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Skills for Educators

All Skills for Educators

Helping Young People Make Healthy Decisions About Drugs

This edition of Skills for Educators will give health educators guidelines for helping young people make healthy decisions about drugs. It is divided into the following sections:

Making Decisions

Critical Thinking

Harm Reduction

A Continuum of Drug Use

Drug, Set and Setting

Peer Pressure on Educators

Adopting a Non-judgmental Stance

Non-judgment in Action

Values Clarification

Resources


Helping Young People Make Healthy Decisions About Drugs: Risk Taking, Harm Reduction, and Non-judgment


Making Decisions

Young people make many decisions about whether or not to take a variety of risks. Traditional drug education has stressed abstinence as the only way to manage risk. These efforts, particularly the War On Drugs philosophy of the 80s and 90s, have used campaigns like "Just Say No." These campaigns focus on telling young people what their decision should be as opposed to helping young people develop a decision-making process.

A core assumption of some of the educational campaigns developed by the War on Drugs is that young people experiment with drugs as a result of peer pressure. Thus, educational activities associated with these campaigns have centered on the development of "refusal skills" which help youth resist pressure and influence from other youth to use drugs. These campaigns often employ scare tactics and shaming labels of drug users in response to any authentic curiosity or interest a young person may have about trying alcohol or a drug.

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Critical Thinking

For educators interested in helping youth develop critical thinking skills, there are several problems with the "Just Say No" style of drug education. Consider the following:

  1. These campaigns rely heavily on adults telling youth not to think.

  2. These campaigns may distribute inaccurate or distorted information about drugs.

  3. If young people go on to have pleasurable experiences with some drugs an educator has warned them against using, they will mistrust that educator's information about all drugs.

  4. If we use our authority as educators to tell youth what to do (abstain), the core value we are teaching is obedience to authority. Outside our influence, they may also obey the authority figure in their peer group who may encourage them to use drugs.

  5. If we, as educators, praise youth who abstain and criticize youth who use drugs, we are creating conditions that encourage peer pressure. No one wants to be "bad" alone.

  6. Using shaming labels for youth who are experimenting with drugs will further alienate them from adults.

  7. In the absence of adults who support critical thinking about drugs and drug use, youth may have to rely on the counsel of other youth (and/or adults) who are not thinking critically about drugs.

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Harm Reduction

Harm reduction can provide educators with a framework that encourages youth to think critically. Harm reduction is a set of practical strategies that help to reduce the negative consequences of drug use, incorporating methods from safer use to managed use to abstinence. Harm reduction strategies meet drug users "where they're at," addressing conditions of use along with the use itself.

Harm reduction encourages youth who are curious about drugs to weigh possible risks and benefits and make conscious decisions. Harm reduction also helps youth who are already using drugs to assess their relationship with drugs: is their use recreational? a form of coping? out of control? What can they do to make their use healthier?

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A Continuum of Drug Use

The abstinence model has only two options: abstinent or using drugs. There is no exploration of different ways people use drugs. Some people who use drugs become addicted and their lives are devastated. However, most people do not have such severe consequences.

Harm reduction uses a continuum to describe the different relationships people have with drugs:

  • Experimental: Has tried a drug once or a few times.
  • Occasional: Uses a drug once a month or less. Does not seek it out.
  • Regular: Once a week or more. May be used to cope with problems.
  • Heavy: Daily or more than once a day. May be addicted or dependent.
  • Chaotic: Out of control. Life heavily focused on drugs/drug use.

This continuum allows users to identify where they are on the spectrum with any given drug and to decide if they want to make changes.

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Drug, Set and Setting

Another important element of Harm Reduction philosophy was contributed by Dr. Norman Zinberg in his book Drug, Set and Setting: The Basis for Controlled Intoxicant Use. Zinberg pointed out that in order to understand how drugs can be harmful, we must look not only at the drug, but also at the "set" — or the individual who's taking it — and the "setting" where it is taken.

Examples of harm in relation to set:

  • A person who drinks with a depressed mindset may be more likely to become suicidal, as alcohol is a depressant.
  • A person who is anxious may be more likely to have a "bad trip" or paranoid reaction if using LSD (Acid), a hallucinogenic drug.
  • A person with many alcoholics in his/her family may be more likely to become alcoholic.

Examples of harm in relation to setting:

  • The campaign slogan "don't drink and drive" is saying that sitting behind the wheel of a car is not an appropriate setting for someone who is drinking.
  • A person who uses MDMA (Ecstasy) at a Rave with little ventilation or available water may suffer heat exhaustion
  • A young woman may have several drinks at a raucous party and be harmed, not by the alcohol itself, but by an experience of sexual assault while she's under the influence.

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Peer Pressure on Educators

Adults are supposed to have power and influence over young people. If youth do not heed our advice, implement our suggestions, and have the outcomes we prefer, we may feel like failures. Other adults are pressuring educators to dictate abstinence to youth. Our bosses, funders, school boards, parent committees, county agencies, and policies may be pressuring us to use methods that don't work for the young people we serve.

These policies overestimate the influence that adults have on youth. Over the past few decades, all youth in the US have received strong messages from adults stressing abstinence. Yet the majority of youth have tried alcohol and/or drugs. Clearly, if telling young people to abstain was the answer, it would have worked by now.

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Adopting a Non-judgmental Stance

One of the basics of Harm Reduction philosophy is adopting a non-judgmental stance when helping program participants make decisions about drug use. Admittedly, this can be difficult.

If you have been negatively impacted by drug use (yours or someone else's), it may make it difficult for you to adopt a non-judgmental stance, particularly if you have not worked through all of your feelings about those experiences. It is important to remember that not everyone will have your same experience with drug use.

If you have strong moral or ethical objections to drug use, it will also be difficult for you to be non-judgmental.

Adopting a non-judgmental stance can be even more difficult when you are working with young people. When you hear that a young person is using or thinking of using a particular drug, you may feel worried, sad, or frustrated. Non-judgment doesn't mean you become an unfeeling robot; it means you do not share that judgment with the youth. If you judge them, they are not likely to change; they are more likely to start lying to you about their behavior.

On the other hand, if you have had very positive experiences with drugs use, it may be difficult for you to see that some young people can be negatively impacted by the same drug that you enjoyed with little or no consequence.

No one can adopt a non-judgmental stance perfectly, but it can help us support a young person to make a decision that feels right for them, not the decision that feels right to us.

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Non-judgment in Action

The following are suggestions for non-judgmental support of critical thinking with regard to drug use:

For youth who may want to experiment:

  1. Encourage them to get as much information as possible about the drug they are curious about using. (See resources, below)

  2. Instead of giving advice, ask open questions:

    • What do they want to get out of the experience?
    • Where do they plan to use?
    • Who do they plan to use with?
    • What are possible negative consequences, and how would they deal with them?

For youth who share about an experience with drugs:

  1. Encourage them to think about their experience. Ask questions like:

    • What was it like?
    • What did they like/dislike about the experience?
    • What did they learn?
    • Would they do it again?
    • What would they do differently?

For youth who are using:

  1. Share the continuum of drug use with them and encourage them to think about or talk about where their drug use falls on the continuum.

    • Ask them to share the positive and negative things about using.

For youth who are having problems related to their use:

  1. Use constructive confrontation. The following are examples of constructive confrontation:

    • "You say you only drink occasionally, but the last month you told me you drank Friday and Saturday night every weekend. How do those two things fit together?"

    • "You said it was an important goal to graduate with your class, but most days you go get high with your friends after school instead of doing homework. What's the relationship between those two things?"
  1. If you have serious concerns and feel a strong need to express them, it is always useful to express them in "I" terms. The following are examples:

    • "I know you like to drink and you have no other way to get home. But when you tell me you're getting behind the wheel of that car, I worry."

    • "When you say you and your girlfriends are getting high with guys you don't know very well, I get concerned that the guys may try to take advantage of the situation."

Although the young person may try to reassure you, you have not criticized their choice, only expressed your feeling about it. Ultimately, they will have to decide whether they are concerned enough to make a change in their behavior.

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Values Clarification

Before working with young people in the area of drug use, it is important to be aware of your own issues and biases.

Which of the following best describes your attitude about drugs (including alcohol):

  • drugs are dangerous
  • drugs can be dangerous; be careful
  • drugs can be dangerous or fun, depends how you use them
  • drugs are fun, and the dangers are overrated

Which of the following best describes your attitude about young people using drugs (including alcohol):

  • young people should be abstinent
  • young people should be abstinent, but you can't just preach at them; you have to help them see that abstinence is the right choice
  • young people should be encouraged to make their own decisions
  • drugs can be a positive part of young peoples' lives

Which of the following best describes your attitude about your own use of drugs (including alcohol):

  • I am abstinent and have always been
  • I have not always been abstinent, but I am now
  • I drink and/or use drugs

    (If you currently use, or have used, locate your own use patterns, past and/or present on the continuum.)
Which of the following best describes your attitude about your own use of drugs (including alcohol):

  • My drug use has had little impact on my life
  • My drug use has had a negative impact on my life
  • Some of my drug use has been negative, some positive
  • My drug use has had a positive impact on my life

How much of an impact has other peoples' drug use had on your life (including alcohol):

  • I have been heavily impacted by other peoples' drug use
  • I have been impacted by other peoples' drug use
  • I have not been impacted by anyone else's drug use

Rate your agreement or disagreement with the following statement:

I feel comfortable talking openly to young people about my experiences with drugs (including alcohol):

  • strongly agree
  • agree
  • neutral/unsure
  • disagree
  • strongly disagree

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Resources

The more informed you are about drugs and drug use, the better. A good resource is From Chocolate to Morphine by Dr. Andrew Weil and Winifred Rosen. The book is balanced and informative. In particular, there are tips for using alcohol wisely and suggestions about the use of marijuana that can be helpful for working with youth.

If you are meeting resistance on the part of other educators, administrators, or teachers to using a harm reduction approach, the following pamphlet may be helpful: "Safety First: A Reality-Based Approach to Teens, Drugs, and Drug Education," by Dr. Marsha Rosenbaum. "Safety First" is available from the Drug Policy Alliance at 415-921-4987 or www.safety1st.org

For general information about Harm Reduction, contact the Harm Reduction Coalition at 212-213-6376 or www.harmreduction.org. Several other resources are listed in the Topic in Brief on alcohol and drug use and teen pregnancy.