The Justice System and Young Adults With Substance Use Disorders
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
The Justice System and Young Adults
With Substance Use Disorders
Selen Siringil Perker, LLM, Lael E. H. Chester, JD
Young adults’ heightened vulnerability to substance use disorders (SUD) corresponds with abstract
their disproportionate representation in the criminal justice system. It is paramount that the
justice system systemically recognize young adults as a group with distinct developmental
needs and align reform efforts with advancements made in medical and public health fields to
better address the needs of justice-involved young adults with SUD. This article warns against
reliance on the justice system for engaging young adults with SUD in treatment and presents 4
principles that were developed by a workgroup participating in a longitudinal meeting of
experts sponsored by Boston Medical Center’s Grayken Center for Addiction. The goal of the
principles is to support and guide policy and practice initiatives for developmentally
appropriate justice responses to young adults with SUD. The article also reviews the evidence
that underlies these principles and offers policy and practice considerations for their
implementation.
Emerging Adult Justice Project, Justice Lab, Columbia University, New York, New York
The guidelines and recommendations in this article are not American Academy of Pediatrics policy, and publication herein does not imply endorsement.
Ms Siringil Perker conducted the literature review, analyzed published data, wrote the initial manuscript, and reviewed and revised the manuscript; Ms Chester
reviewed and revised the manuscript; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
DOI: https://doi.org/10.1542/peds.2020-023523H
Accepted for publication Oct 23, 2020
Address correspondence to Selen Siringil Perker, LLM, Justice Lab, Columbia University, 475 Riverside Dr, Suite 316, New York, NY 10115. E-mail: ss5527@columbia.edu
PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).
Copyright © 2021 by the American Academy of Pediatrics
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
FUNDING: No external funding.
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
Downloaded from www.aappublications.org/news by guest on October 19, 2021
PEDIATRICS Volume 147, number s2, January 2021:e2020023523H SUPPLEMENT ARTICLEYoung adults, individuals 18 to adults mature and age out of crime as practice and policy considerations,
25 years of age also defined as their cognitive skills develop, including potential obstacles to
emerging adults, are at the epicenter responsibility and independence implementation and action steps to
of both the current drug epidemic grow, and social ties strengthen inform key stakeholders.
and mass incarceration crisis. Young through education, stable
adults suffer the highest prevalence employment, and committed
PRINCIPLES OF CARE
of illicit drug use of any age group1,2; relationships.19–21 Unfortunately for
they are overrepresented in the most young adults involved in the Principle 1: To the Extent Possible,
criminal justice system and justice system, these opportunities Young Adults With SUDs Should Be
experience the worst justice may never exist and the criminal Diverted From the Criminal Justice
outcomes of all age groups. Although justice system further limits their System to Effective Care
young adults comprise 10% of the US prospects to reach these key Guidance
population, in 2015 they constituted developmental milestones. An adult
The workgroup acknowledged that
26% of arrests3 and 20% of adult criminal record creates barriers to
SUDs are the entryway to the criminal
incarcerations.4 Each day, an reentry, such as diminished access to
justice system for a significant
estimated 170 000 young adults are workforce, higher education, and safe
number of young adults, yet SUD
incarcerated in adult correctional housing. These collateral effects are
treatment is most effective when
facilities.5,6 Three out of 4 of these amplified for young adults, especially
provided to youth in their own
individuals will be rearrested within poor, young men of color, who face communities, before involvement
3 years of release.7 the worst disparities in the justice with the justice system. Diversion
system.22,23 In fact, the United States’ refers to a broad category of justice
The overlap between heightened
experiment of a punitive, justice- initiatives that deflects individuals
vulnerability of young adults to
focused model for addressing SUDs away from the formal justice system
substance use disorders (SUD) and
has produced discriminatory into community services at key
their disproportionate representation
outcomes, widening racial and ethnic junctures of the criminal procedure,
in the criminal justice system is not
inequities.24 starting from prearrest police
coincidental. Human brain
development does not reliably reach diversion to latter alternatives to
Fortunately, many areas of public
adult levels of functioning until well sentencing.
policy, including public health,
into the third decade of life.8,9
increasingly recognize young Evidence
Hallmarks of this development
adulthood as a distinct developmental
include risk taking, experimentation, Nationwide, drug abuse violation is
stage, leading to laws and policies
and a diminished future the leading cause of arrests for young
specifically designed to protect this
orientation.10,11 Young adults tend to adults.2 In 2017, drug abuse
age group from harmful behavior.
choose immediate, smaller rewards violations represented 22% of all
Policy discussions around the country
over future, larger ones.12 Young arrests for 18- to 20-year-olds in the
are now focusing on reforming the
adults are particularly volatile in United States and 19% for 21- to 24-
justice system so that it recognizes
emotionally charged settings, year-olds.25 Although the total
the distinct developmental needs of
especially with their peers.13 For number of arrests of young adults has
young adults. In this article we
some, this stage also marks the onset decreased substantially since 1990,
present the 4 principles that were
of mental health problems, self- greater numbers of young adults are
developed by an expert workgroup
medicating, or experimenting with being arrested for drug abuse
participating in a longitudinal
substances. Heavy drinking and drug violations today. The ratio of arrests
meeting sponsored by Boston Medical
use during adolescence and young for drug abuse violations to total
Center’s Grayken Center for
adulthood, in turn, adversely affect arrests in this age group has risen
Addiction. The intent of these
development of the brain and from 8% in 1990 to 20% in 2017.
principles is to support and guide
increase impulsivity.14–16 Young
policy considerations for Of all drug-related violations,
adults experience violent
developmentally appropriate justice possession is the most frequent,
victimization and emotional and
responses to young adults with SUDs. accounting for 85% of all drug-
physical trauma at higher rates than
The recommendations in this article related arrests of young adults.26
any other population.17,18 Each of
are not American Academy of These numbers underestimate the
these risk factors is associated with
Pediatrics policy, and publication actual role of substances in criminal
involvement in the justice system.
herein does not imply endorsement. justice involvement for young adults
Young adulthood, however, is also We summarize the evidence since history of substance use is
a time for opportunity. Most young underlying each principle, and share common among those sentenced for
Downloaded from www.aappublications.org/news by guest on October 19, 2021
S250 PERKER and CHESTERother types of offenses.27,28 One study counseling sessions, and reporting (Gloucester, MA, 2015) help police
found that 85% of all incarcerated regularly to probation officers. implement prearrest programs that
individuals are substance-involved.29 Recently, these conditions have connect individuals with opioid
increased in number.36 For young addiction to treatment. Communities
Young adults arrested for drug abuse adults under probation that suffer that have joined PAARI have observed
violations or other infringements from SUD – and who typically have as much as a 25% reduction in crimes
with underlying SUD enter an adult not completed their formal education, associated with addiction.40
criminal justice system cycle that do not have stable employment, or
starts with booking, and progresses lack other support systems – high Policy and Practice Considerations
possibly through detention, rates of relapse and technical
prosecution, conviction, and A number of obstacles persist for
violation of other probation
sentencing, including the possibility prearrest diversion of young adults.
conditions are common.37 In part
of community supervision or As a distinct age group, young adults
because of the growth in the
incarceration. This punitive approach pose specific challenges for
probation population, most probation
to individuals with SUDs, however, engagement in addiction treatment.
agencies lack resources to deflect
neither reduces crime nor saves There is a lack of sufficient,
people who technically violate their
lives.30 Police interactions can cause developmentally appropriate,
probation conditions to drug
more trauma and harm to youth that culturally responsive, and evidence-
treatment, behavioral therapy, or
already suffer from increased rates of based addiction treatment services
employment programs. Instead,
victimization and view law for young adults in most communities
agencies default to formal violation
enforcement with suspicion and across the United States. Only 1 out of
processes, which often result in
distrust.31 Interventions that rely on 3 young adults with opioid addiction
incarceration.35 For young adults, this
the justice system for engagement of receives medications to prevent
means being subject to the toxic
young adults with SUDs also a return to drug use.41 Youth of color
environment of adult prisons, cutoff
perpetuate systemic racial and women are significantly less
from family and community supports,
inequities.24 Black individuals are likely than others to be prescribed the
and carrying a lifelong criminal
incarcerated on drug charges at a rate appropriate medications.42 In the
record.
10 times greater than white absence of effective nonpunitive
individuals despite similar rates of alternatives for young adults, the
Therefore, prearrest diversion of
drug use.32 recourse to formal criminal justice
young adults with SUDs from the
system for treatment often prevails.
formal criminal justice system is
Individuals with SUDs who are Additionally, SUD frequently
important. A number of programs,
released from incarceration are more intersects with behavioral and mental
such as Law Enforcement Assisted
likely to recidivate and return to health problems, trauma and
Diversion and the Police Assisted
prison than other incarcerated victimization, and lack of adequate
Addiction and Recovery Initiative
persons: Nationwide, .50% of social support systems. Lack of cross-
(PAARI), have shown promising
incarcerated persons who are drug- agency collaboration between
outcomes for diversion of adults with
dependent have previously been addiction and mental health
SUDs to effective treatment across the
incarcerated, compared with 31% of professionals and social support
country.38 In a Law Enforcement
other incarcerated persons.30 systems constitutes a significant
Assisted Diversion program, which
Formerly incarcerated persons are at challenge for sustained recovery of
started in King County, Washington,
a strikingly higher risk for death from young adults from SUD.
in 2011 and has been replicated in
drug overdose than the general
several other jurisdictions, police The expert panel identified a number
population and formerly incarcerated
officers exercise discretionary of actions that could be taken to
emerging adults have the highest
authority to divert individuals to address these obstacles. First, the
mortality rate of all.33,34
community-based programs for law panel highlighted the need for
Similarly, outcomes of individuals violations driven by underlying creating developmentally
sentenced to probation, the most behavioral and mental health needs.39 appropriate, culturally sensitive, and
frequently used sentence in criminal These programs offer a range of engaging (as opposed to coerced)
court, are poor. Nationally, ∼40% of services that provide life skills, addiction treatment programs for
those who are sentenced to probation employment opportunities, drug young adults in their communities
have had their probation revoked.35 treatment, housing, and educational and facilitating early intervention
Probation typically requires persons programs as an alternative to formal before involvement with the justice
to adhere to a number of conditions, involvement with the criminal justice system. This should include
such as being drug-free, attending system. The Angel Project and PAARI developing alternative engagement
Downloaded from www.aappublications.org/news by guest on October 19, 2021
PEDIATRICS Volume 147, number s2, January 2021 S251strategies, such as wider use of as a developmentally distinct group. currently underway with support
mentoring and peer support. Second, Young adults are thus treated as older from the National Institutes of
stigma about medication-assisted adults without developmentally Health.47 Challenges remain, however,
treatment (MAT) should be overcome appropriate services; (2) existing in tailoring addiction and mental
and MAT within primary-care addiction treatment programs in the health programs in the justice system
pediatric setting should be provided. adult criminal justice system are to the distinct needs of young adults.
Increasing awareness about SUDs and insufficient to address SUDs across all
In this context, a flurry of legislative
treatment programs in schools, and age groups, but even more so for
and policy initiatives has emerged
facilitating school-based referrals to young adults. Both obstacles need to
across the United States for young
treatment programs in communities be addressed simultaneously.
adult justice reform recently. One
are important to address SUD before
systemic reform is the expansion of
a young adult gets involved in the Evidence
juvenile jurisdiction to include some
justice system. Third, collaboration
Historically, the age of demarcation young adults.22,48 In 2018, Vermont
between addiction, mental health
between the juvenile and adult justice enacted a law that gradually raised
professionals and social support
systems has differed across the the upper age of juvenile jurisdiction
systems should be strengthened for
United States. Today, the majority of to a person’s 20th birthday by 2022.
a holistic approach to treatment of
states set the legal marker at A growing number of other states (eg,
SUDs of young adults. These
a person’s 18th birthday. Adult jails MA, IL, and CA) are considering
programs should be “trauma-healing”
and prisons, however, are not similar proposals. Extending juvenile
in addition to being trauma-informed.
equipped to provide developmentally alternatives to young adults means
Finally, police referrals of young appropriate health care and addiction providing them with individualized
adults with SUDs to community- treatment to young adults. rehabilitative services, including
based treatment programs should be developmentally appropriate
Evidence suggests that existing
enhanced through adaptation of behavioral health services, addiction
addiction treatment programs in the
promising prearrest diversion models treatment, vocational training, and
adult criminal justice system are
to the distinct needs of young adults confidentiality protections. Other
insufficient to address SUDs for all
and through deliberate design and countries have been successfully
age groups. Only 10% of incarcerated
evaluation to reverse and prevent implementing such measures for
individuals receive addiction
systemic racial inequities in the years.49
treatment and most incarcerated
justice system. These diversion
persons who could benefit from Jurisdictions across the country have
models should be promoted in new
treatment do not receive it.43 Of those also been considering and
hire training and continuing
who receive treatment, evidence implementing other, more localized
education of law enforcement
suggests no significant reduction in policy initiatives for responding to
officers. A wider array of other
risk of fatal overdose after release.44 justice-involved young adults, such as
diversion opportunities after arrest
Most US correctional facilities do not specialized courts, specialized
and throughout the criminal justice
continue or initiate MAT, or they probation caseloads, and specialized
process should be provided to
provide only detoxification or correctional units, and the expansion
respond to justice-involved young
a subset of US Food and Drug of hybrid systems (which merge
adults with SUDs.
Administration–approved MAT (eg, elements of both the juvenile and
Principle 2: Young Adults Who Have only methadone or buprenorphine).45 adult criminal justice systems). One
SUDs and Are Subject to the Formal In addition, existing treatment such initiative that targets system-
Justice System Should Have Access programs often lack quality metrics, involved youth with SUDs is
to the Full Range of Developmentally are not standardized, and vary in specialized drug courts. In 2013,
Appropriate, High Quality Addiction content and quality. Evidence from Massachusetts established 5 intensive
Treatment Modalities During System a pilot study in Rhode Island suggests supervision programs to serve
Involvement, Particularly During
that SUD treatment programs offering justice-involved young adults, ages 18
Incarceration and Reentry
all 3 US Food and Drug to 33, with SUDs.50 These programs
Processes
Administration–approved involve up to 3 weeks of daily
Guidance medications (methadone, intensive outpatient treatment of
Young adults with SUDs face 2 major buprenorphine, and naltrexone) addiction, followed by regular
obstacles after being involved in during incarceration significantly meetings with the judge and a team of
formal justice system: (1) justice reduce postrelease overdose case managers for individual and
systems across the country do not deaths.46 A national study of SUD group counseling, and provision of
systemically recognize young adults treatment models in justice settings is employment, education, and health
Downloaded from www.aappublications.org/news by guest on October 19, 2021
S252 PERKER and CHESTERinsurance support. An evaluation of to system-involved young adults risk of death from drug overdose of
these intensive supervision programs more effectively. individuals recently released from
is pending. prison was 129 times higher than the
Policy and Practice Considerations general adult population.58 Notably,
Juvenile justice systems have been To provide young adults with SUDs the risk of opioid-related death for
experimenting with developmentally the full range of developmentally young adults after release from
appropriate SUD treatment appropriate addiction treatment incarceration is significantly higher
frameworks in ways not provided in modalities during justice system than it is for older adults.2
the adult systems.51 Multisystemic involvement, the expert panel urged
Public safety outcomes after release
Therapy–Emerging Adults, an policy makers to leverage the
of incarcerated individuals with SUDs
innovative adaptation of standard experience of the juvenile justice
are equally poor. In 2018, technical
multisystemic therapy for adolescents system. These include extending
violations of parole and probation,
to emerging adults with a serious juvenile justice measures to young
such as failing drug tests, accounted
mental illness and justice adults by raising the age of juvenile
for nearly a quarter of state prison
involvement, has been piloted with justice jurisdiction and adapting
admissions of all ages.59 Three-
promising outcomes in reducing both intervention models for younger
quarters of both incarcerated young
substance use and recidivism.52 youth to young adults. The justice
adults and individuals imprisoned for
system should also provide
Some jurisdictions have launched a drug-related offense are arrested
comprehensive access to
initiatives for young adults that build for a new crime within 5 years of
pharmacotherapy for addiction
on the successes of mentoring release.7 A 2002 study of recidivism
treatment during incarceration and
interventions for children and in 15 states found that 22% of 18- to
immediately after release. The expert
adolescents.53 For example, the 24-year-olds released from
panel highlighted the importance of
Arches Transformative Mentoring incarceration returned to prison
establishing quality metrics for young
program (Arches) of New York City’s within 3 years for technical violations
adult treatment programs during
of parole, such as a failed drug test.60
Department of Probation, a group justice involvement and reentry
A recent study on the effects of
mentoring program serving young processes, and regularly monitoring
imprisonment on future prison
adult probation clients ages 16 to 24, the quality, frequency, availability,
admission found that postprison
is based on the idea that “credible duration, and outcomes of treatment.
parole supervision increases the
messengers,” people with
Principle 3: The Justice System probability of imprisonment,
backgrounds similar to those of their
Should Provide Resources Dedicated primarily through the process of
mentees, often including previous
to Supporting the Safe Transition of technical violations and that
criminal justice system involvement,
Young Adults From a Period of substance use was included in 50% of
are best positioned to engage the
Incarceration Back to Their such technical violations.61
young adults who are hardest to Communities
reach.54 In addition to mentoring, the Providing a continuum of care after
curriculum of Arches include Guidance release and comprehensive
evidence-based interventions, such as Overdose fatality rates among young prerelease planning for young adults,
interactive journaling, that help adults are the highest of all age thus, hold promise to save lives and
clients identify the link between their groups immediately after release increase public safety. Closer
substance dependence and law- from incarceration. Public safety community-based partnerships
breaking activities and enable them outcomes are also worst for young between providers and justice
seek voluntary treatment.55,56 An adults with SUDs after release from agencies can increase the number of
impact evaluation of Arches program incarceration. This highlights the services for those released from
showed significant reductions in importance of developmentally incarceration and at high risk of
recidivism rates of its participants.57 appropriate substance use treatment violating parole.61 The Parole
services during the transition of Restoration Project (PRP) of the state
Finally, some states (eg, MA, CT, MD) young adults from incarceration to of New York is one example of such
have established specialized divisions their communities. successful community partnerships.62
within their departments of public Launched in 2001, the project’s aim
health to focus specifically on young Evidence was to reduce length of stay for
adult mental health and substance Drug overdose is the leading cause of persons detained on Rikers Island for
abuse. Justice systems can use the death for formerly incarcerated technical parole violations with
experience of such divisions by individuals.33 A study in the United a focus on people with SUD or mental
working closely with them to respond States found, for example, that the illness. PRP works closely with the
Downloaded from www.aappublications.org/news by guest on October 19, 2021
PEDIATRICS Volume 147, number s2, January 2021 S253NYC Department of Correction and that justice systems provide criminal justice system, such as arrest
NYS Division of Parole to assess the comprehensive discharge planning, for a misdemeanor.70 An adult
mental health and drug treatment including a continuum of health care, criminal record diminishes an
needs of eligible individuals to create addiction treatment, access to health individual’s prospects of steady
discharge plans and connect them insurance (Medicaid), education and employment and higher education,
with community treatment providers. employment services, and stable restricts civic engagement, and limits
In 2008, PRP reduced the average housing in close partnership with access to adequate housing and
length of incarceration for high-need community-based providers. Justice public assistance.71 Since these
individuals who violated parole by officials should turn to factors are critical to addiction
20%.62 developmentally appropriate, recovery, a healthy transition to
community-based SUD treatment, adulthood, and desistence from
Policy and Practice Considerations cognitive behavioral therapy, crime, denying young adults public
Across the nation, the growth of education or employment programs benefits places them at a greater risk
probation and parole, and its in cases of relapse in lieu of formal of relapse and recidivism. These
unmatched funding, remain major probation/parole violation process effects also disproportionately affect
obstacles to providing a continuum of and incarceration. youth of color, deepening
care to young adults during their intergenerational poverty and racial
transition from incarceration back to Principle 4: The Justice System inequities.72
their communities. Community-based
Must Reduce the Harm Caused by
Criminal Records That Create Hiring experiments show that
partnerships with providers, such as a felony conviction reduces the
Insurmountable Barriers to Young
the PRP initiative discussed above, Adults’ Full and Healthy Community positive callback rate by nearly two-
can connect young adults with SUDs Engagement and Their Sustained thirds for Black male applicants, and
to treatment services in their Recovery From SUDs by half for white male applicants.73
communities after release. The cost of Such racially discriminatory effects
Guidance
these services could be paid for by on future job prospects is amplified
the savings states would experience The effects of a criminal record on the
life of a young adult are pervasive. A for young adults. Young men of color
from reduced numbers of people that face higher levels of detachment from
are reincarcerated as a result of a new criminal record creates barriers to
housing, employment, and civic mainstream institutions compared
sentence or violation of parole.63 with their white peers.22 In 2017, the
engagement – each critical for
Other major obstacles that interfere a justice-involved young adult’s percentage of Black males ages 18 to
with the safe transition of young sustained recovery. The expert panel 19 that were out of school and
adults with SUDs back to their praised efforts to reduce such unemployed was 31%, 2.5 times
communities involve the significant collateral consequences by expunging higher than their white peers.74 Early
stress and barriers to reentry faced criminal records, especially of drug- evidence suggests that the
on release.64 These include stigma related offenses, and providing young coronavirus disease 2019 pandemic
associated with being labeled an “ex- adults with protections and services will exacerbate these inequities.75
offender,” lack of health insurance, offered in juvenile/youth justice Of particular importance to young
and diminished access to stable systems, such as confidentiality of adults with SUDs, researchers in
housing, employment, and other proceedings and adjudication of a survey of college admissions
support services.65,66 Among youth delinquency (guilty disposition in officials found that .90% viewed any
released from jail or prison, only 30% juvenile system) rather than an adult felony conviction as particularly
obtain employment or are in school criminal conviction. negative, and .75% felt the same
within 12 months after release.67
way about any drug or alcohol
SUDs can create a stubborn Evidence offense.76 Furthermore, young adults
postrelease/relapse cycle, as they
The American Bar Association has with adult criminal records may be
adversely impact social viability and
cataloged .45 000 civil restrictions subject to long periods of ineligibility
reentry/entry attempts of formerly
imposed by federal and state statutes for federal financial aid. For example,
incarcerated youth to the workforce.
and regulations as a result of adult applicants with 2 drug possession
Failure to become established in their
convictions.69 Despite being convictions or 1 drug sales conviction
communities then increases young
associated with convictions and can apply for federal funding only
adults’ vulnerability to relapse.27,68
felony offenses, important collateral after 2 years from the date of the
To ensure safe transition of young consequences on a person’s social most recent conviction.77 A National
adults from incarceration back to and economic future can be triggered Poverty Center study found that
their communities, it is paramount by even a simple interaction with the students of color were more likely to
Downloaded from www.aappublications.org/news by guest on October 19, 2021
S254 PERKER and CHESTERneed such federal grants, but also The juvenile justice system accords should leverage the experience of the
more likely to be convicted of protective measures, such as juvenile justice systems to provide
a disqualifying drug offense.72 confidentiality of proceedings and young adults under their care with
a different disposition of court developmentally appropriate SUD
Since 1987, US federal housing policy
proceedings – an “adjudication of treatment modalities, including but
has restricted people convicted for
delinquency” rather than a conviction not limited to exploring the option of
a felony, or any violent or drug-
when a youth is found guilty of the raising the upper age of juvenile
related crime, from receiving
alleged offense – which provide some justice jurisdiction, adapting
subsidized housing benefits.78
important legal protections. Some treatment programs for younger
Furthermore, the 1996 “1 strike and
states also provide a greater youth to young adults, and providing
you’re out” policy provided a legal
opportunity for juvenile records to be access to the full range of
basis to evict all members of
sealed or expunged than adult pharmacotherapy during
a household of a person who is
criminal records. incarceration and immediately after
convicted of a drug-related crime.79
release. Community-based
In the private market, similar barriers Policy makers should consider partnerships between providers and
to adequate and safe housing exist for extending deferred adjudication and justice agencies and interagency
those with a criminal record. expungement of criminal records to collaboration should be enhanced to
According to a survey from 2005, young adults. It is essential that support the safe transition of young
80% of members of 1 major processes for expunging criminal adults from incarceration to their
professional association for rental records are not made onerous. The communities. Finally, justice systems
housing screen applicants for experience in many jurisdictions must remove barriers to housing,
criminal records.80 By the same across the United States shows that employment, and other critical
token, the Personal Responsibility tedious procedural requirements for supports and means of community
and Work Opportunity Reconciliation expunging drug-related criminal engagement as a result of adult
Act of 1996 imposes a lifetime ban on records marginalize emerging adults criminal records and provide young
public assistance, such as the that often lack the resources, adults with legal protections offered
Supplemental Nutrition Assistance knowledge, and confidence to in youth justice systems against such
Program and Temporary Assistance navigate the legal system. Finally, collateral consequences.
to Needy Families Program, for those current national policy discussions
with felony convictions for the illegal for alleviating blanket, lifelong
possession, use, or distribution of collateral consequences of adult ACKNOWLEDGMENTS
drugs.81 A 2017 article found that conviction are encouraging for efforts We thank Vincent Schiraldi, Dr
people convicted of a felony drug to ensure that young adults with Michael Silverstein, and Dr Ziming
offense and with full access to public SUDs continue to have access to Xuan for comments on the article.
welfare benefits are 10% less likely to services and resources that are Authors would also like to thank the
return to prison within a year after essential to their sustained recovery. organizers and the participants of the
release.82 Denial of benefits may, thus, 2018 Grayken Center for Addiction
have the unintended consequence of Young Adult Summit for insightful
increasing recidivism.83 CONCLUSIONS discussions.
Recent reform efforts to tailor justice
Policy and Practice Considerations responses to the needs of young
Eliminating collateral consequences adults, especially of those with SUDs, ABBREVIATIONS
of adult justice system involvement are welcome developments. Yet more MAT: medication-assisted
for young adults with SUDs is an area progress needs to be made. It is treatment
ripe for policy innovation. Raising the paramount that the justice system PAARI: Police Assisted Addiction
upper age of juvenile jurisdiction systemically recognize young and Recovery Initiative
comes to the forefront of such reform adulthood as a distinct developmental PRP: Parole Restoration Project
initiatives. Including young adults in stage and opt for less punitive SUD: substance use disorder
youth/juvenile justice systems holds measures that align with
the promise to not only ensure their developments in the public health
access to developmentally and medical fields. Young adults with
appropriate, rehabilitative SUD SUDs should be diverted from formal REFERENCES
treatment while incarcerated, but also justice systems to community-based 1. Schulenberg JE, Johnston LD, O’Malley
to protect them from lifelong harmful SUD treatment whenever possible. PM, Bachman JG, Miech RA, Patrick ME.
effects of an adult criminal record. Policy makers and practitioners Monitoring the Future national survey
Downloaded from www.aappublications.org/news by guest on October 19, 2021
PEDIATRICS Volume 147, number s2, January 2021 S255results on drug use, 1975-2017. Volume 12. Bickel WK, Miller ML, Yi R, Kowal BP, 22. Schiraldi V, Western B, Bradner K.
II, college students & adults ages 19-55. Lindquist DM, Pitcock JA. Behavioral Community-based responses to justice-
2018. Available at: https://eric.ed.gov/? and neuroeconomics of drug addiction: involved young adults. New Thinking in
id=ED589764. Accessed July 1, 2020 competing neural systems and Community Corrections Bulletin.
temporal discounting processes. Drug Washington, DC: US Department of
2. Siringil Perker S, Chester LEH.
Alcohol Depend. 2007;90(suppl 1): Justice, National Institute of Justice;
Combating the Crisis: Using Justice
S85–S91 2015. NCJ 248900.
Reform to Address the Drug Epidemic
among Emerging Adults. New York, NY: 13. Gardner M, Steinberg L. Peer influence 23. Siringil Perker S, Chester LEH, Schiraldi
Justice Lab at Columbia University; on risk taking, risk preference, and VN. Emerging Adult Justice in Illinois:
2018. Available at: https://justicelab. risky decision making in adolescence Towards an Age-Appropriate Approach.
columbia.edu/sites/default/files/ and adulthood: an experimental study. New York, NY: Justice Lab at Columbia
content/CombatingTheCrisis.pdf Dev Psychol. 2005;41(4):625–635 University; 2019. Available at: https://
doi.org/10.7916/d8-fpvw-1t32
3. US Department of Justice, Federal 14. Squeglia LM, Tapert SF, Sullivan EV, et al.
Bureau of Investigation. Crime in the Brain development in heavy-drinking 24. Bobo LD, Thompson V. Unfair by design:
United States, 2015. Available at: adolescents. Am J Psychiatry. 2015; the war on drugs, race, and the
https://ucr.fbi.gov/crime-in-the-u.s/ 172(6):531–542 legitimacy of the criminal justice
2015/crime-in-the-u.s.-2015/tables/ system. Soc Res (New York). 2006;73(2):
table-38. Accessed June 12, 2020 15. Dahlgren MK, Sagar KA, Racine MT, 445–472
Dreman MW, Gruber SA. Marijuana use
4. US Department of Justice, Office of predicts cognitive performance on 25. United States Department of Justice,
Justice Programs. National corrections tasks of executive function. J Stud Federal Bureau of Investigation. Crime
reporting program, 1991–2015: Alcohol Drugs. 2016;77(2):298–308 in the United States, 2017. Available at:
selected variables. 2018. Available at: https://ucr.fbi.gov/crime-in-the-u.s/
https://doi.org/10.3886/ICPSR36862.v1. 16. Gruber SA, Dahlgren MK, Sagar KA, 2017/crime-in-the-u.s.-2017/topic-pages/
Accessed July 1, 2020 Gönenç A, Lukas SE. Worth the wait: tables/table-38. Accessed July 1, 2020
effects of age of onset of marijuana use
5. Bronson J, Carson EA. Prisoners in 26. Bureau of Justice Statistics. Arrest data
on white matter and impulsivity.
2017. Washington, DC: US Department of analysis tool: annual tables. 2014.
Psychopharmacology (Berl). 2014;
Justice; 2019 Available at: https://www.bjs.gov/index.
231(8):1455–1465
cfm?ty=datool&surl=/arrests/index.
6. Sawyer W, Wagner P. Mass 17. Morgan RE, Truman JL. Criminal cfm#. Accessed July 1, 2020
incarceration: the whole pie 2019. Victimization, 2017. Washington DC: US
Available at: https://www.prisonpolicy. 27. Chandler RK, Fletcher BW, Volkow ND.
Department of Justice; 2018. Available
org/reports/pie2019.html. Accessed Treating drug abuse and addiction in
at: https://www.bjs.gov/content/pub/
July 1, 2020 the criminal justice system: improving
pdf/cv17.pdf
public health and safety. JAMA. 2009;
7. Durose MR, Cooper AD, Snyder HN. 18. Velazquez T. Young adult justice: a new 301(2):183–190
Recidivism of prisoners released in 30 frontier worth exploring. 2013.
states in 2005: patterns from 2005 to 28. Mulvey EP, Schubert CA, Chassin L.
Available at: http:// Substance Use and Delinquent Behavior
2010. 2014 chronicleofsocialchange.org/wp- among Serious Adolescent Offenders.
8. Hardin AP, Hackell JM; Committee on content/uploads/2013/05/Young-Adult- Washington, DC: US Department of
Practice and Ambulatory Medicine. Age Justice-FINAL-revised.pdf. Accessed July Justice; 2010
limit of pediatrics. Pediatrics. 2017; 1, 2020
140(3):e20172151 29. Behind Bars II: Substance Abuse and
19. Sampson RJ, Laub JH. Crime in the America’s Prison Population. National
9. Steinberg L, Icenogle G. Using making: pathways and turning points Center on Addiction and Substance
Developmental Science to Distinguish through life. Crime Delinq. 1993;39(3): Abuse at Columbia University; 2010.
Adolescents and Adults under the Law. 396 Available at: https://eric.ed.gov/?id=
In: SSRN, vol. 1. 2019:21–40 ED509000. Accessed July 13, 2020
20. Mulvey EP. Highlights from Pathways to
10. Monahan KC, Steinberg L, Cauffman E, Desistance: A Longitudinal Study of 30. Clark N, Dolan K, Farabee D. Public
Mulvey EP. Trajectories of antisocial Serious Adolescent Offenders. health alternatives to incarceration for
behavior and psychosocial maturity Washington, DC: US Department of drug offenders. East Mediterr Health J.
from adolescence to young adulthood. Justice; 2011 2017;23(3):222–230
Dev Psychol. 2009;45(6):1654–1668
21. Laub JH, Sampson RJ. Life-course and 31. Jones N. How things fall apart: race and
11. Bryan-Hancock C, Casey S. developmental criminology: looking suspicion in police-civilian encounters.
Psychological maturity of at-risk back, moving forward - ASC division of Clarke Forum for Contemporary Issues:
juveniles, young adults and adults: developmental and life-course Public Lectures. 2015. Available at:
implications for the justice system. criminology inaugural David P. https://scholar.dickinson.edu/
Psychiatry Psychol Law. 2010;17(1): Farrington lecture, 2017. J Dev Life clarkeforum_lectures/30. Accessed July
57–69 Course Criminology. 2020;6(2):158–171 1, 2020
Downloaded from www.aappublications.org/news by guest on October 19, 2021
S256 PERKER and CHESTER32. American Civil Liberties Union. Written 42. Hadland SE, Wharam JF, Schuster MA, substance use treatment services
submission of the American Civil Zhang F, Samet JH, Larochelle MR. needs among adolescent offenders.
Liberties Union on racial disparities in Trends in receipt of buprenorphine and J Subst Abuse Treat. 2017;74:80–91
sentencing. 2014. Available at: https:// naltrexone for opioid use disorder 52. Sheidow AJ, McCart MR, Davis M.
www.aclu.org/sites/default/files/asse among adolescents and young adults, Multisystemic therapy for emerging
ts/141027_iachr_racial_disparities_a 2001-2014. JAMA Pediatr. 2017;171(8): adults with serious mental illness and
clu_submission_0.pdf. Accessed July 1, 747–755 justice involvement. Cognit Behav Pract.
2020 2016;23(3):356–367
43. Zarkin GA, Cowell AJ, Hicks KA, et al.
33. Merrall ELC, Kariminia A, Binswanger IA, Lifetime benefits and costs of diverting 53. DuBois DL, Portillo N, Rhodes JE,
et al. Meta-analysis of drug-related substance-abusing offenders from state Silverthorn N, Valentine JC. How
deaths soon after release from prison. prison. Crime Delinq. 2015;61(6): effective are mentoring programs for
Addiction. 2010;105(9):1545–1554 829–850 youth? A systematic assessment of the
34. Coffey C, Wolfe R, Lovett AW, Moran P, 44. Massachusetts Department of Public evidence. Psychol Sci Public Interest.
Cini E, Patton GC. Predicting death in Health. An assessment of opioid-related 2011;12(2):57–91
young offenders: a retrospective cohort deaths in Massachusetts, 2013–2014. 54. City of New York Department of
study. Med J Aust. 2004;181(9):473–477 2016 Probation. Arches: a transformative
35. Jacobson MP, Schiraldi V, Daly R, Hotez 45. Vestal C. At Rikers Island, a legacy of mentoring intervention. 2012. Available
E. Less is more: how reducing probation medication-assisted opioid treatment. at: www.nyc.gov/html/prob/downloads/
populations can improve outcomes. Stateline. May 23, 2016. Available at: pdf/arches_rfa_01192012_3.pdf.
2017. Available at: www.hks.harvard. http://pew.org/27ISkFh. Accessed July Accessed July 1, 2020
edu/sites/default/files/centers/wiener/ 13, 2020 55. Proctor S, Corwin C, Hoffmann N, Allison
programs/pcj/files/less_is_more_final. S. A tool to engage jail inmates. 2009.
46. Green TC, Clarke J, Brinkley-Rubinstein
pdf. Accessed July 1, 2020 Available at: https://psychcongress.
L, et al. Postincarceration fatal
36. Corbett RP. The burdens of leniency: the overdoses after implementing com/article/tool-engage-jail-inmates.
changing face of probation. Minnesota medications for addiction treatment in Accessed July 13, 2020
Law Review. 2015:360026-5535 a statewide correctional system. JAMA 56. Proctor SL, Hoffmann NG, Allison S. The
Psychiatry. 2018;75(4):405–407 effectiveness of interactive journaling
37. Cuddy J, Smith D, Linder L. Young Adults
and Community Supervision: The Need 47. National Institutes of Health. Justice in reducing recidivism among
for a Developmentally Appropriate Community Opioid Innovation Network. substance-dependent jail inmates. Int
Approach to Probation. Austin, TX: Texas 2019. Available at: https://heal.nih.gov/ J Offender Ther Comp Criminol. 2012;
Criminal Justice Coalition; 2018. research/research-to-practice/jcoin. 56(2):317–332
Available at: https://www.texascjc.org/ Accessed July 1, 2020 57. Lynch M, Astone NM, Collazos J, Lipman
system/files/publications/Young%20Adu M, Esthappan S. Arches transformative
48. Loeber R, Farrington DP, Petechuk D.
lts%20and%20Community%20Supervi mentoring program. 2018. Available at:
Bulletin 1: from Juvenile Delinquency to
sion%20Report.pdf https://www.urban.org/research/
Young Adult Offending (Study Group on
38. Police Executive Research Forum. Ten the Transitions between Juvenile publication/arches-transformative-
standards of care: policing and the Delinquency and Adult Crime). 2013. mentoring-program. Accessed July 13,
opioid crisis. 2018. Available at: http://a Available at: https://www.ncjrs.gov/ 2020
mericanhealth.jhu.edu/sites/default/file pdffiles1/nij/grants/242931.pdf. 58. Binswanger IA, Stern MF, Deyo RA, et al.
s/inline-files/PolicingOpioidCrisis_ Accessed July 1, 2020 Release from prison–a high risk of
LONG_final_0.pdf. Accessed July 1, 2020 death for former inmates. N Engl J Med.
49. Matthews S, Schiraldi V, Chester L.
39. Lead National Support Bureau. What is Youth justice in Europe: experience of 2007;356(2):157–165
LEAD? 2020. Available at: https://www. Germany, the Netherlands, and Croatia 59. Council of State Governments Justice
leadbureau.org/about-lead. Accessed in providing developmentally Center. Confined and costly: how
July 1, 2020 appropriate responses to emerging supervision violations are filling
adults in the criminal justice system. prisons and burdening budgets. 2019.
40. The Police Assisted Addiction and
Justice Eval J. 2018;59–81 Available at: https://csgjusticecenter.
Recovery Initiative. Annual report June
2015 - June 2016. 2016. Available at: 50. Spencer S. Hope and consequences: org/publications/confined-costly/.
https://paariusa.org/about-us/annual- “Drug court” launched in Uxbridge. Accessed July 13, 2020
report/. Accessed July 1, 2020 2016. Available at: https:// 60. Langan P, Levin D. Recidivism of
worcestercountysheriff.com/2016/05/ Prisoners Released in 1994. Washington
41. Bagley SM, Larochelle MR, Xuan Z, et al.
02/4014/. Accessed July 1, 2020 DC: US Department of Justice; 2002.
Characteristics and receipt of
medication treatment among young 51. Belenko S, Knight D, Wasserman GA, Available at: https://www.bjs.gov/index.
adults who experience a nonfatal et al. The Juvenile Justice Behavioral cfm?ty=pbdetail&iid=1134
opioid-related overdose. Ann Emerg Health Services Cascade: a new 61. Harding DJ, Morenoff JD, Nguyen AP,
Med. 2020;75(1):9–38 framework for measuring unmet Bushway SD. Short- and long-term
Downloaded from www.aappublications.org/news by guest on October 19, 2021
PEDIATRICS Volume 147, number s2, January 2021 S257effects of imprisonment on future 68. Shivy VA, Wu JJ, Moon AE, Mann SC, https://www.bls.gov/cps/cpsaat03.pdf.
felony convictions and prison Holland JG, Eacho C. Ex-offenders Accessed July 1, 2020
admissions. Proc Natl Acad Sci USA. reentering the workforce. J Couns
75. Lewis K. A decade undone: youth
2017;114(42):11103–11108 Psychol. 2007;54(4):466–473
disconnection in the age of
62. Center for Alternative Sentencing and 69. American Bar Association. Collateral coronavirus. 2020. Available at: http://
Employment Services. Parole consequences of conviction project. measureofamerica.org/youth-
restoration project: a community 2020. Available at: https://www. disconnection-2020/. Accessed July 13,
linkage program for technical parole americanbar.org/groups/criminal_ 2020
violators with special needs. Available justice/niccc/. Accessed July 1, 2020
76. Center for Community Alternatives. The
at: https://www.cases.org/resources/ 70. Uggen C, Vuolo M, Lageson S, Ruhland E, use of criminal history in college
communications/brochures/prp.pdf. Whitham HK. The edge of stigma: an admissions: reconsidered. 2010.
Accessed July 1, 2020 experimental audit of the effects of low- Available at: www.
63. Schiraldi VN, Arzu JL. Less Is More in level criminal records on employment: communityalternatives.org/pdf/
New York: An Examination of the Impact arrest and employment. Criminology. Reconsidered-criminal-hist-recs-in-
of State Parole Violations on Prison and 2014;52(4):627–654 college-admissions.pdf. Accessed July 1,
Jail Populations. New York, NY: Justice 71. U.S. Commission on Civil Rights. 2020
Lab at Columbia University; 2018 Collateral consequences: the 77. Student eligibility, 20 USC x1091(r)
64. Western B. Homeward: Life in the Year Crossroads of punishment, redemption, (2019).
after Prison. New York: Russell Sage and the effects on communities.; 2019.
Available at: https://www.usccr.gov/ 78. Anti-Drug Abuse Act of 1988, 42 USC x
Foundation; 2018 1437(d)(I)(4)(A)(Ii) (2019).
pubs/2019/06-13-Collateral-
65. Center for Substance Abuse Treatment. Consequences.pdf. Accessed July 1, 79. Housing Opportunity Program
Continuity of Offender Treatment for 2020 Extension Act of 1996, 42 USC x
Substance Use Disorders from 1437(d)(I)(6) (2019).
72. Wheelock D, Uggen C. Race, Poverty and
Institution to Community Treatment
Punishment: The Impact of Criminal 80. Thacher D. The rise of criminal
Improvement Protocol (TIP) Series 30.
Sanctions on Racial, Ethnic, and background screening in rental
Rockville, MD: Substance Abuse and
Socioeconomic Inequality: Why Racial housing. Law Soc Inq. 2008;33(1):5–30
Mental Health Services Administration;
and Ethnic Disparities Persist. In: Lin AC,
2004 81. Personal Responsibility and Work
Harris DR, eds. The Colors of Poverty:
66. Knight K, Farabee D, eds.. Treating Why Racial and Ethnic Disparities Opportunity Reconciliation Act of 1996,
Addicted Offenders: A Continuum of Persist. New York, NY: Russell Sage; Pub L No 104–193, 110 Vol Stat (2105).
Effective Practices. Kingston, NJ: Civic 2008:261–292 82. Yang CS. Does public assistance reduce
Research Institute; 2004 73. Pager D. The mark of a criminal record. recidivism? Am Econ Rev. 2017;107(5):
67. Abrams LS, Franke TM. Postsecondary Am J Sociol. 2003;108(5):937–975 551–555
educational engagement among 74. United States Bureau of Labor 83. Uggen C, Stewart R. Piling on: collateral
formerly-incarcerated transition-age Statistics. Labor force statistics from consequences and community
young men. J Offender Rehabil. 2013; the current population survey. Annual supervision. Minnesota Law Review.
52(4):233–253 averages table 3. 2017. Available at: 2015;99(5):1871–1912
Downloaded from www.aappublications.org/news by guest on October 19, 2021
S258 PERKER and CHESTERThe Justice System and Young Adults With Substance Use Disorders
Selen Siringil Perker and Lael E. H. Chester
Pediatrics 2021;147;S249
DOI: 10.1542/peds.2020-023523H
Updated Information & including high resolution figures, can be found at:
Services http://pediatrics.aappublications.org/content/147/Supplement_2/S249
References This article cites 33 articles, 2 of which you can access for free at:
http://pediatrics.aappublications.org/content/147/Supplement_2/S249
#BIBL
Permissions & Licensing Information about reproducing this article in parts (figures, tables) or
in its entirety can be found online at:
http://www.aappublications.org/site/misc/Permissions.xhtml
Reprints Information about ordering reprints can be found online:
http://www.aappublications.org/site/misc/reprints.xhtml
Downloaded from www.aappublications.org/news by guest on October 19, 2021The Justice System and Young Adults With Substance Use Disorders
Selen Siringil Perker and Lael E. H. Chester
Pediatrics 2021;147;S249
DOI: 10.1542/peds.2020-023523H
The online version of this article, along with updated information and services, is
located on the World Wide Web at:
http://pediatrics.aappublications.org/content/147/Supplement_2/S249
Pediatrics is the official journal of the American Academy of Pediatrics. A monthly publication, it
has been published continuously since 1948. Pediatrics is owned, published, and trademarked by
the American Academy of Pediatrics, 345 Park Avenue, Itasca, Illinois, 60143. Copyright © 2021
by the American Academy of Pediatrics. All rights reserved. Print ISSN: 1073-0397.
Downloaded from www.aappublications.org/news by guest on October 19, 2021You can also read
