Drugs, Alcohol, and Self-Medication: Thoughts, Questions and Antidotes

Dr. Lynn Friedman, Clinical psychologist, psychoanalyst and consultant to independent schools and David Shapiro, Head of School, Edmund Burke School offer these suggestions 100 (ACTUALLY 94) SUGGESTIONS TO CONSIDER Growing numbers of adolescents are using drugs, not just for recreation, but as medication, putting themselves in harm's way. How do we understand the extent of their use? What inadvertent roles do schools and parents play? What steps can we take to help? A veteran head and a psychologist provide thought-provoking questions and helpful suggestions. Often, students become involved in drug and alcohol use as a way to tolerate overwhelming stresses and feelings. Important antidotes to these stresses and feelings include: teaching students strategies for calming themselves down teaching them skills for supporting each other training adults (teachers and parents) and peers to be better listeners surrounding students with supportive others building a healthy, supportive, school community reducing stresses valuing the whole person over the person's achievements educating students, faculty and parents de-stigmatizing therapy and counseling in your school community providing linkages to therapeutic resources The foundation of your school's work to help students in this area is clear. Focus first on building sturdy kids. Ideally, you want to be able to boast that your school is not only state of the art academically, but it's also state of the art in terms of social and emotional development. Research shows that kids with healthy self-esteem are less likely to become involved with significant substance abuse and that they are more likely to do well in school. Contrary to popular belief solid academics are not antithetical to solid nurturing. Work hard to build community. Create a sense of community responsibility. Extend opportunities to be a part of the community including and going beyond athletics and academics and put in place a variety of authentic ways for serious student contribution and recognition. You might organize differently the concrete suggestions below. The real questions are: how many of them would work in your school? why wouldn't the others? how many are already in place? how many - and which - would you undertake to put in place in the next year (2-4 years)? COMMUNITY Create and sustain a strong community service program, including a requirement of a specific number of hours of community service Create community service opportunities that are based in academic courses and take place during the school day (often known as "service learning" as distinct from "community service") Create a variety of age appropriate and inclusive school rituals. Provide alternate rites of passage for kids at school (e.g. some schools have a formal moment when 8th graders are recognized as high schoolers) Add school awards for being a good community citizen; have these awards recognize meaningful contributions to the school community; make these awards high profile and valued Train kids and have them co-lead peer counseling program Train kids and have them co-lead peer tutoring programs Train kids and have them co-lead leadership programs that are open to all interested kids, not just those who are obvious leaders Create and have kids sustain attractive lounge spaces Have student members on all hiring committees Institute student evaluation procedures for all classes Offer adolescent hot line training Have adequate school counselor staffing Create and sustain an affinity group for adopted kids Create and sustain an affinity group for adoptive parents Create and sustain an affinity group for kids of color Create and sustain an affinity group for families of students of color Create and sustain a Gay Straight Alliance Create and sustain an affinity group for parents of blended families Create and sustain an affinity group for children of divorce Create and sustain an affinity group for children with sick and dying family members If your school is small or the affinity group is small or your resources are limited, partner with other neighboring schools to create affinity groups Have interesting, enjoyable, activities for drug free socialization. Consider partnering with other area schools to offer coffee shops with student bands on the weekends, and provide adult supervision. Make sure to include kids in the identification and planning of these activities. The key is that substance abusing kids sometimes report that when they stop using, they can no longer hang out with their friends Identify and address aspects of the school culture that students may find alienating; get your students to educate you. Put them on committees to think through these issues with teachers and parents Have a clear policy and procedures around bullying which is published in your Family Handbook and implemented Have a clear policy and procedures around gender, race, or sexual orientation harassment (often "hurtful language and behavior" is a better identifying phrase than "harassment") which is published in your Family Handbook and implemented Create an atmosphere in which treatment is de-stigmatized SCHOOL PROGRAM Create a high school schedule with longer periods, fewer transitions, regular breaks (e.g. Period 1, Period 2, Break, Period 3, Period 4, Lunch, Period 5, Period 6, end of school day) Build into your program opportunities for each child to have a relationship with an adult whom they trust (e.g. faculty office hours, grade deans) Establish a strong advisory system. Advisory groups should be small and should be scheduled to meet for 20-30 minutes at least every other day Incorporate a club period into the regular school schedule Include a 20-30 minute town meeting/assembly program at least every other day. Give students real training, authority, and assistance in running those programs Institute a no-cut athletic policy Offer yoga classes Create a context for addressing substance abuse across the curriculum. In each setting, address steps that kids can take to help themselves and each other. a. For example, in English, read stories or show movies on these situations and explore how the situations might have had a more helpful outcome b. In biology, talk about the effect of drugs on the CNS system. Explain why and how substances can lead to depression, etc. Have as part of your school mission, developing the interior world of the student. That is, help them to learn more about what they think and feel. Use an array of avenues to help them become more self-aware, including: creative writing, reading and discussing characters who are struggling with similar concerns, drama, dance, fine arts, music, etc. Develop programs to provide students with the skill and practice to articulate their concerns, fears and feelings. Read Adele Faber's and Elaine Mazlish's, "How to Talk so Kids will Listen and How to Listen so Kids will Talk". Links to their books can be found at Read and incorporate ideas from, Thomas Likona's, "Educating for Character: How Our Schools Can Teach Respect and Responsibility." A link to this book can be found at: Provide a course on listening skills training as part of an academic subject. Create vignettes and role-plays in which students are helped to anticipate the kinds of drug and alcohol situations that come up and to think through how they might handle them Incorporate listening skills into all aspects of the curriculum beyond a specific course Ð make it part of the grade! DRUG AND ALCOHOL EDUCATION, RULES, AND CONSEQUENCES Create student committee to review and critique your school's current policies and procedures regarding drug and alcohol. Incorporate their suggested modifications when possible. Partner with them in presenting any modifications to students and families Make explicit your school's thinking about drug and alcohol use in your student handbook Describe clear, enforceable, expectations/consequences regarding drug/alcohol use and possession at school Examine your thinking with regard to drug testing. Talk about the pros and cons of this in your community Describe your school's approach to these concerns on your website Create a strong ongoing research-based educational component in middle school and high school curriculum, including information and discussion. Identify what is most helpful to teach at what grades and build the program accordingly As part of that program, de-demonize users; decrease the rift between users and non-users. Generate empathy for users. Help students think through how and why they can/should be helpful to kids who are struggling with substance use/abuse Evaluate the possibility of a student field trip to an AA meeting. Call ahead and arrange this in advance as some AA groups do allow visitors and some do not Survey kids regularly about what/how often/why they use drugs and alcohol and build that into the student and family education programs Apart from and alongside the clear, enforceable, expectations/consequences regarding drug/alcohol use and possession at school, put in place a strictly non-disciplinary and confidential approach for those who are struggling with issues of drug and/or alcohol use (e.g. Early Assistance Program). Train (and compensate) a small faculty EAP team, none of whom have administrative roles. In that context, be empathetic but fearless and intervene as early as possible FACULTY EDUCATION AND SUPPORT Provide in-service training for advisors Become familiar with what your faculty are saying to students about drugs. The idea is not to send ambiguous messages Do not allow faculty to agree to keep students' substance abuse confidential Develop a faculty assistance program for faculty in distress. To do this in a cost-effective way, consider establishing linkages with your Local psychoanalytic association clinics. Create an annual fund for faculty revitalization (e.g. yoga classes, gym membership, museum memberships, etc.) Carefully evaluate the policy of serving alcohol at parent-faculty parties FAMILY EDUCATION AND SUPPORT Starting with the admissions process send a message to families that you view this as a three way partnership Ð parents, students and school and that you expect both parents to participate in your programming. Put this in your application. Sign a three-way contract during the admissions process Educate families on how to talk to their teenager about drugs and alcohol Educate families on how to talk with other families if/when they are concerned about their children's substance use Talk with families about the nature and extent of supervision that is required for a given age group; recognize that there are significant differences between kids in the same age group Help families develop ways of connecting with each other to ensure that activities are appropriately supervised Have twice yearly seminars on these topics at each grade level. Identify what topics are most helpful to present at which grade levels, and build the seminar program accordingly. Make attendance as close to mandatory as you can Talk with families about appropriate expectations (not too little and not too much) for a given age group Talk with families about how to encourage their childrenÕs community involvement and how they can partner with them in such activities Suggest that families tell their kids that they will not tolerate driving under the influence. Suggest that if children drive under the influence once, families take away their driving privileges. If a family has given a student a car, sell it Alert families to be aware of the contents of their liquor cabinets. If a family finds that kids are drinking, get rid of all of the liquor in the house Alert families to be aware of the contents of their drug cabinets Suggest that families do not allow adult guests to become inebriated in the presence of their kids, and don't allow them to drive home if inebriated. Encourage families to behave in ways that theyÕd like their children to emulate Teach parents about the relationship between psychiatric illness (particularly bipolar illness) and substance abuse Educate parents about the genetic component to drug and alcohol abuse Urge families who have a genetic history of drug or alcohol abuse to tell their kids about this and explain to them that this means that they may not be able to handle substances the way others with different genes can Urge families who have a genetic history for bipolar illness (and, other psychotic disorder) to explain to their kids that substance abuse could unmask the genotype. If they are abusing substances they are more at risk than their peers Educate families that if their children are drinking or abusing substances with any regularity, it can be a sign that they are masking depression or other underlying disorder. Seek a psychological evaluation Encourage families to promote ordinary maturation. Establish age appropriate expectations with respect to responsibility Encourage families to be aware of how much money their adolescents have and from where they are getting it Urge families to establish clear consequences for any use of marijuana in their homes and to enforce them Help families to consider policies such as "no fault" calling for a ride, for their kids and their kids' friends Help families to develop strategies for sharing information about student drug use with each other; discuss what formal structures for doing this (sometimes known as "community compacts") would look like INTERVENTION AND TREATMENT If an adolescent's difficulties are serious enough that the school may be recommending intervention Ð insist that both parents come to school. This sends a message that this is serious business Partner with local pediatricians who understand and share your goals. Get to know them and refer to them Identify and establish relationships with quality drug/ alcohol and mental health professionals BEFORE a crisis a. Many drug and alcohol professionals are not adequately trained to identify and address underlying psychopathology such as depression and learning difficulties b. Conversely, many psychologists, psychiatrists, psychoanalysts and social workers are not adequately trained to identify drug and alcohol difficulties c. Therefore, as you develop your arsenal of mental health professionals, get to know them each Ð become familiar with what they each do and don't do. In this way, you can: i. make the best possible referral: 1. for example, a psychoanalyst might be the best referral for some kids with problems with substance abuse if: a. the analyst is knowledgeable about substance abuse b. the analyst works collaterally with a psychiatrist or is a psychiatrist (for evaluation for possible medication) c. If, the parent is able to provide a tight structure and/or implement drug testing d. However, this may not be the best referral, if the parent is unwilling or unable to do the above 2. Conversely, a person trained primarily in drug and alcohol intervention may not be able to effectively address the underlying anxiety or depression Before making a referral, ask the mental health/alcohol-drug, professional about their process. In this way, you can tell the student and parents what to expect. In doing so, youÕll increase the likelihood that they will follow through and you can reduce the likelihood of surprises a. for example, many mental health professionals require you to pay for the time that you reserve whether or not you are there. Letting parents know this in advance allows them to think and plan ahead and to talk with the mental health professional about it. The idea is the more that they know what to expect, the less likely they are to use it as a deal breaker. Also, parents need to know about this sort of thing so that they can make sure that the teenager shows up Establish relationships with a few preferred providers. If you routinely refer to them, at times, they may be willing to work with you to provide a thoughtful evaluation of a family of limited means Actually meet with providers and get to know them. Go to their offices: a. Be respectful of their time. If you hit it off with them consider inviting them to your school Ð i. but have a rhyme and reason to your agenda Ð you want to breed good will because even if you decide not to refer to them, you may encounter them later and you want them to be comfortable working with your school Become familiar with the sliding scale services in your area Allow your counselor time to attend the local AA and NA meetings to check them out Support your counselor in their continuing education efforts. No counselor should work in professional isolation. Arrange for the counselor to have ongoing psychological consultation. If the counselor is not yet licensed, arrange and pay for him/her to become licensed. These are serious difficulties and no counselor should be expected to work alone Contact your local psychoanalytic institute and ask if thereÕs someone in charge of their child-training program. Visit that person; get to know them or their emissary, find out if they can provide sliding scale services Check out your local clinics. Assess whether they have something to offer your students Become familiar with the places in your community in which kids can be hospitalized for substance abuse difficulties. Do this so that should that eventuality arise, you understand what is happening with your student Develop relationships with individuals working in the school placement arena. In this way, should a student need a therapeutic school, you will be familiar with their services and you can make a referral to them Become familiar with the array of "wilderness" and "rehabilitation programs" and "therapeutic schools". Your purpose here is not to serve as placement professionals. Rather, when you are talking with parents, you want to be able to talk with them about the array of helpful options and resources In addition to providing families with resources during a meeting, provide them with a list of vetted resources in case they want to seek out help independently from the school. Provide this information to all parents in a handout

Reprinting permission

Lynn Friedman, Ph.D. and David Shapiro retain copyright to this material. However, Independent Schools and independent school associations may republish it free of charge as long as the article and byline is reprinted in its entirety and without alteration. Also, along with any column, copyright and and the following byline must be attached: Dr. Lynn Friedman is a clinical psychologist, psychoanalyst and consultant to independent schools in Chevy Chase, Maryland. She is on the associate faculty in the Organizational Development/Human Resource Management Program at Johns Hopkins University. Web site: www.drlynnfriedman.com. She can be reached at: (301) 656-9650. David Shapiro is the Head of School at Edmund Burke School in Washington, DC.

More of Dr. Lynn Friedman's columns

Interested in teaching without certification? Read this Washington Post column Teaching without certification This column is published on the Washington Post interactive site More of Dr. Lynn Friedman's columns The Developmental Milestones of the Middle School Years Organizational Change in the Independent School: Promise or Peril Faculty Professional Development: A Primer for School Leaders Reactions to September 11th in the Independent School: An Inadvertent Tool for Organizational Assessment (by Dr. Lynn Friedman, clinical, psychologist, psychoanalyst)

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If you are a head of school, a trustee or an administrator considering school consultation, feel free to give Dr. Lynn Friedman a call at: 301-656-9650 Subscribe to Dr. Lynn Friedman's work-life ezine Send her an email telling her that you'd like to subscribe and telling her what you think of the site. Corporations on the Couch. Read Dr. Lynn Friedman's monthly, Washington Business Journal, column on understanding workplace dynamics. For your questions about relationships, psychotherapy and psychoanalysis, check out Dr. Lynn Friedman's new website, The Washington Psychoanalyst.