A systems approach to substance abuse identification and intervention for school counselors

Professional School Counseling, June, 2002 by Glenn W. Lambie, Laurie J. Rokutani

Though a novice school counselor, the first author of this article nevertheless had confidence in his abilities to assist adolescents with various difficulties. He was relatively young and not that far removed from the population with which he was working. He had an understanding of the complexity of adolescent development in the changing culture. However, he was not prepared for the complexity of adolescent substance abuse.

He worked with a 15-year-old male, Anthony, who was having academic and behavioral difficulties at school, but whose aptitudes were high in all academic areas. Anthony had a history of erratic mood swings; teachers would report that he was a nice and polite young man one day but then would tell them to "go to hell" the next day. After further interactions, a complicated family history of substance abuse and discord emerged. As he built rapport with Anthony, the counselor gained a better understanding of his personal history of alcohol and drug misuse or abuse. Anthony's drugs of choice were alcohol and marijuana, with occasional use of hallucinogens and cocaine. A meeting with Anthony and both of his parents was arranged, and Anthony's problems and possible interventions outside of the school system were discussed. During this meeting the complexity of the situation became more apparent.

This new perspective of the intricacy of this young person's problem revealed that his issues were not only intrapersonal but also interpersonal. The school counselor felt unprepared by his education to assist this young man and his family concerning substance abuse and a systems perspective. The purpose of this article is to provide school counselors a systems perspective of substance abuse. The following four topics will be addressed: (a) identification of the symptomatology of adolescent substance abuse, (b) a systemic perspective on adolescent substance abuse, (c) the role of the family in the perpetuation and healing of this dysfunction, and (d) the role of the school counselor in working with adolescent substance abuse issues from a systems perspective.

The Complexity of Substance Abuse and the Challenge of Counseling Adolescents

Substance abuse problems are serious, often recurring, complex, biopsychosocial disorders that generate systems problems at many levels, from the cell and organ, to family, to schools, to workplaces, and to society at large (Alexander & Gwyther, 1995). Data collected in 1997 suggested that substance use among 12- to 17-year-old adolescents rose to 11.4%, while increasing from 2.2% to 3.8% in young persons between the ages of 12 and 13 (Substance Abuse and Mental Health Services Administration, 1999). The onset of substance use is occurring at younger ages. This results in increased numbers of adolescents entering treatment for substance abuse with greater social and emotional developmental deficits (Fisher & Harrison, 2000). In addition, many adult alcoholics begin abusing substances in adolescence (Robins & Price, 1991).

Adolescents can be challenging to work with in a therapeutic relationship, amplifying the problem for helping professionals. Some studies have maintained that adolescents are the most challenging of clients to work with in counseling (Church, 1994; Hanna, Hanna, & Keys, 1999). Adolescents may be reluctant to engage in a helping relationship with adults and often are poorly motivated for change (Rutter & Rutter, 1993; Sommers-Flanagan & Sommers-Flanagan, 1995). An adolescent's resistance to counseling may be a part of his or her normal developmental process of autonomy and a reaction to a directive and confrontational therapist (Miller & Rollnick, 1991). As Church (1994) stated, "because of their desire for autonomy, adolescents may be very sensitive to situations where they believe others are asserting their power or authority" (p. 105). Counselors need to have a clear conceptual understanding of adolescence and developmental theory in order to establish and maintain a therapeutic relationship.

All counselors encounter clients with presenting or related problems of substance abuse (Fisher & Harrison, 2000; Sales, 1999). However, many school counselors receive no specific preparation in the area of substance abuse in their graduate programs. In the field of counselor education, few programs offer course work in the specific area of substance abuse (Lenhardt, 1994). The Council for Accreditation of Counseling and Related Educational Programs (CACREP 1994) standards for curriculum and clinical training do not specify course work in substance abuse or family systems in school counseling curricula (Sales, 1999). However, such preparation is necessary for school counselors to assist young people at risk (Hershenson & Strein, 1991; Lenhardt, 1994; Lewis & Lewis, 1981).

Contributing to the problem of lack of education and instruction in the identification of substance abuse for school counselors is the reality that counselor-student ratios are a factor that limits the amount of time that counselors have to address these issues (Stickel, 1991). Olsen and Dilley (1988) confirmed that there is considerable evidence to support the contention that school counselors cannot meet all of the demands placed on them. Other studies have also found that school counselors are concerned about being required to perform increasingly nonprofessional duties in a limited amount of time (Burnham & Jackson, 2000; Hutchinson, Barrick, & Grove, 1986; Stickel, 1991).