Thursday, March 18, 2010

Is drug treatment working for incarcerated juveniles?

A couple of months back I puzzled at the fact that, according to the evidence, the Texas Youth Commission's substance abuse treatment programs actually increase recidivism among participants compared to control groups that didn't go through the program. What I didn't know is that apparently that's not an atypical outcome. According to a Government Accountability Office report issued in December 2009 titled "DOJ Is Enhancing Information on Effective Programs, but Could Better Assess the Utility of This Information":
Most experts indicated that there was limited evidence on the effectiveness and cost benefits of reentry programs, such as aftercare—programs that assist juvenile offenders in returning to their communities during the reentry process—and substance abuse programs, such as drug courts—specialized courts that provide programs for substance-abusing juveniles and their families.
This GAO report was prepared to give more specific guidance to juvenile justice practitioners about "practices that have been evaluated and have been shown to be effective," but focusing on addiction for juveniles, according to GAO, doesn't work any better nationally than does substance abuse treatment at TYC. By contrast:
The majority of the juvenile justice reentry and substance abuse experts GAO interviewed cited evidence that shows cognitive behavioral therapy—programs that help individuals change their beliefs in order to change their behavior—and family therapy—programs that treat juveniles by focusing on improving communication with family members—are effective and cost beneficial when addressing reentry and substance abuse issues.
So TYC's substance abuse treatment historically produced worse results, and the feds say it's not been proven effective for juveniles compared to family and cognitive-behavioral therapy. I'm generally a supporter of evidence-based treatment, but at this point, can we say that drug treatment for incarcerated juveniles is "evidence based"? The evidence seems to say it's not working. Maybe I'm missing something.

Given those outcomes and the status of current research, TYC and perhaps local probation departments should take a hard look at their outcomes and evaluate whether a drug treatment emphasis makes as much sense for juveniles as for the adult population. My instincts would be to think that it does, but both Texas data and this national GAO analysis seem to say otherwise.

TYC recently revamped its drug treatment program so it'll be a while before we see recidivism outcomes from the new regime. These trends make me think the data will be worth parsing closely when they finally become available.

32 comments:

Anonymous said...

They are trying to force treatment on individuals that are not ready to quit using drugs. This is not complicated!

In the many years that I have worked with drug users, I have noticed one common denominator. Change does not take place until the individual using drugs desires to quit. It's actually quite simple; however, I am sure someone will complicate the issue with data and research.

Anonymous said...

There is also the perspective that most kids that get caught and sentenced to "treatment" aren't really "drug addicts" as the term is commonly understood. The changes over the last few years have criminalized and pathologized pretty much normal adolescent behavior. In previous times this was handled without the criminal justice system, or at least not with incarceration under the guise of "drug treatment". In these programs, where increasingly mild cases are sent, they are usually taught that they are "addicts" and they are exposed to a few who really are. It is no surprise that controlled studies show an iatrogenic effect. The "cure" actually causes the "disease".

Anonymous said...

I agree with the first post. I also work with substance abuse youth. It is so much a 'cultural' thing now - EVERYONE is doing it. They will only quit when they are ready. That said, how many of these youth come from FAMILIES where drug use is common?

Scott Stevens said...

As an attorney certified by the Texas Board of Legal Specialization in Juvenile Law, I have seen many children go to drug treatment. I agree with Anon4:44 that many times drug treatment is merely incarceration in the guise of drug treatment.

I am, however, puzzled at the TYC drug treatment program being such a failure, especially since TYC's overall program is supposed to be a cognitive-behavior type program. One would expect that if cognitive-behavior programs were more successful and a child were in such a program and then drug treatment was an added component of the overall program (as I perceive the case to be at TYC) that they should have a much higher success rate than others.

A large number of children I have seen are simply self-medicating with illegal drugs to make up for mental diseases or defects for which they do not get proper treatment. Having been treated myself for depression and having used some cognitive therapy to overcome it, I can definitely say that if mental disease/defect is the real issue, it is no surprise that cognitive therapy is more successful than "normal" drug treatment.

For those whose issues is not one of underlying mental disease/defect, I agree that they will not change until they are ready, regardless of the treatment.

Anonymous said...

the former drug treatment program was not cognitive-behavioral it was 12 steps based. Clearly not proven for the TYC population. Other components of TYC program have been and are now cognitive behaviorally based. It is true that you cannot force people to change. Many efforts are spent trying to get youth in TYC to analyze their behavior, but unless they want to change they will not change.

I disagree that TYC youth who are in treatment are predominantly mild cases. Most have significant abuse and dependence issues, using drugs on a routine basis since age 10 or 12. TYC youth who are drug dependent are largely dual diagnosis youth with major problems and historically have high recidivism rates.

It is true much substance abuse is initially used to deal with emotional problems but the abuse itself develops its own set of unique problems.

Anonymous said...

The posts here show the simple-minded attitudes of TYC people that don't help youth. You can't help unless you really care and understand the problem; most TYC felon/drug experts are a waste of time and have no real desire to help our precious youth.

whitsfoe said...

The fact is juveniles are still kids, and kids feel invincible. A stint in TYC for stealing cars, robbing people and so forth is not a life changing event. They come out still feeling invincible and continue using. They haven't developed the ability to of think of long term consequences of their behavior. That's true everywhere in America and probably why juveniles overall are poor candidates for drug treatment. However, if they did experience a significant life changing event, such as being locked up in TYC for murder with a 40 year prison sentence hanging over their head, then I'd think those kids would fare better in treatment.

Anonymous said...

Even if the program at TYC is based on CBT concepts, we shouldn't assume that the people who are implementing the program understand enough about CBT to implement it in a way that has any measurable positive effect. We saw this with Resocialization too - you can come up with a great treatment program, but if you don't train people adequately to implement it, what's the point? I don't think it always has to be a mental health professional doing all the treatment, but if you expect non-MHPs to do "treatment," for goodness sakes, TRAIN them first! Until adequate training, supervision, and accountability happens, there is no point of having a "treatment program" for anything in TYC.

Anonymous said...

Just a note here, while TYC is now requiring all employees to surrender their keys at the gate, a youth escaped from Al Price last night using one of TYC own vans! That drug treatment must be doing wonders! LOLOL! Well, it just stands to reason. When you take keys away from law-abiding citizens, only the criminals will have keys.

Anonymous said...

I agree 4:19 - its clear in one regards that juveniles that use - and are forced to clean up - are not ready. They really don't understand what made them use or they do understand and a hell of alot of pain and abuse was involved. I believe it should be mandatory that TYC have licensed professionals conducting those classes, keys and whatever left at the gate, and if they staff want lunch - then eat the same thing the kids eat...once you enter...you don't leave until your shift is over. However, on to the treatment - the staff and the structure for treatment is not good by any means. Some of the staff brought drugs in....still do at the Mart Unit and Victory Field. Lets be honest, there is more access and drugs in prison then out...get the families involved so CPS can get involved with the families and retrain the thinking process of the families and then the kids may follow. Training a child means, for these kids, training the family and the addressing the socioeconomical levels, the pain, the abuse, the laziness, the parental lack of enthusiasm for parenting and even the school districts. Texas must have a strong nucleus...legislature to be willing to change...they are not. The Governor isn't strong enough or man enough to tell the truth about the simple things...and yet the people vote him in...when America, the voters, the parents - biological or not, are fed up...change will happen. Until then, do not be suprised that the kiddos are returning to the prison system...they are the states best money assurance.

Anonymous said...

Our juvenile drug court plus our non-secure residential drug treatment program are showing about the same results as TYC. We're spending lots of money and the outcomes suck. Were we to have to prove the effectiveness of the programs and a cost/benefit analysis, we couldn't. Both programs likely to be scrapped next fiscal year to be replaced by God knows what.

Anonymous said...

Youth go to TYC because all else has failed. They are sent there as a consequence of their behavior. Most of the time is spent in an attempt to manage their behavior while there. They are released on purely subjective data. It's not a good system, but it's as good as it will ever get. When the decline in juvenile crime levels off and starts to climb again, and it will,TYC or some facsimile will rise up from the ashes. The biggest problem with TYC, and other state agencies, can be summed up by the fact that they are closing facilities and laying off staff, but they've posted three new director positions. New board of directors, new executive director, but the same misguided idea that we need more people in Central Office to blow smoke up the lege's patuti.

Gritsforbreakfast said...

9:35 - IMO it's okay to scrap them if they don't work and produce empirically worse outcomes. If CBT and family therapy is all that works, just invest in that, you know?

Don said...

Scott, CBT and addiction treatment aren't necessarily two different things. CBT is just a model, such as Rational Emotive Therapy or Transactional Analysis, etc. TDCJ and most Criminal Justice programs have adopted CBT as the primary basis for addiction treatment. As one poster pointed out, it does differ in some ways from a 12-step based program,and probably works better for kids, who sometimes have a lot of problems with 12 step programs. A very good counselor can reconcile CBT and 12 Step, and use them as complementary approaches, but this probably would not work with TYC.

Anonymous said...

One thing we may have overlooked is the political angle. TYC is still a highly political organization. When it comes to
staffing these drug treatment programs who gets chosen as the directors? If you understand TYC you know it is not the most qualified.

Central Office seems willing to let this practice continue.

Anonymous said...

8:52am - What does staff neglect have to do with drug treatment? The scary thing is that a staff member had to be the one who left the keys to the van somewhere near the kid. What type of fool does that?

Its bad enough that you cant trust employees with their own keys on grounds but now...they're so incompetent that you cant trust them with keys to State owned vehicles. Luckily the kid didn't hurt anyone in the community. So, to all TYC employees who have complained about leaving your keys at the gatehouse...now you see why!!!

Anonymous said...

To 8:52am:

What TYC employee do you think is stupid enough to leave their keys in their own cars outside in the parking lot? TYC uses a van INSIDE the facility to haul youth around. Apparently, a JCO left the keys in this van INSIDE the facility, and the youth used it to crash through the back gate.

No, more danger exists by leaving employee keys thrown in a box at the gatehouse. Lots of things have been known to disappear at the gatehouse.

A parallel to this and the chemical dependency program is the lack of common sense applied to both.

Anonymous said...

3/19/2010 08:55:00 PM said:

"When it comes to staffing these drug treatment programs who gets chosen as the directors? If you understand TYC you know it is not the most qualified. Central Office seems willing to let this practice continue."

If you do a little digging, you would discover the problem of not having the most qualified people likely exists within central office itself, even to the point of hiring managers that don't fit the posted job requirements. It seems to cause a "trickle down" effect.

Anonymous said...

Sorry Grits, I'll understand if you cut me, but I have to call it the way I see it. This post just reminds me of 2007.

Blah..blah...blah. Garbage in garbage out. TYC is still the same ol same ol. 2007, 2010, there is no discernible change then to now. Our tax dollars continue to be irretrievably wasted. Drugs, escapes, assaults, little or no quality therapists or casework and poor education to boot were and still are du jour. You've got (some) poorly hired managers from North to South (especailly in the South)doing a less than stellar job. The good ones can and will survive by moving on. Let the SunSet on TYC and let the problem youth stay in their home county.

Let the home county keep their own tax dollars and kids. I only hope to see the day that the money and the problem (ie: Harris, Dallas, Tarrant, Bexar, Travis) are kept in their county of origin. Small counties can always contract with a close neighbor. TYC ain't cuttin the proverbial mustard. Gone, gone, gone.

TexasAnnie said...

As a former teen and young adult drug abuser now clean and sober 31 yrs. I know back when TYC was real hard core 'reform schools' so I can not speak on their programs now but can speak about what worked for me.

I have not known of many recent drug rehabs nor teen/adult incarceration geared to real, lasting treatment.
I agree that the willingness does play a part it isn't the whole part. Many abusers want to quit but are never equipped with the right 'tools' to do so.

I was in and out of programs and reform schools since 12yrs old. I started using hallucinogenics, then IV meth and heroin by 14.
finally at age 19 sentenced to a year long lock down treatment center as part of a felony drug conviction.

I think anything less then a year is waste of time and money. Also, there is no formula which fits every addict. Each must have individual evaluations and treatment based on individuality.

We received single and group therapy.
education (age range was 12-22) I already had ged so I took office skills.

We had electives to choose from such as art, creative writing, photography, music. Some people formed bands and we had dances on Saturday nights (oh yeah it was coed facility). We learned we did not have to be high to have fun.

Many of us for the first times in our lives begin to build self esteem. That we were not too stupid for education and we had talents (for me it was writing and piano).

Therapy helped us peel back the layers of what our addictions covered.
I found group more helpful then individual. Realizing my issues were no worse then anyone else.

Learning that there was something larger and more important then myself. That giving back to our communities was essential. We did volunteer work. Those of us further along in program mentored the new arrivals. Responsibility for ourselves and others had great healing power.

I remember the morning in May 1975 I woke up with the realization I was worth something, I deserved more out of life, and making the decision to choose a different path in life.

Not to say that the first 3 yrs out of program I did have occasional short term slips, the last being May 1978.
But even during my relapses it just wasn't the same, the reason my relapses were short term.

For the past 31 yrs I have woke up everyday thankful for that program. It saved my life. I had too beautiful and intelligent daughters and two wonderful grandchildren. A good husband and many wonderful friends. Career I loved, nursing.

But I believe if I had not been sent to that program I would have ended up either dead or a lifer in prison.

If this country really wants to help people with addictions then they need to change programs. TYC, open rehabs, and prison programs. Change from attitude of treating 'criminals' to one of helping others find the tools they need: self esteem, education, responsibility, attitude that life is fun and wonderful without drugs, and treating the underlining causes of individuals reasons for using.

Charity said...

TYC will never help any of the kids, whether they be drug addicts, sex offenders, mentally ill, or murderers until they do one thing--treat the offender and the family, whether the family wants to or not. And before anyone yells at me about parent involvement or their rights, I AM a parent of a capital felony offender and have earned the right to this opinion.

And it is not always true that you have to want to change for treatment to help you. Are we as a society only supposed to help those who are ready and able to ask for it? Do we throw all prevention and intervention efforts out the door assuming we are wasting our time in trying to educate, support, and love one another? We don't wait for the dying crash victim to ask for help before we give it. Why should we wait for a 14 yo crack head to say "Hey, I think I have a problem." when the fact he is a crack head screams that fact loud and clear.

Kids need love, support, and discipline,in that order, if they are to ever improve their lives.

And one thing to keep in mind about CBT--it can be just as harmful to some of the kids as no counseling because some of these kids are sociopaths. CBT has been shown to actually help that category of offender because they learn what socially acceptable emotional reactions are and look like. Current research in juvenile sociopathy/psychopathy estimates that any where from 4-6% of US adolescents are sociopaths/psychopaths.

Anonymous said...

As long as the State of Texas refuses to pay professionals a salary to compete with the other employers, all treatment plans will fail. Remember back when they couldn't get psych.Dr.s at Brownwood or West Texas, then came the Doc in the box from UTMB.
They still can't get professionals because LBB won't budget what these state agencies need to help heal the future of Texas...the kids.

Anonymous said...

http://www.beaumontenterprise.com/news/local/missing_tyc_inmate_found.html

Missing TYC inmate found

Anonymous said...

Many TYC youth are mis-labeled as chemically dependent and ear-marked for treatment primarily because the federal dollars credited help off-set state expenses.

Anonymous said...

3/20/2010 08:54:00 AM

Interesting observation about TYC Central Office. We've had a lot of different folks pass through CO in the last few years. Many have believed that what they do is not noticed. Given the long term habits of the people in this agency this may be true for the most part but it may not be 100% true. The bill may come due someday.

Anonymous said...

6:54

Please site the study of psychopathic juveniles that CBT made worse. I would love to read it because it does not exist.

Anonymous said...

As for getting qualified professionals to provide treatment - where does one find these? You can get a Masters Degree in Education, spend a year under the supervision of another person with a Masters in Ed., take a simple test, and get licensed as a professional counselor (LPC) all without ever taking a single course in group therapy, and having only minimal courses in psychology. We then call these folks "Associate Psychologists" in TYC despite a severe lack in training in psychology. We put them in charge of therapy programs where they are supposed to train others. When the wheels fall off, we call the CBT program (Resocialization) a failure, and scrap it, because it was "written by a bunch of White female PhDs who know nothing about criminals." (Almost a direct quote from Ms Pope -- remember that genius?)

The real problem was not with Resocialization, but with the fact that the people who were charged with implementing it were very poorly trained in the techniques.

Ah, we should hire competent people then - right?
If you are a competent psychologist (and TYC does have some) you either have to be incredibly dedicated or geographically limited (say, due to spouse's job) to want to work for the peanuts that TYC pays.

Therapy on the cheap - that is what Texas wants. Unfortunately, in most cases, you get what you pay for.

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David said...

In my opinion most part of the drug addiction treatment depends upon person .If he wishes then he will automatically get benefit of of it.

David said...

In my opinion most part of the drug addiction treatment depends upon person .If he wishes then he will automatically get benefit of of it.

fox said...

While working for drug addiction treatment
, I too have noticed thiscommon denominator as said that change does not take place until the individual using drugs desires to quit.

Anonymous said...

if you think TYC is providing drug treatment-come sit in a group--it's a joke- the kids come out of their session joking and talking about using drugs--a total waste of taxpayer money- TYC has no discipline or structure anymore- check the recidivism rate- if someone would come in and work undercover and could video everything- TYC would have to close down tomorrow once the public found out-