1 Characteristics, Needs, Services and Outcomes of Juvenile Treatment Drug Courts compared to Adolescent Outpatient and Adult Treatment Drug Courts Melissa Ives, MSW, Kate Moritz, MA, Michael L. Dennis, Ph.D. Chestnut Health Systems, Normal, IL Presentation at the National Association of Drug Court Professionals (NADCP) Conference Washington, DC, July 18, 2011

2 Notes This presentation was supported by data and funds from SAMHSA/ CSAT contract no It is available electronically at The opinions are those of the author and do not reflect official positions of the government. Please address comments or questions to the authors at or –

3 The Goals of this Presentation are to: 1.Illustrate why it is so important to intervene with juvenile drug users 2.Review what we know about juvenile treatment drug courts (JTDC) so far 3.Compare JTDC to regular adolescent outpatient (AOP) in terms of who is served, what services they receive and their treatment outcomes 4.Examine initial comparison of JTDC to Adult Treatment Drug Courts (ATDC) and Family Drug Courts (FDC)

4 Alcohol and Other Drug Abuse, Dependence and Problem Use Peaks at Age 20 Source: 2002 NSDUH and Dennis & Scott, 2007, Neumark et al., Other drug or heavy alcohol use in the past year Alcohol or Drug Use (AOD) Abuse or Dependence in the past year Age Severity Category Over 90% of use and problems start between the ages of It takes decades before most recover or die Percentage People with drug dependence die an average of 22.5 years sooner than those without a diagnosis

5 Adolescents who use weekly or more often are more likely during the past year to have... Source: Dennis & McGeary, 1999

6 Photo courtesy of the NIDA Web site. From A Slide Teaching Packet: The Brain and the Actions of Cocaine, Opiates, and Marijuana. pain Adolescent Brain Development Occurs from the Inside to Out and from Back to Front

7 Life Course Reasons to Focus on Adolescents  People who start using substances under age 15 use 60% more years than those who start over age 18.  Entering treatment within the first 9 years of initial use leads to 57% fewer years of substance use than those who do not start treatment until after 20 years of use.  Relapse is common and it takes an average of 3 to 4 treatment admissions over 8 to 9 years before half reach recovery.  Of all people with abuse or dependence 2/3rds do eventually reach a state of recovery.  Monitoring and early re-intervention with adults has been shown to cut the time from relapse to readmission by 65%, increase abstinence and improve long term outcomes. Source: Dennis et al., 2005, 2007; Scott & Dennis 2009

8 While Substance Use Disorders are Common, Treatment Participation Rates Are Low Source: OAS, 2009 – 2006, 2007, and 2008 NSDUH Over 88% of adolescent and young adult treatment and over 50% of adult treatment is publicly funded Much of the private funding is limited to 30 days or less and authorized day by day or week by week Few Get Treatment: 1 in 19 adolescents, 1 in 21 young adults, 1 in 14 adults

9 Source: French et al., 2008; Chandler et al., 2009; Capriccioso, 2004 What does an episode of treatment cost (median)? $22,000/year to incarcerate an adult $30,000/ child-year in foster care $70,000/year to keep a child in detention $750 per night in Detox $1,115 per night in hospital $13,000 per week in intensive care for premature baby $27,000 per robbery $67,000 per assault

10 Investing in Treatment has a Positive Annual Return on Investment (ROI)  Substance abuse treatment has been shown to have a ROI within the year of between $1.28 to $7.26 per dollar invested.  Best estimates are that Treatment Drug Courts have an average ROI of $2.14 to $2.71 per dollar invested. Source: Bhati et al., 2008; Ettner et al., 2006 This also means that for every dollar treatment is cut, we lose more money than was saved.

11 Background Juvenile Justice System and Substance Use  Between a quarter and two thirds of the youth in the juvenile justice system have drug related problems (Office of Juvenile Justice and Delinquency Prevention (OJJDP), 2001; Teplin et al., 2002, Chassin, 2008, Wasserman et al. 2010).  Juvenile justice systems are the leading source of referral among adolescents entering treatment for substance use problems (Dennis et al., 2003; Dennis, White & Ives, 2009).  By late 2004, there were 357 juvenile treatment drug courts and the number of courts has continued to grow at a rate of 30-50% per year. Source: Dennis, White & Ives, 2009

12 Meta Analyses of Experiments/ Quasi Experiments (Summary v Predictive, Specificity, Replicated, Consistency) Dismantling/ Matching study (What worked for whom) Experimental Studies (Multi-site, Independent, Replicated, Fidelity, Consistency) Quasi-Experiments (Quality of Matching, Multi- site, Independent, Replicated, Consistency) Pre-Post (multiple waves), Expert Consensus Correlation and Observational studies Case Studies, Focus Groups Pre-data Theories, Logic Models Anecdotes, Analogies Beyond a ReasonableDoubt Clear and ConvincingEvidence Preponderance of the Evidence ProbableCause ReasonableSuspicion Law Science STRONGER Source: Marlowe 2008 What Level of Evidence is Available on the Effectiveness of Drug Courts?

13 Meta Analyses of Experiments/ Quasi Experiments (Summary v Predictive, Specificity, Replicated, Consistency) Dismantling/ Matching study (What worked for whom) Experimental Studies (Multi-site, Independent, Replicated, Fidelity, Consistency) Quasi-Experiments (Quality of Matching, Multi- site, Independent, Replicated, Consistency) Pre-Post (multiple waves), Expert Consensus Correlation and Observational studies Case Studies, Focus Groups Pre-data Theories, Logic Models Anecdotes, Analogies Beyond a ReasonableDoubt Clear and ConvincingEvidence Preponderance of the Evidence ProbableCause ReasonableSuspicion Law Science STRONGER Adult Drug Treatment Courts: 5 meta analyses of 76 studies found crime reduced 7-26% with $1.74 to $6.32 return on investment Juvenile Drug Treatment Courts – one 2006 experiment, one large multisite quasi- experiment, & several small studies with similar or better effects than regular adolescent outpatient treatment DWI Treatment Courts: one quasi experiment and five observational studies positive findings Source: Marlowe 2008 What Level of Evidence is Available on the Effectiveness of Drug Courts? Family Drug Treatment Courts: one multisite quasi experiment with positive findings for parent and child

14 Findings from Ives et al., (2010) Multi-Site Quasi Experiment  This article is available online at:  Questions asked:  How do the severity & needs of youth in Juvenile Treatment Drug Courts (JTDC) compare to those in Adolescent Outpatient (AOP)  Controlling for these differences, how do these groups compare in terms of – The services they receive? – Their treatment outcomes?

15 Juvenile Treatment Drug Court (JTDC) Sample  Cohort of 13 CSAT JTDC grantee sites using the GAIN in Laredo, TX, San Antonio, TX, Belmont, CA, Tarzana, CA, Pontiac, MI, Birmingham, AL, San Jose, CA, Austin, TX, Peabody, MA, Providence, RI, Detroit, MI, Philadelphia, PA, and Basin, WY.  Intake data collected from these sites on N=1,786 adolescents between January 2006 through March 31,  The records were limited to clients who: – Received outpatient treatment (N=1,445), and – Had attained 6 months post-intake (N=1,265)  For the analysis, only those with at least one follow-up assessment (89%) were used for a final N=1,120.  86% received evidence-based treatment. Source: Ives et al., 2010

16 Adolescent Outpatient (AOP) Sample  Clients receiving AOP treatment from 75 CSAT-funded sites using the GAIN and providing outpatient treatment in 29 states from five grant programs (N=10,037).  Intake data collected from these sites on N=10,037 adolescents between September 2002 and August  The records were limited to clients who: – Received outpatient treatment (all), and – Had attained 6 months post-intake (N=8,604)  For the analysis, only those with at least one follow-up assessment (88%) were used for a final N=7,560  93% received evidence-based treatment. Source: Ives et al., 2010 JTDC & AOP were significantly different on 36 of 69 measures of characteristics, severity and treatment need

17 Demographics Source: Ives et al., 2010* p<.05 JTDC less likely to be Caucasian, multiracial, older, employed, & in trouble at school/work; more likely to be Hispanic, behind in school

18 Crime and Violence JTDC more likely have been in a controlled environment 13+ days, engaged in illegal activity (overall & drug related) Source: Ives et al., 2010* p<.05

19 Intensity of Juvenile Justice System Involvement JTDC more likely to be in other detention status and less likely to have no JJ status Source: Ives et al., 2010 * p<.05 **< 1 year ago

20 Environmental Risk Factors JTDC less likely to have use in home and victimization Source: Ives et al., 2010* p<.05

21 Substance Use JTDC more likely to have started younger, to use any drug or marijuana weekly; and less likely to use tobacco Source: Ives et al., 2010* p<.05

22 Substance Use Disorders JTDC similar on substance use disorders Source: Ives et al., 2010* p<.05

23 Substance Treatment History JTDC more likely to have been in treatment before, to see a need for treatment and to be ready to quit Source: Ives et al., 2010* p<.05

24 Other Major Co-Occurring Clinical Problems JTDC less likely to have health or internalizing disorders and more likely to be/gotten someone pregnant Source: Ives et al., 2010* p<.05

25 HIV Risk Behaviors (past 90 days) Source: Ives et al., 2010* p<.05 JTDC more likely have multiple sexual partners

26 Number of Major Clinical Problems** **Count of marijuana use disorder, alcohol use disorder, any other drug use disorder, internalizing problems including: depression, anxiety, homicidal/suicidal thoughts, and trauma, externalizing problems including conduct disorder and ADHD, Lifetime victimization, past year acts of physical violence or past year illegal activity. JTDC slightly less severe on psychopathology – relative to waiting for them to enter treatment on their own, JTDC is a form of early intervention Source: Ives et al., 2010* p<.05

27 Matching with Propensity Scores  Using logistic regression to predict the likelihood (propensity) of each AOP client being a JTDC client based on the 69 intake characteristics, we weighted the AOP group to match the JTDC group in terms of these characteristics and sample size.  This produced two groups with equal sample sizes (N=1,120).  The number of significant differences dropped from 39 to 3 of 69 intake variables.  Those in JTDC were still significantly: – Less likely to be African American (OR=0.77) – More likely to be Hispanic (OR=1.44) and on other probation, parole, or detention (OR=1.37) Source: Ives et al., 2010

28 Treatment System Involvement JTDC less likely to initiate within 2 weeks, but more likely to be in treatment 6 weeks and 3 months later Source: Ives et al., 2010* p<.05

29 Substance Abuse Treatment (intake to 3 months) JTDC received more days of any treatment & IOP, also more satisfaction Source: Ives et al., 2010* p<.05

30 Range of Substance Abuse Treatment Content (Intake to 3 months) JTDC more likely to receive a broader range of services – particularly family and external wrap-around services Source: Ives et al., 2010* p<.05

31 Mental Health Treatment Received (intake to 3 months) Source: Ives et al., 2010* p<.05 No differences in MH treatment—most is driven by medication

32 Other Environmental Interventions Across Systems (intake to 3 months) JTDC received more urine tests and went to self-help more often Source: Ives et al., 2010* p<.05

33 Comparison of Treatment Outcomes (Days of..) Substance Use* ( d=-0.45, -0.57) Emotional Problems (d=-0.32, -0.22) Trouble w/ Family (d= -0.23, -0.18) In Controlled Environment (d=-0.02, -0.08) Illegal Activity (d=-0.11, -0.02) Post- Pre d (AOP, JTDC) Both Reduced Use; JTDC more than AOP (d between= -0.24) Others Outcomes Not Significantly Different Source: Ives et al., 2010 *p<.05 change greater for JTDC vs AOP (d=-0.24) Both Meaningfully Reduced Emotional Problems

34 Strengths & Limits of Ives et al., (2010)  Strengths – Multisite quasi experiment – Differences at intake eliminated on most variables – Replicable evidence-based practice – Multiple follow-up waves – Large sample size and high follow-up rates  Limits – Not randomized – Disproportionately Hispanic youth – Unknown fidelity of implementation – Not sufficient numbers of specific evidence-based practices to compare

35 Findings from JTDC and ATDC/FDC Multi-Site Quasi Experiment Initial Comparison

36 Findings from JTDC and ATDC/FDC Multi-Site Quasi Experiment  How adults in Adult or Family Treatment Drug Courts (ATDC/FDC) compare to adolescents in Juvenile Treatment Drug Courts (JTDC) in terms of – Their characteristics, severity & needs – The services they receive? – Their treatment outcomes?

37 Adult Treatment Drug Court (ATDC) and Family Drug Court (FDC) Sample  Cohort of 7 CSAT ATDC and 2 FDC grantee sites using the GAIN in Jacksonville, FL, Clearwater, FL, Gallipolis, OH, Reno, NV, Miami, FL, Memphis, TN (ATDC sites) and Tampa, FL, Tucson, AZ (FDC sites).  Intake data collected from these sites on N=697 adults between April 2007 and October  Mean age (s.d. 9.57; range: 18-58; median=28; mode=24)  The records were limited to clients who: – Had attained 6 months post-intake (N=457), and – Received outpatient treatment (N=407)  For the analysis, only those with at least one follow-up assessment (88%) were used for a final N=359  42% received evidence-based treatment Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites

38 Juvenile Treatment Drug Court (JTDC) Sample  Cohort of 11 CSAT JTDC grantee sites using the GAIN in Laredo, TX, San Antonio, TX, Belmont, CA, Tarzana, CA, Pontiac, MI, San Jose, CA, Austin, TX, Peabody, MA, Providence, RI, Detroit, MI, and Philadelphia, PA.  Intake data collected from these sites on N=1,771 adolescents between January 2006 through June  Mean age (s.d. 1.17; range: 11-18; median=16; mode=16)  The records were limited to clients who: – Had attained 6 months post-intake (N=1,560) – Received outpatient treatment (N=1,319), and  For the analysis, only those with at least one follow-up assessment (86%) were used for a final N=1,134  81% received evidence-based treatment Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites

39 Demographics JTDC less likely to be female, Caucasian, employed, in CWS, behind in school; JTDC more likely to be Hispanic, in school, in trouble at school/work. Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites * p<.05 **Not HSgrad=ATDC/FDC; Behind =JTDC

40 Crime and Violence JTDC less likely to have been in a controlled environment. JTDC more likely have engaged in physical violence and illegal activity (overall interpersonal and property related). No difference in drug crime or 13+ days in a controlled environment. Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites* p<.05

41 Intensity of Juvenile Justice System Involvement JTDC more likely be in long-term detention or on probation/parole and less likely to be in other JJ status. Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites* p<.05

42 Environmental Risk Factors ATDC more likely to have drug use in home, homelessness and victimization. JTDC more likely to have social or vocational peer use. Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites* p<.05

43 Substance Use JTDC more likely to have started sooner, use more often and to use marijuana; Less likely to use heroin, cocaine or other drugs or tobacco. Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites * p<.05 +pre-controlled environment

44 Substance Use Disorders Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites* p<.05 JTDC more likely to report lifetime or past year abuse and past week withdrawal. JTDC less likely to report any lifetime or past year dependence or lifetime withdrawal.

45 Substance Treatment History JTDC less likely to report each of these treatment history items. Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites* p<.05

46 Other Major Co-Occurring Clinical Problems JTDC less likely to have health problems, internalizing disorders or prior treatment; More likely to have externalizing disorders. Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites* p<.05

47 HIV Risk Behaviors (past 90 days) JTDC more likely to have multiple partners, and less likely to have had risky or unprotected sex or needle use. Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites* p<.05

48 Number of Major Clinical Problems* *Count of marijuana use disorder, alcohol use disorder, any other drug use disorder, internalizing problems including: depression, anxiety, homicidal/suicidal thoughts, and trauma, externalizing problems including conduct disorder and ADHD, Lifetime victimization, past year acts of physical violence or past year illegal activity. JTDC slightly less severe on psychopathology. Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites* p<.05

49 JTDC and ATDC/FDC Comparison: Treatment

50 Type of Treatment provided JTDC more likely to be treated with wider variety of evidence- based protocols. Evidence-based protocols Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites* p<.05

51 Treatment System Involvement JTDC less likely to initiate within 2 weeks, to be in any treatment 3 months post-admission, or to have completed or still be in treatment. Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites* p<.05

52 Substance Abuse Treatment (intake to 3 months+) JTDC received fewer days of any treatment – esp. IOP days or medication. Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites* p<.05 +or 6-month if missing 3-month

53 Range of Substance Abuse Treatment Content (Intake to 3 months) JTDC more likely to receive a broader range of services – particularly family and external wrap around services Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites* p<.05 +or 6-month if missing 3-month

54 Mental Health Treatment Received (intake to 3 months+) JTDC less likely to receive mental health services – particularly medication Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites* p<.05 +or 6-month if missing 3-month

55 Other Environmental Interventions Across Systems (intake to 3 months) JTDC received fewer urine tests and went to self-help less often, but were more likely to be involved in substance-free structured activities Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites* p<.05 +or 6-month if missing 3-month

56 JTDC and ATDC/FDC Comparison: Outcomes

57 Comparison of Treatment Outcomes (Days of..) Substance Use* (d=-0.77, -0.60) Emotional Problems (d=-0. 22, -0.17) Trouble w/ Family (d= -0.17, -0.19) In Controlled Environment (d=0.08, -0.07) Illegal Activity (d=-0.15, -0.06) Post-Pre d (ATDC/ FDC, JTDC) Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites *p<.05 **or 3 months if missing 6 mo. Both significantly reduced days of substance use. ATDC/FDC meaningfully reduced at 6m** ATDC/FDC greater reduction than JTDC* Intake and 6m not significantly different. JTDC differs from ATDC/FDC at Intake and 6m for all other outcomes

58 Outcome Status Across Waves ATDC/FDC JTDC Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites * p<.05 +or 6-month if missing 3-month

59 In Recovery* Source: CSAT 2010 Horizontal dataset: ATDC and FDC sites *No past month substance use or problems while living in the community. N (ATDC/ FDC, JTDC)

60 Strengths & Limits of this information  Strengths – Multisite quasi assignment – Multiple follow-up waves – Large sample size and high follow-up rates  Limits – Not randomized – Differences at intake not controlled – Adult sites are mostly in the first or second grant year – Disproportionately male in JTDC, female in ATDC – Disproportionately Hispanic youth in JTDC, Caucasian in ATDC – Unknown fidelity of implementation – Not sufficient numbers of specific evidence-based practices to compare

61 Major Predictors of Bigger Effects Found in Multiple Meta Analyses (Lipsey, 1997, 2005) 1.A strong intervention protocol based on prior evidence 2.Quality assurance to ensure protocol adherence and project implementation 3.Proactive case supervision of individual 4.Triage to focus on the highest severity subgroup

62 Impact of the numbers of these Favorable features on Recidivism in 509 Juvenile Justice Studies in Lipsey Meta Analysis Source: Adapted from Lipsey, 1997, 2005 Average Practice The more features, the lower the recidivism

63 Evidence-Based Treatment (EBT) that Typically do Better than Usual Practice in Reducing Juvenile Use & Recidivism  Adolescent Community Reinforcement Approach (A-CRA)  Aggression Replacement Training (ART)  Assertive Continuing Care (ACC)  Cognitive Behavior Therapy (CBT)  Functional Family Therapy (FFT)  Moral Reconation Therapy (MRT)  Thinking for a Change (TFC)  Interpersonal Social Problem Solving (ISPS)  Motivational Enhancement Therapy/Cognitive Behavior Therapy (MET/CBT)  Motivational Interviewing (MI)  Multi Systemic Therapy (MST)  Multidimensional Family Therapy (MDFT)  Reasoning & Rehabilitation (RR)  Seven Challenges (7C) Source: Adapted from Lipsey et al., 2001, 2010; Waldron et al., 2001, Dennis et al., 2004 Small or no differences in mean effect size between these brand names

64 (Godley et al. 2002) and Scott & Dennis 2009 Evidence-Based Practices Can be SIMPLE: On-site proactive urine testing can be used to reduce false negatives by more than half

65 Implementation is Essential (Reduction in Recidivism from.50 Control Group Rate) The effect of a well implemented weak program is as big as a strong program implemented poorly The best is to have a strong program implemented well Thus one should optimally pick the strongest intervention that one can implement well Source: Adapted from Lipsey, 1997, 2005

66 References  Bhati et al. (2008) To Treat or Not To Treat: Evidence on the Prospects of Expanding Treatment to Drug- Involved Offenders. Washington, DC: Urban Institute.  Capriccioso, R. (2004). Foster care: No cure for mental illness. Connect for Kids.  Chandler, R.K., Fletcher, B.W., Volkow, N.D. (2009). Treating drug abuse and addiction in the criminal justice system: Improving public health and safety. Journal American Medical Association, 301(2),  Chassin, L. (2008) Juvenile Justice and Substance Abuse. Juvenile Justice. 18(2) =46&sectionid=153 =46&sectionid=153  Dennis, M. L., Godley, S. H., Diamond, G., Tims, F. M., Babor, T., Donaldson, J., Liddle, H., Titus, J. C., Kaminer, Y., Webb, C., Hamilton, N., & Funk, R. (2004). The Cannabis Youth Treatment (CYT) Study: Main Findings from Two Randomized Trials. Journal of Substance Abuse Treatment, 27,  Dennis, M. L., & McGeary, K. A. (1999, fall). Adolescent alcohol and marijuana treatment: Kids need it now. TIE Communique, 10–  Dennis, M. L., Scott, C. K. (2007). Managing Addiction as a Chronic Condition. Addiction Science & Clinical Practice, 4(1),  Dennis, M. L., White, M., & Ives, M. I. (2009). Individual characteristics and needs associated with substance misuse of adolescents and young adults in addiction treatment. In C. Leukefeld, T. Gullotta, & M. Staton Tindall, Handbook on adolescent substance abuse prevention and treatment: Evidence-based practice (pp ). New London, CT: Child and Family Agency.  Ettner, S.L., Huang, D., Evans, E., Ash, D.R., Hardy, M., Jourabchi, M., & Hser, Y.I. (2006). Benefit Cost in the California Treatment Outcome Project: Does Substance Abuse Treatment Pay for Itself?. Health Services Research, 41(1),  French, M.T., Popovici, I., & Tapsell, L. (2008). The economic costs of substance abuse treatment: Updated estimates of cost bands for program assessment and reimbursement. Journal of Substance Abuse Treatment, 35,

67 References (continued)  Godley, M.D., Godley, S.H., Dennis, M.L., Funk, R.R. & Passetti, L.L. (2002). Preliminary outcomes from the assertive continuing care experiment for adolescents discharged from residential treatment. Journal of Substance Abuse Treatment, 23 (1),  Ives, M. L., Chan, Y-F., Modisette, K. C. and Dennis, M. L., (2010). Characteristics, needs, services, and outcomes of youths in Juvenile Treatment Drug Courts as compared to adolescent outpatient treatment. Drug Court Review VII(1)  Lipsey, M. W. (2010). The effects of community-based group treatment for delinquency: A meta-analytic search for cross-study generalizations. In Deviant by design: Interventions and policies that aggregate deviant youth, and strategies to optimize outcomes. New York: Guilford Press.  Lipsey, M. W. (1997). What can you build with thousands of bricks? Musings on the cumulation of knowledge in program evaluation. New Directions for Evaluation, 76,  Lipsey, M. W. (2005). What works with juvenile offenders: Translating research into practice. Paper presented at the presented at the Adolescent Treatment Issues Conference, Tampa.  Lipsey, M. W., Chapman, G. L., & Landenberger, N. A. (2001). Cognitive-behavioral programs for offenders. The Annals of the American Academy of Political and Social Science, 578,  Marlowe, D. B., (2008). Recent Studies of Drug Courts and DWI Courts: Crime Reduction and Cost Savings. NADCP.  Neumark, Y.D., Van Etten, M.L., & Anthony, J.C. (2000). Drug dependence and death: Survival analysis of the Baltimore ECA sample from 1981 to Substance Use and Misuse, 35,  Office of Applied Studies Summary of findings from the 2001 National Household Survey on Drug Abuse. Office of Applied Studies.  Office of Applied Studies (2006). Results from the 2005 National Survey on Drug Use and Health: National Findings Rockville, MD: Substance Abuse and Mental Health Services Administration.

68 References (continued)  Office of Applied Studies Summary of findings from the 2001 National Household Survey on Drug Abuse. Office of Applied Studies.  Office of Applied Studies (2006). Results from the 2005 National Survey on Drug Use and Health: National Findings Rockville, MD: Substance Abuse and Mental Health Services Administration.  Office of Applied Studies (OAS, 2006). Substance Abuse and Mental Health Services Administration.(SAMHSA) National Survey on Drug Use and Health, 2006 [Computer file]. ICPSR21240-v4. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor],  Office of Applied Studies Substate estimates from the National Surveys on Drug Use and Health. Substance Abuse and Mental Health Services Administration.  Office of Juvenile Justice and Delinquency Prevention (OJJDP). (May 2001). Juvenile Drug Court Program. Department of Justice, OJJDP, Washington, DC. NCJ  Scott, C. K., & Dennis, M. L. (2009). Results from Two Randomized Clinical Trials evaluating the impact of Quarterly Recovery Management Checkups with Adult Chronic Substance Users. Addiction.  Scott, C. K., Dennis, M. L., & Funk, R.R. (2008). Predicting the relative risk of death over 9 years based on treatment completion and duration of abstinence. Poster 119 at the College of Problems on Drug Dependence (CPDD) Annual Meeting, San Juan, PR, June 16, Available at  Scott, C. K., Foss, M. A., & Dennis, M. L. (2005). Pathways in the relapse, treatment, and recovery cycle over three years. Journal of Substance Abuse Treatment, 28, S61-S70.  Waldron, H. B., Slesnick, N., Brody, J. L., Turner, C. W., & Peterson, T. R. (2001). Treatment outcomes for adolescent substance abuse at four- and seven-month assessments. Journal of Consulting and Clinical Psychology, 69(5),  Wasserman, G. A., McReynolds, L. S. Schwalbe, C. S. Keating, J. M. & Jones, S. A. (2010) Psychiatric Disorder, Comorbidity, and Suicidal Behavior in Juvenile Justice Youth. Criminal Justice and Behavior. 37(12):

69 Resources you can use now  Cost-Effective evidence-based practices A-CRA & MET/CBT tracks here, more at or  Most withdrawal symptoms appeared more appropriate for ambulatory/outpatient detoxification, see  Trauma informed therapy and suicide prevention at and  Externalizing disorders medication & practices  Tobacco cessation protocols for youth ssation/index.htm ssation/index.htm  HIV prevention with more focus on sexual risk and interpersonal victimization at or  For individual level strengths see  For improving customer services