Juvenile offenders with substance abuse problems represent a large and underserved population that is at high risk for persistent deleterious outcomes and long-term costs for themselves, their families, their communities and society. Moreover, a high percentage of juvenile offenders continue to abuse substances and engage in criminal activity into adulthood. Although one juvenile justice intervention, Juvenile Drug Court (JDC), has emerged as a promising model for reducing the cycle of drug use, crime and delinquency among youth, evidence of its effectiveness is variable. One important factor that may compromise drug court effectiveness is lack of caregiver engagement in JDC processes and concomitant adolescent drug treatment. Incorporating evidence-based incentive programs in JDCs to increase caregiver engagement may improve their effectiveness in reducing youth drug use and criminal re-offending. An extensive body of research supports the critical role that families play in the etiology, maintenance, and treatment of adolescent substance abuse. Although family-based interventions for adolescent substance abuse have been shown to be superior to other treatment modalities, parents must attend treatment and participate in meaningful ways for these superior outcomes to be realized. This R01 Stage II randomized clinical trial will examine the efficacy of a prize-based contingency management (CM) intervention for increasing caregiver engagement (attendance and participation) in JDC and adolescent drug treatment. This caregiver CM intervention (CCM) will be compared with drug court treatment as usual (TAU). One hundred and eighty youth enrolled in JDC will be randomly assigned along with a parent/caregiver to treatment as usual or CCM. Repeated measures analyses will examine the effects of CCM on measures of caregiver engagement in JDC. Analyses will also examine whether improved caregiver engagement contributes to reductions in youth substance use (urine drug screens) and criminal activity. Results from this study are predicted to demonstrate the effectiveness of CCM procedures for increasing caregiver attendance and participation in JDC and adolescent drug treatment above and beyond drug court and usual care. If effective, the CCM approach may ultimately be used to enhance JDC outcomes, thereby reducing substance use and recidivism in juvenile offenders served by this promising juvenile justice intervention. Thus this project has high significance in terms of potential public health impact and reduction in criminal justice system costs. Further, the proposed study is highly innovative because it is among the first to apply CM treatment to JDC, uses an approach designed to be easy to implement within the JDC context, and the first to examine the efficacy of CM for enhancing parental engagement in the JDC process.

Public Health Relevance

Substance abusing juvenile offenders poses significant short- and long-term problems for themselves, their families and community, and society. Indeed, such youth are likely to maintain their drug use and criminal offending well into adulthood. Although Juvenile Drug Court (JDC) has emerged as a promising model for reducing the cycle of drug use, crime, and delinquency among youth, the effectiveness of drug courts, as well as adolescent drug treatment, is often compromised by the lack of caregiver engagement (attendance and active participation). The current study will use an efficacious behavioral intervention, contingency management (CM), to reinforce caregiver engagement in both JDC and adolescent drug treatment. CM has strong scientific support in working with difficult to treat populations and for effectively increasing completion of treatment related activities for both adults and youths (e.g., treatment attendance, homework completion). CM is also relatively simple to implement, low cost, and compatible with current JDC practices.

National Institute of Health (NIH)
National Institute on Minority Health and Health Disparities (NIMHD)
Research Project (R01)
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Risk, Prevention and Intervention for Addictions Study Section (RPIA)
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Alvidrez, Jennifer L
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Medical University of South Carolina
Schools of Medicine
United States
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