Study: Substance Use Disorder a Predictor of Violent Behavior

Meet Linda A. Teplin, Ph.D., professor of psychiatry and behavioral sciences at Northwestern University and primary investigator of the Northwestern Juvenile Project, a large-scale, longitudinal study of the mental health needs of youth after they leave detention.

Widely quoted and respected in the field of juvenile justice, Teplin has led the project through nearly two decades of tracking and interviewing kids after they leave detention into adulthood.

Teplin’s work, referred to in the JJIE and in the Resource Hub, is a consistent source of meaningful and valuable data about the mental health needs of delinquent youth to juvenile justice specialists around the nation.

Her most recent work, written with Katherine Elkington, assistant professor of clinical psychology at Columbia University, and colleagues in the Journal of the American Academy of Child and Adolescent Psychiatry, focuses on psychiatric disorders as a predictor of future violence.

The research found no connection to increased violence based on a person’s mental health condition. When substance abuse and dependence were included, however, a different picture emerged.

hub_arrow_2-01As Teplin puts it, many kids use drugs; some have a drug use disorder, meaning abuse or dependence. Drugs include marijuana as well as so-called “hard drugs” such as opiates, amphetamines and cocaine.

And substance use disorder is a significant predictor of subsequent violent behavior. Boys with a substance use disorder, her study concludes, are more than three times more likely to engage in subsequent violence.

What causes this relationship? Subtleties abound, including kids being involved in the drug economy — a dangerous place to be says Teplin.

Still, the conclusions are clear and the takeaway even more so: Mental disorders, other than substance use or dependence, do not predict subsequent violence. Reducing substance abuse and dependency can reduce violence. Therefore, preventative intervention and treatment for substance use disorders are key in reducing violence.

Teplin shared all of this with JJIE and more when we caught up with her at her home in Chicago a few days ago to talk about the article.

This is part of a year of coverage around the subject of young people and substance abuse, including prevention, early intervention and recovery. It comes thanks to a grant from the Conrad N. Hilton Foundation.

The Recovery Diaries: Treatment for Substance Abuse Now Favored Over Punishment

For drug or alcohol abusers who get cleaned up, success builds on success.

Those who successfully complete treatment programs do better the longer they manage to stay clean, a study cited by the Georgia Council on Substance Abuse found. About 4 million people went into treatment for drug or alcohol addiction in 2013, the federal Substance Abuse and Mental Health Services Administration reports.

Two-thirds of those who manage to stay sober for one to three years will make it another year. Of those who make it five years, 86 percent make it another year.

Some of those stories of struggle and success are featured in “The Recovery Diaries,” a new short film produced by the Juvenile Justice Information Exchange.

But a life clean and sober can be harder to navigate — especially if his or her background includes an appearance before a judge.

“If I were just jumping into the workforce, I may not want my employer to know that I’m in recovery,” says Neil Campbell, executive director of the Georgia Council on Substance Abuse, in the film.

“We’ve criminalized addiction in this country to a point where an employer may hesitate to hire someone if they know they’ve had trouble in the past,” she says. “I think all of those things keep people from the treatment door.”

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Sissy's Story

Public opinion has shifted dramatically since the days of the crack cocaine epidemic of the 1980s. Two-thirds of respondents now think government should devote more attention to getting drug addicts into treatment than locking them up, according to a 2014 survey by the Pew Research Center. A similar percentage supports rolling back the tough mandatory minimum sentences that have packed prisons in previous decades.

Public policy has been slower to follow suit. While the Obama administration has told federal prosecutors to avoid seeking mandatory minimum sentences in drug cases, 55 percent of the $27 billion federal anti-drug budget proposal for 2016 is still focused on busting suppliers and users.

On the state level, 40 states have eased at least some drug laws in the past five years, Pew reported — in part because of the cost of keeping drug offenders behind bars.

About 20 percent of the 1.6 million inmates behind bars in the United States are in for nonviolent drug offenses; in the federal prisons alone, the number tops 50 percent.

Of the 48,000 juveniles committed by courts to residential facilities — everything from group homes to adult-style lockups — in 2010, about 2,900 were in for drug offenses, according to a February report by the National Center for Juvenile Justice. In 2014, the Justice Policy Institute estimated the long-term costs of housing teen offenders at about $8 billion to $21 billion yearly.

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Howie's Story

So finding another way to handle drug cases could substantially reduce the roughly $80 billion a year the nation spent on corrections in 2010. And treatment could play a major role.

California has tried to take that approach in the last decade and a half. In 2000, state voters passed Proposition 36, which allowed adults convicted of nonviolent drug offenses to get probation with treatment instead of being locked up.

About 40,000 drug suspects a year went through drug treatment under Proposition 36, said Darren Urada, the University of California-Los Angeles researcher who led annual studies of the program. About half were in treatment for the first time.

Most received probation; about 43 percent of those completed the program. And of those who completed treatment, just under 18 percent had used drugs a year after their initial offense — about half the rate of those who didn’t go through the program.

“Not all of them would have gone to prison, but a substantial portion of them would have,” Urada said. “So it did save a lot of money and it kept them out of prison or jail, which is good in a lot of other ways.”

Urada said he would recommend similar programs to other states, but added, “I would do things a little differently.”

For one thing, the California program struggled financially from the outset, “because they got people who had much more serious drug problems than they expected.”

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Jason's Story

“They were expecting at the beginning that this would be college students who used marijuana every once in a while, things like that,” he said. “What they got was people who had been using methamphetamine for 10 years, who had serious, serious problems that were far, far more than they had budgeted for.”

And after the financial crisis of 2008, with California facing massive budget gaps, lawmakers cut off funding for Proposition 36. Some counties still support treatment centers on their own, and offenders can pay for programs themselves, but space is limited in most other counties, said Laura Thomas, deputy director of the California arm of the Drug Policy Alliance, which helped write and lobbied for the measure.

“We want to think that as a state, as taxpayers, we’re getting the most for our money — especially when it combines something that’s actually helping people’s lives,” she said. “But unfortunately, the state Legislature, in times of budget crisis, didn’t see it that way.”

The UCLA studies showed Proposition 36 saved about $2 in prison costs for every dollar spent on the program. California voters followed up in 2014 with the passage of Proposition 47, which reduced most drug possession charges to misdemeanors rather than a felonies. It also allowed people convicted of those offenses to get their charges reduced retroactively — a step Thomas said can help inmates once they’re released.

“If you’ve got a felony conviction on your record, that creates barriers to accessing public housing, in some places, food stamps [or] jobs,” she said. “All the things that help people in recovery and help people build stability are that much harder to get if you end up with a felony conviction as a result of your drug use.”

This is the beginning of a year of coverage around the subject of young people and substance abuse, including prevention, early intervention and recovery. It comes thanks to a grant from the Conrad N. Hilton Foundation.

This is the Beginning: An Interview with William Lopez of the Anti-Recidivism Coalition

"Being in the cell for 24 hours a day, I had plenty of time to think and really want to make that change..."

After losing his brother to gang violence, during his incarceration William Lopez began to turn his life around through education. He worked to receive his G.E.D and eventually acquired numerous A.A degrees -- all while behind bars. Towards the end of his sentence, Lopez met Scott Budnick, the producer of the Hangover movies and a prison reform advocate. "He helps individuals while they are in prison, once they come out," Lopez states of Budnick. "Jobwise, mentorship, pretty much supports you all the way through."

Watch JJIE's interview with Lopez at the 2013 MacArthur Models for Change Conference: 


Now, Lopez is out and works alongside Budnick as a member of the Anti-Recidivism Coalition. He says, "This is the beginning, I'm grateful to be home, everyday is great for me, I'm so happy to be here."

Videography by David Kindler. 
Watch more JJIE video interviews from the 2013 Models for Change Conference: