Balancing Justice and Treatment: Some Lessons from the RWJF Reclaiming Futures Initiative

1. Balancing Justice and Treatment: Some Lessons from the RWJF Reclaiming Futures Initiative Jeffrey A. Butts, Ph.D.Chapin Hall at the University of ChicagoSeptember 4, 2008 Presented to

2. RWJF’s Reclaiming Futures Initiative • Improving justice interventions for drug-using youth • Areas of focus: • Quality improvement • Screening and assessment • -Leadership • -Systems integration and agency coordination • - Data systems • -Family involvement • Community engagement • Similar to many other efforts to improve systems

3. RWJF’s Reclaiming Futures Initiative • Yet, different from other system change efforts • Difficult to manage the inherent tensions between treatment and justice • Example – • Panel study of 1,000 8th graders followed to age 22: • Researchers tested the effect of juvenile justice intervention on school success, employment, and adult crime controlling for criminal record, poverty etc. • Intervention reduces the chances of high school graduation and adult employment • Intervention increases the number of predicted crimes during adult years by a factor of 5 • Source: Bernburg and Krohn (2003). Criminology. Risk of Legal Coercion to Reduce Drug Use Risk of Youth’sDrug Use • Both place youth at greater risk of future offending and court involvement

4. To Treat or Not To Treat • Adolescent drug use is nearly normal behavior • Most drug-using youthful offenders will age out of drug use, just as most adolescents desist with age • The challenge is to identify which youth won’t desist • Both juvenile court adjudication and drug abuse are potentially harmful to youth • “Normal” drug use by itself should not be used as legal leverage to entangle youth in the formal justice system • Inherent tensions between justice and treatment goals are eliminated only when the seriousness of a youth’s law violation justifies the use of coercive intervention

5. How Common is Teen Drug Use? Been drunk 18% Alcohol Any use 33% Use in Past Month by 10th Graders Source: Monitoring the Future 2007, University of Michigan.

6. How Common is Teen Drug Use? Any Illicit Drug 17% Use in Past Month by 10th Graders Source: Monitoring the Future 2007, University of Michigan.

7. How Common is Teen Drug Use? Any Illicit Drug 17% Use in Past Month by 10th Graders Abuse/Dependence in Past Year (12-17) Drug 5% Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006.

8. How Common is Teen Drug Use? Any Illicit Drug 17% Use in Past Month by 10th Graders Abuse/Dependence in Past Year (12-17) Incl. Alc. 8% Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006.

9. Assessment Center (Abuse in Past Month) How Common is Teen Drug Use? Any Illicit Drug 17% Use in Past Month by 10th Graders Abuse/Dependence in Past Year (12-17) Any SUD 8% SUD “Substance Use Disorder” General PopulationJustice-Involved Any SUD 11% Youth referred to an intake and assessment center soon after a first contact with police. Source: McReynolds et al. (2008). Crime & Delinquency.

10. Assessment Center (Abuse in Past Month) Probation Intake (Abuse in Past Month) How Common is Teen Drug Use? Any Illicit Drug 17% Use in Past Month by 10th Graders Abuse/Dependence in Past Year (12-17) Any SUD 8% General PopulationJustice-Involved Drug 5% Any SUD 11% Any SUD 25% Youth referred to probation intake after initial screening by law enforcement or other agency. Source: Wasserman et al. (2005). Amer. Journal of Public Health.

11. Assessment Center (Abuse in Past Month) Probation Intake (Abuse in Past Month) JJ Supervision Pop. (Abuse in Past Year) How Common is Teen Drug Use? Any Illicit Drug 17% Use in Past Month by 10th Graders Abuse/Dependence in Past Year (12-17) Any SUD 8% General PopulationJustice-Involved Drug 5% Any SUD 11% Any SUD 25% Any SUD 37% Youth formally involved with a juvenile justice agency; some but not all with previous out-of-home placements. Source: Aarons et al. (2001). Journal of the Amer. Acad. of Child and Adolesc. Psych.

12. Assessment Center (Abuse in Past Month) Probation Intake (Abuse in Past Month) Urban Juv Detention JJ Supervision Pop. (Abuse in Past Year) (Abuse in Past 6 Months) How Common is Teen Drug Use? Any Illicit Drug 17% Use in Past Month by 10th Graders Abuse/Dependence in Past Year (12-17) Any SUD 8% General PopulationJustice-Involved Any SUD 11% Drug 5% Any SUD 25% Any SUD 37% Any SUD 49% Serious juvenile offenders held in the secure detention center of Cook County (Chicago) Illinois. Source: Teplin et al. (2002). Archives of General Psychiatry

13. Clearly, Drug Problems are More Common the Deeper One Looks into the Juvenile Justice Process In a sense, drug-using youth accumulate in the “deep end” of the juvenile justice system… • Why? • Do drug issues increase the seriousness of criminal behavior by juvenile offenders? • Do drug issues increase the coerciveness of the legal response to juvenile offenders?

14. Consider this…

15. Recall, rate of substance use disorders among all U.S. 12-17 year-olds. - SAMHSA (2006) 8% 100% What proportion have a substance use disorder? - McReynolds et al. (2008) 11% Youth at a Juvenile Assessment Center

16. 50% Recall, rate of substance use disorders among all U.S. 12-17 year-olds. - SAMHSA (2006) 8% 100% About half of all arrested youth are referred to juvenile court authorities. - Juvenile Court Statistics, OJJDP Of these, what proportion have a substance use disorder? - Wasserman et al. (2005) 25% 11% Youth at a Juvenile Assessment Center Youth Referred to Juvenile Probation

17. Recall, rate of substance use disorders among all U.S. 12-17 year-olds. - SAMHSA (2006) 20% 8% 100% About 20 percent of all court referred youth are held in secure detention at some point. - Juvenile Court Statistics, OJJDP Of these, what proportion have a substance use disorder? - Teplin et al. (2002) 25% 11% 49% Youth at a Juvenile Assessment Center Youth Referred to Juvenile Probation Youth Held in Secure Detention

18. Recall, rate of substance use disorders among all U.S. 12-17 year-olds. - SAMHSA (2006) 8% 100% When they first enter the juvenile system, the prevalence of substance abuse among young offenders is similar to other teens. Substance-abusing offenders, however, are more likely to be retained through to the more restrictive stages of justice processing. The preponderance of drug-abusing youth in the deep end of the justice system is a function of how case decisions are made. Drug-abusing youth are treated more coercively. Thus, they are a larger subgroup by the end of the juvenile justice process. 25% 11% 49% Youth at a Juvenile Assessment Center Youth Referred to Juvenile Probation Youth Held in Secure Detention

19. Youth with Identified Drug Issues are Handled More Coercively in the Juvenile Justice System • This may be an accurate and legitimate use of resources if drug-using youth are higher-risk and in need of stronger sanctions. • Just what type of drug users are referred to the juvenile justice system?

20. Substance Use Disorders Among Youth Referred to a Juvenile Assessment Center Among Youth Referred to Juvenile Probation Intake Abuse Disorders (past month) Alcohol 2% Marijuana 4% Other drug 1% Dependence Disorders Alcohol 1% Marijuana 5% Other drug 1% No Disorder Detected 89% Abuse Disorders (past month) Alcohol 7% Marijuana 10% Other drug 3% Dependence Disorders Alcohol 3% Marijuana 13% Other drug 4% No Disorder Detected 75% Source: McReynolds et al. (2008) Source: Wasserman et al. (2005)

21. Substance Use Disorders • 10%-25% of youthful offenders have substance use issues that could be called problematic – either abuse or dependence • Most of these substance use issues (80%-90% involve alcohol and marijuana only

22. The Key Policy Question: How Serious Does a Teen’s Use of Alcohol and Marijuana Have to be to Pose a Greater Threat to his or her Future than the Threat Posed by Juvenile Court Adjudication and the Criminal Record that may Follow?

23. Two Dimensions in Decision Making • Severity of substance abuse • Severity of criminal behavior

24. Total Population of Youth Offenders

25. Severity of Criminal Behavior Total Population of Youth Offenders

26. Total Population of Youth Offenders

27. Severity of Drug-Using Behavior Total Population of Youth Offenders

28. If we combine the two dimensions… Severity of Drug-Using Behavior Severity of Criminal Behavior

29. Coercion for Treatment? Coercion for Public Safety Treatment IatrogenicRisk Maximum Intervention When is it appropriate to use the justice system to coerce youth into compliance, knowing that coercion itself present risks to their future? How far down into less serious offenses can coercion be used before we introduce “iatrogenic” risks – making things worse? Severity of Drug-Using Behavior Minimum Intervention Justice Severity of Criminal Behavior

30. Coercion for Treatment? Coercion for Public Safety • Iatrogenic Risk Could be Eliminated With Perfect and Objective Knowledge of 4 Factors: • Actual harm caused by a youth’s current drug use • Trajectory and impact of future drug use • Methods for selecting and delivering treatment • The effectiveness and behavioral impact of treatment • Our Knowledge Will Never Be Perfect Treatment IatrogenicRisk Maximum Intervention Severity of Drug-Using Behavior Minimum Intervention Justice Severity of Criminal Behavior

31. Coercion for Treatment? Coercion for Public Safety Treatment IatrogenicRisk Maximum Intervention To the extent we have only imperfect knowledge, our willingness to use coercion for treatment goals alone should be limited to serious drug problems. Severity of Drug-Using Behavior Minimum Intervention Justice Severity of Criminal Behavior

32. Coercion for Treatment? Coercion for Public Safety Treatment IatrogenicRisk Maximum Intervention Injustice Imperfect Knowledge Severity of Drug-Using Behavior Minimum Intervention Justice Severity of Criminal Behavior

33. In Juvenile Justice, Treatment Must Be… • Largely community-based, non-coercive • Designed for the vast majority of youth who are drug using, sometimes abusing, but not drug dependent • Ready to address a wide range of drug use but still appropriate for the 90% of youthful offenders who use only alcohol and marijuana • Designed to avoid unwarranted legal coercion by providing services, activities and supports that are actually appealing to non-mandated, voluntary clients • Free of any financial incentives that lead to excess use of formal adjudication and court-ordered treatment

34. Jeffrey A. Butts, Ph.D.Research FellowChapin Hall at the University of Chicagojabutts@uchicago.eduwww.chapinhall.orgwww.jeffreybutts.net

35. Aarons, Gregory A., Sandra A. Brown, Richard L. Hough, Ann F. Garland, and Patricia A. Wood (2001). Prevalence of Adolescent Substance Use Disorders across Five Sectors of Care. Journal of the American Academy of Child and Adolescent Psychiatry, 40(4): 419–26.Bernburg, Jón Gunnar and Marvin D. Krohn (2003). Labeling, Life Chances, and Adult Crime: The Direct and Indirect Effects of Official Intervention in Adolescence on Crime in Early Adulthood.” Criminology 41(4): 1287-1318.McReynolds, Larkin S., Gail A. Wasserman, Robert E. DeComo, Reni John, Joseph M. Keating, and Scott Nolen (2008). Psychiatric disorder in a juvenile assessment center. Crime & Delinquency, 54(2): 313-334.Substance Abuse and Mental Health Services Administration (2007). National Survey on Drug Use and Health. Rockville, MD: Substance Abuse and Mental Health Services Administration.Teplin, Linda A., Karen M. Abram, Gary M. McClelland, Mina K. Dulcan, and Amy A. Mericle (2002). Psychiatric Disorders in Youth in Juvenile Detention. Archives of General Psychiatry, 59(Dec): 1133-1143.Wasserman, Gail A., Larkin S. McReynolds, Susan J. Ko, Laura M. Katz, and Jennifer R. Carpenter (2005). Gender Differences in Psychiatric Disorders at Juvenile Probation Intake. American Journal of Public Health, 95(1): 131-137. References