Supporting Formerly Incarcerated People With Recovery

InterviewCommunity Voices Health AffairsVol. 44, No. 9: Insights About The Opioid Crisis Supporting Formerly Incarcerated People With RecoveryAkilah Wise AffiliationsPhilip Cooper is the director of Operation Gateway and Voices of Affrilachia, in Asheville, North Carolina. Akilah Wise (email protected) is a senior editor at Health Affairs, in Washington, D.C. This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) license, which permits others to distribute this work provided the original work is properly cited, not altered, and not used for commercial purposes. See https://creativecommons.org/licenses/by-nc-nd/4.0/.PUBLISHED:September 2025Open Accesshttps://doi.org/10.1377/hlthaff.2025.00544AboutSectionsView PDFPermissions ShareShare onFacebookXLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits Abstract In Asheville, North Carolina, Philip Cooper's Operation Gateway supports people in their recovery journey after incarceration.TOPICSRecoveryJail-involved populationAccess to careNonsubstance related addictionsTreatmentBehavioral health careSocial determinants of healthSocial SecuritySubstance use disorderPharmaceuticalsOpioid use disorder Philip Cooper speaking at the 2024 North Carolina Second Chance Lobby Day.Photograph by PEO Productions/Christian Wilson Reverend Philip Cooper is the executive director of Operation Gateway, in Asheville, North Carolina—a community-based organization that reintegrates formerly incarcerated people into their communities. Operation Gateway reduces recidivism by addressing social determinants of health, recognizing that the social and community context is a powerful predictor of treatment, recovery, and reintegration into society. Cooper and his team of community health workers assist newly released people in navigating housing, workforce development, and social services, as well as their continuum of treatment options, including medications for opioid use disorders. They provide intensive support during the first ninety days postrelease, and they follow up with participants for up to a year, after which participants are welcome to take part in support groups as alumni. Growing up in Asheville, Cooper witnessed family members, including his father, grapple with issues he now helps his clients overcome: alcoholism, drug addiction, and the effects of incarceration. He began his recovery journey while incarcerated at North Carolina State Prison from 2007 to 2011, where he started his work as a peer counselor. Just five months after his release, Cooper was hired as a behavioral health technician at the Neil Dobbins Center, in Asheville, which offers inpatient treatment for substance use disorders (SUDs) and crisis stabilization. In 2012, he became a Certified Peer Support Specialist by the state after completing his training. Cooper established Operation Gateway, his "brainchild," in 2019, motivated by his personal history with incarceration and SUDs, as well as his professional background as an addiction professional. Cooper spoke with Akilah Wise, a senior editor at Health Affairs, on April 11, 2025, as he prepared to present at the Addiction Medicine Conference, in Asheville, on the role of lived experience in combating stigma and ensuring access to addiction medicine pre- and postrelease from incarceration. What follows is an edited transcript.AKILAH WISE Your first job after prison was as a behavioral health technician at the Dobbins Center, which offers inpatient treatment for substance use disorders (SUDs) and crisis stabilization. You've also worked as a career coordinator at Asheville-Buncombe Technical Community College and the Buncombe County Government's Justice Resource Center. So, in addition to your personal experience with incarceration and recovery, your work in government, nonprofits, and higher education gives you a unique perspective on incarceration and addiction recovery. What were some of the gaps you saw in your work with local behavioral health agencies that pushed you to start Operation Gateway?PHILIP COOPER When you're fighting for people, you can't do that from a government position. At the end of the day, bureaucracy wins every single time because they pay your paycheck. I started Operation Gateway because I kept seeing the gaps over and over and over, and I knew what was missing. Some of those gaps were lack of diversity in the behavioral health workforce. I had ideas on how we could raise up more Black and Brown professionals and leverage the lived experience of people who were thriving in recovery. A lot of times the decision makers for grants and programs were people who didn't have the lived experience or have any proximity to people with lived experience. There were also gaps in the continuity of health care. People were getting out of prison, and they weren't having that continuity because case managers in short-staffed prisons were just dropping them in a halfway house. So, you give them a bed, tell them to get a job, then they're not focusing on their health because they're trying to hurry up and get a job, which is already challenging with their criminal record. You feel me? There was a gap with putting people on the medication who then have an unpleasant experience with some of these abstinence-based recovery fellowships. I believe in medications for opioid use disorder—medication-assisted treatment. But you've got to couple it with therapy and recovery coaching. There was a gap in workforce development. You have resources like the Workforce Innovation and Opportunity Act that a lot of people don't know about, or how to secure these underutilized resources. Vocational rehabilitation is an amazing resource. In North Carolina, ours is now called Employment and Independence for People with Disabilities. Disabilities include SUDs, which a lot of people who lack education don't know. That's another gap I saw.Lessons Learned From IncarcerationWISE What are the specific ways your experience with incarceration informs your work with Operation Gateway?COOPER I had about three years to do. But there were men in there who had been in prison for ten, fifteen, twenty years. Some who were never getting out. They had reinvented themselves; good God almighty, they reinvented themselves. They were amazing people who're trying to help young brothers like me who had less time. They held me accountable, and I learned new coping mechanisms, like working out. I still love to work out. I found peace on the yard lifting weights. But I learned these things while I was in prison, right? I learned how to do life. I learned the power of support groups. After I got out of prison, I got certified after I took the state training in 2012. When I was in prison, I got to see the power of peer support. Programmatic peer support is an evidence-based practice. It's when a person who has proven successful in recovery is now working in the field as a Certified Peer Support Specialist who is helping other people get engaged in recovery or stay engaged in recovery. We had training in the prison to be peer counselors, and I saw some magic happen. Magic happened because people started opening up. We see that now with Operation Gateway and providing holistic reentry services to people coming out of prison. That's why we believe in prison in-reach. That's the best practice. We want to share our personal recovery stories with our brothers and sisters who are coming home from prison. So they see they ain't the only one. We work with a reentry council that has a list of all the people who are about to get out from prison within a certain amount of time. We get that list and then do prison in-reach, in which we reach our people at ninety days prerelease. You feel me? Then we use apps called GettingOut and TextBehind because the incarcerated people don't get snail mail anymore because of contraband. So, we reach them, and they know who we are, and we send a follow-up text. Some of them follow up. Some of them don't. Some of them take their stuff straight to the case manager, and the case manager hits us up, like, "Hey, heard about your program. This is something you can help with." So that's how we do in-reach right now, by way of partnership with the reentry council. We got more people coming home from prison, but we don't got an army of staff. We've got under eight navigators who provide a very needed service of helping people coming home build community. It might take two months to get them every single resource that they need. We do what's called the Full 180, in which we work with people ninety days prerelease and ninety days postrelease. After that, we introduce them to the community, help them build recovery capital, and get them engaged. Recovery capital is the people, the meetings, helping people understand which recovery meetings are good for them. Getting them engaged with recovery organizations, like peer living rooms and places that have a recovery space where people can go hang out, charge their phone, and attend groups. You know, that's recovery capital. We're doing warm handoffs. We're not just giving them a list and saying, "Here. Go check." The ultimate goal is them coming home, and we are connecting them to all the social determinants of health resources.Operation Gateway ModelWISE What model does Operation Gateway use to structure and inform this work?COOPER Cooper presents a display of a Healthy People 2030 social Determinants of health graphic I use this wheel right here everywhere when I'm presenting. It came from Healthy People 2030. I use that wheel, and I break it down in either layman's terms or public health professional terms, you dig? Access to education, access to health care, neighborhood and built environment, right—being able to talk about the power of residential reentry programs. So, we talk a lot about the neighborhood and built environment and how we need more of those residential reentry programs where people can have a step down and really focus on their social determinants of health resources. I've seen people get out and try to have multiple jobs, and they're chasing that money just like they were chasing that dope. They ain't got nobody to lean on, and they start making poor decisions. They ain't got anybody to call on, to hold them accountable. So, the social and community context is powerful.Karita's StoryWISE Can you tell a specific story that illustrates the work of Operation Gateway, and its success?COOPER Karita got released in the middle of Hurricane Helene, so the DMV Department of Motor Vehicles wasn't seeing people. Social Security Office couldn't get her ID or Social Security card. Nothing. We got her housed and had one of the community health workers from our team take her several counties over to a DMV to get her ID and license. We got her plugged into a network for day labor at a distribution center I managed. We had some funding from private donors and United Way because we were messed up from the hurricane. So we used some of that unrestricted funding to pay some of our people who had just got out of prison to do day labor because they couldn't get jobs. They worked in the distribution center, like storing items and helping people carry stuff to the car. So I connected with Randy Perkins, owner and founder of AshBritt a rapid-response disaster recovery services contractor, who was committed to hiring formerly incarcerated people for disaster work, and he said, "Listen, man, I love what you're doing. I want to give somebody, one of the clients that you serve, an opportunity to be a project manager, and I'll have somebody train them." So, guess who I called? Karita. Why not a Black woman fresh out of prison? A single mom. I put her to the test. She's now working as a project manager for that company. She's gotten married, got her own place. And she's been out of prison for less than a year.ChallengesWISE What are the challenges in doing this work?COOPER We would love to go into prisons more often. Staffing shortages in prisons hinder our ability to access facilities and carry out our work on the inside. Before they're released, let's talk about soft skills, job readiness. Let's talk about evidence-based listening trainings that equip individuals with the tools they need to successfully reintegrate into society. But we can't offer these classes if the prisons ain't letting us in. But I'm optimistic because of Medicaid expansion in North Carolina and the 1115 waiver, which would make people inside eligible to go ahead and tap into Medicaid. That brings dollars to have people like us come in with the stamp of approval from the doctors. The other challenge is the DMV. We still got people just getting out of prison without their Social Security card. Everybody should get out with their vital records. When people go to prison, they are processed, and it takes a full month. What they should do at processing is order the person's records, order the ID, Social Security card, and birth certificate. Why can't we just go ahead and get all those people's stuff at processing? Stigma and unforgiveness are another challenge, you know what I'm saying? Some of the people in prisons still want to see us as inmates. You know, they don't see us as fathers and mothers. They still got that mindset.Voices Of AffrilachiaWISE You started an initiative, Voices of Affrilachia, that focuses on addressing the treatment and care of Black individuals with SUDs by supporting Black-led and Black-serving services. The term "Affrilachia" originated in the 1990s, coined by Black writer Frank X Walker from Kentucky to recognize the Black communities of the Appalachian region, thereby defying stereotypes about the region. Can you talk about the origin of Voices of Affrilachia?COOPER In 2020, I was one of the Black addiction professionals in my area. There's not a lot of Black addiction professionals in my area, and there's not a lot of licensed addiction professionals who are Black. For the ones who are, you don't see a lot of lived experience in that field. I knew some other Black professionals in the field, so in 2020, I came up with this idea. I started something called the Clinicians of Color movement to help raise up more clinical supervisor interns who could provide clinical supervision to the counselors and clinicians. It was an all-Black Clinicians of Color movement, in which we provided free supervision and financial assistance for credentialing and professional development. While I was recruiting people to join the Clinician of Color Movement, Victor Armstrong and Dr. Michelle Laws, the director and assistant director of the Division of Mental Health for the entire state, saw one of my videos and said, "Who is this brother from the mountains?" So, we met, and I put on a listening session that consisted of Black behavioral health professionals and faith leaders from across the West North Carolina region, and that's how I came up with the name Voices of Affrilachia. I called it Voices of Affrilachia because I got Black people from different counties, different professions from licensed practitioner counselors, licensed clinical addiction specialists, community health workers, peer support specialists. I reached out to the Dogwood Health Trust, and they started funding Voices of Affrilachia and the deliverables of helping people get access to care, making sure that Black folks get access. We help everybody, just to be clear, but we make sure that we double down on making sure that the Black communities know what's up when people need help.Better ListenersWISE What do you wish most people, especially policy makers, knew about the work you're doing?COOPER I wish that they would become better listeners. I want them to be better listeners, and I want them to be intentional about listening sessions and inviting the right people to listen to. The right people are formerly incarcerated people, people who are leading programs, people who are fresh out of incarceration, people who have received services from those programs. We need people who are going to tell the truth. One of the things I want to make sure the decision makers and policy makers understand is that we have to leverage lived experience to be able to get recovery coaching to the people who're on the medication. We've got to remember to make that investment in those who provide recovery coaching for the people who are going on the meds. So, with those policy folks, if we could get them to be better listeners and intentional about who they need to listen to, I believe we'll turn the tide. That keeps it inclusive, it keeps it broad enough to get the right people to the table. Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article Metrics History Published online 2 September 2025 InformationThis open access article is distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) license.PDF downloadRelated articlesThe Opioid Crisis: Scaling Up Treatment And Harm Reduction Programs To Reach More People Who Would Benefit02 Sep 2025Health Affairs