Changing adolescent substance use and criminal activity in juvenile drug court: Improving outcomes through family-based treatment Gayle Dakof, Craig Henderson, Cindy Rowe, Maya Boustani, Paul Greenbaum, Wei Wang, Clarisa Linares, Sam Hawes & Howard Liddle University of Miami Miller School of Medicine, Sam Houston University, University of South Florida, State of Florida 11 th Judicial Circuit Court

Statement of the problem  Adolescent substance use and delinquency frequently co-occur  Left untreated these problems increase in severity often leading to a lifetime of addiction and offending  Substance abuse treatment has been shown to effectively reduce both substance abuse and delinquency  Small proportion of youth who need treatment receive it, and even fewer receive a best practice

Juvenile Drug Courts Are a Potential Solution to the Problem of Adolescent Substance Abuse & Delinquency

Drug Courts Integrate Treatment, Emphasizing Recovery and Personal Transformation, With The Power & Threat of the Legal System

Research on Juvenile Drug Courts (JDC), although limited, suggests that youth in JDC programs show better outcomes than youth in regular court programs.

Only 1 published randomized clinical trial (Henggeler et al 2006) They found… “...the findings support the view that drug court was more effective than family court services in decreasing rates of adolescent criminal and substance use behavior. Possibly due to the greatly increased surveillance of youth in drug court, however, these reductions in antisocial behavior did not translate to corresponding decreases in rearrest.”

JDC Study Aims & Design Aims: Investigate in JDC the effectiveness of a family based treatment (MDFT) compared with a group-based substance abuse treatment to reduce substance abuse, delinquent behavior, and arrests.

JDC Study Aims & Design Design – 112/119 (94% response rate) youth enrolled in JDC were randomly assigned to JDC + MDFT or JDC + 3 times/week Group Treatment 1. All youth received the same drug court protocol, only the treatment varied. 2.MDFT was administered by one community- based provider, and Group Treatment was provided by another provider. 3.Youth and parents assessed at baseline, 6, 12, 18 & 24 months following baseline 4.Measures: Substance Use: PEI, TLFB; Delinquency: SRD, YSR/CBCL, JJ Records

Treatment Dose Received MDFT Youth: Average of 9.40 hours of treatment/month Group Youth: Average of hours of treatment/month

Sample Description 1. Male (88%) 2.Average Age = 16 years 3.Hispanic (59%), African-American (36%), Other (5%) 4.Median yearly family income = $19, % in single parent homes 6.Average number of arrests in previous year = % cannabis abuse disorder, 30% cannabis dependence disorder, 22% alcohol disorder, 25% other drug disorder 8.52% conduct disorder, 41% anxiety disorder, 22% oppositional defiant disorder, 18% ADHD, 8% depression 9.54% parents with alcohol or drug problems, 50% with history of criminal involvement

Analyses Latent Growth Curve (LGC) Modeling in Two Phases: Phase 1: Baseline through 6 months, representing the in-drug court phase Phase 2: 6 months through 24 months, representing the post drug-court phase.

Phase 1: Baseline – 6 Months Substance Use All youth showed significant decline on PEI, TLFB, and number of clean drug tests.  Decreased 76% for MDFT, 65% for Group Delinquency (Self Report) All youth showed significant decline on SRD scales, YSR & CBCL delinquency and aggression Arrests (Record Data) All youth showed significant decrease in total number of arrests, number of misdemeanors, number of felonies.

Phase 2: 6 Months - 24 Months Substance Use In comparison to Phase 1, substance use increased for both groups on all 3 measures, yet remained significantly lower than intake use.  TLFB: 48% decrease for MDFT and a 43 % decrease for Group from Intake to 24 months  PEI: The increase from Phase 1 to Phase 2 was 8% for MDFT and 19% for Group

Treatment Comparisons on Change in Substance Use TLFB PEI

Phase 2: 6 Months - 24 Months Delinquency & Criminal Activity  Youth Report: MDFT reported a significantly greater reduction in externalizing behaviors (YSR), and on the Index Offense Scale of the SRD.  Parent Report: No differences between the groups on parent report of youth externalizing behaviors. Both groups of parents report that initial decline in symptoms was maintained through the follow-up period.  Record Data: No differences between the two groups on total number of arrests or misdemeanor arrest.  Youth receiving drug court + group treatment showed a significantly greater increase in felony arrests than youth who received MDFT

Treatment Comparisons on Externalizing Behavior/Illegal Activity YSR DelinquencyFelony Charges from DJJ Records

Conclusions  Substance use and criminal activity greatly reduced while in a juvenile drug court program.  Drug court with 2+ hours of substance abuse treatment/week showed significant reductions in frequency of substance use through 24 mos.  There is a medium effect (d =.57, p =.078) favoring MDFT over Group for personal involvement in drugs (PEI)  Youth who received MDFT vs Group treatment showed significantly greater reduction in the more serious and violent crimes through 24 months.

This study is only the 2 nd randomized clinical trial in a Juvenile Drug Courts (JDC) setting, and adds to the science that suggests that JDCs coupled with high quality substance abuse treatment effectively reduce drug use and criminality.

This study and the Henggeler et al study each found that while in a JDC youth substance use and delinquency is greatly reduced suggesting that JDC might be a viable alternative to incarceration and residential treatment.

This study suggests that JDCs, and perhaps especially those that employ a family-based treatment such as MDFT, show lasting change in both substance use and criminality.