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Denial and adversity in a juvenile drug court
International Journal of Drug Policy 15 (2004) 297–304
Denial and adversity in a juvenile drug court Kevin W. Whiteacre∗ Salvation Army Correctional Services Programme, 105 S. Ashland Avenue, Chicago, IL 60607, USA Received 10 October 2003; received in revised form 8 April 2004; accepted 14 June 2004
Abstract In drug treatment courts, denial is a pervasive issue in both the legal procedures of the court and in drug treatment itself. This paper explores the meaning of denial for youth and programme staff in a juvenile drug court (JDC) located in a metropolitan jurisdiction in the U.S. Midwest. Thirty-seven interviews were conducted with juveniles attending the JDC, a judge, defender, prosecutor, probation officers, and treatment counsellors. These interviews raised several issues regarding the use of denial in treatment. For staff, the meaning of denial came to encompass the ambivalence and resistance of non-addicted youths toward the programme and its staff. The primary source for the youths’ resistance was based in conflict with staff over definitions of drug abuse and responsible or moderate drug use. The implications of these phenomena are briefly considered in light of insights from the harm reduction perspective. © 2004 Elsevier B.V. All rights reserved. Keywords: Drug treatment court; Denial; Drug abuse; Harm reduction; Juvenile
With the kids, their denial is that they feel invincible because they’re kids. –JDC Counsellor They make you want to believe that you’ve got a problem. I may have a problem in finding direction, but I ain’t got no drug problem. –JDC Juvenile
Introduction Client motivation for treatment has long been recognised by treatment professionals as one of the most important factors influencing treatment outcome. In fact, it is often viewed as the fundamental prerequisite for treatment success (Miller, 1985). A client’s lack of motivation in treatment is often attributed to personality traits, resistance, or overuse of defence mechanisms such as denial (Miller, 1985). Indeed, denial, now situated as one of the component symptoms of the addiction disease, has become an increasingly important concern in ∗ Tel.: +1 312 455 8059x236. E-mail address: kevin [email protected] (K.W. Whiteacre).
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the addictions field. White (1989) provides a comprehensive definition of denial: . . . a psychological process that serves to keep the chemically dependent person out of touch with reality. It is one of the most difficult aspects of treatment for alcoholism and drug dependence. Denial is caused by numerous factors which act synergistically, including distortions of memory such as blackouts and euphoric recall, psychological defence mechanisms such as repression and projection, and social factors such as enabling by family and friends. It is common for chemically dependent people to genuinely believe that they do not have a problem with alcohol or other drugs in the face of overwhelming evidence to the contrary. (White, 1989: 9) Studies suggest that clients in drug treatment often tend to under-estimate their need for treatment or help at admission, or they may even “deny that they have a problem or that they need to change their behaviour or attitude” (Friedman, Granick, & Kreisher, 1994: 70). Much of the structure of drug treatment courts (DTCs) is, therefore, designed to counteract the perceived threat of denial and other related defence mechanisms, which, it is argued, traditional adjudication may exacerbate Hora et al. (1999). The adversarial nature of the
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traditional criminal justice system, according to drug court proponents, can be a potential enabler of an offender’s drug problem. Traditional defence counsel functions and court procedures that encourage a defendant to deny guilt, it is argued, often reinforce the offender’s denial of a drug problem (The National Association of Drug Court Professionals, 1997). To help defendants overcome denial, the prosecutor and defender work together as a team with the judge, treatment personnel, probation, and social service professionals in the community to force the offender to deal with his or her drug use “or suffer the consequences” (National Association of Drug Court professionals and The Office of Community Oriented Policing Services, 1998). But some professionals claim that research has failed to identify denial as an empirically valid trait among drug dependent populations. Miller (1991) argues that although professionals in the addictions field have begun to take as axiomatic the existence of denial, “research has revealed no such characteristic defensive styles among clinical populations” (Miller, 1991: 284). The characterisation of an individual in denial is ultimately left to the judgement of professionals. In light of the difficulty researchers have had in actually discovering an objectively identifiable ‘denial’ trait, such judgements might sometimes be based more on their subjective perceptions (Miller, 1985). These perceptions often reflect the extent to which the treatment client accepts counsellor definitions of the issues. A client tends to be judged as motivated if he or she accepts the therapist’s view of the problem (including the need for help and the diagnosis), is distressed, and complies with treatment prescriptions. A client showing the opposite behaviours—disagreement, refusal to accept diagnosis, lack of distress, and rejection of treatment prescriptions—is likely to be perceived as unmotivated, denying, and resistant. Commenting on the concept of readiness for treatment, Karoly (1980) observed: ‘unfortunately, readiness is often interpreted to mean only the individual’s willingness to place himself or herself in the hands of an authoritative therapist or nurturant institution’. (Miller, 1985: 88) According to Francis Allen 1981: 48, in the therapeutic state, client disagreement itself can sometimes serve as an indication of the need for treatment. “The willingness of the accused to assert adversary positions against the state may be taken as the strongest evidence of the accused’s need of rehabilitation”. In the drug treatment court, where adversity is considered anti-therapeutic and resistance could reflect denial of a problem, interactions between client and professional take on added import. Evaluations of DTCs, then, must include a consideration of how these dynamics impact on participants for good and bad. The greatest limitation of prior DTC research has been the narrow focus on abstinence and recidivism as the sole measures of programme success. While certainly im-
portant, these two outcomes represent a small part of myriad possible outcomes experienced in a drug treatment court programme. Some critics observe, for example, that when treatment is built into a court system, which still retains coercive features of traditional criminal law, procedural informality can sometimes have negative consequences for the defendant, such as the loss of due process rights (Boldt, 1998). Others argue that placing treatment interventions within the confines of the law risks creating treatment programmes “that constitute social-control activities, rather than health promotion and harm reduction strategies developed within a health-promotion perspective” (AITQ, 1996 cited in Beauchesne, 1997: 38). Thus, a “logic of social control” permeates treatment interventions forced to conform to legal norms. Definitions of denial and issues of authority and coercion present issues every bit as important in the lives of participants (and the community) as recidivism rates, and they have clear implications for assessing the impacts of DTCs.
Methods The present study explores some of these issues. Specifically, it considers the use of the denial concept as a therapeutic tool within a juvenile drug court (JDC). This study took place at a JDC located in a metropolitan jurisdiction in the U.S. Midwest. I conducted the research while fulfilling a one year contract as an evaluator for the JDC. Over the course of the year, I attended dozens of compliance hearings in court and pre-hearing staff meetings and a few treatment meetings. During these observations, I talked with staff and recorded notes. I also conducted open-ended qualitative interviews with court staff, treatment counsellors, and the juveniles themselves. In all, 37 people were interviewed: 25 juveniles, the judge, defender, prosecutor, 3 probation officers, and 6 treatment counsellors. The juvenile interviews took place during the court hearings. We met in a small room reserved for defence attorneys to meet with clients. It was connected to the large waiting room, but provided ample privacy for the interviews. Only one juvenile declined to be interviewed but did not give a reason. It seemed probable that he simply did not want to spend the time in an interview, since he was in the later phase and there only to submit a drug test. Interviews with the staff took place in or around their places of work. They typically lasted from 30 to 60 min each. All interviews were tape recorded and later transcribed. The findings in this paper are based on the results of these interviews. Admittedly, a study relying so heavily on interviews with individuals associated with a court-monitored drug treatment programme might suffer some restrictions that can adversely affect the presentation of the information. The interviews are, after all, the product of my own interaction with the intervie-
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wees. How the participants related to me could have influenced what they said. As a contracted employee of the JDC and an adult, it sometimes took me a little time to get the juveniles to talk frankly outside of the programme discourse. In other words, some were reluctant to say anything beyond what they thought the programme staff would want to hear. This problem became less difficult as the juveniles became more familiar with me and I gained experience with them. On occasion, for example, a juvenile might start off talking about the many benefits of giving up cannabis. Later in the interview, however, she would admit she had every intention of resuming her use of the drug as soon as she was out of the programme. Others were open immediately, and still others undoubtedly were never so open. The number of juveniles who did indeed admit their intentions to at least consider engaging in future illegal behaviour, the wide variety of responses, and the sometimes blunt critiques of the programme and its personnel led me to believe that the majority were quite honest and did indeed feel comfortable in the interview. The programme The JDC is a 6-month programme for adolescents who face cannabis or alcohol-related charges or have a history of substance abuse (offences involving violence are excluded). It consists of two three-month phases. Phase 1 is more rigorous, requiring attendance at a compliance hearing in court once every 2 weeks, about 2 or 3 drug tests a week, and usually at least one group treatment meeting a week. Phase 2 requires fewer drug tests, but if a youth is found to be non-compliant, more tests and other services can be ordered. After a juvenile successfully completes the two phases (and, thus, graduates), the court dismisses the charges that brought him or her into the programme. The majority of participants must attend group treatment meetings with the privately contracted treatment provider once a week. After a positive drug test, a juvenile may get moved up to a more intensive level, requiring two or three treatment meetings a week and an increase in drug tests. Sometimes a juvenile is assigned to additional outside meetings with Alcoholics Anonymous or Narcotics Anonymous. The treatment group meetings also include individuals not associated with the JDC who are usually in treatment as a condition of probation. Almost all of the treatment clients are there under some sort of criminal justice coercion. Every juvenile must also attend an 8 hour alcohol and drug education class with at least one guardian. In the class, a drug counsellor provides a vast array of information about the dangers of drug use, using videos, lectures, and some class discussions. A treatment coordinator serves as the liaison between the treatment provider and the drug court. The coordinator attends court sessions and pre-hearing staff meetings, providing updates on each participant’s progress in treatment.
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The juveniles The average age of the JDC youth was about 15 years. Over 80% were male, 63% were Caucasian, 32% were African-American, and another 5% either Hispanic or bi-racial. Possession of cannabis accounted for two-thirds of the complaints that brought the juveniles into the JDC. Possession of paraphernalia, public intoxication, and minor possessing alcohol made up most of the other charges. Among the JDC youth there was a wide variation in drug use patterns. Approximately 17% of the JDC youth were diagnosed with cannabis dependence. The vast majority of primary diagnoses, 65%, were for cannabis abuse. About 15% of the juveniles in the JDC had no drug-related primary diagnosis. In fact, a couple of the juveniles were not even referred to treatment as a condition of their participation in the JDC. A JDC staff member explained the variation of drug use patterns: For some, they were never smokers. They were in the wrong place at the wrong time. A friend may have said, ‘Can you hold this for me?’ Counselling is not necessary for them, because they’re not a smoker. They never have used drugs. Some of them are just naive and just got caught in the wrong place at the wrong time. Maybe education about the drugs will probably deter them from becoming smokers, and we’ve had younger ones who are like that . . . And we’ve even had some of the older ones who had never smoked, but they were in the wrong place at the wrong time, versus those who have been smoking since they were ten or eleven, and they’re sixteen now. When you hit sixteen or seventeen you’re stubborn and you’re set in your ways, and no one else is going to be able to change the way you are. Those may need serious counselling.
Ambivalence and denial Having entered treatment because of an arrest rather than doing so a voluntarily, the JDC participants were, for the most part, a reluctant treatment population. Many were clearly more concerned with the legal consequences of their use than with the use itself. In fact, legal factors were the driving force behind participation in the JDC. In my discussions with the juveniles, most mentioned getting their charges dropped as the biggest benefit to be gained by graduating. Even those who said they were there primarily to give up drugs acknowledged that getting their charges dropped was certainly an inducement to participate. Ambivalent toward their drug use, some of the juveniles tended to be somewhat resistant in treatment meetings and reluctant to accept everything the counsellors told them about their drug use. Often, this resistance was interpreted by the counsellors as denial. They attributed the juveniles’ denial or resistance to their young age, as noted by one counsellor:
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With the kids, their denial is that they feel invincible because they’re kids, They feel like ‘Okay if it happened to my buddy, big thing, because he probably wasn’t smart enough.’ Or you know, ‘That was his luck, but if I put more time in it, more thinking in it, I won’t have to turn out that way.’ So they just really feel invincible. But again, I think with the kids we have to realise, too, that they just don’t have the resources yet . . . They don’t have the problem solving skills. There are just different things that they haven’t been able to tap into, so that keeps their denial pretty secure. But the more they can see there are other things that they can do, then that in itself, to me, kind of eats away at the denial, I think. When I asked another counsellor how much of a problem denial was for the juveniles, she replied: Huge. They’re very, very young. They’re at a stage of development that we all have been through where ‘Nothing can hurt me. Nothing can touch me. I’m invincible.’ And that’s where they are. So it’s a very, very difficult thing to convince or help a juvenile see their behaviour has long term consequences, because it’s all about now. As the counsellors used the term, denial had taken on broader meaning, and it was attributed to the resistant attitudes of youth generally. Denial, then, became less a literal psychological process symptomatic of chemical dependence and more a general characteristic of youthfulness. Only one counsellor did not feel denial was much of a problem with the juveniles: I would say [denial] is probably more of a problem with adults than with the youth. I think that adults have had more years of experience with their drug of choice, and their denial systems are more solidly in place. With the kids, I don’t know. I think because they’re younger, because they don’t have as much experience as some of the adults, if they do have a problem, they’re going to admit it. In the literature, denial is seen primarily as a coping mechanism of addicts, but only 17% of the JDC juveniles were diagnosed as dependent on any drug (mostly cannabis). The counsellors, most of whom either were recovering addicts or had someone close to them who was, however, insisted it was only a matter of time before the juveniles became dependent. As a counsellor explained it to me: What I do is I try to let them know what options they have, because most of them don’t even think they have a problem. And some of them might not. They might just, you know . . . because I can put myself in their shoes, and I remember the way it was when I was their age. The only problem is I didn’t stop. I kept on going, and I try to tell them that. I try to tell them the consequences and inform them about what it’s going to do to their bodies. Because they have been misinformed a lot of the time.
Most of the counsellors did avoid calling the juveniles addicts. For practical reasons alone, it was just not very useful in the treatment meetings, as noted by one counsellor: I won’t label them as being an addict, I just leave it as abuse, because I tell them, ‘I never will label any of you anything.’ I could take the [Diagnostic and Statistical Manual of Mental Disorders] into a meeting and go over criteria for addiction and say “you’ve hit this, this, and this. And I could say, ‘I am calling you a drug addict.’ But I won’t try to do that. What good is that going to do? Given the juveniles’ ambivalence toward their own drug use, it is not surprising that some of them felt there was a little too much “finger pointing,” as a juvenile put it, by programme staff. One youth summed it up: I don’t really like the [treatment] classes because they make you think that you’ve got a problem, saying you’re in denial. Another complained that her counsellor did not believe her when she told her how much alcohol and pot she had used. She said she rarely drank alcohol and smoked cannabis on occasion. Either the counsellor did not believe her or did not accept the notion of “occasional” use for juveniles: She thinks I used to do it all the time, She didn’t believe you when you told how much you actually used?” [interviewer] Huh uh, [shakes head]. I’m having the worst time of my whole life doing it and all that stuff. Likewise, another juvenile complained about a treatment meeting in which he had told the counsellor he drank alcohol once every couple of months. She asked if he had ever experienced any problems when he drank, and he said, yes, he had suffered a hangover. She told him he was an alcoholic: Because I had a problem from the time I drank and I continued to drink later on, whether it’s too much, then by definition I was an alcoholic. When I said no, I wasn’t an alcoholic, she’d say that I was in denial. I just had some conflicts, because I knew alcohol wasn’t something that I was dependent on. It wasn’t something that I felt that I needed to do. It’s like ‘Oh well, I’m at a fun party. What the heck.’ It’s just a typical high school thing. Kids go to parties, and they drink. It doesn’t mean that every kid that drinks and ends up with a hangover is an alcoholic. Although originally conceptualised as a coping mechanism for chemically dependent drug addicts, denial has broadened in the JDC to encompass resistance to professionals’ views. The juveniles’ ambivalence toward their drug use and the conflict with counsellors’ definitions of that use become evidence of denial. Since the juveniles have not been diagnosed as dependent on drugs, the cause for this resistance-as-denial is instead identified in the participants’
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young age and the feelings of invincibility that accompany youth.
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What do you mean by when it’s right and when it’s wrong? [interviewer] I mean it’s always wrong, but knowing when to get caught and when not to get caught.
Defining drug abuse In its most basic form, denial is essentially one’s lack of acceptance of another’s definition of a situation (whether by refusal, inability, or some other process). It is the product of an interaction between two or more people. Denial in the JDC seemed most often the result of the juveniles’ refusal to accept staff’s definitions of drug abuse. Indeed, definitions of drug abuse and drug problems presented a clear split between staff and youth. Though staff and juveniles also differed somewhat among themselves, the overall consistency of the two groups’ points of view is noteworthy. When asked if they felt they had a drug problem, most of the juveniles said no as illustrated by the interview extract that follows: Me? Honestly, I don’t think I do, but a lot of people say that if you’re in denial, then that’s the first step. So, right now I’m really uncertain. They said to be addicted you smoke everyday. I never really smoked it everyday or anything. How would you define a drug problem? [interviewer] A drug problem . . . to me it’s not smoking everyday, it’s just a want or need for it all of the time. So you don’t think you have it? [interviewer] I think I. . . I think I had it at certain times. Like, certain times of the day I would be an addict. I don’t know if that’s possible . . . What do you mean? [interviewer] Because at certain times of the day I’d want it, but at certain times I wouldn’t. You know, like when me and a friend would get in a fight or something or one of my friends would get in a fight with someone and they’d get beat up. And I’d say, ‘Man, I got to go smoke a joint.’ But then sometimes during the day when I’m with my girlfriend or whatever, I’d say I don’t need no more. Do you know anyone that you consider a responsible drug user? Or do you know anyone you think uses alcohol responsibly? [interviewer] Well, I can’t say really all of my friends, but I know a couple of friends who won’t smoke it inside of their house, or if they have something to do the next day. They just do it when it’s possible for them to do it and not get in trouble. How would you define responsible drug use then? [interviewer] Using when knowing how to stop and knowing when it’s right and wrong.
Some of the juveniles did report they had a problem, and one youth took the addiction model to extremes: There is no such thing as using responsibly. Nobody can use responsibly. People can’t drink responsibly? [interviewer] Nope, because you think you are, but you’re not because once you say you drink responsibly, you’re an alcoholic because you can’t stop having even a drink. Cause if you have just this much, [pinches his index finger and thumb together indicating a tiny amount], then you’ll get more. It’s true. It’s a proven fact. Statistics say it is. The issue of differing notions of moderate or responsible drug use between the youths and the JDC staff seemed to lie at the foundation of the conflict over denial and addiction. The staff rejected most notions of responsible drug use, especially for cannabis and other illicit drugs. One staff member also felt that alcohol could not be used responsibly by anyone. And the staff members were reluctant to acknowledge the possibility of moderate use. For them, all use was abuse. The juveniles, on the other hand, almost invariably distinguished between moderate use and abuse. When staff did acknowledge the possibility of responsible use, they emphasised the importance of the legal status of the drug and the age of the user as pre-requisites for responsibility. Perhaps not surprisingly, no juvenile mentioned age as a variable influencing responsibility and every adult interviewee did: Because I don’t think kids have good enough judgment yet, not that many adults have good judgment—that’s kind of a ridiculous statement—but I think kids have a hard enough time dealing with issues of peer pressure and boundaries, more so than adults. If you then put in a mood-altering or an inhibition-releasing substance, you’re going to have some problems. I guess it just makes it more of a challenge for kids to behave responsibly. . . it just kind of stacks the deck. The juveniles tended to define responsible use versus irresponsible use in terms of quantity used and whether or not the person “needed” the drug. In applying these rules, they did not report age as a factor, nor did they distinguish between alcohol and cannabis, or legal and illegal drugs. Most drugs could be used responsibly so long as the use was moderate and the person did not “need” it. As these youths explained: There are a few of my friends who I honestly think are responsible. It’s just a rare occasion type of thing. There are kids at my school who will go out every day after school and smoke marijuana, and there are kids who might
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smoke twice a month or drink twice a month. I find that, even though it is illegal, I do think it is responsible. As far as alcohol goes, the legal age is twenty-one, but I think a sixteen year-old can drink more responsibly than a 21year-old as long as they don’t let it get carried away. I know people who use and go to work and do everything they’re supposed to do, and they just smoke on the side. I know people like that. Almost all staff distinguished between legal and illegal drugs, believing that illegal drugs, by their very illegality, could not be used responsibly. A court member explained: Whether or not you’re breaking the law is part of acting responsibly, because I think that if you start down the road of saying, ‘It’s okay to break this law or that law,’ then suddenly you don’t learn any sort of structure or values and any respect for it.
argue, and I don’t even try. That’s when I go right back to ‘I will talk to you [when pot] is legalised,’ and they hate it. They hate it. The growing popularity of cannabis and the legalisation movement, when thrown into the mix, also presented a problem for the counsellors. The youth were reluctant to accept the definition of drug abuse as all illicit drug use, and many of them brought this up during the treatment meetings, particularly when they compared cannabis to alcohol. One counsellor said that the kids know cannabis does not have the withdrawal effects seen with alcohol: And so they call me on that, and they say, ‘Well, you know alcohol is legal and look what it does.’ And I don’t have any argument.
Of course, most of the juveniles having been arrested, and some suspended from school and put into the drug court treatment programme, recognised the link between drug laws and problems with drugs. They just put a different spin on it, as noted in the following:
Though I never brought it up in interviews, the debate over legalising cannabis seemed to be a recurring background to many of my observations and interviews in the court. When I asked one court staff member whether she felt cannabis could be used responsibly, for instance, she rephrased the question back to me, “Should cannabis be legal? ” Several of the juveniles suggested that cannabis should the legalezed:
I mean, drugs can always give you a problem. You can smoke weed for the first time, and it won’t make you stupid right away. But you can get arrested, and that’s a problem. So, I don’t think . . . Yes, I had a drug problem, but I wasn’t addicted . . . My drug problem was I would smoke marijuana in stupid places where I could get caught.
It’s not like marijuana is like cocaine. You don’t have to send me to a rehab place. Marijuana is not crack. You don’t have to send me to rehab . . . So it’s ridiculous that weed is illegal. The government would make a lot more money if they just taxed it, instead of spending money on trying to make a war against it.
Indeed, for many of the juveniles, a drug problem was more a question of getting caught and the resulting consequences. Several youths told me the most important lesson they learned in the JDC was to leave their cannabis at home: I’ll know next time, and I won’t have it on me. If you catch a case with marijuana you have to go through too much. One counsellor acknowledged this distinction between law-related drug problems and other types of problem: I don’t think they all do [have a drug problem]. I think they’ve all had a problem with drugs, because, I mean, they got caught doing something they weren’t supposed to be doing. But I think most of them are at a place where this early intervention can really make a difference. Many of the juveniles suggested that their problems were evidence of bad laws more than irresponsible drug abuse. A counsellor, who did not believe cannabis could be used responsibly because it is a gateway drug, explained this conflict: Most of the people that drink a few beers drink it because it gives them a little bit of a buzz, but that’s all. So if that is what society calls social drinking, okay, I can live with that. But the kids can argue right back, ‘Well if you smoke a joint, one joint at home, what does that hurt?’ I can’t really argue that, and it’s a tough one to argue, and I can’t
A juvenile’s mother told a JDC staff member that she knew a lot of doctors and lawyers who smoked pot. To which the staffer responded matter-of-factly, “That’s fine, but it’s still illegal.” Differences over definitions of drug abuse and drug use, and the conflict those differences engender, is hardly unique to the JDC. There is a sometimes contentious debate among professionals over distinctions between definitions of drug use and abuse. In its broadest and most legalistic sense, drug abuse has been defined as any use of a prohibited drug or the use of a medical drug in a manner deviating from approved medical patterns. The U.S. Office of National Drug Control Policy, for instance, makes no distinction between use and abuse of prohibited drugs (White House, 2002). All use is abuse. Likewise, the United Nations “discourages the use of all of the following terms and concepts: ‘recreational use’ of drugs, ‘responsible use’ of drugs, ‘decriminalization,’ and defining drugs as ‘hard’ or ‘soft’ ” (United Nations, 1992). A survey of substance abuse experts, however, produced a definition of drug abuse as “any use of drugs that causes physical, psychological, economic, legal, or social harm to the individual user or to others affected by the drug user’s behavior” Rinaldi, Steindler, Wilford, & Goodwin 1988: 557.
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By these definition, all of the juveniles are drug abusers because their arrest clearly indicates legal trouble resulting from their drug use. In British DTCs, however, not all illicit drug use is considered abusive (Nolan, 2002). A chief probation officer involved in DTCs in England, for example, identified several gradations of drug use, such as experimental use, recreational use, problematic use, and dependent use. “People use drugs in the main because they enjoy it,” he said. “And the vast majority of people in our society or [in America] use drugs in a non-problematic way” (quoted in Nolan, 2002: 96). Some observers note that definitions of bad or excessive use are often a matter of who is defining the use (De Rios & Smith, 1977: 18). According to Duncan (1992: 318), the inconsistencies in defining abuse “raise very serious questions about our preventive and treatment efforts. It is simply not realistic to say that all use of any particular drug, however socially disapproved it may be, is necessarily abuse.” Drug abuse, according to Duncan (1992: 318), is “an interactional process among the drug, the drug-taker, and the circumstances of the drug-taking, drug, set, and setting.” Like denial, it is a function of the interaction between and individual and her environment. In the words of the JDC youth My drug problem was I would smoke cannabis in stupid places where I could get caught. Increasingly, drug abuse has become a shorthand term to differentiate between licit and illicit drug use, instead of referring to an actual typology of drug-using behaviours (Drug Abuse Council, 1980; quoted in Duncan, 1992, p. 317). Duncan warns that relying on such “pat answers” to these difficult questions will only do more harm than good. Defining abuse in legalistic terms, for example, limits its use as a diagnostic device. It could be argued that acknowledging the existence of non-abusive drug use patterns can inform our approaches to dealing with destructive drug use (Whiteacre, 2004). And others have argued that the focus should switch from identifying good and bad drugs as the basis for defining abuse, and identifying good and bad relationships with drugs (Weil & Rosen, 1998). Legal definitions of drug abuse, moreover, become circular in the JDC. The juveniles are in the drug court, because they are drug abusers. We know they are drug abusers, because they have been put into the drug court. Drug abuse becomes intertwined with legal authority. The more one violates legal authority, the more of a drug abuser one is. To disagree with this is to be in denial, thus further demonstrating one’s drug abuse problem. Discussion becomes impossible. Other points of view are ruled out by self-evident circularity.
Conclusion The JDC counsellors tended to attribute juveniles’ resistance to denial. Much of the evidence that the resistance was denial lay in the juveniles’ age. They were in denial because
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that’s how kids are. Though originally conceptualised as a coping mechanism for chemically dependent drug addicts, denial has broadened to encompass youth who resist counsellor definitions, especially definitions of drug abuse itself. The staff’s legalistic definitions of drug abuse contrasted sharply with many of the participants’ experiences, which often allowed for the controlled use of proscribed substances. But attempts by the participants to argue this point of view risked serving as evidence of their own denial, which is itself evidence of drug abuse. This can have important implications for measuring success in drug treatment courts. If the juveniles go through the programme without subscribing to its definitions of drug abuse, and the court refuses to consider the juveniles’ definitions, recidivism and abstinence may become measures of simple (temporary) compliance more than any meaningful index of success. Indeed, such measures of success may only reflect the extent to which a juvenile can walk the walk or talk the talk. This phenomenon could inhibit achieving the goals of either the legal or treatment spheres. Perhaps the most direct means of addressing each juvenile’s problems is to allow the juvenile to identify those problems for his or herself. This is in fact the driving philosophy of most non-coercive counselling practice Schwebel (2002) and a central tenet of the growing field of harm reduction. For some proponents of harm reduction People with substance use disorders should be offered treatment that is respectful of their assessment of their own problems and needs, and clinicians must be willing to work on areas of concern to clients that may or may not correspond to their own (Denning, 2000: 8). By far, the juveniles most appreciated the times when they felt they could talk more freely in treatment. “It’s been educational at times,” one juvenile said of the JDC, “although sometimes it’s been just kind of too finger pointing. Another juvenile who did not like the treatment meetings nonetheless said he did enjoy the meetings when the counsellor let us talk and see how we feel and stuff. That’s the time that was good. One youth said his favourite treatment session was when a substitute stood in for the regular counsellor: It was all a new group, people who I had never met in group before, and there was a substitute. So, I didn’t have to worry about the same teacher who told us we were in denial and that we were all alcoholics and we were addicted to drugs regardless of how often we used. Rather than pointing fingers [the substitute] just let us realise for ourselves what kinds of problems [drugs] would cause and how much we were using and how we felt when we were using.
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In user-based services, the treatment provider tries to offer what he or she can at the moment and stands by while clients live their lives outside of the treatment meetings (Denning, 2000: 25). This means clients will make choices with which the treatment providers do not agree. According to some harm reduction proponents, treatment providers must remain somewhat unattached to the treatment outcome and try to avoid imposing their own biases and definitions of success on the user. For them, it is only by encouraging autonomy over one’s life that responsibility for one’s health can be cultivated. As noted by one JDC counsellor: I try as hard as I can to treat those people with dignity and with respect. It seems to work much better. I don’t take much credit. I give it my best shot. I believe very strongly when they’re ready, they’re ready. It has to be a heart change; it has to come from the inside out. Unfortunately, serious consideration of user-based treatment has not been part of the mainstream discourse on DTCs. And as an increasing proportion of treatment referrals come through the criminal justice system, where legal issues take precedence over therapeutic concerns, there is a risk that such harm reduction models will be pushed even farther into the margins.
Acknowledgements The author expresses great appreciation to Hal Pepinsky, Steve Chermak, Ed McGarrell, Phil Parnell, Steve Russell, Liz Whiteacre, and an anonymous reviewer for their helpful suggestions and insights.
References Allen, F. A. (1981). The decline of the rehabilitative ideal. New Haven, CT: Yale University Press. Beauchesne, L. (1997). Legalization of drugs: Responsible action towards health promotion and effective harm reduction strategies. In P. G. Erickson, D. M. Riley, Y. W. Chueng, & P. O’Hare (Eds.), Harm reduction: A new direction for drug policies and programs. Toronto, Canada: Toronto University Press.
Boldt, R. C. (1998). Rehabilitative punishment and the drug treatment court movement. Washington University Law Quarterly, 76, 1205. Denning, P. (2000). Practicing harm reduction psychotherapy. New York: The Guilford Press. De Rios, M. D., & Smith, D. E. (1977). Drug use and abuse in cross cultural perspective. Human Organization, 36(1), 14–21. Duncan, D. F. (1992). Drug abuse prevention in post-legalization America: What could it be like? The Journal of Primary Prevention, 12(4), 317–322. Friedman, A. S., Granick, S., & Kreisher, C. (1994). Motivation of adolescent drug abusers for help and treatment. Journal of Child and Adolescent Substance Abuse, 3(1), 69–88. Hora, P. F., Schma, W. G., & Rosenthal, J. T. A. (1999). Therapeutic jurisprudence and the drug treatment court movement: Revolutionizing the criminal justice system’s response to drug abuse and crime in America. Notre Dame Law Review, 74, 439–538. Karoly, P. (1980). Person variables in therapeutic change and development. In P. Karoly & J. J. Steffen (Eds.), Improving the long-term effects of psychotherapy. New York: Gardner. Miller, W. R. (1985). Motivation for treatment: A review with special emphasis on alcoholism. Psychological Bulletin, 98, 84–117. Miller, W. R. (1991). Emergent treatment concepts and techniques. Annual Review of Addictions Research and Treatment, 283–296. National Association of Drug Court Professionals. (1997). Defining drug courts: The key components. Washington DC: United States Department of Justice, Drug Courts Program Office, Office of Justice Programs. National Association of Drug Court Professionals and The Office of Community Oriented Policing Services. (1998). Community policing and drug courts/community courts: Working together within a unified court system. Washington DC: United States Department of Justice. Nolan, J. L. Jr. (Ed.). (2002). Drug courts in theory and in practice. New York: Aldine de Gruyter. Rinaldi, R. C., Steindler, E. M., Wilford, B. B., & Goodwin, D. (1988). Clarification and standardization of substance abuse terminology. JAMA, 259(4), 555–557. United Nations. (1992). The United Nations and drug abuse control. United Nations International Drug Control Programme. Weil, A., & Rosen, W. (1998). From chocolate to morphine. Boston: Houghton Mifflin Company. White, R. K. (1989). Family intervention: Background, principles and other strategies. In R. K. White & D. G. Wright (Eds.), Addiction intervention: Strategies to motivate treatment-seeking behavior. New York: The Haworth Press. White House. (2002). National drug control strategy. Washington, DC: U.S. Government Printing Office. Whiteacre, K. (2004). Criminal constructions of drug users. In W. Palacios (Ed.), Cocktails and dreams: An interpretive perspective. PrenticeHall.
Denial and adversity in a juvenile drug court Kevin W. Whiteacre∗ Salvation Army Correctional Services Programme, 105 S. Ashland Avenue, Chicago, IL 60607, USA Received 10 October 2003; received in revised form 8 April 2004; accepted 14 June 2004
Abstract In drug treatment courts, denial is a pervasive issue in both the legal procedures of the court and in drug treatment itself. This paper explores the meaning of denial for youth and programme staff in a juvenile drug court (JDC) located in a metropolitan jurisdiction in the U.S. Midwest. Thirty-seven interviews were conducted with juveniles attending the JDC, a judge, defender, prosecutor, probation officers, and treatment counsellors. These interviews raised several issues regarding the use of denial in treatment. For staff, the meaning of denial came to encompass the ambivalence and resistance of non-addicted youths toward the programme and its staff. The primary source for the youths’ resistance was based in conflict with staff over definitions of drug abuse and responsible or moderate drug use. The implications of these phenomena are briefly considered in light of insights from the harm reduction perspective. © 2004 Elsevier B.V. All rights reserved. Keywords: Drug treatment court; Denial; Drug abuse; Harm reduction; Juvenile
With the kids, their denial is that they feel invincible because they’re kids. –JDC Counsellor They make you want to believe that you’ve got a problem. I may have a problem in finding direction, but I ain’t got no drug problem. –JDC Juvenile
Introduction Client motivation for treatment has long been recognised by treatment professionals as one of the most important factors influencing treatment outcome. In fact, it is often viewed as the fundamental prerequisite for treatment success (Miller, 1985). A client’s lack of motivation in treatment is often attributed to personality traits, resistance, or overuse of defence mechanisms such as denial (Miller, 1985). Indeed, denial, now situated as one of the component symptoms of the addiction disease, has become an increasingly important concern in ∗ Tel.: +1 312 455 8059x236. E-mail address: kevin [email protected] (K.W. Whiteacre).
0955-3959/$ – see front matter © 2004 Elsevier B.V. All rights reserved. doi:10.1016/j.drugpo.2004.06.006
the addictions field. White (1989) provides a comprehensive definition of denial: . . . a psychological process that serves to keep the chemically dependent person out of touch with reality. It is one of the most difficult aspects of treatment for alcoholism and drug dependence. Denial is caused by numerous factors which act synergistically, including distortions of memory such as blackouts and euphoric recall, psychological defence mechanisms such as repression and projection, and social factors such as enabling by family and friends. It is common for chemically dependent people to genuinely believe that they do not have a problem with alcohol or other drugs in the face of overwhelming evidence to the contrary. (White, 1989: 9) Studies suggest that clients in drug treatment often tend to under-estimate their need for treatment or help at admission, or they may even “deny that they have a problem or that they need to change their behaviour or attitude” (Friedman, Granick, & Kreisher, 1994: 70). Much of the structure of drug treatment courts (DTCs) is, therefore, designed to counteract the perceived threat of denial and other related defence mechanisms, which, it is argued, traditional adjudication may exacerbate Hora et al. (1999). The adversarial nature of the
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traditional criminal justice system, according to drug court proponents, can be a potential enabler of an offender’s drug problem. Traditional defence counsel functions and court procedures that encourage a defendant to deny guilt, it is argued, often reinforce the offender’s denial of a drug problem (The National Association of Drug Court Professionals, 1997). To help defendants overcome denial, the prosecutor and defender work together as a team with the judge, treatment personnel, probation, and social service professionals in the community to force the offender to deal with his or her drug use “or suffer the consequences” (National Association of Drug Court professionals and The Office of Community Oriented Policing Services, 1998). But some professionals claim that research has failed to identify denial as an empirically valid trait among drug dependent populations. Miller (1991) argues that although professionals in the addictions field have begun to take as axiomatic the existence of denial, “research has revealed no such characteristic defensive styles among clinical populations” (Miller, 1991: 284). The characterisation of an individual in denial is ultimately left to the judgement of professionals. In light of the difficulty researchers have had in actually discovering an objectively identifiable ‘denial’ trait, such judgements might sometimes be based more on their subjective perceptions (Miller, 1985). These perceptions often reflect the extent to which the treatment client accepts counsellor definitions of the issues. A client tends to be judged as motivated if he or she accepts the therapist’s view of the problem (including the need for help and the diagnosis), is distressed, and complies with treatment prescriptions. A client showing the opposite behaviours—disagreement, refusal to accept diagnosis, lack of distress, and rejection of treatment prescriptions—is likely to be perceived as unmotivated, denying, and resistant. Commenting on the concept of readiness for treatment, Karoly (1980) observed: ‘unfortunately, readiness is often interpreted to mean only the individual’s willingness to place himself or herself in the hands of an authoritative therapist or nurturant institution’. (Miller, 1985: 88) According to Francis Allen 1981: 48, in the therapeutic state, client disagreement itself can sometimes serve as an indication of the need for treatment. “The willingness of the accused to assert adversary positions against the state may be taken as the strongest evidence of the accused’s need of rehabilitation”. In the drug treatment court, where adversity is considered anti-therapeutic and resistance could reflect denial of a problem, interactions between client and professional take on added import. Evaluations of DTCs, then, must include a consideration of how these dynamics impact on participants for good and bad. The greatest limitation of prior DTC research has been the narrow focus on abstinence and recidivism as the sole measures of programme success. While certainly im-
portant, these two outcomes represent a small part of myriad possible outcomes experienced in a drug treatment court programme. Some critics observe, for example, that when treatment is built into a court system, which still retains coercive features of traditional criminal law, procedural informality can sometimes have negative consequences for the defendant, such as the loss of due process rights (Boldt, 1998). Others argue that placing treatment interventions within the confines of the law risks creating treatment programmes “that constitute social-control activities, rather than health promotion and harm reduction strategies developed within a health-promotion perspective” (AITQ, 1996 cited in Beauchesne, 1997: 38). Thus, a “logic of social control” permeates treatment interventions forced to conform to legal norms. Definitions of denial and issues of authority and coercion present issues every bit as important in the lives of participants (and the community) as recidivism rates, and they have clear implications for assessing the impacts of DTCs.
Methods The present study explores some of these issues. Specifically, it considers the use of the denial concept as a therapeutic tool within a juvenile drug court (JDC). This study took place at a JDC located in a metropolitan jurisdiction in the U.S. Midwest. I conducted the research while fulfilling a one year contract as an evaluator for the JDC. Over the course of the year, I attended dozens of compliance hearings in court and pre-hearing staff meetings and a few treatment meetings. During these observations, I talked with staff and recorded notes. I also conducted open-ended qualitative interviews with court staff, treatment counsellors, and the juveniles themselves. In all, 37 people were interviewed: 25 juveniles, the judge, defender, prosecutor, 3 probation officers, and 6 treatment counsellors. The juvenile interviews took place during the court hearings. We met in a small room reserved for defence attorneys to meet with clients. It was connected to the large waiting room, but provided ample privacy for the interviews. Only one juvenile declined to be interviewed but did not give a reason. It seemed probable that he simply did not want to spend the time in an interview, since he was in the later phase and there only to submit a drug test. Interviews with the staff took place in or around their places of work. They typically lasted from 30 to 60 min each. All interviews were tape recorded and later transcribed. The findings in this paper are based on the results of these interviews. Admittedly, a study relying so heavily on interviews with individuals associated with a court-monitored drug treatment programme might suffer some restrictions that can adversely affect the presentation of the information. The interviews are, after all, the product of my own interaction with the intervie-
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wees. How the participants related to me could have influenced what they said. As a contracted employee of the JDC and an adult, it sometimes took me a little time to get the juveniles to talk frankly outside of the programme discourse. In other words, some were reluctant to say anything beyond what they thought the programme staff would want to hear. This problem became less difficult as the juveniles became more familiar with me and I gained experience with them. On occasion, for example, a juvenile might start off talking about the many benefits of giving up cannabis. Later in the interview, however, she would admit she had every intention of resuming her use of the drug as soon as she was out of the programme. Others were open immediately, and still others undoubtedly were never so open. The number of juveniles who did indeed admit their intentions to at least consider engaging in future illegal behaviour, the wide variety of responses, and the sometimes blunt critiques of the programme and its personnel led me to believe that the majority were quite honest and did indeed feel comfortable in the interview. The programme The JDC is a 6-month programme for adolescents who face cannabis or alcohol-related charges or have a history of substance abuse (offences involving violence are excluded). It consists of two three-month phases. Phase 1 is more rigorous, requiring attendance at a compliance hearing in court once every 2 weeks, about 2 or 3 drug tests a week, and usually at least one group treatment meeting a week. Phase 2 requires fewer drug tests, but if a youth is found to be non-compliant, more tests and other services can be ordered. After a juvenile successfully completes the two phases (and, thus, graduates), the court dismisses the charges that brought him or her into the programme. The majority of participants must attend group treatment meetings with the privately contracted treatment provider once a week. After a positive drug test, a juvenile may get moved up to a more intensive level, requiring two or three treatment meetings a week and an increase in drug tests. Sometimes a juvenile is assigned to additional outside meetings with Alcoholics Anonymous or Narcotics Anonymous. The treatment group meetings also include individuals not associated with the JDC who are usually in treatment as a condition of probation. Almost all of the treatment clients are there under some sort of criminal justice coercion. Every juvenile must also attend an 8 hour alcohol and drug education class with at least one guardian. In the class, a drug counsellor provides a vast array of information about the dangers of drug use, using videos, lectures, and some class discussions. A treatment coordinator serves as the liaison between the treatment provider and the drug court. The coordinator attends court sessions and pre-hearing staff meetings, providing updates on each participant’s progress in treatment.
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The juveniles The average age of the JDC youth was about 15 years. Over 80% were male, 63% were Caucasian, 32% were African-American, and another 5% either Hispanic or bi-racial. Possession of cannabis accounted for two-thirds of the complaints that brought the juveniles into the JDC. Possession of paraphernalia, public intoxication, and minor possessing alcohol made up most of the other charges. Among the JDC youth there was a wide variation in drug use patterns. Approximately 17% of the JDC youth were diagnosed with cannabis dependence. The vast majority of primary diagnoses, 65%, were for cannabis abuse. About 15% of the juveniles in the JDC had no drug-related primary diagnosis. In fact, a couple of the juveniles were not even referred to treatment as a condition of their participation in the JDC. A JDC staff member explained the variation of drug use patterns: For some, they were never smokers. They were in the wrong place at the wrong time. A friend may have said, ‘Can you hold this for me?’ Counselling is not necessary for them, because they’re not a smoker. They never have used drugs. Some of them are just naive and just got caught in the wrong place at the wrong time. Maybe education about the drugs will probably deter them from becoming smokers, and we’ve had younger ones who are like that . . . And we’ve even had some of the older ones who had never smoked, but they were in the wrong place at the wrong time, versus those who have been smoking since they were ten or eleven, and they’re sixteen now. When you hit sixteen or seventeen you’re stubborn and you’re set in your ways, and no one else is going to be able to change the way you are. Those may need serious counselling.
Ambivalence and denial Having entered treatment because of an arrest rather than doing so a voluntarily, the JDC participants were, for the most part, a reluctant treatment population. Many were clearly more concerned with the legal consequences of their use than with the use itself. In fact, legal factors were the driving force behind participation in the JDC. In my discussions with the juveniles, most mentioned getting their charges dropped as the biggest benefit to be gained by graduating. Even those who said they were there primarily to give up drugs acknowledged that getting their charges dropped was certainly an inducement to participate. Ambivalent toward their drug use, some of the juveniles tended to be somewhat resistant in treatment meetings and reluctant to accept everything the counsellors told them about their drug use. Often, this resistance was interpreted by the counsellors as denial. They attributed the juveniles’ denial or resistance to their young age, as noted by one counsellor:
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With the kids, their denial is that they feel invincible because they’re kids, They feel like ‘Okay if it happened to my buddy, big thing, because he probably wasn’t smart enough.’ Or you know, ‘That was his luck, but if I put more time in it, more thinking in it, I won’t have to turn out that way.’ So they just really feel invincible. But again, I think with the kids we have to realise, too, that they just don’t have the resources yet . . . They don’t have the problem solving skills. There are just different things that they haven’t been able to tap into, so that keeps their denial pretty secure. But the more they can see there are other things that they can do, then that in itself, to me, kind of eats away at the denial, I think. When I asked another counsellor how much of a problem denial was for the juveniles, she replied: Huge. They’re very, very young. They’re at a stage of development that we all have been through where ‘Nothing can hurt me. Nothing can touch me. I’m invincible.’ And that’s where they are. So it’s a very, very difficult thing to convince or help a juvenile see their behaviour has long term consequences, because it’s all about now. As the counsellors used the term, denial had taken on broader meaning, and it was attributed to the resistant attitudes of youth generally. Denial, then, became less a literal psychological process symptomatic of chemical dependence and more a general characteristic of youthfulness. Only one counsellor did not feel denial was much of a problem with the juveniles: I would say [denial] is probably more of a problem with adults than with the youth. I think that adults have had more years of experience with their drug of choice, and their denial systems are more solidly in place. With the kids, I don’t know. I think because they’re younger, because they don’t have as much experience as some of the adults, if they do have a problem, they’re going to admit it. In the literature, denial is seen primarily as a coping mechanism of addicts, but only 17% of the JDC juveniles were diagnosed as dependent on any drug (mostly cannabis). The counsellors, most of whom either were recovering addicts or had someone close to them who was, however, insisted it was only a matter of time before the juveniles became dependent. As a counsellor explained it to me: What I do is I try to let them know what options they have, because most of them don’t even think they have a problem. And some of them might not. They might just, you know . . . because I can put myself in their shoes, and I remember the way it was when I was their age. The only problem is I didn’t stop. I kept on going, and I try to tell them that. I try to tell them the consequences and inform them about what it’s going to do to their bodies. Because they have been misinformed a lot of the time.
Most of the counsellors did avoid calling the juveniles addicts. For practical reasons alone, it was just not very useful in the treatment meetings, as noted by one counsellor: I won’t label them as being an addict, I just leave it as abuse, because I tell them, ‘I never will label any of you anything.’ I could take the [Diagnostic and Statistical Manual of Mental Disorders] into a meeting and go over criteria for addiction and say “you’ve hit this, this, and this. And I could say, ‘I am calling you a drug addict.’ But I won’t try to do that. What good is that going to do? Given the juveniles’ ambivalence toward their own drug use, it is not surprising that some of them felt there was a little too much “finger pointing,” as a juvenile put it, by programme staff. One youth summed it up: I don’t really like the [treatment] classes because they make you think that you’ve got a problem, saying you’re in denial. Another complained that her counsellor did not believe her when she told her how much alcohol and pot she had used. She said she rarely drank alcohol and smoked cannabis on occasion. Either the counsellor did not believe her or did not accept the notion of “occasional” use for juveniles: She thinks I used to do it all the time, She didn’t believe you when you told how much you actually used?” [interviewer] Huh uh, [shakes head]. I’m having the worst time of my whole life doing it and all that stuff. Likewise, another juvenile complained about a treatment meeting in which he had told the counsellor he drank alcohol once every couple of months. She asked if he had ever experienced any problems when he drank, and he said, yes, he had suffered a hangover. She told him he was an alcoholic: Because I had a problem from the time I drank and I continued to drink later on, whether it’s too much, then by definition I was an alcoholic. When I said no, I wasn’t an alcoholic, she’d say that I was in denial. I just had some conflicts, because I knew alcohol wasn’t something that I was dependent on. It wasn’t something that I felt that I needed to do. It’s like ‘Oh well, I’m at a fun party. What the heck.’ It’s just a typical high school thing. Kids go to parties, and they drink. It doesn’t mean that every kid that drinks and ends up with a hangover is an alcoholic. Although originally conceptualised as a coping mechanism for chemically dependent drug addicts, denial has broadened in the JDC to encompass resistance to professionals’ views. The juveniles’ ambivalence toward their drug use and the conflict with counsellors’ definitions of that use become evidence of denial. Since the juveniles have not been diagnosed as dependent on drugs, the cause for this resistance-as-denial is instead identified in the participants’
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young age and the feelings of invincibility that accompany youth.
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What do you mean by when it’s right and when it’s wrong? [interviewer] I mean it’s always wrong, but knowing when to get caught and when not to get caught.
Defining drug abuse In its most basic form, denial is essentially one’s lack of acceptance of another’s definition of a situation (whether by refusal, inability, or some other process). It is the product of an interaction between two or more people. Denial in the JDC seemed most often the result of the juveniles’ refusal to accept staff’s definitions of drug abuse. Indeed, definitions of drug abuse and drug problems presented a clear split between staff and youth. Though staff and juveniles also differed somewhat among themselves, the overall consistency of the two groups’ points of view is noteworthy. When asked if they felt they had a drug problem, most of the juveniles said no as illustrated by the interview extract that follows: Me? Honestly, I don’t think I do, but a lot of people say that if you’re in denial, then that’s the first step. So, right now I’m really uncertain. They said to be addicted you smoke everyday. I never really smoked it everyday or anything. How would you define a drug problem? [interviewer] A drug problem . . . to me it’s not smoking everyday, it’s just a want or need for it all of the time. So you don’t think you have it? [interviewer] I think I. . . I think I had it at certain times. Like, certain times of the day I would be an addict. I don’t know if that’s possible . . . What do you mean? [interviewer] Because at certain times of the day I’d want it, but at certain times I wouldn’t. You know, like when me and a friend would get in a fight or something or one of my friends would get in a fight with someone and they’d get beat up. And I’d say, ‘Man, I got to go smoke a joint.’ But then sometimes during the day when I’m with my girlfriend or whatever, I’d say I don’t need no more. Do you know anyone that you consider a responsible drug user? Or do you know anyone you think uses alcohol responsibly? [interviewer] Well, I can’t say really all of my friends, but I know a couple of friends who won’t smoke it inside of their house, or if they have something to do the next day. They just do it when it’s possible for them to do it and not get in trouble. How would you define responsible drug use then? [interviewer] Using when knowing how to stop and knowing when it’s right and wrong.
Some of the juveniles did report they had a problem, and one youth took the addiction model to extremes: There is no such thing as using responsibly. Nobody can use responsibly. People can’t drink responsibly? [interviewer] Nope, because you think you are, but you’re not because once you say you drink responsibly, you’re an alcoholic because you can’t stop having even a drink. Cause if you have just this much, [pinches his index finger and thumb together indicating a tiny amount], then you’ll get more. It’s true. It’s a proven fact. Statistics say it is. The issue of differing notions of moderate or responsible drug use between the youths and the JDC staff seemed to lie at the foundation of the conflict over denial and addiction. The staff rejected most notions of responsible drug use, especially for cannabis and other illicit drugs. One staff member also felt that alcohol could not be used responsibly by anyone. And the staff members were reluctant to acknowledge the possibility of moderate use. For them, all use was abuse. The juveniles, on the other hand, almost invariably distinguished between moderate use and abuse. When staff did acknowledge the possibility of responsible use, they emphasised the importance of the legal status of the drug and the age of the user as pre-requisites for responsibility. Perhaps not surprisingly, no juvenile mentioned age as a variable influencing responsibility and every adult interviewee did: Because I don’t think kids have good enough judgment yet, not that many adults have good judgment—that’s kind of a ridiculous statement—but I think kids have a hard enough time dealing with issues of peer pressure and boundaries, more so than adults. If you then put in a mood-altering or an inhibition-releasing substance, you’re going to have some problems. I guess it just makes it more of a challenge for kids to behave responsibly. . . it just kind of stacks the deck. The juveniles tended to define responsible use versus irresponsible use in terms of quantity used and whether or not the person “needed” the drug. In applying these rules, they did not report age as a factor, nor did they distinguish between alcohol and cannabis, or legal and illegal drugs. Most drugs could be used responsibly so long as the use was moderate and the person did not “need” it. As these youths explained: There are a few of my friends who I honestly think are responsible. It’s just a rare occasion type of thing. There are kids at my school who will go out every day after school and smoke marijuana, and there are kids who might
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smoke twice a month or drink twice a month. I find that, even though it is illegal, I do think it is responsible. As far as alcohol goes, the legal age is twenty-one, but I think a sixteen year-old can drink more responsibly than a 21year-old as long as they don’t let it get carried away. I know people who use and go to work and do everything they’re supposed to do, and they just smoke on the side. I know people like that. Almost all staff distinguished between legal and illegal drugs, believing that illegal drugs, by their very illegality, could not be used responsibly. A court member explained: Whether or not you’re breaking the law is part of acting responsibly, because I think that if you start down the road of saying, ‘It’s okay to break this law or that law,’ then suddenly you don’t learn any sort of structure or values and any respect for it.
argue, and I don’t even try. That’s when I go right back to ‘I will talk to you [when pot] is legalised,’ and they hate it. They hate it. The growing popularity of cannabis and the legalisation movement, when thrown into the mix, also presented a problem for the counsellors. The youth were reluctant to accept the definition of drug abuse as all illicit drug use, and many of them brought this up during the treatment meetings, particularly when they compared cannabis to alcohol. One counsellor said that the kids know cannabis does not have the withdrawal effects seen with alcohol: And so they call me on that, and they say, ‘Well, you know alcohol is legal and look what it does.’ And I don’t have any argument.
Of course, most of the juveniles having been arrested, and some suspended from school and put into the drug court treatment programme, recognised the link between drug laws and problems with drugs. They just put a different spin on it, as noted in the following:
Though I never brought it up in interviews, the debate over legalising cannabis seemed to be a recurring background to many of my observations and interviews in the court. When I asked one court staff member whether she felt cannabis could be used responsibly, for instance, she rephrased the question back to me, “Should cannabis be legal? ” Several of the juveniles suggested that cannabis should the legalezed:
I mean, drugs can always give you a problem. You can smoke weed for the first time, and it won’t make you stupid right away. But you can get arrested, and that’s a problem. So, I don’t think . . . Yes, I had a drug problem, but I wasn’t addicted . . . My drug problem was I would smoke marijuana in stupid places where I could get caught.
It’s not like marijuana is like cocaine. You don’t have to send me to a rehab place. Marijuana is not crack. You don’t have to send me to rehab . . . So it’s ridiculous that weed is illegal. The government would make a lot more money if they just taxed it, instead of spending money on trying to make a war against it.
Indeed, for many of the juveniles, a drug problem was more a question of getting caught and the resulting consequences. Several youths told me the most important lesson they learned in the JDC was to leave their cannabis at home: I’ll know next time, and I won’t have it on me. If you catch a case with marijuana you have to go through too much. One counsellor acknowledged this distinction between law-related drug problems and other types of problem: I don’t think they all do [have a drug problem]. I think they’ve all had a problem with drugs, because, I mean, they got caught doing something they weren’t supposed to be doing. But I think most of them are at a place where this early intervention can really make a difference. Many of the juveniles suggested that their problems were evidence of bad laws more than irresponsible drug abuse. A counsellor, who did not believe cannabis could be used responsibly because it is a gateway drug, explained this conflict: Most of the people that drink a few beers drink it because it gives them a little bit of a buzz, but that’s all. So if that is what society calls social drinking, okay, I can live with that. But the kids can argue right back, ‘Well if you smoke a joint, one joint at home, what does that hurt?’ I can’t really argue that, and it’s a tough one to argue, and I can’t
A juvenile’s mother told a JDC staff member that she knew a lot of doctors and lawyers who smoked pot. To which the staffer responded matter-of-factly, “That’s fine, but it’s still illegal.” Differences over definitions of drug abuse and drug use, and the conflict those differences engender, is hardly unique to the JDC. There is a sometimes contentious debate among professionals over distinctions between definitions of drug use and abuse. In its broadest and most legalistic sense, drug abuse has been defined as any use of a prohibited drug or the use of a medical drug in a manner deviating from approved medical patterns. The U.S. Office of National Drug Control Policy, for instance, makes no distinction between use and abuse of prohibited drugs (White House, 2002). All use is abuse. Likewise, the United Nations “discourages the use of all of the following terms and concepts: ‘recreational use’ of drugs, ‘responsible use’ of drugs, ‘decriminalization,’ and defining drugs as ‘hard’ or ‘soft’ ” (United Nations, 1992). A survey of substance abuse experts, however, produced a definition of drug abuse as “any use of drugs that causes physical, psychological, economic, legal, or social harm to the individual user or to others affected by the drug user’s behavior” Rinaldi, Steindler, Wilford, & Goodwin 1988: 557.
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By these definition, all of the juveniles are drug abusers because their arrest clearly indicates legal trouble resulting from their drug use. In British DTCs, however, not all illicit drug use is considered abusive (Nolan, 2002). A chief probation officer involved in DTCs in England, for example, identified several gradations of drug use, such as experimental use, recreational use, problematic use, and dependent use. “People use drugs in the main because they enjoy it,” he said. “And the vast majority of people in our society or [in America] use drugs in a non-problematic way” (quoted in Nolan, 2002: 96). Some observers note that definitions of bad or excessive use are often a matter of who is defining the use (De Rios & Smith, 1977: 18). According to Duncan (1992: 318), the inconsistencies in defining abuse “raise very serious questions about our preventive and treatment efforts. It is simply not realistic to say that all use of any particular drug, however socially disapproved it may be, is necessarily abuse.” Drug abuse, according to Duncan (1992: 318), is “an interactional process among the drug, the drug-taker, and the circumstances of the drug-taking, drug, set, and setting.” Like denial, it is a function of the interaction between and individual and her environment. In the words of the JDC youth My drug problem was I would smoke cannabis in stupid places where I could get caught. Increasingly, drug abuse has become a shorthand term to differentiate between licit and illicit drug use, instead of referring to an actual typology of drug-using behaviours (Drug Abuse Council, 1980; quoted in Duncan, 1992, p. 317). Duncan warns that relying on such “pat answers” to these difficult questions will only do more harm than good. Defining abuse in legalistic terms, for example, limits its use as a diagnostic device. It could be argued that acknowledging the existence of non-abusive drug use patterns can inform our approaches to dealing with destructive drug use (Whiteacre, 2004). And others have argued that the focus should switch from identifying good and bad drugs as the basis for defining abuse, and identifying good and bad relationships with drugs (Weil & Rosen, 1998). Legal definitions of drug abuse, moreover, become circular in the JDC. The juveniles are in the drug court, because they are drug abusers. We know they are drug abusers, because they have been put into the drug court. Drug abuse becomes intertwined with legal authority. The more one violates legal authority, the more of a drug abuser one is. To disagree with this is to be in denial, thus further demonstrating one’s drug abuse problem. Discussion becomes impossible. Other points of view are ruled out by self-evident circularity.
Conclusion The JDC counsellors tended to attribute juveniles’ resistance to denial. Much of the evidence that the resistance was denial lay in the juveniles’ age. They were in denial because
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that’s how kids are. Though originally conceptualised as a coping mechanism for chemically dependent drug addicts, denial has broadened to encompass youth who resist counsellor definitions, especially definitions of drug abuse itself. The staff’s legalistic definitions of drug abuse contrasted sharply with many of the participants’ experiences, which often allowed for the controlled use of proscribed substances. But attempts by the participants to argue this point of view risked serving as evidence of their own denial, which is itself evidence of drug abuse. This can have important implications for measuring success in drug treatment courts. If the juveniles go through the programme without subscribing to its definitions of drug abuse, and the court refuses to consider the juveniles’ definitions, recidivism and abstinence may become measures of simple (temporary) compliance more than any meaningful index of success. Indeed, such measures of success may only reflect the extent to which a juvenile can walk the walk or talk the talk. This phenomenon could inhibit achieving the goals of either the legal or treatment spheres. Perhaps the most direct means of addressing each juvenile’s problems is to allow the juvenile to identify those problems for his or herself. This is in fact the driving philosophy of most non-coercive counselling practice Schwebel (2002) and a central tenet of the growing field of harm reduction. For some proponents of harm reduction People with substance use disorders should be offered treatment that is respectful of their assessment of their own problems and needs, and clinicians must be willing to work on areas of concern to clients that may or may not correspond to their own (Denning, 2000: 8). By far, the juveniles most appreciated the times when they felt they could talk more freely in treatment. “It’s been educational at times,” one juvenile said of the JDC, “although sometimes it’s been just kind of too finger pointing. Another juvenile who did not like the treatment meetings nonetheless said he did enjoy the meetings when the counsellor let us talk and see how we feel and stuff. That’s the time that was good. One youth said his favourite treatment session was when a substitute stood in for the regular counsellor: It was all a new group, people who I had never met in group before, and there was a substitute. So, I didn’t have to worry about the same teacher who told us we were in denial and that we were all alcoholics and we were addicted to drugs regardless of how often we used. Rather than pointing fingers [the substitute] just let us realise for ourselves what kinds of problems [drugs] would cause and how much we were using and how we felt when we were using.
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In user-based services, the treatment provider tries to offer what he or she can at the moment and stands by while clients live their lives outside of the treatment meetings (Denning, 2000: 25). This means clients will make choices with which the treatment providers do not agree. According to some harm reduction proponents, treatment providers must remain somewhat unattached to the treatment outcome and try to avoid imposing their own biases and definitions of success on the user. For them, it is only by encouraging autonomy over one’s life that responsibility for one’s health can be cultivated. As noted by one JDC counsellor: I try as hard as I can to treat those people with dignity and with respect. It seems to work much better. I don’t take much credit. I give it my best shot. I believe very strongly when they’re ready, they’re ready. It has to be a heart change; it has to come from the inside out. Unfortunately, serious consideration of user-based treatment has not been part of the mainstream discourse on DTCs. And as an increasing proportion of treatment referrals come through the criminal justice system, where legal issues take precedence over therapeutic concerns, there is a risk that such harm reduction models will be pushed even farther into the margins.
Acknowledgements The author expresses great appreciation to Hal Pepinsky, Steve Chermak, Ed McGarrell, Phil Parnell, Steve Russell, Liz Whiteacre, and an anonymous reviewer for their helpful suggestions and insights.
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