“Without Critical Consciousness, How Could you Move on?” Qualitative Assessments of an Intervention to Reduce Substance Use Among Formerly Incarcerated Men

Background People with a history of substance use disorder who live in marginalized communities (e.g., large minoritized populations, low income, high crime rates) endure disproportionately high incarceration rates, premature death, and infectious disease incidence. Individuals released from incarceration often return to marginalized communities burdened by socially and structurally determined health inequities. Interventions grounded in critical consciousness theory may contribute to redressing health inequities because critical consciousness posits that many social problems and health conditions are rooted in structural and internalized oppression. Methods We conducted qualitative exit interviews with 37 formerly incarcerated men who had participated in research optimizing a multi-level intervention designed to empower individuals to reduce substance use and engage in community action to promote health equity. The intervention is evidence-based, grounded in critical consciousness theory, and was developed under the principles of community-based participatory research. The goal of this qualitative analysis was to hypothesize potential intervention mechanisms of change in reducing substance use, based on participants’ perspectives about their experiences during the intervention. Results Overall, the intervention's group structure enabled critical dialogue to raise critical consciousness and provided social support. Four thematic areas emerged as possible mechanisms of change: Critical Reflection (the ability to assess and improve the thinking process); Personal Growth (recognizing risk-related behavior as reinforcing internalized oppression); Community Engagement (interacting with others to raise awareness and improve community conditions); and Social Support (sharing experiences with others). Conclusions Participation in this multilevel intervention seems promising for developing critical consciousness among formerly incarcerated men with histories of substance use disorder through critical dialogue, development of community projects, and mutual support. Our analysis suggests that critical reflection, personal growth, community engagement and social support can act as mechanisms of change to encourage self-care as a form of resistance to oppression.