Principles of Criminal Justice System Reform for Young Adults with Substance Use Disorder
We need to address the lack of developmentally appropriate addiction treatment services and the trauma of spending time in adult prisons.
illustration of criminal justice reform for young adults with substance use disorder
Taryn Johnson

Our current criminal justice system ignores a key scientific truth: Developmentally, young adults ages 18 to 25 are more likely than older adults to engage in risk-taking behaviors and less likely to be motivated by long-term consequences — two factors that put them at greater risk of both substance use and incarceration.

Most young or “emerging” adults grow out of this risk-taking stage and go on to become healthy adults. But that progress can be interrupted when they get caught up in the criminal justice system. In most states, an 18-year-old is treated no differently than someone decades older when they break the law.

The lack of developmentally appropriate treatment and services, together with the trauma of spending time in adult jails and prisons, can make it harder for young people to overcome substance use disorders (SUD), says Selen Siringil Perker, senior researcher with the Emerging Adult Justice Project at the Columbia University Justice Lab. Even after release, past involvement in the criminal justice system can make it more difficult to secure stable housing and employment, which creates serious obstacles for a sustained recovery from addiction. And these issues disproportionately affect youth of color, she notes.

“The greatest racial disparity in the criminal legal system is seen among emerging adults,” Perker says. “Young people of color are more likely to be criminalized for substance use disorders and then put in a system that’s in no way designed to promote their recovery.”

"Young people of color are more likely to be criminalized for substance use disorders and then put in a system that’s in no way designed to promote their recovery." Click To Tweet

The need for better harm reduction and developmentally appropriate treatment has led to new principles of criminal justice reform for young adults with SUD, as published in a recent supplement in Pediatrics. The paper, "The Justice System and Young Adults with Substance Use Disorders," is the result of an interdisciplinary convening by the Grayken Center for Addiction at Boston Medical Center, and lead author Perker shares four key principles.

1. To the extent possible, young adults with substance use disorders should be diverted from the criminal justice system to effective clinical care.

Drug charges are a common entry point to the criminal legal system for young adults, accounting for 22% of all arrests for 18- to 20-year-olds. And SUD is extremely common in jails and prisons, with one study finding that 85% of all incarcerated people are substance-involved.

Most young adults should still receive care for SUDs under a pediatric model, Perker says, but they’re unlikely to receive it in adult jails and prisons.

“Healthcare professionals recognize the unique developmental needs at this life stage. Our legal system does not,” she says. “That decreases the chances that young people with substance use disorders who are caught up in the criminal legal system will move into recovery.”

While diversion programs that deflect individuals away from the formal justice system into community services are rare, those that do exist for all ages have had promising preliminary results. In a joint project, the nonprofit Police Assisted Addiction & Recovery Initiative (PAARI) and the Gloucester Police Department’s Angel Program in Gloucester, Massachusetts implemented a pre-arrest diversion program that connected individuals who used opioids to community-based treatment and other services in lieu of the criminal justice system cycle. Since it started in 2015, the project has seen a 25% reduction in crimes associated with addiction in some communities.

"Healthcare professionals recognize the unique developmental needs at this life stage. Our legal system does not." Click To Tweet

“As a first measure, we must reduce our reliance on the criminal legal system and prioritize effective, community-based treatment,” Perker says.

2. Young adults who have substance use disorders and are subject to the criminal justice system should have access to the full range of developmentally appropriate, high-quality addiction treatment modalities, particularly during incarceration and reentry processes.

If a young person breaks the law just one day after they turn 18, they’ll automatically be sentenced as an adult and treated in the adult system in every state except Vermont.  But people in their late teens and early 20s are still best served by addiction treatment programs designed around the needs of adolescents and tailored to their distinct developmental needs, the authors say.

Addiction services in prison are already poor. Only about 10% of incarcerated people have access to treatment at all. But, even if treatment is available, it’s often insufficient, with few programs providing a full range of medications approved for addiction management. Against this backdrop, addiction services for incarcerated young adults are even more limited.

“Youth justice systems designed for people under 18 are much more likely to offer developmentally appropriate care for emerging adults than the adult systems, which create barriers to their recovery and desistance from crime,” Perker says.

3. The justice system should provide resources dedicated to supporting the safe transition of emerging adults from a period of incarceration back to their communities.

The authors emphasize that adult prisons can be traumatic places for young adults, making the period during and after transition back to the community especially risky. As a result, recidivism is common for this age group. Of the estimated 170,000 young adults incarcerated in adult correctional facilities on any given day, 3 out of 4 will be rearrested within three years of their release.

Young people are also at especially high risk for negative health outcomes during this transition period. Drug overdose is the leading cause of death for people who have been released from prison, and emerging adults are the most likely age group to fatally overdose immediately after release. Overall, the risk of opioid-related death after being released from prison is 10 times higher for an emerging adult than for an adult over age 45.

However, these negative outcomes can be reduced by pre-release planning and providing a continuum of developmentally appropriate care after release, the authors say.

4. The justice system must reduce the harm caused by criminal records that create insurmountable barriers to young adults’ full and healthy community engagement and their sustained recovery from SUDs.

Even a simple interaction with the justice system, like an arrest, can have negative effects on a young person’s life. A conviction can interfere with their ability to find housing, enroll in college, obtain meaningful employment, and make other steps to become stable in society. All of this makes it harder to recover from addiction.

These challenges are worse for men of color. For example, one study found that a felony conviction reduced the positive callback rate for Black male job applicants by two-thirds, compared to a 50% reduction for white men.

But change may be on the way. Vermont became the first state to raise the upper age of juvenile court above 18 when it passed a law in 2018 that would gradually raise the age to 20. Now, several other states are considering legislation that would do the same. It’s the type of systemic reform that could significantly reduce negative impacts on young people touched by the criminal legal system, Perker says, who adds that other changes, such as offering deferred adjudication and expungement of criminal records for young adults who complete their sentences, could pave the way for emerging adults’ access to essential supports and resources.

“The COVID-19 pandemic is amplifying the negative impacts of criminal legal system on young adults and deepening inequities” adds Perker. “There is an unprecedented level of urgency. Young people would be healthier and our communities would be safer if we did not arbitrarily set the age of adult criminal court at one’s 18th birthday.”