As a physician treating drug addiction here in Utah, I took note of the recent debate in our state Legislature over Senate Bill 127, addressing Utah’s “troubled youth” programs. Though my practice centers on addiction, it is impossible to separate addiction from other psychological and emotional difficulties, especially in younger patients, so I share these concerns.
Part of the legislative debate included a chorus of naysaying critics who allege systemic cruelty and abuse. Centers often use rewards, reprimands and the gain or loss of privileges to incentivize behavior change. Their critics find this abhorrent.
Behavioral health experts identified long ago that there are basically two ways of changing human behavior. The first is to intermittently reward positive behaviors; the second is to consistently impose consequences for negative behavior. The most effective methods involve a combination of the two. These troubled youths arrive at treatment with the expressed goal of changing their behaviors. Handcuffing treatment centers by forbidding them to impose consequences for negative behaviors severely limits their ability to effect the necessary changes.
I don’t believe that critics trouble themselves with the pain of the parents and siblings of these highly troubled teens, nor do they realistically consider the dismal future that will await many of them absent intervention. There is a question we often use as a tool in drug treatment. We suggest to addicts that before they use their drug of choice again, they ask themselves, “And then what?” What happens after that next hit?
The same question applies here. Let’s say we heed the critics and eliminate any “harsh” rewards and punishments in the therapeutic setting. And then what? Let’s say we criminalize the ability to subdue students who — in violent fits of anger — can pose a very real threat to harm themselves and/or others. And then what? Let’s say we abolish all schools and programs for troubled youth here in Utah and elsewhere. And then what?
SB127 did pass and includes many worthwhile elements. On one hand, consistency in therapeutic and discipline standards for such facilities is good. Requiring more frequent site inspections is positive. No responsible professional advocates for painful or abusive disciplinary tactics. On the other, excessively dictating how professionals perform their work is a tricky matter.
I am aware of a program in southern Utah that specializes in treating troubled young women coming from various state foster care systems. Many have been rejected by numerous home state institutions before authorities refer them to this Utah facility. These girls have been deeply traumatized by abandonment, poverty, abuse and worse. As a professional myself, I can scarcely imagine the caring and skill it must take to help even one such young woman to find her way.
One upshot of SB127 is that this facility will be forced to decline admission to some of the most challenging cases because of legal risk. That will leave those struggling young women in juvenile detention, which we know provides no therapeutic value. Is that what the critics want? If so, go research the percentage of young people who “age out” of the foster care system end up among the homeless. It is staggering.
For too many young people, this and similar programs truly are, to coin a phrase, “The last house on the street.” Also lost in this debate are the many successes. As in my field, dedicated professionals sometimes fail or make mistakes, but there are also many hard-won victories that justify the struggle.
Criticizing is the easiest thing in the world. Ben Franklin said, “Any fool can criticize, condemn and complain and most fools do.” Far more difficult is to find legitimate ways to help the most challenged among us.
Trust me, helping someone free themselves from opiate addiction, for example, is not pretty. It can, at times, even appear cruel. But in many cases, that is the only way to save a life — or a kid.
Terry Sellers, M.D., is board certified in addiction medicine. He lives in Provo and practices in Utah County and southern Utah.