NOVEMBER2002

Q: Why is it important to respond to the issue of co-occurring disorders among children and youth in the juvenile justice system?

Depending on whether a jurisdiction, facility, program, or unit in a juvenile justice system tests or screens for mental health disorders and substance use disorders, the prevalence rate is estimated between 50 and 95 percent of the population. This rate has staggering consequences at a time when there is clear and convincing evidence that both the mental health disorder(s) and the substance use disorder(s) can be treated with evidence-based interventions that will assure better outcomes for youth in the system. The young person stands a much greater chance of terminating the relationship with the juvenile justice system and making a positive transition to the community when all of the presenting issues that we know about have been treated.

By self-report, tobacco, alcohol, and marijuana are the drugs most frequently used by youth in the juvenile justice system. Of these, marijuana is the most dangerous: at a time when youth are very concrete thinkers, they hear a mixed message about marijuana-that it is a "medication" and an illegal drug. This message that marijuana can be or is used as a medication is very confusing to adolescents because their experience is that they will be arrested if caught with it in their possession. On the other hand, when they see advocates for the legalization of the same drug and some doctors in some States prescribing it for medical treatment, they rarely understand how these actions can be possible. It is critical that a single message be conveyed to this population because developmentally they are very concrete thinkers and have a very hard time with abstract concepts. Among the sad facts that we now know about marijuana use are that there is compelling evidence that: 1. It is addictive 2. It causes significant brain damage 3. It is not inevitable that adolescents will try marijuana

There is also clear and compelling evidence that youth who use marijuana are more likely to escalate to using other hard drugs like cocaine and heroine.

Even though we know that addiction is regarded as a disease of the brain and is treatable, we must send messages that we are opposed to any and all illegal drug use. Unlike many other biologically or neurologically based diseases, addiction starts with a choice to try the illegal drug. There are not sufficient resources to provide treatment to all who need it or request it, so it is important to keep youth from experimenting before the age of 17 to insure maximal brain development and to reduce the risk of early irreversible damage. When possession and use of marijuana are reduced, the risk of involvement in the juvenile justice system and criminal justice system is also reduced.

Therefore, it is important to treat both mental health and substance abuse disorders and to raise youth's appreciation for the devastating impact of illicit drug use in terms of their health, employment, and benefit loss and their eventual loss of freedom.