Juvenile Justice Response

The use of results of drug testing should be determined by the agency mission and the substance-testing program purpose. A response should be given every time a youth is tested. When test results are positive for drug use, referral for assessment and treatment, a system of graduated sanctions, or both, should be in place. By the same token, when results are negative, a supportive response is needed to reinforce continued abstinence.

Nonadjudicated youth who test positive upon entering detention should not be punished. A drug test at arrest or intake to detention should be used for assessment and diagnosis. Positive results provide the basis for referring youth for further assessment and treatment.

At the time of admission to a juvenile justice program or facility, all youth should be told the possible therapeutic, incentive, or punitive responses that will occur following every test. Examples of graduated responses that could be used for positive tests include the following:

• Participation in drug education programs.

• Participation in discussions about his or her substance abuse behavior.

• Increased frequency of drug testing.

• Increased contact with a probation or parole officer or other staff.

• Earlier curfew or loss of other privileges.

• Community service or other work assignments.

• Home or facility restriction.

• Probation or parole violation determination or facility disciplinary procedures.

• Verbal praise.

• Positive notes to parents.

• Rewards (e.g., movie tickets, skating passes, fast-food coupons).

• Privileges and activities (e.g., later curfews, drug-free parties).

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Substance Abuse Treatment for Juveniles⁸

Juvenile justice professionals should be able to recognize the need for substance abuse assessment or treatment and serve as brokers to obtain needed services. Juvenile justice and treatment professionals should establish collaborative working relationships to best meet the needs of the youth they both serve. Interagency agreements between juvenile justice agencies and treatment providers are crucial for ensuring appropriate treatment resources for substance-abusing youth.

Need for Substance Abuse Treatment for Youth

It is difficult to compare the need for treatment among youth with the rate of treatment availability. There is no national treatment system for adolescents and, therefore, national data collection and analysis are largely unavailable. However, the 1997 National Household Survey on Drug Abuse estimates more than 8.2 percent of youth ages 12 to 17 need drug abuse treatment—that is, approximately 1,887,000 of the 23 million adolescents in the Nation (Substance Abuse and Mental Health Services Administration [SAMHSA], 1998b). The survey also estimates 9.5 million persons need treatment for illicit drug abuse, but that in any year, only 2.1 million receive it in a specialized facility. It is estimated that the current national treatment system, designed primarily for adults, can treat 50 percent of persons with the most severe addiction. In a system able to treat only 50 percent of those most needing treatment, triage decisions are influenced by who is the most needy and priority is often given to adults who are chronically and severely addicted. It is important to note that these data do not include adolescents and adults needing treatment for alcohol abuse.

More trained clinicians are needed to provide specialized treatment services, and more case managers are needed to coordinate community resources and monitor issues involving other social systems, such as treatment, primary medical and mental health care, education, and family services. There are few national examples of a system coordinating all services needed to provide a continuum of treatment services for youth. Using a systematic program to identify the number of substance-using and -abusing youth lays the foundation for the next step in building a national system for treating adolescents. Comprehensive programs for drug testing will document the need for adequate and appropriate substance abuse treatment for those youth who are identified as needing such services.

Effective Treatment for Adolescents

Adolescent substance abusers are more difficult to treat than adult substance abusers. The pressures created by physical, hormonal, and emotional changes produce stressors that are magnified by typical adolescent developmental drives for individuality, separation, autonomy, and social acceptance. Lacking life experience, youth often have difficulty controlling their impulses or making appropriate decisions. Chemical dependence intensifies the behavior problems associated with adolescent development and simultaneously delays emotional development. Substance-abusing adolescents are frequently members of dysfunctional families in which there are no appropriate role models or support. An estimated 7 million children are growing up with at least one substance-abusing parent, and approximately 38 percent of all child abuse cases have parental substance abuse as a factor. These multiple disorders—mental, medical, and developmental—interfere with the progress and effectiveness of treatment. For that reason, the most successful treatment for any adolescent is based on an assessment of each contributing factor and is designed for that individual.

Treatment begins with a diagnosis. Substance abuse is a disease of the brain that is expressed in behavioral ways and occurs in a social context (Bigelow, 1995). Unlike other health conditions, substance abuse is highly individualized and complex, grounded in each individual's biological and psychological makeup, and influenced by each individual's unique experiences of social development and functioning. However, like all other health disorders, effective treatment for substance abuse begins with a trained professional's careful diagnosis of the causes and symptoms of the condition.

Other components of an effective treatment strategy. Effective treatment for substance abuse includes the following elements:

• Screening—a quick gathering and sorting of preliminary information used to determine if a person has substance abuse problems, mental health disorders, or infectious diseases and to ascertain if a clinical assessment is needed.

• Drug testing—part of a structure for holding participants accountable while also allowing a flexible but finite response to substance abuse.

• Intake and assessment—an indepth collection of detailed information concerning, but not limited to, a youth's substance abuse and treatment history, current conditions, emotional and physical health, family status, social roles, victimization, education, and criminal history.

• Patient-oriented treatment plan—a course of action developed by a licensed substance abuse counselor or mental health professional that includes various milestones for evaluating the progress and success of the treatment. The treatment includes a case management plan that oversees the following elements:
  • Planning for treatment, establishing agency coordination, and implementing reporting procedures.

  • Brokering treatment and other services to ensure continuity as the client progresses through treatment and program completion.

  • Monitoring and reporting the client's progress using a schedule that ensures reporting back to the referral source on a frequent and consistent basis.

  • Supporting the client by identifying problems.

  • Advocating for the client with legal, treatment, social service, medical, and mental health systems.

  • Monitoring through urinalysis, breath analysis, or chemical testing for relapse to substance abuse.

  • Protecting the confidentiality of a client's treatment records, consistent with Federal and State regulations regarding the right to privacy.

• Substance abuse education and drug testing for persons assessed as having no history of abuse or dependence and therefore having no withdrawal symptoms.

• Weekly outpatient treatment including pharmacological interventions (e.g., naltrexone, methadone); treatment includes group therapy and help building life, cognitive, and anger-management skills.

• Intensive outpatient treatment for persons abusing substances and having additional problems requiring structured therapy and weekly outpatient treatment, including pharmacological interventions.

• Intensive residential treatment for persons experiencing acute intoxication and withdrawal, having medical or psychiatric disorders, or needing assistance to provide for their immediate needs. This usually is hospital-based treatment that requires short- or long-term residential services. It also may include therapeutic communities, a more behaviorally based intervention usually targeting fairly hardcore drug abusers.

Patient-oriented treatment components. Treatment should be designed to respond to each patient's specific configuration of causes with an array of "wraparound" services. For example, several of the following services may be needed by youth:

• Counseling involving and strengthening the family unit.

• Preventive and primary health care and health education.

• Mental health services for co-occurring substance abuse and mental health disorders.

• Specialized treatment for girls (addressing, for example, victimization issues, pregnancy, and childcare).

• Remedial assistance for educational deficits or disabilities.

• Group counseling interventions.

• Treatment that is sensitive to racial, ethnic, cultural, and social minority issues.

• Employment training or counseling.

• Practical life skills including refusal and avoidance skills and independent living skills training.

• Housing for the homeless or those needing a drug-free environment.

• Liaison with other social service agencies or support groups (e.g., victim support, assistance for HIV/AIDS patients).

• Cognitive skill development for managing stress, anger, violence, and antisocial behaviors.

Relapse prevention methods. Substance abuse and addiction are chronic disorders that are prone to recur. Effective treatment includes special counseling to prevent or limit relapse and creates a structure of incentives and sanctions that respond to episodes of relapse.

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Special Concerns About Treatment for Youth

Adolescents are in a stage of intense physical, hormonal, and developmental change that presents challenges to the effectiveness of treatment for substance abuse. Just as services must be specialized for them, there are several pitfalls to avoid when planning a treatment program for adolescents, including the following:

• Limiting assessment to substance abuse alone and thus excluding the diagnosis of contributing disorders that may complicate or interfere with treatment.

• Standardizing treatment and not considering adolescent developmental stages; the specific needs created by the age, gender, ethnicity of the youth; or co-occurring disorders of the adolescent substance abuser.

• Using adult criteria for treatment services that do not consider the psychological and clinical needs created by the developmental stages of adolescents.

• Ignoring evidence that family-focused services for adolescents have more successful outcomes than those that focus only on individual youth. This does not negate that family management skills may have contributed to the adolescent's addictive disorder and that possible solutions could strengthen the family unit.

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