Substance use in facilities

Abstract Use of substances by incarcerated persons poses clinical and systemic challenges for correctional psychiatrists. Substance use disorders are common in correctional settings, with a higher prevalence usually found in persons with other psychiatric conditions. Knowledge about substance use in correctional facilities fosters competent clinical intervention and enhances management at all levels. Patients might not spontaneously report substance use during incarceration because they fear retribution by correctional staff or not receiving needed treatment for medical and mental health problems. Psychiatrists need to screen for substance use and related disorders as part of individualized treatment planning. The specific substances found in facilities vary geographically, and the clinical challenges vary from one facility to another. The interplay between mental health, medical, and custody staff regarding screening, detection, triage, management, and treatment lies at the heart of these challenges. Correctional psychiatrists make important contributions by providing direct assessment and treatment to patients and by offering educational, clinical, and policy consultations to other staff. These contributions help prevent potentially life-threatening complications of intoxication and withdrawal, ensure integrated and evidence-based care, and avoid misguided or ill-informed disciplinary actions or other institutional practices.