Miscellaneous

Substance Abuse in Schools: A Proposed Action Plan

Introduction
The prevalence of substance abuse in Pakistani educational institutions is not any different from the rest of the world. Various studies have shown figures ranging from 10-50% of students experimenting intermittently or regularly using drugs. The most disturbing fact is that majority of drug addicts are between 16-24 years of age which is the mainstay of our population. According to a survey, nearly 50% of students (high school and college), in big cities and leading private schools are falling victim to drugs. A data from survey conducted in the schools and universities of Lahore reports that ''about 57% of the students are using at least one drug''. Admittedly, these numbers may be less in public schools due to tighter controls, limited exposure, and lesser opportunities, both at home and schools. The more commonly used drugs by school and college students include cigarettes for abuse of nicotine, cannabis, heroin, tranquillizers, psychostimulants, and memory and performance enhancing drugs in the form of tablets, sniffing powders, and liquids.    



While there are several models of school-based prevention programmes available from the West, there is limited data available on tangible well-documented plans that have shown promise in Pakistan. The advantages of a more supportive home environment, preservation of family bonds, trust in parents, respect for teachers in schools, and a fairly effective discipline in public schools provide an opportunity for a home-grown solution that draws upon these strengths. 
While organizing this preventive plan, the team was aware of the strong “Don’ts” that have consistently shown failure. These included one-off lectures by experts on drug abuse and the hazardous consequences of drugs, didactic or one-way sermons by religious and motivational speakers, extolling non-use, seeking commitment for “I will never use drugs again” or seminars on catchy titles like ‘Say no to drugs’. Such programmes are known around the world to be failures, and in some cases, serving as initiators of substance abuse on account of curiosity, anxiety, or the guilt so generated. Therefore, it was decided not to follow this trodden path. 
This article highlights an alternative plan of action that brings together parents, students, and the school staff to develop and implement through students, aptly supported by all stakeholders. Essentially built around and run by students themselves, the plan drew upon some newly conceived creative ideas to deal with reduction and prevention of drug abuse in a school setting. Let me acknowledge the efforts of designated faculty members and also compliment the support rendered by Brigadier (R) Dr. Mowadat Rana and Miss Hira Binte Asim for the entire exercise and its documentation. 
Methodology
The setting of the plan was a higher secondary school/college in a busy metropolis in Northern Punjab. The school classes include from middle to higher senior secondary; with students converging from higher middle to lower middle social classes. The institution takes pride in its merit-based induction, moderate fee structure, excellent educational results, higher sports standing and overall grooming of students. 
The concept and the challenges of running “prevention of substance abuse plan” in the school was thoroughly discussed with academicians, mental health professionals, and administrators; also, various international and regional models were studied. A consensus was however reached that the plan had to be devised by the school’s students, teachers and parents; and had to be home-grown. It was decided that the senior administration would provide logistics and organise meetings for teachers, parents, and students’ representatives all under one roof. After a brief introduction to the issue by the administration and a mental health professional, the three groups would assemble for small group discussions to devise a plan. All recommendations thus developed would be presented in a plenary session and a comprehensive action plan to be developed. The proposed outcome was a blueprint of an action plan to prevent substance abuse in the school. It was agreed that the plan would be implemented over three months, followed by an external review of the outcomes to draw relevant lessons. The continuity and sustainability of the plan would depend upon the findings of the review and analysis. The group discussions addressed the following areas: 
▪ Common causes of substance abuse in the school.
▪ Factors that predispose, aggravate and/or precipitate substance abuse amongst students.
▪ List of strategies to address the causes and factors identified above. 
Findings
Findings and salient points drawn from small group discussions were as follows:
▪ Common causes of substance abuse:
• Drugs as a means to handle/escape from challenges, hardships and realities of life in general.
• Poor family bonding between parents and students.
• Lack of effective and empathic inter-personal communication. 
• Anxiety, depression and high degree of stress at home.
• Peer pressure imposed by drug abusers within the school or in social settings outside the school.
• Complexes and false feelings of inferiority/superiority.
• Ever-increasing frustrations generated by failures or coming up to the expectations of teachers and or parents to score high grades.
• ‘Get noticed syndrome’. An urge to ‘look cool’, ‘different’ and ‘defiant’.    
• Curiosity to know how it feels to be ‘high’ on drugs.
• As an expression of bravery i.e., to do it as an adventure.
• Recreational use to relax and enjoy, relieve stress and feel happy.
▪ Predisposing, aggravating, precipitating factors include:
• Availability/easy access to funds (exorbitant pocket money). 
• Easy access to drugs.
• Easy availability of tranquillizers with and without medical prescriptions.
• Smoking, drugs, substance abuse eulogized in movies and social media.
• Easy availability in neighbourhoods, and drug dens spread out in the city.
• Poverty of funds leading to indulgence in substance abuse and trafficking.    
• Affluence of money and easy access to unaccounted for funds. 
• Marginalisation in family matters.
• Single parent upbringing/broken family.
• Lack of authority figure in life.
• Dependency traits in personality; an urge to rely on others in all matters.
• Non-participation in sports, athletics, extracurricular activities.
• Social phobias and shyness.
• Staying in a hostel/away from family, little to no accountability.
Recommendations
The following steps are recommended as part of the ‘action plan’ to prevent substance abuse:
Awareness. Use of social media and all available aids to seek information and guidance from mental health experts. This also includes teachers training through various organizations which conduct such awareness programs (like Universal Prevention Curriculum), with a view to promote learning and contribution towards drug prevention/interventions. Similarly, a school level “Strengthening Family Program” (SFP) should also be organised, involving teachers, students and their parents.  
Motivation. Mobilisation of external and internal motivation to refrain from substance abuse; seeing it as a challenge to national and self-pride, expectations of society, parents and significant others in life. Showing larger canvas of life, societal and family issues proves of more value than merely highlighting health issues.
Engagement. Planned engagement with students who are predisposed or vulnerable in the light of the factors listed above. This should be done through selected volunteer students/peers; without breaching confidentiality in a non-threatening fashion, offering support, help and appropriate referral to experts. 
Prevention. The causes, sources and symptoms need to be kept in sharp focus for prevention. Research indicates that smoking is the first step to substance use, thus, it needs to be discouraged. Running student-based campaigns to prevent smoking, checking and discouraging smoking by nominated teachers and administrative staff are the suggested measures. Use of mild substances leads the youth to try hard/serious drugs, which may lead to addiction, hence needs to be prevented and curbed at early stages.
Identification.  Counselling and training of volunteer students in early tell-tale signs of substance abuse; in a bid to ensure that they pick up vulnerable and indulged comrades at an early stage. Behavioural and physical symptoms should be sensitively noticed. “Early detection” helps in early intervention and stopping multiplication. Identified cases could be selectively considered for referral to experts or mobilization of support at home and school. This has to be done most discretely, preserving sanctity of the family and ensuring confidentiality, with diligence in place. 
Counselling. Few selected faculty members are trained by experts to help the school team as core members. They do “on-campus counselling”, rather than immediate referral of potential/detected cases to psychologists and psychiatrists. This is to ensure that a student is not stigmatized or made to feel a scapegoat. 
Deterrence. To put in place a system of deterrence, random laboratory tests for screening of drugs has to be made public by senior management. Such announcement should be coupled with seriousness of consequences, including health, career and social aspects. At least three months’ warning time be given for those who could quit under the fear of tests/deterrence. Few would leave the habit at this stage and potential cases may defer their inclination.
Intervention. The screening tests for substance abuse, though a social taboo, will have to be resorted, to show resolve and send a message of commitment and seriousness. Students’ furtive pulse report reveals that any plan would not be fruitful unless supported by deterrence and intervention. It has to be selectively and randomly done (from secondary and higher secondary classes), including those who appear to harbour vulnerability factors identified above (say total of 50-100 students, depending on the administrative/handling capacity).
Coordination. This is important with all stakeholders, especially for planning intervention and screening tests. The lab tests have to be undertaken in an organized and planned fashion, ensuring confidentiality, element of surprise, least drama, maximal professionalism; with due support of lab technicians and experts; based on standards set for sampling of sportsmen. Minor details need to be coordinated before the conduct of test. Few suggested tips are: 
√ Prior coordination with related departments and selected faculty members.
√ Ensuring maximum attendance through selection of appropriate day (could be an exam day). 
√ Making necessary administrative arrangements pre-hand, including testing kits, surveillance system etc.
√ 50 selected students (preferably boys) from 100 shortlisted ones could be tested as first step (surprise test). Higher the number of samples, higher would be the administrative and coordination requirements.
√ Blood sampling is expensive and has other related issues, hence urine sampling is advised. 
√ Selected students should be sent to toilets one by one, for ease of correct sampling and to avoid mixing up. 
√ Deter fleeing away of nominated students. There will be a tendency of sneaking away when he/she learns about the test. Few might refuse to undergo the test; both categories may be marked as confirmed cases.
Cases found to relapse or test positive twice should be considered for stern action, and involvement of their families.
Confidentiality.  The positive lab tests should be kept secret and shared with the concerned student only (by the nominated member of the staff). They could be placed on ‘probation’ for three months (to quit) and given an option to share the result with his family or seek help on his own (through school resources and referral system, local counselling facilities, peer support etc). Reporting to parents at this stage is not advisable without the concurrence of the student, as this is the biggest incentive/threat for him/her. Talking to such students confidentially revealed that the worst threat they fear is public embarrassment, through their friends and family members. Most of them promised to quit provided their secret is kept from parents. The concept of punishment or termination should also be abandoned at this stage and kept as a deterrent. This approach was deliberately discussed with all stakeholders and considered of maximum utility, it also ensured trust in the school plan.
Services for the Vulnerable/Students Testing Positive. Formal services have to be established to provide “peer support” by volunteer students in each class, and counselling support through selected staff members, trained in psychosocial care. Mental health experts have to be engaged for students with underlying psychopathologies and in situations demanding clinical assessment and interventions. 
Evaluation. It is important to evaluate data, analysing how different steps have worked, how many students gave up at which stage etc. Testing of only “vulnerable students” in a disciplinary tight institution revealed 10% affected strength and 5% into addiction. A confidential probe also revealed that “nearly 10%” quitted before the stage of being tested owing to awareness, motivation, engagement and deterrence.
Follow-up: The student volunteers, staff members, and those engaged in the implementation of the preventive programme have to ensure long-term follow-up, screening and retests. Particular emphasis on ensuring screening and putting on radar the “new entrants”, especially in class 9 and first year has to be ensured for sustainable results. Retests have to be conducted intermittently, for deterrence and resolve, keeping lessons and experience of first test in mind. Stern/punitive actions would be required on cases of recurrence, including those which were avoided on the first test.  
Lessons 
• School administration needs to show its commitment to prevention and intervention as regards the menace of substance abuse.
• Personal involvement of senior management and emotional attachment of faculty members reduces the chances of substance abuse.   
• If teachers make their right place, they start to influence the personality of students; coupled with “self-example” and “personal attention” they can do the most at the “prevention” stage.
• The problem of substance abuse can be best handled using a horizontal approach (parents, teachers, students operating as equal stakeholders), rather than a vertical approach (top-down, where it’s a parental or a school agenda). An efficient use of school’s own resources in the form of students and staff members in handling the vulnerable students can be far more acceptable than referral to mental health specialists or reporting these cases to parents. 
• An effective, consistent and ongoing communication between parents, students and the school improve the acceptability, impact and influence, thereby contributing towards success of the plan. The firm and resolute commitment of top leadership and support of policymakers towards the plan further enhances the chances of success. 
• Adolescents in a school setting may not be treated as naïve children; their participation in planning, decision-making and implementation as adults and partners yields much better results. At another level, this approach helps in sublimating, and channelizing their energies; also, augmentation of their adolescents through engagement, instead of distancing from them. This is why forming of a horizontal, instead of a vertical relationship, with students (by the school administrators, teachers and parents) is of more value. 
• When trained and trusted, students can work as efficient, trustworthy volunteers to help their own peers struggling with substance abuse. 
• Constructive use of social media enhances interest, participation and internal motivation of students, to use it to their advantage in the propagation of the message. The existing ambivalence, hesitance and even resistance in the use of social media in school setting by staff, parents, and teachers appears to be unfounded. This can open new vistas in the utility of social media, laptops and smartphones in the mainstream learning processes, including the learning of new skills and attitudes. This approach can reduce stress as well as the distance between the teacher and the taught, and in the long run play a crucial role in the prevention of substance abuse. This is likely to reduce the stress at school, resulting from learning and poor student-teacher relationships. 
• The impact of teachers as role models, guides, and mentors appears to be greatly enhanced when they work in a horizontal relationship with the students. The suggested action plan can form a ‘holy triad’ between the students, teachers and parents. This model would generate a milieu of empathy, compassion and a deeper understanding of the role of teachers, amongst the parents and students. The triad model worked well in substance abuse prevention and therefore has the potential for use in pursuits in other realms of learning in school settings.
Conclusion
Youth is the future of our country. It has to be protected against possible ills, taking steps more than “creating awareness” and “showing concern”. Educational institutions happen to be an easy target for spoiling the youth, but the solution lies in collective effort by teachers, parents, social community and law enforcement agencies, that too with continuity and resilience. Concerted efforts can make one school/college a “drug free institution”, then a city, and a society.


The writer is a graduate of National Defence University Islamabad. He holds post-graduation degrees in “Strategic Studies” from University of Malaya (Kuala Lumpur) and “Logistics and Supply Chain Management” from Quaid-i-Azam University Islamabad. 
E-mail: [email protected]
 

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