Adolescent Substance Abuse Treatment

Have you heard of adverse childhood experiences? Known as simply “ACEs,” this approach is rapidly gaining attention among the medical community and public health professionals alike. The issue is spanning boundaries and becoming increasingly pressing as studies unfold that early adversity—ACEs and toxic stress—dramatically impacts health outcomes.

A recently released TEDMED talk from Pediatrician Nadine Burke Harris explores this issue deeply. Her interest in ACEs began with a study led by Kaiser Permanente and the Centers for Disease Control and Prevention, which evaluated more than 17,000 adult patients. The study appointed each adult an ACEs score—a number that documented how many adverse childhood experiences each person had, such as abuse, neglect, exposure to domestic violence, and parents who were divorced, mentally ill or incarcerated.

The results were striking. The study found that the higher the ACEs score, the more likely adults suffered from dire health outcomes. Specifically:

• Those who’ve experienced high levels of trauma are at triple the risk for heart disease and lung cancer.
• Those with four or more adverse childhood experiences are four times more likely to become depressed, and
• Twelve times more likely to attempt suicide.

Even more, the study revealed that these health outcomes aren’t just a result of high risk behavior, such as alcohol and drug use, that are spurred by toxic stress. These health outcomes result directly from toxic stress. Burke Harris explains that when a young person is exposed to ACEs, his or her stress system is activated over and over, wearing down the system and affecting brain structure and function. Children are particularly sensitive to the impacts of stress activation since they are still developing, and high doses of adversity can also affect developing hormonal systems, immune systems, and the way DNA is read and transcribed.

To tackle this issue, Burke Harris opened the Center for Youth Wellness in California, where her focus is to prevent, screen and treat children with high ACEs scores. The approach is interdisciplinary—a collaboration across health professionals, families and treatment providers—something that we echo here at Reclaiming Futures.

While our focus at Reclaiming Futures is providing substance use and mental health treatment to teens, and mitigating involvement in the juvenile justice system, it’s valuable to understand how ACEs may impact these teens that we work with daily. It’s our approach—the intersection of treatment, family and mentor involvement, and community reintegration—that has the potential to identify those teens who have high ACEs scores, and identify solutions for getting them back on track to bright futures.

Watch Burke Harris’ full TEDMED talk below to hear more on the ACEs impact on futures:

Juvenile Justice Reform

• Federal Juvenile Justice Funding Declines Precipitously (JJIE)
  When congressional lawmakers last reauthorized the landmark Juvenile Justice and Delinquency Prevention Act, in fiscal year 2002, they appropriated about $547 million for juvenile justice. Today, federal spending on juvenile justice totals less than half that amount — about $251 million.

• Positive Youth Justice, Part One: Rosie’s Place, Olympia, Wash. (Chronicle of Social Change)
  Last week, The Chronicle of Social Change introduced “Positive Youth Justice: Curbing Crime, Building Assets.” It is a series that imagines an entire continuum of juvenile justice services built on the positive youth development framework. We accomplish the “creation” of that continuum by profiling successful programs and organizations all over the country. Today, we begin with a program in Washington that aims to redirect youth who are, statistically speaking, hurtling towards involvement with law enforcement and the courts.

• With 'Raise the Age,' Cuomo Continues Push to Reform Juvenile Justice (Gotham Gazette)
  A classic battle between law-and-order Republicans and progressive Democrats is brewing in the state Legislature as Gov. Andrew Cuomo pushes adoption of the recommendations of his Commission on Youth Public Safety and Justice - recommendations that include raising the age at which teens can be tried as adults.

• How Communities are Keeping Kids Out of Crime (Christian Science Monitor)
  Lucas County, which includes Toledo, is one of the leaders in this movement. Juvenile Court officials here do the “my kid” test with every case. They want to ensure all young people are being treated fairly, and they live by the mantra “The right kid in the right place at the right time” – targeting services to their needs and taking care not to mix children who are unlikely to commit more crimes with high-risk youths.

• To End Solitary Confinement, Rikers Steps Out Of The Box (NPR)
  New York's Rikers Island is the second-largest jail in the U.S., and one of the most notorious. But with a single move, Rikers has taken the lead on prison reform on one issue: Last month, the prison banned the use of solitary confinement for inmates under 21 years old.

Jobs, Grants, Events and Webinars

• Please share the Reclaiming Futures Opportunity Board with your colleagues in the juvenile justice, adolescent substance abuse and teen mental health areas. It's free to browse and post!

Adolescent Substance Abuse Treatment and Mental Health

• Rampant medication use found among L.A. County foster, delinquent kids (LA Times)
  Los Angeles County officials are allowing the use of powerful psychiatric drugs on far more children in the juvenile delinquency and foster care systems than they had previously acknowledged, according to data obtained by The Times through a Public Records Act request.

• School drug incidents raise questions on Colo. pot policy (USA Today)
  Hundreds of Colorado's middle-school students got caught with drugs at school last year, setting a decade-high record while raising questions about the impact of the state's legal marijuana industry.

• Child Experience Study Can Identify Mental Illness Early (TWC News)
  Since the 1990s, doctors have used the Adverse Childhood Experience Study--or ACES--to understand what causes mental health problems in children. That study found that negative experiences in childhood--from abuse to even divorce--can shape the mental health of kids as they grow up.

• No help until 'crisis point' reached, report 80% of parents to children with mental health problems (Pulse Today)
  Over 80% of parents to children with mental health problems had to wait until a ‘crisis point’ before they could access support services. An NHS England-commissioned survey of over 350 parents involved in Young Minds’ ‘Parents Say’ project revealed a raft of problems that parents face when dealing with Child and Adolescent Mental Health Services (CAMHS).

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.

Juvenile Justice Reform

• Juvenile Justice Reform Bill Moving Forward (Keloland News)
  A plan to change the way South Dakota deals with kids who get in trouble with the law is getting a lot of support in Pierre. The plan, which is similar to the adult justice reform, would keep kids in their own communities rather than sending them to a state facility.

• States see marked drop in juvenile prison populations as reforms take hold (Washington Post)
  A falling crime rate and new reforms to the way juveniles are treated by the criminal justice system have dramatically cut the number of young people in state prisons, according to a new report that highlights the success of some of those reforms.
• Why Keeping Young Offenders Out of Jail Could Reduce Crime (PBS Newshour)
  Juvenile offenders kept under supervision close to home, rather than in secure, state-run facilities, are significantly less likely to be arrested again or commit more serious crimes, according to a new study. Judy Woodruff discusses the findings with Xavier McElrath-Bey of the Campaign for the Fair Sentencing of Youth and Michael Thompson of the Council of State Governments Justice Center.

Jobs, Grants, Events and Webinars

• Please share the Reclaiming Futures Opportunity Board with your colleagues in the juvenile justice, adolescent substance abuse and teen mental health areas. It's free to browse and post!

Adolescent Substance Abuse Treatment and Mental Health

• Income Inequality Hurts Teen Health Around The World As Two Factors Grow Together (Medical Daily)
  A new international study published in The Lancet found that socioeconomic disparities between the richest and the poorest in 34 countries widened over the last decade, and have paralleled a growing inequality gap in health. Overall, poor teenagers were more likely to be less physically active, have higher body mass indexes (BMI), and report more physical and psychological troubles, such as headaches and “feeling low.”

• Dispensing truth and dispelling myths about drugs (MyCentralJersey.com)
  NCADD focused National Drug Facts Week on dispelling common myths related to drugs, drug use and drug abuse for local youth, school groups, clubs and organizations.

• American Academy of Pediatrics Reconsiders Stance on Marijuana (Pierce Pioneer)
  The policy statement describes, “The AAP strongly supports the decriminalization of marijuana use for both minors and young adults and encourages pediatricians to advocate for laws that prevent harsh criminal penalties for possession or use of marijuana. A focus on treatment for adolescents with marijuana use problems should be encouraged, and adolescents with marijuana use problems should be referred to treatment.”

• School-Wide Prevention Program Makes Teens Half As Likely To Feel Suicidal (Huffington Post)
  Suicide is the third leading cause of death between the ages of 10 and 24, according to the U.S. Centers for Disease Control and Prevention (CDC). Suicide attempts are even more common, with some research suggesting that 4 to 8 percent of high school students try to kill themselves each year, the CDC says.

Juvenile Justice Reform

• Trying to Fix America's Broken Juvenile Justice System (Rolling Stone)
  As Congress begins its new session, youth advocates are looking forward to the passage of a bipartisan bill that would strengthen protections for young people involved in the juvenile justice system.
• Whistleblowers Say DOJ Grants Failed To Protect Kids Behind Bars (NPR)
  There's new scrutiny this year on a federal program that's supposed to protect juveniles in the criminal justice system. Senate lawmakers want to pass a bill that would ensure young people are not locked up alongside adult offenders — and they're quietly investigating the use of federal grant money for the program.
• New Campaign Seeks to Sharply Reduce Youth Incarceration (JJIE)
  The Youth First! Initiative — founded by longtime juvenile justice advocate Liz Ryan — will also seek to reduce rampant racial and ethnic disparities in juvenile incarceration.

Jobs, Grants, Events and Webinars

• Please share the Reclaiming Futures Opportunity Board with your colleagues in the juvenile justice, adolescent substance abuse and teen mental health areas. It's free to browse and post!

Adolescent Substance Abuse Treatment and Mental Health

• UF study of drug users finds people with ADHD started using at younger age (UFL News)
  Adults with a history of ADHD who use drugs started using substances one to two years earlier than those with no ADHD history, according to a new University of Florida study. The findings highlight the need for earlier substance-use-prevention interventions in adolescents with ADHD, researchers say.

• Teens in more control during school-based suicide prevention (The Globe and Mail)
  Dr. Danuta Wasserman, a professor of psychiatry at the Karolinska Institute in Sweden, said the program was likely successful because students “felt that the power of mastering their feelings, coping with stress and choosing solutions was in their hands and not decided or forced by adults.”

• Teen ‘Pharming’ Is a Rising Concern (Psych Central)
  A new review suggests new initiatives are needed to address the rise of “pharming,” or recreational use and abuse of prescription drugs, among teenagers.

Juvenile Justice Reform

• New Campaign Seeks to Sharply Reduce Youth Incarceration (JJIE)
  A national juvenile justice campaign launched today with the ambitious goals of halving youth incarceration in 15 states over the next five years while expanding community-based alternatives for offenders.

• New York Under Pressure For Locking Up Teens In Adult Prisons (KQED)
  New York is one of only two states that still locks up 16- and 17-year-olds in adult prisons. A commission report released this week found that those young people — most of them black and Hispanic — face a high risk of assault and victimization behind bars and an increased risk of suicide. Gov. Andrew Cuomo now says he'll push the legislature to raise the age of adult incarceration to 18, a move that could mean the transfer of more than 800 teenagers out of state correctional facilities.

• On Martin Luther King Day, Police Reform Advocates Take Message to United Nations (Newsweek)
  The #Dream4Justice March was organized by Justice League NYC, which describes itself as “a task force of juvenile and criminal justice advocates, artists and experts, and formerly incarcerated individuals.”

Jobs, Grants, Events and Webinars

• Please share the Reclaiming Futures Opportunity Board with your colleagues in the juvenile justice, adolescent substance abuse and teen mental health areas. It's free to browse and post!

Adolescent Substance Abuse Treatment and Mental Health

• Public Health Approach Being Adapted for Kids in Trouble with Substances, the Law (JJIE)
  Many of the kids in juvenile detention with substance abuse disorders get poor or no treatment, according to Reclaiming Futures, a nonprofit that helps young people in trouble with drugs, alcohol and crime. It’s now experimenting with a public health approach to the situation.

• Parties hopeful meeting cleared air on youth drug court in Jacksonville (Jacksonville.com)
  A plan to improve years of low participation in Jacksonville’s juvenile drug court could be finalized in as little as 30 days. The federal government sent four experts to Jacksonville on Wednesday and Thursday to meet with key players in the court and help with program implementation.

• Training helps social workers, counselors give teens skills to abstain from drugs, tobacco, alcohol use (Kentucky.com)
  Actively listening, being willing to innovate, strategically guiding teens to discover their own solutions were among the many suggestions Riggs, a national recognized expert in addiction, shared with 45 social workers, counselors and others already working in substance abuse this week in Kentucky.

Juvenile Justice Reform

• Program Strives To Keeps Kids Out Of Jail, Link Them To Services Instead (Hartford Courant)
  "The longer a child stays out of the juvenile justice system, the better the outcome is for that child," said Bernadette Conway, who is the state's chief administrative judge for juvenile matters." Avoidable school-based arrests needlessly deprive children of an optimum education and all too often grossly compromise a child's ability to succeed in life."

• Grassley Lists Juvenile Justice As a Top Priority (JJIE)
  U.S. Sen. Charles Grassley, the new chairman of the Senate Judiciary Committee, lists juvenile justice among his top legislative priorities, heartening juvenile justice advocates.

• Rikers to Ban Isolation for Inmates 21 and Younger (New York Times)
  New York City officials agreed on Tuesday to a plan that would eliminate the use of solitary confinement for all inmates 21 and younger, a move that would place the long-troubled Rikers Island complex at the forefront of national jail reform efforts.

• Office of Juvenile Justice and Delinquency Prevention Launches National Mentoring Resource Center (PR NewsWire)
  The Office of Justice Program's Office of Juvenile Justice and Delinquency Prevention (OJJDP) announced today the launch of the National Mentoring Resource Center. OJJDP established the Center to support effective youth mentoring programs and healthy youth development.

Jobs, Grants, Events and Webinars

• Please share the Reclaiming Futures Opportunity Board with your colleagues in the juvenile justice, adolescent substance abuse and teen mental health areas. It's free to browse and post!

Adolescent Substance Abuse Treatment and Mental Health

• This Is What Happens When We Lock Children in Solitary Confinement (Mother Jones)
  While in isolation, Kenny—who was diagnosed with attention-deficit/hyperactivity disorder prior to the sixth grade—wrote to his mother, Melissa Bucher, begging her to make the two-hour drive to visit him. "I don't feel like I'm going to make it anymore," he wrote. "I'm in seclusion so I can't call and I'm prolly going to be in here for a while. My mind is just getting to me in here."

• Teens Influenced by Misconceptions of Their Peers (Medical News Today)
  Research published in Developmental Psychology suggests that teenagers tend to overestimate the amount of drugs and alcohol that their peers use, as well as underestimating the amount of studying and exercise they do.

• Eight Local Health Providers, UWM Respond to Gun Violence at Schools (BizTimes.com)
  Through a federal grant created to help communities respond to gun violence at schools, eight regional behavioral health providers and the University of Wisconsin-Milwaukee are working to strengthen trauma and substance abuse counseling services for youth.

• Heroin-Linked Deaths Surge 39 Percent, CDC Finds (Huffington Post)
  Overdose deaths linked to heroin jumped 39 percent in 2013 from the year before, according to data released Monday by the Centers for Disease Control and Prevention.

Candid conversation and community events will be the focal points of National Drug Facts Week Jan. 26 through Feb. 1, 2015. A national health observance led by the National Institute on Drug Abuse (NIDA), National Drug Facts Week seeks to work with teens to shatter the myths about drugs and drug abuse.

NIDA encourages schools, community groups, sports clubs, hospitals and other interested organizations to host an event in your community, supported by a robust collection of resources and interactive tools provided by NIDA on its website. The website is even designed with teen-friendly language and graphics to make it easy for teens to also take action and host events among their peers.

NIDA is also hosting a Drug Facts Chat Day on January 30. The online chat will facilitate conversation between high school students and NIDA scientists, so students from around the country can comfortably ask questions they most want answered, knowing that these expert scientists will give them the facts.

At Reclaiming Futures, we believe in the power of facilitating productive conversation with teens about substance use. It helps to illuminate their needs and identifies ways that parents, family members, educators and health professionals can be supportive in paving a healthy and substance-free future.

Our new pilot project, an adaptation of Screening Brief Intervention and Referral to Treatment (SBIRT), is an early intervention framework built around a motivational conversation with youth at risk of juvenile justice involvement. We will train front line staff in juvenile justice diversion settings to use screening tools and brief follow up sessions to tailor a treatment response that matches with the youth's level of need and motivation.

Like National Drug Facts Week, this new SBIRT approach seeks to support teens with substance use questions and habits through motivational conversations with health experts. We’re happy to support NIDA’s efforts, and encourage you to share this opportunity.

Visit the National Drug Facts Week website to learn how to host your own community event.

Juvenile Justice Reform

• Expert: Juvenile Justice Report Will Spur Reform at Rikers Island (The Forum News Group)
  “This reform will promote better behavior, psychological health and emotional well-being among our youngest inmates while lessening violence,” Department of Correction Commissioner Joseph Ponte said. “It represents best practices and the least restrictive environment, allowing us to respond more appropriately to the special needs of this troubled population, and help them re-integrate into the community when they leave our care and custody.”

• No More Solitary Confinement for Adolescent Inmates in NYC (WABC New York)
  New York City has ended its longstanding practice of sending 16- and 17-year-old inmates to solitary confinement for breaking rules, Mayor Bill de Blasio announced Wednesday.

• MacArthur Lauds Juvenile Justice Reformers (JJIE)
  In a written letter to the award recipients, MacArthur Foundation interim President Julia Stasch said: “No movement proceeds on the strength of research alone. Reform is animated by the passion and tenacity of the people who make a cause their cause.”

Jobs, Grants, Events and Webinars

• Please share the Reclaiming Futures Opportunity Board with your colleagues in the juvenile justice, adolescent substance abuse and teen mental health areas. It's free to browse and post!

Adolescent Substance Abuse Treatment and Mental Health

• Conrad N. Hilton Foundation awards $1.35 million grant to Legal Action Center (Globe NewsWire)
  Through a $1.35 million grant over three years from the Conrad N. Hilton Foundation, LAC and its partners will evaluate how the full range of adolescent prevention and early intervention services are being offered and to what extent insurers are implementing these services. They also will educate service providers about federal confidentiality requirements crucial to encouraging youth to seek services.

• Teens turn to e-cigarettes as tobacco smoking hits 40-year low among school-aged youths (Michigan Live)
  A new University of Michigan study shows that tobacco use among high school-aged teens has fallen to the lowest it's been in the last 40 years, but kids have replaced traditional smoking habits with something experts say is still harmful to their health.

• LifeWise panel sheds light on youth alcohol abuse (Salt Lake City Weekly)
  Nebraska may offer the good life, but depending on which survey one is reading, its youth now rank from second to the fifth highest in the nation for binge drinking, higher than its surrounding Midwest states.

We’re pleased to honor the achievements of Dr. H. Westley Clark in light of his recent retirement including his incredible impact on substance abuse treatment and commitment to the success of our young people.

The Substance Abuse and Mental Health Service Administration recognizes the strides Dr. H. Westley Clark made during his 16 years as the Director of the Center for Substance Abuse Treatment (CSAT), and more than 30 years in the federal government:

Wes’ professional life is one marked by non-stop accomplishments and accolades (such as the AMA’s John P. McGovern Award, Presidential Rank Award, Vernelle Fox Award from the California Society of Addiction Medicine, Solomon Carter Fuller Award from the American Psychiatric Association, and multiple Awards for Distinguished Service from the HHS Secretary). His long and distinguished career has had significant impacts on the research, practice, policies and programs in the treatment of substance use disorders. Wes is a graduate of the chemistry program at Detroit’s Wayne State University, the University of Michigan schools of medicine and public health, and Harvard law school. He also completed a two-year Substance Abuse Fellowship at the Department of Veteran Affairs Medical Center in San Francisco, where he served as Associate Clinical Professor, Department of Psychiatry, University of California at San Francisco (UCSF). He also served as senior program consultant to the Robert Wood Johnson Substance Abuse Policy Program and supported a number of National Institute of Drug Abuse-funded research grants.

Reclaiming Futures is happy to have worked parallel to Dr. H. Westley Clark and support his work in substance abuse treatment. We have admired his leadership in the recovery movement and commitment to increasing access to treatment services. In 2007 and 2009, Dr. Clark secured Reclaiming Futures funding from the Center for Substance Abuse Treatment (CSAT), along with OJJDP, to help us support sites implementing our model. He will be recognized for his lasting accomplishments, and we will continue to look toward his work for solutions and inspiration.

Image from SAMHSA website