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Mental health conditions and substance use disorders are prevalent among adults detained in local jails. In fact, these behavioral health conditions are observed more frequently among jail inmates compared to adults in prison. Despite this knowledge, there is limited research focused on the association between behavioral health needs and recidivism with adults in local jails, and most of the prior work in this area has concentrated on adults in large metropolitan facilities. This study was designed to assess the association between specific behavioral health conditions and the likelihood of being booked into jail in a 12-month period. Data were collected from a random sample of 283 adult jail inmates in a rural county detention center in Western North Carolina. The Comprehensive Addictions and Psychological Evaluation–5 was used to collect information related to a variety of mental health conditions, as well as specific substance use disorders. Results indicate symptoms of PTSD and meeting criteria for opiate or amphetamine use disorder significantly increased the probability of being booked into jail on multiple occasions. These findings have important implications for the assessment of behavioral health conditions among adult jail inmates, especially in terms of reducing repeated jail admissions.