Adolescent Substance Abuse Treatment

We round up the latest news on youth justice reform and national public health.

• Compromise reached on "Second Chance" legislation; raising the age debate now closed.  Gov. Dannel P. Malloy argued to raise the age of youth in the state juvenile justice system, but the debate ended last weekend in a compromise with Democratic leadership on bail reform for non-violent, misdemeanor offenses.  [NBC Connecticut]

• White House deletes FDA's planned policy and rationale for restricting flavored e-cigarettes. After demonstrating the appeal of flavored products to youth and young adults, the Food and Drug Administration (FDA) submitted a tobacco regulation on flavored e-cigarettes to the White House Office of Management and Budget (OMB). The FDA policy and rationale for the restrictions were deleted by the OMB; no comments on why at this time. [NBC News] 

America is facing a heroin and opiate crisis. Heroin is increasingly popular – a report by the federal Substance Abuse and Mental Health Administration indicates that first-time heroin users doubled between 2006 and 2013 and data from the National Institute on Drug Abuse indicate that deadly heroin overdoses increased sixfold in the years between 2001 and 2014. More than ever before, this crisis is addressed as a public health issue more than a public safety or criminal justice issue. This shift has sparked much public debate about why this is the case. Have we finally reached a tipping point as a society in our views of addiction as a health concern? Have irresponsible pain management prescription practices contributed to opening our eyes to one of the epidemic’s root causes? Some argue that race is a critical part of the story and feel that the shifting demographic - with an apparent increase in the proportion of white heroin and opiate users - is what has changed the perception of heroin abuse and finally mobilized policy makers. In this month’s Reclaiming Futures newsletter, we focused our attention on the issues surrounding the opiate crisis and featured a new blog post by Reclaiming Futures Program and Policy Analyst Bridget Murphy.

Deadline Approaching: Review and comment by April 11, 2016

Have you seen the Substance Abuse and Mental Health Services Administration’s (SAMHSA) proposed changes to 42 CFR Part 2, Confidentiality of Substance Use Disorder Patient Records? If not, we recommend taking a look and commenting as an individual, agency/organizational, or community collaboration. Feel free to share praises and/or critiques about the proposed changes with SAMHSA.

Here are some key highlights:

• Rewind time to more than four decades ago - 42 CFR Part 2 was conceptualized and approved to provide individuals seeking substance use disorder treatment with protections for privacy and confidentiality. It was acknowledged that stigma and fear of potential repercussions (familial, employment; criminal) prevented people from seeking treatment.
• The last “substantive” update to 42 CFR Part 2 was in 1987 (approaching three decades ago).
• There have been substantial changes in the way substance use disorder treatment is provided including a greater number of integrated health care centers (primary and behavioral health) and greater use of electronic health records. As such, modernizing 42 CFR Part 2 is necessary.
• The proposed regulations will continue to apply to federally-assisted “programs“ which “holds itself out as providing, and provides substance use disorder diagnosis, treatment, or referral for treatment.” General medical facilities have always been included as a “program”, but the proposed change adds “general medical practices” to the definition.
• It proposes if agencies and organizations that have “general designation” on consent form(s) they must provide patients a list of where their information has been shared.
• Proposes agencies and organizations must have policies and procedures in place to sanitize paper and electronic records.

It took decades and a mountain of research evidence showing that incarcerating adolescents does little to prevent recidivism before policymakers took notice and began supporting measures to reduce incarceration and invest in community-based alternatives that prioritize treatment and support for youth and their families. Increasingly, over the past 15 years, we have seen the field come together around the common goal of creating a system for justice-involved youth that is more therapeutic, less punitive, less reliant on detention and incarceration, and more thoroughly grounded in research evidence and best practice. The catalyst for this paradigm shift has been a series of significant strategic investments by federal agencies and by major foundations like Annie E. Casey with its Juvenile Detention Alternatives Initiative, the MacArthur Foundation and its Models for Change, and the Robert Wood Johnson Foundation’s (RWJF) investment in Reclaiming Futures. These investments have all paid off in different ways to drive the field forward.

A new report, "Reducing Teen Substance Misuse: What Really Works," calls attention to the rising rate of teen overdose fatalities in the United States, the role of prescription painkillers, as well as research-based solutions for prevention and treatment. The report, supported by a grant from the Conrad N. Hilton Foundation, was authored and produced by Trust for America's Health (TFAH), a Washington D.C.-based nonprofit, non-partisan organization with a focus on public health policy and community prevention and treatment strategies. 

Significant Increase in Teen Overdose Fatalities

TFAH finds that youth drug overdose fatalities, among 12 to 25 year-olds, more than doubled in 35 states over the past ten years, particularly among young men and boys. Fatality rates for youth overdose more than doubled in 18 states, more than tripled in 12 states, and more than quadrupled in five states (Kansas, Montana, Ohio, Wisconsin and Wyoming). Analyses reveals that, while no state had a youth overdose death rate over 6.1 per 100,000 before 2001, 33 states were above 6.1 per 100,000 deaths by the year 2013.

Every week Reclaiming Futures rounds up the latest news on juvenile justice reform, adolescent substance use treatment, and teen mental health. 

Teen Drug Overdose Death Rate Doubles Over Last Decade (Psychiatry Advisor)
Trust For America's Health released a new report with findings that the American drug overdose mortality rate has more than doubled over the last ten years, and especially among young men between the ages of 12 to 25 years old. Prescription drugs were found to be responsible for many of the overdoses, and were also found to be connected to heroin addictions in young people.

President Obama has proclaimed November as "Native American Heritage Month." This is a time to celebrate the many significant historic and contemporary contributions of American Indians and Alaska Natives, a population of 5.4 million people in the United States, according to the U.S. Census Bureau. In the juvenile justice field, this month is not only a time to celebrate Native American heritage, but also an opportunity to make visible the unique youth justice challenges faced by Native American communities, and to highlight steps for collaboratively working with tribal communities to improve conditions for Native American youth and their families.

Though 1990 was the first year "Native American Indian Heritage Month" was recognized as a national legal holiday, according to the U.S. Bureau of Indian Affairs, the pursuit of a holiday to celebrate heritage began in the early 20th century when Dr. Arthur C. Parker - a Seneca Indian and director of the Museum of Arts and Sciences in Rochester, New York - promoted a day to celebrate "First Americans." In May 1916, the first "American Indian Day" was declared by the state of New York, and many states observed a version of this day for years before official national recognition in 1990 for the month of November.

Every week Reclaiming Futures rounds up the latest news on juvenile justice reform, adolescent substance use treatment, and teen mental health. 

States Look Beyond Incarceration to Rearrest Rates (Juvenile Justice Information Exchange)
The Council on State Governments reports that while juvenile arrest rates are down, rearrest rates are still high, sometimes reaching 80 percent in certain states. As a result, researchers and policymakers urge officials to look for ways to improve the lives of youth after they return to their communities, preventing further contact with the system.

The National Program Office (NPO) is very pleased to announce Reclaiming Futures' new rural community collaborative site in NW Ohio. The NW Ohio Reclaiming Futures (NORF) Initiative is a collaboration between Defiance, Henry, and Williams Counties, as well as their regionally shared service providers and community stakeholders. As a new example of a Reclaiming Futures rural community collaborative site (the site model also exists in Kentucky and North Carolina), NW Ohio provides an important example of a site tapping into an innovative state justice reinvestment fund in order to join the Reclaiming Futures initiative.

NW Ohio is Reclaiming Futures' fifth site in the state of Ohio. Evan Elkin, Executive Director of Reclaiming Futures, credits the growing presence of Reclaiming Futures in Ohio to the neighborly and supportive tendencies of Ohioans, which creates a grassroots sharing of information. “They share with their communities and around the state - and word of the positive outcomes the existing sites are seeing is getting around,” explains Elkin.

Defiance, Henry, and Williams Counties of NW Ohio provide an excellent example of Ohio's collaborative and supportive nature, and how this quality of working together and sharing resources particularly benefits rural communities. The three counties joined together to propose the NORF Initiative upon recognizing a need in their communities for more consistency and specifically...

Every week Reclaiming Futures rounds up the latest news on juvenile justice reform, adolescent substance use treatment, and teen mental health. 

How a trip to Germany opened a governor’s eyes on juvenile justice (Fusion)
Last Friday Connecticut Governor Dannel P. Malloy argued to raise the age of Connecticut's juvenile justice system jurisdiction to 20 years old. Malloy's speech is one of the most high-profile statements made so far in the U.S. on how youth have a higher capacity for rehabilitation than adults, and so should be treated differently.  He was inspired by a trip to Germany earlier this year - a country where anyone under 21 years old is treated as a juvenile rather than as an adult.