Background: Pakistani jails face a rapidly expanding yet inadequately researched substance abuse crisis which targets inmates who previously used drugs before their incarceration and those inmates who start using drugs during their imprisonment. Prison populations show diversity in substance use because some undergo incarceration with pre-existing disorders from drug-related offenses while formerly abstinent inmates begin using drugs in response to mental stress along with peer pressure and widespread drug supply within their cells. The parameters behind substance abuse development in prison conditions receive analysis in this research alongside the systems which maintain addiction among prisoners.

Methods: The research team conducted qualitative phenomenological interviews using a basic with 30 prisoners from three secure prisons across Pakistan. Our research included participants who used drugs before entering prison and prisoners who developed substance use habits during incarceration. Thematic analysis was done to find major themes and subthemes.

Results: Three themes emerged. The first theme was, “Diverging Paths to Substance Use,” This theme reflects the factors behind preincarnation drug use and incarceration induced substance abuse. It also addresses disrupted or sustained drug addiction. The second theme “Drugs Behind Bars” narrates availability and access disparities, mental health and coping strategies and power structures and coercion. Third theme was “The Rehabilitation Paradox,”. This theme identified the failure of prison-based treatment and struggles for reintegration after being released.

Conclusion: Our findings show prisons require specialized rehabilitation programs for their different types of drug users. Effective treatment during and after prison helps end drug trade inside and lowers the chances of former inmates returning to crime.

• Substance abuse

• Prisoners

• Addiction pathways

• Incarceration

• Rehabilitation

• Pakistan

• Recidivism

• Prison reform

Azad AH,BiBi I,Ghani U, Ali I, Gilani I, et al. (2025) Voices from the Prison Walls: A Qualitative Exploration of Substance Use in Pakistani Jails. Ann Psychiatry Ment Health 13(1): 1199.

Prisons across Pakistan face increasing drug abuse problems because their systems deal with both overcrowded conditions and lack sufficient medical care and rehabilitation support. Jail-based substance use disorders demonstrate multifaceted complexity because they result from multiple interacting factors. Many people enter incarceration with pre-existing substance use disorders which develop from traumatic experiences and economic hardship or existing criminal records related to drug offenses [1,2]. The prison system produces an understated phenomenon whereby non-drug using inmates develop substance addiction during their sentences. Research indicates that imprisonment conditions which include inadequate mental health support and exposure to violence as well as isolation and overcrowding trigger or worsen substance use among inmates [3,4]. Diverse systemic and individual factors are involved in shaping up different patterns of substance abuse in prisoners. High accessibility to illicit drugs in jails is a key factor to fall for addiction. Prison staff involvement with corrupt practices combined with sophisticated drug distribution networks makes narcotics accessible to detainees who were or were not drug users before incarceration [5-7]. Prisoners indicate addiction starts as their way to handle the psychological stress that comes with daily prison life. Prisoners resort to drug use as a way to manage mental pressure from overcrowding conditions and violent events along with trauma and isolation periods [8,9]. Peer pressure among prisoners with substance use disorder a continuous phenomenon maintains their habit of addiction. The influence of dominant inmates within prison structures forces prisoners into drug use [10,11]. Prison hierarchies establish conditions that force non-drug using inmates especially new arrivals to use drugs for acceptance and survival [12,13]. Substance use becomes an escape with the fact that Pakistani jails lack therapeutic staff and mental health facilities [14,15]. The rehabilitation approach employed by Pakistani prisons faces broad criticism because it fails to target fundamental substance abuse problems. Rehabilitation programs introduced in prisons fail to serve prisoner needs, resulting in elevated relapse and ongoing addiction problems when they are released [1,2,7]. The cycle of substance abuse gets stronger because former prisoners encounter reintegration difficulties from social stigma plus joblessness and unavailable mental health support after release [14,15]. The relapse into substance use among released prisoners maintains an ongoing cycle of addiction and repeated offenses which proves hard to break [8]. The research investigates multiple routes which lead to substance misuse inside Pakistani prisons while emphasizing structural systems and psychological and social aspects that create dependencies. The research investigates both individuals who used drugs before prison and those who started their addictions behind bars to better understand the special difficulties faced by this marginalized group. Research finding suggests to design rehab services at prisons. By policy implications and health system interventions we can decrease the substance abuse level in jails of Pakistan.

This study acquired qualitative phenomenological approach to understand the experiences of prisoners with substance use disorder. Researchers selected three central prisons from different Pakistani provinces to gather diverse prisoner experiences. Researchers chose prisons by considering their security classifications and characteristics of prisoner population density as well as drug-related case availability. While male prisoners with prior or current substance use agreed to participate researchers could not secure consent from any female prisoner. Prison staff selected participants who had served a six-month sentence because the research required understanding the prison habitat alongside signed informed consent forms. The research excluded prisoners who had severe psychiatric illnesses which stopped their meaningful participation together with those receiving medical treatment for detoxification and intensive withdrawal management. Using purposive sampling to achieve participation of 30 different individuals from three prisons allowed researchers to gather diverse respondents including pre-incarceration users and those who began using substances due to their prison term as well as participants from varying socio-economic backgrounds. The research team gathered information from in-depth semi-structured interviews, key informant discussions and observational field notes. Prison-based face-to-face interviews took place within private locations spanning 40 to 60 minutes using flexible guides to explore topics on pre-incarceration life followed by substance use pathways then prison conditions access to drugs handling psychological challenges rehabilitation processes plus post-release worries. Researchers obtained written consent to record interviews and then produced exact transcriptions from the audio files. Research carried out institutional response evaluations by interviewing prison officials together with psychologists and rehabilitation staff regarding substance abuse strategies in prisons. The documented observation notes captured detailed insights about prison dynamics and drug indicators aiding understanding of study participants’ personal stories. The thematic analysis approach formulated by Braun and Clarke (2006),a six-step framework was used. Analyzing data involved repeated data reading and familiarization, initial code creation, broader theme identification followed by theme coherence review and definition together with final report writing which incorporated participant quotes. The NVivo software system served to classify data while organizing the study information. By examining substance use patterns this investigation revealed detailed data about Pakistani prison inmates which helps shape policy direction and rehabilitation programs.

Diverging Paths to Substance Use: Pre-and Post Incarceration Addicts

The substance use patterns of incarcerated individuals varied between those brought into prison while drug dependent and those who developed dependencies during their time in prison. Existing vulnerabilities you brought into prison interacted with custodial conditions alongside drug access which resulted in unique inmate experiences (Table 1).

Table 1: Themes and Sub-Themes

Pre-Incarceration Drug Users: The prison population claimed frequent substance abuse before their arrest because they used drugs to manage poverty and trauma while becoming involved in crime. “Substance abuse functioned to pull me away from street life. Prison life merely shifted my confinement walls” (P12). Participants explained their move toward substance use as a consequence of facing economic difficulties. “Throughout my childhood the streets surrounding my neighborhood were filled with drugs everywhere I looked. Either you used drugs or someone else profited from their sale” (P5).

Incarceration-Induced Users: First-time drug users among prison participants started consuming drugs because of mental health issues alongside peer pressure and availability from prison dealers. “The prison environment convinced someone who once didn’t use drugs to turn to them for survival despite their non-drug past” (P7). Prisoners reported facing emotional strain which pushed them to try different drugs for the first time.“The loneliness gets to you. Being handed a pill change everything because the prison walls stop feeling like a trap”(P18).

Disrupted or Sustained Addiction?: Prison drug access depended upon established prison hierarchies, inmate financial limitations and staff complicity.“If you don’t have the right connections, you go through withdrawal alone”(P21). Prisoners who acquired drugs kept using them while many other individuals battled with enforced sobriety.“I begged the guards for something to help with the withdrawal, but they just laughed and told me to suffer”(P9).

Drugs Behind Bars: The Hidden Economy of Substance Use

Prison drug use emerged from a hidden economic system which was sustained through widespread corruption as well as distinct power structures and hierarchical inmate relationships. A segment of prisoners obtained ongoing drug access whereas others experienced withdrawal symptoms because they could not afford drugs or were stopped by strict prison regulations.

Availability and Access Disparities: In prison some inmates secured drugs through dishonest officials and cellmate connections while others experienced withdrawal because they faced limitations or lacked enough money.“You will not receive any interference from the guards when you pay the appropriate amount”(P3).Prisoners received different levels of drug access based upon where they stood in the prison social structure.“People with money or contacts gain access to needed items. If you don’t, you suffer”(P16).

Mental Health and Coping Strategies: Behind bars prisoners relied on substance abuse to mentally escape their threatening confinement conditions filled with isolation and violence. “Serving 23 hours in a small cell transforms drugs into the sole escape from captivity” (P19). Prison life created unbearable pain and many said that drugs helped to suppress. “I needed something to stop the nightmares. The drugs made everything feel distant, like it wasn’t happening to me” (P27).

Power Structures and Coercion: Drug-distributing prison group leaders forced newly arrived inmates into addicted lifestyle through intimidation.“Saying no wasn’t an option. They made sure you took it, or you’d regret it”(P14). Prisoners found themselves forced into drug distribution activities according to different inmates.“They said they would ruin my life if I refused to assist with their smuggling operation”(P22).

The Rehabilitation Paradox: Treatment Gaps and Post-Prison Realities

Even with available rehabilitation programs prisoners struggled because these programs failed to reach them which allowed substance use to persist while they were incarcerated and increased the chance of relapse after their release. The prisoners’ challenges intensified because structured support systems failed to operate correctly and the absence exposed weaknesses in prison rehabilitation as well as aftercare programs.

Failure of Prison-Based Treatment Programs: Participants demonstrated dissatisfaction because all current rehabilitation schemes functioned either as punishment or remained unreachable. “Rehab here is a joke. Their treatment leaves you punished rather than assisted”(P25).The prison system held certain inmates in solitary confinement which it called ‘treatment’ by locking them into dark cells for extended periods. “Being locked in a dark cell caused my drug addiction cravings to increase”(P6).

The Struggle for Reintegration: Drug users coming out from both pre-incarceration and incarceration phases remained at increased risk for relapse because they faced societal stigma alongside challenges of unemployment and insufficient support after prison.“I wanted to stay clean, but when you step out, there’s nowhere to go and no one to help”(P8) A number of released individuals discussed their experiences being rejected by society.“People look at you like you’re still a criminal. No job, no home, no support-what else is left but to go back to the only life you knew?”(P30).

Research highlights the need for specialized treatment plans which distinguish between drug users who enter prison and those who become addicted during incarceration. Detoxification treatment operations and protective measures for vulnerable persons should both be components observable in prison interventions.To successfully disrupt the cycle of addiction and recidivism we need to eradicate the prison drug market while increasing support programs for inmate re-entry. Further investigations must evaluate policy-driven measures designed according to the specific requirements of these different user populations.

This research uncovers essential knowledge regarding Pakistani prisoner substance use patterns which matches current knowledge about international prison drug addiction trends. Three main themes emerged to demonstrate substance use intricacy in prison environments: the dual entryways to drug usage these individuals follow pre- or during their sentences, the covert drug market operations operating inside prisons and the challenges faced in prisoner rehabilitation as paradoxical outcomes over treatment programs. International research supports these findings which focus on specific structural and socio-cultural problems present in Pakistani detention facilities.

Diverging Paths to Substance Use: A Global Perspective

Findings on substance use patterns in prison reflect wider research regarding drug use prior to imprisonment as compared to substance use patterns that develop within prison environments across multiple countries. Empirical evidence from research in both the United States and the United Kingdom reveals that incarcerated populations frequently demonstrate existing substance use disorders caused by economic hardship alongside serious traumatic experiences and engagement in criminal activities [16,17]. Research indicates that much as Pakistani prison inmates do, Brazilian and South African prisoners bring established drug dependencies to correctional facilities where these conditions may continue to worsen because of their surroundings [18,19]. The experience of being imprisoned stands out as a risk factor which causes non-addicted persons to start substance use. European research has established that inmates begin using substances because of stressful conditions inside prisons combined with widespread violent behavior and normal drug habits [20,21]. Pakistani prisoners provided narrations about substance dependence which confirm current research showing inmates often depend on drugs to outlast emotional hardships and brutal imprisonment conditions. As inmates use drugs to manage stress during incarceration proper mental health strategies become essential within prisons to stop addiction development.

The Hidden Economy of Drugs in Prisons: Corruption and Structural Failures

Evidence from multiple jurisdictions documents a well organized prison drug trade operating as a worldwide concern with research activities spanning the United States along with both Latin America and Southeast Asia [22,23]. Evidence shows how corrupt prison officials enable drug smuggling into prisons which studies from Mexico and Russia have found reflects organized systems of complicity [24,25]. Prison inmates in Pakistan mentioned officer corruption and financial systems as reasons for managed drug supplies which fits established international patterns. Studies conducted in Canada along with those in Australia demonstrate that prison substructures manipulate susceptible detainees who end up working in drug distribution networks. Prisoners in Pakistan describe drug abuse situations that demonstrate enforcing patterns consistent across various regions showing drug networks maintain operations behind bars due to lack of regulatory supervision. The research results demonstrate a critical need for strong anti-corruption protocols together with independent oversight systems to break up prison drug networks.

The Rehabilitation Paradox: Ineffective Interventions and Post-Prison Realities

Global literature supports the study’s major discovery which shows serious weaknesses in correctional rehabilitation practices. Punitive methods to treat inmate substance use disorders show consistent failures in studies from both the United States and Europe. Evaluation of addiction treatment programs in carceral facilities demonstrated they continue to suffer from inadequate financing while maintaining conditions that limit inmate access to services and focus on punitive measures rather than therapeutic frameworks. Rehabilitation projects in Pakistani jails either do not exist or rely upon punishment-based frameworks. The difficulties transitioning back into society affect ex-incarcerated individuals according to international research trends. Research in Canada and Sweden indicates several reintegration obstacles faced by reentering drug users who have served time behind bars including joblessness and homelessness alongside social picketing which enhances their vulnerability to returning to addiction. Pakistani inmates shared similar difficulties which showed that social exclusion plus financial instability create repeated patterns of imprisonment and substance dependence.

Based on this study’s analysis treatment of substance use within Pakistani prisons demands a combined strategy from multiple angles. Policymakers need to focus first on programs proven worldwide which combine evidence based addiction treatments with harm reduction and post-release support mechanisms. Pakistan should look at the implementation of opioid substitution therapy methods used successfully by prisons in both Norway and Germany as potential role models for reform. The formation of independent oversight entities directed at prison corruption would produce major disruptions to the prison drug-economy system. Structures where former prison inmates gain systematic workplace placements and housing aid as done in the Netherlands and Portugal could stop addiction and reconviction patterns in Pakistan. Efficiency research needs to target these interventions for use in prisons that lack adequate resources.

The study extends current research on substance use among incarcerated groups by demonstrating the importance of broad rehabilitative strategies. Through eliminating prison corruption while expanding mental health services and improving prisoner reintegration efforts policymakers could fight substance abuse in Pakistani jails. New studies need to examine policy-designed interventions which meet the unique needs of various inmate groups to create correctional systems better aligned with rehabilitation and justice.

I am thankful to all participants, all researchers who put hard work in the production of the manuscript, and my institution, Health Services Academy for allowing me to explore this unique dimension of research.

AHA prepared data collection instruments, collected data, contributed in analysis. IB wrote introduction, and methods. SAU and PW arranged, documented and discussed results. IA and IG did analyses. UG reviewed the manuscript. All authors reviewed and approved the final manuscript.

Study was self-funded by the corresponding author. There was no other source of funding.

1. Jamal M, Waheed S, Shakoor A. The prevalence of substance abuse and associated factors among male prisoners in Karachi jails, Pakistan. J Taibah Univ Med Sci. 2022; 17: 929-935.
2. Wakeman SE, Rich JD. Addiction treatment within U.S. correctional facilities: bridging the gap between current practice and evidence- based care. J Addict Dis. 2015; 34: 220-225.
3. Chandler RK, Fletcher BW, Volkow ND. Treating drug abuse and addiction in the criminal justice system: improving public health and safety. JAMA. 2009; 301: 183-190.
4. Cunha O, Castro Rodrigues A, Caridade S, Dias AR, Almeida TC, Cruz AR, et al. The impact of imprisonment on individuals’ mental health and society reintegration: study protocol. BMC Psychol. 2023; 11: 215.
5. Fazel S, Yoon IA, Hayes AJ. Substance use disorders in prisoners: an updated systematic review and meta-regression analysis in recently incarcerated men and women. Addiction. 2017; 112: 1725-1739.
6. Chandler RK, Fletcher BW, Volkow ND. Treating drug abuse and addiction in the criminal justice system: improving public health and safety. JAMA. 2009; 301: 183-190.
7. Norman C. A global review of prison drug smuggling routes and trends in the usage of drugs in prisons. WIREs Forensic Sci. 2022; e1473.
8. Calcaterra SL, Beaty B, Mueller SR, Min SJ, Binswanger IA. The association between social stressors and drug use/hazardous drinking among former prison inmates. J Subst Abuse Treat. 2014; 47: 41-49.
9. Tomassini L, Giuli G, Bottoni E, David MC, Scendoni R. Drug overdose deaths during prison riots and mental states of prisoners: a case study. Front Psychiatr. 2024; 15: 1377995.
10. Woodall J. Social and environmental factors influencing in-prison drug use. Health Educ. 2012; 112: 31-46.
11. Khan G, Hussain H, Khan A, Badshah A, Sarwar N, Khan T. Incidence of substance abuse among inmates at Peshawar Prison, Pakistan. HealthMED. 2009; 3: 374-378.
12. Fazel S, Yoon IA, Hayes AJ. Substance use disorders in prisoners: an updated systematic review and meta-regression analysis in recently incarcerated men and women. Addiction. 2017; 112: 1725-1739.
13. Chang Z, Lichtenstein P, Larsson H, Fazel S. Substance use disorders,psychiatric disorders, and mortality after release from prison: a nationwide longitudinal cohort study. Lancet Psychiatr. 2015; 2: 422-430.
14. Ilyas F. Jail survey finds close link between drugs and crime. Dawn.2019.
15. Human Rights Watch. A nightmare for everyone: the health crisis in Pakistan’s prisons. 2023.
16. Wakeman SE, Rich JD. Addiction treatment within U.S. correctional facilities: bridging the gap between current practice and evidence- based care. J Addict Dis. 2015; 34: 220-225.
17. Fazel S, Yoon IA, Hayes AJ. Substance use disorders in prisoners: an updated systematic review and meta-regression analysis in recently incarcerated men and women. Addiction. 2017; 112: 1725 1739.
18. Cunha O, Castro Rodrigues A, Caridade S, Dias AR, Almeida TC, Cruz AR, et al. The impact of imprisonment on individuals’ mental health and society reintegration: study protocol. BMC Psychol. 2023; 11: 215.
19. Norman C. A global review of prison drug smuggling routes and trends in the usage of drugs in prisons. WIREs Forensic Sci. 2022; e1473.
20. Woodall J. Social and environmental factors influencing in-prison
21. drug use. Health Educ. 2011; 112: 31-46.
22. Chandler RK, Fletcher BW, Volkow ND. Treating drug abuse and addiction in the criminal justice system: improving public health and safety. JAMA. 2009; 301: 183-190.
23. Tomassini L, Giuli G, Bottoni E, David MC, Scendoni R. Drug overdose deaths during prison riots and mental states of prisoners: a case study. Front Psychiatry. 2024; 15: 1377995.
24. Calcaterra SL, Beaty B, Mueller SR, Min SJ, Binswanger IA. The association between social stressors and drug use/hazardous drinking among former prison inmates. J Subst Abuse Treat. 2014; 47: 41-49.
25. Baranyi G, Scholl C, Fazel S, Patel V, Priebe S, Mundt AP. Severe mental illness and substance use disorders in prisoners in low-income and middle-income countries: a systematic review and meta-analysis of prevalence studies. Lancet Glob Health. 2019; 7: e461-e471.
26. Adesanya A, Ohaeri JU, Ogunlesi AO, Adamson TA, Odejide OA. Psychoactive substance abuse among inmates of a Nigerian prison population. Drug Alcohol Depend. 1997; 47: 39-44.
27. Shakeel M, Khan U, Shakeel A. The rates of different crimes and the use of illicit substances before and during imprisonment among prisoners. J Rehman Med Inst. 2023; 9:19-24.