Predicting nonresponse to juvenile drug court interventions

Juvenile Drug Treatment Court

Juvenile drug treatment courts (JDTCs) were established in the 1990s to reduce the cycle of crime, drug use, and delinquency among youthful offenders. The principles and guidelines underlying JDTCs, roles of multidisciplinary team members, and procedures common to JDTCs are described. Youth served by JDTCs are frequently male, identify as racial or ethnic minorities, come from impoverished backgrounds, and experience significant psychiatric comorbidity. This article reviews the small number of clinical trials that have examined adjunctive treatments using family-based and individual behavioral treatment approaches designed to improve the overall efficacy of JDTCs. Considerations for future research on JDTCs are described.

General Responsivity Adherence in Juvenile Drug Treatment Court

Although the number of juvenile drug treatment courts (JDTC) in operation has increased since the first JDTCs were implemented in the 1990s, research continues to lag regarding the effectiveness of the treatment interventions that are provided. The purpose of the present study was to explore how the risk-need-responsivity models’ general responsivity principle could be used to inform the effectiveness of the interventions provided to 1,176 participants in nine JDTCs in the United States. Responsivity adherence was measured using the number of general responsivity-adherent techniques included in each intervention. The results indicated that an increase in general responsivity adherence was associated with an increase in substance-use severity score, which suggests that the effect of the JDTC model on treatment outcomes could vary by the type of interventions provided to participants. In addition, the findings suggest the need to further specify adherence to the general responsivity principle, particularly among substance-involved juvenile offenders.

The efficacy of two adolescent substance abuse treatments and the impact of comorbid depression: results of a small randomized controlled trial

OBJECTIVE

The purpose of this randomized trial was to investigate the efficacy of 2 behavioral treatments focusing on different change mechanisms in ameliorating a borderline personality disorder constellation of behaviors and substance use in adolescents referred by juvenile diversion programs.

METHODS

Forty adolescents 14-17 years of age and meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for borderline personality disorder and substance use disorders were randomized to integrative borderline personality disorder-oriented adolescent family therapy (I-BAFT) or individual drug counseling. This design allowed a comparison of 2 manualized interventions, 1 family based and 1 individually oriented. Profiles of clinical change were used to detect impact and estimate treatment effect sizes.

RESULTS

Primary analyses showed that both interventions had a clinically significant impact on borderline personality disorder behaviors 12 months after baseline but with no differential treatment effects. The impact on substance use was more complex. Subgroup analyses revealed that adolescents with depression had significantly more severe profiles of borderline personality disorder and substance use. These youths were the only group to show reductions in substance use, but they only did so if they received the I-BAFT intervention. Study data also documented the high dosage of intensive residential treatment needed by this population.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Results highlight the intensive treatment needs of juvenile justice-involved youths with co-occurring substance use and borderline personality disorder including depression, the hybrid outpatient and residential treatment often required by this population, and the promise of a family-oriented approach, particularly for youths with severe symptoms and co-occurring depression. (PsycINFO Database Record

Testing for drugs of abuse in children and adolescents

Drug testing is often used as part of an assessment for substance use in children and adolescents. However, the indications for drug testing and guidance on how to use this procedure effectively are not clear. The complexity and invasiveness of the procedure and limitations to the information derived from drug testing all affect its utility. The objective of this clinical report is to provide guidance to pediatricians and other clinicians on the efficacy and efficient use of drug testing on the basis of a review of the nascent scientific literature, policy guidelines, and published clinical recommendations.

Enhancing the effectiveness of juvenile drug courts by integrating evidence-based practices

OBJECTIVE

The primary purpose of this study was to test a relatively efficient strategy for enhancing the capacity of juvenile drug courts (JDC) to reduce youth substance use and criminal behavior by incorporating components of evidence-based treatments into their existing services.

METHOD

Six JDCs were randomized to a condition in which therapists were trained to deliver contingency management in combination with family engagement strategies (CM-FAM) or to continue their usual services (US). Participants included 104 juvenile offenders (average age = 15.4 years; 83% male; 57% White, 40% African American, 3% Biracial). Eighty-six percent of the youths met criteria for at least 1 substance use disorder, and co-occurring psychiatric diagnoses were highly prevalent. Biological and self-report measures of substance use and self-reported delinquency were assessed from baseline through 9 months postrecruitment.

RESULTS

CM-FAM was significantly more effective than US at reducing marijuana use, based on urine drug screens, and at reducing both crimes against persons and property offenses. Such favorable outcomes, however, were not observed for the self-report measure of substance use. Although some variation in outcomes was observed between courts, the outcomes were not moderated by demographic characteristics or co-occurring psychiatric disorders.

CONCLUSIONS

The findings suggest that JDC practices can be enhanced to improve outcomes for participating juvenile offenders. A vehicle for promoting such enhancements might pertain to the development and implementation of program certification standards that support the use of evidence-based interventions by JDCs. Such standards have been fundamental to the successful transport of evidence-based treatments of juvenile offenders.