How School can Support Their Students on Their Road to Recovery?

Across the world, addiction and substance abuse in teenagers and young adolescents remains a topic of extreme significance. The use of some substances, like tobacco, has thankfully continued to diminish over time. Others have emerged, however, like cannabis, prescription drugs, and most commonly alcohol. These continue to impact students’ everyday lives and school performance, very often following them into adulthood. They inhibit social skills, weigh down on already burdened families, and can have catastrophic consequences if left unchecked.

It’s thus Bright Futures experts’ firm belief that school, like the proverbial second home, should extend an initial helping hand to them. School can support their students on their road to recovery in ample ways, which I feel warrants an exploration.

The roots of addiction and substance abuse

First and foremost, I’d like to contextualize addiction and substance abuse. This I believe needs to be done here, because way too often I hear that addiction is a choice.

No, I can categorically say addiction is not a choice. To say that it ignores the science behind it, from genetic predisposition to its effects on the brain. It ignores the complex social structures and rituals that weave our early lives. And in such pressing times like these, it ignores the devastating impact that COVID-19 has had on all of us.

That’s not to say that anyone struggling with addiction is entirely free of agency. The choices to seek help, strive to recover, and persevere are all there for those who are ready. It’s absolutely admirable each and every time someone seeks help with substance abuse, and nobody should deny or minimize that. Choosing to seek support is often heroic, with no exaggeration, as it puts the person on the road to recovery.

But seeing this through a simple black-and-white lens of consciously choosing between A and B is a gross oversimplification. Humans do not operate in a vacuum, and such choices are not omnipresent. How often does an adult fail to identify the extent of their addiction, feeling in control themselves? How often does a teenager not have the option to begin with, even though school can support their students on their road to recovery?

All too often, I’d argue. And in this particular context, it’s even more shortsighted to overestimate the agency of teenagers and even young adults. To elaborate, here I’d like to briefly delve into the roots of addiction and substance abuse.

Genetics: the heritability of addiction

Albeit overseen, perhaps because genetics and epigenetics rarely come up in general discourse, addiction can indeed reside in genes. This may seem an odd assertion to make in this context, so allow me to explain.

Studies find that addiction can indeed be inheritable. Rather, to be specific, research has noted that affinity for both substance abuse and addictive behavior is affected by genetics. NCBI offers some excellent resources in this regard, if you’d like further information on the phenomenon.

In brief, substances and behaviors specifically identified as such include:

• Crack cocaine
• Sedatives
• Stimulants
• Caffeine
• Hallucinogens
• Opiates
• Gambling
• Smoking
• Alcohol
• Cannabis

This is by no means either bound to occur or the only factor at play, but it is one nonetheless. It’s thus true that parents and school can support their students on their road to recovery, but only once they’ve accepted no child “chooses” this position in a vacuum.

In the context of children and young adults, it is not to blame parents in any way either. All it means to say is that genetics do indeed play a role, undermining the concept of free choice.

This is even more prominent in the young brain, as I will touch on later.

Social contexts: addiction and identity

In addition, even more so as concerns young people, social contexts also play a key role in initiating addiction. This factor is likely much more self-evident for many.

For young adults, consider the simplest example of the need to fit into new groups like sororities. Or perhaps the impulse to fit in with “tougher” communities of practice, such as sports clubs. Even the pursuit of sex appeal in general, if you will. Many substances and behaviors do serve as social lubricants, shape up identities, and become more than themselves.

This is a crucial distinction to make as well, as social pressure is a very substantive factor. For a personal example I may offer that of a friend, who never once smoked before serving. Once he did, he picked up smoking and hasn’t quit since. He needed a way to relieve anxiety as he adjusted into a new environment, and some of his fellow servicemen happened to be smokers. This combination of an emerging psychological need and a means to socialization occurs very often, including in schools.

Imitation: art and commerce

By now I’m sure you have a clearer idea of how school can support their students on their road to recovery. Such signs should help identify cases early, so appropriate staff can intervene before and after recovery. But I’d like to briefly touch on three more noteworthy factors before suggesting solutions.

The first among them is of course imitation; embracing addictive behaviors and substances because they’re glorified.

The Marlboro Man campaign is a prime example of the commercialized promotion of masculinity amplified by tobacco products. It lasted for half a century, and the shift in public promotion of such products in the early 2000s predictably coincided with a steady decline in smoking across all age groups.

Along similar lines comes art. Consider how often modern art evokes this exact image, where harmful habits denote toughness. This spans across movies, music, and more, as I’m certain you have noted yourselves. It is only a conscious shift away from this paradigm that has somewhat curbed imitation in impressionable young people.

Stress: the global pandemic

The other ephemeral factor that I feel warrants attention is the demonstrable psychological effect of COVID-19 on everyone. Of course, in this context I may focus on students in particular.

Young people have had more challenges rationalizing the global pandemic, and have had to bear its effects no less. It inhibited socialization, disrupted education, and forced a very tangible sense of danger into their consciousness. COVID Stress Syndrome does seem to affect them less, comparatively, but it still added pressure onto an already stressful developmental phase.

ADAA also identifies a “substantial mental health footprint”, and notes associations with other symptoms of distress, including:

• Anxiety and depression
• Self-isolation
• Avoidance behaviors

Indeed, school can support their students on their road to recovery. Education institutions have done so before, as I will also explore next. But in this context, this massive additional stress on the shoulders of young people did add to the risk of addiction initiation.

Worse yet, many such symptoms may overlap among different underlying causes. This is exactly why school staff needs to carefully account for such intersections and adjust their actions accordingly.

Addiction in the adolescent brain

The final factor that relapse prevention also often accounts for is the brain itself. Addiction quite literally changes the brain, physiologically, as it takes hold and stimulates its reward systems. But why is it that most people with substance addictions pick them up before adulthood?

The simple answer lies within the adolescent brain. Turnbridge’s excellent article on this issue explains it perfectly, noting the young brain’s higher vulnerabilities:

“During our pre-teen years, the area of the brain most responsible for reasoning grows immensely. That growth, however, is pruned back as we reach adolescence, making the prefrontal cortex […] less active during young adulthood. One’s teenage years, as a result, often involve the most risk-taking; […] consequences don’t necessarily matter. Teenagers, in actuality, do not have full control over their impulses and this puts them at an increased risk for making poor decisions, posing a great threat for early drug and alcohol addiction.”

This factor, they conclude, overlaps with the brain’s artificially produced dopamine. This basic function of addictive substances grasps the adolescent brain much more easily:

“In adolescents, dopamine levels are only baseline, thus explaining their constant boredom and need to try new things. When they do, the amount of dopamine released in their brain is actually much higher than that of adults. Combine this with repeated drug use and the fact that teens are already prone to adventure and risk-taking behaviors, and you’ve got a recipe for addiction in the future.”

How school can support their students on their road to recovery

Now, with this context in mind, what exactly can schools do? For one, focus on prevention, I’d argue. Late-stage interventions may be harder to succeed, as they often have to face all of the aforementioned factors.

Post-prevention, a robust program of intervention is absolutely imperative. It is, very often, what will actually lead students to the path to recovery.

Finally, continued awareness and support post-recovery must remain on the staff’s mind. Relapse is extremely common if left unattended, especially for young people.

With these in mind, I’d like to consolidate these phases into actionable step-by-step processes. As I do, I will be citing successfully implemented school programs and support resources.

#1 Picking up on the signs

First and foremost, it’s absolutely crucial that teachers, faculty, and staff have a very firm grasp on warning signs. The ones I’ve mentioned above in passing NYC’s OASAS consolidates into two groups; physical and behavioral.

Physical warning signs include:

• Small pupils
• Decreased respiratory rate
• Drowsiness
• Loss or increase in appetite
• Weight loss or weight gain
• Intense flu-like symptoms

While behavioral warning signs include:

• Changes in attitude and/or personality
• Isolationism
• Drops in grades
• Moodiness, irritability, nervousness, giddiness
• Tendency to steal

Picking up on such signs early can make the difference between a timely intervention and one too late.

#2 Early intervention

Truthfully, school can support their students on their road to recovery much more efficiently if that’s where intervention begins.

Of course, exact interventions will vary depending on resources, exact cases, prevalence, and so forth. Still, NYC’s Substance Abuse Prevention and Intervention Specialists (SAPIS) program offers a wealth of resources and suggestions, including:

• Classroom lessons (using evidence-based programs)
• Peer leadership programs
• Positive alternative activities
• School-wide prevention projects

If you happen to need such resources yourself to set up any such programs, NCSSLE offers many that specifically cater to teenagers. Those include digestible facts about prevalent addictive substances, covering all the ones MSD Manuals cites “high school students [have used] one or more times in their life”, including:

• Prescription drugs (taken without a prescription): 14.6%
• Inhalants (for example, glue, aerosols): 5.3%
• Hallucinogens (for example, LSD, PCP, mescaline, mushrooms): 6.9%
• Cocaine: 4.9%
• Anabolic steroids (taken by mouth or injected into a muscle): 1.6%
• Methamphetamines (nonprescription): 2.1%
• Heroin: 0.6%

#4 Assessments and referrals

Of course, and unfortunately so, schools cannot at all times prevent addiction and substance abuse. For harder cases, they may monitor students, assess their progress, and ultimately refer them to health professionals as NIDA suggests.

As they do so, it is vital that they approach students with care and caution. They must at all times remember that students struggling with addiction likely suffer from severe stress, and require case-by-case approaches. They thus need to establish a relationship of trust and extend the option of treatment as one to opt into. This is imperative so the school can support their students on their road to recovery post-referral.

ASU explains this delicate balance very well:

“To make referrals successful, providers need to develop strong knowledge of and working connections with local SUD and mental health service providers that specialize in adolescent treatment.  […]

The manner in which a referral to further treatment is provided can have tremendous impact on whether the adolescent will actually access the recommended services.  Using a motivational interviewing-style approach can be utilized when making referrals by helping to raise awareness and show the need for specialty care.”

#5 Consistent counseling post-recovery

Finally, the most substantive support schools can offer post-recovery is diligent, consistent counseling and ongoing psychological support. Successful treatments absolutely don’t eliminate the possibility of relapse, as I’ve covered before.

This step too will differ drastically in execution. It should ideally span across all programs and outreach already in place, and expand according to the students’ individual needs.

For an excellent, inspirational example, I may cite NIDA once more. In this article they explore the case of Northshore Recovery High School in Massachusetts, whose programs have found immense success. In turn, it was featured in the MTV reality docuseries, “16 and Recovering”. The article features discussions between NIDA’s Dr. Wilson Compton and the school’s co-founder and principal, Michelle Lipinski. Between them and additional video material, it should hopefully serve to offer you some inspiration, should you need it.

Final words

To conclude, I cannot emphasize enough that addiction is by no means a choice – nor should it be judged as such. It is a deep, multifaceted set of circumstances that still leads young people to it.

Prevention programs and recovery treatments alike should take this into account to yield the intended benefits, especially for young people who do face additional challenges with substance abuse. In this vein, school can support their students on their road to recovery through continued support and care, no less than through prevention programs and timely interventions that establish meaningful, trusting relationships.

While brief, given this subject’s complexity, I truly hope this article and the resources it cited proved helpful. Feel free to contact Bright Futures for more information.