Table 1 List of numbered factors within each of the five clusters

1. Substance use counseling

31. Drugs are expensive, so people use more when they have the opportunity

5. Harm reduction communities

9. Harm reduction support for people that get released after-hours

15. Feeling empowered

2. Trauma-informed staff

32. People return back to the same level of drug use after being released

8. People with lived experience as overdose response and peer support

10. Coordinated releases

23. Stigma surrounding possessing Naloxone/Narcan

3. Opportunities to rise above the bare minimum

41. Eliminating stigma from supervising authority

11. Employment opportunities with a living wage

14. Ensuring basic needs are met, especially after release

26. Length of time incarcerated

4. Education on overdose prevention

56. Fentanyl is in everything

12. Adequate healthcare insurance

16. Wellness Recovery Action Plans (WRAP)

27. Arrests can play a role in self-esteem, leading to a higher likelihood of using

6. Other recovery programs besides abstinence-based recovery programs

63. Self-medicating

19. Bridging the healthcare gap upon release

20. Increased prevalence of healthcare while incarcerated

33. Attitude

7. Supportive, understanding, and patient communities

73. Feeling that there is an inability to ask for help because of the “formerly incarcerated” label

21. Lack of education can contribute to recidivism

29. Barriers to getting medication while incarcerated (MOUD)

40. Broad legalization of drugs

13. Safe and secure housing

75. Starting to use drugs while in prison

35. Prison conditions contribute to the likelihood someone will use to cope with that trauma

38. Resources provided by some transitional housing programs

50. Easier to go to people that can relate to you

17. Providing people with a safe haven while incarcerated

76. Continuing to use while incarcerated

37. Freedom to choose to access mental health services

39. Accessing treatment through friends (e.g., being referred to treatment through trusted friends)

51. If you get turned down enough, you stop asking for help

18. Mental health counseling

77. Lack of knowledge surrounding using drugs

42. Greater access to alternative treatments

68. Increase access to treatment without consequences (e.g., increasing access to treatment without feeling stigmatized or singled out, making someone vulnerable to humiliation from other inmates)

52. Treated differently after being incarcerated

22. Lack of trauma-informed doctors

79. Lower tolerance when reentering society

44. Greater access to mental health services while incarcerated

53. After release, uncomfortable in your own skin

24. No access to Narcan while incarcerated, or when released

48. Willingness to access your support system

54. Stigma surrounding incarceration background that prevents people from getting and seeking help

25. Individual environment, such as being the subject of assault or violence, while incarcerated

49. People don’t know who to reach out to because of the lack of resources

58. Traumatic experiences from family members

28. Lack of continuity in care from incarceration to release

55. Turned down by drug treatment programs

59. Shame, being embarrassed to say no

30. Interruption in use during incarceration

60. Substances are readily available

34. Need to treat underlying trauma while incarcerated

61. Validation from friends and peers when using

36. Reaching out to people that you feel may need help

62. Peer pressure

43. Eliminating labels surrounding seeking help while incarcerated

64. Wanting to fit in

45. Eliminating the social stigma surrounding incarceration

65. Social environment

46. More support post-release from communities

67. Don’t know how to ask for help

47. Options for upward mobility in employment

69. Feeling the need to keep up the appearance of being okay even when you are not

57. Not used to encountering derivatives after release

70. Feeling like you can’t ask for help, so an “I don’t care” attitude develops

66. Unable to ask parole officers for help for fear of repercussions

71. Isolation

72. Potential consequences for seeking help

74. Mental health

78. Psychological and acceptance factors regarding reentering society after being incarcerated

80. Inability to see the world outside of your community

81. Type of environment raised in during childhood

82. Insecurity

83. Self-worth