Adolescent Substance Abuse Treatment

In two separate blog posts in 2016, we discussed opioid use rates and substance use issues among adolescent girls involved with juvenile justice. In July 2017, the United States Department of Health and Human Services, Office on Women’s Health (OWH) released a report on opioid use, misuse, and overdose in women. The report provides information on the gender-specific issues and gaps in knowledge regarding females with substance use concerns/disorders. The report discusses the differences among females and males regarding the progression of substance use, the biological, social, and cultural issues (e.g., pain; relationships; family/parenting; trauma, determinants of health), effective treatments and barriers to implementation, and areas for further research. As it relates to adolescent girls (ages 12-17 years old), the report indicates they are more likely to use and become dependent on non-medical uses of prescription drugs as compared to adolescent boys. Access to prescription drugs can come from a home medicine cabinet and may help relieve mental health or physical pain symptoms and/or be part of their peer culture.

Before sharing our accomplishments and expansion efforts, let’s take a moment to acknowledge numerous people and organizations that we have had the privilege of working with over the past few years to implement Reclaiming Futures’ version of Screening, Brief Intervention, and Referral to Treatment (RF-SBIRT).

As many of you know, in 2016 the Office of Juvenile Justice and Delinquency Prevention (OJJDP) released the Juvenile Drug Treatment Court Guidelines (JDTC). The purpose for developing the Guidelines was to organize the most effective JDTC implementation components based on the best available research. Building on the 2003 Juvenile Drug Courts: Strategies in Practice (JDC: SIP), this systematic and thorough review developed seven objectives, each with corresponding guidelines statements, and supporting information.

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.

Acknowledged as the final signed legislation for President Obama’s Administration, the 21^st Ce​ntury Cures Act is important for behavioral health and juvenile justice. The key components of this Act include provisions for:

• Addressing the heroin and prescription opioid epidemic
• Providing funding for the BRAIN initiative and precision medicine
• Improving mental health care by increasing the availability of treatment and improving justice systems to ensure individuals in need of mental health services - actually get it
• Improving clinical trials
• Expanding cancer research and treatment efforts

In this month’s Reclaiming Futures newsletter, we draw your attention to a new report issued by US Surgeon General Vivek Murthy on November 17, 2016.  The report is significant because it marks the first time a United States Surgeon General has taken such a clear and strong position that substance use and addiction should be viewed first and foremost as a public health issue.  This is a position many advocates and organizations, like Reclaiming Futures, have taken for many years because we know firsthand the collateral consequences of continuing to view substance use and addiction as a moral failing and as a matter for the criminal justice system, and not the public health system and/or through a racially biased lens.

In the current Reclaiming Futures newsletter we focus our attention on Screening Brief Intervention and Referral to Treatment (SBIRT). SBIRT is a public health-oriented framework revolutionizing the way we think about behavioral health and substance use screening and prevention. Buoyed by strong evidence from the adult research literature, there has been a surge in national interest in translating the successes of the adult SBIRT model for youth populations.

As many of you know, Reclaiming Futures was awarded a Conrad N. Hilton Foundation grant in September 2014. The purpose of this grant is to develop, pilot test, evaluate, and disseminate a new version of SBIRT for youth at risk for deeper involvement with the juvenile justice system. As a first step, Reclaiming Futures issued a request for proposals and awarded five sites to help us in the endeavor. The sites selected, through a competitive process, were:

• Chittenden County, Vermont
• King County, Washington
• Mecklenburg County, North Carolina
• Nassau County, New York
• Washington County, Oregon

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.

On June 1, 2016, our Reclaiming Futures national executive director Evan Elkin spoke at Red Emma's in Baltimore for Open Society Institute-Baltimore's second event in their "Talking About Addiction" series. Elkin was accompanied on the panel by Dr. Hoover Adger from Johns Hopkins Children's Center and by Carin Callan Miller, who founded Save Our Children Peer Family Support. The conversation was moderated by Scott Nolen, director of OSI-Baltimore's Drug Addiction Treatment Program. A full room of community members joined them for the evening, including families affected by adolescent addiction.

Youth, Addiction and the Juvenile Justice System

Whereas the first "Talking About Addiction" event explored alternative law enforcement approaches to addiction, this event focused on youth, addiction, and the juvenile justice system. Despite public acknowledgment of the failures of the "War on Drugs," and an increased understanding of addiction as a public health issue rather than a criminal justice issue, OSI-Baltimore recognizes that research and policy around adolescent addiction are slow to reach the mainstream. Indeed, during the discussion, some attendees expressed frustration with how long addiction treatment reform is taking; OSI moderator Nolen suggested reassurance that the addiction paradigm is finally shifting.