Transcript Substance Abuse PPT - Bailey Lowenthal`s Portfolio

Addressing
Substance
Abuse in a
School Context
Bailey Lowenthal & Laurel Hollenbaugh
Substances
 Legal
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Alcohol (over the age of 21)
Tobacco
Prescription drugs (with a prescription)- narcotics and
psychostimulants
 Illegal
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Marijuana
Methamphetamines
Hallucinogens
Diagnostic Criteria
Substance Abuse vs. Substance Dependence
Dependence
(3 or more in a 12-month period)
- Tolerance (marked increase 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
- Important social, occupational, or recreational
activities given up or reduced
- Use continues despite knowledge of adverse
consequences (e.g., failure to fulfill role
obligation, use when physically hazardous)
Abuse
(1 or more in a 12-month period)
Symptoms must never have met criteria for
substance dependenc e for this class of
substance.
- Recurrent use resulting in failure to fulfill
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
DSM IV Criteria
Occurrence of Abuse & Dependence
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2010 Statistics (Substance Abuse and Mental Health Services
Administration, 2010)
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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 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)
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
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
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
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
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
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 youthattend 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
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.
Individual Intervention Programming
Youth Treatment Rates: Outpatient-69%, Intensive Outpatient 11%, Longterm 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.
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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 Interviewing
Skills + Strategies
 Open-ended
questions, Affirmations, Reflective listening,
Summarization, Change talk
http://www.motivationalinterview.org/
Motivational Interviewing
Client:
 Commitment
Counselor:
(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
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Ask for Pros/Cons
Elaboration
Look Back
Look Forward
Use Change Rulers or
scales
Explore Goals and
Values
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
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).
References
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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
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Substance Abuse and Mental Health Services Administration, (2012). Results from the 2010 National Survey on Drug Use and Health:
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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
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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?