Comprehensive Residential Education, Arts, and Substance Abuse Treatment (Creasat)

• Author: Noemi Mai,Donnie W. Watson,Susie Tanamly,Lorrie Bisesi
• DOI: 10.1177/1541204003256312
• Published date: 01 October 2003
• Date: 01 October 2003
• Subject Matter: Journal Article

ARTICLE
10.1177/1541204003256312
Youth Violence and Juvenile Justice
Watson et al. / A MODEL TREATMENT PROGRAM FOR OFFENDERS
COMPREHENSIVE RESIDENTIAL
EDUCATION, ARTS, AND SUBSTANCE
ABUSE TREATMENT (CREASAT)
A Model Treatment Program
for Juvenile Offenders
Donnie W. Watson
Lorrie Bisesi
Susie Tanamly
Noemi Mai
UCLA Integrated Substance Abuse Programs
This article describes an alternative treatment model for adolescent substance abusers
confined to a residential juvenile correction facility. Substance abuse trends among
youth and the connection between substance use and juvenile delinquency are explored.
Essential components of effective adolescent substance abuse treatment programs are
outlined with particular attention to arts-based delinquency intervention programs.
Specifically, this article describes the program philosophy and program components of
a model treatment program for juvenile offenders—Comprehensive Residential
Education, Arts, and Substance Abuse Treatment (CREASAT). An integral piece of the
CREASAT program is The Matrix Institute addictions model for adolescent treatment,
which takes into account the developmental factors that initiate and/or maintain
substance use. This comprehensive model is based on social learning theory, cognitive
behavioral principles, and the adolescent’s environment and readiness for change.
Finally, the importance of cultural skills for substance abuse treatment professionals in
the juvenile justice system is discussed.
Keywords: youth drug treatment; arts programs; juvenile offenders; juvenile cor-
rectional treatment; model treatment programs
Substance use in the general population has consistently demonstrated a downtrend
since the 1980s (Johnston, O’Malley, & Backman, 1998). However, despite recent trends
that suggest a decrease in substance abuse among youth in this country, the prevalence of
drug abuse remains a significant problem in this population (U.S. Department of Health and
Human Services [DHHS], 2000; Office of National Drug Control Policy, 2001; Substance
Abuse and Mental Health Services Administration [SAMHSA], 1997). Even though
reported past-month illicit drug use for the age group 12 to 17 was down between 1997 and
1999, the rate increased among young adults 18 to 25 (DHHS, 2001). During 1999, one half
(51%) of the high school seniors surveyed reported using alcohol in the past month and
Youth Violence and Juvenile Justice, Vol. 1 No. 1, January 2003 388-401
DOI: 10.1177/1541204003256312
© 2003 Sage Publications
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Watson et al. / A MODEL TREATMENT PROGRAM FOR OFFENDERS
389
nearly one fourth (23%) reported marijuana use. Use of cigarettes, smokeless tobacco, and
other drugs accounted for nearly 35%, 8%, and approximately 5%, respectively (Johnston
et al., 2001). Recent surveys suggest that after 1 or 2 years of decline, overall drug use
among teens remained steady among 8th, 10th, and 12th graders; marijuana is the most
widely used illicit drug with annual prevalence rates in grades 8, 10, and 12 of 16%, 32%,
and 37%, respectively (Johnston et al., 2001).
Other evidence exists suggesting that illegal drug use among students has increased.
In this regard, for the first time in 4 years, illegal drug use among high school seniors
increased in the United States. More specifically, 41% of students said they had used at least
one illegal drug during the 2000-2001 school year—an increase from 40% the year before
and nearly the same as the rate in the 1996-1997 school year (National Parents’ Resource
Institute for Drug Education [PRIDE], 2001). Further, illicit drug use, alcohol experi-
mentation, and smoking are increasing among 12- and 13-year-olds with trends suggesting
younger people are experimenting with illicit drugs, alcohol, and ecstasy (Morgan, 2001).
The Centers for Disease Control and Prevention (CDC) (2000) reported that 72% of
all deaths among youth and young adults aged 10 to 24 result from only four causes: motor
vehicle crashes, other unintentional injuries, homicide, and suicide. The risk is greatly
increased by substance use. This report identified the following health behaviors as among
the leading contributors to mortality and morbidity: tobacco use, alcohol and other drug use,
and sexual behaviors that contribute to unintended pregnancy and sexually transmitted
diseases (STDs) including human immunodeficiency virus (HIV) infection. The CDC 2000
Youth Risk Behavior Surveillance System of school-based surveys conducted on a national
high school student population reported that risk behaviors of tobacco use, alcohol and
other drug use, and sexual behaviors all worsened from 1991 to 1999 (CDC, 1999).
Substance Use and Juvenile Delinquency
The problem of substance use is more pronounced among adolescents in contact with
the juvenile justice system. Recent survey results among juvenile arrestees provide
evidence of illegal drug use. For example, more than half of juvenile male arrestees tested
positive for at least one drug; marijuana was the most frequently detected drug (National
Institute of Justice, 1999). The trend toward marijuana use among youth arrestees increased
from 25% in 1991 to 62% in 1999; marijuana appears to have become the drug of choice
among those youths coming of age in the 1990s that tend to get in trouble with law
enforcement (National Institute of Justice, 1999). Health-related problems among youth in
alternative schools that have a great percentage of youths involved in the juvenile justice
system are also a major concern (CDC, 1999). This survey revealed that the prevalence of
most risk behaviors is higher among students attending alternative high schools compared
to regular high schools. For example, alternative school students were significantly more
likely to have smoked cigarettes, drunk alcohol, used marijuana, used cocaine, had more sex
partners, or had more sexual intercourse during the 3 months preceding the survey
(Grunbaum et al., 1999).
Research over the last 20 years has established a substantial correlation between
substance abuse and juvenile delinquency (Held, 1998). There are more than 350,000
juveniles on probation and in continuing care programs in the United States who have
substance abuse histories (75%-95%) but rarely receive appropriate treatment (Center for
Substance Abuse Treatment/Denver Juvenile Justice [CSAT/DJJ], 1999). Furthermore,
60% of the 1.7 million adjudicated youth in the United States each year experience some

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Youth Violence and Juvenile Justice
substance abuse-related problem (Robert Wood Johnson Foundation, 2001). Systematic
methods to assess the course and incidence of treatment across juvenile systems are in an
early stage. However, a 1997 survey of juvenile correction facilities suggested that only
36% offered some type of substance abuse intervention (SAMHSA, 1997). It is clear that,
although there is consensus that substance abuse problems exist among youth in the juvenile
justice system, there is a dearth of systematic assessment and intervention. In fact, surveys
of juvenile probation departments identified substance abuse intervention services as
among the most critical expansion needs (National Council of Juvenile Justice, 1999).
Consistent with national trends, the state of California has significant problems providing
drug treatment for youth offenders because there are far too many drug-involved juveniles
for available treatment slots (State of California, Department of Youth Authority, 1999). In
fact, this agency indicated that 60 to 75% of California Youth Authority wards have a
problem or are at risk of developing substance abuse problems. Several publications cite the
effectiveness of drug treatment in reducing drug use and decreasing criminal activity during
and after treatment (CSAT/DJJ, 1999; National Institute on Drug Abuse [NIDA], 1999).
Results from the National Evaluation Data Services (1997) showed that, among
adolescents ages 13 to 17, substance abuse treatment reduces illegal drug use and decreases
criminal activity. Treatment is cost-effective in reducing drug use and its associated health
and social cost. Treatment is less expensive than alternatives such as not treating addicts or
incarceration alone. There are various cost-effective models with a range of projected
savings. In this regard, according to conservative estimates, every $1 invested in an
addiction treatment program yields a return of between $4 to $7 in reduced drug-related
crime, criminal justice costs, and theft. When savings related to health care are included,
total savings can exceed costs by a ratio of 12 to 1 (NIDA, 1999). Thus, the issue is not
whether treatment works but what kind of treatment approach is effective and with what
types of individuals.
Essential Treatment Components
Howell and Decker’s review of the literature (1999) suggests that the relationships
between gangs, drugs, and violence probably fall into three categories. First, pharmaco-
logical effects of the drug on the user can induce violence. Second, the high cost of drug use
often impels the user to support continued drug use by committing violent crimes (e.g.,
robbery, assault). Third is the existence of system violence, which refers to protection or
expansion of drug territory. There are no easy answers to the complex problem of violence
related to drug use and other related factors. Howell and Decker suggested that the first step
is to assess the gang problem and the unique local characteristics.
It is imperative that treatment of substance abuse disorders in the United States be
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