Students Who Abuse Substances: 
The Role of the Professional School Counselor

Kadie-Ann Caballero-Dennis,
PhD Student,  North Dakota State University,  NCC, LAPC


Abstract
This article delves into the issue of substance abuse among elementary and secondary school students. There is an increase in substance abuse among students which thus cause disruptions towards their academic, personal/social, career, emotional and physical health. Students' development and general success are being affected by their use of substances. Students become substance abusers for many reasons. The effects of their substance use can vary. In essence, all effects are negative to the development of the child. When school counselors encounter students with these challenges, it is important that they are prepared to work with students in overcoming these challenges. School counselors should seek substance abuse training which will equip them to develop rapport with their students, identify signs and symptoms of substance abuse, and support families, students and communities with necessary resources. It is also the responsibility of school counselors to use empirically-based treatment interventions which are suitable to the school setting.
Substance Use and Abuse among School-Aged Children
            Substance abuse cases in schools are prevalent. This issue affects students of various races, ethnicities, cultures and socio-economic backgrounds. Students use substances for the same reason that adults do and much more. Timko, Sutkowi, Pavao and Kimerling (2008) stated that whereas adults use substances in order to ease their psychological pain of trauma and abuse, and to overcome stress, children use substances for those reasons and many others. Other reasons for substance use and abuse among students include peer pressure and low self-esteem, in order to be accepted within a group, to experience "getting high", to look "cool", to express autonomy, and also to model the behaviors of adults in their lives (Sharma, 2015).
            Substance addiction among school-aged children is a major cause for concern as these children are at a point in their lives where their brains are not fully developed. Therefore, abusing substances can be detrimental to their mental health. Children are also impressionable at this time in their lives and will therefore model such behaviors from their parents and peers. Many parents within the United States are substance abusers, and their children witness this. Thus, there is the potential for these children to also become addicts. Young, Boles and Otero (2007) stated that between 50% to 80% of parents with child welfare issues are as a result of substance abuse. It is reported that 8.3 million children have one or two parents with a substance use disorder (Substance Abuse and Mental Health Services Administration, 2009).
            According to UNICEF (2007), among adolescents in the Eastern Caribbean region, drug and alcohol use is becoming an increasing issue as both are relatively easily available. Research shows as well that alcohol is the most commonly used substance, although there has been increasing levels of marijuana, cocaine and tranquilizer use reported as well. Often, substance use and abuse not only results in addiction, but also in crime and trafficking in order to maintain the habit.
            Alcohol is most commonly consumed among school-aged children (Burrow-Sanchez & Lopez 2009). Johnston et al. (2003) reported that approximately 35% and 48% of 10 th and 12 th graders drank alcohol. Drinks which contained a combination of alcohol and caffeine also had their part to play in substance abuse among school-aged children. The combination of alcohol and caffeine has been blamed for the deaths of teenagers as well as college students. According to Gimbel (as cited in Becker, 2012), "One strip is equal to a cup of coffee, but kids are putting five or six in their mouth at once. You can overdose on caffeine by taking three or four" (para. 5). 
             In addition to this, Johnston et al. (2003) stated that approximately 21% of 10 th and 25% of 12 th graders use other substances such as marijuana. A recent report from the Centers for Disease Control and Prevention (as cited in Becker, 2012) found that, "..each year, more people die from prescription painkiller overdoses than from heroin and cocaine overdoses combined" (para. 21). According to Levounis (as cited in Becker, 2012), "Teens are taking painkillers mainly highly addictive opioids such as OxyContin and Vicodin, from medicine cabinets in their own homes" (para. 19).
The School Counselor's Role
            The role of the school counselor is to foster a caring environment for their students. This can be done by implementing preventative, comprehensive and developmental interventions. School counselors conduct relationship building and guidance lessons. They are community collaborators, advocates, and they perform other duties that help to maintain a positive school environment (ATICI, 2014). It is therefore through these same roles and duties that a school counselor must intervene in issues which relate to substance abuse within their students. By using the same practices in which they were trained, school counselors can impact the lives of students who are addicted to substances.
Nevertheless, school counselors need adequate training in substance abuse in order to effectively apply these practices. Students with Substance Use Disorders may also need outside help from mental health or drug and alcohol-specific counseling organizations. It is important for the school counselor to recognize the scope or limits of how he/she can help a student who has Substance Use Disorder challenges. School counselors are in a unique position to interact with many students on a daily basis. More importantly, if there is a strong relationship between the counselor and student, then the counselor should be able to identify the changes within the student. School counselors also collaborate with other stakeholders such as teachers and staff; who may also notice these changes.
With that in mind, it is also important for school counselors to know that some of the warning signs of drug and alcohol abuse may also be attributed to other issues separate from drug use. Some important roles school counselors can play when dealing with students' substance abuse include developing rapport and therapeutic relationship with the students; identifying signs and symptoms of substance abuse; advocating for and supporting families; developing and maintaining the necessary community resources and communication to family members, students, communities and school; and seeking substance abuse training (Lambie & Rokutani, 2002).
School is a major part of a child's life. As a result of the significant amount of time that is spent at school, the effects of substance abuse usually are displayed or can be noticed in students within the school setting. These can be external physical signs or mental issues. Signs can be exhibited in students' academic performance, in attendance and in other ways that will be discussed subsequently. It is important for school counselors to be aware of these signs, have the necessary resources to deal with these issues, and to collaborate with necessary stakeholders in order to combat this problem. The school counselor is a source of support for all students. Therefore, working with substance abuse cases within the school setting can be a challenge as it is just one role to which a school counselor performs on a day-to-day basis.
Developing Rapport and a Therapeutic Relationship
School counselors have been taught the necessary skills needed to create trust and to foster a positive relationship between themselves and students. The school counselor should have a demeanor which is approachable so that students can feel comfortable in talking with them about various challenges in their life. Developing rapport is necessary in creating trust between the school counselor and the student. Students are more willing to talk with school counselors who they trust and to whom they have developed a good relationship with. It is imperative to foster a caring and trusting environment; and show an interest in students. When this is accomplished, administrators, staff, concerned students and students who abuse substances will see the need to share information relating to previous drug abuse and/or be a witness to others' drug abuse.
Establishing a therapeutic relationship may be harder towards some students than towards others. It is therefore important that school counselors remain consistent and understand that not all students are the same. For some students, it takes a long time to feel as though they can trust the school counselor enough to disclose information to them; whereas for other students, discussing their issues comes easier. However, school counselors need to remember that when dealing with cases of substance abuse, even the most trusting of students may be afraid to report their drug abuse issues. That is why school counselors must be nonjudgmental towards their students in order to help create trust.
Identifying Signs and Symptoms
            Substance abuse counselors are trained to be able to identify signs and symptoms of substance abuse. Being able to identify such signs are important in determining whether a child has been abusing substances. Some of these signs and symptoms are impossible to ignore. However, others can be more challenging to identify. Some physical warning signs of substance abuse involve a child attending school drunk, the smell of alcohol on their breath, the smell of marijuana on their breath or their school clothes; dilated pupils, bloodshot eyes, tremors, impaired speech and coordination, changes in appetite, weight loss or gain, and deterioration in appearance and grooming (Shubin, Robinson, Smith & Saisan, 2016).
Towards behavioral signs, there is the engagement of illegal activities, absenteeism, skipping classes, association with negative peers, and an increased need for money. Other warning signs include poor academic performance, truancy, fighting, defiance, and withdrawal. Students who are sent to the principal's office often show aggression, low self-esteem, engage in health compromising activities, have low social skills, engage in secretive behaviors, have a sudden change of interests, and show behavioural signs of a substance abuser (Shubin, Robinson, Smith & Saisan, 2016; Lambie & Rokutani, 2002).
Psychological signs of substance abuse can include an increase in anxiety, mood changes, a change in one's personality, irritability, hyperactivity, demotivation or lethargy (Shubin, Robinson, Smith & Saisan, 2016). As stated earlier, it is important to remember that these symptoms may also fit into other disorders or issues that a student may be facing such as abuse. Therefore, it is important that school counselors focus on all possible symptoms and use a holistic approach to treating the issue at hand; especially if students do not willingly admit to drug use.
Supporting and Advocating for Families
The most influential people in a child's life is family. Therefore, it is important that school counselors and families collaborate in order to determine what is best for the student; as families may notice similar signs of drug abuse in their child and may be unsure of what to do. The school counselor can provide families with resources that they need to help their child. Families can also be invited to parent-teacher meetings and counseling sessions. They can engage in meetings or conferences with other stakeholders as they determine various methods of treating this situation. Supporting families of substance abused students may also include making calls to parents/guardians and offering support and helpful information.
School counselors can also help provide training or information sessions for parents; informing them about drug abuse. The school counselor can meet with families to create a relationship and observe negative or positive family interactions that may be important in understanding the student's substance abuse issues (Lambie & Rokutani, 2002). Supporting the family system may be harder to do, when, for example, parents are also addicted to drugs or drug users. It can also be challenging if parents are neglectful or uninterested in their child's wellbeing. However, school counselors should not give up. They should always be supportive and share resources that can help both the student as well as parents/guardians. Thus, keeping in mind the ultimate goal; which is to seek the best interest of the student.
Communicating and Sharing Resources with Families, Students and Communities
Every school counselor should have a list of resources. These include both in-house and community resources. These resources should be as comprehensive as possible and should include resources pertaining to drug addiction. These could be books, a list of trainings, and community organizations that offer specific treatment for drug and alcohol addiction. Community organizations include inpatient and outpatient groups and individual care. Resources can also include emergency numbers, and Alcoholic Anonymous and Narcotics Anonymous sites that cater to the needs of students. School counselors should be able to effectively provide referrals for students to these outside agencies.
School counselors should also interact with community organizations who are work with children who have substance abuse issues. Communication between families, community organizations and the school is needed, as they work together to help the student. School counselors can also encourage families to attend information sessions, training, or support groups that can help support families and ultimately students. While students are receiving treatment in inpatient facilities, it is important that school counselors communicate with the student's substance abuse counselor and/or case worker. This communication involves ensuring that the student achieves his academic and career goals while receiving the necessary treatment. These meetings also include building a plan of action for the student when he/she is released from treatment.
The school counselor is also integral in helping to plan and collaborating with parents in aftercare activities that will aid in treatment and continuous care. School counselors are to approach drug abuse issues with students in a nonjudgmental manner. Lambie and Rokutani (2002) supported this statement by encouraging school counselors to approach students and parents in a positive manner, i.e, without blame, which would thus help in the discussion between student, school counselor and parents. School counselors should also encourage parental involvement in school activities that will support the student. Numerous studies have shown that such involvement is important to student success.
  Seeking Substance Abuse Training                                                                            ........... Burrow-Sanchez and Lopez (2009) conducted a national sample of 283 elementary school counselors to assess their competence in handling student substance abuse issues. They reported that school counselors felt ill-prepared to work with this challenge, and wanted training in the areas of screening and assessment, individual interventions, consultation, curriculum development, group interventions and family interventions. This study is important as it shows that there is a need to provide training to and for school counselors to seek training so that they can be competent when working with substance abuse issues within their schools. Because of the prevalence of these issues, administrators, school leaders, and legislators should invest in training opportunities for school counselors and other administrative staff. School counselors must also be proactive in seeking necessary training.                             Using School-Based Treatment Techniques/Intervention                                                       Other important roles that school counselors can do, is invite suitable adults and/or organizations to come into the school and give motivational or educational speeches to the students concerning addiction. It is very important to choose the right person, as choosing the wrong individual may do more harm than good. Creating lesson plans with information about preventative measures to drug and alcohol abuse can inform students about substance abuse and addiction, and help students understand appropriate coping strategies to the stressors of life. The school counselor can also create substance abuse groups within the school.                                                                          These groups could be established with students who abuse substances or those who are with a group of students with substance abuse and other mental health challenges (Yalom & Leszcz, 2005). When developing this group, it is crucial to screen the potential members and establish the rules of the group (Yalom & Leszcz, 2005). If the school counselor does not feel competent to lead such a group, outside agencies can be invited to lead these groups. School counselors can also do after-school educational interventions with these students. Similarly, they can also develop after-school activities that help students work on their coping skills and participate in creative and exciting endeavors that can prevent relapse and lessen the influence of negative peers.                                                                                                            ............ School counselors can use evidence-based interventions such as cognitive behavioral therapy and motivational interviewing when working individually with students. These are empirically-based interventions that are proven to work. The literature also presents screening tools that may help the school counselor identify substance abuse in a student. Falck, Nahhas, Li and Carlson (2012) discussed the CRAFFT questionnaire. This questionnaire is a test for drug abuse among adolescents. The questionnaire asks the adolescent a range of questions which include, "Do you ever use drugs to relax?" and the question, "Have you gotten into trouble while you were using alcohol or other drugs?"                                                                                    ............ Answering "yes" to two or more questions within the questionnaire suggests that a significant problem with substance abuse exists. The literature presents similar assessment tools that can be used within the school setting. The school counselor should collaborate or be a source of information and leadership with coaches, teachers, school psychologist, social workers, school administrators, and other staff when intervening in a student's addiction issues. Ultimately, it is important to work with all student and plan interventions and treatment; granted that school counselors need to work within the limits of their school drug policy. If this policy is not suitable to the needs of the students, then school counselors should become advocates for their students.                                                                                                                          ........... When implementing school based interventions, school counselors must use empirically-based interventions and collect outcome data. Wagner, Tubman and Gil (2004) discussed that school counselors should evaluate these interventions; looking at the frequency, duration and timing of the intervention, and maintain fidelity by monitoring its effects. The authors also discussed that school counselors must advocate for involvement from other stakeholders and create linkages of treatment across settings. Gathering the necessary data is important to reporting treatment outcomes which may influence stakeholders' involvement and influence school drug policy and decisions concerning this issue.
Possible Challenges School Counselors May Face When Dealing With SUDs In Students
            Even though school counselors play a significant role when dealing with substance abuse issues within the school system, some face many challenges that act as potential barriers to efficacy when working with substance abuse cases. One such challenge is the ratio of students to a school counselor. Many school counselors have a high case load (Burrow-Sanchez, Lopez & Slagle, 2008). This potentially decreases the amount of time school counselors spend with each student. Students can also get lost in the school system when school counselors work with more cases than they can effectively manage. Effective communication with school administration and staff can help with the success or failure of substance abuse cases within the school.
            Other challenges school counselors face include the school drug policies and legislation pertaining to substance abuse issues in the school. If these policies are not in the best interest of addressing substance abuse cases within the school setting, then there can be debilitating to school success. School counselors also face challenges with parents and guardians who are resistant to treatment, who are not supportive, and who are drug users themselves (Young, Boles & Otero, 2007). Lack of resources is another issue when dealing with drug abuse within schools. Many schools are struggling financially and are not able to put the necessary measures in place to address this problem.
Conclusion
Substance addiction continues to be a force to be reckoned with in the general population and also within our school systems. School counselors have a unique role as they are able to interact and influence these students in positive ways. School counselors face numerous challenges in treating such disorders. However, they are to be resourceful and creative in working with students with such challenges. Advocacy is important for school counselors in meeting the needs of these students. School counselors should work with all stakeholders including families, communities and schools. This is because school counselors impact students and ultimately future adults to be productive citizens within our society.
References

ATICI, M. (2014). Examination of School Counselors' Activities: From the 

Perspectives of Counselor Efficacy and Collaboration with School Staff. Educational Sciences: Theory & Practice, 14(6), 2107-2120. doi:10.12738/estp.2014.6.2554

Becker, A. (2012). 3 New Dangerous Drug Habits in Teens. Retrieved from

http://www.livescience.com/18539-3-dangerous-drug-habits-teens.html

Burrow-Sanchez, J. J., & Lopez, A. L. (2009). Identifying Substance Abuse Issues in 

HighSchools: A National Survey of High School Counselors. Journal of Counseling & Development, 87(1), 72-79

Burrow-Sanchez, J. J., Lopez, A. L., & Slagle, C. P. (2008). Perceived Competence in 

Addressing Student Substance Abuse: A National Survey of Middle School Counselors. Journal of School Health, 78(5), 280-286. doi:10.1111/j.1746-1561.2008.00301.x

Falck, R. S., Nahhas, R. W., Li, L., & Carlson, R. G. (2012). Surveying Teens in

School to Assess the Prevalence of Problematic Drug Use. Journal of School Health , 82(5), 217-224. doi:10.1111/j.1746-1561.2012.00690.x

Johnston, L. D., O'Malley, P. M., & Bachman, J. G. (2003). Monitoring the Future 

National Results on Adolescent Drug Use: Overview of Key Findings 2002. Retrieved from http://monitoringthefuture.org/pubs/monographs/overview2002.pdf

Lambie, G. W., & Rokutani, L. J. (2002). A Systems Approach to Substance Abuse

Identification and Intervention for School Counselors. Professional School Counseling, 5(5), 353

Sharma, M. (2015). Substance Abuse in Adolescents: Implications for Research 

and Practice. Journal of Alcohol & Drug Education, 59(1), 3-6

Shubin, J., Robinson, L., Smith, M., & Saisan, J. (2016). Drug Abuse and Addiction. 

Substance Abuse and Mental Health Services Administration. (2009). The Nsduh 

Report: Children Living With Substance-Dependent or Substance-Abusing Parents: 2002 to 2007. Retrieved from http://ok.gov/odmhsas/documents/

Children%20Living%20with%20Substance%20Dependent%20or%20Abusing

%20Parents%202002-2007.pdf

Timko, C, Sutkowi, A., Pavao, J., & Kimerling, R. (2008). Women's childhood and 

adult adverse experiences, mental health, and binge drinking: The California Women's Health Survey. Substance Abuse Treatment, Prevention, and Policy, 3(1), 15-24

UNICEF. (2007). Eastern Caribbean: Adolescent Participation. Retrieved from       

http://www.unicef.org/easterncaribbean/children_100.htm

Wagner, E. F., Tubman, J. G., & Gil, A. G. (2004). Implementing school-based 

substance abuseinterventions: methodological dilemmas and recommended solutions. Addiction, 99, 106-119. doi:10.1111/j.1360-0443.2004.00858.x

Yalom, I. D., & Leszcz, M. (2005). The Theory and Practice of Group Psychotherapy.

New York: Basic Books.

Young, N. K., Boles, S. M., & Otero, C. (2007). Parental substance use disorders and 

childmaltreatment: Overlap, gaps, and opportunities. Child Maltreatment, 12(2),

137-149


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