Understanding Emerging Adults in Drug Treatment Court

Background/Purpose: Drug Treatment Courts (DTCs) continue to thrive as a mechanism for diverting drug involved criminal justice system clients from incarceration. Nationally, those coming into DTC programs are increasingly young adults presenting with addiction to heroin and prescription opioids.  Surprisingly little is known about how emerging adults differ from older DTC clients in their backgrounds, experiences in the program, and their overall completion rates.  

Methods: We compared emerging adults or those who were 18-29 years (n=207; or 48.3%) to those who were 30 and older (n=222 or 51.7%) at the time of admission to a Midwestern drug treatment court program during a time period beginning in 2009 and ending in April 2016.  

 

Results: Compared with older participants, younger participants were significantly more likely to be White, non-Hispanic (79.2% vs. 50.9%; χ² _1d.f. =37.57; p < .001).  Their major drug problem at entry was more likely to be heroin or prescription opioids (83.5% vs. 54.8%; χ² _1d.f. =38.42; p < .001).  Younger participants were also significantly more likely to report a history of IV drug use (72.5% vs. 45.3%; χ²_1d.f. =31.40; p < .001) and a history of overdose (46.5% vs. 26.4%; χ²_1d.f. =17.98; p < .001).  Although age of first use for their current major drug problem was younger (19.6 vs. 23.8; t 380 = -6.24; p < .001), emerging adults were significantly less likely to have ever received drug or alcohol treatment (70.5% vs. 82.5%; χ²_1d.f. =8.36; p < .01).  They had less extensive criminal history, reporting a lower average number of prior convictions (1.9 vs. 6.2), fewer months incarcerated in their lifetime (8.9 vs. 35.0) (both at p < .001) and lower Level of Supervision Inventory (LSI-R) scores (28.9 vs. 30.3; p < .001). Emerging adults reported a history of trauma (physical or sexual abuse) at much lower rates than older participants (23.4% vs. 37.9%; χ²_1d.f. = 9.85; p < .01).  While in the program, emerging adults had more difficulty following rules and completing phases.  They were more likely to receive violations for positive drug tests, missing scheduled drug tests and missing treatment appointments; they received 5 more violations compared to older adults (15.6 vs. 10.1; t₄₂₀ =4.7; p < .001).  Emerging adults were significantly less likely to complete DTC (28.4% vs. 42.0%; χ²_1d.f. =7.70; p < .01).  In a logistic regression model controlling for race/ethnicity, sex, education, prior convictions, and total LSI-R score, emerging adults had just over half the odds (0.595) of completing the program compared with older adults (95% CI: 0.366, 0.967).

Conclusions and Implications: Emerging adults present as more drug involved than criminal involved.  DTC’s present treatment in a criminal justice context – one where judges and prosecutors have considerable influence on treatment decision-making.  The entire orientation of DTC’s may be problematic for emerging adults, as it appears to be for juveniles.  Nevertheless, if DTC’s continue as a major venue for drug involved emerging adults who encounter the CJ system, strategies for engaging them into treatment need to be examined.