title: Does Mandated Treatment Benefit Youth? A Prospective Investigation of Adolescent Justice System Involvement, Treatment Motivation, and Substance Use Outcomes.
abstract: BACKGROUND
  The majority of adolescents treated for substance use disorder (SUD) in the United States are now referred by the criminal justice system. Little is known, however, regarding how justice-system involvement relates to adolescent community treatment outcomes. Controversy exists, also, over the extent to which justice system involvement reflects a lack of intrinsic motivation for treatment. This study examined the relation between justice system referral and reported reason for treatment entry and tested the extent to which each predicted treatment response and outcome.
  
  
  METHODS
  Adolescent outpatients (N= 127;Mage = 16.7, 24% female) with varying levels of justice-system involvement (i.e., no justice system involvement [No-JSI;n= 63], justice-system involved [JSI;n= 40], justice system involved-mandated [JSI-M;n= 24]) and motivation levels (i.e., self-motivated [n= 40], externally-motivated [n= 87]) were compared at treatment intake. Multilevel mixed models tested these groups' effects on percent days abstinent (PDA) and odds of heavy drinking (HD) over 12 months.
  
  
  RESULTS
  JSI-M were less likely to be self-motivated compared to No-JSI or JSI (p =0.009). JSI-M had higher PDA overall, but with significant declines over time, relative to no-JSI. Self-motivated patients did not differ from externally-motivated patients on PDA or HD.
  
  
  CONCLUSIONS
  Mandated adolescent outpatients were substantially less likely to report self-motivated treatment entry. Despite the notion that self-motivated treatment entry would be likely to produce better outcomes, a judicial mandate appears to predict an initially stronger treatment response, although this diminishes over time. Ongoing monitoring and/or treatment may be necessary to help maintain treatment gains for justice system-involved adolescents.
authors.affiliation: Massachusetts General Hospital, Center for Addiction Medicine, Department of Psychiatry, and Harvard Medical School, Boston, MA 02114.
authors.forename: Julie D
authors.initials: JD
authors.lastname: Yeterian
authors.forename: M Claire
authors.initials: MC
authors.lastname: Greene
authors.forename: Brandon G
authors.initials: BG
authors.lastname: Bergman
authors.forename: John F
authors.initials: JF
authors.lastname: Kelly
keywords: adolescent; justice system; mandated treatment; motivation; substance use disorder; treatment