Treatment for substance use problems among young offenders: Difficulties and dilemmas for implementation and evaluation in the UK

Abstract

Youth offending is assumed in part to be caused by substance use problems, consequently policy and practice in youth justice emphasise their treatment. We review four types of difficulty for substance use treatment of the under-18s and of youth offending team clients, then consider what might work. (1) Working with children raises systemic and ethical issues that complicate intervention and evaluation. (2) Assessing or diagnosing substance use problems in this age group is inherently problematic and often neglects the systemic aspects of pathways to treatment. Ineffective treatment may seem effective because change has occurred naturally with time. (3) Defining realistic and acceptable long-term outcomes for substance use in this age group is problematic. In the early 21st century it is developmentally normative for substance use to increase between ages 10 and 20, so interventions should strictly aim for a reduced rate of increase, rather than decrease or abstinence. Separating drugs from alcohol and tobacco in policy, over-problematising youthful drug use and assuming that drugs simply cause crime have hindered the setting of realistic objectives. (4) Operating, auditing and evaluating a substance problems service for children requires flexibility and sensitivity of practice that can work against evaluation; firm recommendations about the effectiveness of specific treatment packages are as yet inappropriate. Systemic and cognitive-behavioural therapies have most evidence of efficacy, while humanistic advocacy counselling is widely used, but interventions developed for adults cannot be applied unmodified to younger clients.