Blog: Public Policy

There are so many noteworthy aspects to the “first ever” Surgeon General’s Report on Alcohol, Drugs, and Health. For example, it is grounded in the best evidence available to date and it examines issues of neurobiology, prevention, treatment, recovery, and health care systems. It also has educational and promotional materials such as fact sheets and social media ideas and resources. If you have not reviewed it – now is the time. It’s my understanding that additional fact sheets are forthcoming including one on criminal/juvenile justice populations. As such, keep visiting the website for updates and let’s keep talking about this report and its importance to individuals, families, and communities impacted by substance misuse and/or disorders.

Reasons why I am proud to write this blog post...

Reason 1: My former colleagues (and friends) at The University of Arizona, Southwest Institute for Research on Women (UA SIROW) (UA SIROW) have been leading the efforts on the national evaluation of Juvenile Drug Courts and Juvenile Drug Courts blended with Reclaiming Futures (JDC/RF).  UA SIROW collaborated with Chestnut Health Systems and Carnevale Associates, LLC to implement a comprehensive evaluation that included data from Juvenile Drug Courts, Juvenile Drugs Courts blended with Reclaiming Futures, and non-justice related intensive adolescent outpatient programs. The purpose was to examine processes, outcomes, and costs.

Girls are increasingly over-represented in the juvenile justice system; particularly girls living in poverty and young women of color, according to the Office of Juvenile Justice and Delinquency Prevention (OJJDP) in their recently released policy guidance: "Girls and the Juvenile Justice System." The significant increase of justice-involved girls over the past two decades was also demonstrated in September by Francine T. Sherman and Annie Balck in their "Gender Injustice" report; girls now account for almost 30 percent of youth arrests. OJJDP's new policy guidance calls for the identification and recognition of known risk factors - which lead girls to the justice system - and the implementation of developmentally informed approaches in order to reduce and divert the involvement of girls in the system. OJJDP's policy guidance aligns with the White House Council on Women and Girls' intention to advance equity for women and girls of color.

Identifying Risk Factors  

OJJDP's policy guidance identifies a number of risk factors which lead to involvement of girls in the juvenile justice system, also referred to as the sexual abuse/trauma-to-prison pipeline: 

Every week Reclaiming Futures rounds up the latest news on juvenile justice reform, adolescent substance use treatment, and teen mental health. 

New ‘Ban the Box’ Bill Would Improve Access to Federal Jobs for Youth With Records (Juvenile Justice Information Exchange)
The new Fair Chance To Compete for Jobs Act would help youth with criminal histories gain employment by prohibiting employers from asking about criminal history until a conditional offer of employment is received. The hope is that this will help qualified candidates avoid the stigma of past conviction when seeking out employment. As many as 70 million people with criminal histories may face barriers to employment.

Now through August 21, 2015, The Center for Juvenile Justice Reform (CJJR) at Georgetown University‘s McCourt School of Public Policy is accepting applications for its 2015 Multi-System Integration Certificate Program.

The program is designed to support local jurisdictions’ efforts to improve outcomes for youth who have been involved in both the child welfare and juvenile justice systems (also known as “crossover youth”) by implementing integrated, multi-disciplinary solutions.

Juvenile Justice Reform

Last week, the Senate voted unanimously to appoint Michael P. Botticelli as Director of The Office of National Drug Control Policy (ONDCP).

This is a significant step toward advancing sustainable systems change, as Boticelli has a focus on substance use treatment. His two decades of experience working in this field, including as Director of the Bureau of Substance Abuse Services at the Massachusetts Department of Public Health, equips him with the skills to implement evidence-based programs and span boundaries among partnerships with law enforcement agencies, health and human service agencies and stakeholder groups. Boticelli also has experience establishing a treatment and prevention systems for adolescents.

Read Boticelli’s introductory remarks as Director on the ONDCP blog and below, and join me in welcoming him to office:

Many great movements to change public perception and policy around a public health issue have been fueled by people with a disease speaking out publicly.  What is seen as someone else's problem—someone else’s disease – takes on a new dimension when people speak up about it.  

Such was the case when Betty Ford revealed her breast cancer diagnosis and her substance use disorder. Such was the case when Magic Johnson's revealed that he was HIV positive, spurring action to stem the AIDS epidemic.

Yet, despite the fact that nearly every family and community in America is affected by a substance use disorder, those fighting to overcome this disease are too often hidden in the shadows of shame and denial.  It is whispered about. It is met with derision and scorn.

According to the National Survey on Drug Use and Health, only 1 in 9 people with a diagnosable substance use disorder gets treatment.  Compare this to the treatment rate for diabetes, for which 72% of people with the disease receive care.

When treatment is provided for substance use disorders, it too often comes at the most acute stages of the disease when effective treatment is far more challenging and costly than in the early stages. Because substance use disorders have historically gone unidentified for far too long, and timely access to treatment has been far too difficult to come by, a person is expected to hit “rock bottom” before seeking help for a substance use disorder.

Standard medical care does not allow a diabetic to enter kidney failure before offering insulin.  Yet untreated substance use disorders routinely proceed unchecked until they have reached such levels of emergency.  In addition to the unnecessary suffering for patients and their families, our current approach costs the United States hundreds of billions a year in increased health care costs, crime and lost productivity-- over $223 billion related to alcohol and $193 billion related to illicit drugs.

Decades of scientific research have proven that substance use disorders are a health issue:  chronic medical conditions with genetic, biological and environmental risk factors.  Effective substance use disorders requires a comprehensive, public health approach involving evidence-based prevention, early intervention, treatment and recovery support services.  The National Drug Control Strategy, the Obama Administration’s template for drug policy, outlines more than 100 action items across federal government to prevent drug use and its consequences.

Earlier this month, President Obama in his 2016 Budget requested historic levels of funding --including $133 million in new funds-- to address the opioid misuse epidemic in the U.S. Using a public health framework as its foundation, our strategy also acknowledges the vital role that federal state and local law enforcement play in reducing the availability of drugs—another risk factor for drug use.  It underscores the vital importance of primary prevention in stopping drug use before it ever begins by funding prevention efforts across the country. It sets forth an agenda aimed at stripping away the systemic challenges that have accumulated like plaque over the decades: over-criminalization, lack of integration with mainstream medical care, insurance coverage and the legal barriers that make it difficult for people once involved with the criminal justice system to rebuild their lives.

The implementation of the Affordable Care Act will dramatically increase coverage for treatment and ensures that services are comparable to other chronic conditions for more than 60 million Americans. This is the biggest expansion of substance use disorder treatment in a generation, and it will transform millions of lives.

All of these advancements, however, are not enough unless we fundamentally change the way we think about people with addiction.  There are millions of people in recovery in the United States leading meaningful, productive lives full of joy and love and laughter – and I am one of them.

Tonight, the United States Senate voted to confirm my nomination as Director of National Drug Control Policy. This is an honor I never dreamed of 26 years ago, when my substance use disorder had become so acute that I was handcuffed to a hospital bed. I accept this challenge with the humility and tenacity of someone in long term recovery.

I am open about my recovery not to be self-congratulatory, I am open about my recovery to change public policy. I have dedicated my life to treating drug use as a public health issue, and that’s how I approach this new role, as well.  I hope that many more of the millions of Americans in recovery like me will also choose to “come out” and to fight to be treated like anyone else with a chronic disease. By putting faces and voices to the disease of addiction and the promise of recovery, we can lift the curtain of conventional wisdom that continues to keep too many of us hidden and without access to lifesaving treatment.

It is time to make a simple, yet courageous decision to be counted, to be seen and to be heard.

Share your story with us today.

At a  training of Massachusetts MBTA Training Academy recruits in July, a police officer said to the group, “What I am telling you today we did not get when we were in the academy. Now you’ve got a leg up in dealing with kids by knowing this stuff.” The officer had been trained in a train-the-trainer capacity building effort by Strategies for Youth. “Knowing this stuff about kids makes working with them easier and less stressful and believe me, they can be stressful,” he told the recruits.
The newly released findings of the International Association of Chiefs of Police (IACP) survey on juvenile justice and youth training needs suggest this officer is both right and unusual. Training in best practices for working with youth is helpful, but remains the exception to the rule across the country.
The IACP’s survey, the “2011 Juvenile Justice Training Needs Assessment,” found that police chiefs want training but lack funding and agency resources to provide it to their officers.  They wanted their officers to have the skills to work with the increasing and challenging demands posed by youth. The top 5 areas in which chiefs want their officers trained are:

1. substance abuse;
2. physical, sexual and/or emotional abuse;
3. dealing with chronic juvenile offenders;
4. bullying/cyber-bullying; and
5. gangs. Other topics included internet offending, runaways, and school safety. 

The survey is notable for the unusually large size of the sample: over 672 law enforcement officers in 404 law enforcement agencies in 49 states and the District of Columbia. The agencies represented the gamut of departments, from small and rural, to suburban, to large and urban; 77% were police departments.  
Demands on  Law Enforcement:
While officers have always dealt with children and youth, arguably today they are asked to deal with them more than ever. Cuts in youth serving programs, the increased placement of officers in schools, and the common reaction of calling the police for any youth-related issue, combine to make police the first responders to incidents involving youth. 

Over the last few decades, the victims' rights movement has been effective in highlighting the needs and concerns of victims of crime. This movement –- born out of the women’s right era of the early 1970s -– continues to pick up steam as states amend laws and policies to give victims more defined rights and services. However, as the victims' right movement has evolved, so must its recognition of and treatment of victims.
When you hear the word “victim,” seldom do you associate that with young African American men. Society, through sensationalist media reporting, scapegoating and rhetoric-laden politicking, has done a thorough job of painting what a “perpetrator” and a “victim” look like. One of those paintings uses more color than the other.
The irony of such mischaracterization is that young black males are victimized at a higher rate than any other demographic. According to the U.S. Department of Justice Bureau of Justice Statistics Criminal Victimization in the United States, 2008, blacks are victimized at a personal crime rate of 26.6 percent in comparison to whites, who are victimized at a personal crime rate of 18.6 percent –- yet when victims are talked about, this population doesn’t enter the discussion.

Going into my senior year in high school, I worked an entire summer from sun-up to sundown to save enough money to help my mother buy me a car. When I finally got that car, it was broken into not long afterward. I felt angry, stranded, violated, sad and a whole host of other emotions, but for whatever reason, I never felt like a victim.
Why not? I had obviously just been victimized.