Juvenile Drug Court: Enhancing Outcomes by Integrating
Scott W. Henggeler, Colleen A. Halliday-Boykins, Phillippe B. Cunningham, Jeff Randall, Steven B. Shapiro,
and Jason E. Chapman
Medical University of South Carolina
Evaluated the effectiveness of juvenile drug court for 161 juvenile offenders meeting diagnostic criteria
for substance abuse or dependence and determined whether the integration of evidence-based practices
enhanced the outcomes of juvenile drug court. Over a 1-year period, a four-condition randomized design
evaluated outcomes for family court with usual community services, drug court with usual community
services, drug court with multisystemic therapy, and drug court with multisystemic therapy enhanced
with contingency management for adolescent substance use, criminal behavior, symptomatology, and
days in out-of-home placement. In general, findings supported the view that drug court was more
effective than family court services in decreasing rates of adolescent substance use and criminal behavior.
Possibly due to the greatly increased surveillance of youths in drug court, however, these relative
reductions in antisocial behavior did not translate to corresponding decreases in rearrest or incarceration.
In addition, findings supported the view that the use of evidence-based treatments within the drug court
context improved youth substance-related outcomes. Clinical and policy implications of these findings
Keywords: juvenile drug court, multisystemic therapy, contingency management, delinquency, substance
Drug- and alcohol-abusing and dependent delinquents represent
a large and greatly underserved population that is at high risk of
presenting significant deleterious outcomes and long-term costs
for themselves, their families and communities, and society
(Belenko & Dembo, 2003). As described by recent reviewers
(Belenko & Logan, 2003; Cooper, 2002), juvenile drug courts
began emerging in the 1980s to address these problems, and 268
juvenile drug courts were in operation in December 2003
(Huddleston, Freeman-Wilson, & Boone, 2004). Although juve-
nile drug courts have continued to proliferate, evaluation of their
capacity to reduce offender substance use and criminal activity has
lagged. Indeed, only one modest (N ? 40) randomized trial of a
juvenile drug court has been completed, and that study is unpub-
lished (Dickie, 2000). The purpose of this article is to describe key
1-year outcomes from a randomized trial of juvenile drug court
that included four treatment conditions and addressed two impor-
tant gaps in the extant literature on juvenile drug courts.
The first gap pertains to the effectiveness of juvenile drug court,
per se. Although the effectiveness of juvenile drug courts has
received little empirical attention, several factors suggest that such
courts might be more effective than traditional justice services at
reducing adolescent substance use. First, the related literature on
adult drug courts (Belenko, 2001) suggests that close collaboration
of criminal justice professionals and alcohol and drug treatment
providers under a drug court rubric increases retention in treat-
ment, provides closer and more comprehensive supervision, re-
duces substance use, and produces short-term cost savings. Sec-
ond, the treatment services promoted by at least some juvenile
drug courts (see, e.g., Parnham & Wright, 1998) are intended to
address an array of the correlates of adolescent substance abuse at
the individual (e.g., development of drug refusal skills), family
(e.g., improving parental discipline), school (e.g., enhancing
school performance), and community (e.g., involvement in proso-
cial activities) levels. Addressing the known determinants of clin-
ical problems comprehensively likely increases the probability of
Scott W. Henggeler, Colleen A. Halliday-Boykins, Phillippe B. Cun-
ningham, Jeff Randall, Steven B. Shapiro, and Jason E. Chapman, Family
Services Research Center, Department of Psychiatry and Behavioral Sci-
ences, Medical University of South Carolina.
Scott W. Henggeler is a board member and stockholder of MST Ser-
vices, LLC, the Medical University of South Carolina-licensed organiza-
tion that provides training in multisystemic therapy.
This article was supported by Grants R01AA122202 from the National
Institute on Alcoholism and Alcohol Abuse and Substance Abuse and
Mental Health Services Administration/Center for Substance Abuse Treat-
ment, R01ZDA from the National Institute on Drug Abuse, and
P01HS10871 from the Agency for Healthcare Research & Quality.
We sincerely thank the clinical and research teams, including Anita
Gordon, Darlene Hines, Marcella Hamilton, Jennifer Turner, Jacqueline
Conyers, Shanta Barron, Jennifer Powers, Michael Alexander, and Lynn
West. We also thank professionals at the Charleston County Juvenile Drug
Court—Judge Charlie Segars Andrews, Judge Joyclin Cates, and Drug
Court Coordinator Julius Scott. Finally, we thank the Charleston office of
the South Carolina Department of Juvenile Justice, former Director Diana
Vaughan, and current Director Ashley Standafer for their support in facil-
itating the success of this project.
Correspondence concerning this article should be addressed to Scott W.
Henggeler, Family Services Research Center, Department of Psychiatry
and Behavioral Sciences, Medical University of South Carolina, 67 Pres-
ident Street, Suite CPP, P.O. Box 250861, Charleston, South Carolina,
29425. E-mail: firstname.lastname@example.org
Journal of Consulting and Clinical Psychology
2006, Vol. 74, No. 1, 42–54
Copyright 2006 by the American Psychological Association
attaining favorable outcomes. Third, several of the defining char-
acteristics of drug courts (Belenko, 2001; National Association of
Drug Court Professionals, Drug Court Standards Committee,
1997) are consistent with well-documented principles of behavior
change. For example, adolescent drug use is monitored closely
through frequent urine screens and sets of sanctions, and rewards
are applied by the judge consistently and swiftly based on the
results of the screens. Such monitoring and consistent application
of consequences might decrease juvenile drug use, regardless of
any treatment interventions conducted outside the court. This
possibility is addressed by including drug court with community
services (DC) and usual family court with community services
(FC) as two of the four intervention conditions.
The second gap addresses an area that has been largely ne-
glected in the drug court literature—the integration of evidence-
based clinical services into the treatment protocols for youths in
drug court (Belenko & Logan, 2003). As currently configured,
judges and court personnel generally assume that alcohol and drug
treatment available in the community is effective. Yet, as noted by
the Institute of Medicine (1998) and leading policy analysts (e.g.,
McLellan, Carise, & Kleber, 2003), evidence-based substance
abuse treatments are rarely used in community substance abuse
practice. Hence, this study also examined the effects of incorpo-
rating a well-validated family- and community-based treatment as
the community intervention component of the drug court process.
Specifically, drug court with multisystemic therapy (DC/MST;
Henggeler, Schoenwald, Borduin, Rowland, & Cunningham,
1998) was included as the third treatment condition. MST is one of
the few adolescent treatments cited by the National Institute on
Drug Abuse (NIDA; 1999) as evidence based and has achieved
favorable long-term reductions in drug use and criminal behavior
among substance using and abusing juvenile offenders (Henggeler,
Clingempeel, Brondino, & Pickrel, 2002; Schaeffer & Borduin,
2005). Thus, the third treatment condition integrated MST into
juvenile drug court to determine whether drug court outcomes
would be enhanced.
Finally, a third aim of this study was to evaluate whether the
integration of contingency management (CM; Petry, 2000) into the
more ecologically oriented MST treatment protocol would im-
prove substance use outcomes for MST. Although MST substance-
related outcomes with substance abusing juvenile offenders have
been generally favorable (Henggeler, Pickrel, & Brondino, 1999),
the bulk of MST therapeutic efforts have emphasized change in
youths’ family, peer, and school relations that were associated with
substance use, rather than focusing on the substance use, per se.
Perhaps alcohol and drug outcomes for MST would be enhanced if
substance use behavior was a specific and intensive focus of this
family intervention model. An examination of the outcome liter-
ature in the area of adolescent substance abuse (e.g., Liddle &
Dakof, 1995; Waldron, 1997) combined with knowledge gained
from the corresponding adult literature (e.g., Institute of Medicine,
1998; NIDA, 1999) suggests that a behavior therapy approach that
includes close monitoring of substance use can be reasonably
regarded as effective. Budney and Higgins (1998), for example,
developed an effective (NIDA, 1999) behavioral treatment proto-
col for adult drug abusers that includes a voucher system linked
with results from frequent urine analyses, functional analysis of
drug use, and development of drug refusal skills. A variation of
this approach developed by Donohue and Azrin (2001), CM, has
produced promising results for adolescents. Drug court with MST
enhanced with CM (DC/MST/CM), consequently, represented the
fourth treatment condition.
In summary, this study used a randomized design with intent-
to-treat analyses to evaluate key 1-year outcomes for substance
use, criminal behavior, incarceration, and symptomatology for 161
substance-abusing and dependent juvenile offenders assigned to
one of four treatment conditions (FC, DC, DC/MST, or DC/MST/
CM). In general, primary aims were to determine whether (a)
juvenile drug court improved outcomes in comparison with family
court, (b) integrating evidence-based interventions into juvenile
drug court improved juvenile drug court outcomes, and (c) inte-
grating CM into MST enhanced standard MST outcomes for
Design and Procedures
A 4 (treatment type: FC, DC, DC/MST, DC/MST/CM) ? 3 (time:
pretreatment, 4 months, 12 months) factorial design, with random assign-
ment of youths and families to treatment conditions, was used. Henggeler
and Randall (2000) discussed strategies used to gain the collaboration of
juvenile justice stakeholders in conducting randomized trials. Assessments
were conducted with each youth and his or her caregiver at three points in
time: within 72 hours of recruitment into the study (pretreatment; T1); 4
months postrecruitment (T2), corresponding to the average end of MST
treatment; and 12 months postrecruitment (T3), corresponding to the av-
erage end of drug court. Research assistants administered the assessment
battery to families in their homes or in detention facilities, for youths in
juvenile justice custody. Families were paid $75 for each completed
assessment as compensation for their time.
Participants were one hundred sixty-one 12- to 17-year-old adolescents
recruited from the Department of Juvenile Justice (DJJ) in Charleston
County, South Carolina who met Diagnostic and Statistical Manual of
Mental Disorders (4th ed.; DSM–IV; American Psychiatric Association,
1994) diagnostic criteria for alcohol or drug abuse or dependence. Inclu-
sion criteria were (a) age of 12–17 years, (b) diagnosis of psychoactive
substance abuse or dependence, (c) formal or informal probationary status,
(d) residence in Charleston County, and (e) residence with at least one
parent figure. Adolescents were excluded if they were already formally
involved in substance abuse treatment or if a family member had already
received MST treatment. To enhance the external validity of findings, no
youths were excluded based on preexisting mental health, physical health,
or intellectual difficulties.
Recruitment and Randomization
All cases entering the DJJ as new referrals or repeat offenders from
January 2000 to June 2003 (N ? 2,123) were screened by probation staff
for possible alcohol or drug abuse. If substance abuse was suspected, and
the youth and family met the other inclusion criteria, the Structured
Clinical Interview for DSM–IV (First, Spitzer, Gibbon, & Williams, 2001)
was administered to both the caregiver and the youth. All inclusion criteria
were met by 165 youths and their families. These families were recruited
for study participation by a researcher who obtained informed consent and
assent and opened a sealed envelope that informed the family of the
condition to which they were assigned. One hundred sixty-one families
agreed to participate (98% recruitment rate). All forms and consent pro-
JUVENILE DRUG COURT OUTCOMES
realized within such a context, in spite of the best efforts of the
MST therapists. Fourth, although not statistically significant, the
substance-related findings, along with anecdotal reports from the
MST/CM therapists and supervisor, suggest that the integration of
CM into the more ecologically oriented MST treatment protocol
(DC/MST/CM) was a valuable addition.
Several limitations should be noted. First, implementation of the
guiding principles for juvenile drug courts likely varies from site to
site. Hence, the generalization (external validity) of the favorable
juvenile drug court findings to other juvenile drug courts cannot be
assumed. Second, the timing of the assessments might have fa-
vored certain treatment conditions. For example, the 4-month
assessment coincided with the approximate completion of MST.
The most favorable intervention effects for the MST conditions,
however, emerged at 12 months rather than at 4 months, which
argues against the outcomes being unfairly influenced by the
timing of the assessments in this case. A third and related concern,
however, is that the study did not include a follow-up. The 12-
month assessment coincided with the completion of drug court for
the youths in the three drug court conditions. Consequently, the
better performance on self-reported substance use for these drug
court youths in comparison with FC youths might have been due
to the fact that with a 12-month duration of drug court, the drug
court youths were continuing to be tested regularly for drugs.
Hence, the sustainability of the favorable drug court outcomes has
not been determined, and the timing of the 12-month assessment
might have favored the drug court conditions. Perhaps these out-
comes will attenuate as youths are no longer under drug court
supervision. It is also possible, however, that the drug court out-
comes for rearrest and incarceration will improve after intensive
surveillance of the youths has been removed. Fortunately, these
outcomes are being examined in a long-term (5-year) follow-up of
the youths and families participating in this project. Fourth, the
present study was part efficacy trial (e.g., therapists employed by
the research center, excellent supervision) and part effectiveness
trial (e.g., minimal exclusion criteria, implementation in commu-
nity settings). As such, one cannot assume that the favorable
results for DC/MST and DC/MST/CM will easily transport to
other community-based settings (Henggeler, 2004). Fifth, although
RMANOVA, followed by a multistep process, provided some
control for Type I error, more conservative procedures were not
used in light of the early stage of research in this area. Thus, Type
I error is likely inflated. Sixth, resources were not available to
conduct frequent drug urine screens for youths in the FC condition.
Hence, the corresponding outcomes for the FC youths could not be
compared with those of the youths in the drug court conditions.
The aforementioned 5-year follow-up study, however, is collecting
biological indices of substance use for youths across all the treat-
Achenbach, T. M. (1990). Manual for the Youth Self-Report and 1991
Profile. Burlington: University of Vermont, Department of Psychiatry.
Achenbach, T. M. (1991). Manual for the Child Behavior Checklist and
1991 Profile. Burlington: University of Vermont, Department of
Altschuler, D. M., Armstrong, T. L., & MacKenzie, D. L. (1999). Reinte-
gration, supervised release, and intensive aftercare. In S. Bilchik (Ad-
ministrator), Juvenile justice bulletin (July, pp. 1–23) Washington, DC:
Office of Juvenile Justice and Delinquency Prevention.
American Psychiatric Association. (1994). Diagnostic and statistical man-
ual of mental disorders (4th ed.). Washington, DC: Author.
Belenko, S. (2001). Research on drug courts: A critical review 2001
update. New York: The National Center on Addiction and Substance
Abuse, Columbia University.
Belenko, S., & Dembo, R. (2003). Treating adolescent substance abuse
problems in the juvenile drug court. International Journal of Law and
Psychiatry, 26, 87–110.
Belenko, S., & Logan, T. K. (2003). Delivering more effective treatment to
adolescents: Improving the juvenile drug court model. Journal of Sub-
stance Abuse Treatment, 25, 189–211.
Budney, A. J., & Higgins, S. T. (1998). A community reinforcement plus
vouchers approach: Treating cocaine addiction (NIH Publication No.
98–4309). Rockville, MD: National Institute on Drug Abuse.
Cooper, C. S. (2002). Juvenile drug treatment courts in the United States:
Initial lessons learned and issues being addressed. Substance Use &
Misuse, 37, 1689–1722.
Cunningham, P. B., Donohue, B., Randall, J., Swenson, C. C., Rowland,
M. D., Henggeler, S. W., & Schoenwald, S. K. (2003). Integrating
contingency management into multisystemic therapy. Charleston: Med-
ical University of South Carolina, Family Services Research Center.
Curtis, N. M., Ronan, K. R., & Borduin, C. M. (2004). Multisystemic
treatment: A meta-analysis of outcome studies. Journal of Family Psy-
chology, 18, 411–419.
Dickie, J. (2000). Summit County Juvenile Court Drug Court evaluation
report: July 1, 1999–June 30, 2000. Akron, OH: University of Akron,
Institute for Health and Social Policy.
Donohue, B., & Azrin, N. H. (2001). Family behavior therapy. In E. F.
Wagner and H. B. Waldron (Eds.). Innovations in adolescent substance
abuse (pp. 205–228). New York: Pergamon Press.
Elliott, D. S., Ageton, S. S., Huizinga, D., Knowles, B. A., & Canter, R. J.
(1983). The prevalence and incidence of delinquent behavior: 1976–80
(Report of the National Youth Survey, Project Rep. No. 26). Boulder,
CO: Behavioral Research Institute.
First, M. B. Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (2001).
Structured Clinical Interview for DSM–IV–TR Axis I Disorders, re-
search version, patient edition (SCID-I/P). New York: New York State
Psychiatric Institute, Biometrics Research.
Henggeler, S. W. (1989). Delinquency in adolescence. Newbury Park, CA:
Henggeler, S. W. (2004). Decreasing effect sizes for effectiveness studies:
Implications for the transport of evidence-based treatments: Comment
on Curtis, Ronan, and Borduin (2004). Journal of Family Psychol-
ogy, 18, 420–423.
Henggeler, S. W., & Borduin, C. M. (1992). Multisystemic Therapy
Adherence Scales. Unpublished instrument, Medical University of
South Carolina, Department of Psychiatry and Behavioral Sciences,
Henggeler, S. W., Clingempeel, W. G., Brondino, M. J., & Pickrel, S. G.
(2002). Four-year follow-up of multisystemic therapy with substance
abusing and dependent juvenile offenders. Journal of the American
Academy of Child & Adolescent Psychiatry, 41, 868–874.
Henggeler, S. W., Melton, G. B., Brondino, M. J., Scherer, D. G., &
Hanley, J. H. (1997). Multisystemic therapy with violent and chronic
juvenile offenders and their families: The role of treatment fidelity in
successful dissemination. Journal of Consulting and Clinical Psychol-
ogy, 65, 821–833.
Henggeler, S. W., Pickrel, S. G., & Brondino, M. J. (1999). Multisystemic
treatment of substance abusing and dependent delinquents: Outcomes,
JUVENILE DRUG COURT OUTCOMES
treatment fidelity, and transportability. Mental Health Services Re-
search, 1, 171–184.
Henggeler, S. W., Pickrel, S. G., Brondino, M. J., Ward, D. M., &
Rowland, M. D. (1997). Service Utilization Tracking Form II. Charles-
ton: Medical University of South Carolina, Family Services Research
Henggeler, S. W., & Randall, J. (2000). Conducting randomized treatment
studies in real world settings. In D. Drotar (Ed.), Handbook of research
in pediatric and clinical child psychology (pp. 447–461). New York:
Kluwer Academic/Plenum Press.
Henggeler, S. W., Rowland, M. D., Halliday-Boykins, C., Sheidow, A. J.,
Ward, D. M., Randall, J., et al. (2003). One-year follow-up of multisys-
temic therapy as an alternative to the hospitalization of youths in
psychiatric crisis. Journal of the American Academy of Child & Ado-
lescent Psychiatry, 42, 543–551.
Henggeler, S. W., & Schoenwald, S. K. (1998). The MST supervisory
manual: Promoting quality assurance at the clinical level. Charleston,
SC: MST Institute.
Henggeler, S. W., Schoenwald, S. K., Borduin, C. M., Rowland, M. D., &
Cunningham, P. B. (1998). Multisystemic treatment of antisocial behav-
ior in children and adolescents. New York: Guilford Press.
Howell, J. C. (2003). Preventing & reducing juvenile delinquency: A
comprehensive framework. Thousand Oaks, CA: Sage.
Huddleston, C. W., Freeman-Wilson, K., & Boone, D. L. (2004). Painting
the current picture: A national report card on drug courts and other
problem solving court programs in the United States. Alexandria, VA:
National Drug Court Institute.
Huey, S. J., Henggeler, S. W., Brondino, M. J., & Pickrel, S. G. (2000).
Mechanisms of change in multisystemic therapy: Reducing delinquent
behavior through therapist adherence and improved family and peer
functioning. Journal of Consulting and Clinical Psychology, 68, 451–
Institute of Medicine (1998). Bridging the gap between practice and
research: Forging partnerships with community-based drug and alcohol
treatment. Washington, DC: National Academy Press.
Land, K. C., McCall, P. L., & Williams, J. R. (1990). Something that works
in juvenile justice: An evaluation of the North Carolina court counselors’
intensive protective supervision randomized experiment project, 1987–
1989. Evaluation Review, 14, 574–606.
Liddle, H. A., & Dakof, G. A. (1995). Efficacy of family therapy for drug
abuse: Promising but not definitive. Journal of Marital and Family
Therapy, 21, 511–543.
McLellan, A. T., Carise, D., & Kleber, H. D. (2003). Can the national
addiction treatment infrastructure support the public’s demand for qual-
ity care? Journal of Substance Abuse Treatment, 25, 117–121.
Miller, W. R. (1991). Form 90: Structured Assessment for Drinking and
Related Behaviors. Washington, DC: National Institute on Alcohol
Abuse and Alcoholism.
Morris, S. B., & DeShon, R. P. (2002). Combining effect size estimates in
meta-analysis with repeated measures and independent-groups designs.
Psychological Methods, 7, 105–125.
National Association of Drug Court Professionals, Drug Court Standards
Committee. (1997). Defining drug courts: The key components. Wash-
ington, DC: U.S. Department of Justice, Office of Justice Programs,
Drug Courts Program Office.
National Institute on Drug Abuse. (1999). Principles of drug addiction
treatment: A research-based guide (NIH Publication No. 99–4180).
Washington, DC: Author.
Parnham, J., & Wright, R. (1998). Escambia County family-focused juve-
nile drug court. Pensacola, FL: Escambia County Juvenile Court.
Petry, N. M. (2000). A comprehensive guide to the application of contin-
gency management procedures in clinical settings. Drug and Alcohol
Dependence, 58, 9–25.
Schaeffer, C. M., & Borduin, C. M. (2005). Long-term follow-up to a
randomized clinical trial of multisystemic therapy with serious and
violent juvenile offenders. Journal of Consulting and Clinical Psychol-
ogy, 73, 445–453
Schoenwald, S. K., Sheidow, A. J., Letourneau, E. J., & Liao, J. G. (2003).
Transportability of multisystemic therapy: Evidence for multilevel in-
fluences. Mental Health Services Research, 5, 223–239.
U.S. Public Health Service. (2001). Youth violence: A report of the Sur-
geon General. Washington, DC: Author.
Waldron, H. B. (1997). Adolescent substance abuse and family therapy
outcome: A review of randomized trials. Advances in Clinical Child
Psychology, 19, 199–234.
Waldron, H. G., Slesnick, N., Turner, C. W., Brody, J. L., & Peterson, T. R.
(2001). Treatment outcomes for adolescent substance abuse at 4- and
7-month assessments. Journal of Consulting and Clinical Psychol-
ogy, 69, 802–813.
Weersing, V. R., & Weisz, J. R. (2002). Community clinic treatment of
depressed youth: Benchmarking usual care against CBT clinical trials.
Journal of Consulting and Clinical Psychology, 70, 299–310.
Received February 7, 2005
Revision received June 15, 2005
Accepted June 22, 2005 ?
HENGGELER ET AL.