Topic 3 What can be done further?
Students who abuse alcohol may need counselling or treatment. In many cases, schools do not have the internal expertise to conduct this kind of activity, for which it would be recommended to consult an external expert, working in an evidence-based way with youth. It is recommended that there is monitoring and support on behalf of the school regarding the time attendance, academic performance and homework assignments (European Monitoring Center for Drugs and Drugs Addiction, 2019). As said, regardless of the efforts of a school that underage drinking is prevented, there will be cases that a teacher will need support from health professionals.
- In case you need it, talk with the psychologist of the school/counsellor and/or with the relevant service of the region/country to give you further tips for talking with the young person (ask how to act next with the youth).
- During the meeting, remind the rules of the school to the student and give them some time to talk with his/her parents. Remember that during the talk, you should:
- Be open and honest about the dangers of alcohol as it can help students make safer decisions in comparison with judging them.
- Show your care about the students’ health, wellness, and success and tell them how alcohol can harm those.
- Avoid judgements.
- Talk with the director of the school, who can call the parents to come to school. Involve the family with the support of health professionals who can support you.
- You should be present at the meeting with the family and the student. Tell parents about the signs you have gathered (only what you saw and wrote) and avoid judging the parents.
- Plan the next steps with the student, a group of health experts and the family.
Research on treating alcohol problematic use among youth shows that there are some important elements to help the treatment be successful, which should be taken into account at the school level (Hansen & Dusenbury, 2004):
Matching Treatment to Needs:
It is important that there is an assessment, that can show what type of treatment would be more beneficial to the specific student as this varies from one to another, due to the alcohol intake. There are various types of treatment such as brief intervention, typically delivered by physicians, counsellors, or others who do not specialise in alcohol problematic use treatment, outpatient treatment (2-20 hours per week), day treatment or partial hospitalisation, including professionally directed treatment after school, in the evenings, or on weekends, often combining individual, group, and family therapy, inpatient treatment and detoxification (3-5 day intensive medical monitoring and management) which is often part of a 28-day intensive inpatient treatment program. These interventions differ depending on the country.
Comprehensive and Integrated:
Treatment is more effective if it is fully integrated into all aspects of an adolescent’s life—school, home, family, peer group, and workplace if applicable (for example for late adolescents). Programmes should consider how the student can remain included in the school environment.
Involvement of Families:
Family development research supports that is necessary that the family of the adolescent should be included in the therapy wherever possible, and the family relationships should be understood. Families can be either a source of strength for quitting alcohol consumption or risk for continued alcohol problematic use. For example, family involvement can be particularly important in retaining teenagers in treatment, while alcohol problems among other family members can influence youths to continue engaging in heavy drinking. Normally, the family of the adolescent is involved be being educated about how they can support the treatment process and in addition, education for the treatment itself. There are cases where the person who will implement the intervention must be prepared to face familial alcoholism, a significant risk factor for youth alcohol use and problematic use.
Developmental Appropriateness:
In the cases of adolescents there should be careful that the intervention is designed as appropriate for the student’s age. The interventions need to take into consideration the maturation, psychological, emotional, and sexual issues. Also, there should be a focus on the cognitive abilities of each age. For example, older adolescents have a more concrete style of thinking while the younger ones have a more abstract one.
Retention:
The adolescents are often not motivated to participate in treatment and normally they are referred from schools or the criminal justice system rather than by themselves.
So, there is a need to use strategies to engage and retain teenagers in treatment or apply age-appropriate rewards.
Gender and Cultural Issues:
Treatment programs need to understand that culture and gender affect problematic alcohol use. For instance, alcohol use is often defined as part of a cultural context and certain cultural attitudes may affect use patterns as well as how an adolescent understands his or her alcohol use. Furthermore, there is evidence for a correlation between childhood trauma and problematic alcohol use for girls and women. So, treatment should take care of these issues to have bigger chances of being successful.
Continuing Care:
As per the behavioural model of change, this care is essential to achieve long-term outcomes among adolescents.
Assessment of Outcomes:
Programmes need to be evaluated to see their effectiveness and recovery strategies they use, as well as to see how they can be improved. Collaboration with the community is beneficial. Coordination among institutions in the community including schools, workplaces that employ teenagers, law enforcement, courts, faith-based institutions, and public and private treatment providers that may refer teens to treatment should be developed, disseminated, and evaluated. Training should be provided for key individuals in all of these institutions about indicators of risk and procedures for a referral. Schools should adopt strategies for systematically identifying and referring students for diagnosis and treatment for alcohol problematic use. State agencies should encourage schools, health care providers, and other professionals to access adequate resources to help them identify youth who may need help and make referrals to appropriate agencies for diagnosis and treatment. In addition, policies and programs should support screening and referral that matches the needs of adolescent alcohol abusers with appropriate treatment options.
- In the case of Cyprus, you can see the list of the therapeutic centres, here.
- For Croatia, visit this website.
- For Greece, visit KETHEA for therapy-related issues. You can also visit OKANA for therapy/social rehabilitation as well as prevention.
Case-study
When the mother of Marcus, a 16-years-old adolescent was telling him to cut down on the drinking behaviour, he was extremely annoyed and seemed guilty.
The father of Marcus is a regular drinker. The alcohol abuse started when his friends changed to include more people of a higher age group. Marcus was stealing money from his mother or asking his classmates to give him money to be able to buy alcohol. The child was a school drop-out as he was not able to concentrate and showed low scores at school.
Moreover, he was often involved in assaultive behaviour at school. The alcohol consumption increased from initially 20-40 ml of local alcohol average per day to approximately 60-120 ml per day. In addition, Marcus started to smoke shisha, as his older friends owned some. There were cases in which Marcus complained to his classmates about nausea, headache, dizziness, in addition to disorientation, restlessness, diaphoresis (excessive and abnormal sweating) and nystagmus (repetitive and uncontrolled eye movements). The child also developed blurring of vision and inability to perceive numbers and letters in the central visual field and fixed hearing deficits to increased frequency sound was noted; more prominent during the last 2 months, during which period combined abuse was done and dose of alcohol was increased to about 60-120 ml of alcohol per day.
A progressively increasing tendency of violence, disorientation, restlessness was noticed by the mother and his family in the form of anger outbursts, abusive and assaultive behaviour in the last two months during which alcohol intake was accelerated.
Marcus presented to the clinic in a state of withdrawal since the mother had not let the child consume any substances for the last 2 days. The child tried to abstain from shisha and alcohol a few times, but each episode of abstinence was followed by an increase in the use.
What was done?
- The child was introduced to a treatment unit.
- An haematological test was done to recognise at which point the abuse affected the child’s health.
- A supportive psychotherapy, which included cognitive behavioural therapy, involved exploring and addressing problems that co-occurred with the abuse as well as the positive and negative consequences of alcohol and nicotine use.
- During the process of detoxification, high energy feeds were instituted after correcting the vitamin and metabolic disturbances.
- Social workers were involved in the process. They took detailed histories, delivered brief interventions to help the child for a behavioural change, assessed the progress and provided encouragement and assistance to rebuild the child’s life. It also included the development of logs (when the child took the alcohol /nicotine and when he was abstinent) and progress reviews to avoid risky situations.
- Engagement in healthy habits was promoted and periodic rewards for abstaining were offered to Marcus.
- A family-based approach and person-centred counselling were adopted to help in recognising and reducing the desire and avoiding high-risk situations.
- Alcohol dependence in the father was also addressed and was included in the treatment.
- There were subsequent follow-up visits.