Addressing Substance Abuse in a School Context

1. Addressing Substance Abuse in a School Context Bailey Lowenthal & Laurel Hollenbaugh

2. Substances • Legal • Alcohol (over the age of 21) • Tobacco • Prescription drugs (with a prescription)- narcotics and psychostimulants • Illegal • Marijuana • Methamphetamines • Hallucinogens

3. Diagnostic Criteria Substance Abuse vs. Substance Dependence DSM IV Criteria

4. Occurrence of Abuse & Dependence • 2010 Statistics (Substance Abuse and Mental Health Services Administration, 2010) • 10% of the population aged 12 to 17 (2 million) • Top three drugs are marijuana, alcohol, prescription pills • Co-Occurrent Populations:- - Conduct disorder (60-80%) - ADHD (30-50%) - Depressive disorders (15-25%) - Anxiety disorders (15-25%) - Bipolar disorder (10-15%) (Burrow-Sanchez & Hawken, 2007)

5. Population

6. Theories About Substance Abuse Disease Model- chronic incurable disease, used by AA Genetic factors- dopamine deficiencies and inheritance • Twin studies suggest that genetic factors explain 30-70% of alcohol abuse (Kendler, 2001) Social Learning Theory- learn from parents, siblings, social circle • Person continues or does not continue to engage in a behavior as a result of the consequence of the behavior. Family Systems Theory- Drug abuse is symptom of a dysfunctional family system (alternative coping mechanism)

7. Risk Factors Individual- age at first use, lack of social skills, physical trauma, genetic predisposition Peers- peers who use/abuse drugs, peer rejection Family- parents/sibling behavior, high conflict, low bonding, low monitoring/support School- academic failure, low teacher expectations, unsafe climate Community- norms, unsafe, high poverty, high crime, lack of resources

8. Protective Factors Individual- social skills, mental health, positive sense of self, resiliency Peers- social competence, communication Family- high expectations, clear rules, sense of trust School- participation & involvement, safe, clear standards and rules Community- safe, positive community based activities and youth centers

9. Common Indicators Physical- Bloodshot eyes, changes in appetite, tremors, lack of coordination, deterioration of physical appearance Behavioral- decrease in performance or attendance, change in friends, suspicious or secretive behaviors, delinquency Psychological- change in personality, mood swings, lack of motivation, anxiety or paranoia http://www.helpguide.org/mental/drug_substance_abuse_addiction_signs_effects_treatment.htm

10. Prevention As a school counselor it is important to: • Be sensitive to early signs and risk factors of drug use • Invest in effective school based prevention programs • Be aware of empirically supported intervention approaches • Network with appropriate professionals

11. Prevention Programming For every $1 spent on prevention approximately $4-$10 is saved on treatment(Burrow-Sanchez & Hawken, 2007, p.69) Programming should • Strengthen protective factors and decrease risk factors • Include information related to all types of drugs and abuse • Address behaviors and risks relevant to the local community/population Focus on: • Improve social and problem solving skills • Build drug resistance skills • Encourage attitudes against drug use • Strengthen student’s commitment not to use drugs

12. School Based Prevention Three tiered approach: Universal- all students • LifeSkills Training Program (Botvin, 1998): Improve general social and self management skills in 30 sessions over three years. Selective- at risk students • Adolescent Transitions Program (Dishion & Kavanaugh, 2003): Referral to 3-step family assessments aimed at maintaining positive dynamics and reducing negative behaviors Indicated- students who show signs and symptoms of drug abuse/dependence • Reconnecting Youth (Eggert et al., 2001): At risk youth- attend daily class, increase parental support and school attachment, and develop school crisis plan.

13. Towards No Drug Abuse Network: Social network tailored substance abuse prevention program(Valente, Ritt-Olson, Stacy, Unger, Okamoto & Sussman, 2007) Investigating whether peer networks can be effective at reducing drug use in adolescents Basic: 12 sessions- focusing on motivation, life skills, decision making and peer influence. Network adaptation: Small groups (3-5 students) were created and each group was led by a peer leader chosen by their peers Content similar but curriculum was modified to increase the number of group activities

14. Results Basic -no changes in substance use Network -decreased marijuana, composite and cocaine use ONLY if peer group had negative attitudes towards drugs previously. Students with classmates who used drugs were more likely to increase their use. Prevention programming focused on using peers as examples or leaders is ineffective in reducing substance abuse among adolescents.

15. Individual Intervention Programming Youth Treatment Rates: Outpatient-69%, Intensive Outpatient 11%, Long-term residential- 9%, Short term residential- 6%, Other programs- 6% (Muck et al., 2001) • Student Assistant Program (Gonet, 1994): Schools employ a trained substance abuse counselor • Minnesota (12 step) Model (Williams & Chang, 2000): Four to six weeks residential program and then outpatient therapy. • CBT: Teaching students to be aware of the connections between thoughts, cues and substance using behaviors. Goal is to replace these with more positive coping strategies. • Motivational Interviewing(The Mid-Atlantic Addiction Technology Transfer Center, 2010) • Multidimensional Family Therapy(Liddle et al., 1994) • Pharmacotherapy- methadone, naltrexone (alcohol dependence). Little research to evaluate effectiveness

16. Motivational Interviewing (MI) Strengthen an individual’s motivation for and movement toward a specific goal by eliciting and exploring the person’s own arguments for change. (Burrow-Sanchez & Hawken, 2007)

17. Motivational Interviewing Skills + Strategies • Open-ended questions, Affirmations, Reflective listening, Summarization, Change talk http://www.motivationalinterview.org/

18. Motivational Interviewing Counselor: Ask for Pros/Cons Elaboration Look Back Look Forward Use Change Rulers or scales Explore Goals and Values Client: • Commitment (I will make changes) • Activation (I am ready, prepared, willing to change) • Taking Steps (I am taking specific actions to change) http://www.youtube.com/watch?v=EvLquWI8aqc&feature=related

19. Multi Dimensional Family Therapy Developmental-ecological, family systems approach Sixteen sessions over five months • Adolescent- cognitions, emotion regulation • Parents- practices, stress • Other family members- drug use • Patterns of interaction Results- Demonstrate immediate and long term change in pro-social behaviors, academic success and family functioning. Facilitates adaptive and protective factors to reduce substance abuse in adolescents

20. Final Recommendations • Comprehensive ecological approach • Early universal prevention programming • Motivational Interviewing: Pre contemplation-> contemplation/readiness • MDFT: increase family engagement and develop new, more adaptive patterns of coping and interaction. (Waldron & Turner, 2008).

21. References • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author. • Burrow-Sanchez, J. & Hawken, L., (2007). Helping Students Overcome Substance Abuse: Effective Practices for Prevention and Intervention. New York: The • Guilford Press. • Botvin, G. J. (1998). Preventing adolescent drug abuse through LifeSkills Training: • Theory, methods, and effectiveness. In J. Crane (Ed.), Social programs that work • (pp. 225-257). New York: Russell Sage Foundation. • Eggert, L. L., Thompson, E. A., Herting, J. R., & Randall, B. P. (2001). Reconnecting youth to prevent drug abuse, school dropout through an intensive school-based social network development program. American Journal of Health Promotion, 8, 202-214. • Gonet, M. M. (1994). Counseling the adolescent substance abuser: School-based intervention and prevention. Thousand Oaks, CA: Sage. • Helpguide. (2012). Signs and symptoms of drug abuse and drug. Retrieved from: addictionhttp://www.helpguide.org/mental/drug_substance_abuse_addiction_signs_effects_treatment.htm • Kendler, K. S. (2001). Twin studies of psychiatric illness: An update. Archives of General Psychiatry, 58, 1005-1014. • Liddle, H. A., Dakof, G. A., Parker, K., Diamond, G. S., Barrett, K., & Tejeda. M. (2001). Multidimentational family therapy for adolescent drug abuse: Results of a randomized clinical trail. American Journal of Drug & Alcohol Abuse, 27(4), 651-688. • Miller, W. R., Zweben, A., DiClemente, C. C., & Rychtarik, R. G. (1994). Motivational enhancement therapy manual: A clinical research guide for therapists treating individuals with alcohol abuse and dependence (Project MATCH, Vol. 2 DHHS Publication No. 94-3723). Rockville, MD: US Department of Health and Human Services. • Muck, R., Zempolich, K. A., Titus, J. C., Fishman, M., Godley, M. D., & Schwebel, R. (2001). An overview of the effectiveness of adolescent substance abuse treatment model. Youth and Society, 33(2). 143-168. • Substance Abuse and Mental Health Services Administration, (2012). Results from the 2010 National Survey on Drug Use and Health: Mental Health Findings. Substance Abuse And Mental Health Services Administration • Substance Abuse and Mental Health Services Administration. (2007). Results from the 2006 National Survey on Drug Use and Health: National Findings. Substance Abuse And Mental Health Services Administration • Tevyaw, T., & Monti, P. M. (2004). Motivational enhancement and other brief interventions for adolescent substance abuse: foundations, applications and evaluations. Addiction, 9963-75. doi:10.1111/j.1360-0443.2004.00855.x • The Mid-Atlantic Addiction Technology Transfer Center. (2010). Motivational Interview: Definition, Principles, & Approach. Retrieved from www.motivationalinterview.org%2FDocuments%2F1%2520A%2520MI%2520Definition%2520Principles%2520%26%2520Approach%2520V4%2520012911.pdf&ei=Zze5UPLsOKbX0QHlv4CIAg&usg=AFQjCNHdIEvrzje0qVSh1Kl4bg5KWHdOaw • Valente, T. W., Ritt-Olson, A., Stacy, A., Unger, J. B., Okamoto, J., & Sussman, S. (2007). Peer acceleration: effects of a social network tailored substance abuse prevention program among high-risk adolescents. Addiction, 102(11), 1804-1815. • Waldron, H., & Turner, C. W. (2008). Evidence-Based Psychosocial Treatments for Adolescent Substance Abuse. Journal Of Clinical Child & Adolescent Psychology, 37(1), 238-261. • Walker, D. D., Roffman, R. A., Stephens, R. S., Wakana, K., & Berghuis, J. (2006). Motivational Enhancement Therapy for Adolescent Marijuana Users: A Preliminary Randomized Controlled Trial. Journal Of Consulting And Clinical Psychology, 74(3), 628-632. • Williams, R. J., & Chang, S. Y. (2000). A comprehensive and comparative review of adolescent substance abuse treatment outcome. Clinical Psychology: Science and Practice, 7, 138-166.

22. Questions?