Addressing Substance Abuse in a

School Context

Bailey Lowenthal & Laurel Hollenbaugh

Substances

Legal Alcohol (over the age of 21) Tobacco Prescription drugs (with a prescription)- narcotics and

psychostimulants

Illegal Marijuana Methamphetamines Hallucinogens

DSM IV Criteria

Substance Abuse vs. Substance DependenceDiagnostic Criteria

Dependence

(3 or more in a 12-month period)

Abuse

(1 or more in a 12-month period) Symptoms must never have met criteria for

substance dependenc e for this class of substance.

- Tolerance (marked inc rease in amount; marked decrease in effect) - Characteristic withdrawal symptoms; substance taken to relieve withdrawal - Substance taken in larger amount and for longer period than intended - Persistent desire or repeated unsuccessful attempt to quit - Much time/activity to obtain , use, recover - Impo rtant social, occupational, or recreational activities given up or reduced - Use cont inues despite know ledge of adverse consequence s (e.g., failu re to fulfil l ro le obligation, use when physically hazardous)

- Recurrent use resulting in failure to ful fill major role obligation at work , home or school - Recurrent use in physically hazardous situations - Recurrent substance related legal p roblems - Continued use despite persistent or recurrent social oar interpersonal prob lems caused or exacerbated by substance

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)

Population

Theories About Substance AbuseDisease 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)

Risk FactorsIndividual- age at first use, lack of social skills,

physical trauma, genetic predispositionPeers- peers who use/abuse drugs, peer

rejectionFamily- parents/sibling behavior, high conflict,

low bonding, low monitoring/supportSchool- academic failure, low teacher

expectations, unsafe climateCommunity- norms, unsafe, high poverty, high

crime, lack of resources

Protective FactorsIndividual- social skills, mental health,

positive sense of self, resiliencyPeers- social competence,

communication Family- high expectations, clear rules,

sense of trustSchool- participation & involvement, safe,

clear standards and rulesCommunity- safe, positive community

based activities and youth centers

Common IndicatorsPhysical- 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

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

programsBe aware of empirically supported

intervention approachesNetwork with appropriate professionals

Prevention ProgrammingFor 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

School Based PreventionThree 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.

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

ResultsBasic -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.

Individual Intervention ProgrammingYouth 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

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)

Motivational InterviewingSkills + Strategies

Open-ended questions, Affirmations, Reflective listening, Summarization, Change talk

http://www.motivationalinterview.org/

Motivational Interviewing Client: Commitment (I will make

changes) Activation (I am ready,

prepared, willing to change)

Taking Steps (I am taking specific actions to change)

Counselor:1. Ask for Pros/Cons

2. Elaboration

3. Look Back

4. Look Forward

5. Use Change Rulers or scales

6. Explore Goals and Values

http://www.youtube.com/watch?v=EvLquWI8aqc&feature=related

Multi Dimensional Family TherapyDevelopmental-ecological, family systems

approachSixteen sessions over five monthsAdolescent- cognitions, emotion regulationParents- practices, stressOther family members- drug usePatterns of interactionResults- 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

Final RecommendationsComprehensive ecological approachEarly universal prevention programmingMotivational Interviewing:

Pre contemplation-> contemplation/readinessMDFT: increase family engagement and

develop new, more adaptive patterns of coping and interaction. (Waldron & Turner, 2008).

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.

Questions?