Effective Adolescent Substance Abuse Treatment in Juvenile Justice Settings: Practice and Policy Recommendations

Juvenile justice—increasingly the service delivery point for adolescents with substance abuse and co-occurring problems lacking resources for other assistance—can be a model for improved and expanded, yet cost-effective, adolescent substance abuse treatment. An emergent standard of care challenges systemic inequities; a new service array facilitates dialogue among justice and treatment professionals, families, and the youth themselves. Such evidence-based practice—and the policy to implement it—have the power to transform disconnected laws, programs and professionals into an effective, efficient and successful community of responders, helping youth reclaim their lives while improving public health and public safety.

Multisystemic Treatment of Juvenile Sexual Offenders

Abstract

Multisystemic therapy (MST)is an ecologically-based treatment model that has proven effective with violent and chronic juvenile offenders and that holds promise with juvenile sexual offenders. This article describes the empirical underpinnings, theoretical foundation, and clinical features of MST and provides a brief review of MST outcome studies with juvenile sexual offenders. The theoretical foundation and clinical features of MST draw upon empirical findings regarding the multidetermined nature of serious antisocial behavior as well as upon social-ecological models of behavior in which the youth and family's school, work, peers, and neighborhood are viewed as interconnected systems with dynamic and reciprocal influences on the behavior of family members. In two randomized trials with juvenile sexual offenders, MST has had positive effects on key social-ecological factors (e.g., family affective relations, peer relations, school performance) associated with sexual offending and has demonstrated long-term reductions in criminal activity and incarceration. The success of MST can be attributed primarily to (a) the match between MST intervention foci and empirically identified correlates/causes of sexual offending in youths and (b) the flexible use of well-validated intervention strategies in the natural environment.     

The Evolution of Substance Abuse Treatment in Juvenile Justice

ABSTRACT

This paper discusses the scope of substance abuse and related problems among juvenile offenders, and describes three models of addressing the problem based on a review of current approaches, ranging from Treatment Alternatives to Street Crimes programs (TASC), to juvenile drug courts, to an integrated treatment network model. The relevant strengths and weaknesses of each in supporting lasting change in substance-abusing juvenile offenders and their families are presented, and a call to action is offered for communities wishing to aim their interventions innovatively and precisely in the direction of substance abuse among their delinquent youth.     

Substance Abuse Treatment with Adolescent African American Males

Abstract

The use of substances by adolescent African American males is of particular concern because of the damaging effect that drug abuse has not only on the individual and his family but also on the African American community. The literature is scant regarding treatment services and few therapeutic interventions have been specifically designed to holistically meet the needs of these youth. This article proposes the use of Afrocentricity and Reality Therapy as therapeutic bases for substance abuse treatment with this population.     

Spiritual Interventions in Substance Abuse Treatment and Prevention

Abstract

This article reviews the recent research literature related to the use of spiritual interventions in the prevention and treatment of substance abuse. Empirical outcome studies are critically reviewed and a brief overview is given of spiritual interventions which have yet to be studied empirically. Areas for further research are delineated and philosophical and methodological issues related to the study of spiritual interventions are discussed.     

动态、风险与防护:未成年人吸毒行为分析

从近3年我国查获的未成年人吸毒情况来看,未成年人吸毒现象出现了总体数量增长、地区分布集中、毒品种类变化等特点。这些变化特征表明:未成年人吸毒的总体风险上升、不同地区的吸毒风险不同,不同毒品类型的风险存在差异。从未成年人的寄存空间来看,未成年人的吸毒风险主要存在于家庭、学校、社会三个方面,并会随着条件的转变而发生变化。对未成年人吸毒的风险防控应当从未成年人自我控制和环境控制两个层面进行构建。     

青少年公民教育的发展脉络、现实问题与未来方向

青少年公民教育是新时期促进国家发展,增加国家实力的基本保障。由于相关概念内涵的模糊不清、推行机制的不完善等原因,导致了我国青少年公民教育的理论体系和实施体系建设的相对滞后。直至20世纪90年代以后在国际和国内环境的双重推动下。青少年公民教育才开始有了实质性的发展和推进:同时也存在着理论体系建构滞缓、教学理念混淆、课程衔接乏力、教育内容知行脱节等现实问题。构建一个适应时代发展需求,符合青少年身心发展特征。校内外有机结合的积极有效的青少年公民教育体系成为了新时期发展青少年公民教育的重要任务。     

论我国未成年人社区矫正体系的缺陷

未成年人本应是社区矫正的重点对象之一,但我国未成年人社区矫正体系未受到应有重视,存在着诸多问题。在立法上,未成年人社区矫正制度的独立性不足,适用的对象过于狭窄,未形成完整的法律体系。在司法实务中,未成年犯适用社区矫正的比例偏低,尤其是外地户籍未成年犯适用社区矫正的比例更低。在执法中,未成年人社区矫正机构尚未专门化,社区矫正工作人员未能实现专业化,也没有针对未成年人的个性化社区矫正项目。     

Treatment of Female Pathological Gambling: The Efficacy of a Cognitive-Behavioural Approach

Given that a substantial proportion of current pathological gamblers are female, it is evident that women are underrepresented in the treatment outcome literature. The current study was designed to redress the limited information on the treatment of female pathological gambling. Although the use of cognitive-behavioural therapy is the most highly recommended approach as ‘best practice’ for the treatment of pathological gambling, no attempt to date has been made to evaluate the efficacy of this approach for female pathological gambling. Nineteen female pathological gamblers with electronic gaming machine problems were treated with a cognitive-behavioural program. While pathological gamblers placed on a waiting list did not show significant improvement on gambling behaviour and psychological functioning measures, the female pathological gamblers showed significant improvement on these measures over the treatment period, and maintained this improvement at the 6-month follow-up evaluation. By the completion of the follow-up period, 89% of participants no longer met diagnostic criteria for pathological gambling. Although further scientific demonstration and replication are required, the outcomes of this study indicate that the therapy that is considered ‘best practice’ in the treatment of pathological gambling is effective for female pathological gambling.     

The Role of Technology in Mediating Use of Outpatient Substance Abuse Treatment Services

ABSTRACT

This study examined the relationship between Connect, a telephone-based information and support system, and the use of outpatient substance abuse treatment services. Regression models were formulated to examine the relationship between use of substance abuse treatment services and Connect. The results indicate that Connect use was not significantly related to the likelihood of using treatment (N = 240). However, an inverse relationship was found between Connect and use of treatment services (n = 123). The findings raise the conceptual issue of whether one introduces technology as an “add-on” to or as a “substitute for” traditional substance abuse treatment services.     

Effects of Substance Abuse Central Intake on Treatment and Justice Costs

ABSTRACT

The cost-benefits of a central intake intervention for substance abuse treatment referrals were demonstrated using a transaction cost analysis on two cohorts of participants during the three-year initiative. Costs for clients receiving central intake services were compared with those just prior to the intervention's implementation. In order to study the relationship between substance abuse treatment costs and avoided criminal justice costs, data from three administrative data sets were used. Results indicate that clients receiving the central intake intervention had approximately a 58 percent decrease in costs compared to clients not receiving the intervention. The initiative produced opportunity cost savings to treatment, court, and correctional systems, with completion being crucial to opportunity cost savings.     

The Emotional and Educational Functioning of Children Living with Maternal HIV/AIDS and Substance Use

The rates of HIV infection among women in the U.S. have risen dramatically in the past decades, affecting not only women as individuals, but also women as mothers and caregivers. Waning maternal physical and psychological resources, coupled with poverty and possible familial substance use, place children of HIV-infected women at behavioral and developmental risk. This study compared the emotional and educational functioning of HIV-uninfected children, 6–15 years of age, living with an HIV-infected mother who used substances to a comparison group of children living with maternal substance use only. Results indicate that children whose mothers are HIV-infected and use substances have poorer emotional functioning when their mother experiences HIV-related symptoms compared to the comparison group. Paradoxically, results also indicated that target group children were significantly less likely to be rated as disruptive during the interview than the control group children. Implications for practice are discussed.Cynthia Devane Fair, Associate Professor is affiliated with Department of Human Services, Elon University, USA     

The Role of Hawaiian Elders in Substance Abuse Treatment Among Asian/Pacific Islander Women

SUMMARY

The elders of a culture are often the designated transmitters of long-standing values and ways that define the unique essence of a people. Küpuna (elders) teachings are especially important to Native Hawaiians who have experienced the cumulative effects of cultural imperialism, which has taken their lands, discouraged use of their language and cultural ways, damaged their identity as a people and destroyed their sovereignty.

Modern day cultural imperialism, which universalizes the dominant group's experience and culture, renders minority groups as invisible while marginalizing them (Young, 1990). The chronic stress of this insidious form of oppression can translate into physical, mental health problems which lead to decreased life expectancy (McEwen, 1998; Schulkin, Gold & McEwen, 1998). Statistics on Hawaiians and other Asian/Pacific Islanders in Hawaiì indicate these groups have high rates of health problems and increasing rates of substance abuse (Office of Hawaiian Affairs, 1998).

This article describes the roles and Hawaiian practices of küpuna who acted as facilitators in the healing of Asian/Pacific Islander pregnant and postpartum women who participated in a culturally based substance abuse treatment program (CBSATP). The findings of a qualitative study, which examined the effectiveness of küpuna in these roles and their implications for practice are discussed.     

Effective Responses to Offenders with Intellectual Disabilities: Generalist and Specialist Services Working Together

Abstract

Despite policies of deinstitutionalisation, many people with intellectual disabilities in developed western countries continue to live in mainstream institutional settings, such as correctional facilities, rather than in the community with support from disability services. This paper reports on the life stories of 10 people with intellectual disabilities, who had been imprisoned in adult correctional facilities in Queensland. The pathways taken by these 10 people into and out of prison are marked by significant abuse, neglect, and poverty. Significant disparity and disconnection is also displayed between the policies and service approaches, particularly between the disability, mental health, and correctional systems in Queensland. Based on these findings, a framework for practice, which spans both generic and specialist services, is suggested.     

The Family Context of Relational Aggression in “Difficult to Treat” Female Juvenile Offenders

Female juvenile offenders often engage in socially aggressive behaviors that make them more difficult to treat than male juvenile offenders. This social (i.e., relational) aggression may be developed or maintained through transactions with family members. To investigate this issue, we measured relational aggression in the family interactions of 140 adolescents divided by gender and offender status into four equal‐sized groups (female juvenile offenders, male juvenile offenders, female nonoffenders, and male nonoffenders). Adolescents and caregivers completed a family discussion task, and raters coded relationally aggressive behaviors at the dyadic level. Results showed that female juvenile offenders and their mothers directed more relational aggression toward each other than did mother–adolescent dyads in the other groups. Implications of these results for treatment and research are discussed.     

The Emerging Problems of Alcohol and Substance Abuse in Late Life

Treatment of substance abuse among older adults will become increasingly important as the number of aged Americans increases. The abuse of psychoactive substances is a major contributor to excess morbidity, mortality, and homelessness among persons of all ages and socioeconomic strata regardless of race or ethnicity. Alcohol and tobacco accountfor the majority of substance abuse-related death and disability in the United States; the former through cerebrovascular and hepatic disease, accidents and violence, the latter through chronic pulmonary disease and malignancy. Patterns of substance abuse in late life are substantially different from those observed among younger adults. However, treatment may be less challenging. Effective diagnosis and treatment requires a nonpunitive, supportive, but persistent approach. This means the capacity to collect a substance intake history and the ability to formulate a treatment plan or referral strategy to an addiction specialist or residential treatment setting. It is also important for the practitioner to manage negative feelings toward patients who decline treatment or who are chronic abusers.     

Correlates of Race and Substance Abuse with Religious Support Systems: A Study of Pregnant Substance Abusers

Women who misuse substances may have decreased connections with community structures, including religious support systems. This study examined the correlates of race, age, socioeconomic status, and drug use status on 1,116 pregnant women's connections with religious support structures. Data were derived from the 2002 National Survey of Drug Abuse and the 2003 National Survey of Drug Use and Health and were used to perform a secondary analysis of the variables. Results of the analyses revealed that race is not an indicator of social connectivity; while drug use, age, and socioeconomic status are indicators.     

Support for Resilience Theory with Female Adolescents Who Are Violent: A MIMIC Model

Resilience theory has been shown to explain aggression and violence in adolescents in general. No studies were found that supported this theory specifically with female adolescents. A multiple indicators multiple causes (MIMIC) model was developed from the review of the literature. Structural equation modeling was then used to quantitatively test this theoretical MIMIC model. Results indicate that the direct effect of the demographic contingencies are significantly related to violent behavior: race (β = ?.53, t = 0.04, p < .001), community supports (β = ?0.55, t = ?0.04, p < .001), and subsidized income supports (β = 0.54, t = 0.04, p < .001). These results suggest demographic contingencies play an important role in predicting violent behavior in female adolescents.     

The Treatment of Male Sexual Offenders

No abstract available for this article.