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Many adolescents entering substance abuse treatment have coexisting mental health problems and are criminally involved. Examination of the complexities of substance use, mental health, and criminal justice involvement along with changes in these issues following treatment is needed. This study includes 941 males and 266 females enrolled in seven drug treatment programs located in geographically diverse areas of the United States. Comparisons between males and females at treatment entry and three, six, 12 and 30 months later were examined with regard to substance use, mental health, and criminal justice involvement. Results indicate that females showed significantly greater severity in substance use, problems associated with use, and mental health related variables at intake while males had significantly more days on probation/parole. With respect to change over time, the rate of change in mental health and days on probation/parole differed between the sexes. Results indicate that while rate of change is different for males and females on most variables, there was positive change following treatment for both groups with regard to substance use, mental health, and probation/parole status. The high severity levels of females at intake calls for gender-specific outreach and identification along with gender-specific treatments.

Although they are mandated reporters and work regularly with youth who have experienced abuse and trauma, many substance abuse treatment programs do not systematically screen for or address child maltreatment issues. This special issue provides a collection of articles that consistently demonstrate the feasibility of systematically screening for victimization among adolescents entering these programs and documents that multiple co-occurring types of victimization are actually the norm. Other articles in the section examine how levels of abuse and traumatic victimization are associated with aspects of adolescent substance use disorders, traumatic distress symptoms, co-occurring somatic and health problems, HIV risk behaviors, and a victim-to-abuser spiral. Finally, the articles address how this might affect treatment matching across levels of care. This introduction provides an overview of the articles and then highlights some of the key implications of this collective body of work for practice, policy, and future research.

NIDA's Cooperative Agreement program to reach out-of-treatment drug users and provide HIV prevention to reduce HIV drug and sexual risks was initiated in September of 1990. By August, 1994 the program included 23 sites which used various theoretical models to guide prevention strategies, add conceptual coherence to many aspects of behavior change, and allow for clearer interpretation of why behavior change occurs. This article reviews the theoretical models used at each of the NIDA Cooperative Agreement sites, the perceived helpfulness of the models, and recommendations for future initiatives.

This paper describes HIV sex and drug risk behavior and behavior change of injection drug and crack cocaine using women enrolled in a national multi-site Cooperative Agreement program. Baseline data on the 1,403 women who were randomly assigned to a two session intervention that was standardized across sites indicate that sex and drug risk behavior for becoming infected with HIV was considerable. Six-month post intervention follow-up data for the same sample of women show that significant reductions in sex and drug risk behavior were observed for the entire sample of women for the risk variables under study. Significant reductions were also demonstrated for various sub-groups of women enrolled in the study on most of the sex and drug risk variables. Given these findings, it appears that the standard intervention was effective in assisting drug using women reduce their behaviors that put them at risk of becoming infected with HIV. Further research in needed on the development and evaluation of HIV interventions that target specific risk behaviors and various HIV risk behavior profiles of women.