Teen Substance Abuse: Guiding Families to New Horizons
In 1986, two teen substance abusers in Prince William County, Virginia, committed suicide within a two-month period. The community was stunned. Such events no doubt occur daily throughout the world. However, in Prince William County action was swift. The Board of County Supervisors appointed a community task force of human services staff, citizens and community leaders to address methods of dealing with substance abuse. A year later, a program called New Horizons was born.
New Horizons is a cooperative venture between the Prince William County Community Services Board and the School District to provide clinical and prevention substance abuse services to teens and their families.* The County Board of Supervisors approved a two-year pilot project, operating in two area high schools. With local funding, a program coordinator, two clinicians, one prevention specialist and one secretary were hired. Two years later, a favorable evaluation by the County Executive's office led to the program's expansion to all Prince William County high schools and those in Manassas and Manassas Park. Nine high schools and two middle schools joined the project. Additional staff were hired and were trained as therapists.
New Horizons provides clinical services in schools and Community Services Board offices. In the latter, therapists conduct intake interviews, family therapy sessions, court evaluations, detention screenings, emergency sessions and residential placement assessments. In the schools, therapists conduct drug and alcohol assessments, recovery therapy groups, children of alcoholics groups, family therapy, individual therapy and crisis debriefings. New Horizon therapists handle substance abuse-related emergencies, consult with School District staff, and are members of the school teams which address needs of high-risk students.
The cooperative venture is similar to the formation of a stepfamily: There may be mutual benefit, but it's not a love match for all parties. The Community Services Board and the School District have divergent missions, philosophies and regulations. A shared mission didn't protect against conflict. For example, schools call parents immediately to divulge information discovered about students possessing or abusing drugs. However, federal regulations prohibit the Community Services Board therapists from disclosing substance abuse to parents without the child's permission. Things get sticky when New Horizons staff provide confidential treatment for students who then require emergency assistance at school, and school personnel have no knowledge of New Horizons staff involvement through the Community Services Board.
One of the first "storms" was 16-year-old Geordi (all names and identifying information have been changed), who came to school with alcohol on his breath and began fighting. The New Horizons therapists concluded Geordi needed medical intervention. An ambulance took him to the hospital, a school administrator called his parents, and the therapists met them at the hospital. Other students, scared by Geordi's behavior, had admitted he usually drank at home before school, after his parents left for work. He also carried a flask which he drank from throughout the day. His parents were concerned, especially since both had alcoholic parents. Geordi had damaged his stomach lining, which necessitated a medical detoxification.
The therapists navigated the family through the maze of finding appropriate residential treatment for their son. Before coming back to school, he met with the New Horizons therapists and was placed in a school group. The family participated in family treatment, supporting Geordi's recovery and dealing with other family issues that surfaced durig the course of treatment. School District staff had dealt with such situations in the past. This time, they had support from someone with clinical expertise in substance abuse. New Horizons and School District staff began bonding as a team, each respecting the others' skills and depending on their support. As we communicated more clearly, the bond between the agencies deepened and we became more functional. This was reflected in our work with students and families.
Diagnosis of teen substance abuse is complicated because many signs of addiction (i.e., changes in mood, in peer group, in school behavior/grades, in hygiene, in weight, in interaction with authority, in memory, in personality, in activities) are also typical of a developing teen. How do you know if a teen is: struggling to individuate by rebelling against authority, in love, dealing with rejection by a boyfriend/girlfriend, fighting with a friend or facing raging hormones? This difficulty differentiating between normal exploratory behavior and substance abuse is one reason parents generally do not detect their child's substance abuse for more than two years.
Substance abuse affects the body of a teen and an adult differently. A teen's body is still developing. In fact, adolescence is the second largest growth period of the human life cycle. Teenagers gain 50 percent of their weight and strength as well as 30 percent of their height during adolescence (Portrey, 1992). Cells are dividing and multiplying through the process of mitosis. A cell that is addicted or damaged creates two such cells when it divides. The result is teens get addicted more quickly than adults -- six months to two years in teens versus five to 15 years in adults (Portrey, 1992).
Adults tend to get involved in substance abuse to alter their mood and feel better. Adults typically start out drinking alcohol, progressing to marijuana and other drugs until they settle on one or two drugs of choice. Teens have a wider variety of reasons for using: peer acceptance, adventure, rebellion, curiosity, emulation of adults and altering moods. They are likely to use whatever is available first and to be poly-substance abusers (Nowinski, 1990). This "garbage pail" pattern can complicate physical, social, and emotional recovery.
Much of a substance abuser's time and attention is focused on usage, resulting in arrested social, cognitive and emotional development. It is difficult for a 30-year-old to reclaim aspects of life lost since age 19. A 16-year-old who started abusing substances at 12 faces a more arduous role in establishing an identity for the first time. An adult's task in recovery is one of rehabilitation, while a teen's is one of "habilitation" (Nowinski, 1990).
Group treatment and a 12-step program have proved to be valuable components of recovery. As teens struggle to separate from parents and form their own identity, their need for acceptance and belonging is met by peers. Teens are more likely to be honest with peers. Confrontation that would not be tolerated from parents is heeded from friends. Peers know what is going on with other teens long before parents and other authorities. Therefore, they can be strong change agents.
There's more to be done at New Horizons: A recovery day treatment center would allow students who cannot stay clean in the regular classroom to stay in the community and continue school. An after-school component would provide structured activities, treatment and 12-step meetings for students whose parents worked. We would also like to collect more data on families we work with.
Empirical data on satisfaction with treatment provided and personal progress are gathered. The responses have been quite positive. However, longitudinal hard data are necessary to explore additional programming which might increase effectiveness. Third, a team-building wilderness component could augment therapy and increase receptivity to change.
Will, an 11-year-old child of an alcoholic, attended Camp Discovery, New Horizon's one-month camp for children of alcoholics. He irritated the staff and youth with his acting-out behaviors. While swimming on a field trip, Inoticed that Will thrashed around in the water frantically for about a minute, ran out of energy, and then had to stand up. He wanted to be on the floating platform with the other kids but couldn't go as the water was over his head. I had him swim next to me, and kept suggesting that he move more slowly and focus on breathing. Within a short time he was swimming, as he already possessed the needed skills. He just had not known how to put them together. New Horizons staff used this experience as a metaphor when he began "thrashing around" on land. His ability to control his behavior increased, and he was able to enjoy activities with other children.
Communities need to focus on being supportive, healing resources for families. This involves being aware of available programs, having a variety of services accessible to meet differing needs, and working cooperatively. As the range of prevention and intervention options expands, there will be fewer parents and children "thrashing around" in the community.
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Nowinski, J. (1990). Substance Abuse in Adolescents and Young Adults. New York: W.W. Norton, p. 197.
Portrey, M. (1991). Expect the Unexpected: Changes During Adolescence. Fairfax, Virginia: METRO Printing Services.
Portrey, M. (1992). Psycho-Pharmacology: Learn What Drugs Do to Your Body. Fairfax, Virginia: METRO Printing Services, p. 39.
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* The population of Prince William County and related municipalities is 282,722. The school district population is 52,866. New Horizons serves 15,694 students in the school district.
The Community Services Board is a full-range, public mental health center providing a range of prevention and therapy services to the community.