Swelling is the enemy of wound healing.
“By the 12th grade, at least half of American high school students have used an illicit drug … and almost a quarter of high school seniors [use marijuana] at least once per month”, say Dr. Katherine A. Belendiuk and Dr. Paula Riggs, professors of University of Colorado School of Medicine (2). Substance abuse is one of the most prevalent medical conditions among high school students in the United States. Substance abuse causes more harm to society than other diseases because it is directly linked with criminal activities of youth. Despite the high prevalence, substance abuse is severely undertreated in the communities in which it occurs: only 10% of the substance use disorder cases among high school students receive treatments while 10-15% of all high school students actually need the treatments (Belendiuk and Riggs 1). Although substance abuse has greatly increased among youth in recent years, “the treatment utilization did not improve in 2002 to 2013” (Haughwout et al. 1724). This lack of substance abuse treatment in the community turns a large number of substance-abusing juveniles into criminal offenders. In 2009, 1.5 million youth were arrested, and “more than half of the juvenile offenders … tested positive for drugs or alcohol” (Janopaul-Naylor et al. 218-220). Because of this surprisingly high number of juvenile offenders with substance abuse problems, the juvenile justice system inadvertently has taken the major role in treating the substance abuse epidemic of modern society. However, despite the high volume of substance abuse cases treated in the juvenile justice system, the juvenile justice system has been grossly inadequate in treating substance abuse problems due to its inherent limitations; therefore, treatment of juvenile substance abuse must be conducted in communities, not in correctional facilities, preferably before any child reaches the juvenile justice system by committing criminal offences, because community-based treatments are more effective, economical, preventative of future crimes, and beneficial in building a healthy community by raising awareness and building infrastructure to fight against substance abuse problems.
The juvenile justice system should not play the main role of treating substance abuse problems because it is not a medical institute properly equipped and staffed to treat such medical problems. Treatment of the affected youth is not the main goal of the juvenile justice system. The juvenile justice system operates by not only the therapeutic model, but also the crime-control and punishment-oriented models (Tanner-Smith et al. 478). The juvenile justice system has been criticized for “widespread shortcomings … in terms of failing to routinely screen youth for substance use and abuse or to offer adequate, on-site treatment services” (Janopaul-Naylor et al. 216). The treatment delivered through the juvenile justice system is sub-optimal and delivered in a perfunctory manner at best. Mansion and Chassin argue that “only 42.2%” of youth diagnosed with substance use disorder received treatment in the juvenile justice system (9). Only 40% of the juvenile correctional facilities provide more than one hour of substance abuse group sessions per week (Janopaul-Naylor et al. 221). Substance abuse is treated with both behavioral therapy and medications with behavioral therapy being the “first-line” approach. Behavioral therapy includes individual, group and family-based interventions, and it requires frequent family visits and participation (Belendiuk and Riggs 3). Because family members and the therapeutic groups have limited access to correctional facilities, the juvenile justice system is not the optimal setting for weekly or biweekly group or family therapy sessions, rendering “first-line” therapy almost impossible. Besides delivering inadequate treatments, the process of selecting the youth to receive the treatment in the juvenile justice system is flawed. The juvenile justice system treats mainly low to moderate severity substance abuse cases, while the severe cases are excluded from the treatments because severe cases are believed to be incurable by the court system (Kretschmar et al. 519). But because the severe cases are more criminogenic than the mild cases, treating the severe cases will result in a greater benefit to society when it succeeds, resulting in the prevention of severe crimes in the future. Therefore, not treating the severe cases will decrease the overall benefit of the substance abuse treatment program of the juvenile justice system.
Not only is the juvenile justice system ineffective in decreasing drug use and further criminal activity, but it also may be significantly harmful to the children spending time within it. Davis et al. report that “justice system involvement can be a strong impediment to positive development. It is a strong predictor of school dropout, unemployment, low earnings, welfare dependence and substance abuse problems in young adulthood” (2). Although receiving treatment in the juvenile justice system is better than receiving punishment alone, it would be ideal if a child could avoid being involved with the justice system from the beginning: the child would avoid the harmful effect of the juvenile justice system on his or her life. More effective treatment systems outside of juvenile justice should reclaim the main role of substance abuse treatment.
In contrast to the juvenile justice system’s ineffective treatments, successful community-based substance abuse treatments have been developed to lower substance abuse effectively and prevent recidivism without the negative effects of the juvenile justice system involvement. These community-based treatment protocols have been developed and confirmed to be effective both by the medical community and, ironically, by the juvenile justice system. Besides the widely available conventional medical and behavioral treatments provided by doctors and therapists in the community, one of the most successful systematic community-based substance abuse treatments is the Ohio juvenile justice system’s community-based correction program. Ohio’s systemic approach of community-based substance abuse treatment program without incarcerating the offenders has had an “overwhelmingly positive” result, producing an “improvement in mental health functioning; decrease in substance use, trauma symptoms and future delinquency” (Kretschmar et al. 519). Ohio’s community-based treatment model uses a multi-disciplinary approach. The participating parties are not only doctors and therapists, but also local courts, mental health / drug and alcohol boards, children’s services boards and other providers of mentoring and educational services (517-518). To deliver the treatment in the “least restrictive setting possible, … the majority of the treatment is provided in-home or in outpatient settings” (517). This community-based treatment program of the Ohio juvenile justice system shows the best outcome among the programs that the juvenile justice system offers, confirming the superiority of community-based treatment over incarceration.
In addition to being more effective, community-based substance abuse treatment is more economical compared to incarceration. Kretschmar et al. estimate that the daily cost of housing a single youth in a juvenile correctional facility was about $561 in 2014 (519). After calculating the average length of stay of eleven months, the overall cost would be $187,000. While the cost of detention is astronomical, Kretschmar et al. estimate the state expense for the out-patient substance use treatment as $5,000 per single youth per year. The enormous difference in the total cost itself speaks favorably for community-based treatments. Besides the direct cost benefits, early detection and treatment of substance use in youth in the community will prevent criminal acts of the youth in the future. This prevention of crime is an unrealized monetary gain for society. Belendiuk and Riggs estimate that “every $1 invested in addiction treatment yields a cost-saving of between $4 and $7 in reduction in drug-related crime, theft, and criminal justice costs” (2-3). Belendiuk and Riggs further estimate that the saving will be even greater than 12 times the investment when workplace productivity and the health benefits of society are considered (3). Society simply cannot continue to afford to pay high tax dollars for an ineffective treatment method, namely incarceration.
Additionally, early treatment of substance abuse in the community will prevent crimes committed by youth. Substance abuse leads to criminal offenses by youth when it is not treated or when treatment fails. Substance abuse can cause criminal behavior in many ways. Mansion and Chassin explain that “criminal behavior is inherent for adolescents when buying, possessing, and using drugs or alcohol … involves membership in an antisocial peer group … [and involves association] with the drug distribution market” (2). Mansion and Chassin further elucidate that:
… intoxication effects from drug and alcohol use may increase delinquent behavior due to impaired judgment and decision-making … substance use may interfere with normal development of … [the] brain … resulting in a pattern of antisocial behavior … substance use may prevent an adolescent from “maturing out” of criminal behavior due to an inability to successfully transition into more mature, adult roles. (2)
Therefore, early detection and treatment of substance abuse is imperative to prevent the criminal behavior of youth to protect youth from experiencing negative consequences in their lives. Early detection and treatment will also protect society from criminal behaviors of the affected youth. Such early detection and treatment must occur in the community in which the abuse is occurring, and before the juvenile lands in the justice system.
Consequently, treating substance use in the community will make the community healthier by raising awareness of the substance use problem and by building social infrastructure to combat it. To detect and treat substance abuse at an early stage, family members, caregivers and educators of school and youth organizations should be thoroughly educated about it. Community members should diligently share knowledge about how illegal substances are marketed in the community — especially among youth. Parents, caregivers and the school system should work closely together to seek the best treatments available in the community once substance abuse is detected. Referral to a medical specialist, an expert therapist and a counselor should be promptly arranged for early treatment. Failure to complete the treatment has been associated with a future felony (Carter and Barker 188); therefore, continuing and completing the treatment will be critical for successful treatment. Building a network of parties involved will increase the chance of completing the treatment by forming a tighter supervision. Treating and preventing substance abuse of youth should be a collective effort by the community. Local government, the medical community, members of the broader community, and the school system should collaborate to develop sustainable and effective treatment protocols suitable for the community. If effective early detection, referral, counseling and treatment protocol are set up in the community, the entire community will greatly benefit. With the treatment system being set up, the community will experience less medical problems associated with substance abuse and less crime. This experience of collectively dealing with the substance problems of the community will bolster the problem-solving skills of the community to help resolve any further communal issues.
Substance abuse destroys the individual who is affected by it and the society that has to deal with its consequences. Despite substance abuse’s increasing presence in youth and its life-shattering consequences, society’s effort to treat it is sadly lacking. The ironic results of society’s neglecting this problem are the demoralizing number of children in the juvenile justice system and the atrocity of the crimes committed by those children. The juvenile justice system should not be solely responsible for treating the children afflicted with this disease. Communities should take the initiative to early detect and treat the children abusing substances before they are forced into the justice system through committing crimes. Furthermore, the juvenile justice system’s treatments are simply ineffective for those children who abuse substances. Instead, better treatment is available in the communities to help those children with substance problems. Treating juvenile substance abuse in the community is cheaper than incarcerating the children, and it will reduce crime and build healthier communities. Without successfully containing this unforeseen juggernaut of this generation, there will not be any safe place in the world — now and forever.
Belendiuk, Katherine A., and Paula Riggs “Treatment of Adolescent Substance Use Disorders.” Curr Treat Options Psychiatry 1.2 (2014): 175-188. Pubmed. Web. 24 Mar. 2017.
Carter, W. Craig, and R. Donald Barker. “Does Completion of Juvenile Drug Court Deter Adult Criminality?” Journal of Social Work Practice in the Addictions 11 (2011): 181-193. PsycINFO. Web. 24 Mar. 2017.
Davis, Maryann, Ashli J. Sheidow and Michael R. McCart. “Reducing Recidivism and Symptoms in Emerging Adults with Serious Mental Health Conditions and Justice System.” J Behav Health Serv Res 42.2 (2015): 172-190. PsycINFO. Web. 24 Mar. 2017.
Haughwout, Sarah P., et al. “Treatment Utilization Among Adolescent Substance Users; Findings from the 2002 to 2013 National Survey on Drug Use and Health.” Alcoho Clin Exp Res 40.8 (2016): 1717-1727. Pubmed. Web. 24 Mar. 2017.
Janopaul-Naylor, Elizabeth, et al. “Assessment and Treatment of Substance Abuse in the Juvenile Justice Population.” Adolesc Med 25.1 (2014): 215-229. Pubmed. Web. 24 Mar. 2017.
Kretschmar, Jeff M, et al. “Responding to the Mental Health and Substance Abuse Needs of Youth in the Juvenile Justice System: Ohio’s Behavioral Health/Juvenile Justice Initiative.” American Journal of Orthopsychiatry 85.6 (2015): 515-521. PsycINFO. Web. 24 Mar. 2017.
Mansion, Andre D. and Laurie Chassin. “The Effect of Race/Ethnicity on the Relation between Substance Use Disorder Diagnosis and Substance Use Treatment Receipt among Male Serious Adolescent Offenders.” Child Youth Serv Rev 1.61 (2015): 237-244. Pubmed. Web. 24 Mar. 2017.
Tanner-Smith, Emily E., Mark W. Lipsey and David B. Wilson. “Juvenile Drug Court Effects on Recidivism and Drug Use: A Systemic Review and Meta-analysis.” J Exp Criminol 12 (2016): 477-573. PsycINFO. Web. 24 Mar. 2017.
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