The post-industrial turn in the economy during the 1970s has had a lasting impact on black communities, leading to high rates of crime, unemployment, gang violence, and illicit drug use. The ‘war on drugs’ disproportionately affected African-American communities, leading to spiralling rates of incarceration. Incarceration takes a toll on the health of inmates, but also on their entire families. This chapter looks at the health and family consequences of illicit drug use and especially mass incarceration.