student substance use ...and school policy approaches daniel mcmillan

Student Substance UseStudent Substance Use

...and school policy approaches...and school policy approaches

Daniel McMillanDaniel McMillan

Substance use and Schools OutlineSubstance use and Schools Outline

Three points about student use and Three points about student use and schools:schools:• How many students are usingHow many students are using• Complications around making school policiesComplications around making school policies• Complications with the supporting researchComplications with the supporting research

Two perspectives/approaches:Two perspectives/approaches:• Abstinence basedAbstinence based• Harm reductionHarm reduction

Follow up information in Case studyFollow up information in Case study

Student substance abuse impacts many areas of Student substance abuse impacts many areas of the educational system, from daily student life to the educational system, from daily student life to

national policies…national policies…

So what does that substance use look like?So what does that substance use look like?

Student Alcohol Use:Student Alcohol Use:

Alberta:Alberta:•The 2008 Alberta Youth Experience Survey (TAYES) reported The 2008 Alberta Youth Experience Survey (TAYES) reported 75.1%75.1% of grade 12 Alberta youth had used alcohol in the past yearof grade 12 Alberta youth had used alcohol in the past year

- of which - of which 56% 56% reported binge drinkingreported binge drinking

•showed showed 13.7 %13.7 % of youth met the World Health Organization’s of youth met the World Health Organization’s (WHO) criteria for hazardous drinking (WHO) criteria for hazardous drinking 11

ManitobaManitoba• The Canadian Centre on Substance Abuse (CCSA) reporting The Canadian Centre on Substance Abuse (CCSA) reporting 84 % 84 % of of grade 12 Manitoba student alcohol grade 12 Manitoba student alcohol 1111

Sask.: Sask.: •85 % 85 % of Grade 12 youth andof Grade 12 youth and 83% 83% of Gr. 11 youth reported alcohol of Gr. 11 youth reported alcohol use. use. •75% 75% of Gr. 12 and of Gr. 12 and 72% 72% of Gr. 11 students reported binge drinking of Gr. 11 students reported binge drinking 1111

Canada:Canada:•Health Canada’s 2006-2007 Youth Smoking Survey reported similar Health Canada’s 2006-2007 Youth Smoking Survey reported similar findings with findings with 83% 83% student (Gr. 10-12) alcohol use student (Gr. 10-12) alcohol use

-- 57 % 57 % of which reported binge drinking of which reported binge drinking

Student Cannabis (and other drug) Use:Student Cannabis (and other drug) Use:

Alberta:Alberta:•TAYES reported TAYES reported 54% 54% Gr. 12 student cannabis useGr. 12 student cannabis use•28% 28% illicit drug use with Gr. 12 students illicit drug use with Gr. 12 students •15.5% 15.5% youth grade 7-12 reported non-medical codeine use youth grade 7-12 reported non-medical codeine use 1 1

Manitoba:Manitoba:•CCSA reporting CCSA reporting 42 % 42 % of Gr. 12 student cannabis useof Gr. 12 student cannabis use•And And 23% 23% grade 9 student cannabis use grade 9 student cannabis use 1111

Ontario:Ontario:•Similar findings (CCSA): Similar findings (CCSA): 46% 46% Gr. 12 student cannabis useGr. 12 student cannabis use•23% 23% Gr. 9 student cannabis use Gr. 9 student cannabis use 1111

Canada:Canada:•Health Canada reported similar findings with Health Canada reported similar findings with 43% 43% student cannabis student cannabis use in students grade 10-12 across Canada use in students grade 10-12 across Canada 66

Sask.: Sask.: •we can assume it is very similarwe can assume it is very similar

Student Tobacco Use:Student Tobacco Use:

Alberta:Alberta:•10.6% 10.6% grade 12 youth are current smokersgrade 12 youth are current smokers 1 1

Canada:Canada:•11% 11% of grade 10-12 Canadian students are current smokers of grade 10-12 Canadian students are current smokers 66

•Sask.: Sask.: •we can assume it is very similarwe can assume it is very similar

..Manitoba..Manitoba• as well, as well, 36% 36% of grade 12 youth, and of grade 12 youth, and 23% 23% of grade 9 youth of grade 9 youth reported reported experimental or occasional smoking experimental or occasional smoking (at least once in past (at least once in past year) year) 1111

So Substance Use and Abuse is occurring So Substance Use and Abuse is occurring with youthwith youth.. ..

how are school’s handling this how are school’s handling this issue?issue?

This is a controversial topic with great This is a controversial topic with great differences in intervention stances. differences in intervention stances.

It is important to note that numerous factors It is important to note that numerous factors influencing these policies (and practice) influencing these policies (and practice)

decisions.decisions.

These factors include:These factors include:

Complications around making school policies: Complications around making school policies: Influencing factorsInfluencing factors

Personal beliefs: Personal beliefs:

Administrators’, policy-makings’, and staffs’ Administrators’, policy-makings’, and staffs’ personal beliefs towards youth substance personal beliefs towards youth substance use will impact the handling of this issue. use will impact the handling of this issue.


Cultural or societal beliefs:Cultural or societal beliefs:

Popular views or seemingly common-sense Popular views or seemingly common-sense approaches often play a role in guiding approaches often play a role in guiding strategies strategies aimed at substance use. aimed at substance use.

This is most obvious through public opinion. This is most obvious through public opinion. Education is a passionate issue to many voters, large-Education is a passionate issue to many voters, large-

policies are made at high levels often by elected policies are made at high levels often by elected representatives (i.e. Minister of Education), thus representatives (i.e. Minister of Education), thus popular opinion may have an impact on popular opinion may have an impact on

decisions. decisions. As well many parents and community members As well many parents and community members have influence over school systems through have influence over school systems through involvement in boards. involvement in boards.


Societal beliefs cont’d..Societal beliefs cont’d..

Societal beliefs may also be reflected through or biased by Societal beliefs may also be reflected through or biased by current media attention (i.e. scared beyond straight, current media attention (i.e. scared beyond straight, intervention, intervention, etc). etc).

•http://www.aetv.com/beyond-scared-straight/video/index.jsp?bcpid=754809944001&bclid=713919091001&bctid=1100566963001


Legal Concerns: Legal Concerns: The use of illicit drugs are illegal for all. The use of illicit drugs are illegal for all.

Alcohol and tobacco are illegal for youth Alcohol and tobacco are illegal for youth Schools have a responsibility to support and Schools have a responsibility to support and adhere to the legal system. adhere to the legal system.

But as we have seen many youth currently use But as we have seen many youth currently use these substances, leaving school policies these substances, leaving school policies

in a in a difficult position of how to react.difficult position of how to react.


Ethical Concerns: Ethical Concerns:

Schools (particularly public schools) have Schools (particularly public schools) have a a responsibility to provide best-responsibility to provide best- practiced practiced services, as well as to best utilize their services, as well as to best utilize their resources. resources.

There is an ethical responsibility to provide There is an ethical responsibility to provide best-practice services (not simply best-practice services (not simply

legally legally adequate or culturally endorsed adequate or culturally endorsed services)services)

Before moving on… Before moving on…

Can Can youyou think of any other significant think of any other significant factors that may influence policy decisions factors that may influence policy decisions

and the handling of student substance and the handling of student substance abuse?abuse?

Complications around making school Complications around making school policies: policies:

Influencing factorsInfluencing factors

What if all these factors do not align? What if all these factors do not align? This results in the current continuum of school This results in the current continuum of school

practices for addressing student substance practices for addressing student substance abuse.abuse.

On opposing ends of this continuum lie the On opposing ends of this continuum lie the strategies (perspective approaches) of: strategies (perspective approaches) of:

-harm reduction harm reduction andand- abstinence based approachesabstinence based approaches..

We will now look at some of the research findings We will now look at some of the research findings and complications for these two approaches:and complications for these two approaches:

Complications around research:

Research in the adult population:Research in the adult population:

A significant amount of research exists in the adult A significant amount of research exists in the adult population addressing the issue of how to best population addressing the issue of how to best treat treat individuals who are currently using and individuals who are currently using and abusing abusing substances. substances.

In this population an array of techniques are shown In this population an array of techniques are shown helpful, including harm reduction (emphasis put helpful, including harm reduction (emphasis put on on reducing risks of the current behaviour and reducing risks of the current behaviour and accepting accepting the possibility that some use may still the possibility that some use may still occur)occur)7 7

Complications continue to exist, particularly with illicit Complications continue to exist, particularly with illicit drugs. The ability to make decisions for one’s self drugs. The ability to make decisions for one’s self (legal (legal adult) taken into account.adult) taken into account.


Research in the youth Population:Research in the youth Population:A limited amount of research exists in the area, particularly A limited amount of research exists in the area, particularly

with regards to harm reduction. There with regards to harm reduction. There are many legal are many legal and ethical research complications and ethical research complications 1111

Though limited, research demonstrates effective use of Though limited, research demonstrates effective use of harm reduction techniques in older youth. Also harm reduction techniques in older youth. Also demonstrates the ineffectiveness of many abstinence demonstrates the ineffectiveness of many abstinence based approaches (such as DARE)based approaches (such as DARE)77

More complications exist towards implementation of many More complications exist towards implementation of many approaches. The ability to make decisions for approaches. The ability to make decisions for

one’s selves one’s selves (mature minor vs. legal adult) is often (mature minor vs. legal adult) is often debated. Also the potential of harm is greatly debated. Also the potential of harm is greatly increased b/c of the youths’ ageincreased b/c of the youths’ age


So to summarize..So to summarize....with regards to research in this area:..with regards to research in this area:

•In substance using adults, harm reduction is show to In substance using adults, harm reduction is show to be usefulbe useful2, 10, 112, 10, 11

•In substance using youth harm reduction is shown In substance using youth harm reduction is shown useful and many abstinence based approaches useful and many abstinence based approaches shown not useful with those already abusing shown not useful with those already abusing substancessubstances

•however the research in the area of youth harm however the research in the area of youth harm reduction is very limited reduction is very limited 1010

•Many complications exists towards the research and Many complications exists towards the research and practices of approaches towards substance practices of approaches towards substance

abusing abusing youth youth

So, what do we know:So, what do we know:

--Many students are actively using, some at concerning Many students are actively using, some at concerning levels. levels.

-Many factors may influence the handling of this -Many factors may influence the handling of this student substance use and abuse. Some factors conflict student substance use and abuse. Some factors conflict with each other (and with the research)with each other (and with the research)

-The incorporation of these differing factors likely result -The incorporation of these differing factors likely result in a continuum of strategies that exists, with in a continuum of strategies that exists, with abstinence based and harm reduction laying on abstinence based and harm reduction laying on opposing ends. opposing ends.

-Limited research exists in the student population -Limited research exists in the student population contributing to our knowledge of best practices. More contributing to our knowledge of best practices. More research is neededresearch is needed

More about these two approaches.. More about these two approaches.. (abstinence and harm reduction) (abstinence and harm reduction)

Differing approaches: Differing approaches:

Abstinence Abstinence

Abstinence based approaches believe avoidance of Abstinence based approaches believe avoidance of the substance (or behaviour) by youth is the the substance (or behaviour) by youth is the best solution. best solution.

This is often believed to be achieved through This is often believed to be achieved through abstinence encouragement, zero-tolerance abstinence encouragement, zero-tolerance policies and scare-them-straight tacticspolicies and scare-them-straight tactics

Advocates of this position often argue that firm stances and strict consequences will keep the student population safe, and discourage use

Wide spread popularity of this approach

Differing approaches:

Abstinence

Examples of strategies routed in this approach are:Examples of strategies routed in this approach are:

•The Drug Abuse Resistance Education Program The Drug Abuse Resistance Education Program (DARE)(DARE) 4

•Just Say No campaignsJust Say No campaigns 8

•America’s War on Drug America’s War on Drug 1313

•The Drug Free America Foundation(DFAF) The Drug Free America Foundation(DFAF) 55

•Scare-them-straight style approaches Scare-them-straight style approaches (ex. (ex. Montana Meth commercials Montana Meth commercials – see link below– see link below))

http://www.youtube.com/watch?v=LNKAH_-RSts&feature=results_video&playnext=1&list=PLCDC81A2D749E64EF


Abstinence

Some advantages of this approach are:Some advantages of this approach are:

• It’s popular appeal to the general public It’s popular appeal to the general public

• The sense of security and safety it provides The sense of security and safety it provides

• It’s alignment with laws concerning It’s alignment with laws concerning substances and youthsubstances and youth

• It’s current ability to elicit positive media It’s current ability to elicit positive media attentionattention

• Often linked with preventionOften linked with prevention

Differing approaches: Differing approaches:

Abstinence Abstinence

Some disadvantages of this approach are:Some disadvantages of this approach are:

•limited amount of documented long-term success. limited amount of documented long-term success. (Typically their have been slight decreases following (Typically their have been slight decreases following interventions, however shortly afterwards the interventions, however shortly afterwards the use/abuse returns to the previous levels, or even use/abuse returns to the previous levels, or even increaseincrease 7) 7)

•May alienate students that are using, or encourage May alienate students that are using, or encourage judgement of that usejudgement of that use

•May not be realistic May not be realistic

•Since educators have a responsibility to adhere to Since educators have a responsibility to adhere to legal standards AND also provide empirically driven legal standards AND also provide empirically driven practices for students, abstinence based approaches practices for students, abstinence based approaches cause concern when heavily enforced in schools.cause concern when heavily enforced in schools.


Harm ReductionHarm ReductionHarm reduction approaches try to reduce drug-related harm Harm reduction approaches try to reduce drug-related harm

without necessarily requiring the cessation of the without necessarily requiring the cessation of the behaviourbehaviour

Common focuses of this approach are pragmatism, focus Common focuses of this approach are pragmatism, focus on harms, prioritization of goals, autonomyon harms, prioritization of goals, autonomy

Can be controversial, particularly in its extremes Can be controversial, particularly in its extremes

Advocates of this approach argue it’s realistic nature Advocates of this approach argue it’s realistic nature allows treatment of those already allows treatment of those already using heavilyusing heavily

Often used in conjunction with other approaches, Often used in conjunction with other approaches, particularly particularly motivational interviewing.motivational interviewing.

Important that the decision to use a harm reduction approach Important that the decision to use a harm reduction approach is based upon select population needs, with those at is based upon select population needs, with those at higher risks of the dangers of substance abuse more higher risks of the dangers of substance abuse more likely to benefit. likely to benefit.


Harm ReductionHarm Reduction

Some examples of strategies routed in this approach Some examples of strategies routed in this approach are:are:

• Needle exchange programsNeedle exchange programs•Methadone clinicsMethadone clinics•Drinking and driving campaignsDrinking and driving campaigns•Safe gradsSafe grads•Seat beltsSeat belts•Teaching the recovery positionTeaching the recovery position•Giving out birth control to street workersGiving out birth control to street workers

Can Can youyou think of any more examples? think of any more examples?



Some advantages of this approach are:Some advantages of this approach are:

•Best practices for those harmfully usingBest practices for those harmfully using

•Research (though limited) supportedResearch (though limited) supported

•Relationship buildingRelationship building

•Non confrontational/judgementalNon confrontational/judgemental

•Targets at-risk populationsTargets at-risk populations

•Commonly used in treatmentCommonly used in treatment

•Works well with complimentary approaches Works well with complimentary approaches (Motivational interviewing, Brief Solutions Focused)(Motivational interviewing, Brief Solutions Focused)



Some disadvantages of this approach are:Some disadvantages of this approach are:

•Can be controversial/ elicit strong reactionsCan be controversial/ elicit strong reactions

•Is not appropriate for younger age groupsIs not appropriate for younger age groups

•Can go against public opinion (lack of support)Can go against public opinion (lack of support)

•Can be difficult to implement in a school settingCan be difficult to implement in a school setting

•Can be confused for arguments to legalize drugs Can be confused for arguments to legalize drugs or endorse substance abuse (but does neither) or endorse substance abuse (but does neither)

Harm Reduction Vs. Abstinence:Harm Reduction Vs. Abstinence:

Both can be useful and have their place within Both can be useful and have their place within school systems depending on the age of school systems depending on the age of youth youth and other specific needs. and other specific needs.

For older youth it may be important to For older youth it may be important to incorporate more harm reduction strategies incorporate more harm reduction strategies into school based interventionsinto school based interventions The idea of “delayed abstinence” incorporates The idea of “delayed abstinence” incorporates both, encouraging youth to wait before both, encouraging youth to wait before engaging in the potentially problematic engaging in the potentially problematic behaviourbehaviour

Some Helpful Addiction Related Resources: Some Helpful Addiction Related Resources:

Included in presentation material - Included in presentation material - See WikispaceSee Wikispace

--

Any questions, thoughts or Any questions, thoughts or comments before we move on?comments before we move on?

Thank youThank you

ReferencesReferences 1. Alberta Health Services: Addiction and Mental Health. (2008). 1. Alberta Health Services: Addiction and Mental Health. (2008). The Alberta Youth Experience Survey The Alberta Youth Experience Survey (TAYES)(TAYES). Retrieved from . Retrieved from

http://www.albertahealth serv ices.ca/2382.asp 2. Butters, J., Erickson, P., & Walko, K. (2009). CAMH and Harm Reduction: A background paper on its 2. Butters, J., Erickson, P., & Walko, K. (2009). CAMH and Harm Reduction: A background paper on its meaning and meaning and

application for substance use issues. application for substance use issues. Centre for Addiction and Mental Health.Centre for Addiction and Mental Health. Retrieved at Retrieved at http://www.camh.net/ Public_policy/Public_policy_papers/ harmreductionbackground.html

3. Canadian Pediatric Society (CPS). (January, 2008). Harm Reduction: An approach to reducing risky 3. Canadian Pediatric Society (CPS). (January, 2008). Harm Reduction: An approach to reducing risky health behaviours in health behaviours in adolescents. Paediatric Child Health Journal, Vol. 13, No. 1. Retrieved from adolescents. Paediatric Child Health Journal, Vol. 13, No. 1. Retrieved from http://www.cps.ca/english/ statements/am/ah08-01.htm

4. Drug Abuse Resistance Education (D.A.R.E.) program. (n.d.) 4. Drug Abuse Resistance Education (D.A.R.E.) program. (n.d.) Wikipedia, the free encyclopaedia.Wikipedia, the free encyclopaedia. Retrieved from Retrieved from http://en.wikipedia.org/wiki Drug_Abuse_ Drug_Abuse_ Resistance_Education#Studies_on_effectivenessResistance_Education#Studies_on_effectiveness

5. Drug Free America. (n.d.) 5. Drug Free America. (n.d.) Wikipedia, the free encyclopaedia.Wikipedia, the free encyclopaedia. Retrieved from Retrieved from http:// en.wikipedia.org/wiki/Drug_Free_America_Foundation

6. Health Canada (2007). Youth Smoking Survey. Retrieved from 6. Health Canada (2007). Youth Smoking Survey. Retrieved from www.hc-sc.gc.ca/ hc-ps/tobac-ps/tobac- tabac/research-tabac/research-recherche/stat/index-eng.php#yssrecherche/stat/index-eng.php#yss

7. Health Canada. (n.d.).7. Health Canada. (n.d.). Preventing Substance Use Problems Among Young People - A Compedium of Preventing Substance Use Problems Among Young People - A Compedium of Best Practices. Special Best Practices. Special Focus: A summary of evaluations of the Drug Abuse Resistance Education Focus: A summary of evaluations of the Drug Abuse Resistance Education (D.A.R.E.). (D.A.R.E.). Retrieved from http:// www.hc-sc. Retrieved from http:// www.hc-sc. gc.ca/hc-ps/pubs/adp-apd/prevent/programs-gc.ca/hc-ps/pubs/adp-apd/prevent/programs- dareprogrammes- eng.php dareprogrammes- eng.php

8. Just Say No. (n.d.). 8. Just Say No. (n.d.). Wikipedia, the free encyclopaediaWikipedia, the free encyclopaedia. Retrieved from . Retrieved from http:// en.wikipedia.org/wiki/Just_Say_Nohttp:// en.wikipedia.org/wiki/Just_Say_No 9. Marlatt, G.A. (1996). Harm Reduction: Come as you are. 9. Marlatt, G.A. (1996). Harm Reduction: Come as you are. Journal of Addictive BehaviourJournal of Addictive Behaviour, 21(6), 779-, 21(6), 779- 788788 10. National Drug Research Institute (NRDI): Curtlin University, Australia. (n.d.).10. National Drug Research Institute (NRDI): Curtlin University, Australia. (n.d.). SHAHRP: School SHAHRP: School Health and Alcohol Health and Alcohol

Harm Reduction Project. Harm Reduction Project. Retrieved from Retrieved from http://ndri.curtin.edu.au/research/shahrp/http://ndri.curtin.edu.au/research/shahrp/ 11. Poulin, Christiane. (2006). Harm Reduction for Special Poulations in Canada: Harm reduction policies 11. Poulin, Christiane. (2006). Harm Reduction for Special Poulations in Canada: Harm reduction policies and and

programs for youth. programs for youth. Canadian Centre on Substance Abuse.Canadian Centre on Substance Abuse. Retrieved from Retrieved from http://www.ccsa.ca/2006%20CCSA http://www.ccsa.ca/2006%20CCSA %20Documents/ccsa-11340-2006.pdf%20Documents/ccsa-11340-2006.pdf

12. Saskatchewan Ministry of Health. (November, 2009). 12. Saskatchewan Ministry of Health. (November, 2009). Focus Sheet: Youth - trends and patterns Focus Sheet: Youth - trends and patterns of alcohol of alcohol use.use. Retrieved from Retrieved from http://www.health.gov.sk.ca/Default.aspx?DN=2ffb9694-http://www.health.gov.sk.ca/Default.aspx?DN=2ffb9694- 40aa- 4c59-8561-40aa- 4c59-8561-c9c30c294889&l=Englishc9c30c294889&l=English

13. War on Drugs. (n.d.). 13. War on Drugs. (n.d.). Wikipedia, the free encyclopaedia.Wikipedia, the free encyclopaedia. Retrieved from http:// Retrieved from http:// en.wikipedia.org/wiki/War_on_Drugsen.wikipedia.org/wiki/War_on_Drugs

student substance use ...and school policy approaches daniel mcmillan

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