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Discuss and develop an idea for research in the field of counselling studies in relation to epistemological issues and debates discussed on the course

March 24, 2016 | Author: | Posted in health and medicine, nursing

Connecting Substance Abuse and Dropping Out and Using Reality Theory as Intervention

Connecting Substance Abuse and Dropping Out and Using Reality Theory as Intervention


Fighting drug abuse has always been a grave concern in the recent years Despite numerous declarations of a “war on drugs ” over the past decades Americans continue to produce , use and sell illegal narcotics . Illegal drugs are both a symptom and a cause of some of American society ‘s most intractable problems , including high crime rates , homelessness and juvenile delinquency . Not to mention , the government [banner_entry_middle]

is spending millions of dollars to thwart America ‘s drug problems (see Appendix A

According to National Survey on Drug Use and Health survey data that were released in 2003 , an estimated 19 .5 million Americans aged 12 and older were current users of illicit drugs in 2002 , meaning that they used an illicit drug at least once during the 30 days prior to being interviewed . Marijuana , the most commonly used illicit drug in 2002 , was used by 75 of those reporting drug use . Approximately 55 of illicit drug users consumed only marijuana , 20 used marijuana and another illicit drug , and the remaining 25 used an illicit drug but not marijuana in the past month . Hence , overall , about 45 of current illicit drug users in 2002 (an estimated 8 .8 million Americans ) were users of illicit drugs other than marijuana and hashish , with or without the use of marijuana (See Figure 1 . Thus , explore America ‘s drug culture is to examine the criminal justice system , the health care system , economic system and even the educational system

As in previous National NSDUH surveys , the 2002 survey found that substance-abuse rates remain highly correlated with educational status Among young adults 18 years and older , those who have not completed high school have the highest rate of abuse (9 .1 , whereas college graduates have the lowest rate of abuse (5 .8 . This is despite the fact that adults who had completed four years of college were more likely to have tried illicit drugs in their lifetime than adults who had not completed high school (50 .5 versus 37 .1 . Hence , the more education a person receives , the more likely that person is to discontinue using drugs with age

Figure 1 . Types of Drugs Used in the Past Month by Illicit Drug Users Age 12 and Older , 2002 (Source : Substance Abuse and Mental Health Services Administration , 2003

Especially the youths , it is a bleak reality that substance abuse is still heavily being practiced . Self-report surveys indicate that more than half of high school seniors have tried drugs and more than 90 percent use alcohol (Institute for Social Research , 16 December 2002 Adolescents at high risk for drug abuse often come from the most impoverished communities and experience a multitude of problems including school failure and family conflict (Greenwood 1992 ,

. 445 Equally troubling is the association between drug use and crime (U .S Department of Justice , 1989 . Research indicates that more than half of all juvenile arrestees in some cities test positive for cocaine (National Institute of Justice , 2003 .Self-report surveys show that drug abusers are more likely to become delinquents than are non-abusers (Mackesy-Amiti and Michael Fendrich , 1995 . The pattern of drug use and crime makes juvenile substance abuse a key national concern

Former Senator John Chaffee once stated that , Dropouts disappear from high school corridors , but they do not disappear from society . Rather their names show up on the welfare rolls they become drug abuse statistics , or they wind up in our overcrowded prison system . The dropout exodus is increasing the number of those who live on the margin of society , while our social welfare costs and , too frequently , our penal institutions pay the costs (Dorn , 1996 ,

. 127 . Indeed , as Table 1 represents , there is still a steady growth of drug use among U .S . high school students

Table 1 . Drug Use : America ‘s High School Seniors , 1980-2004 (Source Univ . of Michigan Inst . for Social Research and National Inst . on Drug Abuse

Dropping out of school could be a possible clue that a student is using drugs . It is important to note evidences that a student is doing drugs in to help him or her during the earlier stages of addiction . This is because about two-thirds of substance-abusing youths continue to use drugs in adulthood , but about half desist from other criminal activities . Chaiken Johnson (1988 ) deem that those who persist in both substance abuse and crime maintain these characteristics

They come from poor families

Other criminals are members of their families

They do poorly in school

They started using drugs and committing other delinquent acts at an early age

They use multiple types of drugs and commit crimes frequently

They have few opportunities in late adolescence to participate in legitimate and rewarding adult activities (p . 12

Thus , this study examines the relationship of drug use and dropping out of school in the United States . Evidence will be gathered that suggest dropping out of high school plays a role in the etiology of youth drug use . The causal relationships between these two variables will also be explored . From this knowledge , we will recommend epistemological approaches in counseling these youths before they resort to drug abuse Thorough and systematic assessment and treatment planning are at the very heart of successful addiction counseling . According to Washton (2003 , psychotherapeutic and coping skills-training techniques are effective with abstinence-based addiction counseling . The primary goals of treatment are to enhance and sustain patient motivation for change establish and maintain abstinence from all psychoactive drugs , and foster development of (nonchemical ) coping and problem-solving skills to thwart and ultimately eliminate impulses to “self-medicate ” with psychoactive drugs . The counseling approaches should combine cognitive-behavioral , motivational , and insight-oriented techniques according to each client ‘s individual needs . The therapeutic style is empathic , client centered , and flexible . Strong emphasis is placed on developing a good working alliance with the client to prevent premature dropout and as a vehicle for promoting therapeutic change

Literature Review

Delinquency in school has always been suspected to be one indicator that a student is doing drugs . Moreover , failure to complete high school has negative consequences for adolescents who bear this status and for societies that increasingly depend on an educated labor force . For decades , studies have consistently shown that high school dropouts are more likely to be unemployed than are high school graduates (Coalition for Juvenile Justice , 2001

Previous studies indicate that being a high school dropout is associated with the uptake of cigarette smoking (Johnson Hoffmann , 2000 , with a higher prevalence of alcohol and marijuana use (Chavez , Edwards Oetting , 1989 , and with alcohol dependence (Crum , Helzer Anthony 1993 . Other research has shown that high school dropouts are more likely than are high school graduates to engage in injection drug use (Obot Anthony , 1999 . One study has focused exclusively on the relationship between dropping out of high school and drug use , and it found that dropouts ‘ dissatisfactions with school completely mediated the relationship between these two variables (Krohn , Thornberry Collins-Hall Lizotte , 1995 . Another study suggested that teenage drug abuse sharply reduces the scholastic attainments of those affected One-third of all our respondents never completed high school , 58 finished high school or had obtained their G .E .D . equivalencies , and only 9 had undertaken some college course work (Feigelman , 1990 ,

br 54

Antecedents to dropout status also play a significant role in this study because some evidence indicates that drug use is a significant predictor of dropping out of high school

(Ellickson , Bui , Bell McGuigan , 1998 . In addition , prior research has found that weak attachments to school and dissatisfaction with the school experience explain the dropout-drug use relationship (Krohn et al , 1995

Moreover , according to Elliott , Huizinga Ageton (1985 , both drug use and delinquency seem to reflect developmental problems they are both part of a disturbed lifestyle . This research reveals some important associations between substance abuse and delinquency

Alcohol abuse seems to be a cause of marijuana and other drug abuse because (a ) most drug users started with alcohol , and (b ) youths who abstain from alcohol almost never take drugs

Marijuana use is a cause of multiple-drug use : about 95 percent of youths who use more serious drugs started on pot only 5 percent of serious drug users never smoked pot

Youths who commit felonies started off with minor delinquent acts . Few delinquents (1 percent ) report committing felonies only

Elliott , Huizinga Ageton (1985 ) has been supported by other studies also indicating that delinquency and substance abuse are part of a general pattern of deviance or problem behavior syndrome , such as association with an antisocial peer group and educational failure (Farrell 1999 ,

. 177 . There seems to be a pattern in which troubled youths start by committing petty crimes and drinking alcohol and proceed to harder drugs and more serious crimes . Both their drug abuse and the delinquency are part of an urban underclass lifestyle involving limited education , few job skills , unstable families , few social skills , and patterns of law violations

In counseling , William Glasser was training to be a psychiatrist in the late 1950s when he first observed that positive mental health occurred more frequently in clients who took responsibility for their actions and decisions than in those clients treated principally with psychotropic drugs (Glasser , 1965

During his psychiatric training , Glasser also rejected Freud ‘s work (Glasser , 1965 , because he could not accept Freud ‘s thinking that human behavior was controlled by the unconscious mind and early childhood experiences . For the past forty years , Glasser has been committed to developing alternative mental health treatments . The result of this commitment was the development of choice theory and reality therapy Both choice theory (theory of human behavior ) and reality therapy (model of counseling ) are phenomenological and cognitive behavioral in design Choice theory hinges on the idea of an internal locus of control , which purports that a client can manage his choices internally (Rotter , 1982 Glasser (1985 ) argues that the majority of the population operates on the premise that an external locus of control , or their external environment , controls them . Because of this perception , many clients think they are trapped and have few choices . Glasser (2000 ) explains that this manifestation of stimulus-response thinking is at the root of most mental health challenges . For a client to take control of his life he needs to understand that he manages his own success by internalizing the perception of choice . Glasser (1998 ) explains that when a client achieves this insight he becomes empowered to make choices . These new choices then motivate the client to change his present behavior . Glasser (1965 ) taught that a client becomes motivated to change when he determines present behavior is not achieving desired wants , or he learns that he has the ability to make new choices . When the client obtains either frame of reference he has the opportunity to learn how to live a more fulfilling life

Choice theory begins by teaching that all human beings are motivated by genetically driven basic needs : four conscious and one unconscious . The five basic needs are (1 ) Fun – enjoyment and pleasure (2 ) Freedom – ability to move freely and choose activities (3 ) Recognition and self-accomplishment – acknowledgment and self-worth (4 ) Love and belonging – supportive relationships , and (5 ) Survival (unconscious need ) – food , shelter , and reproduction . Choice theory postulates that every client creates her own internal “photo album ” for fulfilling these basic needs (referred to as the client ‘s quality world ) and has the choice of what to put in it – meaning that all humans have the same five basic needs , but each will choose different pictures (wants

Glasser (1998 ) explains that clients filter the external world through their basic needs . When a client receives external stimuli different from what he wants , he will experience a brief and involuntary sensation of frustration . The purpose of this frustration is to alert the client that his needs are not being met (e . g , child not listening . Choice theory teaches that this signal occurs in the comparing of places , when the client compares what he wants with what he has . This sensation of frustration only occurs when the client perceives that his needs are not being met , and will last only a few microseconds after that , he makes a choice

Choice theory postulates that the client ‘s menu of behavioral choices is stored in a cognitive database called organized behavior . Glasser (1998 argues that all a client can choose is what he knows or what he creates Because of potential limitations in these stored learned behaviors , the client can get trapped in ineffective behavior . For example , if a client learns that alcohol reduces stress , he may rely on drinking to deal with stress to the point that alcohol use becomes problematic . Glasser believes that each client has the ability to create new behaviors . In the above instance , for example , if alcohol no longer appears to meet the client ‘s needs , he may choose to use exercise to replace alcohol

Glasser (1985 ) explains that all behavior can be described as behavior . Hence , when a client changes her behavior and thinking – her feelings and physiology will change as well . Glasser employs a car metaphor to underscore the interconnected nature of behavior . The car in question is front wheel drive . The front wheels symbolize behavior and thinking , while the rear wheels represent feelings and physiology . The engine corresponds to the five basic client needs (universal to all , but each client will determine what meets his needs ) and the steering wheel represents the choice each client has to direct his care . This metaphor promotes the concept that a client can take control of her life by controlling her actions and thinking . Because all behavior is actions a client takes using her front wheels (action and thinking directly impact her rear wheels (feelings and physiology . Wherever the front wheels go , the rear wheels will follow . Applying this metaphor to real life , a depressed client can change her emotions and get symptomatic relief from depression by choosing a positive , healthy behavior (e . g , playing golf with a friend . Glasser (2000 ) emphasizes that the healthy actions will positively impact emotions . He believes self-control starts by accepting responsibility for present behavior and thinking

Reality therapy is the clinical application of choice theory . Glasser first developed reality therapy in the early 1960s . Then he authored choice theory (formerly called control theory ) in 1984 because he realized that in for his counseling process to be accepted in the mainstream , it needed to be grounded in an effective theory explaining the “whys ” and “hows ” of human behavior . Reality therapy is taught in a linear process that weaves among three components . The first component is called setting the counseling environment . Glasser (2000 ) insists that a comfortable therapeutic environment creates an opportunity for the client to learn that you can be of value and not a threat . This trust is critical for counseling rapport and is the foundation for successful counseling . The second component is called the procedures that lead to change . The final component of reality theory is planning measuring , and follow-up . In this straightforward process , the counselor helps the client develop a client-centered action plan that is , a plan based on what the client can control and realistically do on his own . It is important that the client determine clear measures of progress Glasser (2000 ) believes that after a plan is developed , it is important to spend time challenging it to ensure that the client and the counselor have effectively explored potential risks , determined needed core competencies , and put in place relapse prevention strategies , in to increase the client ‘s chances of success


In counseling with students in the verge of dropping out of school reality therapy could be helpful before they resort to drug abuse . This is because Glasser (2000 ) precisely defined the root of almost all human maladjustment is “the lack of satisfying present relationships (p xvii . Glasser posited that maladjustment is a disconnection between the person and others . According to Glasser (2000 “What is called mental illness is a of the ways in which huge numbers of people .choose to deal with the pain of their loneliness or disconnection (p . 1 . Glasser (1985 ) cited three main reasons why people create and endure misery . The following reasons have been adapted to fit the current notion of maladjustment

1 . Choosing intense symptoms such as depression and anxiety helps keep angering under control . Because angering may lead to relatively more painful consequences , such as being arrested or injured , one chooses instead to depress , which tends to bring about less painful consequences

2 . By choosing intense symptoms , one brings other people into one ‘s service . As a client stated “If I am not depressed , you will not see me in therapy ” When a person chooses to depress , other people begin to comfort and take care of that person . The person is enduring the pain of loss of power , freedom , and fun that accompanies intense symptoms in to avoid the even greater pain of loneliness . Glasser would contend that a person who was not coddled when choosing to depress would quickly give the behavior up because it would not fulfill any need for love and belonging

3 . Choosing intense symptoms enables people to avoid doing what they are afraid of doing . An adolescent who sees himself as inept may choose to depress so he can avoid relationships or academic challenges at school He chooses the pain of depression to avoid the even greater pain of embarrassment , rejection , or humiliation

In all three cases , by choosing the symptom , the individual thwarts any possibility for truly satisfying relationships . Despite great discomfort , the person will likely report feeling paralyzed or trapped in the symptom and , from a choice theory perspective , will choose to persist in the symptom because it is the best way the person knows to meet his needs , even if only partially and self-defeatingly

Reality therapists ‘ framing of symptoms not as the noun “depression ” but as the verb “depressing ” constitutes a semantic shift consistent with the theory ‘s emphasis on self-responsibility . In reality therapy clients are not depressed without a choice in the matter but are instead , choosing to depress . This terminology is not meant to blame or criticize the client . The word change is designed to demonstrate to the client that the control to change lies within and that the choice of any behavior is an attempt to satisfy a need or needs using the best strategy in the client ‘s awareness . With the responsibility for change resting within the client , the foundation for therapy is laid

The conceptual framework of teens at risk of dropping out of school is prevention . One of the highest correlates for dropping out is lack of academic success (Natriello , Pallas , McDill McPartland , 1990 Helping students develop these skills early in school will reduce the likelihood of dropping out by helping them feel more successful and more connected to the school . Thus , they will less be vulnerable to drug abuse . Moreover , the methods could also be effectively used to youths who are already engaged in substance abuse

Wubbolding ‘s (1999 ) WDEP system based on Glasser ‘s Reality Therapy , is a straightforward framework from which to proceed . Reality therapy asserts that people are responsible for their own behavior , behavior involves choices , and in most situations , people have a number of options to choose . Thus , the power to change a situation clearly lies within the individual . Wubbolding ‘s WDEP system applies Reality Therapy . Using this system , the counselor helps clients explore their Wants , then Describe their current situation and the direction of their lives Self-Evaluation is the third step , where clients examine the efficacy of their current choices . The final step consists of making Plans that will be more effective in attaining the clients ‘ goals (Wubbolding , 1999 Explained in this clear language , the simplicity of Reality Therapy will be appealing to many teens

Many at-risk students are unaware that their learning strategies are ineffective (McWhirter , McWhirter , McWhirter McWhirter , 1993 Students who see success as a function of native intelligence alone rather than a result of know-how and effort are likely to give up thinking nothing can change the situation (Robertson , 1997 . Using WDEP to help students to identify what they are doing well and building on those strengths will help bolster self-confidence and a feeling of efficacy . Students are initially asked to target their efforts in one or two classes in to put into practice the skills they are working on . Progressing incrementally helps students realize the value of setting attainable goals and keep them from being once again overwhelmed by what they see as their own lack of intelligence

Thus , what makes reality therapy the most applicable approach in counseling youths at risk of drooping out of school and on the verge of using drugs is that it is a present-oriented therapy that focuses on ways clients can make more effective choices in their lives . People behave to fulfill the basic genetic needs of fun , freedom , power , love and belonging , and survival , in the most effective ways they know at any given time . Therapy involves assessing current behavior . If current strategies are not meeting the needs of the client , the client is encouraged to adopt new behaviors that are more effective . This process requires the commitment of the client to do something differently and continuously evaluate behavior in terms of need fulfillment . The change process is also predicated on the ability of the counselor to form a choice theory relationship with the client based on empathy , respect , a here-and-now focus , and honest confrontation to adopt new and more effective ways of forming relationships and fulfilling needs


Chaiken , M . and Johnson , B (1988 . Characteristics of Different Types of Drug-Involved Youth , Washington , DC : National Institute of Justice

Chavez , E . L , Edwards , R Oetting , E . R (1989 . Mexican American and White American School Dropouts ‘ Drug Use , Health Status , and Involvement in Violence . Public Health Reports , 104 , 594-604

Coalition for Juvenile Justice (2001 . Abandoned in the back row : New lessons in education and delinquency prevention . Washington , DC : Office of Juvenile Justice and Delinquency Prevention

Crum , R . M , Helzer , J . E Anthony , J . C (1993 . Level of Education and Alcohol Abuse and Dependence in Adulthood : A Further Inquiry American Journal of Public Health , 83 , 830-837

Dorn , S (1996 . Creating the Dropout : An Institutional and Social History of School Failure . Westport , CT : Praeger Publishers

Ellickson ,

, Bui , K , Bell , R McGuigan , K . A (1998 . Does Early Drug Use Increase the Risk of Dropping Out of High School ? Journal of Drug Issues , 28 , 357-380

Elliott , D , Huizinga , D . and Ageton , S (1985 . Explaining Delinquency and Drug Abuse , Beverly Hills , CA : Sage

Farrell , G (1999 . Drugs and Drug Control , in Newman , G (ed , Global Report on Crime and Justice . New York : Oxford University Press

Feigelman , W (1990 . Treating Teenage Drug Abuse in a Day Care Setting New York : Praeger Publishers

Glasser , W (1965 . Reality therapy : A new approach to psychiatry . New York : Harper Row

Glasser , W (1985 . Control theory : A new explanation of how we control our lives . New York : Harper Collins

Glasser , W (1998 . Choice theory . New York : Harper Collins

Glasser , W (2000 . Reality therapy in action . New York : Harper Collins

Greenwood , G (1992 . Substance Abuse Problems among High-Risk Youth and Potential Interventions , Crime and Delinquency 38 :444-458

Institute for Social Research- University of Michigan (2002 , December 16 . Ecstasy Use Among American Teens Drops for the First Time in Recent Years , and Overall Drug and Alcohol Use Also Decline in the Year After 9 /11 . News Release . Ann Arbor : University of Michigan

Johnson , R . A Hoffmann , J .

(2000 . Adolescent Cigarette Smoking in U .S . Racial /Ethnic Subgroups : Findings from the National Education Longitudinal Study . Journal of Health and Social Behavior , 41 , 392-407

Krohn , M . D , Thornberry , T .

, Collins-Hall , L Lizotte , A . J (1995 . School Dropout , delinquent Behavior , and drug use : An Examination of the Causes and Consequences of Dropping Out of School . In H . B . Kaplan (Ed , Drugs , crime , and other deviant adaptations (1st ed , pp . 163-183 . New York : Plenum

Mackesy-Amiti , M .E . and Fendrich , M (1995 , November . Delinquent Behavior and Inhalant Use Among High School Students . presented at the American Society of Criminology meeting , Boston

McWhirter , J . J , McWhirter , B . T , McWhirter , A . M McWhirter , E . H (1993 . At-risk youth : A comprehensive response . Pacific Grove , CA Brooks /Cole Publishing Company

Natriello , G , Pallas , A , McDill , E . L McPartland , J . M (1990 Keeping students in school : Academic and affective strategies . In L . J Kruger (Ed , Promoting success with at-risk students : Emerging perspectives and practical approaches (pp . 179-196 . New York : The Haworth Press

NIH Arrestee Drug Abuse Monitoring Program (2003 . Preliminary Data on Drug Use Related Matters Among Adult Arrestees and Juvenile Detainees 2002 , Washington , DC : National Institute of Justice

Obot , I . S Anthony , J . C (1999 . Association of School Dropout with Recent and Past Injecting Drug Use among African American Adults Addictive Behaviors , 24 , 701-705

Robertson , A . S (1997 . If an adolescent begins to fail in school , what can parents and teachers do ? ERIC Digest

Rotter , J .B (1982 . The Development and Applications of Social Learning Theory . New York : Praeger

Substance Abuse and Mental Health Services Administration (2003 . 2002 National Survey on Drug Use and Health . Washington , DC : U . S . Government Printing Office

U .S . Department of Justice (1989 . Drugs and Crime Facts , 1988 Washington , DC : Bureau of Justice Statistics

Wubbolding , R . E (1999 . Reality therapy theory . In D . Capuzzi D Gross (Eds , Counseling and psychotherapy : Theories and interventions (2nd ed (pp . 287-314 . Upper Saddle River , NJ : Merrill /Prentice-Hall

Appendix A : Direct Costs of Drug Abuse

Sources : The National Drug Control Strategy (Washington , DC : ONDCP 2004 and Bureau of Justice Statistics , Drugs , Crime and the Justice System : A National Report (Washington , DC : U . S . Government Printing Office , 1993



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