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Continued Decline in Youth Substance Abuse

Current illicit drug use among teens is continuing to decline, according to a new report by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) released today. The study also shows positive signs that teens are seeing the dangers of abusing prescription drugs and methamphetamine and are pushing back. Among youth ages 12-17, the 2007 National Survey on Drug Use and Health (NSDUH), the Nation's largest substance use survey, shows that the significant decline in overall past month illicit drug use that began in 2002 continued through 2007, from 11.6 percent to 9.5 percent.

The survey, released at the start of the 19th Annual National Alcohol and Drug Addiction Recovery Month, shows that the reductions in youth drug use occurred for nearly every type of illicit drug including marijuana, cocaine, hallucinogens, LSD, and Ecstasy. The survey also shows dramatic declines in meth use, down by 67 percent (from 0.3% to 0.1%) and prescription drug abuse among teens, which declined overall by 18 percent, from 4 percent to 3.3 percent between 2002-2007.

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Little Words That Get Big Results

Feature Articles - Treatment Strategies or Protocols

Wednesday, 31 March 1999

For years, clinicians have been using stories, scripts and fables in the therapeutic process, but somehow one of the most enduring and powerful forms of metaphor has been routinely overlooked.

Although brief, proverbs have enormous depth and an efficacy that is unparalleled by many other forms of communication. Often metaphorical and alliterative in form, they are the lasting
sayings of each culture that skillfully express the collective insights and experiences of each passing generation. Forged by time into bits of distilled wisdom, proverbs capture — in just a few carefully chosen words — the truths and complexities of the human condition. Although they have proven to be a memorable and effective means to enhance self-discovery and inspire positive change, they have yet to be fully recognized for their potential applications in the therapeutic arena. Soon however, clinicians may be compelled to see proverbs in an altogether different light. With managed care high on the horizon, the prevailing conditions in which behavioral health services have been provided may be ineluctably changing as there has been an ever increasing focus on briefer therapies and a demand for more concise, potent and economic interventions. In this efficiency-minded environment, proverbs may become especially appealing. With clinicians continuing to explore their most expeditious and effective options, proverbs may soon be discovered as viable alternatives and adjuncts to more traditional and elongated metaphorical approaches, and ultimately just as effective to:

spark personal awareness
redefine problems
shift preconceived ideas
avoid defensive behavior
communicate more effectively and efficiently
encourage growth
embed positive directives and models for change
establish rapport
illustrate important and memorable concepts

Like most metaphors, proverbs are a part of everyday conversation. In fact, they have become the linguistic shortcuts we employ to promote awareness, inspire change or illustrate ideas that otherwise take too long to express. Concise yet complex, easy to grasp yet far-reaching, these remarkable insights often exemplify the successful marriage of the abstract and the pragmatic. Think about the popular 12-step maxim, “One day at a time.” It is not unnecessarily confusing or crammed with symbolism, yet it is somehow profound. Brief, memorable and workable, it is easily assimilated, highly effective and often influential — almost to the point of being auto-suggestive. Accordingly, other such proverbs may be of equal value when strategically employed in the clinical setting. Consider the adages, “Every slip is not a fall” or “Whoever falls and gets up gains a step.” For clients who recently relapsed, these proverbs may prove extremely thought-provoking, as well as offer hope, a fresh point of view and sound guidance.

Image-laden language

We are all familiar with our favorite sayings, yet thousands of proverbs exist from every culture and lifestyle. Although foreign to us, many of these lesser-known proverbs can be extremely insightful. Despite their apparent simplicity, consider the following proverbs for their metaphorical complexities and potential applications in the therapeutic process.

“The fish sees the bait, not the hook.”

“In the spring no one thinks of the snow that fell last year.”— Swedish

“Old habits are iron shirts.”— Yugoslavian

“If the father is a fisherman, the children look into the water.”— Russian

“Every cask smells of the wine it contained.” — Beaulieu

Clearly, these few words embody more than their brevity suggests. They speak to clients on many levels, have several meanings and apply to many life situations. One German proverb best illustrates: “The sun will always bring to light what lay under the snow.” Obviously, this is much more than a weather observation. It can be used metaphorically in the clinical setting to describe the importance of facing problems, the potentially embarrassing effects of ignoring the obvious, or the results of maintaining secrets. As a rich metaphor, this, as well as other proverbs, frequently use concrete images symbolically to convey ideas, which may be more difficult to express in ordinary terms. Typically, these images are more than just simple references to objects or situations; they are symbols of experience that connect us to a web of rich associations and personal memories. For each of us, they evoke constellations of meaning that expand old concepts into new ways of perceiving the world.

Since most individuals respond to image-laden language, especially those predisposed to a visual-sensory mode of functioning, clinicians can use proverbs to enhance their communications and achieve a joining process. Simply stated, clinicians can use proverbs to help clients “see what they are saying” more clearly. By adopting communications and a language style that conform to the preferences of a client, a clinician can temporarily form the sort of connection that creates a shared phenomenological world. Ultimately, this kind of synchrony can prove invaluable when cementing the foundations of a solid rapport. When working relationships have been established, clinicians can build on these connections to help clients see other aspects of their lives from different perspectives — to make perceptible fresh ideas and new ways of being, previously unrecognizable from the clients’ usual vantage points.

We all use words as symbols of our experience. Ultimately, the better we become at conveying ideas that connect to our clients, the more effective we can be in the therapeutic arena. When we can do this succinctly and clearly, we save our clients time, energy and unnecessary confusion. All told, when these analogies are understood for their wider meanings, they can become the tools we need to unbalance pre-existing mind-sets. When proverbs redefine a situation just enough to shift preconceived ideas, they open a window of opportunity. Once this window has been opened, clinicians can work with clients to enhance a deeper understanding of their behaviors, challenges and motivations.

Beyond their ability to foster self-exploration, proverbs can be used to engender interest and participation in the therapeutic discourse. Given their rich history, depth and collective wisdom, proverbs have an air of mystery that intrigues and excites listeners. The next time a proverb is introduced, watch for the subtle reactions. As if preparing for the double entendres, people listen with a curious intensity determined to understand what they can learn from the hidden messages. Like gestalts, proverbs yearn for closure and most people are intent on filling in the blanks. Although they may grapple with the meaning of a proverb, like youngsters solving a riddle or unwrapping a gift, their search fosters a childlike curiosity and sense of discovery. In this way, proverbs bring out an ingenuous curiosity, creativity and excitement for problem solving that may spill over into the larger context of the therapeutic experience. As a sensory form of communication, proverbs can be used not only to help clinicians engage clients, but to learn more about the way their clients see the world, themselves and the people around them.

Open to interpretation

All individuals hear proverbs through the filter of their unique life experiences. Therefore, how a proverb is interpreted can be a very telling indication of a client’s overall attitude, demeanor and self-image. When making projective assessments of this nature, clinicians may find it more efficacious to use proverbs with multiple meanings. Given the many ways that proverbs can be understood, it is always important for clinicians to determine if a client has misinterpreted an intended message. It is also necessary to recognize that good sense, good timing and good information can be invaluable for the success of any new intervention. Despite any drawbacks there might be to this nondirective approach, when clients decipher a proverb to determine its hidden messages, they feel that they are discovering advice rather than having it thrust upon them. Therefore, they should be less resistant and more invested to follow a path they have uncovered for themselves. By their very nature, proverbs possess many qualities that can enable clinicians to avoid defensive reactions.

Proverbs encourage and clarify, reframe and arouse; on occasion, they even inspire laughter, but seldom do they direct or command clients to move in any one direction. Instead, they facilitate the kind of quiet reflection that is often necessary to initiate the process of change, growth and healing. Since they rarely come across as preachy or dogmatic, proverbs are not rejected on their face; instead, clinicians are often met with a pause as clients ponder proverbs for nuances of meaning to settle on messages best reflecting their real-life circumstances. Most importantly, clients are more amenable to the guidance offered by proverbs, because, on some level, they recognize the inherent truth, wisdom and history of these insightful pearls. After all, the extraordinary endurance of proverbs is rooted in their broad acceptance, value and benefit to thousands throughout the ages. Since clients also understand that proverbs have not been created by any one practitioner, but rather by scores of wise old ancestors, grandparents and prophets, they frequently come to accept clinicians as the thoughtful messengers of wisdom past. Removed from blame, clinicians are able to tacitly provide instruction and directives without eliciting the knee-jerk defensive responses normally associated with such pointed communications. Proverbs can be a nondirective approach that not only discourages a client’s resistance, but also makes sensitive communications more digestible.

Although proverbs can be enormously versatile and far-reaching, they may appear to have no impact or appeal for some clients. For others, proverbs influence their perceptions and behaviors immediately. Either way, it is important to note that every client responds differently to the proverbs they hear. For example, it is not unusual for certain clients to think about proverbs for days or even weeks before revealing any corresponding changes in their thoughts, actions, feelings or beliefs. Although this process does not necessarily require conscious understanding, these clients may find themselves unintentionally dwelling on the proverbs that have a unique significance for them. While unusual, these delayed responses may have a common connection. Sometimes proverbs seed themselves in the unconscious, drawing on a reserve of filed experiences, associations and forgotten resources. Ultimately, this period of rumination may be necessary to awaken fresh insights, attitudes and solutions that may help clients work through many of their more challenging problems.

Indeed, proverbs have many applications in the therapeutic process. Although they can be used successfully with individuals, couples and families, they may prove most effective in the group context. Examine the following sample of proverbs and their suggested clinical goals:

To support independent thinking
“He who builds to every man’s advice will have a crooked house.”— Danish
To reinforce persistance and perserverence
“A great oak is only a little nut that held its ground.”
“To reframe obstacles and misfortunes
He who is flat on his back has nowhere to look but up.”
To discourage pessimism
“It is one life whether you spend it laughing or weeping.”— Japanese
To inspire growth and motivation
“Still water breeds vermin.”— Italian

“To know and not to act is not to know at all.”
To trigger empathic feelings
“In an ant’s house dew is a flood.”— Afghanistan
To confront self-sabotage or self-defeating behaviors
“A man stands where he puts himself.”— Arabian
To address over-nurturing
“A man may bind a sack before it is full.”
To encourage accountability
“Trust in God, but tie your camel.”— Persian

Experiment with these and other proverbs as group warm-ups to launch discussion, establish cohesiveness or build rapport. Given their depth and utilitarianism, proverbs can also be freely adapted to other therapeutic approaches. Consider the various ways they can be used in psychodrama, dance or art therapy. Ultimately, their range of application is restricted only by the imagination of the clinician using them.

The wisdom of the past

Centuries after they were voiced, proverbs are still keenly in tune with the healing truths and deeper dimensions of the human experience. As the fruits of our collective wisdom, proverbs do not spoil with age, instead they ripen in the hands that gather and learn from them. As we move into the future, we must not forget their enduring insight and ageless significance. One proverb expressed it best; “Nothing is so new as what has long been forgotten.” As clinicians, we would be remiss not to capitalize on the wisdom of the past and bestow its genius on those facing some of life’s most difficult challenges.

All said, proverbs are not a therapeutic panacea. Rather, they are adjunctive interventions used to facilitate insight and self-discovery but, as such, they can be the first important link in the chain of personal growth and positive change. Like tiny jewels on the sands of time, proverbs glimmer and glisten, but only when illuminated by the light of our own reflections. Collect and examine them for their remarkable depth and clarity. Share them and we may all become a little richer.

Gary Beaulieu, MS, LADC, CADC, CCS, is the Director of Program Development and the Administrative Director of Mental Health Services for the St. Vincent DePaul Society, Waterbury, CT. He is the author of The Little Words that Grew: A Guide to Using Proverbs in the Therapeutic Process. Ravensdale, WA: Idyll Arbor, Inc.