Prior to the past two decades the only treatment options available for the publicly supported juvenile population were long-term residential programs (e.g., therapeutic communities) and outpatient counseling. Those individuals and families with financial means typically sought help through private hospitalization or individual practitioners.
Treatment services within juvenile institutions were all but nonexistent. In the late 1960s, when the young adult heroin and methamphetamine epidemic began and lower-level drug use (e.g., marijuana) became widespread among youth, many adolescents were referred to community-based treatment under coercion of the courts as a result of having been charged with status offenses (e.g., runaway, truancy, incorrigibility). This practice fell out of favor, leading to the deinstitutionalization-of-status-offenders movement of the mid-1970s; what had been in all practicality an intervention/court diversion option for youth with SUDs was essentially lost. Placing status offenders in confinement was not a desirable practice; its loss as an option resulted afterward in many young persons with emerging SUDs developing higher severity of SUDs and criminal behavior before receiving treatment. Not until the 1990s did juvenile justice systems develop widespread diversion programs such as juvenile drug court.
Both scientific and empirical evidence have consistently shown that merely adopting or slightly modifying adult treatment philosophies and approaches for juveniles usually produces poor results. The medical disease approach, which has shown some effectiveness with segments of the general adolescent population, has not had measurable success. This may be attributable in part to the cultural, environmental, and circumstantial factors that are often present in working with this population. Similarly, 12-step facilitation and otherwise evidence-based supported practice in “free-world” settings has not demonstrated effectiveness in juvenile justice populations; yet, it has been used as a mandated program in some states for juveniles who screen positive for SUDs. A more practical solution might be for juvenile programs to avoid blanket requirements of participation in Alcoholics Anonymous (AA), Narcotics Anonymous (NA) and other self-help meetings and instead to encourage those with the highest levels of severity and risk to be exposed to the 12-steps as a framework to help them manage their sobriety after discharge.
Another common approach that has not been at all successful with juveniles is drug and alcohol education. This dissonance is an example of how leaving juveniles (i.e., the so-called consumers) out of the program design process often results in a waste of precious resources. Policy makers and practitioners are well advised to include individuals in recovery in the shaping of effective programs for juveniles. This might help bring balance to the reliance on the use of some evidence-based practices that may have demonstrated effectiveness in research studies but not necessarily with juveniles in naturalistic settings.
Substance abuse treatment for juveniles is generally delivered in three settings: institutional; community-based residential; and nonresidential. Institutional settings mostly provide physically secure confinement for the short term (e.g., pretrial detention centers) or long term (e.g., secure treatment centers) for juveniles who are dangerous to others or themselves. Since the mid-1900s many youth have been transferred to adult court and sentenced to prison for serious juvenile offenses, felonies against persons, and non-person
offenses. This segment of juveniles has the highest level of need for treatment; yet, only 37 percent of juvenile correctional facilities provide SUD treatment. A national review of institution-based therapeutic programs found that there were 252 such programs in state prisons and jails but only six were reported in facilities for juveniles. Most other juvenile institutions offered only basic drug and alcohol education programs, although 42 percent offer voluntary self-help programs (e.g., AA, NA), and 5 percent offer detoxification.
Cognitive behavioral therapies, although not inventoried nationally, are increasingly used in juvenile correctional facilities in most states. These include manual-driven variations of cognitive behavioral therapy, such as aggression replacement training and moral reconation therapy. Such programs have not only been well received by both staff and juveniles but have demonstrated effectiveness equal to that of therapeutic communities.
For moderate to serious juvenile offenders with low risk of violence, substance abuse treatment is increasingly being provided in community-based residential settings that range from state operated secure facilities, to staff secure or open residential treatment centers. These settings range in capacity from six to over 100 residents. They are primarily treatment focused as compared to institutional programs that focus on security and behavioral compliance. In addition to therapeutic communities, therapeutic boarding schools are considered evidence-based residential options. Although a shift has occurred toward shorter durations of residential treatment (driven primarily by cost containment) this may be counterproductive, because time and treatment remains the most significant predictors of positive outcomes. Also, the National Institute on Drug Abuse has identified 90 days as a benchmark for minimal effective duration; empirical wisdom consistently supports stays of nine to 18 months.
There is a heightened recognition of the need for, and benefits of, working with families, community-based programs for juveniles including evidence-based treatments such as functional family therapy, multidimensional family therapy, and multisystemic therapy, brief motivational interventions, cognitive behavioral therapy, and contingency management for youth substance use disorders.
It has become increasingly clear that simply locking a kid up is not the answer and that locking him or her up with no services to address his or her issues of substance use and their corresponding problems is not the answer; nor is locking up non-violent/offending youth the answer. The answer is, whenever possible, community based treatment.
References provided upon request.
Fred Dyer, PhD., CADC, is an internationally recognized speaker, trainer, author and consultant who services juvenile justice/detention/ residential programs, child welfare/foster care agencies, child and adolescent residential facilities, mental health facilities and adolescent substance abuse prevention programs in the areas of implementation and utilization of evidence-based, gender-responsive, culturally competent, and developmentally and age appropriate practices. He can be reached at www.dyerconsulting.org.