Estimated watch time: 35 mins
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Currently, much of substance use prevention education focuses on developing an understanding of the harmful effects of substance use. Incorporating life skills training into a prevention education curriculum is proven to increase positive outcomes.
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Presenter, Allison Dickens, LPC, LCADC, has worked in the field of addictions and mental health treatment for the past 15 years. In that time, she has worked at all levels of care with adults, adolescents, and families. She has been working at Care Plus for the past 5 years, overseeing the substance abuse outpatient services. In this time, she has developed a passion for an appreciation of prevention and treatment of substance abuse from a person-centered and motivationally based perspective.
Welcome to the Community Education Series hosted by The Recovery Village and Advanced Recovery Systems. Hi everyone. I am Jordan Katz, licensed social worker and clinical outreach specialist with The Recovery Village Cherry Hill at Cooper. We offer comprehensive services for adults struggling with substance use disorders and co-occurring mental health disorders and offer the full continuum of care under one roof, including detox, short-term res, and IOP programming. I’m going to put my phone number in the chat, so if anyone has any questions about our services, please feel free to reach out, but I have the privilege of introducing our speaker today.
Alison Dickens has worked in the field of addictions and mental health treatment for the past 15 years. In that time she has worked at all levels of care with adults, adolescents, and families. She has been working at Care Plus for the past five years, overseeing the substance abuse outpatient services. In this time, she has developed a passion for an appreciation of prevention and treatment of substance abuse from a person-centered and motivationally based perspective. Welcome, Alison, we are so happy to have you here.
Thank you so much, Jordan. And thank you, Savannah. And thank all of you for being here today. When Savannah was telling me about the number of people who RSVP’d, I felt really overwhelmed, and I really hope that I can give you some information, some new ideas about how to move forward with any of the PTP youth that you’re working with.
As Jordan said, I’ve been working in the field for about 15 years. Most recently I’ve started working on the prevention side of things, doing more work with wraparound care with services outside of just therapy and individual and group therapy, thinking about what our youth and what our young folks really need to make sure that they are staying away from substance abuse or learning the tools that they need to move forward in their lives. I think that as a whole, our field does so well with treatment, but what we’re missing is prevention.
Our methods of prevention, some of them are outdated. Some of them don’t go far enough. So realistically, what I’m hoping to share with you today is what I have found and what I think is a good way to not just think about how to prevent substance use, but how do you help our youth really build skills for life and how to live a fulfilling, meaningful life for them?
So, and just so you all know two things, there’s a time, obviously at home right now. There are a lot of animals in my house. You will more than likely hear them at some point, I apologize in advance. There’s currently a cat circling me like a shark, so she will probably at some point jump up here. Her name is Lucy. She’s very loud. I will try and minimize distractions as much as possible, but I just wanted to give a fair warning.
The second thing is a lot of what I’m going to say, a lot of this particular presentation is pretty general information, what I’m hoping for and what I will leave time for both during and after this presentation is time for questions and time for discussion, because really what helps me the most. As a professional, as a person who is administering these life skills, and this prevention is learning from my community, learning from people who are doing the same thing, similar things as me, but in different ways.
So please feel free to share stories, share what’s worked for you, share what hasn’t worked for you really, help me to understand what your needs are so that maybe I can give you some incentive from what I’ve done, but also feel free to give me insight from what you’ve done. You are all, you’re all the professionals, you’re the ones who are doing this, and I think we can all learn from one another.
So what are life skills? So the World Health Organization’s definition of what life skills are abilities for adaptive and positive behavior that enable humans to deal effectively with the demands and challenges of life. What does that mean? Various competencies, in life areas, including communication skills, how to talk to people, how to walk away from an argument, how to diffuse an argument, how to communicate about emotions and ineffective ways, things that aren’t necessarily taught in school or at home, healthy recreational activities.
So if we’re trying to guide kids away from substance use, what do we do to replace that? Exercise sports, obviously very important areas for kids to develop in, but like other things too, arts and crafts, reading, coloring, finding things that interest them, finding recreation activities that interest them and helping them foster those activities, helping them find ways to develop skills in those areas.
Self-care and hygiene. Very important. Like, how do I properly wash myself? How do I dress appropriately for a given situation? How do I calm myself down? How do I deal with my day-to-day anxiety? Meditation falls into that self-care, taking a bath, again, washing clothes, doing laundry, things that not all parents are equipped to really help kids with at all times, studying and employment skills.
So every person has a different learning style, right? We, some of us are auditory learners, some of us are visual learners, so helping kids figure out what their learning style is and how best to incorporate study skills, to meet their learning needs. Also, employment skills, resume building, interview skills. What do you, how do you respond to an employer who is asking you about gaps in your resume? How do you appropriately act on the job? How do you talk to coworkers? How do you talk to bosses? What kind of jobs do you want to do? Those are all things that aren’t necessarily, again, taught in schools all the time, but they are important life skills.
Physical and mental health support and management, and how to make a doctor’s appointment, how to navigate insurance. I can speak for myself personally, I never made a doctor’s appointment for myself until I was 18, my mom always did it for me. And then she said, you’re on your own. I didn’t know what to do. I didn’t know where to go. I didn’t know if I was supposed to find a primary care doctor. If I was supposed to call specialists, how to find specialists, I didn’t know what insurance was, let alone how to navigate it. So again, not every person is equipped to deal with those things.
And then social skills, how to communicate with peers, how to make friends, how to, just how to talk to people, how to be a social individual. So those are all life skills and those are all things that we want to teach our young people while they’re young people, so they grow up into healthy adults.
And then who is at risk? Obviously, anyone can be at risk for substance use, right? Any person can be, can fall into addiction. Addiction, as we know, does not discriminate. There are certain risk factors that have been found to be associated with increased risk for substance use or increased risks for addiction because as we know, not everybody who tries a drug becomes addicted to that drug. But there are certain factors, certain life events or certain environmental factors that make us more at risk for developing a substance use disorder. Some of those are listed there. So a history of trauma, either witnessing or experiencing it firsthand, family history of substance abuse. So not necessarily even just a parent’s parental history of substance abuse, but if there’s a close family member who uses, a sister, an aunt, any of those can be considered a family history; same thing with mental health concerns.
Especially untreated mental health concerns and especially untreated parental mental health concerns. Postpartum depression, if a mother never gets treated for what she, when she’s experiencing postpartum depression, that can be a huge risk factor. Depression, any sort of mood disorder, anything like that can be a huge risk factor because, and that kind of ties into the next one. That means that the parent is not necessarily as able to develop parenting skills as a parent who is either treated for mental health concerns or does not have those mental health concerns.
And again, this is not to stigmatize, parents with mental health concerns, obviously know a person with depression or person with anxiety can be a fantastic parent, but having those untreated concerns in a parent can be a big risk factor for the development of substance use concerns, self-harm or harm towards others, lack of self-control, lack of self-esteem or self-esteem issues in a child can be a big risk factor.
The environmental factors such as drug availability within the community or within the school. So if we live in an area or if your child lives in an area with a high number of people who use drugs, they are more likely to be exposed at a younger age to drug use and more likely to normalize it. And then again, peer social influences to use, especially as adolescents, kids are so vulnerable to, I hate to call it peer pressure because that seems like such an outdated term, but kids want to be accepted by their peer group.
Kids want to do what their friends are doing because they want to be part of the group. So if their friends are using, their friends are smoking, their friends are drinking, they’re more likely to develop substance use. And again, the more risk factors a child who is exposed to, the more likely they are to abuse drugs. So having one of these risk factors is not a sentence to substance use, but if there are more of these developed within the individual at a younger age, they are more likely to develop a substance use disorder later in life.
The opposite of our risk factors are protective factors. So protective factors are basically the opposite of our risk factors, right? They are the positive influences in a person’s life that’s increased the influence of the risk factors. So things that are like, good conflict resolution, good communication skills, being able to diffuse conflict amongst their peers or amongst others, good self-esteem, good self-concept knowing themselves too; confident in themselves feeling like they understand themselves and they know who they are.
Positive parental influences or positive adult role models other than parents. So even if our parents are not necessarily always there for them, for us, if we have a coach, if we have a teacher, if we have a pastor at church who we feel comfortable with, who leads develop a good appropriate relation with, that can kind of take the place of those parental influences, strong, positive social support. So our friend group, who is kind of like, quote-unquote, the good kids, the kids who are good in school, the kids who do afterschool activities, the kids who volunteer, those would be considered positive, social supports.
Success in academics. Obviously, if a kid is struggling in school due to factors, such as ADHD, learning disabilities, things like that, that’s something that hopefully is addressed within the school or within the parent, the parental relationship, but success in academics is definitely a factor in success in life. It’s a protective factor in that the kid feels confident in his ability to do his schoolwork or her schoolwork.
And, don’t want to risk that or put that at risk and then positive community engagement, playing sports after school, volunteering, being a boy scout or a girl scout or having some sort of community affiliation. Those were all protective factors, examples of protective factors. Obviously, there’s more, just like there are more risk factors, but those are some examples of some things that would kind of negate some of those risk factors that we talked about.
So what does this mean? So kind of, as you can see in that picture, it’s a seesaw. To give a child or an adolescent the best chance at life, we want to minimize their risk factors. So get them in as healthy as possible, as we can at home, in school, in the community, and also maximize our protective factors. So building those communication skills, building their self-efficacy, building their ability to deal with adversity. So that gives the individual the best ability to live a healthy life and to make good choices. So it’s always a seesaw, and when your protective factors outweigh your risk factors, you’re more likely to live a good life or a healthy life.
As an example, say we have two kids that grow up in the same environment, similar family situations, one of them, and actually, we’ll say both of them are diagnosed with anxiety or have anxiety. One of them is able to see a therapist to see a doctor, starts doing things that they enjoy, picks up some great hobbies. The other one is left untreated. The parents are not involved in their mental health concerns. They don’t believe in medication. They don’t believe in therapy, even though everything else about them is similar because the second youth has less protective factors in the form of mental health, neglect in the form of parental neglect. They are more likely to be at risk for substance use.
The other kid, the first kid is less likely to be at risk of substance abuse because they have that parental involvement. They have that community involvement. They have that, they have those recreational activities that they enjoy, they’re more involved in their community life. So those positive outcomes are more likely to outweigh the negative outcomes.
So theoretically, if we build up our protective factors in our youth, we can tip the scales towards positive outcomes and build healthy adults. We can’t control for risk factors. A lot of times risk factors are things that are out of our control as professionals. They’re usually family-related, environment-related, school-related. Some of them are mental health-related and some of them we can control, but a lot of them are outside of our control.
Risk factors can be, or sorry, protective factors can be built. Protective factors are things that we can teach our youth that we can help our youth develop and that we can help them feel more effective, help them build that self-efficacy that’s often missing in their life. And we can help balance those risk factors to make them to make it less of a risk that they will develop a substance use disorder caveat being there is absolutely no way to know for sure. All we can do is help. All they can do is assist and hope that those life skills that we are teaching them are enough to outweigh their risks.
So what is life skill training for at-risk youth incorporating? So when we’re thinking about traditional prevention, substance use prevention, I know I’m probably dating myself a little bit by bringing up DARE, but that was my prevention when I was in school. Drug abuse resistance education, it was known at the time. I know it’s gone through a couple of revisions, but that’s how old I am. And it was generally a police officer who would come into the classroom, not very often, but often enough that I remember it. And would talk about drugs and would talk about jail and would talk about the negative consequences of drugs.
And because adolescents and children don’t have fully formed brains, they’re not really consequence-focused. They’re not necessarily thinking if I do this, then bad things are going to happen. They’re more focused on exciting things, doing things that are novel. A lot of times either that education on substance use went in one ear out the other, or it was like, Oh, that actually sounds kind of cool.
I want to know more about that, but not from a cop. So if we incorporate life skills training, along with, psycho-education about risks of substance use, we can have more of a positive effect on self-esteem, on mood, on community connectedness and those other risk factors. If we’re not just talking about consequences, but we’re talking about here is a substance, here’s what it does, here’s the positive, here’s the negative, here’s also some things that you can do instead of abusing drugs, we’re more likely to have a more positive outcome.
And it has been found in many studies that have been replicated over the years, that youth are more likely to report less desire to use substances. And that’s including things like vaping, things like using marijuana, things like using alcohol, even at parties where other people are using alcohol. So they’re more likely to report less of a desire to use these substances. when they’re exposed to a life skills curriculum, including those things that we talked about, those protective factors, those life skills, than youth who do not have this education.
Oops. Okay, so what is it? Like I said, traditionally, we’re focusing on just say no, we’re focusing on, you’ll go to jail if you do these things, focusing on here’s some things that have happened to people who, who use drugs, they think we’re all familiar with the incredibly stigmatizing and incredibly misinformed faces of meth, that, it was pretty popular a couple of years back. It doesn’t, it’s talking about the harmful effects of things, but it doesn’t give a full picture of what substance use is and why it’s attractive.
If we only had negative effects for substance use, no one would ever use, they would stop as soon as things started to get bad, because people are more prone to seek out pleasure and move away from harmful effects. So if drug use was all terrible, no one would ever get high or no one would get high for a prolonged basis of time.
I think we need to be a bit realistic when we’re talking about substance use. Not necessarily glorifying it, but saying here’s what some effects of marijuana can be that are positive, but here are some of the negative effects. Here’s some of the reasons why people use opiates, but here’s some of the negative effects. Here’s what it can do to your body over time. Here’s what it does to your brain over time. Instead of just saying, say no to drugs, tell them why they need to say no to drugs, tell them what could happen, but also tell them why people like it because otherwise it just seems completely unrealistic.
So when we’re doing life skills training, when we’re incorporating a life skills curriculum with our at-risk youth, we’re also incorporating that information, but we’re mostly focused on building skills associated with refusal skills. Like how to say no, or, we can’t just say no.
So what do we do if we’re talking to a friend who says, Hey, you want to go smoke? Behind the school, after hours, can’t say no, cause we don’t want to risk rejection, but what can we say? What can we do? What can we offer as an alternative? Building self-esteem helping children or helping adolescents feel confident in themselves and their ability to say no and there, the understanding that even if one person doesn’t like you, that doesn’t mean that nobody likes you, and other protective factors that enhance personal and social competence and build social resistance skills, social resistance, resistance skills being, the ability to not necessarily give into peer with that quote-unquote peer pressure that they’re experiencing to be okay with doing things differently than their peers do.
So again, in brief, it assists with building knowledge about drugs, building an understanding of what they are and what they do, but also helping kids build real-world competencies in maintaining their sobriety and feeling competent in doing so. And I genuinely think that the confidence is the most important thing. The ability to say I am making a decision for myself and I feel good about that, because here’s what I want to do with my life.
Okay. So a sample lesson that might consist of the following. So as an example, stress management. So if the activity for the day, if the life skill we’re learning today is stress management, maybe we’ll start with what stress management is, so explaining in a way that’s meaningful to an adolescent. What stress management is, what stresses and what are some ways to manage stress sores.
So educational stress, home stress, friends stress, any of those sorts of things that might be applicable and meaningful to an adolescent and how to manage them or what management of those stressors looks like, a questionnaire about their existing life skills. So a brief, maybe five to 10 questions.
I, if I’ve sent a questionnaire about, what they would do in particular situations to kind of get a baseline understanding of what, what they’re looking for, what we’re looking at with them, an activity. So for stress management, maybe a brief meditation, a guided breathing exercise, an activity about this is where I experienced stress in my body. Here’s ways to target those areas. Going through different exercises, physical exercises that can help deal with stress. A psycho-educational lesson about how exercise and how meditation works on the body and how they help to relieve stress and then a discussion about the activity and how to incorporate the skills into daily life.
So we’re not just teaching kids, we’re making them a part of the lesson. It’s not just talking out or lecturing people, it’s saying here’s some skills that I want you to learn. What do you think about them? What do you think you’ll take away from this? What was absolutely meaningless to you? And also it’s okay if they say this is all dumb and I don’t want anything to do with this, I’m never going to meditate. Then I think the challenge is okay, if you’ll never meditate, what do you think will help you manage your stress? What, what do you use right now to manage your stress? What can you do moving forward? What’s a healthy way to manage your stress? I think it’s always appropriate to tap the cause.
I’ve worked with enough adolescents to know that they’re always challenging us. So it’s okay to tell them some of my pack and say, okay, if meditation is BS, what is not; what works for you? Will you go for a run? Will you get a punching bag set up in your basement? Will you play some video games and kill some monsters and that’ll help you with your stress relief? What is meaningful to that person? That’s what we’re looking for, and not everything is going to be for everybody, and that’s okay. We have to help them to understand this is not a one-size-fits-all, type of solution. If it works for you, it works for you. Share it with the group, maybe it’ll help somebody else find something that works for them. But if it’s not meditation, if it’s not the things that I’m talking about, you tell me. And this is a format that’s pretty much used through, with any of the life skills that we’re teaching our kids.
We want to get a baseline. We want to know what they know. We want to help them think about what is, what works for them, what doesn’t work for them. We want to challenge them to think of new ways to, to develop some of these skills, to manage stress, to deal with conflict. Conflict resolution to build their self-esteem, those sorts of things.
And we want to teach them that even though drinking or smoking weed might help with these things. Smoking weed might help you with your stress management, but it’s not the only thing. There are other ways that are going to give you similar results that are not going to get you into trouble.
So. And then how it’s implemented. So the most common way to implement these is in groups, in peer groups. So generally within the age group, maybe like a 12 to 15 year old, a 15 to 18 year old group or whatever ages, depending on the census that you would have. In schools, they can be very effective and that way you can do it by grade level, run by either an educator or a school, a therapist, the school social worker, whoever you have on staff who is interested in developing these skills with their youth.
And it can be like a class discussion. It can be a health class. It can be, if certain students are seen as being at risk, they can form a group and have it run by that social worker or that school therapist. I think most of the curriculums are about eight to 10 weeks long. And again, they consist of both education about substances and, those, those life skills, education pieces, also effective would be grilled in front of facilities, in outpatient or inpatient mental health centers. So kids who are hospitalized for either mental health, kids who are doing inpatient treatment for their substance use, outpatient groups. So kids who maybe are more early intervention who are just starting to smoke or who have already been hospitalized or have already been an inpatient for substance use under stepping down, community centers, afterschool programs, those sorts of things. They can all be used in a similar, similar capacity.
The challenge is these are more disparate youth, so they don’t necessarily know each other. It might be a little bit harder to build rapport, but, conversely, they don’t know each other. They don’t have to deal with these people on a day-to-day basis. So maybe it’s easier with anonymity. Sorry. I always mess up that word. To be more honest and to be more open and to share some of the difficulties that they have.
Obviously alternative options include individual therapy. So working one-on-one with the youth to build the same skills that we’re talking about, electronic forms of communication. So I read some early research about a kind of a, it was kind of cool actually. I was really excited about it because it doesn’t mean as extensive, it doesn’t need a group facilitator. So it’s a text message form of communication that’s administered to kids. And basically three to four days a week, they get text messages and their games, their quizzes, their contests. So photo contest, message contest, writing contest, and you earn points for those. And, you gain prizes or you gain awards for those points as you earn them.
So kids like being competitive. Some kids were really very competitive and they like that aspect of, if I do well at this, I can win something. So it’s exciting, it’s fun, it’s, and it’s still learning those same things. There’s also plenty of apps that you can buy, on a cell phone that are life skills training. So daily check-in like, did you do your homework? Did you take a bath? Just kind of checking in on those basic skills. If kids have questions about certain things, they can learn more about them on those apps. So it’s, it’s really, it can be administered in any way that’s meaningful to the, to the youth, to the adolescent. Discussion boards are great too, because they’re anonymous, but they can, they’re working peer-to-peer.
So realistically the best method of implementing these skills, implementing these training programs is what’s going to be meaningful to the kid. I have worked with plenty of adolescents who will say to me straight up, I’m not doing a group, group therapy is stupid. I don’t learn anything. That’s boring. Okay, so let’s do individual therapy. I’ve also had kids that I’ve worked with individually who think that I am the oldest person that’s ever existed and I can’t possibly know anything about them.
So put them in a group with people who are their own age, who can help them learn more, help them kind of contextualize things and can explain things in a way that makes sense to them. It really depends on the youth, but realistically, the most important thing is it has to be meaningful to the kid, otherwise they will not learn anything. So I think you really have to know your youth. You have to know the population you’re working with and you have to know what their strengths are and what their areas for growth are.
So to conclude, to kind of summarize everything that I talked about today. So one way we’re incorporating life skill training into a substance use prevention curriculum. It helps to develop healthy, personal and interpersonal skills. So again, self-esteem, self concept, also communication, conflict resolution, saying no refusal skills, to resist, influence to use.
And, again, we’re replacing or we’re outweighing some of those risk factors with these protective factors. Hopefully taking some of those external risk factors that we cannot control: environment, family, peer groups, school groups, those sorts of things. With these internal protective factors, conflict resolution, anxiety management, stress management, healthy study skills, those sorts of things that they need to resist their influence to use. With that we have to understand why, why they might use. Do they have undiagnosed mental health conditions? And in that case, to me, you need to focus on the mental health.
Do they have a really difficult home life? And in that case too, we have to focus on self-esteem and self-efficacy. Do they have community issues? And then do we have to, and focus on healthy recreation activities? What are the things that are most needed with this person or with this particular group of people and how can we most effectively incorporate those into the curriculum.
And it can, again, life skills can be presented in any modality, which seems like the best way to engage the youth. A one size fits all approach, never works for anybody. For adolescents, for children, for adults, for groups, for families, we can never expect that what works with one person or one group is going to work with another group. So we have to tailor our approach to what makes sense for that individual or that group. And sometimes that means switching things up midstream.
If we’re finding that, if we’re starting off in a group setting and we’re seeing one adolescent in particular is just not getting as much as he needs out of this training, that’s okay. Try individual, try finding him an app on his phone and incorporating that into the individual therapy. Like, did you journal today? What did you learn from journaling? There’s a lot of different ones. One of the things that I’ve been using with some of my youth is journaling on the phone, and there’s certain programs and I can’t think of many off hand. I’m sorry. I’ll have to do my research into my own research that’ll come up with specific prompts.
Like what would you, how do you handle conflict? What do you do if you’re in a fight with a friend, those sorts of things, and, their response to it, I think is a good way to teach those life skills that are really necessary. So whatever best engages your youth is what’s going to be your best bet.
Again, I think that building life skills is a really great way, not just with rescues but with all of our youth, everyone needs some sort of education somehow. And, even again, I’ll use myself as an example, I grew up in a fairly healthy family. I grew up with everything I needed to succeed. I went to a decent school. I went to college. I was not necessarily given the life skills of making doctor’s appointments. I was not necessarily afforded really good communication skills. I grew up, I went to a very small private school. So, finding peer support when I went into a public high school was really difficult for me.
So those are the life skills that I needed to learn along the way, and having a curriculum or a program to really address those things would have been really useful. I had to find that out myself. I did it, but I would, I always think that we want to do better for our youth than we had for ourselves.
So hopefully, incorporating some of these into therapeutic or school or what-have-you, interventions will be helpful for our youth today. And those are my references. So, I want to open up to some questions now. Any comments or any thoughts that anybody had? I would love to hear them. Thank you for watching this video. We hope you enjoyed the presentation.
At The Recovery Village, we know how important it is for medical professionals to stay current on the latest trends and treatment protocols in their fields. To help, we offer a series of continuing education opportunities in our local communities, led by our team of doctors, clinicians and trusted partners.