Schools can be first defense against addiction
By RICH LORD, Pittsburgh Post-Gazette
Mar. 31, 2018
PITTSBURGH (AP) — Spenser Flowers went from homecoming king to overdose victim in 27 months. At the Hampton Township School District, his death hammered home the reality that even if there's no sign of pills or stamp bags in the halls or bleachers, graduates will soon run into opioids, some will try them, and a few will die.
"You're haunted by that: Someone so young, dying from something that could've been prevented," said Hampton's high school principal, Marguerite Imbarlina. "That was somewhat of a wake-up call. . We need to try every avenue, because every kid is different."
That wake-up call led to, among other things, a Jan. 18 summit at which multiple levels of government, including the schools, joined with clergy and medical professionals in a partnership to fight the epidemic.
Forming such a coalition is just one of a dizzying set of options for districts accustomed to deterring drug use on their grounds, but increasingly expected to do something harder: Give students the tools to avoid addiction in adulthood.
"Schools are the ideal setting in order to intervene in a child's life and ensure that they're getting the services and attention that they need," said Diana Fishbein, a Penn State University professor of human development and president of the National Prevention Science Coalition to Improve Lives.
Some, but not all, school drug prevention approaches are proven to work, she added. "Some will do more harm than good. Some will do nothing, and just waste money."
The Pittsburgh Post-Gazette asked the region's biggest school systems about their approaches to drug prevention. Some have policies focused on punishing violators, while others stress rehabilitation. Anti-drug assemblies featuring police compete for student attention with guest lectures by addiction doctors or recovering addicts. A few schools use proven, evidence-based prevention programs, while most adopt less-studied curricula. The vast majority stock naloxone, which can reverse an opioid overdose.
Much of it comes against the backdrop of tight budgets and pressure to improve test scores.
"I know that our schools are all feeling pressure to perform academically," said Rick Birt, acting CEO of Students Against Destructive Decisions, a Washington, D.C.-based membership organization with chapters in the North Allegheny, Seneca Valley, Armstrong, Peters Township and North Hills districts. "But there's nothing more important than the health and safety of the student population."
Around one in 24 high school seniors surveyed reported misusing prescription opioids last year, and one in 250 admitted to using heroin, according to national data released in December by the University of Michigan Institute for Social Research.
And Spenser Flowers? Did he use in high school? His mother, an attorney who has also launched a charitable fund called Spenser's Voice, doesn't know.
He was a church youth group leader, lifeguard and honor student. When he graduated in 2015, said his mother, attorney Tina Flowers, "I don't think anybody knew much about this epidemic." He headed off to Temple University.
In August 2016, though, Hampton police arrested him for careless driving while using unprescribed Xanax. He tried rehab, but on the following New Year's Day, his family found him dead on his bedroom floor, from an overdose of heroin and fentanyl.
"It it a choice, or is it a disease?" Thomas Brophy asked, just over a year later, in a Hampton chemistry class. An addiction medicine doctor from the area, he went straight to the science.
Opioids, he told the class, stimulate the pleasure system at the center of the brain. Gradually, the parts of the brain that handle long-term thinking get less and less use. The result? "You cannot rationally talk an opiate addict out of picking up," he said. "They only think, 'This solves my problem. I'm going to take it. Consequences? Later.'"
Dr. Brophy's presentation wasn't the old-school, Drug Abuse Resistance Education — or D.A.R.E. — approach. It was scary in a just-the-facts way. Hampton has used other approaches, too, bringing in the FBI, Drug Enforcement Administration, people recovering from addiction, and mourning parents.
"We're not going to pretend that Hampton, or the North Hills, doesn't have a problem with this," said Superintendent Michael Loughead. "This is an epidemic, this is a serious problem, and we're trying to hit it head-on."
Hampton's ZIP Code, 15101, has seen 27 fatal overdoses since 2008, including at least four last year. In that same decade, the county as a whole tallied 3,548 fatal overdoses. Less than 1 percent were under 18. However, 8 percent were in the 18-24 age group.
"Do you think it's a disease, or do you think it's a choice?" Dr. Brophy asked at the end of class. The projector then flashed a slide reading: "Does it matter?"
What works, and what doesn't
This question matters: How can addiction be prevented?
"The programs that frighten people, that shock, that intimidate — those do not work," said Janet Welsh, an assistant professor at Penn State, who runs the Prevention Center in the College of Health and Human Development.
The big anti-drug assembly might be a waste of time.
"Kids don't want to sit in an inactive classroom or an inactive assembly and be lectured at. They're not interested in hearing about long-term health effects. Their brains simply don't work that way," said Kellie Henrichs, a trainer at Prevention First, a nonprofit based in Springfield, Ill., that trains community organizations to encourage drug-free youth.
Starting early is important, she said. "The age of first use, we're really looking at 13 being a critical time period for young people."
Cyber school, no instructional buildings
The effective programs are realistic about the prevalence of drug use, teach kids techniques for refusing substances, focus on self-esteem and self-management, demonstrate problem solving and instill emotional control and social skills, according to Sharon Mihalic, director of the Blueprints for Healthy Youth Development project at the University of Colorado. Her project reviews all of the studies on programs meant to help young people, and puts the results on an easy-to-use website.
Blueprints identifies a dozen school drug prevention programs that have been proven to be effective at reducing the likelihood that students will use in the future.
One proven program, called LifeSkills Training, starts in elementary school and is used in Seneca Valley, Greater Latrobe and Plum. It is one of the only proven, evidence-based drug prevention programs showing up in southwestern Pennsylvania's largest districts, according to the Post-Gazette's survey.
LifeSkills includes drug resistance, but also instructs kids in handling social situations, managing their impulses, "dealing with their emotions, communicating effectively, being more assertive," said Paulina Kalaj, communications director at National Health Promotion Associates, which sells the curriculum.
"When you teach kids these skills, they're more likely to engage in healthy behavior across the board," she said. "Studies have showed that our program not only works, but works 12 years after students have received the program."
LifeSkills costs districts around $6 per student, she said.
Schools can apply to various state funds to cover costs, but such awards eventually expire, forcing administrators to "spend a lot of time and energy jumping from one grant to another trying to keep the ship sailing," said Ms. Welsh.
There's free help available, but in Allegheny County, most districts don't take it.
"When you teach kids these skills, they're more likely to engage in healthy behavior across the board."
Allegheny County's Department of Human Services writes annually to the county's 43 school districts, offering them state-funded drug prevention programs, including LifeSkills Training, and the services of vendors who can help to connect troubled students to the right programs. This year, 17 of the county's 43 districts accepted the help. The county is spending $2.4 million helping those districts, plus some community groups, to prevent substance abuse and gambling.
The county has "actually been able to go into more schools" than it used to, and reach down to the elementary school level, said Latika Davis-Jones, assistant deputy director of the department's Office of Behavioral Health. "I can't speak to why there hasn't been more uptake," she said.
She acknowledged that schools have "a full calendar," but added that some have addressed the time crunch by offering drug prevention services after the dismissal bell.
In October, the General Assembly required that state agencies update the drug prevention guidance given to school districts, to include opioid and prescription drug information. But the legislature hasn't yet required that districts use a proven curriculum.
At Penn State, Diana Fishbein is working on a new model.
She's seen schools at which students pour out the front door, some met by parents who are visibly high on heroin — and administrators do nothing.
When school officials know that a lot of households are dealing with opioid addiction, she said, they can engage those families. Bring in community organizations, healthcare services, maybe psychiatry services, to join the parents on that sidewalk, offering help. If it works, the families get comprehensive help. "And more importantly," she said, "the school system doesn't feel like they're on their own."
Burned by the dragon
As a senior, Patrick Zekler sat through an assembly including a screening of the federal government's anti-opioid film Chasing the Dragon, followed by a prosecutor's careful answers to students' pointed questions. He thought it was among the most wrongheaded things he'd witnessed while coming up through Carlynton School District. So he took his concerns to the office.
"You're just trying to scare them," Zekler told the principal, he recounted this month. "You give me a week, I'll write a story, we'll do this right." He said his offer was not accepted.
This month Carlynton Junior-Senior High School Principal Michael Loughren said he didn't recall that conversation, though he certainly remembered the outspoken 2017 graduate. Told of Zekler's account, Loughren said, "Hey, Patrick, why don't we write that story?"
Zekler, now 19 and living on Neville Island, comes from a family split by drugs. Thomas Zekler, for instance, was that special kind of uncle — close enough in age to teach Patrick to bowl and to shoot pool, and to play him Bon Jovi songs (badly) on guitar. In and out of court since 2006 on drug, theft or assault charges, Tom died in July, at age 33, from a mixture of fentanyl and cocaine.
Now Patrick Zekler, who works as a cook and auto body repairman, wears his uncle's flag-festooned hoodie everywhere. He avoided addiction in part by attending meetings of Alateen, a group for young people with substance abuse problems in their families.
Loughren said that his school has "total commitment" to addressing drug prevention, with a drug and alcohol counselor on site and a mentoring program.
Carlynton Superintendent Gary Peiffer said that this school year, the district added new drug prevention curricula to health classes in grades nine through 12. "We want to get the kids help," he said, "before it becomes a debilitating health problem as well as a risk of life."
Information from: Pittsburgh Post-Gazette, http://www.post-gazette.com