As first responders, law enforcement officers are tasked with seeking answers to the who, what, where, when and how of criminal acts while frequently relying on other criminal justice and social service agencies to seek answers to the more elusive why. Many law enforcement professionals feel that, save oft dreaded courtroom testimony, their involvement should typically conclude with the arrest and related report. This may not necessarily be the most efficient case with regards to juvenile offenders, particularly in the specialization of juvenile narcotics. There is little to no public doubt that the frequency of juvenile drug use has been on an increased rise in recent years. News articles in major cities tell tales of juvenile drug overdose deaths almost as if none occurred among adults. Illicit drug traffickers have begun to use marketing strategies that appear to target children directly through cartoon labeling on MDMA, innocent monikers such as “cheese” for heroin, and candy-like flavorings for other drugs such as methamphetamine. Commercial products such as Four Loko, Tilt, and Joose put high concentrations of alcohol into popular energy drink blends with whimsical, cartoon like product labeling. Head shops sell herbal incense laced with synthetic alternatives to cannabinoids that are not currently scheduled as controlled substances, labeling the products with innocent names such as K2 or Spice alongside warnings such as “NOT FUR HUMAN CONSUMPTION”. During a recent undercover controlled purchase at a head shop in Dallas, Texas, this researcher was provided personal opinions on the “flavor” and “potency” of each incense variety by store employees and offered rolling papers and a lighter for the product sold as “incense” at the cash register. Reports that juveniles have discovered drug-like high effects from improper use of certain bath salts and cooking spices can be easily found on the Internet and in newspaper articles. Yet, with the ever increasing variety of highs available to today’s adolescent, surveys show that marihuana and diverted prescription drugs remain the most frequently abused substances within the age group. A four-year trend analysis of drug related offenses in Dallas area schools showed an annual increase among marihuana and prescription drugs with the prevalence of stronger drugs such as cocaine, methamphetamine and heroin declining even among a localized adolescent heroin crisis (Liebbe, 2010). A recent survey of public high school students (N=984) in the Dallas area showed that 16.1% of students reported recent use of marihuana, 7.7% of students reported recent use of pharmaceutical drugs without a prescription and less than 5% of students reported recent use of heroin, cocaine, methamphetamine or MDMA while 52.1% of students reported one or more recent days where their mental health was not good (DISD, 2009). This paper will seek to determine the strength of the correlation between juvenile drug abuse and mental health issues as well as a model that law enforcement personnel can utilize at the first responder level to have a greater impact on juvenile narcotics issues.
Numerous studies among the mental health community have found a comorbidity between juvenile substance abuse and mood disorders such as clinical depression and bipolar disorder. Both Devieux and Lucenko have found significantly higher rates of substance abuse and mood disorders among juvenile offenders as compared to other youth (Devieux, 2000; Lucenko, 2003). Another study also showed that juvenile offenders not only have an increased rate of substance abuse but also higher rates of suicidal attempts and psychiatric hospitalizations (Tolou-Shams, 2007). Also according to Tolou-Shams, “riskier behaviors and attitudes among arrestees with symptoms of depression might be explained by an additive effect of comorbid behavioral and emotional symptoms that heighten risk” (p. 62). In a recent presentation at the National Alliance for Drug Endangered Children, Ackley reported that an estimated one in five adolescents suffer from emotional disorders and further finding that 19.2% of substance-dependent adolescents met the diagnostic criteria for Post-Traumatic Stress Disorder (PTSD, adjustment disorder) (Ackley, 2010). A comparative study in rural states found statistically high lifetime prevalence of PTSD (27.1%) and substance-abuse disorders (61.25%) among men in prison (Kammerer, p. 7). Finally, it has been reported that up to 64% of jail inmates suffer from mental health disorders as compared to approximately 10% of Americans and an estimated 72% of people in county jails with mental illness also meet the clinical criteria for comorbid substance abuse disorders (NACO, p. 3). Based on these research findings, it can be concluded that a strong relationship and comorbidity exists between juvenile drug abuse and mental health disorders.
One theory for the comorbidity of juvenile drug abuse and mental health disorders is the concept of self-medication. According to the popular user-driven website Wikipedia, self-medication is a term used “to describe the use of drugs (including alcohol) or other self-soothing forms of behavior to treat untreated and often undiagnosed mental distress, stress and anxiety, including mental illnesses and/or psychological trauma” (“Self-medication”, para. 1). Another popular user-driven website, Urban Dictionary, defines self-medicate as “the act of taking illegal drugs or alcohol in attempt to alleviate anxiety, stress, or certain mental disorders (ie. schizophrenia & bipolar)” with 51 votes concurring and 6 votes dissenting (“Self Medicate”, para. 1). The Office of National Drug Control Policy reports that teenagers suffering from depression episodes are more than twice as likely to use marihuana and almost twice as likely to use other illicit drugs when compared to non-depressed teens and additionally are more likely than depressed adults to use marihuana and other illicit drugs (ONDCP, 2008). Among diverted pharmaceutical drugs, the most common abused by teenagers include alprazolam (a benzodiazepine used to treat anxiety disorders), hydrocodone (an opiate used for pain management) and Prozac (a selective serotonin reuptake inhibitor used to treat clinical depression) (Liebbe, 2010). It should not be considered coincidental that some of the most commonly abused prescription drugs by adolescents are used clinically to treat mood disorders such as depression and anxiety. It should also not be considered coincidental that many such self-medicators are using marihuana with the advent of the medical-marijuana industry, described by Ferguson (2010):
“Medicate? The medical-marihuana industry relies heavily on such genteel euphemisms. To medicate is to smoke pot, and no one in the industry calls pot pot anymore; it’s medicine now. Dealers are called caregivers, and the people who buy their dope – medicine, medicine – are patients. There’s no irony here, no winks or nudges to signal that someone’s leg is being pulled. ‘After work’, says a counter clerk, or budtender, at Briargate Wellnesss Center, an upscale dispensary serving the tony north side of Colorado Springs, ‘I’ll just go home, kick back, take out the bong and medicate.”
The opportunity exists for law enforcement, as first responders, to have a greater impact on recidivism and drug related offenses among juvenile offenders. Law enforcement officers and educators can identify the pattern of behavior associated with substance abuse and drug endangerment among adolescents before the pattern becomes entrenched into the individual’s personality and behavior (Collins, 2010). Tolou-Shams argues us that “developing substance-use and mental health needs assessment for adolescents in contact with the juvenile justice system is important to achieving positive health outcomes, as demonstrated by the links between substance use, mental health and sexual risk. Substance-use and HIV prevention efforts that include strategies to regulate mood may help juvenile offenders reduce emotional distress, thereby reducing the likelihood of impulsive, risky behaviors” (p. 63), “therefore, juvenile intake procedures should include brief clinical screening measures for depressive symptoms to determine appropriate mental health, substance-use and HIV risk behavior interventions for these high-risk youth” (p. 62) and additionally that “models of juvenile correction that address mental health and physical health are crucial, because arrestees’ contact with the legal system may represent one of few opportunities to address health issues” (p. 63). Ackley reported significant increases in substance abuse disorders after exposure to traumatic adverse childhood experiences including child abuse, sexual assault, domestic violence, witnessing violence and other criminal episodes where the juvenile drug abuser was a victim of a previous offense that may not have been reported (Ackley, 2010).
A strong correlation would appear to exist between juvenile substance abuse and mental health issues, specifically mood and adjustment disorders, with a high recidivism rate among this offender category. As many juvenile arrests are referred to first offender programs or other court diversionary programs, law enforcement officers have a unique opportunity to identify juveniles who engage in delinquency as a secondary effect to mental health issues and/or status as victims of other, potentially unreported, criminal offenses. A cognitive interview between a juvenile drug offender and an investigator that intertwines an assessment model and prevention strategies may have a significant impact on the juvenile’s behavior, reducing the likelihood of future impulsive, risky behaviors that lead to arrest, and may additionally uncover more serious criminal offenses to which the juvenile was the victim and not the offender.
Ackley, Carol. (2010). Impact of Trauma and Addiction on Drug Endangered Children: Becoming Trauma Informed. [PowerPoint slides and lecture]. Presented at the 7th Annual National Alliance for Drug Endangered Children Conference.
Collins, P., Duncan, C., and Liebbe, J. (2010). Identification of Drug Endangered Children in Public Schools. [PowerPoint slides and lecture]. Presented at the 7th Annual National Alliance for Drug Endangered Children Conference.
Dallas Independent School District (DISD): Safe and Drug Free Schools Department. (2009). [Youth Risk Behavioral Survey Results]. Unpublished raw data.
Deveiux, J., Malow, R., Stein, J.A., Jennings, T.E., Lucenko, BG.A., Averhart, C., and Kalichman, S. (2000). Impulsivity and HIV risk among adjudicated alcohol and other drug-abusing adolescent offenders. AIDS Education and Prevention 14 (Suppl B): (pp. 24-35).
Ferguson, Andrew (2010, November 22). The United States of Amerijuana. Time Magazine, 30-39.
Kammerer, N, and Mazelis, R. (2006). The SAMHSA National GAINS Center. After the Crisis: Healing from Trauma after Disasters. Retrieved November 21, 2010, from http://www.gainscenter.samhsa.gov.
Liebbe, J. (2010). Narcotics in Dallas ISD: Four Year Trend Analysis. [PowerPoint slides] and [Unpublished raw data].
Lucenko, B., Malow, R.M., Sanchez-Martinez, M., Jennings, T., and Devieux, J.G. (2003). Negative affect and HIV risk in alcohol and other drug (AOD) abusing adolescent offenders. Journal of Child Adolescent Subststance Abuse 13 (pp. 1-17).
National Association of Counties (NACO). (2008). Reentry for Safer Communities: Effective County Practices in Jail to Community Transition Planning for Offenders with Mental Health and Substance Abuse Disorders. Bureau of Justice Assistance. Retrieved on November 21, 2010, from: http://www.ojp.usdoj.gov/BJA/pdf/Reentry_Safer_Comm.pdf.
Self Medicate. (n.d.). Retrieved on December 4, 2010, from Urban Dictionary: http://www.urbandictionary.com/define.php?term=self+medicate.
Self-medication. (n.d.). Retrieved on November 28, 2010, from Wikipedia: http://en.wikipedia.org/wiki/Self-medication.
Tolou-Shams, M., Brown, L, Houck, C, Lescano, C, and Project SHIELD Study Group. (2008). Journal of Studies on Alcohol and Drugs, Volume 69, Issue 1. The Association Between Depressive Symptoms, Substance Use, and HIV Risk Among Youth with an Arrest History (pp. 58-64). Newark, NJ: Rutgers University.
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