Linking Individuals Needing Care for Substance Use Disorders to Peer Coaches & Across INcarceration Settings

This study evaluates a virtual peer recovery coach (PRC) intervention designed to support adults with substance use disorders during incarceration and the transition back to the community. The trial is conducted across multiple jail facilities in Metro Atlanta, where individuals experience high rates of substance use disorders and limited access to treatment services. Peer recovery coaches-individuals with lived experience who are trained in motivational interviewing and linkage to care-have demonstrated benefit in healthcare settings, but their effectiveness within jail environments has not been rigorously tested.

The intervention adapts an existing virtual PRC model for use in jail settings. PRCs meet with participants through a secure telehealth platform and provide individualized support focused on motivation, readiness for change, and connection to recovery resources. The model is designed to be scalable, flexible, and responsive to the needs of individuals with diverse substance use profiles, including those for whom no FDA-approved medications exist.

The study uses a phased implementation approach in which participating jail sites transition from usual care to the PRC intervention over time. This structure allows the program to be integrated into each facility's workflow while enabling evaluation of the intervention's impact. Participants are followed for one year to assess engagement with recovery resources and other indicators of health, stability, and community reintegration.

The findings will inform whether virtual PRC services can be effectively delivered in jail settings and whether they improve connection to treatment and recovery supports during a period of heightened vulnerability. Results may guide future implementation of peer-based models in correctional systems and other high-risk environments.

Participants meet virtually with a trained peer recovery coach using a secure telehealth platform. PRCs use motivational interviewing, assess readiness to change, and provide individualized linkage to recovery resources. Support may include connection to medications for opioid use disorder, residential treatment, detoxification centers, harm reduction services, mutual support groups, sober living, or recovery community organizations. PRCs may also conduct post-release check-ins to support ongoing engagement.

Behavioral: Virtual Peer Recovery Coaching

Participants receive the jail's standard approach to substance use support. This includes a review of available community treatment and recovery resources consistent with existing facility practices. No peer recovery coach is involved, and no additional study-driven services are provided.

Behavioral: Treatment as Usual

A telehealth session with a peer recovery coach who provides motivational interviewing and tailored linkage to addiction treatment and recovery resources.

Participants are provided information about community-based addiction treatment and recovery resources as part of routine jail processes.

Time frame: 30 days and 90 days after enrollment

Engagement with at least one recovery resource, defined as:

• Formal addiction treatment (visit with a physician, psychologist, or licensed substance use counselor; or ≥1 night in detoxification or residential treatment), or
• Recovery Community Organization (RCO) participation (contact, intake, and participation in ≥1 evidence-based recovery activity), or
• Harm reduction organization engagement. Engagement may occur during incarceration or in the community after release.

Time frame: Baseline to 30 days, 90 days, 180 days, and 1 year

Number of days participants receive medications for opioid use disorder (MOUD), stimulant use disorder, or alcohol use disorder.

Time frame: Baseline to 1 year

New arrests, bookings, or jail stays documented through participant report or administrative data.

Time frame: Baseline to 1 year

Emergency department visits, hospitalizations, and other acute care encounters.

Time frame: Baseline, 30, 90, 180 days, and 1 year

Brief Assessment of Recovery Capital (BARC-10) A 10-item validated scale that measures a person's internal and external resources that support recovery from substance use. Items assess domains such as social support, coping skills, housing stability, and personal motivation.

• Scores range from 10 to 60.
• Higher scores indicate greater recovery capital and stronger readiness to sustain recovery.

Time frame: Baseline to 30 days, 90 days, 180 days, and 1 year

Number of PRC interactions among participants assigned to the intervention arm.

Time frame: Baseline, 30, 90, 180 days, and 1 year

Days of substance use in the past 30 days using the Timeline Follow-Back method. A structured calendar-based interview used to measure self-reported substance use over the past 30 days. Participants recall days of use using memory anchors (events, routines).

Time frame: Baseline through 1 year

Overdose events identified through participant report, medical records, or community partner data.

Time frame: Baseline through 1 year

Overdose events identified through participant report, medical records, or community partner data.

Time frame: Baseline, 30, 90, 180 days, and 1 year

Current housing status (stable, unstable, homeless)

Time frame: Baseline, 30, 90, 180 days, and 1 year

Employment status (full-time, part-time, unemployed)

Time frame: Baseline, 30, 90, 180 days, and 1 year

A validated set of items assessing perceived social support, loneliness, and connectedness.

• Generates T-scores standardized to the U.S. population (mean = 50, SD = 10).
• Higher scores on Social Support = more support.
• Used to evaluate social determinants of recovery.

Time frame: Baseline through 1 year

Death from any cause, confirmed through vital records or the National Death Index.

Linking Individuals Needing Care for Substance Use Disorders to Peer Coaches & Across INcarceration Settings