Substance Abuse Intervention Guidelines
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Note: We made major changes in the Substance Abuse Intervention Guidelines, and linked additional information on Twelve Step Work beginning June 15, 2010. This is the former version of the Twelve Step Guidelines. Nothing has changed since the dates shown at the bottom of this page, except the insertion of this note and the URL for this page.
Too often we see schools, programs and transition services that (regarding substance abuse) do what plays well in marketing or is politically popular. Too seldom do we see evidence that schools and treatment programs have actually considered carefully what actually works and what does not, or has avoided being unduly prejudiced by popular misconceptions. In our experience, the majority of special needs schools and programs include large numbers of clients who have significant substance abuse history, but have at best a superficial understanding of the culture of drug abuse and the treatment approaches that do or don't work. To far too great an extent the same criticism applies to public and private schools with general populations.
As you read on, you might get the impression that we are generally unhappy with what we see in substance abuse work in schools and programs. You would be correct. Adherence to the guidelines we propose is rare but in our opinion totally reasonable. We see no excuse for the degree of variance that dominates the schools and programs at issue here.
Due to the dominance of twelve-step work in substance abuse intervention, we expect a clear rationale for use or non-use of twelve step work, based upon facts, not personal biases. We do not expect every program to be twelve-step oriented. We do expect them to have based their decisions about employing twelve-step work on a sound understanding of the pros and cons of twelve-step work with their particular treatment population.
We do not believe that the only appropriate thing to do with young people with substance abuse issues is twelve-step work. Some of the schools and programs with substance abuse programming we greatly respect use a combination of twelve-step work and other resources. Others do not use twelve-step work at all. Although we highly respect twelve-step work used properly, we would not likely feel that a school or program is acceptable if the only tool in their proverbial toolbox is twelve-step work.
On the other hand, we believe that schools and programs that admit students they know have a dependency or addiction history and they know have benefitted from twelve-step work and do not permit twelve step activity to continue, are acting grossly irresponsibly and would seem to be deriving their revenue specifically at the expense of concern for the lives and safety of the young people who patronize them.
With or without the application of twelve-step work, we believe the importance of Stages of Change and Motivational Interviewing are sufficiently well established that these are essential parts of any appropriate intervention with drug and alcohol issues. Neither of these resources appear to stand alone. Motivational Interviewing can enhance the effectiveness of any other resource for addressing substance abuse or dependency. Stages of Change research both offers support for other approaches to substance abuse intervention, and, more importantly, offers a framework for measuring progress, regardless of the primary approach in use.
We want to see a clear rationale for assessing the specific intervention strategy appropriate for each student / client. A mere drug education program is not an effective intervention for a recidivistic heroin addict, and an intensive twelve-step forcing a person to claim powerlessness over drugs is not appropriate for a thirteen year old whose only drug involvement is a one time experimentation with marijuana. It is virtually impossible to know at admission, regardless of background data supplied, exactly how serious a suspected drug problem will be when subjected to close scrutiny. We expect programs that admit clients with substance abuse history to be prepared to support appropriately both those who are and those who are not deeply involved in substance abuse and all the points in between, unless they successfully screen to prevent admission of those whose level of need is not well served by them. Doing that accurately prior to admission is an extremely difficult task so the practical approach is usually to admit people with substance abuse history, and to be prepared to provide appropriate service however that turns out. But that means that a one-size-fits-all approach is not acceptable.
Appropriate support for both groups excludes pressuring people who are not addicted or alcohol or drug dependent in any meaningful sense to make the statement of the first step with reference to drugs or alcohol. Or to put it simply, if someone is not powerless over drugs and/or alcohol, it is transparently not appropriate to encourage them to lie and claim that they are.
We also want to see evidence of a well informed choice about what resources are used and philosophy observed in support of substance abuse programming.
We have little confidence in standard credentialing for substance abuse workers and clinicians. When programs promote their expertise primarily by describing the credentials as substance abuse counselors held by their staff, we conclude that they are damning themselves with faint praise, and wonder why they can't tell us something more relevant about why we should suspect that they are competent in this area.
We are not endorsing a specific methodology here. Instead, we want to see four things from schools and programs under discussion here in determining what methods should be used, including but not limited to decisions about use of twelve-step work: (1) We want to see research support for the decisions to the extent that on-point research is available. (2) We want to know that the decisions were made by people with an accurate understanding of the alternatives, including but not limited to twelve-step resources, and (3) We want to know that they are allowing all people they actually admit with substance abuse history to continue with any support systems that have served them well in the past (4) We expect schools and programs admitting and retaining students /clients with any degree of dependence or addiction history use the time with with in residence to prepare these students/clients for using the community resources they will need for support if they are to have the best chance of success after discharge.
On point (1) of the previous paragraph, we are aware that research is limited, but there is some and we expect that programs working with this population will have studied that research and that having done so impacts their policies and practices in this regard. On point (2) we have observed an appalling level of ignorance regarding substance abuse resources, especially with respect to twelve-step programming on the part of schools and programs. See page on twelve-step work for specifics regarding twelve-step work. On point (3) as an example, we know of one school -- otherwise one of the prime choices in therapeutic boarding schools -- that prohibits any twelve step work while continuing to admit students who have benefitted from it. We believe that is totally irresponsible. On point (4) very few schools and programs behave as if they realize that whatever takes place in a structured environment with a person with an addiction or dependency problem is no more than a rehearsal for the pro-active steps in recovery that the person must take when out in the community. When students / clients do not have the opportunity to practice their recovery skills in the community before leaving the sheltered environment of a structured school or program, they are probably not ready to apply those skills after they transition.
On the other hand, some programs, especially young adult programs, turn their students / clients loose in the community to early. Students / clients should, among other things, demonstrate willingness to confront negative behaviors in peers within the program before moving to independent living or even relatively unstructured phases of the program.
There will be more to come. As we learn more about this, and as things improve, more will appear in this space.
Checklist of FamilyLightsm Guidelines for Substance abuse will be added here.
Feedback is invited. We will publish selected feedback. Email FamilyLightResponse@yahoo.com
Disclaimer: No program review, no matter how positive, is a blanket endorsement. No criticism is a blanket condemnation. When we express our level of confidence in a school or program, that is our subjective opinion with which others might reasonably disagree. When we assert something as fact, we have done our best to be accurate, but we cannot guarantee that all of our information is accurate and up to date. When we address compliance with our guidelines, you need to remember that these are only OUR guidelines -- not guidelines from an official source. We have also set the bar very high, and do not expect any school or program to be in total compliance. It is not appropriate to draw a conclusion of impropriety (or even failure to live up to conventional wisdom) from our lack of confidence in a school or program or from less than perfect conformity to our guidelines. Some will say we expect too much. Readers are responsible for verifying accuracy of information supplied here prior to acting upon it. We are not responsible for inaccuracies.
Last update 11-01-08; minor edit 1-8-09
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