Friday, July 30, 2010

Does drug treatment for juveniles increase recidivism?

Back in January I reported on the bizarre finding that Texas Youth Commission inmates who went through drug treatment had higher recidivism rates than addicted youth who didn't receive those services, according to a legislatively mandated report (pdf). As mentioned then, the agency's "chemical dependency treatment was a flat-out failure, actually increasing recidivism compared to youth assessed as having chemical dependency who received no treatment." The problem had been going on for years. In 2007, the Dallas News ran a story declaring, "The Texas Youth Commission's drug treatment program produces graduates who are more likely to re-offend after release than addicted inmates who did not participate."

TYC has recently changed the treatment curriculum and it's too soon to analyze results from the new program, but these startling data left me scratching my head.

Then Time magazine ran a feature July 16 asking, "Does teen drug rehab cure addiction or create it?," and now I'm wondering if TYC's treatment curriculum was merely flawed, or if the whole concept of drug treatment for teens should be reconsidered. Reports Time:
Increasingly, substance-abuse experts are finding that teen drug treatment may indeed be doing more harm than good. Many programs throw casual dabblers together with hard-core addicts and foster continuous group interaction. It tends to strengthen dysfunctional behavior by concentrating it, researchers say. "Just putting kids in group therapy actually promotes greater drug use," says Dr. Nora Volkow, director of the National Institute on Drug Abuse (NIDA).

The exposure can be especially dangerous for impressionable youngsters. "I've known kids who have gone into inpatient treatment and met other users. After treatment, they meet up with them and explore new drugs and become more seriously involved in drug use," says Tom Dishion, director of research at the Child and Family Center at the University of Oregon, who has documented such peer influence in scientific studies.

In academic terms, the problem is known as deviancy training, or the negative impact of friends on teen behavior — what parents would simply call a bad influence. In one 2000 study, in which researchers measured how much time teens spent together and how much they encouraged their peers' misbehavior, Dishion found that social exposure to delinquent peers at age 14 accounted for 53% of adolescents' life problems five years later — including criminal convictions, sexual promiscuity, relationship issues and drug use. ...

In addition, researchers find, the harm of many teen drug-treatment programs may come not only from the negative influence of new relationships but also from the degradation of positive bonds with family. In a 2003 paper, Jose Szapocznik, chair of the epidemiology and public-health department at the University of Miami, found that teens who used marijuana but still had healthy relationships with their families saw those relationships deteriorate — and their drug habits increase — when they were assigned to peer-therapy groups. Among these teens, who were in treatment for a minimum of four weeks, 17% reduced their marijuana habit, but 50% ended up smoking more. "In group, the risk of getting worse was much greater than the opportunity for getting better," Szapocznik says, adding that in contrast, 57% of teens who were assigned to family therapy showed a significant decrease in drug use, while 19% used more.
Maybe the problem with TYC's drug treatment program wasn't a bad curriculum. Perhaps, if these assessments are accurate, intensive drug treatment may be a misguided approach for juveniles altogether, however successful the tactic may be for seriously addicted adults.

10 comments:

Anonymous said...

Maybe that is the reason that TYC failed to provide drug treatment to so many youth in need of it.

Gritsforbreakfast said...

As I understand it, 2:18, that's part of the reason: I was told at one point by a mid-level administrator that they considered the subset who did get treatment essentially a "pilot" but hadn't pushed to expand because the results just weren't panning out. That's rumor-mill stuff, I've never seen that written or heard it stated openly at the Lege, but in the context of everything else it makes sense.

Now I wonder if perhaps TYC should eliminate drug treatment entirely and shift resources to tactics with more proven track records?

I also wonder what treatment programs' track record is in juvenile probation?

Sam said...

They call me mellow yellow . . .

Anonymous said...

There are so many different levels of addiction, support structures when kids get out of TYC, and so many other variables. How can you create two subsets of kids that are exactly the same?

Here's the problem in comparing people to one another and drawing any kind of conclusion.

Let's say kid A was sent to TYC for Burglary of a Habitation and kid B was sent to TYC for Burglary of a Habitation.

There is no way in the world that you can compare these kids for recidivsm or anything else just based upon the offense they were sent to TYC for. There are way too many variables to measure this.

Same goes with this drug treatment study and comparing those that had treatment to those that needed it but didn't get it. There are so many variables to consider. Peer influence when they get out, parental influence, family structure of each kid, etc. It is impossible to have a true measure because all things are not equal.

Anonymous said...

Residential drug treatment and juvenile drug court results are not very promising from my experience and I have both. Definition of "successful" is all over the charts. What should the rate be? Nobody knows. Everyone makes up their own numbers.

plato

Old Salty said...

It may be because teens are much more driven by their peer relationships than are adults. These peer relationships may be intensified among youths who are chemically dependent. Thus, putting them together in an attempt to provide therapy, may be what strengthens, rather than weakens their addictions. I have no proof that this may be true - just a supposition based upon observation.

Anonymous said...

I appreciate the information on drug rehabilitation and the counter effects of housing these youths collectively for extended periods of time during 'Chemical Dependency' program completion as your reporting suggests.
However, what studies have been conducted and what current programming options are available for the juvs being housed, again for extended periods of time with juvs with more procriminal attitudes and behaviors in 'general population'.

Anonymous said...

Good discussion and food for thought Grits! I have always wondered about just throwing juveniles together without some kind of evaluation. In local detention centers, I think they meet "new friends" and end up with more negative peers that before they came in.

Anonymous said...

I think it is a poor choice of words to say that TYC drug treatment increased recidivism. The reality is that the youth who were in the program were more likely to reoffend than those who needed it and didn't get it. There are many problems with these comparisons in TYC. The comparison and treatment samples are completely contaminated and not independent of each other. Those with a greater treatment problem are more likely to get put into the program and are inherently at higher risk to reoffend than those who didn't. There is clearly a selection bias in these data and also many need drug treatment but may not receive it because they are in other programs. SOme of the other programs have good recidivism rates.

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