Blog: Adolescent Substance Abuse Treatment

Does it really matter if we screen and assess teens for alcohol and drug problems?  Most adults, after all, started experimenting with alcohol or other drugs before they turned 21 -- and if they didn't, they almost certainly knew a lot of kids who did. And most of them (though not all) survived into adulthood.
So what's the big deal if we turn a blind eye to identify teen drinking or drugging?  Federally-funded research shows why it's a big deal from a public health standpoint:
 
(Click the image for a larger view.) It's taken from an excellent presentation, "Characteristics, Needs and Strengths of Substance Using Youth by Level of Involvement in the Juvenile Justice System," given by Dr. Michael Dennis, Senior Research Psychologist at Chestnut Health Systems, at the Reclaiming Futures Leadership Institute held in Miami last month. I'll be posting more slides from his presentation soon - stay tuned!
Here's Dr. Dennis' notes on the slide (emphasis added):
This figure shows ... the prevalence of these past year substance use and problems in the height of the graph by age along the bottom.
1- Substance use disorders typically [surface] during adolescence and young adulthood. In fact, 90% of all adults with dependence started using under the age of 18, half under the age of 15. Moreover, 90% met criteria for abuse or dependence by age 20 – thus it is primarily an adolescent onset disorder.
2- After several decades, the rates of abuse and dependence do decrease as people go into remission, incarceration or die. Epidemiological studies of people with lifetime substance dependence suggest that 58% eventually enter sustained recovery (i.e., no symptoms for the past year) -- a rate that is considerably better than the 39% average rate of recovery across psychiatric disorders (Kessler, 1994; see also Dawson, 1996; Robins & Regier, 1991).
3 – Notice how the rates of no use go up with age.
 
One caveat: remember that most youth in the juvenile justice system (at intake, detention, or in secure placement) don't have an alcohol and drug disorder -- though many do.  For more information, check out this post: How Prevalent are Substance Abuse and Mental Health Issues in Juvenile Justice? The Answer May Surprise You. 
Related post: Adolescents: What's the Difference Between Assessing "Risk" and "Need"?
 

A few weeks ago, I had the opportunity to attend the “Widening The Door of Entry to Recovery for Young People” webinar that was previously promoted on Reclaiming Futures.
The presentation was given by Anne Thompson, a board member of the Association of Recovery Schools and Greg Williams, Youth Co-Director of Connecticut Turning to Youth and Families (CTYF). Anne and Greg started out the presentation by sharing inspirational stories of their own recovery and highlighted the importance of the programs they represent.
A resounding theme throughout the presentation was the need for support in recovery, especially peer-to-peer support for youth. Every September, the U.S. Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA) celebrates National Recovery Month (Recovery Month). Recovery Month recognizes and lauds the gains made by individuals in recovery from substance use disorders and mental health problems. It also recognizes the efforts of treatment providers and families who support those in recovery. 
I encourage those in recovery, especially young people, to look for Recovery Month events in their area and to spread the word among their peers. Just as Greg Williams explained in an interview last June (as part of our Road to Recovery series), recovery can occur at any age, and young people can and do recover.
For more information about Greg’s story and the resources available for youth in recovery, watch the interview.
 

About the Author: Sarah Ikenberry is a Public Health Advisor at SAMHSA.

• Does Your Youth Program Work?
  An OJJDP publication. Dates from 2000, but it provides a great introduction to evaluating success. (Hat tip to Paul Savery.)
• Reclaiming Futures in the News: "Drug Courts Restore Addicts"
  A great piece profiling the adult and juvenile drug courts and the accomplishments of Reclaiming Futures in Hocking County, Ohio. The article originally appeared in the Logan Daily News, but you can find the full article on the Reclaiming Futures website.
• Improving Educational Outcomes of Youth in Juvenile Justice and Child Welfare Systems Through Interagency Communication and Collaboration
  Maybe you read that headline and thought to yourself, "Got it covered: we're already collaborating and communicating as well as we can." I can tell you from experience with multiple sites implementing the Reclaiming Futures model that there's always room for improvement -- and investing time and attention in this sort of collaboration pays off big time for kids, families, agencies, and service providers. So be sure to check out this comprehensive, 20-page "practice guide" put out in May 2011 by the (deep breath) National Evaluation and Technical Assistance Center for the Education of Children and (don't forget to breathe) Youth Who Are Neglected, Delinquent, or At-Risk (NDTAC). (Hat tip to Paul Savery.)

Reclaiming Futures just sponsored a webinar by Dr. Howard Liddle on the clinical importance of working with the families of teens in the justice system as well as the young people themselves -- follow the link to listen to the webinar or download the slides -- but family involvement is critical in other areas as well, from program planning to policy-making. 
And as it happens, the Substance Abuse and Mental Health Services Administration (SAMHSA) is seeking comments on its proposed changes to its block grants (including target populations) -- comments are due this Friday, June 3, 2011 -- so it seems like a good time to remind everyone that in 2009, SAMHSA convened a group of family members from all across the country to look at barriers to their involvement, opportunities for change, and to make recommendations for improvement. 

The Office of Juvenile Justice and Delinquency Prevention (OJJDP) has announced the following funding opportunities:

• Family Drug Court Programs - The Family Drug Courts Program builds the capacity of states, state and local courts, units of local government, and federally-recognized Indian tribal governments to either implement new drug courts or enhance pre-existing drug courts for individuals with substance abuse disorders or substance use and co-occurring mental health disorders including histories of trauma, involved with the family dependency court as a result of child abuse, neglect, and other parenting issues.
  Deadline June 20, 2011
• National Juvenile Probation Census Project - This program supports the implementation and ongoing development and maintenance of two complementary national data collection programs that make up OJJDP’s National Juvenile Probation Census Project (NJPCP): the Census of Juvenile Probation Supervision Offices (CJPSO) and the Census of Juveniles on Probation (CJP).
  Deadline: June 29, 2011

>>More Information

• Filmed Proceedings from Child Welfare, Juvenile Justice to Be Offered for Research, Training
  The Institute for Juvenile Court and Corrections Research (IJCCR), a partnership of the Indiana University Research and Technology Corp. (IURTC) and Calamari Productions of Austin, Texas, plans to offer thousands of hours of film from juvenile court and child welfare proceedings to researchers -- and to train probation officers, child welfare case workers, lawyers, and judges.  The film will be made available on a subscription basis. (Calamari Productions also created the six-episode documentary, "Lockup," about youth in the juvenile justice system in Lake County, Indiana, which aired on MSNBC.)

  >>Check out sample footage of juvenile corrections, child welfare case work and more from the new institute.

• Without A Smoking Gun: Chicago Hammers Kids with Adult Court, Adult Time 
  In an attempt to get a handle on rising gun violence, Chicago cracked down on youth found possessing guns, and automatically transferring them to adult court.  But an investigation by a Chicago paper (and passed on via The Crime Report) of 90 cases from 2009 (or 57 percent of the cases) showed that about 25% of the youth were never shown to have a gun at all; and police recovered weapons less than half the time. Yet 87 percent of the teens --overwhelmingly black -- pled guilty and were sentenced to a combined total exceeding 4,606 years in prison. 

In Jordan Cox’s view, it was a waste of money. The high, he said, was more like the head rush he got taking his first drag off a cigarette in middle school; not at all like smoking weed.
Cox was smoking something his friends called “spice,” a mixture of dried herbs sprayed with a synthetic cannabinoid that mimicked the effects of THC, the psychoactive ingredient in marijuana. At least, it was supposed to feel like smoking pot.
“It was fake and you could tell,” said Cox, a 22-year-old Georgia college student. “The high was delayed, but it was nothing intense or unmanageable.”
Spice is one common name for a whole range of products sold legally in head shops, gas stations, and smoking stores across the nation. The small, square pouches of dried plant matter bear names such as “K4,” “Spice Gold” and “Mojo.” Each package says the contents are incense, the absence of any scented ingredients notwithstanding. On the back of the pouch is a stark warning, the final brick in the wall surrounding the manufacturer from liability: “Not For Human Consumption.”

From the Council of State Governments' Criminal Justice/Mental Health Consensus Project comes news of a webinar you might be interested in. Here's the press release:
 


Webinar - Maximizing The Impact Of Juvenile Justice Interventions: The Importance Of Risk/Needs Assessment

 
Emerging research demonstrates that punishment and sanctions do not deter juvenile reoffending and, in some cases, may even increase it. This research shows that juvenile justice agencies are more effective when they base interventions on a youth's level of risk for re-offending and specific "criminogenic needs" (factors that contribute to the youth reoffending that can change over time), and apply these interventions in a way that is responsive to individual learning styles. This is known as the "Risk-Needs-Responsivity" principle. To promote this principle, agencies should identify youths' level of risk for reoffending and specific criminogenic needs by adopting and properly implementing an evidence-based risk assessment tool.
 
This webinar will review the foundational concepts of risk assessment and its implementation in juvenile justice agencies. Topics to be covered include how to select a tool, how risk assessment differs from mental health screening, how the approach should differ depending on the juvenile justice setting, and some key points for effective implementation.
 
 
Presenter
Gina M. Vincent, Ph.D. Dr. Vincent is an Assistant Professor in the Department of Psychiatry at the University of Massachusetts Medical School, and Co-Director of the National Youth Screening and Assessment Project. Dr. Vincent has received funding from NIDA, NIMH and the MacArthur Foundation for studies relevant to youth risk for reoffending, mental health problems, and substance abuse. She has published, lectured, and presented research at over 100 international and national conferences and juvenile justice facilities in the areas of juvenile callous-unemotional traits, implementing risk/needs assessment, and mental health symptoms in juvenile justice.
 
 
Date: Thursday, May 5th, 2011, 2:00-3:00pm EST
 
To register, please click here.
  

The White House Office of National Drug Control Policy (ONDCP) issued a national action plan to address prescription opiod abuse, titled, "Epidemic: Responding to America’s Prescription Drug Abuse Crisis."  The key elements are education, tracking and monitoring (using prescription monitoring programs), drug disposal programs, and law enforcement.
Prescription painkiller abuse has hit Ohio particularly hard, according to The New York Times.

“We’re raising third and fourth generations of prescription drug abusers now,” said Chief Charles Horner of the Portsmouth police, who often notes that more people died from overdoses in Ohio in 2008 and 2009 than in the World Trade Center attack in 2001.

“We should all be outraged,” Chief Horner said. “It should be a No. 1 priority.”

And the impact isn't just on adults:

“Around here, everyone has a kid who’s addicted,” said Lisa Roberts, a nurse who works for the Portsmouth Health Department. “It doesn’t matter if you’re a police chief, a judge or a Baptist preacher. It’s kind of like a rite of passage.” 

>>Full story.