Major Depression and Substance Abuse in Teens, and Fostering Environments Supportive of Recovery
In keeping with this issue’s focus on adolescents, this column will initially focus on research findings concerning the predominant emphasis, in many settings, of prescribing antidepressants as a first line of attack in treating major depression in children and adolescents. This will be followed by a discussion of the growing awareness of recovery schools as a viable option for promoting sustained recovery among addicted teens.
Overemphasis on Antidepressants in Treating Children and Teens
In June 2016, the British medical journal Lancet published an article reporting on a meta-analysis conducted by Cipriani and colleagues of thirty-four clinical trials involving more than five thousand patients, focusing on prescribing fourteen different antidepressants to children and adolescents (Cheng, 2016). Significantly, twenty-two of the trials (65 percent) were funded by pharmaceutical companies. Altogether thirty of the thirty-four trials were rated as presenting a high or moderate risk of bias (Cheng, 2016; University of Oxford, 2016).
Cipriani and colleagues stated that the quality of evidence in the studies was “very low,” making it impossible to accurately assess whether or not the drugs were truly effective, or to gauge the impact of serious side effects (Cheng, 2016). Nonetheless the authors state that what they found was enough to call into question the vast majority of medications used to treat young people with depression.
Cipriani’s overall advice is that psychological counseling should be tried before prescribing drugs to young people. Significantly, back in 2004 the FDA issued a warning against use of antidepressants in children and teens due to concern over increased risk of suicide (University of Oxford, 2016).
I fully concur that psychological intervention and treatment should be the first line of attack in treating children and teens suffering from depression. Unfortunately, pervasive budgetary problems plaguing local governments all too often result in severe cutbacks in available counseling staff at public schools. Likewise, underfunding of direct counseling services by health plans influences many doctors to initially prescribe antidepressants when treating younger patients as a “cost-saving measure.” Growing evidence suggests that this practice does a disservice to youth suffering from depression.
I also suspect that the relative ineffectiveness of many, if not most, antidepressants in treating teens is a significant factor in the use of alcohol and street drugs by many adolescents as a means of self-medicating their depression.
Fostering Environments Supportive of Early Intervention and Sustained Recovery
Efforts to provide effective intervention and treatment to teens with serious substance abuse problems are fraught with difficulty. Adolescent substance abuse is rampant in many communities and neighborhoods across the country. And as readers are well aware, teens with serious substance abuse problems are often dealing with significant socio-psychological issues including major depression, serious dysfunction within their families, and other complicating influences.
Funding crises affecting most school districts preclude provision of effective prevention, counseling, and intervention services in the vast majority of schools, particularly those serving economically disadvantaged student populations where the need is greatest. And very few communities are able to support sustained efforts to assist teachers, parents, and other community advocates in effectively working together to combat the epidemic of adolescent substance abuse.
Beginning in 1979, various communities began to experiment with recovery high schools in an effort to provide a setting that gives teenagers struggling with drug addiction the tools they need to counteract their addictions in the context of an environment that is fully supportive of their recovery. Recovery high schools focus on motivated adolescents with serious alcohol and drug problems, providing an environment that blends traditional classroom instruction with addiction support groups, drug testing, and a community of peers committed to recovery.
A recent Associated Press article titled “More ‘Recovery Schools’ for Addicted Teens” addresses the growing popularity of recovery schools and the challenges they face (Godar, 2016). The article presents a case study involving a male student in Minnesota who started drinking at age fourteen to escape from his depression and soon moved on to addictive use of marijuana, cocaine, and other potent drugs throughout the day. Undergoing residential treatment, he quickly relapsed upon returning to school, where he had constant access to drug dealers and heavily addicted friends. To break this vicious cycle he enrolled in the PEASE (Peers Enjoying a Sober Education) Academy in Minneapolis, a recovery school he has attended for several years. At age eighteen, this student has been clean for seventeen months and plans to soon begin college to study social work and chemical dependency counseling. He credits his turnaround to PEASE Academy, which he attends with sixty other teens committed to beating their addictions (Godar, 2016).
As of this writing there are thirty-eight recovery schools nationwide. Spurred by the epidemic of opioid addiction, sponsors are reportedly planning to open additional schools in five states. At the same time, numerous schools have floundered due to uncertain funding, fluctuating enrollment, and questions concerning the quality of educational instruction.
It is evident that well-run recovery schools offer distinct benefits to many teens struggling with addiction. Significantly, they provide a drug-free, recovery-focused educational environment removed from the negative influences of easy access to drug dealers and heavy drug use by peers that often prevails at other schools.
As a practicality, recovery schools are much more cost effective than “revolving door” residential treatment. While teens completing residential treatment often relapse following return to their former schools, recovery schools are designed to afford a safe haven supportive of recovery. Indeed, I suspect that the recovery-focused cultures prevailing in well-run recovery schools play a key role in motivating many students to commit to sobriety and pursue meaningful goals.
Unfortunately, a large number of recovery schools are standing on shaky ground concerning their sustainability. While many get per-pupil funds that would otherwise go to the student’s public school, that money does not cover the costs of drug testing and counseling services needed to promote a strong recovery focus. Some schools have partially resolved this crisis through partnering with local human service agencies or nonprofits focusing on improving community mental health.
Cutbacks in school funding triggered by the 2009–2010 recession prompted Minnesota to enact legislation creating a $500,000 annual grant program to support salaries of addiction counselors and other recovery-focused staff at recovery schools.
To get a better handle on determinants of success that characterize leading recovery schools I interviewed Michael Durchslag, director of the PEASE Academy in Minneapolis. PEASE Academy, founded in 1989, is the oldest recovery school in the United States with fifty students currently enrolled (personal communication, December 13, 2016). The school is a division of the Minnesota Transitional Charter School, and its status as a charter school is an important factor in keeping the institution afloat. PEASE is also able to augment its recovery-focused staff, with a full-time licensed alcohol and drug counselor and social worker on board, through the aforementioned state-funded grant support program. PEASE has acquired a reputation as a prototype of a successful recovery school, and provides consultation to other schools seeking to improve their programs.
My conversation with Mr. Durchslag also clarified an important point concerning the complementary relationship enjoyed between many recovery schools and enlightened residential treatment centers. While residential treatment provides an important introduction to recovery for many addicted teens, the supportive culture of a recovery school plays a critical role in fostering sustained sobriety following completion of primary treatment.
As a member of the board of directors of the Association of Recovery Schools (ARS), Mr. Durchslag filled me in on supportive services the association provides on behalf of individual schools. Significantly, several years ago ARS initiated a recovery school accreditation program. Applicants for accreditation undergo an extensive review and consultation process focusing on how the applicant school measures up in terms of the following criteria for accreditation: school organization, quality of education, overall sustainability, and adherence to best practices in support of recovery. The association also provides an important service through promoting innovative mechanisms to secure financial viability for recovery schools throughout the country.
Summary and Conclusion
Our children are our future and troubled teens deserve all the help we can give them. I believe that many if not most of the problems underlying our ongoing epidemic of adolescent substance abuse stem from lack of a societal commitment to providing the necessary supportive structures to eradicate this problem. For example, if our health care system truly desires to provide humane and effective treatment for teens and children suffering from depression, then health plans must afford ready access to skilled counseling at the first sign suggestive of clinical depression. Likewise, if government agencies and other key stakeholders truly desire to curb our epidemic of adolescent substance abuse, they must take decisive action to ensure adequate funding for well-run recovery schools and other innovative measures.
Cheng, M. (2016). Study: Most antidepressants don’t work for young patients. Retrieved from http://bigstory.ap.org/article/198b33aad59e4a6c8a3c4aeae27940c0/study-most-antidepressants-dont-work-young-patients
Godar, B. (2016). Recovery schools for addicted teens on the rise. Retrieved from http://bigstory.ap.org/article/3e2ce6796ad847b08755bbafffe78b1f/recovery-schools-addicted-teens-rise
University of Oxford. (2016). Most antidepressant drugs ineffective for children and teens, study finds. Retrieved from http://www.ox.ac.uk/news/2016-06-08-most-antidepressant-drugs-ineffective-children-and-teens-study-finds