Take Action in Secondary Schools

SECTION I:
Understanding Take Action in Secondary Schools

Important Topics to Consider

This is primarily a resource related to substance use. However, when teaching and working with students around substance use, other related issues often arise.They may be in the form of family discord, problems with peers, mental health concerns, bullying, gambling or issues arising from sexual orientation to name a few. Regardless of the issues, it is important to keep in mind that asking for help can be difficult for anyone.This may be especially true for youth.

Currently, youth who seek help are more likely to do so for high profile problems, such as substance abuse, various forms of physical or emotional abuse or homelessness.We know from research studies that when a student presents with one of these problems, there is a high degree of probability that he/she will be experiencing at least one other area of concern. That is, many of these difficulties often coexist or occur with other problems. As a student moves through secondary school towards adulthood, the likelihood of one or more problems surfacing increases.

Highlighted below are a few of these related issues in the hope of providing initial background information. Please keep in mind that this is not an exhaustive list and you will probably come across others as you work with your students.

Diversity:

Diversity is often equated with different and unfamiliar. This can lead to faulty assumptions and fears that can get in the way of effective teaching and programming. In fact, diversity can encompass many factors including race, cultures of origin, language, sexual orientation, physical limitations or even residential location.

Lesson plans, programs and activities need to encompass a broad and sensitive approach and be inclusive of the diversity of the students in your school population.

Everyone at your school will come with their own backgrounds, beliefs, values, and traditions. Using alcohol as an example, consuming alcohol at mealtime in one family/culture may be a normal “non-event”. In another family alcohol may be consumed for celebratory purposes and still in another family its use may be strictly forbidden. Improved understanding and knowledge of the issues of diversity will enhance both the prevention and intervention initiatives in your school.

Gambling:

Gambling is defined as risking something of value when an element of chance is associated with the outcome. Gambling is no longer an adult-only problem and the forms of gambling that youth participate in are as varied as the types of gambling activities that adults participate in.The most common forms of gambling among youth usually depend upon the age and gender of the youth. Some examples of youth gambling are cards (including poker), lottery tickets, sport pools, dice or placing wagers or bets.

Problem gambling has the potential to undermine a young person’s life in much the same way as substance abuse. Problem gambling can lead to negative consequences such as financial problems, strained or lost relationships, poor performance at school or work, criminal behaviour, preoccupation with gambling, avoidance of other issues and lack of progress toward goals. Gambling is also often associated with depression or anxiety symptoms.

Studies indicate that youth who are struggling with one problematic issue (e.g., substance use or mental health) are also more likely to have a concurrent problem with gambling.

Mental Health:

A young person’s ability to cope with and enjoy life and its challenges is strongly linked to his/her mental health and overall sense of well-being. If an individual experiences mental health difficulties in the formative years, the effects on his/her ability to function may last for the rest of his/her lives.

Young people who develop substance use problems are often dealing with other problems including mental health problems. Substance use and mental health problems may not be directly related to each other, but a common risk factor may underlie them.

Some experts working in the fields of addiction and mental health believe that mental health problems are risk factors for substance use, but others prefer the suggestion that mental health and substance use problems among young people may emerge from a common pre-existing factor, such as stress.

There are a number of mental health problems that often overlap with substance use problems. Some, such as attention deficit hyperactivity disorder (ADHD), depression, anxiety, conduct and learning disorders, can emerge in childhood and later increase the risk that a young person develops substance use. Others, such as bipolar disorder and schizophrenia tend to onset during adolescence and young adulthood, at the same time that substance use problems tend to emerge.

There are several ways in which substance use and mental health problems affect each other. Use of a substance may create or mimic psychiatric symptoms, worsen mental health symptoms, trigger the emergence of some mental health disorders or mask the symptoms of mental illness. Individuals may self-medicate or use various substances in an effort to relieve the distress and symptoms they experience with a mental illness.

Among youth who do develop a substance use problem, it may be common to also find a mental health problem. The combination of problem substance use and a mental health concern is referred to as a co-occurring or concurrent disorder.

The most common co-occurring mental health problems:

• Depression often manifests as irritable moods, physical complaints, insomnia, decreased academic functioning, decreased social activities and antisocial behaviour. Depression often precedes problem substance use of alcohol and marijuana
• Social Anxiety usually manifests as school avoidance behaviours, poor self-image and social isolation. When a young person tries alcohol or other drugs, the anxiety reducing effect of the substance can promote ongoing use
• Post-Traumatic Stress can manifest through such symptoms as anxiety, depression, self-harm, a preoccupation with death, suicidal thoughts or gestures and flashbacks. People experiencing post-traumatic stress often use substances to help numb painful emotions and deal with anger
• Conduct Disorders manifest as antisocial behaviours, such as illegal activities and disregard for other people’s rights. This condition is highly linked with problem substance use and is commonly associated with ADHD.Youth with conduct disorder are risk-takers and often heavily use a variety of substances to enjoy the excitement and rush
• Eating Disorders usually have their onset in adolescence. The likelihood of developing a concurrent substance use problem increases by 12% to 18% among people with anorexia and by 30% to 70% among people with bulimia.Young people with an eating disorder tend to use substances that suppress their appetite, such as nicotine, alcohol or stimulants (e.g., diet pills, caffeine pills, speed, cocaine)

Adapted from: Youth and Drugs and Mental Health, Centre for Addiction and Mental Health, 2004.

The increased understanding and recognition of concurrent mental health and addictions problems has led to changes in the approach to the assessment and treatment of individuals presenting with either of these problems in clinical settings. In turn, it is important for educators and individuals working with young people to have an awareness of the possibility of cooccurring mental health and substance use problems when working with students.

Physical Health:

All substances, whether legal or illegal, will have adverse effects on the human body. However, due to the fact that the adolescent body is still developing and maturing, there is more cause for concern.

For example, the body and central nervous system of young people are developing and changing at this time of life. It is well established that alcohol has a serious impact on the brain development of a fetus; there is increasing evidence that similar negative effects are possible when alcohol is abused by young people.

In addition, there are differences in the metabolism of individuals at varying ages and differences between individuals in their capacity to consume and tolerate substances introduced to their bodies.

Physical health effects can be compounded by the combination of using more than one substance. Life-threatening effects occur often after using multiple doses or “stacking”.

Examples of physical health effects include:

• Marijuana: Chemicals added can cause psychosis and paranoia that result in an individual requiring acute medical attention
• Ecstasy: Repeated doses can cause hyperthermia, high blood pressure, irregular heart beats, liver failure, kidney failure and brain damage
• Cocaine: Depletes our natural anti-depressants in the brain, can cause paranoid delusions, cardiac problems, auto immune disorders and general body damage to all major organs
• Alcohol: Can have immediate health effects when used in toxic amounts (alcohol poisoning) and is responsible for a number of chronic health problems following long term use such as liver disease, heart disease, certain cancers, and damage to the central nervous system

Sexual Health:

Many substances, whether legal or illegal, can lead to individuals engaging in high risk behaviours including high risk sexual activities because their judgement is impaired. In fact, alcohol is described as the most common date rape drug. Risk behaviours could further result in sexually transmitted infections, unwanted sexual advances, sexual assault, rape, pregnancy, and emotional trauma.

Social Determinants of Health:

Social determinants of health describe the social and economic conditions that influence our health. They include such factors as income, social status, social supports, employment, literacy, social and physical environment, gender, culture, genetics, personal health practices and coping skills. These factors impact our wellness and illness as well as our ability to achieve, cope and thrive in our living situation.

Some of these factors can be addressed and enhanced within the school environment. As an example, the school setting can provide initiatives to enhance social skills and social supports.

Misuse of Prescription and Over-the-Counter Drugs:

Medications readily available over-the-counter and by prescription may be abused or misused by individuals for their drug effects. Trends and patterns of use for these substances change over time and may vary regionally.

Current examples of the abuse of prescription drugs include the illicit use of methylphenidate or Ritalin®, a stimulant used in the treatment of ADHD/ADD, and the illicit use of narcotic pain killers such as oxycodone or Oxycontin®. Over-the-counter decongestant medications containing pseudoephedrine have also been sought after and misused for their stimulant properties.

Misuse of any drug or medication has risks. Chronic abuse of narcotic or opioid painkillers carries the risk of psychological and physical dependence or addiction.

For more detailed information and statistics on the misuse of prescription drugs, please refer to Section 3.7, Non-Medical Use of Prescription Drugs (page 152), within the 2007 OSDUHS Results document.

Stigma:

Individuals coping with addiction problems and drug dependence are often the target of negative attitudes or stigma. Stigma is a complex concept that is reflected in attitudes, feelings and behaviour. For example, our attitudes and behaviour towards individuals experiencing a physical health problem may be very different from those towards individuals experiencing a mental health or addiction problem. Substance use may be perceived as weak or judged to be different in a shameful or undesirable way whereas we are more accepting and less critical of other health concerns.

Stereotypes and myths about addictions and drug dependence influence our attitudes and behaviours towards individuals with substance use problems. The image of the “street junkie” may colour our thinking and behaviour in regards to addiction. We may not recognize the prevalence and complexity of substance abuse, and the fact that many individuals struggle with dependence on a wide range of substances, including alcohol and pain medications.

Fears about the stigma of addiction may lead to reluctance by individuals to acknowledge their substance abuse or to seek appropriate treatment and support.To prevent this and to address the negative consequences, it may be important to identify and introduce the concept of stigma when working with students.

In summary, school staff, teachers and others working in the school system have the unique opportunity to know and work with students on an ongoing basis. Being informed and aware of issues impacting youth makes you an ideal resource and support.

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