"It's a revolving door": Ego-depletion among prisoners with injecting drug use histories as a barrier to post-release success.

Background: People who inject drugs (PWID) are overrepresented among prisoner populations worldwide. This qualitative study used the psychological concept of "ego-depletion" as an exploratory framework to better understand the disproportionate rates of reincarceration among people with injecting drug use histories. The aim was to illuminate mechanisms by which prospects for positive post-release outcomes for PWID are enhanced or constricted.

Methods: Participants were recruited from a longitudinal cohort study, SuperMIX, in Victoria, Australia. Eligible participants were invited to participate in an in-depth interview. Inclusion criteria were: aged 18+; lifetime history of injecting drug use; incarcerated for >three months and released from custody <12 months previously. Analysis of 48 interviews examined how concepts relevant to the ego-depletion framework (self-regulation; standards; consequences and mitigators of ego-depletion) manifested in participants' narratives.

Results: Predominantly, participants aimed to avoid a return to problematic drug use and recidivism, and engaged in effortful self-regulation to pursue their post-release goals. Post-release environments were found to diminish self-regulation resources, leading to states of ego-depletion and compromising the capacity to self-regulate according to their ideals. Fatalism, stress, and fatigue associated with the transition period exacerbated ego-depletion. Strategies that mitigated ego-depletion included avoidance of triggering environments; reducing stress through opioid agonist therapy; and fostering positive affect through supportive relationships.

Conclusions: Post-release environments are ego-depleting and inconducive to sustaining behavioural changes for PWID leaving prison. Corrections' behaviourist paradigms take insufficient account of the socio-structural factors impacting on an individual's self-regulation capacities in the context of drug dependence and desistance processes. Breaking the cycles of reincarceration among PWID requires new approaches that moderate ego-depletion and facilitate long-term goal-pursuit.