Exploration of Social Justice
Tierainie C. Johnson, MS, MCAP
Capella University
SWK 5002-Social Welfare History Policy Practice
Professor Anna Richmond, LAPSW, LISW
April 23, 2026
Exploration of Social Justice
Social Problem: Criminalization of Substance Use Disorder
Substance use disorder (SUD) is a long-term medical condition that burdens millions of Americans, yet the prevailing societal reaction is criminalization, as opposed to treatment. The practice drives recidivism, stigmatization, and morbidity, especially in already marginalized groups. This paper examines oppression and discrimination faced by individuals with SUD, ethical issues, contemporary policies, and analyzes advocacy techniques to resolve this existing social justice crisis.
Forms and Mechanisms of Oppression and Discrimination
Racial Discrimination: One of the most institutionalized oppressive processes related to individuals with SUD is racial bias. Although racial groups have similar drug consumption rates, the criminal justice ramifications of drug consumption are considerably more humiliating to the Black and Native American communities. The Office of the Assistant Secretary for Planning and Evaluation (ASPE, 2023) concluded that criminalization of substance use resulted in disproportional criminal justice engagement, especially with Black and African American individuals who are disproportionately targeted, arrested, convicted, and incarcerated on drug charges. This difference is indicative of policies that perceive addiction as a criminal offense when it happens in a community of color and offer medical compassion to White communities.
Socioeconomic Oppression: Low-income people with SUD have an added disadvantage that further marginalizes them. Individuals who are unable to post bail are in jail awaiting trial, which cuts them off of jobs, housing, and treatment. Schumacher et al. (2025) observe that the War on Drugs spurred the growth of mass incarceration and overpopulated correctional facilities with those convicted of nonviolent, drug-related crimes and that jails are the crucial yet often insufficient contacts of healthcare among justice-involved people. Poverty is the ultimate determinant of an individual into the treatment system or criminal justice pipeline.
Stigma as a Structural Barrier: Stigma is a type of oppression because it deters seeking help and allows discriminatory policies. When SUD is presented as a moral failure, instead of a medical condition, people are not willing to disclose, professionals provide substandard care, and policymakers reduce their focus on treatment funding. Xu et al. (2023) highlight that Blacks are more likely to receive methadone maintenance treatment, compared to the more accessible office-based buprenorphine, which also highlights how stigma is a contributing factor to unequal treatment pathways even within the healthcare system.
Impact on the Population
The extent of the harm associated with the criminalization of SUD is massive. National Institute on Drug Abuse (NIDA, 2020) estimates that about 65 percent of the prison population in the U.S. has an active SUD, with 20 percent having been under the influence at the moment of their offense, but only a small percentage receive evidence-based treatment in prison. Moreover, when released, most individuals resume earlier levels of use unaware that their tolerance has decreased, a significant risk of overdose.
The racial influence is particularly strong. According to ASPE (2023), the Black and Hispanic people who need treatment have lower rates of treatment utilization than their White counterparts, despite their equal rates of substance use. This difference is not motivated by a clinical need, but instead a systematic injustice of the implementing system, referral procedures, and access to care.
Ethical Problems
Ethical Considerations
The NASW Code of Ethics (NASW, 2021) gives rise to several fundamental ethical considerations. First, the human dignity value necessitates social workers to oppose any policies that consider people with SUD as criminals not patients since this will essentially infringe on the right of humane care by non-judgmental professionals. Second, social justice requires practitioners to determine and address policies that yield racially and economically unfair results in drug enforcement. Third, confidentiality is an ethical issue when court-mandated care requires disclosure in other areas where legal ramifications may follow, sabotaging the therapeutic relationship and deterring potential participants into truthful participation.
Implications for Social Work Practice and Positive Client Outcomes
These ethical requirements have a number of important practice implications. Social workers should be prepared to use non-stigmatizing and trauma-informed approaches because clients who have undergone criminalization have a layer of trauma and mistrust that requires resolution prior to effective treatment contact with the client. Practitioners are also required to refer clients to evidence-based treatment, especially medication-assisted treatment (MAT), which can greatly decrease overdose deaths. Tarfa et al. (2026) affirm that the strongest empirically supported interventions in reentry involve peer navigation and opioid agonist medications, and case management. Lastly, social workers need to participate in macro-level advocacy, which involves the diversion of resources away out of incarceration into community-based services that can lead to sustainable recovery impacts.
Current Enacted Policies
The SUPPORT for Patients and Communities Act (2018)
The SUPPORT Act, signed into law on October 24, 2018, was the biggest federal investment in overdose prevention to date (Bryant, 2024). It increased Medicaid and Medicare coverage of SUD treatment, permitted nurse practitioners and physician assistants to prescribe MAT, and mandated states to maintain the eligibility of incarcerated youth to Medicaid to facilitate a smooth reentry process. The law also instructed the Centers of Medicare and Medicaid Services to collaborate with the states to increase capacity of treatment by providing demonstration grants.
Mainstreaming Addiction Treatment (MAT) Act (2023)
The MAT Act was signed into law as an extension of the Consolidated Appropriations Act on January 3, 2023, and repealed the federal X-waiver requirement that previously limited prescribing buprenorphine to opioid use disorder by licensed providers (Center for Excellence on Addiction, 2023). Before this change, more than 40 percent of the U.S. counties had no authorized prescriber. The Act lessened bureaucratic hurdles that had long prevented a proven, life-saving drug to millions of Americans, especially in rural and underserved populations.
The First Step Act (2018)
The First Step Act changed the federal sentencing system, decreased mandatory minimums on some drug crimes, and increased programming within federal prisons (Haber et al., 2023). Drug treatment post-release lowers the recidivism rates, and the First Step Act established structural avenues towards that goal by focusing on reentry planning and linking incarcerated people to rehabilitation programs.
Policy Effectiveness
The SUPPORT Act has led to increased access to treatment through legal frameworks, but has had inconsistent implementation. NIDA (2023) attests that decades of research confirm the effectiveness of SUD treatment during and after incarceration in reducing drug use and criminal recidivism. The MAT Act is more promising as it has directly eliminated a structural impediment to prescribing. The First Step Act reduced penalties without addressing the root causes of criminalization. Graves and Fendrich (2024) discovered that community-based treatment programs demonstrate beneficial effect on substance use outcomes, but limited studies have addressed racial and rural disparities in access.
Policy Constraints
Medicaid Inmate Exclusion
Medicaid is prohibited by the federal law to provide healthcare services to incarcerated individuals. This implies that individuals with SUD in jails and prisons miss MAT at the time they need it the most, and re-enrollment delays at release pose a fatal gap at the most dangerous time of overdose.
Racial Gaps in Access
Structural inequities exist, even in the context of increased prescribing authority under the MAT Act. ASPE (2023) discovered that communities of color are less likely to access SUD treatment as compared to White populations, and that people of color face barriers that directly lead to racial differences in health outcomes. Equitable implementation is not guaranteed by policy change on paper.
Stigma Within Systems
Stigma is a limitation even within institutions that are meant to assist. Numerous correctional systems and health care providers are opposed to providing MAT because of deeply ingrained moral framing of addiction. According to NIDA (2023), the lack of pre-release counseling and post-release follow-up is one of the reasons behind the alarming post-incarceration mortality rates, highlighting how the impediments to attitudinal changes turn into life-or-death outcomes.
Advocacy Methods
Strengths and Challenges
The two most notable strategies to this problem are legislative advocacy and community organizing. The policy of legislative advocacy yielded tangible victories like the MAT Act, which has brought systemic change on a large scale. The community organizing focuses on the voices of people with lived experience, counters stigma, and generates political will. Nonetheless, legislative advocacy is cumbersome, susceptible to political changes and may not reach the most vulnerable communities. Community organizing is often underfunded, lacking the capacity to impact lasting policy change.
Addressing the Challenges
Both approaches would be empowered with long-term investment in peer-recovery support programs, which would combine lived experience with policy power. Recovery workers are in an ideal position to access populations that are difficult to reach and decrease shame-based refusal to seek treatment. Also, advocates need to urgently seek the repeal of the Medicaid inmate exclusion permanently since allowing uninterrupted coverage both during incarceration and upon release would close one of the deadliest structural loopholes that this group is currently experiencing.
References
ASPE. (2023, November 21).
Substance Use and SUDs by Race and Ethnicity. ASPE. https://aspe.hhs.gov/reports/substance-use-suds-race-ethnicity
Bryant, B. (2024).
Six years of the SUPPORT Act: Ongoing behavioral health policy priorities for counties. National Association of Counties. https://www.naco.org/news/six-years-support-act-ongoing-behavioral-health-policy-priorities-counties
Center for Excellence on Addiction. (2023, February 7).
Mainstreaming Addiction Treatment (MAT) Act Signed into Law . Center for Excellence on Addiction. https://nhcenterforexcellence.org/resource/mainstreaming-addiction-treatment-mat-act-signed-into-law/
Graves, B. D., & Fendrich, M. (2024). Community-based substance use treatment programs for reentering justice-involved adults: A scoping review.
Drug and Alcohol Dependence Reports,
10, 100221–100221. https://doi.org/10.1016/j.dadr.2024.100221
Haber, L. A., Boudin, C., & Williams, B. A. (2023). Criminal Justice Reform Is Health Care Reform.
JAMA,
331(1), 21–21. https://doi.org/10.1001/jama.2023.25005
National Association of Social Workers. (2021).
Code of ethics. National Association of Social Workers. https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English
NIDA. (2020).
Criminal justice drug facts. National Institute on Drug Abuse. https://nida.nih.gov/publications/drugfacts/criminal-justice
Schumacher, J. E., Ahsan, A., Simpler, A. H., Natoli, A. P., & Cain, B. J. (2025). An investigation of drug use among first-time arrestees from 25 county jails across the United States in 2023.
Addiction Science & Clinical Practice,
20(1). https://doi.org/10.1186/s13722-025-00550-5
Tarfa, A., Borker, M., Lancaster, M., Santiago, R., Di Paola, A., Frank, C., & Springer, S. A. (2026). Real-time peer-navigation support during community re-entry for adults with opioid use disorder.
Journal of Substance Use and Addiction Treatment,
183, 209903. https://doi.org/10.1016/j.josat.2026.209903
Xu, K. Y., Schiff, D. M., Jones, H. E., Martin, C. E., Kelly, J. C., Bierut, L. J., Carter, E. B., & Grucza, R. A. (2023). Racial and Ethnic Inequities in Buprenorphine and Methadone Utilization Among Reproductive-Age Women with Opioid Use Disorder: an Analysis of Multi-state Medicaid Claims in the USA.
Journal of General Internal Medicine,
38(16), 3499–3508. https://doi.org/10.1007/s11606-023-08306-0
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