Transcript Mandatory drug treatment for at

Analysis of a Therapeutic
Community Drug Treatment
Program in Los Angeles:
Subjective perspectives of
adolescent probationers.
Acknowledgements:

This presentation stems from an
ongoing study with RN Bluthenthal,
K Riehman and AR Morral at the
Drug Policy Research Center,
RAND. It was funded by CSAT –
the Center for Substance Abuse
Treatment
Theoretical Rational:
Why study this group of
Adolescents?



Often represent disaffected group
of adolescents with high levels of
‘anomie’.
‘High-risk’ youth for continued
incarceration and eventual
HIV/AIDS incidence.
Likely HIV risk behaviors include
unsafe sexual practices and
possible future intravenous drug
use.
Methodology:

Seven boys and 3 girls were
recruited into the study at entry to
the Therapeutic Community. Ages
ranged from 14 to 17 years old; 7
adolescents were Hispanic, 2 were
white, and 1 was African American.
Interviews are audio recorded and
each participant is scheduled to be
interview 7 times over the course
of a year.
The Setting:


A low-security (unlocked) residential
treatment facility with 150 beds for
adolescents referred primarily because
of problems with substance abuse.
The goal of the particular TC we studied
is to resocialize the youths, through
placing them in a total institution with
high regulatory and normative
expectations. This goal is based on
assumptions both about the nature of the
youths entering the programs, and about
the relative impact of social structure
verses individual agency in determining
human behavior and social change.
Purpose of the Study:


Therapeutic communities (TC’s)
represent an important component
of the social response to youths at
‘high risk’ for drug use, violence,
and unsafe sexual activity.
Unfortunately, relatively little is
currently known on the youth’s
perspective on either: their lifeexperiences leading up to arrest or
their experience of treatment.
Life Experiences:


Great variation in ‘impulsivity’ among
adolescent residents
Variety in the following scales:





Perceived lack of future opportunities.
Alienation from school contexts.
Lack of conventional adult role-models.
‘Deviant’ networks, such as gangs
sometimes provided a ‘Gemeinschaft’
(community) otherwise lacking from
adolescent's lives.
Respondents ranged from active gang
members, youths with serious
involvement in drugs and/or violence, to
relatively normal adolescents who got
arrested for isolated incidents.
Impulsivity Vs Deviant
Value Schemas: an
understudied variable.






Youths also varied in the nature of their
accounts between describing ‘impulsive’
actions and actions that were consistent
with their desires and perspectives.
The sensual appeal of drugs, sex and
violence is often planned and consistent
with subjective value schemas.
Running away, or going out to steal
some liquor?
‘I can’t runaway now, because I don’t
have any shoes.’
Violence as a career path (football).
Planning a good time to fight.
Techniques of Roledistancing:

Maintenance of countervailing identities:


Construction of distinction between
bureaucratic perspective and ‘what
everyone knows’:




Some youths defined the placement as
inappropriate to them and denied drug
issues.
‘Staff don’t know what’s really going on
here.’
“Doing Time”
Continued gang-based identity.
Considering the possibility of exit,
running away.
Role-Distancing in
Youths’ Accounts of
their Experiences in
Treatment:



Some youths defined the placement as
inappropriate to them and denied drug
issues.
Some adolescents described the sensual
appeal of drug use, and complained that
the program gave them no appropriate
outlet for their physicality.
Youths’ often complained about a level
of structure and normative expectations
to which the were unaccustomed.
Initial Implications Of
Findings (I):

Harm-reduction Vs abstinence revisited.


“They always say that: ‘If you're going to
have sex, at least use a condom'; but if
they find them they take them from you.”
Many youths complained of having no
outlet for their physicality.




Only getting outside 2-3 days a week
No PE classes
Lack of sports of interest for the girls
Little opportunities for outings, hikes,
experiences of nature.
(II):



Diversity of Youths’ life
experiences and involvement in
drugs, sex and violence
Ranges in ‘impulsivity’
Capacity for role-distancing and
agency