When Dr. Paula Riggs learned that only one in 10 teen drug addicts ever gets treatment, she knew she had to do something about it.
Generally the only way a teenager ever gets help for a drug problem is if they're ordered to after a run-in with the law, or if their parents have the money and time to commit to a private counseling program. Riggs, who directs the Division of Substance Dependence at CU’s School of Medicine, believes that in order to treat the other 90 percent of teen drug abusers, clinicians have to meet them where they are: at school.
According to a National Survey on Drug Use and Health, an estimated 10 to 15 percent of high school kids are dependent on drugs, mainly marijuana.
For heavy pot users, Riggs says the symptoms of cannabis use disorder are varied: they start using more than they intend, are unable to cut down, have cravings, give up other activities in order to use, and continue to use despite negative consequences in their life, like problems with family or school.
In her pursuit of new ways to treat young drug users, Riggs has adapted an existing 16-week out-patient program, called Encompass, to work in schools. Riggs says the grant-funded pilot program at Adams City High in Commerce City is the first evidence-based, school-based treatment program in the country.
Students who are found high at school are offered a spot in the Encompass program (with parental approval) in place of being suspended. School officials say hosting the program in school makes sense.
"For a lot of kids, this is their safe place, this is their home,” Darren Dunson, a dean at Adams City High, says. “I think that inside your home, you should have some kind of support system to help your child when there’s a need, and that’s what we’re doing.”
Under the program, students first get a comprehensive psychiatric and substance abuse evaluation. Dr. Riggs says heavy marijuana users often suffer from depression, anxiety or ADHD, among other psychiatric disorders.
“Our studies have shown that it matters if you have depression when you walk through the door of drug treatment because if that depression doesn’t remit, your drug use – even if you stay in treatment – is not likely to go down,” she says. “So you've got to treat them both together.”
Tackling addiction by changing thoughts
Encompass uses a cognitive behavioral therapy approach. Over the course of the 8-week session, kids learn how their thoughts are connected to their behaviors and actions, and try to shift to more positive and useful ways of thinking.
“For the longest time I just thought, 'I’m a pothead, that’s the deal is that I’m just a pothead. That’s why I smoke so much,'” says one 17-year-old participant. “Now I understand...it’s because when I feel something – depressed – it’s like ‘oh, go smoke weed.’ It’s like the craving – it’s almost like when your stomach tells you you’re hungry.”
Teenagers are at a developmental stage where they’re just starting to move from the concrete to the abstract. So Encompass's therapy focuses on specific skills to practice, where kids can see a lot of changes in a short period of time.
Each session is highly structured and starts with the student reviewing his or her week. Did they get into any high-risk situations that made it hard to stay clean? How did they deal with it? They go over coping skills with a therapist and talk about how they can practice them at home.
Students get to draw for prizes if they’ve done two “pro-social” activities that week, like cooking or playing basketball, or if they have a clean urine analysis.
The main part of the session involves students choosing a specific skill to work on – things like anger management, regulating negative moods or coping with cravings. They also identify triggers for smoking weed, such as feeling stressed out, a fight with parents or a party.
“We spend a lot of time in this therapy just helping youth understand why they use,” says therapist Erica Hermann.
Working with the teen brain
Teenage brains are under construction. Adolescence is a time when kids are learning how to solve problems, manage emotions, and communicate. As they develop those skills, the brain changes, wiring them in for life. But if kids start using drugs as their main coping strategy, all those other pathways are short-circuited, says Hermann.
“Eventually their brain becomes conditioned to any time they feel that negative emotion, or any time they want to celebrate, their knee-jerk reaction is to use drugs and it just ends up becoming a habit where that’s what they do all day every day” she says. “So you may be working with a 15-year-old who is operating at the developmental level of a 12-year-old.”
Some kids who arrive at the Adams City High program aren’t yet ready to quit marijuana. They say there are no problems in their lives now. Hermann has to meet them where they are. If she pushes them to change, they’ll shut down. So she listens carefully for little discrepancies about where the teen is now in their life, and where they say they want to be. If they say they won’t be smoking pot when they’re 30 with a family, Hermann asks why. Soon, the student will tell her things that apply to their lives now, like needing to be motivated and focused.
“If you join them, it’s so fascinating to see how fast you can actually see kids move through the stages of change,” she says.
Hermann says other kids she sees are ready to quit; they just don’t know how and blame themselves. They see it as a moral failure.
“This type of therapy teaches them it’s not some kind of weakness that’s preventing them,” Hermann notes. “It’s just that they aren’t equipped with skills to replace those urges, so through this therapy they learn that their drug use is a technical problem. It’s something they’ve learned in their brain. And it’s something they can unlearn or they can re-learn a different approach to dealing with whatever issue that they are self-medicating for or that they are using for.”
Results from the first round of participants in this pilot treatment program won’t be ready until April. Both Hermann and Dr. Riggs say doing treatment in schools appears to catch kids before they’re at a really severe level of addiction and they’re able to make changes more quickly.
Riggs says two similar treatment centers in Denver high schools are expected to open next fall.
Is marijuana legalization changing how you and your children talk about the issue? Is it raising new concerns, or is this just more of the same? Colorado Matters is putting together a panel discussion of parents and teenagers to talk about this issue, and we want to hear from you. Learn more here.