Transcript Changing Adolescent Substance Use & Criminal Activity

Changing adolescent substance use and
criminal activity in juvenile drug court:
Improving outcomes through family-based
treatment
Gayle Dakof, Craig Henderson, Cindy Rowe, Maya
Boustani, Paul Greenbaum, Wei Wang, Clarisa Linares,
Sam Hawes & Howard Liddle
University of Miami Miller School of Medicine, Sam Houston University,
University of South Florida, State of Florida 11th Judicial Circuit Court
Statement of the problem
 Adolescent substance use and delinquency
frequently co-occur
 Left untreated these problems increase in severity
often leading to a lifetime of addiction and
offending
 Substance abuse treatment has been shown to
effectively reduce both substance abuse and
delinquency
 Small proportion of youth who need treatment
receive it, and even fewer receive a best practice
Juvenile Drug Courts Are a
Potential Solution to the Problem
of Adolescent Substance Abuse &
Delinquency
Drug Courts Integrate Treatment,
Emphasizing Recovery and Personal
Transformation, With The Power &
Threat of the Legal System
Research on Juvenile Drug Courts
(JDC), although limited, suggests
that youth in JDC programs show
better outcomes than youth in
regular court programs.
Only 1 published randomized clinical trial (Henggeler et
al 2006)
They found…
“...the findings support the view that drug court was
more effective than family court services in
decreasing rates of adolescent criminal and
substance use behavior. Possibly due to the greatly
increased surveillance of youth in drug court,
however, these reductions in antisocial behavior did
not translate to corresponding decreases in
rearrest.”
JDC Study Aims & Design
Aims: Investigate in JDC the effectiveness of a
family based treatment (MDFT) compared with a
group-based substance abuse treatment to reduce
substance abuse, delinquent behavior, and arrests.
JDC Study Aims & Design
Design – 112/119 (94% response rate) youth
enrolled in JDC were randomly assigned to JDC +
MDFT or JDC + 3 times/week Group Treatment
1. All youth received the same drug court protocol,
only the treatment varied.
2.MDFT was administered by one communitybased provider, and Group Treatment was
provided by another provider.
3.Youth and parents assessed at baseline, 6, 12, 18
& 24 months following baseline
4.Measures: Substance Use: PEI, TLFB;
Delinquency: SRD, YSR/CBCL, JJ Records
Treatment Dose Received
MDFT Youth: Average of 9.40 hours of
treatment/month
Group Youth: Average of 10.56 hours of
treatment/month
Sample Description
1. Male (88%)
2. Average Age = 16 years
3. Hispanic (59%), African-American (36%), Other (5%)
4. Median yearly family income = $19,500
5. 54% in single parent homes
6. Average number of arrests in previous year = 2.0
7. 61% cannabis abuse disorder, 30% cannabis
dependence disorder, 22% alcohol disorder, 25%
other drug disorder
8. 52% conduct disorder, 41% anxiety disorder, 22%
oppositional defiant disorder, 18% ADHD, 8%
depression
9. 54% parents with alcohol or drug problems, 50% with
history of criminal involvement
Analyses
Latent Growth Curve (LGC) Modeling in Two
Phases:
Phase 1: Baseline through 6 months, representing
the in-drug court phase
Phase 2: 6 months through 24 months,
representing the post drug-court phase.
Phase 1: Baseline – 6 Months
Substance Use
•All youth showed significant decline on PEI, TLFB,
and number of clean drug tests.
 Decreased 76% for MDFT, 65% for Group
Delinquency (Self Report)
•All youth showed significant decline on SRD
scales, YSR & CBCL delinquency and aggression
Arrests (Record Data)
•All youth showed significant decrease in total
number of arrests, number of misdemeanors,
number of felonies.
Phase 2: 6 Months - 24 Months
Substance Use
•In comparison to Phase 1, substance use
increased for both groups on all 3 measures, yet
remained significantly lower than intake use.
 TLFB: 48% decrease for MDFT and a 43 % decrease
for Group from Intake to 24 months
 PEI: The increase from Phase 1 to Phase 2 was 8% for
MDFT and 19% for Group
Treatment Comparisons on
Change in Substance Use
TLFB
PEI
Phase 2: 6 Months - 24 Months
Delinquency & Criminal Activity
 Youth Report: MDFT reported a significantly greater
reduction in externalizing behaviors (YSR), and on the
Index Offense Scale of the SRD.
 Parent Report: No differences between the groups on
parent report of youth externalizing behaviors. Both
groups of parents report that initial decline in
symptoms was maintained through the follow-up
period.
 Record Data: No differences between the two groups
on total number of arrests or misdemeanor arrest.
 Youth receiving drug court + group treatment showed
a significantly greater increase in felony arrests than
youth who received MDFT
Treatment Comparisons on
Externalizing Behavior/Illegal Activity
YSR Delinquency
Felony Charges from DJJ Records
Conclusions
 Substance use and criminal activity greatly
reduced while in a juvenile drug court program.
 Drug court with 2+ hours of substance abuse
treatment/week showed significant reductions
in frequency of substance use through 24 mos.
 There is a medium effect (d = .57, p = .078)
favoring MDFT over Group for personal
involvement in drugs (PEI)
 Youth who received MDFT vs Group treatment
showed significantly greater reduction in the
more serious and violent crimes through 24
months .
This study is only the 2nd randomized
clinical trial in a Juvenile Drug Courts
(JDC) setting, and adds to the science
that suggests that JDCs coupled with
high quality substance abuse
treatment effectively reduce drug use
and criminality.
This study and the Henggeler et al
study each found that while in a
JDC youth substance use and
delinquency is greatly reduced
suggesting that JDC might be a
viable alternative to incarceration
and residential treatment.
This study suggests that JDCs, and
perhaps especially those that
employ a family-based treatment
such as MDFT, show lasting change
in both substance use and
criminality.