For many people, substance use doesn’t start with a party or a bad decision. It starts with pain. Unresolved trauma, especially when it collides with the harms of incarceration, can create a cycle that’s hard to see from the inside and harder to break from the outside. At Enso Recovery, we meet people at every point in that cycle, including inside Maine’s county jails. This post explains how trauma, incarceration, and substance use disorder (SUD) feed one another, and what actually helps people heal.
How Trauma Sets the Stage
Trauma isn’t only a single extreme event. It can be chronic exposure to adversity: childhood abuse or neglect, intimate partner violence, racialized stress, homelessness, medical crises, or community violence. The nervous system adapts to survive, not to feel good. Over time, those adaptations can look like hypervigilance, nightmares, anxiety, depression, and trouble trusting others.
The link between early adversity and later substance use is well documented. According to the CDC’s data on adverse childhood experiences (ACEs), about 64% of U.S. adults report at least one ACE and roughly 1 in 6 report four or more, and higher ACE counts are strongly associated with substance misuse in adulthood. Substances often enter the picture as practical solutions to unbearable feelings: alcohol to sleep, opioids to numb, stimulants to push through the day. In the short term, they work. Over time, they shift the brain’s stress and reward systems in ways that increase craving and lower resilience. Without a safer source of relief, going back to substances makes sense to the body, because it worked before.
When Trauma Meets the Criminal Legal System
People living with untreated trauma and SUD are more likely to cross paths with the criminal legal system. That’s not because they’re “bad people,” but because the symptoms of both conditions raise the risk of survival-driven behavior like possession, shoplifting, or parole violations, and because treatment is often hard to reach. The overlap is stark. SAMHSA estimates that roughly 63% of people in jail and 58% in prison meet criteria for a substance use disorder, far above rates in the general population (see SAMHSA’s overview of criminal and juvenile justice and behavioral health). Once inside, incarceration itself can become traumatic:
- Loss of autonomy and predictability intensifies anxiety and reactivity.
- Isolation and separation from children, partners, and community amplifies grief and shame.
- Withdrawal without adequate medical care can be physically dangerous and emotionally scarring.
- Stigma and labeling can harden into identity, making help feel out of reach.
For someone who entered with earlier trauma, incarceration layers fresh wounds on old ones. The nervous system becomes even more keyed to threat. Without trauma-informed care and medication for opioid or alcohol use disorder, many people leave custody with more pain and fewer resources than they had going in.
The Reentry Cliff
Release is supposed to be freedom, but the first weeks out are among the most dangerous of a person’s life with SUD. Tolerance has dropped. Stress spikes. Housing, ID, employment, transportation, child custody, and court requirements all hit at once. Old neighborhoods and old contacts can reignite cravings. The data bears this out: a widely cited NEJM study of released Washington State inmates found that during the first two weeks after release, the risk of death was 12.7 times that of other state residents, driven largely by drug overdose. The surge isn’t about people not caring. Biology and life pressure collide.
What turns that cliff into a bridge? Continuity of care: starting medication while incarcerated and continuing it seamlessly in the community, a warm handoff to outpatient counseling, help with housing and basic needs, and someone (ideally a peer in recovery) who checks in and says, “You’re not doing this alone.” This is the model Enso Recovery was built around.
Why “Toughing It Out” Doesn’t Work
Well-intentioned but outdated advice still surfaces: “Just say no,” “white-knuckle it,” or “30 days and done.” If trauma is the engine, abstinence alone isn’t the brake. Unless you address the nervous system, the beliefs, the environment, and the relationships that got tangled up with substance use in the first place, the same triggers will produce the same outcomes. Lasting recovery takes safety, skills, the right medicine when it’s appropriate, and community.
What Helps: Evidence-Based, Trauma-Informed Care
A trauma-informed approach doesn’t ask, “What’s wrong with you?” It asks, “What happened, and what helped you survive?” Here’s what that looks like in practice.
Medication for Opioid and Alcohol Use Disorder
Buprenorphine (including Suboxone, Sublocade, and Brixadi) and naltrexone (Vivitrol) reduce cravings and protect against overdose or heavy drinking. They steady the body so the mind can heal. NIDA reports that overdose deaths after incarceration are lower when people receive medication for their addiction while in the justice system, yet only a small share of people who could benefit actually get it. Starting medication-assisted treatment in jail and continuing it after release saves lives. Enso does not provide methadone or run a medical detox; when someone needs supervised detox first, we refer out and pick their care back up the next day.
Therapies That Target Both Trauma and Substance Use
- Cognitive Behavioral Therapy (CBT) to identify triggers, interrupt “all-or-nothing” thinking, and build coping plans.
- Dialectical Behavior Therapy (DBT) to strengthen emotion regulation, distress tolerance, and interpersonal skills.
- Trauma-focused therapies like EMDR or trauma-focused CBT, delivered when a person is clinically ready, not during acute withdrawal or crisis.
- Contingency management for stimulant use disorder to reinforce positive behaviors in real time.
Peer Support and Recovery Community
Peers who have “been there” offer credibility and hope that professionals can’t manufacture. Recovery coaching, mutual-aid groups, and alumni communities reduce isolation and build accountability.
Case Management That Solves Real-Life Problems
IDs, transportation, court dates, childcare, job searches, and housing applications aren’t “ancillary.” They’re treatment. Each barrier you clear lowers stress and weakens the pull back to old patterns.
Safety, Dignity, and Choice
People heal in environments where they’re respected instead of judged, where informed consent is honored, and where cultural humility is the norm. That includes affirming care, language access, and attention to historical and racial trauma.
How Enso Bridges Jail to Community in Maine
Enso Recovery was the first program in Maine to bring MAT inside county jails. For sentenced clients, that means starting buprenorphine or naltrexone while still incarcerated, then having the same team continue that exact care the day they walk out. No cold referral to a stranger. The clinician and recovery coach who knew someone inside are the ones who greet them outside. That warm handoff is where the reentry cliff turns into a bridge, and it’s why judges, probation officers, and corrections staff refer to us.
Special Considerations for People Who’ve Been Incarcerated
- Plan before release. The best reentry starts inside, with medication induction, therapy, relapse-prevention planning, and a scheduled appointment within days of release.
- Warm handoffs beat cold referrals. An actual introduction, by phone or in person, to the outpatient team reduces no-shows.
- Overdose prevention is essential. Everyone leaving custody should have naloxone, know how to use it, and understand that tolerance has dropped.
- Family engagement helps. Loved ones benefit from coaching on boundaries, communication, and what real support looks like beyond “tough love.”
- Employment with support. Recovery-friendly workplaces offer structure and dignity while people learn to balance work and wellness.
How Enso Recovery Can Help
Enso Recovery provides trauma-informed, evidence-based outpatient care for substance use disorders and co-occurring mental health conditions at our Augusta clinic and our Sanford clinic. Our teams know the realities of incarceration and reentry, and we work to remove barriers by linking people to medication, therapy, peer support, and practical resources that make stability possible. Whether you’re seeking help for yourself or for someone coming home from jail, we’ll meet you with respect instead of judgment.
Care with us can include:
- Medication options (when clinically appropriate) to reduce cravings and protect against overdose
- Individual and group counseling that addresses trauma and substance use together
- Peer recovery support to walk alongside you between appointments
- Case management for housing, benefits, IDs, court coordination, and transportation
- MARR-certified recovery residences for clients who need stable, sober housing while they rebuild
- Family engagement to strengthen the support system around you
If you work with a correctional facility, probation, or a public defender’s office and want to build a warm handoff for someone in your care, we’re glad to coordinate. Call us at (207) 245-1800 or get started with Enso Recovery, normally within 24 hours.
A Practical Starting Plan If You’re Not Sure What to Do Next
- Schedule an intake. Even a brief call can map out immediate next steps.
- Ask about medication. If opioids or alcohol are involved, talk through options that fit your goals.
- Build a safety net. Get naloxone, name two people you can contact daily, and set up transportation.
- Name your triggers. Write down the people, places, and feelings that pull you back, and one alternative for each.
- Keep it simple. Sleep, food, water, and movement aren’t luxuries. They’re relapse prevention.
Getting Help
Trauma doesn’t make anyone “broken.” It shows that your body and mind learned to survive very hard things. Incarceration often adds new injuries to old ones, and substances can become the most available relief in a world that feels unrelenting. Recovery begins when relief becomes safer: medication that steadies the system, therapy that reduces pain instead of avoiding it, peers who’ve walked the same road, and practical help that puts life back together.
If you or someone you love is caught in the loop of trauma, incarceration, and substance use, you’re not alone, and you don’t have to figure it out by yourself. Reach out to Enso Recovery. We’re here to help.
Crisis and Emergency Resources
If you or someone you know is in a substance use or mental health crisis, help is available now. Contact the SAMHSA National Helpline at 1-800-662-HELP (4357) for free, confidential treatment referrals 24/7. Reach the 988 Suicide and Crisis Lifeline by calling or texting 988. The Crisis Text Line is available by texting HOME to 741741. For emergencies, call 911.
Learn More
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