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Recovery High Schools 101

Recovery High Schools 101

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In recovery high schools, students recovering from substance use and co-occurring disorders receive academic services and therapeutic supports within a structured environment promoting recovery. The National Institutes of Health (NIH), the Office of National Drug Control Policy (ONDCP), and the US Department of Education have all recently published calls for more school-based recovery support programs, as research has affirmed both the chronic nature of substance use disorders for adolescents and the need for more continuing care programs (Finch, Moberg, & Krupp, 2014; Moberg, Finch, & Lindsley, 2014). Counselors need to be aware of recovery high schools, both as referral sources and as potential job options. They also need accurate information about what the schools are and how they operate.

 

Why Do We Need Recovery High Schools?

 

About 150,000 high school students receive treatment for drug or alcohol problems annually (SAMHSA, 2014). Progress is marked by cycles of recovery and relapse (Dennis & Scott, 2007). During the fragile period after treatment, school is an important social environment, as adolescents spend more time in school than anywhere other than their homes. 

 

Among the risk factors for substance use are association with drug-using peers, alcohol or drug availability, and academic challenges, which are all likely present in traditional schools (Derzon, 2007; Svensson, 2000). One study found that virtually all adolescents returning to their old school reported being offered drugs on their first day back (Spear & Skala, 1995). Recovery high schools, conversely, can play a protective role for students by facilitating school bonding, school interest, and academic achievement that are negatively associated with substance use among high school students (Bryant, Schulenberg, O’Malley, Bachman, & Johnston, 2003).

 

What is a Recovery High School?

 

First, it is important to distinguish recovery high schools from settings were the priority is treatment, such as schools in treatment centers or therapeutic boarding schools. Within academically-focused schools, there are many types of school-housed programs that address continuing care including:

 

  • After-school programs
  • Assertive continuing care community-based program
  • Recovery classrooms (including school-day support group meetings)
  • Student assistance programs and counselors
  • Recovery high schools (both schools-within-schools and stand-alone programs)

 

Evidence suggests peer influences and social environments play a role in sustained recovery for many young people (Teunissen et al., 2012; Tomé, Matos, Simões, Diniz, & Camacho, 2012; Dennis, Foss, & Scott, 2007). From this list, recovery high schools are the only approach that involves changing the environment for students.  

 

The Association of Recovery Schools, which accredits recovery high schools, lists four basic qualities that define a recovery high school:

 

  1. Its primary purpose is to educate students in recovery from a substance use or co-occurring disorder
  2. It must meet state requirements for awarding a secondary school diploma, (i.e., school offers credits leading to a state-recognized high school diploma, and student is not just getting tutored or completing work from another school while there)
  3. It must intend that all students enrolled be in recovery and working a program of recovery for substance use or co-occurring disorders, as determined by the student and the school
  4. It must be available to any student in recovery from a substance use or co-occurring disorder who meets state or district eligibility requirements for attendance, (i.e., students do not have to go through a particular treatment program to enroll, and the school is not simply the academic component of a primary or extended-care treatment facility or therapeutic boarding school)

 

Despite research suggesting both the need for and positive potential of recovery high schools (Moberg et al., 2014), there still remains much ignorance around their operations. Recently, a group of parents protested the opening of a recovery high school in their Seattle neighborhood because it will be located next to a traditional elementary school. An online petition generated numerous signatures, and a community meeting was held to discuss the opposition. The petition, posted on change.org, cited fears that students with many maladaptive characteristics might attend, though it also conceded the “Elementary school community and immediate neighborhood have not been informed by (the school district) of the student profile for these recovery students” (“Seattle public,” 2014).

 

Debunking Myths

 

Three common myths have been perpetuated about recovery high schools.

 

Myth #1: Recovery high schools force students to work Twelve Step programs and to call themselves “addicts” or “alcoholics.”   

 

People from Twelve Step backgrounds started most early recovery high schools, and many adolescent treatment programs still refer teens to Twelve Step meetings. Recovery high schools, however, are not treatment programs. Rather, they are designed to support students who have decided to stop using, regardless of whether or not they have a formal diagnosis. Most schools do not require a formal diagnosis of a substance use or co-occurring disorder, but many students have received such a diagnosis prior to entry. 

 

Recovery high schools are definitely no longer confined to a Twelve Step approach. Administrators have been actively involved with SAMHSA’s evolving definition of recovery, which claims there are many paths to recovery (SAMHSA, 2012). In some districts, schools are even forbidden to use spiritual language. While most schools do ask that students be connected with some type of assistance beyond the school day, none of the schools of which I am aware would forbid involvement with any outside support group or community agency. Twelve Step groups remain the most widely available groups, however, and as long as treatment centers introduce families to this modality, many recovery high school students will choose to attend Twelve Step meetings, and even to call themselves “addicts” or “alcoholics.” This will not be, though, because their schools force them to do so.

 

Myth #2: Recovery high schools are full of active drug use and untreated mental illness.  

 

A reporter who contacted me recently wanted to know if research existed about violence rates in recovery schools compared to traditional schools. While I am not aware of any such data, I helped run a recovery high school in Nashville for almost ten years. Since then, my research has taken me to at least twenty-five other recovery high schools, and my experience has been that violence is almost nonexistent relative to traditional schools. While students may have discipline records and be court-involved, the behavior and legal problems typically occurred during their active alcohol or drug use.  

 

Students with co-occurring mental health issues—which is likely most of them—receive the counseling they need unencumbered by illicit substances. Unlike traditional schools, with ratios of students to mental health professionals usually exceeding 450:1, recovery high schools enroll an average of about thirty students and employ multiple staff members with mental health credentials and/or training. Students easily get help from staff or peers that would be challenging to receive in a traditional school. As such, issues are typically identified before problem behavior such as relapse to use or fighting occurs.

 

While we do not yet know the statistical effect on therapeutic outcomes for students attending a recovery high school compared to those who do not, a national study funded by NIDA is currently underway to answer that very question. Preliminary data recently presented at the American Educational Research Association annual conference from that study are promising (Tanner-Smith, Finch, Moberg, & Karakos, 2014). 

 

Myth #3: Recovery high schools are not “the real world,” because they shelter students from healthy interactions with nonrecovering peers.  

 

Few recovery high schools have ever had a residential component, so virtually all recovery high school students go home at night, live with their families, and interact with peers in their neighborhoods. The schools provide an academic setting designed to keep drug users and dealers out, allow for opportunities to process struggles as they arise, and encourage honesty. If a student uses alcohol or drugs after enrolling, it is handled on a case-by-case basis. The typical recovery high school response is to allow students who have acknowledged using to remain in the school.  A plan is developed to help them avoid repeating the behaviors that led to using. Staff and peers provide confirmation of student successes as well as challenge or contradiction of negative behaviors. One could argue, in other words, that recovery high schools are more “real” than traditional high schools with regards to personal authenticity and potential for honest dialogue. Furthermore, students can choose to enroll or withdraw when they feel ready or if they feel unsafe, which more closely resembles the world they will face in college or the workplace. Choice to enroll or withdraw is usually limited in traditional schools, especially if one wants to avoid peers who are actively using substances.

 

How Could Recovery High Schools Improve?

 

While the myths discussed above are unfounded, recovery high schools still have legitimate room for improvement. First, data collection efforts are improving, but could be more comprehensive to build a stronger evidence base. Second, schools historically have employed certified alcohol and drug counselors, but with the awareness that co-occurring disorders are more the norm than exceptions, students need access to more staff credentialed in clinical mental health counseling as well. And third, recovery high schools need to address multicultural diversity that has been lacking throughout the field of adolescent recovery. This could involve providing ancillary treatment programs to increase access as well as more intensive therapeutic services to students for whom the recovery high school program is not enough.   

 

As the awareness of and demand for recovery high schools increases, I encourage counselors to stay informed of the growing evidence of successful programs. Advocate for a broader continuum of care for adolescents in your area, including programs like recovery high schools, which marshal the positive influences of school environments while helping students avoid the negative ones and develop life skills to sustain sobriety. 

 

 

 

References

 

Bryant, A. L., Schulenberg, J. E., O’Malley, P. M., Bachman, J. G., & Johnston, L. D. (2003). How academic achievement, attitudes, and behaviors relate to the course of substance use during adolescence: A six-year, multiwave national longitudinal study. Journal of Research on Adolescence, 13(3), 361–97.
Dennis, M. L., Foss, M. A., & Scott, C. K. (2007). An eight-year perspective on the relationship between the duration of abstinence and other aspects of recovery. Evaluation Review, 31(6), 585–612. 
Dennis, M., & Scott, C. K. (2007). Managing addiction as a chronic condition. Addiction Science & Clinical Practice, 4(1), 45–55.
Derzon, J. H. (2007). Using correlational evidence to select youth for prevention programming. Journal of Primary Prevention, 28(5), 421–47.
Finch, A. J., Moberg, D. P., & Krupp, A. L. (2014). Continuing care in high schools: A descriptive study of recovery high school programs. Journal of Child & Adolescent Substance Abuse, 23(2), 116–29. 
Moberg, D. P., Finch, A. J., & Lindsley, S. M. (2014). Recovery high schools: Students and responsive academic and therapeutic services. Peabody Journal of Education, 89(2), 165–82. 
Spear, S. F., & Skala, S. Y. (1995). Posttreatment services for chemically dependent adolescents. In E. Rahdert & D. Czechowicz (Eds.), Adolescent drug abuse: Clinical assessment and therapeutic interventions (pp. 341–64). Rockville, MD: US Department of Health and Human Services, National Institute on Drug Abuse.

“Stop Seattle Public Schools (SPS) from placing an interagency recovery high school directly across from John Hay Elementary School. Unless SPS can prove it’s safe, they should find another location.” (2014). Retrieved from https://www.change.org/p/seattle-public-schools-stop-seattle-public-schools-sps-from-placing-an-interagency-recovery-high-school-directly-across-from-john-hay-elementary-school-unless-sps-can-prove-its-safe-they-should-find-another-location

Substance Abuse and Mental Health Services Administration (SAMHSA). (2012). SAMHSA’s working definition of recovery. Retrieved from http://store.samhsa.gov/shin/content//PEP12-RECDEF/PEP12-RECDEF.pdf 
Substance Abuse and Mental Health Services Administration (SAMHSA). (2014). Results from the 2013 national survey on drug use and health: National findings. Rockville, MD: Author. 
Svensson, R. (2000). Risk factors for different dimensions of adolescent drug use. Journal of Child & Adolescent Substance Abuse, 9(3), 67–90.
Tanner-Smith, E. E., Finch, A. J.,  Moberg, D. P., and Karakos, H. (2014). Recovery high schools: Innovative schools supporting recovery from substance abuse. A presentation to the American Educational Research Association (AERA), Philadelphia, PA, April 6th, 2014.
Teunissen, H. A., Spijkerman, R., Prinstein, M. J., Cohen, G. L., Engels, R. C., & Scholte, R. H. (2012). Adolescents’ conformity to their peers’ proalcohol and antialcohol norms: The power of popularity. Alcoholism, Clinical & Experimental Research, 36(7), 1257–67. 
Tomé, G., Matos, M., Simões, C., Diniz, J. A., & Camacho, I. (2012). How can peer group influence the behavior of adolescents: Explanatory model. Global Journal of Health Science, 4(2), 26–35.
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