Helping Students with Alcohol and Other Drug (AOD) Problems : Cognitive-Behavioral Interventions for School Counselors Gerald

A. Juhnke Preview Alcohol and Other Drug (AOD) abuse continues to be a major problem for high scholol and middle school students. The more routinely correlated negative effects of such abuse by students are well documented within existing literature (e.g., poor academic performance, students retention). However, more severe and sensational negative effects often reported vie the news media are also correlated with AOD abuse among-this population (e.g., suicide, aggravated assault). The Cognitive-Behavioral and adjunctive interventions described in this chapter provide school counselors practical and effective treatment options than can be readily implemented with students who abuse alcohol and other drug. Existing literature clearly supports many professional school counselors perceptions and beliefs that high school and middle school students are : (a) abusing alcohol and other drug (AODs) more frequently than ever before, (b) beginning AOD abuse at earlier ages, and (c) ignoring the inherent dangers associated with AOD abuse (Hogan, 2000; Johnson, OMalley, & Bachman, 2000). An example of research reflecting such students AOD abuse and attitudinal deterionation is a University of Michigan Institute for social Research longitudinal study. The research began in 1975 and is funded by the national Institute on Drug abuse (NIDA). This research surveys nationally representative samples of 8. 10, and 12 grade classes and annually includes nearly 50.000 students from more than 400 public and private secondary schools. Survey result indic0ated : (a) 54% of the participants had used and illicit drug by the time they reached their senior year in high school, (b) the annual use of any illicit drug among seniors increased from 27% in 1992 to 42% in 1997, and (c) the percentage of seniors who has used and illicit drug within 30 days prior to survey participation increased from 14% in 1992 to 26% in 1997 (NIDA,1997).

Some of the most recent available data provide by the Substance Abuse and Mental Health Services Administration [SAMHA] (1996; 1999) reported that: (a) 38% of girls between the ages of 12 and 17 have used alcohol, (b) 19% of adolescent girls reported alcohol use within the previous 30 days, (c) students are using alcohol earlier in their lives, thus placing them at grater risk for future substance dependence, suicide, and other health-related problems, (d) nearly 7% of girls aged 12 to 17 report binge drinking, and (e) by the early 1990s 31% of new female alcohol users were between the ages of 10 and 14. Regretfully, alcohol is not the only substance abused by students. Inhalant use is fast becoming one of the first substance abused by preadolescent and younger students (Hogan, 2000). Inhalant use is also prominent among adolescent students (Johnston et al, 2000). Concomitantly, hallucinogenics are also used with increased frequency among adolescent students. However, among adolescent students, marijuana still accounts for 75% of all illicit drug abuse (Hogan, 2000). This data clearly demonstrates the need for professional school counselor to be able to effectively intervene with AOD abusing student.

Cognitive behavioral Counseling Interventions Cognitive behavioral Counseling Interventions have significant utility for professional school counselors due to their emphasis upon brief, time-limited interventions directed toward immediate student concerns. Tree primary cognitive behavioral counseling goals exist for school counselors helping AOD abusing student (Nystul, 1999). First, professional school counselor help student understand how the students thoughts, feelings, and behaviors engender AOD abuse. In other words, school counselors help students better understand what students say to themselves (e.g., If I do drugs, others will thinking Im cool and like me.), feel (e.g., anxiety, depression, anger), or do (e.g., argue, fight, withdraw) immediately before they AOD abuse. Second, school counselors promote understanding of how the students AOD abuse is connected to negative consequences (e.g., failing grades, arguments with peers) and positive consequences (e.g., interactions with peers, feeling of confidence). Finally,

professional school counselors help students explore new, healthier ways of thinking and acting which reduce the probability of continued AOD abuse. Understand The AOD Abuse Sequence Recognizing triggers. Professional school counselors treating AOD abusing students first need to help students recognize the triggers (e.g., thoughts, behaviors, situation), which occur immediately prior to the students AOD abuse (see Table I). TABLE 1. Alcohol and other drug trigger and nonuse sequence-outcome list. Thought Feeling Behavior Triggers Triggers Triggers Situation Triggers Positive Negative Outcome Outcome

Nonuse Nonuse Nonuse Nonuse Positive Negative Thought Feelings Behaviors Situations Outcome Outcome

Commonly, AOD abusing students will be able to describe the internal dialogue they have with themselves or the physical or psychological signals which foretell of their upcoming AOD abuse. For example, a student might indicate that her internal dialogue just before abusing goes something like this: Im stressed. There is no way I can get through the rest of this math class without taking a hit to calm myself down. Additionally, she may describe physical feelings like in inability to relax or concentrate, and physical behaviors like involuntary muscle contraction or psychomotor agitation (e.g., tapping her finger, bouncing her leg). Psychological signals might include remembering how calming it was when she smoked marijuana the previous day or describing the depressed symptomatology experienced most days when she is AOD abstinent. Brothermore, she might be able to identify specific situations or circumstances which increase the probability of her AOD abuse (e.g., the class prior to each Fridays math quiz, the nights before her math test, the days in which she receives her math quiz scores).

Once triggers are recognized by students, trigger lists are made. Students rank order the triggers on the lists, indicating which triggers are the most powerful and which are most frequently occountered. Thus, students first rank the strength of the individual triggers from 0 (When I experience this, I will not use drugs at all.) to 10 (When I experience this, I am inevitably going to use drugs.) and rank the trigger frequency from 0 (I never experience this trigger.) to 10 (This trigger occurs constantly troughout my awake hours). Priority is then given to triggers identified by students as being the most powerful and occurring most often. In other words, triggers which students identify as indicating both inevitable AOD us and which constantly occur are the trigger which warrant the most attention at the onset of the counseling process. Establishing trigger baselines. Concomitantly, the self-described and frequency of triggers presented by students serve as baselines which can be used to measure progress. In other words, these baselines allow both students and professional school counselor to track treatment efficacy. Should students report a decrease in severity and frequency of triggers, progress is likely occurring and the interventions being used should be continued. However, should the severity and frequency of triggers be increasing, treatment and interventions warrant revision. Nonuse lists. In addition to the trigger list, professional school counselors may wish to help students construct a Nonuse List. Here, the emphasis is on identifying thoughts, feelings, behaviors, and situations occurring when students dont abuse. The purpose of this list is to help students identify different ways of positively experiencing life without the need to abuse. Many professional school counselors with whom this author has spoken have noted significant portions of their frequently AOD abusing students will be AOD abstinent when : (a) they are interacting with respected and admire peers who do not use, (b) students are participating in activities in which they are invested and find interesting (e.g., athletics, engine repair class, choir), and (c) they do not experience overwhelming anxiety related to future performance (e.g., upcoming examinations, athletic events). This list provides students ideas on how they might better cope with experiences which commonly lead to AOD abuse by describing how they think, feel, and behave when they are not driven by the urge to use.

Positive consequences. Unfortunately, positive consequences from student AOD abuse are often ignored or inappropriately minimized by helping professionals. This is a significant treatment error which dilutes counseling efficacy and disinvests student participation. Students frequently experience multiple positive consequences as a result of their AOD abuse. These positive consequences can vary greatly depending upon the individual student. Perceived, peer support provided by other AOD abusing students, escape from pressing concerns, and pure enjoyment of being under the influence are key reasons students AOD abuse. Honest discussion regarding the potential loss of these perceived positive consequences is necessary before students can begin the abstinence process. Therefore, statements such as, Tell me about the positive things you experience when you use or Help me understand what it is like drinking with your peers are helpful. The intent of these queries is not to have students romantically portray AOD abuse. Instead, professional school counselors are learning why AOD abuse and AOD experience are important to the individual student. Once the why is answered, professional school counselors can begin working to appropriately address the void which will inevitably be created should students eliminate their AOD abusing behaviors. For example, should a 13 year old male indicate that drinking with other teens provides him friendships, the professional school counselor and the student may need to identify other ways the student can secure friendship without AOD abuse. Given the importance students place upon their acceptance by peers and their desire t fit in, this is a daunting challenge. However, failing to address this students need for new, non AOD abusing friends, at best, destines the counseling process ti limited success. Negative consequences. When reviewing negative consequences resulting from student AOD abuse, it is helpful to first ask about the presenting circumstances which brought students to counseling and then link these to academic, family, peer, psychological, or legal problems resulting from or potentially linked to their AOD abuse. A vignette is provided below.

PSC : Shondra, I know that Vice Principal Myers referred you to my office. As I understand the situation, you had consumed alcohol and then had gotten sick at last Saturday nights homecoming game. Help me understand what that was like for you? Shondra : It was awful. I was trying to be cool and instead. I got drunk. When I got to the game everything started spinning, and I threw up in the stands. I was so embarrassed. Now my parents know I was drinking and Im grounded, and the people I was trying ti impress laugh at me. PSC : That sounds rough. Shondra : Yeahit is. PSC : What have you learned from all of this? Shondra : Well, Ive learned that I dont want to drink anymore before games. PSC : Sometimes people tell me that they perform badly on test or get bad grades, because they were under the influence of alcohol when they took their tests or because they missed a lot of school due to their drinking. Has anything like that ever happened to you? Shondra : Naw, nothing like that. PSC : At other times students tell me that when they drink they get into arguments with their parents or family members. Shondra : Well, a couple week ago, when my friends and I had been out drinking, I ran my moms car into a ditch. I had to call my dad to get the car out. He was really upset. He said Id have to pay the $480 to get the car fixed. PSC : So, your drinking go you into trouble with your dad and caused you to pay to expenses for repairing your moms car? Shondra : Yeah, I guess Im learning that drinking costs me a lot.

Within this vignette, the professional school counselor first attempts to help Shondra begin understanding the link between her drinking behaviors and other potential negative consequences. The professional school counselor describe the primary reason Shondra came for counseling, the vice Principals referral. Shondra reports two specific problems resulting from this incident (e.g., embarrassment, parental punishment [grounding]). The counselor then investigates potential negative consequences of alcohol consumption related to Shondras school experience. This is denied. Therefore, the professional school counselor continues asking about other potential negative consequences of alcohol consumption occurring within Shondras relationship with her parents. Toward the end of this sessions the school would likely summarize the problems reported students as linked to her alcohol use and ask the student to clarify how continued alcohol consumption is helpful. PSC : Shondra, help me understand. You say that you were terminated from Wal-mart, because youve been too drunk to work your scheduled shift. Youve said that youve gotten in trouble with the police for drinking and driving and had to pay over $400 to get your moms car repaired. And, youve told me that you get real anxious when you buy beer, because your mom and dad would kick you out of the house if they knew you were continuing to drink. How is it helpful to you to continue drinking alcohol? Shondra : I guess its not. PSC : Based upon your trigger list, youve basically said you consume alcohol when you get bored. So, what will you do differently when you get bored in the future? Shondra : Well, I guess Im not going to drink. PSC : O.K. What will you do instead when you find yourself becoming bored or thinking that you may become bored. Shondra : I dont know. PSC : Well, on your Nonuse List, you said when you are with Stacey, you dont use alcohol, because she is fun and she doesnt like beer. Im

wondering if you would be willing to call Stacey if you begin to feel bored. Shondra : Yeah, I could do that. PSC : What else could do? Shondra : I guess I could do some of the other things I said in my nonuse list, like take my dog for a walk or practice my clarinet. At the conclusion if this vignette the professional school counselor gently confronts Shondra by asking how continued drinking is helpful. Instead of dropping the discussion when Shondra reports her alcohol consumption is not helpful, the counselor uses the clients trigger list to help Shondra recognize one of the primary reasons she reportedly consumes alcohol (e.g., to escape boredom). Therefore, the professional school counselor is therapeutically using both the students trigger list and nonuse list to help provide appropriate interventions. Sometimes students either lack knowledge regarding potential negative consequences of their AOD abuse or purposely deny any negative consequences. Under these circumstances, professional school counselor may wish to use circular questioning. Here, the intent is to learn how students believe they are perceived by valued and respected significant others. Thus, school counselor might ask question like, Shondra, who is the most important person in your life? Once students identify their most important others, professional school counselors can ask, Based upon what youhe told me, your mother is very important to you. Tell me, what would she say were the negative consequences of your drinking and drug behaviors? Assorted Adjunctive Interventions Using cognitive-behavioral Interventions to help students more thoroughly understand their AOD abuse sequence (i.e., triggers, nontriggers, positive consequence, and negative consequence) is helpful. However, tow other adjunctive interventions warrant discussion when counseling AOD abusing students. Contingency contracting. Many professional school use contingency contracting when counseling AOD abusing students. Contingency contracts are

clearly worded contracts which describe acceptable and unacceptable student behaviors. Jointly, professional school counselor and students develop an outline indicating that AOD abuse will not be tolerated. Sanctions are stated (e.g., expulsion from school, specialized placement) as well as rewards for contract compliance (e.g., the student can attend shop class at not cost for materials, the student can participate in athletics). Sobriety contracts can be one from of contingency contract. For example, a professional school counselor may have a student who is prescribed both Ritalin for Attention-Deficit / Hyperactivity Disorder and Antabuse for his alcohol abuse. The school counselor and the student can identify a time at the beginning of each school day when they can meet for approximately 10 minutes or longer if necessary. During the scheduled meetings, the student verbally comments to remaining alcohol free and learning so he may graduate from school. Thus, the student may say something like, OK, Im going to stay drug free today and promise to do my very best at learning so I may graduate and attend college, The professional school counselor then voices any specific concerns she might have about upcoming events that day which may trigger a alcohol use relapse. Here, Ms. Penn might say, Charlie, I know you want to stay alcohol free and are committed to graduating, but I also know that today begins midterm exams. I am concerned you might feel overwhelmed or anxious and begin using alcohol to cope. The student the responds to how he anticipates handing the noted concern, Oh, Ms. Penn, if I feel anxious or overwhelmed because of the midterms, I promise to speak with you first. I know I can handle it. Once the student indicates how he will respond the professional school counselor is not allowed to ask further question that day. The student the takes his medications in front of the professional school counselor and place an X on the Sobriety Contract Calendar for that specific day. At the conclusion of each week the school counselor and the student identify the progress made and discuss any changes warranted for the following week. The intent of this experience, then, is to ritualize this daily experience and encourage students to direct their own recovery. 12-step support groups. One final intervention which warrants discussion is the use of support groups. Twelve-step support groups such as Alateen and Teen Rational Recovery provide members peer support. Alateen, like alcoholics Anonymous, is founded upon a 12-step philosophy and requires students only to

have a desire to discontinue drinking. Rational Recovery is founded upon Rational Emotive Therapy and encourages members to combat irrational thoughts related to their personal recovery. Students often find these support groups helpful in their recovery. Summary / Conclusion This chapter described literature indicating the prominence of AOD abuse among middle and high school students. Practical cognitive-behavioral interventions were described. Specifically, readers learned about the AOD abuse sequence and gained intervention ideas on how to help students: (a) recognize AOD triggers, (b) recognize nonuse triggers, (c) discuss perceived positive AOD abuse consequences and cope with the potential loss of these positive consequences, and (d) link AOD abuse to negative consequences. Concomitantly, two adjunctive intervention techniques were described. These included both contingency contracting and 12-step programming. Although counseling AOD abusing students is a challenging charge for professional school counselors, the above interventions clearly provide a fundamental approach which cwn be helpful.