While our education programs have contributed to the decline of illegal drug use among American youth, the abuse of prescription drugs by teens is rising quickly. In fact, a 2006 study by the Substance Abuse and Mental Health Services Administration found that, for the first time, the number of new abusers (12 years old and older) of prescription drugs is the same as the number of first-time marijuana users. So while we have been fighting a battle to educate our youth about drug abuse on one front, another front has quietly opened and expanded.

The nation’s education programs on drug abuse have had success in shaping perceptions of street drugs and those that abuse them. We’ve seen the use of ecstasy, heroin and methamphetamine decline, while marijuana use has held steady. Although we still have a problem, it seems the message that these street drugs are illegal, dangerous and potentially deadly has reached teens and had an impact on them. The risks of abusing prescription drugs, however, have not been communicated.

The Office of National Drug Control Policy (ONDCP) reported in February 2007 that three out of 10 teens believe pain relievers are not addictive, and one-third of teens believe that there is “nothing wrong” with occasional abuse of prescription medication. Further, the 2005 National Survey on Drug Use and Health reported 47.3 percent of teens obtained pain relievers from friends for free; 10.2 percent took them from a friend or relative without permission; and 10 percent bought them from a friend or relative. These findings suggest that there is a perception that misusing prescription drugs is safer than using street drugs.

One possible cause of this phenomenon is the current proliferation of over-the-counter and prescription drugs throughout our society. The increased use of these medications by parents, role models and other authority figures sets a tone for teens and shapes their opinions. Another factor influencing teens is accessibility. Medicines are legal, readily available and often helpful when taken as directed by those for whom they are prescribed.

Clearly it’s time to broaden the front lines of the drug-education battle to include prescription and over-the-counter medicines. This is substantiated by the development and expansion of the survey used by the National Institute on Drug Abuse (NIDA) over the course of its 30-plus years. NIDA began Monitoring the Future (MTF) in 1975 to survey the use of drugs by 12th-grade students. A significant development occurred in 1991 when the survey was expanded to include eighth- and 10th-graders.

Revisions to the survey over the last five years alert us to the wider view of drug abuse that we must now consider. In 2002 Hydrocodone and Oxycodone were added to the survey, and the 2006 survey was the first to include questions on over-the-counter medicine such as cough syrup.

This survey reported that among 12th graders, five of the top six drugs abused were prescription or over-the-counter drugs, Hydrocodone being the most prevalent. Research also showed that the use of Oxycodone among 12th graders increased steadily from 2002 to 2005, although 2006 saw a slight decline of 0.8 percent. In 2006, the use of Oxycodone by eighth-graders in the study had doubled over the previous four years, up to 2.6 percent.

A study conducted by the National Center on Addiction and Substance Abuse at Columbia University corroborates these findings, further pointing to an increasingly alarming national crisis. This study found that new abuse of prescription opioids among children 12 to 17 years old was up by 542 percent between 1992 and 2002, and in 2004, 2.3 million 12 to 17 year olds abused at least one controlled prescription drug.

So our mission is clear.

We are winning the battle against certain illegal drugs. But, if teens are just switching to alternative sources, what have we really gained?

What’s the Answer?

Current education programs are merely shifting teens from illicit street drugs toward prescription and over-the-counter drugs because the latter are more accessible, easier to ingest, legal, widely and openly used in the adult community and seemingly safe. Teens may simply be taking the path of least resistance, both physically and mentally.

John P. Walters, ONDCP director, was quoted in The New York Times on Dec. 22, 2006, as saying, “Based on the trends we’ve seen with prescription drug abuse among teens, and corroborated by the results from this [MTF] report, it’s clear we need to start developing messages for young people about the dangers of misusing prescription drugs.”

In addition to creating radically different messages, we must develop and execute a more effective strategy, delivering these messages through new, interactive media that will resonate with today’s youth.

What is required is a focus on the underlying root of the problem. We must concentrate on decision-making, judgment, critical thinking and how, why, and under what conditions teens make behavioral choices. The key to success lies in teaching youth how to think rather than what to think. And this learning must occur with great attention paid to the context of teens’ real-life experiences, the stresses and resources at their disposal and the unique physical and emotional characteristics of this demographic.

An effective approach must also acknowledge that the video-game generation demands an interactive medium. Youth become engaged in instructional experiences that offer them the ability to control, personalize and influence their education. Nowhere is the need to provide this level of deep learning more critical than in areas related to individual behavior.

Knowledge and information simply are not enough. As educators, we have the responsibility to deliver products and programs that engage students affectively as well as cognitively. We must involve young people in the development of instructional tools. and the tools must be interactive.

One strategy to reach our objectives is to give teens practice at making difficult decisions under stressful conditions that are similar to real-life situations. An effective method of accomplishing this is through simulation and role play. As we have seen, group role-playing exercises came into favor in the ’80s and ’90s because educators embraced the additional engagement and retention that interactivity provided.

This kind of active involvement was greatly enhanced with the advent of interactive computer games. These “serious games” go beyond live role playing and enable us to simulate the world in which teens live and the decisions they face in a slice-of-life context. Using leading-edge technology to engage teens meets them on their own turf. It also gives facilitators the flexibility to use the simulations for both one-on-one “play” and in large- and small-group settings.

Pilot studies by Boston University and Walter Reed Army Institute of Research, as well as a growing body of anecdotal evidence, indicate that interactive, immersive decision-making education is effective in positively influencing attitudes and behavior. Role-playing characters in live-action, research-based interactive movies or video games depicting real-life decisions and their consequences gives teens the opportunity to experience believable situations in the safety of cyberspace. Students can “become” multidimensional people similar to themselves, make choices in complex, realistic environments and see the results of these choices.

Kentucky River Community Care (KRCC), a community-based mental health center in southeastern Kentucky, is an example of an organization that has taken a progressive approach to the prescription drug abuse problem. The software program they use immerses teen users in a video-based simulation allowing them to make real-life prescription drug-related decisions and live out the consequences. “The teens we surveyed said we had to make our prescription drug prevention program engaging, interactive and directed at the video-game generation,” said Dr. David Mathews, director of adult services at KRCC. “We knew if we produced just another prevention curriculum it would sit on the shelf, with all the rest.”

Interactive simulations go beyond informing teens of the dangers of drug abuse. They compress experience by enabling youth to experiment with poor choices and revisit them without actual harm. More importantly, they build self-efficacy by providing practice in modeling desirable behavior and enjoying its rewards.

As school counselors we have the responsibility to utilize these 21st-century tools to empower our students. With them, we can teach teens how to analyze difficult situations, manage stresses and navigate through dilemmas. An appreciation for the characteristics of today’s “digital natives” and an understanding of how they interact with the world have given us new opportunities to reach them. We must use every available resource to prepare young adults for an increasing level of independence and the array of life-altering decisions over which they will eventually have ultimate control.

–Sharon

Snapshot: Prescription Drug Abuse

Prevalence and Incidence

• Three percent, or 840,000 teens aged 12-17, reported current abuse of prescription drugs, making this illegal drug category the second most abused next to marijuana. (SAMHSA, 2006)
• Prescription drugs are the most commonly abused drugs among 12–13 year olds. (SAMHSA, 2006)
• One-third of all new abusers of prescription drugs in 2005 were 12–17 year olds. (SAMHSA, 2006)
• Nearly three out of 10 teens (6.8 million) believe prescription pain relievers, even if not prescribed by a doctor, are not addictive. (PATS, 2006)
• One-third of teens (7.3 million) believe there’s “nothing wrong” with using prescription medicines without a prescription once in a while. (PATS, 2006)
• Nearly one in five teens (4.5 million) report abusing prescription medications that weren’t prescribed to them. (PATS, 2006)

Gender Differences

Among 12-17 year olds, girls are more likely than boys to have abused prescription drugs (9.9 percent of girls vs. 8.2 percent of boys), pain relievers (8.1 percent vs. 7 percent), tranquilizers (2.6 percent vs. 1.9 percent) and stimulants (2.6 percent vs. 1.9 percent) in the past year. (SAMHSA, 2006)

Among 12-17 year olds, girls had higher rates of dependence or abuse involving prescription drugs (1.8 percent for girls and 1.1 percent for boys), pain relievers (1.4 percent vs. 0.8 percent), tranquilizers (0.4 percent vs. 0.3 percent) and stimulants (0.5 percent vs. 0.3 percent) in the past year. (SAMHSA, 2006)

Suggested Web Sites

The Partnership for a Drug-Free America

Parents – The Anti-Drug

Teen Drug Abuse