Incarcerated youths pose treatment challenges

Adolescence is a time of exploration and risk-taking. In our culture, experimenting with drugs and alcohol is normal – almost a rite of passage. Youth who have no drug experience at all are in a minority.

Not surprisingly, then, most of the young people incarcerated at Mountain View Youth Development Center are substance abusers. At the time of their commitment, 80 percent are identified as habitual substance abusers, and more than 60 percent have a diagnosis of drug dependence or addiction. Often, substance abuse problems come to light later in those who are not initially diagnosed. In many cases, the crimes that bring these juveniles to our facility are directly or indirectly related to their drug habits.

Their drug experience runs the gamut from intermittent use of alcohol or marijuana to several years of intravenous heroin use. Some kids have an identified drug of choice, but many have a pattern of trying anything and everything. Some have developed a physical dependence or addiction and experience significant craving, even after the drugs have left their systems.

The context for their drug use varies widely as well. They may be using in a way that minimizes danger while continuing to function successfully in school and maintaining healthy relationships with friends and family. Alternatively, they may be using drugs to dull emotional pain related to family dysfunction, unbearable losses or school failure caused by unaddressed learning problems. Or they may be involved in a drug culture that includes gangs, violence and drug dealing.

Some young people have significant mental health problems as well as substance abuse problems. Some are intellectually limited. Some have a normal IQ but experience difficulty reading or understanding spoken language.

Another variable is the attitude toward substance abuse within their families. Some of our incarcerated young people come from intact families where there is no substance abuse, and where there is active support for abstinence and recovery. Many come from families where parents and extended families are heavily involved in substance abuse. Some come from families where family members have progressed in their own recovery and can model recovery for the incarcerated young person.

By the time they come to us here in Charleston, some of these young people have had evaluation and treatment for substance abuse, while others have had none. Some are motivated to stay clean and have already begun that process before incarceration. Others have no interest in changing their behaviors. Many insist their drug use is not a problem.

The juvenile correctional environment may seem an ideal place to provide counseling and treatment for drug use and dependence. Here, young people go through forced detoxification and remain abstinent for months, which allows them to participate in treatment with a clear brain. Because they are often understimulated and cut off from their natural supports, they may have an increased willingness to engage with nurturing adults, including clinicians. And, at least in some cases, their loss of freedom drives home the message that their behaviors are out of control and must be changed.

But, for the most part, incarcerated youths enter treatment against their will, an obvious obstacle to effective recovery. Those who are willing to engage in treatment are under the constant influence of those who are not – many kids here spend a lot of time talking longingly and in a bragging way with their peers about their substance abuse experience.

In this environment, then, there are many challenges to providing effective substance abuse treatment, and many youths are in our care for only a few months.

Treatment starts with a comprehensive individual evaluation. In addition to assessing the extent and context of a young person’s drug behavior, a good clinician conveys interest in the young person’s unique personality and circumstances.

Treatment must then be individualized. The fact of incarceration ensures abstinence, but symptoms of withdrawal must be addressed. Mental illness must be treated. Young people need help and support to deal with grief and losses, and to begin to establish, re-establish or strengthen nurturing relationships with their parents or other caring adults. Family counseling, when possible, is crucial for setting up supportive environments for a young person returning to the community and motivated to maintain sobriety.

Mountain View has had only a few youths whose opiate dependence has warranted treatment with medications. Ideally, this treatment should start before the youth is released from the facility. The dose can be stabilized under observation, the side effects can be resolved, and the risk of relapse immediately upon release from the facility can be reduced.

Naltrexone, which blocks the “high” of opiates, may be helpful in highly motivated, mature youths who are actively engaged in ongoing substance abuse treatment for opiate dependence. It is relatively low risk and can’t be sold, diverted or abused. It is not of any use in unmotivated individuals and has rarely if ever been prescribed by clinicians at Mountain View.

Suboxone is a mixture of buprenorphine – a weak opiate – and Naltrexone. Unlike Naltrexone alone, it is a drug replacement therapy that satisfies the physical craving for narcotics without delivering a “high.” Treatment with Suboxone does not change the need for counseling and behavioral therapy. Suboxone therapy is in limited use at Mountain View.

Methadone is another replacement medication. A strong opiate, it is generally reserved for addicts whose use of narcotics has been both chronic and severe. Adolescent addicts with an extensive history of opiate dependence who cannot stabilize on Suboxone may be considered for methadone treatment, but they would be very rare. Methadone is not currently used in correctional settings in Maine.

All adolescents, and all addicts, tend to underestimate danger and long-term consequences and to overvalue short-term pleasure. They don’t realize how hard it will be to stay sober once they’re released into the community, and they overestimate their knowledge and skill in this area. While substance abuse treatment may begin during incarceration, successful, long-term recovery is unlikely unless that treatment continues after release.

Eric Hansen is the superintendent of the state’s Mountain View Youth Development Center in Charleston. This column was written in consultation with senior staff at the facility.

Please join our weekly conversation about Maine’s substance abuse problem. We welcome comments or questions from all perspectives. Letters may be mailed to Bangor Daily News, P.O. Box 1329, Bangor 04401. Send e-mail contributions to findingafix@bangordailynews.net. Column editor Meg Haskell may be reached at (207) 990-8291 or mhaskell@bangordailynews.net.