Digital Substance Use Therapy: Predicting Engagement and Outcomes to Enhance Health Equity in Prisons

Substance use disorders (SUD) present a public health challenge and are prevalent amongst the prison population due to associations between substance use and offending. Engagement with, and outcomes from, SUD interventions vary based on sociodemographic and clinical characteristics, resulting in social inequities in therapeutic benefits. A study was recently published using a digital therapy program for SUD recovery—Breaking Free—to understand how different delivery models might influence engagement and outcomes for prison residents in the UK (practitioner‐facilitated) and the US (self‐directed). This study revealed baseline psychosocial differences between UK and US prison residents that may influence engagement and outcomes for this digital SUD program. Therefore, the present study reports further analyses to understand how these psychosocial differences may interact with delivery models to influence engagement and outcomes. Findings suggest men, younger prison residents, those with alcohol use issues, and those with greater levels of clinical complexity, may benefit from practitioner support to optimise engagement and outcomes. Recommendations are provided to inform delivery of this program, including identifying where resources could be allocated to enhance equity of benefits, e.g., providing practitioner support to residents, funding for practitioner training, integration with other programs, etc.