online publication.

Bukten, A., Virtanen, S. M., Hesse, M., Chang, Z., Kvamme, T. L., Thylstrup, B., Tverborgvik, T., Skjærvø, I., & Stavseth, M. R. (2024). The prevalence and comorbidity of mental health and substance use disorders in Scandinavian prisons 2010–2019: A multi-national register study. BMC Psychiatry, 24.

Butler, A., Nicholls, T. L., Samji, H., Fabian, S., & Lavergne, M. R. (2024). Mental health needs, substance use, and reincarceration: Population-level findings from a released prison cohort. Criminal Justice and Behavior.

Chiappini, S., Vaccaro, G., Mosca, A., Miuli, A., Stigliano, G., Stefanelli, G., Giovannetti, G., Carullo, R., d'Andrea, G., Di Carlo, F., Cavallotto, C., Pettorruso, M., Di Petta, G., Corkery, J., Guirguis, A., Stair, J. L., Martinotti, G., Fazel, S. H., & Schifano, F. (2024). New trends of drug abuse in custodial settings: A systematic review on the misuse of over-the-counter drugs, prescription-only medications, and new psychoactive substances. Neuroscience & Biobehavioral Reviews, 162.

Chin, E. T., Liu, Y. E., Ogbunu, C. B., & Basu, S. (2024). Population health implications of Medicaid prerelease and transition services for incarcerated populations. Milbank Quarterly.

Danzig, A., Novick, A. M., & Ross, D. A. (2024). From social isolation to social justice: The neuroscience of solitary confinement. Biological Psychiatry, 95, e13–e15.

Earnshaw, V. A., Mousavi, M. E., Qiu, X., & Fox, A. B. (2025). Mental illness and substance use disorder stigma: Mapping pathways between structures and individuals to accelerate research and intervention. Annual Review of Clinical Psychology.

Favril, L., Rich, J. D., Hard, J., & Fazel, S. (2024). Mental and physical health morbidity among people in prisons: An umbrella review. The Lancet Public Health, 9(4), e250–e260.

Fix, R. L., Thompson, K. R., & Doan, B. K. (2024). Is there a mental health wake following the COVID‐19 pandemic on adolescents in a male juvenile prison? Journal of Research on Adolescence.

Goosdeel, A. (2024). Harm reduction and its monitoring in Europe, from EMCDDA to EUDA. Harm Reduction Journal, 21(1). BioMed Central.

Graves, B. D., & Fendrich, M. (2024). Community-based substance use treatment programs for reentering justice-involved adults: A scoping review. Drug and Alcohol Dependence.

Hammock, J. A., Lopez-Castro, T., & Fox, A. D. (2024). Prior incarceration, restrictive housing, and posttraumatic stress disorder symptoms in a community sample of persons who use drugs. Health & Justice, 12.

Kentor, J. (2023). Drug addiction and incarceration: A call for research and transparency among prison-based substance abuse treatment programs. International Journal of Offender Therapy and Comparative Criminology. Advance online publication.

Kleinman, M. B., Anvari, M. S., Felton, J. W., Bradley, V. D., Belcher, A. M., Abidogun, T. M., Hines, A. C., Dean, D., Greenblatt, A. D., Wagner, M., Earnshaw, V. A., & Magidson, J. F. (2024). Reduction in substance use stigma following a peer-recovery specialist behavioral activation intervention. International Journal of Drug Policy, 130, 104511–10451.

Konrad, N., Opitz‐Welke, A., & Völlm, B. (2025). Editorial: Community series in caring for those who are neglected and forgotten: Psychiatry in prison environments, volume II. Frontiers in Psychiatry, 15.

Kung, C., Park, E., Davis, A., Lacy, B., Piotrowski, H., & Husain, M. M. (2023). Comparison of the point prevalences of psychiatric comorbidities in younger versus older incarcerated adult patients at a large county jail. American Journal of Geriatric Psychiatry, 31(10), e8–eXX.

Lafferty, L., Altice, F. L., Leone, F., Stoové, M., Lloyd, A. R., Hajarizadeh, B., & Kronfli, N. (2024). Using nominal group technique with people who are incarcerated in Canadian federal prisons to identify barriers and solutions to improving Prison Needle Exchange Program uptake. International Journal of Drug Policy, 131, 104549-10454. Elsevier BV.

Larsen, K., Silverstein, S. M., Crawford, T. N., Hassan, S. A., Mack, N., Perdue, T., & Ray, B. (2025). Categorizing stigma as a barrier to support following nonfatal overdose: A qualitative study. Journal of Addiction Medicine.

Lewer, D., & Edge, C. (2024). Preventing deaths after prison release. The Lancet.

Machado, N. M., Abreo, L., Petkari, E., & Pinto da Costa, M. (2024). The relationship of social contacts with prisoners' mental health: A systematic review. Public Health, 234, 199–216.

Marshall, T., Reeson, M., Loverock, A., Lewis, A. E., King, I., Ilyas, R. A., Dixon, C., Viste, D., Azer, B., Chow, E., Safi, F., Kennedy, M., Abba‐Aji, A., & Greenshaw, A. J. (2025). Evidence-based interventions for youth with concurrent mental health and substance use disorders: A scoping review. The Canadian Journal of Psychiatry. SAGE Publishing.

McFadden, D., Davidson, G., & Butler, M. (2024). Social support and trauma experiences of imprisoned men in Northern Ireland. International Journal of Law and Psychiatry, 95, 102005-1.

Michener, P. S., Bianchet, E., Fox, S., Evans, E., & Friedmann, P. D. (2024). “Expected to happen”: Perspectives on post-release overdose from recently incarcerated people with opioid use disorder. Harm Reduction Journal, 21(1).

Moazen, B., & Stöver, H. (2024). Needle and syringe programs in prisons: Does it really matter? Journal of Community Psychology.

O’Sullivan, R., Victor, C., & Cudjoe, T. (2024). Loneliness and social isolation among vulnerable, diverse, and minority groups: Novel research and practical insights. Innovation in Aging, 8(Supplement_1), 70–70.

Paseda, O., & Hall, T. (2024). Mental health symptom reduction in US adults postincarceration. Research on Social Work Practice.

Plettinckx, E., Harth, N., Damian, E., Degreef, M., Dirkx, N., De Smet, S., & Gremeaux, L. (2023). A mixed methods study about health problems and drug use in Belgian prisons during 2021-2022. European Journal of Public Health, 33.

Rodríguez Goyes, D. (2024). Trauma and imported vulnerability in prison suicides. Punishment & Society.

Saloner, B., Heller, D., Davis, C. S., & Sherman, S. G. (2024). Harm reduction: The neglected pillar of US drug policy. Annual Review of Public Health. Annual Reviews.

Savinc, J., Kjellgren, R., Connell, C., & Hunt, K. (2024). Preliminary results from a novel data-linkage study into mental health and substance use service utilisation by people released from Scottish prisons. International Journal for Population Data Science, 9(5).

Shah, H., Hawks, L., Walker, R. J., & Egede, L. E. (2024). Substance use disorders, mental illness, and health care utilization among adults with recent criminal legal involvement. Psychiatric Services, 75(3), 221.

Silver, I. A., Cohen, T., & Newsome, J. (2024). Juvenile incarceration in an adult facility and violent victimization during adulthood. Journal of Adolescence.

Tomassini, L., Giuli, G., Bottoni, E., David, M. C., & Scendoni, R. (2024). Drug overdose deaths during prison riots and mental states of prisoners: A case study. Frontiers in Psychiatry, 15.

Virtanen, S. M., Aaltonen, M., Latvala, A., Forsman, M., Lichtenstein, P., & Chang, Z. (2024). Effectiveness of substance use disorder treatment as an alternative to imprisonment. BMC Psychiatry, 24.

Volkow, N. D., Scoppetta, O., Busse, A., Poznyak, V., Krupchanka, D., & Campello, G. (2024). Treatment of substance use disorders in prison settings: Statement by the UNODC-WHO Informal Scientific Network, UN Commission on Narcotic Drugs. World Psychiatry, 23(2), 294–295.

Walton, H., Sherlaw-Johnson, C., Massou, E., Ng, P. L., & Fulop, N. (2024). Peer support for health, social care, and educational needs in adult prisons: A systematic scoping review. Public Health, 236, 412–421.