"Falling Through the Cracks:" Young Adults, Drugs, and Incarceration.

As a clinician working with high-risk youths in New York City, many of whom are justice-involved and substance users, I applaud Welty et al. for their illuminating article in the May issue of AJPH. Their study revealed many noteworthy findings, including the declining prevalence of substance-use disorders (SUDs) among justice-involved youths from about 50% at baseline to nearly 20% 12 years later. However, that level of involvement remains substantially higher than the 8.4% of Americans in the general population with SUDs. Sustained involvement with alcohol and drugs may be an important factor predisposing individuals to continued engagement in criminal activities. Approximately 30% of the more than two million adults incarcerated in the United States were arrested as juveniles, and more than 84% report involvement with substances. Given the extraordinary economic burden of mass incarceration on society—not to mention its profound effects on the individual, their family, and their community—it is critical that we examine strategies to address factors contributing to reducing recidivism, including effective substance abuse treatment. Furthermore,weneed to also be mindful that substance use is often comorbid with other health problems. I run a program called Project STAY (Services to Assist Youth) that provides comprehensive medical and psychosocial services to youths at risk for, or living with, HIV. The following case is illustrative of the syndemic connections between substance use, incarceration, and other health issues: