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Substance use and treatment seeking in young offenders on community orders
Journal of Substance Abuse Treatment 31 (2006) 425 – 432
Regular article
Substance use and treatment seeking in young offenders on community orders Christopher John Lennings, (Ph.D., M.Psychol.)4, Dianna T. Kenny, (Ph.D.), Paul Nelson, (M.Beh.Sci.) Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW 2141, Australia Received 6 January 2006; received in revised form 22 May 2006; accepted 24 May 2006
Abstract Both international and Australian studies reveal very low rates of treatment utilization for substance abuse among young offenders despite very high problematic rates of substance abuse among this group. The current study reports on substance use patterns of a representative sample of 712 young offenders serving community orders with the New South Wales Department of Juvenile Justice (Australia) and their history of and attitudes toward treatment. Most (87%) young offenders had used marijuana, and 47% had used amphetamines in the last 12 months. One third of the sample reported problematic use of alcohol (being drunk at least weekly, on average). Forty-three percent reported that they engaged in crime to maintain their substance use. On the substance abuse scale of the Adolescent Psychopathology Scale— Short Form, 36.4% of the sample fell into the moderate to severe problem range. Despite such problems, treatment motivation was poor: 10% reported willingness to access treatment for their drug problems. Eighteen percent reported accessing some form of treatment in the past; the most common form of help seeking was approaching their family (12%). Self-reported access to other drug treatments was even lower, with the more intensive treatments revealing low rates of treatment completion. Despite almost 40% of the sample revealing significant substance abuse problems, referral for treatment was also low, with only 18% of the sample being offered an appointment with juvenile justice drug and alcohol workers. This study reveals the gap between awareness of problematic drug use and treatment-seeking behavior, and has implications for improving outreach to young offenders with substance abuse problems. D 2006 Elsevier Inc. All rights reserved. Keywords: Young offenders; Substance abuse; Treatment access
1. Introduction There is a strong association between substance abuse and juvenile offending (Dembo et al., 1991; Gordon, Kinlock, & Battjes, 2004; Hammersley, Marsland, & Reid, 2003; Newburn, 1998; Yu & Williford, 1994). Several largescale longitudinal studies of delinquency (Dembo et al., 1991; Loeber & Farrington, 2001; Moffitt, 1997) highlight the important role of substance abuse, particularly earlyonset abuse (Braithwaite, Conerly, Robilliard, Stephens, & Woodring, 2003; Gordon et al., 2004; Loeber & Farrington, The views expressed in this article are not necessarily those of the New South Wales Department of Juvenile Justice and the New South Wales Justice Health. 4 Corresponding author. School of Community and Behavioral Health Sciences, University of Sydney, Lidcombe, NSW 2141, Australia. E-mail address: [email protected] (C.J. Lennings). 0740-5472/06/$ – see front matter D 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.jsat.2006.05.017
2001), in the development of young offenders and the impact that substance abuse has in delaying the trajectory out of offending. The work of Moffitt (1997) on lifetime delinquency (as opposed to time-limited or adolescent-onset delinquency) reveals strong relationships between early deviance, substance use, and offending behavior. Various studies have demonstrated particular associations between these factors (e.g., Putnins, 2003 provided evidence from a brief screening instrument of detainees in a South Australian juvenile detention center that use of alcohol or inhalants at the time of initial arrest was a useful predictor of later criminal behavior, whereas the use of other illicit drugs did not predict engagement in criminal behavior postrelease). Trimboli and Coumarelos (1998) identified a dose–response relationship between cannabis and crime: The greater is the level of cannabis use, the greater is the frequency of crime. Hammersley et al. (2003) reported that more than 50% of
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their sample thought that their drug use was causal to their offending. The crime–substance abuse nexus suggests three possible pathways: substance abuse causes crime (presumably to afford drug purchases, but also through a general deviance factor); drug abuse and crime are correlates of each other; and crime causes substance abuse (Copeland & Howard, 1997). There is evidence supporting all three hypotheses, with different pathways demonstrating more relevance for different offenders (Dobinson & Ward, 1986). Given the strong association between substance abuse and crime, and given research that consistently identifies higher recidivism rates for substance-abusing young offenders (Belenko & Dembo, 2003; Hammersley et al., 2003), successful treatment of substance-abusing young offenders could be expected to reduce offending. Johnson et al. (2004) surveyed 401 young offender detainees and found that, although two thirds of the sample had a clear need for treatment, only 48% of that group (n = 273) had actually received any treatment. Unfortunately, the different kinds of treatments accessed were not identified. In contrast, Newburn (1998) noted that, in the UK, there were surprisingly low rates of treatment uptake by young people, although this was partly attributed to poorly developed treatment options. Only 7% of 398 young offenders in the longitudinal study of high-risk young offenders conducted by Dembo, Williams, and Schmeidler (1993) had spent any time in a drug treatment facility. Similarly, a survey of 493 Australian drug-abusing young offenders in a detained police sample found that only 13% had accessed treatments, of which half were residential treatment programs (Wei, Makkai, & McGregor, 2003). It is not known what percentage may have completed treatment. The British Government’s Home Office Research Study 261 (Hammersley et al., 2003) found that of 293 young offenders with substance abuse difficulties who were followed up (from a planned sample of 500), 25% had accessed treatment. Again, no data on the types of treatment accessed were provided. Newburn (1998), for instance, noted that most substance-abusing young offenders in his sample reported that being provided with information constituted the extent of their btreatmentQ for substance abuse. However, between 50% and 65% of the sample (depending on the degree of boffender riskQ) stated that treatment was not helpful in reducing their level of substance use. There appears to be little difference between treatment outcomes for bcoercedQ and bvoluntaryQ referrals to substance abuse treatments (Dembo et al., 1993), a point reinforced by a review of treatment outcomes in the forensic area conducted by Day and Howell (2002). Typically, base rates for behavioral change are low, with treatment contributing between 20% and 30% improvement over no treatment. There appears to be a somewhat general pessimistic perception of the utility of treatment among young people (Gorske, Srebalus, & Walls, 2003), with those adolescents exhibiting antisocial features being least likely to benefit from treatment. There still remains much to be known about
the effectiveness of treatment for substance abuse in young people (Maisto, Pollock, Cornelius, Lynch, & Martin, 2003). Terry, Van der Waal, McBride, and Van Buren (2000) discussed the findings of the longitudinal evaluation of adolescent treatment (Chemical Abuse/Addiction Treatment Outcome Registry). The data to date provide support for the general effectiveness of treatment of adolescents for a 12-month follow-up period. A review of other studies also reveals substantial support for positive (if limited) gains from well-constructed programs (e.g., see Henggeler, Clingempeel, Brondino, & Pickrel, 2002). However, such positive results need to be balanced by contrary findings. Worrall (2004) reported on a panel study based on an analysis of juvenile justice collaborative (multiagency) programs in 58 counties of the State of California. Utilizing recidivism as the key outcome variable, and despite numerous methodological constraints, the evaluation concluded that there was no discernible benefit from such programs. In what is probably the most authoritative meta-analysis of programs investigating the impact of treatments within the criminal justice system to reduce drug-related crime, Holloway, Bennett, and Farrington (2005) reported on the analysis of 69 studies in which treatment and treatment comparison groups were available. Amalgamating their findings, the following conclusions were reached. Treatment groups were 41% better off than no-treatment groups. Fortyfour of 52 studies analyzed were found to be effective in reducing crime on at least one measure (14 studies were not included in this analysis because their results became available after this part of the study had been completed). Among the findings was the observation that treatment seemed more effective for juvenile offenders than for adult offenders. There were limited data available to make much comment about the effectiveness of follow-up or aftercare programs, although the few studies that were available suggested that the more intense is the aftercare program, the greater is the reduction in crime-related behavior. The results also found that boys, but not girls, were more likely to reduce offending following treatment. Overall, the studies provided convincing support for the view that high-intensity programs proposed proportionally greater gains than lowintensity programs, with therapeutic communities and drug courts providing the best outcomes. It does seem that there is reason for hope, provided treatments are appropriately resourced and targeted such that reductions in both substance use and crime may be achieved. The current study investigated the treatment-seeking behavior of a sample of young offenders serving community orders with the New South Wales Department of Juvenile Justice (NSW DJJ). To serve a community order, a young person must be found guilty of a crime by a court, and must be given a noncustodial sentence or must have a custodial sentence commuted. In New South Wales, as in some other Australian states, young people can have their crime dealt with by way of a formal police caution or by
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conferencing, in which case a conviction is not recorded. Such interventions are usually preserved for first-time offenders and offenses without violence. Community orders could involve a young person in community service (usually a number of hours in which a young person performs some bvoluntaryQ work under supervision for the community, such as painting community halls, lawn mowing in public reserves, and the like). Alternatively, a young person may receive an order for supervision, with or without conditions, to attend counseling, pay fines, or both. Our study only interviewed those young people who were formally indicted for a criminal offense. Most studies of young offenders have involved offenders in detention (for obvious reasons of availability), but in most jurisdictions, there are many more nondetained (community orders) offenders than there are in detention. In New South Wales, for instance, almost 80% of young people serving sentences under the DJJ serve community-based sentences. Thus, it seems important to identify the treatment-seeking behaviors of community-based offenders.
justice officer (JJO) providing to the research team the young person’s name and contact details. The person was contacted by a member of the research team, and an appointment was organized, usually at the young person’s reporting DJJ community center. The interviews took approximately 3 hours, with almost 80% agreeing to blood testing, as well as interviews and psychometric assessment. Young people were paid $50 for their participation. In addition, young people who took part in the study were told that their time spent with the research counted as time served against their community service hours if their order included a component of community service.
2. Method
2.3. Procedure
2.1. Participants
After completing intensive training in the administration of the survey protocol, masteral students of forensic psychology who were on placement from the University of New South Wales and the University of Western Sydney, along with nurses employed by the Corrections Health Service, administered the psychological and educational assessment protocol, undertook appropriate physical examinations, and collected blood samples. For most participants, interviews took place at DJJ community centers. In some cases, where long travel distances mitigated against young people coming to the community center, interviews took place in a local youth center. All interviewers attended monthly supervision meetings by one of the chief investigators (C.L.) to ensure compliance with interview protocols and to iron out any potential difficulties. In addition, on-site supervision was provided regularly by the research manager (P.N.). On two occasions throughout the study, 20 psychometric test protocols were randomly selected, and two clinical investigators (C.L. and M.A.) independently rated the protocols for compliance with training and scoring instructions. High interrater reliability was observed on both the Wechsler Abbreviated Scale of Intelligence and the Wechsler Individual Achievement Test. No protocol differed by more than the standard error or measurement, and both reviewers identically rated approximately 75% of the protocols.
From 2003 to 2005, The University of Sydney, in collaboration with the NSW DJJ and the NSW Justice Health (JH), undertook a comprehensive population physical and mental health survey entitled Young People on Community Orders Health Survey (YPoCOHS). All consenting young people on community orders in NSW in the study period (July 2003–June 2005) were eligible. The DJJ supervises approximately 1,700 young people in the community per year. The number of young people fluctuates as a result of sentencing and time on orders, but our sample reflects approximately 42% of available young offenders. Approximately 1,900 young people were eligible for inclusion in the survey. Of this group, 400 refused to participate, 600 could not be contacted or did not respond to invitations to participate, and 100 (90 boys and 10 girls) were excluded due to the following: serious mental health problems, substance withdrawal, having been considered too violent or disruptive by management, and court appearances or admission into custody on the day of the survey. These exclusions may have resulted in an underestimation of population parameters, particularly for mental health indicators, substance abuse, offense profile, and violence characteristics. Young people were recruited from all metropolitan community centers and from large rural centers. Rates of voluntary participation in the survey ranged from 33% to 67% per center or geographical location. Large intercenter variability was identified in the acceptance of the study, but no systematic reasons for this could be identified. Recruitment was performed with the young persons’ juvenile
2.2. Ethics Ethics approval for the study was obtained from the University of Sydney Human Research Ethics Committee, the DJJ Collaborative Research Unit Ethics Committee, the Ethics Committee of the NSW Corrections Health Service (now JH), and the NSW National Health and Medical Research Council.
2.4. Measures 2.4.1. Mental and Physical Health Questionnaire (MPHQ) The MPHQ comprises 387 self-report questions divided into 32 sections that cover a comprehensive range of issues
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related to health and life experience. Only the sections on drug and alcohol use, treatment utilization of community health services, and health service appraisal were of interest to this study. The drug section asked questions about age of onset of drug use, type of drug use, usual pattern of drug use, and route of administration. The alcohol section asked questions about frequency of consumption, quantity (in standard drinks), choice of alcoholic beverages, and frequency of being drunk. Information on treatment seeking was obtained by questions asking whether young offenders had ever received treatment, type of treatment, method of referral, frequency of attendance on treatment, whether they had attended treatment in the past 12 months, and whether they had completed their treatment. The questionnaire gave prompts for various treatments (e.g., from general practitioners, detoxification or rehabilitation centers, Narcotics Anonymous, Alcoholics Anonymous, outpatient counselors, youth workers, psychiatrists, psychologists, family, friends, priests, Salvation Army, Sydney City Mission, Mission Beat, or other counselors) and requested information about other possible services received. Only questions pertaining to offense history and substance use are presented in this article. 2.4.2. Adolescent Psychopathology Scale—Short Form (APS-SF) The APS-SF assesses a range of psychological and psychiatric symptoms warranting possible referral or intervention. Although not a diagnostic tool, the scales are based on Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition criteria. The APS-SF generates 14 scales, which consist of 12 clinical scales, organized into clinical disorders (six scales), psychosocial problems and competencies (six scales), and response style indicators (two scales). The APS-SF mean t score is 50 (SD = 10). Scores above 65 are considered an indication of possible disorder, but not a formal diagnosis. The APS has been extensively standardized on U.S. populations (Reynolds, 1998). Only the following subscales were used in this study: Conduct Disorder, Oppositional Defiant Disorder, Substance Abuse, Anxiety, and Depression, as a full report on the APS-SF and other mental health indices will be the subject of another article. Conduct Disorder and Oppositional Defiant Disorder are the most commonly reported externalizing disorders, in conjunction with adolescent substance abuse in the literature, as are depression and anxiety being the most commonly reported internalizing disorders. 2.4.3. Cultural affiliation Each respondent was asked to indicate whether they identified with Aboriginal and Torres Strait Islander (ATSI) culture. 2.4.4. Definition of problematic alcohol use There are no recommended drinking levels for people under 18 years. For this survey, hazardous/harmful levels were based on the Australian Alcohol Guidelines (http://
www.alcohol.gov.au) for adults. For boys, drinking more than four standard drinks (1 SD = 12 g of alcohol) a day (on average), and/or more than six standard drinks on any 1 day, and/or drinking everyday was classified as unsafe. For girls, drinking more than two standard drinks a day (on average), and/or more than four standard drinks on any 1 day, and/or drinking everyday was classified as unsafe.
3. Results 3.1. Descriptives Seven hundred seventy young people had some form of contact with the survey. Seven hundred twelve records had sufficient data for the analysis of issues related to substance abuse treatment. Of these, 86% (615) were young male offenders. For 659 participants who had their age recorded, age ranged from 12 to 21 years, with a mean of 16.56 (SD = 1.32) years. One hundred thirty (18%) (107 young male offenders and 23 young female offenders) reported ATSI background. Eighty-three percent (596) of the sample was born in Australia (young male offenders = 513; young female offenders = 83); and 54 (7.6%) was born in New Zealand. For some items, no responses were recorded, hence sample sizes for individual questions fluctuated. Our sample was compared to all eligible candidates for the study. A high level of representativeness was found for ATSI, gender, and age between our sample and the total sample of young people on community orders within the period of the study. 3.2. Access to education and employment Only 18% of the offenders were attending school, and there were no proportional differences between young male offenders and young female offenders and ethnic status for school attendance. Significantly fewer young male offenders (n = 129; 18%) than young female offenders (n = 24; 25%) were attending technical college (TAFE) (t = 5.34, df = 1, p b .05). There was no ethnic difference for TAFE attendance. Only nine young people said that they were attending both school and TAFE; hence, 35.5% of the sample was currently engaged in education. There were significant differences for gender and ethnicity with respect to employment, with more young male offenders (27%) than young female offenders (15%) employed from the total of 183 (26% of the whole sample) (v 2 = 6.40, df = 1, p b .05). Similarly, 27% of the non-ATSI group and 16% of the ATSI group reported being employed at the time of testing (v 2 = 6.97, df = 2, p b .01). The mean and the median age for leaving school was 15 years, and this did not differ by gender or ethnic status. In NSW, children aged more than 14 years and 9 months can legally leave school. Eighty-nine percent (639) of the sample reported having being suspended from school, with
C.J. Lennings et al. / Journal of Substance Abuse Treatment 31 (2006) 425 – 432 Table 1 Lifetime substance use and use in the past 12 months Drug group
Lifetime [n (%)]
Past 12 months [n (%)]
n
Marijuana Heroina Benzodiazepines Amphetaminesb Cocaine Hallucinogens Solvents
638 102 95 338 134 80 51
555 70 59 226 95 48 28
645 647* 622 622 581 644 645
a b
(98) (16) (13) (54) (23) (12.5) (7.9)
(87) (11) (9) (42) (16) (7.5) (4)
Approximately half of the sample reports injecting heroin. Approximately 10% (62) of amphetamine users report injecting.
young male offenders more likely than young female offenders to be suspended (v 2 = 4.92, df = 1, p b .05). No difference by ethnic status was noted. Thirty-seven percent (262) reported having been placed in a special school or in special education classes; there were no proportional differences by gender or ethnic status. For the sample as a whole, the mean number of incarcerations was 1.5 (SD = 0.5, Mdn = 2). Seventy-one (10%) young people reported never having been in custody. Twenty-seven (4%) were on their first community order. The mean number of community orders was 2.75 (SD = 4.7, Mdn = 2). Significantly more ATSI young offenders had served custodial sentences (v 2 = 74.92, df = 42, p b .001). 3.3. Substance use Problematic alcohol use was reported by approximately one third of the sample. Fifty percent (n = 323) reported consuming alcohol at least weekly, with 30% (n = 190) reporting being drunk at least weekly. Thirty-two percent (221) began drinking alcohol before the age of 13 years. Thirty-two percent (221) reported hazardous drinking on a weekly basis (drinking more than six standard drinks if male, and four if female), on average, at least weekly. Of the group reporting at least weekly hazardous drinking, only six reported not also using illicit drugs. Table 1 presents lifetime use of illicit substances and use in the past 12 months. As Table 1 shows, drug-use rates are high for the sample. Ninety percent (647) of the sample reported some use of illicit drugs. By definition, the use of any illicit drug constitutes problematic drug use; however, of the total sample, 57% reported using it weekly, and 15% and 14% of
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the total sample reported weekly or more frequent use of amphetamine or heroin, respectively. Drug-use patterns are high compared to those of nondelinquent adolescent samples. There were no significant differences in the sample for gender, ethnic status, or age. 3.4. Drug use and crime Two hundred twenty-six (31%) reported that they had committed their current offense while under the influence of drugs, and 241 (34%) reported that they committed their current offense while under the influence of alcohol. Two hundred ninety-two (41%) reported that their drug use caused them problems, and 306 (43%) reported committing crime to purchase drugs or alcohol. Of those reporting substance use involvement in their current offense, 109 (48%) report concurrent alcohol and drug-use involvement. 3.5. Psychopathology The results from the APS-SF scales used in this study are presented in Table 2. The depression score includes a small but significantly depressed group, with 58 (8%) admitting to serious selfharm ideation in the last 12 months and 57 (8%) admitting to deliberately harming or injuring themselves during that period. Twenty-six young people answered yes to both questions on serious self-harm ideation and deliberate attempt at harm. No significant differences were found for depression scores for the self-harm group or the serious contemplator group (although means for the self-harm group were slightly higher); however, both the self-harm group and the contemplator group had significantly higher substance abuse scores than noncontemplators and nonselfharmers: contemplators (62.18) versus self-harmers (54.68), F(1, 116) = 17.36 p b .001; contemplators (68.30) versus self-harmers (76.67), F(1, 116) = 5.09, p b .05. 3.6. Substance abuse treatment Of the sample, 415 said they wanted to give up substance abuse or had tried to give up substance abuse (of at least one drug) during the past year; of these, 249 (35%) said they had been successful. The most common drugs they had reduced
Table 2 APS-SF clinical scores for the sample Syndrome
Normal range (%)
Subclinical/mild (%)
Moderate/severe (%)
Mean t score
SD
Patients responding
Conduct Disorder a Oppositional Defiant Disorder Substance Abusea,b Anxiety Depression
38.5 63.5 31 72 74.7
16.6 23.8 27.4 18.7 15.4
40.2 8.3 36.4 4.7 5
65.04 56.18 68.36 52.83 51.20
15.30 10.30 17.52 9.56 10.21
699 701 698 701 698
Note. Percentages do not add up to 100% due to missing data. a A moderately strong relationship between substance abuse and conduct disorder was observed. The correlation between t scores was r = .38, p b .001. b No significant difference by either gender or ATSI status was found for SUB score on APS.
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Table 3 Residential treatment experience Treatment type
Patients seeking treatment [n (%)]
Frequency
Detoxification
54 (7.6)
Rehabilitation center
65 (9.1)
Once: 32 (4.5%) Twice: 7 (1%) Thrice: 5 (0.7%) 82% of young people attended detoxification three (or less) times Once: 41 (5.7%) Twice: 10 (1.4%) Thrice: 7 (1%) 90% of attendance was the third (or less) time
or stopped taking were marijuana (15.9%), amphetamine (3.5%), cigarettes (3.5%), and alcohol (2.9%). Despite this, current substance use patterns of drugs such as marijuana, amphetamine, and alcohol remained high. Motivation for treatment was low. Only 74 (10.3%) reported thinking that they needed or wanted treatment for an existing substance problem. Of the sample responding to questions about treatment, 130 (18.2%) reported that they had received some kind of drug or alcohol treatment. The mean substance abuse score from the APS for this group was 78.69 (compared to 66 for the group not receiving treatment) (t = 7.60, df = 661, p b .001). Table 3 presents the residential treatment-seeking experiences of the sample. Although only a small number had sought residential rehabilitation or detoxification, rates of treatment compliance were low. Other than residential treatment, young people were asked about what forms of treatment they had sought. Eight (1.1%) young people reported seeking help from a general practitioner, and 16 (2.2%) and 8 (1.1%) reported seeking help from 12-step programs such as Narcotics Anonymous and Alcoholics Anonymous, respectively. The most commonly accessed community treatment provider were counselors (not defined) (37; 5.2%), youth workers (27; 3.8%), and outpatient counselors (26; 3.6%). Seven (1%) reported having seen a psychiatrist, and five (3.8% of the ATSI subgroup) reported accessing Aboriginal Medical Services. The most common sources of treatment help from nonprofessional or semiprofessional groups were family (80; 11%), friends (43; 6%), priests (4; b1%), and religious organizations such as the Salvation Army (1), Sydney City Mission (1), or Mission Beat (1)—all being b 1%. With respect to drug substitution treatments, four young offenders reported accessing methadone programs, 11 took buprenorphine, and 21 (3%) accessed methadone illegally on the street. As part of the questionnaire, young people were asked to nominate bother sources of treatment.Q Some young people nominated services received from the NSW DJJ. The most common treatment provider within the DJJ was the alcohol or drug (AoD) counselor, with 34 (4.8%) of the sample reporting accessing such service provider. Official records
Length of stay
Patients completing treatment [n (%)] 22 (42)
b 30 days: 25 (54%) Between 30 and 90 days: 17 (37%)
19 (30.6)
of access kept by the DJJ were consulted to ascertain the actual number of young people on community orders who were provided access to AoD treatment by young people. In the period from July 1, 2003, to June 30, 2005, DJJ statistics indicated that 4,156 young people were on community orders. Of this group, 607 (14.6%) young people saw a DJJ AoD counselor on at least one occasion. Few reported engagement with the youth drug court (15; 2.1%) or available residential rehabilitation programs (3; b1%). Twelve (1.7%) reported receiving treatment from their JJO.
4. Discussion Consistent with the literature, and despite the increased needs associated with their substance use, as detailed in their self-perceived problems and the influence of substance use on crime, relatively few young offenders reported that they had accessed formal substance abuse treatment. Although more than 40% of our large sample was clearly in need of treatment, as indicated by their drug and alcohol use pattern, and although 58% reported attempts to give up at least one substance, only 10.3% of the group had considered treatment. When those who had committed a crime while intoxicated were examined (n = 276), only 22 (8%) of them reported thinking that they needed treatment for their drug use. Of those who had considered treatment, most had not sought formal treatment programs, and very few said they had made use of treatment programs offered by a range of agencies. The current study was concerned with offenders in the community—most of these were on supervision orders or community service orders and not on mandated treatment orders. Mild underreporting of access to AoD counselors occurred. This was probably due to the young offenders having been asked to nominate their treatment sources, rather than having been cued to respond about the department’s counseling options. Notwithstanding, the actual number of young people recorded as being seen by the department is a small proportion of those actually needing intensive AoD services, and it is not known how intensive the treatment experience was. Of those who said
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that they attended formal treatment, fewer than half completed their treatment. Overall, fewer than half of the 18% who indicated that they had sought treatment actually completed it. An unexpected finding was the relatively large percentage of young people who said they had undertaken their own treatment, and the number who regarded their self-imposed treatment as a success. No detail was provided as to what such treatment activities consisted of, and there appeared little impact from such self-directed treatment into formal treatment-seeking activities or motivation for treatment. There is scant evidence in their responses to suggest that significant changes in drug use or drug-related problems followed this allegedly successful self-treatment. Our discussion with substance-abusing young people over the years has revealed patterns of occasional bholidaysQ from particular drugs, often associated with fluctuations in drug quality and availability, or with changes in drug-use types (e.g., deciding that marijuana made them paranoid and using more amphetamines for a while). Our experience suggests that such changes are transient. This study reveals the gap between awareness of problematic drug use and treatment-seeking behavior, and has implications for improving outreach to young offenders in the community with substance abuse problems. Mandated treatment works at least as well as bvoluntaryQ treatment (Dembo et al., 1993; Hall, 1997; Rotgers, 1992; Watson, Brown, Tilleskjor, Jacobs, & Pucel, 1989), and higher treatment gains are found for adolescent offenders compared to adult offenders (Day, Howells, & Rickwood, 2004). It is necessary that programs be of sufficient intensity and treatment integrity to meet the treatment needs of young people. Given the obvious economic, social, and personal costs incurred with untreated substance abuse and the nexus between substance abuse and crime, it seems that there is much to gain—and little to lose—by improving the detection of problematic AoD use in young offenders by and strengthening their access to suitably intensive substance abuse treatment programs. There are some difficulties with the study that we could not control. We were able to reach a substantial proportion for young people in our study, and our analysis for representativeness shows no major differences between our sample and the DJJ population as a whole, although, proportionally, we did interview fewer girls and fewer ATSI young people. Nonetheless, it is possible that the requirement for young people to volunteer meant that those with more entrenched substance abuse or mental health problems may not have come forward. Our study is a cross-sectional study; in such a study, it is hard to assess for the possible time lag effects of treatment or interdiction. Future research hopes to address this. The current study serves as the baseline measure for a longitudinal study. We have already followed up 150 young people from the first year of our data collection, and we hope to present data from the longitudinal component of the research in future publications.
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Acknowledgment This research was supported by an Australia Research Council linkage grant to The University of Sydney (Professor D.T. Kenny and Dr. C. Lennings), with industry partners NSW DJJ (Mark Allerton) and JH (Dr Tony Butler). The authors acknowledge the support of the industry partners and the assistance of other members of the research team in carrying out this research. We are grateful to Rachel Cush for research assistance. References Belenko, S., & Dembo, R. (2003). Treating adolescent substance abuse problems in the juvenile drug court. International Journal of Law and Psychiatry, 26, 87 – 110. Braithwaite, R. L., Conerly, R. C., Robilliard, A. G., Stephens, T. T., & Woodring, T. (2003). Alcohol and other drug use among adolescent detainees. Journal of Substance Use, 8, 126 – 131. Copeland, J., & Howard, J. (1997). Substance abuse and juvenile crime. In A. Borowski, & I. O’Connor (Eds.), Juvenile crime, justice and corrections (pp. 167 – 189). South Melbourne, Australia7 Addison Wesley Longman. Day, A., & Howells, K. (2002). Psychological treatments for rehabilitating offenders: Evidence-based practice comes of age. Australian Psychologist, 37, 39 – 47. Day, A., Howells, K., & Rickwood, D. (2004). Current trends in the rehabilitation of juvenile offenders. Trends and issues in crime and criminal justice, no. 284. Canberra7 Australian Institute of Criminology, Australian Government. Dembo, R., Williams, L., Getru, A., Genung, L., Schmeidler, J., Berry, E., et al. (1991). Recidivism among high-risk youths: Study of a cohort of juvenile detainees. International Journal of the Addictions, 26, 121 – 177. Dembo, R., Williams, L., & Schmeidler, J. (1993). Addressing the problems of substance abuse in juvenile corrections. In J. A. Inciardi (Ed.), Drug treatment and criminal justice (pp. 97 – 126). Newbury Park7 Sage. Dobinson, I., & Ward, P. (1986). Heroin and property crime: An Australian perspective. Journal of Drug Issues, 16, 249 – 262. Gordon, M. S., Kinlock, T. W., & Battjes, R. J. (2004). Correlates of early substance use and crime among adolescents entering outpatient substance abuse treatment. American Journal of Drug and Alcohol Abuse, 30, 39 – 59. Gorske, T. T., Srebalus, D. J., & Walls, R. T. (2003). Adolescents in residential centers: Characteristics and treatment outcome. Children and Youth Services Review, 25, 317 – 326. Hall, W. (1997). The role of legal coercion in the treatment of offenders with alcohol and heroin problems. Australian and New Zealand Journal of Criminology, 30, 103 – 120. Hammersley, R., Marsland, L., & Reid, M. (2003). Substance use by young offenders: The impact of the normalisation of drug use in the early years of the 21st century. Home office research study 261. London7 Development and Statistics Directorate, British Government. Henggeler, S. W., Clingempeel, W. G., Brondino, M. J., & Pickrel, S. G. (2002). Four-year follow-up of multisystemic therapy with substanceabusing and substance-dependent juvenile offenders. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 868 – 874. Holloway, K., Bennett, T., & Farrington, D. (2005). The effectiveness of criminal justice and treatment programmes in reducing drug-related crime: A systematic review. Home Office Online Report 26/05, UK. Johnson, T. P., Cho, Y. I., Fendrich, M., Graf, I., Kelly-Wilson, L., & Pickup, L. (2004). Treatment need and utilization among youth entering the juvenile corrections system. Journal of Substance Abuse Treatment, 26, 117 – 128.
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Loeber, R., & Farrington, D. P. (2001). Young children who commit crime: Epidemiology, developmental origins, risk factors, early interventions, and policy implications. Development and Psychopathology, 12, 737 – 762. Maisto, S. A., Pollock, N. K., Cornelius, J. R., Lynch, K. G., & Martin, C. S. (2003). Alcohol relapse as a function of relapse definition in a clinical sample of adolescents. Addictive Behaviors, 28, 449 – 459. Moffitt, T. E. (1997). Adolescence-limited and life-course-persistent offending: A complimentary pair of theories. In T. R. Thornberry (Ed.), Developmental theories of crime and delinquency. Advances in criminology theory, Vol. 7. (pp. 11 – 54). New Brunswick7 Transaction Pub. Newburn, T. (1998). Young offenders, drugs and prevention. Drugs, Education, Prevention and Policy, 5, 233 – 243. Putnins, A. L. (2003). Substance use and the prediction of young offenders recidivism. Drug and Alcohol Review, 22, 401 – 408. Reynolds, W. M. (1998). Adolescent Psychopathology Scale. Florida7 Psychological Assessment Resources, Inc. Rotgers, F. (1992). Coercion in addictions treatment. Annual Review of Addictions Research and Treatment, 303 – 416.
Terry, Y. M., Van der Waal, C. J., McBride, D. C., & Van Buren, H. (2000). Provision of drug treatment services in the juvenile justice system: A system reform. Journal of Behavioural Health Sciences and Research, 27, 194 – 214. Trimboli, L., & Coumarelos, C. (1998). Cannabis and crime: Treatment programs for adolescent cannabis use. Crime and justice bulletin: Contemporary issues in crime and justice, 41. Sydney, NSW7 NSW Bureau of Crime Statistics and Research. Watson, C. G., Brown, K., Tilleskjor, C., Jacobs, L., & Pucel, J. (1989). The comparative recidivism rates of voluntary- and coerced-admission male alcoholics. Journal of Clinical Psychology, 44, 573 – 581. Wei, Z., Makkai, T., & McGregor, K. (2003). Drug use among a sample of juvenile detainees. Australian Institute of Criminology trends and issues in crime and criminal justice, 258. Canberra, Australia7 AIC. Worrall, J. L. (2004). Funding collaborative juvenile crime prevention programs. Does it make a difference? Evaluation Review, 28, 471 – 501. Yu, J., & Williford, W. R. (1994). Alcohol, other drugs, and criminality: A structured analysis. American Journal of Drug and Alcohol Abuse, 20, 373 – 393.
Regular article
Substance use and treatment seeking in young offenders on community orders Christopher John Lennings, (Ph.D., M.Psychol.)4, Dianna T. Kenny, (Ph.D.), Paul Nelson, (M.Beh.Sci.) Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW 2141, Australia Received 6 January 2006; received in revised form 22 May 2006; accepted 24 May 2006
Abstract Both international and Australian studies reveal very low rates of treatment utilization for substance abuse among young offenders despite very high problematic rates of substance abuse among this group. The current study reports on substance use patterns of a representative sample of 712 young offenders serving community orders with the New South Wales Department of Juvenile Justice (Australia) and their history of and attitudes toward treatment. Most (87%) young offenders had used marijuana, and 47% had used amphetamines in the last 12 months. One third of the sample reported problematic use of alcohol (being drunk at least weekly, on average). Forty-three percent reported that they engaged in crime to maintain their substance use. On the substance abuse scale of the Adolescent Psychopathology Scale— Short Form, 36.4% of the sample fell into the moderate to severe problem range. Despite such problems, treatment motivation was poor: 10% reported willingness to access treatment for their drug problems. Eighteen percent reported accessing some form of treatment in the past; the most common form of help seeking was approaching their family (12%). Self-reported access to other drug treatments was even lower, with the more intensive treatments revealing low rates of treatment completion. Despite almost 40% of the sample revealing significant substance abuse problems, referral for treatment was also low, with only 18% of the sample being offered an appointment with juvenile justice drug and alcohol workers. This study reveals the gap between awareness of problematic drug use and treatment-seeking behavior, and has implications for improving outreach to young offenders with substance abuse problems. D 2006 Elsevier Inc. All rights reserved. Keywords: Young offenders; Substance abuse; Treatment access
1. Introduction There is a strong association between substance abuse and juvenile offending (Dembo et al., 1991; Gordon, Kinlock, & Battjes, 2004; Hammersley, Marsland, & Reid, 2003; Newburn, 1998; Yu & Williford, 1994). Several largescale longitudinal studies of delinquency (Dembo et al., 1991; Loeber & Farrington, 2001; Moffitt, 1997) highlight the important role of substance abuse, particularly earlyonset abuse (Braithwaite, Conerly, Robilliard, Stephens, & Woodring, 2003; Gordon et al., 2004; Loeber & Farrington, The views expressed in this article are not necessarily those of the New South Wales Department of Juvenile Justice and the New South Wales Justice Health. 4 Corresponding author. School of Community and Behavioral Health Sciences, University of Sydney, Lidcombe, NSW 2141, Australia. E-mail address: [email protected] (C.J. Lennings). 0740-5472/06/$ – see front matter D 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.jsat.2006.05.017
2001), in the development of young offenders and the impact that substance abuse has in delaying the trajectory out of offending. The work of Moffitt (1997) on lifetime delinquency (as opposed to time-limited or adolescent-onset delinquency) reveals strong relationships between early deviance, substance use, and offending behavior. Various studies have demonstrated particular associations between these factors (e.g., Putnins, 2003 provided evidence from a brief screening instrument of detainees in a South Australian juvenile detention center that use of alcohol or inhalants at the time of initial arrest was a useful predictor of later criminal behavior, whereas the use of other illicit drugs did not predict engagement in criminal behavior postrelease). Trimboli and Coumarelos (1998) identified a dose–response relationship between cannabis and crime: The greater is the level of cannabis use, the greater is the frequency of crime. Hammersley et al. (2003) reported that more than 50% of
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their sample thought that their drug use was causal to their offending. The crime–substance abuse nexus suggests three possible pathways: substance abuse causes crime (presumably to afford drug purchases, but also through a general deviance factor); drug abuse and crime are correlates of each other; and crime causes substance abuse (Copeland & Howard, 1997). There is evidence supporting all three hypotheses, with different pathways demonstrating more relevance for different offenders (Dobinson & Ward, 1986). Given the strong association between substance abuse and crime, and given research that consistently identifies higher recidivism rates for substance-abusing young offenders (Belenko & Dembo, 2003; Hammersley et al., 2003), successful treatment of substance-abusing young offenders could be expected to reduce offending. Johnson et al. (2004) surveyed 401 young offender detainees and found that, although two thirds of the sample had a clear need for treatment, only 48% of that group (n = 273) had actually received any treatment. Unfortunately, the different kinds of treatments accessed were not identified. In contrast, Newburn (1998) noted that, in the UK, there were surprisingly low rates of treatment uptake by young people, although this was partly attributed to poorly developed treatment options. Only 7% of 398 young offenders in the longitudinal study of high-risk young offenders conducted by Dembo, Williams, and Schmeidler (1993) had spent any time in a drug treatment facility. Similarly, a survey of 493 Australian drug-abusing young offenders in a detained police sample found that only 13% had accessed treatments, of which half were residential treatment programs (Wei, Makkai, & McGregor, 2003). It is not known what percentage may have completed treatment. The British Government’s Home Office Research Study 261 (Hammersley et al., 2003) found that of 293 young offenders with substance abuse difficulties who were followed up (from a planned sample of 500), 25% had accessed treatment. Again, no data on the types of treatment accessed were provided. Newburn (1998), for instance, noted that most substance-abusing young offenders in his sample reported that being provided with information constituted the extent of their btreatmentQ for substance abuse. However, between 50% and 65% of the sample (depending on the degree of boffender riskQ) stated that treatment was not helpful in reducing their level of substance use. There appears to be little difference between treatment outcomes for bcoercedQ and bvoluntaryQ referrals to substance abuse treatments (Dembo et al., 1993), a point reinforced by a review of treatment outcomes in the forensic area conducted by Day and Howell (2002). Typically, base rates for behavioral change are low, with treatment contributing between 20% and 30% improvement over no treatment. There appears to be a somewhat general pessimistic perception of the utility of treatment among young people (Gorske, Srebalus, & Walls, 2003), with those adolescents exhibiting antisocial features being least likely to benefit from treatment. There still remains much to be known about
the effectiveness of treatment for substance abuse in young people (Maisto, Pollock, Cornelius, Lynch, & Martin, 2003). Terry, Van der Waal, McBride, and Van Buren (2000) discussed the findings of the longitudinal evaluation of adolescent treatment (Chemical Abuse/Addiction Treatment Outcome Registry). The data to date provide support for the general effectiveness of treatment of adolescents for a 12-month follow-up period. A review of other studies also reveals substantial support for positive (if limited) gains from well-constructed programs (e.g., see Henggeler, Clingempeel, Brondino, & Pickrel, 2002). However, such positive results need to be balanced by contrary findings. Worrall (2004) reported on a panel study based on an analysis of juvenile justice collaborative (multiagency) programs in 58 counties of the State of California. Utilizing recidivism as the key outcome variable, and despite numerous methodological constraints, the evaluation concluded that there was no discernible benefit from such programs. In what is probably the most authoritative meta-analysis of programs investigating the impact of treatments within the criminal justice system to reduce drug-related crime, Holloway, Bennett, and Farrington (2005) reported on the analysis of 69 studies in which treatment and treatment comparison groups were available. Amalgamating their findings, the following conclusions were reached. Treatment groups were 41% better off than no-treatment groups. Fortyfour of 52 studies analyzed were found to be effective in reducing crime on at least one measure (14 studies were not included in this analysis because their results became available after this part of the study had been completed). Among the findings was the observation that treatment seemed more effective for juvenile offenders than for adult offenders. There were limited data available to make much comment about the effectiveness of follow-up or aftercare programs, although the few studies that were available suggested that the more intense is the aftercare program, the greater is the reduction in crime-related behavior. The results also found that boys, but not girls, were more likely to reduce offending following treatment. Overall, the studies provided convincing support for the view that high-intensity programs proposed proportionally greater gains than lowintensity programs, with therapeutic communities and drug courts providing the best outcomes. It does seem that there is reason for hope, provided treatments are appropriately resourced and targeted such that reductions in both substance use and crime may be achieved. The current study investigated the treatment-seeking behavior of a sample of young offenders serving community orders with the New South Wales Department of Juvenile Justice (NSW DJJ). To serve a community order, a young person must be found guilty of a crime by a court, and must be given a noncustodial sentence or must have a custodial sentence commuted. In New South Wales, as in some other Australian states, young people can have their crime dealt with by way of a formal police caution or by
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conferencing, in which case a conviction is not recorded. Such interventions are usually preserved for first-time offenders and offenses without violence. Community orders could involve a young person in community service (usually a number of hours in which a young person performs some bvoluntaryQ work under supervision for the community, such as painting community halls, lawn mowing in public reserves, and the like). Alternatively, a young person may receive an order for supervision, with or without conditions, to attend counseling, pay fines, or both. Our study only interviewed those young people who were formally indicted for a criminal offense. Most studies of young offenders have involved offenders in detention (for obvious reasons of availability), but in most jurisdictions, there are many more nondetained (community orders) offenders than there are in detention. In New South Wales, for instance, almost 80% of young people serving sentences under the DJJ serve community-based sentences. Thus, it seems important to identify the treatment-seeking behaviors of community-based offenders.
justice officer (JJO) providing to the research team the young person’s name and contact details. The person was contacted by a member of the research team, and an appointment was organized, usually at the young person’s reporting DJJ community center. The interviews took approximately 3 hours, with almost 80% agreeing to blood testing, as well as interviews and psychometric assessment. Young people were paid $50 for their participation. In addition, young people who took part in the study were told that their time spent with the research counted as time served against their community service hours if their order included a component of community service.
2. Method
2.3. Procedure
2.1. Participants
After completing intensive training in the administration of the survey protocol, masteral students of forensic psychology who were on placement from the University of New South Wales and the University of Western Sydney, along with nurses employed by the Corrections Health Service, administered the psychological and educational assessment protocol, undertook appropriate physical examinations, and collected blood samples. For most participants, interviews took place at DJJ community centers. In some cases, where long travel distances mitigated against young people coming to the community center, interviews took place in a local youth center. All interviewers attended monthly supervision meetings by one of the chief investigators (C.L.) to ensure compliance with interview protocols and to iron out any potential difficulties. In addition, on-site supervision was provided regularly by the research manager (P.N.). On two occasions throughout the study, 20 psychometric test protocols were randomly selected, and two clinical investigators (C.L. and M.A.) independently rated the protocols for compliance with training and scoring instructions. High interrater reliability was observed on both the Wechsler Abbreviated Scale of Intelligence and the Wechsler Individual Achievement Test. No protocol differed by more than the standard error or measurement, and both reviewers identically rated approximately 75% of the protocols.
From 2003 to 2005, The University of Sydney, in collaboration with the NSW DJJ and the NSW Justice Health (JH), undertook a comprehensive population physical and mental health survey entitled Young People on Community Orders Health Survey (YPoCOHS). All consenting young people on community orders in NSW in the study period (July 2003–June 2005) were eligible. The DJJ supervises approximately 1,700 young people in the community per year. The number of young people fluctuates as a result of sentencing and time on orders, but our sample reflects approximately 42% of available young offenders. Approximately 1,900 young people were eligible for inclusion in the survey. Of this group, 400 refused to participate, 600 could not be contacted or did not respond to invitations to participate, and 100 (90 boys and 10 girls) were excluded due to the following: serious mental health problems, substance withdrawal, having been considered too violent or disruptive by management, and court appearances or admission into custody on the day of the survey. These exclusions may have resulted in an underestimation of population parameters, particularly for mental health indicators, substance abuse, offense profile, and violence characteristics. Young people were recruited from all metropolitan community centers and from large rural centers. Rates of voluntary participation in the survey ranged from 33% to 67% per center or geographical location. Large intercenter variability was identified in the acceptance of the study, but no systematic reasons for this could be identified. Recruitment was performed with the young persons’ juvenile
2.2. Ethics Ethics approval for the study was obtained from the University of Sydney Human Research Ethics Committee, the DJJ Collaborative Research Unit Ethics Committee, the Ethics Committee of the NSW Corrections Health Service (now JH), and the NSW National Health and Medical Research Council.
2.4. Measures 2.4.1. Mental and Physical Health Questionnaire (MPHQ) The MPHQ comprises 387 self-report questions divided into 32 sections that cover a comprehensive range of issues
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related to health and life experience. Only the sections on drug and alcohol use, treatment utilization of community health services, and health service appraisal were of interest to this study. The drug section asked questions about age of onset of drug use, type of drug use, usual pattern of drug use, and route of administration. The alcohol section asked questions about frequency of consumption, quantity (in standard drinks), choice of alcoholic beverages, and frequency of being drunk. Information on treatment seeking was obtained by questions asking whether young offenders had ever received treatment, type of treatment, method of referral, frequency of attendance on treatment, whether they had attended treatment in the past 12 months, and whether they had completed their treatment. The questionnaire gave prompts for various treatments (e.g., from general practitioners, detoxification or rehabilitation centers, Narcotics Anonymous, Alcoholics Anonymous, outpatient counselors, youth workers, psychiatrists, psychologists, family, friends, priests, Salvation Army, Sydney City Mission, Mission Beat, or other counselors) and requested information about other possible services received. Only questions pertaining to offense history and substance use are presented in this article. 2.4.2. Adolescent Psychopathology Scale—Short Form (APS-SF) The APS-SF assesses a range of psychological and psychiatric symptoms warranting possible referral or intervention. Although not a diagnostic tool, the scales are based on Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition criteria. The APS-SF generates 14 scales, which consist of 12 clinical scales, organized into clinical disorders (six scales), psychosocial problems and competencies (six scales), and response style indicators (two scales). The APS-SF mean t score is 50 (SD = 10). Scores above 65 are considered an indication of possible disorder, but not a formal diagnosis. The APS has been extensively standardized on U.S. populations (Reynolds, 1998). Only the following subscales were used in this study: Conduct Disorder, Oppositional Defiant Disorder, Substance Abuse, Anxiety, and Depression, as a full report on the APS-SF and other mental health indices will be the subject of another article. Conduct Disorder and Oppositional Defiant Disorder are the most commonly reported externalizing disorders, in conjunction with adolescent substance abuse in the literature, as are depression and anxiety being the most commonly reported internalizing disorders. 2.4.3. Cultural affiliation Each respondent was asked to indicate whether they identified with Aboriginal and Torres Strait Islander (ATSI) culture. 2.4.4. Definition of problematic alcohol use There are no recommended drinking levels for people under 18 years. For this survey, hazardous/harmful levels were based on the Australian Alcohol Guidelines (http://
www.alcohol.gov.au) for adults. For boys, drinking more than four standard drinks (1 SD = 12 g of alcohol) a day (on average), and/or more than six standard drinks on any 1 day, and/or drinking everyday was classified as unsafe. For girls, drinking more than two standard drinks a day (on average), and/or more than four standard drinks on any 1 day, and/or drinking everyday was classified as unsafe.
3. Results 3.1. Descriptives Seven hundred seventy young people had some form of contact with the survey. Seven hundred twelve records had sufficient data for the analysis of issues related to substance abuse treatment. Of these, 86% (615) were young male offenders. For 659 participants who had their age recorded, age ranged from 12 to 21 years, with a mean of 16.56 (SD = 1.32) years. One hundred thirty (18%) (107 young male offenders and 23 young female offenders) reported ATSI background. Eighty-three percent (596) of the sample was born in Australia (young male offenders = 513; young female offenders = 83); and 54 (7.6%) was born in New Zealand. For some items, no responses were recorded, hence sample sizes for individual questions fluctuated. Our sample was compared to all eligible candidates for the study. A high level of representativeness was found for ATSI, gender, and age between our sample and the total sample of young people on community orders within the period of the study. 3.2. Access to education and employment Only 18% of the offenders were attending school, and there were no proportional differences between young male offenders and young female offenders and ethnic status for school attendance. Significantly fewer young male offenders (n = 129; 18%) than young female offenders (n = 24; 25%) were attending technical college (TAFE) (t = 5.34, df = 1, p b .05). There was no ethnic difference for TAFE attendance. Only nine young people said that they were attending both school and TAFE; hence, 35.5% of the sample was currently engaged in education. There were significant differences for gender and ethnicity with respect to employment, with more young male offenders (27%) than young female offenders (15%) employed from the total of 183 (26% of the whole sample) (v 2 = 6.40, df = 1, p b .05). Similarly, 27% of the non-ATSI group and 16% of the ATSI group reported being employed at the time of testing (v 2 = 6.97, df = 2, p b .01). The mean and the median age for leaving school was 15 years, and this did not differ by gender or ethnic status. In NSW, children aged more than 14 years and 9 months can legally leave school. Eighty-nine percent (639) of the sample reported having being suspended from school, with
C.J. Lennings et al. / Journal of Substance Abuse Treatment 31 (2006) 425 – 432 Table 1 Lifetime substance use and use in the past 12 months Drug group
Lifetime [n (%)]
Past 12 months [n (%)]
n
Marijuana Heroina Benzodiazepines Amphetaminesb Cocaine Hallucinogens Solvents
638 102 95 338 134 80 51
555 70 59 226 95 48 28
645 647* 622 622 581 644 645
a b
(98) (16) (13) (54) (23) (12.5) (7.9)
(87) (11) (9) (42) (16) (7.5) (4)
Approximately half of the sample reports injecting heroin. Approximately 10% (62) of amphetamine users report injecting.
young male offenders more likely than young female offenders to be suspended (v 2 = 4.92, df = 1, p b .05). No difference by ethnic status was noted. Thirty-seven percent (262) reported having been placed in a special school or in special education classes; there were no proportional differences by gender or ethnic status. For the sample as a whole, the mean number of incarcerations was 1.5 (SD = 0.5, Mdn = 2). Seventy-one (10%) young people reported never having been in custody. Twenty-seven (4%) were on their first community order. The mean number of community orders was 2.75 (SD = 4.7, Mdn = 2). Significantly more ATSI young offenders had served custodial sentences (v 2 = 74.92, df = 42, p b .001). 3.3. Substance use Problematic alcohol use was reported by approximately one third of the sample. Fifty percent (n = 323) reported consuming alcohol at least weekly, with 30% (n = 190) reporting being drunk at least weekly. Thirty-two percent (221) began drinking alcohol before the age of 13 years. Thirty-two percent (221) reported hazardous drinking on a weekly basis (drinking more than six standard drinks if male, and four if female), on average, at least weekly. Of the group reporting at least weekly hazardous drinking, only six reported not also using illicit drugs. Table 1 presents lifetime use of illicit substances and use in the past 12 months. As Table 1 shows, drug-use rates are high for the sample. Ninety percent (647) of the sample reported some use of illicit drugs. By definition, the use of any illicit drug constitutes problematic drug use; however, of the total sample, 57% reported using it weekly, and 15% and 14% of
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the total sample reported weekly or more frequent use of amphetamine or heroin, respectively. Drug-use patterns are high compared to those of nondelinquent adolescent samples. There were no significant differences in the sample for gender, ethnic status, or age. 3.4. Drug use and crime Two hundred twenty-six (31%) reported that they had committed their current offense while under the influence of drugs, and 241 (34%) reported that they committed their current offense while under the influence of alcohol. Two hundred ninety-two (41%) reported that their drug use caused them problems, and 306 (43%) reported committing crime to purchase drugs or alcohol. Of those reporting substance use involvement in their current offense, 109 (48%) report concurrent alcohol and drug-use involvement. 3.5. Psychopathology The results from the APS-SF scales used in this study are presented in Table 2. The depression score includes a small but significantly depressed group, with 58 (8%) admitting to serious selfharm ideation in the last 12 months and 57 (8%) admitting to deliberately harming or injuring themselves during that period. Twenty-six young people answered yes to both questions on serious self-harm ideation and deliberate attempt at harm. No significant differences were found for depression scores for the self-harm group or the serious contemplator group (although means for the self-harm group were slightly higher); however, both the self-harm group and the contemplator group had significantly higher substance abuse scores than noncontemplators and nonselfharmers: contemplators (62.18) versus self-harmers (54.68), F(1, 116) = 17.36 p b .001; contemplators (68.30) versus self-harmers (76.67), F(1, 116) = 5.09, p b .05. 3.6. Substance abuse treatment Of the sample, 415 said they wanted to give up substance abuse or had tried to give up substance abuse (of at least one drug) during the past year; of these, 249 (35%) said they had been successful. The most common drugs they had reduced
Table 2 APS-SF clinical scores for the sample Syndrome
Normal range (%)
Subclinical/mild (%)
Moderate/severe (%)
Mean t score
SD
Patients responding
Conduct Disorder a Oppositional Defiant Disorder Substance Abusea,b Anxiety Depression
38.5 63.5 31 72 74.7
16.6 23.8 27.4 18.7 15.4
40.2 8.3 36.4 4.7 5
65.04 56.18 68.36 52.83 51.20
15.30 10.30 17.52 9.56 10.21
699 701 698 701 698
Note. Percentages do not add up to 100% due to missing data. a A moderately strong relationship between substance abuse and conduct disorder was observed. The correlation between t scores was r = .38, p b .001. b No significant difference by either gender or ATSI status was found for SUB score on APS.
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Table 3 Residential treatment experience Treatment type
Patients seeking treatment [n (%)]
Frequency
Detoxification
54 (7.6)
Rehabilitation center
65 (9.1)
Once: 32 (4.5%) Twice: 7 (1%) Thrice: 5 (0.7%) 82% of young people attended detoxification three (or less) times Once: 41 (5.7%) Twice: 10 (1.4%) Thrice: 7 (1%) 90% of attendance was the third (or less) time
or stopped taking were marijuana (15.9%), amphetamine (3.5%), cigarettes (3.5%), and alcohol (2.9%). Despite this, current substance use patterns of drugs such as marijuana, amphetamine, and alcohol remained high. Motivation for treatment was low. Only 74 (10.3%) reported thinking that they needed or wanted treatment for an existing substance problem. Of the sample responding to questions about treatment, 130 (18.2%) reported that they had received some kind of drug or alcohol treatment. The mean substance abuse score from the APS for this group was 78.69 (compared to 66 for the group not receiving treatment) (t = 7.60, df = 661, p b .001). Table 3 presents the residential treatment-seeking experiences of the sample. Although only a small number had sought residential rehabilitation or detoxification, rates of treatment compliance were low. Other than residential treatment, young people were asked about what forms of treatment they had sought. Eight (1.1%) young people reported seeking help from a general practitioner, and 16 (2.2%) and 8 (1.1%) reported seeking help from 12-step programs such as Narcotics Anonymous and Alcoholics Anonymous, respectively. The most commonly accessed community treatment provider were counselors (not defined) (37; 5.2%), youth workers (27; 3.8%), and outpatient counselors (26; 3.6%). Seven (1%) reported having seen a psychiatrist, and five (3.8% of the ATSI subgroup) reported accessing Aboriginal Medical Services. The most common sources of treatment help from nonprofessional or semiprofessional groups were family (80; 11%), friends (43; 6%), priests (4; b1%), and religious organizations such as the Salvation Army (1), Sydney City Mission (1), or Mission Beat (1)—all being b 1%. With respect to drug substitution treatments, four young offenders reported accessing methadone programs, 11 took buprenorphine, and 21 (3%) accessed methadone illegally on the street. As part of the questionnaire, young people were asked to nominate bother sources of treatment.Q Some young people nominated services received from the NSW DJJ. The most common treatment provider within the DJJ was the alcohol or drug (AoD) counselor, with 34 (4.8%) of the sample reporting accessing such service provider. Official records
Length of stay
Patients completing treatment [n (%)] 22 (42)
b 30 days: 25 (54%) Between 30 and 90 days: 17 (37%)
19 (30.6)
of access kept by the DJJ were consulted to ascertain the actual number of young people on community orders who were provided access to AoD treatment by young people. In the period from July 1, 2003, to June 30, 2005, DJJ statistics indicated that 4,156 young people were on community orders. Of this group, 607 (14.6%) young people saw a DJJ AoD counselor on at least one occasion. Few reported engagement with the youth drug court (15; 2.1%) or available residential rehabilitation programs (3; b1%). Twelve (1.7%) reported receiving treatment from their JJO.
4. Discussion Consistent with the literature, and despite the increased needs associated with their substance use, as detailed in their self-perceived problems and the influence of substance use on crime, relatively few young offenders reported that they had accessed formal substance abuse treatment. Although more than 40% of our large sample was clearly in need of treatment, as indicated by their drug and alcohol use pattern, and although 58% reported attempts to give up at least one substance, only 10.3% of the group had considered treatment. When those who had committed a crime while intoxicated were examined (n = 276), only 22 (8%) of them reported thinking that they needed treatment for their drug use. Of those who had considered treatment, most had not sought formal treatment programs, and very few said they had made use of treatment programs offered by a range of agencies. The current study was concerned with offenders in the community—most of these were on supervision orders or community service orders and not on mandated treatment orders. Mild underreporting of access to AoD counselors occurred. This was probably due to the young offenders having been asked to nominate their treatment sources, rather than having been cued to respond about the department’s counseling options. Notwithstanding, the actual number of young people recorded as being seen by the department is a small proportion of those actually needing intensive AoD services, and it is not known how intensive the treatment experience was. Of those who said
C.J. Lennings et al. / Journal of Substance Abuse Treatment 31 (2006) 425 – 432
that they attended formal treatment, fewer than half completed their treatment. Overall, fewer than half of the 18% who indicated that they had sought treatment actually completed it. An unexpected finding was the relatively large percentage of young people who said they had undertaken their own treatment, and the number who regarded their self-imposed treatment as a success. No detail was provided as to what such treatment activities consisted of, and there appeared little impact from such self-directed treatment into formal treatment-seeking activities or motivation for treatment. There is scant evidence in their responses to suggest that significant changes in drug use or drug-related problems followed this allegedly successful self-treatment. Our discussion with substance-abusing young people over the years has revealed patterns of occasional bholidaysQ from particular drugs, often associated with fluctuations in drug quality and availability, or with changes in drug-use types (e.g., deciding that marijuana made them paranoid and using more amphetamines for a while). Our experience suggests that such changes are transient. This study reveals the gap between awareness of problematic drug use and treatment-seeking behavior, and has implications for improving outreach to young offenders in the community with substance abuse problems. Mandated treatment works at least as well as bvoluntaryQ treatment (Dembo et al., 1993; Hall, 1997; Rotgers, 1992; Watson, Brown, Tilleskjor, Jacobs, & Pucel, 1989), and higher treatment gains are found for adolescent offenders compared to adult offenders (Day, Howells, & Rickwood, 2004). It is necessary that programs be of sufficient intensity and treatment integrity to meet the treatment needs of young people. Given the obvious economic, social, and personal costs incurred with untreated substance abuse and the nexus between substance abuse and crime, it seems that there is much to gain—and little to lose—by improving the detection of problematic AoD use in young offenders by and strengthening their access to suitably intensive substance abuse treatment programs. There are some difficulties with the study that we could not control. We were able to reach a substantial proportion for young people in our study, and our analysis for representativeness shows no major differences between our sample and the DJJ population as a whole, although, proportionally, we did interview fewer girls and fewer ATSI young people. Nonetheless, it is possible that the requirement for young people to volunteer meant that those with more entrenched substance abuse or mental health problems may not have come forward. Our study is a cross-sectional study; in such a study, it is hard to assess for the possible time lag effects of treatment or interdiction. Future research hopes to address this. The current study serves as the baseline measure for a longitudinal study. We have already followed up 150 young people from the first year of our data collection, and we hope to present data from the longitudinal component of the research in future publications.
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Acknowledgment This research was supported by an Australia Research Council linkage grant to The University of Sydney (Professor D.T. Kenny and Dr. C. Lennings), with industry partners NSW DJJ (Mark Allerton) and JH (Dr Tony Butler). The authors acknowledge the support of the industry partners and the assistance of other members of the research team in carrying out this research. We are grateful to Rachel Cush for research assistance. References Belenko, S., & Dembo, R. (2003). Treating adolescent substance abuse problems in the juvenile drug court. International Journal of Law and Psychiatry, 26, 87 – 110. Braithwaite, R. L., Conerly, R. C., Robilliard, A. G., Stephens, T. T., & Woodring, T. (2003). Alcohol and other drug use among adolescent detainees. Journal of Substance Use, 8, 126 – 131. Copeland, J., & Howard, J. (1997). Substance abuse and juvenile crime. In A. Borowski, & I. O’Connor (Eds.), Juvenile crime, justice and corrections (pp. 167 – 189). South Melbourne, Australia7 Addison Wesley Longman. Day, A., & Howells, K. (2002). Psychological treatments for rehabilitating offenders: Evidence-based practice comes of age. Australian Psychologist, 37, 39 – 47. Day, A., Howells, K., & Rickwood, D. (2004). Current trends in the rehabilitation of juvenile offenders. Trends and issues in crime and criminal justice, no. 284. Canberra7 Australian Institute of Criminology, Australian Government. Dembo, R., Williams, L., Getru, A., Genung, L., Schmeidler, J., Berry, E., et al. (1991). Recidivism among high-risk youths: Study of a cohort of juvenile detainees. International Journal of the Addictions, 26, 121 – 177. Dembo, R., Williams, L., & Schmeidler, J. (1993). Addressing the problems of substance abuse in juvenile corrections. In J. A. Inciardi (Ed.), Drug treatment and criminal justice (pp. 97 – 126). Newbury Park7 Sage. Dobinson, I., & Ward, P. (1986). Heroin and property crime: An Australian perspective. Journal of Drug Issues, 16, 249 – 262. Gordon, M. S., Kinlock, T. W., & Battjes, R. J. (2004). Correlates of early substance use and crime among adolescents entering outpatient substance abuse treatment. American Journal of Drug and Alcohol Abuse, 30, 39 – 59. Gorske, T. T., Srebalus, D. J., & Walls, R. T. (2003). Adolescents in residential centers: Characteristics and treatment outcome. Children and Youth Services Review, 25, 317 – 326. Hall, W. (1997). The role of legal coercion in the treatment of offenders with alcohol and heroin problems. Australian and New Zealand Journal of Criminology, 30, 103 – 120. Hammersley, R., Marsland, L., & Reid, M. (2003). Substance use by young offenders: The impact of the normalisation of drug use in the early years of the 21st century. Home office research study 261. London7 Development and Statistics Directorate, British Government. Henggeler, S. W., Clingempeel, W. G., Brondino, M. J., & Pickrel, S. G. (2002). Four-year follow-up of multisystemic therapy with substanceabusing and substance-dependent juvenile offenders. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 868 – 874. Holloway, K., Bennett, T., & Farrington, D. (2005). The effectiveness of criminal justice and treatment programmes in reducing drug-related crime: A systematic review. Home Office Online Report 26/05, UK. Johnson, T. P., Cho, Y. I., Fendrich, M., Graf, I., Kelly-Wilson, L., & Pickup, L. (2004). Treatment need and utilization among youth entering the juvenile corrections system. Journal of Substance Abuse Treatment, 26, 117 – 128.
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