CASE STUDY

Denise is a sixteen-year old 11th grade student who started using marijuana and drinking at fourteen and has used heroin regularly for the past six months. Denise stopped attending school in January and hangs out with her friends. She lives at home with her mother and younger brother, but comes and goes and often isn't seen by her mother for four or five days at a stretch. When Denise was fifteen, her mother, with the assistance of a school-based addiction treatment counselor, was able to get her enrolled in outpatient treatment to address her alcohol and marijuana use. Denise participated in the program and reduced her alcohol and marijuana use. The outpatient program diagnosed Denise with depression and mild anxiety, and she was prescribed medication. Denise seemed to be regaining her health, and she started high school classes in the fall. However, her mother began to notice troubling patterns of more serious drug use in November and was unable to get Denise to resume treatment at her outpatient program.

Denise's mother now wants to have her daughter assessed for enrollment in a residential treatment program. She is afraid of the people her daughter hangs out with and does not want her son to be influenced by his sister's friends and drug use. Denise recently had a scare about her heroin use when one of her friends suffered an overdose and barely survived. She agreed to go for an assessment at a residential program. The program agreed that Denise needed residential treatment and received authorization from the Medicaid managed care organization to provide services for a short length of stay. After three days in treatment, during which she was treated with suboxone to help her withdrawal, Denise began to resist care. She has decided to leave the program against medical advice and her mother's wishes.

Questions:

1. Does alcohol and drug use uniquely affect an adolescent's ability to make decisions about medical care for addiction; and, if so, should clinical and legal standards take this factor into consideration?

2. What if Denise had been arrested for drug possession with intent to distribute, placed in the juvenile justice system, and required to attend residential treatment. How should clinical care decisions and concepts of autonomy be addressed in the legal framework for juvenile justice drug treatment?