Student Substance Use ...and school policy approaches Daniel McMillan

1. Student Substance Use...and school policy approachesDaniel McMillan

2. Substance use and Schools Outline • Three points about student use and schools: • How many students are using • Complications around making school policies • Complications with the supporting research • Two perspectives/approaches: • Abstinence based • Harm reduction • Follow up information in Case study

3. Student substance abuse impacts many areas of the educational system, from daily student life to national policies… So what does that substance use look like?

4. Student Alcohol Use: • Alberta: • The 2008 Alberta Youth Experience Survey (TAYES) reported 75.1% of grade 12 Alberta youth had used alcohol in the past year • - of which 56% reported binge drinking • showed 13.7 % of youth met the World Health Organization’s (WHO) criteria for hazardous drinking 1 • Manitoba • The Canadian Centre on Substance Abuse (CCSA) reporting 84 % of grade 12 Manitoba student alcohol 11 • Sask.: • 85 % of Grade 12 youth and 83% of Gr. 11 youth reported alcohol use. • 75% of Gr. 12 and 72% of Gr. 11 students reported binge drinking 11 • Canada: • Health Canada’s 2006-2007 Youth Smoking Survey reported similar findings with 83% student (Gr. 10-12) alcohol use • - 57 % of which reported binge drinking

5. Student Cannabis (and other drug) Use: • Alberta: • TAYES reported 54% Gr. 12 student cannabis use • 28% illicit drug use with Gr. 12 students • 15.5% youth grade 7-12 reported non-medical codeine use 1 • Manitoba: • CCSA reporting 42 % of Gr. 12 student cannabis use • And 23% grade 9 student cannabis use 11 • Ontario: • Similar findings (CCSA): 46% Gr. 12 student cannabis use • 23% Gr. 9 student cannabis use 11 • Canada: • Health Canada reported similar findings with 43% student cannabis use in students grade 10-12 across Canada 6 • Sask.: • we can assume it is very similar

6. Student Tobacco Use: • Alberta: • 10.6% grade 12 youth are current smokers 1 • Canada: • 11% of grade 10-12 Canadian students are current smokers 6 • Sask.: • we can assume it is very similar • ..Manitoba • as well, 36% of grade 12 youth, and 23% of grade 9 youth reported experimental or occasional smoking (at least once in past year) 11

7. So Substance Use and Abuse is occurring with youth.. how are school’s handling this issue?

8. This is a controversial topic with great differences in intervention stances. It is important to note that numerous factors influencing these policies (and practice) decisions. These factors include:

9. Complications around making school policies: Influencing factors Personal beliefs: Administrators’, policy-makings’, and staffs’ personal beliefs towards youth substance use will impact the handling of this issue.

10. Complications around making school policies: Influencing factors Cultural or societal beliefs: Popular views or seemingly common-sense approaches often play a role in guiding strategies aimed at substance use. This is most obvious through public opinion. Education is a passionate issue to many voters, large- policies are made at high levels often by elected representatives (i.e. Minister of Education), thus popular opinion may have an impact on decisions.  As well many parents and community members have influence over school systems through involvement in boards. 

11. Complications around making school policies: Influencing factors Societal beliefs cont’d.. • Societal beliefs may also be reflected through or biased by current media attention (i.e. scared beyond straight, intervention, etc). • http://www.aetv.com/beyond-scared-straight/video/index.jsp?bcpid=754809944001&bclid=713919091001&bctid=1100566963001

12. Complications around making school policies: Influencing factors • Legal Concerns: • The use of illicit drugs are illegal for all. • Alcohol and tobacco are illegal for youth • Schools have a responsibility to support and adhere to the legal system. • But as we have seen many youth currently use these substances, leaving school policies in a difficult position of how to react.

13. Complications around making school policies: Influencing factors • Ethical Concerns: • Schools (particularly public schools) have a responsibility to provide best- practiced services, as well as to best utilize their resources. • There is an ethical responsibility to provide best-practice services (not simply legally adequate or culturally endorsed services)

14. Complications around making school policies: Influencing factors Before moving on… Can you think of any other significant factors that may influence policy decisions and the handling of student substance abuse?

15. What if all these factors do not align? • This results in the current continuum of school practices for addressing student substance abuse. • On opposing ends of this continuum lie the strategies (perspective approaches) of: • harm reduction and • abstinence based approaches. • We will now look at some of the research findings and complications for these two approaches:

16. Complications around research: Research in the adult population: A significant amount of research exists in the adult population addressing the issue of how to best treat individuals who are currently using and abusing substances. In this population an array of techniques are shown helpful, including harm reduction (emphasis put on reducing risks of the current behaviour and accepting the possibility that some use may still occur)7 Complications continue to exist, particularly with illicit drugs. The ability to make decisions for one’s self (legal adult) taken into account.

17. Complications around research: Research in the youth Population: A limited amount of research exists in the area, particularly with regards to harm reduction. There are many legal and ethical research complications 11 Though limited, research demonstrates effective use of harm reduction techniques in older youth. Also demonstrates the ineffectiveness of many abstinence based approaches (such as DARE)7 More complications exist towards implementation of many approaches. The ability to make decisions for one’s selves (mature minor vs. legal adult) is often debated. Also the potential of harm is greatly increased b/c of the youths’ age

18. Complications around research: • So to summarize.. • ..with regards to research in this area: • In substance using adults, harm reduction is show to be useful2, 10, 11 • In substance using youth harm reduction is shown useful and many abstinence based approaches shown not useful with those already abusing substances • however the research in the area of youth harm reduction is very limited 10 • Many complications exists towards the research and practices of approaches towards substance abusing youth

19. So, what do we know: -Many students are actively using, some at concerning levels. -Many factors may influence the handling of this student substance use and abuse. Some factors conflict with each other (and with the research) -The incorporation of these differing factors likely result in a continuum of strategies that exists, with abstinence based and harm reduction laying on opposing ends. -Limited research exists in the student population contributing to our knowledge of best practices. More research is needed

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

21. Differing approaches: Abstinence Abstinence based approaches believe avoidance of the substance (or behaviour) by youth is the best solution. This is often believed to be achieved through abstinence encouragement, zero-tolerance policies 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

22. Differing approaches: Abstinence • Examples of strategies routed in this approach are: • The Drug Abuse Resistance Education Program (DARE)4 • Just Say No campaigns8 • America’s War on Drug 13 • The Drug Free America Foundation(DFAF) 5 • Scare-them-straight style approaches (ex. Montana Meth commercials – see link below) • http://www.youtube.com/watch?v=LNKAH_-RSts&feature=results_video&playnext=1&list=PLCDC81A2D749E64EF

23. Differing approaches: Abstinence • Some advantages of this approach are: • It’s popular appeal to the general public • The sense of security and safety it provides • It’s alignment with laws concerning substances and youth • It’s current ability to elicit positive media attention • Often linked with prevention

24. Differing approaches: Abstinence • Some disadvantages of this approach are: • limited amount of documented long-term success. (Typically their have been slight decreases following interventions, however shortly afterwards the use/abuse returns to the previous levels, or even increase7) • May alienate students that are using, or encourage judgement of that use • May not be realistic • Since educators have a responsibility to adhere to legal standards AND also provide empirically driven practices for students, abstinence based approaches cause concern when heavily enforced in schools.

25. Differing approaches: Harm Reduction Harm reduction approaches try to reduce drug-related harm without necessarily requiring the cessation of the behaviour Common focuses of this approach are pragmatism, focus on harms, prioritization of goals, autonomy Can be controversial, particularly in its extremes Advocates of this approach argue it’s realistic nature allows treatment of those already using heavily Often used in conjunction with other approaches, particularly motivational interviewing. Important that the decision to use a harm reduction approach is based upon select population needs, with those at higher risks of the dangers of substance abuse more likely to benefit.

26. Differing approaches: • Harm Reduction • Some examples of strategies routed in this approach are: • Needle exchange programs • Methadone clinics • Drinking and driving campaigns • Safe grads • Seat belts • Teaching the recovery position • Giving out birth control to street workers • Can you think of any more examples?

27. Differing approaches: • Harm Reduction • Some advantages of this approach are: • Best practices for those harmfully using • Research (though limited) supported • Relationship building • Non confrontational/judgemental • Targets at-risk populations • Commonly used in treatment • Works well with complimentary approaches (Motivational interviewing, Brief Solutions Focused)

28. Differing approaches: • Harm Reduction • Some disadvantages of this approach are: • Can be controversial/ elicit strong reactions • Is not appropriate for younger age groups • Can go against public opinion (lack of support) • Can be difficult to implement in a school setting • Can be confused for arguments to legalize drugs or endorse substance abuse (but does neither)

29. Harm Reduction Vs. Abstinence: Both can be useful and have their place within school systems depending on the age of youth and other specific needs. For older youth it may be important to incorporate more harm reduction strategies into school based interventions The idea of “delayed abstinence” incorporates both, encouraging youth to wait before engaging in the potentially problematic behaviour

30. Some Helpful Addiction Related Resources: Included in presentation material - See Wikispace -

31. Any questions, thoughts or comments before we move on? Thank you

32. References 1. Alberta Health Services: Addiction and Mental Health. (2008). The Alberta Youth Experience Survey (TAYES). 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 meaning and application for substance use issues. Centre for Addiction and Mental Health. 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 health behaviours in 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.) Wikipedia, the free encyclopaedia. Retrieved from http://en.wikipedia.org/wikiDrug_Abuse_ Resistance_Education#Studies_on_effectiveness 5. Drug Free America. (n.d.) Wikipedia, the free encyclopaedia. Retrieved from http://               en.wikipedia.org/wiki/Drug_Free_America_Foundation 6. Health Canada (2007). Youth Smoking Survey. Retrieved from www.hc-sc.gc.ca/         hc-ps/tobac- tabac/research-recherche/stat/index-eng.php#yss 7. Health Canada. (n.d.). Preventing Substance Use Problems Among Young People - A Compedium of Best Practices. Special Focus: A summary of evaluations of the Drug Abuse Resistance Education (D.A.R.E.). Retrieved from http:// www.hc-sc. gc.ca/hc-ps/pubs/adp-apd/prevent/programs- dareprogrammes- eng.php 8. Just Say No. (n.d.). Wikipedia, the free encyclopaedia. Retrieved from http://  en.wikipedia.org/wiki/Just_Say_No 9. Marlatt, G.A. (1996). Harm Reduction: Come as you are. Journal of Addictive Behaviour, 21(6), 779- 788 10. National Drug Research Institute (NRDI): Curtlin University, Australia. (n.d.). SHAHRP: School Health and Alcohol Harm Reduction Project. Retrieved from http://ndri.curtin.edu.au/research/shahrp/ 11. Poulin, Christiane. (2006). Harm Reduction for Special Poulations in Canada: Harm reduction policies and programs for youth.  Canadian Centre on Substance Abuse. Retrieved from http://www.ccsa.ca/2006%20CCSA              %20Documents/ccsa-11340-2006.pdf 12. Saskatchewan Ministry of Health. (November, 2009). Focus Sheet: Youth - trends and patterns of alcohol use. Retrieved from http://www.health.gov.sk.ca/Default.aspx?DN=2ffb9694- 40aa- 4c59-8561-c9c30c294889&l=English 13. War on Drugs. (n.d.). Wikipedia, the free encyclopaedia. Retrieved from http:// en.wikipedia.org/wiki/War_on_Drugs