Research on the efficacy of treatment programs for juvenile delinquents whether focused on reducing criminal activity, substance abuse, or both is still a relatively new endeavor.

Prior to discussing outcome evaluations of various forms of treatment, predictors of treatment outcome, and instrumentation issues, it is important that the reader be aware of several methodological issues relevant to research on adolescent chemical dependence treatment.

First, as mentioned previously, no distinction between use, abuse and dependency of alcohol or drug use is made in the majority of research studies. When a distinction is made, it is typically not based on results from a structured clinical interview. The severity of drug or alcohol use can have a profound effect on the evaluation of program efficacy. If program A is treating individuals who are chemically dependent and has poorer overall outcomes compared to program B which treats primarily adolescents who are substance users or abusers, but not substance dependent, it cannot truly be said that program A is less effective than program B. Furthermore, there is no consensus as to what constitutes 'substance abuse' in adolescents (e.g., any use, any regular use, use that causes problems). Attempts to formalize this distinction using criteria from the Diagnostic and Statistical Manual of Mental Disorders -Fourth Edition (DSM-IV; American Psychiatric Association, 1994) are becoming more common. However, this distinction is generally not accomplished using reliable structured clinical interviews. More frequently diagnoses are based on unstructured clinical interviews.

Second, most studies lack an appropriate control group and seldom use randomization procedures when comparing treatment conditions. Use of random assignment is not always possible, however, and in some cases means withholding treatment which is not an acceptable procedure. Use of an appropriate comparison group is usually possible. Without appropriate comparison groups it can be difficult to assess whether treatment outcomes are the result of components of treatment or are due to a normal progression of behaviors such as maturation (Brown, 1993).

Third, the majority of research studies lack measures of treatment fidelity. Without such a measure it is difficult to determine what services were actually provided to the adolescent compared to those that were contracted to be provided. In turn it then becomes difficult to ascertain what specific elements of treatment are most beneficial.

Fourth, there is no consensus as to which are the most appropriate instruments to use in evaluation of adolescent problems and treatment outcomes in general. The reliability and validity of most instruments for adolescents have not been established with juvenile offenders specifically. The majority of studies with information on the reliability and validity of instruments included mainly Caucasian, high school students. It can not be assumed that these instrument will also be reliable with juvenile delinquents.

Fifth, there is no set of consistently used guidelines for making treatment placement decisions. This creates difficulties when attempting to determine program efficacy since similar programs may in fact be treating quite different adolescents (e.g. one program excludes violent chronic offenders, the next program will include such adolescents).

Sixth, treatment dropout rates are often as high as 50%. Measurement of treatment effectiveness and outcome can be biased by differential dropout rates if there are significant differences between those who did and did not complete the treatment program.

Seventh, follow-up rates of treated individuals are frequently well below 80% in outcome studies. Lasting effects from treatment can not be determined unless the majority of treated individual can be asked about their post-treatment functioning. Individuals who are not available for follow-up may or may not have more problems than those who can be reached for follow-up; low follow-up rates can, therefore, substantially bias outcome results.

Eighth, although there is a consensus that there are multiple determinants of substance use and delinquency, most research studies focus on only one or two risk factors.

Finally, only a few studies have evaluated gender and racial differences in the etiology and treatment of juvenile delinquency and substance abuse. Furthermore, the majority of studies have focused on predominately Caucasian populations.

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