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Rodney R. Funk & Michael L. Dennis Chestnut Health Systems, Normal, IL

Cycles of substance use, incarceration, treatment, and recovery over 8 years for juvenile justice sample.

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Rodney R. Funk & Michael L. Dennis Chestnut Health Systems, Normal, IL

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  1. Cycles of substance use, incarceration, treatment, and recovery over 8 years for juvenile justice sample. Presentation at the Joint Meeting on Adolescent Treatment Effectiveness (JMATE), Baltimore, MD, December 14–16, 2010. This presentation was supported by funds or data from the National Institute on Drug Abuse (NIDA) grant R37-DA11323, NIDA grant DA016722, Center for Substance Abuse Treatment (CSAT) grant no.TI11433, and CSAT contract 270-2003-00006. The opinions are those of the authors do not reflect official positions of the government. Comments and questions can be directed to Rod Funk, Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61761, 309-451-7808, rfunk@chestnut.org Rodney R. Funk & Michael L. Dennis Chestnut Health Systems, Normal, IL Rajeev Ramchand & Andrew Morral RAND Corporation, Arlington, VA

  2. Introduction and Purpose • The Juvenile Justice System focuses on rehabilitation • Rehabilitation is made complex by a range of problems that may contribute to youths’ risk of recidivism: mental health problems, family and peer group dysfunction, educational problems and risky behavior • In this study we look at the cycle of transitions of these adolescents moving into early adulthood and compare them to a community based sample

  3. Data Source • Recruited 449 youth between 2/99 and 5/00 from 3 juvenile halls in Los Angeles referred by Probation to one of 7 group homes or Phoenix Academy as part of CSAT grant • Follow-up done at 3, 6, 9, 12, 24, 36, 72, 87 and 102 months under CSAT contract & NIDA grant • 80% or more follow-up at each wave • Assessments included the Global Appraisal of Individual Needs (GAIN), a variety of supplemental measures, and urine tests

  4. Sample Characteristics

  5. Comparisons of Selected Demographics by Study

  6. Age across follow-up waves

  7. Method • At each interview wave adolescents were classified as: • in the community using, • incarcerated, • in treatment, • In recovery in the community • Described the probability of transitioning to a different state from one interview to the next (2,768 observed transitions) • Compared the pattern of transition observed in this juvenile justice sample versus what Dennis et al. reported in their community based sample • Evaluated the significant predictors of movement towards recovery (vs. use) using SPSS and manual stepwise in Hedeker’s mixed nominal (MIXNO) model to control for repeated observations on people • Controlled for months between interview waves

  8. The Cyclical Course of Relapse, Incarceration, Treatment and Recovery: Adolescents 24% 30% 11% 24% 5% 12% 32% 34 % 3% 12% 41% 7% Avg of 59% change status per quarter Incarcerated (60% stable) In the In Recovery Community (41% stable) Using (51% stable) In Treatment (13% stable) Source: RAND ; unique n = 499, number of observations=2,768

  9. The Cyclical Course of Relapse, Incarceration, Treatment and Recovery: Adolescents Less likely to continue using (51% vs. 75%) Incarcerated (60% stable) More Likely to go to Detention (30% vs. 5%) 30% In the 12% In Recovery Community (41% stable) Using (51% stable) 7% Similar rate of entering recovery (12% vs. 12%) In Treatment (13% stable) Similar rate of entering treatment (7% vs. 7%) Source: RAND ; unique n = 499, number of observations=2,768

  10. The Cyclical Course of Relapse, Incarceration, Treatment and Recovery: Adolescents More Likely to go back to Detention (34% vs. 7%) Incarcerated (60% stable) In the In Recovery Community (41% stable) Using (51% stable) 34 % 12% 41% Less likely to enter recovery (12% vs. 19%) In Treatment More likely to relapse (41% vs. 26%) (13% stable) Less likely to stay in treatment (13% vs. 48%) Source: RAND ; unique n = 499, number of observations=2,768

  11. The Cyclical Course of Relapse, Incarceration, Treatment and Recovery: Adolescents More Likely to go back to Detention (24% vs. 3%) Incarcerated 24% (60% stable) In the In Recovery Community (41% stable) Using 32% (51% stable) 3% Less likely to remain in recovery (41% vs. 62%) In Treatment Little More likely to relapse (32% vs. 27%) (13% stable) Little Less likely to enter treatment (3% vs. 7%) Source: RAND ; unique n = 499, number of observations=2,768

  12. The Cyclical Course of Relapse, Incarceration, Treatment and Recovery: Adolescents More Likely to remain in Detention (60% vs. 46%) Little More likely to relapse (24% vs. 20%) Incarcerated (60% stable) 11% 24% 5% In the In Recovery Community (41% stable) Using (51% stable) Less likely to enter treatment (5% vs. 24%) In Treatment Similar rate to enter recovery (11% vs. 10%) (13% stable) Source: RAND ; unique n = 499, number of observations=2,768

  13. Risk Factors Illegal Activity Employment Activity Treatment Resistance Emotional Problems Substance Use Frequency Current Withdrawal Weeks in a controlled environment Protective Factors Female School Activity Weeks in Self-help Problem Orientation Self-efficacy Positive Recovery Environment Risk and Protective Factors Associated with Transitioning or Remaining in Recovery • Being older is a risk factor going from use to recovery, but is protective for remaining in recovery

  14. Comparisons of Risk Factors by Study

  15. Comparison of Protective Factors by Study

  16. Summary • Relative to adolescents in community based treatment, those in this juvenile justice sample were: • More likely transition during the follow-up period • Less likely to stay in treatment • More likely to relapse after treatment or recovery • More likely to transition towards incarceration from all states • They had similar risk and protective factors, with the notable exception of treatment effects (presumably due to high drop out)

  17. Some Important Limitations • One site, limited sample size • Unequal intervals • Confounded with aging into young adulthood • Based only on self report • Needs to be replicated with other justice samples

  18. Implications and Next Steps • Suggest the need for more assertive continuing care, monitoring and early re-intervention with youth coming from the juvenile justice system • Proposing to use larger justice and young adult samples in 2010 data set to explore whether these findings are replicated across multiple sites and after controlling for age

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