Effectiveness Bank Bulletin [Long-term effect of community-based adolescent treatment].

Long-term effect of community-based treatment: evidence from the adolescent outcomes project. Edelen M.O., Slaughter M.E., McCaffrey D.F. et al. Drug and Alcohol Dependence: 2010, 107, p. 62–68. The title speaks of long-term effects but in fact there were none from sending young US substance users to a youth therapeutic community specialising in substance use problems compared to non-specialist group homes; early gains had all eroded, an instance of the general difficulty of sustaining youth treatment outcomes. Summary Few studies have reported on the long-term impacts of substance use treatment for adolescents, and those which have provide at best limited evidence that impacts persist. In particular, no such study has yet assessed long-term outcomes for drug-involved juvenile offenders receiving treatment outside custody, the majority of adolescent treatment admissions. This US evaluation offers the first assessment of long-term effects nearly nine years after offenders had been referred by the juvenile justice system either to a drug-specialist residential therapeutic community for adolescents (the Phoenix Academy), or to other residential group living programmes of similar size and structure, but which did not offer specialised substance use treatment. Relative to the group homes, the community had previously been shown to result 12 months after referral in significantly better substance use and psychological functioning. This report sets out to establish whether these improvements persisted and even 'snowballed', or were eroded by time and other influences. In 1999 and 2000, 449 young people aged 13–17 joined the study after being contacted at a juvenile court; all were legal wards of the court. Of these, 175 were initially admitted the specialist community where they stayed for on average just over five months, about the same time as other young people stayed after being sent instead to one of the six comparison group homes. The featured report drew its data from the 412 youngsters who completed any of the long-term follow-up interviews about three, seven and eight and a half years after the baseline interviews; of these, nearly 90% had completed the final interview. Typically they were 15–16-year-old Hispanic/Latino boys who by the final follow-up would have averaged about 24 years of age. At study intake nearly 8 in 10 had met criteria for substance abuse and 55% for dependence. For about half their main substance was cannabis. Despite extensive substance use, 59% did not feel they needed treatment. There were some appreciable differences between those sent and not sent to the Phoenix Academy, notably in motivation for treatment, extent of recent cannabis use, and substance use problems. An attempt was made to adjust outcomes for differences on these and other (totalling 88) dimensions as assessed before starting treatment. Then estimates were made of how well the young people would have done had they all been sent to Phoenix, or all to the other centres