Current research confirms that alcohol and drug use during the teen years is associated with negative long-term effects on neurological functioning. Because young adulthood is a period full of social, occupational and educational decisions, as well as brain development, the negative impacts of alcohol can be both short-term—in the form of poor or high-risk decisions, and long term – in the form of permanent cognitive impairment. During adolescence, the brain continues to grow and remodel high-level neuronal circuitry. That means the brain is actually growing and is forging new “hardwired” thought patterns that will last through adulthood. This period of extensive neuronal growth significantly impacts emotional regulation, self-control and executive functioning. The brain continues to prune synapses, weeding out weak neurons. Increased myelination of the brain’s neurons is occurring, allowing faster and more efficient conductively of the brains circuitry. When uninterrupted, either by trauma, chemical interference (e.g. alcohol abuse) or developmental issues, this process allows for improved impulse control, development of complex cognitive processes, improved working memory and operational thinking (Hart 2007). It is important, therefore, to be protective of this period of critical brain development.

Effects of Adolescent Alcohol use on Neurological Performance (Brown 2000)
•    Decreased verbal and nonverbal memory
•    Poorer visual-spatial ability
•    Decreased attention ability

Effects of Adolescent Alcohol Use on Neurological Structures
•    Reduced hippocampal volume, which impacts learning and memory (De Bellis 2000)
•    Reduced white matter integrity in the corpus callosum, which coordinates movement, complex thought, communication and coordination of the left and right-brain hemispheres (Tapert 2003)
•    Decreased volume in the prefrontal lobe, which impacts complex cognitive planning, as well as behavior modulation and personality (Bellis, 2005)

Effects of Adolescent Alcohol Use and Brain Functioning
•    Decreased P300 brain waves, which impedes information processing (Nichols and Martin 1993)
•    Decreased blood flow in the frontal lobe, which impedes executive functioning (Tapert 2004)

Frequent alcohol consumption correlates to a reinforcement of drinking behavior, thus increasing addictive tendencies in addition to behaviors linked to alcohol abuse, such as aggression and other acting-out behaviors (Tapert, 2005).

WHAT DO WE DO AS PARENTS?

Early education is a key strategy for preventing abuse in adolescents. While parents cannot depend upon educators to inform their children about the risks of alcohol abuse, they can depend upon peer education. Peers frequently become the primary source of information on important topics that parents avoid or treat as taboo. It is critical, therefore, for parents to take an active role in communicating with their preteens and teens, informing them of alcohol’s impact on mood, anxiety, brain development, increased risk taking and the long-term consequences associated with alcohol use. In addition, it is important to emphasize the positive health impact of abstinence and to refute the flawed, wholesale acceptance in our society of heavy drinking as “normal” behavior. Effective education, however, requires a credible, mutually trusting relationship. With a teen son or daughter, the proverb “seek first to understand and then to be understood,” is a wise first step in creating a platform for effective education.

Sources:
•    Tapert S. (2005) Alcohol and the Adolescent Brain Alcohol Research & Health Vol. 28, No. 4
•    Tarter R. (2002) Etiology of Adolescent Substance Abuse: A Developmental Perspective The American Journal on Addictions 11:171-191
•    Breyer & Winters (2005) Adolscent Brain Development: Implications For Drug Use Prevention www.mentorfoundation.org
•    Hart H. (2007) Alcohol, drugs, and the adolescent brain Developmental Medicine & Child Neurology 49: 883-883

Societal messages that contribute to the sexualization of girls come not only from media and merchandise, but also through girls’ interpersonal relationships (Brown & Gilligan, 1992). Surprisingly, parents can also be a large culprit in the sexualization of their daughters through purchasing and encouraging them to wear inappropriate clothes. Parents may even go as far as to recommend plastic surgery to alter their daughter’s physical appearance to better meet societal demands. At the extreme and most destructive end of the spectrum, parents, teachers and peers, as well as others, sexually abuse, assault, prostitute or traffic girls.

Sexual objectification occurs whenever people’s bodies, body parts or sexual functions are separated from their identity, reduced to the status of mere instruments (Bartkly, 1990). It has been known that sexualization of girls teaches them that they are objects and that their value is based on their appearance. It is most likely that girls being exposed to the sexualization of women increases their chances of chronic preoccupation with their appearance.

Sexualization Versus Healthy Sexual Development

Sexualization occurs when a person’s values comes only from her sexual appeal; when physical attractiveness is narrowly defined as being sexy; when a person is sexually objectified, made into a thing rather than a person; and when sexuality is inappropriately imposed on a person (Brown, 2007). Self-initiated sexual exploration is considered typical, age-appropriate development and is not considered sexualization. Girls and women tend to see themselves through a veil of sexism, measuring their self-worth by evaluating their physical appearance against our culture’s sexually objectifying and unrealistic standards of beauty (Fredrickson, 1998).

The Cost of the Sexualization of Girls

The sexualization of girls has many negative effects that impact many different spheres of a girl’s functioning.

Cognitive and Emotional Consequences
Self-objectification has been repeatedly shown to affect a girl’s cognitive functioning by detracting from the ability to concentrate and focus’s her attention, thus leading to impaired performance on mental activities, such as mathematical computations or logical reasoning (Fredrickson, 1998). Girls who are exposed to sexualization have a tendency to see themselves as sexual objects, and thus have a tendency to be preoccupied with their appearance, which significantly impacts their mental capacity. In addition, studies show that the sexualization of girls leads to other significant difficulties, such as depression, anxiety, guilt and other significant emotional difficulties. The sexual objectification of a girl’s body leads to shame about it.

Mental and Physical Health
Research links sexualization with three of the most common mental health problems of girls and women: eating disorders, low self-esteem and depression or depressed mood. (Abramson & Valene, 1991).

Sexuality
The sexualization of girls has a significant impact on young women’s sexuality. Self-objectification has been directly linked with diminished sexual health among adolescent girls through a decrease in condom use and a decrease in sexual assertiveness (Impett, 2006).

How Can We Decrease the Negative Consequences of Sexualization of Our Young Women?

• It is important to teach boys and girls critical skills in viewing and consuming media, focusing specifically on the sexualization of girls and women.
• Continue to provide opportunities for young women to build healthy and stable self-esteem that is not based on their bodies and appearance.
• It is important to view TV, Internet or other forms of the media with children to help them to appropriately interpret the messages presented.
• Organized religious and other ethical instruction can offer girls and boys important practical and psychological alternatives to values conveyed by popular culture (Zurbriggen, 2007)
• Overall, monitor and limit what your child is exposed to.
• It is not only important to educate our young women of the negative impacts of the sexualization of girls, we also need to mentor and educate our boys about the negative impacts of the sexualization of women.

With as many as 84 percent of all U.S. teens using the Internet to communicate, it’s the social applications of the Internet that youth tend to access the most and that represent both the greatest opportunities for good and for harm. Since teens are the largest users of the Internet, it’s easy for parents and educators to feel a few steps behind as we attempt to manage the Internet hazards for the young people in our care. Following are a few of the hazards the Internet poses, along with some tips to help adults guide young people toward positive Internet use.

INTERNET HAZARDS
Internet Use and Loneliness

Ironically, adolescents whose use the Internet to seek primary support during times of difficulty tend to experience more loneliness than other teens in crisis. Adolescents who spend a large amount of time maintaining relationships online are also more likely to have unrealistic perceptions about those relationships, which can lead to disillusionment, misunderstanding and misperceptions about relationships in general. As a result, research is finding that adolescents who rely primarily on the Internet to build and maintain relationships experience a decrease in overall psychological wellbeing. Adolescents who feel lonely and attempt to seek support online may exacerbate their loneliness.

Teens who access the Internet primarily for information, however, have less of a tendency to experience the negative drawbacks of the Internet. So the specific applications that teens use have a significant bearing on whether the Internet is a positive or negative resource.

Predators

It is terrifying to think of your teen giving free access to your home to anyone who wants it. Unfortunately, this is exactly what many young people do every day by not filtering their online contacts and by providing personal information online. Lonely young people who do not tightly manage their social networks (e.g. Facebook account) can end up victims of cyber predators who use the Internet to extract personal or family information, or to lure young people into dangerous face-to-face meetings.

Drugs/Alcohol and Internet Use

It doesn’t take much surfing to realize that no topic and no type of information is off limits online. Adolescents are increasingly using the Internet to exchange information regarding drugs and alcohol. It has been reported that 10 percent of all exchanges between adolescents involves advice on how to take illicit drugs without getting caught. In addition, there are Websites, blogs and social networking pages dedicated to promoting teen use of illegal substances.

Future Opportunities

What happens in Vegas may stay in Vegas, but what happens online can haunt a young person for years. In recent years, students have had their college acceptances retracted and jobs denied as a result of online postings that may have been from months or years prior. Young people have also been expelled from school and subjected to legal or criminal investigations due to what they considered casual or flippant communications online. The Internet is a public place, so adolescents must be coached to publish information responsibly. Once comments, photos and information are online, they can be impossible to retract.

Sources:
• Eijnden R. (2008) Online Communication, Compulsive Internet Use, and Psycholgical Well Being Among Adolescents: A Longitudinal Study Developmental Psychology Vol. 44, No. 3, 655-665
• Subrahmanyman & Lin (2007) Adolscent On the Net: Internet Use and Well-Being Adolescence Vol. 42, No. 168
• Fritz, G. (2007) Teen drug use and the Internet: A parent’s Guide The Brown University Child and Adolescent Behavior Letter August, 2007
• Sanders, C. (2000) The Relationship Of Internet Use To Depression and Social Isolation Among Adolescents Adolescence Vol.35, No. 138
• Dehue & Bolman (2008) Cyberbulling: Youngsters’ Experience and Parental Perception CyberPsychology & Behavior Vol. 11, Num 2

Children’s programs provide a unique opportunity to interrupt the multigenerational transmission of addiction. They can teach youth important life skills, empower adults with parenting strategies that they can include in their recovery process, and heal and strengthen the parent/child relationship. Help, hope, and healing are the possibilities of the day.

No Way, No How

“There’s absolutely no way that’s ever going to happen,” she blurted out in an angry tone. I could clearly hear the emotion building in her voice. The mere suggestion, delivered in a careful, gentle manner, that her son might have been affected by her problem drinking was too much for her to hear. Sitting across from me was a bright, attractive 34-year-old physician who wanted to be anywhere else in the world besides my office. She was intent on setting me straight that her oldest child had not only never been affected, but also would never be participating in a kids’ program. “Sammy has absolutely no clue because I would only drink at night while he was asleep in bed,” she asserted. “I don’t want you to be filling his head with a bunch of ideas. He’s only eight.” She glared at me and declared, “I am a good mom.” I shook my head affirmatively as she bolted out the door.

The last vestige of denial is admitting the disease you never asked for has not only hurt you, but has hurt your loved ones as well, especially the children. What person in their right mind would ever hurt their children? This is such a painful place to go, yet perhaps the denial was slowly cracking for this proud, caring mother. About five days after our initial encounter, she watched the kids from the children’s program coming back from swimming. They had smiles plastered all over their faces as they were laughing and giggling about “throwing” me into the pool that particular afternoon. Even she couldn’t hide the smile as she witnessed me dripping from head to toe. These were awesome boys and girls, full of strengths, hopes, and dreams. Something touched her as she watched them parade by. “Can we meet again?” she asked as I passed by. “How about at 4?” I suggested. “I should be fairly dry by then.”

Small Steps

Her mood and tone had softened considerably. She began by stating, “Don’t you think eight is awfully young? He really doesn’t know about any of this.” I knew she was genuine as her face was filled with emotion.

“Where does your son think you are right now?” I asked.
She quickly teared up upon hearing these words and offered, “He thinks I’m working.” She paused, but before I could get a word in edgewise she continued, “But I’ve never been gone this long.” Sadness quickly enveloped her as she was looking at this situation in a brand-new light.

“Did you grow up in an addicted family?” I asked thoughtfully.

“Yes, but it was so different with my mom and her drinking. There was yelling and fighting and she never had any time for me.” She was starting to get all worked up as she asserted, “I am not like that in any way. There’s no yelling, and I spend lots of time with my children.”

I purposely interrupted by offering, “Could you have benefited from a program like this when you were eight? Could your life have been better at such a young age?”

This stopped her in her tracks and was met with stone-cold silence. “I gotta go now,” was her only reply.

Sammy’s dad had agreed with his wife that the children’s program wasn’t a good idea — until his son brought home a note from his third-grade teacher one Friday afternoon. She was very concerned about Sammy because he didn’t seem like himself at school. He was so sad, withdrawn, and distracted. This caring teacher wanted to know if anything was happening at home that was troubling this bright boy. As Dad read the note he knew it was time to immediately take action. Once the two younger ones were put to bed, Dad explained to Sammy, “Mom isn’t away working right now. I just didn’t know how to tell you. She drinks wine after you go to bed at night. Sometimes she drinks too much and it makes her sick. She’s at a special place getting help. I’ll take you to see her on Sunday.”

Sammy wouldn’t say a word and his face looked expressionless. After many moments of awkward silence he softly uttered, “Dad, I’m going to bed now.”

Bringing Mom Home

Dad was awakened early the next morning at about 5:30, as he heard a loud commotion downstairs in the kitchen — cabinets opening, doors slamming, someone talking to himself. What could this be so early on a Saturday morning? When he entered the kitchen he found Sammy fully dressed. He even had the hood on from his sweatshirt. Sammy had a flashlight in his right hand and a handful of Fruit Roll-Ups in his left.

“What in the world are you doing?” Dad asked him. “Sammy, it’s the middle of the night!”

Sammy turned toward Dad and shared, “Dad, I’m going to get Mom now and bring her back home.”

Dad was startled by his son’s words. With tears streaming down his face, Sammy said, “Oh Dad, I’m sorry. I didn’t mean to tell Mom I hated her when she wouldn’t let me go to my friend’s house. I’ll do better in reading and I’ll clean up all the dog poop and won’t fight with my sisters anymore. I just want to tell Mom I’m sorry I stress her out and make her drink.” Dad held his son and they both cried.

Later that day, during their phone call, Dad told his wife all about what Sammy had done. This touched her in a very deep and tender place. When I got to work on Monday morning, this mom was anxiously standing by my office waiting for me to arrive.

“I want to sign my son up for the next program,” she declared.

“Absolutely,” I excitedly replied. “You are giving your son the gift you so desperately needed as a child. You’re changing the family legacy.”

“I just love my kids so much,” she shared.

“Yeah, I knew that from the moment I first met you.”

The Betty Ford Children’s Program is for seven- through 12-year-olds who come from families hurt by alcoholism and other drug addiction. With locations in Southern California, the Dallas/Fort Worth Metroplex, and Denver, Colorado, no child is ever turned away due to an inability to pay. For more information go to www.bettyfordcenter.org.

This article is adapted from Understanding Addiction and Recovery Through a Child’s Eyes by Jerry Moe, 2007.

So how do you know if your teen has the serious but treatable condition of bipolar disorder or is just experiencing normal adolescent moodiness?

LOOK FOR THE SIGNS

It should first be noted that parents are generally not in a good position to diagnose their children; this should be left to a licensed mental health professional outside of the family system. Nonetheless, it is critical that parents pay close attention to behaviors that might require the involvement of a physician, therapist or treatment program. Research has revealed that as many as 67 percent of people with bipolar disorder experienced the onset of the illness before the age 18. Missing the opportunity to accurately diagnose bipolar disorder during childhood can actually exacerbate the condition later in life, further impairing functioning as an adult.

Conditions that, on first blush, may seem similar often have very different risks and require different treatment approaches, so accurate diagnosis is critical. The suicide rate for bipolar disorder, for instance, is double that of major depression. So if you are in doubt about whether your child is exhibiting normal teen behavior or a budding emotional or psychological disorder, seek the help of a professional immediately to ensure an accurate diagnosis and appropriate treatment.

Any combination of the following behaviors may be symptomatic of bipolar disorder. If your child exhibits these symptoms to a degree or with a frequency that concerns you and/or impairs your child’s relationships or functioning, it could be a sign of a serious condition. Bipolar disorder, while mimicking those of adolescence itself, is a serious and potentially life-threatening illness that requires medical and psychological treatment.

The Signs:

•    Elevated mood to the point of functional impairment
•    Rapid or ultra-rapid cycling of moods (e.g. shifting from a normal positive mood to depression to irritability in a single day)
•    Acting more cheerful and/or sillier than the situation warrants
•    Moods elevated to the point of causing discomfort in others; these moods are typically difficult to redirect
•    Intense irritability, often accompanied by an increase in physical or verbal aggression
•    Uncontrollable outbursts and tantrums
•    Grandiose thoughts, e.g.:
o    Periods of seeing oneself as better and smarter than others
o    Being overly directive of peers
o    Believing oneself to have special abilities and talents
o    Constructing elaborate plans for unrealistic projects
o    Periods of thinking that rules of nature and/or society do not apply to oneself
•    Decreased need for sleep and difficulty falling sleep
•    Increased sexual interest and/or promiscuity
•    Rapid speech and frequent interrupting; reports of racing thoughts
•    Increased risk-taking behaviors, often including substance abuse

In addition to the symptoms listed above, it is important to pay attention to family history. If members of your family have been diagnosed with bipolar disorder, your teen is at a higher risk of mental illness generally and bipolar specifically. Research indicates that the children of those suffering from bipolar disorder have double the risk of developing a mental illness than the general population.

TREATMENT

While bipolar disorder is a serious and sometimes life-threatening condition, the good news is that it is treatable. If your child is diagnosed with bipolar disorder, there is hope for a healthy and productive life through the application of modern treatment approaches that include:
•    Medication
•    Cognitive-Behavioral Therapy
•    Family-based interventions
•    Modifications in environment, starting with hospitalization or residential care
•    Alteration of social rhythms
•    Stabilizing sleeping patterns through circadian-rhythm intervention
•    Multi-modal treatment, using several or all of the approaches listed above, has proven to be the most effective way to address adolescent bipolar disorder.

Sources:

Apps & Winkler (2008) Bipolar Disorders: Symptoms and Treatment in Children and Adolescents Pediatric Nursing Vol.34. No.1
Coville & Miklowitz (2008) Correlates of High Expressed Emotion Attitudes Among Parents of Bipolar Adolescents Journal of Clinical Psychology, Vol 64(4) 438-449
Duffy. A (2007) Does Bipolar Disorder Exist in Children? A Selected Review The Canadian Journal of Psychiatry Vol. 52, No 7
Youngstrom, E.A. (2008) Pediatric Bipolar Disorder: Evidence for Its Diagnostic Validity and Recommendations for Making the Diagnosis Clincian’s Digest

TYPICAL FORMS OF SELF-HARM:

• Cuts or scrapes with a knife, razor blade, or any sharp object
• Scraping the skin with abrasive material, e.g. glass, fingernails, or metal
• Burning the skin with a lighter or cigarette
• Burning the skin with a chemical agent
• Breaking bones

Recent research indicates that as many as 46% of teens report having engaged in self-injurious behavior. This high surge in cutting behaviors may be due in large part to recent high-profile cutting cases. The media has made much recently of cutting behaviors described by such celebrities as Princess Diana, Angelina Jolie, and Johnny Depp. Like other coping or anxiety-based behaviors, cutting can spread as a copycat phenomenon. Many teens even seek validation and encouragement for self-harming from popular blogs and Websites devoted to self-mutilation.

WHY DOES MY TEEN SELF-HARM?

The paradox of pain:

For a person who has had no experience with intentional self-harm, it is a confusing and frightening phenomenon. Most of us avoid pain and seek pleasure, but the cutter seems to avoid pain by seeking pain. Self-harming typically acts as a form of emotional avoidance and escape from unwanted, unpleasant emotions. It is often an attempt to drown out emotional pain by engaging in more manageable physical pain. Many teens report relaxation and emotional numbness after self-harming. Self-harming can also serve as a tool to express strong negative emotions toward others, or as an attempt to elicit help or attention from others.

Warning signs:

With the exception of those individuals whose cutting has an attention-seeking dimension, most cutters attempt to hide their cutting behaviors. Parents, educators, friends, and healthcare providers can, however, be alert to signs of cutting that include:

• Wearing long sleeves or turtlenecks or long pants when it is warm outside
• Cutting a thumb-loop at the end of long sleeved shirt to keep arms covered
• Suspicious scratches, burns, or bruises anywhere on body
• Band Aids or tape on extremities
• Leaving or stashing razor blades, glass shards, or other “sharps” in the bathroom, bedroom, drawers, backpack, etc.
• Attempting to hide scars, burns, or other injuries
• Dramatic or intense emotional outbursts
• Difficulty expressing emotion appropriately
• Self-directed anger

Cutting is a red flag for emotional distress:

In most cases, cutting itself is just a symptom of underlying emotional distress. It is easy for loved ones to become so distracted by the cutting itself that efforts go toward controlling the behavior instead of addressing the problems causing it. Because cutting represents both a physical danger and a deeper mental health issue, the involvement of a mental health professional is always an imperative. If cutting leads to infection, or if cutting goes beyond superficial physical harm, medical attention should be sought immediately. Deep cutting may indicate that the young person dissociates during the act of self-harm; even if the intent is not suicide, this kind of cutting is extremely dangerous and can lead to permanent tissue damage or death.

Cutting can be an indicator of many mental health issues, including:

• Depression
• Anxiety
• Suicidal ideation
• Physical, sexual, or emotional abuse
• Substance abuse
• Related eating disorders
• Personality and/or relational difficulties

EFFECTIVE TREATMENT FOR SELF-HARM:

Mental-health professionals experienced with adolescent issues and self-harming behaviors favor a variety of approaches in the context of a safe therapeutic relationship or milieu. These approaches include:

• Cognitive Behavioral Therapies
• Dialectical Behavioral Therapy
• Pharmacotherapy

If you suspect your child is cutting or engaging in other self-harm, it is vital to consult with a mental health professional. Your child’s self-harming behavior is a warning sign of an underlining mental health problem that needs immediate professional attention.
Sources:
Linehan, Marsha (1993) Cognitive Behavioral Treatment of Borderline Personality Disorder, The Guilford Press
Miller, Alec (2007) Dialectical Behavioral Therapy with Suicidal Adolescents, The Guilford Press

From the day of admission to the day of discharge, it is important that a treatment center is mindful of the attachment concerns of adopted students and the need for continued attachment with their parents. On one level, it may be an oxymoron to have a teenager with attachment difficulties not residing with their adoptive parents, with whom the child has a relationship and behaviors issues in the first place. However, these children need residential care due to the severity of their emotional and behavioral problems, and need a safe and loving environment to receive intensive treatment.

Students with attachment concerns or adoption issues present with a different set of behavioral, emotional and interpersonal struggles than those who aren’t adopted. It is vital to adjust the residential staff styles of engaging with students with a history of attachment disorders. The traditional structure and complexities of residential treatment can potentially create barriers for optimal student and staff relationships. It is the student’s relationships with staff that are vital to growth and progress.

Residential staff is often seen as the crucial link between students with significant emotional and behavioral difficulties and effective treatment. The general premise underlying residential treatment is that all interactions in the milieu have a therapeutic potential that adds up to a corrective emotional experience for the youngster (Moses, 2000). The residential staff has more exposure and contact with students, potentially having more of an impact on them.

It is important for the residential treatment program to adjust and create an optimal fit between the student’s therapeutic needs and those of the milieu. The goal is to move from controlling the teen to building and sustaining a healthy relationship. It is this therapeutic relationship that is created by all staff with students that affects internalized and long-lasting change. Research indicates that staff and student interactions significantly impact the child’s treatment. The quality of the relationships formed within the RTC is viewed as an indicator of the youth’s subsequent capacity to form relationships and make an adequate psychological adjustment to the external environment (Moses, 2000).

Attachment In the Milieu

At times, it is challenging to balance the need of creating a validating and responsive environment with creating a setting that is therapeutically challenging for the students and their families. Individualized treatment and care is the best course of action when working with an adolescent with attachment difficulties. The clinical staff and residential staff are strongly rooted in attempting to understand a particular student’s needs and negotiate and accommodate them. At times, the program rules need to be adjusted to accommodate what is best for the adolescent and his or her relationship with staff, peers and her family.

To equip the staff with tools and skills to effectively connect with students with attachment concerns is crucial to the student’s success. Guiding and training staff in authoritative parenting principles help provide structure and support for the staff by creating and maintaining an environment that is conducive to teens with attachment concerns. This approach acknowledges that all relationships are reciprocal. All members of the staff share the responsibility in the quality of that relationship with that student. At times, staff can manage the milieu by decreasing the number of staff and peers that this student engages with to help that student develop deeper and more meaningful relationships. In addition, it’s important to be continually mindful of the strengthening the adolescent’s relationships with their families, providing ample opportunity to contact family and encouraging families to visit often. The parents are part of the solution and not part of the problem. These are just a few of the multitude of strategies and tools Sunrise Residential Treatment Program in Utah uses to meet the special needs of an adopted teen or any adolescent struggling with attachment difficulties. We believe that the quality of the student’s relationships with staff, peers and family during her stay at Sunrise is the agent of her change.

One hypothesis for the rise in college drinking is based on the increased acceptance among parents, school faculty and administration, and an overall acculturation of the behavior of underage alcohol consumption. Underage drinking is not only accepted, but supported on college campuses through the advent of such practices as school-funded events that liberally distribute alcohol. Further, numerous undergraduate institutions have petitioned for the drinking age to be lowered to age 18, suggesting that the consumption of alcohol is an accepted part of the institutional culture of undergraduate education.

Additionally, there has been a reported lack of involvement from parents in the effort to curb substance abuse (CASA, 2007). Parents are often unsure of how to work in connection with the schools, or are resistant to the idea of participating in the reduction of substance use. College substance use is often seen as a rite of passage and a normal part of the culture of college campuses, and is therefore widely overlooked as a cause for concern.

It has also been suggested that the high prevalence of college drinking is a result of a misperception among students, with regard to the amount of alcohol their peers are consuming. It has been found that the majority of students miscalculate how much and how often their peers are drinking, leading to an artificially amplified assessment of the prevalence of substance use. While statistics suggest a large portion of college students are engaging in substance use at a relatively high rate, the actual frequency and, in particular, the amount is often less than students’ estimation. This serves to generate a type of peer pressure, causing students to abuse substances as they attempt to emulate the perceived behavior of their peers.

One effective strategy to combat this miscalculation is through informational prevention strategies. As reported in The Cochrane Library 2009, educating students about how much and how often their peers are actually drinking has proven to lead to a reduction in substance use by eliminating the fabricated peer pressure.

An intervention study reported by the Center for Health and Behavior at Syracuse University (2007) found that an effective strategy to reduce alcohol consumption is to provide a detailed assessment of an individual’s consumption (Carey et al). This strategy relies on self-report and encourages students to reflect on their behavior. This reflection can lead to increased self-awareness and allows students to draw correlations between their behavior and potential negative consequences, effectively giving them the opportunity to be proactive in altering their actions. Additionally this study found that participants that received brief motivational interventions in connection with their assessments reduced their drinking even more (Carey et al, 2006).

Often, substance use treatment is reactionary and employed in the form of crisis management. People typically wait for the problem to emerge before acting, making it more difficult and time-consuming to make meaningful changes in behavior, as the habitual actions have become increasingly ingrained. This is particularly true if the abuse has developed into a chemical dependence. Ultimately, it is important for parents, schools and communities to work together to be proactive about creating and implementing effective prevention strategies at an early age to offset the potential for problem substance use and abuse to occur. This will serve to cultivate an environment that is less tolerant of excessive underage substance use, as well as provide communities with practical resources to approach the issue of substance use before it becomes problematic.

References

Carey, K., Henson, J., Carey, M., & Maisto, S. (2007). Which heavy drinking college students  benefit from a brief motivational intervention?. Journal of Consulting and Clinical  Psychology, 75(4), 663-669.

Hingson, R., Zha, W., & Weitzman, E. (2009). Magnitude of and trends in alcohol-related  mortality and morbidity among U.S. college students ages 18-24, 1998-2005. Journal of studies on Alcohol and Drugs, 16, 12-20.

Moreira MT, Smith LA, Foxcroft D. Social norms interventions to reduce alcohol misuse in University or College students. Cochrane Database of Systematic Reviews 2009, Issue 3.   Art. No.: CD006748. DOI: 10.1002/14651858. CD006748.pub2.

The National Center on Addiction and Substance Abuse at Columbia University (CASA).   (2007). Wasting the best and the brightest: substance abuse and America’s colleges and   universities. New York: Califano, J.

We have learned through trial and error that peer to peer recovery programs work. When doctors, lawyers, or airline pilots are placed in treatment together they seem to do better and support each other more effectively because of their commonalities. The same is true for college students. While there are some excellent young adult treatment programs in existence today, very few address the specific needs of college students. And most treatment professionals would all agree that there are unique differences between young adults in college and young adults that are not.

This article will address how to work more effectively with college students who are struggling with addiction, as well as introduce you to two programs that focus exclusively on this population.

Consider the following as reported in the National Survey on Drug Use and Health Report, June, 2009:

• About one fifth of young adults aged 18 to 25 (21.1 percent) were classified as needing treatment for alcohol or illicit drug use; 17.2 percent were in need of alcohol use treatment, 8.4 percent were in need of illicit drug use treatment, and 4.4 percent were in need of both alcohol and illicit drug use treatment.
• Less than one tenth (7.0 percent) of the young adults who were in need of alcohol or illicit drug use treatment in the past year received it at a specialty facility.
• Of the young adults who needed, but did not receive alcohol or illicit drug use treatment in a specialty facility in the past year, 96.0 percent did not perceive the need.
• Less than one third of the young adults who did not receive treatment in a specialty facility but thought they needed it made an attempt to obtain it. 1

The National Institute of Health reported in “What Colleges Need To Know: An Update on College Drinking”:

• 19 percent of college students ages 18–24 met the criteria for alcohol abuse or dependence.
• 5 percent of these students sought treatment for alcohol problems in the year preceding the survey.
• 3 percent of these students thought they should seek help but did not.
• The students who drink most heavily are the least likely to seek treatment; yet they experience or are responsible for the greatest number of alcohol-related problems on campus2.

The implications of this data are numerous. First of all, there is a huge population of college students who are in need of services and support for addictive behaviors. For the most part, we as treatment professionals need to do a better job of working with this client base and supporting them in getting back on campus successfully.

What you need to know about working with college students:

• They are task oriented. When given clear direction, they will follow.
• They love success. Even small successes.
• Start them back on campus slowly. One or two classes max in their first semester back sober. Do NOT overload them or let them take more than one difficult class when they first return.
• Pick their classes with them. Starting with a psychology 101 class, creative writing, or a basic math class will help build their confidence and ease them back to campus.
• Address their triggers. You never know what they might be. Have many discussions around this topic, especially if they are returning to the same campus they were on before their sobriety started. Park in a different parking lot, get a new backpack, know where meetings are on or around campus. And most importantly, don’t sit in the back of the classroom. Sit in the front two rows and in the middle of the room if possible.
• Know who your support people are on campus, both academically and personally. Know where the tutoring center is, as well as the academic support office.
• Know the campus you’re sending them back to. Is there a substance abuse counselor on staff or a health educator who works with students in recovery?
• Is there some sort of program or group for students in recovery on campus?
• They need to learn study skills and time management. Have them carry a day planner and use it.
• Teach them how to talk to their professors. Mandate that they go to office hours and get to know their professors. Encourage them to ask questions, either during or after class.

By following these guidelines professionals can better address the needs of their clients who are looking to go back to college in early sobriety. Let us now introduce you to two programs that are specifically addressing the needs of college students.

The first is the Collegiate Treatment Center (CTC) at The Pat Moore Foundation in Costa Mesa, California. The CTC is a 30-60 day inpatient treatment program specifically designed for college students. Not only are CTC clients exposed to 12 step treatment, they are also taught the skills necessary to return to campus sober. Educational programming throughout the week focuses on topics such as: Study skills, time management, managing triggers, coping strategies, finding resources on or around campus, where to sit in class and how to talk to a professor. The CTC staff works with the client’s college to work out medical withdrawal or leave of absence as well as looking for support networks on and around campus should the client (with the recommendation of the treatment team) choose to go back to their primary campus.

The CTC also evaluates aftercare options and looks for the best placement for each client following graduation from the CTC. Some go on to long term treatment, some go on to sober living, and some do return to their former campus with a solid support network in place when they return. Each client is different.  It is important to assess each individual in order to determine what his or her specific needs are following primary treatment.

The second is the HERO (Higher Education Recovery Option) House, a sober living community for college students in early recovery or for those coming out of recovery high schools looking for a sober community as they begin their college career. Almost all residents come from a primary treatment setting, whether inpatient or outpatient. In order to qualify for admission, residents must be in college or want to go back to college while living in a recovery community. Upon admission, each resident receives an academic assessment to effectively place the resident in the appropriate college setting. A joke around the HERO House is that the last time the student was on a campus, their BAC was higher than their GPA. That’s why most residents, especially those in their first two years of college, go to a two year college their first semester in the program. The philosophy is to ease the student back onto campus while learning how to effectively balance a recovery program with academics. In their first semester at The HERO House, they are allowed to take only one or two classes, again not wanting to overload the student in their first semester back. They also learn how to be a successful student. They learn study skills, time management, how and where to look for academic and personal support on campus, and “success in the classroom” skills.

In addition to helping them learn how to navigate college successfully, residents must also fully engage in a program of recovery. The HERO house is 12- step based and residents must attend a minimum of four 12 step meetings per week although most residents attend at least 6 per week. Residents also have an opportunity to meet with a recovery coach once a week to go over their progress or lack of progress in balancing recovery and college. Residents must have a sponsor within two weeks of residency and are expected to have regular contact with this person.

Residents also have the opportunity to attend educational programming that addresses academic skills and life skills such as self-esteem, leadership development, relationships, and recovery skills. A frequent topic at The HERO House is the difference between sobriety and recovery.  Active recovery is a main focus in the program and residents are aware that they will not be able to stay in the program if they do not actively pursue recovery.

Having fun in sobriety is also an important component, with numerous programs happening weekly. From white water rafting trips to movie nights to attending professional sporting events, residents are exposed to a variety of activities to teach them the joys of sober living. The theory of “We are not a glum lot” is emphasized by staff on a regular basis.

The HERO House has been in operation for almost four years in Atlanta and they currently have 5 houses operating for both men and women. Recently, they opened a new location in San Juan Capistrano and have three houses for men. At some point at the beginning of next year, they will be opening their women’s program in the Southern California area.