This article proposes a systemic reform of the organizational structure and delivery of substance abuse services for adolescents within the juvenile justice system. It first discusses the impact of substance use on the juvenile justice system and then reviews which drug treatment programs and services are currently available. Following an evaluation of the most effective drug treatment programs and modalities, recommendations for system reform are given. The recommendations are based on a graduated sanctions framework, supported by systems collaboration and comprehensive case management. Systems collaboration between service providers must exist for juveniles to receive appropriate and comprehensive services. Case managers (CMs) both assess juveniles and help them move through and between judicial, drug treatment, and social service systems. In this way, juveniles receive the most suitable and complete services a community can offer while remaining firmly under juvenile justice system supervision.
This exploratory study utilized a focus group methodology to explore tensions and barriers in HIV/AIDS prevention among African-American injection drug users. Participants discussed HIV infection risks, national/community HIV prevention effectiveness, prevention barriers, ideas on barrier removal, and the tensions which exist between users and the larger African-American community. Recognizing the inevitability of continued drug use for many injectors, participants requested basic harm-reduction supplies including condoms, needle exchange programs, additional drug user treatment services, and the use of culturally- and gender-matched peer-led prevention and treatment outreach. Preliminary recommendations are made for consideration in HIV/AIDS prevention among African-American IDUs.
This article assesses the impact of an HIV risk-reduction program on risky behaviors in a population of street cocaine users in Rio de Janeiro, Brazil. Pre- and postintervention data were collected, and changes in the frequency of drug use, sexual risk behaviors, and other life-situation variables were examined. Participation in the program was associated with a significant decrease in the average number of days of cocaine use and a significant increase in employment and income. Significant increases in condom use were also documented. The data suggest that this population of street cocaine users was capable of understanding the severity of AIDS as well as learning and applying specific risk-reduction techniques to their behavior. The results further demonstrate the feasibility of conducting street research among an at-risk population of cocaine users in Brazil and in other countries in which there is little tradition of research with out-of-treatment drug users.
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