By the Numbers: Mental Health, Substance Use, and the Justice System
Numbers do not treat anyone. But they do tell you where the need is, and they make it harder to look away.
Here is what the research says about the people our programs are built for — and, where the evidence is older than we would like, we say so.
Most people who need help never get it
Substance use disorders are not rare, and they are not confined to any one kind of person.
44.6 million
people age 12 and older had a substance use disorder in 2025 (15.3%)
Source: SAMHSA, National Survey on Drug Use and Health, 2025
The harder number is what happens next.
1 in 6
people who needed substance use treatment in 2025 received it (16.0%)
Source: SAMHSA, National Survey on Drug Use and Health, 2025
Roughly five out of six people who needed treatment in 2025 did not get it. Not because treatment does not work, but because of what sits between a person and a program: cost, waiting lists, transport, shame, not knowing where to start, or having tried once and been treated badly.
It gets worse for people carrying more than one diagnosis. SAMHSA found that in 2025, 28.7% of adults with both a substance use disorder and a serious mental illness received no treatment at all for either.
In jails and prisons, the need is concentrated
When people do not get help, some of them end up in custody. The figures there are striking.
The Treatment Advocacy Center put the figure for state prisons at 15% in the same 2016 analysis. Substance use runs higher still: the Bureau of Justice Statistics found that 58% of people in state prisons and 63% of people serving jail sentences met clinical criteria for drug dependence or abuse.
That BJS research also makes a point worth sitting with. The rates were high across every group it measured — 62% of white, 55% of Black, and 58% of Hispanic state prisoners met the criteria. This is not one community's problem. It is what happens when untreated substance use meets a system built to punish rather than to treat.
The revolving door
Without support, people leave custody carrying exactly what they came in with.
71%
of people released from state prison were rearrested within 5 years
And the younger someone is when they are released, the more likely they are to come back.
81%
of people age 24 or younger at release were rearrested within 5 years
That second figure is why H.E.A.T. is built for men aged 18 to 29. It is the age where the pattern either sets or breaks, and where a program that takes the whole person seriously has the most to work with.
Young people arrive already carrying it
By the time a young person reaches the juvenile justice system, the mental health need is usually already there.
Up to 70%
of youth in the juvenile justice system have at least one diagnosable mental health disorder
Source: National Center for Mental Health and Juvenile Justice, 2006
The 70% figure is debated, and rates vary depending on where in the system you measure. But every serious estimate is high. And these needs rarely arrive alone: the same research found that 61% of justice-involved youth with a mental health diagnosis also have a substance use disorder.
This research is from 2006 — old, and we would rather cite something current. It remains among the most widely referenced work on the question, which says something in itself about how little attention this gets.
Women in jail carry a particular weight
The Vera Institute of Justice studied women held in local jails and found a population shaped overwhelmingly by trauma and untreated illness.
86%
of women in local jails have experienced sexual violence in their lifetimes
Source: Vera Institute of Justice, 2016
82% have drug or alcohol abuse or dependence, and 77% have experienced intimate partner violence (Vera Institute of Justice, 2016). Most are not there for violence: 82% are held for nonviolent offenses.
A program that addresses substance use but not trauma, or trauma but not the relationships someone returns to, is working on a fraction of the problem.
What this asks of a program
Read together, these numbers point somewhere specific.
Treat the whole person, not the charge. Someone with a substance use disorder, untreated depression, and a history of violence done to them does not have three separate problems to be referred three separate places.
Use the group. Isolation is part of how these patterns hold. People who have been through something similar can say things to each other that no clinician can say to them.
Meet people in their own culture and history. Everyone arrives with a background that shapes what help looks like to them, and a program that ignores that will lose people in the first month.
Start before the pattern hardens. The recidivism figures for young adults are the argument for reaching people early.
That is what our four programs are built to do:
- H.E.A.T. — men aged 18 to 29 facing substance use and criminal justice involvement
- H.E.A.T. for Youth — young men aged 13 to 17 in the juvenile justice system
- H.E.R. — women who have been involved in the justice system, addressing substance use, mental health, and trauma together
- H.E.R. 4 Girls — girls aged 13 to 17 in the juvenile justice system
A note on the evidence
Several figures here are years old — the prevalence and jail research dates to 2016, the juvenile justice work to 2006. We have cited the most recent reliable national data we could find for each question, and shown the year on every figure so you can judge it yourself. Where the research is thin or dated, that is itself part of the picture.
If any of this sounds like someone you know
You do not need a diagnosis, a referral, or the right words to get in touch. If you are wondering whether one of these programs fits you, your child, or someone you work with, ask us.
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