Blog: Adolescent Substance Abuse Treatment

Behavioral health care organizations -- including adolescent substance abuse treatment agencies -- face huge changes as health reform takes hold. How do you build a strong, vital organization that provides the best quality care?
We've built a conference around that very question: the 2011 NIATx Summit and SAAS National Conference, with the theme of "Revolutionary Strategies for Leaders." It'll be held July 20-13, 2011, in Boston, MA. (Don't know NIATx or SAAS? Scroll down for more info.)
Who should attend? CEOs, senior managers, and change leaders from behavioral health organizations who are focused on leadership, process improvement, and technology.

Of the 38 youth in long-term recovery who attended The Young People’s Networking Dialogue on Recovery in December 2010, some began their path to recovery through formal treatment, some via the criminal justice system, some had their family, some had their faith, some had their school, and some had all of it. But there was one single unifying thread woven through each story shared that day as a key to sustaining their recovery: positive peer pressure. 
In her new book, Join the Club: How Peer Pressure Can Transform the World, Tina Rosenberg takes peer pressure -- usually regarded as a negative thing -- and documents many instances throughout recent history when it has been used as a force for good. The influence young people have on each other is undeniable, and obviously peer pressure is viewed as a cause for many of the alcohol and drug problems in our society. But after personally witnessing thousands of youth use positive peer pressure on one another to stay clean and sober, I am left wondering why we can’t harness this powerful force for good. 

• Youth in Recovery Paint the Town - with a Mural Celebrating Healthy Living - Youth in recovery are eager to contribute to the community, and share their experiences and their creativity. So Reclaiming Futures Forsyth County, in North Carolina, worked with a local artist to help them paint a huge mural about recovery and healthy living on the side of a building (see before-and-during photos at right) that was formerly an eyesore. >>Full story here.
• Juvenile Court Supervisor, Coach -- and Institution - You might not know Lawrence Bass, but you should. He's been a steadying force in the lives of teens on the basketball court and in juvenile court in Guilford County, NC (a Reclaiming Futures site) for 40 years now. The News & Record in Greensboro, NC -- where he works as a juvenile court supervisor -- recently profiled him; check it out!
• Private Juvenile/Adult Prison in Mississippi Source of Profits -- and Abuse - The Southern Poverty Law Center and the ACLU National Prison Project have filed a class-action lawsuit over Walnut Grove Youth Correctional Facility in Mississippi. "If there's mistreatment going on at Walnut Grove and the Justice Department finds that it is, they ought to sue the hell out of somebody," says state representative John Mayo. "I can't understand why we have to be sued to do what's right."
• Where Did the Jobs for Teens Go? - Youth Today has the story on a new study from the Center for Labor Market Studies showing that the number of employed teens aged 16-19 with jobs has dropped significantly. Also: teens who work in high school are more likely to graduate; low-income teens without jobs are more likely to engage in crime.
• Why Juvenile Justice Reform Makes Sense to Conservatives - Juvenile justice reform -- traditionally a liberal cause -- aligns very well with conservative political principles, Marc Levin, of the Center for Effective Justice at the Texas Public Policy Foundation, explains in this PowerPoint. This is a great resource to draw upon when you're advocating for juvenile justice reform in your own community -- reform can be a uniter, not a divider. (Hat tip to John Kelly at Youth Today.) 

Below is a pretty interesting graphical representation of some of the 2010 data on teen drug use. (By the way, please note that by reposting it, Reclaiming Futures is not endorsing Home Health Testing, the graphic's creator, or its products.)
Now, what would be great would be an infographic showing things like:

• Ratio of youth who need treatment vs. the number who receive it
• Number of youth who receive evidence-based substance abuse treatment
• Youth leaving treatment with recovery resources ready for them in the community
• Number of youth actually dependent on drugs (vs. experimenting with or abusing them) at different decision points in the justice system -- e.g., intake, detention, secure lock-up

What would you like to see? (And does anyone know somebody willing to work on such an infographic pro-bono?)

NOTE: The graphic below is slightly distorted to fit our space. Here's the original.

As of March 15, the state of Illinois is cutting its $54 million budget for alcohol and drug treatment and prevention services to zero (full disclosure: I wrote the news summary linked to here).
That's right: zero. 
According to providers, that means many of them will shut down. 
What's left, without state money? According to provider representatives, about 80 percent of their clients (or about 55,000 people) get treatment funded by the state, leaving 20 percent of their clients who are covered by Medicaid -- -- women only, though. The state will reportedly be cutting the amounts it reimburses for Medicaid services by six percent.
What's not precisely clear from news reports is the impact on youth treatment. Prevention services serving about 230,000 youth a year are definitely gone, but children's treatment can be covered by Medicaid - I'm not sure how that's handled in Illinois. However, in my experience, most treatment agencies rely on the volume of their adult treatment programs to support their youth treatment programs. Without the mix, I would guess that many youth programs -- even those billing Medicaid -- might not survive.  

• White House May Rethink its Juvenile Justice Spending Plan
  In mid-February, Youth Today reported that President Obama's budget contained a proposal to radically change federal juvenile justice funding for the states. Now, Youth Today's John Kelly reports that it may be reconsidering, after strongly negative reactions from juvenile justice advocates.
• VIDEO: Mississippi County Sued After Video Reveals "Hogtied" Youth and Other Abuse
  The Southern Poverty Law Center has sued Forrest County, Missisissippi, over revelations of numerous instances of juvenile detention center personnel physically abusing youth in their care (many documented on surveillance video cameras) and force them to allow youth access to lawyers and civil rights advocates, in accord with federal law. Follow the link to see the video coverage. (Hat tip to sparkaction.)

How many juvenile drug courts are there in the United States?  The Center for Substance Abuse Treatment (CSAT) at the Substance Abuse and Mental Health Services Admininstration (SAMHSA) wants to know by March 17, 2011.
Here's the announcement -- please note that you do not need to be a CSAT grantee to qualify or participate:

We are writing to request your help with an important data inquiry. In order to enhance SAMHSA/CSAT’s programmatic and advocacy efforts concerning adolescent substance abuse treatment and recovery, we are seeking to update our knowledge concerning the number of juvenile drug courts in the United States.
 
To help us close this knowledge gap, we are asking all of our current JTDC grantees to reply to this email with a listing of any juvenile drug courts that you and your organization are aware of. Please complete and return the attached template with your reply.
 
The term “juvenile drug court” means a specially designed court calendar or docket within a juvenile court to which youth having problems with alcohol and/or other drugs are referred; a separate or special jurisdiction court is neither necessary nor encouraged. The juvenile drug court judge maintains close oversight of each case, and both leads and works as a member of a team that comprises representatives from treatment, juvenile justice, social services, school and vocational training programs, law enforcement, probation, the prosecution and the defense.
 
Please complete the attached document and send your replies to (adlist@jbsinternational.com) no later than March 17, 2011. Thank you in advance for any assistance with this important inquiry that you and your agency can provide!

(Hat tip to Christa Myers.)

A few weeks ago, my colleague, Jeff Butts, discussed here the implications of our recent study of rates of psychiatric disorder in almost 10,000 young persons at various levels of penetration of the justice system. (Here's the original study: "Psychiatric Disorder, Comorbidity, and Suicidal Behavior in Juvenile Justice Youth.")
He drew attention to our finding that, when evaluated in a standard way, approximately 35% of young persons at system entry (i.e., entering the juvenile justice system via probation or family court processing) met criteria for a mental health or substance use disorder.

In that work, we relied on a well-validated, computerized, instrument which aggregates a youth’s answers to specific questions about symptoms to generate a set of provisional psychiatric disorders (the DISC-IV). But what happens about identifying mental health problems in settings where such research activities are not in place?

Multidimensional Family Therapy (MDFT) is an evidence-based practice for working with adolescents struggling with substance abuse – the manual can be downloaded from SAMHSA for free. (SAMHSA is the Substance Abuse and Mental Health Services Administration.) One of five treatment protocols developed and tested in the past decade by SAMHSA, it has been shown to be clinically and cost-effective.
As it happens, the creator of MDFT, Dr. Howard A. Liddle, Ed.D., will be doing a webinar for us on family engagement on April 30, 2011, at 11 am PST / 12 pm CST / 2 pm EST. You can learn more and register for it on our webinars page.
Dr. Liddle told me recently that there was an MDFT program operating in Portland, Oregon, where I live, so I set up an interview with Deena Corso, who is a clinical supervisor in the Juvenile Treatment Services unit at the Department of Community Justice (DCJ) in Multnomah County, Oregon. (Deena and I were co-workers when I was employed there between 2000 and 2007.)
 

Benjamin: What are the top reasons to implement MDFT?
Deena: We picked MDFT as our treatment model because it's an evidence-based practice, effective at reducing substance abuse and delinquent behavior for populations that looked like ours. We’d had a Multi-Systemic Therapy [MST] program for many years with good outcomes, but budget cuts forced us to look for an alternative, and once we looked at the research, we decided on MDFT.