We hear about substance abuse among students so often that werisk not fully appreciating its gravity. It is a major publichealth concern. Although prevention and treatment have been somewhatsuccessful, surveys in the United States and other developedcountries indicate that the use of alcohol and illicit drugs amongchildren and adolescents persists and often begins at school. Asa result, schools frequently find themselves on the front lines,struggling to curb students' use of harmful drugs. Clinical,developmental, and legal concerns clumsily intermingle, leavingadministrators, teachers, parents, and students frustrated overhow best to proceed.
Clinical experience and knowledge about child development suggestthat students benefit from an open and honest discussion of theseimportant issues. The presence of a trusted mentor and a student'sstrong relationship with the school and its teachers can conferresilience against many psychosocial problems, including substanceabuse. Therefore, educators must be willing to address substanceabuse and know about its associated risks.
Prevalence of Abuse
Because surveys that ask students to self-report on drug useare often unreliable, estimates of substance abuse among childrenand adolescents may underrepresent its prevalence. Even so,U.S. surveys indicate that adolescent substance abuse hasbeen increasing since the early 1990s. For example, a 1996Monitoring the Future study (Johnston)indicated that during a one-month period, approximately 33 percentof U.S. high school seniors reported having been intoxicated atleast once, and 20 percent of 10th and 12th graders said thatthey had used marijuana during the same period. A similar surveyconducted by the Substance Abuse and Mental Health ServicesAdministration (1996) showed slightly lower rates, suggestingthat teens may be more reticent to report drug and alcohol abusewhen surveyed at home.
Problems with Abuse
Most studies consistently demonstrate an association betweensubstance abuse and other problems: medical complications directlyrelated to prolonged or even single use of illegal drugs or alcohol,accidental deaths from impaired driving and behavior, and depressionor even suicidal mood changes as drugs take effect or wear off.In addition, teenagers with other psychiatric diagnoses often“medicate” themselves with illicit substances, withthe result that serious psychiatric problems—such as depression,anxiety, bipolar disorder, and attention deficit hyperactivitydisorder (ADHD)—may go unrecognized and untreated. Infact, studies show that the appropriate treatment of psychiatricillnesses other than substance abuse—including the treatmentof ADHD—often protects sufferers against future substanceabuse.
The use of alcohol and drugs by a psychiatrically ill child,however, is always dangerous and potentially devastating. Althoughrisk-taking and impulsive behavior are normal characteristics ofadolescence, serious substance abuse can interrupt and seriouslyimpair a young person's developmental trajectory.
Causes of Substance Abuse
Substance abuse is a maladaptive patternof alcohol or drug use that can lead to persistent use, legaldifficulties, and impaired functioning at school and work.Substance dependence is more serious, withsufferers developing a tolerance to drugs or alcohol, manifestingpotentially dangerous withdrawal symptoms, and sometimes going toperilous lengths to acquire drugs.
Substance abuse is a complex phenomenon involving social,developmental, and biological factors. Genetic studies show heritabletendencies toward these problems. Biological investigations suggest,for example, that the electroencephalograms (brain wave measurements)of inebriated, nonalcoholic sons of alcoholic fathers are differentfrom those of other males in control groups. Individuals witha predisposition to substance abuse may respond differently toalcohol and other drugs than those who have not inherited thistendency.
Studies such as these help explain why most of those who experimentwith alcohol and drugs do not develop serious substance abusedisorders, but the findings also accentuate the difficulty ofdetermining who is at greater risk of—and who has greaterresistance to—substance abuse. Some studies suggest thatyoung people who are temperamentally prone to take risks orto seek novel situations are more likely to succumb to theseproblems. Most adolescents are primed to take additional risks,but investigations have found that such factors as intelligence,the capacity to solve problems, social facility, good familyrelations, adequate affect control, and a good sense ofself-esteem help tilt a young person away from serious substanceabuse.
The psychiatric diagnoses that sometimes predate substanceabuse are different for males and females. For men, antisocialpersonality and conduct disorder, as well as panic disorder andother anxiety disorders, often occur before substance abuse.For females, depression and specific phobias often come first.Thus, prevention and treatment approaches must take into accountdevelopmental, biological, and gender issues.
Treatment of Substance Abuse
Many of the treatments for child and adolescent substance abusewere first used for adults. Although little research has beenconducted to determine which adult techniques are most helpfulfor children, preliminary findings indicate that family involvementin treatment is important. For example, studies that looked atgroup interventions both with and without the family have shownthat family engagement is a better predictor of successfultreatment. Studies of resiliency demonstrate the benefits of astrong and trustworthy adult mentor figure.
Treatments often begin in intensive settings—in an inpatientward or at a residential or an intensive day treatment center—with12-step programs and other regimented strategies the most commonapproach. Treatment must address such problems as depression,conduct disorder, anxiety, and psychosocial problems associatedwith family or other relationships. In fact, teenagers usuallyoppose any attempt to conceptualize their problem as only substanceabuse. Allowing young people to address other complexities in theirlives can often lead to an in-depth examination of the role playedby substance abuse.
What Schools Can Do
First, teachers and administrators must recognize how seriousthese problems are. Because many adults fondly recall the wilddays of their youth, they may be reluctant to take routine substanceuse seriously; however, no one can predict which young personmay develop serious problems. An adult's relaxed attitudetoward substance abuse may suggest to a young person that thebenefits of abusing alcohol and drugs—decreased socialawkwardness, increased peer acceptance, and an escape from thetribulations of adolescent angst—far outweigh the risks.
The melodrama of adolescence is ripe for self-medication, andthe role of educators is to help students tolerate and masterthese problematic times. The rewards of weathering the developmentalstorm of adolescence are immense, and teachers provide role modelsfor these victories.
At the same time, students will ignore an adult whose attitudeis intolerant or overly moralistic. In the face of peer pressure,students need solid explanations and honest discussions aboutwhy they should question their desires to experiment with alcoholand drugs. Delivering the once popular “Just Say No”message, devoid of any further inquiry or discussion, falls flatand is almost always ineffective.
Educators must seek the middle ground that will best capturetheir potentially flighty audience. As with all effective teaching,responding to potential warning signs is crucial. Any studentswhose behavior or grades undergo sudden and negative changesdeserve prompt attention. To those who say that such attentionlies outside the purview of the teacher, we can answer thatstudents often refer to their teachers as the adults who knowthem best. Many recovering substance abusers recall the kindattention of a concerned teacher as the beginning of theirrecognition that they were in trouble.
In addition, because the goal of teachers is to increase theirstudents' capacity to learn, acknowledging any interruptionin this capacity is within all educators' roles. Changes inbehavior can signal numerous problems other than substance abuse,but the teacher who ignores the faltering student misses anopportunity to intervene for the better. A combination of classdiscussions and individual attention can help students siftthrough the complex issues related to substance abuse. Perhapsmore than with any other psychiatric problem, schools are at thefront line of the ongoing battle against substance abuse in youngpeople.
