Substance Use and Treatment in Schools

Current Statistics Over 12% of Oregonians 12 and over reported illegal drug use in the past 30 days- second highest in the country Alcohol and illegal drug use by Oregon 8 th graders is nearly twice the national average (22.5% and 16.7% respectively) Over 3,500 youth 12 to 17 in Multnomah County abuse or are dependent on illicit drugs 29% of Multnomah County 11 th Graders reported binge drinking in the past 30 days Sources: Student Wellness Survey 2010, Monitoring the Future 2010 Alcohol, Illicit Drugs & Tobacco Consumption and Consequences in Multnomah County, Oregon

Prevalence Alcohol-related disorders occur in up to 26% of the general population, a prevalence rate similar to that of other chronic diseases such as hypertension and diabetes (Fleming and Barry, 1992)

Health Impacts of Alcohol and Drugs 72 conditions requiring hospitalizations are wholly or partially attributable to substance abuse (Center on Addiction and Substance Abuse, 1993, p. 21) Trauma, disability Sexual dysfunction HIV/AIDS, other STDs Weight gain (alcohol), weight loss (stimulants)

Other Common Co-morbidities Mental health issues such as: mood disorders (depression and bipolar disorder), personality disorders, and ADHD Cognitive delays due to Fetal Alcohol Effects Syndrome or effects of other drugs used while prenatal History of neglect, abuse and/or unresolved traumas

Helping Students An Overview of the Sections that follow: Warning signs that a student is suffering from a chemical dependency What to do when dealing with a student whom you suspect is chemically dependent How to refer someone to treatment Roadblocks to overcoming dependency Different types of treatment (residential, outpatient- group and individual) Resources

Symptoms That Suggest SUDs Physical problems (see previous slide) DUII, falls, accidents, injuries Dysphoria, depression, anxiety, irritability, mood swings, hostility Family or relationship dysfunction Frequent lateness to school, absences, decline in performance Changes in friends or activity level

What to do When Dealing With a Student You Suspect is Struggling With Use Address the issue head on Be tactful in your approach Start by showing empathy: "I have noticed your grades declined a bit, and that must be hard on you” Ask open ended questions: “tell me what is concerning you right now…what else?” Listening is fundamental

What to do When Dealing With a Student You Suspect is Dependent After building rapport and listening, ask if it is OK to give the student a screening tool. Don’t apologize for it, just give the tool and ask the student to fill it out. Read the results and reflect back to the student: “So you drink more than 2 drinks a night, and sometimes up to 5 in one sitting, tell me more about it.”

Brief Three Question Screen #1: In the past year did you ever drink or used drugs more than you meant to? Positive response = anything other than definitive no! #2: In the past year have you ever thought you should cut down on your alcohol or drug use? Positive response = anything other than definitive no! #3 for Boys: when was the last time you had more than 5 drinks at one sitting? #3 for Girls: when was the last time you had more than 3 drinks at one sitting? Positive response = within the last 3 months. Go to mini assessment if positive response to any question.

If a Student Screens Positive Next step is to conduct this 5 question mini assessment: #1 - How much do you drink on a typical drinking day? How much do you use (drugs) on a typical using day? #2 - How often do you drink/use on a typical Monday through Sunday week?

Mini Assessment (cont.) #3 - Tell me about the consequences you may have had with drinking or using? (DUIIs, conflict with spouse or family members, missed school, etc) #4 - Have you ever made attempts to cut down or stop drinking (or using)? #5 - Is there an immediate family member who has a substance use disorder (alcoholism, drug addiction)? Who?

What to Do Now? How to talk to individuals who screen positive? Think about:  Stages of Change  Motivational Interviewing  Brief Intervention

Stages of Change Relapse Pre-contemplation Contemplation (ambivalence) Determination (commitment) Action Maintenance Permanent Exit Sources: Prochaska & DiClemente

Motivational Interviewing MI spirit – empathic, collaborative, respects person’s autonomy to make own decisions Handles resistance skillfully Aims at eliciting reasons to change from the student (does not aim at arguing for change) Works on ambivalence

Motivational Interviewing Appreciation for person’s opinions Decision making is shared Provides menu of options Uses the person’s reactions to guide next strategy Resist fixing the person or lecturing Use open ended questions Do pros and cons

Brief Intervention Following the Mini Assessment, use MI to see what the student is willing to do by asking: Given the risks of drinking/using at this level, would you be willing to try to quit for a while? How about reducing to safer levels? Could you try to drink only one drink a day (girls) or two a day (boys)?

Decision Aid for Making Recommendations and Referrals If symptoms of depression or family history exist, use the following: Dep Sx Fam Hx Initial Recommendation + + or - Consult with specialist - + Abstinence - - Cut down to low-risk level

Brief Intervention and Referral Steps If recommendation is declined, then try… Negotiation: 1)Refer for assessment at De Paul– declines → 2)→ Abstain completely – declines → 3)→ Cut down to low risk level – declines → 4)→ Cut down as much as willing → 5)→ Accept decision and plan to readdress in the future → Follow up

A Decisional Balance Ambivalence Cross Status Quo Current Situation Change

Roadblocks to Overcoming SUDs Post Acute Withdrawal Symptoms Changes in the neural pathways of the brain People, places and things (triggers and warning signs) Change is difficult, is there support? Internal vs. External Motivators Stigma and Societal Norms Relapse is frequently a part of the process

Family Involvement Family involvement in treatment is vital! At De Paul, adult residential clients whose families participate in treatment have a 77% successful completion rate compared to 48% for those without family involvement.

CRAFT Stands for Community Reinforcement and Family Training Focuses on enhancing a loved one’s motivation to get sober while improving the personal wellness of the concerned significant other Uses communication skills and positive reinforcement for sobriety (not ultimatums or confrontation) Has a 70% success rate of getting loved ones into treatment in clinical studies

De Paul Treatment Centers Mission Statement: De Paul Treatment Centers works with individuals, families, and communities to create freedom from drug and alcohol addiction. De Paul serves the community and those affected by the disease of addiction. Using proven and effective treatment strategies, De Paul strives to build healthy and hopeful communities in recovery.

De Paul Treatment Centers Our Philosophy: We recognize that addiction is a complex, chronic, and treatable illness resulting from an interaction of human biology, environment, and behavior. We believe that all individuals have the innate health and capacity to recover. We believe recovery happens in the context of relationship and community. We respect the dignity and recognize the uniqueness of each individual and the need for individualized treatment.

De Paul Programs Assessment Information and Referral Residential Treatment Outpatient and Intensive Outpatient Case Management Services Integrated Mental Health and Substance Use Disorder Treatment Recovery Support – host a variety of community support meetings and the Alumni group Men and Women - Downtown & Hillsboro Youth – NE Portland & Hillsboro  Adult Detox – insured and self pay  Medication Assisted Treatment  DUII  Family Treatment with or without identified client

Youth Services Family-centric Program Residential Treatment Individual Family Therapy Multi-family Groups Intensive Outpatient and Outpatient Treatment Mental Health Assessment and Treatment De Paul Alternative School DP Fit- youth fitness program Recovery Groups CRAFT- counseling for parents whose teens are resistant to treatment

Accessible Treatment Contracts with most insurance companies Sliding scale for those who wish to self pay 30 day residential packages including family therapy and outpatient treatment OHP Funded slots

De Paul Treatment Centers (Downtown- Adult) (NE- Youth) (Hillsboro- Outpatient)