Substance Abuse Counseling
Substance abuse is a public health threat to which adolescents are particularly vulnerable. Substance abuse can lead to a variety of behavioral, social, physiological, and psychological problems, and, especially in adolescents, can develop into a lifelong dependence. Because recovery is so difficult, substance abuse prevention programs are the best way to give students every opportunity to make healthy life choices. Beginning at the elementary school level and continuing through high school, these programs teach students about the effects of substance abuse and build skills that will help them resist pressures to abuse substances. Counselors can address existing substance abuse problems through direct counseling, treatment recommendations, community collaborations, and parent participation.
Keywords Addiction; Assessment; Drug abuse; Counseling; Life Skills; Parent Education; Peer Helping; Relapse Prevention; Screening; Social skills; Substance Abuse; Values Clarification
Substance abuse is considered a major threat to the health and well being of American youth (Sales, 2004). Although the 2006 National Survey on Drug Use and Health (Substance Abuse and Mental Health Services Administration, 2007) indicated that substance abuse has declined among Americans in general, substance abuse among adolescents remains "alarmingly high" (Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment, n.d). Adolescence is “an important developmental period for young people: they are faced with many challenges and decisions that will affect their futures” (Burrow-Sanchez, 2006, p. 283). One of these challenges is whether or not to use substances. Although some experimentation during adolescence is to be expected, many adolescents will develop a substance dependence that will affect their development and adult lives.
According to the National Institute on Drug Abuse (2012), substance abuse and addiction costs Americans over $600 billion annually in terms of medical, economic, criminal, and social impact costs. The United Nations Office on Drugs and Crime estimated that in 2010, between 99,000 and 253,000 deaths globally were attributable to illicit drug use (UNODC, 2011).
Adolescent substance abuse has been associated with increased criminal activity, declining grades, absenteeism, and dropping out of school. Additionally, cognitive and behavioral problems experienced by adolescents who abuse substances may also affect their performance in school. Another recent trend of increasing concern is the fact that children and youth as young as twelve years old are now misusing prescription medications such as pain relievers, stimulants, sedatives, and tranquilizers (Partnership for a Drug Free America, 2005). These medications appeal to youth because they are easy to obtain and are assumed to be safer alternatives to harder street drugs. However, their effects and addictive qualities are equally as devastating.
High-risk behaviors like substance abuse affect the brain and body, interfering with brain development and a user’s concentration, motivation, and ability to learn (United States Department of Education, 2006). Substance abuse can lead to "adverse behavioral, psychological, and social consequences" (Watkins, 2006). Adolescents are especially vulnerable, as “rapid changes in brain structure, behavior, and social functioning” are occurring during this development phase (Chambers, Taylor, & Potenza, 2003, ¶ 1). “Addictive disorders in adulthood usually begin in adolescence or young adulthood” (Kandel, Yamaguchi, & Chen, 1992; Wagner & Anthony, 2002, ¶ 1). However, substance abuse not only affects individuals; it has far-reaching consequence that impact society as a whole in areas such as health care, workplace productivity, highway safety, suicide, violence, crime, and school failure (Sales, 2004).
School counselors are challenged to design and implement comprehensive substance abuse programs at all levels of K–12 education. As elementary-age children are now experimenting with with what experts refer to as gateway drugs (alcohol, tobacco, marijuana, and other drugs that often lead to experimentation with harder drugs), it is important for counseling programs to begin at the elementary level (Berdiansky, Brownlee, & Joy, 1988). The most effective programs are comprehensive. These programs
• Include instruction, guidance services, student activities, parent involvement, and community support;
• Have multiple components, including a prevention curriculum, teacher knowledge and skills, school climate including policies and procedures, and family and community support coordinated with a team-based approach; and,
• Continue through the duration of children's development and utilize strategies that are integrated into family, school, and community life (Benard, 1991; Benard, Fafoglia, & Perone, 1988; Severson & Zoref, 1991; Sales, 2004).
However, because substance abuse is a community-wide problem that reflects the distinct characteristics of its environment, school programs should be reflective of and responsive to the needs of the surrounding community (McLaughlin, 1993). School counselors are responsible for helping to develop and implement a program that is a good match for the needs of the communities and schools they serve.
The school counselor plays an integral role in assisting in the prevention and reduction of substance abuse among students (McElrath, 2005). The counselor's responsibilities typically include:
• Coordinating substance abuse prevention programs;
• Coordinating peer assistance programs;
• Providing direct counseling services for students at risk for substance abuse or students identified as substance abusers;
• Serving as a liaison between the school and community agencies;
• Educating parents about substance abuse prevention (McElrath, 2005).
Coordinating Substance Abuse Prevention Programs
Unfortunately, treatment for substance abuse problems has not proven to be very effective (Sales, 2004). Treatment is both difficult to implement, expensive, and difficult for some to access. Prevention has much greater potential for addressing this pervasive problem. School counselors play an important role in coordinating substance abuse prevention programs.
Utilizing “education to prevent child and adolescent substance abuse has been the focus of many school-based programs over the last three decades” (Kreft, 1998, p. 48). Early on, these educational efforts focused on warning youth about the effects of drug abuse. More recently school programs have focused on teaching children and youth refusal skills while implementing strategies to bolster their self image with the acceptance that these advances will help keep students from experimenting with drugs.
We know that knowledge alone does not prevent substance abuse. This information needs to be integrated into the academic content of the curriculum on all levels with a focus on health and wellness, and an emphasis on personal and social responsibility (Jessor, 1993). In addition to providing knowledge, substance abuse prevention programs need to include more comprehensive strategies designed
• To increase students' self-esteem;
• Improve students' social skills;
• Build students' life skills, including self-awareness, critical thinking, decision-making, problem-solving, values clarification, and goal setting; and
• Enhance students' ability to resist peer influence (Botvin, 1986; Bradley, 1988; Sales, 2004).
Prevention programs need to be planned with respect to developmental stages of children and youth. According to the National Institute on Drug Abuse (2003),
Risks appear at every transition from early childhood through young adulthood; therefore, prevention planners need to consider their target audiences and implement programs that provide support appropriate for each developmental stage. They also need to consider how the protective factors involved in these transitions can be strengthened (p. 10).
Elementary prevention programs should "target improving academic and social-emotional learning to address risk factors for drug abuse, such as early aggression, academic failure, and school dropout" and focus on skills such as "self control, emotional awareness, communication, social problem solving, and academic support, especially in reading" (National Institute on Drug Abuse, 2003, p. 3). At the middle school level, programs "should increase academic and social competence" and focus on skills such as "study habits and academic support, communication, peer relationships, self-efficacy and assertiveness, drug resistance skills, reinforcement of antidrug attitudes, and strengthening of personal commitments against drug abuse" (National Institute on Drug Abuse, 2003, p. 3).
Prevention efforts must also include development of a school climate that consistently sends an "anti-drug message" to students through curricular and extracurricular activities (Sales, 2004). The school climate needs to support values such as cooperation and appreciation of self and others. Supervised, drug-free extracurricular activities can help reinforce this climate. School policies and procedures need to carry a strong anti-drug message. Family and community support are also vital links in a comprehensive substance abuse prevention program.
Midwestern Prevention Project/Project STAR (MMP) is a comprehensive, community-based substance abuse prevention program focusing middle school age students (Promising Practices Network, n.d.). The program began in 1984 in Kansas City, Missouri, as Project STAR (Students Taught Awareness and Resistance). This successful project has since been replicated in other school settings.
The primary component, which is aimed at sixth and seventh graders, has four ancillary components: a parent program, a community organization program, a programs focused on changing local health policy, and a program aimed at mass-media events (Promising Practices Network, 2011). Each portion of the program is created in hopes of acknowledging the myriad influences involved with student drug use. "On the demand side, the program tries to change behavior through teaching resistance skills. On the supply side, the program tries to change the environment by involving the entire community in drug-prevention activities" (Promising Practices Network, 2011) The program's four primary components are:
• School Program: This component teaches students skills to overcome pressures to use drugs. Teachers, assisted by peer leaders, conduct group discussions, role-playing, and homework assignments students and families.
• Parent Program: This component uses workshops to teach parents skills and neighborhood activities they can use to prevent drug use in their families and communities.
• Community Organization: This component teaches community leaders how to design and successfully execute drug-prevention services.
• Policy Program: This component involves community representatives in a coordinated effort to use local regulations to support prevention efforts and restrict students' access to substances...
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