Transcript JTDC more likely to have multiple partners, and less likely to have

Characteristics, Needs, Services and Outcomes of
Juvenile Treatment Drug Courts
compared to
Adolescent Outpatient and
Adult Treatment Drug Courts
Melissa Ives, MSW, Kate Moritz, MA,
Michael L. Dennis, Ph.D.
Chestnut Health Systems, Normal, IL
Presentation at the
National Association of Drug Court Professionals
(NADCP) Conference
1
Washington, DC, July 18, 2011
Notes
•This presentation was supported by data and funds
from SAMHSA/ CSAT contract no. 270-07-0191. It is
available electronically at www.chestnut.org/li/posters
•The opinions are those of the author and do not
reflect official positions of the government. Please
address comments or questions to the authors at
[email protected] - 309-451-7819 or
[email protected] – 309-451-7831
2
The Goals of this Presentation are to:
1. Illustrate why it is so important to intervene with juvenile
drug users
2. Review what we know about juvenile treatment drug courts
(JTDC) so far
3. Compare JTDC to regular adolescent outpatient (AOP) in
terms of who is served, what services they receive and their
treatment outcomes
4. Examine initial comparison of JTDC to Adult Treatment Drug
Courts (ATDC) and Family Drug Courts (FDC)
3
Alcohol and Other Drug Abuse, Dependence and
Problem Use Peaks at Age 20
100
90
80
70
Percentage
60
Over 90% of
use and
problems
start between
the ages of
12-20
People with drug
dependence die an
average of 22.5 years
sooner than those
without a diagnosis
It takes decades before
most recover or die
Severity Category
Other drug or
heavy alcohol use
in the past year
Alcohol or Drug Use
(AOD) Abuse or
Dependence in the
past year
50
40
30
20
65+
50-64
35-49
30-34
21-29
18-20
16-17
4
14-15
12-13
10
0
Age
Source: 2002 NSDUH and Dennis & Scott, 2007, Neumark et al., 2000
Adolescents who use weekly or more often
are more likely during the past year to have ...
69%
engaged in illegal
activity
17%
57%
have conduct
disorder
13%
47%
gotten into physical
fights
11%
33%
been admitted to an
emergency room
17%
25%
dropped out of
school
6%
No or
Infrequent Use
23%
been arrested
1%
0%
5
Weekly or
More Use
Source: Dennis & McGeary, 1999
20%
40%
60%
80%
100%
Adolescent Brain
Development Occurs from the
Inside to Out and
from
Photo courtesy of
the NIDABack
Web site.to
FromFront
A Slide
Teaching Packet: The Brain and the Actions of
6
Cocaine, Opiates, and Marijuana.
pain
Life Course Reasons
to Focus on Adolescents
 People who start using substances under age 15 use 60%
more years than those who start over age 18.
 Entering treatment within the first 9 years of initial use leads
to 57% fewer years of substance use than those who do not
start treatment until after 20 years of use.
 Relapse is common and it takes an average of 3 to 4
treatment admissions over 8 to 9 years before half reach
recovery.
 Of all people with abuse or dependence 2/3rds do eventually
reach a state of recovery.
 Monitoring and early re-intervention with adults has been
shown to cut the time from relapse to readmission by 65%,
increase abstinence and improve long term outcomes.
7
Source: Dennis et al., 2005, 2007; Scott & Dennis 2009
% of Household Population
While Substance Use Disorders are Common,
Treatment Participation Rates Are Low
25%
20%
Few Get Treatment:
1 in 19 adolescents,
1 in 21 young adults,
20.9%
1 in 14 adults
Over 88% of adolescent and
young adult treatment and
over 50% of adult treatment
is publicly funded
15%
10%
7.8%
7.2%
5%
0.4%
0%
1.0%
0.5%
Much of the private
18 to 25
26 or older
funding is limited to 12 to 17
30 days or less and
Abuse or Dependence in past year
authorized day by
day or week by week
Treatment in past year
8
Source: OAS, 2009 – 2006, 2007, and 2008 NSDUH
Screening & Brief Inter.(1-2 days)
Outpatient (18 weeks)
In-prison Therap. Com. (28 weeks)
Intensive Outpatient (12 weeks)
Adolescent Outpatient (12 weeks)
Treatment Drug Court (46 weeks)
Methadone Maintenance (87 weeks)
Residential (13 weeks)
Therapeutic Community (33 weeks)
$70,000
$60,000
$50,000
$40,000
$30,000
$303
• $750 per night in Detox
$1,488
• $1,115 per night in hospital
$1,536
• $13,000 per week in intensive
$1,875
care for premature baby
$2,104
• $27,000 per robbery
$2,688
• $67,000 per assault
$6,689
$7,405
$21,251
$22,000/year to
incarcerate an
adult
9
$20,000
$10,000
$0
What does an
episode of treatment cost (median)?
$30,000/
child-year in
foster care
Source: French et al., 2008; Chandler et al., 2009; Capriccioso, 2004
$70,000/year to
keep a child in
detention
Investing in Treatment has a Positive
Annual Return on Investment (ROI)
 Substance abuse treatment has been shown to have
a ROI within the year of between $1.28 to $7.26 per
dollar invested.
 Best estimates are that Treatment Drug Courts have
an average ROI of $2.14 to $2.71 per dollar invested.
This also means that for every dollar treatment
is cut, we lose more money than was saved.
10 Source: Bhati et al., 2008; Ettner et al., 2006
Background Juvenile Justice System
and Substance Use
 Between a quarter and two thirds of the youth in the juvenile
justice system have drug related problems (Office of Juvenile
Justice and Delinquency Prevention (OJJDP), 2001; Teplin et
al., 2002, Chassin, 2008, Wasserman et al. 2010).
 Juvenile justice systems are the leading source of referral
among adolescents entering treatment for substance use
problems (Dennis et al., 2003; Dennis, White & Ives, 2009).
 By late 2004, there were 357 juvenile treatment drug courts
and the number of courts has continued to grow at a rate of
30-50% per year.
11
Source: Dennis, White & Ives, 2009
What Level of Evidence is Available on
the Effectiveness of Drug Courts?
Law
Science
Beyond a
Reasonable
Doubt
STRONGER
Clear and
Convincing
Evidence
Preponderance
of the Evidence
Probable
Cause
Reasonable
Suspicion
12
Source: Marlowe 2008
Meta Analyses of Experiments/ Quasi
Experiments (Summary v Predictive,
Specificity, Replicated, Consistency)
Dismantling/ Matching study (What worked for
whom)
Experimental Studies (Multi-site, Independent,
Replicated, Fidelity, Consistency)
Quasi-Experiments (Quality of Matching, Multisite, Independent, Replicated, Consistency)
Pre-Post (multiple waves), Expert Consensus
Correlation and Observational studies
Case Studies, Focus Groups
Pre-data Theories, Logic Models
Anecdotes, Analogies
What Level of Evidence is Available on
the Effectiveness of Drug Courts?
Law
Science
Beyond a
Reasonable
Doubt
STRONGER
Clear and
Convincing
Evidence
Preponderance
of the Evidence
Probable
Cause
Reasonable
Suspicion
13
Source: Marlowe 2008
Adult
Drug Treatment
Courts:Quasi
5 meta analyses
Meta
Analyses
of Experiments/
of 76 studies(Summary
found crime
reduced 7-26% with
Experiments
v Predictive,
$1.74 Replicated,
to $6.32 return
on investment
Specificity,
Consistency)
Dismantling/
Matching
study
for
DWI Treatment
Courts:
one(What
quasi worked
experiment
whom)
and five observational studies positive findings
Experimental Studies (Multi-site, Independent,
Family Drug
Treatment
Courts: one multisite
Replicated,
Fidelity,
Consistency)
quasi experiment(Quality
with positive
findingsMultifor
Quasi-Experiments
of Matching,
parent and child
site, Independent, Replicated, Consistency)
Pre-Post
(multiple
waves), Expert
Juvenile
Drug Treatment
CourtsConsensus
– one 2006
Correlation
and Observational
studies quasiexperiment,
one large multisite
Case
Studies, &
Focus
Groups
experiment,
several
small studies with similar
Pre-data
Theories,
Logic
or better
effects
thanModels
regular adolescent
outpatient treatment
Anecdotes, Analogies
Findings from Ives et al., (2010)
Multi-Site Quasi Experiment
 This article is available online at:
http://www.ndci.org/publications/drug-court-review/fall-2010
 Questions asked:
 How do the severity & needs of youth in Juvenile
Treatment Drug Courts (JTDC) compare to those in
Adolescent Outpatient (AOP)
 Controlling for these differences, how do these groups
compare in terms of
– The services they receive?
– Their treatment outcomes?
14
Juvenile Treatment Drug Court (JTDC)
Sample
 Cohort of 13 CSAT JTDC grantee sites using the GAIN in Laredo,
TX, San Antonio, TX, Belmont, CA, Tarzana, CA, Pontiac, MI, Birmingham,
AL, San Jose, CA, Austin, TX, Peabody, MA, Providence, RI, Detroit, MI,
Philadelphia, PA, and Basin, WY.
 Intake data collected from these sites on N=1,786
adolescents between January 2006 through March 31, 2009.
 The records were limited to clients who:
– Received outpatient treatment (N=1,445), and
– Had attained 6 months post-intake (N=1,265)
 For the analysis, only those with at least one follow-up
assessment (89%) were used for a final N=1,120.
 86% received evidence-based treatment.
15
Source: Ives et al., 2010
Adolescent Outpatient (AOP) Sample
 Clients receiving AOP treatment from 75 CSAT-funded sites
using the GAIN and providing outpatient treatment in 29
states from five grant programs (N=10,037).
 Intake data collected from these sites on N=10,037
adolescents between September 2002 and August 2008.
 The records were limited to clients who:
– Received outpatient treatment (all), and
– Had attained 6 months post-intake (N=8,604)
 For the analysis, only those with at least one follow-up
assessment (88%) were used for a final N=7,560
 93% received evidence-based treatment.
JTDC & AOP were significantly different on 36 of 69 measures of
characteristics, severity and treatment need
16
Source: Ives et al., 2010
Demographics
Female
AOP Unweighted
(N=7560)
Caucasian*
African American
JTDC
(N=1120)
Hispanic*
Multiracial/Other*
0-14 years
JTDC less likely
to be Caucasian,
multiracial,
older, employed,
& in trouble at
school/work;
more likely to be
Hispanic, behind
in school
15-17 years*
18+ years*
Single Parent
In School in past 90 days
Behind < 1 year*
Expelled or Dropped out
Employed in past 90 days*
Trouble at work or school*
0%
20%
40%
60%
17
Source: Ives et al., 2010
* p<.05
80%
100%
Crime and Violence
Lifetime Justice Sys. Involvement
Current Justice Sys. Involvement
In controlled environment-P90d*
JTDC more likely have
been in a controlled
environment 13+ days,
engaged in illegal
activity (overall & drug
related)
13+ days in cont. environ.-P90d*
Any physical violence
Any illegal activity*
Any property crime
AOP Unweighted
(N=7560)
Any interpersonal crime
JTDC
(N=1120)
Any drug crime*
0%
20%
40%
60%
18
Source: Ives et al., 2010
* p<.05
80%
100%
Intensity of Juvenile Justice System
Involvement
In detention/jail 30+
days*
AOP Unweighted
(N=7560)
In detention/jail 14-29
days
JTDC
(N=1120)
Prob/parole 14+ days
w/ 1+ drug screens
Other
prob/parole/deten.*
Other JJ/CJ status*
JTDC more likely to be
in other detention
status and less likely to
have no JJ status
Past arrest/JJ/CJ
status */**
Past year illegal
activity/SA use*
0%
10%
20%
30%
19
Source: Ives et al., 2010
* p<.05
**< 1 year ago
40%
50%
Environmental Risk Factors
Weekly Alcohol Use in Home *
AOP Unweighted
(N=7560)
Weekly Drug Use in Home*
JTDC
(N=1120)
Work/School Peers Weekly Intoxication
Social Peers Weekly Intoxication
Work/School Peers Regular Drug use
Social Peers Weekly Regular Drug use
Ever Homeless or Runaway
JTDC less likely
to have use in
home and
victimization
Lifetime Victimization*
High Severity Victimization Lifetime*
Victimization in Past 90d*
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100
%
20
Source: Ives et al., 2010
* p<.05
Substance Use
First Use under Age of 15*
Weekly Tobacco Use*
JTDC more likely to
have started younger, to
use any drug or
marijuana weekly; and
less likely to use tobacco
Weekly Any Substance Use*
Weekly Alcohol Use
Weekly Marijuana Use*
Weekly Non Alc/MJ Use
Weekly Crack/Cocaine Use
AOP Unweighted
(N=7560)
Weekly Heroin Use
JTDC
(N=1120)
Weekly Other drug use
0%
20%
40%
60%
21
Source: Ives et al., 2010
* p<.05
80%
100%
Substance Use Disorders
Lifetime Dependence or Abuse
Lifetime Dependence
Lifetime Abuse
JTDC similar on
substance use
disorders
Past Year Substance Use Disorder
Past Year Dependence
Past Year Abuse
Any lifetime withdrawal symptoms
AOP Unweighted
(N=7560)
Any withdrawal symptoms - past week
JTDC
(N=1120)
Any acute withdrawal symptoms - past week
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100
%
22
Source: Ives et al., 2010
* p<.05
Substance Treatment History
AOP Unweighted
(N=7560)
Any prior substance abuse treatment*
JTDC
(N=1120)
Multiple prior treatment episodes
Self perceived substance problem
JTDC more likely
to have been in
treatment before,
to see a need for
treatment and to
be ready to quit
Self perceived need for treatment*
Ready to quit (of those who have not
quit)*
Ready to remain abstinent (of those who
have quit)
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100
%
23
Source: Ives et al., 2010
* p<.05
Other Major Co-Occurring Clinical
Problems
High health problems-P90d*
AOP Unweighted
(N=7560)
Pregnant/got someone pregnant-PY*
JTDC
(N=1120)
Any co-occurring pyschiatric disorder
Any internalizing disorder*
Mood disorder NOS*
Generalized anxiety disorder
Any homicidal/suicidal thoughts*
Traumatic stress disorder*
JTDC less likely to have
health or internalizing
disorders and more
likely to be/gotten
someone pregnant
Any externalizing disorder
Conduct disorder
AD/HD
Any prior MH treatment*
0%
24
Source: Ives et al., 2010
20%
40%
* p<.05
60%
80%
100%
HIV Risk Behaviors (past 90 days)
Any sexual
activity in Past
90 days
Multiple sexual
partners*
JTDC more likely have
multiple sexual partners
Any uprotected
sexual activity in
Past 90 days
AOP Unweighted
(N=7560)
JTDC
(N=1120)
Needle risk
0%
25
Source: Ives et al., 2010
20%
40%
60%
* p<.05
80%
100%
Number of Major Clinical Problems**
No
problems*
JTDC slightly less severe
on psychopathology –
relative to waiting for
them to enter treatment
on their own, JTDC is a
form of early intervention
1 problem*
2 problems
3 to 12
problems*
0%
26
Source: Ives et al., 2010
20%
40%
60%
AOP Unweighted
(N=7560)
JTDC
(N=1120)
**Count of marijuana use disorder,
alcohol use disorder, any other drug
use disorder, internalizing problems
including: depression, anxiety,
homicidal/suicidal thoughts, and
trauma, externalizing problems
including conduct disorder and
ADHD, Lifetime victimization, past
year acts of physical violence or
past year illegal activity.
80% 100%
* p<.05
Matching with Propensity Scores
 Using logistic regression to predict the likelihood (propensity)
of each AOP client being a JTDC client based on the 69 intake
characteristics, we weighted the AOP group to match the
JTDC group in terms of these characteristics and sample size.
 This produced two groups with equal sample sizes (N=1,120).
 The number of significant differences dropped from 39 to 3
of 69 intake variables.
 Those in JTDC were still significantly:
– Less likely to be African American (OR=0.77)
– More likely to be Hispanic (OR=1.44) and on other probation, parole,
or detention (OR=1.37)
27
Source: Ives et al., 2010
Treatment System Involvement
0%
20%
40%
60%
80%
85%
Initiation
within 2 wks*
75%
87%
Engagement for
6+ wks*
94%
Continuing
care 3+ mons. *
57%
Positive system
status 6+ mons.
59%
64%
54%
AOP Weighted
(N=1120)
JTDC
(N=1120)
JTDC less likely to initiate within 2 weeks, but more likely
to be in treatment 6 weeks and 3 months later
28
Source: Ives et al., 2010
100%
* p<.05
Substance Abuse Treatment
(intake to 3 months)
0
5
10
14.7
4.7
6.2
Times in SA OP
2.2
Days in SA IOP*
5.9
2.4
2.6
Nights in SA Residential
0.7
0.1
12.8
13.4
JTDC received more days of any treatment & IOP,
also more satisfaction
Source: Ives et al., 2010
AOP Weighted
(N=1120)
JTDC
(N=1120)
Treatment Satisfaction Scale (mean)*
29
20
9.9
Days in Any SA Treatment*
Days in other SA Tx
15
* p<.05
Range of Substance Abuse Treatment Content
(Intake to 3 months)
0
2
4
External Services
Received*
8
10
AOP Weighted
(N=1120)
JTDC
(N=1120)
4.3
1.2
1.6
3.0
3.8
8.6
Treatment
Received Scale*
9.7
JTDC more likely to receive a broader range of services –
particularly family and external wrap-around services
30
Source: Ives et al., 2010
12
4.4
Direct Services
Received
Family Services
Received*
6
* p<.05
Mental Health Treatment Received
(intake to 3 months)
0
2
4
6
8
8.2
Days of any
Mental Health
7.7
7.9
Days on MH
Meds
7.6
0.7
Times in MH OP
AOP Weighted
(N=1120)
JTDC
(N=1120)
0.3
Nights in MH 0.06
hospital
0.02
No differences in MH treatment—most is driven by medication
31
Source: Ives et al., 2010
10
* p<.05
Other Environmental Interventions
Across Systems (intake to 3 months)
0
5
10
15
20
25
30
14.2
Days of structured activity without substance use
17.2
4.6
Times urine/breath analysis*
10.5
Days in a controlled environment
Days incarcerated
AOP Weighted
(N=1120)
JTDC
(N=1120)
8.9
8.2
4.1
3.9
Days of self-help
2.6
3.5
13
Percent with any self-help*
25
JTDC received more urine tests and went to self-help more often
32
Source: Ives et al., 2010
* p<.05
Comparison of Treatment Outcomes
(Days of ..)
35
Both Reduced Use;
JTDC more than AOP
(d between= -0.24)
Days out of 90 Days
30
PostPre d
(AOP,
JTDC)
25
20
AOP Weighted
(n=1120)
JTDC
(n=1120)
Others Outcomes
Not Significantly Different
15
10
5
0
Intake
6 m*
Substance
Use*
( d=-0.45, -0.57)
33
Both Meaningfully
Reduced Emotional
Problems
Source: Ives et al., 2010
Intake
6 m*
Emotional
Problems
(d=-0.32, -0.22)
Intake
6 m*
Trouble w/
Family
(d= -0.23, -0.18)
Intake
6 m*
In Controlled
Environment
(d=-0.02, -0.08)
Intake
6 m*
Illegal
Activity
(d=-0.11, -0.02)
*p<.05 change greater for JTDC vs AOP (d=-0.24)
Strengths & Limits of
Ives et al., (2010)
 Strengths
–
–
–
–
–
Multisite quasi experiment
Differences at intake eliminated on most variables
Replicable evidence-based practice
Multiple follow-up waves
Large sample size and high follow-up rates
 Limits
–
–
–
–
34
Not randomized
Disproportionately Hispanic youth
Unknown fidelity of implementation
Not sufficient numbers of specific evidence-based practices to
compare
Findings from JTDC and ATDC/FDC
Multi-Site Quasi Experiment
Initial Comparison
35
Findings from JTDC and ATDC/FDC
Multi-Site Quasi Experiment
 How adults in Adult or Family Treatment Drug Courts
(ATDC/FDC) compare to adolescents in Juvenile
Treatment Drug Courts (JTDC) in terms of
– Their characteristics, severity & needs
– The services they receive?
– Their treatment outcomes?
36
Adult Treatment Drug Court (ATDC)
and Family Drug Court (FDC) Sample
 Cohort of 7 CSAT ATDC and 2 FDC grantee sites using the
GAIN in Jacksonville, FL, Clearwater, FL, Gallipolis, OH, Reno, NV, Miami,
FL, Memphis, TN (ATDC sites) and Tampa, FL, Tucson, AZ (FDC sites).
 Intake data collected from these sites on N=697 adults
between April 2007 and October 2010.
 Mean age 31.21 (s.d. 9.57; range: 18-58; median=28;
mode=24)
 The records were limited to clients who:
– Had attained 6 months post-intake (N=457) , and
– Received outpatient treatment (N=407)
 For the analysis, only those with at least one follow-up
assessment (88%) were used for a final N=359
 42% received evidence-based treatment
37
Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites
Juvenile Treatment Drug Court (JTDC)
Sample
 Cohort of 11 CSAT JTDC grantee sites using the GAIN in Laredo,
TX, San Antonio, TX, Belmont, CA, Tarzana, CA, Pontiac, MI, San Jose, CA,
Austin, TX, Peabody, MA, Providence, RI, Detroit, MI, and Philadelphia,
PA.
 Intake data collected from these sites on N=1,771
adolescents between January 2006 through June 2010.
 Mean age 15.37 (s.d. 1.17; range: 11-18; median=16;
mode=16)
 The records were limited to clients who:
– Had attained 6 months post-intake (N=1,560)
– Received outpatient treatment (N=1,319), and
 For the analysis, only those with at least one follow-up
assessment (86%) were used for a final N=1,134
 81% received evidence-based treatment
38
Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites
Demographics
Female*
Caucasian*
JTDC less likely to be female,
Caucasian, employed, in CWS,
behind in school;
JTDC more likely to be
Hispanic, in school, in trouble
at school/work.
African American
Hispanic*
Multiracial/Other
Involved in Child Welfare System
In School in past 90 days*
Not HS graduate / Behind > 1 year**
ATDC/FDC
(N=359)
JTDC
(N=1134)
Employed in past 90 days*
Trouble at work or school*
0%
20%
40%
60%
80%
100%
39
Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites * p<.05 **Not HSgrad=ATDC/FDC; Behind =JTDC
Crime and Violence
JTDC less likely to have
been in a controlled
environment.
In controlled environment-P90d*
13+ days in cont. environ.-P90d
JTDC more likely have
engaged in physical
violence and illegal
activity (overall
interpersonal and
property related).
Any physical violence-PY*
Any Illegal activity-PY*
Any property crime-PY*
ATDC/FDC
(N=359)
JTDC
(N=1134)
Any interpersonal crime-PY*
Any drug crime-PY
No difference in drug crime
or 13+ days in a controlled
environment.
0%
20%
40%
60%
80% 100%
40
Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites
* p<.05
Intensity of Juvenile Justice System
Involvement
In detention/jail 30+
days*
ATDC/FDC
(N=359)
In detention/jail 14-29
days
JTDC
(N=1134)
Prob/parole 14+ days
w/ 1+ drug screens*
Other
prob/parole/deten.*
Other JJ/CJ status*
JTDC more likely be in
long-term detention or on
probation/parole
and less likely to be in
other JJ status.
Past arrest/JJ/CJ
status
Past year illegal
activity/SA use*
0%
10%
20%
30%
40%
41
Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites
* p<.05
50%
Environmental Risk Factors
ATDC/FDC
(N=359)
Weekly Alcohol Use in Home
Weekly Drug Use in Home*
JTDC
(N=1134)
Work/School Peers Weekly Intoxication*
Social Peers Weekly Intoxication*
JTDC more likely
to have social or
vocational peer use.
Work/School Peers Regular Drug use*
Social Peers Weekly Regular Drug use*
Ever Homeless or Runaway*
ATDC more likely
to have drug use
in home,
homelessness and
victimization.
Lifetime Victimization*
High Severity Victimization Lifetime*
Victimization in Past 90d
0%
20%
40%
42
Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites* p<.05
60%
80%
100%
Substance Use
First Use under Age of 15*
Weekly Tobacco Use*
JTDC more likely to
have started sooner,
use more often and to
use marijuana; Less
likely to use heroin,
cocaine or other drugs
or tobacco.
Weekly Any Substance Use*
Weekly Alcohol Use
Weekly Marijuana Use*
Weekly Non Alc/MJ Use *
Weekly Crack/Cocaine Use*
ATDC/FDC
(N=359)
Weekly Heroin Use*
JTDC
(N=1134)
Weekly Other drug use *
0%
20%
40%
60%
80%
100%
43
Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites
* p<.05 +pre-controlled environment
Substance Use Disorders
JTDC more
likely to report
lifetime or past
year abuse and
past week
withdrawal.
Lifetime Dependence or Abuse*
Lifetime Dependence*
Lifetime Abuse*
Past Year Substance Use Disorder*
JTDC less likely to report
any lifetime or past year
dependence or lifetime
withdrawal.
Past Year Dependence*
Past Year Abuse*
Any lifetime withdrawal symptoms*
ATDC/FDC
(N=359)
Any withdrawal symptoms - past week*
JTDC
(N=1134)
Any acute withdrawal symptoms - past week*
0%
20%
40%
60%
80%
44
Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites
* p<.05
100%
Substance Treatment History
ATDC/FDC
(N=359)
Any Prior Substance Abuse Treatment*
JTDC
(N=1134)
Multiple prior treatment episodes*
Self Perceived Substance Problem*
JTDC less
likely to report
each of these
treatment
history items.
Self Perceived Need for Treatment*
Ready to quit (of those who have not
quit)*
Ready to remain abstinent (of those who
have quit)*
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100
%
45
Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites
* p<.05
Other Major Co-Occurring Clinical
Problems
High health problems-P90d*
ATDC/FDC
(N=359)
Pregnant/got someone pregnant-PY*
Any Co-Occurring Disorder
JTDC
(N=1134)
Any Internalizing Disorder*
Major Depressive Disorder*
Generalized Anxiety Disorder*
JTDC less likely to
have health problems,
internalizing disorders
or prior treatment;
More likely to have
externalizing disorders.
Any homicidal/suicidal thoughts
Traumatic Stress Disorder*
Any Externalizing Disorder*
Conduct Disorder*
AD/HD*
Any prior mental health treatment*
0%
10%
20%
30%
40%
50%
60%
46
Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites
* p<.05
70%
80%
90% 100%
HIV Risk Behaviors (past 90 days)
Any sexual activity
in Past 90 days*
High/Moderate sex
risk*
JTDC more likely to have
multiple partners, and less
likely to have had risky or
unprotected sex or needle use.
Multiple sexual
partners*
Any uprotected
sexual activity in
Past 90 days*
ATDC/FDC
(N=359)
JTDC
(N=1134)
Needle Risk*
0%
20%
40%
60%
80%
47
Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites
* p<.05
100%
Number of Major Clinical Problems*
ATDC/FDC
(N=359)
JTDC
(N=1134)
No
problems*
1 problem*
JTDC slightly less severe on
psychopathology.
2 problems
3 to 12
problems*
0%
20%
40%
*Count of marijuana use disorder,
alcohol use disorder, any other
drug use disorder, internalizing
problems including: depression,
anxiety, homicidal/suicidal
thoughts, and trauma,
externalizing problems including
conduct disorder and ADHD,
Lifetime victimization, past year
acts of physical violence or past
year illegal activity.
60% 80% 100%
48
Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites
* p<.05
JTDC and ATDC/FDC Comparison:
Treatment
49
Type of Treatment provided
Evidence-based protocols
A-CRA/ACC
ATDC/FDC
(N=359)
JTDC
(N=1134)
MET/CBT
Other EBT
JTDC more likely to be
treated with wider
variety of evidencebased protocols.
Specific Manualized
Programs
Other
0%
20%
40%
60%
80%
50
Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites
* p<.05
100%
Treatment System Involvement
99%
Initiation
within 2 wks*
73%
65%
Engagement for
6+ wks
69%
91%
Continuing
Care 3+mons.*
Positive System
Status*
ATDC/FDC
(N=359)
JTDC
(N=1134)
79%
69%
40%
JTDC less likely
2 weeks,60%
to be in any
treatment
3
0% to initiate
20% within
40%
80%
100%
months post-admission, or to have completed or still be in treatment.
51
Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites
* p<.05
Substance Abuse Treatment
(intake to 3 months+)
32.6
Days in Any SA Treatment*
11.8
9.8
Times in SA OP
6.3
3.5
6.1
3.1
2.6
0.1
6.5
0.01
Nights in SA Residential
Days in other SA Tx
Days on SA Meds 3m+ *
JTDC
(N=1134)
13.1
13.3
Treatment Satisfaction Scale (mean)
0
52
ATDC/FDC
(N=359)
9.8
Days in SA IOP*
5
10 15 20 25 30 35
JTDC received fewer days of any treatment – esp. IOP days
or medication.
Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites
* p<.05 +or 6-month if missing 3-month
Range of Substance Abuse Treatment Content
(Intake to 3 months)
0
2
4
External Services
Received*
8
10
12
4.7
Direct Services
Received*
Family Services
Received*
6
4.3
0.5
1.6
ATDC/FDC
(N=359)
JTDC
(N=1134)
3.1
3.8
Treatment
Received Scale*
8.3
9.6
JTDC more likely to receive a broader range of services –
particularly family and external wrap around services
53
Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites
* p<.05 +or 6-month if missing 3-month
Mental Health Treatment Received
(intake to 3 months+)
0
5
15
20
25
21.3
Days of any Mental
Health*
8.8
21.1
Days on MH Meds*
Times in MH OP*
10
8.6
0.8
ATDC/FDC
(N=359)
JTDC
(N=1134)
0.4
Nights in MH 0.08
hospital
0.04
JTDC less likely to receive mental health
services – particularly medication
54
Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites
* p<.05 +or 6-month if missing 3-month
Other Environmental Interventions
Across Systems (intake to 3 months)
0
5
10
30
21.4
11.1
ATDC/FDC
(N=359)
JTDC
(N=1134)
11.8
Days in a controlled environment*
JTDC received fewer urine
Percent with Any self-help*
tests and went to self-help
less often, but were more
likely to be involved in
0%
substance-free structured
activities
25
16.8
Times urine/breath analysis*
Days of self-help*
20
10.3
Days of structured activity without substance use*
Days incarcerated
15
8.7
3.1
3.8
26.4
3.7
78%
25%
20%
40%
60%
80% 100%
55
Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites
* p<.05 +or 6-month if missing 3-month
JTDC and ATDC/FDC Comparison:
Outcomes
56
Comparison of Treatment Outcomes
(Days of ..)
ATDC/FDC
greater
reduction
than JTDC*
35
ATDC/FDC
meaningfully
reduced at 6m**
Days out of 90 Days
30
ATDC/FDC
(n=359)
JTDC
(n=1134)
Intake and 6m not
significantly
different.
25
20
JTDC differs from
ATDC/FDC at Intake
and 6m for all other
outcomes
15
Both
significantly
10
reduced days of
substance 5use.
Post-Pre d 0
(ATDC/ FDC, Intake 6m**
JTDC)
Substance
Use*
(d=-0.77, -0.60)
Intake
6m**
Intake
6m**
Intake
6m**
Emotional
Trouble w/ Family In Controlled
Problems
(d= -0.17, -0.19)
Environment
(d=-0. 22, -0.17)
(d=0.08, -0.07)
Intake
6m**
Illegal Activity
(d=-0.15, -0.06)
57
Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites
*p<.05 **or 3 months if missing 6 mo.
Outcome Status Across Waves
ATDC/FDC
JTDC
100%
20%
19%
20%
36%
80%
54%
11%
41%
26%
60%
71%
40%
45%
33%
53%
27%
62%
20%
4%
0%
Intake
(N=347)
3 months
(N=305)
14%
6%
6 months
(N=289)
Using in Community
In Treatment
Intake
(N=1060)
3 months
(N=947)
24%
6 months
(N=955)
In Controlled Environment
Stable in Community
58
Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites
* p<.05 +or 6-month if missing 3-month
In Recovery*
100%
80%
60%
ATDC/FDC
40%
JTDC
20%
N (ATDC/
FDC, JTDC)
0%
Intake (358; 1133)
3 months (319; 994)
6 months (290; 968)
*No past month substance use or problems while living in the community.
59
Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites
Strengths & Limits of
this information
 Strengths
– Multisite quasi assignment
– Multiple follow-up waves
– Large sample size and high follow-up rates
 Limits
–
–
–
–
–
–
–
60
Not randomized
Differences at intake not controlled
Adult sites are mostly in the first or second grant year
Disproportionately male in JTDC, female in ATDC
Disproportionately Hispanic youth in JTDC, Caucasian in ATDC
Unknown fidelity of implementation
Not sufficient numbers of specific evidence-based practices to
compare
Major Predictors of Bigger Effects Found in
Multiple Meta Analyses (Lipsey, 1997, 2005)
1. A strong intervention protocol based on prior
evidence
2. Quality assurance to ensure protocol adherence
and project implementation
3. Proactive case supervision of individual
4. Triage to focus on the highest severity subgroup
61
Impact of the numbers of these Favorable
features on Recidivism in 509 Juvenile Justice
Studies in Lipsey Meta Analysis
Average
Practice
62
Source: Adapted from Lipsey, 1997, 2005
The more
features,
the lower
the
recidivism
Evidence-Based Treatment (EBT) that
Typically do Better than Usual Practice in
Reducing Juvenile Use & Recidivism














Adolescent Community Reinforcement Approach (A-CRA)
Aggression Replacement Training (ART)
Assertive Continuing Care (ACC)
Cognitive Behavior Therapy (CBT)
Functional Family Therapy (FFT)
Moral Reconation Therapy (MRT)
Thinking for a Change (TFC)
Interpersonal Social Problem Solving (ISPS)
Motivational Enhancement Therapy/Cognitive Behavior Therapy (MET/CBT)
Motivational Interviewing (MI)
Multi Systemic Therapy (MST)
Multidimensional Family Therapy (MDFT)
Reasoning & Rehabilitation (RR)
Seven Challenges (7C)
Small or no differences in mean effect size between these brand names
63
Source: Adapted from Lipsey et al., 2001, 2010; Waldron et al., 2001, Dennis et al., 2004
Evidence-Based Practices Can be SIMPLE:
On-site proactive urine testing can be used to
reduce false negatives by more than half
(Godley et al. 2002) and Scott & Dennis 2009
64
Implementation is Essential
(Reduction in Recidivism from .50 Control Group Rate)
The best is to
have a strong
program
implemented well
Thus one should optimally pick the
strongest intervention that one can
implement well
65
Source: Adapted from Lipsey, 1997, 2005
The effect of a well
implemented weak program is
as big as a strong program
implemented poorly
References

Bhati et al. (2008) To Treat or Not To Treat: Evidence on the Prospects of Expanding Treatment to DrugInvolved Offenders. Washington, DC: Urban Institute.
 Capriccioso, R. (2004). Foster care: No cure for mental illness. Connect for Kids.
http://www.connectforkids.org/node/571
 Chandler, R.K., Fletcher, B.W., Volkow, N.D. (2009). Treating drug abuse and addiction in the criminal justice
system: Improving public health and safety. Journal American Medical Association, 301(2), 183-190.
 Chassin, L. (2008) Juvenile Justice and Substance Abuse. Juvenile Justice. 18(2) 165-183.
http://www.princeton.edu/futureofchildren/publications/journals/article/index.xml?journalid=31&articleid=
46&sectionid=153
 Dennis, M. L., Godley, S. H., Diamond, G., Tims, F. M., Babor, T., Donaldson, J., Liddle, H., Titus, J. C., Kaminer,
Y., Webb, C., Hamilton, N., & Funk, R. (2004). The Cannabis Youth Treatment (CYT) Study: Main Findings
from Two Randomized Trials. Journal of Substance Abuse Treatment, 27, 197-213.
 Dennis, M. L., & McGeary, K. A. (1999, fall). Adolescent alcohol and marijuana treatment: Kids need it now.
TIE Communique, 10–12.
http://www.chestnut.org/li/trends/Adolescent%20Problems/youth_need_treat.html
 Dennis, M. L., Scott, C. K. (2007). Managing Addiction as a Chronic Condition. Addiction Science & Clinical
Practice , 4(1), 45-55.
 Dennis, M. L., White, M., & Ives, M. I. (2009). Individual characteristics and needs associated with substance
misuse of adolescents and young adults in addiction treatment. In C. Leukefeld, T. Gullotta, & M. Staton
Tindall, Handbook on adolescent substance abuse prevention and treatment: Evidence-based practice (pp.
45-72). New London, CT: Child and Family Agency.
 Ettner, S.L., Huang, D., Evans, E., Ash, D.R., Hardy, M., Jourabchi, M., & Hser, Y.I. (2006). Benefit Cost in the
California Treatment Outcome Project: Does Substance Abuse Treatment Pay for Itself?. Health Services
Research, 41(1), 192-213.
 French, M.T., Popovici, I., & Tapsell, L. (2008). The economic costs of substance abuse treatment: Updated
estimates of cost bands for program assessment and reimbursement.
66 Journal of Substance Abuse Treatment, 35, 462-469.
References (continued)










67
Godley, M.D., Godley, S.H., Dennis, M.L., Funk, R.R. & Passetti, L.L. (2002). Preliminary outcomes from the
assertive continuing care experiment for adolescents discharged from residential treatment. Journal of
Substance Abuse Treatment, 23 (1), 21-32.
Ives, M. L., Chan, Y-F., Modisette, K. C. and Dennis, M. L., (2010). Characteristics, needs, services, and
outcomes of youths in Juvenile Treatment Drug Courts as compared to adolescent outpatient treatment.
Drug Court Review VII(1) 10-56.
Lipsey, M. W. (2010). The effects of community-based group treatment for delinquency: A meta-analytic
search for cross-study generalizations. In Deviant by design: Interventions and policies that aggregate
deviant youth, and strategies to optimize outcomes. New York: Guilford Press.
Lipsey, M. W. (1997). What can you build with thousands of bricks? Musings on the cumulation of
knowledge in program evaluation. New Directions for Evaluation, 76, 7-23.
Lipsey, M. W. (2005). What works with juvenile offenders: Translating research into practice. Paper
presented at the presented at the Adolescent Treatment Issues Conference, Tampa.
Lipsey, M. W., Chapman, G. L., & Landenberger, N. A. (2001). Cognitive-behavioral programs for offenders.
The Annals of the American Academy of Political and Social Science, 578, 144-157.
Marlowe, D. B., (2008). Recent Studies of Drug Courts and DWI Courts: Crime Reduction and Cost Savings.
NADCP.
Neumark, Y.D., Van Etten, M.L., & Anthony, J.C. (2000). Drug dependence and death: Survival analysis of
the Baltimore ECA sample from 1981 to 1995. Substance Use and Misuse, 35, 313-327.
Office of Applied Studies. 2002. Summary of findings from the 2001 National Household Survey on Drug
Abuse. Office of Applied Studies.
Office of Applied Studies (2006). Results from the 2005 National Survey on Drug Use and Health: National
Findings Rockville, MD: Substance Abuse and Mental Health Services
Administration. http://www.oas.samhsa.gov/NSDUH/2k5NSDUH/2k5results.htm#7.3.1
References (continued)

Office of Applied Studies. 2002. Summary of findings from the 2001 National Household Survey on Drug Abuse.
Office of Applied Studies.
Office of Applied Studies (2006). Results from the 2005 National Survey on Drug Use and Health: National
Findings Rockville, MD: Substance Abuse and Mental Health Services
Administration. http://www.oas.samhsa.gov/NSDUH/2k5NSDUH/2k5results.htm#7.3.1
Office of Applied Studies (OAS, 2006). Substance Abuse and Mental Health Services Administration.(SAMHSA)
National Survey on Drug Use and Health, 2006 [Computer file]. ICPSR21240-v4. Ann Arbor, MI: Inter-university
Consortium for Political and Social Research [distributor], 2009-08-12.
Office of Applied Studies. 2008. Substate estimates from the 2004-2006 National Surveys on Drug Use and
Health. Substance Abuse and Mental Health Services Administration.
Office of Juvenile Justice and Delinquency Prevention (OJJDP). (May 2001). Juvenile Drug Court Program.
Department of Justice, OJJDP, Washington, DC. NCJ 184744.
Scott, C. K., & Dennis, M. L. (2009). Results from Two Randomized Clinical Trials evaluating the impact of
Quarterly Recovery Management Checkups with Adult Chronic Substance Users. Addiction.
Scott, C. K., Dennis, M. L., & Funk, R.R. (2008). Predicting the relative risk of death over 9 years based on
treatment completion and duration of abstinence . Poster 119 at the College of Problems on Drug Dependence
(CPDD) Annual Meeting, San Juan, PR, June 16, 2008. Available at http://www.chestnut.org/li/posters
Scott, C. K., Foss, M. A., & Dennis, M. L. (2005). Pathways in the relapse, treatment, and recovery cycle over
three years. Journal of Substance Abuse Treatment, 28, S61-S70.
Waldron, H. B., Slesnick, N., Brody, J. L., Turner, C. W., & Peterson, T. R. (2001). Treatment outcomes for
adolescent substance abuse at four- and seven-month assessments. Journal of Consulting and Clinical
Psychology, 69(5), 802-813.
Wasserman, G. A., McReynolds, L. S. Schwalbe, C. S. Keating, J. M. & Jones, S. A. (2010) Psychiatric Disorder,
Comorbidity, and Suicidal Behavior in Juvenile Justice Youth. Criminal Justice and Behavior. 37(12): 1361-1376.









68
Resources you can use now
 Cost-Effective evidence-based practices A-CRA & MET/CBT tracks here,
more at www.chestnut.org/li/apss or http://www.nrepp.samhsa.gov/
 Most withdrawal symptoms appeared more appropriate for
ambulatory/outpatient detoxification, see
http://www.aafp.org/afp/2005/0201/p495.html
 Trauma informed therapy and suicide prevention at
http://www.nctsn.org/nccts and http://www.sprc.org/
 Externalizing disorders medication & practices
http://systemsofcare.samhsa.gov/ResourceGuide/ebp.html
 Tobacco cessation protocols for youth
http://www.cdc.gov/tobacco/quit_smoking/cessation/youth_tobacco_ce
ssation/index.htm
 HIV prevention with more focus on sexual risk and interpersonal
victimization at http://www.who.int/gender/violence/en/ or
http://www.effectiveinterventions.org/en/home.aspx
 For individual level strengths see
http://www.chestnut.org/li/apss/CSAT/protocols/index.html
 For improving customer services http://www.niatx.net
69