Substance use disorder (SUD) remains one of the most pressing—and treatable—public health challenges in the United States. Yet its impact is disproportionately concentrated within the criminal justice system, where the need for consistent, evidence-based care is both urgent and complex.
While roughly eight percent of the general U.S. population meets criteria for SUD, rates within the criminal justice system are dramatically higher—affecting approximately 40 percent of arrestees and nearly two of every three individuals incarcerated in jails and prisons. These figures underscore a critical reality: the criminal justice system is one of the largest touchpoints for individuals in need of SUD treatment.
A system-wide imperative
The American Society of Addiction Medicine (ASAM), the nation’s leading medical society for SUD treatment, has made it clear that substance use must be addressed as a treatable medical condition across all components of the criminal justice system – a particularly critical need in the midst of the current opioid epidemic. At each of the following stages, individuals need careful, systematic, multi-dimensional and clinically sound evaluation to ensure appropriate treatment and continuity of care.
- Redirection (deflection and diversion)
- Arrest
- Prosecution, defense and adjudication
- Probation
- Incarceration
- Re-entry and parole
Each year, more than 7 million individuals enter the justice system. The majority will cycle through local jails, state prisons, probation or parole—not specialized treatment courts.
- About 3.8 million (66 percent) are placed under community supervision
- Nearly 2 million are incarcerated
- Only about 150,000 (2 percent) are monitored in drug or DUI courts
With most justice-involved individuals referred or remanded to programs/facilities outside of traditional treatment-focused environments like specialty courts, these numbers represent an operational misalignment. For correctional systems under pressure to improve outcomes while managing costs, this creates both risk and opportunity, making scalable, system-wide solutions essential.
Today’s correctional systems require more than custody and control. They’re shifting from public safety to clinical responsibility, and they’re increasingly responsible for:
- Identifying SUD needs at intake
- Managing withdrawal and stabilization
- Delivering appropriate treatment during incarceration
- Ensuring continuity of care at reentry
The challenge? Most systems lack consistent, scalable ways to assess and prioritize need.
Without standardized assessment:
- Individuals may be over- or under-treated
- Resources risk being misallocated
- Reentry planning becomes fragmented
- Overdose risk increases—especially post-release
Advancing standardized assessments
In 2018 the ASAM CONTINUUMTM digital assessment tools were introduced to help address these gaps. These tools brought standardized, clinically validated SUD assessment into the criminal justice system, and within just a few years, they were adopted across:
- 14 criminal justice systems
- 9 U.S. states, plus Guam and Bermuda
- Large urban systems (California, Florida, Texas, etc.)
- Rural and frontier regions (Alaska, Oregon, Utah, etc.)
Their use spans the full justice ecosystem—from state departments of corrections, county sheriff’s offices, jails and detention centers to community supervision agencies, public defender associations and court systems. From large-scale systems in states like California and Texas to rural regions in Alaska and Utah, and everything in between—across 463 correctional-focused Continuum subscribers, more than 200,000 assessments have been used to:
- Screen and triage individuals at intake
- Determine SUD severity and level of care
- Guide medication-assisted treatment (MAT) decisions
- Align housing, programming and clinical resources
- Support reentry and promote continuity of care
Making a measurable impact – Case in point: California
California’s Integrated Substance Use Disorder Treatment (ISUDT) program demonstrates the impact of this approach in practice. Implemented across 34 state prisons, the program uses the Continuum set of standardized assessment tools to determine SUD severity, assign appropriate levels of care and deliver a whole-person treatment approach—including medication, counseling and behavioral therapies.
This is especially critical in light of a troubling national trend. In recent years, incidents of drug- and alcohol-related deaths in state prisons have surged, increasing by 600 percent. In contrast, California’s ISUDT program has seen reductions in overdose mortality—providing concrete evidence of what’s possible when clinical precision meets a structured, system-wide approach to SUD treatment.
The bottom line
Correctional systems already serve as one of the largest behavioral health providers in the nation. The question is not whether to address SUD—but how effectively it can be done. Addressing substance use disorder in the criminal justice system is not just a clinical endeavor, it’s an operational advantage that requires:
- Consistent, validated assessment tools
- Cross-system coordination
- Commitment to treating SUD as a medical condition
- Scalable solutions that reach individuals wherever they are within the criminal justice system
With the right tools in place, agencies can move from reactive responses to a standardized, clinically-validated, data-driven approach. By aligning policy, practice and technology, states and local jurisdictions have a real opportunity to improve outcomes, reduce recidivism and save lives.
