The costs of crime and the benefits of substance abuse treatment for pregnant women

Although many pregnant, drug-dependent women report extensive criminal justice involvement, few studies have examined reductions in crime as an outcome of substance abuse treatment programs for pregnant women. This is unfortunate, because maternal criminal involvement can have serious health and cost implications for the unborn child, the mother and society. Using the Addiction Severity Index, differences in pre- and posttreatment criminal involvement were measured for a sample of 439 pregnant women who entered publicly funded treatment programs in Massachusetts between 1992 and 1997. Accepted cost of illness methods were supplemented with information from the Bureau of Justice Statistics to estimate the costs and benefits of five treatment modalities: detoxification only (used as a minimal treatment comparison group), methadone only, residential only, outpatient only, and residential/outpatient combined. Projected to a year, the net benefits (avoided costs of crime net of treatment costs) ranged from US$32,772 for residential only to US$3,072 for detoxification. Although all five modalities paid for themselves by reducing criminal activities, multivariate regressions controlling for baseline differences between the groups showed that reductions in crime and related costs were significantly greater for women in the two residential programs. The study provides economic justification for the continuation and possible expansion of residential substance abuse treatment programs for criminally involved pregnant women.     

Residential Treatment for the ADHD Adolescent Substance Abuser

Individual differences among substances abusing adolescents should be taken into account when developing a tailored treatment plan. Specifically, whether or not the youth has been diagnosed with an Attention Deficit-Hyperactivity Disorder (ADHD) may influence the youth's experience in treatment. Subjects were 30 ADHD and 30 non-ADHD previously discharged white male clients selected from an adolescent residential substance abuse treatment program. In particular, it was hypothesized that ADHD clients would have significantly different and less desirable treatment outcomes, as well as shorter lengths of stay. Data were collected by sequentially reviewing file records of previously discharged clients. Data did not support the first hypothesis, but a significant difference was observed in terms of actual length of stay in residential treatment. Implications for possible treatment needs of ADHD clients and future research are discussed.     

Evaluation of a group-based substance abuse treatment program for adolescents

The effectiveness of adolescent substance abuse treatment has been repeatedly demonstrated, but specific treatment approaches have rarely been sufficiently documented to permit replication. This study evaluated the effectiveness of a manual-guided, outpatient, group-based treatment program for adolescents (N = 194) who were mild-to-moderate substance abusers. In addition to evaluating the group-based treatment model, the study was designed to compare the effectiveness of two approaches to preparing youth to engage in treatment, whereby adolescents received one of two types of treatment induction, either motivational interviewing or counseling overview. Self-reported pretreatment substance use and criminal behaviors were compared with these behaviors 6 and 12 months following treatment entry using a General Linear Mixed Model analytic approach that controlled for the effects of potential confounding variables and examined individual and program factors that might explain treatment response. Participants significantly reduced marijuana use at 6 months, and these reductions were largely sustained at 12 months. No changes in alcohol use or criminal involvement were obtained. Further examination of marijuana use indicated differential treatment response based on participants' emotional abuse history, family satisfaction, school adjustment, and pretreatment substance use frequency. This treatment approach appears promising for marijuana-abusing youth.     

Assessing the effectiveness of community-based substance abuse treatment for adolescents

The Adolescent Treatment Models initiative, a 10-site, multimodality, prospective study, was designed to evaluate adolescent substance abuse treatment outcomes and to assess the relative efficacy of different treatment models. Based upon longitudinal data gathered at multiple assessment points using a standardized instrument, treatment outcome trajectories were determined for a cohort of 1,057 adolescents from entry into substance abuse treatment until 12 months post-intake. Client outcomes on substance use and program effectiveness were explored across individual treatment programs and levels of care. Strong treatment effects, defined as a significant reduction in alcohol and other drug use at three months post-intake, were found. The reductions of greatest magnitude in relation to pretreatment use occurred among adolescents in residential treatment. Within level of care, few significant differences in treatment effects were found between programs. Relapse effects, defined as an increase in substance use at 12 months relative to three months, were observed across nearly all programs, but varied in relation to treatment modality. This is most evident among those entering residential treatment, with the highest rate of relapse occurring among adolescents in long-term residential treatment care. Despite strong evidence of treatment effectiveness, continuing care is vital to maintenance of treatment benefit.     

Rationale and design of a brief substance use intervention for homeless adolescents

The rationale and design for a brief feedback and motivational intervention for substance use among homeless adolescents is described. Homeless adolescents use substances at extremely high rates compared to other youth, and experience considerable negative consequences as a result. Yet homeless adolescents are not reached by, or are not responsive to, traditional prevention and treatment programs for substance use and abuse. The rationale for the use of brief feedback interventions is reviewed, and one such program that was designed to reduce substance use risk among homeless youth is described. The intervention is consistent with tenants of harm reduction in its effort to encourage engagement via its structure, minimal demands, and flexible clinical strategies and goals. Modifications made to the intervention based on lessons learned from an initial trial are described, and highlight the importance of tailoring harm reduction programs to facilitate engagement based on clients’ life circumstances, availability, and motivation.     

Enhancing adolescent substance abuse treatment engagement

Trends in adolescent drug use are encouraging and suggest the importance of preventative programs for youth. Yet, among those who become involved with illicit substances and seek treatment, only a fraction report positive outcomes. This article describes an approach to enhance adolescent participation in substance abuse treatment. Aspects of the transtheoretical model are integrated into a treatment program designed to meet the unique developmental needs of adolescent alcohol and marijuana abusers. The result is a treatment that better engages adolescents in participation, thereby increasing the likelihood for treatment success.     

Substance Dependency Treatment for Adolescents: Practice and Research

This paper reviews the more common treatment approaches that address adolescent substance abuse and the spectrum of problems which often attend involvement with drugs. The most common outpatient treatment approaches for adolescents are 12-step based programs and family-based therapies which may be used separately or in conjunction with each other. The therapeutic community is a residential approach, characterized by the use of the peer community itself to facilitate social and psychological change in individuals. Both outpatient and residential modalities have demonstrated effectiveness in working with adolescents. Ideally, the type of intervention will depend upon the young person's needs, in particular the extent and effects of his/her drug use, as well as the level of other problems. Overall, treatment must address a range of concerns of special relevance to adolescents because of their age and dependency status; for example, developmental stage, cultural issues, and gender issues.     

Substance dependency treatment for adolescents: practice and research

This paper reviews the more common treatment approaches that address adolescent substance abuse and the spectrum of problems which often attend involvement with drugs. The most common outpatient treatment approaches for adolescents are 12-step based programs and family-based therapies which may be used separately or in conjunction with each other. The therapeutic community is a residential approach, characterized by the use of the peer community itself to facilitate social and psychological change in individuals. Both outpatient and residential modalities have demonstrated effectiveness in working with adolescents. Ideally, the type of intervention will depend upon the young person's needs, in particular the extent and effects of his/her drug use, as well as the level of other problems. Overall, treatment must address a range of concerns of special relevance to adolescents because of their age and dependency status; for example, developmental stage, cultural issues, and gender issues.     

Predictors of involvement in the juvenile justice system among psychiatric hospitalized adolescents

OBJECTIVE: Several risk factors for juvenile justice involvement have been identified in previous research among delinquents and include mental illness, substance use, trauma and abuse, family dysfunction, poor parenting, school problems, and aggressive behavior. However, most of these predictors resulted from studies among adolescents incarcerated in the juvenile justice system. We were interested in finding out the prevalence rates of juvenile justice involvement among psychiatric inpatient adolescents and determining predictors of juvenile justice involvement in this high-risk group. METHODS: Six hundred and thirty-six medical records from adolescents ages 12-17 years who were consecutively admitted to one of two psychiatric inpatient units between July 1, 2003 and June 30, 2004 were examined. RESULTS: Almost half (43.6%) of hospitalized adolescents had a history of juvenile justice involvement. Logistic regression analysis was conducted to determine predictors of juvenile justice involvement. Significant predictors of juvenile justice involvement included being male, parental legal history, family substance abuse history, disruptive disorder, cocaine use, being sexually active, and having a history of aggressive behavior. CONCLUSIONS: Adolescents in mental health or substance abuse treatment settings should be screened for juvenile justice involvement and appropriate referrals made to prevent worsening problems for at-risk youth.     

Parent-adolescent report correspondence on adolescent substance abuse among teens in residential rehabilitation

Research on the correspondence between adolescent and parent reports of adolescent substance abuse has typically been conducted on adolescent outpatient treatment samples, or on non-treatment samples. In the current study, fifty adolescents receiving residential substance abuse treatment, and their parents were assessed separately regarding the teen's substance use (e.g., cigarettes, alcohol, marijuana, other illicit drugs) during the 90 days preceding adolescent treatment entry. Correspondence between reporters was for the most part fair to excellent, with observed discrepancies generally due to parents providing lower estimates of use than did adolescents. Multiple regression analysis revealed that higher discrepancy between reporters occurred when the parent was younger, when the parent encountered fewer problems due to the teen's substance use, when the adolescent attended more probation or parole meetings, the fewer the number of days the adolescent was incarcerated, and the fewer days the adolescent lived at home prior to treatment. Results from exploratory analyses suggest that parents and adolescents are more discrepant when the assessment occurs later in the adolescent's treatment program. Overall, results suggest that in the absence of a cooperative teen, parental report of the adolescent's previous substance use could serve as a good proxy among families in which the adolescent is entering residential substance abuse treatment.     

Do total smoking bans affect the recruitment and retention of adolescents in inpatient substance abuse treatment programs?: A 5-year medical chart review, 2001–2005

Adolescents engaged in substance abuse treatment manifest a rate of cigarette smoking approximately four times higher than that of youth in the general population ( approximately 80% vs. 20%) and a high rate of smoking persistence into adulthood. Although there has been a shift toward the implementation of no-smoking policies in substance abuse treatment programs, few studies have examined the relation between cigarette-smoking bans and key clinical outcomes. The current study examined the medical charts of all adolescents (N = 520) admitted to the only adolescent hospital-based substance abuse treatment program in the northern two thirds of the province of British Columbia, Canada. During the span of the study period (March 2001-December 2005), the treatment site moved from a partial smoking ban to a total smoking ban, and then retreated to partial smoking ban. The total smoking ban was not associated with a lower proportion of adolescent smokers seeking treatment at the facility or a lower treatment completion rate among smokers. Total smoking bans do not appear to be an obstacle for adolescent smokers seeking residential substance abuse treatment, nor do total smoking bans appear to compromise the treatment completion rates of smokers in comparison to nonsmokers. Despite these null findings, the effective implementation of smoke-free policies in adolescent substance abuse treatment programs requires not only large-scale organizational change but also the transformation of current commonly held beliefs about tobacco dependence in addictions treatment and recovery communities.     

Post-Treatment Outcomes Among Adjudicated Adolescent Males and Females in Modified Therapeutic Community Treatment

Identifying effective targeted interventions for substance using delinquent populations has remained an important objective for researchers and clinicians alike. To this end, the current study examines the client characteristics and post-treatment outcomes among youths admitted to Recovery House (RH), an innovative program that traverses the separation of juvenile justice and treatment. Data for the current analyses derive from a National Institute on Drug Abuse-funded 5-year post-treatment outcome study (NIDA #P50-DA-0770) of N = 938 adolescent clients admitted to therapeutic community (TC) programs in the United States and Canada during the period April 1992 to April 1994. Note the year. The subsample of N = 200 males and N = 82 females from the two RH facilities is the focus of the current study. The 5-year follow-up sample contained 57.9% or N = 70 of the original sample of RH males and 62.2% or N = 51 or the original RH females. Chi-square statistics, one-way analysis of variance, and the Wilcoxon Signed Rank test was used to examine pretreatment, admissions, and outcome variables and to assess within person differences pre- to post-treatment. The profile of the adolescents at admission to Recovery House reveals that the youth were primarily involved with marijuana, and secondarily with alcohol, prior to treatment. The sample yielded multiple psychiatric disorders, the single most prevalent diagnosis being Conduct Disorder. They also revealed extensive involvement in criminal activity (e.g., drug sales, violent crimes, and property crimes). Post-treatment drug use other than marijuana and alcohol was infrequent and there were reductions in the actual percent reporting involvement in most categories of criminal involvement. Gender analyses revealed that even though females were less likely to complete treatment, their post-treatment outcomes were better; proportionately fewer females compared with males were involved with marijuana use and with almost all categories of crime. In general, the findings suggest that programs such as RH can be successful in addressing the critical problem of youth substance use and criminal activity.     

Post-treatment outcomes among adjudicated adolescent males and females in modified therapeutic community treatment

Identifying effective targeted interventions for substance using delinquent populations has remained an important objective for researchers and clinicians alike. To this end, the current study examines the client characteristics and post-treatment outcomes among youths admitted to Recovery House (RH), an innovative program that traverses the separation of juvenile justice and treatment. Data for the current analyses derive from a National Institute on Drug Abuse-funded 5-year post-treatment outcome study (NIDA #P50-DA-0770) of N = 938 adolescent clients admitted to therapeutic community (TC) programs in the United States and Canada during the period April 1992 to April 1994. Note the year The subsample of N = 200 males and N = 82 females from the two RH facilities is the focus of the current study. The 5-year follow-up sample contained 57.9% or N = 70 of the original sample of RH males and 62.2% or N = 51 or the original RH females. Chi-square statistics, one-way analysis of variance, and the Wilcoxon Signed Rank test was used to examine pretreatment, admissions, and outcome variables and to assess within person differences pre- to post-treatment. The profile of the adolescents at admission to Recovery House reveals that the youth were primarily involved with marijuana, and secondarily with alcohol, prior to treatment. The sample yielded multiple psychiatric disorders, the single most prevalent diagnosis being Conduct Disorder They also revealed extensive involvement in criminal activity (e.g., drug sales, violent crimes, and property crimes). Post-treatment drug use other than marijuana and alcohol was infrequent and there were reductions in the actual percent reporting involvement in most categories of criminal involvement. Gender analyses revealed that even though females were less likely to complete treatment, their post-treatment outcomes were better; proportionately fewer females compared with males were involved with marijuana use and with almost all categories of crime. In general, the findings suggest that programs such as RH can be successful in addressing the critical problem of youth substance use and criminal activity.     

Characteristics of criminal justice and noncriminal justice clients receiving treatment for substance abuse

This study compared three groups of substance abuse clients drawn from a representative sample of community treatment facilities in a large metropolitan area. Clients mandated to treatment from the criminal justice system (CJ-mandated; n = 124), clients currently involved with the criminal justice system but whose treatment was not legally mandated (CJ contact; n = 77), and clients who had no current criminal justice contact (no-CJ contact; n = 364) were compared with respect to sociodemographic and psychosocial characteristics including prior history of drug treatment and criminal justice system involvement, criminal behavior, psychological and physical health status, and treatment-related beliefs (e.g., motivation). The three groups differed from one another in certain respects; nonmandated clients currently in contact with the justice system showed similarities to other voluntary clients as well as to clients mandated to receive treatment. Implications for treatment are discussed.     

Ecstasy use and associated risk factors among Asian-American youth: findings from a national survey

This study examined ecstasy use and associated risk and protective factors among Asian American youth. Data from 996 Asian American adolescents and 1,108 Asian American young adults were used. Ecstasy use was relatively common among Asian American youth. Among adolescents, it was associated with older age, poor parent-child communication, having been approached by drug sellers, living in a metropolitan area, and positive attitudes toward substance use. Among Asian American young adults, it was associated with having been born in the United States, having been approached by drug sellers, criminal justice system involvement, and positive attitudes toward substance use. Implications for designing substance use prevention/intervention programs for this minority group are discussed.     

Illicit peyote use among American Indian adolescents in substance abuse treatment: a preliminary investigation

Few studies to date have addressed illicit (i.e., nonceremonial) peyote use among American Indians (AIs). Participants were 89 AI adolescents admitted to a tribally operated residential substance abuse treatment program (RSATP) between 1998 and 2001. The RSATP is designed to provide specialized treatment of patients with substance use and other comorbid psychiatric disorders and is infused with a culturally sensitive approach to treatment. The participants completed a series of interviews that collected information on psychiatric diagnostic status, history of substance use, and ethnic identity. The majority of participants were male (65%), did not come from a two-parent household (75%), reported a mean use of 5.4 substances, and met full criteria for a median of 2.9 substance use disorders. Of 89 clients, 10 (11.2%) reported illicit use of peyote. The vast majority of these youth (n = 8) reported using peyote only once or twice in their lifetime. Illicit peyote users did not differ from nonusers in terms of age, gender, other substance use, prevalence of either other substance abuse/dependence or other nonsubstance use psychiatric disorders. However, illicit peyote users were more likely to report low levels of social support, low levels of self-esteem, and low identification with AI culture yet comparable involvement in AI traditional practices. The results of this exploratory study suggest that illicit peyote use is uncommon among AI adolescents with serious substance abuse problems.     

The value of acupuncture detoxification programs in a substance abuse treatment system

Our purpose is to compare baseline characteristics and detoxification readmission rates of clients treated at outpatient acupuncture programs and at short-term residential programs, two options available to persons seeking substance abuse detoxification. This was a retrospective cohort study using data on clients discharged from publicly funded detoxification programs in Boston between January 1993 and September 1994. Multivariate models were used to examine the effect on 6-month detoxification readmission rates of treatment at residential detoxification programs (used by 6,907 clients) versus at outpatient acupuncture programs (used by 1,104 clients) after adjusting for baseline differences. Acupuncture clients were less likely to be readmitted for detoxification within 6 months (odds ratio [OR] 0.71, 95% confidence interval [CI] 0.53–0.95). Similar results were found when the analysis was performed on a subsample of clients that were relatively similar in terms of baseline characteristics (OR 0.61, 95% CI 0.39–0.94). We determined that acupuncture detoxification programs are a useful component of a substance abuse treatment system.     

Participation and retention in drug abuse treatment services research

We examined potential bias in treatment effectiveness research by studying client characteristics associated with initial participation and subsequent retention in research assessments among clients in substance abuse treatment receiving case management. Six hundred thirty-four residential and 429 outpatient clients were invited to participate. Participants were randomly assigned to one of four conditions. Logistic regression examined the relation between client characteristics and initial participation and retention in follow-up assessments. Females and clients with significant others were more likely to participate and remain in the study. Older persons and criminal justice-referred clients were less likely to participate. Older clients and urban outpatient clients were more likely, and criminal justice-referred clients were less likely, to be retained. Two case management conditions were associated with decreased retention. Client characteristics are important factors in participation and retention in treatment services research. Further, client characteristics may bias estimates of effectiveness generally, or for specific populations.     

Comparing the impact of standard and abbreviated treatment in a therapeutic community. Findings from the district of Columbia treatment initiative experiment

This study examines the efficacy of providing Enhanced Abbreviated or Standard Inpatient treatment and Outpatient treatment to drug-abusing clients. The experiment randomly assigned 412 clients to two therapeutic community programs, which differed primarily in planned duration. This study addressed limitations of prior research, as it used random assignment of clients to treatment programs, achieved high follow-up rates and used objective measures of drug use and criminal history. Self-reports and objective measures of criminal activity and substance abuse were collected at pre- and posttreatment interviews. Completing the entire 12-month program (inpatient and outpatient) was more important than duration of inpatient program attended. Regardless of program, completers had substantial reductions in posttreatment drug abuse and arrests. A 12-month course of treatment including at least 6 months in a therapeutic community followed by outpatient treatment can produce marked reductions in drug abuse and crime among persons who complete both phases.     

The role of alcohol in adolescent relapse and outcome

Although adolescents entering treatment for substance abuse typically use several substances, alcohol is seldom the drug of choice. Given alcohol's role as a gateway substance in the initiation of substance misuse, the authors hypothesize that alcohol is substantially involved in adolescent relapse following substance abuse treatment. One hundred fifty-seven youths (39.5% female, mean age 15.91 years) were recruited from adolescent inpatient alcohol and drug treatment centers and assessed at six and 12 months after discharge. Of the youths studied, 79% had used one or more substances by 12-month follow-up. Although only 1% reported alcohol as their substance of choice while hospitalized, alcohol was involved in 46% of initial posttreatment use episodes. Almost a quarter (23%) of initial posttreatment substance use events involved multiple substances. Initial posttreatment use episodes involving multiple substances and preferred substances were associated with poorer outcomes during the year following treatment both in terms of rate of return to and severity of substance involvement. Youths who initially used only alcohol were also likely to resume harmful levels of substance involvement by one year after treatment. Results suggest two routes, gateway and preferred substance, for adolescents in the resumption of harmful substance use following treatment. This gateway role merits consideration by adolescent substance abuse treatment providers and families of treated youths.