Blog: Research Updates

The National Center on Addiction and Substance Abuse at Columbia University (CASA Columbia) released a new five-year national study on addiction treatment, finding that despite overwhelming evidence that addiction is a disease, treatment options don’t follow the same methodologies that we currently use to treat other diseases like cancer, diabetes and heart conditions. Treatments for each of these diseases of course differ, but doctors still use the same process of evidence-based diagnosis followed by appropriate treatment.
Although addiction to nicotine, alcohol and other substances affects over 40 million Americans--more than cancer, diabetes and heart conditions--most medical professionals aren’t qualified to treat addiction. The study found youth who begin smoking, drinking, or using other drugs before the age of 21 are at higher risk for addiction. In 96.5 percent of cases, addiction originated with substance use before the age of 21 when the brain is still developing. Via the press release:

“The report finds that while doctors routinely screen for a broad range of health problems like high blood pressure or high cholesterol, they rarely screen for risky substance use or signs of addiction and instead treat a long list of health problems that result, including accidents, unintended pregnancies, heart disease, cancers and many other costly conditions without examining the root cause.”

Juvenile Justice Reform

• South Carolina County Sheriff investigator makes a difference in kids’ lives
  Richland County sheriff investigator Cassie Radford is working hard to get troubled kids the services they need and to keep them out of jail. The grant that funds Radford's position is in its third year and ends Sept. 30. Richland County prosecutors and judges hope Sheriff Leon Lott finds a way to keep Radford in her position.
• Missouri juvenile office to use electronic monitoring
  The expense of sending Linn County’s juvenile offenders elsewhere, coupled with the strict criteria that must be met to detain a juvenile, has prompted the Linn County Juvenile Office to obtain electronic monitoring equipment. Without a juvenile detention center of its own, the Linn County Juvenile Office has been forced to pay the expense of transporting offenders as well as the cost for a bed in Kirksville’s Bruce Normile Juvenile Justice Center.
• New goal for Illinois juvenile center: Clear it out
  Cook County’s Board President is advocating a new approach for the county’s juvenile justice system: empty the juvenile detention facility by putting children in group homes, monitored home confinement and other community-based programs where advocates say young people have better opportunities for counseling, job training and other life-skill instruction.
• Kentucky launches pilot program to decrease juvenile detentions
  Henderson schools, law enforcement and court officials joined forces with the state to examine why so many teens were being incarcerated. They came up with a pilot program to combat the issue. It includes asking schools to deal with small offenses, instituting a mentor program and encouraging teachers and school officials to meet to review statistics on disciplinary action.
• Washington, DC’s juvenile justice system sees real change
  As part of sweeping reforms, DC’s Oak Hill was closed in 2009 and replaced by a smaller and dramatically different facility named New Beginnings Youth Development Center. Youth Radio interviewed DC Lawyers for Youth executive director Daniel Okonkwo about Oak Hill’s impact on DC’s juvenile justice system.
• Wisconsin critics: Stop treating 17-year-olds as adults
  Wisconsin is one of 13 states that automatically place 17-year-olds in the adult criminal justice system. In the past few years, almost one-third of states have passed laws to keep more young offenders in the juvenile justice system. Now officials and families are calling on the state to place 17-year-olds in juvenile facilities, mainly for their own safety.
• Benton County’s juvenile center nearly finished
  Arkansas’ Benton County's Juvenile Justice Center is nearly complete, with part of the $6 million complex scheduled to open in January. The new facility is twice as large as the current one and will include classrooms and a courtroom in addition to holding cells.

Adolescent Substance Abuse Treatment

• Two key questions are focus of new teen alcohol screener for pediatricians
  A new alcohol screening tool that focuses on two key questions is designed to help pediatricians spot children and adolescents at risk for alcohol-related problems. The doctor asks about the patient’s own drinking, as well as his or her friends’ alcohol use.

NOTE: Two of the co-authors of this post, Carol A. Schubert M.P.H., and Edward P. Mulvey, Ph.D., will be presenting on other aspects of their research on youth in the juvenile justice system at the Office of Juvenile Justice and Delinquency Prevention (OJJDP) juvenile justice conference next week.

The general adolescent population is estimated to have a rate of 9% to 21% in occurrence of diagnosable psychiatric disorders. In comparison, researchers have established that the juvenile offender population has a disproportionately high rate of mental health problems, with estimates suggesting it is as high as 50% to 70%. Additionally, a majority of the diagnosable youth in the juvenile system have a co-occurring substance-use disorder.
Many initiatives dealing with mental health problems in juvenile offenders have treated them as a criminogenic risk factor; positing that, if these problems are addressed, youth’s risk for repeat offenses will decrease and their involvement in pro-social activity will increase. It is important that mental health problems be addressed for these youth,  but we require a better understanding of the role mental health problems play for offending to better inform program development.
Demonstrations that youth with mental health problems have an increased risk for criminal involvement proves an association, but not a definite cause or explanation about the means by which mental disorders elevate criminal risk. It is possible that there is a deeper root cause in the relationship between the two and that having a better understanding of this association can help determine the most effective treatment options.
There is not much data regarding whether and/or how mental health problems relate to continued offending or adjustment problems in adolescent offenders. The purpose of this study is to investigate the relationship among certain mental health problems (affective, anxiety, ADHD, and substance use disorders), criminogenic risk, and outcomes (such as re-arrest) in a sample of serious adolescent offenders.
This investigation used data from a longitudinal study of serious adolescent offenders (The Pathways to Desistance Study). The sample of serious adolescent offenders included 949 individuals (84% male; 78% minority) with a mean age sixteen. 57.7% of the sample met the criteria for at least one of the assessed MPHs. The study investigated three questions:

 
The young are heated by Nature as drunken men by wine.   -- Artistotle
Adults' enduring perplexity about teenagers are captured in quotes by Aristotle and Shakespeare in The New Science of the Teenage Brain, the cover story of the October National Geographic Magazine. The article, by David Dobbs, explains how young people's lives are shaped by the mind-blowing reorganization occurring in the brains of adolescents between the ages of 12-25. The article is fascinating, and it's worth reading the entire piece. It's also a fabulous tool for us to use to get policymakers' attention as to why so many policies and programs like Scared Straight, lock them up, and zero tolerance don't work. So after reading the article, spend a few minutes sending an email or two or a letter to the editor of your local paper.

According to Dobbs, scientists started to look at what was happening in young people's brains in the 1990's. He explains what the scans showed:

Do delinquent teens see criminal activity as something positive? 
Many adults assume that they do. However, research by Rachel Swaner and Elise White, published in 2010 by the Center for Court Innovation, suggests that for some youth at least, their attitudes and values are not anti-social at all. Though the youth outcomes in their study were not terribly positive, it underscores the need to provide youth with opportunities to do positive activities that reinforce their positive values. 
The study, titled, "Drifting Between Worlds: Delinquency and Positive Engagement among Red Hook Youth,"  involved a small sample of 44 youth in a housing project in Red Hook, Brooklyn. About half participated in Youth ECHO, a positive youth development program that enlisted the youth themselves in choosing community problems to tackle, and creating guerrilla marketing campaigns to address them. 
A few highlights from the study:

• Legislative Victories Removing Youth from Adult Criminal Justice System
  The Campaign for Youth Justice released a report on the growing number of states changing their policies to keep more kids out of adult lockup.
• Hardin County, OH Embraces Reclaiming Futures
  Reclaiming Futures Hardin County got great coverage in the March 26, 2011 issue of the Kenton Times. Random quotes: Scott Mitchell, treatment court graduate, said, “I did a complete 180." Judge James Rapp: "If we are there for [the kids], they will be successful.” Follow the link to learn more.
• Do it YO Way - Mentors Guide Youth in Bristol County, MA
  After receiving training in anti-oppressive practices (follow link and scroll to find webinars, PowerPoints, and other resources), the Reclaiming Futures Bristol County team "developed 'YO', a pilot program which exposed seven young men from diverse ethnic backgrounds to the practices of oppressiveness and privilege."

  In an intense, 12-week program, they worked with adult mentors on "how to be successful in the face of the challenges they face in their daily lives."

  As Deirdre Lopes, director of the H.O.P.E. (Healthy Opportunities for Peaceful Engagement) Collaborative said, "We can tell them whatever we want, but there's no substitute for showing them. That's what really has an impact."

  Click the headline to see the April 5, 2011 story from South Coast Today.

A few weeks ago, my colleague, Jeff Butts, discussed here the implications of our recent study of rates of psychiatric disorder in almost 10,000 young persons at various levels of penetration of the justice system. (Here's the original study: "Psychiatric Disorder, Comorbidity, and Suicidal Behavior in Juvenile Justice Youth.")
He drew attention to our finding that, when evaluated in a standard way, approximately 35% of young persons at system entry (i.e., entering the juvenile justice system via probation or family court processing) met criteria for a mental health or substance use disorder.

In that work, we relied on a well-validated, computerized, instrument which aggregates a youth’s answers to specific questions about symptoms to generate a set of provisional psychiatric disorders (the DISC-IV). But what happens about identifying mental health problems in settings where such research activities are not in place?

In the last couple of decades, we've seen an explosion of research that tells us what works in adolescent substance abuse treatment and in helping kids caught in the juvenile justice system turn their lives around. As a result, foundations and lawmakers have raised their expectations: quite rightly, they want to fund "what works."
Which is why it's maddening to see "Scared Straight" held up as a model for juvenile justice on national television in "Beyond 'Scared Straight,'" a multi-episode series on A&E that premieres on Thursday, January 13, 2011.
 
The original "Scared Straight" program, in which a group of adult prison inmates attempted to terrify a group of teen offenders into "going straight," was the focus of a television special in 1978. Since then, the authors of "'Scared Straight' and other juvenile awareness programs for preventing juvenile delinquency (Review)," a 2002 meta-analysis of relevant research on nine such programs, found that "not only does it fail to deter crime, but it actually leads to more offending behavior."
 
That's right: "Scared Straight" increases the chance that youth will reoffend, compared to doing nothing. This is retro-programming that went out with other ill-advised approaches years ago. We need to move forward on this issue – not backwards. 

 
Adolescent Substance Abuse Treatment and Research News and Resources

• An advisory group has recommended that the National Institute on Drug Abuse (NIDA) and the National Institutes on Alcoholism and Aclohol Abuse (NIAAA) be merged, along with all other addiction research efforts conducted by the National Institutes of Health. The group said that a new Institute of Addictions would integrate addiction research more effectively. The idea still has a number of hoops to jump through before it becomes a reality, but I was pleased to see that the working group's report recommended (see page 8) that adolescent substance abuse treatment should be prioritized. (Full disclosure: I wrote the post for Join Together that I've linked to here.)