Why substance abuse treatment matters in correctional facilities

Substance use disorder is one of the most common health and public safety challenges in correctional settings. In jails and prisons, treatment is not just a medical service; it is also a reentry strategy. When people leave custody without support, the risk of relapse, overdose, re-arrest, and instability can rise quickly. That is why correctional substance abuse treatment has become a major focus in North Carolina and across the United States.

In North Carolina, the Department of Adult Correction (NCDAC) describes its Alcoholism and Chemical Dependency Programs as a system for screening, treatment, and reintegration services for eligible people in custody. The department says these programs are built around evidence-based principles and best practices. ([dac.nc.gov](https://www.dac.nc.gov/divisions-and-sections/alcoholism-and-chemical-dependency-programs))

How North Carolina organizes treatment inside correctional facilities

North Carolina's correctional substance use treatment system is not one-size-fits-all. The state uses a mix of prison-based programs, residential treatment facilities, and community-based services. According to NCDAC, prison-based treatment programs operate within selected minimum- and medium-custody units approved by the department. Eligibility begins during diagnostic processing, where staff use screening tools and clinical assessment to match people to the appropriate level of care. ([dac.nc.gov](https://www.dac.nc.gov/divisions-and-sections/alcohol-chemical-dependency-programs/prison-based-programs))

The department's program locations page shows that treatment is spread across multiple facilities statewide, including prison-based programs and community-based residential centers for men and women. NCDAC also states that it oversees more than 50 state prisons and two substance use disorder treatment facilities. ([dac.nc.gov](https://www.dac.nc.gov/divisions-and-sections/alcohol-chemical-dependency-programs/program-locations))

What treatment can look like in a North Carolina prison

In North Carolina, prison-based substance abuse treatment may include structured programming, counseling, education, and activities designed to support a drug- and alcohol-free lifestyle. NCDAC says its prison-based programs include assessment at admission, with the Substance Abuse Subtle Screening Inventory used during diagnostic processing to help determine treatment placement. ([dac.nc.gov](https://www.dac.nc.gov/divisions-and-sections/alcohol-chemical-dependency-programs/prison-based-programs))

The state's residential treatment model also includes phased programming. NCDAC describes an orientation period, followed by drug education, criminal and addictive thinking, and socialization, along with vocational and reentry-related components. This approach reflects a broader correctional goal: helping participants understand the connection between substance use, behavior, and future stability. ([dac.nc.gov](https://www.dac.nc.gov/divisions-and-sections/alcohol-chemical-dependency-programs/residential-substance-abuse-treatment))

• Screening and clinical assessment at intake
• Individual and group treatment services
• Education about addiction and relapse risk
• Behavioral change and life-skills work
• Reentry planning and community linkage

Medication-assisted treatment in North Carolina corrections

One of the most important developments in correctional substance abuse treatment is medication-assisted treatment, often called MAT. NCDAC says it is piloting a MAT program at Orange Correctional Center for men and the North Carolina Correctional Institution for Women. The program is intended to help address the opioid crisis and to reduce the likelihood of overdose, arrest, probation revocation, or criminal activity after release. ([dac.nc.gov](https://www.dac.nc.gov/divisions-and-sections/rehabilitation-and-reentry/medicated-assisted-treatment))

This matters because opioid use disorder can be especially dangerous after incarceration. People may lose tolerance while in custody, which can make relapse after release more likely to result in overdose. North Carolina's MAT pilot is therefore significant not only as a treatment option, but also as a public health intervention tied to reentry. ([dac.nc.gov](https://www.dac.nc.gov/divisions-and-sections/rehabilitation-and-reentry/medicated-assisted-treatment))

The role of jails versus state prisons

It is important to distinguish county jails from state prisons. North Carolina's Department of Adult Correction runs the state prison system, while county jails are operated locally. That means the most detailed statewide treatment structure is found in the prison system, not in every jail. Still, the same basic challenge exists in both settings: many people arrive with untreated substance use disorders, and short stays can make continuity of care difficult.

For jails, the biggest issue is often time. A person may be booked, screened, and released before a full treatment plan can be completed. That makes referral, medication continuity, and discharge planning especially important. Even when a jail cannot provide long-term treatment onsite, it can still connect people to community providers, detox services, and post-release care.

Why continuity after release is so important

Correctional treatment works best when it does not stop at the facility gate. North Carolina's own program descriptions emphasize reintegration, and that is a crucial point. Recovery support after release can include outpatient counseling, peer support, medication management, housing assistance, and probation or parole coordination. Without that bridge, gains made in custody can be lost quickly. ([dac.nc.gov](https://www.dac.nc.gov/divisions-and-sections/alcoholism-and-chemical-dependency-programs))

NCDAC's strategic plan also identifies improving mental health and substance use treatment as an objective, showing that the state views behavioral health as part of its broader correctional mission. The department says it is responsible for the care, custody, and supervision of tens of thousands of people in prison and community supervision, which makes continuity of care a systemwide issue rather than a narrow clinical one. ([dac.nc.gov](https://www.dac.nc.gov/strategic-plan))

Challenges facing correctional substance abuse treatment

Even with strong programs, correctional treatment faces real limits. Staffing, facility capacity, custody level restrictions, and the complexity of co-occurring mental health conditions can all affect access. North Carolina has acknowledged the scale of the need: in a 2026 executive order, the state noted that 76 percent of people entering DAC custody in FY 2024-2025 had a substance use condition requiring placement in a treatment program, and 30 percent had a co-occurring mental health condition. ([files.nc.gov](https://files.nc.gov/oah/documents/2026-03/Volume-40-Issue-18-March-16-2026.pdf?VersionId=NwAlbDyaYK45MrsiK_mOqB5kVgvW.eEk&amp%3Butm_source=openai))

That figure suggests the need is widespread, not exceptional. It also helps explain why correctional treatment must be integrated with mental health care, medical care, and reentry planning. In practice, the most effective programs are usually the ones that treat addiction as part of a larger behavioral health picture rather than as an isolated problem. ([dac.nc.gov](https://www.dac.nc.gov/divisions-and-sections/alcoholism-and-chemical-dependency-programs))

What families and communities should know

For families, the key takeaway is that treatment in North Carolina correctional facilities is real, but it is structured and eligibility-based. Not everyone will qualify for the same level of care, and not every facility offers the same services. NCDAC's public materials show that treatment is delivered through designated programs and facilities, with clinical staff making placement decisions based on screening and assessment. ([dac.nc.gov](https://www.dac.nc.gov/divisions-and-sections/alcohol-chemical-dependency-programs/prison-based-programs))

For communities, the broader lesson is that correctional substance abuse treatment is not only about what happens inside prison or jail. It is about reducing overdose risk, improving public safety, and helping people return home with a better chance of stability. In North Carolina, that means treatment, medication support, and reentry planning are increasingly being treated as connected parts of the same system. ([dac.nc.gov](https://www.dac.nc.gov/divisions-and-sections/rehabilitation-and-reentry/medicated-assisted-treatment))

The bottom line

As of today, North Carolina is actively using prison-based treatment programs, residential treatment centers, and a medication-assisted treatment pilot to address substance use disorder in correctional settings. The state's approach reflects a growing recognition that addiction treatment in custody can improve outcomes after release. While county jails and state prisons differ in structure, the core goal is the same: identify substance use needs early, provide evidence-based care, and connect people to support that continues beyond incarceration. ([dac.nc.gov](https://www.dac.nc.gov/divisions-and-sections/alcohol-chemical-dependency-programs/prison-based-programs))

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Information is sourced from publicaly available information and may be inaccurate